Hasil untuk "Diseases of the circulatory (Cardiovascular) system"

O. A. Saygina, T. S. Sukhinina, M. A. Terenicheva et al.

Aim. To study the safety of using the intravenous beta-blocker (BB) esmolol in the early stages of ST-segment elevation myocardial infarction (STEMI) before primary percutaneous coronary intervention (PCI) based on an analysis of the incidence and clinical significance of adverse events (acute heart failure, hypotension, bradycardia, disorders of atrioventricular conduction (AV conduction), etc.) compared with the control group.Material and methods. The presented study is part of the randomized controlled trial ESMO-VASCMI (ClinicalTrials.gov NCT number 06376630) on the study of the cardioprotective effect of IV BB esmolol in the early stages of STEMI. The study included 121 patients (n=60 in the control group and n=61 in the esmolol group) with STEMI in the first 48 hours after the onset of symptoms contraindications to BB, who were not prescribed metoprolol before PCI due to safety concerns. The administration of esmolol began with a loading dose of 500 mcg/kg for 1 minute, followed by an infusion for 6 hours. With the development of adverse events, esmolol therapy was discontinued prematurely or temporarily suspended.Results. No statistically significant difference was observed in the frequency of adverse events potentially provoked by β1‑blocker administration between the study groups. In the esmolol group, there was a trend toward a higher incidence of bradycardia during PCI (18.03% vs 6.63%, p=0.058); hypotension (down to 70/40 mm Hg) was observed in 2 patients (3.3%), and AHF manifestations in 2 (3.3%). In 4 patients (7%), the infusion was prematurely discontinued, and in 8 (13%) it was temporarily suspended and resumed after hemodynamic stabilization. No cases of bronchospasm were detected. All cases of bradycardia and hypotension were clinically insignificant. Bradycardia developed during reperfusion with PCI, atropine was administered to 2 patients, and esmolol infusion was subsequently resumed. In the esmolol group, there was no development of stable ventricular rhythm disturbances (ventricular fibrillation (VF) or ventricular tachycardia (VT)) on the first day of the disease, in contrast to the control group (n=4; 6.67%). The differences were significant (p=0.04). The incidence of hospital deaths was low (n=1 in the control group), with no significant difference between the study and control groups (0% vs 1.7%).Conclusion. The study results confirm the favorable safety profile of esmolol. Intravenous esmolol administration reduced the incidence of life-threatening arrhythmias without increasing the frequency of conduction disturbances, bradycardia, or AHF. In most cases, discontinuation of the infusion was sufficient to manage bradycardia in the esmolol group.

Albert L. Gonzales, Nicholas R. Klug, A. Moshkforoush et al.

Significance Capillaries—the most abundant vessels in the circulatory system—deliver O2 and nutrients to all cells of the body. In the brain and retina, capillaries also act as a sensory web that detects neuronal activity. Here, we demonstrate that pericytes localized at capillary junctions in a postarteriole transitional region possess unique properties, notably including contractility, that enable them to dynamically manipulate capillary branch diameters and exert fine control over the distribution of blood within the capillary network. In so doing, these contractile junctional pericytes fine tune the delivery of O2 and nutrients and thus serve to meet the specific needs of neurons. Given these unique properties, pericytes represent a therapeutic target for cardiovascular and neurodegenerative diseases. The essential function of the circulatory system is to continuously and efficiently supply the O2 and nutrients necessary to meet the metabolic demands of every cell in the body, a function in which vast capillary networks play a key role. Capillary networks serve an additional important function in the central nervous system: acting as a sensory network, they detect neuronal activity in the form of elevated extracellular K+ and initiate a retrograde, propagating, hyperpolarizing signal that dilates upstream arterioles to rapidly increase local blood flow. Yet, little is known about how blood entering this network is distributed on a branch-to-branch basis to reach specific neurons in need. Here, we demonstrate that capillary-enwrapping projections of junctional, contractile pericytes within a postarteriole transitional region differentially constrict to structurally and dynamically determine the morphology of capillary junctions and thereby regulate branch-specific blood flow. We further found that these contractile pericytes are capable of receiving propagating K+-induced hyperpolarizing signals propagating through the capillary network and dynamically channeling red blood cells toward the initiating signal. By controlling blood flow at junctions, contractile pericytes within a functionally distinct postarteriole transitional region maintain the efficiency and effectiveness of the capillary network, enabling optimal perfusion of the brain.

