The phenomenon of reversible myometrial dysfunction and delayed rehabilitation of uterine contractive ability

The author introduces the conception o f potentially reversible myometrial dysfunction with unaffected main physiological function o f myometrium (viability o f myometrium). This dysfunction is connected with the disturbances o f uterine haemodynamics. The phenomenon o f reversible myometrial dysfunction reflects the process o f prolonged decreased contractile ability o f the uterus.The therapy o f reversible myometrial dysfunction phenomenon should be directed to blood flow restoration under the conditions o f uterine hypoperfusion.The special treatment is not required fo r myometrium with reserved main physiological functions (tonus, excitability) because restoration o f myometrial contractile ability improves spontaneously in case o f blood flow restoration.With the aim o f prophylaxis o f myometrial dysfunction and delayed rehabilitation o f the uterine contractile function administration o f Ca antagonists, beta-adrenomymetics, antioxidants and preparations, which improve myometrial metabolic processes, is recommended before the expected delivery.

Translational Stroke Research Review: Using the Mouse to Model Human Futile Recanalization and Reperfusion Injury in Ischemic Brain Tissue

The approach to reperfusion therapies in stroke patients is rapidly evolving, but there is still no explanation why a substantial proportion of patients have a poor clinical prognosis despite successful flow restoration. This issue of futile recanalization is explained here by three clinical cases, which, despite complete recanalization, have very different outcomes. Preclinical research is particularly suited to characterize the highly dynamic changes in acute ischemic stroke and identify potential treatment targets useful for clinical translation. This review surveys the efforts taken so far to achieve mouse models capable of investigating the neurovascular underpinnings of futile recanalization. We highlight the translational potential of targeting tissue reperfusion in fully recanalized mouse models and of investigating the underlying pathophysiological mechanisms from subcellular to tissue scale. We suggest that stroke preclinical research should increasingly drive forward a continuous and circular dialogue with clinical research. When the preclinical and the clinical stroke research are consistent, translational success will follow.

Time to resuscitate cardiopulmonary resuscitation! The 3R/CPR: Refill-Recoil-Rebound.

Introduction Sudden cardiac arrest (SCA) remains a major health issue worldwide with gloomy outcomes due to poor perfusion of cardiopulmonary resuscitation (CPR), deemed unsuitable for hemostatic conditions, cardiotorsal anatomy, electrophysiology and thoracic biomechanics. Alternatively, we propose a new management, implementing rational mobilization of stagnant blood: manually with a novel technique of cardiac massage and mechanically with a circulatory flow restoration (CFR) device. Methods Simulated chest compressions were performed through the 5th intercostal space in professional Lifeguards volunteers, placed in the left lateral decubitus position with raised legs and abdominal compression. Expected results Compared to CPR, bypassing the sternal barrier, refilling the heart and then compressing the chest with a recoil-rebound maneuver (3R / CPR) can significantly promote ROSC. Results of CFR device were previously demonstrated. Conclusion 3R/CPR adapts human morphology promoting adequate perfusion and ROSC safely, under all circumstances. Preclinical computational models can confirm the effectiveness of 3R/CPR versus CPR.

On the Efficient Flow Restoration in Spectrally-Spatially Flexible Optical Networks

We focus on the efficient modeling and optimization of the flow restoration in the spectrally-spatially flexible optical networks (SS-FONs) realized using a single mode fiber bundle. To this end, we study a two-phase optimization problem, which consists of: (i) the network planning with respect to the spectrum usage and (ii) the flow restoration after a failure aiming at maximizing the restored bit-rate. Both subproblems we formulate using the integer linear programming with two modeling approaches—the node-link and the link-path. We perform simulations divided into: (i) a comparison of the proposed approaches, (ii) an efficient flow restoration in SS-FONs—case study. The case study focuses on the verification whether the spectral-spatial allocation may improve the restoration process (compared to the spectral allocation) and on the determination of the full restoration cost (the amount of additional resources required to restore whole traffic) in two network topologies. The results show that the spectral-spatial allocation allows us to restore up to 4% more traffic compared to the restoration with only the spectral channels. They also reveal that the cost of the full traffic restoration depends on plenty of factors, including the overall traffic volume and the network size, while the spectral-spatial allocation allows us to reduce its value about 30%.

