Short-term results of retrograde pulmonary embolectomy in massive and submassive pulmonary embolism: a single-center study of 30 patients

Objective: Surgical pulmonary embolectomy is usually reserved for critically ill patients with pulmonary embolism. The conventional antegrade technique of embolectomy may miss peripheral clots, rendering the patient amenable to developing pulmonary hypertension. Here, we present our experience with a new retrograde pulmonary embolectomy supplementing the current antegrade technique. Methods: From January 2004 through December 2010, 30 consecutive patients underwent pulmonary embolectomy in our center. The study included 15 men and 15 women whose age ranged from 28 to 80 years, with mean age of 58 ± 15 years. All the patients except one were taken to the operating room with at least one imaging modality confirming the presence of a large thrombus in pulmonary-arterial vasculature. Results: The most common presenting symptoms of patients was dyspnea (n = 27, 90%). The major indications for surgery were severe hemodynamic or respiratory compromise (n = 11, 36%). After performing antegrade embolectomy, retrograde flushing of the pulmonary veins was done. The in-hospital mortality in our study was 6.6% (2/30). Mean intubation time for the patients was 52.7 ± 36.5 h, with a range of 12–120 h. Mean intensive care unit (ICU) admission for the patients was 7 days with a range of 2–60 days. Conclusions: As far as we know, this is the largest series of cases published so far regarding the immediate results of retrograde pulmonary embolectomy. This technique can successfully dislodge the remaining clots in distal pulmonary vasculature not directly visualized. Surgical pulmonary embolectomy is a safe method and should not be used as a last resort for patients with pulmonary embolism.     

Identification of sympathetic and parasympathetic nerves function in cardiovascular regulation using ANFIS approximation

Objective

In this paper a new nonlinear system identification approach is developed for dynamical quantification of cardiovascular regulation. This approach is specifically focused on the identification of the heart rate (HR) baroreflex mechanism. The principal objective of this paper is to improve the model accuracy in the estimation of HR by proposing a modified nonlinear model.

Methods and material

The proposed HR baroreflex model is based on inherent features of the autonomic nervous system for which we develop an adaptive neuro-fuzzy inference system (ANFIS) structure. This method allows incorporation of physiological understandings about the sympathetic and parasympathetic nerves through the selection of appropriate membership functions in the ANFIS structure. The required data for system modeling are collected from the publicly available PhysioNet database.

Results

The results agree with the natural characteristics and physiological understanding of the cardiovascular regulatory system, such as delay in the parasympathetic function, durability in the function of sympathetic nerves and the correlation between the HR and the ABP signals. They also show significant improvements in HR prediction in terms of the normalized root mean square error (NRMSE) in comparison with other reported methods. We achieved to 0.191 in mean NRMSE in prediction of HR in this paper which is about 20% better than the best reported result in other researches.

Conclusion

We have shown that for cardiovascular system regulation, our proposed nonlinear model is more accurate than other recently developed methods. Accurate HR baroreflex modeling enables clinicians to have more reliable information for their patients.     

Acute ethanol administration affects memory reactivation: a look at the neuronal density and apoptosis in the rat hippocampus

This study is an attempt to examine whether administration of ethanol after memory reactivation will modulate expression of memory in rats or not. We further examined whether this administration alters the number of tunnel positive cells in hippocampus.Adult male Wistar rats were trained in a fear conditioning system using two 1 s , 0.6 mA shock with an interval of 180 s. 24 h later the rats were returned to the chamber for reactivation, and then they were injected with ethanol (0.5, 1, 1.5 mg/kg) or saline, ip. Again, one, seven and fourteen days after reactivation, the rats were returned to the context for 5 min. The freezing time (absence of all movements except respiration) was scored in seconds.In the second experiment, after test 1, the animals were anesthetized and a transcardial perfuse with phosphate buffer and paraformaldehyde 4% was conducted. After post-fixation of brains 5-μm sections were stained with cresyl violet.Finally, paraffin-embedded sections of 10 μm were cut out throughout the tissue and each sample was processed with TUNEL. The number of apoptotic cells in a 130 μm-long segment of the hippocampal CA1 and CA3 fields and dentate gyrus was counted.The data demonstrate that ethanol exposure impairs post retrieval processes. Rats receiving ethanol (1.5 mg/kg) showed lower freezing levels during the first test. Moreover, ethanol decreases the density of CA1, CA3 and DG cells and increases the density of apoptotic cells in all regions of hippocampus. Therefore, ethanol exposure impairs reconsolidation of contextual fear conditioning probably via decreasing the density of CA1, CA3 and DG cells.     

Bilateral lower limb compartment syndrome: a potentially destructive complication of breast reduction

Compartment syndrome is a serious condition in which the pressure in the limb increases and potentially compromises capillary circulation with subsequent ischaemic complications. This case report presents a case of bilateral lower limb compartment syndrome after bilateral breast reduction for back pain. The patient was an otherwise healthy 24-year-old Afro-Caribbean woman. This report aims to highlight the need for an increased index of suspicion for compartment syndrome in any postoperative patient complaining of lower limb pain.     

