Predictive value of sonoelastography of secondary changed lymphous nodes in the assessment of effectiveness of immunotherapy.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e15225-e15225
Author(s):  
Fedor Vladimirovich Moiseenko ◽  
Vladimir Moiseyenko ◽  
Vera Chernobrivtceva ◽  
Vitaliy Egorenkov ◽  
Arina Zhegalina ◽  
...  
Keyword(s):  
Blood Flow ◽  
Lymph Nodes ◽  
Objective Assessment ◽  
Objective Response ◽  
Peripheral Resistance ◽  
Resistance Index ◽  
Subsequent Treatment ◽  
Response To Treatment ◽  
Rapid Progression ◽  
Neoplastic Disease

e15225 Background: With the use of existing predictors of the effectiveness of immunotherapy it is not possible to identify patients who will have a response to treatment or a rapid progression. The mechanism of the antitumor effect of the modern generation of immunotherapeutic drugs leads to significant changes in the cellular structure of the tumor and, as a consequence of this, in its physical characteristics. Sonoelastography allows to evaluate the stiffness of the tumor. Methods: The study included 17 patients with malignant neoplastic disease with the presence of secondarily affected peripheral lymph nodes (l.n.). 11/17 patients had melanoma, 2/17 - NSCLC, 3/17 - neck cancer. 8/9 - M / F, average age 61.8 years. 5/17 patients received combined immunotherapy (Ipilimumab + Nivolumab), 12/17 - anti-PD-1 (8 people Nivolumab, 4 people Pembrolizumab). Results: An ultrasound examination of the l. n. in a multimodal mode with compression elastography was performed on a Philips Epic 7 device before the first administration of the antitumor drug and every 3 weeks. Before the first objective assessment of the effect was done, in 5/17 patients was registered an increase in the size of the studied lymph nodes by 2 or more times, in 7/17 patients the size of the l. n. did not change, in 5/17 patients the affected l. n. decreased (26% - 64%).The results of control examination after 2 months of treatment: PR - 2/17, CR - 4/17, SD- 9/17, PD- 4/17.In the group with an objective response (PR, CR, SD - 13/17), the average value. St. Ratio before treatment was 5.7 ± 0.4; during treatment decreased to an average of 3.2 ± 0.5 (p < 0.05). In the group with progression during treatment, the average St. Ratio value before treatment was 4.1 ± 0.4, and during treatment increased on average to 5.7 ± 0.5 (p < 0.05).A qualitative analysis of tumor blood flow was carried out, the Resistance Index (RI) was studied. The RI in the first group of patients was 0.65 ± 0.4; after treatment, the RI increased to 0.74. In the second group of patients, the RI before and after treatment did not significantly change. Conclusions: During the immunotherapy treatment, a decrease in the stiffness of the tumor is observed, regardless of the change in size and an increase in the indices of peripheral resistance to blood flow in case of further regression or stabilization of the process. An early change in the sonographic characteristics of tumor foci can identify patients with a subsequent treatment effect, and can also distinguish true progression from pseudoprogression, which requires confirmation in larger studies.

Ultrasound features of peripheral angiodistonic syndrome of the upper extremities in vibration disease

2020 ◽  
Vol 60 (11) ◽  
pp. 815-817
Author(s):  
Nadezhda I. Kuprina ◽  
Ekaterina V. Ulanovskaya ◽  
Olga A. Kochetova
Keyword(s):  
Blood Flow ◽  
Heart Defects ◽  
Peripheral Resistance ◽  
Resistance Index ◽  
Ulnar Artery ◽  
Upper Extremities ◽  
Disease Stage ◽  
Peripheral Blood Flow ◽  
Pronounced Increase ◽  
Vibration Disease

