Increased serum chemerin levels associated with carotid intima-media thickness / Aumento dos níveis séricos de chemerin associados à espessura das camadas intima-media carotídea

ABSTRACT Background: Elevated levels of chemerin can predict future ischemic cerebrovascular disease. Although chemerin is thought to play a role in atherosclerotic inflammation, whether circulating chemerin levels are associated with the severity of atherosclerosis remains to be determined. Objectives: Through the use of carotid Doppler ultrasonography, our aim in this study was to investigate the relationships of serum chemerin levels with carotid intima-media thickness (CIMT) as an indicator of generalized atherosclerosis. Methods: This study compared 40 patients with ischemic stroke and 40 healthy subjects. Measurements were made at end-diastole using color Doppler ultrasonography (CDUS) after a 5-min rest interval in a quiet and dark room. CIMT was defined as the distance between the innermost edge of the luminal echo to the innermost edge of the media/adventitia echo. CIMT was measured in the posterior wall of both common carotid arteries within 1 cm proximally to the bulbus. Three measurements were made on both sides and the average measurement was taken as the CIMT. Serum chemerin levels were determined in all patients and healthy subjects. Results: Serum chemerin levels were significantly higher in the patient group than in the control group (p=0.004). Serum chemerin levels were positively correlated with CIMT (p<0.05). There was a significant difference between the groups with regard to CIMT (p<0.001). Conclusion: Elevated serum chemerin levels appear to be associated with CIMT, thus suggesting that a link exists between chemerin and atherosclerotic ischemic cerebrovascular disease.

RESUMO Introdução: Níveis elevados de chemerin podem prever doenças cerebrovasculares isquêmicas futuras. Embora se acredite que a chemerin desempenhe um papel na inflamação aterosclerótica, ainda não foi determinado se os níveis circulantes de chemerin estão associados à gravidade da aterosclerose Objetivos: Por meio do uso da ultrassonografia Doppler da carótida, nosso objetivo neste estudo foi investigar as relações dos níveis séricos de chemerin com a espessura da íntima-média da carótida (EIMC) como um indicador de aterosclerose generalizada. Métodos: Este estudo comparou 40 pacientes com AVC isquêmico e 40 indivíduos saudáveis. As medidas foram feitas no final da diástole usando ultrassonografia Doppler em cores (USDC), após um intervalo de descanso de 5 minutos em um quarto silencioso e escuro. A EIMC foi definida como a distância entre a borda mais interna do eco luminal e a borda mais interna do eco da mídia/adventícia. EIMC foi medido na parede posterior de ambas as artérias carótidas comuns dentro de 1 cm proximalmente ao bulbo. Três medições foram feitas em ambos os lados e a medição média foi tomada como o EIMC. Os níveis séricos de chemerin foram determinados em todos os pacientes e indivíduos saudáveis. Resultados: Os níveis séricos de chemerin foram significativamente maiores no grupo de pacientes do que no grupo controle (p=0,004). Os níveis séricos de chemerin foram positivamente correlacionados com EIMC (p<0,05). Houve diferença significativa entre os grupos em relação à EIMC (p<0,001). Conclusão: Níveis séricos elevados de chemerin parecem estar associados com a EIMC, sugerindo que existe uma ligação entre chemerin e doença cerebrovascular isquêmica aterosclerótica.

Íntima media carotidea como predictor de enfermedad aterosclerótica en pacientes con psoriasis / Carotid intima media as a predictor of atherosclerotic diseasein psoriasis patients

La psoriasis es una enfermedad inflamatoria cutánea crónica, conocida como un desorden multisistémico. En pacientes con enfermedades inflamatorias crónicas se ha descrito una correlación directa entre el grosor de la arteria carótida común y el desarrollo de futuras complicaciones cardiovasculares. Algunos estudios han demostrado una correlación de psoriasis y el desarrollo de eventos cardiovasculares dado que tienen un riesgo aumentado de desarrollar enfermedad aterosclerótica. En Venezuela las enfermedades cardiovasculares se ubican como primera causa de muerte, y a pesar del creciente número de pacientes con psoriasis no se han llevado a cabo estudios que permitan determinar el papel de psoriasis y la enfermedad arterial coronaria. Por ello la presente investigación se planteó determinar la relación entre el grado de severidad de psoriasis y el grosor de la íntima media carotidea a un grupo de 20 pacientes con diagnóstico de psoriasis. Recopilada la información, se realizó la prueba de chi-cuadrado,considerando un contraste estadísticamente significativo si p< 0,05. El análisis de datos se hizo con JMP-SAS versión 12,obteniéndose como evidencia que existe asociación entre el grado de severidad de psoriasis y el espesor del grosor de la capa íntima media carotidea, por lo que se pudo predecir la existencia de enfermedad aterosclerótica subclínica(AU)

