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

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

To substantially reduce the risk of hospitalization and death among subjects with heart failure (HF) and reduced left ventricular ejection fraction, it is necessary to make a comprehensive approach of the different neurohormonal systems that are implied in its etiopathogenesis, including not only sympathetic nervous system, and renin-angiotensin system, but also vasoactive peptides and sodium-glucose transport protein 2. The DAPA-HF trial demonstrated that the addition of dapagliflozin to the standard treatment in HF with reduced left ventricular ejection fraction, markedly decreases the risk of cardiovascular death, HF hospitalization and overall death. In addition, dapagliflozin improves functional class and quality of life. Importantly, the prognostic benefit starts early after initiating treatment with dapagliflozin, regardless baseline therapy or the presence of diabetes. All these evidences make dapagliflozin as one of the mainstays of treatment for the management of HF with reduced left ventricular ejection fraction.

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

This article summarizes and critiques the evidence for use of available pharmacotherapies (vasoactive, psychoactive, and hormonal medications) and energy-based therapies (laser, radiofrequency, shockwave, and neurostimulation) for treatment of female sexual dysfunction. The enthusiasm with which energy-based treatments for sexual dysfunction have been adopted is disproportionate to the amount of data currently available to support their clinical use. Pharmacotherapy for female sexual dysfunction has considerably more research evidence to justify its use. Patients must be empowered to make an informed, autonomous determination as to whether the risk/reward ratio favors the use of pharmacotherapy, energy-based therapy, or some other treatment intervention.

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

BACKGROUND Multiple sclerosis (MS) is a chronic inflammatory neurodegenerative disease of the central nervous system. Vasoactive and intestinal peptide (VIP) and pituitary adenylate cyclase-activating peptide (PACAP) are neuropeptides that play roles in anti-inflammation and neuroprotection in MS. In this study, we aimed to determine the serum levels of VIP and PACAP in MS patients versus healthy controls and to correlate them with demographics and clinical characteristics. METHODS Serum samples were collected from MS patients (n = 145) and healthy controls (n = 73) to measure serum levels VIP and PACAP. RESULTS VIP serum levels were lower in MS patients than healthy controls (p

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

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

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

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

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

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

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

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

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

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

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

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

Lithium is an effective treatment option for bipolar disorder in children and adolescents; however, the therapeutic window is narrow, and psychiatric, neurological, renal, gastrointestinal, dermatological, and endocrine side effects have been observed during lithium therapy.1 Iatrogenic dysphagia has been reported with psychotropic drugs, benzodiazepines, anti-inflammatory drugs, and some vasoactive drugs.2 However, oropharyngeal dysphagia due to lithium toxicity has not been reported in the literature.

BACKGROUND The aims of this study were to assess the viability of livers from older donors ≥80 years of age and to study the evolution of both the graft and the recipient during a minimum follow-up period of 6 months. METHODS This was a retrospective study (January 2011 to July 2019), including older liver donors, offered by the National Transplant Organization to the Transplant Coordination Team of our hospital. We compared livers excluded exclusively because of donor's age to those that were implanted. The following variables were studied: age, sex, body mass index, cardiovascular risk factors, toxic habits, comorbidities, natremia, use of vasoactive drugs, development of diabetes insipidus, use of antibiotics and length of stay in the intensive care unit. We also conducted a 6-month minimum follow-up of recipients, assessing graft and patient survival. RESULTS During the period, 130 livers were offered. Of these, 102 (78%) livers were rejected. In 62 (47%), the reason for rejection was age exclusively. Twenty-eight (21%) livers ≥80 years of age were implanted; 2 needed retransplantation. There were no statistically significant differences between livers that were rejected and implanted in the variables detailed above, except for the number of comorbidities, which were lower in the rejected group. During the follow-up period, 7 deaths were registered. CONCLUSION In our series, liver rejection due exclusively to age was frequent. Recipients of livers that came from older donors had an evolution that is similar to what has been previously described for younger livers. Patients an older age should be evaluated carefully as liver donors before excluding them based exclusively on age criteria.

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

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

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

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

The emerging role of BRAF and MEK tyrosine-kinase inhibitors has shown new opportunities of treatment for patients with advanced melanoma and BRAF mutations. Its use is associated with some toxicities, as pyrexia, that clinicians may not be familiarized with. We present the case of a patient diagnosed with stage IV melanoma BRAF Val600E mutated who was started on dabrafenib and trametinib and developed three severe episodes of fever, hypotension and acute phase reactants elevation during the first 3 months of therapy, in the absence of microbiological demonstration of infection. The episodes were initially managed as a septic shock with broad-spectrum antibiotics and vasoactive drugs, while treatment with dabrafenib and trametinib was withheld. After two subsequent dose reduction of dabrafenib, the patient did not experience new episodes of fever.

Coagulopathy, acidosis and hypothermia form the lethal triad in trauma patients with acute hemorrhage. The prevention of this chain reaction relies on an adapted management from the first care in pre-hospital situation: rapid arrest of bleeding, fight against hypothermia, limited vascular filling with an early recourse to vasoactive amines. Pre-hospital transfusion is still rare, whereas in the hospital, an adapted transfusion strategy can wait for or support a surgical or radiological hemostasis procedure.

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