Hongyu Chen, Fangfang Fan, Ziliang Ye et al.

ABSTRACT Photoplethysmography‐derived arterial stiffness index (ASI) has been proven to be associated with various cardiovascular diseases. The present study aims to determine whether the predictive value of ASI varies between elderly and non‐elderly and whether ASI improves the discrimination and reclassification ability of the updated Systematic Coronary Risk Evaluation (SCORE2) in different age groups. This retrospective study included UK Biobank participants with ASI recordings. Multivariable Cox proportional hazard models were used to estimate the associations between ASI and major adverse cardiovascular events (MACE) in different age groups. The difference in C‐statistic, integrated discrimination improvement (IDI), and continuous net reclassification improvement (NRI) were calculated to test the predictive performance of ASI beyond SCORE2 in the elderly and non‐elderly. A total of 127 045 participants were included in the primary analysis. During a median of 11.7 years, 2606 (10.7%) and 4408 (4.3%) MACE were identified in the elderly and non‐elderly, respectively. The non‐elderly exhibited a greater extent of increased risk for MACE with higher ASI (HR, 1.314 [1.280–1.350] vs. HR, 1.066 [1.026–1.107]). Furthermore, the IDI and continuous NRI of ASI beyond SCORE2 for MACE were more than two times higher for non‐elderly individuals than their elderly counterparts (IDI, 0.0481% [0.0182%–0.0953%] vs. IDI, 0.0010% [−0.0052% to 0.0295%]; NRI, 8.76% [6.83% to 10.60%] vs. NRI, 3.27% [−3.92% to 5.97%]). Our findings suggested that ASI should primarily be utilized for primary cardiovascular prevention in individuals below 65.

Maryna Mishchenko, Volodymyr Ponomaryov, Oleksandr Mishchenko et al.

Introduction. In recent years, cardiovascular diseases (CVDІS), especially circulatory diseases (CDS), cerebrovascular diseases (CVDS) and cerebral strokes (CS), have been ranked first in terms of prevalence, mortality and disability of the entire world population. Purpose of the study. To analyze the epidemiological situation regarding the prevalence of CDS, CVDS and CS and their medical and social consequences in Ukraine and Kharkiv region. Materials and methods. Data from official sources of statistical information of Ukraine (State Institution "Center for Medical Statistics of the Ministry of Health of Ukraine") were used. The results. A decrease in the prevalence of all diseases and illnesses detected for the first time in life in Ukraine was determined for CDS (trends -16.3% and -28.0%) and CVDS (-22.8% and -24.1%) and CS and a significant increase in the primary prevalence for CS (+83.9%). An increase in mortality rates in Ukraine due to CDS and CVDS per 100 thousand people was noted: trends of +2.3% and -13.6%, respectively. An increase in the level of primary disability among the adult population has been identified for all diseases (trend +3.7%), as well as for CDS (+5.8%) and CVDS (+8.3%). Trends in the decline of CDS and CVDS in the Kharkiv region have been identified: -10.8% and -14.1% (all diseases) and -44.3% and -31.3% (newly diagnosed). Significant growth rates of the prevalence of CS were determined both for the total morbidity (trend +62.5%) and for those detected for the first time in life (+249.2%). An increase in mortality rates in the adult population of the region due to CDS and CVDS with trends of +1.9% (absolute values) and +4.9% (per 100 thousand population) was noted. There was an increase in the levels of primary disability for all diseases, CDS and CVDS among the adult population of the Kharkiv region with the corresponding trends for absolute values: +2.4%, +10.1% and +24.3% and rates per 10 thousand people: +4,9%, +12,1% +25,6%. Conclusions. The trends in the growth of CDS, CVDS and CS among the adult population of our country, the city of Kharkiv and Kharkiv region have been determined.

