OBJECTIVE: This study examined the psychological impact of the coronavirus disease 2019 (COVID-2019) outbreak on medical staff in China. MATERIALS AND METHODS: In February 2020, an online survey was carried out by using an online survey tool (WeChat) to evaluate the effects of the outbreak on the mental health of medical staff in China. RESULTS: A total of 11,118 medical staff responded to the survey. About 4.98% of the respondents reported middle and high levels of anxiety, while 13.47% of the respondents reported middle and high levels of depression since the COVID-19 outbreak. Nurses, frontline medical staff, and younger medical staff were more likely to have anxiety and depression than physicians, nonfrontline medical staff, and older medical staff. CONCLUSIONS: Although the serious psychological impact of COVID-19 is not so common in medical staff in China, programs are needed to protect them against the negative impacts of COVID-19.

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The increasing prevalence of chronic and end-stage renal disease creates an increased need for reliable vascular access; although arteriovenous fistulae (AVF) are the preferred mode of hemodialysis access, 60% fail to mature and only 50% remain patent at 1 year. Fistulae mature by diameter expansion and wall thickening; this outward remodeling of the venous wall in the fistula environment relies on a delicate balance of extracellular matrix remodeling, inflammation, growth factor secretion, and cell adhesion molecule upregulation in the venous wall. AVF failure occurs via two distinct mechanisms with early failure secondary to lack of outward remodeling, that is, insufficient diameter expansion or wall thickening, whereas late failure occurs with excessive wall thickening due to neointimal hyperplasia and insufficient diameter expansion in a previously functional fistula. In recent years, the molecular basis of AVF maturation and failure are becoming understood to develop potential therapeutic targets to aid maturation and prevent access loss. Erythropoietin-producing hepatocellular (Eph) carcinoma receptors, along with their ligands and ephrins, determine vascular identity and are critical for vascular remodeling in the embryo. Manipulation of Eph receptor signaling in adults, as well as downstream pathways, is a potential treatment strategy to improve the rates of AVF maturation and patency. This review examines our current understanding of molecular changes occurring following fistula creation, factors predictive of fistula success, and potential areas of intervention to decrease AVF failure.

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AIMS: The aim of this analysis was to (a) determine the long-term 5-year all-cause and cardiovascular (CV) mortality in patients with asymptomatic internal carotid artery stenosis (ACS), (b) identify risk factors that could be used in mortality risk stratification, and (c) develop a model for predicting a patient's risk of CV death within 5 years. METHODS: This was a multicenter natural history study involving 1121 patients with ACS undergoing medical intervention alone. Proportional-hazards models were used to calculate all-cause and CV mortality using clinical and plaque texture features. RESULTS: Totally 1121 patients with 50%–99% ICA stenosis (European Carotid Surgery Trial criteria) from the Asymptomatic Carotid Stenosis and Risk of Stroke study were included in this analysis for mortality. Mean follow-up was 48 months (range, 6–96 months). There were 213 (19%) deaths during follow-up. Average annual all-cause mortality was 4.6%. About 68.1% of all deaths were due to CV causes. Independent predictors of all-cause mortality were age, male gender, carotid stenosis >80% (NASCET criteria), diabetes, cardiac failure, left ventricular hypertrophy (LVH) on electrocardiogram (ECG), smoking, absence of antiplatelet therapy, and history of vertebrobasilar symptoms. It was also shown that age, male gender, diabetes, fibrinogen >3.6 g/L, carotid stenosis >80% (NASCET criteria), cardiac failure, absence of antiplatelet therapy, and LVH on ECG were independent risk factors for CV mortality. Receiver operating characteristic curves for the above models were 0.709 (95% confidence interval [CI], 0.659–0.754) and 0.701 (95% CI, 0.656–0.746), respectively. The CV mortality prediction model could identify several subgroups of asymptomatic patients with different risk. The highest 90%–100% predicted 5-year CV mortality carried 25 times the risk of the low-risk subgroup in which the 5-year predicted CV mortality was 4%. CONCLUSION: Mortality risk can be taken into consideration in clinical practice, in order to identify patients with ACS who are unlikely to benefit from carotid endarterectomy. The majority of patients with ACS have a very high risk of myocardial infarction and should not be denied aggressive risk factor modification or a full cardiac investigation according to the current guidelines.

