Normal-tension glaucoma (NTG) is a progressive optic neuropathy in which intraocular pressure (IOP) reduction is important for limiting disease progression. Latanoprost is commonly used as first-line therapy, but treatment response varies. We investigated whether concomitant oral limaprost use was associated with the IOP response to latanoprost in patients with NTG. We retrospectively reviewed patients with NTG treated between January 2015 and August 2021 at the Veterans Health Service Medical Center. The final matched cohort included 446 patients: 223 patients receiving latanoprost with concomitant limaprost and 223 age- and sex-matched controls receiving latanoprost alone. Three-month IOP was analyzed at the patient level.Multivariable linear regression was performed with 3-month IOP as the outcome, adjusting for baseline IOP, age, sex, nonsteroidal anti-inflammatory drug use, systemic beta-blocker use, diabetes, and hypertension. Baseline IOP was similar between groups. The median IOP reduction at 3 months was 1.0 mm Hg [interquartile range (IQR), -0.5 to 2.5] in the limaprost group and 2.0 mm Hg [IQR, 0.5-3.0] in controls. In the adjusted analysis, concomitant limaprost use was associated with a 0.91-mm Hg higher IOP at 3 months (95% confidence interval, 0.54 to 1.27; P < .001). In a secondary exploratory subgroup of 63 patients who subsequently received add-on dorzolamide/timolol, 35 were in the limaprost group and 28 were controls; no statistically significant between-group difference in IOP reduction was detected. Concomitant limaprost use was associated with a modestly smaller observed IOP reduction after latanoprost treatment in patients with NTG. Because of the retrospective design and the modest magnitude of the association, prospective studies are needed to determine whether a clinically meaningful pharmacologic interaction exists.

The use of prostaglandin E1 is well documented in ductus arteriosus-dependent congenital heart disease (CHD) and severe neonatal pulmonary hypertension. Standard therapy involves intravenous infusion, with onset of action typically 30 min to 2 h. We report three patients with ductal-dependent CHD who developed acute ductal spasm during cardiac catheterization. In all cases, a bolus of alprostadil improved ductal spasm, increased pulmonary or systemic flow, stabilized hemodynamics, and allowed successful patent ductus arteriosus (PDA) stent implantation. Transient hypotension was observed in two patients, resolving promptly; one premature infant had a delayed response requiring temporary extracorporeal membrane oxygenation support. No serious complications or neurological sequelae were observed. These findings suggest that intravenous alprostadil bolus may be an effective and relatively safe rescue therapy for acute ductal spasm. Further studies are warranted to better define its role in this critical setting.

Sudden sensorineural hearing loss is associated with inner-ear microcirculatory disturbance and oxidative stress, which can damage auditory cells and cause permanent hearing impairment without timely treatment. Current management targets blood supply and inflammation, but single-agent efficacy remains unstable. This retrospective study explored whether alprostadil combined with Ginkgo biloba extract is associated with improved audiological outcomes and quality of life. Patients treated from January 2024 to December 2024 at a single center were included. A total of 100 patients who met the eligibility criteria were identified and divided into two groups based on their actual treatment: 50 who received alprostadil alone (control group) and 50 who received alprostadil plus Ginkgo biloba extract (combination therapy group). Primary outcomes were changes in affected-ear pure-tone average threshold [four-frequency pure-tone average (PTA-4)] and quality-of-life scales [36-Item Short Form Health Survey (SF-36); Hearing Handicap Inventory for Adults (HHIA)]. Assessments were performed before treatment and at follow-up as documented in the medical records. Statistical analyses included repeated-measures analysis of variance and independent-samples t-tests, with Bonferroni correction when required (α = 0.05/k), and adverse events (AE) were compared using the χ[2] test or Fisher's exact test. The PTA-4 group × time interaction was significant (P = 0.002). On day 90, PTA-4 improvement was greater in the combination therapy group than in the control group (P = 0.002). After 90 days, the proportion of mild hearing loss differed between groups (P = 0.040), whereas the proportions for other grades did not. Significant group × time interactions were observed for all SF-36 dimensions (all P < 0.05) and HHIA scores (P = 0.007). On days 10, 30, and 90, HHIA improved more in the combination therapy group; SF-36 scores were also higher at follow-up. All included patients had completed treatment and 90-day follow-up per medical records and were included in the efficacy and safety analyses. Alprostadil plus Ginkgo biloba extract improved short-term audiological and quality-of-life outcomes without increasing adverse reactions, supporting the short-term potential of early combination therapy.

