An Exploratory Study on the Relationship between Brachial Arterial Blood Flow and Cardiac Output

Background. We have obtained prospective clinical outcomes using the brachial artery largely, such as Korotkoff sound and vasomotor function measurement by ultrasound guidance to predict the prognosis of cardiovascular diseases. Very few reports on the quantitative measurement of the relationship between the brachial artery blood flow and cardiac output have been reported. Purpose. (1) To investigate whether the quantitative relationship between the brachial artery blood flow and cardiac output existed. (2) To provide a theoretical basis for taking advantage of artificial intelligence (AI) using Korotkoff sound analogously as far as possible to predict the cardiac output. Methods. A total of 586 patients who underwent cardiac color ultrasound in our center from 2021.3 to 2021.7 were included for analyses. The vascular parameters of the right upper limb brachial artery (such as the Diameter, Area, Blood Velocity, and Flow) were measured immediately after the cardiac color ultrasound, and some basic clinical parameters (Age, Sex, BMI, and Disease) were recorded subsequently. Ultimately, the Mann–Whitney and independent sample T-test were used to analyze the data. Results. (1) The mean Rate of the brachial arterial blood flow to cardiac output was 1.23%, and the mean 95% CI was (1.18%, 1.29%), indicating that the value was mainly concentrated in the current value interval. The indicator demonstrates that there is no significant difference currently among the patients with hypertension, coronary heart disease, and cardiac dysfunction. (2) The brachial artery wall diameter (Dist) is significantly thicker in patients with coronary heart disease and hypertension compared to patients with other cardiovascular diseases. (3) Cardiac output augments remarkably in patients with hypertension. Conclusion. Our study suggests that the Rate (brachial artery blood flow/cardiac output) is a constant of 1.23% approximately. It provides a theoretical basis for the subsequent application of the artificial intelligence (AI) method to predict heart function using Korotkoff sound, cope with large computational amounts, and improve computational speed. It is also indirectly proved that hypertension can lead to a change in peripheral vascular hyperplasia and increase cardiac output.

Putting the Squeeze on Compression Garments: Current Evidence and Recommendations for Future Research: A Systematic Scoping Review

Background Compression garments are regularly worn during exercise to improve physical performance, mitigate fatigue responses, and enhance recovery. However, evidence for their efficacy is varied and the methodological approaches and outcome measures used within the scientific literature are diverse. Objectives The aim of this scoping review is to provide a comprehensive overview of the effects of compression garments on commonly assessed outcome measures in response to exercise, including: performance, biomechanical, neuromuscular, cardiovascular, cardiorespiratory, muscle damage, thermoregulatory, and perceptual responses. Methods A systematic search of electronic databases (PubMed, SPORTDiscus, Web of Science and CINAHL Complete) was performed from the earliest record to 27 December, 2020. Results In total, 183 studies were identified for qualitative analysis with the following breakdown: performance and muscle function outcomes: 115 studies (63%), biomechanical and neuromuscular: 59 (32%), blood and saliva markers: 85 (46%), cardiovascular: 76 (42%), cardiorespiratory: 39 (21%), thermoregulatory: 19 (10%) and perceptual: 98 (54%). Approximately 85% (n = 156) of studies were published between 2010 and 2020. Conclusions Evidence is equivocal as to whether garments improve physical performance, with little evidence supporting improvements in kinetic or kinematic outcomes. Compression likely reduces muscle oscillatory properties and has a positive effect on sensorimotor systems. Findings suggest potential increases in arterial blood flow; however, it is unlikely that compression garments meaningfully change metabolic responses, blood pressure, heart rate, and cardiorespiratory measures. Compression garments increase localised skin temperature and may reduce perceptions of muscle soreness and pain following exercise; however, rating of perceived exertion during exercise is likely unchanged. It is unlikely that compression garments negatively influence exercise-related outcomes. Future research should assess wearer belief in compression garments, report pressure ranges at multiple sites as well as garment material, and finally examine individual responses and varying compression coverage areas.

Alteration of Relative Rates of Biodegradation and Regeneration of Cervical Spine Cartilage through the Restoration of Arterial Blood Flow Access to Rhomboid Fossa: A Hypothesis

We found the logical way to prove the existence of the mechanism that maintains the rates of biodegradation and regeneration of cervical spine cartilage. We demonstrate, that after we restore access to arterial blood flow through cervical vertebral arteries to rhomboid fossa it causes the prevalence of regeneration over biodegradation. This is in the frames of consideration of the human body as a dissipative structure. Then the recovery of the body should be considered as a reduction of the relative rates of decay below the regeneration ones. Then the recovery of cervical spine cartilage through redirecting of inner dissipative flow depends on the information about oxygen availability that is provided from oxygen detectors in the rhomboid fossa to the cerebellum. Our proposed approach explains already collected data, which satisfies all the scientific requirements. This allows us to draw conclusions that permit reconsidering the way of dealing with multiple chronic diseases.

