Korani, Setayesh Sotoudehnia

Background: Echocardiographic evaluation of Aortic valve stenosis (AS) severity relies on aortic valve area, peak jet velocity, and mean transaortic gradient. In pursuit of improving accuracy, the transaortic flow rate (FR), defined as the ratio of stroke volume to systolic ejection time, has been introduced. However, its prognostic value in AS patients remains controversial. Aim: This study aims to systematically review the predictive value of FR in AS patients and provide quantitative pooled analysis results where applicable. Methods: A systematic search of PubMed/Medline, Embase, Scopus, Web of Science, and Cochrane was conducted for observational studies on AS patients published up to March 15, 2024. Studies were included if they assessed the clinical prognostic utility of FR with at least three months of follow-up. Pooled estimates and 95% CI for FR's hazard ratio (HR) in each binary outcome were calculated using a random effects model. Results: Nineteen studies with 9456 patients (mean age 75) underwent descriptive analysis, and 17 eligible studies were included in the meta-analysis. For predicting all-cause mortality, the pooled HR for low FR measured at rest (cut-off value 200-210 mL/s) was 1.32 (95% CI: 1.01–1.63, I2: 69%, p<0.05) (Figure 1. A). For FR measured during stress echocardiography, the pooled HR was higher at 1.58 (95% CI: 1.20–1.96, I2: 0%, p<0.05). Additionally, every 100 mL/s increase in FR significantly reduced all-cause mortality; the HR was 0.61 (95% CI: 0.47–0.75, I2: 47%) for FR measured at rest (Figure 1. B), and 0.61 (95% CI: 0.31–0.91, I2: 65%) for FR measured during stress echo. For the combined endpoint of mortality and hospitalization, the HRs were as follows: 2.54 (95% CI: -0.99–6.08, I2: 48%) and 2.57 (95% CI: 0.69–4.44, I2: 0%) for the low FR group at rest and during stress echo, respectively. For every 100 mL/s increase in FR, the HRs were 0.19 (95% CI: -0.19–0.58, I2: 61%) at rest and 0.36 (95% CI: 0.18–0.54, I2: 0%) during stress echo. Conclusion: FR is a prognostic marker for all-cause mortality in AS patients, indicating its potential for risk stratification. Incorporating FR into clinical assessments could help personalize follow-up and monitoring strategies.

Abstract Background Accurate assessment of axillary lymph nodes (ALNs) is a critical step for timely diagnosis of metastasis and proper subsequent intervention in breast cancer patients. Herein, we compare the diagnostic utility of quantitative high-definition microvasculature imaging (qHDMI), shear wave elastography (SWE) and their combination for differentiation of metastatic ALNs from reactive. Methods A total of 85 female patients with suspicious ALNs recommended for fine needle aspiration biopsy (FNAB) were included in the study, and the pathology results were used as the gold standard for labeling the status of each ALN. Three SWE metrics and ten qHDMI-derived biomarkers were used in our analyses. Additionally, age, as well as clinical ultrasound features such as nodal size and cortical thickness were included as clinical factors. The Wilcoxon rank-sum test was utilized to analyze distributional differences in biomarkers between metastatic and reactive ALNs. Multiple elastic-net logistic regression models were developed based on varying combinations of clinical, qHDMI, and SWE feature sets. A 70%/30% train/test split was adopted, and ROC curve analyses were performed to evaluate and compare classification performance. Moreover, distributional differences in qHDMI and SWE biomarkers between ALNs corresponding to breast cancer immunohistochemical subtypes luminal A and B were investigated. Results Of the total of 85 ALNs included in the analysis, 42 were metastatic. Statistically significant (p-value < 0.05) differences were observed in all but one of the qHDMI biomarkers, as well as all the SWE metrics. Test-set discrimination defined by area under ROC curve (AUC) was low for the model using only clinical features (0.62; 95% CI = [0.39,0.84]), with higher performance observed for models using SWE only (0.93; [0.82,1.00]), qHDMI only (0.97; [0.91,1.00]), qHDMI-SWE (0.97; [0.92,1.00]), and qHDMI-SWE plus clinical biomarkers (0.98; [0.94,1.00]). No statistically significant improvements were seen in the combined SWE-qHDMI and SWE-qHDMI-C classification models relative to the qHDMI-only model, although power for comparison was limited. Four qHDMI biomarkers and two SWE measures exhibited statistically significant distributions among breast cancer luminal A and B subtypes. Conclusions qHDMI classification model was able to separate metastatic from reactive ALNs with high accuracy. qHDMI, SWE, and the combined models had improved classification performance over the baseline Clinical model. qHDMI biomarkers can be valuable in determining the malignancy status of suspicious ALNs, providing helpful information regarding breast cancer prognosis.

