Annals of translational medicine
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Currently, no clear diagnostic indicator of vertebral artery hypoplasia (VAH) or intracranial stenosis exists in clinic. This study aims to study the feasibility of neck-brain integrated ultrasound for evaluating stenosis of the intracranial segment in the vertebral artery by comparing with those of computed tomography angiography (CTA) and digital subtraction angiography (DSA). ⋯ Neck-brain integrated ultrasound is of great value as a noninvasive examination in the diagnosis of stenotic lesions of the internal cervical vertebral artery. VAD, EDV, blood flow, RI, and the difference in RI can be used as indicators to evaluate stenosis of the internal carotid segment of the vertebral artery and provide a reliable basis for the clinical diagnosis of posterior circulation ischemia.
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There has been a significant increase in the utilisation of mechanical circulatory support (MCS) devices for the management of cardiogenic shock over recent years, with new devices being developed and introduced with the aim of improving outcomes for this group of patients. MCS devices may be used as a bridge to recovery or transplantation or intended as a destination therapy. Although these devices are not without their complications, good outcomes are achieved, but not without risk of significant complications. In this article, the complications of MCS devices have been reviewed, including the intra-aortic balloon pump (IABP), Impella, TandemHeart, extracorporeal membrane oxygenation (ECMO) and ventricular assist devices (VAD)-temporary and durable.
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Cardiogenic shock remains a major cause of morbidity and mortality for patients with acute myocardial infarction and advanced heart failure. Intra-aortic balloon pump has been the most widely used short-term mechanical circulatory support device to rapidly stabilize hemodynamics. However, it provides modest support, current evidence does not show a decrease in mortality, and the latest guidelines no longer recommend its routine use. ⋯ Premature initiation of mechanical circulatory support exposes the patient to unnecessary risk, whereas delaying therapy leads to irreversible end-organ injury, rendering any intervention medically futile. Cannulation methods, pump designs, and circuit configurations differ between devices, as do the adverse effects and physiological impact on the myocardium, which needs to be factored into consideration before deployment on the patient in cardiogenic shock. This article will review the commonly used percutaneous mechanical circulatory support devices in the setting of cardiogenic shock, compare their advantages and disadvantages, evaluate key clinical trials, and discuss a practical approach to guide clinicians' decision and management.
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In the late 19th century, Otto Frank published the first description of a ventricular pressure-volume diagram, thus laid the foundation for modern cardiovascular physiology. Since then, the analysis of the pressure-volume loops became a reference tool for the study of the ventricular pump properties. However, understanding cardiovascular performance requires both the evaluation of ventricular properties and the modulating effects of the arterial system, since the heart and the arterial tree are anatomically and functionally related structures. ⋯ Moreover, this analysis could also provide valuable information about their pathophysiological mechanisms and may help to determine the best therapeutic strategy to correct them. In this review, we will describe the basic principles of the VA coupling assessment, its limitations, and the most common methods for its estimation at the bedside. Then, we will summarize the current knowledge of the application of VA coupling in critically ill patients and suggest some recommendations for further research.
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Since the first appearance in Wuhan, China in December 2019, the novel coronavirus disease (COVID-19) has posed serious threats to the public health in many Chinese places and overseas. It is essential to quantify the transmissibility on real-time basis for designing public health responses. ⋯ The control of COVID-19 epidemic was effective in substantially reducing the disease transmissibility in terms of the reproduction number in China reduced to 0.98 as of February 16. At the same time, the reproduction number in Wuhan was probably still larger than 1, and thus the enhancement in the public health control was recommended to maintain.