Diagnostic value and clinical significance of serum miR-134-5p combined with uterine artery color Doppler ultrasound parameters in endometriosis.

OBJECTIVE: To exploit the combination diagnostic performance of serum microRNA-134-5p (miR-134-5p) and color Doppler ultrasound in patients with endometriosis patients. METHODS: Quantitative real time polymerase chain reaction (qRT-PCR) analysis was applied to measure relative abundance of miR-134-5p in serum of patients with endometriosis and gynecological benign diseases. Calculation of uterine artery blood flow parameters was conducted using Color Doppler ultrasound. Receiver operating characteristic (ROC) curve was established to evaluate the diagnostic capacity of miR-134-5p and Doppler parameters. Kaplan-Meier method was used for the analysis of recurrence-free survival rate. RESULTS: Compared with the control group, serum miR-134-5p expression was remarkably diminished in endometriosis patients (P < 0.001). End-diastolic velocity (EDV) and peak systolic velocity (PSV) were notably decreased in endometriosis patients compared with the control group (P < 0.001), while pulsatility index (PI) and resistance index (RI) were distinctly increased (P < 0.001). Serum miR-134-5p expression was positively correlated with EDV (r = 0.5777, P < 0.0001) and PSV (r = 0.6945, P < 0.0001), but negatively correlated with PI (r=-0.6382, P < 0.0001) and RI (r=-0.6247, P < 0.0001). The area under the ROC curve (AUC) of serum miR-134-5p combined with Doppler parameters was 0.905, with the sensitivity of 87.40%, and the specificity of 82.29%. The recurrence-free survival time was shorter in patients with low miR-134-5p expression than those with high miR-134-5p expression (P = 0.013). CONCLUSION: A better diagnostic value of endometriosis detection could be obtained when serum miR-134-5p was combined with Doppler parameters.

Association between cerebral blood flow variation and cognitive decline in older patients undergoing hemodialysis.

Background: The mechanism of cognitive impairment in hemodialysis patients is multifactorial. The relationship between cerebral blood flow and the decline of cognitive function is poorly understood. Objective: To investigate the association between cerebral blood flow variation and decline of cognitive function in older patients undergoing hemodialysis. Methods: In this prospective observational cohort study of 121 older patients undergoing hemodialysis, we used transcranial Doppler ultrasound (TCD) to measure cerebral arterial mean flow velocity (MFV) throughout dialysis, assessed cognitive function at baseline and 12-month follow-up, and then analyzed associations between MFV and changes on cognitive scores. Results: TCD recordings demonstrated a significant reduction in MFV throughout dialysis, which were significantly correlated with cumulative ultrafiltration volume (rho 0.356, p < 0.001), ΔSBP (rho 0.251, p = 0.005), and ΔMAP (rho 0.194, p = 0.032). Compared with the baseline assessments, cognitive scores of participants at the 12-month follow-up were significantly worsened in global cognition (MOCA), some tests of memory (CFT-memory), executive function (TMT-B, SCWT-C, and SCWT-T), attention/processing speed (SDMT), and visuospatial function (CFT-copy) (p < 0.05). The worsening scores in global cognition (MOCA) (ß = 0.066, 95% CI 0.018-0.113, p = 0.007) and some tests of memory (AVLT5) (ß = 0.050, 95% CI 0.004-0.097, p = 0.035) and executive function (TMT-B, SCWT-C, SCWT-T) (ß = 1.955, 95% CI 0.457-3.453, p = 0.011; ß = 0.298, 95% CI 0.112-0.484, p = 0.002 and ß = 1.371, 95% CI 0.429-2.303, p = 0.004, respectively) were significantly associated with the reduction of MFV. Conclusion: Hemodialysis may significantly reduce cerebral blood flow in older patients; Repetitive intradialytic decreases in CBF may be one of the mechanisms underlying the decline of cognitive function. Clinical trial registration: https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000C5B5&selectaction=Edit&uid=U0003QEL&ts=4&cx=-djoi2.

