FEATURES OF ULTRASONIC CHARACTERISTICS OF MESENTERIC LYMPH NODES IN COVID-19 IN CHILDREN WITH ACUTE ABDOMINAL SYNDROME: DESCRIPTION OF CLINICAL CASES

The authors describe clinical observations of children with acute mesenteric adenitis with PCRconfirmed COVID-19 infection. Attention during ultrasound diagnostics is drawn to the condition of the lymph nodes – mesenteric adenitis in COVID-19 infection was manifested by a significant increase in the size of the nodes – more than 15 mm, a large number of nodes in the cut with a tendency to form a conglomerate, a more rounded shape, significantly increased blood flow, a reaction of the peritoneum in the form its thickening and the presence of free fluid in the abdominal cavity. Unusual for a «ordinary» respiratory viral or intestinal infection type of lymph nodes was the only sign that distinguishes the manifestations of mesenteric infection in COVID-19 infection.

The effectiveness of dry needling on hamstring flexibility: A systematic review

Background: Hamstring injuries are a common problem for athletes, and hamstring tightness has been found to be a contributing factor to these injuries. Dry needling is a growing trend that poses the possibility of increasing flexibility through several mechanisms; however, there is currently no review on all of the studies done concerning the effectiveness of dry needling for improving hamstring flexibility. Purpose: The purpose of this systematic review was to evaluate the effectiveness of dry needling on hamstring flexibility in people with hamstring tightness. Methods: Search terms included dry needling or intramuscular stimulation, flexibility or range of motion or ROM, and hamstring. The databases searched were PubMed, MEDLINE, SPORTDiscus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL.) Results: Ten articles were found from the initial search, and three remained after the removal of duplicates and screening the articles for abstracts and full text. Patients consisted of relatively young individuals with hamstring tightness. All studies used a stretching group for the comparison while interventions consisted of dry needling alone or dry needling with a stretching program. No studies showed a significant difference between dry needling and the control; however, all studies found that flexibility increased from baseline measurements following a dry needling treatment. Discussion: The results indicate that while dry needling may not be a better option than stretching, it could be used as a means for improving hamstring flexibility. Possible factors for the effectiveness of dry needling include increased blood flow and oxygen saturation to the muscle as well as the release of myofascial trigger points. Conclusion: Dry needling was not found to be significantly better than stretching, but poses a possibility as another method for improving hamstring flexibility. KEY WORDS: Hamstrings, Athletes, Flexibility, Tightness, Dry Needling, Stretching.

O006 Early vascular ageing in children with sleep disordered breathing: evidence of vascular hypertrophy and hyperplasia

Children with sleep disordered breathing (SDB) have evidence of increased blood flow velocity and sympathetic overactivity. Sympathetic overactivity leads to peripheral vasoconstriction, increased vascular resistance and consequently, increases blood flow velocity. Early vascular ageing involves premature arterial thickening and stiffening that leads to changes in vascular function. Both increased blood flow velocity and sympathetic overactivity are promoters of arterial remodelling and hence, early vascular ageing. No studies have directly histologically investigated arterial wall structure in children with SDB and how it relates to vascular function. Thirty-six children scheduled for tonsillectomy underwent polysomnography to determine SDB severity and resting brachial artery blood flow velocity (velocity time integral and peak systolic velocity) using Doppler ultrasound. The dorsal lingual artery (tonsil) was stained using hematoxylin and eosin techniques to examine arterial wall structures. Increased velocity time integral correlated with increased arterial medial thickness (r = 0.50, P<0.01), arterial smooth muscle cells (r =0.43, P<0.05) and arterial smooth muscle layers (r=0.45, P<0.01). These relationships remained significant after controlling for body-mass index (BMI). Increased BMI was associated with increased velocity time integral (r=0.61, P<0.01), arterial medial thickness (r=0.37, P<0.05) and arterial medial area (r=0.36, P<0.05). SpO2nadir (TST/REM) was inversely associated with arterial medial area (r=-0.35; r=-0.38, P<0.05). These results demonstrate that increased blood flow velocity is associated with changes in arterial wall composition in children with SDB. This suggests that paediatric SDB, a treatable disorder, is potentially a modifiable risk factor for early vascular ageing and resultant cardiovascular disease in adulthood.