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AIMS: Stenting to relieve iliac vein obstruction is now practical and safe. However, the rates of ulcer healing, pain, and edema relief are 76%, 52%, and 42% respectively. In addition, a high ulcer recurrence (up to 86%) has been reported. Currently, patient selection depends on symptoms, imaging methods, and intravascular ultrasound (IVUS) for the assessment of iliac vein stenosis without consideration of the collateral circulation. The aim of this article is to present the results of a noninvasive method of measuring lower limb outflow resistance (LOR) and also to test the hypothesis that LOR is extremely variable in limbs with iliac obstruction and that some patients with iliac stenosis may have a LOR close to that of normal limbs as a result of a well-developed collateral circulation.MATERIALS AND METHODS: LOR was measured at different venous pressures from 60 to 25 mmHg using air-plethysmography in 15 limbs without and 15 limbs with iliac vein obstruction. Reflux in ml/sec (venous filling index [VFI]) and venous clinical severity score (VCSS) were also measured in all limbs. RESULTS: The LOR at 25 mmHg (LOR₂₅) was found to be the most discriminating measurement between the two groups. The area under the receiver operating characteristic curve was 0.973 (95% confidence interval [CI] 0.923–1.000). The range of LOR₂₅in limbs without obstruction was 0.0043–0.038 mmHg/ml/min and 0.0170–0.330 mmHg/ml/min in limbs with obstruction. By plotting VFI against LOR₂₅, a subgroup of limbs was identified with iliac obstruction that had a high VCSS (5–12) and a near-normal LOR₂₅(0.050 mmHg/ml/min) presumably as a result of a well-developed collateral circulation but a high VFI in the range of 5–14 ml/s. Another subgroup of limbs with iliac obstruction and a high VCSS (5–18) had a high LOR₂₅ (0.100–0.330 mmHg/ml/min) presumably from a poorly developed collateral circulation. CONCLUSION: The noninvasive measurement of LOR₂₅provides a quantitative estimation of overall lower LOR. It can indicate which limbs are compensated by the development of a good collateral circulation and which are not. The combination of LOR₂₅with VFI enables the clinician to determine the relative contribution of reflux and obstruction in individual limbs. A low LOR₂₅in the presence of severe iliac stenosis or occlusion is an indication of a well-developed collateral circulation and suggests that stenting would provide little benefit if any. However, this hypothesis needs to be verified by future prospective studies.

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BACKGROUND: Augmentation indexes (AIxs) and pulse wave velocity (PWV) are arterial stiffness parameters. They can be studied by pulse wave analysis (PWA) noninvasively. Before use, AIx and PWV need normative baseline study to find the predictors. MATERIALS AND METHODS: We conducted a cross-sectional study in 801 nonhypertensives, aged 15–65 (divided into five subgroups) years. PWA was accomplished by Mobil-o-Graph (IEM, Germany) based on oscillometric principle and cardiovascular parameters reported were further analyzed. Value of P < 0.05 was taken as statistical significance. RESULTS: There were five age-based subgroups from 15 to 65 years, showing an increase in [email protected] and PWV with age. Females had significantly higher AIx in male in age groups (31.4 vs. 25.8, 34.95 vs. 27.21, 32.62 vs. 27.61, 34.32 vs. 26.36, 37.09 vs. 29.63; P < 0.05 for all), but PWV was higher in males than females in young age group (15–24 years-4.94 vs. 4.71, 25–34 years-5.28 vs. 5.12, 35–44 years-6.00 vs. 5.84; P < 0.05 in all) and in females than males in older age group (45–54 years-6.88 vs. 6.78,55–65 years-8.13 vs. 8.03). Major positive significant predictors of PWV were age, Body Mass Index, and systolic blood pressure; and of [email protected] were age, height (negative), heart rate, and pulse pressure. [email protected] and PWV showed a positive correlation with each other across all age group in either sex except for 55–65 years and 25–34 years age groups. CONCLUSIONS: Oscillometric measurement of PWV and [email protected] is feasible in our population. They are dependent on each other and age, totally not dependent on blood pressure and have difference in predictors. This baseline data can be used as a reference for future studies.

