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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]

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]

Background and purpose Experimental approach Key results Conclusion and implications 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.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.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.This is the first demonstration of pharmacokinetic and molecular pharmacodynamic properties as well as the cardioprotective effect of miR‐125b* mimic in vivo. [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]

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]

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 term hydrocephalus is commonly used to indicate increased volume of the cerebral ventricles, particularly the lateral ventricles. The disease is characterized by increased accumulation of cerebrospinal fluid (CSF) in the skull, and can occur in any animal, more frequently in puppies, although considered a rare congenicity in felines. Diagnosis is based on history, clinical examination, ultrasound examination, tomography or magnetic resonance imaging of the skull. The treatment of hydrocephalus is based on the patient's clinical condition and age and can be performed clinically or surgically. The surgical method consists of promoting a diversion of CSF flow from the lateral ventricle to the jugular vein or peritoneal cavity, while drug treatment is based on medications that reduce CSF production. The present study aimed to report a clinical case of congenital hydrocephalus diagnosed in adulthood in a feline. We opted for clinical treatment, with systemic drug therapy. The therapeutic choice was in line with recommended practices in the literature, aiming to stabilize the case and minimize patient discomfort. Although the animal presented relapses, pharmacological therapy was effective in managing the disease. [ABSTRACT FROM AUTHOR]

Direct common carotid puncture (DCP) is conventionally used as a bailout technique in stroke patients. However, little is known about the relevant anatomy. Our objective was to examine the relationship of the common carotid artery (CCA) to surrounding structures based on different DCP trajectories passing through the artery's center. Fifty randomly selected head/neck CTAs were analyzed. The trajectory of DCP and relationship to the internal jugular vein (IJV) and thyroid were analyzed at 1 cm intervals above the clavicle on 7 axial sections. Using the trans-carotid sagittal plane as the 0° trajectory, we plotted 3 additional trajectories at 30° intervals and the relationship with the IJV and thyroid proximity was graded as following: 0 = absent, 1 = adjacent, and 2 = crossing. The CCA tortuosity index was also analyzed for each vessel. Analysis of 2800 trajectories across 100 CCAs showed that the IJV and thyroid were least encountered on the axial sections 2 cm above the clavicle, at 0° on the right (9 thyroids and 6 IJV), and at 90° on the left (0 Thyroids and 14 IJVs). The tortuosity index of the CCA was significantly lower above the clavicle than its entire length (P < 0.001). DCP performed 2 cm above the clavicle at 0° on the right, and 90° on the left appears to minimize encounters with the IJV and thyroid gland, reducing potential complications. However, despite these findings, ultrasound guidance remains vital for DCP safety. Further focus on endovascular device safety in DCP is needed. [ABSTRACT FROM AUTHOR]

Raini Cashmere goat is one of the most important breeds of goats in Iran, which has a high economic value in the world markets due to its high-quality fluff. It is mostly found in the southeast of Iran, especially in Kerman province where there are about three million head of this breeds. The present study aimed to evaluate serum lipids profile and thyroid hormones in the Raini Cashmere goat in peripartum for better identification of this breed. Blood samples were taken from the jugular vein of six adult Raini Cashmere goats and sent to the laboratory for evaluation of cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, very low-density lipoprotein, serum glucose, and thyroid hormones. The results showed that glucose, HDL, and LDL levels increased 2 to 3 weeks before parturition and decreased after parturition. However, the triglyceride, cholesterol, T3, and T4 concentrations decreased before parturition and increased after parturition. According to the results, it was concluded that the glucose concentration increases due to the high need of the mother for nutrients to grow the fetus too. Other factors such as triglycerides and cholesterol decrease due to the absorption of fatty acids by the liver and the storage of triglycerides and cholesterol. In addition, the negative energy balance preceding parturition is associated with a reduction in the T3 and T4 levels. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Catheter malposition after subclavian venous catheterization (SVC) is not uncommon and can lead to serious complications. This study hypothesized that the left access is superior to the right access in terms of catheter malposition after ultrasound-guided infraclavicular SVC due to the asymmetry of the bilateral brachiocephalic veins. DESIGN: Parallel-armed randomized controlled trial. SETTING: A tertiary referral hospital in Korea. PATIENTS: Patients 20-79 years old who were scheduled to undergo SVC under general anesthesia. INTERVENTIONS: Patients were randomly assigned to either the left (n = 224) or right (n = 225) SVC group. The primary outcome measure was the overall catheter malposition rate. The secondary outcome measures included catheter malposition rates into the ipsilateral internal jugular and contralateral brachiocephalic veins, other catheterization-related complications, and catheterization performance. MEASUREMENTS AND MAIN RESULTS: The catheter malposition rate was lower (10 [4.5%] vs. 31 [13.8%], p = 0.001), especially in the ipsilateral internal jugular vein (9 [4.0%] vs. 24 [10.7%], p = 0.007), in the left SVC group than in the right SVC group. In the left SVC group, catheterization success rates on the first pass (88 [39.3%] vs. 65 [28.9%], p = 0.020) and first-catheterization attempt (198 [88.4%] vs. 181 [80.4%], p = 0.020) were higher whereas times for vein visualization (30 s [18-50] vs. 20 s [13-38], p < 0.001) and total catheterization (134 s [113-182] vs. 132 s [103-170], p = 0.034) were longer. There were no significant differences in other catheterization performance and catheterization-related complications between the two groups. CONCLUSIONS: These findings strengthen the rationale for choosing the left access over the right access for ultrasound-guided infraclavicular SVC. [ABSTRACT FROM AUTHOR]