Low incidence of deep vein thrombosis in critically ill medical patients in Thais: a prospective study.

Background: Critically ill medical patients face a heightened risk of developing venous thromboembolism. In Thailand, routine thromboprophylaxis is not employed. The incidence of deep vein thrombosis (DVT) in the medical intensive care unit (ICU) has not been elucidated in the Thai population. Objectives: The aims were to evaluate the incidence of DVT and identify associated risk factors in critically ill medical patients. Methods: A single-center, prospective cohort study was conducted from 2019 to 2020. Consecutive patients underwent screening for proximal DVT by duplex ultrasound of both legs. Results: A total of 200 patients were enrolled, with 115 being male (57%). The mean (SD) age was 66.5 (16.4) years. The mean (SD) Acute Physiology and Chronic Health Evaluation II score was 27 (8). The cumulative incidence of DVT over 5 days was 7% (95% CI, 3.4%-10.6%). No clinically or radiologically diagnosed pulmonary embolism occurred in patients with DVT. No independent risk factor associated with DVT was identified. Hospital mortality in those with and those without DVT was 42.9% and 32.3%, respectively. There was no significant difference in the length of ICU or hospital stay or inpatient mortality between those with and those without DVT. Conclusion: Without thromboprophylaxis, the incidence of DVT in the Thai population remains low. A strategy of screening ultrasound 5 to 7 days after admission to the ICU may be a suitable alternative to anticoagulant prophylaxis in critically ill Thai patients without symptoms of venous thromboembolism.

Impact of Sonographer Experience, Insonation Angle, and Bladder Filling on Uterine Artery Doppler Measurements in the First Trimester of Pregnancy.

OBJECTIVE: To investigate the influence of different measurement conditions and ultrasound training level on uterine artery pulsatility index (UtA-PI) measurements as required for combined first trimester preeclampsia (PE) screening. METHODS: This was a prospective study of consecutive patients with singleton pregnancies presenting for an ultrasound examination between 11 and 14 weeks' gestation. UtA-PI measurements were conducted by residents in training and repeated by experienced sonographers thereafter. UtA-PI measurements were conducted under different examination conditions. First, the trainee sonographers performed transabdominal sagittal and transverse UtA-PI measurements without bladder filling. These measurements were then repeated by the expert sonographers. Additionally, the expert sonographers also performed transvaginal UtA-PI measurements and transabdominal measurements with bladder filling. Statistical analysis was conducted with the statistical software R and included descriptive statistics as well as 2-sided paired t tests. RESULTS: A total of 100 women were included in the study. Mean age was 31.7 ± 4.92 years and mean gestational week was 12.5 ± 0.53 weeks. A total of 56% were nulliparous and 44% were parous. UtA-PI was significantly lower if performed by a sonographer in training versus an experienced sonographer (P = .031). No significant difference was observed in comparing transverse and sagittal techniques (P = .241). There was also no significant difference in transabominal versus transvaginal measurements (P = .806) and with an empty versus full bladder (P = .444). CONCLUSION: Experience of sonographer has a significant impact on UtA-PI. Supervised onsite training is necessary to improve reliability and consistency of UtA-PI measurements and make PE screening reliable for implementation in a universal screening setting.

The effect of flunixin meglumine on the premature regression of corpus luteum, recovery rate, and embryo production in superovulated Dorper ewes.