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BACKGROUND: Myocardial ischemia/reperfusion injury associated with coronary artery bypass graft (CABG) surgery characterizes as a clinically critical problem. The incidence of oxidative stress, inflammation, and apoptosis are induced throughout the reperfusion of the cardiac muscles following ischemia. The present study aims to examine the protective role of melatonin in ameliorating the degree of myocardial injury in patients undergoing bypass surgery, and whether this effect is dose related. PATIENTS AND METHODS: A total of 45 patients who were undergoing CABG in (Al-Najaf Cardiac Center, Al-Najaf, Iraq) were enrolled in this study between January 2015 and November 2015. Patients were randomly allocated into three study groups: placebo-controlled group (C), low-dose melatonin treatment group, 10 mg capsule once daily (M1) and high-dose melatonin treatment group 20 mg capsule once daily (M2). RESULTS: Compared to the control group, there was a significant increase in the plasma level of melatonin associated with a significant reduction in plasma levels of high sensitive C-reactive protein, creatine kinase isoenzyme muscle/brain, and cardiac troponin-I, in the melatonin groups (Group M1 and M2) compared to the control group, (P < 0.05) in melatonin-treated groups. Comparing the two melatonin study groups, the changes in the parameters mentioned above were more significant in the M2 group compared to the M1 group (P < 0.05). CONCLUSION: These findings suggested that melatonin administration can ameliorate the degree of myocardial injury, dose-dependent effects.

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The aim of this review is to provide a clear understanding of the pathophysiological mechanisms of chronic venous disease (CVD) at different clinical stages and the possible role of these mechanisms in the development of symptoms in C0s clinical class of the Clinical, Etiologic, Anatomic, and Pathophysiologic classification, which consists of symptomatic patients without any visible or palpable signs of venous disease. The prevalence of C0s class in several epidemiological studies varies between 13% and 23% of the general population. Wall remodeling and valve destruction due to white cell endothelial interaction is the main cause of primary varicose veins, while deep vein thrombosis produces secondary changes leading to the postthrombotic syndrome. The underlying mechanism of the skin changes and ulceration is venous hypertension, which is transmitted to the skin microcirculation. Over the last 10 years, an improved videocapillaroscopic technique, the orthogonal polarization spectral imaging technique demonstrated that quantitative measurements in the skin microcirculation are progressively altered from C1 to C6 patients and that values in CVD patients are significantly different from healthy individuals (P < 0.05): capillary diameter increases and capillary morphology worsens from C2 to C5; diameter of the dermal papilla and diameter of the capillary bulk increase from C3 to C5; and functional capillary density (FCD) decreases from C4 to C5. In addition, significant changes have been shown between C0a and C0s patients despite the presence of normal conventional duplex scans in the latter: a decrease of FCD and an increase in the diameter of the dermal papilla. Functional abnormalities found to be present in C0s patients by recent studies include increased compliance of the venous wall (hypotonic phlebopathy), dilatation of deep veins in the calf producing an abnormally increased venous volume, reduction in emptying of venous reservoir, reduction in the venoarteriolar response on standing, and blood reflux in small venules despite a normal conventional duplex scan. However, most of the studies are small, and their findings need to be confirmed by larger series. It remains to be seen whether functional changes and microcirculatory changes respond to venoactive medications in parallel to the relief of symptoms.

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BACKGROUND: The impairment of blood flow to the kidney causes renal injury occurs by ischemia/reperfusion (I/R) in surgical procedures, in which the kidneys remain without blood supply for sometime. This is observed during kidney transplantation, vascular surgery of aorta and renal arteries, and in partial nephrectomy. Ghrelin is an orexigenic growth hormone secretagogue of a 28 amino acid peptide derived mainly from ghrelinergic cells in the gastrointestinal tract. It plays an important physiological role in regulating of energy homeostasis and appetite stimulant. In this study, we aimed to assess the ability of ghrelin to exert potential protective effects on the kidney I/R and subsequent kidney dysfunctions in the rat through the modulation of pro-inflammatory cytokines. MATERIALS AND METHODS: A total of 28 rats were used in this experiment and the I/R was induced in a rat model by unilateral renal artery clamping for 30 min and reperfusion for 3 h, and ghrelin (40 μg/kg/rat) or vehicle was injected through intraperitoneal before ischemia and at reperfusion time immediately. Ghrelin administration could exert a protective role in the kidney against injury by significantly reducing serum and tissue levels of pro-inflammatory markers (tumor necrosis factor-alpha, high mobility group box protein 1, and interleukin 1 beta), decreasing the serum levels of (urea and creatinine), and reduction of the severity score of renal damage. CONCLUSIONS: We conclude that ghrelin has renoprotective effects through modulation of inflammation.