Purpose: The current supraomohyoid neck dissection (SOHND) is performed above the omohyoid muscle to dissect levels I, II, and III in the levels of cervical lymph nodes. However, the anatomical boundary between levels III and IV is the inferior border of the cricoid cartilage. We investigated the anatomical relationship between the omohyoid muscle and cricoid cartilage using contrast-enhanced CT (CE-CT) images to assess the validity of the current SOHND. Methods: CE-CT images of the head and neck regions in patients were reviewed. The patients were divided into two groups: "malignant tumors" and "others". The vertebral levels corresponding to the positions of anatomical structures such as the intersection of the omohyoid muscle and internal jugular vein (OM-IJ), and the inferior border of the cricoid cartilage (CC), were recorded. Results: The OM-IJ was located around the seventh cervical to the first thoracic vertebra. There was a significant difference between the malignant tumor and others groups in females (p = 0.036). The CC was located around the sixth to seventh cervical vertebrae. There was a significant sex difference in each group (malignant tumor: p < 0.0001; others: p = 0.008). Both sexes tended to have lower OM-IJ than CC, and females had significantly lower OM-IJ than males. Conclusion: This study provides clear anatomical evidence showing the difference between the SOHND dissection area and levels I, II, and III. It could be considered that in most cases SOHND invades level IV, not just levels I, II, and III, especially in female patients. [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]

This study explored the alteration in kisspeptin and reproductive hormones during different superovulation protocols (SOP) in dromedary camel. The kisspeptin and reproductive hormonal profile, ovarian response, and the quality and quantity of embryos in dromedary camel donors were evaluated. A total of thirty donor camels were divided into two groups: the 5dSOP group, which received diluent containing 400 mg pFSH dissolved in 20 ml and administered two times daily for 5 days at decreasing doses (2.5, 2, 1.5, and 1 ml); and the 3dSOP group, which received diluent containing 400 mg pFSH dissolved in 12 ml and administered two times daily for 3 days at decreasing doses (3 ml, 2 ml, and 1 ml). Ultrasonography was used to monitor the ovarian environment, recording daily follicle count and dimensions and the time taken for follicles to mature. On the sixth day after mating, a corpus luteum (CL) count was conducted. On the 8th day after mating, records of the quantity and quality of embryos collected were kept. Blood samples from the jugular vein were collected at the commencement of the superovulation protocol and at 8:00 a.m. for the following 48 h to measure the concentrations of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), kisspeptin (KP), and progesterone (P4). The findings indicated that the 3dSOP yielded superior results compared to the 5dSOP in terms of follicle quantity and size, as well as the quantity of CL and embryos. This improvement was attributed to significantly higher concentrations of reproductive hormones, including FSH, LH, E2, kisspeptin, and P4 (P ≤ 0.05), in the 3dSOP than in the 5dSOP. In conclusion, reducing the duration of superovulation protocols contributed to the proliferation of follicles with improved dimensions and counts, ultimately resulting in a greater quantity of embryos of superior quality. The levels of FSH, LH, E2, KP, and P4 were affected significantly by SOP and time of evaluation. • This is the first experiment to study the alteration in kisspeptin, FSH, LH, E2, and P4 during superovulation protocols in camel. • This study recommended reducing the doses of pFSH to three days instead of five days. • There were significantly higher concentrations of FSH, LH, E2, kisspeptin, and P4 in the 3dSOP than in the 5dSOP. [ABSTRACT FROM AUTHOR]

Background: Owing to its unique characteristics, the lateral circumflex femoral artery perforator (LCFAP) flap is often preferred for repairing head wounds with exposed skulls. However, given the vascular distribution in the head, particularly the veins, can lead to postoperative complications such as venous congestion of the flap. The rates of vascular exploration and necrosis in these flaps are significantly higher than in other body regions. Therefore, it is crucial to identify a safe and effective method for venous anastomosis of free flaps in the head region. Methods: This retrospective case series study included 10 patients with large head soft tissue defects treated at the Burn and Plastic Surgery Department of the Affiliated Hospital of Zunyi Medical University from January 2020 to December 2022. The head defects were reconstructed using LCFAP flaps, with flap veins anastomosed to the external jugular vein in the neck, either directly or via a bridging technique. Results: Among the 10 adult patients with massive head wound defects, 7 (70%) were men. The patients' mean age was 53.0 years (48--59 years). The wound defects were caused by trauma in 6 (60%) patients and by tumors in 4 (40%) patients. Postoperatively, no significant complications occurred, and all LCFAP flap survived without necrosis. Conclusion: The descending branch of the LCFAP flap effectively repairs massive head wound defects. The venous anastomosis method for this flap is associated with a low incidence of venous complications and a high patency rate, making it a clinically valuable reference. [ABSTRACT FROM AUTHOR]

Objective: To verify the administration of a new nano delivery system coated with Tirofiban on preventing early thrombosis in vein graft. Methods: Forty New Zealand white rabbits were randomly divided into five groups with eight rabbits in each group. The rabbits of all groups underwent jugular vein transplantation, except group I with only neck opening and closing operation. Vein grafts of group II were preprocessed by intravenous injection of normal saline; group III were preprocessed by tirofiban alone; group IV were preprocessed by unloaded nanoparticles of PLGA-PEG; group V were preprocessed by PLGA-PEG coated with tirofiban. Coagulation and platelet function of peripheral and vein graft blood were detected at 1, 2, 4, 12 h and 1, 3, 7, 10, 14 days after operation. Patency rate of vein graft and blood flow index were measured by vascular ultrasound at third, seventh, 10th, and 14th days after operation; two rabbits in each group were randomly sacrificed at the corresponding time of detection. Pathological differences of vein grafts were observed by HE stainin. Results: The patency rate of vein grafts in group V was significantly higher than that in group II to IV. The platelet and platelet aggregation rate in group V were inhibited in vein graft blood significantly. The post-operative PT and APTT in vein graft blood in group V were increased obviously while the FBG, D-dimer and FDP were significantly inhibited. Except group I, the lumen loss rate of vein grafts in group V was significantly lower than that in other groups, and vein graft blood in group V had a significant lower expression of platelet P-selectin and GP IIb/IIIa receptor than that in other groups. Conclusion: This study proves that PEG-PLGA coated with tirofiban can effectively prevent early vein graft stenosis from thrombosis by inhibition of platelet function, coagulation function. [ABSTRACT FROM AUTHOR]

