Long-Term Clinical Outcomes after Endovascular Therapy for Anti-Centromere Antibody-Positive Patients with Critical Limb-Threatening Ischemia

PurposeTo examine the long-term clinical outcomes of patients with anti-centromere antibody (ACA)-positive critical limb-threatening ischemia (CLTI) who were treated with endovascular therapy (EVT).Materials and MethodsThis was a retrospective analysis using a database of 423 consecutive CLTI patients (543 limbs, Rutherford class 4–6) who underwent EVT between January 2011 and March 2013. The patients were divided into 2 groups: an ACA-positive group (10 limbs, 8 patients) and a control group (46 limbs, 43 patients). The control group was defined as female, non-dialysis, and those who were able to obtain a below-knee angiogram.ResultsNone of the 8 ACA-positive CLTI patients had previously been diagnosed as ACA positive. No significant difference was observed in the below-the-knee lesion distribution and severity between the ACA-positive group and the control group. The median observational period was 51 months. The survival rate was 54% in the ACA-positive group and 76% in the control group at 5 years after EVT (P = .732). The freedom from major amputation rate was 60% in the ACA-positive group and 91% in the control group at 5 years after EVT (P = .029). The technical EVT success rate in the ACA-positive group was 70% (7/10). Of the successful EVT cases, 71% (5/7) of patients achieved complete wound healing or rest pain relief; however, 60% (3/5) had a recurrence of wounds.ConclusionsIn a series of ACA-positive patients with CLTI, successful EVT had acceptable outcomes with respect to wound healing with short-term results. However, the major amputation rate for ACA-positive patients was high in long-term follow-up.     

Cardioprotective effects of sinomenine in myocardial ischemia/reperfusion injury in a rat model

BackgroundIschemia reperfusion (I/R) play an imperative role in the expansion of cardiovascular disease. Sinomenine (SM) has been exhibited to possess antioxidant, anticancer, anti-inflammatory, antiviral and anticarcinogenic properties. The aim of the study was scrutinized the cardioprotective effect of SM against I/R injury in rat.MethodsRat were randomly divided into normal control (NC), I/R control and I/R + SM (5, 10 and 20 mg/kg), respectively. Ventricular arrhythmias, body weight and heart weight were estimated. Antioxidant, inflammatory cytokines, inflammatory mediators and plasmin system indicator were accessed.ResultsPre-treated SM group rats exhibited the reduction in the duration and incidence of ventricular fibrillation, ventricular ectopic beat (VEB) and ventricular tachycardia along with suppression of arrhythmia score during the ischemia (30 and 120 min). SM treated rats significantly (P < 0.001) altered the level of antioxidant parameters. SM treatment significantly (P < 0.001) repressed the level of creatine kinase MB (CK-MB), creatine kinase (CK) and troponin I (Tnl). SM treated rats significantly (P < 0.001) repressed the tissue factor (TF), thromboxane B2 (TXB2), plasminogen activator inhibitor 1 (PAI-1) and plasma fibrinogen (Fbg) and inflammatory cytokines and inflammatory mediators.ConclusionOur result clearly indicated that SM plays anti-arrhythmia effect in I/R injury in the rats via alteration of oxidative stress and inflammatory reaction.     