Effect of increased positive end-expiratory pressure on intracranial pressure and cerebral oxygenation: impact of respiratory mechanics and hypovolemia

Background To evaluate the impact of positive end-expiratory pressure (PEEP) on intracranial pressure (ICP) in animals with different respiratory mechanics, baseline ICP and volume status. Methods A total of 50 male adult Bama miniature pigs were involved in four different protocols (n = 20, 12, 12, and 6, respectively). Under the monitoring of ICP, brain tissue oxygen tension and hemodynamical parameters, PEEP was applied in increments of 5 cm H2O from 5 to 25 cm H2O. Measurements were taken in pigs with normal ICP and normovolemia (Series I), or with intracranial hypertension (via inflating intracranial balloon catheter) and normovolemia (Series II), or with intracranial hypertension and hypovolemia (via exsanguination) (Series III). Pigs randomized to the control group received only hydrochloride instillation while the intervention group received additional chest wall strapping. Common carotid arterial blood flow before and after exsanguination at each PEEP level was measured in pigs with intracranial hypertension and chest wall strapping (Series IV). Results ICP was elevated by increased PEEP in both normal ICP and intracranial hypertension conditions in animals with normal blood volume, while resulted in decreased ICP with PEEP increments in animals with hypovolemia. Increasing PEEP resulted in a decrease in brain tissue oxygen tension in both normovolemic and hypovolemic conditions. The impacts of PEEP on hemodynamical parameters, ICP and brain tissue oxygen tension became more evident with increased chest wall elastance. Compare to normovolemic condition, common carotid arterial blood flow was further lowered when PEEP was raised in the condition of hypovolemia. Conclusions The impacts of PEEP on ICP and cerebral oxygenation are determined by both volume status and respiratory mechanics. Potential conditions that may increase chest wall elastance should also be ruled out to avoid the deleterious effects of PEEP.

Improving the Algorithm for the Management of Patients with Viral Hepatitis Using Contrast-Free Hepatic Arterial Spin Labelling Magnetic Resonance Perfusion

Objective: improving the algorithm for the management of patients with viral hepatitis using contrast-free arterial spin labelling (ASL) magnetic resonance (MR) perfusion.Material and methods. A total of 116 patients with viral hepatitis (VH) B, C and B + C were examined on the basis of Clinical hospital No. 1 (Smolensk): 75 (64.7%) men and 41 (35.3%) women, mean age 49.7 ± 2.3 years. The patients underwent instrumental diagnostic methods: ultrasound, clinical elastography, contrast-free hepatic ASL MR perfusion. Liver biopsy (n = 57) was used as the reference method.Results. The results of ASL MR perfusion had a high correlation with the data of clinical elastography in the diagnosis of fibrotic process; the diagnostic and prognostic significance of ASL liver perfusion in the diagnosis of fibrotic process was: AUROC 0.943 (95% CI, 0.884–0.953). There was a high correlation between ASL MR perfusion with Doppler ultrasound of hepatic blood vessels in the diagnosis of arterial blood flow disorders, but in VH В + C and cirrhosis – diagnostic and prognostic significance of the method: AUROC 0.951 (95% CI 0.932–0.972).Conclusion. ASL MR perfusion in VH patients allows to predict fibrotic changes in the hepatic parenchyma (AUROC 0.934 (95% CI 0.845–0.957)), provides information about changes in blood flow in the parenchymal structure (p < 0.005). The algorithm for the examination of VH patients should include contrast-free ASL MR perfusion at admission (AUROC 0.865 (95% CI 0.843–0.928)) and in dynamic follow-up (AUROC 0.915 (95% CI 0.881–0.946)).

Pioglitazone Ameliorates Acute Endotoxemia-Induced Acute on Chronic Renal Dysfunction in Cirrhotic Ascitic Rats

Endotoxemia-activated tumor necrosis factor (TNFα)/nuclear factor kappa B (NFκB) signals result in acute on chronic inflammation-driven renal dysfunction in advanced cirrhosis. Systemic activation of peroxisome proliferator-activated receptor gamma (PPARγ) with pioglitazone can suppress inflammation-related splanchnic and pulmonary dysfunction in cirrhosis. This study explored the mechanism and effects of pioglitazone treatment on the abovementioned renal dysfunction in cirrhotic rats. Cirrhotic ascitic rats were induced with renal dysfunction by bile duct ligation (BDL). Then, 2 weeks of pioglitazone treatment (Pio, PPAR gamma agonist, 12 mg/kg/day, using the azert osmotic pump) was administered from the 6th week after BDL. Additionally, acute lipopolysaccharide (LPS, Escherichia coli 0111:B4; Sigma, 0.1 mg/kg b.w, i.p. dissolved in NaCl 0.9%) was used to induce acute renal dysfunction. Subsequently, various circulating, renal arterial and renal tissue pathogenic markers were measured. Cirrhotic BDL rats are characterized by decreased mean arterial pressure, increased cardiac output and portal venous pressure, reduced renal arterial blood flow (RABF), increased renal vascular resistance (RVR), increased relative renal weight/hydroxyproline, downregulated renal PPARγ expression, upregulated renal inflammatory markers (TNFα, NFκB, IL-6, MCP-1), increased adhesion molecules (VCAM-1 and ICAM-1), increased renal macrophages (M1, CD68), and progressive renal dysfunction (increasing serum and urinary levels of renal injury markers (lipocalin-2 and IL-18)). In particular, acute LPS administration induces acute on chronic renal dysfunction (increasing serum BUN/creatinine, increasing RVR and decreasing RABF) by increased TNFα-NFκB-mediated renal inflammatory markers as well as renal M1 macrophage infiltration. In comparison with the BDL+LPS group, chronic pioglitazone pre-treatment prevented LPS-induced renal pathogenic changes in the BDL-Pio+LPS group. Activation of systemic, renal vessel and renal tissue levels of PPARγ by chronic pioglitazone treatment has beneficial effects on the endotoxemia-related TNFα/NFκB-mediated acute and chronic renal inflammation in cirrhosis. This study revealed that normalization of renal and renal arterial levels of PPARγ effectively prevented LPS-induced acute and chronic renal dysfunction in cirrhotic ascitic rats.

