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Backgrounds: Although COVID-19 is primarily known as a respiratory disease, there is growing evidence of neurological complications, such as ischemic stroke, in infected individuals. This study aims to evaluate the impact of COVID-19 on acute ischemic stroke (AIS) using radiomic features extracted from brain MR images and machine learning methods. Methods: This retrospective study included MRI data from 57 patients diagnosed with AIS who presented to the Department of Radiology at Hacettepe University Hospital between March 2020 and September 2021. Patients were stratified into COVID-19-positive (n = 30) and COVID-19-negative (n = 27) groups based on PCR results. Radiomic features were extracted from brain MR images following image processing steps. Various feature selection algorithms were applied to identify the most relevant features, which were then used to train and evaluate machine learning classification models. Model performance was evaluated using a range of classification metrics, including measures of predictive accuracy and diagnostic reliability, with 95% confidence intervals provided to enhance reliability. Results: This study assessed the performance of dimensionality reduction and classification algorithms in distinguishing COVID-19-negative and COVID-19-positive cases using radiomics data from brain MR scans. Without feature selection, ANN achieved the highest AUC of 0.857 (95% CI: 0.806–0.900), demonstrating strong discriminative power. Using the Boruta method for feature selection, the k-NN classifier attained the best performance, with an AUC of 0.863 (95% CI: 0.816–0.904). LASSO-based feature selection showed comparable results across k-NN, RF, and ANN classifiers, while SVM exhibited excellent specificity and high PPV. The RFE method yielded the highest overall performance, with the k-NN classifier achieving an AUC of 0.882 (95% CI: 0.838–0.924) and an accuracy of 79.1% (95% CI: 73.6–83.8). Among the methods, RFE provided the most consistent results, with k-NN and the ANN identified as the most effective classifiers for COVID-19 detection. Conclusions: The proposed radiomics-based classification model effectively distinguishes AIS associated with COVID-19 from brain MRI. These findings demonstrate the potential of AI-driven diagnostic tools to identify high-risk patients, support optimized treatment strategies, and ultimately improve clinical implications. [ABSTRACT FROM AUTHOR]

AIM Analysis of the outcomes of endovascular stent thrombectomy in patients with acute arterial thrombosis of the lower extremities on the background of COVID-19.MATERIAL AND METHODS This retrospective study for the period from January 1, 2020 to March 1, 2022 included 34 patients with acute lower limb ischemia who were diagnosed with the novel coronavirus infection SARS-COV-2. Endovascular stent thrombectomy was performed according to the standard technique using a Destination 8F guiding sheath (Terumo), an Advantage 0.014`` guidewire (Terumo), and a Casper stent (Microvention, Terumo) as a stent retriever. In case of fragmentation of thrombotic masses in the guide sheath, manual aspiration of thrombi was performed using a standard 50,0 ml syringe. Self-expanding nitinol stents were implanted in 11 clinical cases.RESULTS Intraoperative bleeding from the puncture site of the artery developed in 14.7% of cases, which required additional manipulation to achieve hemostasis. Every tenth (11.8%) patient developed myocardial infarction, in 2.9% of cases — ischemic stroke. In the hospital postoperative period during the first hours after surgery, 26.5% of patients developed rethrombosis which required re-intervention. In 8.8% of cases, retrombectomy was unsuccessful, and limb amputation was performed. A fatal outcome occurred in 67.6% of cases, which was due to an increase in multiple organ failure and the development of sepsis.CONCLUSION Endovascular stent thrombectomy is characterized by a low risk of rethrombosis and amputation in the context of COVID-19.

Avascular necrosis (AN) of bone tissue is a common pathology that affects people of any age, more often young and able-bodied. The disease leads to rapid destruction of the subchondral bone and collapse, followed by the development of secondary osteoarthritis (OA) of the affected joint.The purpose of this review article is to present the accumulated knowledge about the prevalence of AN, the most commonly affected joints, risk factors and pathogenesis of the disease. Since most of the world’s literature sources present knowledge about the individual parts and facts that make up the pathogenesis of AN, this article analyzes all known paths of the development of the disease from the onset of ischemia to collapse and the development of secondary OA and the pathogenesis is presented in chronological order. Based on the results of the article, a definition of the term AN was proposed, and the stages of the disease within the pathogenesis, the most promising for conservative methods of treatment, were identified.

Background: Peripheral artery disease (PAD) frequently affects multiple segments of the limbs. Contradictory data have reported worse prognosis in aortoiliac lesions, nevertheless, diabetes and chronic limb ischemia frequently affects the infrapa-tellar territory. Our aim was to assess the impact of infrapatellar disease in cardiovascular outcomes. Methods: We performed a retrospective, observational cohort study at a university hospital in Argentina. Electronic health records were retrospectively reviewed including symptomatic PAD patients requiring revascularization. A multivariable regression model was performed to account for confounders. The primary endpoint was a composite of hospitalizations due to chronic limb threatening ischemia (CLTI) and major amputation events between infrapatellar and suprapatellar patients. Minor amputation events, all-cause death, myocardial infarction (MI), stroke, and major cardiovascular events (MACE) were secondary endpoints. Results: From January 2014 through July 2020, a total of 309 patients were included in the analysis. 151 patients had suprapatellar disease, and 158 had infrapatellar disease. The primary composite endpoint occurred in 35 patients (22.2%) in the infrapatellar patients and 18 patients (11.9%) in the suprapatellar patients (HR = 2.16; 95% confidence interval [CI] = [1.22-3.82]; p = 0.008). Both com-ponents of the primary outcomes occurred more frequently in infrapatellar patients. Minor amputation events were more pre-valent in infrapatellar patients (HR = 5.09; 95% CI = [1.47-17.6]; p = 0.010). Death, MI, stroke, and MACE events were not different among groups (all p > 0.05). Conclusion: Infrapatellar disease was an independent factor for increased hospitalization of CLTI, major and minor amputations events, compared to suprapatellar disease in symptomatic revascularized PAD patients. [ABSTRACT FROM AUTHOR]

We describe a 74-year-old male with delayed onset of acute left upper extremity ischemia after blunt chest trauma with left clavicular fracture, resulting in left subclavian artery injury, including pseudoaneurysm formation, intramural hematoma, thrombosis, and distal embolization to the brachial artery. The patient presented with left upper extremity pain, forearm and hand numbness, and digital cyanosis. The patient was treated with a hybrid approach, consisting of transfemoral percutaneous deployment of a covered stent in the left subclavian artery and concomitant surgical thrombectomy of the left brachial artery, resulting in excellent recovery and resolution of symptoms.