Neonates with ductal-dependent congenital heart disease (CHD) will receive a continuous infusion of a prostaglandin E1 analogue such as alprostadil prior to surgical correction. Alprostadil can cause apnoea, which may be mitigated in practice with the use of caffeine citrate. Caffeine citrate can lead to tachyarrhythmias, which could be detrimental in this patient population. The purpose of this study was to determine if the practice of utilising caffeine citrate in neonates with ductal-dependent CHD receiving continuous alprostadil infusions is safe. In this single-centre, retrospective, cohort study of neonates admitted to the congenital heart service from November 2017 to September 2024, patients were included if they had ductal-dependent CHD and a gestational age greater than or equal to 35 weeks. Neonates that received continuous infusion of alprostadil alone were compared to those that received alprostadil in addition to caffeine citrate. The primary outcome was the frequency of sustained tachycardia during treatment. Seventy-five patients were included for review in each cohort. The median number of incidences of sustained tachycardia per patient was 7 (interquartile range 1-20) in the alprostadil plus caffeine citrate group and 4 (interquartile range 0-18) in the alprostadil alone group (p = 0.293). Other arrhythmias during the treatment course were common and similar between each cohort. Utilising caffeine citrate was not associated with a statistically significant increased incidence of tachycardia in neonates with ductal-dependent CHD on alprostadil infusions at the University of Florida.

Background/Objectives: The treatment of patients with advanced peripheral arterial disease, such as chronic limb-threatening ischemia (CLTI), often requires more than the use of conventional vasodilators and revascularization procedures, when these are feasible. Alprostadil is typically administered intravenously to treat these patients. However, existing studies reported conflicting results regarding the efficacy of the aforementioned treatment. It is hypothesized that, based on clinical experience, this therapy may exhibit a benefit for patients with CLTI, promoting ulcer healing, alleviating pain, and improving limb salvage rates. Consequently, the concept of employing blood-circulating microvesicles (MVs) as biomarkers for evaluating treatment effectiveness and estimating clinical prognoses has been proposed. Methods: These were analyzed in a group of patients with CLTI before and during alprostadil treatment, with and without revascularization procedures, to assess their correlation with clinical outcomes. Results: Our data indicated that CLTI results in an increase in circulating levels of MVs, as well as in specific subtypes of plasma MVs-MVs derived from endothelial cells (EMVs), platelets (PMVs), leukocytes (LeMVs), monocytes (MMVs), and erythrocytes (ErMVs)-compared to levels observed in the plasma of healthy individuals. Furthermore, treatment with alprostadil was associated with a significant reduction in plasma levels of total MVs, as well as EMVs, PMVs, LeMVs, and MMVs. In contrast, revascularization procedures do not appear to result in a reduction in circulating MV levels. These results are consistent with the clinical improvements observed in CLTI patients treated with alprostadil. Conclusions: In summary, the findings of this preliminary study suggest that blood-circulating MVs, including specific subtypes such as EMVs, PMVs, LeMVs, and MMVs, may have potential as biomarkers for assessing the response to alprostadil treatment in patients with CLTI.

Chemsex involves the use of psychoactive substances to facilitate or enhance sexual activity, particularly among gay, bisexual, and other men who have sex with men (GBMSM). Common substances used include methamphetamine, gamma-hydroxybutyric acid/gamma-butyrolactone (GHB/GBL), mephedrone, ketamine, inhaled nitrites ('poppers'), and cocaine, all of which are linked to various dermatological complications. Dermatologists are often the first to recognize skin and mucosal manifestations in chemsex users, providing an opportunity for timely intervention and risk reduction. A targeted literature search until January 2026 was conducted using PubMed/MEDLINE to identify relevant publications on chemsex-associated dermatological manifestations. The studies included were observational, case series, case reports and clinical guidelines, focusing on the clinical presentation, substances involved and routes of administration. Cutaneous and mucosal lesions vary depending on the substance and route of administration. Poppers dermatitis, commonly seen in GBMSM, is a well-defined manifestation and often misdiagnosed as impetigo. 3,4-Methylenedioxymethamphetamine (MDMA), often used in chemsex, leads to oral mucositis and painful aphthous-like ulcers due to its acute effects, such as bruxism and xerostomia. Injection-related lesions from substances like mephedrone and ketamine are particularly concerning, often resembling infectious or vasculitic processes and frequently leading to delayed diagnoses. Cocaine use, especially when combined with levamisole, can cause cutaneous necrosis, vasculitis and soft tissue infections. GHB/GBL use may cause traumatic genital and perianal injuries due to reduced pain sensitivity, while alprostadil injections can result in localized oedema, haematomas or fibrosis. Lastly, constricting devices used in chemsex settings can lead to mechanical trauma, ischaemic injury and chronic complications like fibrosis and penile deformities. Chemsex is a significant public health concern with dermatological implications. Improved awareness of characteristic cutaneous and mucosal lesions can support earlier recognition, targeted investigation and non-stigmatizing risk-reduction advice and referral. More prospective studies and standardized diagnostic criteria are needed to enhance the management of chemsex-related dermatological and systemic complications.

