Extra corporeal membrane oxygenation support for neonatal vein of Galen aneurysmal malformation: Case report.

BACKGROUND: The vein of Galen aneurysm (VGAM) is the most common type of arteriovenous malformation in the neonate. These neonates commonly present with high output cardiac failure that may be associated with pulmonary hypertension. The medical management and stabilization of these neonates can be challenging before staged transarterial embolization of the aneurysm is undertaken. CASE: A 2.34 kilogram neonate, antenatally diagnosed to have VGAM, was born at 36 weeks of gestation for fetal distress. The neonate failed to respond to medical management including inotropes, high frequency mechanical ventilation and inhaled nitric oxide. The patient's high-output heart failure and persistent pulmonary hypertension were stabilized with veno-arterial extra-corporeal membrane oxygenation (VA-ECMO) using central cannulation. Further transarterial staged embolization of the VGAM was undertaken on VA-ECMO support. CONCLUSION: There may be a role of VA-ECMO using central cannulation to optimize management of high output cardiac failure and persistent pulmonary hypertension in neonatal VGAM patients who fail medical management to facilitate staged transarterial embolization of the VGAM.

High-intensity interval training improved fasting blood glucose and lipid profiles in type 2 diabetic rats more than endurance training; possible involvement of irisin and betatrophin.

BACKGROUND AND AIMS: In this study, we aimed to investigate the effects of 10 weeks of high-intensity interval training (HIIT) and endurance training (END) on irisin, betatrophin, insulin, fasting blood glucose (FBG) concentrations, and lipid profiles in diabetic rats. METHODS: Twenty-four Wistar rats (weight: 200-250 g) were randomly assigned into four groups as follows: (1) control (Cnt), (2) diabetic (Dibt), (3) diabetic HIIT (Dibt-HIIT), and (4) diabetic END (Dibt-END). For inducing diabetes, after 12 h of food starvation, nicotinamide (120 mg/kg) and streptozotocin (STZ; 65 mg/kg) were intraperitoneally injected. The diabetic training groups received 10 weeks of HIIT or END training following the induction of diabetes. Twenty-four hours following the last training session, blood serum samples were collected for evaluating the concentration of irisin, betatrophin, and insulin hormones through enzyme-linked immunosorbent assay. RESULTS: FBG and lipid profiles were measured by biochemical kits. A significant increase in the serum concentration of irisin (p < 0.05), betatrophin (p < 0.05), and insulin (p < 0.001) and significant decrease in the FBG (P < 0.01) and lipid profiles (p < 0.01) were observed in the Dibt-HIIT group compared to the Dibt-END group. In addition, irisin revealed a significant positive association with betatrophin and insulin values in diabetic training groups (p < 0.01). CONCLUSIONS: It seems that HIIT leads to a more extensive improvement in diabetic conditions compared to the END training. Therefore, HIIT appears to be an important time-efficient approach for the treatment of type 2 diabetes.

Peripheral tissue oxygenation and the number of organs transplanted per donor.

Current donor management practices target macrohaemodynamic parameters, but it is unclear if this leads to improvements in microvascular perfusion and tissue oxygenation; the latter may have more impact on organ status. In a recent preclinical study we determined that brain death impaired tissue perfusion and oxygen utilisation in swine while pharmacologic correction of these deficits improved organ function and reduced markers of tissue injury. As a first step in translating the preclinical findings, we conducted a prospective observational study to determine if there was an association between peripheral tissue oxygenation (measured by near-infrared spectroscopy) in deceased by neurological criteria human donors and the number of organs transplanted. In 60 donors, the mean time-weighted average of tissue oxygenation was 87.5% (standard deviation, SD, 5.2%) and the average number of organs transplanted was 3.5 (SD 2); there was a positive linear relationship between these two parameters. A 5% rise in tissue oxygenation was associated with an increase of 0.47 organs transplanted (95% confidence intervals 0.16 to 0.78) after adjusting for age (P=0.004). No such correlations were observed for the macrohaemodynamic or macro-oxygenation parameters (including arterial blood oxygenation). The results of this clinical trial are consistent with our preclinical work and support the postulate that targeting the microvasculature to improve tissue perfusion and tissue oxygen delivery in human donors has the potential to increase the quantity of organs suitable for transplant.