Psoriasis is a chronic inflammatory skin disease, known as a multi-system disorder. A direct correlation between the thickness of the common carotid artery and the development of future cardiovascular complications has been described in patients with chronic inflammatory diseases. Some studieshave shown a correlation of psoriasis and the developmentof cardiovascular events since they have an increased risk of developing atherosclerotic disease. In Venezuela, cardiovascular diseases are the leading cause of death, and despite the increasing number of patients with psoriasis, no studies have been carriedout to determine the role of psoriasis and coronary artery disease. There fore, the present investigation set out to determine the relationship between the degree of severity of psoriasis and thethickness of the carotid intima media in a group of 20 patientsdiagnosed with psoriasis. Once the information was collected, the chi-square test was performed, considering a statistically significant contrast if p <0.05. The data analysis was done withJMP-SAS version 12, obtaining as evidence that there is anassociation between the degree of severity of psoriasis and the thickness of the thickness of the carotid medial intima layer,so the existence of atherosclerotic disease could be predicted. subclinical(AU)

Prevalence and morphological analysis of the atheromatous plaque in digital panoramic radiograph of a brazilian subpopulation / Prevalencia y análisis morfológico de las placas ateromatosas en radiografías panorámicas digitales de una subpoblación brasileña

This study had as a goal to analyze the prevalence of suggestive images of atheromatous calcification in the common carotid artery, aiming to relate it to age, sex, antimere and to analyze the morphology of its calcification, through digital panoramic radiographs of the jaws. It's an observational, transversal and retrospective study, on which there were analyzed 4.837 radiographs, that came from the files of a dental radiology private service in the city of Cabo de Santo Agostinho-PE, Brazil, referring to the period between 2011-2017. The morphology of the calcified atheromatous plaque was classified in: Grade I ­ normal (plaque not displayed); Grade II ­ intimal thickening; Grade III ­ simple plaque (less than 5mm thick); Grade IV ­ complex plaque (over 5mm thick) and Grade V ­ debris (irregular plaque with moving projections). The data collected was expressed in absolute values and frequency, analyzed through the chi-square, considering p< 0,05. Of the analyzed radiographs, 1.321 filled the eligibility criteria, of these 51 (3,8%0 presented suggestive image of atheromatous plaque, 71% were of the female sex (p = 0,003), 45% were at the age range between 5th and 6th decade of life (p= 0,001), most of the identified plaques were unilateral, to the left (p=0,02) and 76% were morphologically classified as grade III (less than 5mm thick). In this study, it was verified the low prevalence of suggestive images of atheromatous in carotid artery, with greater occurrence on the female sex, between the 5th and 6th decade of life, unilaterally, to the left and morphologically classified in grade III.

Este estudio tuvo como objetivo analizar la prevalencia de imágenes sugerentes de calcificación ateromatosa en la arteria carótida común, con el objetivo de relacionarla con la edad, sexo, antimería y analizar el aspecto morfológico de la calcificación, a través de radiografías panorámicas digitales de los maxilares. Se trata de un estudio observacional, transversal y retrospectivo, en el que se analizaron 4.837 radiografías, provenientes de los archivos de un servicio privado de radiología dental en la ciudad de Cabo de Santo Agostinho-PE, Brasil, referido al período 2011-2017. La morfología de la placa ateromatosa calcificada se clasificó en: Grado I - normal (no aparece placa); Grado II: engrosamiento de la íntima; Grado III: placa simple (menos de 5 mm de espesor); Grado IV: placa compleja (más de 5 mm de grosor) y grado V: Irregular o amorfo (placa irregular con proyecciones móviles). Los datos recolectados se expresaron en valores absolutos y frecuencia, analizados mediante el chi-cuadrado, considerando p <0,05. De las radiografías analizadas, 1.321 cumplieron los criterios de elegibilidad, de estas 51 (3,8% presentaron imagen sugerente de placa ateromatosa, 71% eran del sexo femenino (p = 0,003), 45% estaban en el rango de edad entre 5 y 6a década de la vida (p = 0,001), la mayoría de las placas identificadas eran unilaterales, hacia la izquierda (p = 0,02) y el 76% se clasificaron morfológicamente como grado III (menos de 5mm de espesor). verificó la baja prevalencia de imágenes sugerentes de ateromatosas en arteria carótida, con mayor ocurrencia en el sexo femenino, entre la 5ª y 6ª década de la vida, unilateralmente, hacia la izquierda y clasificadas morfológicamente en grado III.