B. Ahmad, W. Hamid, Muhammad Ali Khan Khan et al.

Background: Rheumatic heart disease is more prevalent in lower-income nations, such as Pakistan, where it significantly contributes to symptoms, functional impairment, and circulatory system-related morbidity and mortality.1,2 Worldwide, it is considered a significant cause of cardiovascular disease and death, resulting in a notable decline in quality of life and increased physical impairment.3 Patients with advanced valvular disease often require valve replacement surgery.1 Objective: to evaluate the early outcomes of posterior pericardiotomy in patients undergoing heart valve surgery, with a focus on reducing the incidence of postoperative atrial fibrillation (AF), pericardial effusion (PE). Methods: A total of 150 patients undergoing elective valve heart surgery were included in this prospective study. The mean age of patients was 35.26 years, with a gender distribution of 70.2% female and 29.8% male. Patients were followed up for postoperative complications, including AF, PE, and tamponade requiring intervention. ICU and total hospital stay durations were recorded and analyzed based on the presence of complications. Results: Results: Among 150 patients undergoing posterior pericardiotomy (PP) during elective heart valve surgery, the incidence of postoperative atrial fibrillation (POAF) was 4% (6 patients), with no significant association with age, gender, smoking, or residential status (p > 0.05). Pericardial effusion occurred in 2% (3 patients) but needs no drainage, predominantly in smokers, although this was not statistically significant (p = 0.121). The mean ICU stay was 1.82 ± 0.54 days, and the mean hospital stay was 5.06 ± 0.99 days. No cases of cardiac tamponade or significant pericardial effusion requiring intervention were observed. These findings suggest that PP may contribute to a low incidence of early postoperative complications in heart valve surgery patients. Conclusion: Posterior pericardiotomy is a safe and effective procedure that can significantly reduce the incidence of postoperative AF, PE, and left pleural effusion following valve heart surgery. The procedure is associated with shorter ICU and hospital stays in patients without complications, contributing to improved postoperative outcomes.

S. J. Wimalawansa, S. T. Weiss, B. W. Hollis

Background/Objectives: Vitamin D is essential for bone health, immune function, and overall well-being. Numerous ecological, observational, and prospective studies, including randomized controlled clinical trials (RCTs), report an inverse association between higher serum 25-hydroxyvitamin D [25(OH)D; calcifediol] levels in various conditions, including cardiovascular disease, metabolic disorders such as diabetes and obesity, susceptibility to infection-related complications, autoimmune diseases, and all-cause mortality. Results: Vitamin D operates through two distinct systems. The endocrine system comprises the renal tubular cell-derived circulatory calcitriol, which primarily regulates calcium homeostasis and muscular functions. In contrast, intracellularly generated calcitriol in peripheral target cells is responsible for intracrine/paracrine system signaling and calcitriol–vitamin D receptor-mediated genomic effects. Government-appointed committees and health organizations have developed various clinical practice guidelines for vitamin D supplementation and management. However, these guidelines heavily relied on the 2011 Institute of Medicine (IoM) report, which focused solely on the skeletal effects of vitamin D, ignoring other body systems. Thus, they do not represent maintaining good overall health and aspects of disease prevention. Additionally, the IoM report was intended as a public health recommendation for the government and is not a clinical guideline. Discussion: New country- and regional-specific guidelines must focus on healthy nations through disease prevention and reducing healthcare costs. They should not be restricted to bone effect and must encompass all extra-skeletal benefits. Nevertheless, due to misunderstandings, medical societies and other governments have used faulty IoM report as a foundation for creating vitamin D guidelines. Consequently, they placed disproportionate emphasis on bone health while largely overlooking its benefits for other bodily systems, making current guidelines, including 2024, the Endocrine Society less applicable to the public. As a result, the utility of published guidelines has been significantly reduced for clinical practice and RCTs that designed on bone-centric are generate misleading information and remain suboptimal for public health and disease prevention. Conclusions: This review and its recommendations address the gaps in current vitamin D clinical practice guidelines and propose a framework for developing more effective, country and region-specific recommendations that capture the extra-skeletal benefits of vitamin D to prevent multiple diseases and enhance public health.

Rebecka A Sadler, A. Shoveller, U. Shandilya et al.

Vitamin K (VK) is an essential micronutrient impacting many systems in the body. This lipid-soluble vitamin is found in various plant and animal products and is absorbed via the lymphatic system. This biomolecule’s importance to human health includes but is not limited to its promotion of brain, cardiovascular, bone, and immune functions. These biological properties are also necessary for maintaining domesticated animal health. The synergistic impact of both VK and vitamin D (VD) maximizes these health benefits, specifically for the circulatory and skeletal systems. This manuscript reviews VK’s properties, molecular structures, nutrikinetics, mechanisms of action, daily requirements, safety in supplemental form, biomarkers used for its detection, and impacts on various organs. The purpose of synthesizing this information is to evaluate the potential uses of VK for the treatment or prevention of diseases.