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INTRODUCTION: Hypertension is on a high with preponderance of undiagnosed and untreated at-risk individuals. Pulse wave analysis (PWA) provides noninvasive assessment of arterial stiffness and central hemodynamic parameters. It provides more discrete and direct inference about cardiovascular aging that is expected to be exaggerated with systemic hypertension. MATERIALS AND METHODS: A case–control study was conducted in 116 newly diagnosed, never treated, apparently healthy hypertensives and 116 matched nonhypertensive controls. Oscillometric PWA was accomplished by Mobil-o-Graph (IEM, Germany) to derive cardiovascular parameters that were further analyzed. P < 0.05 was considered statistically significant. RESULTS: Cases showed significantly higher brachial arterial parameters (blood pressure [BP], heart rate, and rate pressure product); arterial stiffness (augmentation pressure, augmentation index, pulse wave velocity, total arterial stiffness, and pulse pressure amplification); and central hemodynamics (central BP, cardiac output, and stroke work) than age-, gender-, and height-matched controls. Major study parameters correlated with BP, heart rate, and age, but in multiple regressions, they were independent of most of these parameters. CONCLUSIONS: Oscillometric PWA is feasible in our population. It revealed beyond brachial BP abnormal profile suggestive of early cardiovascular aging in new and never treated hypertensives. It also suggests further work to consolidate and explore these results.

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Critical limb ischemia (CLI) is the advanced stage of peripheral artery diseases and is characterized by limb pain. Current available treatments for CLI include pharmacological agents, bypass surgery, and endovascular therapy. When these conventional therapies fail, some patients may eventually suffer from amputation because of long-term blood flow insufficiency to the affected extremity. Novel therapeutic approaches are emergently needed. At present, proangiogenic gene/protein therapies and stem cell-based proangiogenic therapies have been proposed, and the promising results have been reported. Gene-modified stem cells and pretreated stem cells have been evaluated in the animal models. Proper bioscaffolds are also used to increase the survival and engraftment of delivered stem cells. Here, we address the current situation of stem cell research for CLI in China.

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The introduction of direct oral anticoagulant drugs has added a new dimension to the management of thrombotic and cardiovascular diseases. Although clinical useful, the use of these drugs has been associated with bleeding complications of varying magnitude. Until recently, there was no antidote available for the control of bleeding associated with DOAC's. Such traditional approaches as the use of blood products and mechanical methods have been used to control bleeding in past. Molecular approaches have resulted in the development of specific antidotes for the oral anti-Xa and anti-IIa drugs. Andexanet alfa is a molecularly modified recombinant human factor Xa which is developed as an antidote for rivaroxaban and apixaban. Praxbind is an antibody which neutralizes dabigatran. Both agents have approved by the FDA and the European Medicine Agency, while these two agents are valuable in the management of bleeding with DOAC's, their use is associated with various adverse responses. Since both agents are proteins, antibody generation and interactions with endogenous proteins may also contribute to some of the observed adverse effects. The clinical data on their use is rather limited and additional studies are warranted to optimize their use. A global antidote, Ciraparantag, (PER977) is also developed for the neutralization of DOAC's. Both the activated and non-activated forms of prothrombin complexes are reportedly effective as an antidote for DOAC's. Additional studies are needed to develop guidelines for the safe use of antidotes to minimize the observed complications with the use of antidotes.

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CONTEXT: The COVID-19 pandemic is probably the most challenging health crisis of the modern era as international health systems were not prepared to fight a virus whose capacity of spread is still being debated. The following are the two main challenges: the management of patients with acute infection of SARS-CoV-2, which needs more attention to have results in brief time, and the prevention of resultant neglect of patients who are not infected but need constant care for their chronic diseases. AIMS: To prevent the deaths from the “indirect effect” of the virus, the main aim was, with the help of telemedicine, to follow-up patients with high risk of poor outcome and to develop a protective system to reduce emergency department and hospitalizations access. The secondary aim was to develop an efficient telehealth model to be applied also after the COVID-19 pandemic. SETTINGS AND DESIGN: The study was voluntary and observational on patients enrolled between March and May 2020, during the first wave of the Italian pandemic. The project involved primary care and specialist physicians, nurses, informatics, and administrative services in the complex unity of primary care in Catanzaro Lido, Calabria Region. MATERIALS AND METHODS: Data such as blood pressure, heart rate, blood oxygenation, and glycemia were recorded using sphygmomanometer, oximeter, and glucometer and were communicated with a smartphone or a Bluetooth directly to a control room. The alerts were stratified according to the common emergency code: green for low risk, yellow for intermediate risk, red for high risk, and critic red for very high risk. RESULTS: Regarding patients with glycemic alerts, totally, 2135 were alert, 25% of them were at high risk, but only in 1 single case (0.04%), the intervention of 118 was necessary. The rest was resolved by telemedicine system with the help, when necessary, of first-level medical intervention. In 6.1% of cases, a specialist advice was required. Moreover, cardiovascular alerts were all resolved by the telemedicine system. CONCLUSIONS: The results obtained are preliminary but satisfying, a clear sign of how telemedicine could improve the management of disease chronicity but also of infectious disease.