高压氧治疗对慢性脑缺血大鼠认知功能的影响及其作用机制

目的 探讨高压氧（hyperbaric oxygen，HBO）治疗对慢性脑缺血（chronic cerebral ischemia，CCI）大鼠 学习记忆能力的影响及其作用机制。 方法 选取240只雄性SD大鼠随机分为假手术组、CCI组和HBO组，每组80只。采用双侧颈总动脉阻 断法建立CCI模型，HBO组建模12 h后开始进行HBO治疗28 d，压力0.2 MPa，每日1次，每次60 mi n。采用 Morri s水迷宫实验评估7、14、21、28 d大鼠的学习记忆能力，每个时间点20只，检测前均进行3 d训练， 记录各组大鼠的逃避潜伏时间、穿越平台次数。28 d后处死大鼠取海马组织进行HE染色评估神经元 损伤病理变化，RT-PCR法检测Nogo-A mRNA，Western blot法检测Nogo-A蛋白的表达水平。 结果 ①与假手术组比较，CCI 组7、14、21、28 d逃避潜伏时间均延长（均P＜0.05），28 d跨越平台次 数减少（P＜0.05）；与CCI 组比较，HBO组7、14、21、28 d逃避潜伏时间均缩短（均P＜0.05），28 d跨越 平台次数增加（P＜0.05）。②HE染色显示HBO组神经元损伤程度较CCI组减轻；③CCI组Nogo-A mRNA 和Nogo-A蛋白表达水平均较假手术组升高（均P＜0.05），HBO组表达水平均较CCI组下降（P＜0.05）。 结论 HBO治疗可改善慢性脑缺血大鼠认知功能，其机制可能与下调海马组织中Nogo-A的表达水平 有关。     

Idiopathic myointimal hyperplasia of mesenteric veins: Rare case of ischemic colitis mimicking inflammatory bowel disease

Idiopathic myointimal hyperplasia of mesenteric veins (IMHMV) is a rare and poorly understood ischemic colitis that occurs in the rectosigmoid colon of predominantly young, previously healthy, male patients. A 76‐year‐old Japanese man presented to our hospital with a 1‐year history of worsening diarrhea, lower abdominal pain, and weight loss (−6 kg). Laboratory evaluation revealed white blood cell count of 13 200/μL, C‐reactive protein level of 2.0 mg/dL (normal range, 0.0–0.3), and negative results for stool culture (including Clostridium difficile). Colonoscopy showed circumferential and edematous narrowing of the sigmoid colon with deep longitude ulceration. Biopsy was done and examination of the specimen demonstrated no specific ischemia. The patient was treated with bowel rest, antibiotics, and i.v. fluids; however, his symptoms worsened. Finally, sigmoidectomy was carried out. Histological examination demonstrated significant myointimal hyperplasia of mesenteric veins leading to thickening and stenosis of the venous lumen. Therefore, the final diagnosis was IMHMV. Three months following sigmoidectomy, he was asymptomatic.     

Deficiency of anti-inflammatory cytokine IL-4 leads to neural hyperexcitability and aggravates cerebral ischemia–reperfusion injury

Systematic administration of anti-inflammatory cytokine interleukin 4 (IL-4) has been shown to improve recovery after cerebral ischemic stroke. However, whether IL-4 affects neuronal excitability and how IL-4 improves ischemic injury remain largely unknown. Here we report the neuroprotective role of endogenous IL-4 in focal cerebral ischemia–reperfusion (I/R) injury. In multi-electrode array (MEA) recordings, IL-4 reduces spontaneous firings and network activities of mouse primary cortical neurons. IL-4 mRNA and protein expressions are upregulated after I/R injury. Genetic deletion of Il-4 gene aggravates I/R injury in vivo and exacerbates oxygen-glucose deprivation (OGD) injury in cortical neurons. Conversely, supplemental IL-4 protects Il-4^−/− cortical neurons against OGD injury. Mechanistically, cortical pyramidal and stellate neurons common for ischemic penumbra after I/R injury exhibit intrinsic hyperexcitability and enhanced excitatory synaptic transmissions in Il-4^−/− mice. Furthermore, upregulation of Nav1.1 channel, and downregulations of KCa3.1 channel and α6 subunit of GABA_A receptors are detected in the cortical tissues and primary cortical neurons from Il-4^−/− mice. Taken together, our findings demonstrate that IL-4 deficiency results in neural hyperexcitability and aggravates I/R injury, thus activation of IL-4 signaling may protect the brain against the development of permanent damage and help recover from ischemic injury after stroke.     

