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Background and purpose: MicroRNA (miRNA) therapy is a promising approach to induce cardioprotection. We have previously identified cardiac microRNA‐125b* (microRNA‐125b‐2‐3p; miR‐125b*) as a potential cardioprotective miRNA, termed ProtectomiR. We aimed to characterize the pharmacokinetics and pharmacodynamics, and the effect of miR‐125b* mimic on infarct size using an in vivo mouse model. Experimental approach: To characterize the pharmacokinetics properties of miR‐125b* mimic, a single injection of 10‐μg miR‐125b* mimic or its scramble miRNA control, or vehicle i.v. was given to C57BL/6 mice. MiR‐125b* expression was measured from plasma, heart, kidney and liver samples. Effect of miR‐125b* on area at risk and infarct size was assessed after 45‐min coronary occlusion, followed by 24‐h reperfusion; 10‐μg miR‐125b* mimic or 10‐μg non‐targeting miRNA mimic control or vehicle were administered via the right jugular vein at 10th mins of coronary occlusion. To assess molecular mechanism involved in cardioprotection, expression of mRNA targets of miR‐125b* were measured from ventricular myocardium at 1, 2, 4, 8 or 24 h post‐treatment using quantitative real time polymerase chain reaction. Key results: MiR‐125b* expression was markedly increased in plasma and myocardium 1 h, and in the liver 2h after treatment. Infarct size was significantly reduced after miR‐125b* mimic treatment when compared to the vehicle. The expression of Ccna2, Eef2k and Cacnb2 target mRNAs was significantly reduced 8 h after injection of miR‐125b* mimic. Conclusion and implications: This is the first demonstration of pharmacokinetic and molecular pharmacodynamic properties as well as the cardioprotective effect of miR‐125b* mimic in vivo. LINKED ARTICLES: This article is part of a themed issue Non‐coding RNA Therapeutics. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v182.2/issuetoc [ABSTRACT FROM AUTHOR]

Background: The cannulation of the internal jugular vein (IJV) is a frequent procedure in critically ill patients. According to the guidelines, real-time ultrasound navigation is recommended. Traditional techniques pose several disadvantages, such as suboptimal needle visualization. Therefore, this non-inferiority trial aimed to describe the novel approach and compare the novel lateral in-plane short-axis approach for IJV access with the conventional short-axis out-of-plane approach. Objectives: The primary objective of the trial was to prove that the first attempt success rate in the novel technique is non-inferior to the conventional technique. The secondary objectives were to demonstrate that the complication rate and the functional duration of the catheter in the novel technique are not inferior to those in the conventional technique. Methods: Patients eligible for IJV cannulation were randomly assigned to either the novel technique (Group A) or the conventional one (Group B). The procedure duration, success rate and the number of attempts required were documented. The functionality of the catheter and complications were monitored from insertion until the catheter removal. Standard descriptive statistical methods were employed for the analysis. Results: A total of 200 subjects were equally divided between Group A and Group B. For the primary outcome, there was no significant difference in first attempt success rate (Group A: 79, Group B: 77, p = 0.434). Secondary outcomes, including complications and catheter functional time, did not differ significantly between the groups. However, the novel technique demonstrated a significantly faster procedure time (Group A: 315 s, Group B: 330 s, p = 0.016). Notably, the novel approach was linked with significantly larger IJV diameter measured during the procedure (Group A: 18.2 mm, Group B: 12.1 mm, p < 0.001). Conclusion: The novel lateral in-plane short-axis approach for IJV cannulation is a non-inferior alternative with a lower incidence of posterior vessel wall puncture compared to the conventional approach. [ABSTRACT FROM AUTHOR]

Lemierre syndrome is an extremely rare but life-threatening condition, characterized by septic thrombophlebitis of the internal jugular vein. There is usually a preceding oropharyngeal infection, and the culprit pathogen is usually Fusobacterium necrophorum. We present an unusual case of Lemierre syndrome caused by Streptococcus pyogenes. The patient initially presented to ophthalmology with multiple cranial nerve palsies and cavernous sinus thrombosis. He was successfully treated with antibiotics in a timely fashion. This is the first report to show this pathogen causing severe ophthalmic complications from Lemierre syndrome. [ABSTRACT FROM AUTHOR]

The list of standard abbreviations for JDS is available at adsa.org/jds-abbreviations-24. Nonstandard abbreviations are available in the Notes. The objective of this experiment was to estimate the bioavailability (BA) of rumen-protected (RP) His, RPLys, and 2 RPMet products using 3 in vivo methods: area under the curve (AUC), plasma dose-response (PDR), and fecal free AA (FFAA) methods. We used 8 rumen-cannulated cows in a replicated 4 × 4 Latin square experiment with 16-d periods. Treatments were (1) abomasal infusion of water (control), (2) abomasal infusion of free His, Lys, and Met (FAA), (3) administration of RPHis + RPLys + RPMet1 (rumen-protected methionine protected with ethyl cellulose; RPAA1), and (4) administration of RPHis + RPLys + RPMet2 (rumen-protected methionine protected with a pH-sensitive polymer; RPAA2). On d 7 of each experimental period, a pulse-dose of water (control) or FAA were infused into the abomasum of the cows, or RPAA were placed directly in the rumen, and blood samples were taken from the jugular vein through a catheter 11 times over a 24-h period for the AUC method. Following the AA pulse-dose, infusion lines were installed into the abomasum for continuous infusion of FAA for the PDR method, or RPAA were fed from d 12 to d 16 and cows were fitted with urinary catheters for total collection of feces for the FFAA method. Fecal collection and blood sampling were conducted from d 14 to 16. Due to technical issues likely leading to unrealistic BA estimates, data for the PDR method are reported in the supplemental material. Relative BA based on the AUC method (computed as AUC of RPAA treatment plasma AA concentration divided by AUC of FAA treatment plasma AA concentration) was lower for RPMet1 compared with RPMet2 (43% vs. 61%) and was 45% (SEM = 3.35) and 72% (SEM = 5.99), for RPHis and RPLys, respectively. Rumen escape fractions of RPAA, estimated in a previous study using an in situ method, and digestibility data from the current study were used for calculations of BA for the FFAA method. Bioavailability based on the FFAA method was lower for RPMet1 (67%) compared with RPMet2 (91%) and was 87% (SEM = 0.71) and 75% (SEM = 2.75) for RPHis and RPLys, respectively. The relative differences in estimated BA based on both the AUC and FFAA methods between the RPMet products were as expected, based on literature, and data for all 4 RPAA products corresponded well with previously estimated BA using the FFAA method. The unrealistic data for the PDR method were likely caused by technical deviations from the original method (e.g., once-daily dosing of RPAA and inability to capture representative plasma concentration data with the sampling time points). Therefore, comparison of the PDR method with the AUC and FFAA methods were not possible in this study. Further comparisons are needed without deviations from the original PDR method. Variability in BA data and differences in estimated BA between the in vivo methods highlight the current challenges for accurate measurements of relative in vivo BA of RPAA products. Different protection technologies may call for different methodology to be used for BA estimations. Further research and standardization of in vivo BA methods are warranted. [ABSTRACT FROM AUTHOR]