This study evaluated the use of flunixin meglumine to prevent the occurrence of premature corpus luteum (CL) regression in superovulated ewes, improving embryo recovery and viability. Ewes (n=23) submitted to conventional superovulatory protocol and laparoscopic artificial insemination were treated with 2.2 mg/kg/day of flunixin meglumine (FLU, n=12) or 1.5 mL saline solution (CONT, n=11) on Days 2, 3, and 4 (Day 0 = 48 h after device removal). Serum progesterone (P4) concentrations were measured (Day 1-6). Ultrasound (US, Days 3 and 6) and laparoscopic evaluation (Day 6) were performed to identify luteinized structures. In the US, laparoscopy, and P4 assessments, the percentage of ewes with premature CL regression differed (P<0.05) between CONT (54.5; 63.6; and 54.5 %) and FLU (0.0; 0.0; and 0.0 %), respectively. The US exams revealed the effect (P<0.05) of treatment on the number of regressing CL between CONT (1.4 ± 0.6) and FLU (0.0 ± 0.0). Greater (P<0.05) number of normal CLs (10.5 ± 1.8 vs. 4.4 ± 1.5), ova/embryos (9.1 ± 2.1 vs. 3.7 ± 1.3), viable embryos (5.1 ± 1.1 vs. 2.6 ± 1.2), and recovery rate (79.5 ± 9.6 vs. 41.3 ± 15.0 %) were observed in FLU compared to CONT, respectively. The embryo viability rate did not differ (P>0.05) between FLU (60.7 ± 10.5 %) and CONT (45.5 ± 16.1 %). In conclusion, the flunixin meglumine protocol was able to prevent the occurrence of premature CL regression in superovulated ewes, increasing the recovery rate and embryo production.

[Stenotic FAV: Success of the Collaboration Between Spoke and HUB].

The arteriovenous fistula constitutes the vascular access of first choice in hemodialysis. We present three clinical cases that highlight the resolution in interventional radiology of venous stenosis, one of the major complications. Clinical monitoring and instrumental diagnostics with color Doppler ultrasound have prevented the failure of the AVF due to high risk of thrombosis. The angiographic interventions, thanks to the collaboration between Spoke and Hub, were completed without complications.

Diagnostic value and efficacy evaluation value of transvaginal color doppler ultrasound parameters for uterine scar pregnancy and sub-type after cesarean section.

OBJECTIVE: We aimed to probe the diagnostic value of transvaginal color Doppler ultrasound (TV-CDU) parameters in cesarean scar pregnancy (CSP) and CSP sub-types, and the relevant factors affecting patients' surgical effects. METHODS: Seventy-five CSP patients (all requested termination of pregnancy) were selected as the observation group, and 75 normal pregnant women with a history of cesarean section were selected as the control group. All the study subjects underwent TV-CDU and their cesarean scar muscle (CSM) thickness, minimum sagittal muscle thickness and resistance index (RI) of blood flow in the anterior wall of the lower uterine segment were calculated. The diagnostic value of CSM, minimum sagittal muscle thickness, and RI for CSP and CSP sub-types was analyzed. The patients in the observation group were grouped into the effective group and the ineffective group according to whether the surgical treatment was effective or not, and the independent factors affecting CSP efficacy were analyzed. RESULTS: The observation group had lower CSM, minimum sagittal muscle thickness and RI than the control group. CSM, RI, and minimum sagittal thickness in patients with type II CSP were lower than those in patients with type I, and these indicators in patients with type III were lower than those in patients with type II. The area under the curve (AUC) of CSM, RI and minimum sagittal muscle thickness in combination for CSP diagnosis and the AUC for CSP sub-types were higher than those of each indicator alone. Gestational sac size and CSM were independent factors affecting CSP treatment. CONCLUSION: Changes in TV-CDU parameters facilitates CSP diagnosis after cesarean section. CSM, minimum sagittal muscle thickness changes, and RI in combination possesses high value for CSP diagnosis and CSP sub-types. Gestational sac size and CSM are independent factors affecting CSP treatment.

Absolute Stenosis Measures of Renal Artery Independently Influence Kidney Perfusion in Contrast-Enhanced Multidetector Computed Tomography.