Intermittent claudication (IC) from peripheral arterial disease is typically managed with pharmacologic interventions and lifestyle changes. However, despite societal guidelines, initial endovascular interventions are being used more frequently with an increased incidence of complications, resulting in rapid disease progression to critical and acute limb-threatening ischemia (ALI). The present report describes the case of a patient who developed ALI after treatment of IC at another facility, with malpositioned bilateral common iliac stents, continuous stent extension into the popliteal artery, and acute occlusion of the entirety of the right lower extremity vasculature. This case illustrates how extensive endovascular intervention for IC can result in ALI requiring urgent revascularization.

Unstructured abstract: There are no clear guidelines addressing the use of thrombolysis to treat acute limb ischemia in patients with heparin-induced thrombocytopenia. We report the case of a 75-year-old man presenting three episodes of acute limb ischemia, associated with type II heparin-induced thrombocytopenia, repeatedly treated by catheter-directed thrombolysis. Despite a thrombocyte count as low as 29 G/L, there were no bleeding complications. Catheter-directed thrombolysis seems safe to treat acute limb ischemia even with severe type II heparin-induced thrombocytopenia.

The aim of the study. To examine the changes in structure and morphometry in sensorimotor cortical edema with cell swelling in mature white rats after common carotid artery occlusion of various durations.Material and methods. Acute ischemia was modeled on white adult Wistar rats by 20-, 30- and 40-min occlusion of the common carotid arteries (CCA). Histological (hematoxylin-eosin and Nissl staining), immunohistochemical (NSE, MAP-2, GFAP) and morphometric methods were used. Morphometry was assessed on hematoxylin and eosin-stained specimens using ImageJ 1.53 plug-ins (Find Maxima, Find Foci). Statistical hypothesis testing (nonparametric criteria) was performed using Statistica 8.0 software.Results. In the sensorimotor cortex (SMC) of white rats after 20, 30 and 40 minutes of CCA occlusion the signs of cytotoxic brain edema appeared, focal destructive and adaptive changes of neurons and astroglia evolved. The edema persisted throughout the observation period (7 days). The increase in the relative area, the number of cell swelling zones and their hydration (pixel brightness) was significant. On days 1 and 3 after CCA occlusion, some of the SMC astrocyte processes underwent destruction. Subpial and perivascular zones suffered to a greater extent. Mild and moderate (after unilateral 30-min CCA occlusion) to moderate and severe (after bilateral 40-min CCA occlusion) scattered structural and functional changes of the SMC with large areas of clearing in the «porous» neuropil, severe perivascular and perineuronal edema of the astrocyte processes developed. The latter was associated with a moderate reduction of the total neuronal density.Conclusion. After occlusion of CCA, signs of edema with cellular swelling appeared in the SMC amid dystrophic and necrotic pyramidal neurons and activated neuroglial cells. To a greater extent, the signs of brain swelling were evident three days after bilateral 40-min occlusion of CCA.

While SARS-CoV-2 infection continues to circulate around the world, there are still many uncertainties on how to treat the patients with this potentially deadly virus, and more importantly, for how long! COVID-19 causes many different symptoms, among which coagulopathy seems to play an essential role in the survival prognosis of patients. While medical centers worldwide have developed various algorithms for preventing thrombosis in COVID-19 patients, there are still no clear guidelines on the length of thromboprophylaxis therapy, target groups who should receive suitable anticoagulant prophylaxis, and even the choice of the most appropriate agent for such treatment.

Introduction and objectives: Infectious pseudoaneurysm of the superficial femoral artery is an uncommon pathological condition that requires a rapid prompt management. Ruptures remain an unpredictable complication during the natural evolution of pseudoaneurysmal pathology. The aim of this paper is to assess clinical manifestations and to analyze the different methods of management. Case presentation: We report a case of a 69-year-old male with past medical history of tobacco-alcoholic abuse. He presented to our department for necrotizing fasciitis of the left lower limb associated with stage IIb of acute ischemia. The etiological investigation revealed an Escherichia Coli pseudoaneurysm of distal segment of superficial femoral artery. Thus, the patient underwent a resection of pseudoaneurysm and tissue necrosis associated with direct revascularization. Conclusion: Septic pseudoaneurysm of the superficial femoral artery represents a medical emergency that involves limb functionality and vital prognosis. Among the therapeutic arsenal, the appropriate treatment should be discussed in a multidisciplinary approach.

Acute aortic occlusion due to fungal endocarditis remains rare. Yet, it results in high mortality and morbidity if it is not recognized and treated promptly. We present a case of a drug fiend man diagnosed with acute ischemia of lower limbs due to Candida parapsilosis endocarditis. Key points of this uncommon pathology and its management are discussed.