CREB controls cortical circuit plasticity and functional recovery after stroke.

Treatments that stimulate neuronal excitability enhance motor performance after stroke. cAMP-response-element binding protein (CREB) is a transcription factor that plays a key role in neuronal excitability. Increasing the levels of CREB with a viral vector in a small pool of motor neurons enhances motor recovery after stroke, while blocking CREB signaling prevents stroke recovery. Silencing CREB-transfected neurons in the peri-infarct region with the hM4Di-DREADD blocks motor recovery. Reversing this inhibition allows recovery to continue, demonstrating that by manipulating the activity of CREB-transfected neurons it is possible to turn off and on stroke recovery. CREB transfection enhances remapping of injured somatosensory and motor circuits, and induces the formation of new connections within these circuits. CREB is a central molecular node in the circuit responses after stroke that lead to recovery from motor deficits.

The effect of inhalational anaesthesia during deceased donor organ procurement on post-transplantation graft survival.

Many deceased by neurologic criteria donors are administered inhalational agents during organ recovery surgery-a process that is characterised by warm and cold ischaemia followed by warm reperfusion. In certain settings, volatile anaesthetics (VA) are known to precondition organs to protect them from subsequent ischaemia-reperfusion injury. As such, we hypothesised that exposure to VA during organ procurement would improve post-graft survival. Lifebanc (organ procurement organisation [OPO] for NE Ohio) provided the investigators with a list of death by neurologic criteria organ donors cared for at three large tertiary hospitals in Cleveland between 2006 and 2016-details about the surgical recovery phase were extracted from the organ donors' medical records. De-identified data on graft survival were obtained from the United Network for Organ Sharing (UNOS). The collated data underwent comparative analysis based on whether or not VA were administered during procurement surgery. Records from 213 donors were obtained for analysis with 138 exposed and 75 not exposed. Demographics, medical histories, and organ procurement rates were similar between the two cohorts. For the primary endpoint, there were no significant differences observed in either early (30-day) or late (five-year) graft survival rates for kidney, liver, lung, or heart transplants. Our findings from this retrospective review of a relatively small cohort do not support the hypothesis that the use of VA during the surgical procurement phase improves graft survival. Reviews of larger datasets and/or a prospective study may be required to provide a definitive answer.

A survey of the incidence of dyslipidemia and its components in people over 20 years old in Ahvaz: A cohort study 2009-2014.

INTRODUCTION: Dyslipidemia is one of the major risk factors for atherosclerosis and the main cause of death in the developing and developed countries. In this cohort study, the incidence of dyslipidemia and its components have been studied among individuals over 20 years old in Ahvaz, southwest of Iran. MATERIALS AND METHODS: The Phase 1 of this study was conducted on the prevalence of Metabolic syndrome and its related factors by Diabetes Research Center in 2009. The target population included individuals over 20 years old who were selected using cluster sampling in Ahvaz health centers. In the second phase of the study, 5 years later in 2014, subjects were again recalled by health centers. Questionnaires, anthropometric indices and measurements were repeated similar to Phase 1. The blood sample was taken from everyone after 12h of fasting and then the factors (Chol, TG, HDL) were measured. RESULTS: The cumulative incidence of dyslipidemia obtained 60.7% (males 56.7% and females 64.8%). lipid profile {HDL, Triglycerides and Cholesterol had changes in their means(a significant reduction in the mean about 10, 22.25 and 13 units respectively) between baseline and 5 years later. Waist circumference here associated with incidence of high LDL and high chol, also sex and High LDL 'educational level and daily consumption of vegetables were associated with incidence of low HDL and dyslipidemia respectively. CONCLUSION: Age, educational level and daily intake of fruits and vegetables were effective variables on incidence of dyslipidemia. According to various studies, LDL and HDL levels in different regions of Iran, seems to be influenced by factors such as climate, nutrition and activity levels.

Prevalence, awareness and risk factors of diabetes in Ahvaz (South West of Iran).