Two cases treated by different strategies for common carotid artery dissection with thrombosis due to a type a aortic dissection

Abstract Total arch replacement and stent trunk were performed for two patients. One of these underwent a total bilateral carotid artery replacement in anatomical position while the other underwent partial carotid artery dissection. The first patient demonstrated no neurological complication after surgery and a postoperative computed tomography angiography (CTA) showed bilateral common carotid artery patency. However, the second patient had neurological dysfunction after surgery, while a postoperative CTA showed occlusion of the left common carotid artery. Anatomical replacement for a common carotid artery dissection with thrombus has the potential to significantly improve cerebral perfusion and reduce postoperative neurological complications.

Protective effects of adrenomedullin on rat cerebral tissue after transient bilateral common carotid artery occlusion and reperfusion

Abstract Objective: We aimed to investigate the protective effect of adrenomedullin (ADM) on cerebral tissue of rats with cerebral ischemia/reperfusion (I/R) injury. Methods: Thirty-two Wistar rats were randomized into four groups (n=8). In the I/R Group, bilateral common carotid arteries were clamped for 30 minutes and, subsequently, reperfused for 120 minutes. In the ADM Group, rats received 12 µg/kg of ADM. In the I/R+ADM Group, bilateral common carotid arteries were clamped for 30 minutes and, subsequently, the rats received 12 µg/ kg of ADM. Then, reperfusion was performed for 120 minutes. The Control Group underwent no procedure. Blood and brain tissue samples were collected for biochemical and histopathological analysis. Serum malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione peroxidase (GPx) were analysed. Brain tissue was evaluated histopathologically and neuronal cells were counted in five different fields, at a magnification of ×400. Results: Brain MDA in I/R Group was significantly higher than in ADM Group. Brain GPx and SOD in I/R+ADM Group were significantly higher than in I/R Group. The number of neurons was decreased in I/R Group compared to the Control Group. The number of neurons in I/R+ADM Group was significantly higher than in I/R Group, and lower than in Control Group. Apoptotic changes decreased significantly in I/R+ADM Group and the cell structure was similar in morphology compared to the Control Group. Conclusion: We demonstrated the cerebral protective effect of ADM in the rat model of cerebral I/R injury after bilateral carotid artery occlusion.

Feasibility and Applicability of Wireless Handheld Ultrasound Measurement of Carotid Intima-Media Thickness in Patients with Cardiac Symptoms

0.9 between all observers). Receiver operating characteristic curve analysis showed that the predictive power for CAD was improved when max-CIMT and plaque information (plaque≥2) was added [area under the curve (AUC): 0.838] to the traditional clinical CV risk factors (AUC: 0.769). The cutoff values for CAD prediction with the standard device and the WHUS device were 1.05 mm (AUC: 0.807, sensitivity: 0.78, specificity: 0.53) and 1.10 mm (AUC: 0.725, sensitivity: 0.98, specificity: 0.27), respectively.CONCLUSION: max-CIMT measured by a WHUS device showed excellent agreement and repeatability, compared with standard ultrasound. Combined max-CIMT and plaque information added predictive power to the traditional clinical CV risk factors in detecting high-risk CAD patients.

Prevalence of carotid artery calcification detected by digital panoramic radiographs in a sample of yemeni dental patients / Prevalencia de la calcificación de la arteria carótida detectada por radiografías panorámicas digitales en una muestra de pacientes dentales yemeníes

Background: Carotid artery calcification (CAC) is one of risk factors of cardiovascular disorders (CVDs). Digital panoramic radiographs can detect it. Aim of the study: This study aimed to determine the prevalence of CAC detected by digital panoramic radiographs in a sample of Yemeni dental patients. Materials and Methods: An observational and analytical cross-sectional study was used to investigate a convenience sample of 443 patients. These patients were interviewed face-to-face for their socio-demographic information and their medical background regarding CVDs and associated risk factors. The researchers for detection of CAC assessed the digital panoramic radiographs. Results: High income and middle-aged patients were risk factors of CVDs significantly associated with increased incidence of CAC (42 patients (9.5%) and 32 patients (7.2%), respectively). Patients with a previous medical consultation, previous medications and family history of CVDs revealed a significant higher prevalence of CAC (p=0.001). Conclusion: There was an increased prevalence of CAC detected on digital panoramic radiographs, as a risk factor of CVDs. CAC was more common in females than males.