Functional ultrasound (fUS), an emerging hemodynamic-based functional neuroimaging technique, is especially suited to probe brain activity and primarily used in animal models. Increasing use of pharmacological models for essential tremor extends new research to the utilization of fUS imaging in such models. Harmaline-induced tremor is an easily provoked model for the development of new therapies for essential tremor (ET). Furthermore, harmaline-induced tremor can be suppressed by the same classic medications used for essential tremor, which leads to the utilization of this model for preclinical testing. However, changes in local cerebral activities under the effect of tremorgenic doses of harmaline have not been completely investigated. In this study, we explored the feasibility of fUS imaging for visualization of cerebral activation and deactivation associated with harmaline-induced tremor and tremor-suppressing effects of propranolol. The spatial resolution of fUS using a high frame rate imaging enabled us to visualize time-locked and site-specific changes in cerebral blood flow associated with harmaline-evoked tremor. Intraperitoneal administration of harmaline generated significant neural activity changes in the primary motor cortex and ventrolateral thalamus (VL Thal) regions during tremor and then gradually returned to baseline level as tremor subsided with time. To the best of our knowledge, this is the first functional ultrasound study to show the neurovascular activation of harmaline-induced tremor and the therapeutic suppression in a rat model. Thus, fUS can be considered a noninvasive imaging method for studying neuronal activities involved in the ET model and its treatment.

High blood pressure is a potential adjustable risk factor for vascular complications of diabetes. Numerous categories of anti-hypertensive medications have proven to effectively reduce these complications. Additionally, metformin, besides lowering glucose and lipid levels, has advantages on vascular blood flow and improving endothelial function. In this review, we investigate the potential benefits of metformin in lowering blood pressure. Previous studies suggested that the administration of metformin to non-diabetic patients could efficiently reduce systolic blood pressure. The whole comparison of the evidence shows that metformin may have small effects on lowering blood pressure; however, this effect is not directly via a change in sympathetic activity. Mechanisms of blood pressure reduction by metformin may be due to its indirect effects on insulin resistance, nephroprotective, cardioprotective, improvement of the sympatric nerve system, and endothelial function.

IgA vasculitis nephritis (Schönlein-Henoch purpura nephritis) is an autoimmune circumstance characterized by palpable purpura involving the lower limbs, arthralgia, abdominal pain and kidney involvement. It is possible that a cytokine storm following coronavirus disease 2019 (COVID-19) could lead to an immunological dysregulation responsible for IgA vasculitis nephritis in these cases. Reactivation or first onset of IgA vasculitis nephritis is uncommon; however, there have been increasing reports of this disease, as a complication of COVID-19 vaccination. It is possible that COVID-19 mRNA vaccination may trigger several auto-inflammatory and autoimmune cascades. Previous research has shown that Toll-like receptors play a role in the development of IgA vasculitis nephritis. Following injection of a COVID-19 mRNA vaccine, the uptake of double-stranded RNA by-products will trigger Toll-like receptors, leading to a series of intracellular cascades starting an innate immunity-driven process of cell-mediated and humoral- mediated immunity.

Cardiovascular diseases (CVDs) pose a serious threat to people’s health, with extremely high global morbidity, mortality, and disability rates. This study aimed to review the literature that examined the relationship between blood groups and CVD. Many studies have reported that non-O blood groups are associated with an increased risk and severity of coronary artery disease and acute coronary syndromes. Non-O blood groups increase the risk and severity of these conditions by increasing von Willebrand factor and plasma cholesterol levels and inducing endothelial dysfunction and inflammation. They have also been linked with increased coronary artery calcification, coronary lesion complexity, and poor collateral circulation. Blood groups also affect the prognosis of coronary artery disease and acute coronary syndrome and can alter the rate of complications and mortality. Several cardiovascular complications have been described for coronavirus disease 2019, and blood groups can influence their occurrence. No studies have found a significant relationship between the Lewis blood group and CVD. In conclusion, people with non-O blood groups should be vigilantly monitored for cardiovascular risk factors as prevention and proper treatment of these risk factors may mitigate their risk of CVD and adverse cardiovascular events.