Background: A renal artery lumen reduction of ≥60% indicates hemodynamically significant stenosis and is one of the main criteria for invasive revascularization. We hypothesize that direct parameters describing renal artery stenosis (RAS) could better correlate with renal blood flow and improve the criterion for revascularization. This study aimed to investigate RAS parameters independently associated with renal blood flow estimated in contrast-enhanced multidetector computed tomography (CE-MDCT). Methods: Ultrasound Doppler dynamic renal cortical perfusion (dRCP), CE-MDCT with cortical blood flow (CBF), and RAS assessment in the form of cross-sectional area reduction (CSAR), maximal diameter reduction (MaxDR), mean diameter (MeD), and minimal diameter (MinD) were investigated. Results: CBF correlated with CSAR (r = -0.422, p = 0.003), MeD (r = 0.344, p = 0.005) and MinD (r = 0.348, p= 0.005), whereas RCP correlated only with MeD (r = 0.357, p = 0.005) and MinD (r = 0.427, p< 0.001). In multivariable regression, only MeD was independently associated with CBF (R2 = 0.179; p < 0.001), and MeD < 3.5 mm substantially indicated CBF < 175 mL/100 g/min in ROC analysis. Conclusions: The directly measured mean diameter of RAS is independently associated with renal cortex blood flow and is probably a more appropriate parameter for the invasive RAS treatment criterion.

Subendometrial blood flow detected by Doppler ultrasound associates with pregnancy outcomes of frozen embryo transfer in patients with thin endometrium.

PURPOSE: Multiple factors have been shown to influence the rate of clinical pregnancy after FET in IVF treatment, including embryo quality, synchronization of embryo and endometrium, and endometrial receptivity (ER). The subendometrial blood flow conditions could also contribute potentially major effects toward the establishment and maintenance of pregnancy. We conducted a retrospective cohort study to examine the correlation between subendometrial blood flow, as determined by Doppler ultrasound, and pregnancy outcomes in IVF patients with a thin endometrium (endometrium thickness [EMT] ≤ 0.7 cm). METHODS: This was a retrospective cohort study conducted at a university-affiliated reproductive hospital from January 2017 to April 2023. The EMT and subendometrial blood flows were assessed using transvaginal color Doppler ultrasound and evaluated by experienced clinical ultrasound physicians on the endometrial transformation day. The pregnancy outcomes were followed up and documented in clinical medical records through the IVF cohort study at our center. RESULTS: In the patients with 0.5 cm ≤ EMT ≤ 0.7 cm, the embryo implantation rate was statistically significant increased in the patients with the presence of subendometrial blood flow (OR 1.484; 95% CI, 1.001-2.200; P = 0.049; aOR 1.425; 95% CI, 1.030-2.123; P = 0.003). Patients with discernible subendometrial blood flow have superior live birth (P = 0.028), clinical pregnancy (P = 0.049), and embryo implantation (P = 0.027) compared to the patients without subendometrial blood flow when the EMT is ≤ 0.7 cm. CONCLUSIONS: The presence of subendometrial blood flow detected by ultrasound was positively associated with successful embryo implantation and favorable pregnancy outcomes in patients with thin endometrium undergoing FET.

Evaluation of the ability of laboratory, ultrasonography, and Doppler ultrasonography findings to distinguish between simple and complicated appendicitis.

OBJECTIVE: To evaluate the utility of laboratory ultrasonographic and Doppler ultrasonographic findings in the differentiation of simple and complicated appendicitis. METHODS: A prospective study was conducted, including pediatric patients who underwent surgery with the diagnosis of appendicitis. RESULTS: Fifty patients, who were found to have appendicitis on ultrasonographic examination, were included. The mean age was found to be 12.80 ± 3.67 years, with 30% female and 70% male. The patients were histopathologically divided into two groups: simple appendicitis (Group 1, 41 patients, 82%) and complicated appendicitis (Group 2, 9 patients, 18%). CRP (C-reactive protein) levels (p = 0.004) and periappendiceal fatty tissue thickness (PFI) (p < 0.005) were found to be statistically significantly higher in Group 2 compared to Group 1. The portal vein (PV) diameter and peak systolic velocity (PSV) values were significantly higher in the study group compared to the control group (p = 0.033, p = 0.001). CONCLUSION: Doppler ultrasonographic examination did not significantly differentiate complicated from simple appendicitis. The CRP value is an independent risk factor in the diagnosis of complicated appendicitis, and the presence of a significant increase in mesenteric tissue thickness is one of the important criteria for differentiating complicated appendicitis from simple appendicitis.

