Search Results (191)

Vagal nerve stimulators (VNSs) improve seizure control in up to half of the patients who have them implanted. In non-responding patients, VNS removal may be necessary. Removal is traditionally accomplished through two incisions. We present our experience removing VNSs through a single incision. Background/Objectives: To determine if VNS removal can be safely performed through a single incision. Methods: The medical records of 73 consecutive patients who underwent VNS removal at our institution from 2012 to 2024 were reviewed. Patients were divided into single-incision and two-incision treatment groups. Operative time and surgical complications were compared between groups. Results: A total of 73 patients underwent VNS removal during the study timeframe. Forty-eight VNS removals were accomplished via a single incision, while 25 required both incisions. Time in the operating room was roughly half as long for single-incision removal vs. two-incision removal (29.4 min, range 11–84 vs. 74.2 min, range 33–203); however, single incision was initially attempted in all cases. In two of the incision cases, the neck dissection resulted in an injury to the internal jugular (IJ) vein. In one case, the IJ was repaired and the lead wire removed. In a second case, the IJ could not be repaired, and a segment of lead wire was retained. In a third case, a short length of lead wire was discovered after a single-incision removal and a second procedure was necessary for removal. There were no significant differences in the rates of transient vocal cord weakness, cough, and/or dysphagia between both treatment groups (p = 0.7368), and there were no cases of permanent nerve palsy. Conclusions: VNS removal can be safely accomplished via a single incision in most cases. Successful single-incision procedures may be shorter than the two-incision approach. Attempted VNS removal via a single incision may result in increased incidence of transient hoarseness, dysphagia, and/or cough, but may result in reduced rates of permanent injury or IJ injury. Full article

The axillary and cephalic veins are commonly utilized for transvenous pacemaker lead access. They typically advance to the heart through the subclavian, brachiocephalic, and superior vena cava veins. Anatomical variations such as a persistent left superior vena cava (PLSVC) may pose a challenge, necessitating an alternative approach for lead placement. This anomaly can often be identified during venographic contrast imaging or by visualizing atypical venous courses during the procedure. Another challenge occurs when the venous pathway is tortuous. Careful monitoring during the procedure is crucial to ensure that the lead follows the intended path. If not, the lead may inadvertently enter a collateral, such as the inferior thyroid vein, which drains into the internal jugular or left brachiocephalic vein. Despite these deviations, the lead may eventually reach the heart, although via an unusual course. If such a lead is left in place, even in the absence of immediate complications, long-term outcomes are unpredictable and carry the risk of unforeseen complications. Full article

A four-year-old female patient was admitted for evaluation after a mass on the right side of her neck was noticed during straining (Valsalva maneuver). The family first observed the mass when the patient was one year old, and noted that it gradually increased in size over time. A family history assessment revealed no known genetic disorders. The patient underwent neck ultrasonography and computed tomography angiography (CTA), which revealed two aneurysms in a right-sided communicating vein. One aneurysm was located above the jugular notch, and the other was located in the retro-parotid region. The presence of two venous aneurysms in a right-sided communicating vein—one above the jugular notch and the other in the retro-parotid region—suggests a rare and apparently benign congenital anomaly. The progressive enlargement of these malformations warrants close monitoring and surgical intervention, and long-term follow-up may be necessary to prevent complications such as thrombosis, rupture, or compression of adjacent structures. Full article

Background: Prior studies have shown an association between jugular venous reflux and age-related neurological conditions, including cognitive decline and potentially incident dementia. However, a relationship between internal jugular vein (IJV) outflow disturbance and cognitive impairment has yet to be elucidated. This study evaluates the relationship between impaired IJV drainage and cognitive function. Methods: We recruited a prospective sample of 106 participants with subjective memory complaints. Subjects underwent neuropsychological assessments and ultrasound examination of IJV, including time-averaged mean velocity (TAMV) and the cross-sectional area of the IJV at the middle (J2) and distal (J3) segments. Impaired IJV drainage was defined by either of the following: (1) TAMV < 4 cm/s at the J2 or J3 segment on either side, or (2) IJV lumen collapse during inspiration at the J2 segment on either side. Results: The impaired cognition group had a significantly higher prevalence of both impaired flow velocity and impaired IJV drainage compared to the normal cognition group (34% vs. 16%, p = 0.032; 68% vs. 30%, p < 0.001). Furthermore, the impaired IJV drainage group demonstrated lower scores across all neuropsychological tests, with statistical significance observed in the Mini-Mental State Examination (median (IQR) 27 vs. 29, p = 0.013), Montreal Cognitive Assessment (median (IQR) 23 vs. 26, p < 0.001) and Chinese Version of the Verbal Learning Test (median (IQR) 23.5 vs. 27, p = 0.024). Notably, incorporating IJV lumen collapse during deep inspiration into the definition of impaired IJV drainage further increased its prevalence in the impaired cognition group. Conclusions: Our results revealed that the impaired cognition group exhibited a higher prevalence of impaired outflow in the bilateral IJV, while the impaired IJV drainage group scored lower on all neuropsychological tests compared to the normal group. These findings support the hypothesis that impaired IJV drainage is correlated with global cognitive decline. Full article