Simple Summary: This study evaluated the effects of adding the probiotic Bacillus (B.) subtilis to the feed of preweaning neonatal calves. Fifty Holstein calves from the same farm were split into two groups: a control group (CG) fed milk replacer and a treatment group (TG) receiving milk replacer plus 7.5 mL/calf/day of B. subtilis. The study began 24 h after birth, with calves' health monitored daily. Significant differences in body weight were observed between the CG and the TG at 30, 60, and 90 days of age. The TG had a higher average body weight at each time point. At 30 days, the TG also showed lower AST activity and higher GGT activity compared to the CG. Phosphorus levels were higher in the TG, while total protein concentrations were lower at both 30 and 60 days. The inclusion of B. subtilis in the calves' diet led to improved growth and a better metabolic profile, suggesting its potential as a beneficial feed additive in dairy farming. This study focused on assessing whether the inclusion of probiotics (B. subtilis) as feed additives during the preweaning stage can enhance the body weight and metabolic condition of neonatal calves. A total of 50 Holstein calves, all born on the same farm, were randomly divided into two homogeneous treatment groups after birth. The calves in the control group (CG) were fed a milk replacer (n = 25) (13 females and 12 males) and those in the B. subtilis-supplement-treated group (TG), (n = 25) (13 females and 12 males) were fed a milk replacer with 7.5 mL/calf/day of B. subtilis probiotic (complied with the manufacturer's guidelines). The probiotic was administered 24 h post-birth, signifying the start of the experimental period. It took one month to collect the animals. Body weight was measured at birth for all animals. A local veterinarian, working on the farm, conducted daily health checks of the calves, recording health parameters and any antibiotic treatments. Blood samples were collected from each calf at birth and 30, 60, and 90 days by puncturing the jugular vein using 10 mL evacuated serum tubes before morning feeding. Significant differences in body weight were observed between the CG and the TG at 30, 60, and 90 days of age. At 30 days, the TG had a 4.11% higher average body weight than the CG (54.38 kg vs. 52.71 kg). At 60 days, the TG's average weight was 3.75% higher (79.21 kg vs. 76.34 kg), and at 90 days, the TG had a 2.91% higher average weight (112.87 kg vs. 109.67 kg). At 30 days of age, the TG showed significantly lower AST activity, with a 41.12% decrease compared to the CG (51.02 IU/L vs. 72.00 IU/L). Conversely, GGT activity was significantly higher in the TG by 64.68% (40.64 IU/L vs. 14.35 IU/L). Phosphorus concentration at 30 days was also significantly higher in the TG by 9.36% (3.27 mmol/L vs. 2.99 mmol/L). Additionally, the TG had a significantly lower total protein concentration, with a 21.63% decrease at 30 days (46.32 g/L vs. 56.34 g/L) and a 20.28% decrease at 60 days (48.32 g/L vs. 58.12 g/L) compared to the CG. These findings indicate that dairy calves given conventional milk replacer along with a daily dose of 7.5 mL of B. subtilis probiotic experienced enhanced growth performance and a more favourable metabolic profile during the first 90 days of their lives. [ABSTRACT FROM AUTHOR]

The fungus Wickerhamiella pararugosa (Candida pararugosa) has been detected in various human organs but has rarely caused bloodstream infections. This report presents a case of central venous catheter-related bloodstream infection (CRBSI) of W. pararugosa in an adult. A female patient in her 80s was admitted to our facility for intestinal obstruction caused by colorectal cancer. The patient's ability to consume food was hindered, necessitating the insertion of a central venous catheter (CVC) into the internal jugular vein. On day 3 after admission, the patient developed a fever, prompting blood and CVC tip cultures to be performed. On day 5, yeast-like fungi were discovered in the blood cultures, and fosfluconazole (fluconazole [FLCZ] pro-drug) treatment was initiated. On day 8, yeast-like fungi were identified in both the blood and CVC tip cultures, leading to a diagnosis of CRBSI. The fungus was identified as W. pararugosa through biochemical and genetic characterization. This finding justified the use of micafungin (MCFG) for combination therapy. On day 17, the minimum inhibitory concentrations (MIC) for FLCZ and MCFG were 4–8 and 0.06 μg/mL, respectively. Accordingly, the treatment was changed to monotherapy with MCFG. After a 21-day treatment regimen, the patient was discharged on day 31. We present a case of CRBSI caused by W. pararugosa in an adult with intestinal obstruction. The notable increase in the MIC of FLCZ necessitated monotherapy with MCFG, which resulted in successful recovery of the patient. [ABSTRACT FROM AUTHOR]

Background and Objectives: The jugular bulb (JB) is the uppermost part of the internal jugular vein receiving the sigmoid sinus. The aim of the present research is to aid the comprehension of the JB, its abnormalities, and surrounding structures for improving both academic and surgical awareness. Materials and Methods: Various studies on this topic were critically reviewed. Cone-beam CT scans and CT and MR angiograms were used to demonstrate each type of the discussed variations. Results: Variations in the JB anatomy were thoroughly documented: high JB, dehiscent JB, hypoplasia and hyperplasia, and diverticula of the JB, as they have significant clinical implications, particularly in the context of otological and neuro-otological surgery, skull base pathology, and diagnostic imaging. Definitions and critical arguments were also specified to clarify existing literature. Additionally, we present a case report illustrating a high and dehiscent JB, an anatomical variation of clinical interest due to its potential for misdiagnosis as a glomus tumor. Another case describes a dehiscent JB with a hypotympanic air cell protruding into it, further highlighting the variability of this condition. Conclusions: It is necessary to proceed with caution when observing abnormal morphological characteristics of the JB. Preoperative assessment of each case is essential for optimal outcomes. [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: 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.

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.

