PJ34, a poly-ADP-ribose polymerase inhibitor, modulates visceral mitochondrial activity and CD14 expression following thoracic aortic ischemia-reperfusion

Background

Visceral ischemia-reperfusion injury (VI) contributes to adverse outcomes following the repair of thoracoabdominal aneurysms. Experiments were designed to determine whether a poly-adenosine diphosphate-ribose polymerase (PARP) inhibitor modulates indexes of metabolic function (mitochondrial activity), inflammatory cell activation, and tissue inflammation (lipopolysaccharide receptor CD14 messenger ribonucleic acid) following VI.

Methods

129S1/SvImj mice were subjected to thoracic aortic occlusion followed by 48 hours of reperfusion. Normal saline was administered to 25 untreated control mice and PJ34 to 21 mice before and immediately after thoracic aortic ischemia-reperfusion. Sham mice (n = 13) underwent median sternotomy alone. At 48 hours, all animals were euthanized and tissues harvested for quantitative analysis.

Results

PJ34 improved intestinal (P < .05) but not hepatic mitochondrial activity following reperfusion. CD14 messenger ribonucleic acid levels in liver (P < .004), kidney (P < .003), and spinal cord (P < .03) tissue were less in PJ34-treated mice.

Conclusions

PJ34 preserved the metabolic function of intestinal but not hepatic tissue during reperfusion. PJ34 uniformly decreased the expression of an important marker of inflammatory cell activation and tissue inflammation in visceral tissue following VI. PARP inhibitors may serve as a therapeutic modality to abrogate the stress response to VI.     

Endovascular repair of abdominal aortic aneurysm in octogenarians: an analysis based on EUROSTAR data

PURPOSE: To investigate the early and late outcome after endovascular treatment of abdominal aortic aneurysm (EVAR) in octogenarians compared with patients aged < 80 years. METHODS: Patients treated for abdominal aortic aneurysm (AAA) with endovascular repair during the period 1996 to 2004 were collated in the EUROSTAR registry. This study group consisted of 697 patients aged > or = 80 years. Comparison was made with 4198 patients aged < 80 years with regard to the incidence of preoperative characteristics and outcomes of the procedure. RESULTS: The proportion of octogenarians treated by EVAR increased during the study period, from 11% in the first year to 18% in the last year. Octogenarians more frequently had cardiac disease, impaired renal function, and pulmonary disease (P = .03, P < .0001 and P = .0001). Thirty-two percent of the octogenarians were recorded unfit for open surgery as opposed to 22% in younger patients (P < .0001); they also had a larger aneurysm diameter (62 vs 58 mm, respectively; P < .0001). The 30-day and in-hospital mortality in octogenarians was 5% vs 2% in the younger group (P < .0001). More device-related complications and systemic complications, including cardiac disease, were noted in octogenarians (7% vs 5% and 19% vs 11%, P = .03 and P < .0001, respectively). This group of patients also had a higher incidence of postoperative hemorrhagic complications, including hematoma (7% vs 3%, P < .0001, respectively). No differences in conversion to open repair and post-EVAR rupture rate were observed. Aneurysm-related mortality and late all-cause mortality was 7% vs 3% and 10% vs 7%, both P < .0001. CONCLUSION: Our study supports that EVAR might be considered when treating elderly patients, provided their aneurysms are anatomically suited for the endovascular technique. The risk for late complications compared with open repair may be outweighed by a lower early mortality as well as a shorter time for physical recovery.     

Spinal Trauma and Symptoms in High School Football Players

In brief: Responses from 101 coaches (98%) and 3,063 players (81%) In a retrospective epidemiological study of 103 Minnesota secondary school varsity football teams showed an overall injury rate of 78 injuries per 100 players, which included a high incidence of spinal trauma and spinal trauma symptoms. Recognition of the incidence, severity, and chronicity of spinal trauma requires ongoing assessment of participants in contact activities. Continued use of the illegal techniques of butt-blocking and face-tackling by as many as 40% of the players was found to increase the risk of these symptoms significantly.     

Pulmonary Contusion in Contact Sports

Computed tomography (CT) is always more precise than chest x-ray for evaluating pulmonary contusions and other forms of lung trauma. CT is also valuable in guiding treatment for patients who have pulmonary contusions. As demonstrated by two case studies, not all sports-related pulmonary contusions are minor. Supportive treatment usually consists of maintaining the patient's oxygenation, treating associated injuries, and preventing complications.     