INTRODUCTION: This study was designed to assess the prevalence of diabetes in people aged over 20 years in Ahvaz, Iran. MATERIALS AND METHODS: The study population was chosen by cluster sampling. A checklist included: age, sex, weight, height, blood pressure, waist circumference, educational level, smoking status and previous history of diabetes was completed for each patient. Fasting Plasma Glucose (FPG) ≥126mg/dl and/or oral hypoglycemic treatment and/or insulin consumption was defined as diabetes, FPG=100-125mg/dl as Impaired Fasting Glucose (IFG) and FPG <100mg/dl as normal. RESULTS: Study population was 944 persons. Mean age of population was 42.2±14 years. Diabetes was detected in 15.1% of population. Only 40.4% of cases were aware of their disease. Diabetes was detected in 14.7% of female and 15.7% of male participants. Diabetes was related to age, waist circumference, family history of diabetes, hypertension, waist to hip ratio, educational level, marital status, serum triglyceride, cholesterol and body mass index (BMI) in both genders. But by using logistic regression analysis, age, family history of diabetes, hypertension, hypertriglyceridemia, and marital status had significant effect on diabetes. CONCLUSION: This study showed that using FPG criteria or current medication 15.1% of this population had diabetes and about 60% of patients were unaware of their disease. Age, hypertension, family history of diabetes, hypertriglyceridemia and marital status are the risk factors of diabetes in Ahvaz population. IFG have high prevalence and diabetes screening should be intensified in this population.

Do spinal cord-injured individuals with stronger sense of coherence use different psychological defense styles?

OBJECTIVES: Although the importance of sense of coherence (SOC) and psychological defense mechanisms (PDMs) in the process of coping has been demonstrated, it has not yet been clarified whether individuals with stronger SOC use specific PDMs. STUDY DESIGN: Cross-sectional. SETTING: Iran. METHODS: Demographic and injury-related variables including injury level, time since injury, American Spinal Cord Association (ASIA) Scale and Spinal cord independence measure-III were collected among individuals with spinal cord injury (SCI). SOC was assessed by the Short-form Sense of Coherence Scale. PDMs were identified using 40-version of the Defense Style Questionnaire. RESULTS: Neurotic defense style was the most commonly used style especially. The overall most commonly used PDM was 'rationalization', which was used by 95%. Individuals with stronger SOC used more mature style (P=0.001, r=0.52), particularly 'humor' and 'suppression' mechanisms (P<0.0001 and 0.024, respectively). There was a negative correlation between stronger SOC and the use of immature defenses including passive aggression (P=0.001, r=-0.51), acting out (P=0.001, r=-0.48), isolation (P=0.009, r=-0.50), autistic fantasy (P=0.010, r=-0.30) and somatization (P<0.0001, r=-0.62). Married individuals had significantly stronger SOC (P=0.01). Age, gender, age at the time of injury incidence, time since injury, ASIA score and cause of injury were not determinants of SOC. CONCLUSION: In this study, PDMs, which are more probable to be used by individuals with stronger SOC, have been identified. Mature defenses including 'humor' and 'suppression' are used by stronger SOC more often, whereas immature mechanisms are less likely to be used.

Comparison of the efficacy and safety of zinc sulfate vs. placebo in the treatment of pruritus of hemodialytic patients: a pilot randomized, triple-blind study.

AIM: Improvement of uremic pruritus has been reported under short-term administration of oral zinc sulfate. Objective of the study was to confirm efficacy and safety of oral zinc sulfate in pruritus of hemodialytic patients METHODS: A pilot randomized, triple-blind study was conducted to evaluate the pruritus of hemodialytic patients. Forty eligible patients were screened and assigned to receive either zinc sulfate (220 mg/d) or matched placebo for a 4-week trial. Pruritus scale was evaluated at the initiation of the study and 1, 2, 3, and 4 weeks after the treatment. We used a modified score proposed by Duo assessing pruritus severity, distribution of pruritus, and frequency of pruritus-related sleep disturbance. RESULTS: Thirty-six patients completed the study. The mean pruritus score decreased in both groups during the first and the second weeks of trial; however, it was more prominent in zinc group than placebo one. In the zinc group, 4 (20%) patients showed pruritus discontinuation during treatment period whereas, in the placebo group, the number was only 1 (5%) patient. Nonetheless, T-test revealed no statistically significant difference between the zinc and placebo groups (P=0.88 and P=0.56, respectively). CONCLUSION: Our findings demonstrated that oral zinc sulfate (220 mg/d) during four weeks treatment might be safe and effective in discontinuation of uremic pruritus, but it was not significant. This could be because of the small number of patients; therefore, we suggest conducting more studies with larger sample size.

