Analysis on severity of cerebral edema and prognostic influencing factors after mechanical thrombectomy in patients with acute ischemic stroke due to anterior circulation large vessel occlusion / 重庆医学

Objective To observe the severity of cerebral edema after mechanical thrombectomy in the patients with acute ischemic stroke caused by large vessel occlusion,and to statistically analyze the related fac-tors affecting the prognosis quality of the patients,so as to guide the patients to conduct scientific interven-tion.Methods Ninety-one patients with acute ischemic stroke due to anterior circulation large vessel occlusion treated with mechanical thrombectomy in this hospital from October 2021 to October 2022 served as the ana-lytic subjects.According to the severity of brain edema,they were divided into the group Ⅰ(mild),group Ⅱ(moderate),and group Ⅲ(severe);after 12-week treatment,the improved Rankin scale was used to evaluate the prognosis.The patients with good prognosis were included in the excellent group,and the patients with poor prognosis were included in the poor group.Single factor and multifactor logistic analysis was used to ana-lyze the influencing factors and prognostic related factors of different degrees of brain edema.Results The univariate analysis showed that the percentage of patients with NIHSS score at admission ≥15,time from on-set to thrombolysis ≥6 h,history of hypertension,successful vascular recanalization and good collateral circu-lation were significantly different among the groups Ⅰ,Ⅱ and Ⅲ(P＜0.05);the multivariate logistic regres-sion analysis results showed that the NIHSS score at admission ≥15,time from onset to thrombolysis ≥6 h,and hypertension history were the risk factors leading to severe cerebral edema,while successful recanalization of blood vessels was a protective factor for cerebral edema(P＜0.05).The univariate analysis showed that in the good prognosis group the percentage of patients had good circulation of lateral branches,successful reca-nalization of blood vessels,severe cerebral edema,hypertension,time from onset to thrombolysis ≥6 h,and NIHSS score ≥15 at admission were significantly different from those in the poor prognosis group(P＜0.05).The multivariate logistic regression analysis results showed that severe cerebral edema,time from onset to thrombolysis ≥6 h and NIHSS score ≥15 at admission were the risk factors for poor prognosis,while good collateral circulation and successful recanalization of blood vessels were the positive factors for good prognosis(P＜0.05).Conclusion Mechanical thrombectomy patients with hypertension and time from onset to throm-bolysis ≥6 h and NIHSS score at admission ≥15 have more severe brain edema after treatment;severe brain edema,time from onset to thrombolysis ≥6 h,NIHSS score at admission ≥15 were the adverse factors affect-ing the prognosis of the patients with mechanical thrombectomy.

Vascular suture, closure and occlusion devices at femoral artery puncture hemostasis after neuro-intervention: a clinical comparative study / 中华放射学杂志

Methods:From February 2018 to January 2022, the clinical data of 1 123 patients who underwent Starclose vascular closure device, Angio-Seal and Exoseal vascular occlusion devices and Perclose ProGlide vascular suture device at femoral artery puncture hemostasis after neuro-intervention, in the Department of Interventional Radiology (Eastern District), The First Affiliated Hospital of Zhengzhou University, were retrospectively analyzed. The patients were divided into three groups based on the intervention method: the closure group (Starclose, n=271), the occlusion group (Angio-Seal, n=327 and Exoseal, n=352) and the suture group (ProGlide, n=173). Next, the hemostatic efficacy and complications associated with the three devices were analyzed and compared. Additionally, regression analysis was conducted to identify any relevant factors that may contribute to complications. Results:Three vascular hemostatic devices demonstrated effective hemostasis and the success rate were 92.6% in the closure group (Starclose), 93.4% in the occlusion group (Angio-Seal 93.0% and Exoseal 93.8%) and 89.6% in the suture group (ProGlide). There was no statistically significant difference( χ2=3.026, P=0.388). Single or multiple complications were observed in 102 patients (9.1%), including local oozing (16 cases in the closure group, 39 cases in the occlusion group, 13 cases in the suture group), local hematoma (14 cases in the closure group, 31 cases in the occlusion group, 11 cases in the suture group), pseudoaneurysm (13 cases in the closure group, 35 cases in the occlusion group, 10 cases in the suture group), local infection (2 cases in the closure group, 3 cases in the occlusion group, 1 case in the suture group). There were no statistically significant differences ( P>0.05). Moreover, serious complications such as femoral artery occlusion, embolus shedding and permanent nerve injury weren′t observed in the three groups. Multivariate logistic regression analysis revealed that overweight ( OR=1.562,95% CI 1.023—2.385, P=0.039), femoral artery with calcified plaque ( OR=1.934,95% CI 1.172-3.189, P=0.010), combined use of multiple antiplatelet drugs ( OR=1.769,95% CI 1.103—2.839, P=0.018), use of an 8F sheath( OR=2.824,95% CI 1.406—5.671, P=0.004) and the operator′s proficiency ( OR=0.508,95% CI 0.328—0.788, P=0.002) were the independent factors influencing complications, of which the first four were identified as risk-promoting factors for complications while the operator′s rich experience and high proficiency were the protective factors. Conclusions:Three hemostatic devices demonstrate effective hemostasis and comparable rates of complications at femoral artery puncture hemostasis after neuro-intervention. Overweight, femoral artery with calcified plaque, combined use of multiple antiplatelet drugs, use of an 8 F sheath and the operator′s proficiency were independent factors influencing complications.Ojective:To investigate the efficacy and complications associated with vascular suture, closure and occlusion devices at femoral artery puncture hemostasis after neuro-intervention.