Efficacy of color Doppler ultrasound signs combined with serum tumor-specific growth factor in the diagnosis of differentiated thyroid cancer.

OBJECTIVE: To construct a diagnostic model for follicular thyroid carcinoma (FTC) and papillary thyroid carcinoma (PTC), both subtypes of differentiated thyroid carcinoma (DTC), using color Doppler ultrasound signs in conjunction with serum laboratory markers. METHODS: We conducted a retrospective analysis of patients with thyroid nodules who underwent ultrasonography at Yulin Hospital from February 2021 to March 2023. The cohort included 269 subjects: 105 with benign nodules and 164 with DTC (59 with FTC and 105 with PTC). We compared baseline demographics and laboratory indices between the groups. Diagnostic values of ultrasound features and laboratory markers were assessed using receiver operating characteristic (ROC) curves, and logistic regression was employed to pinpoint independent diagnostic factors for FTC. A predictive nomogram was subsequently developed based on these factors. RESULTS: There were significant differences between the benign and malignant groups regarding ultrasound signs (including border, morphology, echogenicity, calcification, blood flow, lymph node zoning) and laboratory indices (free triiodothyronine (FT3), free thyroxine (FT4), thyroglobulin (Tg), thyroid-stimulating hormone (TSH), vascular endothelial growth factor (VEGF), tumor-specific growth factor (TSGF)), with all P-values <0.05. The areas under the curve (AUCs) for FT3, FT4, Tg, TSH, VEGF, and TSGF were all above 0.75, with Tg achieving the highest at 0.91. Logistic regression identified borders, morphology, echogenicity, VEGF, and TSGF as independent diagnostic factors for distinguishing between FTC and PTC, with significant P-values. The constructed nomogram demonstrated an AUC of 0.853, indicating high diagnostic accuracy. Both calibration and decision curve analysis (DCA) validated the model's stability and clinical utility. CONCLUSION: We successfully developed a nomogram combining ultrasound features and serum markers that enhances the diagnostic precision for FTC. This model offers a valuable tool for clinical diagnostics in differentiated thyroid cancer.

Cerebrovascular hemodynamics association with brain structure and function in Multiple Sclerosis.

BACKGROUND: Vascular risk factors seem to contribute to disease progression in Multiple Sclerosis (MS), but the mechanistic connection between vascular risk and MS is unknown. Understanding cerebrovascular hemodynamics (CVH) in MS may help advance our understanding of the link between vascular risk and MS. OBJECTIVES: Examine the relationship between CVH [dynamic cerebral autoregulation (dCA) and vasoreactivity (VR)] and brain structure (MRI) and function (cognition, and gait) in individuals with MS. METHODS: Transcranial Doppler ultrasound (TCD) was utilized to assess two key markers of CVH: dCA and VR. dCA (reported as phase and gain) is calculated from the spontaneous blood pressure and flow velocity oscillations. VR is calculated as the slope of change in cerebral blood flow velocity in response to end-tidal CO2. Global gray matter (GM), white matter (WM), WM hyperintensity (WMH) volumes and WM lesion counts were measured from brain MRI. All participants underwent detailed cognitive and gait assessments. RESULTS: Eighty participants were included (age 44 ± 11, 26 % male); 75 had relapsing-remitting MS (94 %), with disease duration of 8 (11) years [median (IQR)] since MS diagnosis and an Expanded Disability Status Scale (EDSS) of 2.0 (4.0). Higher phase (better dCA) was associated with greater GM volume, lower WHM burden and higher cognitive scores in the memory and global cognitive domains (all P values <0.05). There was no relationship between CVH and gait speed in our study participants. There was no relationship between VR and any measures of brain structure and function. CONCLUSIONS: More efficient cerebral autoregulation is associated with better brain structure (larger GM and lower WMH volumes) and function (cognition, but not gait) in patients with MS.

