Mitochondrial Dependent Apoptosis: Ameliorative Effect of Flunarizine on Ischemia–Reperfusion of Celiac Artery-Induced Gastric Lesions in the Rat

Objectives  

Ischemia–reperfusion is a major event for induction of cellular apoptosis. Apoptosis is due to the activation of death receptor and/or mitochondrial pathways. Mitochondrial permeability transition pore opening is the cause of apoptosis. In our present study, we tried to evaluate the role of flunarizine in ischemia and reperfusion of celiac artery-induced gastric lesion in the rat.     

Antibiotic Prophylaxis Prevents the Development of a Post-Infectious Phenotype in a New Rat Model of Post-Infectious IBS

Background  

A recent post-infectious rat model with Campylobacter jejuni 81-176 has replicated the events noted in humans with post-infectious irritable bowel syndrome (IBS). In this study, we test whether prophylactic treatment with the antibiotic rifaximin will prevent the development of long-term altered bowel function in this model.     

Relapse Rate Following Azathioprine Withdrawal in Maintaining Remission for Crohn’s Disease: A Meta-Analysis

Background  

The duration of use of azathioprine (Aza) and 6-mercaptopurine (6-MP) for maintaining remission for Crohn’s disease is debatable.     

Management principles of the critically ill obstetric patient

The goals in management of critically ill obstetric patients involve intensive monitoring and physiologic support for patients with life-threatening but potentially reversible conditions. Management principles of the mother should also take the fetus and gestational age into consideration. The most common reasons for intensive care admissions (ICU) in the United States and United Kingdom are hypertensive disorders, sepsis, and hemorrhage. The critically ill obstetric patient poses several challenges to the clinicians involved in her care, because of the anatomic and physiologic changes that take place during pregnancy.     

Low-permeability Gore Excluder device versus the original in abdominal aortic aneurysm size regression

We sought to compare the efficacy of a low-permeability version of the Gore Excluder™ device with that of the original device. We used volumetric analysis and maximum transverse diameter measurements to examine abdominal aortic aneurysm size regression after endovascular aneurysm repair.From November 2002 through April 2007, 101 patients (82% men; mean age, 71.5 ± 8.9 yr) underwent endovascular aneurysm repair with the Excluder stent-graft: 34 with the original device, and 67 with the low-permeability device. Only patients without endoleak and with preprocedural and 1- and 2-year follow-up computed tomographic scans were included. Eight patients with type II endoleak and 2 with type I endoleak were excluded. Maximum abdominal aortic aneurysm diameter and volume were measured before endovascular aneurysm repair and annually thereafter. Postprocessing, multiplanar computed tomography, and 3-dimensional reconstructions were compared with baseline measurements. Diameter and volume changes that were greater than 5 mm or that exceeded 10% were considered significant.At 12 months, the mean maximum transverse diameter had decreased by −0.16 ± 12.1 mm in recipients of the original device and by −4.8 ± 5.9 mm in recipients of the low-permeability device (P = NS). In addition, mean reduction in volume had changed by −17 ± 16 mL in original-device recipients and by −36.1 ± 37.9 mL in low-permeability device recipients (P < 0.01).One-year follow-up revealed that the low-permeability stent-graft resulted in a greater decrease in abdominal aortic aneurysm volume than did the original stent-graft.Key words: Aortic aneurysm, abdominal/exclusion/repair; blood vessel prosthesis; endoleak; stent-grafts; stents; tomography, x-ray computed; treatment outcomeEndovascular aortic repair (EVAR) has become an accepted treatment technique for patients with abdominal aortic aneurysm (AAA). Compared with surgery, EVAR is associated with less operative blood loss, shorter hospital and intensive care unit stays, fewer major postoperative complications, and more rapid convalescence.^1–3 In addition, EVAR has proved beneficial in the treatment of high-risk patients who cannot undergo standard surgical AAA repair. Two recent prospective, randomized trials have shown that, compared with surgery, EVAR is associated with a reduction in 30-day perioperative mortality.^4,5 The GORE® EXCLUDER® AAA Endoprosthesis (W.L. Gore & Associates, Inc.; Flagstaff, Ariz) is currently 1 of 5 endografts approved by the U.S. Food and Drug Administration for clinical use in the treatment of infrarenal AAA. The Excluder endograft is a bifurcated endoprosthesis composed of a trunk-ipsilateral endoprosthesis and a contralateral leg endoprosthesis. The graft material consists of expanded polytetrafluoroethylene (ePTFE) and fluorinated ethylene propylene. The material is supported by nitinol (nickel-titanium alloy) wire along its external surface, which is attached to the graft by a bonding film.In the mid-term Excluder Pivotal Trial, the original Excluder device was associated with a higher aneurysm expansion rate than that observed with other commercially available devices.^6,7 Some patients in this trial had aneurysm expansion without an identifiable endoleak, a phenomenon termed endotension. As the trial showed, the causes of aneurysm enlargement are multifactorial and include both endoleaks and endotension due to the material''s high permeability by plasma. As a result, several patients in this trial had to undergo late conversion to open surgical intervention.⁸ In an effort to resolve this issue, in June 2004, W.L. Gore & Associates modified the Excluder graft material to reduce its permeability. The purpose of the present study was to compare the efficacy of the new, low-permeability (LP) Excluder device with that of the original device by using volumetric analysis and measuring maximum transverse diameter to examine regression in AAA size after EVAR.     