The prone position is often used for patients with adult respiratory distress syndrome and specific surgical postures. When performing venous cannulation in this position, it is important to have a structured review to introduce the available major veins and ultrasound-guided procedure. In this review, we discuss the techniques of ultrasound-guided cannulation and provide insights into various aspects, including the anatomical locations of veins, vein sizes, placement techniques, surrounding structures at risk, and reported experiences with catheter placements. Eight major veins can be accessed in the prone position: the internal jugular vein, external jugular vein, brachiocephalic vein, basilic vein, mid-thigh femoral vein, popliteal vein, posterior tibial vein, and small saphenous vein. To minimize the risk of venous thromboembolism, the ratio of catheter diameter to vessel diameter should be less than 0.67. The review also presents the minimal requirement of venous diameter for different catheters in a tabulated form. For larger veins, real-time ultrasound guidance with the long-axis view/in-plane technique is suggested, while for smaller vessels, the short-axis view/out-of-plane technique is recommended. The review includes sonographic illustrations of the two techniques and surrounding arteries and nerves for the eight major veins. The aim of this review is to help clinicians assess the eight major veins and safely insert various types of catheters for patients in the prone position. [ABSTRACT FROM AUTHOR]

Sport-related concussions are a common type of brain injury, and the best treatment is prevention. Recently, external jugular vein compression collars have been worn by National Football League players, but the current evidence is limited. To the best of the authors' knowledge, this is the first comprehensive, up-to-date systematic review addressing the use of jugular vein compression collars for decreasing concussion incidence in high-impact sports and activities. Overall, when compared to control, the results indicated that jugular vein compression collars resulted in significantly reduced white matter alteration, improved short-term neurocognitive outcomes, increased internal jugular vein cross-sectional area, decreased internal carotid artery cross-sectional area, and moderating effects on peak pulse pressure. There was no significant difference in concussion incidence rate between groups. While promising, these findings warrant future research to assess jugular vein compression collar's role in concussion prevention, brain injury, and long-term neurocognitive outcomes. The authors are hopeful for the role jugular vein compression collars will play in the future. [ABSTRACT FROM AUTHOR]

The article in CVIR Endovascular discusses the use of direct percutaneous puncture of occluded venous stents as an adjunctive technique to restore patency in patients with chronic venous diseases. The study involved four patients who underwent this procedure after conventional endovascular techniques failed. The technique was successful in all patients, with no adverse events reported, demonstrating its feasibility and usefulness as an escalation technique in recanalizing chronically occluded venous stents. [Extracted from the article]

Summary This report describes the identification of C7‐T1 discospondylitis on myelography and confirmed on postmortem computed tomography and necropsy in a 4‐year‐old Standardbred gelding as the consequence of jugular vein catheterisation and secondary septic thrombophlebitis. Staphylococcus aureus was isolated from both sites. Diagnosis was complicated by non‐specific signs of pain and the acute presentation of the gelding. Clinical signs included cervical pain, low head carriage, fever and ataxia. Antimicrobial therapy and multimodal pain management were initiated but were unsuccessful. Spread of infection from septic thrombophlebitis has uncommonly been reported in horses, and this is the first reported case of secondary discospondylitis in this species. [ABSTRACT FROM AUTHOR]

Background: The standard of care for placement of a central venous catheter (CVC) includes a real-time ultrasound (US)-guided technique. We describe a rare case in which the guidewire penetrated the posterior wall of the vessel, forming a knot, which precluded simple removal. This occurred despite the procedure being performed under real-time US guidance. The guidewire was eventually removed under fluoroscopic guidance in a hybrid operation room. Case presentation: An 89-year-old male underwent the placement of a CVC in the left internal jugular vein. During the US-guided procedure, the guidewire penetrated the posterior wall of the vessel and formed a knot, which impeded simple removal. This was confirmed by radiologic imaging. Using a short sheath and a push–pull technique, the radiologist was able to untangle the knot to allow for catheter removal. The guidewire was safely removed without vascular injury. Conclusions: A very rare complication of guidewire knotting was observed despite the use of US-guidance during needle and wire placement. The use of US, computed tomography, and fluoroscopy were beneficial for diagnosis, while the hybrid operating room provided the optimal environment for the removal procedure. [ABSTRACT FROM AUTHOR]

Background: Complications, namely, catheter-related thrombosis (CRT) and venous stenosis, are associated with non-cuffed hemodialysis catheters used for emergency vascular access. However, only a few reports have demonstrated changes in the venous lumen and intravenous thrombosis after catheter removal. In this study, we comprehensively investigated the risk factors for residual thrombus 1 month after hemodialysis catheter removal. Methods: This prospective observational study was conducted from June 2021 to October 2022. We included patients with end-stage kidney disease who underwent hemodialysis catheter placement in the internal jugular vein (IJV). After catheter removal, we observed the IJV using vascular ultrasound and evaluated the thrombus and vein properties. Furthermore, we observed thrombosis 1 month after catheter removal, and investigated the risk factors for residual thrombus 1 month after catheter removal. Results: A thrombus was observed at the site of catheter removal in all the cases. Of the 37 patients who were followed up, 11 exhibited a residual thrombus 1 month after catheter removal. Patients with arteriovenous (AV) access dysfunction and enlarged lymph nodes during catheter removal were significantly more likely to have a residual thrombus 1 month after catheter removal. These associations remained significant even after adjusting for age, sex, and diabetes status. Conclusions: In 29.7% of the patients, CRT persisted even 1 month after the removal of the non-cuffed hemodialysis catheter. The provision of early intervention in patients with AV access dysfunction and enlarged lymph nodes during catheter removal may prevent CRT persistence. [ABSTRACT FROM AUTHOR]

Ligamentous cervical instability, especially ligamentous upper cervical instability, can be the missing structural cause and/or co-morbidity for many chronic disabling brain and systemic body symptoms and diagnoses. Due to the forward head-facedown lifestyle from excessive computer and cell phone usage, the posterior ligament complex of the cervical spine undergoes a slow stretch termed "creep" which can, over time, lead to cervical instability and a breakdown of the cervical curve. As this degenerative process continues, the cervical curve straightens and ultimately becomes kyphotic, a process called cervical dysstructure; simultaneously, the atlas (C1) moves forward, both of which can lead to encroachment of the structures in the carotid sheath, especially the internal jugular veins and vagus nerves. This obstruction of fluid flow can account for many brain diseases, and compression and stretch of the vagus nerve for body diseases, including dysautonomia. This article describes the consequences of impaired fluid flow into and out of the brain, especially venous flow through the internal jugular veins, leading to intracranial hypertension (formerly called pseudotumor cerebri). Cervical structural, internal jugular vein, and optic nerve sheath measurements are presented from a retrospective chart review of 227 consecutive patients with no obvious cause for 1 of 8 specific brain or mental health symptoms—anxiety, brain fog, concentration difficulty, depression/hopelessness, headaches, obsessive thoughts, panic attacks, and rumination on traumatic events. A case example is given to demonstrate how cervical structural treatments can open up internal jugular veins and improve a patient's chronic symptoms. [ABSTRACT FROM AUTHOR]

The correction notice in Scientific Reports addresses errors in the original article regarding patient age data and the study's date range. The corrected version now accurately reflects the clinical data of 21 hemodialysis patients who underwent percutaneous transluminal angioplasty for reinsertion of tunneled cuffed catheters in the right internal jugular vein from July 2020 to July 2023 at the First and Second Affiliated Hospitals of Bengbu Medical College. The correction ensures the accuracy of the study's findings and methodology. [Extracted from the article]