A rare subclavian artery aneurysm potentially misidentified as the internal jugular vein in ultrasound-guided central venous catheterization-a case report.

Background: Central venous catheterization by anesthesiologists carries risks such as accidental arterial puncture. This case report highlights a rare subclavian artery aneurysm (SAA) detected during ultrasound-guided internal jugular vein (IJV) access, emphasizing the importance of recognizing anatomical variations. Case: An 88-year-old female with hypertension and atrial fibrillation was scheduled for lumbar laminectomy and posterior fusion. Preoperative evaluation revealed right lower lobe atelectasis and mild aortic sclerosis. During ultrasonography for right IJV catheterization, two vessels of different diameters were observed on the common carotid artery's (CCA's) lateral side. The larger vessel disappeared at the upper neck level, showing arterial pulsation on Color Doppler. Postoperative neck computed tomography confirmed a right SAA and a 5-mm saccular aneurysm in the left intracranial artery. The patient had no vascular disease, trauma, or relevant family histories. Conclusions: Anesthesiologists should be aware of anatomical variations during IJV catheterization. Ultrasound with Doppler is crucial for accurate artery identification.

The intratesticular artery resistive index as a predictor of spermatogenesis: A prospective study.

INTRODUCTION: With the objective to assess the correlation between the resistive index of intratesticular artery as predictor of spermatogenesis this case control study was conducted. METHODS: A Prospective study conducted during period April 2021 to March 2023. Total 50 patients, with oligoasthenozoospermia taken as cases and other 50 men with normal sperm count taken as controls. History taken & clinical examination, Semen analysis, hormonal evaluation & Color Doppler ultrasonography of scrotum done. Resistive Index of testicular arteries was obtained. Cases and controls were compared. RESULTS: The age of the study group ranged between 21 and 40 years. Among the cases maximum patients 23 out of 50 and among controls with maximum number 21 out of 50 patients were belonged to age group 26-30 years.The mean semen volume for the cases & controls was 2.76 ± 0.44 ml and 3.32 ± 0.54 ml respectively. The Mean sperm concentration in the cases & controls was 14.33 million/ml & 84.8 million/ml. Mean Type A sperm motility was 20.82% ± 7.86 in cases and 54.96% ± 5.41 in controls. The mean testicular volume in cases was 18.36 ± 0.75 & in controls was 18.39 ± 0.62 ml. Hormonal evaluation done in both cases and controls and mean value of FSH in cases and controls was 7.57 ± 2.34 and 6.27 ± 3.55 respectively (p-value = 0.036). Mean value of Resistive Index (PSV - EDV)/PSV) in cases and controls were found 0.63 ± 0.32 and 0.53 ± 0.37 respectively (p-value = 0.001). CONCLUSION: The intratesticular artery resistive index can be utilized as valuable predictive marker to indicate spermatogenesis.

Feeding Flow Velocity on Doppler Ultrasound Predicting the Outcome of Type II Endoleak following Endovascular Aneurysm Repair of Abdominal Aortic Aneurysm.

Background: The objective is to study the relation between the velocity of the arterial feeder and the progression of the postendovascular aneurysm repair aneurysm to find out the cut point velocity, which causes a significant increase in size of the aneurysm sac. Methods: Retrospective study of patients with Type II endoleak followed up with the duplex ultrasound between January 2010 and June 2022. The sensitivity, specificity, and accuracy of the velocity, number of feeding artery, and flow pattern were studied. Receiver operating characteristic analysis was performed to evaluate a test performance and the most appropriate cutoff velocity of the arterial feeder. Results: The peak systolic velocity (PSV) of >75 cm/s, multiple feeding arteries, and the to-and-fro pattern show a significant distinguish the stable size from the significant increase in the size of the aneurysm with a sensitivity of 100.0%, a specificity of 100.0%, and an accuracy of 100.0% (P = 0.002). Conclusion: The patient with a PSV >75 cm/s, multiple feeding arteries, and the to-and-fro pattern are correlated with significant aneurysm expansion and need closer follow-up than the patient with low PSV, single feeding artery, and monophasic pattern.