Brachytherapy practice across Canada: A survey of workforce and barriers

PurposeTo determine the current use of brachytherapy, characteristics of the brachytherapy workforce, and barriers to development and maintenance of brachytherapy programs across Canada.Methods and MaterialsA survey was designed to inquire about the use of brachytherapy and was sent to all Canadian radiation oncologists.ResultsOf the 116 respondents, we identified 80 radiation oncologists from 33 of 41 responding centers who currently or in the past have practiced brachytherapy. Responses were received from 30% overall and 80% of provinces. Approximately 58% of the respondents treat in one site with brachytherapy, whereas 12% treat in three or more sites. Gynecologic (GYN) and genitourinary are the most commonly treated sites (49% of respondents). For all sites, there was a large range in the number of patients treated with brachytherapy by each radiation oncologist per year (i.e., cervix: 1–50). Approximately 49% of the respondents have discontinued practicing brachytherapy for a certain site, most commonly head and neck (28%), GYN (25%), and bronchus (24%). The most common reasons include reassignment or lack of a local program. The most common reasons why brachytherapy is not used for sites other than GYN and prostate include lack of infrastructure and insufficient training of radiation oncologists rather than insufficient patient numbers or lack of evidence for a benefit of brachytherapy.ConclusionsWithin its limitations, our study suggests a mismatch between demand and availability of brachytherapy programs across Canada. In light of finite resources, a rational approach to investment in brachytherapy is needed and this must be based on a formal audit of brachytherapy demand and use.     

Metabolic adaptations to endurance training and nutrition strategies influencing performance

ABSTRACT

Endurance performance is the result of optimal training targeting cardiovascular, metabolic, and peripheral muscular adaptations and is coupled to effective nutrition strategies via the use of macronutrient manipulations surrounding training and potential supplementation with ergogenic aids. It is important to note that training and nutrition may differ according to the individual needs of the athlete and can markedly impact the physiological response to training. Herein, we discuss various aspects of endurance training adaptations, nutritional strategies and their contributions to towards performance.     

Addition of proximal intervention to carotid endarterectomy increases risk of stroke and death

Objective

Adding ipsilateral, proximal endovascular (IPE) intervention to carotid endarterectomy (CEA) for the treatment of tandem bifurcation and supra-aortic trunk disease is controversial. Some suggest that this combined strategy (CEA + IPE) confers no risk over isolated CEA (ICEA). Others disagree, reserving CEA + IPE for symptomatic patients. Using the Vascular Quality Initiative (VQI), this study assessed the effect of adding IPE to CEA on stroke and death risk. We further weighed CEA + IPE outcomes in the context of symptomatic status and Society for Vascular Surgery guidelines.

Beitrag zum Problem der parietalen Alexie

Zusammenfassung Es wird ein Fall von Hirnläsion im Bereich des linken Parietallappens auf den Gestaltwandel seiner Leseleistung hin analysiert, wobei das Gewicht vor allem auf die Fehleranalyse gelegt wurde. Die Leseleistung erwies sich nach zwei Seiten hin verändert; sowohl die Differenzierung gegebener Wortgestalten wie auch die Integrierung von Teilen (Buchstaben oder Wörtern) zu höheren Gestalten war gestört, während ein rein physiognomisches ratendes Erkennen von substantivischen Wortbildern, wie auch von Einzelbuchstaben möglich war. In dieser differentialen und integralen Gestaltfunktion wird die epikritische Leistung des Lesens gesehen, die durch die Hirnläsion so weit abgebaut wird, daß eine primitivierte, vorgestaltete, d. h. protopathische Leistung übrigbleibt. Es liegt also gar nicht ein einfacher Verlust des Lesevermögens durch die Hirnläsion vor, sondern ein ganz bestimmten Gesetzen folgender Gestaltwandel der Leseleistung. Dieser steht in Beziehung zu anderen Leistungsveränderungen, auf die jedoch nur andeutend verwiesen werden konnte. Bezüglich der Lokalisationsfrage wird daran erinnert, daß die parieto-occipitale Rinde nicht im Sinne eines Lesezentrums die Leseleistung bewirke, sondern daß ihre Läsion diese Leistung nur störe, und zwar vermutlich infolge ihrer eigenartigen Mittelständigkeit zwischen den primären optischen, akustischen und taktil-motorischen Projektionsfeldern. Die Annahme positiv definierter Zentren ist nach den Erfahrungen der Pathologie vorläufig nicht zwingend. Ernst Kretschmer zur Vollendung seines 60. Lebensjahres gewidmet. (Die Arbeit wird als IX. Mitteilung der Strukturanalysen hirnpathologischer Fälle geführt und zitiert werden.)