Role of Flavonoids in Traditional Chinese Medicine to Improve Cerebral Ischaemia-reperfusion Injury and Its Mechanism： A Review / 中国实验方剂学杂志

Cerebral ischemia-reperfusion injury （CIRI） has a very high incidence， disability， and mortality rates， which seriously affects human life and health. In recent years， modern medicine has made some progress in the diagnosis and treatment of CIRI， but there are still problems such as difficulties in postoperative rehabilitation and adverse drug reactions， and new therapeutic drugs for CIRI are urgently needed. As an important class of active ingredients in traditional Chinese medicine， flavonoids can play antioxidant， apoptosis inhibition， anti-inflammatory， and other pharmacological effects to improve brain tissue damage， which is important for improving the quality of life of CIRI patients and slowing down the aging of the social population. Numerous studies have found that flavonoids in traditional Chinese medicine can regulate cell surface receptors Toll-like receptor 4/nuclear factor-kappaB （TLR4/NF-κB）， phosphatidylinositol 3-kinase/protein kinase B （PI3K/Akt）， adenylate-activated protein kinase/mammalian target of rapamycin protein （AMPK/mTOR）， Ras homologous gene family member A/Rho-associated coiled-coil protein kinase （RhoA/ROCK）， nuclear factor E2-associated factor 2/Kelch-like epoxychloropropane-associated protein-1/haemoglobin oxygenase 1 （Nrf2/Keap1/ HO-1）， Notch， and other signaling pathways， so as to regulate the transcription and expression of related proteins after CIRI， alleviate brain tissue injury， and improve CIRI. This paper analyzed the relevant literature in China and abroad in recent years， reviewed the mechanism of action and related pathways of flavonoids in traditional Chinese medicine to improve CIRI， and explored the new therapeutic direction of CIRI at the metabolic level， with a view to providing a basis for the further development and application of flavonoids in traditional Chinese medicine.

Effect of Tongdu Xingshen Needling Method （通督醒神针刺法） on Expression of AMPA Receptors and Their Accessory Proteins in the Hippocampus of Rats with Learning Memory Impairment After Cerebral Ischaemia-Reperfusion / 中医杂志

ObjectiveTo explore the possible mechanism of Tongdu Xingshen needling method （通督醒神针刺法） on post-stroke cognitive impairment. MethodsSD rats were randomly divided into a normal group （n=12）， a sham surgery group （n=12）， a model group （n=12）， and a electroacupuncture group （n=13）. The rats in the model group and electroacupuncture group were subjected to the wire bolus method to establish the rats model with learning memory impairment after cerebral ischaemia-reperfusion. After successful modelling， the rats in the electroacupuncture group were given electroacupuncture interventions at “Shenting （GV 24）” and “Baihui （GV 20）” once a day for 30 minutes for 14 days. The other three groups did not receive other interventions but grasp. A 5-day localisation navigation experiment was conducted on the 9th day of intervention， and a spatial exploration experiment was conducted on the 14th day of intervention to evaluate the learning and memory abilities of the rats. After the spatial exploration experiment， hippocampal tissues were taken from each group of rats， and the changes in the volume of cerebral infarction were observed by TTC staining； the changes in the morphology of pyramidal neurons and the density of dendritic spines in the CA1 area of the hippocampus were observed by Golgi staining； protein immunoblotting was used to detect the relative protein expression of the subunits of the α-amino-3-carboxy-5-methylisoxazole-4-propionic acid （AMPA） receptor including glutamate receptor 1 （GluR1）， glutamate receptor 2 （GluR2）， glutamate receptor 3 （GluR3） and auxiliary proteins TARPγ2， TARPγ8 in hippocampal tissues of rats in each group； the real-time fluorescence quantitative PCR was used to detect GluR1， GluR2， GluR3 mRNA levels in the hippocampal tissues of rats. ResultsIn the localisation navigation experiment， compared with the normal group and sham surgery group， the escape latency and total distance of rats in the model group were significantly extended （P＜0.05） at day 1， 2， 3， 4， and 5； and the escape latency and total distance of rats in the electroacupuncture group tended to be significantly shorter than those in the model group （P＜0.05）. In the spatial exploration experiment， compared with the normal group and the sham surgery group， the number of rats crossing the platform in the model group was significantly reduced （P＜0.05）， and the number of crossings of the platform in the electroacupuncture group increased significantly （P＜0.05）. The results of TTC staining showed that the volume of cerebral infarction increased clearly in the model group compared with the sham surgery group （P＜0.05）， and apparently decreased in the electroacupuncture group compared with the model group （P＜0.05）. Golgi staining showed that the number of dendritic branches of pyramidal neurons and dendritic spines in hippocampal CA1 region significantly decreased in the model group compared with the normal group and the sham surgery group （P＜0.05）. The number of dendritic branches of pyramidal neurons and the density of dendritic spines in hippocampal CA1 region significantly increased in the electroacupuncture group compared with the model group （P＜0.05）. The protein relative expression levels of GluR1， GluR2， GluR3， TARPγ2 and TARPγ8， and the mRNA levels of GluR1， GluR2 and GluR3 in hippocampus decreased in the model group compared with the normal group and the sham surgery group （P＜0.05）. The protein relative expression levels of GluR1， GluR2， GluR3， TARPγ2 and TARPγ8， and the mRNA levels of GluR1， GluR2 and GluR3 in hippocampus increased in the electroacupuncture group compared with model group （P＜0.05）. ConclusionThe Tongdu Xingshen needling method can improve learning memory impairment after cerebral ischaemia-reperfusion， which may be related to up-regulation of the expression of AMPA receptor and their auxiliary protein TARP， and promoting the synaptic plasticity of hippocampal tissues.