Background: Internal jugular vein thrombosis (IJVT) is a rare but serious complication in hospitalized patients, often associated with central venous access devices (CVADs). The primary objective of the study was to analyze the clinical characteristics of patients with newly diagnosed IJVT, in particular to evaluate mortality, development of pulmonary embolism and incidence of bleeding at 30 days from diagnosis. Secondly, a sub-analysis was performed between patients with device-related and non-device-related thrombosis. Methods: Prospective study on adult inpatients diagnosed with IJVT from January to December 2024. Data on demographics, comorbidities, device use, laboratory values at diagnosis (D-dimer, platelet count, C-reactive protein (CRP), liver/renal function), treatment, and outcomes (mortality, pulmonary embolism, bleeding) were collected. Results: Thirty-one patients with IJVT were included. Mean age was 71.0 ± 13.2 years; 54.8% female; 35.5% had CVADs (central venous catheter (CVC) 36.4%, midlines 36.4%, peripherally inserted central catheter (PICC) 27.2%). Device-associated IJVT patients exhibited lower D-dimer (2.1 ± 0.5 vs. 3.6 ± 0.8 µg/mL; p = 0.018), higher platelet counts (249.0 ± 86.7 vs. 184.3 ± 53.6 × 10⁹/L; p = 0.044), and elevated CRP (12.5 ± 9.2 vs. 5.1 ± 5.6 mg/L; p = 0.033). Overall mortality was 16.1%; pulmonary embolism occurred in 16.1% and bleeding in 6.5%. CVAD use was not independently associated with adverse outcomes. Conclusions: IJVT presents with distinct biomarker profiles when associated with CVADs, characterized by lower systemic fibrinolysis and heightened inflammation. Recognition of these differences may refine diagnostic thresholds and guide prophylactic strategies. Larger prospective studies are warranted. Full article

Objective: Cerebral vascularization is made of the symmetrical arterial system, with muscular walls, and the venous system, more variable and dominated by sinuses and jugular veins. Factors like age and posture influence this network, complicating its study. Phase-contrast MRI is the gold standard for quantifying cerebral circulation. This study aimed to quantify the dynamics of the cerebral blood system using PC-MRI. Materials and Methods: Thirty-six healthy adults participated. Imaging was performed on a 3T MRI (Philips Achieva) in a supine position. Two slices were acquired: intracranial and extracranial. In-house software analyzed flow curves over a cardiac cycle. Each vessel’s contribution was evaluated. Results: Extracranial venous drainage was categorized as jugular-dominant, equivalent, or peripheral-dominant. A similar classification applied intracranially. Intracranial flows showed low variability (5–9%), while extracranial venous flows, especially in the internal jugular veins, had higher variability (17–21%). Some extracranial veins were absent. Conclusions: There is significant venous heterogeneity in the extracranial region. PC-MRI enables the quantification of cerebral dynamics. Full article

