BACKGROUND: Nocturnal shoulder pain is seen in patients with rotator cuff tears. The purpose of the present study was to determine whether Doppler ultrasound parameters predict the intensity of nocturnal pain in patients with rotator cuff tears.
METHODS: A total of 60 patients with rotator cuff tears were included. Doppler ultrasound parameters (peak systolic velocity in the anterior humeral circumflex artery, Doppler activity in the glenohumeral joint and subacromial space) and clinical parameters were examined. For the presence of nocturnal pain, the clinical parameters were compared with and without nocturnal pain. For the intensity of the nocturnal pain, a multivariate analysis of clinical parameters and nocturnal pain intensity was performed.
RESULTS: In all, 39 patients (65%) reported nocturnal pain, and the mean pain intensity was 47.0 (standard deviation, 26.0) on the visual analogue scale. In nocturnal pain presence analysis, Doppler activity in the subacromial space showed significant associations (p < 0.001). In nocturnal pain intensity analysis, Doppler activity in the subacromial space and diabetes showed significant associations (p < 0.001, p = 0.01, respectively).
CONCLUSIONS: Doppler activity in the subacromial space emerges as an independent factor associated with the presence and intensity of nocturnal pain in patients with rotator cuff tears. Our findings may provide a basis for further exploration and refinement of treatment strategies.

BACKGROUND: Stress-transthoracic Doppler echocardiography (S-TDE) provides a noninvasive assessment of coronary flow parameters in the left anterior descending artery (LAD). However, the association between morphological characteristics and coronary flow changes after elective percutaneous coronary intervention (PCI) remains unclear. We aimed to evaluate the relationships between periprocedural coronary flow changes observed on S-TDE and lesion-specific plaque characteristics obtained by optical coherence tomography (OCT) in the interrogated vessels in patients with chronic coronary syndrome (CCS).
RESULTS: Patients with CCS who underwent pre- and post-PCI S-TDE and elective fractional flow reserve (FFR)-guided PCI under OCT guidance for de novo single LAD lesions were included. S-TDE-derived hyperemic diastolic peak flow velocity (hDPV) was used as a surrogate for coronary flow. Lesions were categorized into two groups based on the %hDPV increase or decrease. The baseline clinical, physiological, and OCT findings were compared between the groups. In total, 103 LAD lesions were studied in 103 patients. After PCI, hDPV significantly increased from 55.6 cm/s to 69.5 cm/s (P<0.01), with a median %hDPV increase of 27.2 (6.32-59.1) %, while %hDPV decreased in 20 (19.4%) patients. The FFR improved in all patients. On OCT, layered plaques were more frequently present in the culprit vessels in the %hDPV-decrease group than in the %hDPV-increase group (85.0% vs. 50.6%, P = 0.01). Multivariable logistic regression analysis showed that the presence of layered plaques and high pre-PCI hDPV were independent predictors of %hDPV decrease.
CONCLUSIONS: In patients who underwent successful uncomplicated elective PCI for de novo single LAD lesions, the presence of layered plaques was independently associated with hyperemic coronary flow decrease as assessed by S-TDE.

BACKGROUND: In assessing the effects of smoking cessation on endothelial function, low-flow-mediated constriction (L-FMC) may provide complementary information to flow-mediated dilation (FMD). However, the value of flow-mediated total dilation (FMTD), an index that incorporates L-FMC into FMD, remains underreported. We aimed to evaluate the effect of smoking cessation on endothelial function, as assessed by FMD and FMTD, and clarify its associated clinical factors.
METHODS: We enrolled 118 consecutive current smokers without previous coronary artery disease (72.9% were men; age: 59 ± 11 years) who underwent smoking cessation treatment. The clinical variables %FMD, %L-FMC, and %FMTD were examined before and 20 weeks after treatment initiation. A multivariate linear regression model was used to investigate the effects of smoking cessation on %FMD and %FMTD and the interaction between smoking cessation and baseline clinical variables.
RESULTS: After 20 weeks, 85 smokers (69.4% were men; age: 59 ± 12 years) ceased smoking (abstainers), whereas 33 smokers (81.8% were men; age: 58 ± 11 years) did not (continued smokers). The estimated group differences (abstainers - continued smokers) in changes in the %FMD and %FMTD were 0.77% (95% confidence interval [CI], -0.22-1.77%; p = 0.129) and 1.17% (95% CI, 0.16-2.18%; p = 0.024), respectively. Smoking cessation-associated improvement in %FMTD was greater in women than in men (5.41% [95% CI, 3.15-7.67%] versus 0.24% [95% CI, -0.81-1.28%]; p-value for interaction, < 0.001). Additionally, a greater %FMTD improvement was observed in patients who smoked fewer cigarettes per day (p-value for interaction, 0.042) and those who had a smaller resting baseline lumen diameter (Dbase) (p-value for interaction, 0.023).
CONCLUSIONS: Smoking cessation was associated with an improvement in %FMTD. Sex, cigarettes smoked per day, and Dbase significantly affected this improvement. The FMTD may help in risk stratification after smoking cessation.