Safety of autologous intramuscular platelet lysate injections in patients with critical limb ischaemia: A pilot, exploratory study

Background & objectives: Platelet concentrate contains a rich cocktail of growth factors that support growth and proliferation of cells. The primary goal of this study was to investigate the safety of platelet lysate (PL) in patients with critical limb ischaemia (CLI) not suitable for standard revascularization. Data on the preliminary efficacy are also presented. Methods: Seven patients (18-70 yr) with CLI classified in the Rutherford grades 3-5, with history of intermittent claudication for more than eight weeks and were not suitable for standard revascularization, underwent autologous intramuscular injections of PL. These patients were examined physically alongside other parameters such as TcPO2, toe pressure, and ankle brachial index, at baseline and were followed up for 12 months. Results: The procedure was well tolerated with no serious adverse or any adverse events reported during follow up. Although not the primary aim of this report, preliminary data showed significant clinical improvement in Rutherford stage, ankle-brachial index and toe pressure which persisted for a year. Interpretation & conclusions: Intramuscular injection of PL was well tolerated with no major adverse events reported in our study participants. With the observed satisfactory safety data, preliminary efficacy data of PL should be further validated.

The effect of lithium tetraborate as a novel cardioprotective agent after renal ischemia-reperfusion injury

Abstract Epidemiological studies suggest that acute kidney injury has certain effect on myocardial function. In this study, for the first time, we tested a boron compound namely lithium tetraborate an act as an anti-oxidant and anti-inflammatory agent in ischemia-reperfusion injury. For this, we employed an in vivo rat model with kidney ischemia reperfusion injury to evaluate cardiac injury to clarify the mechanisms of lithium tetraborate. The evaluation of cardiac injury through kidney artery occlusion and reperfusion rat model indicated that lithium tetraborate could (1) reduce oxidative stress-induced endothelial dysfunction; (2) attenuate the inflammatory response of cardiac cells; and (3) alleviate the apoptosis and necrosis of myocytes. In summary, lithium tetraborate demonstrates significant therapeutic properties that contribute to the amelioration of cardiac damage, and it could be a promising candidate for future applications in myocardial dysfunction.

Two-year clinical outcomes following lower limb endovascular revascularisation for chronic limb-threatening ischaemia at a tertiary Asian vascular centre in Singapore

INTRODUCTION@#Percutaneous transluminal angioplasty (PTA) is commonly used to treat patients with chronic limb-threatening ischaemia (CLTI). This study aimed to examine the mortality and functional outcomes of patients with CLTI who predominantly had diabetes mellitus in a multi-ethnic Asian population in Singapore.@*METHODS@#Patients with CLTI who underwent PTA between January 2015 and March 2017 at the Vascular Unit at Singapore General Hospital, Singapore, were studied. Primary outcome measures were 30-day unplanned readmission, two-year major lower extremity amputation (LEA), mortality rates, and ambulation status at one, six and 12 months.@*RESULTS@#A total of 221 procedures were performed on 207 patients, of whom 184 (88.9%) were diabetics. The one-, six- and 12-month mortality rate was 7.7%, 16.4% and 21.7%, respectively. The two-year LEA rate was 30.0%. At six and 12 months, only 96 (46.4%) and 93 (44.9%) patients were ambulant, respectively. Multivariate analysis revealed that preoperative ambulatory status, haemoglobin, Wound Ischaemia and foot Infection (WIfI) score, and end-stage renal failure (ESRF) were independent predictors of one-year ambulatory status. Predictors of mortality at one, six and 12 months were ESRF, preoperative albumin level, impaired functional status and employment status.@*CONCLUSION@#PTA for CLTI was associated with low one-year mortality and two-year LEA rates but did not significantly improve ambulation status. ESRF and hypoalbuminaemia were independent predictors of mortality. ESRF/CKD and WIfI score were independent predictors of loss of ambulation at six months and one year. We need better risk stratification for patients with CLTI to decide between initial revascularisation and an immediate LEA policy.