Platelet glycoprotein (GP)VI is a transmembrane protein that was originally characterized as a collagen receptor supporting platelet adhesion and activation through its association with the Fc receptor γ-chain (FcRγ). The FcRγ subunit contains immunoreceptor tyrosine-based activation motifs (ITAMs) that recruit and activate Syk (spleen tyrosine kinase), a key player in intracellular signaling pathways. The absence or dysfunction of GPVI produces a mild bleeding defect in humans like the impaired hemostasis reported in the murine knockout. Here, we took an ultrastructure approach to examine the impact of ligand binding to GPVI versus the downstream pharmacologic inhibition of the GPVI-dependent ITAM signaling pathway. Clots were generated for analysis following a puncture wound in the mouse external jugular vein. Images were obtained using mice genetically missing GPVI and mice pretreated with the Syk inhibitor, BI 1002494. Our study was designed to test the hypothesis that the predominant contribution of GPVI to hemostasis is mediated by a Syk-dependent signaling cascade. If true, the clot structure observed with a Syk inhibitor versus the GPVI knockout would be similar. If the extracellular domains of the protein had a Syk-independent platelet adhesion role, then significant comparative differences in the thrombus structure would be expected. Our results clearly indicate an important, Syk-independent role of the GPVI extracellular domain in the adherence of platelets within the intravascular crown of a growing venous clot, a site distant from exposed collagen-rich adventitia. In striking contrast, the adventitial proximal role of GPVI was Syk-dependent, with the GPVI knockout and Syk inhibitor giving the same, limited structural outcome of collagen-proximal platelet cytosol loss and a thinned extravascular cap. Consistent with the lesser role of Syk-dependent processes on the thrombus structure, the Syk inhibitor had no detectable effect on jugular puncture wound bleeding times, while the knockout had a statistically significant, but modest effect on bleeding time. Based on this contrast, we suggest that Syk inhibition may be the more selective approach to modulating the role of GPVI in occlusive clotting. Full article

Background/Objectives: In chronic liver disease, a rebalanced coagulation state often results in an increased risk of thrombosis, particularly in the splanchnic region. While systemic coagulation abnormalities are well documented, alterations in regional (portal) hemostasis remain underexplored. This study aimed to compare systemic and portal hemostasis during liver transplantation and to determine whether systemic parameters can accurately predict regional coagulation status. Methods: Thirty-five liver transplant recipients were included in this study. Systemic blood samples (S1–S5) were collected from the external jugular vein at five surgical time points, while portal blood samples (R3) were obtained immediately before reperfusion simultaneously with S3. All samples were analyzed using ClotPro^® viscoelastic assays, conventional coagulation tests, and blood gas analysis. Results: The EX-test comparison between S3 and R3 samples revealed a discrepancy between systemic and regional hemostasis in 45.7% of patients. Among these, eight regional samples exhibited hypocoagulation characterized by coagulation factor consumption and hyperfibrinolysis. Another eight samples demonstrated hypercoagulation with fibrinolytic shutdown, which was confirmed by a fibrin-rich thrombus identified via scanning electron microscopy. Systemic samples failed to predict these regional variations. Conclusions: Regional (portal) hemostasis significantly differs from systemic coagulation and cannot be accurately predicted using systemic assays alone. These findings suggest that fibrinolytic shutdown in the portal vein may contribute to intraoperative and long-term graft damage, highlighting a potential need for regional coagulation assessment during liver transplantation. Full article

Background/Objectives: The hypoglossal nerve plays a crucial role in cervical surgery, requiring precise anatomical knowledge to prevent iatrogenic injury. This study examined its position relative to key structures using cadaveric dissections and assessed ChatGPT-4’s reliability in providing anatomical insights. Methods: Ten cadavers were dissected to identify the hypoglossal nerve’s course in relation to the internal jugular vein, carotid arteries, thyro-linguo-facial trunk, hyoid bone, and digastric muscle. Measurements were taken, and ChatGPT was queried for anatomical guidance and surgical recommendations. Results: The hypoglossal nerve was consistently medial to the internal jugular vein and lateral to the carotid arteries. The measured distances to the surrounding structures showed notable variability, particularly with the thyro-linguo-facial trunk. ChatGPT accurately described major landmarks but overlooked lesser-known anatomical triangles and provided no additional dissection guidance. It primarily suggested intraoperative monitoring and preoperative imaging. Conclusions: The carotid and submandibular triangles serve as reliable landmarks for identifying the hypoglossal nerve. This study highlights an unreported variability in its relationship with the thyro-linguo-facial trunk. ChatGPT, while informative, lacked detailed surgical applicability for dissection. Full article