During or after rituximab treatment, various serious side effects may occur. Cerebrovascular diseases are relatively limited among these side effects, and whether they are contingent on rituximab treatment is unclear. This case report highlights an unusual and severe event after rituximab treatment. Our patient was a 32-year-old female diagnosed with primary angiitis of the central nervous system (PACNS). Despite meticulous management with azathioprine, the patient's condition exhibited persistent ischemic activity, necessitating a therapeutic shift to rituximab. Regrettably, very soon after the initial rituximab infusion, a substantial acute ischemic stroke took place in the right cerebral hemisphere. We have interpreted that the significant stenosis in the right internal carotid artery, which had developed due to PACNS, may pose a risk for the development of acute ischemia in our patient after rituximab treatment. In conclusion, careful evaluation of rituximab treatment may be appropriate in patients with serious stenosis of intracranial major arteries., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Asan et al.)

Lipoid proteinosis (LP), or Urbach-Wiethe disease, is an infrequent autosomal recessive disorder typified by hyaline material deposition in diverse tissues, including the skin, mucous membranes, and internal organs. This case report addresses an unusual presentation of LP in a 25-year-old male, whose initial symptom was sudden-onset left lower limb weakness. This deviation from the typical dermatological and laryngeal manifestations prevalent in LP compels us to consider LP as a potential causative factor in neurological deficits. Physical examination revealed motor weakness in the left lower limb with several dermatological manifestations. Laboratory tests indicated potential thyroid, liver, and urinary tract pathologies. Brain imaging studies revealed bilateral mesial temporal lobe calcifications consistent with LP with associated cortico-subcortical infarcts and hemorrhagic transformation. Additionally, foraminal disc protrusion at L5-S1 in the patient's back MRI suggested nerve compression contributing to limb weakness. This patient's sudden-onset left lower limb weakness accompanied by imaging findings of cortical and subcortical abnormalities aligns with the spectrum of neurological manifestations associated with LP but is less commonly reported. Moreover, the disturbed liver and thyroid blood tests in this patient suggest a potential link between LP and thyroid and liver pathologies, which needs further investigation. This case illustrates that motor weakness, potentially due to cerebral infarcts and intracerebral hemorrhage, is a possible complication of LP. Further research is necessary to confirm and understand the phenomenology of this complication., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Lebanese American University Institutional Review Board issued approval N/A. This case report was conducted with approval from the Institutional Review Board at our hospital. In accordance with the ethical standards of our institution, formal ethical approval was not necessarily due to the report's observational, non-interventional nature. However, all patient data were handled according to the Declaration of Helsinki. Written informed consent was obtained from the patient for participation in this study. Consent for publication: Written informed consent was obtained from the patient for the publication of this case report and any accompanying images. A copy of the written consent is available for review by the editor of this journal. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Mobarak et al.)

Recent studies suggest that a subset of cortical microinfarcts may be identifiable on T2* but invisible on T1 and T2 follow-up images. We aimed to investigate whether cortical microinfarcts are associated with iron accumulation after the acute stage. The RUN DMC – InTENse study is a serial MRI study including individuals with cerebral small vessel disease (SVD). 54 Participants underwent 10 monthly 3 T MRIs, including diffusion-weighted imaging, quantitative R1 (=1/T1), R2 (=1/T2), and R2* (=1/T2*) mapping, from which MRI parameters within areas corresponding to microinfarcts and control region of interests (ROIs) were retrieved within 16 participants. Finally, we compared pre- and post-lesional values with repeated measures ANOVA and post-hoc paired t -tests using the mean difference between lesion and control ROI values. We observed 21 acute cortical microinfarcts in 7 of the 54 participants (median age 69 years [IQR 66–74], 63% male). R2* maps demonstrated an increase in R2* values at the moment of the last available follow-up MRI (median [IQR], 5 [5–14] weeks after infarction) relative to prelesional values (p =.08), indicative of iron accumulation. Our data suggest that cortical microinfarcts are associated with increased R2* values, indicative of iron accumulation, possibly due to microhemorrhages, neuroinflammation or neurodegeneration, awaiting histopathological verification. [ABSTRACT FROM AUTHOR]

Aim. To study the distribution and spatial organization of dentate gyrus (DG) astrocytes and CA4 area of hippocampus of Wistar rats following 20-minute occlusion of common carotid arteries (OCCA) compared to sham-operated control animals.Material and methods. Histological (Nissl staining with hematoxylin and eosin), immunohistochemical (GFAP, MAP-2) and morphometric methods were used. Astrocytes and neurons in control (sham-operated animals, n = 5) group, after 6 hours (n=5), 1 days (n=5), 3 days (n=5), 7 days (n=5), 14 days (n=5) and 30 days (n=5) after 20-minute OCCA were studied on thin (4 µm) serial frontal sections of the hippocampus. Fractal analysis (ImageJ 1.52; fraclac 2.5 plugin) was used to obtain additional quantitative information on the spatial organization of astrocyte networks. Statistical hypotheses were tested using nonparametric criteria.Results. 30 days after the 20-minute OCCA, only 5.3% of CA4 neurons were irreversibly destroyed and the total numerical density of DG granular cells remained at the control level. Hypertrophy and increased complexity of the spatial organization of astrocyte processes were observed 6 hours and 1 day after OCCA and persisted for 30 days. Astrogliosis was accompanied by an increased relative area of GFAP-positive material and fractal dimension and reduced lacunarity of the astrocyte network. The latter was especially evident in 1, 14 and 30 days after the OCCA.Conclusion. After the 20-minute OCCA, the density of GFAP-positive material increased, the fibroarchitecture reorganized and gained more complexity due to the branching of astrocyte processes. At the same time, the total numerical density of neurons changed only slightly. All this indicated the probable role of astrocytes in post-ischemic activation of natural neuroprotection mechanisms.

