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Objective:To explore the clinical characteristics of superior mesenteric artery ischemic diseases.Methods:The clinical and followup data of 141 hospitalized patients with ischemic disease of superior mesenteric artery in the Affiliated Hospital of Southwest Medical University from 1999 to 2021 were reviewed.Results:There were 99 males (70.2%) and 42 females (29.8%). The average age of the patients was (63.75±13.16) years; 127 patients (90.1%) complained abdominal pain.The number of all-cause deaths in the perioperative period was 27 (19.1%). ROC curve analysis showed that the optimal cutoff value of the age with predictive value was 64.5 years. The results of multivariate COX regression analysis showed that age ≥65 years old ( HR=3.855, 95% CI: 1.739-8.545), neutrophil count ( HR=1.072, 95% CI: 1.018-1.130), heart failure ( HR=2.863, 95% CI: 1.332-6.154), creatinine ( HR=1.009, 95% CI: 1.003-1.015), D-Dimer ( HR=1.112, 95% CI: 1.025-1.205) was an independent risk factor for all-cause death from superior mesenteric artery ischemic disease. Long-term survival rate of SMAD group was significantly higher than that of other SMAID; By comparing the clinical characteristics of different SMAID, neutrophil count, neutrophil ratio, D-dimer of SMAE group and SMAT group were significantly higher than that of SMAD group and ASSMA group. Conclusions:SMAID usually occurs in elderly men over 65 years old, with abdominal pain as the main symptom and often accompanied by hypertension. Risk factors included age, increased WBC count and D-dimer; The neutrophil count, neutrophil ratio, D-dimer in SMAE and SMAT group were significantly higher than that of SMAD and ASSMA group.
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Objective:To study the risk factors of complications after bowel resection for acute mesenteric ischemic disease.Methods:Retrospective case-control study was used to analyze the case data of 68 patients diagnosed with acute mesenteric ischemic disease (AMI) with bowel resection at the First Medical Center of the PLA General Hospital from January 2010 to January 2020, including 43 males and 25 females. The patients were divided into complication group ( n=21) and the non-complication group ( n=47) according to whether they had complications after surgery. The risk factors associated with the development of postoperative complications were analyzed by multivariate Logistic stepwise regression method to determine the risk factors with clinical significance. Measurement data with normal distribution were expressed as mean ± standard deviation ( ± s), and t-test was used for comparison between groups. Chi-square test was used for comparison between count data groups. Results:Univariate analysis showed that age >60 years, Marshall score≥2, type of resected bowel, pathology suggestive of irreversible transmural necrosis, length of ICU stay >6 d, length of mechanical ventilation >2 d, American Society of Anesthesiologists (ASA) classification, and preoperative procalcitonin≥2 ng/mL were the risk factors affecting the development of complications after bowel resection for acute mesenteric ischemic disease risk factors ( P<0.05). Multivariate Logistic regression analysis showed that age>60 years ( HR=12.364, 95% CI: 1.135-134.662, P=0.039) and preoperative procalcitonin ≥2 ng/mL ( HR=14.144, 95% CI: 1.280-156.303, P=0.031) were independent risk factors for the development of postoperative complications after AMI parallel bowel resection. Conclusion:The rate of complications after combined bowel resection for AMI is high. When patients are combined with age>60 years and preoperative procalcitonin≥2 ng/mL, preoperative prevention of postoperative complications should be emphasized to improve the prognosis of patients.
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RESUMEN La enfermedad hipóxico-isquémica constituye una de las principales causas de morbi-mortalidad neurológica en el recién nacido. Las diferentes adaptacio-nes vasculares a la hipoxia tanto en el neonato pretérmino como en niño a término hacen que su presentación en neuroimagen, sobre todo en el ultrasonido (US) sea caracterizable según el territorio afectado y el momento de la enfermedad. El ultrasonido se ha convertido en una poderosa herramienta para la evaluación del recién nacido con sospecha de EHI, y el patrón de las lesiones tiene importantes implicaciones en el tratamiento y en el pronóstico neurológico a largo plazo. A continuación, presentamos el caso de un recién nacido masculino, prematuro extremo, que requirió reanimación cardiopulmonar avanzada en el nacimiento y que además presento dos episodios de parada cardiorrespiratoria en el segundo y tercer día de vida, en el cual se llegó al diagnóstico con patrones ecográficos característicos de lesión isquémica y además se detalla la evolución de los hallazgos en el tiempo.Palabras claves: Enfermedad hipóxico-isquémica, ultrasonido transfontanelar, matriz germinal, leucomalacia periventricular.