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CONTEXT: The COVID-19 pandemic is probably the most challenging health crisis of the modern era as international health systems were not prepared to fight a virus whose capacity of spread is still being debated. The following are the two main challenges: the management of patients with acute infection of SARS-CoV-2, which needs more attention to have results in brief time, and the prevention of resultant neglect of patients who are not infected but need constant care for their chronic diseases. AIMS: To prevent the deaths from the "indirect effect" of the virus, the main aim was, with the help of telemedicine, to follow-up patients with high risk of poor outcome and to develop a protective system to reduce emergency department and hospitalizations access. The secondary aim was to develop an efficient telehealth model to be applied also after the COVID-19 pandemic. SETTINGS AND DESIGN: The study was voluntary and observational on patients enrolled between March and May 2020, during the first wave of the Italian pandemic. The project involved primary care and specialist physicians, nurses, informatics, and administrative services in the complex unity of primary care in Catanzaro Lido, Calabria Region. MATERIALS AND METHODS: Data such as blood pressure, heart rate, blood oxygenation, and glycemia were recorded using sphygmomanometer, oximeter, and glucometer and were communicated with a smartphone or a Bluetooth directly to a control room. The alerts were stratified according to the common emergency code: green for low risk, yellow for intermediate risk, red for high risk, and critic red for very high risk. RESULTS: Regarding patients with glycemic alerts, totally, 2135 were alert, 25% of them were at high risk, but only in 1 single case (0.04%), the intervention of 118 was necessary. The rest was resolved by telemedicine system with the help, when necessary, of first-level medical intervention. In 6.1% of cases, a specialist advice was required. Moreover, cardiovascular alerts were all resolved by the telemedicine system. CONCLUSIONS: The results obtained are preliminary but satisfying, a clear sign of how telemedicine could improve the management of disease chronicity but also of infectious disease.

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Infrapopliteal pseudoaneurysms can occur after trauma. In recent years, endovascular repair has been increasingly used to treat infrapopliteal pseudoaneurysms. Nevertheless, there has been no covered stent specifically for small peripheral vessels. Here, we report a case of a 65-year-old male with a pseudoaneurysm of the anterior tibial artery which was managed with a physician-modified covered stent. 6 months after the procedure, the mass had completely disappeared and the vascular anatomy of the calf is well preserved.

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Abstract: BACKGROUND: Premature ovarian failure (POF) is a typical condition of pathological ovarian ageing. Injuries and atrophies of blood vessels in the ovaries can lead to ovarian insufficiency, but the underlying mechanism remains unclear. AIMS: This study investigated the epigenetic mechanism by which thymopentin (TP-5) activated ovarian angiogenesis to achieve its effects on POF. MATERIALS AND METHODS: The qPCR, western blot and immunofluorescence staining were used to detecte the expression levels of gene. The hematoxylin and eosin stainingwas used to histopathological examination. The RNA-Seq sequencing was used to transcriptome detection. RESULTS: First, pathological examination revealed that TP-5 significantly increased ovary weight in the cyclophosphamide-induced POF mouse model. The proportion of atretic follicles was reduced, and the level of E2 in the peripheral blood was elevated. Meanwhile, immunofluorescence staining showed that TP-5 increased protein expression of CD31 and Tie1 in the ovarian tissues of mice with POF, suggesting that TP-5 could induce ovarian angiogenesis. RNA-Seq sequencing results suggested that TP-5 could induce the high level of Notch/Tie2 pathway expression that is associated with angiogenesis in ovarian tissues. qPCR and western blotting showed significantly increased expression of METTL3, a methyltransferase that catalyses the formation of N6-methyladenosine (m6A) in RNA. Meanwhile, the results of the dot blot suggested that the overall RNA methylation level was significantly higher in the ovarian tissues of mice in the TP-5 group than in the control group. Finally, RIP-PCR analysis showed that specific sites in the 3'-untranslated region (3'UTR) of the mRNA of key factors in the Notch/Tie2 pathway were hypermethylated in the ovaries of mice in the TP-5 treatment group. CONCLUSION: Therefore, this study demonstrated that TP-5 exerted its therapeutic effect on POF by stimulating angiogenesis. The mechanism of action is the promotion of the expression of RNA m6A methyltransferases by TP5, which increases the overall RNA m6A methylation level in mouse ovarian tissue. Specifically, the methylation ofspecific m6A sites in the 3'UTR of the RNA of key factors in the Notch/Tie2 pathway increased, which enhanced their stability and expression levels, leading to the induction of angiogenesis.