ABSTRACT Background Aims and Objectives Results Conclusion Trial Registration Tunneled dialysis catheters (TDCs) are preferred over temporary noncuffed catheters for access in patients on maintenance hemodialysis. The removal of TDC after catheter‐related blood stream infections (CRBSIs) is often not practiced even when indicated, and the adverse outcomes after such salvage are presently unclear.The study aimed to evaluate adverse outcomes after the first episode of definite or probable CRBSI. The composite adverse outcome was recorded as the presence of at least one of three adverse outcomes—death in the index hospital admission, occurrence of recurrent bacteremia, and death within 3 months.During the study period, the TDC CRBSI incidence rate was 6.9/1000 catheter days. Of the 110 study participants, majority were male (63%), with a median age of 35 years, belonging to rural (56%) and agrarian (39%) communities, and 66% were getting dialyzed at stand‐alone dialysis units. Gram‐negative infections predominated (64%), with 37% of isolates showing resistance to carbapenems. Catheter salvage was practiced in 80%, and immediate catheter removal was done only in the sickest of patients (in seven of eight with in‐hospital mortality). Predictors of composite adverse outcomes included sites other than right internal jugular vein (OR 3.6) and resistance to β lactam‐β lactamase inhibitors (OR 16.2). At a median follow‐up of 7 months, all survivors at 3 months were alive and 46% had recurrent TDC CRBSIs.Up to one‐half of patients with end‐stage kidney disease experienced composite adverse outcomes after the first episode of TDC CRBSI, with infection‐related 3‐month mortality of 15%.Clinical trial number: CTRI/2023/10/058556 [ABSTRACT FROM AUTHOR]

Background: Lemierre syndrome is a rare and life-threatening disease. It is characterized by septic thrombophlebitis of the internal jugular vein, historically associated with Fusobacterium necrophorum infection. However, atypical cases and associations with other organisms have been reported. Methods: Here, we describe a challenging case of Lemierre syndrome in a 71-year-old woman caused by Streptococcus constellatus and review the related literature. Case: The patient experienced multiple hospital admissions due to misdiagnoses and developed thrombosis involving the internal jugular vein and transverse sinus bilaterally, pulmonary complications including the formation of a pseudoaneurysm, and occipital abscess. She presented with headaches, neck pain, and blindness. Prolonged antibiotic therapy was administered, leading to gradual improvement of symptoms, with partial resolution of blindness. Prophylaxis with intramuscular penicillin was prescribed at discharge. Conclusions: Our case underscores the importance of considering Lemierre syndrome in patients who present with multiple thrombotic events affecting the intracranial circulation and/or jugular veins, particularly in those already receiving anticoagulation therapy or with no identifiable cause for thrombosis, even in the absence of sore throat or fever. [ABSTRACT FROM AUTHOR]

Background: Vein grafts are commonly employed in revascularisation surgery for multivessel coronary artery disease, yet neointimal hyperplasia (NIH) remains a critical impediment to the long‐term patency of these grafts. Despite this, effective methods to precisely identify and target interventions for the neointima are still inadequate. Methods: In this study, Sprague–Dawley (SD) rats were used to establish an external jugular vein transplantation model, and the NIH pathophysiological process was tracked across 11 time points (0–35 days) using various histological stains. Spatial transcriptomics was performed on normal veins and 19‐day grafts to explore gene expression in neointimal regions. Immunohistochemical analysis identified neointima‐specific markers, while NIH progression was assessed in SD rats with four and a half LIM domains protein 1 (Fhl1) knockout and in human saphenous veins (HSV) with adenovirus‐mediated Fhl1 overexpression. Results: Typical neointimal formation commenced by day 11 postgrafting and peaked at day 19. Neointimal cells originated from newly generated α‐SMA(+) repair cells located outside the grafted vein, displaying a hybrid fibroblast‐smooth muscle cell phenotype. Spatial transcriptomics identified stable and sustained Fhl1 expression within the neointima throughout the entire NIH phase. Systemic knockout of Fhl1 in SD rats via the phosphoinositide 3‐kinase pathway exacerbated graft inflammation, heightened cell proliferation, and accelerated NIH. Conversely, FHL1 overexpression in cultured HSV suppressed NIH. Conclusion: These findings indicate that, following grafting into the arterial system, the newly formed repair cells external to the grafted vein play a pivotal role in NIH, with neointimal cells exhibiting stable and continuous Fhl1 expression. Fhl1 serves as a protective factor against NIH both in vivo and in HSV, likely due to its anti‐inflammatory and anti‐proliferative effects. Key points: This study firstly used spatial transcriptomics technique to analyse the neointima and generated a specific neointimal transcriptomic atlas.Fhl1 exhibits specific and stable expression in the spatial region of the neointima. It has thus far the highest enrichment of expression in the neointima in NIH phases, suggesting that it is a prominent molecular biomarker of neointima.We generated rats with a Fhl1 deletion and found that insufficient Fhl1 expression caused an increase in the severity of vascular inflammation and proliferation during neointimal hyperplasia. Adenovirus‐mediated FHL1 overexpression in human saphenous vein have beneficial effects in preventing neointimal hyperplasia. These highlight its potential as a therapeutic target for mitigating vein graft failure associated with cardiovascular procedures.Spatial transcriptomics profiles and morphological observations demonstrated that a newly generated cell population outside the grafted vein with hybrid phenotype between SMCs and fibroblasts contributes to neointimal formation. [ABSTRACT FROM AUTHOR]

Background: The internal jugular vein (IJV) is a vascular structure that is responsible for the venous drainage of both the head and neck and is commonly found posterior to the internal carotid artery and adjacent to cervical lymph nodes or nerve structures such as the glossopharyngeal and accessory nerves. As a vagal nerve, it is an important reference point for surgical access in neck interventions and dissections. Methods: The databases Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS were searched until August 2024. Methodological quality was evaluated with an assurance tool for anatomical studies (AQUA). Pooled prevalence was estimated using a random effects model. Results: A total of 10 studies met the established selection criteria in this meta-analysis study. The prevalence of variants of the IJV was 3.36% (CI: 2.81–6.96%), with a heterogeneity of 94.46%. Regarding the subgroup analysis, no study presents statistically significant differences in the studies analyzed for this review. Conclusions: Knowing the IJV variants in detail will make early diagnosis useful, especially in surgeries in the neck region and in classic surgeries such as thyroidectomies and tracheostomies, among others. It will be important to know the position of the IJV. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the feasibility of catheterizing the portal vein to obtain serial portal vein blood samples in steers. We hypothesized that the portal vein catheterization would be a successful continuous sampling technique with minimal adverse effects in steers. METHODS: 2 groups of steers were used: a pilot group (n = 2) and experimental group (n = 6). In both groups, steers were sedated with xylazine. The right rib spaces were clipped and aseptically prepped. The portal vein was visualized via ultrasound, and a 14-gauge catheter was placed percutaneously and advanced into the portal vein. A guide wire was passed through the catheter, followed by a tissue dilator and then a vascular balloon catheter. In the pilot group, blood chemistries were performed prior to portal vein catheterization and then again once the catheter was placed (with samples from both the jugular vein and portal catheter). The liver was also examined at necropsy for any gross lesions in both groups. RESULTS: All steers tolerated the portal vein catheters well, with the catheters lasting for the full length of the study period (7 days). The only observed adverse reaction was a superficial abscess at the catheter site (n = 3). On necropsy, 1 liver had gross discoloration, but no other abnormalities were noted. There were no significant changes in biochemistry profiles before or after portal vein catheterization. CONCLUSIONS: Portal vein catheterization is a novel and feasible serial sampling technique of the portal vein. CLINICAL RELEVANCE: This technique can be used in future pharmacokinetic, nutrition, metabolism, or toxicity studies. [ABSTRACT FROM AUTHOR]