ABSTRACT Hypoxic-ischemic disease is one of the main causes of neurological morbidity and mortality in the newborn. The different vascular adaptations to hypoxia in both the preterm and term infants make their presentation on neuroimaging, especially on ultrasound (US), characterizable according to the affected terri-tory and the time of the disease. Ultrasound has become a powerful tool for evaluating the newborn with suspected IBD, and the pattern of the lesions has important implications for treatment and long-term neurological prognosis. Next, we present the case of a male newborn, extremely premature, who required advanced cardiopulmonary resuscitation at birth and who also presented two episodes of cardiorespiratory arrest on the second and third day of life, in which the diagnosis was reached with patterns sonographic characteristics of ischemic injury and also the evolution of the findings over time.Keywords: Hypoxic-ischemic disease, transfontanelar ultrasound, germ matrix, periventricular leukomalacia
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Humans , Infant, Newborn , Infant, Premature , Ultrasonography , Hypoxia , Leukomalacia, Periventricular , Morbidity , NeuroimagingABSTRACT
Objective: To summarize the research progress of tibial transverse transport (TTT) in treatment of chronic ischemic diseases of the lower extremities. Methods: The related literature was systematically searched and the mechanisms, clinical treatment methods, clinical efficacy, indications, contraindications, and complications of TTT were discussed. Results: Based on the law of tension-stress, TTT is a new method in the treatment of chronic ischemic diseases of the lower extremities. It can relieve the ischemic symptoms, promote the wound healing, and increase the limb salvage rate. The clinical application in recent years has shown good effectiveness, and the scope of application is expanding. Conclusion: Due to the current limited clinical application, the sample size of the TTT for the chronic ischemic diseases of the lower extremities is relatively small, and the follow-up time is limited. So its validity, long-term effectiveness, and bone transport standards are need further research.
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Objective: To evaluate the efficacy of bone marrow mesenchymal stem cells (BMSCs) in the treatment of lower limb ischemic disease using Meta-analysis. Methods The literature of clinical controlled trials concerning BMSCs in treatment of lower limb ischemic disease were retrieved by searching PubMed, EMbase and Cochrane Library databases. Literature screening and data extraction were carried out according to the inclusion and exclusion criteria. Meta-analysis was conducted by using RevMan 5.3 software. The amputation rate, amputation-free survival rate, ankle-brachial index, ulcer healing rate, pain score and pain-free walking distance were compared between BMSCs group and control group. Results A total of 5 articles were included. Meta-analysis showed that ankle-brachial index (mean difference [MD]=0.15, 95%CI [0.12,0.18], P<0.000 01), pain score (MD=-1.38, 95%CI [-1.65, -1.11], P<0.000 01), pain-free walking distance (MD=202.20, 95%CI [154.30, 250.10], P<0.000 01) and ulcer healing rate (relative risk [RR]=1.42, 95%CI [0.82, 2.46], P=0.021) were significantly improved in BMSCs group than those in control group. The amputation rate (RR=0.52, 95%CI [0.24, 1.10], P=0.09), amputation-free survival rate (RR=1.09, 95%CI [0.98, 1.21], P=0.12) demonstrated no significant differences between BMSCs and control group. Conclusion: Meta-analysis shows no advantage of BMSCs therapy on the amputation rate and amputation-free survival rate in patients with lower limb ischemic disease, but BMSCs treatment is more effective in improving clinical symptoms of patients.
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Adenosine,also known as adenine nucleoside,is an important bioactive substances. A large number of studies found that adenosine is involved in the prevention and treatment of many diseases by activating adenosine receptors. Up to now,Adenosine receptors have cloned four subtypes,such as A1,A2a,A2b and A3 and they can be combined with AD and start the downstream signal transduction mechanism,then have different effects on the body. This article will summarize the distribution and activation of adenosine A2 receptor and its role and mechanism in the prevention and treatment of disease.