Open revascularization for chronic mesenteric ischemia in the endovascular era: a quaternary-center experience and management algorithm / Revascularização aberta na isquemia mesentérica crônica durante a era endovascular: experiência de um centro quaternário e um algoritmo de tratamento

Abstract Background Chronic mesenteric ischemia (CMI) is a debilitating disease with a heavy burden on quality of life. Stenting of the superior mesenteric artery (SMA) is the first option for treatment, but there is a lack of consensus defining precise indications for open revascularization (OR). Objectives To describe a series of 4 patients with CMI treated with OR and to present an algorithm for the management of this condition. Methods Three patients presented with typical intestinal angina and weight loss. One patient was subjected to prophylactic revascularization during open abdominal aortic aneurysm repair. Surgical techniques included: 1) Bypass from the infrarenal aorta to the SMA; 2) Bypass from an aorto-bifemoral polyester graft to the SMA; 3) Bypass from the right iliac artery to the SMA; 4) Bypass from the right graft limb of an aorto-biiliac polyester graft to the median colic artery at Riolan's arcade. PTFE was used in all surgeries. All grafts were placed in a retrograde configuration, tunneled under the left renal vein, making a smooth C-loop. A treatment algorithm was constructed based on the institution's experience and a review of recent literature. Results All patients demonstrated resolution of symptoms and recovery of body weight. All grafts are patent after mean follow-up of two years. Conclusions Open revascularization using the C-loop configuration is a valuable technique for CMI and may be considered in selected cases. The algorithm constructed may help decision planning in other quaternary centers.

Resumo Contexto A isquemia mesentérica crônica (IMC) é uma doença debilitante, com grave impacto na qualidade de vida. A literatura recomenda a angioplastia com stent da artéria mesentérica superior (AMS) como primeira opção de tratamento, mas há falta de consenso que defina indicações precisas para a revascularização aberta. Objetivos Descrever uma série de quatro pacientes com IMC, tratados com revascularização aberta, e apresentar um algoritmo para o manejo dessa condição. Métodos Três pacientes apresentaram angina intestinal típica e perda ponderal. Uma paciente foi submetida a reparo aberto de aneurisma da aorta abdominal e apresentava obstrução da AMS, que foi revascularizada profilaticamente. As técnicas cirúrgicas incluíram: 1) enxerto entre a aorta infrarrenal e a AMS; 2) enxerto entre o dácron utilizado em um enxerto aortobifemoral e a AMS; 3) enxerto entre a artéria ilíaca comum direita e a AMS; e 4) enxerto entre o ramo direito do dácron utilizado em um enxerto aorto-biilíaco e a artéria cólica média (ao nível da arcada de Riolan). Todos os enxertos foram feitos utilizando politetrafluoretileno em uma configuração retrógrada, tunelizados abaixo da veia renal esquerda, fazendo uma alça em C. Resultados Todos os pacientes demonstraram resolução dos sintomas e ganho ponderal. Todos os enxertos se mantiveram pérvios durante um seguimento médio de 2 anos. Conclusões A revascularização aberta para IMC utilizando-se a alça em C é uma técnica valiosa e pode ser considerada em pacientes selecionados. O algoritmo proposto pode auxiliar na decisão terapêutica em centros quaternários.

Restricción de flujo sanguíneo en la rehabilitación del ligamento cruzado anterior

Introducción: La rotura del ligamento cruzado anterior provoca atrofia y pérdida de fuerza, por lo que resulta necesaria una rehabilitación precoz y adecuada. El entrenamiento mediante restricción de flujo sanguíneo parece ser una herramienta segura y efectiva para la ganancia de fuerza y masa muscular en sujetos sanos y en población clínica. Objetivo: Evaluar el efecto de la rehabilitación con restricción de flujo sanguíneo sobre la fuerza, la masa muscular y la intensidad del dolor en pacientes con reconstrucción del ligamento cruzado anterior. Métodos: Se realizó la búsqueda de artículos en tres bases de datos, mediante una combinación de términos relativos a la restricción de flujo sanguíneo y rehabilitación del ligamento cruzado anterior. Los estudios seleccionados evaluaron la fuerza, la masa muscular y el dolor. La mayoría de ellos refieren efectos positivos en el uso de la restricción del flujo sanguíneo. Conclusiones: El entrenamiento con restricción de flujo sanguíneo durante la rehabilitación temprana en la reconstrucción del ligamento cruzado anterior puede ser una alternativa para mejorar la fuerza y aumentar la masa muscular. Se equipara al entrenamiento con cargas altas; además, reduce el dolor y el estrés mecánico sobre la articulación de la rodilla.

Introduction: Anterior cruciate ligament rupture causes atrophy and loss of strength, which is why early and adequate rehabilitation is needed. Blood flow restriction training is a safe and effective tool for gaining strength and muscle mass in healthy subjects and in the clinical population. Objective: To evaluate the effect of rehabilitation with blood flow restriction on strength, muscle mass, and pain intensity in patients with anterior cruciate ligament reconstruction. Methods: Three databases were searched for articles using a combination of terms related to blood flow restriction and anterior cruciate ligament rehabilitation. Selected studies assessed strength, muscle mass, and pain. Most of them report positive effects in the use of blood flow restriction. Conclusions: Blood flow restriction training during early rehabilitation in anterior cruciate ligament reconstruction may be an alternative to improve strength and increase muscle mass. It is equated to training with high loads; it also reduces pain and mechanical stress on the knee joint.