UNASSIGNED: To explore the correlation between left atrial appendage morphology, blood flow velocity and plasma galectin-3 and thrombosis in patients with atrial fibrillation.
UNASSIGNED: Patients with atrial fibrillation who received treatment and completed ultrasound examination in hospital from 2022 to December 2023 were enrolled. According to whether there was left atrial appendage thrombosis, the patients were divided into a control group (no left atrial appendage thrombosis was found) and a study group (left atrial appendage thrombosis was found). The morphology and structure of the left atrial appendage, blood flow velocity and plasma galectin-3 level were recorded exploring its correlation with left atrium thrombosis.
UNASSIGNED: A total of 330 patients with atrial fibrillation were enrolled, including 278 in the control group and 52 in the study group. Left group and the control group of morphological structure differences (P < 0.05). The main lobe length, ostial area, longest diameter, shortest diameter, left atrial appendage volume and left atrial volume in the study group were higher than those in the control group (P < 0.05). The left atrial appendage emptying velocity, filling velocity and left ventricular ejection fraction of the study group were lower than those of the control group, and the left ventricular end-diastolic diameter was higher than that of the control group (P < 0.05). Group of white blood cell count, neutrophils/lymphocyte ratio, plasma galactose lectin-3 levels were higher than control group (P < 0.05). ROC curve analysis of left atrial appendage emptying velocity, left atrial appendage filling velocity, left atrial enddiastolic diameter and left atrial ejection fraction had higher diagnostic value (P < 0.05).
UNASSIGNED: Left atrial appendage morphology, blood flow velocity and plasma galectin-3 level are important factors to evaluate the risk of left atrial appendage thrombosis in patients with atrial fibrillation. This study improves the understanding of thrombosis, further elucidates the risk factors for thrombosis, and improves patient prognosis.
UNASSIGNED: Cilj je bio da se istraži korelacija između morfologije dodatka levog atrijala, brzine protoka krvi i plazma galektina-3 i tromboze kod pacijenata sa atrijalnom fibrilacijom.
UNASSIGNED: Uključeni su pacijenti sa atrijalnom fibrilacijom koji su lečeni i obavili ultrazvučni pregled u bolnici od 2022. do decembra 2023. godine. Prema tome da li je postojala tromboza dodatka leve pretkomore, bolesnici su podeljeni u kontrolnu grupu (nije utvrđena tromboza dodatka leve pretkomore) i studijsku grupu (utvrđena je tromboza dodatka leve pretkomore). Zabeleženi su morfologija i struktura dodatka levog atrija, brzina krvotoka i nivo galektina-3 u plazmi, istražujući njegovu korelaciju sa trombozom leve pretkomore.
UNASSIGNED: Uključeno je ukupno 330 pacijenata sa atrijalnom fibrilacijom, uključujući 278 u kontrolnoj i 52 u studijskoj grupi. Leva grupa i kontrolna grupa razlika morfološke strukture (P < 0,05). Dužina glavnog režnja, područje ušća, najduži prečnik, najkraći prečnik, zapremina dodatka levog atrijala i zapremina leve pretkomode u ispitivanoj grupi bili su veći od onih u kontrolnoj grupi (P < 0,05). Brzina pražnjenja dodatka leve pretkomore, brzina punjenja i ejekciona frakcija leve komore u ispitivanoj grupi bili su niži od onih u kontrolnoj grupi, a krajnji dijastolni prečnik leve komore bio je veći od onog u kontrolnoj grupi (P < 0,05). Grupa sa brojem belih krvnih zrnaca, odnosom neutrofila/limfocita, nivoom lektina galektina-3 u plazmi je bila veća od kontrolne grupe (P < 0,05). Analiza ROC krive brzine pražnjenja dodatka leve pretkomore, brzine punjenja dodatka leve pretkomore, krajnjeg dijastolnog prečnika leve atrijalne pretkomore i ejekcione frakcije leve pretkomora imala je veću dijagnostičku vrednost (P < 0,05).
UNASSIGNED: Morfologija dodatka levog atrijala, brzina krvotoka i nivo galektina-3 u plazmi su važni faktori za procenu rizika od tromboze dodatka levog atrijala kod pacijenata sa atrijalnom fibrilacijom. Ova studija poboljšava razumevanje tromboze, dodatno razjašnjava faktore rizika za trombozu i poboljšava prognozu pacijenata.