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Objective To observe the effects of carotid artery stenting (CAS) on ophthalmic artery blood flow in patients with ischemic ophthalmopathy (IOP).Methods A prospective case-control study.Sixty IOP patients (60 eyes) who met inclusive criteria for CAS were enrolled in this study.There was 50％ stenosis of internal carotid artery on one side at least confirmed by color doppler flow imaging (CDFI).Among 60 eyes,there were 3 eyes with central retinal artery occlusion,15 eyes with retinal vein occlusion,37 eyes with ischemic optic neuropathy,5 eyes with ocular ischemia syndrome.The patients were randomly divided into CAS group (32 eyes of 32 patients) and medicine therapy group (28 eyes of 28 patients).The difference of age (t=1.804) and sex (x2=1.975) between two groups was not significant (P＞0.05).The examinations of fundus fluorescein angiography (FFA),CDFI and digital substraction angiography (DSA) were performed before,1 week and 6 months after treatment.The following parameters were recorded:arm-retinal circulation time (A-Rct),peak systolic velocity (PSV),end-diastolic velocity (EDV),and resistance index (RI) in the ophthalmic artery (OA) and central retinal artery (CRA),and the best corrected visual acuity (BCVA).Results There was no significant differences in A-Rct (t=1.354) and BCVA (t=0.376) between the two groups before treatment (P＞0.05).Also,there was no significant differences in PSV (t=-0.294,-2.446),EDV (t=0.141,-0.305),and RI (t=-0.222,-0.694) of OA and CRA between the two groups before treatment before treatment (P＞0.05).Compared with the medicine therapy group,the lower A-Rct was found in the CAS group at different time points after the treatment.The difference was significant on 1 week after treatment (t=-3.205,P＜0.05),but not on 6 months after treatment (t=1.345,P＞0.05).The BCVA of eyes in the two groups were increasing with the extending of time of therapy.Compared with the medicine therapy group,the better BCVA was found in the CAS group at different time points after the treatment (t=0.800,1.527;P＜0.05).Compared with the medicine therapy group,the higher PSV,EDV and lower RI of OA and CRA were found in the CAS group at different time points after the treatment.(P＜0.05).Conclusion Compared with conventional medicine therapy,CAS shows earlier effects in improving ocular hemodynamics for IOP patients with carotid artery stenosis,which benefits visual function improvement of the patients.
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Objective: To summarize the clinical effects of Shuxuening Injection on diseases and evaluate the quality of evidence to provide reference for the clinical application of Shuxuening Injection. Methods: Journal articles and conference papers were retrieved from the databases CNKI, Wanfang, VIP, CBM, EMbase, Pubmed and Cochrane with thematic word"Shuxuening"in Chinese and English, then all forms of clinical studies were screened and the disease types and frequency were analyzed, the dominant disease types of Shuxuening Injection were identified. Futhermore, RCT was extracted, and the literature quality was graded using the cochrane manual recommendation method, and its effectiveness and safety were evaluated. Results: All clinical research results show that Shuxuening Injection to treat disease with as many as 74 kinds of varieties, mainly circulation system disease and neural system disease, followed by endocrine disease, respiratory disease, scattered remaining research in ten other system diseases. These researches appeared with the highest frequency of the three diseases were cerebral infarction and its aftermath, angina pectoris and coronary heart disease, diabetes mellitus and its complication. A total of 337 RCT articles were included, all of which were of poor quality. In general, the efficiency of Shuxuening Injection treatment group was significantly higher than that of the control group, with a total efficiency of 84.48％. There were 21.96％ references to adverse reactions, but all of them were minor adverse reactions, such as pruritus, which generally got better by itself or after treatment. Conclusion:Shuxuening Injection has a wide range of clinical application and remarkable effect, especially for the ischemic diseases of cardiovascular and cerebrovascular diseases with good efficacy, less adverse reactions and safety. However, the quality of evidence is generally poor, which needs further study.
