Can lower risk patients presenting with transient ischaemic attack be safely managed as outpatients?

This study aimed to examine outcome in low risk transient ischaemic attack (TIA) patients presenting to emergency departments (ED) in a regional Australian setting discharged on antiplatelet therapy with expedited neurology review. All patients presenting to Gosford or Wyong Hospital ED with TIA, for whom faxed referrals to the neurology department were received between October 2008 and July 2010, were included in this prospective cohort study. Classification of low risk was based on an age, blood pressure, clinical features, duration of symptoms and diabetes (ABCD²) score <4 and the absence of high risk features, including known carotid disease, crescendo TIA, or atrial fibrillation. Patients with ABCD² scores ⩾4 or with high risk features were discussed with the neurologist on call (a decision regarding discharge or admission was then made at the neurologist’s discretion). Patients were investigated with a brain CT scan and/or CT angiography, routine pathology, and an electrocardiogram. All discharged patients were commenced on antiplatelet therapy and asked to follow up with their local medical officer within 7 days. The patients were contacted by the neurology department to arrange follow-up. Our primary outcome was the number of subsequent strokes occurring within 90 days. Of 200 discharged patients for whom referrals were received, three patients had a stroke within 90 days. None of these would have been prevented through hospitalisation. In conclusion, medical assessment, expedited investigation with immediate commencement of secondary prevention and outpatient neurology review may be a reasonable alternative to admission for low risk patients presenting to the ED with TIA.     

远隔缺血处理在心肌保护中的研究进展

背景 在心血管手术围术期,远隔缺血处理作为一种无创性,启动机体自身内源性心肌保护的方法已被外科医师接受.然而,在临床非急性器官缺血时,由于受到时间,伦理上的约束,该处理很难开展. 目的 就远隔缺血处理的心肌保护作用作一综述. 内容 远隔缺血处理的发现、发展过程、临床应用及作用机制. 趋向 远隔缺血处理在溶栓治疗、血管成形和心脏外科手术等领域将有巨大的应用潜力.     

星形胶质细胞在脑缺血损伤中的作用及其机制

背景 脑血管疾病严重危害人类健康,其中脑卒中是我国60岁以上人群致死第二大病因,同时因其高致残性愈发受到关注。先前脑保护研究主要针对神经元受损机制,而作为中枢神经系统中数量最多的星形胶质细胞,因其在构建中枢神经系统结构、辅助细胞间信号转导、调节神经元可塑性等过程中的重要作用,成为近年来脑保护治疗研究热点。目的 探究星形胶质细胞在脑缺血性损伤中的作用。内容 综述星形胶质细胞生理功能,星形胶质细胞在脑缺血性损伤中细胞形态和功能变化,星形胶质细胞神经保护作用。 趋向 星形胶质细胞有望成为脑缺血性损伤治疗的新靶点。     

Combined remote ischemic perconditioning and local postconditioning on liver ischemia–reperfusion injury

Background

Remote ischemic perconditioning (rPER) is the newest technique described to mitigate ischemia and reperfusion (IR) injury. Local postconditioning (POS) is also an effective technique for this purpose. It is uncertain if adding local POS to rPER provides superior liver protection, so we tested this hypothesis.

Materials and methods

Twenty five Wistar rats were assigned into five groups: sham, IR, POS, rPER, and rPER + POS. Animals were subjected to liver ischemia for 60 min. POS consisted of four cycles of 5-min liver perfusion followed by 5-min liver ischemia (40 min total) after the major ischemic period. rPER consisted of four cycles of 5-min hindlimb ischemia followed by 5 min hindlimb perfusion contemporaneously to major liver ischemic period, during its last 40 min. After 2 h, median and left lobes were harvested for malondialdehyde and Trolox equivalent antioxidant capacity (TEAC) measurement, and blood for the measurement of serum transaminases.

Results

All tissue conditioning techniques were able to reduce transaminases serum levels, having no differences among them. All tissue conditioning techniques were able to reduce hepatic tissue MDA level; however, only rPER + POS had higher values than SHAM. All tissue conditioning techniques also enhanced TEAC; however, only POS had lower TEAC than SHAM.

Conclusions

rPER appears as the most promising technique to avoid IR injury. This technique reduced oxidative stress of cell membranes and lowered transaminases serum level. There was no additive protection when POS and rPER were held together.     

Remote ischemic conditioning enhanced the early recovery of renal function in recipients after kidney transplantation: a randomized controlled trial

Background

To investigate whether remote ischemic conditioning (RIC) can attenuate ischemic reperfusion injury (IRI) in recipients after kidney transplantation using donation after cardiac death.

Methods

Forty-eight recipients referred for kidney transplantation were recruited. The paired recipients who received the kidneys from the same donor were randomly assigned (one received RIC and the other did not). RIC was induced by three 5-min cycles of brief repetitive ischemia and reperfusion by clamping the exposed external iliac artery. Blood samples were withdrawn at hour 2, hour 12, days 1–7, day 14, and day 30 to measure serum creatinine level and estimated glomerular filtration rate after transplantation. Urine samples were collected at hours 2, 12, 24, and 48 to measure urine neutrophil gelatinase–associated lipocalin after transplantation. Renal tissues were obtained at 30 min for histologic changes after transplantation.

Results

There were no significant differences in clinical characteristics of the recipients and donors between RIC and control groups. The serum creatinine level was lower in the RIC group compared with that of the control group (12 h, days 1–14, P < 0.05; other P > 0.05); the estimated glomerular filtration rate was higher in the RIC group compared with that of the control group (12 h, days 1–14, P < 0.05; other P > 0.05); urine neutrophil gelatinase–associated lipocalin, an early marker of IRI, was lower in the RIC group at hours 2, 12, 24, and 48 (2 h, 48 h, P > 0.05; 12 h, 24 h, P < 0.05) compared with that of the control group. The graft pathology showed no differences between RIC and control groups.

Conclusions

RIC enhanced the early recovery of renal function in recipients after kidney transplantation. Our results provide a novel potential approach to attenuate transplantation-associated IRI.     

椎动脉发育不良与后循环缺血性卒中： 从假说到发病机制

椎动脉发育不良是临床常见的后循环血管变异。已有的研究结果显示,椎动脉发育不良是
后循环缺血性卒中的危险因素,并与之存在区域性关联。椎动脉发育不良在后循环缺血性卒中的发
生发展中起到重要作用。本文对椎动脉发育不良与后循环缺血性卒中之间的关系以及潜在的发病机
制进行综述,以期为后循环缺血性卒中的科学预防和临床治疗提供参考。