Цель. Изучить возможность уменьшения неблагоприятных эффектов реперфузии на отдаленные органы и системы при острой ишемии конечности. Материалы и методы. В исследование, проведенное в Институте общей и неотложной хирургии имени В. Т. Зайцева, включены 37 пациентов, оперированных в период с 2016 по 2019 г. по поводу тяжелой острой ишемии вследствие острой проксимальной окклюзии артерий нижней конечности. В 1-й группе (сравнительной) 23 пациентам проводили стандартное лечение. У 14 пациентов 2-й группы (основной) во время восстановления кровотока применяли предложенную методику модифицированной управляемой реперфузии в комбинации с малопоточным гемодиализом в первые 12 ч реперфузионного периода. Изучали динамику концентрации интерлейкинов (IL-1β, IL-6, IL-8, IL-10) и фактора некроза опухоли альфа (TNF-α) в течение 48 ч после операции в периферической венозной крови. Также в раннем послеоперационном периоде оценивали уровни миоглобина, общей креатинфосфокиназы, креатинина и калия. Результаты. В раннем реперфузионном периоде наблюдали повышение концентрации провоспалительных цитокинов в сыворотке крови, особенно IL-6 и IL-8. Применение предложенного метода управляемой реперфузии позволило в течение первых 2 сут снизить концентрацию IL-6 на 51 - 67%, а концентрацию IL-8 – на треть. Также при применении предложенной методики существенно снижались как пиковые, так и средние показатели уровней миоглобина и общей креатинфосфокиназы в сыворотке периферической крови. Клинически отмечено уменьшение тяжести почечной дисфункции и количества неблагоприятных сердечно-легочных событий. Выводы. Применение разработанного метода управляемой реперфузии приводит к уменьшению воспалительного ответа и системного влияния продуктов ишемического метаболизма и рабдомиолиза в раннем послеоперационном периоде у пациентов с тяжелой ишемией нижних конечностей.

While SARS-CoV-2 infection continues to circulate around the world, there are still many uncertainties on how to treat the patients with this potentially deadly virus, and more importantly, for how long! COVID-19 causes many different symptoms, among which coagulopathy seems to play an essential role in the survival prognosis of patients. While medical centers worldwide have developed various algorithms for preventing thrombosis in COVID-19 patients, there are still no clear guidelines on the length of thromboprophylaxis therapy, target groups who should receive suitable anticoagulant prophylaxis, and even the choice of the most appropriate agent for such treatment. [ABSTRACT FROM AUTHOR]

The effectiveness of endovascular treatment for popliteal arterial injury has not been well-documented. This study was aimed to investigate the midterm outcomes of endovascular repair of traumatic isolated popliteal arterial injury. Medical records of the patients who underwent endovascular repair for traumatic popliteal arterial injuries from January 2012 to February 2020 were reviewed retrospectively. Clinical data including patient demographics, Injury Severity Score, type of injury, classification of acute limb ischemia, concomitant extremity fracture, runoff vessel status, complications, time of endovascular procedure, time interval from injury to blood flow restoration, length of hospital stay, reintervention, and follow-up were collected and analyzed. Endovascular repair was performed in 46 patients with traumatic popliteal arterial injuries. The mean Injury Severity Score was 15.8 ± 6.2. The overall limb salvage rate was 89.1%. There were 10 penetrating and 36 blunt injuries (78.3%). The initial angiographic findings revealed occlusion in 34 patients (73.9%), pseudoaneurysm in 2 (4.4%), active extravasation in 9 (19.5%), and arteriovenous fistulas in 1 (2.2%). Technical success was achieved in all 46 patients, via antegrade access in 24 patients (52.2%) and concurrent retrograde access in 22 (47.8%). The mean time interval from popliteal artery injury to blood flow restoration was 10.6 ± 4.9 hours and mean operative time was of 54.9 ± 10.0 minutes. The mean follow-up was 36.1 ± 14.5 months. The primary patency rate was 75.3% at 12 months, 61.9% at 24 months, and 55.7% at 48 months. The secondary patency rate was 92.2% at 12 and 24 months and 85.2% at 48 months. A Cox multivariate analysis revealed that single vessel runoff was an independent risk factor for primary patency loss. Endovascular repair of an isolated popliteal artery injury may be a safe and effective alternative treatment in select patients, with acceptable midterm outcomes. Single vessel runoff was an independent risk factor for primary patency loss. [ABSTRACT FROM AUTHOR]

Introduction: Acute myocardial ischemia occurs when coronary perfusion to the heart is inadequate, which can perturb the highly organized electrical activation of the heart and can result in adverse cardiac events including sudden cardiac death. Ischemia is known to influence the ST and repolarization phases of the ECG, but it also has a marked effect on propagation (QRS); however, studies investigating propagation during ischemia have been limited.Methods: We estimated conduction velocity (CV) and ischemic stress prior to and throughout 20 episodes of experimentally induced ischemia in order to quantify the progression and correlation of volumetric conduction changes during ischemia. To estimate volumetric CV, we 1) reconstructed the activation wavefront; 2) calculated the elementwise gradient to approximate propagation direction; and 3) estimated conduction speed (CS) with an inverse-gradient technique.Results: We found that acute ischemia induces significant conduction slowing, reducing the global median speed by 20 cm/s. We observed a biphasic response in CS (acceleration then deceleration) early in some ischemic episodes. Furthermore, we noted a high temporal correlation between ST-segment changes and CS slowing; however, when comparing these changes over space, we found only moderate correlation (corr. = 0.60).Discussion: This study is the first to report volumetric CS changes (acceleration and slowing) during episodes of acute ischemia in the whole heart. We showed that while CS changes progress in a similar time course to ischemic stress (measured by ST-segment shifts), the spatial overlap is complex and variable, showing extreme conduction slowing both in and around regions experiencing severe ischemia. [ABSTRACT FROM AUTHOR]