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OBJECTIVE: To compare the effectiveness of surgical bypass and endovascular therapy for juxtarenal abdominal aortic occlusion. METHODS: Data of 37 patients treated with open arterial bypass surgery or endovascular therapy for juxtarenal abdominal aortic occlusion in the last 10 years were retrospectively analyzed. RESULTS: Of the 37 cases, 32 were male and five were female; the mean age was 58.5 years; the mean disease history was 8.2 months. Open surgery was performed in 18 cases and endovascular treatment was done in 19 cases. No significant differences in either technical success rate or perioperative symptom improvement rate were found between the open surgery and endovascular therapy groups. There w as much more blood loss, hospital stay time, and fewer hospitalization expenses in the open group than the endo group. In the open group, the mean follow-up time was 60.5 months and graft patency rate was 94.4%; in the endo group, the mean follow-up was 52.5 months but the patency rate was 82.4% (P = 0.009). CONCLUSIONS: Both open surgery and endovascular treatment are effective for juxtarenal aortic occlusion. In comparison, open surgery has lower cost with better long-term eff icacy, while endovascular therapy has less invasiveness with faster postoperative recovery. O perative approach should be made according to the patient's clinical conditions.

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AIM: This study analyzed the association between carotid and coronary atherosclerosis, particularly in terms of the severity as well as the extension of the disease. MATERIALS AND METHODS: We have recruited a consecutive series of 478 patients (admitted to the Cardiology Unit of University Hospital Paolo Giaccone during 2004–2014). These patients underwent both carotid Doppler ultrasound and coronary angiography. Sex, age, and traditional cardiovascular risk factors were considered. The SYNTAX score was used to grade the complexity of coronary disease. RESULTS: The present study revealed a clear association between carotid atherosclerosis and coronary disease: 68.2% of the examined population showed atherosclerosis in both carotid and coronary arteries. The absence of carotid atherosclerosis was predominantly associated with angiographically normal coronary arteries (37.6%) rather than a single-vessel disease (22.8%), a two-vessel disease (21.8%), or a three-vessel disease (17.8%). When carotid atherosclerosis was present, a normal coronary angiography was uncommon (13.5%), while the detection of a single-vessel disease was more frequent (17.2%), a two-vessel disease was even more frequent (27.6%), and the highest rate described was related to a three-vessel coronary artery disease (CAD) (41.6%). The thickness of the carotid lesion was directly proportional to the number of diseased coronary vessels, and it was also related to the severity of coronary involvement measured by the SYNTAX score. CONCLUSIONS: This study has shown a strong correlation between carotid atherosclerosis and CAD, in terms of extension, and most importantly, severity. It is fundamental to consider a systemic approach to atherosclerosis to obtain an adequate stratification of patients with cardiovascular risk factors and an appropriate therapeutic management and reduce the incidence of adverse events, improving the quality of life and prolonging survival.