Antecedentes: La calcificación de la arteria carótida (CAC) es uno de los factores de riesgo de enfermedades cardiovasculares (ECV). La CAC puede ser detectada por radiografías panorámicas digitales. Objetivo del estudio: Este estudio tuvo como objetivo determinar la prevalencia de CAC detectada por radiografías panorámicas digitales en una muestra de pacientes dentales yemeníes. Materiales y métodos: Se utilizó un estudio transversal observacional y analítico para investigar una muestra de conveniencia de 443 pacientes. Estos pacientes fueron entrevistados en persona para obtener su información sociodemográfica y sus antecedentes médicos con respecto a las ECV y los factores de riesgo asociados. Los investigadores evaluaron las radiografías panorámicas digitales para detectar CAC. Resultados: Los pacientes de ingresos altos y de mediana edad fueron factores de riesgo de ECV significativamente asociados con una mayor incidencia de CAC (42 pacientes (9,5%) y 32 pacientes (7,2%), respectivamente). Los pacientes con una consulta médica previa, medicamentos previos y antecedentes familiares de ECV revelaron una prevalencia significativamente mayor de CAC (p=0.001). Conclusión: Hubo una mayor prevalencia de CAC detectada en radiografías panorámicas digitales como factor de riesgo de ECV, y CAC fue más común en mujeres que en hombres.

Effect of Ghrelin on Memory Impairment in a Rat Model of Vascular Dementia / 간호학회지

PURPOSE: The purpose of this study was to identify the effect of ghrelin on memory impairment in a rat model of vascular dementia induced by chronic cerebral hypoperfusion. METHODS: Randomized controlled groups and the posttest design were used. We established the representative animal model of vascular dementia caused by bilateral common carotid artery occlusion and administered 80 µg/kg ghrelin intraperitoneally for 4 weeks. First, behavioral studies were performed to evaluate spatial memory. Second, we used molecular biology techniques to determine whether ghrelin ameliorates the damage to the structure and function of the white matter and hippocampus, which are crucial to learning and memory. RESULTS: Ghrelin improved the spatial memory impairment in the Y-maze and Morris water maze test. In the white matter, demyelination and atrophy of the corpus callosum were significantly decreased in the ghrelin-treated group. In the hippocampus, ghrelin increased the length of hippocampal microvessels and reduced the microvessels pathology. Further, we confirmed angiogenesis enhancement through the fact that ghrelin treatment increased vascular endothelial growth factor (VEGF)-related protein levels, which are the most powerful mediators of angiogenesis in the hippocampus. CONCLUSION: We found that ghrelin affected the damaged myelin sheaths and microvessels by increasing angiogenesis, which then led to neuroprotection and improved memory function. We suggest that further studies continue to accumulate evidence of the effect of ghrelin. Further, we believe that the development of therapeutic interventions that increase ghrelin may contribute to memory improvement in patients with vascular dementia.

Availability of end-tidal carbon dioxide on change in stroke volume in spontaneous breathing subjects

OBJECTIVE: Stroke volume (SV) measurements have been used to guide fluid management. Noninvasive, indirect, and convenient measurements of the SV for fluid therapy are required for most patients during spontaneous breathing (SB). On the other hand, the preferred method for an indirect prediction of the SV is unclear. This study examined the best of the indirect and predictable parameters responding to a SV variation during SB. METHODS: Hemodynamic parameters, such as collapsibility of the inferior vena cava (cIVC), peak velocity variation in the common carotid artery (pvvCCA), collapsibility of the internal jugular vein (cIJV), and end-tidal carbon dioxide (ETCO₂) were measured 180 times (6 different positions each in 30 normal subjects). The variables changed with the SV at the upper body elevation of 60°and 30°, in the supine position, at the lower body elevation of 60°and 30°, and lumbar elevation. RESULTS: The SV showed the highest value at 30°of lower body elevation. Following fixed position changes, the ETCO₂ during SB was the factor most correlated with the SV when compared to cIVC, cIJV, and pvvCCA (β coefficient, 2.432 vs. −0.41, −0.033, and −0.654; P=0.004). The adjusted ETCO₂ showed a significant change with the SV, even though the change in ETCO₂ was not large. CONCLUSION: ETCO₂ was less influenced by the SB than cIVC, pvvCCA, and cIJV because the ETCO₂ change was in accordance but the variations of the other blood vessels did not coincide with a SV change. Therefore, ETCO₂ monitoring for predicting the SV would be more important than the variations in the vessels during SB.