FORMATION OF OUTFLOW PATHWAYS IN PATIENTS WITH COMBINED STENOTIC-OCCLUSIVE LESIONS OF THE FEMORAL AND TIBIAL ARTERIAL SEGMENTS

The aim of the study. To prevent the development of postoperative thrombosis of the reconstruction segment after endovascular and hybrid revascularization of the femoral-distal arterial portion in the conditions of stenotic-occlusive process of the tibial arteries by forming functionally capable pathways in the tibial segment. Materials and methods. The results of treatment 135 patients with atherosclerotic occlusive-stenotic lesions of the infrainguinal arterial segment of the lower extremities were analyzed. According to the severity violation of chronic arterial insufficiency of the lower extremities, grade IIB was detected in 50 (37.04%) patients, grade III - in 63 (46.66%) examinee, grade IV- in 22 (16.30%) examinee. Patients were divided into 2 groups. Group I included 61 (45.19%) patients with occlusal-stenotic lesions at the level of the infrainguinal segment, who underwent only endovascular correction of the peripheral arterial portion, the second group consisted of 74 (54.81%) patients with multilevel occlusive-stenotic lesions of the infrainguinal arterial segment which was performed hybrid arterial reconstruction. Results and discussion. The proposed tactic involves endovascular angioplasty of at least two tibial arteries. During revascularization of 135 patients by endovascular (61 supervision) and hybrid (74 supervision) methods of a femoral-distal arterial blood flow under conditions of arterial sclerotic disease of tibial arteries carried out in 115 (85,18%) patients endovascular dilatation of two arteries. Thrombosis of the reconstruction segment in the postoperative period was finding in 9 (6.67%) cases: when using endovascular and hybrid revascularization methods, respectively - in 4 (6.56%) and 5 (6.76%) cases. Thrombosis of the reconstruction segment in the early postoperative period in 8 cases developed after endovascular angioplasty of one of the tibial arteries and only in 1 observation after endovascular angioplasty of 2 tibial arteries. Conclusion. Reconstruction of outflow pathways at the tibial arterial segment with occlusive-stenotic lesions of the infranguinal arterial portion during endovascular and hybrid techniques of revascularization by performing angioplasty of the two tibial arteries of the tibia can provide a positive result of revascularization in the early postoperative period, respectively in 95.08% and 95.95% of cases.

The potential of duplex scanning in the diagnosis of pathological tortuosity of the vertebral artery

Aim. To assess the capabilities of duplex scanning and study the features of hemodynamics in the vertebral arteries before and after surgical treatment.Material and methods. The results of anatomical and circulatory characteristics of an extracranial segment of the vertebral arteries in 52 patients with various forms of pathological tortuosity were analyzed. Kinking was present in 38 patients, coiling in 8 patients, and Powers anomaly in 6 patients. There were 18 men and 34 women. The mean age of the patients was 45.6±8.7 years.Results and discussion. In all types of PT of VA with ostium stenosis, the diameter of the artery was decreased, and based on tortuosity it contributed both to the reduction and deterioration of arterial blood flow to the vertebrobasilar basin. The decrease or increase in the linear velocity of blood flow, as well as other blood flow parameters, depended on both the type of pathological tortuosity of the PA and on the vessel diameter and the value of angulation. Hypoplasia of the opposite vertebral artery also occurred in 28 patients, which resulted in impaired blood supply to the brain.Vascular examination after reconstructive surgeries resulted in normalization of the parameters of arterial circulation and cerebral perfusion. Primary vascular patency was 96.2%, restenosis was not revealed in any observation.Conclusion. Duplex scanning is a highly informative technique for both diagnosing pathological deformities of the vertebral arteries and assessing the restoration of the hemodynamics of the vertebrobasilar system after reconstructive surgery. This method provides the most accurate information on the anatomical form and localization of pathological deformities of the vertebral artery. It also allows quantitative assessment of cerebral blood flow.