Introduction. Vibration disease (VD) is an example of the most common pathology due to the systematic exposure of the worker to intense vibration with sufficient work experience, the main manifestation of which is peripheral angiodystonic syndrome. The aim of study was to learn the features of peripheral blood flow in the arteries of the forearm in vibration disease using the ultrasound method. Materials and methods. The radial and ulnar arteries in patients with vibration disease were examined by ultrasound in B- and PW-mode. These materials present the results of an ultrasound assessment of the speed indicators of the main arteries of the forearm in vibration disease stages 1 and 2. The selection criteria for patients in the study ware the presence of pronounced clinical manifestations of angiodystonic syndrome in vibration disease, confirmed by instrumental research methods and data on the sanitary and hygienic characteristics of working conditions, the absence of cardiovascular chronic diseases (ischemic heart disease, heart defects, rhythm and conduction disturbances), rheumatic, oncological, infectious diseases, osteo-traumatic changes in the upper extremities. Results. The groups of patients with the established diagnosis of vibration disease of 1 and 2 degrees were studied. With vibration disease stage 1 a decrease in the pulse velocity of blood flow was observed in isolation on the ulnar artery and an increase in peripheral resistance (pulsation index and resistance index) in the radial and ulnar arteries symmetrically on both upper extremities. The second stage of vibration disease differed from the first by a more significant decrease in speed indicators both on the ulnar and radial arteries on both sides, symmetrically in combination with a more pronounced increase in peripheral resistance indicators on both main arteries of the forearm (pulsation index and resistance index). The revealed changes were determined with the same frequency in men and women. Conclusions. A significant decrease in speed indicators on the ulnar artery and an increase in peripheral resistance indicators are detected already at the initial stages of vibration disease. Thus, the method of ultrasound examination of the main arteries of the middle caliber of the upper extremities is currently the only available and objective method for examining the vascular system in vibration disease.

RATIONALIZATION FOR THE DIFFERENTIAL DIAGNOSIS OF OVARIAN CANCER AND CHRONIC SALPINGOOPHORITIS IN THE PARAMETERS OF DISINTEGRATION AND NETWORK MODELING CHANGES OF BLOOD FLOW IN UTERINE AND OVARIAN ARTERIES AND VEINS

2017 ◽  
Vol 63 (5) ◽  
pp. 766-769
Author(s):  
Nikolay Agarkov ◽  
Pavel Tkachenko ◽  
Dmitriy Kicha ◽  
Vitaliy Aksenov ◽  
Aleksandr Ivanov ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Blood Flow ◽  
Diagnostic Criteria ◽  
Peripheral Resistance ◽  
Resistance Index ◽  
Diagnostic Process ◽  
Venous Outflow ◽  
Flow Changes ◽  
Arteries And Veins ◽  
Selection Of

Analysis of ultrasonic blood flow changes in uterine and ovarian arteries and veins in 92 patients with ovarian cancer and 87 patients with chronic salpingoophoritis has allowed to identify the leading differential diagnostic criteria, which include minimum diastolic blood flow velocity, resistance index, while fast hyperemia, the index of venous outflow diastolic index and index of peripheral resistance. Based on a selection of leading differential diagnostic criteria for ovarian cancer and chronic salpingoophoritis developed a network model of differentiation of these groups of patients, streamlining the differential diagnostic process

scholarly journals Cuff-Method Thigh Arterial Occlusion Counteracts Cerebral Hypoperfusion Against the Push–Pull Effect in Humans

2021 ◽  
Vol 12 ◽  
Author(s):  
Changyang Xing ◽  
Yuan Gao ◽  
Xinpei Wang ◽  
Wenjuan Xing ◽  
Yunnan Liu ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
High Performance ◽  
Cerebral Blood Flow Velocity ◽  
Blood Pressure Response ◽  
Peripheral Resistance ◽  
Arterial Occlusion ◽  
Resistance Index ◽  
Systemic Blood Pressure ◽  
Cerebral Hypoperfusion

