Predictive Factors for Limb Salvage and Foot Ulcer Recurrence in Patients with Chronic Limb-Threatening Ischemia After Multidisciplinary Team Treatment: A 6-Year Japanese Single-Center Study

Chronic limb-threatening ischemia (CLTI) is associated with a short-term risk of limb loss. Multidisciplinary teams are often involved in CLTI treatment; however, in Asian countries, multidisciplinary teams that include podiatrists specializing in foot wounds and vascular surgeons who can perform distal bypass surgery are lacking. We investigated predictive factors for limb salvage and foot ulcer recurrence in patients with CLTI treated by a Japanese single-center intensive multidisciplinary team over 6 years. We retrospectively investigated 84 patients with CLTI and foot ulcers who had undergone revascularization and wound treatment between October 2013 and December 2019. Following postrevascularization treatment, including undertaking minor amputations, the healing rate was 77.8%, and the average wound healing time was 75 ± 68 days. To achieve adequate blood supply, 17.7% of patients were treated using a combination of endovascular revascularization and bypass surgeries. Thirty-three (44%) patients had wound recurrence and there was wound recurrence within 6 months in 58.9% of these patients. Multivariate logistic regression analysis showed that postrevascularization skin perfusion pressure was significantly associated with wound healing (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.033-1.243, P = .0078). Diabetes mellitus (OR 9.72, 95% CI 1.855-50.937, P = .0071), and heart disease (OR 3.51, 95% CI 1.052-11.693, P = .0411) were significantly associated with wound recurrence ( P < .05). Treatment within a single-center intensive multidisciplinary team resulted in good patient outcomes. Our study indicates that the revascularization endpoint of CLTI treatment should be marked by attainment of adequate blood supply and wound healing. The timing of revascularization and debridement is of utmost importance for the successful treatment of CLTI wounds.

Yogic agnisara increases blood flow in the superior mesenteric artery

Objectives Medieval yoga texts claim that a special exercise of the muscles of the anterior abdominal wall, called agnisara, improves digestive function. Main objective of the study was to demonstrate change in the blood flow through superior mesenteric artery (if any) after performance of agnisara. Design and subjects: Ultrasound examination of the linear and volumetric indicators of blood flow in the superior mesenteric artery (SMA) before and after performing the agnisara yoga exercise 100 times was carried out in 12 healthy volunteers of both sexes (8 of them women). Results A significant increase in the diameter of the SMA, peak systolic and diastolic velocities, and blood flow in the superior mesenteric artery after performing the agnisara exercise 100 times was found, which contrasts with the established data on a decrease in splanchnic blood flow in humans in response to normal physical activity. Conclusion Properly performed agnisara increases blood flow to the splanchnic region, registered by the SMA, which should contribute to adequate blood supply to the gastrointestinal tract for successful performance of digestive function.

Mechanisms Involved in Apice Closure of Pulpless Teeth – Literature Review

Background: Unfinished root formation has always offered challenges in endodontics due to technical difficulties and weakened teeth resistance during the lifetime of an individual. Pulp revascularization therapy appeared as a solution for apical closure and root maturation. The existence of oral stem cells involved in the process associated with traditional resident cells requires adequate blood supply given by induced controlled injury deliberately accomplished into the periapical zone. Objective: The aim of this work was to research, through literature review, the main mechanisms involved in the process of apical closure through the technique of pulp revascularization. Conclusion: Apice closure in pulpless teeth seems to happen as a result of professional intervention and biological activity. The success rate depends on the role of traditional local immune cells and stem cells associated with adequate blood supply to finish root formation.

EDUKASI KADER PKK MENJADI PERINTIS KAMPUNG DONOR DARAH MANDIRI SAAT PANDEMI COVID-19

The Corona Virus-19 (Covid-19) outbreak in Indonesia has caused many problems including blood supply which will be significantly affected by decreasing the amount of blood donated. The Blood Transfusion Unit (UTD) must be ready to move quickly in response to the changes that occur, where an adequate blood supply is most likely to be affected. Purpose: to encourage the community of Partners to become voluntary blood donors so that they can help residents in keeping the availability of blood safe during the Covid-19 Pandemic. Methods: cadres from members of Family Welfare Empowerment (PKK) Sungapan, Sriharjo, Imogiri, Bantul, were trained to carry out initial donor selection examinations including blood pressure checks, hemoglobin level checks, blood type checks and doing it independently so that it can increase the role of voluntary blood donors. This outreach activity is to educate the community to form a cadre of PKK mothers to be trained in conducting initial donor selection checks so that data can be used as a means of obtaining voluntary donors in Mitra areas and creating independent blood donor villages. Conclusion: PKK cadres have been able to provide counseling to residents and are able to check blood pressure, hemoglobin levels and blood type keywords: cadre, blood donation village

Monoaminergic Receptors as Modulators of the Perivascular Sympathetic and Sensory CGRPergic Outflows