Introduction: We present our experience in the treatment of senile patient with multifocal atherosclerosis and severely impacted quality of life Clinical case: We describe a clinical case of a 86 years old patient with critical limb ischemia who received a femoroperoneal bypass with resection of the fibula in 2023 on the left lower extremity and perfect early result with dramatic improvement of the symptoms. Due to critical limb ischemia of the right lower extremity the patient received femoropopliteal bypass with prosthesis in 2024. During his second stay in the hospital the patient complained of chest pain and dispnea with massive elevation of troponin level. He was diagnosed with NSTEMI and but refused intervention at the time. Ten days later he is admitted in the cardiology unit in Gotse Delchev with clinical signs of right lower extremity ischemia. The treating physician performed thrombolysis with percutaneous angioplasty of the bypass with full restoration of the blood flow to the foot. Blood transfusion was also performed due to low haemoglobin level. Nevertheless the patient had anuria and progressing hypotension which led to patient's death 48 hours later. Discussion: In the recent years we observe an increasing number of patients with uncontrolled hypertension, diabetes, chronic renal disease. These patients are usually unsuitable for standard endovascular or open surgery procedures due to lack of outlet vessels. The only viable options for them is extraanatomical bypass surgery of deep venous arterialisation. Conclusion: Multidisciplinary approach is always needed in patients with multifocal atherosclerosis and failed attempts for revascularisation. In cases with other surgical options distal peroneal bypass with resection of the fibula offers the only appropriate solution for limb salvage. [ABSTRACT FROM AUTHOR]

Acute limb ischemia is a rare disorder in the perinatal period. The etiology and management of acute limb ischemia is not well described. We report 4 cases of acute limb ischemia in the neonatal period. Observations: We present the cases of four premature neonates aged between 6 and 15 days. The mothers of one of the neonates had a history of gestational diabetes. Three neonates were born by eutocic vaginal delivery and one, by cesarean section. Reasons for hospitalization of the neonates included infections (3 cases), hyaline membrane disease (2 cases) and congenital malaria (1 case).The neonates presented with cyanosis localized in the fingers (1 case), cyanosis on the fingers extending to the forearm (2 cases) and cyanosis localized in the toe (1 case). All patients had a peripheral intravenous catheter implanted in the affected limb. In three cases, there was an infectious syndrome and in one case, hemostasis was impaired. Doppler ultrasound of the blood vessels in the affected limb revealed arterial thrombosis in 2cases. Management involved antibiotics, heparin therapy and fasciotomy. During hospitalization, 1 patient had spontaneous distal phalanx amputation, 1 required surgery for forearm segmental gangrene and 2 died. Conclusion: Neonatal acute limb ischemia is rare but can be fatal due to functional and vital repercussions. Treatment outcomes depend on early diagnosis, etiology and treatment.

Acute upper limb ischemia is considered a vascular emergency. These events are mostly thromboembolic and are often detected in patients with atrial fibrillation (AF). Surgical thrombectomy and percutaneous mechanical thrombectomy are the usual methods to treat this medical emergency. In this case, we report the case of a 75-years old woman with a history of AF who initially presented to our center because of syncope resulting from Torsades de pointes due to a known long-QT syndrome. Those episodes were treated adequately from the implanted ICD. In addition to the symptoms of syncope, the patient also noted symptoms of right upper-limb ischemia. Using duplex sonography, we noticed a thrombotic occlusion at the level of the axillary artery. Using femoral access, we performed an antegrade angiography of the axillary artery, which confirmed a fresh thrombotic occlusion. The initially performed thrombus aspiration wasn't successful, and the decision was made to use an ekosonic endovascular system (Ekosonic ™ Endovascular System, Boston Scientific, EKOS) catheter to perform catheter-directed thrombolysis. Locally, 10 mg Actilyse were administrated. Then an EKOS Catheter was delivered to the occlusion area and was placed for 6 h. Symptoms of ischemia were resolved, and the angiographic control showed normal flow in the axillary artery. The patient was discharged without any local deficits of the right hand. [ABSTRACT FROM AUTHOR]

We present a case of Achenbach syndrome, which is an alarming disease for both patients and physicians, although it is a rare, benign and self-limiting disorder. It is also reported as "paroxysmal finger haematoma", but the majority of cases are misdiagnosed, and unnecessarily investigated and treated. [ABSTRACT FROM AUTHOR]

Ultrasound-mediated microbubble cavitation improves perfusion in chronic limb and myocardial ischemia. The purpose of this study was to determine the effects of ultrasound-mediated microbubble cavitation in acute limb ischemia and investigate the mechanism of action. The animal with acute hindlimb ischemia was established using male Sprague-Dawley rats. The rats were randomly divided into three groups: intermittent high-mechanical-index ultrasound pulses combined with microbubbles (ultrasound [US] + MB group), US alone (US group) and MB alone (MB group). Both hindlimbs were treated for 10 min. Contrast ultrasound perfusion imaging of both hindlimbs was performed immediately and 5, 10, 15, 20 and 25 min after treatment. The role of the nitric oxide (NO) pathway in increasing blood flow in acutely ischemic tissue was evaluated by inhibiting endothelial nitric oxide synthase (eNOS) with Nω-nitro-L-arginine methyl ester hydrochloride (L-NAME). In the US + MB group, microvascular blood volume and microvascular blood flow of the ischemic hindlimb were significantly increased after treatment (both p values <0.05), while the microvascular flux rate (β) increased, but not significantly (p > 0.05). The increases were observed immediately after treatment, and had dissipated by 25 min. Changes in the US and MB groups were minimal. Inhibitory studies indicated cavitation increased phospho-eNOS concentration in ischemic hindlimb muscle tissue, and the increase was significantly inhibited by L-NAME (p < 0.05). Ultrasound-mediated microbubble cavitation transiently increases local perfusion in acutely ischemic tissue, mainly by improving microcirculatory perfusion. The eNOS/NO signaling pathway appears to be an important mediator of the effect. [ABSTRACT FROM AUTHOR]