Exposure to acute transition from negative (−Gz) to positive (+ Gz) gravity significantly impairs cerebral perfusion in pilots of high-performance aircraft during push—pull maneuver. This push—pull effect may raise the risk for loss of vision or consciousness. The aim of the present study was to explore effective countermeasures against cerebral hypoperfusion induced by the push—pull effect. Twenty healthy young volunteers (male, 21 ± 1 year old) were tested during the simulated push–pull maneuver by tilting. A thigh cuff (TC) pressure of 200 mmHg was applied before and during simulated push—pull maneuver (−0.87 to + 1.00 Gz). Beat-to-beat cerebral and systemic hemodynamics were measured continuously. During rapid −Gz to + Gz transition, mean cerebral blood flow velocity (CBFV) was decreased, but to a lesser extent, in the TC bout compared with the control bout (−3.1 ± 4.9 vs. −7.8 ± 4.4 cm/s, P &lt; 0.001). Similarly, brain-level mean blood pressure showed smaller reduction in the TC bout than in the control bout (−46 ± 12 vs. −61 ± 13 mmHg, P &lt; 0.001). The systolic CBFV was lower but diastolic CBFV was higher in the TC bout. The systemic blood pressure response was blunted in the TC bout, along with similar heart rate increase, smaller decrease, and earlier recovery of total peripheral resistance index than control during the gravitational transition. These data demonstrated that restricting thigh blood flow can effectively mitigate the transient cerebral hypoperfusion induced by rapid shift from −Gz to + Gz, characterized by remarkable improvement of cerebral diastolic flow.

Atrial extract: hemodynamics in Wistar-Kyoto and spontaneously hypertensive rats

1985 ◽  
Vol 249 (2) ◽  
pp. H265-H271 ◽  
Author(s):  
B. L. Pegram ◽  
M. B. Kardon ◽  
N. C. Trippodo ◽  
F. E. Cole ◽  
A. A. MacPhee
Keyword(s):  
Blood Flow ◽  
Cardiac Output ◽  
Vascular Resistance ◽  
Total Peripheral Resistance ◽  
Peripheral Resistance ◽  
Resistance Index ◽  
Organ Blood Flow ◽  
Spontaneously Hypertensive ◽  
Wistar Kyoto ◽  
Atrial Natriuretic

Partially purified low (LMW) and high-(HMW) molecular-weight atrial natriuretic extracts were administered intravenously (540 micrograms protein/kg) to conscious Wistar-Kyoto (WKY) and spontaneously hypertensive (SHR) rats. Both LMW and HMW atrial natriuretic extracts produced an immediate decrease in mean arterial pressure that reached maximum within 5 min and returned to control levels within 30 min. In both strains, cardiac output decreased approximately 14% following administration of LMW. Total peripheral resistance increased only in SHR. Organ blood flow was significantly decreased to skin, brain, heart, kidneys, and splanchnic organs of WKY and to skin, muscle, heart, and splanchnic organs of SHR following administration of LMW. Corresponding increases in organ vascular resistance index were observed in brain, heart, and splanchnic organs of WKY and in skin, heart, and splanchnic organs of SHR. To some extent, the changes in organ blood flow may be a reflection of the decrease in cardiac output induced by LMW. After administration of HMW, no significant changes were observed in cardiac output or total peripheral resistance, although they tended to decrease. Organ vascular resistance was decreased to skin, muscle, brain, and splanchnic organs of SHR. Little difference was observed between WKY and SHR responses to atrial natriuretic extracts. These data indicate that atrial natriuretic extracts have an effect on systemic and regional hemodynamics in conscious rats that differs markedly from those of vasodilators such as nitroglycerin or hydralazine.

scholarly journals Dynamics of characteristics of cerebral circulation during combined treatment with amlodipine and bisoprolol

2017 ◽  
Vol 94 (12) ◽  
pp. 908-914
Author(s):  
Irina L. Zapesochnaya ◽  
A. G. Avtandilov
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Flow Velocity ◽  
Combined Therapy ◽  
Peripheral Resistance ◽  
Resistance Index ◽  
Downward Trend ◽  
Hypertensive Patients ◽  
Group 2 ◽  
Group 1