Nonthrombotic iliac vein lesions (NIVLs) are significant causes of chronic venous insufficiency (CVI) in the left lower limb and symptom recurrence following left lower limb varicose vein treatment. The goal of this study was to explore the haemodynamic and morphological characteristics of iliac veins in patients with NIVLs. Pressure at the caudal end of the stenotic left common iliac vein (LCIV) segment, local blood flow velocity, and time-averaged wall shear stress in the stenotic segment exhibited positive correlations with the clinical CVI classification (R = 0.92, p < 0.001; R = 0.94, p < 0.001; R = 0.87, p < 0.001), while the relative retention time showed a negative correlation (R = -0.94, p < 0.001). The pressure difference (∆P) between the two ends of the stenotic segment and the velocity difference (∆V) between the stenotic segment and the caudal end were positively correlated with the clinical classification (R = 0.92, p < 0.001; R = 0.9, p < 0.001). The cross-sectional area stenosis rate and length of the stenotic LCIV segment were positively correlated with the clinical classification (R = 0.93, p < 0.001; R = 0.63, p < 0.001). The results suggest that haemodynamic assessment of the iliac vein could effectively portray blood flow disturbances in stenotic segments of the LCIV, potentially reflecting the degree of iliac vein stenosis. Haemodynamic indicators are correlated with the severity of clinical CVI symptoms.

OBJECTIVE: Cardiogenic shock still has a high mortality. In order to correctly manage these patients, it is useful to have available haemodynamic parameters, invasive and non-invasive. The aim of this review is to show the current evidence on the use of echocardiographic aortic flow assessment by left ventricular outflow tract - velocity time integral.
METHODS: Publications relevant to the discussion of echocardiographic aortic flow assessment by left ventricular outflow tract - velocity time integral and cardiogenic shock, were retrieved from PubMed®.
RESULTS: Left ventricular outflow tract - velocity time integral is an easily sampled and reproducible parameter that has already been shown to have prognostic value in various cardiovascular pathologies, including myocardial infarction and heart failure. Although there are still few data available in the literature, the LVOT-VTI also seems to have an important role in CS from prognosis to guidance in the escalation/de-escalation of vasoactive therapy and to support devices by allowing an estimate of patient\'s probability of response to fluid administration.
CONCLUSIONS: Aortic flow assessment can become a very useful invasive parameter in the management of cardiogenic shock.

The study of blood flow is becoming a new trend in cardiology and cardiovascular surgery. Based on the literature and our own data, a review is presented on the use of 4D flow in diseases of the heart and blood vessels. The main state of the question about the features of the application of the technique in various pathologies of the cardiovascular system is described in detail, the priorities, limitations and promising directions of the technique application are considered taking into account the goals of practical medicine. The review consists of two parts. The first is devoted to general issues, limitations of the technique, and issues of 4D flow mapping in patients with lesions of the great vessels. In the second part, the emphasis is on the use of 4D flow MRI in the study of intraventricular blood flow and the application of the technique in congenital heart and vascular diseases.
Изучение кровотока становится новым трендом в кардиологии и сердечно-сосудистой хирургии. На основе литературных и собственных данных представлен обзор применения 4D магнитно-резонансной визуализации потока при заболеваниях сердца и сосудов. Подробно изложено основное состояние вопроса об особенностях применения методики при разных патологиях сердечно-сосудистой системы, рассмотрены приоритеты, ограничения и перспективные направления использования методики с учетом целей практической медицины. Обзор состоит из 2 частей: 1-я часть посвящена общим вопросам, ограничениям методики и 4D-картированию потока у пациентов с поражением магистральных сосудов; во 2-й части акцент сделан на использование 4D магнитно-резонансного томографического потока при изучении внутрижелудочкового кровотока и на применение методики при врожденных пороках сердца и сосудов.