Objectives Acute thrombotic ischemia is a very dangerous limb-threatening and life-threatening disease. It is better treated by catheter-directed thrombolysis. Now, tissue plasminogen activator like alteplase is safer than streptokinase or urokinase. The current study is designed to show its efficacy and safety and to investigate variables that correlate with outcome. Patients and methods This is a prospective cohort study. It included patients with acute thrombotic limb ischemia. Excluded ones were acute ischemia due to embolism, trauma, arterial dissection, complicated aneurysm, bleeding risk, history of recent intracranial bleeding, massive gangrene, or uncontrolled hypertension. The study is approved by ethical committee of Beni-Suef University. Primary end points were technical success, clinical success, and limb salvage. Secondary end points were procedural complications. Results A total of 36 patients were enrolled in the study from March 2019 to February 2020 in Beni-Suef University Hospital. It included 21 (58.33%) male patients. The patients' mean age was 58.42 years and mean BMI was 31.56 kg/m2. Risk factors were smoking in 15 (41.67%) patients, diabetes mellitus in 16 (44.44%) patients, hypertension in 15 (41.67%) patients, ischemic heart disease in nine (25%) patients, and hyperlipidemia in 14 (38.89%) patients. Clinical presentation showed that 16 (44.44%) patients were in Rutherford IIa category and 20 (55.56%) patients were in Rutherford IIb category. Limb salvage was achieved in 14/16 (87.5%) of patients in Rutherford IIa category and 12/20 (60%) of patients in Rutherford IIb category. Statistical analysis showed a correlation of BMI and severity of ischemia with outcome. Moreover, the frequency of risk factors was correlated with outcome. Conclusion Catheter-directed thrombolysis using alteplase is effective and safe to treat acute thrombotic limb ischemia. Its outcome is better with lower BMI, less severe ischemia, and less or no comorbid disease. [ABSTRACT FROM AUTHOR]

The second part of the review presents modern ideas about vision of the role of Epac proteins in the regulation of inotropic and rhythmic functions of the heart, intercellular coupling of cardiomyocytes and their apoptosis. The contribution of Epac proteins to the development of hypertrophy, fibrosis, and myocardial remodeling, as well as their role in the genesis of acute ischemic damage to the heart muscle and cardiac arrhythmias, is examined in detail. [ABSTRACT FROM AUTHOR]

Objective. To study the activity of apoptotic proteins (bcl-2, p53, caspase-3) and neuroplasticity proteins (p38, MAP-2) in the sensorimotor cortex (SMC) in the brains of white rats in health and at different times after 20-min occlusion of the common carotid arteries (OCCA). Materials and methods. Light microscopy (hematoxylin and eosin staining), immunohistochemistry, and morphometry methods were used. Study materials: the control group consisted of sham-operated animals (n = 5) and the study group consisted of animals 1, 3, 7, 14, and 30 days after OCCA (n = 25). Results. OCCA was followed, on the background of irreversible destruction of a proportion of SMCC neurons (layer III 25.1%, layer V 19.0%), by reorganization of processes (MAP-2) and synapses (p38) of surviving neurons. The relative contents of labeled anti-p38 and anti-caspase-3 antibodies located in synaptic terminals decreased (on days 1 and 3) and then recovered (on day 7). The most marked changes in caspase-3 during the postischemic period were noted at 7, 14, and 30 days, when its content was greater than that of p38. Conclusions. Postischemic compensatory reorganization of the neuronal communication system (processes, synapses) occurred on the background of a high axon caspase-3 level. No signs of apoptosis (activation of caspase-3 in the perikaryon) were seen. Caspase-3 should be regarded as aspect of pleiotropy, as it is involved in adaptive and restorative processes, i.e., neuroplasticity. [ABSTRACT FROM AUTHOR]

Le thrombus mural flottant de l'aorte est une pathologie rare et grave, responsable d'embolisation périphériques et viscérales. Une thrombose survenant sur une aorte saine est exceptionnelle, de rares cas isolés sont rapportés dans la littérature. Une recherche étiologique exhaustive doit être réalisée. Le traitement repose essentiellement sur une anticoagulation systémique avec recours à la chirurgie chez certains patients. The floating mural thrombus of abdominal aorta is a rare and serious pathology detected as cause of peripheral and visceral embolism. Isolated aortic mural thrombosis is an unusual pathology occurring in an apparently normal aorta. A thorough search of embolic source must be initiated. Therapeutic management is based on systemic anticoagulation with the use of surgical approach in some cases. [ABSTRACT FROM AUTHOR]

We present a case of acute and chronic ischemia in the bilateral cerebellar border zones in a patient with migraine with aura. To our knowledge, this imaging presentation has not been published. The patient presented with 20 years of migraines that had worsened with developing aura prior to MRI, which showed restricted diffusion in the bilateral cerebellar border zones, consistent with acute ischemia. Additional ADC hyperintensities were demonstrated in the border zones, consistent with chronic infarcts. Follow-up CT angiogram showed no occlusion, stenosis, vasospasm, or significant atherosclerosis in the posterior circulation. Additionally, follow-up MRI performed 56 days after initial MRI showed that post-migraine ischemia can be associated with signs of microscopic damage on DWI/ADC map that are not visible with T2 weighted or FLAIR sequences. Cerebellar border zone hypoperfusion from cortical spreading depression and/or transient vasospasm is the most likely etiology due to poor collateral circulation and thus a lower ischemic threshold. Changes in physiologic response to 5-HT during migraine with aura may be responsible for these perfusional abnormalities. Some patients may be more prone due to anatomic variability of the superior cerebellar arteries (SCA) and posterior inferior cerebellar arteries (PICA). Radiologist should be aware of subtle small cerebellar zone infarcts with migraine patients when scrutinizing the posterior fossa. • Migraine may cause borderzone ischemia in the cerebellum • Ischemic lesions due to migraine may be reversible on FLAIR and T2 weighted imaging • ADC map data may show microstructural abnormalities in patients with acute migraine [ABSTRACT FROM AUTHOR]