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Objective:Using Meta analysis comprehensive evaluation of the curative effect of stem cells to treat lower limb ischemic diseases.Methods:Using a computer to retrieve published both at home and abroad literatures about stem cell therapy for lower limb ischemic diseases,after quality evaluation according to certain standard into literature,using RevMan 6.0 software is analyzed.Using the funnel figure,Begg's regression analysis for publication bias estimation between different studies.Results:Participants included 16 studies,including 629 cases of the object of study.Meta analysis results show that the stem cells before,during and after the treatment of lower limb ischemic diseases,TcPO2 statistically significant TcPO2 levels after treatment (WMD=9.27,95％ CI:9.27,4.53,P=0.000).Before and after treatment was statistically difference between ABI,ABI levels after treatment (WMD=0.13,95％ CI:0.13,0.19,P=0.000).Temperature measurement was statistically difference,temperature measuring levels after treatment(WMD=2.75,95％CI:2.75,1.92,P=0.000).Three Meta analysis exists heterogeneity and publication bias results show that the funnel chart is symmetrical,at the same time Begg's regression analysis results showed that no publication bias.Couclusion:Stem cells to treat lower limb ischemic diseases effectively,the forward security still need massive evidence-based medicine.
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c-kit+ cells are mainly derived from bone marrow and cardiac tissue.The cells include various subpopulations.Recent studies have shown that c-kit+ cells are a kind of ideal cells of transplantation therapy for myocardial infarction.However,there is a great debate on the differentiation efficiency of c-kit+ cells towards cardiomyocytes and endothelial cells.Therefore,it is necessary to evaluate the potential of c-kit+ cell differentiation and explore the effects of different developmental stages and microenvironments on differentiation of c-kit+ cells again.These studies could be significant for increasing efficiency of c-kit+ cell transplantation in repairing the infarcted myocardium.
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@#Objective To evaluate the cerebrovascular reserve (CVR) with 13N-ammonia PET/CT and methazolamide in patients with cerebral ischemic disease. Methods From January, 2014 to December, 2015, basal and stress PET/CT were performed in ten healthy persons and 53 patients with unilateral internal carotid artery or middle cerebral artery stenosis. Radioactive counts were measured on mirror regions of bilateral frontal lobe, parietal lobe, temporal lobe, occipital lobe, basal ganglia and thalamus to calculate the blood flow change rate. Results For the healthy persons, the radioactive distribution of bilateral frontal lobe, parietal lobe, temporal lobe, occipital lobe, basal ganglia and thalamus were roughly symmetrical on both basal and stress PET/CT. The radioactive counts were more in basal ganglia and thalamus than in cortex, and the least in white matter. The radioactive counts were more on stress PET/CT than basal PET/CT, and there was no significant difference between both sides (t=1.552, P=0.132). For the patients, the blood flow perfusion decreased in 39 patients with 126 regions on basal PET/CT, and 49 patients with 183 regions on stress PET/CT. Within the 39 patients who found decreased blood flow perfusion regions, 16 patients were found new regions on stress PET/CT, and 29 regions of 13 patients improved in blood flow perfusion on stress PET/ CT. The blood flow change rate was significantly different between basal and stress PET/CT (t=2.466, P<0.05). Conclusion 13N-ammonia PET/CT cerebral blood flow perfusion imaging combined with methazolamide stress test can evaluate the cerebrovascular reserve in patients with unilateral internal carotid artery or middle cerebral artery stenosis, and is valuable for clinical assessment and early intervention for patients with cerebral ischemic disease.
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Mesenchymal stem cells (MSCs) offer significant therapeutic promise for various regenerative therapies. However, MSC-based therapy for injury exhibits low efficacy due to the pathological environment in target tissues and the differences between in vitro and in vivo conditions. To address this issue, we developed adipose-derived MSC spheroids as a novel delivery method to preserve the stem cell microenvironment. MSC spheroids were generated by suspension culture for 3 days, and their sizes increased in a time-dependent manner. After re-attachment of MSC spheroids to the plastic dish, their adhesion capacity and morphology were not altered. MSC spheroids showed enhanced production of hypoxia-induced angiogenic cytokines such as vascular endothelial growth factor (VEGF), stromal cell derived factor (SDF), and hepatocyte growth factor (HGF). In addition, spheroid culture promoted the preservation of extracellular matrix (ECM) components, such as laminin and fibronectin, in a culture time- and spheroid size-dependent manner. Furthermore, phosphorylation of AKT, a cell survival signal, was significantly higher and the expression of pro-apoptotic molecules, poly (ADP ribose) polymerase-1 (PARP-1) and cleaved caspase-3, was markedly lower in the spheroids than in MSCs in monolayers. In the murine hindlimb ischemia model, transplanted MSC spheroids showed better proliferation than MSCs in monolayer. These findings suggest that MSC spheroids promote MSC bioactivities via secretion of angiogenic cytokines, preservation of ECM components, and regulation of apoptotic signals. Therefore, MSC spheroid-based cell therapy may serve as a simple and effective strategy for regenerative medicine.