G. Balaraju, M. Reddy, S. Manjunath et al.

The heart stands as the most essential part in the human system, providing the circulatory system to each part of the body. The prediction of cardiovascular diseases is an important task in medicine. Machine learning helps process large medical data and reveal hidden knowledge that would otherwise be impossible to detect with the human eye. Various data mining and machine learning approaches, including Decision Tree, Logistic Regression, K-Nearest Neighbor (KNN), Naive Bayes, and Support Vector Machine (SVM), are utilized to predict cardiovascular disease. This large-scale project seeks to find the potential of using machine learning for accurate disease prediction (cardiovascular diseases), contributing to the advancement of health research. The Random Forest Classifier achieved the highest accuracy of 93%, along with impressive scores for AUC (98%), recall (94%), precision (94%), F1-score (94%), and MCC (87%). Other ensemble algorithms like Extra Trees and Gradient Boosting variants also exhibited high accuracies above 90%. In contrast, traditional algorithms like Logistic Regression, Naive Bayes, and linear models lagged behind, with accuracies ranging from 84-87%.

Matteo Nagni, Marco Severino, Ciro Cotticelli et al.

Objective: Cardiovascular diseases (CVD) are diseases of the circulatory system that affect the anatomy and pathophysiology of the heart and blood vessels; hypertension is one of the most common cardiovascular diseases. This case report aims to illustrate the implant survival rate and marginal bone loss in patients with hypertension undergoing fixed prosthetic rehabilitation, according to the all-on-four method, in both arches, at two years of follow-up. Materials and methods: The patient, suffering from hypertension, presented with severe diffuse periodontitis in both arches. Requiring a fixed rehabilitation, considering a more severe bone loss in the posterior maxillary and mandibular sectors, we opted for rehabilitation with a reduced number of implants according to the “All-on-Four” method. Follow-up visits were performed one week after surgery, after six months, and once a year for the following period (24 months). Any intra- and postoperative complications were noted so that the patient could be monitored. Every four months after surgery, hygiene maintenance sessions were carried out. Results: No implants were lost during the follow-up period, and no intra- and postoperative complications were recorded. Conclusion: By promoting reasonable blood pressure control, implant placement in patients with hypertension could be considered a predictable and safe procedure. Moreover, constant patient monitoring and adherence to a strict hygiene maintenance protocol could be crucial to promote implant survival

Mengxue He, Jiachen Shi, Cong Wu et al.

Inflammation plays a critical role in the development of numerous diseases. Cannabidiol (CBD), found in hemp, exhibits significant pharmacological activities. Accumulating evidence suggests that CBD has anti-inflammatory and cardiovascular protection effects, but the potential mechanisms require further exploration. In this study, we aimed to reveal the mechanisms of CBD against high-fat, high-cholesterol (HFC) diet-induced inflammation combining metabolomics with network pharmacology. First, plasma lipidomics results indicated that oxidized lipids could serve as potential biomarkers for HFC diet-induced inflammation, and CBD reversed the elevated levels of oxidized lipids. The HFC diet was also found to enhance intestinal permeability, facilitating the entry of lipopolysaccharides (LPSs) into the circulatory system and subsequently increasing systemic inflammation. Additionally, cell metabolomic results indicated that CBD could reverse 10 important differential metabolites in LPS-induced RAW 264.7 cells. Using network pharmacology, we identified 49 core targets, and enrichment analysis revealed that arachidonic acid was the most significantly affected by CBD, which was closely associated with inflammation. Further integrated analysis focused on three key targets, including PTGS2, ALOX5, and ALOX15. Molecular docking showed high affinities between key targets and CBD, and qPCR further demonstrated that CBD could reverse the mRNA expression of these key targets in RAW 264.7 cells. Collectively, this finding integrates lipidomics and metabolomics with network pharmacology to elucidate the anti-inflammatory effects of CBD and validates key therapeutic targets.

Yuehuan Wang, Yi Yang, Yanjuan Song

Exercise is an effective measure for preventing and treating cardiovascular diseases, although the exact molecular mechanism remains unknown. Previous studies have shown that both irisin and exosomes can improve the course of cardiovascular disease independently. Therefore, it is speculated that the cardiovascular protective effect of exercise is also related to its ability to regulate the concentrations of irisin and exosomes in the circulatory system. In this review, the potential synergistic interactions between irisin and exosomes are examined, as well as the underlying mechanisms including the AMPK/PI3K/AKT pathway, the TGFβ1/Smad2/3 pathway, the PI3K/AKT/VEGF pathway, and the PTEN/PINK1/Parkin pathway are examined. This paper provides evidence to propose that exercise promotes the release of exosomes enriched with irisin, miR-486-5p and miR-342-5p from skeletal muscles, which results in the activation protective networks in the cardiovascular system. Moreover, the potential synergistic effect in exosomal cargo can provide new ideas for clinical research of exercise mimics.