Objective: to assess dynamics of cerebral blood flow when starting combined therapy with amlodipine and bisoprolol in hypertensive patients working in the Far North under various labor schedules. Material and methods. We studied 140 patients with grade 1-2 hypertension divided into two groups depending on their work schedule. Group 1 (n=72) included subjects working only at daytime; group 2 (n=68) consisted of subjects working in shifts. All patients received combined therapy with amlodipine and bisoprolol. The final mean daily dose of amlodipine/bisoprolol amounted to 8,3±1,3/9,8±1,6 mg/day and 9,5±1,5/14,5±1,2 mg/day in groups 1 and 2 respectively. Doppler ultrasound of the common carotid, internal carotid and vertebral arteries (OCA, BCA and PA, respectively) was performed before, 12 weeks, and 6 months after onset of therapy. Results. At the end-point of intervention (6 months) patients of group 1 showed an increase in peak systolic velocity (Vps) in OCA, BCA and PA (by 4,1, 5,9 and 5,5% respectively) and maximum end-diastolic flow velocity (Ved) in ОCA and ВCA (by 5,8 and 5,2% respectively). Patients of group 2 showed an increase of Vps in OCA, BCA and PA by 6,3, 8,4 and 7,1% respectively; Ved in OCA and BCA by 6,4 and 14,5% respectively. All patients exhibited a pronounced downward trend of the peripheral resistance index of in all studied arteries. The tendency to a decrease in the thickness of the intima-media complex was documented: by 4,1%, in group 1, 6,8% in group 2, without reaching the normal level. Conclusion. 6-month starting combined therapy with amlodipine and bisoprolol in hypertensive patients has positive effect on cerebral hemodynamics manifest as the increase in parameters of cerebral blood flow velocity and reduced peripheral resistance index. Pronounced downward trend in the thickness of the intima-media monitoring in both groups was apparent but without reaching the standard level.

WISE 2005: responses of women to sublingual nitroglycerin before and after 56 days of 6° head-down bed rest

2012 ◽  
Vol 113 (3) ◽  
pp. 434-441 ◽  
Author(s):  
K. A. Zuj ◽  
H. Edgell ◽  
J. K. Shoemaker ◽  
M. A. Custaud ◽  
P. Arbeille ◽  
...  
Keyword(s):  
Blood Flow ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Femoral Artery ◽  
Peripheral Resistance ◽  
Resistance Index ◽  
Cardiovascular Effects ◽  
Cardiovascular Responses ◽  
Bed Rest ◽  
Sublingual Nitroglycerin

This study tested the hypothesis that cardiovascular effects of sublingual nitroglycerin (NG) would be exaggerated after 56 days of 6° head-down bed rest (HDBR) in women, and that an aerobic and resistive exercise countermeasure (EX, n = 8) would reduce the effect compared with HDBR without exercise (CON, n = 7). Middle cerebral artery maximal blood flow velocity (CBFV), cardiac stroke volume (SV), and superficial femoral artery blood flow (Doppler ultrasound) were recorded at baseline rest and for 5 min following 0.3 mg sublingual NG. Post-HDBR, NG caused greater increases in heart rate (HR) in CON compared with EX (+24.9 ± 7.7 and +18.8 ± 6.6 beats/min, respectively, P < 0.0001). The increase in HR combined with reductions in SV to maintain cardiac output. Systolic, mean, and pulse pressures were reduced 5–10 mmHg by NG, but total peripheral resistance was only slightly reduced at 3 min after NG. Reductions in CBFV of −12.5 ± 3.8 cm/s were seen after NG, but a reduction in the Doppler resistance index suggested dilation of the middle cerebral artery with no differences after HDBR. The femoral artery dilated with NG and blood flow was reduced ∼50% with the appearance of large negative waves suggesting a marked increase in downstream resistance, but there were no effects of HDBR. In general, responses of women to NG were not altered by HDBR; the greater increase in HR in CON but not EX was probably a consequence of cardiovascular deconditioning. These results contrast with the hypothesis and a previous investigation of men after HDBR by revealing no change in cardiovascular responses to exogenous nitric oxide.