Mechanical thrombectomy in patients with cervical artery dissection and stroke in the anterior or posterior circulation – a multicenter analysis from the German Stroke Registry

Background Cervical artery dissection (CAD) is a rare cause of acute ischemic stroke (AIS) with large vessel occlusion (LVO) and may constitute a challenge for mechanical thrombectomy (MT). We compared procedural characteristics, reperfusion rates, and clinical outcome in AIS patients undergoing MT with and without CAD. Methods We performed a pre-specified analysis of patients registered within the German Stroke Registry, a prospectively maintained multicenter registry of consecutive patients with AIS patients treated by MT. Procedural characteristics included time periods and additional application of medication. Results Of 2589 patients, 62 (2.4%) were diagnosed with CAD. CAD patients were younger, had lower rates of known vascular risk factors and larger baseline stroke volumes. MT in CAD patients took significantly longer (median [IQR] groin-puncture-to-flow restoration time: 98 [67–136] versus 70 [45–100] minutes; p < 0.001) and more often required use of intra-arterial medication (34.4% versus 15.6%; p < 0.001). Reperfusion success (modified Treatment in Cerebral Infarction score 2b-3: 85.2% versus 83.3%, p = 0.690) and favorable functional outcome after 3 months (modified Rankin Scale score ≤ 2: 70.9% versus 36.4%, adjusted p = 0.086) did not differ significantly between patients with and without CAD. The latter findings held true for both CAD in the anterior and posterior circulation. Conclusion CAD in AIS requiring MT is rare. MT in patients with CAD constitutes a particular procedural challenge, but still achieves favorable radiological and functional outcomes in most patients. Our data provide indirect evidence that MT is of clinical benefit in patients with AIS due to LVO and CAD.

Lessons Learned after Iatrogenic Complete Transection of the Right Common Carotid Artery with Segmental Vessel Loss

Carotid arterial injuries occur in 5-6% of persons with penetrating trauma. Complete transection is rare in civilian practice and is most often due to penetrating injuries. Complete transection as an iatrogenic complication is rare. We present a case where we were required to repair a complete transection of the carotid artery with segmental loss which occurred as an iatrogenic complication during thyroidectomy. We could find no previous reports of this type of iatrogenic complication. The lessons learned during the management of this case were the following: (1) surgeons should call for help early, (2) a multidisciplinary approach ensures that all options are considered, (3) adhere to surgical principles of proximal and distal control, (4) always use atraumatic clamps to control vessels, and (5) flow restoration should be attempted, leaving carotid ligation as the last resort.

Relationship between the degree of recanalization and functional outcome in acute ischemic stroke is mediated by penumbra salvage volume

Background The presence of metabolically viable brain tissue that may be salvageable with rapid cerebral blood flow restoration is the fundament rationale for reperfusion therapy in patients with large vessel occlusion stroke. The effect of endovascular treatment (EVT) on functional outcome largely depends on the degree of recanalization. However, the relationship of recanalization degree and penumbra salvage has not yet been investigated. We hypothesized that penumbra salvage volume mediates the effect of thrombectomy on functional outcome. Methods 99 acute anterior circulation stroke patients who received multimodal CT and underwent thrombectomy with resulting partial to complete reperfusion (modified thrombolysis in cerebral infarction scale (mTICI) ≥ 2a) were retrospectively analyzed. Penumbra volume was quantified on CT perfusion and penumbra salvage volume (PSV) was calculated as difference of penumbra and net infarct growth from admission to follow-up imaging. Results In patients with complete reperfusion (mTICI ≥ 2c), the median PSV was significantly higher than the median PSV in patients with partial or incomplete (mTICI 2a–2b) reperfusion (median 224 mL, IQR: 168–303 versus 158 mL, IQR: 129–225; p < 0.01). A higher degree of recanalization was associated with increased PSV (+ 63 mL per grade, 95% CI: 17–110; p < 0.01). Higher PSV was also associated with improved functional outcome (OR/mRS shift: 0.89; 95% CI: 0.85–0.95, p < 0.0001). Conclusions PSV may be an important mediator between functional outcome and recanalization degree in EVT patients and could serve as a more accurate instrument to compare treatment effects than infarct volumes.

Correction to: Association of culprit lesion plaque characteristics with flow restoration post-fibrinolysis in ST-segment elevation myocardial infarction: an intravascular ultrasound-virtual histology study

An amendment to this paper has been published and can be accessed via the original article.