Does consumption of polyunsaturated fatty acids influence on neurorehabilitation in traumatic spinal cord-injured individuals? A double-blinded clinical trial.

STUDY DESIGN: A double-blinded randomized clinical trial. OBJECTIVES: The anti-inflammatory and neuroprotective effect of omega-3 fatty acids have been shown so far, but still its influence on clinical measures in spinal cord-injured human models were not known. We tried to investigate changes in disability and dependency scores in chronic traumatic spinal cord-injured patients after 14 months of ω-3 fatty-acid consumption. METHODS: Main inclusion criteria were: traumatic spinal cord injury (SCI) and post injury duration longer than 1 year. Disability and dependency was assessed using U.K Functional Independence Measure and Functional Assessment Measure (FIM+FAM) scale. MorDHA capsules (435 mg of docosahexaenoic acid and 65 mg of eicosapentaenoic acid) were administered in treatment group, whereas control group received placebo capsules for 14 months. U.K. FIM+FAM scale were estimated before intervention and at the end of the trial. RESULTS: Fifty-four patients in treatment group and 50 patients in placebo group completed the trial. Highest scores were detected in cognitive domain in both groups before and after intervention. Most dependency was observed in locomotion subscale and secondly in sphincter control. Scores of none of these components were changed by ω-3 fatty-acid consumption. CONCLUSION: Although omega-3 fatty acids have been shown to have neuroprotective effect in acute phase of SCI, it seems that they have no significant influence in chronic inflammatory state of SCI. The positive effect of ω-3 fatty acid in chronic neurorecovery process, if exists, is weaker to exert any significant improvement in UK FIM+FAM scores in spinal cord-injured individuals.

Changes of leptin concentration in plasma in patients with spinal cord injury: a meta-analysis.

OBJECTIVE: The aim of this study was to investigate changes of leptin concentration in plasma in patients with spinal cord injury to come to a single concept by using a Meta-analysis. SETTING: Systematic Review. METHODS: Searching relevant articles was performed in Ovid data base, Medline (PubMed) EMBASE, Google Scholar, Cochrane and Scopus up to February 2013. Five articles were selected using two independent reviewers. Analysis were performed using SPSS version 18 and Comparative Meta-analysis software version 2.0. RESULTS: The combined analysis with confidence interval of 95% using comprehensive meta-analysis showed significant higher leptin levels in patients with spinal cord injury in comparison with able bodies (P<0.0001). The effect of spinal lesion level on plasma leptin concentration was also statistically significant (P<0.0001). Body mass index was positively related to plasma leptin concentration in both groups (P<0.0001). CONCLUSION: This Meta analysis approves increased level of leptin in spinal cord injured patients which can be due to fat distribution changes and sympathetic dysfunction in these patients. Our results also showed that patients with higher spinal lesion level have higher plasma leptin concentration.

Comparison of changes in postprandial serum leptin between healthy and type 2 diabetic individuals.

INTRODUCTION: Leptin resistance may be intensified by insulin resistance. This vicious cycle between insulin resistance and leptin resistance may increase feelings of hunger and reduce energy expenditure and ultimately increase obesity. In this study, postprandial changes in leptin, insulin and glucose were compared between healthy subjects and patients with Type 2 diabetes mellitus (DM). METHODS: Six men with Type 2 DM and seven healthy men (matched for age and body mass index), after 12 hours of fasting, ate the same Iranian meal (chelo kebab kobibeh) consisting of 46% carbohydrate, 21% protein, 33% fat and 743 kcal energy. Blood samples were obtained before and 1, 2 and 4 hours after the meal, and serum leptin, insulin and glucose levels were measured. The area under incremental curve (AUIC) computed using the Trapezoidal method with fasting values was deducted from each time point, yielding net postprandial changes. RESULTS: Leptin levels at the first hour were significantly reduced in both groups and then increased at the second and fourth hours after the meal, although not reaching fasting values in the diabetic group at the 4th hour. AUIC for leptin was significantly lower in the diabetic group (p = 0.023). Despite high levels before the meal, the early increase in insulin in the diabetic group was lower and declined more slowly than in the healthy group. The incremental area under the insulin curve was significantly lower in the control group than in the diabetic group (p = 0.006). CONCLUSION: It appears that an increased leptin level two hours after the meal is due to increased serum insulin and glucose levels. Leptin AUIC after meals in people with Type 2 DM is lower than in healthy people and may be due to decreased responsiveness to insulin in adipocytes because of insulin resistance.