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Animals , Apoptosis , Caspase 3 , Cell Survival , Cell Transplantation , Cell- and Tissue-Based Therapy , Cytokines , Extracellular Matrix , Fibronectins , Hepatocyte Growth Factor , Hindlimb , In Vitro Techniques , Ischemia , Laminin , Mesenchymal Stem Cells , Methods , Phosphorylation , Plastics , Regenerative Medicine , Stem Cell Niche , Stromal Cells , Vascular Endothelial Growth Factor AABSTRACT
Diseases with excessive angiogenesis such as tumors need to be treated with anti-angiogenesis agents, while ischemic diseases need to be treated with pro-angiogenesis agents. Salviae Miltiorrhizae Radix et Rhizoma, the representative drug which promotes circulation and resolves clots, was widely used in treating tumors and ischemic diseases. This review focused on the current research on the angiogenic effect of Salviae Miltiorrhizae Radix et Rhizoma and its water-soluble or fat-soluble components. It was found that there are some controversy reports. Both pro-angiogenic and anti-angiogenic effects of Salviae Miltiorrhizae Radix et Rhizoma and its components have been reported. The major difference between tumor and ischemia is the maturity and stability of vessels. Angiogenesis is a complex process involving many signaling molecules. Therefore, the components of Salviae Miltiorrhizae Radix et Rhizoma will regulate the levels and functions of angiogenesis, and then vessels produce different maturity and stability. Overall, such controversy may be caused by differences in experimental conditions, the diversity of Salviae Miltiorrhizae Radix et Rhizoma components, the complexity of the angiogenic process, and the differences of drug distribution under different pathological states in vivo.
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Background Carotid stenosis is one of the important causes of ocular ischemic diseases,To study their relationship is helpful for us to classify and manage the ocular ischemic diseases.Objective This study was to investigate the correlation between ocular ischemic diseases and carotid stenosis.Methods Twenty patients with internal carotid artery stenosis rate more than 60％ defined by digital subtraction angiography(DSA) or magnetic resonance angiography (MRA) were selected,including 9 patients with lateral carotid artery stenosis and 11 patients with bilateral carotid artery stenosis.The best corrected visual acuity,intraocular pressure and fundus examinations were carried out,and the peak systolic velocity (PSV) and end diastolic velocity (EDV) of the central retinal artery(CRA) were detected with color doppler flowimaging (CDFI).The resistance index(RI) was calculated by the formula RI =PSV- EDV/PSV.The correlation between internal carotid artery stenosis rate and PSV or RI was evaluated by Spearman rank correlated analysis.Results The subjective inanifestations included transient amaurosis in 77.4％ frequency and visual blur in 22.6％ frequency in the 31 carotid artery stenosis.Twelve eyes(38.7％ ) appeared the ocular vascular abnormality.Other 2 patients were diagnosed as hypoperfusion retinopathy complicated by neovascular glaucoma.A negative relationship was found between internal carotid artery stenosis rate and PSV of CRA ( r =-0.41,R2 =0.168,P =0.021 ＜0.05 ),but no significant relationships was found between internal carotid artery stenosis rate and RI ( r =- 0.26,R2 =0.068,P =0.159 ).Conclusions Carotid artery stenosis can cause the of ocular ischemic symptoms.The characteristics of retinal hemodynamics is the type of low speed and normal resistance.