Gastrite isquêmica grave por isquemia mesentérica crônica / Severe ischemic gastritis caused by chronic mesenteric ischemia

Resumo A gastrite isquêmica é uma doença rara, podendo ocorrer por insuficiência vascular focal ou sistêmica. Essa condição é raramente vista na prática médica devido à vasta rede colateral arterial do estômago pelo tronco celíaco e mesentérica superior. A apresentação clássica da isquemia crônica é formada pela tríade de dor pós-prandial, perda de peso e sopro abdominal. A intervenção está indicada naqueles pacientes sintomáticos, sendo o tratamento endovascular uma alternativa à cirurgia em pacientes com alta comorbidade, tendo bons resultados. Reportamos um caso de gastrite isquêmica grave com úlceras e sangramento que foi causado por isquemia mesentérica crônica, em uma paciente de 71 anos, com oclusão do tronco celíaco e mesentérica inferior, além de estenose crítica da superior. O diagnóstico foi confirmado por exame de imagem, e a paciente foi submetida a tratamento endovascular. Trata-se de uma condição rara de diagnóstico e tratamento desafiadores, a qual requer uma equipe multidisciplinar para o manejo adequado.

Abstract Ischemic gastritis is a rare illness caused by localized or systemic vascular insufficiency. This condition is rarely seen in medical practice due to the vast arterial collateral blood supply to the stomach through the celiac trunk and superior mesenteric artery and also because other etiologies are much more frequent. The classic presentation of chronic ischemia is comprises the triad of postprandial pain, weight loss, and abdominal bruit. Intervention is indicated in symptomatic patients and endovascular treatment is an alternative to surgery in patients with high comorbidity that offers good results. We report a case of a 71-year-old female patient with severe ischemic gastritis with ulcers and bleeding caused by chronic mesenteric ischemia with occlusion of the celiac trunk and inferior mesenteric artery and critical stenosis of the superior mesenteric artery. The diagnosis was confirmed by imaging, and the patient underwent endovascular treatment. This is a rare condition that is difficult to diagnose and treat and a multidisciplinary team is needed for proper management.

Perfusión 2D por angiografía en oclusión arterial periférica. Método de evaluación inmediato posproceder / 2D perfusion by angiography in peripheral arterial occlusion. Post-procedural immediate evaluation method

La enfermedad arterial periférica se considera la mayor causa de hospitalización, con riesgo de amputación de la extremidad afectada y muerte debido a la enfermedad per se o sus complicaciones. Se reporta la experiencia del tratamiento a un paciente con macroangiopatía diabética, estenosis del 64 por ciento de la arteria ilíaca izquierda y afectación de los segmentos fémoro-poplíteos bilaterales, al cual, a través de un acceso percutáneo vía arteria braquial izquierda, se le realizó revascularización mediante la implantación de stent de cromo-cobalto liberado por balón catéter. El objetivo de este estudio fue describir la utilidad del 2D-ASD y su valor como herramienta para determinar el transproceder y la repercusión en el flujo sanguíneo de la revascularización realizada, y establecer un pronóstico funcional para el paciente. Se utilizó la angiografía por perfusión bidimensional como herramienta para evaluar el éxito técnico del proceder y la repercusión inmediata en la perfusión distal de la extremidad afecta, y describir la utilidad de la escala paramétrica de colores y las curvas de densidad en función del tiempo obtenidos en el estudio(AU)

Peripheral artery disease is considered the leading cause of hospitalization, with risk of amputation of the affected limb and death due to the disease per se or its complications. It is reported the experience of treatment in a patient with diabetic macroangiopathy, stenosis of 64 percent of the left iliac artery and involvement of the bilateral femoro-popliteal segments, to which, through a percutaneous access via the left brachial artery, revascularization was performed through the implantation of cobalt-chromium stent released by balloon catheter. The objective of this study was to describe the usefulness of 2D-ASD and its value as a tool to determine the trans-procedure and the impact on blood flow of the revascularization performed, and to establish a functional prognosis for the patient. Two-dimensional perfusion angiography was used as a tool to evaluate the technical success of the procedure and the immediate impact on distal perfusion of the affected limb, and to describe the usefulness of the parametric color scale and density curves as a function of the time obtained in the study(AU)

Perfusión 2D por angiografía en oclusión arterial periférica. Método de evaluación inmediato posproceder / 2D perfusion by angiography in peripheral arterial occlusion. Post-procedural immediate evaluation method

La enfermedad arterial periférica se considera la mayor causa de hospitalización, con riesgo de amputación de la extremidad afectada y muerte debido a la enfermedad per se o sus complicaciones. Se reporta la experiencia del tratamiento a un paciente con macroangiopatía diabética, estenosis del 64 por ciento de la arteria ilíaca izquierda y afectación de los segmentos fémoro-poplíteos bilaterales, al cual, a través de un acceso percutáneo vía arteria braquial izquierda, se le realizó revascularización mediante la implantación de stent de cromo-cobalto liberado por balón catéter. El objetivo de este estudio fue describir la utilidad del 2D-ASD y su valor como herramienta para determinar el transproceder y la repercusión en el flujo sanguíneo de la revascularización realizada, y establecer un pronóstico funcional para el paciente. Se utilizó la angiografía por perfusión bidimensional como herramienta para evaluar el éxito técnico del proceder y la repercusión inmediata en la perfusión distal de la extremidad afecta, y describir la utilidad de la escala paramétrica de colores y las curvas de densidad en función del tiempo obtenidos en el estudio(AU)

Peripheral artery disease is considered the leading cause of hospitalization, with risk of amputation of the affected limb and death due to the disease per se or its complications. It is reported the experience of treatment in a patient with diabetic macroangiopathy, stenosis of 64 precent of the left iliac artery and involvement of the bilateral femoro-popliteal segments, to which, through a percutaneous access via the left brachial artery, revascularization was performed through the implantation of cobalt-chromium stent released by balloon catheter. The objective of this study was to describe the usefulness of 2D-ASD and its value as a tool to determine the trans-procedure and the impact on blood flow of the revascularization performed, and to establish a functional prognosis for the patient. Two-dimensional perfusion angiography was used as a tool to evaluate the technical success of the procedure and the immediate impact on distal perfusion of the affected limb, and to describe the usefulness of the parametric color scale and density curves as a function of the time obtained in the study(AU)

Retinal venous occlusion in a child following Corbevax COVID-19 vaccination

A 13-year-old boy developed painless diminution of vision in left eye 15 days after taking first dose of coronavirus disease 2019 (COVID-19) vaccine (Corbevax). Fundus and fluorescein angiography revealed central retinal vein occlusion in the left eye. Blood investigations were noncontributory. He was administered three doses of pulse corticosteroids followed by a tapering dose of oral corticosteroids. Retinal vascular occlusion can occur following COVID-19 vaccination in children, and early and aggressive systemic anti-inflammatory therapy can be helpful.