Health-care Professionals' Perspectives on Ultrasound Evaluation of Arteriovenous Hemodialysis Fistula: A Narrative Review.

Arteriovenous hemodialysis fistulas play a critical role in maintaining life on hemodialysis. With the growing use of Doppler ultrasound in nephrology, its utility has expanded to improve the prognosis and quality of life of patients receiving hemodialysis. On a fistula care team, different health-care professionals, including nephrologists, dialysis technicians, and surgeons or vascular interventionalists, require different information. This review article comprehensively explains how Doppler ultrasound evaluation can be beneficial in the management of arteriovenous fistulas from different perspectives of health-care professionals. The article also introduces the pathophysiology of arteriovenous fistula disease and provides a thorough introduction to the use of Doppler ultrasound for the evaluation of arteriovenous fistulas and their associated diseases, addressing the need for a comprehensive understanding among ultrasound practitioners.

Multi-Modal Assessment of Cerebral Hemodynamics in Resuscitated Out-of-Hospital Cardiac Arrest Patients: A Case-Series.

We assessed the feasibility of concurrent monitoring of cerebral hemodynamics in adult, comatose out-of-hospital cardiac arrest (OHCA) patients admitted to the National University Heart Centre Singapore from October 2021 to August 2023. Patients underwent continuous near-infrared spectroscopy (NIRS) monitoring in the first 72 h after return of spontaneous circulation (ROSC) and 30-min transcranial Doppler ultrasound (TCD) monitoring at least once. With constant mechanical ventilatory settings and continuous electrocardiographic, pulse oximeter and end-tidal carbon dioxide monitoring, blood pressure was manipulated via vasopressors and cerebral autoregulation assessed by measuring changes in regional cerebral oxygenation (NIRS) and cerebral blood flow velocities (TCD) in response to changes in mean arterial pressure. The primary outcome was neurological recovery at hospital discharge. Amongst the first 16 patients (median age 61, 94% males), we observed four unique patterns: preserved cerebral autoregulation, loss of cerebral autoregulation, cardio-cerebral asynchrony and cerebral circulatory arrest. Patients with preserved cerebral autoregulation had lower levels of neuro-injury biomarkers (neurofilaments light and heavy) and the majority (86%) were discharged with good neurological recovery. Multi-modal assessment of cerebral hemodynamics after OHCA is feasible and derived patterns correlated with neurological outcomes. The between- and within-patient heterogeneity in cerebral hemodynamics calls for more research on individualized treatment strategies.

Effects of Prostaglandin E1 and Balloon Atrial Septostomy on Cerebral Blood Flow and Oxygenation in Newborns Diagnosed with Transposition of the Great Arteries.

Dextro-transposition of the great arteries (D-TGA) is a critical congenital heart defect that can impact neurodevelopment due to cerebral perfusion and oxygenation disorders followed by alterations in synaptogenesis, gyrification, sulcation, and the microstructure. Brain injuries can occur both pre-operatively and postoperatively, especially white matter injuries, neuronal loss, and stroke. Materials and Methods: In a retrospective study conducted at a tertiary center between 2016 and 2023, we investigated the early effects of Prostaglandin E1 (PGE1) administration and balloon atrial septostomy (BAS) on cerebral blood flow and oxygenation in inborn neonates with D-TGA. Cerebral Doppler Ultrasound in the anterior cerebral artery (ACA) was performed to assess the resistive index (RI), Peak Systolic Velocity (PSV), and End-Diastolic Velocity (EVD) before PGE1, before the BAS procedure, and 24 h after birth. Cerebral regional saturations of oxygen (crSO2) and cerebral fractional tissue oxygen extraction (cFTOE) were evaluated. D-TGA patients were divided into the PGE1 group and the PGE1 + BAS group. Age-matched healthy controls were used for comparison. Results: All 83 D-TGA newborns received PGE1 within two hours after delivery, of whom 46 (55.42%) underwent BAS. In addition, 77 newborns composed the control group. PGE1 administration increased crSO2 from 47% to 50% in the PGE1 group, but lower than in controls at 24 h of life, while cFTOE remained elevated. The RI increased 24 h after delivery (0.718 vs. 0.769; p = 0.000002) due to decreased EDV (10.71 vs. 8.74; p < 0.0001) following PGE1 treatment. The BAS procedure resulted in a significant increase in crSO2 from 42% to 51% at 24 h of life in the PGE1 + BAS group. Doppler parameters exhibited a similar trend as observed in the PGE1 group. Conclusions: PGE1 treatment and BAS are lifesaving interventions that may improve cerebral perfusion and oxygenation in newborns with D-TGA during the transition period, as reflected by increasing SpO2 and crSO2.