Yu Sun, Qingxin Shang

To investigate the research levels, hotspots, and development trends regarding microRNAs in hypertension, this study conducted a visual analysis of studies on miRNA in hypertension based on the Web of Science core collection database using CiteSpace and VOSviewer analysis software along with literature from 2005–2023 as information data. Using citation frequency, centrality, and starting year as metrics, this study analyzed the research objects. It revealed the main research bodies and hotspots and evaluated the sources of literature and the distribution of knowledge from journals and authors. Finally, the potential research directions for miRNAs in hypertension are discussed. The results showed that the research field is in a period of vigorous development, and scholars worldwide have shown strong interest in this research field. A comprehensive summary and analysis of the current research status and application trends will prove beneficial for the advancement of this field.

Yi Li, Hui Wu, Songlin Zhang et al.

In recent years, the interaction of intracellular organelles such as mitochondria and lysosomal functions has attracted increasing attention. Recent evidence suggests that mitochondrion-lysosomal contact plays a key role in regulating lysosomal biogenesis and maintaining cellular homeostasis. Myocardial ischemia and reperfusion will lead to corresponding changes in the autophagy flux in cardiomyocytes, and lysosomes are a key link in the process of autophagy, and the fusion of lysosomes and autophagosomes is an essential link in the occurrence of autophagy. Therefore, the function and homeostasis of lysosomes also undergo different changes during myocardial ischemia and reperfusion. Lysosomal-related biological factors and membrane proteins also play different roles. This article will review the mechanism of lysosomes in myocardial ischemia-reperfusion injury and the research progress of lysosomal-related proteins.

Peter A. Kavsak, Sameer Sharif, Isabella Globe et al.

Serial cardiac troponin (cTn) testing on patients with symptoms suggestive of acute coronary syndrome (ACS) is primarily to identify those patients with evolving myocardial injury. With the improved analytical performance of the high-sensitivity cTn (hs-cTn) assays, different change criteria have been proposed that are mostly assay dependent. Here, we developed and compared a new Common Change Criteria (3C for the combined criteria of >3 ng/L, >30%, or >15% based on the initial cTn concentration of <10 ng/L, 10 to 100 ng/L, or >100 ng/L, respectively) method, versus the 2 h assay-dependent absolute change criteria endorsed by the European Society of Cardiology (ESC), versus the common relative >20% change criterion. These different analytical change criteria were evaluated in 855 emergency department (ED) patients with symptoms of ACS and who had two samples collected 3 h apart. The cTn concentrations were measured with four different assays (Abbott hs-cTnI, Roche hs-cTnT, Ortho cTnI-ES, and Ortho hs-cTnI). The outcomes evaluated were myocardial infarction (MI) and a composite outcome (MI, unstable angina, ventricular arrhythmia, heart failure, or cardiovascular death) within 7 days of ED presentation. The combined change criteria (3C) method yielded higher specificities (range: 93.9 to 97.2%) as compared to the >20% criterion (range: 42.3 to 88.1%) for all four assays for MI. The 3C method only yielded a higher specificity estimate for MI for the cTnI-ES assay (95.9%) versus the absolute change criteria (71.7%). Similar estimates were obtained for the composite outcome. There was also substantial agreement between hs-cTnT and the different cTnI assays for MI with the 3C method, with the percent agreement being ≥95%. The Common Change Criteria (3C) method combining both absolute and different percent changes may be used with cTnI, hs-cTnT, and different hs-cTnI assays to yield similar high-specificity (rule-in) estimates for adverse cardiovascular events for patients presenting to the ED with ACS symptoms.

M. Chashchin, L.N. Zelenkina, A. I. Atabekov

The development and implementation of new comprehensive preventive approaches to the problem of reducing morbidity and mortality rates from diseases of the circulatory system of workers in the oil and gas complex is an urgent task of modern corporate systems for maintaining the health of workers. The purpose of this study was to evaluate the effectiveness of medical prevention measures, the main component of which was the detection of early forms of cardiovascular diseases using targeted screening examinations. Targeted screening and assessment of cardiovascular risk using the SCORE scale were used as the main research method. The results of the examination of the main observation group showed that 13.7% of the examined had an average cardiovascular risk, 15.9% of the examined had a high cardiovascular risk. In the high-risk group, 42% of the study participants needed high-tech medical care, 18.7% needed an additional specialized examination. A preliminary assessment of the results of targeted scoring showed that such programs have a high potential and can reduce the number of cases of sudden death due to diseases of the circulatory system among workers by 25%.