Testes Ergométricos em Pacientes com Anemia Falciforme: Segurança, Viabilidade e Possíveis Implicações no Prognóstico / Exercise Testing In Patients with Sickle Cell Disease: Safety, Feasibility and Potential Prognostic Implication

Resumo Fundamento Pacientes com anemia falciforme (AF) têm risco aumentado de complicações cardiovasculares. O teste ergométrico é usado como marcador de prognóstico em uma série de doenças cardiovasculares. Entretanto, há uma escassez de evidências sobre exercícios em pacientes com AF, especialmente em relação à sua segurança, viabilidade e possível função prognóstica. Objetivos Usamos o teste em esteira máximo para determinar a segurança e a viabilidade do teste ergométrico em pacientes com AF. Além disso, os fatores associados à duração do exercício, bem como o impacto das alterações causadas pelo exercício em resultados clínicos, também foram avaliados. Métodos 113 pacientes com AF que passaram pelo teste ergométrico e por uma avaliação cardiovascular abrangente incluindo um ecocardiograma e os níveis do peptídeo natriurético do tipo B (BNP). O desfecho de longo prazo foi uma combinação de eventos incluindo morte, crises álgicas graves, síndrome torácica aguda ou internações hospitalares por outras complicações associadas â doença falciforme. A análise de regressão de Cox foi realizada para identificar as variáveis associadas ao resultado. Um p valor <0,05 foi considerado estatisticamente significativo. Resultados A média de idade foi de 36 ± 12 anos (intervalo, 18-65 anos), e 62 pacientes eram do sexo feminino (52%). A presença de alterações isquêmicas ao esforço e resposta pressórica anormal ao exercício foram detectadas em 17% e 9 % da´população estudada respectivamente. Dois pacientes apresentaram crise álgica com necessidade de internação hospitalar no período de 48 horas da realização do exame. Fatores associados à duração do exercício foram idade, sexo, velocidade máxima de regurgitação tricúspide (RT), e relação E/e', após a padronização quanto aos marcadores da gravidade da doença. Durante o período médio de acompanhamento de 10,1 meses (variando de 1,2 a 26), 27 pacientes (23%) apresentaram desfechos clínicos adversos. Preditores independentes de eventos adversos foram a concentração de hemoglobina, velocidade do fluxo transmitral tardio (onda A), e a resposta da PA ao exercício. Conclusões A realização de testes ergométricos em pacientes com AF, clinicamente estáveis, é viável. A duração do exercício estava associada à função diastólica e a pressão arterial pulmonar. A resposta anormal da PA foi um preditor independente de eventos adversos.

Abstract Background Patients with sickle cell disease (SCD) are at increased risk for cardiovascular complications. Exercise testing is used as a prognostic marker in a variety of cardiovascular diseases. However, there is a lack of evidence on exercise in SCD patients, particularly regarding its safety, feasibility, and possible prognostic role. Objectives We used the maximal treadmill test to determine safety and feasibility of the exercise testing in SCD patients. Additionally, the factors associated with exercise duration, as well as the impact of exercise-induced changes on clinical outcome, were also assessed. Methods One-hundred thirteen patients with SCD, who underwent exercise testing, were prospectively enrolled. A comprehensive cardiovascular evaluation, including echocardiography and B-type natriuretic peptide (BNP) levels, were obtained. The long-term outcome was a composite endpoint of death, severe acute painful episodes, acute chest syndrome, or hospitalization for other SCD-related complications. Cox regression analysis was performed to identify the variables associated with the outcome. A p-value<0.05 was considered to be statistically significant. Results The mean age was 36 ± 12 years (range, 18-65 years), and 62 patients were women (52%). Ischemic electrocardiogram and abnormal blood pressure (BP) response to exercise were detected in 17% and 9%, respectively. Two patients experienced pain crises within 48 hours that required hospitalization. Factors associated with exercise duration were age, sex, tricuspid regurgitation (TR) maximal velocity, and E/e' ratio, after adjustment for markers of disease severity. During the mean follow-up of 10.1 months (ranging from 1.2 to 26), the endpoint was reached in 27 patients (23%). Independent predictors of adverse events were hemoglobin concentration, late transmitral flow velocity (A wave), and BP response to exercise. Conclusions Exercise testing in SCD patients who were clinically stable is feasible. Exercise duration was associated with diastolic function and pulmonary artery pressure. Abnormal BP response was an independent predictor of adverse events.

Estrategia de superación para el mejoramiento del desempeño profesional de oftalmólogos de la Atención Primaria de Salud en Santiago de Cuba / Training strategy for improving the professional performance in primary health care ophthalmologists in Santiago de Cuba

El vertiginoso desarrollo científico - tecnológico de la oftalmología requiere de una actualización sistemática desde el punto de vista teórico - práctico. A tales efectos, se diseñó una estrategia de superación para el mejoramiento del desempeño profesional de los oftalmólogos de la Atención Primaria de Salud dirigida a la atención integral de los pacientes con oclusiones vasculares retinianas. Se emplearon métodos de los niveles teórico y empírico. Fue diseñada en 4 etapas y se utilizó el ciclo Deming como referente metodológico. Se establecieron relaciones esenciales que ofrecen coherencia lógica interna a la educación médica en su concepción como ciencia en construcción, en particular en el área de la formación permanente y continuada de los profesionales de la salud, al profundizar en el orden conceptual, metodológico y epistemológico en los procesos de desempeño profesional y superación.