End‐stage renal disease (ESRD) patients frequently encounter challenges at the time of dialysis catheter insertion from concomitantly associated with thoracic central venous obstruction (TCVO). TCVO complicates the placement of tunnelled dialysis catheters (TDCs). In cases where TCVO is unexpectedly encountered and TDC insertion becomes difficult, central venoplasty followed by catheter reinsertion is required. This report details a novel technique to salvage a TDC that was trapped at the TCVO site after removal of the peel‐away sheath. We describe the case of a 67‐year‐old diabetic male ESRD patient on haemodialysis since 2017, with history of multiple prior accesses, who presented with acute thrombosis of his arteriovenous fistula. TDC placement was attempted via the left internal jugular vein (IJV). Angiography revealed severe stenosis at the left brachiocephalic vein‐superior vena cava confluence, necessitating venoplasty. Post‐venoplasty, the TDC could not be advanced past the IJV venous entry site due to unfavourable catheter tip profile. Utilising a double guidewire railroad technique, the TDC was successfully reinserted, ensuring functional dialysis. The technique carries potential risks, which mandates careful hemodynamic monitoring and prophylactic measures. In conclusion, percutaneous placement of a TDC following a central venoplasty is at times life‐saving in patients with exhausted peripheral vascular access and concomitant TCVO. In the absence of a peel‐away sheath, TDC reinsertion using a double guidewire railroad technique is a helpful technique for salvaging the catheter, especially in financially‐constrained settings. [ABSTRACT FROM AUTHOR]

Hematology and biochemistry parameters were evaluated in a zoological population of Krefft's river turtles (Emydura macquarii krefftii) to determine the effect of sex and venipuncture site. Blood samples were collected from 17 (9 male, 8 female) healthy adult Krefft's river turtles. Females were reproductively active during the study period. Three venipuncture sites were sampled in each individual, including jugular vein, subcarapacial sinus, and dorsal coccygeal vein. Statistically significant differences were found between venipuncture sites and between sexes. Packed cell volume percentage was significantly lower in samples from the subcarapacial sinus compared to the other sites. Basophil concentration was significantly lower in samples from the subcarapacial sinus compared to the jugular vein. Azurophil, cholesterol, triglycerides, calcium, phosphorus, and magnesium concentrations were significantly higher in females compared to males. Based on the results of this study, the jugular vein is the recommended venipuncture site in Krefft's river turtles. Sex and reproductive status should be assessed at the time of venipuncture when possible and considered in interpretation of hematology and biochemistry results. [ABSTRACT FROM AUTHOR]

Objective: The present study describes a rare anatomical variation of the anterior jugular vein (AJV) and discusses its clinical relevance. Methods: A head and neck specimen fixed in 10% formaldehyde from a 42-year-old female cadaver was submitted to angio technique with pre-vulcanized latex and water-soluble ink. During a routine dissection for the discipline of topographic anatomy, the presence of an arcuate AJV was detected in the anterior triangle of the neck. Results: An arcuate AJV was formed by the confluence of the submental and facial veins in the left submandibular region, which presented a complex network of anastomoses superficially to the left submandibular gland. After its origin, this vessel curved to the right at the level of the laryngeal prominence and followed the medial border of the right sternohyoid muscle to flow into the right AJV. In this topography, the arcuate AJV was located between the sternocleidomastoid muscle's anterior margin and the thyroid gland's right lobe. The presence of anastomoses between the two AJVs communicating the submandibular triangles was not detected. Conclusion: The arcuate AJV is a relevant anatomical variant in the superficial venous drainage of the neck that should be known by head and neck surgeons and radiologists to avoid surgical iatrogenic events. [ABSTRACT FROM AUTHOR]

Background: Pediatric idiopathic intracranial hypertension (IIH) is a rare and challenging condition. As implied by the nomenclature, the etiologies remain unknown, and multiple etiologies are being investigated. In this study, we explored the potential role of increased systemic or cerebral venous pressure in the pathogenesis. Method: An observational cohort study following the STROBE guidelines, including prepubertal children with clinical symptoms and imaging findings consistent with IIH referred to the neurosurgical department, was conducted. The patients underwent a comprehensive diagnostic protocol, including MRI, continuous intracranial pressure (ICP) monitoring, and endovascular venography with venous pressure measurements. Results: The study included 11 consecutive patients (six boys and five girls) with an average age of 2.3 years, and an average BMI of 18.4. Among these, one patient was found to have venous stenosis with a gradient; the other 10 patients presented with normal intracranial anatomy. All patients exhibited elevated venous pressures, with an average superior sagittal sinus pressure of 18.9 mmHg, average internal jugular vein pressure of 17.0 mmHg, and average central venous pressure of 15.9 mmHg. Daytime ICP averaged 12.9 mmHg, whereas nighttime ICP averaged 17.2 mmHg with either A- or B-waves in 10 of the 11 patients. Despite pathological ICP, only three patients had papilledema. Conclusions: All patients had an increased systemic venous pressure, indicating a possible pathological factor for prepubertal IIH. Additionally, our findings show that young children often only partly meet the Friedman criteria due to a lack of papilledema, emphasizing the need for pediatric-specific diagnostic criteria. Further large-scale studies are needed to confirm these findings and to explore the underlying reasons for this increase in venous pressure and potential new treatment avenues. [ABSTRACT FROM AUTHOR]

The arterial wall not only moves in the radial direction to expand circumferentially but also moves in the axial (longitudinal) direction in a predictable bidirectional pattern during a normal cardiac cycle. While common carotid artery (CCA) longitudinal wall motion (CALM) has been described previously, there is a lack of evidence-based method standardization to align practices for human measurement. The purpose of this study was to evaluate whether different scanning planes impact CALM outcomes in healthy males and females to provide clarity on data collection strategies. Thirty-one healthy adults (16 females, 23 ± 3 y of age) underwent ultrasound scanning of the right CCA in the anterior, lateral, and posterior imaging planes. CALM was evaluated using a custom speckle-tracking algorithm and was analyzed as segmental motion outcomes (anterograde, retrograde, maximum displacement and radial-axial path length). No differences in any CALM outcome were observed between imaging planes (p > 0.05), and equivalence testing indicated that retrograde CALM displacement was similar between anterior and posterior distal walls (p = 0.04). We observed no differences (p > 0.05) in CALM outcomes between the proximal (free-wall, adjacent to the internal jugular vein [IJV]) and distal wall in the posterior imaging plane. Qualitatively, it was more difficult to successfully track vascular tissue between the IJV and CCA due to the thin wall components and highly mobile wall in the radial direction. In the absence of clear differences between scanning planes, we recommend standardizing acquisition in the lateral plane and avoiding the IJV free-wall when evaluating CALM in humans. [ABSTRACT FROM AUTHOR]

Background: Achieving hemostasis of large bore venous access sites can be challenging and time consuming. Closure devices have proven to be superior in achieving hemostasis, reducing time to ambulation and improving patient comfort, compared to manual hemostasis techniques after femoral venous and arterial access. The closure of the jugular vein following large bore access has not been investigated in previous studies. In addition, scar formation of the neck after large bore access of the jugular vein has not been investigated. In this study, the safety and feasibility of the double Perclose ProGlide (PP), for achieving hemostasis of the internal jugular vein (IJV) following large bore access with 27 French Micra Transcatheter Pacemaker System (TPS) was examined. Also, the scar formation in the neck after IJV closure was examined during follow-up. Methods: 136 consecutive patients from May 2018 until June 2024, in whom the IJV was closed with a double PP, following Micra TPS implantation were included. All patients were examined for hemostasis of the IJV and vascular complications, resulting in additional interventions. Time to ambulation, discharge and patient discomfort were also assessed. During follow-up the scar formation of the neck was examined. Results: In all patients, the double PP was successful in achieving acute hemostasis of the IJV after large bore access. In all patients, 2 PP were deployed without device failure. One patient required additional manual pressure due to a minor hematoma. Ultrasound guided examination did not reveal any vascular complications. All patients were ambulated immediately. During follow-up, the scar in the neck was hardly visible. Conclusions: Although the PP was designed as a closure device for femoral venous and arterial access, our data suggest that the PP can be used safely as a closure device for the IJV to achieve acute hemostasis, facilitate direct ambulation and improve patient comfort. [ABSTRACT FROM AUTHOR]