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Recent researches have achieved new progress in the function and signal transduction molecular mechanisms of erythropoietin (EPO).Previous studies confirmed that EPO is an independent angiogenic factor,especially in the development of retinopathy of prematurity (ROP).Recent research found that EPO protect the neurons as a neurotrophic factor.However,in proliferation stage as an angiogenic factor,EPO shares similarities with vascular endothelial growth factor ( VEGF ) in the early phase of diabetes.Besides,a recent study about effects of intravitreal EPO therapy for patients with chronic and progressive diabetic macular edema showed a short-term positive response.Here,the effects and molecular mechanisms of EPO/EPOR system in ischemic retinal disease were reviewed.
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With the population aging, diet changing and incveasing risk factors on vascular disease, the lower extremity ischemic disease has become a frequently occurring disease of older person, and it is the main reason for amputation disability. In the 21st century the stem cells transplantation is one of the most advanced technologies and has been applied quickly to clinical therapy, regarded as a radical treatment of lower extremity ischemic disease. Endothelial progenitor cells have gradually become a new direction and a new research focus because of its unique biological characteristics in the treatment of this disease. This article focuses on endothelial progenitor cells in treating extremity ischemia lesions on the theoretical basis and research developments.
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Ischemic disease of lower extremity is a severe disease threatening human health.In the 21st century the stem cells transplantation is one of the most advanced technologies and has applied quickly to clinical therapy.The stem cells possess the potential differentiation capability and can differentiate into all kinds of tissue cells.We transplant stem cells from peripheral blood or bone marrow to isehemie appendicular muscle or obsructed vessal in order to make them differentiate into newborn blood capillary,improve and re-cover blood flow of lower limb and achieve the aim of treating lower limb ischemia.
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[Objective] This study was to investigate the effect of TMP on function of EPCs in normal or hydrogen peroxide(H2O2)inducing injury model cell culture,and to approach a therapy to coronary heart disease(CHD).[Method] Total mononuclear cells were isolated from the cord blood by ficoll density gradient centrifugation,cultured in vitro.After the cells cultured for 7 days,identified them by cellmarkers and the ability of intaking the ac-LDL,and made sure they were EPCs.To divide the cells into three groups,TMP(5,25,100,200mg),H2O2(500??)model and TMP together with H2O2,cultured for 24h and then detected the function and apoptosis of EPCs.[Result] Versus to control group,the TMP(5,25,100mg)groups had no important effect on the proliferation and adhesion of EPCs,but TMP(200mg)group had negative effect on EPCs.Versus to H2O2 model group,TMP(5,25,100mg)preincubated groups had important protective effect on EPCs in proliferation,adhesion and apoptosis.[Conclusion] TMP could protect EPCs from oxidative stress injury,but had little benefit to EPCs in normal incubation.
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Objective To evaluate the effect of hyperhomocysteinemia on ischemic diease in rats. Methods Thirty-two SD rats were randomized into two groups,control group(n=16,administered with tap water) and hyperhomocysteinemia group(HH group,n=16,administered with water containing L-methionine at 1 g/kg/d).At the 14thday of dietary modification,the left femoral artery and vein were excised,and the interventions continued for another 14 days.At the 15th day after operation,serum biochemical parameters as well as NOx and cGMP in ischemic tissues were tested,capillary vessel density of both hindlimbs were measured by histological analysis,and angiogenesis of ischemic hindlimb was observed by angiography. Results At the 15th day after operation,the level of high-density lipoprotein-cholesterol(HDL-C),blood urea nitrogen,uric acid and ratio of blood urea nitrogen to serum creatinine were significantly higher in HH group than those in control group,while the level of serum folic acid,VitB12,HDL-C and endogenous creatinine clearance rate were significantly lower in HH group than those in control group(P
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Objective To evaluate the clinical efficacy of transplantation of autologous peripheral blood stem cells(PBSC) for the treatment of toe or heel ulcer and of rest pain in patients with lower limb arterial ischemic diseases.Methods To mobilize patients' own stem cells with G-CSF for 5 days.At the sixth day,PBSC are collected with a blood-cells separator.The PBSC were then intramuscularly injected into ischemic areas of the lower limbs.Results After transplantation,all patients are followed up from 3 to 24 months.The rest pain disappeares in 12 patients,while toe or heel ulcers are cicatrized in 11 cases.However,4 patients lost in following up.ConclusionTransplantation of autologous peripheral blood stem cells is an effective method for the treatment of arterial ischemic disease.