Protective effect of naringin in rat model of renal ischemia reperfusion injury / Efecto protector de la naringina en modelo de rata con lesión por reperfusión de isquemia renal

ABSTRACT Objective: We aimed to research that naringin whether protects from renal ischemia/reperfusion induced renal damage in rats. Methods: Twenty-four Wistar albino female rats randomly were divided into three groups: 1) control group, in which the rats were only performed right nephrectomy; 2) a second group received right nephrectomy and left kidney ischemia (1 h) and reperfusion (24 h) group ischemia/reperfusion (I/R); 3) a third group received 50 mg/kg naringin orally once a day for two weeks before ischemia/reperfusion (I/R/N). Expression of cyclooxygenase-2 (COX-2), cytosolic phospholipase A2 (cPLA2), inducible nitric oxide synthase (iNOS), caspase-3, B-cell lymphoma-2 (Bcl-2), Bcl-2 associated x protein (Bax), serum creatinine (Cr), tumor necrosis factor α (TNF-α), interleukin 6 (IL-6) were measured by using enzyme-linked immunosorbent assay (ELISA). Results: Naringin-treated rats that performed renal ischemia/reperfusion demonstrated significant decrease in Cr, IL-6 and TNF-α levels when compared to the only renal ischemia/reperfusion performed rats. While renal ischemia/reperfusion caused a decrease of bcl-2 (1.72 ± 0.20 pg/ml) levels, while an increase of COX-2 (11882 ± 642 pg/ml), cPLA2 (2448 ± 139 pg/ml), iNOS (4331 ± 438 IU/ml), cleaved caspase-3 (7.33 ± 0.76 ng/ml) and Bax (2.33 ± 0.44 ng/ml) levels. The treatment of naringin reversed these kidney effects (7.47 ± 60.35 pg/ml; 9299 ± 327 pg/ml; 2001 ± 78 pg/ml; 3112 ± 220 IU/ml; 3.38 ± 0.54 ng/ml; 2.33 ± 0.44 ng/ml, respectively) (p <0.05). Conclusion: This study showed that naringin treatment attenuated renal damage induced by ischemia/reperfusion in rats.

RESUMEN Objetivo: Nuestro objetivo fue investigar si la naringina protege del daño en los riñones provocado por isquemia-reperfusión renal en ratas. Material y métodos: De forma aleatoria, dividimos 24 ratas albinas Wistar hembras en tres grupos: 1) grupo control, en el que solo se les realizó a las ratas una nefrectomía derecha; 2) un segundo grupo isquemia-reperfusión, con nefrectomía derecha e isquemia de riñón izquierdo (1 h) y reperfusión (24 h); 3) un tercer grupo al que se le administró 50 mg/kg de naringina por vía oral una vez al día durante dos semanas antes de la isquemia-reperfusión. Por medio de un ensayo inmunoabsorbente ligado a enzimas (ELISA), se midieron las siguientes expresiones: ciclooxigenasa-2 (COX-2), fosfolipasa citosólica A2 (cPLA2), óxido nítrico sintetasa inducible (ONSi), caspasa-3, linfoma de células B2 (Bcl-2), proteína X asociada a Bcl-2 (Bax), creatinina sérica (Cr), factor de necrosis tumoral alfa (FNT-α) e interleucina 6 (IL-6). Resultados: Las ratas tratadas con naringina por isquemia-reperfusión renal mostraron un descenso significativo en los niveles de Cr, IL-6 y FNT-α en comparación con las ratas a las que se les indujo isquemia-reperfusión renal pero que no se les suministró naringina. La isquemia-reperfusión renal provocó un descenso de los niveles de Bcl-2 (1,72 ± 0,20 pg/ml) y un ascenso en los niveles de COX-2 (11882 ± 642 pg/ml), cPLA2 (2448 ± 139 pg/ml), ONSi (4331 ± 438 UI/ml), caspasa-3 escindida (7,33 ± 0,76 ng/ml) y Bax (2,33 ± 0.,44 ng/ml). El tratamiento con naringina diminuyó estos efectos en el riñón (7,47 ± 60,35 pg/ml; 9299 ± 327 pg/ml; 2001 ± 78 pg/ml; 3112 ± 220 UI/ml; 3.38 ± 0.54 ng/ml; 2.33 ± 0,44 ng/ml, respectivamente) (p <0,05). Conclusión: En este estudio se demostró que el tratamiento con naringina atenuó el daño renal producido por isquemia-reperfusión en ratas.

The Effects of Lung Ischaemia/Reperfusion on TRPM Gene Expression

ABSTRACT Objective: Transient receptor potential melastatin (TRPM) are integral membrane proteins that have broad range of cellular functions. Roles of TRPM2, TRPM3, TRPM4 and TRPM7 among these channels are very important, and their roles in lung ischaemia/reperfusion injury have not been evaluated yet. The aim of this study is to investigate the contribution of these genes in lung ischaemia/reperfusion injury and evaluate histopathology of tissues. Methods: A total of 40 Wistar albino rats were enrolled for the study. Ischaemia was performed by the application of an atramvatic clamp to pulmonary artery. Gene expressions were determined by the semi-quantitative reverse transcription-polymerase chain reaction method. Histopatholical evaluations were held by a standard haematoxyline-eosin staining. Results: The major histopathological tissue damage was observed in ischaemia performed groups, and expression of TRPM channels was found to be obviously downregulated. Substantial changes were determined between TRPM2, TRPM3, TRPM4 and TRPM7 and lung ischaemia/reperfusion injury. In particular, expression of TRPM2 and TRPM7 was reversibly downregulated in ischaemia. Yet, the expression of TRPM3 and TRPM4 was irreversibly down-regulated after ischaemia. Conclusion: Consequently, these results indicate that TRPM family of cation channels may have significant roles in the lung ischaemia/reperfusion injury.