HEMODYNAMIC DISORDERS IN VARICOSE VEIN DISEASE

2021 ◽  
Vol 9 (1) ◽  
pp. 68-76
Author(s):  
R.E. Kalinin ◽  
◽  
I.A. Suchkov ◽  
I.N. Shanaev ◽  
V.A. Yudin ◽  
...  
Keyword(s):  
Blood Flow ◽  
Flow Velocity ◽  
Varicose Vein ◽  
Blood Flow Velocity ◽  
Peripheral Resistance ◽  
Resistance Index ◽  
Significant Difference ◽  
Retrograde Blood Flow ◽  
Varicose Disease ◽  
Vein Disease

Aim. Duplex ultrasound scanning (DUS) is a routine diagnostic procedure in patients with varicose vein disease. DUS mostly evaluates the qualitative (anatomical) parameters of the disease. Still, it is difficult to assess the microcirculatory parameters in trophic disorders based only on the anatomy, therefore assessment of quantitative blood flow parameters is needed. Our aim was to determine the potentials of conventional DUS in assessment of the hemodynamic disorders in patients with varicose disease. Materials and Methods. The study included 583 patients with varicose disease, 348 of which had trophic alterations. The patients were divided into 4 groups according to the CEAP clinical classes. Standard Valsalva and Siegel tests were performed during DUS. The following parameters were assessed in the superficial and deep veins: diameter of veins, antegrade blood flow velocity, retrograde blood flow velocity, reflux time; in the perforator veins (PV) – diameter, maximum velocity and average velocity of reflux. Peripheral resistance index (RI) in the arteries accompanying the PV was also analyzed. Results. A statistically significant difference in the diameter of the GSV was obtained between classes C2 and C3, C3 and C4, but not between class C5, 6 and class C4. Similar findings were observed in the assessment of diameter of the PVs and the velocity of retrograde blood flow through them. A gradual increase in these parameters could be seen with the progression of the disease, but a statistically significant difference was obtained only between classes C2 and C3 for the diameter of the PV and the peak velocity of retrograde blood flow. As for the average blood flow velocity, a statistically significant difference was obtained between classes C2 and C3, C3 and C4. Arteries in the perforator bundles demonstrated low RI which may be attributed to the presence of an arteriolo-venular bypass. Statistically significant differences were obtained for CEAP classes C2 and C3. Conclusions. Ultrasound duplex scanning of the study with use of Superb Micro-Vascular Imaging mode is an effective method in assessing the quantitative and microcirculatory parameters of hemodynamic disorders in patients with varicose vein disease of the lower extremities. Trophic ulcers in varicose vein disease are not an obligatory component of the disease, but only its complication.

Diastolic pressure and peripheral resistance during stellate ganglion stimulation

1963 ◽  
Vol 204 (1) ◽  
pp. 71-72 ◽  
Author(s):  
Edward D. Freis ◽  
Jay N. Cohn ◽  
Thomas E. Liptak ◽  
Aristide G. B. Kovach
Keyword(s):  
Heart Rate ◽  
Blood Flow ◽  
Cardiac Output ◽  
Total Peripheral Resistance ◽  
Diastolic Pressure ◽  
Stellate Ganglion ◽  
Peripheral Resistance ◽  
Resistance Vessels ◽  
Left Stellate Ganglion ◽  
Increased Blood Flow

The mechanism of the diastolic pressure elevation occurring during left stellate ganglion stimulation was investigated. The cardiac output rose considerably, the heart rate remained essentially unchanged, and the total peripheral resistance fell moderately. The diastolic rise appeared to be due to increased blood flow rather than to any active changes in resistance vessels.

scholarly journals Germline Mutations in Other Homologous Recombination Repair-Related Genes Than BRCA1/2: Predictive or Prognostic Factors?

