New Findings r What is the central question of this study?What is the effect of acute endurance exercise on circulating angiogenic cell (CAC) and microparticle (MP)

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Aims Pregnancy is a known risk factor for arterial dissection, which can result in significant morbidity and mortality in the peripartum period. However, little is known about the risk factors, timing, distribution, and outcomes of arterial dissections associated with pregnancy. Methods and results We included all women ≥12 years of age with hospitalizations associated with pregnancy and/or delivery in the Nationwide Readmissions Database between 2010 and 2015. The primary outcome was any dissection during pregnancy, delivery, or the postpartum period (42-days post-delivery). Secondary outcomes included timing of dissection, location of dissection, and in-hospital mortality. Among 18 151  897 pregnant patients, 993 (0.005%) patients were diagnosed with a pregnancy-related dissection. Risk factors included older age (32.8 vs. 28.0 years), multiple gestation (3.6% vs. 1.9%), gestational diabetes (14.3% vs. 0.2%), gestational hypertension (6.0% vs. 0.6%), and pre-eclampsia/eclampsia (2.7% vs. 0.4%), in addition to traditional cardiovascular risk factors. Of the 993 patients with dissection, 150 (15.1%) dissections occurred in the antepartum period, 232 (23.4%) were diagnosed during the admission for delivery, and 611 (61.5%) were diagnosed in the postpartum period. The most common locations for dissections were coronary (38.2%), vertebral (22.9%), aortic (19.8%), and carotid (19.5%). In-hospital mortality was 3.7% among pregnant patients with a dissection vs. <0.001% in patients without a dissection. Deaths were isolated to patients with an aortic (8.6%), coronary (4.2%), or supra-aortic (<2.5%) dissection. Conclusion Arterial dissections occurred in 5.5/100 000 hospitalized pregnant or postpartum women, most frequently in the postpartum period, and were associated with high mortality risk. The coronary arteries were most commonly involved. Pregnancy-related dissections were associated with traditional risk factors, as well as pregnancy-specific conditions.

A 65-year-old man developed purpuric palpable lesions of the legs 2 days after receiving his third dose (booster) of Pfizer BioNTech vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Panels A and B). He received his initial vaccinations 4 months prior to receiving his booster injection. He denied any prior SARS-CoV-2 infection. He denied any systemic symptoms. The patient has a history of diabetes and hypertension for which he is on metformin and lisinopril, respectively; he otherwise has no other medical problems. Punch biopsy of the leg showed neutrophilic inflammation with fibrinoid necrosis and fragmented neutrophilic nuclei (leukocytoclasis), consistent with leukocytoclastic vasculitis (LCV). He was treated with one dose of triamcinolone 60 mg (IM), oral prednisone (tapered from 60 mg/d to 10 mg/d), along with topical clobetasol propionate and mupirocin.LCV is a cutaneous, small-vessel vasculitis characterized by deposition of immune complexes in the dermal capillaries and venules. 1 Half of all cases of LCV are idiopathic; among secondary LCV, infections and medications are the most common triggers. Numerous medications have been implicated, including several antibiotics, furosemide, allopurinol, nonsteroidal antiinflammatory drugs (NSAIDs), amiodarone, metformin, warfarin, and several vaccines, including the influenza, hepatitis B (HBV), Bacille Calmette-Guérin (BCG), and human papillomavirus (HPV) vaccines. 2 Most cases of cutaneous LCV are mild and resolve with supportive measures; if LCV is more chronic or resistant, oral corticosteroids can be used. For medication-induced LCV, withdrawal of the drug is crucial for resolution.With the mass vaccination effort to address the coronavirus disease 2019 (COVID-19) pandemic caused by the SARS-CoV-2, there have been numerous reports of cutaneous manifestations after receiving the SARS-CoV-2 vaccine, including those manufactured by Moderna, Pfizer BioNTech, and Johnson & Johnson. The most commonly reported cutaneous manifestations are vaccine-related eruption of papules and plaques (V-REPP), bullous pemphigoid-like, dermal hypersensitivity reactions, herpes zoster, lichen planus-like, and pernio. 3 There have been case reports of the development of LCV after the Moderna and Pfizer BioNTech SARS-CoV-2 vaccines; however, there have been no other reported cases of LCV development after the SARS-CoV-2 booster vaccine. [3][4][5] The mechanism of SARS-CoV-2 vaccine-induced

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Background Fibromuscular dysplasia (FMD) is a nonatherosclerotic arterial disease that has a variable presentation including pulsatile tinnitus (PT). The frequency and characteristics of PT in FMD are not well understood. The objective of this study was to evaluate the frequency of PT in FMD and compare characteristics between patients with and without PT. Methods and Results Data were queried from the US Registry for FMD from 2009 to 2020. The primary outcomes were frequency of PT among the FMD population and prevalence of baseline characteristics, signs/symptoms, and vascular bed involvement in patients with and without PT. Of 2613 patients with FMD who were included in the analysis, 972 (37.2%) reported PT. Univariable analysis and multivariable logistic regression were performed to explore factors associated with PT. Compared with those without PT, patients with PT were more likely to have involvement of the extracranial carotid artery (90.0% versus 78.6%; odds ratio, 1.49; P =0.005) and to have higher prevalence of other neurovascular signs/symptoms including headache (82.5% versus 62.7%; odds ratio, 1.82; P <0.001), dizziness (44.9% versus 22.9%; odds ratio, 2.01; P <0.001), and cervical bruit (37.5% versus 15.8%; odds ratio, 2.73; P <0.001) compared with those without PT. Conclusions PT is common among patients with FMD. Patients with FMD who present with PT have higher rates of neurovascular signs/symptoms, cervical bruit, and involvement of the extracranial carotid arteries. The coexistence of the 2 conditions should be recognized, and providers who evaluate patients with PT should be aware of FMD as a potential cause.

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