Vasospasm and delayed cerebral ischaemia in patients with spontaneous subarachnoid haemorrhage (aneurysmal and pretruncal non-aneurysmal): a centre’s perspective

@#Spontaneous subarachnoid haemorrhage (SAH) is a significant cause of stroke and may lead to severe neurological deficit or death. It is also associated with high morbidity and mortality for patients despite optimal medical and surgical treatment. Based on the World Health Organization the annual incidence of spontaneous SAH varies in different regions of the world between 2.0-22.5 per 100,000 populations with Finland and Japan having the highest incidence and South and Central America with lowest incidence.1

Study of Silent Myocardial Infarction in Type Two Diabetes Mellitus Patients in a Tertiary Care Center

Coronary artery disease is known as a serious plague because of its regularity in different bits of the world. The signs of coronary artery issue handle a wide range from the mind boggling minor coronary atherosclerosis without angina or ischaemia to sudden passing METHODSThe present study was cross sectional, observational study carried out at tertiary care center. This study was conducted during the period from January 2016 to June 2017. All Type two Diabetes Mellitus 100 patients attending Department of Medicine included in the study. RESULTSMajority of study subjects were in age 51 - 60 years (46 %) having DM (Diabetes Mellitus) since 5 - 10 years (46 %). A lot of patients overweight (40 %), dyslipidaemia (22 %). It mean fasting and post prandial glucose among patients was 164 ± 15.18 mg / dL and 189.4 ± 23.29 mg / dL exclusively. The mean LDL, HDL, VLDL, complete cholesterol and greasy oils levels among patients was 118.14 ± 24.2 mg / dL, 42.60 ± 5.12 mg / dL, 35.68 ± 7.09 mg / dL, 204.96 ± 28.76 mg / dL, 166.17 ± 31.92 mg / dL independently. The regularity was 27 %. The prevalence of MI among DM patients was major in age pack 51 - 60 years (13 %). The ECG changes in calm MI among DM patients showed that a lot of calm MI patients had ST dejection and adjusted T wave inversion (77.77). CONCLUSIONSStandard checking ECG is be commonly useful and unobtrusive gadget in myocardial ischaemia area n asymptomatic diabetic patients

Sigmoid volvulus - an important cause of intestinal obstruction: how to deal with it?

Background: The objective of the study was to discuss the appropriate course of action in cases of sigmoid volvulus. It becomes important due to its high morbidity and mortality and its acute emergency presentation.Methods: This is a retrospective study of sigmoid volvulus admitted in the department of surgery at Late SBRKM Government Medical College, Jagdalpur. The study period was from January 2017 to August 2019. A total of 27 cases were under study. On admission, they were examined, investigated and treated surgically and the outcome noted.Results: Out of 27 patients 25 were male and 2 cases were female. The mean age group was 65 years. The co-morbidities consisted of previous abdominal surgeries, diabetes mellitus, hypertension, and renal complications. The common factor was chronic constipation and purgative abuse. All underwent a definitive surgical procedure like sigmoidectomy and colorectal anastamosis or sigmoidectomy and colostomy. In the second group colostomy closure and end to end anastamosis carried on at a later date. We have lost 5 patients in the post-operative period.Conclusions: The sigmoid volvulus presents with the features of intestinal obstruction. The real danger is the gangrene of the bowel, as a consequence of ischaemia. It requires an early surgical intervention for the maximum benefit of the patient.

GDF -15 and Severity Scores in Sickle Cell Disease Patients Attending Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria

Aim:Granulocyte differentiation factor 15 (GDF15) is a growth factor andbiomarker for many disorders where Ischaemia Reperfusion Injury (IRI) is pathophysiologically relevant. Hence theneed to evaluate GDF-15 as a biomarker inSickle Cell Disease (SCD).Study Design:This is a cross sectional study.Place and Duration of Study: Department of Haematology, Nnamdi University Teaching Hospital, Nnewi, Anambra state, Nigeria, between January and December 2018.Methods:Ninety subjects were randomly recruitedwith haemoglobin (Hb) phenotypesSS (test),AS and AA (controls); numbering30,28and 32 respectively. Disease severity was determined by calculating an objective score. 5 mls of blood was collectedandused to determine Full Blood Count (FBC),haemoglobin Phenotype andGDF-15 levels(byEnzymeLinked Immunosorbent assay).Data collected was analysed using Statistical Package for Social Sciences software version 20 (SPSS Inc., IL, Chicago, USA). P< 0.05 was considered as significant.Results: GDF-15 level was found to be significantly differentin the different HB phenotypes p= 0.005 and correlated negatively with sickle cell disease severity (r= -0.307, p= 0.098). The difference betweenmedianGDF-15 levels of HBSS subjects with mild and moderate disease was statistically significant at p= 0.01.Conclusion:We hypothesize that GDF-15 maybeapotential therapeutic target for intervention against ischaemia/reperfusion inducedmicro-vascularinjury.Natural GDF-15 mimetics maybe useful in taking advantage of this potential therapeutic target.