The fast scientific and technological development of Ophthalmology requires a systematic updating from the theoretical and practical points of view. To such effects, a training strategy was designed for the improvement of professional performance of the primary care ophthalmologists directed to the comprehensive care of patients with retinal vascular occlusions. Empiric and theoretical level methods were used. The strategy was designed in 4 stages and the Deming cycle was implemented as methodological referent. Essential relationships were established which offer internal logical coherence to the Medical Education in its conception as science, particularly in the area of permanent and continued training of the health professionals, as there is a deepening in the conceptual, methodological and epistemological order in the processes of professional and training performance.

Vasculopatía Livedoide, la punta del témpano: a propósito de un caso / Livedoid vasculopathy, the tip of the iceberg: a case report

Resumen La vasculopatía livedoide (VL), es una enfermedad vascular oclusiva que afecta la microvasculatura, se caracteriza por ser recurrente y no inflamatoria. Su incidencia es de 1/100.000 casos por habitantes, afectando en su mayoría a mujeres de edad media. Su patogenia se desconoce, pero se destaca el componente trombótico de la misma, causado por un estado de hipercoagulabilidad, que conduce a la oclusión vascular, debiendo distinguirse una forma primaria y una secundaria.Clínicamente se observan úlceras dolorosas a nivel maleolar que evolucionan progresivamente a una cicatrización atrófica, blanquecina nacarada y estrellada característica.Presentamos un caso clínico en un varón con múltiples comorbilidades y difícil tratamiento, el cual requirió un trabajo multidisciplinario.

Abstract Livedoid vascular disease (VL), is an occlusive vascular disease that affects the microvasculature, is characterized by being recurrent and non-inflammatory. Its incidence is 1 / 100,000 cases per inhabitant, affecting mostly middle-aged women. Its pathogenesis is unknown, but its thrombotic component stands out, caused by a state of hypercoagulability, which leads to vascular occlusion, and a primary and secondary form must be distinguished. Clinically, painful ulcers are observed at the malleolar level, progressing progressively to characteristic atrophic, pearly whitish and starry healing. We present a clinical case in a male with multiple comorbidities and difficult management, which required multidisciplinary work.

Effects of blood flow restriction in large and small muscle groups / Efeitos da restrição do fluxo sanguíneo em grupamentos musculares grandes e pequenos / Efectos de la restricción del flujo sanguíneo en grupos musculares grandes y pequeños

ABSTRACT Introduction It is known that strength training brings improvements in health and sports performance by causing muscle hypertrophy and increased strength, as well as modifying some hemodynamic and physiological factors. Several strength training methodologies have been developed, one of which is vascular occlusion. There are few studies with large muscle groups due to poor adherence to the training style and the fact that vascular occlusion of large muscle groups is more difficult. Objective To verify and compare the hemodynamic effects of exercise with and without vascular occlusion in different muscle groups. Methods Quantitative crossover study, with cross-sectional and field procedures. The sample consisted of 10 physically active healthy male and female subjects between 18 and 30 years of age. With the cross-over design, all the volunteers participated in 3 groups: intervention with vascular occlusion, intervention without vascular occlusion and the control group. Results Overall, lactate and cholesterol remained elevated after 15 minutes of recovery and blood glucose and blood pressure did not vary among the groups. Conclusion Vascular occlusion training is an effective method for manipulating hemodynamic variables. Evidence level II; Clinical study.

RESUMO Introdução Sabe-se que o treino de força traz melhorias para a saúde e o desempenho esportivo, por ocasionar hipertrofia muscular e aumento de força, além de modificar alguns fatores hemodinâmicos e fisiológicos. Foram desenvolvidos vários métodos de treinamento de força, entre eles, a oclusão vascular. Porém, existem poucos estudos com grandes grupamentos musculares, devido à pouca adesão ao estilo de treino e ao fato de a oclusão vascular de grandes grupos musculares ser mais difícil. Objetivo Verificar e comparar os efeitos hemodinâmicos do exercício com e sem oclusão vascular em diferentes grupamentos musculares. Métodos Estudo quantitativo, cruzado, com procedimentos transversais e de campo. A amostra foi composta por 10 indivíduos saudáveis e fisicamente ativos do sexo masculino e feminino, na faixa etária de 18 a 30 anos. Com o desenho cruzado, todos os voluntários participaram de 3 grupos: intervenção com oclusão vascular, intervenção sem oclusão vascular e grupo controle. Resultados De forma geral, entre grupos, o lactato e o colesterol se mantiveram elevados depois de 15 minutos de recuperação, a glicemia e as pressões arteriais não variaram. Conclusão O treinamento com oclusão vascular é um método eficaz para manipular as variáveis hemodinâmicas. Nível de evidência II; Estudo clínico.

RESUMEN Introducción Se sabe que el entrenamiento de fuerza trae mejoras para la salud y el desempeño deportivo, por causar hipertrofia muscular y aumento de fuerza, además de modificar algunos factores hemodinámicos y fisiológicos. Fueron desarrollados varios métodos de entrenamiento de fuerza, entre ellos, la oclusión vascular. Sin embargo, existen pocos estudios con grandes grupos musculares, debido a la poca adhesión al estilo de entrenamiento y al hecho de que la oclusión vascular de grandes grupos musculares grandes es más difícil. Objetivo Verificar y comparar los efectos hemodinámicos del ejercicio con y sin oclusión vascular en diferentes grupos musculares. Métodos Estudio cuantitativo, cruzado, con procedimientos transversales y de campo. La muestra fue compuesta por 10 individuos saludables y físicamente activos del sexo masculino y femenino, en el grupo de edad de 18 a 30 años. Con el diseño cruzado, todos los voluntarios participaron en 3 grupos: intervención con oclusión vascular, intervención sin oclusión vascular y grupo control. Resultados De forma general, entre los grupos, el lactato y el colesterol se mantuvieron elevados después de 15 minutos de recuperación, la glucemia y las presiones arteriales no variaron. Conclusión El entrenamiento de oclusión vascular es un método eficaz para manipular las variables hemodinámicas. Nivel de evidencia II; Estudio clínico.