2021 ◽  
Vol 11 (4) ◽  
pp. 245
Author(s):  
Laura Cortesi ◽  
Claudia Piombino ◽  
Angela Toss
Keyword(s):  
Prognostic Factors ◽  
Homologous Recombination ◽  
Pancreatic Adenocarcinoma ◽  
Objective Response ◽  
Metastatic Breast ◽  
Germline Mutations ◽  
Response To Treatment ◽  
Homologous Recombination Repair ◽  
Dna Breaks ◽  
Recombination Repair

The homologous recombination repair (HRR) pathway repairs double-strand DNA breaks, mostly by BRCA1 and BRCA2, although other proteins such as ATM, CHEK2, and PALB2 are also involved. BRCA1/2 germline mutations are targeted by PARP inhibitors. The aim of this commentary is to explore whether germline mutations in HRR-related genes other than BRCA1/2 have to be considered as prognostic factors or predictive to therapies by discussing the results of two articles published in December 2020. The TBCRC 048 trial published by Tung et al. showed an impressive objective response rate to olaparib in metastatic breast cancer patients with germline PALB2 mutation compared to germline ATM and CHEK2 mutation carriers. Additionally, Yadav et al. observed a significantly longer overall survival in pancreatic adenocarcinoma patients with germline HRR mutations compared to non-carriers. In our opinion, assuming that PALB2 is a high-penetrant gene with a key role in the HRR system, PALB2 mutations are predictive factors for response to treatment. Moreover, germline mutations in the ATM gene provide a better outcome in pancreatic adenocarcinoma, being more often associated to wild-type KRAS. In conclusion, sequencing of HRR-related genes other than BRCA1/2 should be routinely offered as part of a biological characterization of pancreatic and breast cancers.

scholarly journals Effects of nasal high flow on nocturnal hypercapnia, sleep, and sympathovagal balance in patients with neuromuscular disorders

2020 ◽  
Author(s):  
Anna Christina Meyer ◽  
Jens Spiesshoefer ◽  
Nina Christina Siebers ◽  
Anna Heidbreder ◽  
Christian Thiedemann ◽  
...  
Keyword(s):  
Neuromuscular Disorders ◽  
Ventilatory Support ◽  
Peripheral Resistance ◽  
Resistance Index ◽  
High Flow ◽  
Apnea Hypopnea Index ◽  
Sympathovagal Balance ◽  
Peripheral Oxygen Saturation ◽  
Depth Analysis ◽  
Nasal High Flow Therapy

Abstract Purpose In neuromuscular disorders (NMD), inspiratory muscle weakness may cause sleep-related hypoventilation requiring non-invasive ventilation (NIV). Alternatively, nasal high flow therapy (NHF) may ameliorate mild nocturnal hypercapnia (NH) through washout of anatomical dead space and generation of positive airway pressure. Ventilatory support by NIV or NHF might have favourable short-term effects on sympathovagal balance (SVB). This study comparatively investigated the effects of NHF and NIV on sleep-related breathing and SVB in NMD patients with evolving NH. Methods Transcutaneous CO2 (ptcCO2), peripheral oxygen saturation (SpO2), sleep outcomes and SVB (spectral analysis of heart rate, diastolic blood pressure variability) along with haemodynamic measures (cardiac index, total peripheral resistance index) were evaluated overnight in 17 patients. Polysomnographies (PSG) were randomly split into equal parts with no treatment, NIV and NHF at different flow rates (20 l/min vs. 50 l/min). In-depth analysis of SVB and haemodynamics was performed on 10-min segments of stable N2 sleep taken from each intervention. Results Compared with no treatment, NHF20 and NHF50 did not significantly change ptcCO2, SpO2 or the apnea hypopnea index (AHI). NHF50 was poorly tolerated. In contrast, NIV significantly improved both gas exchange and AHI without adversely affecting sleep. During daytime, NHF20 and NHF50 had neutral effects on ventilation and oxygenation whereas NIV improved ptcCO2 and SpO2. Effects of NIV and NHF on SVB and haemodynamics were neutral during both night and daytime. Conclusions NHF does not correct sleep-disordered breathing in NMD patients with NH. Both NHF and NIV exert no immediate effects on SVB.

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