Aflatoxin B₁ (AFB₁) is widely present in raw materials for food and feedstock, posing a significant threat to the health of humans and animals. This study explored the toxicokinetics of a single oral administration of AFB₁ at a dose of 100 µg·kg⁻¹ BW (body weight). Donkey blood samples were gathered at 0, 5, 10, 15, 20, 30, 45, and 60 min and at 1.5 h, 2 h, 2.5 h, 3 h, 3.5 h, 4 h, 4.5 h, 6 h, 9 h, 12 h, 24 h, 48 h, 72 h, 96 h, and 120 h through jugular vein sampling needles at intervals. Fecal and urinary samples were collected at 0 h and every 6 h thereafter until 120 h. The concentrations of AFB₁ and AFM₁ in plasma, urine, and feces were quantitatively analyzed using LC-MS/MS. The maximum concentrations of AFB₁ and AFM₁ in plasma were 13.10 ± 6.35 µg·L⁻¹ and 0.72 ± 0.33 µg·L⁻¹, occurring at 1.38 ± 0.89 h and 2.25 ± 1.57 h after oral administration, respectively. The AFB₁ and AFM₁ elimination half-lives (T_1/2Elim) were 6.65 ± 2.84 h and 5.85 ± 3.00 h, respectively. The total clearances (CL) of AFB₁ and AFM₁ were 163 ± 52.2 L·kg⁻¹ BW⁻¹·h⁻¹ and 3210 ± 2450 L·kg⁻¹ BW⁻¹·h⁻¹, and the volumes of distribution (Vd) for AFB₁ were 1440 ± 417 L·kg⁻¹·BW and 22,400 ± 14,800 L·kg⁻¹·BW, respectively. In addition, the total amounts of AFB₁ and AFM₁ excreted over 120 h through urine and feces accounted for 3.38 ± 0.92% and 3.44 ± 1.45% of the total intake, respectively (calculated by material mass). Furthermore, the research showed that the absorption and metabolism of AFB₁ were rapid in male donkeys, with the tissue exhibiting a wide distribution and long duration. Full article

Background and Objectives: This study aimed to discuss positional changes in the sternocleidomastoid (SCM) muscle and vagus nerve with head position, their effect on the surgical path, positional variations, the selection of an appropriate position for surgery, their effects on the surgical procedure, and complications by using peroperative ultrasonography. Materials and Methods: Vagal nerve stimulation surgery patients over the age of 18 years were included. Peroperative ultrasonography images were scanned, and changes in head position and anatomical and positional variations in the SCM muscle and vagus nerve at the surgical incision level were examined. Results: SCM localization was most frequently observed in the lateral aspect of the carotid sheath (n:16) in neutral position, while it was mostly observed in the medial aspect of the carotid sheath (n:16) at a 15 degree rotation. The vagus nerve was mostly observed between the jugular vein and carotid artery in neutral position (n:21), and it was observed at the same position at a 15 degree rotation (n:17). The positional change of the SCM muscle with head position was found to be statistically significant (p < 0.001), while the positional change of the vagus nerve was not (p:0.198). Conclusions: The SCM muscle closes the surgical path with head rotation by either deviating over the carotid sheath or increasing its deviation. In addition to its anatomical variations, the vagus nerve shows different positional changes with head rotation. Deciding on the head position in vagal nerve stimulation surgery, using peroperative ultrasonography rather than a routine position, may be effective in reducing surgical time and possible complications. Full article

This study aimed to evaluate the practicality and feasibility of using intracavitary electrocardiography to confirm the proper placement of a central venous catheter for hemodialysis. Central venous catheters are typically placed using an echo-guided technique based on anatomical landmarks, followed by X-ray confirmation. Anesthesiology guidelines recommend evaluating the intracavitary electrocardiogram during the procedure to verify the correct CVC placement. This study involved 11 patients without rhythm disturbances, in whom a central venous catheter was placed in the right internal jugular vein at our institute in 2024. The patient’s electrocardiogram was analyzed using the MAGELLANO^® (Italy) device to identify changes in the P wave or QRS complex, which confirmed the CVC’s correct placement at the right cavoatrial junction. Thoracic ultrasound was used to identify the right internal jugular vein and exclude iatrogenic pneumothorax. A subsequent chest X-ray was performed to further confirm the correct placement. In addition, a non-systematic review of the most recent literature on this topic was conducted using the Database PubMed—United States National Library of Medicine. Chest X-ray consistently verified the correct placements identified by ECG-IC, with no post-procedure complications. ECG-IC is a straightforward, viable, and cost-effective technique with high sensitivity when administered by properly trained professionals. This approach, combining ultrasound-guided CVC placement in the right internal jugular vein and intracavitary ECG monitoring, can omit X-ray control in more than 90% of cases. Full article