Prostaglandin E1 (PGE1), prostaglandin E2 (PGE2), prostacyclin and their analogues are widely used in clinical practice for their potent biological effects. PGE1/PGE2 analogues, including misoprostol and sulprostone, are primarily used in obstetrics for labour induction, abortion, and postpartum haemorrhage management, whereas PGI2 analogues such as iloprost and treprostinil are key drugs in pulmonary arterial hypertension treatment. Despite structural similarities, these compounds produce contrasting vascular effects due to differences in receptor selectivity, signalling pathways, and tissue distribution. PGE1/PGE2 analogues activate EP receptors, particularly EP1 and EP3 with varying selectivity profile, promoting vasoconstriction and have been associated with cardiovascular complications such as coronary vasospasm. In contrast, PGI2 analogues act mainly on IP receptors, promoting vasodilation, inhibition of platelet aggregation, and beneficial vascular remodelling, with a generally favourable cardiovascular safety profile. Although cardiovascular effects have been reported with both classes of analogues, the underlying mechanisms, and especially their direct effects on human coronary arteries (HCA) remain insufficiently explored. In this context, we combined a review of the clinical and experimental literature that integrates clinical reports with original ex vivo pharmacological investigations on isolated HCA. Both PGE2 and misoprostol induce concentration-dependent vasoconstriction, primarily via EP3 receptors, which is significantly reduced by a TP receptor antagonist, suggesting a potential EP3-TP pathway interaction. All tested PGI2 analogues consistently induced relaxation in our HCA preparations, a finding that aligns with their general improvement of cardiovascular clinical parameters, with only rare exceptions. Together, these findings summarize the cardiovascular effects of clinically-used prostanoids and provide mechanistic insights to optimize their therapeutic use while minimizing cardiovascular risk.

ObjectivesExtracorporeal Membrane Oxygenation (ECMO) is associated with high risks of bleeding and clotting. While traditional anticoagulants like heparin and bivalirudin target the coagulation cascade, prostaglandins including PGE1 and PGI2 may offer adjunctive platelet inhibition. This study evaluated whether prostaglandin use modifies the risk of severe bleeding or clotting events in pediatric ECMO patients.Material and MethodsWe used the Pediatric Health Information System database from 2004 to 2025, and included children supported with ECMO. Primary outcomes were severe bleeding and clotting events. Generalized linear mixed model regressions adjusted for site, patient and ECMO data, and pulmonary hypertension.ResultsA total of 22,061 pediatric ECMO patients were included. Pulmonary hypertension was present in 12.4% (2736/22,061). PGE1 and PGI2 were independently associated with increased risk of pulmonary hemorrhage (PGE1: adjusted OR 1.24, P = .003; PGI2: adjusted OR 1.21, P = .047). Conversely, neither PGE1 nor PGI2 were independently associated with intracranial hemorrhage (PGE1: adjusted OR 1.01, P = .92; PGI2: adjusted OR 0.96, P = .79), stroke (PGE1: adjusted OR 1.02, P = .84; PGI2: adjusted OR 0.88, P = .38), or other bleeding or thrombotic events.ConclusionIn this large multicenter cohort of more than 22,000 pediatric ECMO patients, neither PGE1 nor PGI2-modulated anticoagulation conferred measurable protection against the major bleeding or clotting complications.

Retiform purpura (RP) is a morphological pattern of cutaneous ischemia resulting from vascular compromise. Its clinical relevance lies in its orientation toward vasculitis or thrombotic vasculopathy. We report the case of a woman with painful violaceous retiform lesions on the distal lower extremities, Raynaud's phenomenon with a "blue toe" on the hand, and polyarthralgias. Laboratory workup revealed antinuclear antibodies (ANA) 1:2560 (AC-5 pattern), anti-RNP > 240 U/mL, anti-Sm > 320 U/mL, low C4, and negative antineutrophil antibodies (ANCA) and rheumatoid factor. Magnetic resonance imaging showed diffuse muscular edema and bilateral fascial thickening; computed tomography reported reactive adenopathies. Skin biopsy demonstrated ischemic changes consistent with small vessel involvement in a mixed vasculitic/vasculopathic pattern, with epidermal necrosis and intraluminal fibrin. Systemic lupus erythematosus (SLE) with features of small vessel vasculitis was diagnosed. Treatment included methylprednisolone and prednisone pulses, cyclophosphamide, rituximab, and alprostadil for digital ischemia, with clinical improvement. RP may reflect a mixed inflammatory/thrombotic process in the context of overlapping autoimmunity. Deep biopsy, autoimmune profiling, and assessment of prothrombotic state are key axes for decisions regarding immunosuppression and/or antithrombotic strategies. Key Points • Retiform purpura is a high-risk cutaneous pattern that requires early differentiation between vasculitis and thrombotic vasculopathy, as each condition demands divergent therapeutic strategies (immunosuppression versus antithrombotic therapy). • In patients with SLE, cutaneous vasculitis - though uncommon - may present with a dominant ischemic phenotype (retiform purpura, digital ischemia) that initially mimics medium-vessel vasculitis such as polyarteritis nodosa or systemic sclerosis; accurate diagnosis requires integration of clinical, histological, and immunological data. • Management of severe ischemic SLE with a mixed inflammatory/occlusive mechanism may require a parallel approach: intensive immunosuppression to control vascular inflammation, combined with vasoactive and anticoagulant measures to preserve distal perfusion and tissue viability.