L. Nesti, A. Natali

Shaojie Chen, Yongping Lin, Yue Zhu et al.

PRKAG2 cardiomyopathy is a rare progressive disease characterized by increased ventricular wall thickness and preexcitation. Dysfunction of the protein 5′-AMP-activated protein kinase (AMPK) plays a decisive role in the progression of ventricular lesions. Although patients with the PRKAG2-R302Q mutation have a high incidence of atrial fibrillation (AF), the molecular mechanism contributing to the disease remains unclear. We carried out whole-genome sequencing with linkage analysis in three affected members of a family. Atrial samples were obtained from the proband via surgical intervention. Control atrium biopsies were obtained from patients with persistent AF. Pathological changes were analyzed using the hematoxylin and eosin (H&amp;E), Masson, and periodic acid–Schiff (PAS) staining. The AMPK signaling pathway was investigated by western blot. A murine atrial cardiomyocyte cell line (HL-1) and human induced pluripotent stem derived atrial cardiomyocytes (hiPSC-ACMs) were transfected with an adenovirus carrying the same mutation. We used enzyme linked immunosorbent assay (ELISA) to determine the AMPK activity in HL-1 cells and hiPSC-ACMs overexpressing PRKAG2-R302Q. Pathological results showed a large quantity of glycogen accumulation and vacuolization in cardiomyocytes from the proband atrial tissue. Western blot analysis revealed that the AMPK activity was significantly downregulated compared with that of the controls. Furthermore, remarkable glycogen deposition and impairment of AMPK activity were reproduced in HL-1 cells overexpressing PRKAG2-R302Q. Taken together, PRKAG2-R302Q mutation directly impair atrial cardiomyocytes. PRKAG2-R302Q mutation lead to glycogen deposition and promote the growth of atrial lesions by disrupting the AMPK pathway.

Donald C. Haas, Maureen Hummel, Patricia Barrella et al.

Background: Randomized controlled trials (RCT) of ultrafiltration (UF) have demonstrated conflicting results regarding its efficacy and safety. Objective: We reviewed 10 years of data for adjustable UF during heart failure hospitalizations in a real world cohort. Methods: We performed a retrospective, single center analysis of 335 consecutive patients treated with adjustable rate UF using the CHF Solutions Aquadex Flex Flo System from 2009 to 2019. Results: Compared to previous RCTs investigating UF, our cohort was older, with worse renal impairment and more antecedent HF hospitalizations in the year preceding therapy. Mean fluid removal with UF was 14.6 l. Mean weight loss with UF was 15.6 lbs (range 0.2–57 lbs) and was sustained at 1–2 week follow-up. Mean creatinine change upon stopping UF, at discharge and follow-up (mean 30 days) was +0.11 mg/dl, +0.07 mg/dl and +0.11 mg/dl, respectively. HF rehospitalizations at 30 days, 90 days and 1 year were 12.4 %, 14.9 % and 27.3 % respectively. On average patients had 1.74 fewer hospitalizations for HF in the year following UF when compared to 12 months preceding UF. Major bleeding defined as requiring discontinuation of anticoagulation occurred in 3.6 % of patients. Conclusions: Compared with previous UF trials, our study demonstrates that UF compares favorably for HF rehospitalizations, renal function response, and weight/volume loss. Importantly, our real world experience allowed for the adjustment of UF rate during therapy and we believe this is a major contributor to our favorable outcomes. In clinical practice, UF can be a safe and effective strategy for decongestion.

Sergio Quilici Belczak, PhD, Felipe Coelho Neto, PhD, Walter Junior Boim de Araújo, PhD et al.

We have reported a case of a 36-year-old woman with flank and pelvic pain and hematuria. She had posterior nutcracker syndrome and pelvic varices involving one anterior and three posterior renal veins (including one major vein). We used a complete endovascular approach, which included stent implantation in the major posterior renal vein and left gonadal vein embolization. During a 12-month follow-up period, the patient had had no symptoms and good computed tomography results. Endovascular treatment represents a safe and successful option for patients with nutcracker syndrome and pelvic varices involving the anterior and posterior renal veins.

E. Ford