This study investigated differences in gastrointestinal microbiota and blood metabolomes in calves with different heat stress (HS) responses in the same hot environment. Ten high (H) and ten low (L) HS response preweaning Holstein calves were selected based on their heat stress level (respiratory rate and rectal temperature), jugular vein blood samples and ruminal and fecal samples were collected. Notable variations were observed in the serum levels of heat shock protein 70 (HSP-70) and IL-2 between the two calf groups (p < 0.05). In group H, rumen and fecal microbiota synergism was disrupted. In the H group, the host metabolome exhibited enrichment in pyruvate metabolism and the tricarboxylic acid cycle (p < 0.05). Key factors bridging the relationship between gastrointestinal microbiota and serum metabolites included the rumen bacterial genus g__Ruminococcus, serum HSP-70, malic acid, and fumaric acid. These hubs served as potential indicators for distinguishing the response to heat stress in calves (p < 0.05). In conclusion, this study identified the relationship between gastrointestinal microbiota characteristics and different HS responses of the host, thus providing evidence and new directions for future studies aimed at understanding HS in individual calves (gut microbiota-host interactions). Full article

Background/Objectives: In neurocritical care, usually, the only continuous measurement of brain pathophysiology is intracranial pressure (ICP). The objective of this study was to find the relationship between cerebral blood flow (CBF) and parameters usually measured in neurocritical care, mainly central venous pressure and ICP. Methods: If the venous outflow of the CBF is considered, the CBF is controlled only by two parameters, the rICP (the ICP minus the venous blood pressure in the venous sinus at its outflow) and the Rv (the flow resistance of the soft-walled veins). For the rICP, the sinus blood pressure can be calculated from the central venous pressure (measured at the same horizontal level as the ICP) and the cervical venous flow resistance. For the Rv, the systolic ICP increase indicates the systolic arterial inflow volume, which then flows out before the diastole. The mean ICP increase divided by the mean outflow of the increased blood volume gives the Rv. This method of calculating the CBF by dividing the rICP by the Rv was named CBF(1). For validation of CBF(1), data from nine subjects in an open study were used. The data were ICP and MR blood flow measurements of arterial inflow and jugular vein outflow. Since the rICP, Rv, and CBF were unknown, an iterative method was needed to calculate these parameters. Results: The observed Rv and rICP values showed a close correlation, which indicated that CBF was dependant on the rICP only. Consequently, the comparison between the data in the study of the nine subjects, and the calculated values from CBF(1), boiled down to a comparison between the supine ICP values and the calculated rICP. The comparison showed that the rICP and supine ICP had highly significant similarity, and that the CBF(1) method was validated. Conclusions: A method for CBF measurement from ICP data in neurocritical care was found. Full article

This study aims to explore the impact of adding sodium acetate and sodium butyrate on the composition, blood biochemical parameters, and volatile flavor compounds of lactating mares’ milk. By assessing the influence of these additives on milk flavor enhancement, the findings provide scientific evidence for optimizing flavor characteristics and offer new strategies for improving the sensory attributes of mare milk products. Eighteen lactating Yili mares were randomly assigned to three groups: a control group, a sodium acetate group (85 mg/kg·BM⁻¹), and a sodium butyrate group (85 mg/kg·BM⁻¹). The experiment lasted 90 days, with milk yield recorded on days 0, 30, 60, and 90. Milk samples were collected on day 60 (peak lactation) for compositional analysis, and GC-IMS was employed to identify and quantify volatile compounds. Additionally, blood samples were drawn from the jugular vein before morning feeding on day 60 using heparinized tubes to assess key biochemical markers, including glucose, triglycerides, total cholesterol, and urea. The results revealed the following findings: (1) Milk yield and composition: The addition of sodium acetate and sodium butyrate had no significant effect on milk yield. However, both treatment groups exhibited significantly or extremely significantly higher milk fat content compared to the control group, whereas milk protein and lactose levels remained largely unchanged. (2) Blood biochemical indicators: The sodium butyrate group showed an extremely significant increase in urea levels compared to the sodium acetate and control groups. Glucose levels in the sodium acetate group were also significantly higher than in the control group. Moreover, triglyceride levels were markedly elevated in the sodium butyrate group compared to the sodium acetate group, while total bilirubin concentrations were significantly higher in the sodium acetate group than in the control group. (3) Volatile compounds: The addition of these additives led to a significant increase in the diversity and concentration of volatile compounds in mare milk. Notably, esters, aldehydes, and ketones showed substantial enrichment in both treatment groups. The relative abundance of esters such as butyl acetate, L-lactic acid ethyl ester, 1-pentene-3-ol, pentanol, and 3-pentanone increased, alongside a significant rise in aldehydes and ketones, including 2-heptenal and 3-pentanone. In conclusion, sodium acetate and sodium butyrate enhance milk flavor by modulating milk composition and metabolic parameters, providing a scientific foundation for improving the quality of mare milk products. Full article