Acute Abdomen: Unmasked the Bleeding Site in Severe Haemophilia A

@#Haemophilia A is an inherited bleeding disorder, commonly involve soft tissues and joints. Gastrointestinal tract bleeding, are not uncommon but seldom highlighted. A 23-year-old male with underlying severe haemophilia A was presented with a generalised abdominal pain for 2 days, abdominal distension, diarrhoea and vomiting. He did not have any trauma to the abdomen. Abdominal examination revealed generalized tenderness with sign of guarding on palpation. Laboratory investigations revealed isolated, prolonged activated partial thromboplastin time (APTT) with normal total white blood cell count and haemoglobin level. In view of acute abdomen, which was not resolved by conservative treatment, an emergency laparotomy was done with FVIII concentrate and recombinant factor VII (rFVII) coverage. Intraoperative findings noted patchy gangrenous spots of about 30 cm in length in the small bowel. Histopathology examination revealed an evidence of haemorrhage within the submucosal and intramuscularis layer from the resected specimen. This case highlighted the possibility of gastrointestinal bleeding without prior trauma, which can be presented as acute abdomen in severe haemophilia patient.

Tao-Hong-Si-Wu Decoction promotes angiogenesis after cerebral ischaemia in rats via platelet microparticles / 中国天然药物

Platelet microparticles (PMPs) are membrane particles derived from the platelet membrane that enter into the blood circulation. We sought to explore the therapeutic effects of Tao-Hong-Si-Wu Decoction (THSWD) on angiogenesis in a rat model of cerebral ischaemia-reperfusion (I/R). The protective effect of THSWD on I/R rats was observed morphologically by immunohistochemical expression of VEGF and CD34, along with immunofluorescence results of co-expression of BrdU and vWF. Then, PMPs from different groups of rats were extracted, and cytokine array analysis was used to screen for angiogenesis associated proteins. The results showed that THSWD can promote the expression of VEGF, CD34, BrdU and vWF. Cytokine array analysis revealed the changes in the expression of 29 related angiogenic proteins in the total protein of PMPs, which involved the Notch signalling pathway. Compared with model group, the expression levels of NICD and Hes-1 in the THSWD group were significantly increased. In the context of I/R, the angiogenesis-related proteins of PMPs are different. THSWD may involve the promotion of activation of the Notch signalling pathway to achieve therapeutic effects on cerebral ischaemia.

A prospective study of clinical manifestations of snake bite in government general hospital

Background: Snake bite is an occupational and rural hazard because India has always been a land of exotic snakes. Although full burden of human suffering attributable to snake bite remains obscure, hundreds of thousands of people are known to be envenomed and tens of thousands are killed or maimed by snakes every year. This study is aimed at studying the clinical manifestations in snake bite at government general hospital.Methods: This Prospective Observational study was done from March 2019 to August 2019 in Government General Hospital Nalgonda. A total of 60 cases male and female admitted with snake bite were studied based on inclusion and exclusion criteria. All patients were done routine investigations, ECG was done to rule out cardiac anomalies. Patients below 12 years, pregnant women and patients with previous heart ailments were excluded from the study. The study was carried out in all patients fulfilling the inclusion and exclusion criteria.Results: A total of 60 patients 35 females and 25 males presented during the study period. Most of the patients presented with pain at the site 40(66%), Nausea 30(50%), Swelling 25(42%), Paraesthesia 25(42%), Bleeding 15(25%), Ptosis 15(25%), Sweating 10(17%), Cellulitis 10(17%) and dyspnoea 5(9%). Among the ECG manifestations- Tachycardia- 30(50%), Ischaemia 5(9%), Sinus arrythmia 2(4%), Myocardial Infarction-0.Conclusions: It was Observed from the study that the pt. had more of Haemolytic presentation than neuroparalytic presentation. Pain at the site was the most common presentation followed by nausea. Some patients developed neuroparalytic symptoms like cellulitis, and paraesthesia. Further it was observed that timely shifting to the Hospital and administration of Anti-Snake venom prevented major manifestations in the patients.

Prevalencia de cardiopatía isquémica asintomática en pacientes con diabetes mellitus tipo 2 / Prevalence of asymptomatic ischaemic heart disease in patients with type 2 diabetes mellitus