Simple Summary: Donkey milk is recognized as a functional food due to its high whey protein content. It is especially beneficial for newborn nutrition because of its nutritional similarities to human milk and its hypoallergenic properties. It can be used to prevent hypercholesterolemia and atherosclerosis. However, donkey lactation is less productive in terms of liters/d than dairy cow lactation. It has been suggested that the energy content of the diet in late pregnancy is the main factor influencing the composition of postpartum colostrum in dairy animals. However, research on the influence of dietary energy in late gestation on the mineral content of postpartum jenny milk is limited. Therefore, this study aimed to investigate the effect of dietary energy levels during late gestation on mineral contents in the colostrum milk of lactating jennies. The results showed that appropriately increasing dietary energy levels in late gestation increased the concentrations of Ca, P, K, Mg, Cu, Fe, Zn, and Mo in milk, but high dietary energy levels showed the opposite effect. The concentrations of these minerals in jenny milk decreased with the duration of lactation. This study investigated the effects of dietary energy levels during late gestation on mineral content in the plasma, colostrum, and milk of jennies postpartum. Twenty-four pregnant multiparous DeZhou jennies, aged 6.0  ±  0.1 years, with a body weight of 292  ±  33 kg, an average parity number of 2.7  ±  0.1, and similar expected dates of confinement (74  ±  4 days), were randomly allocated to three groups and fed three diets: high energy (12.54 MJ/kg, HE), medium energy (12.03 MJ/kg, ME), and low energy (11.39 MJ/kg, LE). Blood samples were collected from the jugular vein of each jenny at time points of 0 h, 24 h, 48 h, 5 d, 7 d, and 14 d after parturition. Additionally, milk samples were collected through manual milking, and an analysis of the mineral content was conducted. The results showed that compared with HE, both ME and LE significantly increased the levels of calcium (Ca), phosphorus (P), zinc (Zn), selenium (Se), molybdenum (Mo), and cobalt (Co) in the plasma and Ca, P, magnesium (Mg), copper (Cu), manganese (Mn), Zn, selenium (Se), molybdenum (Mo), and Co in the milk of jennies postpartum (p < 0.05); ME also increased the levels of potassium (K), iron (Fe), and Mn in plasma and K and Fe in milk (p < 0.05). The levels of Ca, K, Mg, P, Fe, Cu, Mn, Co, Se, Zn, and Mo in plasma and milk gradually decreased with increasing postpartum time. Their contents were the highest at 0 h postpartum, rapidly decreased after 24 h postpartum, and declined to the lowest on day 14 postpartum. The interaction between dietary energy level and postpartum time showed that although the concentrations of the minerals Ca, P, K, Mg, Fe, Cu, Mn, Zn, Co, Se, and Mo decreased in jennies' plasma and milk in the treatment groups with different energy levels as postpartum time increased, the pattern of change was also influenced by dietary energy level. The influence of dietary energy level in late gestation on the mineral content of milk and plasma during the postpartum colostrum phase was higher than that during the milk phase. In conclusion, this study demonstrated that, under the current experimental conditions, the mineral content of the colostrum, milk, and plasma of jennies after parturition was dependent on the dietary energy level during late gestation. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionsOrbital venous malformations (VM) pose challenges in complete resection due to indistinct borders and bleeding proclivity. Current methods for aiding surgical excision of distensible orbital venous malformations are inadequate. We investigated whether external neck compression could facilitate intraoperative distension of venous orbital lesions during surgical excision in patients diagnosed with VM.Eighteen patients (8 males and 10 females) diagnosed with distensible venous anomalies were enrolled. Neck compression technology, was employed to distend the lesions before puncture embolization using n-butyl-2-cyanoacrylate glue under general anesthesia. The surgical process, along with preoperative to postoperative changes in ocular symptoms, were recorded.The average surgical duration was 95 min. A mean of 3.41 ml surgical glue was used for embolization. The compression belt maintained pressure at 35–40 mmHg. Total lesion resection was achieved in 12 patients, with 6 patients undergoing subtotal removal not requiring supplementary surgery. Symptoms were entirely alleviated in 17 patients, and signs of distensible lesions during the Valsalva maneuver were absent. One patient underwent secondary surgery for residual eyelid lesions. Minor complications included mild ocular movement restriction, residual subcutaneous induration, transiently increased orbital pressure, and lower lid ectropion in four, three, four, and one patient, respectively. Three patients experienced a mild post-operative visual acuity decrease, although none experienced vision loss.Direct orbital embolization aided by a jugular vein compression device is safe and demonstrates satisfactory outcomes in orbital varicose vein treatment. [ABSTRACT FROM AUTHOR]

Intraosseous occurrence of a spinal AVM is anecdotal, with only four such cases reported previously. This is the first report of a spinal intraosseous AVM in the cervical vertebrae. A 44-year-old male patient presented with a 2-month history of progressive quadriparesis and bladder dysfunction. Magnetic resonance imaging showed multiple flow voids within the C4 and C5 vertebral bodies, and an extradural component causing cord compression. CT showed extensive bony destruction at both levels. The diagnosis of an intraosseous AVM was confirmed with spinal angiography. The AVM was noted to be fed by branches from the ascending cervical arteries and the vertebral artery. The nidus was draining into the vertebral venous plexus and thence into the jugular vein through the marginal sinus. The patient underwent partial embolization of the AVM. Surgical resection was attempted but found to be unfeasible due to torrential bleeding. A 360-degree stabilization along with decompressive laminectomies was performed, resulting in clinical improvement and disease stabilization at one year follow-up. The case and its management dilemmas are discussed in light of a brief literature review. [ABSTRACT FROM AUTHOR]