脑心通胶囊治疗脑梗死合并心肌缺血的多中心非随机临床对照试验

目的：观察脑心通胶囊（步长制药）治疗脑梗死合并心肌缺血患者的临床疗效。方法选取2013年10月至2014年12月北京21所医院神经内科收治的符合入组条件的急性脑梗死伴心肌缺血患者，非随机分为脑心通组（基础治疗基础上加用步长脑心通胶囊）和对照组（仅基础治疗）。对比分析第4周、8周、12周时2组心电图变化以及使用NIHSS和改良mRankin评估第12周时神经功能变化。结果入组544例，剔除16例（不良事件2例、自动放弃1例、违背规则1例、失访6例、其他6例），实际完成试验528例（包含测量资料缺失病例），其中脑心通组291例，对照组237例。心肌缺血改善的有效率脑心通组和对照组第4周差异无统计学意义（18．1％、14．9％， P ＝0．704）；但第8周（27．7％、14．3％， P ＝0．001）和第12周（31．3％、16．9％，P ＜0．01）差异有统计学意义（ P ＜0．05）。第12周时NIHSS减少≥2分脑心通组（77．7％）明显高于对照组（68．4％）（ P ＜0．05），mRankin 减少≥1分脑心通组（67．7％）显著高于对照组（56．1％）（ P ＜0．05）。多因素分析心电图改善的独立影响因素是脑心通（ P ＝0．005）和第12周时AST的降低（ P ＝00．47）；神经功能改善的影响因素包括脑心通治疗、基线收缩压和肌酐水平、既往心脏病或高脂血症病史。结论脑心通胶囊联合基础治疗对脑梗死合并心肌缺血临床疗效确切。     

Recipient hypertonic saline infusion prevents cardiac allograft dysfunction

Objective

Hypertonic saline (HTS) has potent immune and vascular effects. We assessed recipient pretreatment with HTS on allograft function in a porcine model of heart transplantation and hypothesized that HTS infusion would limit endothelial and left ventricular (LV) dysfunction following transplantation.

Elevación del lactato en el postoperatorio como marcador de isquemia mesentérica aguda. Descripción de dos casos

Serum lactate is a non-specific marker of tissue hypoperfusion. Elevated serum lactate is used in the differential diagnosis of acute intestinal ischemia. Although this practice is controversial, in the absence of other validated markers lactate is still used because of its high sensitivity.We present the cases of two patients who developed acute mesenteric ischemia as a post-surgical complication. The patients reported moderate abdominal pain —a non-specific symptom in the postoperative context— and tests showed progressively increasing serum lactate levels, which facilitated suspicion and subsequent diagnostic confirmation through an imaging test.These cases highlight the physiopathological importance of lactate elevation in the perioperative context and of performing a differential diagnosis of its possible causes, including mesenteric ischemia. Although the outcome was negative in the first case, early suspicion allowed us to make an effective diagnosis and administer appropriate treatment in the second patient.     

急诊心肌梗死冠状动脉介入治疗术后患者T3水平与心肌再灌注的关系

目的探讨急性心肌梗死（AMI）患者急诊经皮冠状动脉介入治疗（PCI）术后血清三碘甲状腺原氨酸（T3）与心肌再灌注的关系。方法采用化学发光法检测205例AMI患者PCI术后血清T3水平，根据T3水平将患者分为A、B、C、D4组，记录并比较4组患者术后冠状动脉TIMI血流分级、心肌呈色分级（MBG）。结果A组（重度低T3组）TIMI3级比例低于B、C、D组，差异有统计学意义（P＜0.01）；MBG3级比例低于B、C、D组，差异有统计学意义（P＜0.01）。女性患者T3水平（1.00±0.05）nmol/L、TIMI3级比例（32/46，69.6%）、MBG3级比例（24/46，52.2%）均低于男性患者，后者分别为（1.19±0.02）nmol/L、（143/159，89.9%）、（110/159，69.2%），差异均有统计学意义（P＜0.05或0.01）。结论女性AMI患者心肌再灌注水平较男性患者低。AMI患者T3水平与PCI术后冠状动脉再灌注相关，监测T3可以间接反映病情的严重程度。