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Non-invasive, real-time venous oxygen saturation (SvO2) measurements provide the potential to improve health outcomes in transfusions, ventilator care, and in the intensive care unit. Current methods use catheters which are invasive, expensive, and pose potential high-risk, with only discrete measurements from a jugular vein obtained. This research designed, developed, and tested a proof-of-concept optical sensor similar to a pulse oximeter for non-invasive, continuous SvO2 monitoring at the external jugular vein (EJV). Testing on three subjects met the aim of correctly identifying the EJV waveform and provided an SvO2 estimation within the usual healthy range of 60-90%. SvO2 estimates from the EJV pulse of 71.1%, 72.2%, and 70.4% and breathing pulse of 74.7%, 75.3%, and 74.1%, all fall within range, with trials capturing clear EJV waveforms from the single-point sensor. Further research is necessary to calibrate and validate the device against gold-standard blood gas analysers. However, the initial results prove the sensor's reliability and potential in detecting and estimating SvO2 non-invasively, which has the potential to benefit patients across a wide range of clinical settings. [ABSTRACT FROM AUTHOR]

Lemierre syndrome is a life‐threatening but treatable septic thrombosis of the internal jugular vein (IJV) derived from a craniocervical bacterial infection. Metastatic septic embolization is common. However, diagnostic delay and poor prognosis remain a problem, largely due to the diverse clinical presentations and unclear symptomatology of Lemierre syndrome. In contrast, occipital neuralgia is a common disease typically treated with symptomatic therapy in emergency settings, as most cases are not life‐threatening. The present case involved a 70‐year‐old female with Lemierre syndrome stemming from Streptococcus anginosus infection originating in sinusitis or periodontitis. The onset was characterized by headache with typical occipital neuralgia, a severe trigger point in the posterior neck ipsilateral to the infected IJV, and reduced sensation of the C2 nerve root area. Given the anatomical relationship of the cranial venous emissary system into the posterior cervical venous plexus, the case highlights the potential for the neighboring occipital nerve to be directly involved in Lemierre syndrome. Interestingly, despite Lemierre syndrome typically arising from pharyngeal bacterial infections and infected IJV located in the “anterior” neck, many prior case reports have described “occipital” or “posterior” pain at the head or neck. History taking and physical examination remain essential to identify the causes of these posterior/occipital symptoms, since imaging investigations, as in this case, often fail to identify them. Early recognition of occipital neuralgia as a potential initial symptom of Lemierre syndrome could lead to earlier diagnosis and treatment, potentially improving patient outcomes. [ABSTRACT FROM AUTHOR]

We have shown that briefly inhaled isoflurane rapidly halts convulsions and protects the central nervous system (CNS) from organophosphate-induced neuronal loss when administered at 5% for 5 min, even as late as 1 h after organophosphate exposure. In the current study we investigated if an injectable form of isoflurane was as effective as inhaled isoflurane. We used a mixture of 10% isoflurane dissolved in an IV-compatible lipid-water emulsion for intravenous administration. Rats with an implanted jugular vein cannula were infused with 1,000 μL of the 10% isoflurane-lipid emulsion (ILE) mixture at a rate of 200 μL per minute, which achieved full anesthesia lasting approximately 10 min. When administered 30 min after a highly lethal dose of the organophosphate insecticide paraoxon (POX), the short-duration administration halted convulsions over the course of the study and prevented the great majority of neuronal loss as shown by Fluoro-Jade B staining (FJB). Our results indicate that injectable isoflurane is very effective for treating organophosphate poisoning, negating the need for vaporizer equipment and enabling intravenous therapy. [ABSTRACT FROM AUTHOR]

Background and Aims: Various methods are used to predict the depth of insertion of central venous catheters (CVCs). We evaluated a bronchoscopy-based carinal measurement technique to predict this depth. Methods: We randomised adults undergoing cardiac surgery into a bronchoscopy group or the Peres' formula-based method group. CVCs were inserted through the right internal jugular vein. The skin insertion reference point was at the level of the cricoid cartilage lateral to the carotid artery. In the bronchoscopy group, the depth of insertion was determined by the total length from the carina to the proximal end of the tracheal tube (TT) (measured with a flexible bronchoscope) minus (the sum of the distances from the skin insertion reference point to the TT and the length of the TT outside the mouth). In the Peres' group, height (cm)/10 determined the depth of insertion. Confirmation of CVCs' distal tip position was done with transoesophageal echocardiography. The area from 2 cm proximal to 1 cm distal to the superior vena cava–right atrium junction was considered ideal. The primary outcome was the proportion of correct CVC placements. The secondary outcome was the alignment of the CVCs. Results: Forty-one patients in the bronchoscopy group and 40 patients in the Peres' group were enroled. A greater proportion of CVCs was placed correctly in the bronchoscopy group (87.8% vs. 37.5%; P = 0.001). A more significant proportion of CVC tips was abutting the vessel wall in the Peres' group (45% vs. 19.5%; P = 0.014). Conclusion: Bronchoscopy-based carinal measurement technique results in more accurate placement of CVCs compared to the Peres' method. [ABSTRACT FROM AUTHOR]

Background: High riding jugular bulb (HRJB) develops after 2 years and is rare at younger ages. High riding jugular bulb sometimes protrudes into the tympanic cavity, which can cause hemorrhagic complications during otologic surgery. Case Presentation: We describe a congenitally deaf child with bilateral inner ear malformations and a right-sided HRJB on CT at 9 months. This child had undergone left cochlear implantation (CI) at 19 months, and right CI was planned at 6 years. However, we decided not to perform the right CI because preoperative CT images revealed that the right jugular bulb (JB) was enlarged and protruded into the tympanic cavity, completely covering the round window (RW). Conclusion: This is the first pediatric case in which a longitudinal CT scan proves that HRJB develops and protrudes over time. These findings suggest that the earlier the HRJB forms, the larger it may grow. We must keep in mind the possibility of the enlargement and protrusion of HRJB. [ABSTRACT FROM AUTHOR]

Introduction: The decremental properties of the nodoventricular pathway (NVP) are uncertain. Methods and Results: During short RP supraventricular tachycardia, a His‐refractory premature ventricular contraction (PVC) consistently terminated the tachycardia without atrial capture immediately after the PVC. Whereas a slightly earlier PVC failed to reset the subsequent His but terminated the tachycardia without atrial capture one cycle later. Conclusion: These observations are diagnostic of slow‐fast atrioventricular nodal reentrant tachycardia (AVNRT) with a bystander concealed‐NVP and can be explained by decremental properties in the NVP itself; greater prematurity of the PVC resulted in more decremental conduction over the NVP, causing the AVNRT termination one cycle later. [ABSTRACT FROM AUTHOR]

Objectives: This report presents a rare anatomical variation, double fenestration of the External jugular vein on the right side. Materials and methods: During the routine dissection of a male cadaver aged 60 years, we observed a unilateral large double fenestration of the External jugular vein on the right side. Results: After its formation from the posterior division of the retromandibular and posterior auricular veins, External jugular vein descended in the posterior triangle of neck. Here, it divided into medial, intermediate, and lateral veins that united again before draining into the subclavian vein. Lateral vein was the largest (7.2 cm) and intermediate and medial veins were measuring 6.4 cm each. Two large fenestrations, measuring 5.8 cm each, arranged like a "double bubble" were seen in the External jugular vein extending from fourth to sixth cervical (C4 to C6) vertebrae. The medial branch of supraclavicular nerve was seen passing superficial to the distal part of External jugular vein. On the left side, the course of External jugular vein showed a standard pattern. Conclusion: Surgeons must be acquainted with the varied anatomy of the superficial neck veins to prevent major bleeding during operative procedures, including carotid endarterectomy, flap operations, & central venous catheterisation. [ABSTRACT FROM AUTHOR]