Activation of NADPH oxidase 1 increases intracellular calcium and migration of smooth muscle cells

Redox-dependent migration and proliferation of vascular smooth muscle cells (SMCs) are central events in the development of vascular proliferative diseases; however, the underlying intracellular signaling mechanisms are not fully understood. We tested the hypothesis that activation of Nox1 NADPH oxidase modulates intracellular calcium ([Ca(2+)](i)) levels. Using cultured SMCs from wild-type and Nox1 null mice, we confirmed that thrombin-dependent generation of reactive oxygen species requires Nox1. Thrombin rapidly increased [Ca(2+)](i), as measured by fura-2 fluorescence ratio imaging, in wild-type but not Nox1 null SMCs. The increase in [Ca(2+)](i) in wild-type SMCs was inhibited by antisense to Nox1 and restored by expression of Nox1 in Nox1 null SMCs. Investigation into potential mechanisms by which Nox1 modulates [Ca(2+)](i) showed that thrombin-induced inositol triphosphate generation and thapsigargin-induced intracellular calcium mobilization were similar in wild-type and Nox1 null SMCs. To examine the effects of Nox1 on Ca(2+) entry, cells were either bathed in Ca(2+)-free medium or exposed to dihydropyridines to block L-type Ca(2+) channel activity. Treatment with nifedipine or removal of extracellular Ca(2+) reduced the thrombin-mediated increase of [Ca(2+)](i) in wild-type SMCs, whereas the response in Nox1 null SMCs was unchanged. Sodium vanadate, an inhibitor of protein tyrosine phosphatases, restored the thrombin-induced increase of [Ca(2+)](i) in Nox1 null SMCs. Migration of SMCs was impaired with deficiency of Nox1 and restored with expression of Nox1 or the addition of sodium vanadate. In summary, we conclude that Nox1 NADPH oxidase modulates Ca(2+) mobilization in SMCs, in part through regulation of Ca(2+) influx, to thereby promote cell migration.     

Sporotrichosis in Delhi among the migrant population from Uttarakhand, India

Six cases of sporotrichosis in Delhi (non-endemic area) were recorded in migrants from Uttarakhand over a period of one year (2008-2009). The clinico-epidemiological and mycological profile of the patients is discussed. These were confirmed by mycological culture, histopathological examination and/or remission of lesion with potassium iodide. Sporotrichosis is endemic in Uttarakhand, a north-western state in the sub-Himalayan region.     

Fluid infusion into the pericardium resulting from accidental displacement of a subclavian venous cannula

A patient for double valve replacement developed an unusual complication consequent to extra-vascular displacement of a port of a central venous catheter, placed through the right subclavian vein. The patient had an uneventful surgical course and the trachea extubated after routine mechanical ventilation. Patient developed excessive mediastinal drainage later, which was noticed to be watery in nature. The source of the drainage was found to be a port of the central venous catheter, draining extra-vascular into the subclavian vascular sheath and thereafter through the pericardium into the mediastinal drains.     

Entropy score, patent ductus arteriosus (PDA), and cardiopulmonary bypass (CPB): ligation of PDA on CPB can compromise cerebral blood flow

A patent ductus arteriosus (PDA) is often present in patients undergoing correction of congenital heart disease. It is well appreciated that during cardiopulmonary bypass (CPB), a PDA steals arterial inflow into pulmonary circulation, and may lead to systemic hypoperfusion, excessive pulmonary blood flow (PBF) and distention of the left heart. Therefore, PDA is preferably ligated before initiation of CPB. We describe acute decreases of arterial blood pressure and entropy score with the initiation of CPB and immediate increase in entropy score following the PDA ligation in a child undergoing intracardiac repair of ventricular septal defect and right ventricular infundibular stenosis. The observation strongly indicates that a PDA steals arterial inflow into pulmonary circulation and if the PDA is dissected and ligated on CPB or its ligation on CPB is delayed the cerebral perfusion is potentially compromised.