Introduction: Central venous access plays a crucial role in various clinical settings, and ultrasound guidance has become increasingly popular for improving its safety and success rates. The aim of this meta‐analysis was to compare the short‐axis (SAX) and long‐axis (LAX) ultrasound‐guided techniques for internal jugular vein (IJV) cannulation in terms of first needle pass success rate, number of cannulation attempts, access time, guidewire insertion time, posterior IJV wall puncture, arterial puncture, haematoma and catheter‐related bloodstream infection. Methods: A comprehensive literature search was conducted, and randomised controlled trials (RCTs) comparing SAX and LAX techniques for IJV cannulation on adults were included. Results: A total of 11 RCTs involving 1183 patients were included in the meta‐analysis. The SAX technique demonstrated a significantly greater first needle pass success rate and faster IJV access time compared to the LAX technique. However, more posterior IJV wall puncture was significantly associated with the SAX technique. There was no significant difference between the two techniques in terms of number of cannulation attempts, guidewire insertion time, arterial puncture, haematoma and catheter‐related bloodstream infection. Conclusion: This meta‐analysis suggests that the SAX technique may have advantages over the LAX technique in terms of first needle pass success rate and potentially reducing cannulation attempts and access time. However, the occurrence of posterior IJV wall puncture raises concerns. The decision on the choice of technique should be based on individual patient factors and operator proficiency. [ABSTRACT FROM AUTHOR]

Carotid artery puncture is a common complication of internal jugular vein (IJV) catheterization. However, there are few reports about an aneurysm from the carotid artery that can develop into an occult mediastinal hematoma, leading to airway compression. In this case study, we present the case of a 71-year-old male who experienced an aneurysm and delayed mediastinal hematoma, ultimately resulting in airway compression after right jugular line insertion. Our findings highlight the importance of not only addressing local hematoma formation at the puncture site promptly, but also recognizing the potential for aneurysm extension into the mediastinum and the formation of an occult hematoma, which can lead to airway compression. Additionally, we provide a summary of landmark technique precautions that can help reduce the occurrence of such severe complications. [ABSTRACT FROM AUTHOR]

This clinical case presents an unusual case of Lemierre's syndrome (LS) in a young woman of 38-year-old. She arrived in the Emergency Department with a high fever and pharyngology resistant to antibiotic therapy with clarithromycin, ceftriaxone, and cortisone for two weeks. At the blood sampling, there is a marked leucocytosis, and the advice of the otolaryngologist is required given the strong pain in the throat. Due to the tonsillar abscess, a neck CT with a contrast medium is necessary for the otolaryngologist's opinion. The CT shows thrombosis of the jugular vein and left subclavian, with thickening of soft perivascular tissues; these findings suggest Lemierre's syndrome: a septic thrombophlebitis of the jugular vein that occurs as a complication of a peritonsillar abscess. The diagnostic process is then completed with a chest HR-CT, which reveals lung density and excavation areas suggesting tuberculosis. Blood culture reveals the presence of Veillonella Parvula (an anaerobic gram-negative coccus), sputum culture reveals the presence of some colonies of Enterobacter cloacae complex, real-time PCR examination on sputum reveals the presence of Streptococcus Pneumoniae and the borderline presence of rhinovirus. Microbiologists, after these results and neck and chest CT with a contrast agent, agree with the diagnosis of suspected LS at an early stage: a septic dissemination fortunately limited only to the neck and lungs region. [ABSTRACT FROM AUTHOR]

Internal jugular vein (IJV) thrombosis is a life-threatening condition most often associated with local risk factors such as head or neck infection or central venous catheterisation. Underlying malignancy is a rare but important aetiology to consider in patients presenting with spontaneous IJV thrombosis. We describe a case of necrotic cervical lymphadenopathy with thrombosis of the IJVs, cavernous sinuses and superior ophthalmic veins in a patient with metastatic squamous cell carcinoma, which was further complicated by an orbital compartment syndrome. The differential diagnosis of IJV thrombosis includes a range of infective, metastatic and thrombophilic pathologies. This case illustrates that, in the absence of an underlying precipitating factor, spontaneous IJV thrombosis should prompt further systemic investigations. Furthermore, patients with thrombotic events affecting the orbital venous drainage system should be monitored closely for signs of an acute orbital compartment syndrome. [ABSTRACT FROM AUTHOR]

Introduction: Successful implantations of the Aveir VR, have been effectively demonstrated in adults; however, there remain limited reports supporting safe and feasible implantation of the Aveir VR in the young population. Methods: Retrospective, observational study of Aveir VR implantation of young patients (≦21 years old) at UC Davis Medical Center from November 2022 to January 2024 via the internal jugular or femoral vein implantation approaches. Indications for pacing, patient demographics, pacing thresholds and longevity were reported at the time of implantation and last follow‐up. Results: A total of 10 patients received the Aveir VR with a median age of years (IQR 12.5–17) and median weight of 50.8 kg (IQR 44.6–60.9) kg. The majority were male (80%). Aveir VR leadless pacemaker occurred via internal jugular venous (90%) or femoral venous (10%) approaches. Indications for placement were intermittent complete heart block (60%) and sinus pauses (40%). Adequate impedance, sensing and thresholds were maintained from implantation to a median follow‐up of 9 months. Predicted pacemaker longevity at follow‐up median was 23.8 years. There were no complications in any of the 10 patients. Conclusion: Aveir VR implantation via the internal jugular and femoral veins is feasible in the young patient population with stable pacing parameters at follow‐up. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Radiation for head and neck cancer (HNC) can lead to neck fibrosis, commonly known as "woody neck", limiting neck mobility. We report the case of a 46-year-old male with a history of tonsillar squamous cell carcinoma, with a "woody neck" following multiple radiation treatments. Facial swelling and impending airway loss prompted emergent intubation. Despite nasotracheal tube placement, bilateral internal jugular vein occlusion led to a difficult tracheostomy. An airway exchange catheter (AEC) facilitated multiple attempts at tracheal cannulation, but due to challenging anatomy, prolonged nasotracheal intubation was maintained. Tracheostomy was attempted again with extracorporeal membrane oxygenation (ECMO) support, which resulted in successful tracheal cannulation. [ABSTRACT FROM AUTHOR]