Blood pressure is a highly controlled cardiovascular parameter that normally guarantees an adequate blood supply to all body tissues. This parameter is mainly regulated by peripheral vascular resistance and is maintained by local mediators (i.e., autacoids), and by the nervous and endocrine systems. Regarding the nervous system, blood pressure can be modulated at the central level by regulating the autonomic output. However, at peripheral level, there exists a modulation by activation of prejunctional monoaminergic receptors in autonomic- or sensory-perivascular fibers. These modulatory mechanisms on resistance blood vessels exert an effect on the release of neuroactive substances from the autonomic or sensory fibers that modify blood pressure. Certainly, resistance blood vessels are innervated by perivascular: (i) autonomic sympathetic fibers (producing vasoconstriction mainly by noradrenaline release); and (ii) peptidergic sensory fibers [producing vasodilatation mainly by calcitonin gene-related peptide (CGRP) release]. In the last years, by using pithed rats, several monoaminergic mechanisms for controlling both the sympathetic and sensory perivascular outflows have been elucidated. Additionally, several studies have shown the functions of many monoaminergic auto-receptors and hetero-receptors expressed on perivascular fibers that modulate neurotransmitter release. On this basis, the present review: (i) summarizes the modulation of the peripheral vascular tone by adrenergic, serotoninergic, dopaminergic, and histaminergic receptors on perivascular autonomic (sympathetic) and sensory fibers, and (ii) highlights that these monoaminergic receptors are potential therapeutic targets for the development of novel medications to treat cardiovascular diseases (with some of them explored in clinical trials or already in clinical use).

Anterior Mandibular Composite Graft for Regeneration of Knife-Edge Ridges in Implant Surgery: A Treatment Case Report

Implant insertion into an atrophic knife-edge ridge with non-simultaneous extraction of anterior and posterior teeth is challenging; this is why bone regeneration before implant placement is of great importance. One of the best sources for reconstruction is an intraoral autogenous bone graft. A composite bone graft is a combination of autogenic bone and mucosal flap that provides adequate blood supply and fixation compared to conventional (from the mandibular symphysis or ramus) and extraoral bone grafts.

GASOTRANSMITTERS IN THE REGULATION OF THE FUNCTIONS OF THE INTRAORGANIC BLOOD VESSELS OF THE UTERUS

Несмотря на то, что внутриорганное кровеносное русло является основным звеном для адекватного кровоснабжения органных структур, в матке ее строение, функции и механизмы регуляции во многом не изучены. В обзоре представлены данные литературы и собственные материалы по локализации и распределению газотрансмиттеров во внутриорганных сосудах матки. Рассматриваются клеточные и молекулярные механизмы участия NO, СО и HS в регуляции функций этих сосудов. Приведенные материалы, с одной стороны, подчеркивают значимость данных сигнальных молекул в регуляции сократимости гладких мышц сосудов, проницаемости капилляров, с другой - указывают на необходимость дальнейших исследований роли газотрансмиттеров в общей системе регуляции гемодинамики матки. Despite the fact that the intraorganic circulatory bed is the main element providing adequate blood supply to organ structures, its structure, functions and regulatory mechanisms in the uterus are largely unknown. The review presents the literature data and own materials on the localization and distribution of gasotransmitters in the intraorganic vessels of the uterus. The cellular and molecular mechanisms of the participation of NO, CO and H2S in the regulation of the function of these vessels are rewieved. On the one hand, these materials emphasize the importance of these signaling molecules in the regulation of contractility of the smooth muscles of the blood vessels and capillary permeability, on the other hand, point out the need for further studies of the role of gasotransmitters in the general system of uterine hemodynamic regulation.

A Hypothetical Vascular Stent with Locally Enlarged Segment and the Hemodynamic Evaluation

Among the interventional stenting methods for treating coronary bifurcation lesions, the conventional treatments still have disadvantages, which include increased intervention difficulties or inadequate supply of blood flow to side branches and may alter the physiological function of downstream organs. Thus, the optimized design of stent geometry needs to be improved based on the specific shape of branches to minimize the complications of inadequate blood flow to the downstream organs and tissues. Our research used 3D modeling and fluid dynamics simulation to design and evaluate a new stent with locally enlarged segment by altering the proportion and length of enlarged surface area based on Bernoulli’s equation. The aim is to increase the pressure and blood flow supply at side branches. According to series of blood flow simulations, the stent with 10% enlargement of surface area and length of 3 folders of stent diameter was assigned as the optimized design. The results revealed that by using this design, according to the simulation results, the average pressure on side branches increased at the rate of 43.6%, which would contribute to the adequate blood supply to the downstream organs. Besides, the average wall shear stress (WSS) at sidewalls increased at 9.2% while the average WSS on the host artery wall decreased at 14.1%. There is in the absent of noticeable rise in the total area of low WSS that blows the threshold of 0.5 Pa. Therefore, the present study provides a new method to optimize the hemodynamics features of stent for bifurcation arteries.

The Organizational Field of Blood Collection: A Multilevel Analysis of Organizational Determinants of Blood Donation in Europe

Maintaining an adequate blood supply for transfusion poses a pressing challenge to society. We argue that this challenge has not been adequately addressed in previous research. Building upon Healy’s seminal work on ‘blood-collection regimes’ and the subsequent shift towards a field-level approach that broadens the analytical focus beyond the dyadic relationship between donors and organizations, we embed the act of blood donation within the organizational field in which blood establishments operate. We assume that varying modes of governance shape the organizational practices of donor recruitment and blood collection. Our analysis is based on Eurobarometer data from 2014 (number of countries = 28; number of individuals = 19,363). The results identify considerable variance in donation rates according to field characteristics in terms of hierarchical centralization and competitiveness. Decentralized systems without competition perform worst in terms of the recruitment of (first-time) blood donors. Competitive systems in which several different bodies share responsibility for the provision of blood to patients yield the highest donation rates.