P105 Endocrine, autonomic and vascular function in children with Sleep Disordered Breathing

SDB is a risk factor for cardiovascular disease and co-exists with chronic endocrine disorders such as type II diabetes and metabolic syndrome. Children with SDB have increased blood flow velocity, an indicator of reduced vascular compliance and early vascular aging. Increased blood flow velocity is positively associated with sympathetic activity, increased arterial sympathetic nerve fibre density and endothelial damage. Whether changes in endocrine function occur concomitantly with altered autonomic and vascular function in children with SDB was assessed. Thirty six children scheduled for tonsillectomy underwent overnight polysomnography (SDB severity), pupil light reflex (autonomic function), fasting brachial artery blood flow assessment (vascular function - Doppler Ultrasound). Leptin and Ghrelin - both hormonal markers associated with sympathetic activity were measured in urine using ELISA and serum using MagPlex. The following dimensions of the dorsal lingual artery (tonsil) were measured – medial thickness, medial area, smooth muscle cell number/layers. We observed a positive correlation between serum and urine leptin and ghrelin concentrations. Increased blood flow velocity and arterial medial thickness were both associated with increased serum and urine leptin and ghrelin concentrations. Pupil light reflex was negatively associated with serum leptin and ghrelin levels. OAHI was positively correlated with leptin and ghrelin concentration (urine and serum) but not blood flow velocity. Blood flow velocity was inversely correlated with SpO2 nadir (REM). Our findings suggest that SDB has a global effect on the autonomic, vascular and endocrine systems.The impact of untreated paediatric SDB on the development of comorbidities in later life needs urgent attention.

Cerebral Venous Thrombosis and Persistent Pulsatile Tinnitus After Sigmoid Sinus Resurfacing Surgery

We report a case with rare complication of cerebral venous thrombosis, as well as an incomplete response, after sigmoid sinus resurfacing surgery for pulsatile tinnitus (PT). A 24-year-old female patient with PT originating from the sigmoid sinus underwent sigmoid sinus resurfacing surgery. The tinnitus was immediately resolved, but it recurred with headache 5 days after surgery. A cerebral venous thrombosis was identified and treated, but PT persisted, although its frequency and loudness decreased. Sigmoid sinus resurfacing surgery is a safe and effective method to treat PT, but in some patients, it can cause serious complications and/or persistent tinnitus. In our patient, factors such as changes in blood viscosity due to warfarin intake or increased blood flow due to weight loss may have influenced the persistence of the tinnitus. It is important to identify the various associated factors and the weight of each of these factors to provide more tailored treatment of PT for individual patients in the future and to reduce complications and increase the effectiveness of sigmoid sinus resurfacing surgery.

ASDIN white paper: Management of cephalic arch stenosis endorsed by the American Society of Diagnostic and Interventional Nephrology

Brachiocephalic arteriovenous fistulas (AVF) makeup approximately one third of prevalent dialysis vascular accesses. The most common cause of malfunction with this access is cephalic arch stenosis (CAS). The accepted requirement for treatment of a venous stenosis lesion is ⩾50% stenosis associated with hemodynamically abnormalities. However, the correlation between percentage stenosis and a clinically significant decrease in access blood flow (Qa) is low. The critical parameter is the absolute minimal luminal diameter (MLD) of the lesion. This is the parameter that exerts the key restrictive effect on Qa and results in hemodynamic and functional implications for the access. CAS is the result of low wall shear stress (WSS) resulting from the effects of increased blood flow and the unique anatomical configuration of the CAS. Decrease in WSS has a linear relationship to increased blood flow velocity and neointimal hyperplasia exhibits an inverse relationship with WSS. The result is a stenotic lesion. The presence of downstream venous stenosis causes an inflow-outflow mismatch resulting in increased pressure within the access. Qa in this situation may be decreased, increased, or within a normal range. Over time, the increased intraluminal pressure can result in marked aneurysmal changes within the AVF, difficulties with cannulation and the dialysis treatment, and ultimately, increasing risk of access thrombosis. Complete characterization of the lesion both hemodynamically and anatomically should be the first step in developing a strategy for management. This requires both access flow measurement and angiographic imaging. Patients with CAS present a relatively broad spectrum as relates to both of these parameters. These data should be used to determine whether primary treatment of CAS should be directed toward the anatomical lesion (small MLD and low Qa) or the pathophysiology (large MLD and high Qa).