Ischemic perconditioning on mesenteric ischemia/reperfusion injury in rats

ABSTRACT Purpose: To evaluate if the perconditioning affects the antioxidant capacity in mesenteric ischemia and reperfusion injury. Methods: Twenty-one Wistar rats were assigned into three groups, as follows: Sham, IR and rPER. The animals were subjected to mesenteric ischemia for 30 min. rPER consisted of three cycles of 5-min hindlimb ischemia followed by 5 min hindlimb perfusion at the same time to mesenteric ischemic period. After 5 minutes, blood and 5 cm of terminal ileum were harvested for thiobarbituric acid reactive substances (TBARS) and Trolox equivalent antioxidant capacity (TEAC) measurement. Results: rPER technique was able to reduce intestinal tissue TBARS levels (p<0.0001), but no statistic difference was observed in blood levels between groups, although it was verified similar results in rPER and Sham group. rPER technique also enhanced TEAC levels in both blood (p = 0.0314) and intestinal tissue (p = 0.0139), compared to IR group. Conclusions: rPER appears as the most promising technique to avoid IR injury. This technique reduced TBARS levels in blood and intestinal tissue and promoted the maintenance of antioxidant defense in mesenteric acute injury.

Effect of exercise with continuous and intermittent blood flow restriction on hemodynamics / Efeito do exercício com restrição de fluxo sanguíneo contínua e intermitente na hemodinâmica / Efecto del ejercicio con restricción de flujo sanguíneo continuo e intermitente en la hemodinámica

ABSTRACT Introduction: Strength training with blood flow restriction (BFR) involves the use of low loads (20-30% of 1RM) with restriction of blood flow to promote gains in physical fitness. The restriction can be applied continuously or intermittently; however, it is unclear how it affects the hemodynamics of hypertensive women. Objective: To analyze the acute effect of resistance exercise (RE) on the upper and lower limbs with continuous and intermittent blood flow restriction (BFR) on the hemodynamic variables of women with hypertension. Methods: Thirteen women with controlled hypertension (40 to 65 years) underwent eight experimental protocols, with a randomized, counter balanced, crossover design; four exercise sessions for the right upper limb (elbow flexion) and four for the right lower limb (knee extension). The systolic arterial pressure (SAP), diastolic arterial pressure (DAP), and heart rate (HR) were measured before, during, immediately after and 15, 30, 45 and 60 minutes after the exercises. Results: There were no significant interactions between the protocols vs. segments vs. time, protocols vs. segments, protocols vs. time, segments vs. time, protocol, segment and time, on the variables SAP, DAP, and HR during and after the RE (p>0.05). Although all these protocols had significantly elevated SAP, DAP and HR, the values remained within the normal range. The protocols of this study did not cause hypotensive effect. Conclusion: Low-load RE combined with continuous and intermittent BFR, on the upper and lower limbs, appears to promote similar variations in the hemodynamic variables of women with hypertension. Level of evidence II; Randomized clinical trial.

RESUMO Introdução: O exercício de força com restrição de fluxo sanguíneo (RFS) consiste no uso de cargas baixas (20-30% de 1RM) associado à restrição de fluxo sanguíneo para melhorar o desempenho físico. A restrição pode ser realizada de forma contínua ou intermitente; contudo, não está claro como isso afeta a hemodinâmica de mulheres com hipertensão. Objetivo: Analisar o efeito agudo do exercício de força (EF) no membro superior e inferior com restrição de fluxo sanguíneo (RFS) contínua e intermitente sobre as variáveis hemodinâmicas em mulheres hipertensas. Métodos: Treze mulheres com hipertensão controlada (entre 40 e 65 anos de idade) foram submetidas a oito protocolos experimentais em um estudo randomizado, cruzado e contrabalançado, sendo quatro sessões de exercícios para o membro superior direito (flexão de cotovelo) e quatro sessões de exercícios para o membro inferior direito (extensão de joelho). As medidas das variáveis pressão arterial sistólica (PAS), pressão arterial diastólica (PAD) e frequência cardíaca (FC) foram realizadas antes, durante, imediatamente depois e nos minutos 15, 30, 45 e 60 no período pós-exercício. Resultados: Observou-se que não houve interações significativas entre protocolos × segmentos × tempo, protocolos × segmentos, protocolos × tempo, segmentos × tempo, protocolo, segmento e tempo nas variáveis PAS, PAD e FC e durante e depois do EF (p > 0,05). Embora todos esses protocolos tenham elevado significativamente a PAS, PAD e FC, os valores permaneceram dentro da normalidade. Os protocolos do estudo não promoveram efeito hipotensor. Conclusão: O EF de baixa carga combinado com RFS contínua e intermitente, no membro superior e inferior, parece promover alterações similares nas variáveis hemodinâmicas em mulheres hipertensas. Nível de evidência II; Estudo clínico randomizado.