Background: Continuous kidney replacement therapy (CKRT) has recently become the preferred kidney replacement modality for children with acute kidney injury (AKI). We hypothesise that CKRT technical parameters and treatment settings in addition to the clinical characteristics of patients may influence the circuit lifetime in children. Methods: The study involved children included in the EurAKId registry (NCT 02960867), who underwent CKRT treatment. We analysed patient characteristics and CKRT parameters. The primary end point was mean circuit lifetime (MCL). Secondary end points were number of elective circuit changes and occurrence of dialysis-related complications. Results: The analysis was composed of 247 children who underwent 37,562 h of CKRT (median 78, IQR 37–165 h per patient). A total of 1357 circuits were utilised (3, IQR 2–6 per patient). MCL was longer in regional citrate anticoagulation (RCA), compared to heparin (HA) and no anticoagulation (NA) (42, IQR 32-58 h; 24, IQR 14-34 h; 18, IQR 12-24 h, respectively, p < 0.001). RCA was associated with longer MCL regardless of the patient's age or dialyser surface. In multivariate analysis, MCL correlated with dialyser surface area (beta = 0.14, p = 0.016), left internal jugular vein vascular access site (beta = -0.37, p = 0.027), and the use of HA (beta = -0.14, p = 0.038) or NA (beta = -0.37, p < 0.001) vs. RCA. RCA was associated with the highest ratio of elective circuit changes and the lowest incidence of complications. Conclusion: Anticoagulation modality, dialyser surface, and vascular access site influence MCL. RCA should be considered when choosing first-line anticoagulation for CKRT in children. Further efforts should focus on developing guidelines and clinical practice recommendations for paediatric CKRT. [ABSTRACT FROM AUTHOR]

The American Institute of Ultrasound in Medicine (AIUM) revised the Practice Parameter for the Performance of Vascular Ultrasound for Postoperative Assessment of Hemodialysis Access in collaboration with other organizations. The document provides recommendations for personnel requirements, documentation, quality assurance, and safety for ultrasound examinations. It addresses the importance of monitoring hemodialysis access to detect complications and ensure proper function, with specific guidelines for evaluating AVFs and grafts. The parameter emphasizes the need for accurate documentation, equipment specifications, and adherence to quality and safety standards in ultrasound practices. [Extracted from the article]

We aim to explore the feasibility of head and neck time‐of‐flight (TOF) magnetic resonance angiography (MRA) at ultra‐low‐field (ULF). TOF MRA was conducted on a highly simplified 0.05 T MRI scanner with no radiofrequency (RF) and magnetic shielding. A flow‐compensated three‐dimensional (3D) gradient echo (GRE) sequence with a tilt‐optimized nonsaturated excitation RF pulse, and a flow‐compensated multislice two‐dimensional (2D) GRE sequence, were implemented for cerebral artery and vein imaging, respectively. For carotid artery and jugular vein imaging, flow‐compensated 2D GRE sequences were utilized with venous and arterial blood presaturation, respectively. MRA was performed on young healthy subjects. Vessel‐to‐background contrast was experimentally observed with strong blood inflow effect and background tissue suppression. The large primary cerebral arteries and veins, carotid arteries, jugular veins, and artery bifurcations could be identified in both raw GRE images and maximum intensity projections. The primary brain and neck arteries were found to be reproducible among multiple examination sessions. These preliminary experimental results demonstrated the possibility of artery TOF MRA on low‐cost 0.05 T scanners for the first time, despite the extremely low MR signal. We expect to improve the quality of ULF TOF MRA in the near future through sequence development and optimization, ongoing advances in ULF hardware and image formation, and the use of vascular T1 contrast agents. [ABSTRACT FROM AUTHOR]

Abstract Background The cannulation of the internal jugular vein (IJV) is a frequent procedure in critically ill patients. According to the guidelines, real-time ultrasound navigation is recommended. Traditional techniques pose several disadvantages, such as suboptimal needle visualization. Therefore, this non-inferiority trial aimed to describe the novel approach and compare the novel lateral in-plane short-axis approach for IJV access with the conventional short-axis out-of-plane approach. Objectives The primary objective of the trial was to prove that the first attempt success rate in the novel technique is non-inferior to the conventional technique. The secondary objectives were to demonstrate that the complication rate and the functional duration of the catheter in the novel technique are not inferior to those in the conventional technique. Methods Patients eligible for IJV cannulation were randomly assigned to either the novel technique (Group A) or the conventional one (Group B). The procedure duration, success rate and the number of attempts required were documented. The functionality of the catheter and complications were monitored from insertion until the catheter removal. Standard descriptive statistical methods were employed for the analysis. Results A total of 200 subjects were equally divided between Group A and Group B. For the primary outcome, there was no significant difference in first attempt success rate (Group A: 79, Group B: 77, p = 0.434). Secondary outcomes, including complications and catheter functional time, did not differ significantly between the groups. However, the novel technique demonstrated a significantly faster procedure time (Group A: 315 s, Group B: 330 s, p = 0.016). Notably, the novel approach was linked with significantly larger IJV diameter measured during the procedure (Group A: 18.2 mm, Group B: 12.1 mm, p

In the majority of animal experiments, vein puncture is necessary for the drugs administration. This study aimed to propose a new vein puncture method, ultrasound-guided internal jugular vein (IJV) puncture, and compare it with the traditional tail vein puncture. We divided 24 male SpragueDawley rats randomly into 2 groups: 12 rats in the tail vein puncture group and other 12 rats in the ultrasound-guided IJV puncture group. After successful puncture, rats from two groups were injected with 0.1 mL ultrasound contrast agents. The average puncture time, the success rate of the first puncture, and the imaging effects of contrast-enhanced ultrasound in the sciatic nerve and liver parenchyma of rats after injecting ultrasound contrast agents were evaluated using time–intensity curves for both different puncture methods. The average puncture time of the ultrasound-guided IJV group was lower than that of the tail vein puncture group (p = 0.013), and the success rate of the first puncture was significantly higher than that of the tail vein puncture group (p = 0.037). There were no significant differences in the imaging effects of contrast-enhanced ultrasound on the sciatic nerve and liver parenchyma between the two different puncture methods. Additionally, neither of the two puncture methods resulted in obvious symptoms such as hematoma formation, convulsions, restlessness or even death in rats. Ultrasound-guided IJV puncture could be a safe, effective method with a high success rate for rat vein puncture and drug administration, which could be an alternative to rat tail vein puncture. [ABSTRACT FROM AUTHOR]

Background: Bronchial stenosis associated with bronchial anastomosis dehiscence after lung transplantation is a catastrophic complication following lung transplantation with a paucity of therapeutic solutions. Purpose: To describe an adaptation of the parallel stent grafting technique in the pulmonary arterial territory to treat this challenging situation. Research Design: This is a case report of a 52-year-old patient who presented bronchus stenosis and bronchial anastomosis dehiscence after lung transplantion. Bronchial stenting and lung retransplantation were contraindicated. Therefore, an endovascular approach using pulmonary artery endograft placement to prevent bleeding during repeated right bronchial balloon dilation was propposed. The technique consists of the deployment of an aortic extender endoprosthesis in the right main pulmonary artery and a balloon expandable stent in the upper lobe pulmonary artery (using a parallel graft configuration) through the common femoral and right internal jugular veins, respectively. Intraoperative transesophageal echocardiogram and one-lung ventilatory ventilation are needed. Results: The patient underwent a new bronchoscopy 16 days after the procedure, that showed epithelization at the previous eroded zone, enabling bronchocopic balloon dialtion to be safely performed. A post-operative contrast-enhanced CT scan revealed an adequate positioning of the stent grafts. Despite all eforts, the patient succumbed to ventilator associated pneumonia on postoperative day 108. Data Analysis: The technique's advantages include its feasibility even in situations in which other techniques may be contraindicated and its potential use in emergencies. Its limitations include the need for experienced interventionists to perform it, and the potential risk of acute tricuspid regurgitation. Conclusion: This study illustrates the early feasibility of the parallel stent grafting technique applied to the pulmonary artery territory. However, it's safety profile regarding infectious risk was not demontrated. [ABSTRACT FROM AUTHOR]