Hypoxia Inducible Factors as Central Players in the Pathogenesis and Pathophysiology of Cardiovascular Diseases

Cardiovascular (CV) diseases are the major cause of death in industrialized countries. The main function of the CV system is to deliver nutrients and oxygen to all tissues. During most CV pathologies, oxygen and nutrient delivery is decreased or completely halted. Several mechanisms, including increased oxygen transport and delivery, as well as increased blood flow are triggered to compensate for the hypoxic state. If the compensatory mechanisms fail to sufficiently correct the hypoxia, irreversible damage can occur. Thus, hypoxia plays a central role in the pathogenesis and pathophysiology of CV diseases. Hypoxia inducible factors (HIFs) orchestrate the gene transcription for hundreds of proteins involved in erythropoiesis, glucose transport, angiogenesis, glycolytic metabolism, reactive oxygen species (ROS) handling, cell proliferation and survival, among others. The overall regulation of the expression of HIF-dependent genes depends on the severity, duration, and location of hypoxia. In the present review, common CV diseases were selected to illustrate that HIFs, and proteins derived directly or indirectly from their stabilization and activation, are related to the development and perpetuation of hypoxia in these pathologies. We further classify CV diseases into acute and chronic hypoxic states to better understand the temporal relevance of HIFs in the pathogenesis, disease progression and clinical outcomes of these diseases. We conclude that HIFs and their derived factors are fundamental in the genesis and progression of CV diseases. Understanding these mechanisms will lead to more effective treatment strategies leading to reduced morbidity and mortality.

An imaging approach for determining the mechanism of enhancement of intestinal absorption of an L-theanine supplement

Background & objective Theanine (L-glutamylethylamide) contained in green tea is a functional food component that has been attracting attention due to its relaxation effect. It was shown that the ingredients added to the theanine formulations increased the absorption of theanine. If this mechanism can be elucidated, it would be possible to contribute to development of evidence-based formulations. In this study, we investigated the effect of ingredients in the formulations on the absorption of theanine in detail. Main methods After oral administration of a mixture of theanine and additional components to Wistar rats the plasma concentration was determined by an HPLC and the pharmacokinetic parameters were calculated. In addition, a new system for evaluating intestinal blood flow was developed since the involvement of intestinal blood flow was considered as a factor that increased absorption of theanine. Key findings Plasma concentration of theanine increased significantly in the combined use group with eight ingredients containing piperine as compared with theanine only group. Piperine would increase theanine absorption by increased blood flow, not an inhibition of metabolism. We succeeded to develop a visual and quantitative system to evaluate the effect of these ingredients directly including piperine on the intestinal blood flow using indocyanine green while maintaining physiological conditions. Significance Increased intestinal blood flow by these ingredients including piperine enhanced the absorption of theanine. Other mechanisms may also be considered as the mechanism by which theanine absorption is increased in addition to increased blood flow.

Vascular Perfusion of the Preovulatory Follicle and its Relationship in Pregnancy Establishment during Natural and Induced Estrus in Buffaloes

Background: In buffaloes, little attention has been devoted on the haemodynamics of preovulatory follicle (POF) and serum estradiol profiles and their relationship with conception rate following AI at natural and induced estrus. Methods: Sixty healthy pleuriparous graded Murrah buffaloes were selected and divided into two groups, viz., Group I and II. Group I buffaloes were artificially inseminated twice at an interval of 24 hours during natural estrus. Estrus induction was done using PIVD and PGF2α in group II buffaloes and AI was performed 48 h and 72 h after the withdrawal of PIVD. The blood flow of the preovulatory follicle (POF) and early pregnancy were assessed in both the groups by Doppler ultrasonography.Result: On statistical analysis, the mean (± SE) of spectral indices revealed there was an increased blood flow to the POF during induced estrus (Group II) when compared to natural estrus (Group I). The conception rate observed was 66.67 and 58.33 per cent in group I and II, respectively. It is concluded that increased vascular perfusion to POF resulted in almost similar conception rates in induced and natural estrus following AI in buffaloes.

Case Report: Intrapulmonary Arteriovenous Anastomoses in COVID-19-Related Pulmonary Vascular Changes: A New Player in the Arena?

Up to now, COVID-19-related vascular changes were mainly described as thrombo-embolic events. A handful of researchers reported another type of vascular abnormality referred to as “vascular thickening” or “vascular enlargement,” without specifying whether the dilated vessels are arteries or veins nor providing a physiopathological hypothesis. Our observations indicate that the vascular dilatation occurs in the venous compartment, and underlying mechanisms might include increased blood flow due to inflammation and the activation of arteriovenous anastomoses.