RESUMEN Introducción: El ejercicio de fuerza con restricción de flujo sanguíneo (RFS) consiste en el uso de cargas bajas (20 a 30% de 1RM) asociado a la restricción de flujo sanguíneo para mejorar el desempeño físico. La restricción puede ser realizada de forma continua o intermitente; sin embargo, no está claro cómo esto afecta a la hemodinámica de mujeres con hipertensión. Objetivo: Analizar el efecto agudo del ejercicio de fuerza (EF) en el miembro superior e inferior con restricción de flujo sanguíneo (RFS) continua e intermitente sobre las variables hemodinámicas en mujeres hipertensas. Métodos: Trece mujeres con hipertensión controlada (entre 40 y 65 años de edad), fueron sometidas a ocho protocolos experimentales en un estudio aleatorizado, cruzado y contrabalanceado, siendo cuatro sesiones de ejercicios para el miembro superior derecho (flexión de codo) y cuatro sesiones de ejercicios para el miembro inferior derecho (extensión de rodilla). Las medidas de las variables presión arterial sistólica (PAS), presión arterial diastólica (PAD) y frecuencia cardíaca (FC) se realizaron antes, durante, inmediatamente después y en los minutos 15, 30, 45 y 60 en el período post-ejercicio. Resultados: Se observó que no hubo interacciones significativas entre protocolos × segmentos × tiempo, protocolos × segmentos, protocolos × tiempo, segmentos × tiempo, protocolo, segmento y tiempo en las variables PAS, PAD y FC y durante y después del EF (p> 0,05). Aunque todos estos protocolos hayan elevado significativamente la PAS, PAD, y FC, los valores permanecieron dentro de la normalidad. Los protocolos del estudio no promovieron un efecto hipotensor. Conclusión: El EF de baja carga combinado con RFS continua e intermitente, en el miembro superior e inferior, parece promover alteraciones similares en las variables hemodinámicas en mujeres hipertensas. Nivel de evidencia II;. Ensayo clínico aleatorizado.

Spectrum of Eye Disease in Diabetes (SPEED) in India: A prospective facility-based study. Report # 3. Retinal vascular occlusion in patients with type 2 diabetes mellitus

Purpose: To determine the proportion of people with type 2 diabetes mellitus (T2DM) attending large eye care facilities across India who have retinal vascular occlusion (RVO). Methods: A 6-month descriptive, multicenter, observational hospital-based study of people was being presented to the 14 eye care facilities in India. The retina-specific component of comprehensive eye examination included stereoscopic biomicroscopy, binocular indirect ophthalmoscopy, and fundus fluorescein angiography, and optical coherence tomography was also available when needed. Data recording of the duration of diabetes, hypertension (HTN), stroke, and other variables was obtained from the medical history. The statistical analysis included frequencies, mean, and standard deviations for continuous variables. Odds ratio (OR) and multivariate analysis were undertaken to assess the associations between risk factors and RVO. Results: The study recruited 11,182 consecutive patients (22,364 eyes) with T2DM. About 59.0% (n = 6697) were male. The mean age was 58.2 ± 10.6 years. In this cohort, RVO was detected in 3.4% (n = 380) of patients; 67.6% (n = 257) of them had branch retinal vein occlusion (BRVO) and the remaining 32.4% (n = 123) had central retinal vein occlusion (CRVO). The frequency of unilateral BRVO (n = 220, 85.6%) and unilateral CRVO (n = 106, 86.18%) was much common. Unilateral RVO was more frequent (n = 326, 85.8%) than bilateral diseases (n = 54, 14.2%) (?2 = 126.95, P < 0.001). Ischemic CRVO was more common (n = 103, 73.6%) than nonischemic CRVO (n = 37, 26.4%). Macula-involving BRVO was found in 58.5% (n = 172) of cases, suggesting more than 50% of cases in RVO carries a risk of severe vision loss. The duration of diabetes apparently had no influence on the occurrence of RVO. On the multivariate analysis, a history of HTN [OR: 1.7; 95% confidence interval (CI): 1.3–2.1; P = 0.001) and stroke (OR: 5.1; 95% CI: 2.1–12.4; P < 0.001) was associated with RVO. Conclusion: RVO is a frequent finding in people with T2DM. History of stroke carries the highest risk followed by HTN. The management of people with T2DM and RVO must also include comanagement of all associated systemic conditions.

Therapeutic effects of albendazole on mice with artery stenosis and its mechanism / 上海交通大学学报（医学版）

Objective • To investigate the effect of albendazole (ABZ) on mouse femoral arteries restenosis and explore its possible mechanism. Methods • Vascular smooth muscle cells (VSMCs) were cultured in vitro with 0.5 and 1 μmol/L ABZ, and evaluated for cell proliferation, migration, and apoptosis by MTT, Transwell assay, and Annexin V-PI staining flow cytometry, respectively; and Western blotting was also used for the analysis of phosphorylation mechanism of cytoskeleton proteins cofilin (CFL) and myosin light chain (MLC). Stenosis was established in the unilateral femoral artery of 10-week-old wildtype male C57BL/6 mice by perivascular cuff placement and high fat chow breeding for 4 weeks. After successful modeling, mice were randomly divided into control group (equal volume of solvent) and ABZ group (1.5 mg/d) for gavage, and femoral arteries were collected 4 weeks later for H-E histological analysis of intimal area, medial area, and intima/media (I/M) ratio to clarify the severity of restenosis. Results • Both 0.5 and 1 μmol/L ABZ could significantly inhibit the proliferation and migration of VSMCs (both P<0.05), while 0.5 μmol/L had no significant effect on the apoptosis of VSMCs. ABZ gavage could significantly reduce the neointimal area and I/M ratio in the restenosis mice, while there were no effects on the median area. Both 0.5 and 1 μmol/L ABZ treatment could significantly inhibit CFL dephosphorylation and MLC phosphorylation, which showed a concentration-dependent trend (both P<0.05). Conclusion • ABZ inhibits VSMCs migration and intimal hyperplasia, via affecting the phosphorylation of cytoskeleton protein CFL and MLC, thereby resulting in therapeutic effects on restenosis of mice.