α-Lipoic acid,functional fatty acid,as a novel therapeutic alternative for central nervous system diseases: A review

Objectives: α-lipoic acid (ALA) is a natural antioxidant which acts as a cofactor of bioenergetic mitochondrial enzymes. Along with its mitochondrial action, ALA and its reduced form have many biological functions resulting in a wide variety of actions such as anti-inflammation and antioxidant protection, scavenging reactive oxygen species, regenerating other antioxidant agents, such as vitamins C and E, and cytosolic glutathione, chelating the transitional metal ions (e.g. iron and copper), and modulating the signal transduction of nuclear factor.

Methods: By selecting papers from PubMed, Science Direct, EBSCO, and databases, this review discusses the biochemical properties of LA, its mechanism of action, pharmacokinetics, and its possible therapeutic role in central nervous system diseases, such as Alzheimer’s disease, Parkinson’s disease, Multiple sclerosis, stroke, and spinal cord injury.

Results: ALA as an antioxidant and anti-inflammation agent has therapeutical effects on central nervous system diseases, especially multiple sclerosis and PD.

Discussion: ALA can be considered as a potentially useful treatment in central nervous disorders.     

Study on the effect of neem (Azadirachta indica A. juss) leaf extract on the growth of Aspergillus parasiticus and production of aflatoxin by it at different incubation times

Aflatoxins are secondary metabolites that are produced by toxigenic strains of some Aspergillus species on foods. Neem plant is a known inhibitor of aflatoxin production. We studied the effects of different concentrations of aqueous neem leaf extract on fungal growth and aflatoxin production by Aspergillus parasiticus (NRRL 2999) at different incubation times. The toxigenic fungus was cultured on sucrose low salts medium in the presence of various concentrations of extracts (0.2, 0.8, 3.12, 12.5 and 50% v/v). After shaking incubation of cultures for 2, 4, 6, 8, 10 and 12 days at 28 degrees C, the fungal mycelia was collected and processed for determination of dry weight. Mycelia and culture media were assayed by TLC method to detect aflatoxin B(1) (AFB(1)). The extracts did not have any obvious effect on fungal growth. AFB(1) production in the control samples increased to the maximum level on the 8th day. The inhibition of aflatoxin synthesis by plant extracts was found to be time- and dose-dependent. The maximum inhibitory effect was 80-90% in the presence of 50% concentration that when compared with control samples was significant (P < 0.05). AFB(1) secretion/production ratio in all of control and treated samples, other than 2nd day, approximately stayed and neem had no effect on it.     

TGFβ and Wnt Signaling Pathways Cooperatively Enhance Early Dopaminergic Differentiation of the Unrestricted Somatic Stem Cells

Journal of Molecular Neuroscience - So far no evidence is available as to whether TGFβ and Wnt signaling pathways cooperatively modulate dopaminergic differentiation of the adult stem cells....     

Effect of extra virgin olive oil consumption on glycemic control: A systematic review and meta-analysis

AimsSeveral health benefits are contributed to extra virgin olive oil (EVOO). The polyphenol fraction of EVOO may be responsible for its cardioprotective impacts. This systematic review and meta-analysis aimed to investigate the effect of EVOO intake on glycemic parameters. Electronic literature searched through 1 September 2020 across MEDLINE/PubMed, Web of Science, and SCOPUS databases to find all clinical trials that reported the effect of EVOO intake on glycemic parameters [FBS(fasting blood glucose), insulin, HOMA-IR (Homeostatic Model Assessment for Insulin Resistance) and HbA1c (glycated hemoglobin A1c)] vs. control.Data synthesisWe pooled standardized mean differences (SMD) and 95% confidence intervals (CIs) from randomized clinical trials (RCTs) using random-effects models. Heterogeneity was assessed by Cochran Q-statistic and quantified (I²). We found 13 related trials comprising a total of 633 subjects. In pooled analysis, EVOO intake had no effect on FBS (SMD: ?0.07; 95% CI: ?0.20, 0.07; I² = 0.0%), insulin (SMD: ?0.32; 95% CI: ?0.70, 0.06; I² = 38.0%), and HOMA-IR (SMD: ?0.32; 95% CI: ?0.75, 0.10; I² = 51.0%). However, a decreasing trend was observed in these effects. Subgroup analysis based on age, health status, dose, and EVOO intake duration also did not significantly change results.ConclusionAlthough EVOO seems a promising hypoglycemic effects, we did not find any significant evidence that EVOO consumption impacts glucose homeostasis. Furthermore, well-designed RCTs with longer durations are still needed to evaluate the EVOO's efficacy on glycemic parameters.