The expression and meaning of Hippo signaling pathway in carotid artery ligation induced arterial remodeling model of rats / 中国应用生理学杂志

OBJECTIVE@#To establish an arterial remodeling model of rats and to investigate the expression and role of Hippo signaling pathway in this model.@*METHODS@#In the model group (n=40), the left common carotid artery was removed through the median incision of the neck. The 6-0 non-absorbable line was used to ligate the carotid artery near the proximal end as far as possible, completely blocking the blood flow. The common carotid artery of rats in control group (n=20) was not ligated using the operative line. After 14 days, the animals were sacrificed and the common carotid arteries were separated through the original surgical pathway and the arteries from the ligature to the distal end were collected. Arterial morphology and fibrosis were observed by HE and MASSON staining. Immunohistochemical staining was used to detect the expressions of anti-α smooth muscle actin (α-MSA) and proliferating cell nuclear antigen (PCNA) in the carotid artery. Western blot was used to detect the expressions of yes associated protein (YAP), transcriptional coactivator with PDZ-binding motif (TAZ), TEAD1, Bcl-2-like protein 4 (Bax), and B-cell lymphoma-2 (Bcl-2).@*RESULTS@#Compared with the control group, the HE staining showed that the vascular remodeling was obvious, the ratio of the neointima/middle membrane was increased significantly, and the MASSON staining indicated that the fibrosis was significantly increased in model group. The immunohistochemical staining suggested that the expressions of α-SMA and PCNA were increased significantly; Western blot suggested that the expressions of YAP, TAZ, TEAD1, and Bcl-2 were increased in carotid artery of the model group. While the expression of Bax and the ratio of Bax/Bcl-2 were decreased.@*CONCLUSION@#A rat model of arterial remodeling mediated by carotid artery ligation was established successfully in this study. Hippo signaling pathway was proved to be activated in the arterial remodeling model induced by carotid artery ligation in rats, and might regulate the change of Bax/Bcl-2 ratio related to proliferation and apoptosis, and subsequently involved in the proliferation of smooth muscle cells to promote vascular remodeling.

Differences of brain pathological changes and cognitive function after bilateral common carotid artery occlusion between Sprague-Dawley and Wistar rats / 生理学报

The aim of the present study was to investigate the differences of the pathological changes and cognitive function after bilateral common carotid artery occlusion (BCCAO) between Sprague-Dawley (SD) and Wistar rats. Male SD and Wistar rats were randomly divided into 2 groups, respectively: sham operated (S-sham and W-sham) and operated (S-BCCAO and W-BCCAO) groups. The survival rate and the rate of loss of pupillary light reflex (PLR) were observed on day 1, 3, 7, 14 and 28 after the operation, and the light-dark box, Y-maze and odor recognition tests were performed to detect cognitive function on day 28 after the operation. HE and Luxol fast blue staining were used to observe the pathological changes of gray matter (hippocampus), white matter (optical tract), optic nerve, and retina. The results showed that the survival rate of the W-BCCAO group was 62.5%, and PLR loss rate was 100%; whereas the survival rate of the S-BCCAO group was 100%, and PLR loss rate was 58.3%. In the W-BCCAO group, percentages of time spent and distance traveled in the light box were more than those in the W-sham group, but there was no statistical significance between the S-BCCAO and S-sham groups. In the S-BCCAO group, the percentages of time spent and distance traveled in the III arm (labyrinth arm) of the Y-maze were less than those in the S-sham group, but no statistical significance was found between the W-BCCAO group and W-sham group. In the S-BCCAO group, the discrimination ratio of the odor recognition task was less than that in the S-sham group, but no statistical significance could be seen between the W-BCCAO and W-sham groups. Ischemic injury was observed in the CA1 area of the hippocampus in the S-BCCAO group, but no readily visible damage was observed in the W-BCCAO group. Ischemic injury of the visual beam and optic nerve was observed in both the S-BCCAO and W-BCCAO groups. Compared with the corresponding sham groups, the S-BCCAO and W-BCCAO groups showed serious retinal damage with significant thinner retina. The ganglion cell layer (GCL), inner plexiform layer (IPL), and outer plexiform layer (OPL) were thinner in the S-BCCAO group, but no statistical significances were shown in the other layers. All the layers, except the outer nuclear layer (ONL), were significantly thinner in the W-BCCAO group. The results indicate that there are differences of the pathological changes in the hippocampus and visual conduction pathway after BCCAO between SD and Wistar rats, and the degree of learning and memory injury was also different, which suggests that the vascular dementia model of different rat strains should be selected according to research purpose.