Acute effects of strength exercise with blood flow restriction on the arterial resistance index / Efeitos agudos do exercício de força com restrição do fluxo sanguíneo sobre o índice de resistência arterial

ABSTRACT The present study aimed to evaluate the acute behavior of the brachial artery resistance index (BARI) and popliteal artery resistance index (PARI) in response to low intensity strength exercises involving small (SMG) and large muscle groups (LMG) performed with and without blood flow restriction. Eleven men (age 23 ± 3.29 years) underwent a four-arm, randomized, cross-over experiment: Small muscle group exercise (SMG), small muscle groups with blood flow restriction (SMG+BFR), large muscle groups (LMG) and large muscle groups with blood flow restriction (LMG+BFR). The behavior of BARI and PARI was evaluated at rest, immediately after exercise, and at 15 and 30 minutes during recovery. Data analysis showed a significant reduction of the BARI from rest to post-exercise only in the protocols involving SMG, regardless of the BFR (p <0.05). Protocols involving LMG, with or without BFR, did not affect PARI (p> 0.05), but were efficient to promote significant increases in BARI (p <0.05) immediately after exercise. Our findings indicate that the exercises involving SMG, regardless of BFR, are efficient to promote local vasodilatation (brachial artery), but without systemic effects. None of the analyzed protocols affected the PARI behavior.

RESUMO O presente estudo objetivou avaliar o comportamento agudo do índice de resistência da artéria braquial (IRAB) e da artéria poplítea (IRAP) em resposta a exercícios de força de baixa intensidade envolvendo pequenos (PGM) e grandes grupos musculares (GGM), realizado com e sem restrição de fluxo sanguíneo. Onze homens (idade 23 ± 3,29 anos) realizaram um experimento randomizado, cruzado, com quatro braços: Exercício para pequenos grupos musculares (PGM), pequenos grupos musculares com restrição de fluxo sanguíneo (PGM+RFS), grandes grupos musculares (GGM) e grandes grupos musculares com restrição de fluxo sanguíneo (GGM+RFS). O comportamento de IRAB e IRAP foi avaliado em repouso, mediatamente após o exercício, e aos 15 e 30 minutos da recuperação. A análise dos dados mostrou uma redução significativa do IRAB do repouso para o pós-exercício apenas nos protocolos de PGM com ou sem RFS (p <0,05). Protocolos envolvendo GGM, independentemente do BFR, não afetaram o IRAP (p> 0,05), porém, foram eficientes para promover aumentos significativos do IRAB (p <0,05) imediatamente após o exercício. Nossos achados indicam que os exercícios envolvendo PGM, independentemente da BFR, são capazes de promover a vasodilatação local (artéria braquial), porém, sem efeitos sistêmicos. Nenhum dos protocolos analisados afetou o comportamento do IRAP.

Síndrome de Leriche / Leriche's syndrome

Resumen El síndrome de Leriche es una vasculopatía oclusiva que afecta de manera progresiva la aorta abdominal, las iliacas comunes o ambas. Se comunica el caso de una paciente con distintos factores de riesgo vascular, quien manifestó de manera aguda un cuadro clínico compatible con oclusión vascular (claudicación). Se confirmaron mediante estudio imagenológico las características de un síndrome de Leriche. La paciente finalmente falleció. La incidencia y prevalencia de este síndrome se desconocen, los casos en mujeres se asocian principalmente con enfermedades autoinmunitarias. Para el diagnóstico se requiere la realización de una adecuada historia clínica y se confirma mediante estudios imagenológicos. El tratamiento está dirigido a prevenir el avance de la enfermedad. Como parte del manejo farmacológico se encuentran algunos vasodilatadores, antiagregantes plaquetarios y las estatinas. El manejo quirúrgico puede ser cirugía a cielo abierto o endovascular, la primera demuestra mayor beneficio, a pesar de los riesgos que conlleva.

Abstract Leriche's syndrome is an occlusive vasculopathy that progressively affects the abdominal aorta and the common iliacs. This paper reports the case of a female patient with various vascular risk factors, which presented a clinical picture compatible with vascular occlusion (claudication). The characteristics of a Leriche's syndrome were confirmed by imaging. The patient finally died. Incidence and prevalence of Leriche's syndrome are unknown, cases in the female gender are the main ones in autoimmune diseases. For the diagnosis, an adequate clinical history is required and confirmed by imaging studies. The treatment is aimed at preventing the progress of the disease. Within the pharmacological management are some vasodilators, antiplatelet agents and statins. Surgical management can be an open or endovascular surgery, the first one offers the greatest benefit, despite the risks involved.

Current status and prospect of liver surgery / 中华外科杂志

In the past 20 years,the advancement and breakthrough of applied basic research,the invention and renewal of medical devices,the popularization and improvement of minimally invasive techniques,the development and debate of innovative surgical methods and the establishment of the diagnosis and treatment standard brought the unprecedented development momentum to traditional liver surgery.This article combined the domestic and foreign related literature and the research results of our team. The current status and progress of the application of preoperative evaluation and surgical planning of liver surgery,surgical techniques of liver resection,laparoscopic and robotic techniques in liver surgery,enhanced recovery after surgery and associating liver partition and portal vein ligation for staged hepatectomy are briefly discussed.

Conservative treatment for hemorrhage during mcaesarean operation / 中国实用妇科与产科杂志

Hemorrhage often occurs during caesarean section,which can lead to severe postpartum hemorrhage if not treated in time.Effective treatment can avoid serious bleeding and following complications.This paper discussed the advantages and disadvantages of various hemostasis schemes,which included uterotonics,uterine cavity tamponade,uterine compression suture,and vascular occlusion.Any hemostasis selected should be used as early as possible to achieve sufficient effect and reduce the morbidity of complications after massive hemorrhage.