Aims Leadless pacemaker therapy was introduced to overcome lead- and pocket-related complications in conventional transvenous pacemaker systems. Implantation via the femoral vein, however, may not always be feasible. The aim of this study was to evaluate leadless pacemaker implantation using a jugular vein approach and compare it to the standard implantation via the femoral vein. Methods and results The records of the first consecutive 100 patients undergoing Micra™ leadless pacemaker implantation via the right internal jugular vein from two centres were included in this study. Peri-procedural safety and efficacy of the jugular approach were compared to the first 100 patients using a femoral implantation approach at the University Hospital Zurich. One hundred patients underwent successful implantation of a leadless pacemaker via the internal jugular vein (mean age, 81.18 ± 8.29, 60% males). Mean procedure time was 35.63 ± 10.29 min with a mean fluoroscopy time of 4.66 ± 5.16 min. The device was positioned at the inferior septum in 25 patients, at the high septum in 24 patients, and mid-septum in 51 patients. The mean pacing threshold was 0.56 ± 0.35 V at 0.24 ms pulse width with a sensed amplitude of 10.0 ± 4.4 mV. At follow-up, electrical parameters remained stable in all patients. Compared with femoral implantation, patients undergoing the jugular approach were of similar age and had similar comorbidities. Mean procedure (48.9 ± 21.0 min) and fluoroscopy times (7.7 ± 7.8 min, both P < 0.01) were shorter compared to the femoral approach. Electrical parameters were similar between the two approaches. There were only two complications during jugular veinous implantations (1 pericardial effusion and 1 dislocation), compared to 16 complications using the femoral approach (1 pericardial effusion, 2 femoral artery injuries, and 13 major groin haematomas). Conclusion The jugular approach may represent a safe and efficient alternative to femoral implantation of the Micra leadless pacemaker. [ABSTRACT FROM AUTHOR]

Hemorheological factors may show arterio-venous differences. Alterations in acid-base and metabolic parameters may also influence these factors. However, little is known about changes in micro-rheological parameters during abdominal surgery, influencing splanchnic circulation. In anesthetized pigs, the external jugular vein, femoral artery and vein were cannulated unilaterally, and paramedian laparotomy was performed. In the anastomosis group, after resecting a bowel segment, end-to-end jejuno-jejunostomy was completed. Blood samples (from cannulas and by puncturing the portal vein) were taken before and after the intervention. Hematological, acid-base and blood gas parameters, metabolites, red blood cell (RBC) deformability and aggregation were determined. The highest hematocrit was found in portal blood, increasing further by the end of operation. A significant pH decrease was seen, and portal blood showed the highest lactate and creatinine concentration. The highest RBC aggregation values were found in arterial, the lowest in renal venous blood. The RBC aggregation increased with higher lactate concentration and lower pH. Osmotic gradient deformability declined, with the lowest values in portal and renal venous samples. In conclusion, micro-rheological parameters showed arterio-venous and porto-renal venous differences, influenced by oxygenation level, pH and lactate concentration. The intestinal anastomosis operation caused an immediate micro-rheological deterioration with portal venous dominancy in this experiment. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Papillary thyroid carcinoma (PTC) often extends to adjacent organs. According to the 8th Tumor‐Node‐Metastasis Classification, extension to the strap muscles was graded as T3b. We investigated the prognostic impact of T3b and the appropriateness of T3b in patients aged ≥55 years who were classified as stage II.We enrolled 7811 patients with M0 PTC who underwent initial surgery at the Kuma Hospital (Kobe, Japan) between January 2007 and December 2016. Tumor extension was divided into T3b, T4a1 (extension to the tracheal adventitia, tracheal cartilage, esophageal muscle layer, recurrent laryngeal nerve, cricothyroid, and inferior constrictor muscles), and sT4a2 (extension to the subcutaneous soft tissues, tracheal mucosa, esophageal mucosa, internal jugular vein, brachiocephalic vein, larynx, pharynx, and sternocleidomastoid muscle).In patients ≥55 years, the local recurrence‐free survival (LR‐FS), distant recurrence‐free survival (DR‐FS), and cause‐specific survival (CSS) rates of T3bN0M0 were significantly poorer than those of T1/T2N0M0 but did not significantly differ from those of T3aN0M0. The LR‐FS, DR‐FS, and CSS rates of T3b stage II patients did not differ from those of T4a1 stage III patients but were significantly better than those of T4a2 stage III patients. T3b was an independent predictor of local recurrence and distant recurrence but not of death due to carcinoma in the multivariate analysis. In patients aged <55 years with M0 PTC, T3b had no prognostic value in both analyses.T3bM0 patients are appropriate to be classified as stage II in patients ≥55 years but be kept in stage I in patients <55 years. [ABSTRACT FROM AUTHOR]

AIM/OBJECTIVE: This retrospective study aimed to analyze the device-related complication rates and compare them with the literature. BACKGROUND: When it comes to providing care for cancer patients who need a continuous or frequent venous access channel for either their primary care treatments or their supportive care treatments, portacaths play a crucial role. Many cases are straight forward, however there may occasionally be issues. MATERIALS AND METHODS: A total of 59 consecutive patients (20 males and 39 females) having a mean age of 57.07 - 16.01 years presented to the interventional radiology department of Shifa International Hospital Islamabad who were implanted with portacaths from 2017 to 2023 were included. We retrospectively assessed all infectious and noninfectious complications associated with the implanted device. RESULT: The most common indication for portacath insertion was malignancy (94.9%) with breast cancer being more common. The most common site for portacath placement was the right internal jugular vein (76.3 %) followed by the left internal jugular vein (23.7%). The average period for which porta cath was placed was 13 months. No complications were seen in 67.8% of the patients. Infectious causes were seen in 25.4% of the cases, while noninfectious complications were seen in 6.8% of the cases. Following microbiology reports it was seen that pseudomonas aeruginosa was the common bug seen in infectious cases. CONCLUSION: Although portacaths are associated with lower complication rates, infections by different bugs are still the most common complications and should be prevented by taking appropriate steps. [ABSTRACT FROM AUTHOR]