OBJECTIVE: After a traumatic brain injury (TBI), monitoring of both macrovascular and microvascular blood circulation can potentially yield a better understanding of pathophysiology of potential secondary brain lesions. We investigated the changes in phase shift (PS) between cardiac-induced oscillations of cerebral blood flow (CBF) measured at macro (ultrasound Doppler) and microvascular (laser Doppler) level. Further we assessed the impact of intracranial pressure (ICP) on PS in TBI patients. A secondary aim was to compare PS to TCD-derived cerebral arterial time constant (τ), a parameter that reflects the circulatory transit time.
METHODS: TCD blood flow velocities (FV) in the middle cerebral artery, laser Doppler blood microcirculation flux (LDF), arterial blood pressure (ABP), and ICP were monitored in 29 consecutive patients with TBI. Eight patients were excluded because of poor-quality signals. For the remaining 21 patients (median age = 23 (Q1: 20-Q3: 33); men:16,) data were retrospectively analysed. PS between the fundamental harmonics of FV and LDF signals was determined using spectral analysis. τ was estimated as a product of cerebrovascular resistance and compliance, based on the mathematical transformation of FV and ABP, ICP pulse waveforms.
RESULTS: PS was negative (median: -26 (Q1: -38-Q3: -15) degrees) indicating that pulse LDF at a heart rate frequency lagged behind TCD pulse. With rising mean ICP, PS became more negative (R = -0.51, p < 0.019) indicating that delay of LDF pulse increases. There was a significant correlation between PS and cerebrovascular time constant (R = -0.47, p = 0.03).
CONCLUSIONS: Pulse divergence between FV and LDF became greater with elevated ICP, likely reflecting prolonged circulatory travel time.

OBJECTIVE: The aim of this study is to assess early wound healing expression of local angiogenic biomarkers following connective tissue graft (CTG) at dental implant sites.
METHODS: Twenty-eight subjects with single dental implants exhibiting a soft tissue dehiscence were included and randomly treated with CTG, either with coronally advanced flap (CAF) or with tunnel technique (TUN). Peri-implant crevicular fluid (PICF) was collected at the midfacial and midlingual aspect of the implant sites at baseline and at 3, 7, 14, 30, and 90 days after the surgical intervention. The expression of angiogenin (ANG), fibroblast growth factor-2 (FGF-2), platelet-derived growth factor (PDGF), tissue inhibitor of metalloproteinases-2 (TIMP-2), and vascular endothelial growth factor (VEGF) was investigated over a period of 3 months. Patient-reported outcomes, clinical measurements, and ultrasonography scans at multiple time points were also evaluated.
RESULTS: The longitudinal regression revealed a significant difference in the expression of VEGF and TIMP-2 between CAF- and TUN-treated sites over 3 months (p = .033 and p = .004, respectively), whereas no significant differences were observed for ANG, FGF-2 and PDGF between the two groups. At 7 days, a direct correlation was observed between ANG levels and ultrasonographic color velocity in the CAF group (p < .001) and between ANG levels and ultrasonographic color power in the TUN group (p = .028). VEGF levels and ultrasonographic mean perfused area of the CTG were significantly correlated at the 7-day time point (p < .001 for both CAF and TUN). The expression of VEGF at 7 days was directly associated with mucosal thickness gain at 1 year (p < .001 for both groups). Early TIMP-2 expression showed an inverse correlation with time to recovery (p = .002). TIMP-2 levels at 3 months exhibited inverse correlations with mean dehiscence coverage (p = .004) and the rate of complete dehiscence coverage (p = .012).
CONCLUSIONS: PICF biomarkers can be used to monitor early wound healing events following soft tissue grafting at implant sites. VEGF and TIMP-2 showed correlations with the 1-year clinical and volumetric outcomes, as well as with post-operative patient-reported outcomes and Doppler Ultrasonographic tissue perfusion-related parameters.

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