Apple cider vinegar attenuates lipid profile in normal and diabetic rats.

In this study, the effect of apple cider vinegar on Fasting Blood Glucose (FBG), glycated haemoglobin (HbA1c) and lipid profile in normal and diabetic rats was investigated. Diabetes was induced in male Wistar rats (300+/-30 g) by the intraperitoneal injection of streptozotocin (60 mg kg(-1) of body weight). Both normal and diabetic animals were fed with standard animal food containing apple cider vinegar (6% w/w) for 4 weeks. Fasting blood glucose did not change, while HbA1c significantly decreased by apple cider vinegar in diabetic group (p<0.05). In normal rats fed with vinegar, significant reduction of low density lipoprotein-cholesterol (LDL-c) (p<0.005) and significant increase of high density lipoprotein-cholesterol (HDL-c) levels (p<0.005) were observed. Apple cider vinegar also reduced serum triglyceride (TG) levels (p<0.005) and increased HDL-c (p<0.005) in diabetic animals. These results indicate that apple cider vinegar improved the serum lipid profile in normal and diabetic rats by decreasing serum TG, LDL-c and increasing serum HDL-c and may be of great value in managing the diabetic complications.

The genotoxicity study of garlic and pasipy herbal drops by peripheral blood micronucleus test.

The in vivo rodent micronucleus test is widely used as a genotoxic assay to detect the clastogenic activity of chemicals. In this research the genotoxic effects of herbal drops of garlic and pasipy were evaluated using the micronucleus test. Maximum Tolerated Dose (MTD) was determined by a dose-response test. For each medicine three treatment groups were considered with doses of MTD, 1/2 MTD and 1/4 MTD according to the CSGMT protocol (1995 Japan). Drugs were administered orally to mice (test groups). Mitomicin C was used as a known genotoxic agent in positive control group. The peripheral blood samples before treatment (zero time samples) were considered as negative control. The appearance of a micronucleus is used as an index for genotoxic potential. The results obtained indicated that the herbal drops showed genotoxicity effect and it was dose-dependent compared to the negative control group. This genotoxicity was significant (p < 0.05) but the genotoxic effects of garlic and pasipy were "not significant" compared to the historical negative control group (p > 0.05). Therefore our results if compared to the negative control group is significant and it is worthy of consideration.

Pharmacology of inotropic agents in infants and children.

Inotropic agents are drugs which increase the stroke work of the heart at a given pre-load and after-load. All of these agents work through a final common pathway involving the modulation of calcium interactions with various myocardial contractile proteins. The agents employed with pediatric patients include the cardial glycosides, catecholamine beta-agonists and the selective phosphodiesterase III inhibitors. Digoxin is the prototypic cardiac glycoside which has a long history of safe and effective use in infants and children. Its utility in improving right ventricular dysfunction in patients with cor pulmonale leading to biventricular dysfunction makes it ideally suited to the pediatric population. Monitoring digoxin pharmacokinetics in infants is confounded by the presence of an endogenous digoxin-like substance. Nevertheless, the drug is well suited for subacute and chronic myocardial support. In contrast, the catecholamines are the drugs of choice for acute intervention. Their pharmacokinetics permit rapid dosing titration. In infants and children the greatest experience has been accrued with dopamine, a mixed alpha- and beta-agonist but both epinephreine and norepinephrine are being used with increasing frequency as the need for drugs with increased potency and pressor activity becomes more common. The phosphodiesterase inhibitors amrinone and milrinone are the newest additions to our therapeutic armamentarium. In addition to their modest inotropic effects, amrinone and to a greater extent, milrinone offer significant pulmonary vasodilatation as part of their therapeutic package. These effects occur with little or any impact on myocardial oxygen consumpton while their lusitropic effects enhance relaxation in hypertrophied ventricular muscle. Of the two agents milrinone is probably preferred due to its greater therapeutic index and shorter elimination half-life. All of these agents remain important tools in the care of critically ill infants and children. The rational use of these drugs based upon their pharmacokinetic and pharmacodynamic properties is essential to achieve their optimal effects.