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

Background: Chronic obstructive pulmonary disease (COPD) exacerbations constitute a significant proportion of patients presenting to the emergency department (ED). It has been suggested that measurement of jugular venous diameter and compliance may have prognostic value in patients with heart failure. We hypothesized that these measurements may also be valuable in patients with advanced COPD. Methods: This study was a single-center, prospective, and cross-sectional study conducted in a university hospital between November 2020 and November 2021. In the study, internal jugular vein (IJV) diameters (inspiration, forced expiration, and rest) and jugular venous compliance were measured with ultrasound in patients who presented to the ED with COPD exacerbation. One month later, data about mortality, intensive care unit (ICU) admission, and any hospitalization were obtained and evaluated together with a range of laboratory parameters. Results: Data from a total of 93 patients were analyzed. Of these, 17 (18.2%) died, 19 (20.4%) were admitted to the ICU, and 36 (38.7%) were hospitalized at the end of the 1-month period. Consequently, a total of 44 patients (47.3%) were in the good outcome group and 49 patients (52.7%) were in the poor outcome group. In terms of mortality, inspiratory IJV diameter was 5.6 ± 2.9 mm in the survived group (n = 76) and 7.6 ± 3.9 mm in the deceased group (n = 17) (P = 0.031). There was no difference between the venous compliance values and other diameter measurements of the patients. In the analysis performed with the subgroup with high N-terminal prohormone brain natriuretic peptide values, it was shown that both resting and inspiration diameter measurements were higher in the group with poor outcomes. Conclusion: There was no difference between the jugular vein compliance values in terms of mortality in patients admitted to the ED with COPD exacerbation. However, these measurements may have prognostic value in patients with COPD exacerbations complicated by heart failure.

Introduction: The external jugular vein (EJV) is a superficial vein of the neck in dogs; its significance is evident in veterinary clinical practice, encompassing surgeries and interventional procedures. However, there have been no reports on EJV variations in canines, despite extensive studies on variations in the jugular veins in humans. This study aimed to use CT imaging to evaluate the prevalence of anatomic vascular variations of the EJVs in Shih Tzu dogs and to describe the clinical and CT characteristics of these vascular variants. Methods: This is a retrospective, multi-center study. The medical imaging records of Shih Tzu dogs that underwent pre- and post-contrast CT examinations of the head, neck, and thorax at the Veterinary Medical Teaching Hospital, Konkuk University, and 10 referral hospitals between 2015 and 2023 were reviewed. Results: We defined five types of EJV vascular variants: normal (type I), unilateral hypoplasia (type II), unilateral aplasia (type III), bilateral hypoplasia (type IV), and bilateral aplasia (type V), based on the morphological and diameter differences observed in the transverse images of Shih Tzu dogs. CT images from 547 Shih Tzu dogs revealed 119 cases (21.7%) of EJV variants. Type I was observed in 428 dogs (78.2%), type II in 46 dogs (8.4%), type III in 41 dogs (7.5%), type IV in 14 dogs (2.6%), and type V in 18 dogs (3.3%). In types II--V, compensatory drainage through the internal jugular vein (IJV) was observed, often involving the medial passage of the maxillary or linguofacial veins. A moderate negative correlation (R = 0.5) was recorded between the hypoplastic EJV and the affected-side IJV (p < 0.01). Some cases exhibited other supplementary drainage routes, such as the hyoid venous arch or median thyroid vein. Additionally, 63 persistent left cranial vena cava (PLCVC) cases (11.9%) were identified among 529 Shih Tzu dogs, showing a significant association with EJV abnormalities (p < 0.05). Discussion: Overall, this study identified anatomical variants of the EJV in Shih Tzu dogs and introduced a new classification system. These findings revealed that EJV variants and compensatory tributary enlargement were more prevalent than previously recognized, emphasizing the need to consider these nuances in veterinary procedures and imaging. [ABSTRACT FROM AUTHOR]

We report the case of a 56-year-old male diagnosed with acute myeloid leukemia who developed a severe cervical hematoma following an ultrasound-guided right internal jugular vein catheterization. Despite receiving platelet transfusions prior to the procedure, the patient experienced progressive hematoma enlargement, leading to respiratory distress. Further investigations, including carotid Computed Tomography Angiography (CTA), ruled out arterial injury, but thromboelastography revealed severe coagulation dysfunction. The patient subsequently developed cerebral hemorrhage and died despite intensive care interventions. [ABSTRACT FROM AUTHOR]

The article discusses the management of lower extremity venous congestion during peripheral venoarterial extracorporeal membrane oxygenation (ECMO). A case study of a 76-year-old female patient with heart failure is presented, where lower extremity congestion occurred after ECMO support initiation. The patient's condition improved after inserting an additional 8-Fr drain sheath cannula into the superficial femoral vein, resolving the congestion and preventing deep vein thrombosis. The successful treatment allowed the patient to undergo a heart transplant and be discharged without complications, highlighting the importance of effective venous drainage methods during ECMO support. [Extracted from the article]

Eagle syndrome is defined as an elongated styloid process (ESP) that compresses nearby vasculo-nervous structures. The vascular variant of Eagle syndrome can lead to neurological symptoms including syncope, transient ischemic attack, or stroke; however, it has also been associated with other atypical presentations, making its diagnosis challenging. This review aimed to depict the characteristics of patients with the symptomatic vascular variant of Eagle syndrome. The literature search identified 56 reported cases of vascular variants of Eagle syndrome, with a mean age at onset of 51 years (range: 15-85 years), and the male-to-female ratio was 2:4. The ESP was bilateral in 63% of the cases, and the mean length was 48 mm (range: 31-77 mm). Vascular complications were mostly represented by internal jugular vein (IVJ) stenosis (n = 28), followed by internal carotid artery (ICA) dissection (n = 15). Additionally, eight cases of ICA thrombosis and two cases of severe chronic stenosis of the ICA > 90% were reported. Vascular complications may lead to cerebral ischemia due to either a thromboembolic mechanism or, less frequently, reduced blood flow. Laminar cortical necrosis, as a cerebral complication of ICA compression, was exceptionally described in one case, and such an atypical clinical presentation may be regarded as a diagnostic pitfall. [ABSTRACT FROM AUTHOR]