Resumen Introducción: La enfermedad cardiovascular es la causa principal de muerte en pacientes con diabetes mellitus. La prevalencia de cardiopatía isquémica asintomática es más alta en pacientes diabéticos que en no diabéticos y se asocia a peor pronóstico. Objetivo: Identificar la prevalencia de cardiopatía isquémica asintomática en pacientes con diabetes mellitus tipo 2 en un hospital de tercer nivel de atención de Guatemala y analizar la posible asociación de dicha enfermedad con características epidemiológicas, clínicas y metabólicas. Métodos: Estudio de corte transversal en el que se estudió una muestra de 92 pacientes diabéticos seleccionados de forma aleatoria simple. Se realizó electrocardiograma, que cuando fue negativo para isquemia ameritó prueba de esfuerzo, o de lo contrario, ecocardiograma de estrés con dobutamina. Resultados: La edad media de los participantes fue de 57 años, 88% de los cuales eran mujeres; la duración media de la diabetes fue 7 años. Se encontró cardiopatía isquémica asintomática en el 22,8% de los casos. No se hallaron posibles asociaciones entre cardiopatía isquémica asintomática y edad, sexo, enfermedad arterial periférica, índice de masa corporal, índice tobillo-brazo, hipertensión arterial, dislipidemia, tabaquismo activo, sedentarismo, sobrepeso/obesidad, alcoholismo, glucosa en ayunas, hemoglobina glicosilada, colesterol total, colesterol HDL, colesterol LDL, ácido úrico, creatinina, tasa de filtrado glomerular y microalbuminuria. Conclusiones: La prevalencia de cardiopatía isquémica asintomática en la población estudiada con diabetes mellitus tipo 2 fue de 22,8%. No se encontraron posibles asociaciones de cardiopatía isquémica asintomática con las variables estudiadas.

Abstract Introduction: Cardiovascular disease is the main cause of death in patients with diabetes mellitus. The prevalence of asymptomatic ischaemic heart disease is higher in diabetic patients than in non-diabetic ones, and is associated with a worse prognosis. Objective: To determine the prevalence of asymptomatic ischaemic heart disease in patients with type 2 diabetes mellitus in a third level of care hospital in Guatemala, as well as to analyse the possible relationship of this disease with epidemiological, clinical, and metabolic characteristics. Methods: A cross-sectional study was conducted on a sample of 92 randomly selected diabetic patients. An electrocardiogram was performed, which when it was negative for ischaemia, an exercise stress test or a dobutamine stress echocardiogram was performed. Results: The mean age of the participants was 57 years, 88% of whom were women. The mean duration of the diabetes was 7 years. Asymptomatic ischaemic heart disease was found in 22.8% of case. No significant associations were found between ischaemic heart disease and age, gender, peripheral arterial disease, body mass index, ankle-brachial index, arterial hypertension, dyslipidaemia, active smoking, sedentarism, overweight/obesity, alcoholism, fasting glucose, glycosylated haemoglobin, total cholesterol, HDL-cholesterol, LDL-cholesterol, uric acid, creatinine, glomerular filtration rate, and urine microalbumin. Conclusions: The prevalence of asymptomatic ischaemic heart disease was 22.8% in the population studied with type 2 diabetes mellitus. No significant associations were found between ischaemic heart disease and the variables studied.

Evaluation by damped least-square algorithm on target identification ability of intracranial focal bidirectional electrical impedance perturbation / 医疗卫生装备

Objective To evaluate the effect of damped least-square algorithm on the identification of focal bidirectional electrical impedance perturbation in the intracranial area, and to analyze the influence of this kind of perturbation on the reconstruction quality of electrical impedance tomography. Methods Focal bidirectional electrical impedance perturbation was built based on the three-dimensional model and damped least-square algorithm was introduced into imaging. The position error and resolution were used to evaluate the imaging performance.Results When the focal electrical impedance perturbation existed,the target whose conductivity varied greatly or volume was large was more likely to be identified in the images while the target with smaller volume or variable conductivity presented in the reconstruction image was not obvious. It's pointed out that it may cause reconstruction images in some cases could not truly reflect the location and change information of the object of primary cerebral hemorrhage.At the same time,it affected the reconstruction precision,causing the position error and resolution with large fluctuation. Conclusion In reconstruction algorithm linearity correct matrix introduced for bidirectional electrical impedance perturbation contributes to enhancing the recognition of bidirectional perturbation, so that the characterization of the electrical impedance imaging can be augmented for clinical intracerebral hemorrhage.

Impact of renal malperfusion on the perioperative and long-term outcome in patients with type A aortic dissection / 中华胸心血管外科杂志

Objective To confirm the impact of renal malperfusion on early and late outcomes of patients undergoing sur-gery for type A aortic dissection(TAAD). Methods From June 2011 to July 2012,a total of 165 TAAD patients undergoing surgery in hospital were enrolled and divided into 2 groups based on the results:research group(complicated with renal malper-fusion),control group(without renal malperfusion). A cohort follow-up project was conducted among these patients. The pri-mary outcome was all-cause death. Baseline and operative characteristics,early and late outcomes were analyzed to assess difference between 2 groups. Cumlative survival rates within 72 months among the 2 groups was described with Kaplan-Meier curves. Cox proportional hazards model was used to estimate the hazard ratios(HR)and 95％ confidence intervals(95％ CI)of late mortality among the 2 groups. Results Renal malperfusion was detected in 38(23. 0％)of 165 TAAD patients. 30-day mortality was 15. 8％ and 3. 9％ in patients with and without renal malperfusion(P < 0. 05),respectively. The mean follow-up period was(67 ± 3)months,late survival was 68. 4％ in patients with renal malperfusion and 88. 2％ in patients without(P <0. 05). By Cox proportional hazards model,after adjusting forage,sex,group(acute or chronic),presence of cardiac tampon-ade,brachiocephalic vessels involvement,coronary arteries involvement,root replacement,total arch replacement,concomitant coronary artery bypass grafting(CABG)and other organ-malperfusion,when compared to the control group,the HR(95％ CI) of late mortality was 5. 18( 1. 07 - 5. 18)in the research group. Besides renal malperfusion,concomitant coronary artery bypass grafting was presented as an independent risk factor of long-term survival(HR = 10. 08,95％ CI:2. 28 - 44. 62,P = 0. 002). Conclusion Coexistence of renal malperfusion is associated with a substantially increased risk of death in patients undergoing surgery for TAAD. A more exact stratification that weight every malperfusion-affected organ but not base on the number of malp-erfusion-affected organ simply may be more helpful to TAAD patients with malperfusion syndrome.