Acute limb ischemia (ALI), the most challenging form of ischemia-reperfusion injury (IRI) in skeletal muscle tissue, leads to decreased skeletal muscle viability and limb function. Mitochondrial injury has been shown to play a key role in skeletal muscle IRI. In previous studies, we have demonstrated that mitochondrial transplantation (MT) is an efficacious therapeutic strategy to replace or to augment mitochondria damaged by IRI, allowing enhanced muscle viability and function in cardiac tissue. In this study, we investigated the efficacy of MT in a murine ALI model. C57BL/6J mice (male, 10-12 weeks) were used in a model of ALI. Ischemia was induced by applying a tourniquet on the left hindlimb. After 2 hours of ischemia, the tourniquet was released, and reperfusion of the hindlimb was re-established; either vehicle alone (n = 15) or vehicle containing mitochondria (n = 33) was injected directly into all the muscles of the hindlimb. Mitochondria were delivered at concentrations of 1 × 106 to 1 × 109 per gram wet weight to each muscle, and the animals were allowed to recover. Sham mice received no ischemia or injections but were anesthetized for 2 hours and allowed to recover. After 24 hours of recovery, limb function was assessed by DigiGait (Mouse Specifics Inc, Boston, Mass), and animals were euthanized; the gastrocnemius, soleus, and vastus medialis muscles were collected for analysis. After 24 hours of hindlimb reperfusion, infarct size (percentage of total mass) and apoptosis were significantly decreased (P <.001, each) in the gastrocnemius, soleus, and vastus medialis muscles in MT mice compared with vehicle mice for all mitochondrial concentrations (1 × 106 to 1 × 109 per gram wet weight). DigiGait analysis at 24 hours of reperfusion showed that percentage shared stance time was significantly increased (P <.001) and stance factor was significantly decreased (P =.001) in vehicle compared with MT and sham mice. No significant differences in percentage shared stance time (P =.160) or stance factor (P =.545) were observed between MT and sham mice. MT ameliorates skeletal muscle injury and enhances hindlimb function in the murine model of ALI. Acute limb ischemia (ALI) is the most challenging form of ischemia-reperfusion injury (IRI), leading to loss of muscle viability and function. Mitochondria have been shown to play a key role in IRI. Previously, we have demonstrated that mitochondrial transplantation (MT) is an efficacious therapy to replace or to augment mitochondria damaged by IRI in cardiac tissue. In this study, we demonstrate that MT significantly decreases infarct size and apoptosis and significantly enhances hindlimb function in a murine model of ALI. MT provides a novel therapy for ALI, allowing preservation of muscle viability and muscle function. [ABSTRACT FROM AUTHOR]

Despite the improving imaging techniques, it remains challenging to produce magnetic resonance (MR) imaging fingerprints depicting severity of acute ischemia. The aim of this study was to evaluate the potential of the overall high‐field 1H MR Spectroscopy (1H‐MRS) neurochemical profile as a metabolic signature for acute ischemia severity in rodent brains. We modeled global ischemia with one‐stage 4‐vessel‐occlusion (4VO) in rats. Vascular structures were assessed immediately by magnetic resonance angiography. The neurochemical responses in the bilateral cortex were measured 1 h after stroke onset by 1H‐MRS. Then we used Partial‐Least‐Squares discriminant analysis on the overall neurochemical profiles to seek metabolic signatures for ischemic severity subgroups. This approach was further tested on neurochemical profiles of mouse striatum 1 h after permanent middle cerebral artery occlusion, where vascular blood flow was monitored by laser Doppler. Magnetic resonance angiography identified successful 4VO from controls and incomplete global ischemia (e.g., 3VO). 1H‐MR spectra of rat cortex after 4VO showed a specific metabolic pattern, distinct from that of respective controls and rats with 3VO. Partial‐Least‐Squares discriminant analysis on the overall neurochemical profiles revealed metabolic signatures of acute ischemia that may be extended to mice after permanent middle cerebral artery occlusion. Fingerprinting severity of acute ischemia using neurochemical information may improve MR diagnosis in stroke patients. [ABSTRACT FROM AUTHOR]

Stroke is a life-threatening event that is expected to more than double over the next 40 years. Approximately 85% of strokes are ischemic in nature and result from thromboembolic occlusion of a major cerebral artery or its branches. One of the diagnostic methods for detection of the cerebral ischemia is the gadolinium-enhanced MRI imaging. It is mainly used in patients to detect brain tissue damaged by an ischemic stroke and brain hemorrhage. These techniques are expensive, require sophisticated machines and are time consuming. A recent study in acute stroke patients showed gadolinium leakage into ocular structures (GLOS) during MRI imaging with gadolinium administration. The results indicate that at 2 hours after administration of the contrast agent, GLOS was more common in the aqueous chamber alone, compared to the vitreous chamber with increasing amount in 24 hours after the administration of the contrast agent. This could be due to disruption of blood-ocular barrier similar to the disruption of blood-brain barrier in acute stroke. A new approach to diagnosis of acute stroke and transient ischemic attack (TIA) is through the detection of sodium fluorescein contrast agent in the eye by i.v. injection. The agent is safe and is used routinely in eye fluorescein angiography. Fluorescein fluorescence occurs at the visible wavelengths and can be detected by fluorescein angiography camera. The fluorescein angiography camera prices are affordable for any medical clinic. The innovation of this method is to leverage the eye as the window to the brain. The method can potentially detect acute stroke and TIA without MRI. This can have a far-reaching impact on the healthcare system. The eventual feature of the device will be portability and simplicity of operation that can be used by a medical technician in medical office, emergency outfits and even in ambulances given the portability. [ABSTRACT FROM AUTHOR]