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BACKGROUND: This study is to assess the applicability and performance of the near-infrared spectroscopy (NIRS) in the diagnosis of exercise-induced arterial endofibrosis (EIAE). METHODS: NIRS was measured on each thigh, in 12 highly trained asymptomatic cyclists (controls) and 14 EIAE patients highly trained competition cyclists. All patients had an incremental bicycle stress test until exhaustion or symptom limitation. Results are presented as median (25°; 75° centiles) and between groups difference calculated with Mann–Whitney test. RESULTS: Six of the NIRS recordings technically failed: three in controls and three in EIAE patients due to probe disconnection. In the remaining nine controls and 11 EIAE patients, no difference was found at peak exercise for tissue saturation index (−2.0% [−8.5; 2.1] vs. −4.0% [−5.9; 5.5]; P = 0.710) or for half-time recovery (42.0 s [24.9; 105.0] vs. 42.0 s [33.0; 112.7]; P = 0.905) between EIAE and controls, respectively. CONCLUSION: NIRS, when available, does not satisfactorily discriminate patients with EIAE from asymptomatic healthy athletes.

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INTRODUCTION: Diabetes mellitus is a major cardiovascular risk factor. To put appropriate preventive measures in place, there is a need to estimate the 10-year cardiovascular risk. Most of the available risk estimators are cumbersome while some are inaccurate in estimating the risk for individuals with Type 2 diabetes. This study aimed to describe the diabesity lipid index (DLI), a composite index for predicting 10-year cardiovascular risk in Type 2 diabetes. METHODS: The study design was a cross-sectional study involving 70 individuals living with Type 2 diabetes mellitus. Ethical approval and informed consent were obtained for the study. Body mass index and waist circumference were determined for each participant. Fasting plasma glucose, fasting lipid profile, and glycated hemoglobin (HbA1c) were also measured. Atherogenic index of plasma (AIP), DLI, and QRISK 3 were calculated using the appropriate formulae. Receiver operating characteristics (ROC) curve analysis was performed for DLI. DLI = HbA1c (%) x Waist circumference (cm) / HDL -- C (mg/dl) RESULTS: The mean age of the subjects was 53.34 ± 9.57 years. The median duration of diabetes was 11.50 years. Hypertension, dyslipidemia, and truncal obesity were found in 70%, 65.7%, and 64.3% of the participants, respectively. About 38.6% had sub-optimal glycemic control. There was a statistically significant positive correlation between 10-year cardiovascular risk using QRISK 3 and DLI (r = 0.317; P = 0.008). Moreover, a ROC curve analysis done showed that the area under curve was 0.72 (95% confidence interval 0.56–0.85; P = 0.032). The sensitivity and specificity of using this cut-off value to define high cardiovascular risk were 87.5% and 79.2%, respectively CONCLUSION: DLI is a simple estimator of 10-year cardiovascular risk among individuals with Type 2 diabetes mellitus. It compares favorably with AIP, a previously validated cardiovascular risk estimator.

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Background: Atherosclerosis is a chronic disease characterized by lipid accumulation, apoptosis and necrosis, smooth muscle cell proliferation and local inflammation. Polygonum multiflorum & Codonopsis pilosula Granule (PmCp Granule), akidney-tonifying compound used in Chinese medicine, has been used for the clinical treatment of atherosclerosis for the past 10 years and exhibits good therapeutic effects. Aims and Objectives: We want to prove that PmCp Granule inhibits the expression of the DAB2IP-ASK1 pathway in vascular endothelial cells, thereby alleviating the development of atherosclerosis. Materials and Methods: Blood lipid biochemical test and histopathology H&E staining were used to determine the efficacy of the PmCp Granule. qPCR and western blot were used to determine the expression of DAB2IP-ASK1 pathway. Results: The results of pathology assay showed that the plaque area, volume fraction of collagen fibers and lipid area in the aortic root was markedly reduced in the PmCp Granule group compared with the Saline group. Besides, the peripheral blood levels of total cholesterol, triglycerides and low-density lipoprotein cholesterol were statistically significantly increased, whereas the high-density lipoprotein cholesterol was statistically significantly decreased in the PmCp Granule group in comparison to the control group. Finally, the results of western blot analysis showed that the expression levels of the proteins related to the DAB2IP-ASK1 pathway were significantly lower in the vascular endothelial cells of PmCp Granule group compared to control group. Conclusion: the present study demonstrated that PmCp Granule significantly alleviated the development of atherosclerosis in mice. The main mechanism of action of PmCp Granule involved the inhibition of the expression of the DAB2IP-ASK1 pathway in vascular endothelial cells.