Assessing for volume overload is a key component of both short and long-term management of heart failure patients. Physical examination findings are neither sensitive nor specific for detecting congestion, and subclinical congestion may not be evident at the time of examination. Point of care ultrasound (POCUS) is an efficient and non-invasive way to assess heart failure patients for volume overload. The aim of our narrative review is to summarize how each of the following ultrasound modalities can be used to assess for congestion in the heart failure population: 2D and Doppler echocardiography, lung ultrasound, inferior vena cava ultrasound, internal jugular vein ultrasound, and venous excess grading. While each of these modalities has their limitations, their use in the acute and outpatient space offers the potential to reduce heart failure readmissions and mortality. [ABSTRACT FROM AUTHOR]

Critically ill newborns admitted to Neonatal Intensive Care Unit often require a centrally inserted central catheters (CICCs) inserted by ultrasound-guided puncture of the internal jugular or brachio-cephalic vein. Achieving an appropriate level of sedation and analgesia is paramount for procedure success and patient safety, avoiding the potential risks associated with excessive deep sedation. The aim of this study is to evaluate the feasibility of a novel protocol of sedation. Data from 46 patients were prospectively collected. The feasibility was assessed throughout the monitoring of adverse events and the incidence of spontaneous movements. The procedure was completed in 100% of cases. There were no cases of escalation of the baseline ventilatory support despite the procedure and no case of hypotension, and all spontaneous movements were controlled with additional boluses when required. Conclusion: Our study represents the very first step towards the design of a validated protocol for analgosedation during ultrasound-guided CICC insertion in NICU. What is Known: • Critically ill newborns admitted to Neonatal Intensive Care Unit often require a centrally inserted central catheter. • Achieving an appropriate level of sedation and analgesia is paramount for procedure success and patient safety, avoiding the potential risks associated with excessive deep sedation. What is New: • The use of this new protocol for analgosedation is able to achieve a good level of sedation and pain control without significant adverse event. • Ultrasound-guided CICC insertion can be performed even in non-ventilated newborns. [ABSTRACT FROM AUTHOR]

Simple Summary: Anesthesia in red-eared sliders is necessary both for surgical procedures and for imaging techniques. Propofol is a nonbarbiturate anesthetic agent used for induction in many species and should be administered intravenously. Jugular intravenous cannulas provide safe access with the least lymph contamination for anesthetic administration. In this study, red-eared sliders were anesthetized with 5 mg/kg and 10 mg/kg propofol administered in the jugular veins. Our results indicate that the 10 mg/kg dose is efficient for inducing anesthesia for short non-painful procedures, whereas the 5 mg/kg dose did not prove to be enough for anesthetic induction. This study compares the effects of two different doses of propofol administered intravenously (IV), in the jugular vein, to red-eared sliders (Trachemys scripta elegans). In this crossover study, 5 or 10 mg/kg propofol was administered to six Trachemys scripta elegans after cannulation of the jugular vein. Each turtle received each dose, G1 (5 mg/kg IV) and G2 (10 mg/kg IV), after a 7-day washout period. The parameters evaluated were heart rate, palpebral reflex, cloacal reflex, muscle relaxation, ease of handling, sensitivity to anterior and posterior pinch stimuli, and possibility of intubation. Additionally, respiratory rate was measured when possible, and the times from propofol administration to full recovery and from intubation to extubation were recorded. None of the turtles in G1 could be intubated, and this dose provided little relaxation and ease of handling, with a duration of effect until full recovery of 12.16 ± 8.32 (SD) min for this group. In G2, five out of the six turtles could be intubated, and the duration of effect was 32.33 ± 5.85 (SD) min. Heart rates were influenced by manipulation for catheter placement. There were statistically significant differences (p value ≤ 0.05) between the two groups in muscle relaxation degree, handling, cloacal reflex, and possibility of intubation. The 5 mg/kg propofol dose was not sufficient to induce anesthesia, even when administered in the jugular vein, in red-eared sliders. A dose of 10 mg/kg IV or higher should be used. [ABSTRACT FROM AUTHOR]

Active sampling in the olfactory domain is a fundamental aspect of mouse behavior, and there is increasing evidence that respiration-entrained neural activity outside of the olfactory system sets an important global brain rhythm. It is therefore crucial to accurately measure breathing during natural behaviors. We develop a new approach to do this in freely moving animals, by implanting a telemetry-based pressure sensor into the right jugular vein, which allows for wireless monitoring of thoracic pressure. After verifying this technique against standard head-fixed respiration measurements, we combined it with EEG and EMG recording and used evolving partial coherence analysis to investigate the relationship between respiration and brain activity across a range of experiments in which the mice could move freely. During voluntary exploration of odors and objects, we found that the association between respiration and cortical activity in the delta and theta frequency range decreased, whereas the association between respiration and cortical activity in the alpha range increased. During sleep, however, the presentation of an odor was able to cause a transient increase in sniffing without changing dominant sleep rhythms (delta and theta) in the cortex. Our data align with the emerging idea that the respiration rhythm could act as a synchronizing scaffold for specific brain rhythms during wakefulness and exploration, but suggest that respiratory changes are less able to impact brain activity during sleep. Combining wireless respiration monitoring with different types of brain recording across a variety of behaviors will further increase our understanding of the important links between active sampling, passive respiration, and neural activity. NEW & NOTEWORTHY: Animals can alter their respiration rate to actively sample their environment, and increasing evidence suggests that neurons across the brain align their firing to this changing rhythm. We developed a new approach to measure sniffing in freely moving mice while simultaneously recording brain activity, and uncovered how specific cortical rhythms changed their coherence with respiration rhythm during natural behaviors and across arousal states. [ABSTRACT FROM AUTHOR]