Background/Objectives: Diagnosing acute pulmonary embolism (PE) is challenging due to its wide range of symptoms and numerous differential diagnoses. Medical professionals must balance performing all essential examinations and avoiding unnecessary testing. This study aimed to retrospectively audit the diagnosis and treatment of acute PE at a Swiss public teaching hospital to determine the adherence to current guidelines and to identify the factors associated with the delayed initiation of anticoagulation in PE patients. Methods: In this retrospective observational cohort study, we included all adult patients hospitalized with PE at the Cantonal Hospital Baselland (KSBL) between November 2018 and October 2020, where the diagnosis was made within the first twelve hours of their arrival to the emergency department (ED). LASSO regression was employed to identify clinical characteristics associated with delayed anticoagulation initiation. Results: A total of 197 patients were included (mean age: 70 years, 54% female). The audit revealed that diagnostic workup was conducted according to guidelines in 57% of cases. Often, D-dimer levels were measured although not strictly necessary (70%). Pretest probability was assessed and documented using the Wells or Geneva score in only 3% of patients, and risk assessment via the Pulmonary Embolism Severity Index (PESI) score was documented in 21% of patients. The median time from ED arrival to CT scan was 120 min (IQR 89.5–210.5), and the median time to anticoagulation initiation was 193 min (IQR 145–277). Factors identified by LASSO associated with delayed anticoagulation included prolonged time from ED arrival to CT scan, the presence of distended jugular veins on examination, ED arrival in the morning, and presenting symptoms of weakness or tiredness. Complementary leg ultrasound was performed in 57% of patients, with 38% of these cases lacking prior clinical examination for deep vein thrombosis. The duration of the anticoagulation treatment was not specified in the discharge report for 17% of patients. A medical follow-up after discharge was recommended in 75% of the patients. Conclusions: In conclusion, while the management of PE at the KSBL generally adheres to high standards, there are areas for improvement, particularly in the morning performance, the use of a pretest probability assessment, D-dimer measurement, risk assessment via the PESI score, the performance of complementary leg ultrasounds, clarification of the anticoagulation duration, and follow-up management. [ABSTRACT FROM AUTHOR]

Background and Purpose: The ability to measure specific molecules at multiple sites within the body simultaneously, and with a time resolution of seconds, could greatly advance our understanding of drug transport and elimination. Experimental Approach: As a proof‐of‐principle demonstration, here we describe the use of electrochemical aptamer‐based (EAB) sensors to measure transport of the antibiotic vancomycin from the plasma (measured in the jugular vein) to the cerebrospinal fluid (measured in the lateral ventricle) of live rats with temporal resolution of a few seconds. Key Results: In our first efforts, we made measurements solely in the ventricle. Doing so we find that, although the collection of hundreds of concentration values over a single drug lifetime enables high‐precision estimates of the parameters describing intracranial transport, due to a mathematical equivalence, the data produce two divergent descriptions of the drug's plasma pharmacokinetics that fit the in‐brain observations equally well. The simultaneous collection of intravenous measurements, however, resolves this ambiguity, enabling high‐precision (typically of ±5 to ±20% at 95% confidence levels) estimates of the key pharmacokinetic parameters describing transport from the blood to the cerebrospinal fluid in individual animals. Conclusions and Implications: The availability of simultaneous, high‐density 'in‐vein' (plasma) and 'in‐brain' (cerebrospinal fluid) measurements provides unique opportunities to explore the assumptions almost universally employed in earlier compartmental models of drug transport, allowing the quantitative assessment of, for example, the pharmacokinetic effects of physiological processes such as the bulk transport of the drug out of the CNS via the dural venous sinuses. [ABSTRACT FROM AUTHOR]

Lemierre's syndrome, a forgotten clinical entity, is characterised by septic thrombophlebitis of the internal jugular vein due to oropharyngeal infection. In the past, it was mainly associated with Fusobacterium necrophorum infections. We present a unique case report of Lemierre's syndrome due to Klebsiella pneumoniae. Patient reported with progressive swelling involving right side of the neck that eventually increased in size. After confirming the diagnosis through CECT, patient was managed through combined medical and surgical therapy in the form of incision and drainage, targeted antibiotic therapy, glycaemic control and anticoagulation therapy. This case report highlights the association of poor glycaemic control in the pathogenesis and the isolation of Klebsiella pneumoniae as the rare organism of Lemierre's syndrome. [ABSTRACT FROM AUTHOR]

The study aimed to explore changes in serum creatinine, iron, and blood metabolites in different parity statuses in traditionally managed Saanen Etawah crossbred goats. Mature lactating goats (n = 130) were divided into primiparous (n = 45) and multiparous groups (n = 85) (body condition score 3, early-middle stage of lactation). Blood samples were collected from the jugular vein and centrifuged to collect plasma; blood metabolites were measured using UV Vis methods. The result showed creatinine concentrations in multiparous goats were significantly (P < 0.05) higher (0.87 ± 0.21 mg/dl) than in the primiparous group (0.79 ± 0.15 mg/dl). Meanwhile, the albumin concentration in primiparous goats (3.99 ± 0.20 mg/dl) was significantly higher than in multiparous goats (3.82 ± 0.16 mg/dl); also the total cholesterol level of primiparous goats (122.28 ± 29.20 mg/dl) was significantly higher than in multiparous goats (107.37 ± 24.40 mg/dl). The urea-creatinine ratio was higher in primiparous goats (27.07 ± 11.90) than in multiparous goats (22.37 ± 8.12). It was concluded that distinct blood metabolites between primiparous and multiparous goats were due to different physiological needs which led to different mobilization of stored nutrients inside the body. Different feeding strategies were suggested for each parity group following their nutritional needs, such as a high-protein diet to optimize primiparous body development, and a high-energy diet to enhance multiparous milk production before and after giving birth. Further research is needed to understand the exact optimal ratio of feed energy and protein. [ABSTRACT FROM AUTHOR]

Collecting and sending of samples for laboratory analysis in animals such as cattle, sheep, and horses is essential for accurate disease diagnosis and the assessment of animal health. Proper handling of whole blood samples is crucial to maintain the integrity of the specimen and ensure accurate serological results, thereby, facilitating precise diagnoses and appropriate treatment. Additionally, proper biosafety protocols help prevent the incidence of zoonotic diseases and mitigates other negative outcomes resulting from poor handling practices. Furthermore, it is necessary to accurately identify specific anatomical sites for blood sample collection in different species, such as the jugular vein in horses and sheep, and the coccygeal vein in cattle. The study emphasizes the importance of correctly labeling samples to ensure traceability, as well as the proper preservation of samples through refrigeration or freezing, depending on the required analysis. The article also addresses the proper collection and submission of other sample types, such as feces, milk, and rumen contents, for microbiological and serological analysis. Sample collection must follow specific techniques based on the specie, and vary based on the type of sample: venipuncture of the jugular, coccygeal, mammary vein, or femoral artery for blood samples; swabs for nasal, conjunctival, and rectal cavities; and collection of milk, feces, and rumen contents. In deceased animals, necropsy allows for the extraction of organs for analysis, which requires the use of appropriate equipment for sample collection. [ABSTRACT FROM AUTHOR]

Background: Heart failure (HF) is number one reason for hospitalization in people over 65 years with nearly 1 million patients hospitalized every year in US and Europe. Objectives: To study the correlation between invasive central venous pressure (CVP) and collapsibility indices of internal jugular veins (IJVs) and inferior vena cava (IVC) utilizing ultrasonography in hospitalized HF patients. Methods: This prospective observational study had been conducted on 55 participants aged from >18 years old with decompensated HF admitted to CCU of Menoufia University hospitals. Clinical evaluation was done by using EVEREST score. CVP catheter was inserted via right (RT) subclavian vein. Ultrasound examination was performed using the GE Vivid S5 diagnostic US system. Results: There was positive correlation between CVP and expiration diameter of (IVC, RT IJV and LT IJV) at admission and discharge. Negative correlation existed between CVP and CI of (IVC, RT IJV and LT IJV) at admission and discharge. CVP, expiration, inspiration diameter of (IVC, RT IJV and LT IJV) and EVEREST score had been significantly lower at discharge contrasted to at admission (P <0.001). CI of (IVC, RT IJV and LT IJV) were significantly greater at discharge compared to at admission. Conclusions: Assessment of diameters of IVC, RT IJV and LT IJV showed strong positive correlation with invasive CVP. CI of IVC, RT IJV and also LT IJV showed strong negative correlation with invasive CVP. LT IJV can be used as an indicator for follow up volume status but less sensitive than RT IJV. [ABSTRACT FROM AUTHOR]