Circle of Willis atherosclerosis, Alzheimer's disease and the Dean number

The important role of atherosclerosis in pathophysiology of Alzheimer's Disease has become evident.Mechanisms such as hyperlipidemia,inflammation,abdominal obesity and insulin resistance are important yet they may not fully explain the specific involvement of the Circle of Willis in these pathologies.The Circle of Wills is a complex geometrical structure which has several areas with different curvature as well as various branching angles of vessels composing the circle.The hemodynamics in this region should take into account the Dean number which indicates the influence of curvature on the resistance to blood flow.Thus,areas with various curvature and angles may have different hemodynamics and there are certain areas in the Circle of Willis that are more likely to develop atherosclerotic changes.Therefore,this could suggest the novel pathophysiological pathway resulting from the geometric peculiarities of the Circle of Willis.One of the directions of future research is to examine whether specific areas of the Circle of Willis are more likely to develop atherosclerotic changes compared to other ones.Selective areas of the Circle of Willis affected by atherosclerotic changes could indicate the primary role of atherosclerosis promoting Alzheimer's disease although other pathophysiological mechanisms suggesting the opposite direction should be also examined in prospective studies.

Greater awareness of biosimilars and shared decision-making among patients attending rheumatology practices in Colorado,United States:Real-world data

BACKGROUND There is a lack of studies and educational programs focused on biosimilars and shared decision-making among patients diagnosed with various rheumatic diseases.AIM To improve knowledge and awareness of biosimilars and shared decision-making among patients attending rheumatology practices in Colorado as well as to assess a rheumatology patient’s interest in discussing biosimilars as well as shared decision-making with others(e.g.,medical professionals,family members,friends).METHODS Our goal was to work with 80 rheumatology teams in Colorado.We developed and distributed 2000 multi-page brochures to each participating office and later conducted an online anonymous survey.RESULTS There were a total of 49(2.5%)rheumatology patients who responded to our survey.After reading our educational booklet,many survey respondents identified the correct answer in most questions focused on biosimilars or shared decision-making.Our survey results suggest that patients attending rheumatology practices in Colorado are generally not involved in discussions with their providers regarding treatment plans or options.The improvement in scores after reading our educational materials was statistically significant for biosimilars and shared decision-making.CONCLUSION Overall,the level of knowledge and awareness of biosimilars and shared decisionmaking among patients attending rheumatology practices in Colorado was low.More educational programs as well as follow up trainings to measure changes in knowledge and awareness regarding biosimilars and shared decision-making among patients attending rheumatology practices are recommended.