The internal jugular vein (IJV) is an important vein encountered during most routine major head and neck surgeries. The IJV is known to infrequently present with anatomical variations, commonly duplication and fenestration. This report presents two cases that highlight an unusual anatomical variation of the IJV, namely the posterior tributary, which was encountered during neck dissection for papillary carcinoma of the thyroid and metastatic cervical lymph nodes. The first case was a 50-year-old woman with papillary carcinoma of the thyroid and regional metastasis, who underwent extensive neck dissection. During dissection, an anomalous posterior tributary of the IJV was discovered, originating around 3 cm above the omohyoid tendon–IJV junction. In case 2, a 40-year-old woman with a history of thyroidectomy exhibited a similar anomaly during neck dissection. In both cases, the posterior tributary was observed branching into two divisions. These cases emphasize the significance of recognizing anatomical variations to avoid inadvertent damage during surgical procedures. Anomalies like the posterior IJV tributary could have implications for surgical planning, emphasizing the importance of thorough exploration and understanding of individual variations. Awareness of such variations will help facilitate surgeons in safely performing neck dissections. [ABSTRACT FROM AUTHOR]

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Blood volume shifts during postural adjustment lead to irregular distension of the internal jugular vein (IJV). In microgravity, distension may contribute to flow stasis and thromboembolism, though the regional implications and associated risk remain unexplored. We characterized regional differences in IJV volume distension and flow complexity during progressive head-down tilt (HDT) (0°, −6°, −15°, −30°) using conventional ultrasound and vector flow imaging. We also evaluated low-pressure thigh cuffs (40 mmHg) as a fluid shifting countermeasure during −6° HDT. Total IJV volume expanded 139 ± 95% from supine position (4.6 ± 2.7 mL) to −30° HDT (10.3 ± 5.0 mL). Blood flow profiles had greater vector uniformity at the cranial IJV region (P < 0.01) and became more dispersed with increasing tilt (P < 0.01). Qualitatively, flow was more uniform throughout the IJV during its early flow cycle phase and more disorganized during late flow phase. This disorganized flow was accentuated closer to the vessel wall, near the caudal region, and during greater HDT. Low-pressure thigh cuffs during −6° HDT decreased IJV volume at the cranial region (−12 ± 15%; P < 0.01) but not the caudal region (P = 0.20), although flow uniformity was unchanged (both regions, P > 0.25). We describe a distensible IJV accommodating large volume shifts along its length. Prominent flow dispersion was primarily found at the caudal region, suggesting multidirectional blood flow. Thigh cuffs appear effective for decreasing IJV volume but effects on flow complexity are minor. Flow complexity along the vessel length is likely related to IJV distension during chronic volume shifting and may be a precipitating factor for flow stasis and future thromboembolism risk. NEW & NOTEWORTHY: The internal jugular vein (IJV) facilitates cerebral outflow and is sensitive to volume shifts. Concerns about IJV expansion and fluid flow behavior in astronauts have surfaced following thromboembolism reports. Our study explored regional volume distension and blood flow complexity in the IJV during progressive volume shifting. We observed stepwise volume distension and increasing flow dispersion with head-down tilting across all regions. Flow dispersion may pose a risk of future thromboembolism during prolonged volume shifts. [ABSTRACT FROM AUTHOR]

Background Total anomalous pulmonary venous connection (TAPVC) to left superior vena cava (LSVC) is an extremely rare congenital heart disease, and its surgical management is very challenging. Case summary We report one such case of a 5-year-old south Asian male with double outlet right ventricle and unbalanced atrioventricular canal defect, where all the pulmonary veins were found opening into LSVC, which was then opening into the left side of the common atrium. Intraoperatively, the LSVC was transected just below the left internal jugular vein and left subclavian vein junction and left-sided bidirectional Glenn shunt done using 8 mm Dacron tube graft. Pulmonary veins were left draining through the LSVC into the common atrium. Right-sided Glenn shunt was completed as usual. Currently, the patient is year and half post-surgery and is doing well; school going on par with the peer group maintaining a room air saturation of 87%. Discussion Here, we report a successful surgical correction of TAPVC to LSVC in a child with univentricular physiology, however due to the paucity of data and rarity of such cases, optimal surgical management is yet to be defined. [ABSTRACT FROM AUTHOR]

Evaluating fluid responsiveness with dynamic parameters is recommended for fluid management. However, in hemodynamically stable patients who are breathing spontaneously, accurately measuring stroke volume variation via echocardiography and passive leg raising is challenging due to subtle SV changes. This study aimed to identify normal SV changes in healthy volunteers and evaluate the precision of hemodynamic parameters in screening mild hypovolemia in patients. This prospective, repeated-measures, cross-sectional study screened 269 subjects via echocardiography. Initially, 45 healthy volunteers underwent a fluid challenge test, the outcomes of which served as criteria to screen 215 ICU patients. Among these patients, 53 underwent additional fluid challenge testing. Hemodynamic parameters, including medians of maximum velocity time integrals (VTImaxs), peak velocity of VTImax (PV), internal jugular vein diameters (IJVD), and area (IJVA) were repeatedly measured first at a 60° upper body elevation (UBE), second in a supine position, third at UBE, fourth in a supine position, and lastly in a supine position after fluid loading. The hemodynamic responses to the position changes were compared between 83 fluid non-responders and 15 fluid responders. Fluid responsiveness was defined as fluid-induced medians' change of VTImaxs (fluid-induced median VTImax change) ≥ 10%. None of the healthy volunteers showed the mean value of repeatedly measured medians of VTImaxs ≥ 7%, following either UBE position (UBE-induced median VTImax change) or fluid loading (fluid-induced median VTImax change). UBE-induced median VTImax and PV changes were significantly correlated with fluid responsiveness (p < 0.001, AUC 0.959; p < 0.001, AUC 0.804). The significant correlations were demonstrated via multivariable analysis using binary logistic regression (p = 0.001, OR 90.1) and the correlation coefficient (R2 = 0.793) using linear regression analysis. UBE-induced median VTImax changes (≥ 11.8% and 7.98%) predicted fluid-induced median VTImax changes ≥ 10% and 7% (AUC 0.959 and 0.939). The collapsibility and variation of IJVD and IJVA showed no significant correlation. An increase in the mean value of medians of repeatedly measured VTImaxs transitioning from an UBE to a supine position, effectively screened mild hypovolemia and demonstrated a significant correlation with fluid responsiveness in spontaneously breathing patients maintaining hemodynamic stability. [ABSTRACT FROM AUTHOR]