Frecuencia de los tipos de infarto agudo de miocardio según la tercera definición / Frequency of myocardial infarction according to the third universal definition

Resumen Introducción y objetivos: El infarto agudo de miocardio (IAM) es una patología muy prevalente con una morbimortalidad significativa en Colombia y en el mundo. Es por esto, que desde el 2011 en la Fundación Santa Fe de Bogotá se inició la recolección de datos demográficos y clínicos de pacientes con patologías cardiovasculares en una base de datos denominada, Registro Colombiano de Enfermedades Cardiovasculares. Actualmente se tienen 736 registrados según el tipo de IAM que presentan de acuerdo a la tercera clasificación de infarto. Por lo anterior, se quiso conocer la frecuencia de cada tipo de infarto en nuestra población y su asociación con diferentes variables. Métodos: Se realizó un estudio descriptivo observacional de corte transversal en el cual se revisaron los datos de los pacientes pertenecientes a RECODEC, evaluando el tipo de IAM que presentaba. Resultados: Se encontró una alta frecuencia para el infarto tipo 1, intermedia para el tipo 2 y baja para los otros tipos de infarto; además una asociación positiva entre ser hombre y presentar infarto tipo 1 (n=427, 85.7% con un OR 1.91 IC95% 1.29-2.82) y una asociación entre infarto tipo 2 y ser mujer (n=51, 21.4% con un OR 0.51 IC95% 0.33-0.76). Conclusiones: Una adecuada clasificación del tipo de infarto permite definir una mejor ruta terapéutica para el paciente y predecir posibles complicaciones. Con este estudio se logró realizar la caracterización de la población en cada grupo establecido por la tercera definición.

Abstract Introduction and objectives: Acute myocardial infarction is a disease associated with a high prevalence and morbidity in Colombia and worldwide. Since 2011, at the Fundación Santa Fe de Bogotá, a registry known as RECODEC began to be used to collect data in order to characterise the population with cardiovascular diseases. A total of 736 patients have currently been registered according to the type of myocardial infarction, taking into account its third universal definition. The application of this definition has been related with an increase in the number of cases diagnosed, with prediction of 10 year mortality, and with improvement of care. The prevalence is presented of each type of infarction and its association with different kind of variables. Methods: A descriptive, observational, cross sectional study was conducted using the patient data from RECODEC registry, in order to evaluate the type of infarction each patient presented. Results: A high prevalence was found for type 1 infarction, with intermediate for type 2, and low for the other types of myocardial infarction. A positive association was also found between being male and having a type 1 infarction (n=427, 85.7% and OR: 1.91, 95% CI: 1.29-2.82, P<.001) and an association between being female and type 2 infarction (n=51, 21.4% and OR: 0.51, 95% CI: 0.33-0.76, P<.001). Conclusions: It is important to classify the type of infarction presented by the patients, so that the type of population that suffers from each type could be characterised, so that it may be possible to offer a more specific treatment for each disease.

Tourniquet-induced ischaemia-reperfusion injury: the comparison of antioxidative effects of small-dose propofol and ketamine / Lesão de isquemia-reperfusão induzida por torniquete: comparação dos efeitos antioxidantes de propofol e cetamina em doses baixas

Abstract Objectives: The aim of the present study was to investigate the preventive effects of propofol and ketamine as small dose sedation during spinal anaesthesia on tourniquet-induced ischaemia-reperfusion injury. Methods: 30 patients were randomly assigned into two groups of 15 patients. In the propofol group, sedation was performed with propofol 0.2 mg·kg-1 followed by infusion at a rate of 2 mg·kg-1·h-1. In the ketamine group, a continuous infusion of ketamine 0.5 mg·kg-1·h-1 was used until the end of surgery. Intravenous administration of midazolam was not used in any patients. Ramsay sedation scale was used for assessing the sedation level. Venous blood samples were obtained before propofol and ketamine infusion (T1), at 30 minutes (min) of tourniquet ischaemia (T2), and 5 min after tourniquet deflation (T3) for malondialdehyde (MDA) measurements. Results: No differences were noted between the groups in haemodynamic (p > 0.05) and demographic data (p > 0.05). There was no statistically significant difference between the two groups in terms of T1, T2 and T3 periods (p > 0.05). There was a statistically increase observed in MDA values respectively both in Group P and Group K between the reperfusion period (1.95 ± 0.59, 2.31 ± 0.48) and pre-ischaemia (1.41 ± 0.38, 1.54 ± 0.45), and ischaemia (1.76 ± 0.70, 1.71 ± 0.38) (µmoL-1) periods (p < 0.05). Conclusions: Small-dose propofol and ketamine has similar potential to reduce the oxidative stress caused by tourniquet-induced ischaemia-reperfusion injury in patients undergoing arthroscopic knee surgery under spinal anaesthesia.