Cerebral hyper perfusion syndrome after carotid artery stenting / 北京大学学报(医学版)

OBJECTIVE@#To explore the risk factors, clinical characteristics, precaution and treatment of hyper perfusion syndrome (HPS) after carotid artery stenting (CAS).@*METHODS@#From September 2014 to March 2018, the clinical data of 226 patients with severe carotid stenosis (70%-99%) treated with carotid artery stenting (CAS)at Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, were analyzed retrospectively．Five of them developed HPS after CAS．The relationship between the clinical baseline data, imaging characteristics, perioperative management and HPS were assessed.@*RESULTS@#In this group, 5 patients of them (2.21%, 5/226) developed HPS after CAS, and 2 patients of them (0.88%, 2/226) were hyper perfusion induced intracranial hemorrhage (HICH). The 5 patients consisted of 4 men and 1 woman whose age ranged from 58 to 74 years. The symptoms of HPS occurred within 4 hours to 3 days after CAS. Among the 5 cases, the clinical manifestations were that 2 cases with headache, 1 case with delirium,1 case with hemiparesis of left limbs, and 1 case with coma(died ultimately).The main manifestations of case 1 and case 2 were headache in the frontal parietal temporal region of the operative side, accompanied by nausea and vomiting. The symptoms were relieved after blood pressure lowering treatment and mannitol dehydration. The main manifestations of case 3 were excitement and delirium. The symptoms were relieved by a small dose of sedatives, also with blood pressure lowering treatment and mannitol dehydration. The initial symptoms of case 4 were excitement and delirium, accompanied by mild headache of the operative side, and hemiplegia of the contralateral limb occurred within a short time. The main manifestation of case 5 was severe headache and went into deep coma within a short time. This patient died of massive cerebral hemorrhage ultimately.@*CONCLUSION@#HPS is an uncommon but serious complication after CAS. Improving our understanding and heightening vigilance of HPS is necessary. The earlier diagnosis, the earlier treatment.

Neuroprotective effects of erythropoietin on rat retinas subjected to oligemia

OBJECTIVES: Erythropoietin may have neuroprotective potential after ischemia of the central nervous system. Here, we conducted a study to characterize the protective effects of erythropoietin on retinal ganglion cells and gliotic reactions in an experimentally induced oligemia model. METHODS: Rats were subjected to global oligemia by bilateral common carotid artery occlusion and then received either vehicle or erythropoietin via intravitreal injection after 48 h; they were euthanized one week after the injection. The densities of retinal ganglion cells and contents of glial fibrillary acidic protein (astrocytes/Müller cells) and cluster of differentiation 68 clone ED1 (microglia/macrophages), assessed by fluorescence intensity, were evaluated in frozen retinal sections by immunofluorescence and epifluorescence microscopy. RESULTS: Retinal ganglion cells were nearly undetectable one week after oligemia compared with the sham controls; however, these cells were partially preserved in erythropoietin-treated retinas. The contents of glial fibrillary acidic protein and cluster of differentiation 68 clone ED1, markers for reactive gliosis, were significantly higher in retinas after bilateral common carotid artery occlusion than those in both sham and erythropoietin-treated retinas. CONCLUSIONS: The number of partially preserved retinal ganglion cells in the erythropoietin-treated group suggests that erythropoietin exerts a neuroprotective effect on oligemic/ischemic retinas. This effect could be related to the down-modulation of glial reactivity, usually observed in hypoxic conditions, clinically observed during glaucoma or retinal artery occlusion conditions. Therefore, glial reactivity may enhance neurodegeneration in hypoxic conditions, like normal-tension glaucoma and retinal ischemia, and erythropoietin is thus a candidate to be clinically applied after the detection of decreased retinal blood flow.