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Coronavirus disease 2019 (COVID-19) is a highly infectious disease caused by the severe acute respiratory syndrome-CoV-2 virus that appeared in China and has spread globally. Accumulating evidence suggests that the development of specific prothrombotic changes in patients with COVID-19 reflected a high incidence of thrombotic complications. This paper is a narrative review of the diagnostic and management of COVID-19-associated coagulopathy and related venous thromboembolism (VTE). The consecutive search and review of relevant literature were carried out between March 23 and May 22, 2020. Eleven studies assessing the incidence of VTE and eleven guidelines on the management of coagulopathy were identified. The prevalence of VTE in patients with COVID-19 appeared to be unexpectedly high, reaching 8%–13% in the general ward and 9%–18% in the intensive care unit despite pharmacological prophylaxis. The current guidelines suggest prophylactic anticoagulation with low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH) in all inpatients. Intensified anticoagulation in the absence of VTE is not generally recommended but may be considered for patients with obesity, elevated D-dimer, an individually highest risk of VTE, or critical illness. The value of mechanical prophylaxis is underestimated. Extended prophylaxis after discharge may be indicated for patients with increased risk of VTE and low risk of bleeding. Increased D-dimer may be used as an indication for VTE screening by appropriate imaging tests. If VTE is highly suspected according to the clinical signs or D-dimer, then therapeutic anticoagulation may be initiated before VTE confirmation. For putative or confirmed VTE, therapeutic anticoagulation with LMWH or UFH is preferred during inpatient treatment, followed by switching to direct oral anticoagulants after discharge for 3 months. Primary VTE prophylaxis for outpatients is not generally recommended. Most of the guidelines are interim and ambiguous.

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Critical limb ischemia (CLI) is the most advanced stage of peripheral arterial disease (PAD). Its prognosis is poor, with high rates of limb amputation and cardiovascular mortality. The international guidelines consider limb revascularization as the first line of the treatment strategy for CLI. However, despite the progress of revascularization techniques, many patients with CLI are still considered not suitable for these procedures and treated with conservative limb treatments. We have consulted the most important guidelines on PAD and CLI published over the past two decades focusing on the epidemiology, treatment, and outcomes of CLI patients not suitable for revascularization. Our review shows that only the TASC guidelines report 25% of CLI patients conservatively treated. Regarding the treatments, all the guidelines agree that the conservative treatment is based on the best medical management of cardiovascular risk factors associated with pain drugs and wound management. Other treatments such as prostanoids, spinal cord stimulation, vasodilators, or angiogenic therapies have shown uncertain positive outcomes in reducing limb amputation and mortality. In conclusion, this work outlines the scarce consideration that the guidelines have had about these patients over the past two decades. However, this review tries to draw the main novelties and possible future treatments for the better management of this group of patients still resident in the “dark side” of the CLI.

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This is a narrative review of the relevant literature on the epidemiology, pathogenesis, and treatment of venous thromboembolism (VTE) in cancer patients. In accordance with actual guidelines, the duration of anticoagulant therapy for cancer-associated venous thrombosis should be at least 6 months. The use of Vitamin K antagonists (VKA) is associated with an increased risk of VTE recurrence and bleeding, so low-molecular-weight heparin (LMWH), in particular dalteparin, has been the “gold standard” until recently. Compared to VKA, prolonged use of LMWH can reduce the incidence of VTE recurrence without affecting the risk of bleeding or death. The main disadvantage of LMWH is low compliance, leading to premature discontinuation of treatment or switching to alternative anticoagulants. Direct oral anticoagulants (DOACs) have changed the situation. Compared to VKA, they demonstrated increased efficacy with similar or improved safety in patients with cancer-related VTE. Recently, the results of specialized studies comparing the use of DOACs to the use of dalteparin in cancer patients have been published: SELECT-D (rivaroxaban), HOKUSAI-VTE Cancer (edoxaban), ADAM VTE (apixaban), and CARAVAGGIO (apixaban). Rivaroxaban showed higher efficacy than dalteparin with a similar risk of major bleeding, but with an increased risk of clinically relevant nonmajor (CRNM) bleeding. Edoxaban had the same efficacy as dalteparin, though it showed an increased risk of major but not CRNM bleeding. Apixaban showed similar efficacy and safety as dalteparin in the CARAVAGGIO study, but did not provide higher safety in the ADAM VTE study. It was noted that gastrointestinal and urogenital bleeding dominated the structure of hemorrhagic complications of DOACs. The results of published trials are reflected in the current guidelines of the specialized societies. DOACs are recommended for VTE treatment in cancer patients.

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