Resumo Objetivos: O objetivo do presente estudo foi investigar os efeitos preventivos de propofol e cetamina em sedação com doses baixas durante a raquianestesia sobre lesão de isquemia-reperfusão induzida por torniquete. Métodos: 30 pacientes foram randomicamente alocados em dois grupos de 15 pacientes cada. No grupo propofol, a sedação foi feita com 0,2 mg.kg-1 de propofol seguida por infusão a uma taxa de 2 mg.kg-1.h-1. No grupo cetamina, uma infusão contínua de 0,5 mg.kg-1.h-1 de cetamina foi usada até o final da cirurgia. Midazolam intravenoso não foi administrado em nenhum dos pacientes. A Escala de Sedação de Ramsay (ESR) foi usada para avaliar o nível de sedação. Amostras de sangue venoso foram colhidas antes da administração de propofol e infusão de cetamina (T1), aos 30 minutos (min) de isquemia do torniquete (T2) e 5 min após a desinsuflação do torniquete (T3), para medir os valores de malondialdeído (MDA). Resultados: Não observamos diferenças entre os grupos em relação à hemodinâmica (p > 0,05) e dados demográficos (p > 0,05). Não houve diferença estatisticamente significativa entre os dois grupos nos períodos T1, T2 e T3 (p > 0,05). Um aumento estatisticamente significativo foi observado nos valores de MDA, respectivamente, no Grupo P e Grupo C entre os períodos de reperfusão (1,95 ± 0,59, 2,31 ± 0,48) e pré-isquemia (1,41 ± 0,38, 1,54 ± 0,45) e isquemia (1,76 ± 0,70, 1,71 ± 0,38) (µmoL-1) (p < 0,05). Conclusões: Propofol e cetamina em doses baixas apresentam potencial semelhante para reduzir o estresse oxidativo causado pela lesão de isquemia-reperfusão induzida por torniquete em pacientes submetidos à artroscopia de joelho sob raquianestesia.

Puente muscular miocárdico: causa de infarto agudo de miocardio en paciente sin factores de riesgo cardiovascular / Myocardial bridge: cause of myocardial acute infarction in a patient without cardiovascular risk factors

Resumen Los puentes miocárdicos están constituidos por haces de fibras musculares que recubren un trayecto variable de una arteria coronaria; son un hallazgo relativamente frecuente, con incidencia que varía en función del método de estudio usado (angiográfico). Aunque por lo general tienen pronóstico benigno, pues en muchos casos cursan de manera asintomática y su hallazgo es casual, su existencia se considera causa de angina, arritmias malignas, infarto de miocardio y muerte súbita. Su diagnóstico se realiza in vivo por estudio angiográfico al comprobar una compresión sistólica (contracción muscular) de una arteria coronaria que desaparece durante la diástole (relajación muscular). Comunicamos el caso de una paciente de 46 años de edad, sin factores de riesgo cardiovascular, que ingresó al servicio de Urgencias por cuadro de dolor precordial típico y síntomas de descarga neurovegetativa, con signos electrocardiográficos de lesión subendocárdica en la cara anteroseptal y biomarcadores positivos. La paciente estaba fuera del periodo de ventana de trombólisis, por lo que se decidió realizarle intervención coronaria percutánea, en la que se documentó la existencia de puente muscular sobre la arteria descendente anterior en su tercio medio, que generaba compresión sistólica moderada con disminución del flujo de llenado en el tercio distal, sin otras lesiones coronarias asociadas.

Abstract Myocardial bridges consist of muscle fiber bundle lining an epicardial coronary artery for a variable distance. They are a relatively common finding, with incidence changing on the basis of the study method used (angiographic/necropsy). Although myocardial bridges have usually a benign prognosis, being in many cases asymptomatic and only found by chance, their presence has also been considered a cause of angina, malignant arrhythmia, myocardial infarction and sudden death. They are diagnosed in vivo by angiography when a systolic compression of a coronary artery which disappears during diastole is evidenced. We report the case of a female patient without risk factors, with electrocardiographic signs of severe ischemia in the territory of the anterior descending artery, which was initially assessed as myocardial infarction and treated as such. Eventually, the ECG returned to normal, and no new Q waves of necrosis occurred. An angiohemodynamic study confirmed the existence of an isolated muscular bridge over the middle third of the anterior descending artery, with no other associated coronary lesions.