Linfonodos do nível VI: estudo anatômico dos linfonodos localizados entre o nervo laríngeo recorrente e a artéria carótida comum direita / Level VI lymph nodes: an anatomic study of lymph nodes located between the recurrent laryngeal nerve and the right common carotid artery

RESUMO Objetivo: descrever a presença de linfonodos e suas relações com características demográficas e antropométricas em uma região específica ainda não descrita pelos compêndios de anatomia, por nós denominada de Recesso Carotídeo Recorrencial (RCR), localizada entre o nervo laríngeo recorrente direito, a artéria carótida comum direita e a artéria tireoidea inferior direita. Métodos: foram dissecadas 32 regiões cervicais à direita de cadáveres com até 24 horas de post mortem. O tecido fibrogorduroso do RCR foi ressecado e preparado com fixação em formol. Em seguida, foi submetido a uma sequência crescente de álcoois (70%, 80% e 90%), posteriormente a uma solução de Xilol e, por fim, a uma solução de Salicilato de Metila, respeitando o tempo necessário de cada etapa. O estudo macroscópico foi realizado na peça diafanizada, observando a presença ou não de linfonodos. Quando presentes, foram fotografados e suas medidas foram aferidas com um paquímetro digital. No estudo microscópico, foi utilizada a coloração hematoxilina-eosina para confirmação do linfonodo. Resultados: observou-se a presença de linfonodos em 22 dos 32 espécimes (68,75%), com o número de linfonodos por cadáver variando de zero a seis (média de 1,56±0,29) e tamanho com média de 7,82mmx3,86mm (diâmetros longitudinal x transversal). Conclusão: a relação entre dados antropométricos e presença de linfonodos no RCR (teste exato de Fischer) foi significante para indivíduos normolíneos (p=0,03) e também significante entre a etnia branca (p=0,04).

ABSTRACT Objective: to describe the presence of lymph nodes and their relationships with demographic and anthropometric characteristics in a specific region, not yet described in anatomy compendiums, called by us Recurrent Carotid Recess (RCR) and located among the right recurrent laryngeal nerve, the right common carotid artery, and the right inferior thyroid artery. Methods: 32 right cervical regions were harvested from cadavers within 24 hours post-mortem. The fibro-fatty tissue of the RCR was resected and prepared with formalin fixation. It was then subjected to an increasing sequence of alcohols (70%, 80%, and 90%), subsequently to a solution of Xylol, and finally to a solution of Methyl Salicylate, respecting the time required for each step. The macroscopic study was carried out on the diaphanized piece, observing the presence or not of lymph nodes. When present, they were photographed and their measurements were gauged with a digital caliper. In the microscopic study, hematoxylin-eosin staining was used to confirm the lymph node. Results: the presence of lymph nodes was observed in 22 (68.75%) of the 32 specimens. The number of lymph nodes ranged from zero to six (mean of 1.56±0.29), per cadaver, and their mean size was 7.82mmx3.86mm (longitudinal x transversal diameters). Conclusion: the relationship between anthropometric data and presence of lymph nodes in the RCR (Fisher's exact test) was significant for medium-height individuals (p=0.03) and also white ones (p=0.04).

Preliminary study on application of augmented reality visualization in robotic thyroid surgery

PURPOSE: Increased robotic surgery is attended by increased reports of complications, largely due to limited operative view and lack of tactile sense. These kinds of obstacles, which seldom occur in open surgery, are challenging for beginner surgeons. To enhance robotic surgery safety, we created an augmented reality (AR) model of the organs around the thyroid glands, and tested the AR model applicability in robotic thyroidectomy. METHODS: We created AR images of the thyroid gland, common carotid arteries, trachea, and esophagus using preoperative CT images of a thyroid carcinoma patient. For a preliminary test, we overlaid the AR images on a 3-dimensional printed model at five different angles and evaluated its accuracy using Dice similarity coefficient. We then overlaid the AR images on the real-time operative images during robotic thyroidectomy. RESULTS: The Dice similarity coefficients ranged from 0.984 to 0.9908, and the mean of the five different angles was 0.987. During the entire process of robotic thyroidectomy, the AR images were successfully overlaid on the real-time operative images using manual registration. CONCLUSION: We successfully demonstrated the use of AR on the operative field during robotic thyroidectomy. Although there are currently limitations, the use of AR in robotic surgery will become more practical as the technology advances and may contribute to the enhancement of surgical safety.