Systolic versus diastolic differences in cerebrovascular reactivity to hypercapnic and hypocapnic challenges.

INTRODUCTION: Cerebrovascular reactivity (CVR) describes the vasculature's response to vasoactive stimuli, where prior investigations relied solely on mean data, rather than exploring cardiac cycle differences. METHODS: Seventy-one participants (46 females and 25 males) from two locations underwent TCD measurements within the middle or posterior cerebral arteries (MCA, PCA). Females were tested in the early-follicular phase. The hypercapnia response was assessed using a rebreathing protocol (93% oxygen and 7% carbon dioxide) or dynamic end-tidal forcing as a cerebral blood velocity (CBv) change from 40 to 55-Torr. The hypocapnia response was quantified using a hyperventilation protocol as a CBv change from 40 to 25-Torr. Absolute and relative CVR slopes were compared across cardiac cycle phases, vessels, and biological sexes using analysis of covariance with Tukey post-hoc comparisons. RESULTS: No differences were found between hypercapnia methods used (p > 0.050). Absolute hypercapnic slopes were highest in systole (p < 0.001), with no cardiac cycle differences for absolute hypocapnia (p > 0.050). Relative slopes were largest in diastole and smallest in systole for both hypercapnia and hypocapnia (p < 0.001). Females exhibited greater absolute CVR responses (p < 0.050), while only the relative systolic hypercapnic response was different between sexes (p = 0.001). Absolute differences were present between the MCA and PCA (p < 0.001), which vanished when normalizing data to baseline values (p > 0.050). CONCLUSION: Cardiac cycle variations impact CVR responses, with females displaying greater absolute CVR in some cardiac phases during the follicular window. These findings are likely due to sex differences in endothelial receptors/signalling pathways. Future CVR studies should employ assessments across the cardiac cycle.

Limb dominance does not have a meaningful impact on arterial occlusion pressure.

INTRODUCTION: Limb dominancy has been suggested, by some, to influence arterial occlusion pressure (AOP). However, we hypothesized that the differences in AOP between the dominant and nondominant legs were more likely explained by differences in cuff position. AIMS: To determine the impact of limb dominance, composition, and cuff position on AOP in the context of error associated with measuring AOP twice on the same leg. METHODS: Fifty-eight adults (30 males) volunteered to have AOP measured on their dominant legs with the cuff bladder covering their inner thighs and on their nondominant legs with the bladder covering their inner and outer thighs (in random order). Thigh circumference and muscle and fat thicknesses were also measured on each leg. RESULTS: We found evidence for differences in AOP between legs [median δ of -0.222, 95% credible interval: (-0.429, -0.016)] when the cuff position was matched. The mean difference was -2.8 mmHg, and the 95% limit of agreement in a Bland-Altman plot was -24.8 to 19.0 mmHg. When plotting this alongside an error range (i.e., 95% limits of agreement) of taking the same measurement twice from our previous study (Spitz et al., 2020), 52 out of 58 measurements were within the error range. This difference was not due to the cuff position. Additionally, there was no evidence that thigh circumference or composition (muscle/fat thickness) moderated any difference between limbs. CONCLUSION: The difference in AOP between limbs is small and is mostly indistinguishable from the difference observed from taking the measurement twice on the same limb.