Neonatal gangrene is a rare condition during the neonatal period. Its prognosis is generally poor. Acute ischemia of the limbs is most often caused by thromboembolic events. Although there are several predisposing factors, in the majority of cases no causative factor is found. Also the extent of the gangrene is variable; it can affect one or several fingers or toes or even the whole upper or lower limb. We here report a case of congenital gangrene of the hand treated in our Department. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the immediate outcome of percutaneous mechanical thromboembolectomy in acute infrainguinal leg ischemia in a consecutive cohort of patients with acute lower limb ischemia.Material and Method: We retrospectively analyzed the data of 156 acute infrainguinal ischemic events in 148 patients. Patients presented with acute limb ischemia Rutherford category I in 68 cases (44%), Rutherford category II A in 64 instances (41%) and Rutherford II B in 24 instances (15%). In 62 cases (39.7%), the occlusion site started below the knee joint level, in 94 (60.3%) cases above. As a basic technique, an intervention was started by manual aspiration but if aspiration failed, an additional device was added. Most frequently, a rotational thrombectomy device (Rotarex, Straub Medical, Wangs, Switzerland) was used. An antegrade access to the femoral artery was the preferred access to the limb (154/156).Results: In 145 of 156 incidents, a technical success was achieved (93%). Aspiration was used in 153 cases (98%). Rotational thrombectomy by use of the Rotarex catheter was added in 60 cases (38%). Directional atherectomy was applied in a total of five patients. As main technical complications, a downward embolization occurred (n = 11). There were four surgical groin revisions. Five patients died during the early follow-up with four not related to the intervention. Clinically, 135 patients (86.5%) showed an improvement in their clinical situation.Conclusion: Acute lower limb ischemia can be successfully treated by mechanical thromboembolectomy only by combining aspiration embolectomy with rotational thrombectomy in most cases but manual aspiration alone will frequently fail especially above the knee joint level. [ABSTRACT FROM AUTHOR]

Acute limb ischemia occurs as a result of sudden decrease in its perfusion, which usually occurs during the obturation of the lumen of large arteries due to acute thrombosis or embolism either impaired of vascular patency caused by trauma or compression (including the application of hemostatic tourniquets). In the case of restoration of blood supply to previously ischemic tissues, there is an ischemic-reperfusion syndrome, in which one of the main pathogenetic links of tissue alteration is the activation of lipid peroxidation. The content of diene conjugates, triene conjugates, TBA-active products, superoxide dismutase and catalase in homogenate of the muscle tissue and blood serum of 30 white rats under condition of experimental acute ischemia was determined. Acute ischemia was caused by the application of SWAT (Stretch-Wrap-And-Tuck) rubber bundles on the hind limbs of the animals for 2 hours. It was experimentally found that the maximum increase in the content of diene and triene conjugates in the injured muscle tissue of the animals occurred in the early post-ischemic period on the 2nd hour of reperfusion with a decreaseing on the 1st and 7th day and the subsequent return of indicators in the late postischemic period on the 14th day to the level of control group. The increasing of TBA-active products in the muscle tissue occurred in the first three groups of the rats and peaked in the third group (reperfusion for the 1st day), after which their level decreased in the animals during the late reperfusion period, reaching in the last group on the 14th day of reperfusion indices, close to the values of the control group. The dynamics of activity of superoxide dismutase and catalase in the muscle homogenate were to a large extent similar (as indicated by the strong positive correlation (+0,99) between them), gradually increasing and reaching the maximum on 7th day of the ischemia-reperfusion symdrome. As a result of the experiment, a decreasing in the antioxidant-prooxidant index in all experimental groups of the rats was also observed in the muscle homogenate, which was the most pronounced on the 1st day of ischemia-reperfusion. The comparative analysis of the similar parameters of lipid peroxidation and antioxidant protection in the muscle homogenate and blood serum showed a direct correlation in all the studied pairs. The strong and moderate positive correlation between analogous indices of LPO and AOP in muscle homogenate and blood serum in all five studied pairs indicates similar changes of these indicators at the local and systemic levels.

We present two cases of acute arterial thrombosis in patients who were confirmed to be SARS-CoV-2 positive. Neither of the patients had a background of underlying vascular morbidity. At the time of presentation, both patients exhibited only mild respiratory symptoms of COVID-19. After initial assessment and work-up, both patients underwent surgery for their respective vascular pathologies. They both did well post-operatively and were discharged home. This is an unusual presentation of acute arterial thrombosis in two patients with only mild symptoms of COVID-19 infection. [ABSTRACT FROM AUTHOR]

More blast injuries are encountered in the civilian setting in recent years as terrorist attacks have increased globally. A 17-year-old male patient with severe blast injury of the right lower extremity was admitted to our department on the fifth day after a terrorist bombing attack. Initially he had been admitted to an emergency department with segmental tibia fracture and arterial injury (Gustilo IIIC). An amputation had been foreseen due to ischemia that persisted even after orthopedic fixation and revascularization interventions, followed by fasciotomy incisions. After consultation with our department hyperbaric oxygen (HBO2) therapy was administered twice daily for the first week. Ischemia improved prominently after 10 HBO2 sessions. HBO2 therapy was continued together with antibiotherapy and wound care. The patient underwent a total of 40 HBO2 sessions and two reconstructive operations and healed without amputation. Vascular injuries with concomitant orthopedic trauma cause most of the delayed amputations in bombing attacks since ischemia can persist at the microvascular level even though adequate treatments are applied. HBO2 corrects hypoxia at tissue level and so provides oxygen for the critically ischemic cells in the injured area. HBO2 also enhances host defense and decreases the ischemia reperfusion injury. In this case, HBO2 was effective in survival and functional recovery (salvage) of the extremity together with regular wound care, antibiotherapy and surgical repair. [ABSTRACT FROM AUTHOR]