Vascular endothelial growth factor overexpression does not enhance adipose stromal cell-induced protection on muscle damage in critical limb ischemia.

OBJECTIVES: Critical limb ischemia complicates peripheral artery disease leading to tissue damage and amputation. We hypothesized that modifying adipose stromal cells (ASCs) to overexpress human vascular endothelial growth factor 165 (VEGF) would limit ischemic muscle damage to a larger extent than nonmodified ASCs. APPROACH AND RESULTS: Rabbits with critical hindlimb ischemia were injected with allogeneic abdominal fat-derived ASCs transfected with plasmid-VEGF165 (ASCs-VEGF; n=10). Additional rabbits received nontransfected ASCs (ASCs; n=10) or vehicle (placebo; n=10). One month later, ASCs-VEGF rabbits exhibited significantly higher density of angiographically visible collaterals and capillaries versus placebo (both P<0.05) but not versus ASCs (both P=NS). Arteriolar density, however, was increased in both ASCs and ASCs-VEGF groups (both P<0.05 versus placebo). ASCs-VEGF and ASCs showed comparable post-treatment improvements in Doppler-assessed peak systolic velocity, blood pressure ratio, and resistance index. Ischemic lesions were found in 40% of the muscle samples in the placebo group, 19% in the ASCs-VEGF group, and 17% in the ASCs groups (both P<0.05 versus placebo, Fisher test). CONCLUSIONS: In a rabbit model of critical limb ischemia, intramuscular injection of ASCs genetically modified to overexpress VEGF increase angiographically visible collaterals and capillary density. However, both modified and nonmodified ASCs increase arteriolar density to a similar extent and afford equal protection against ischemia-induced muscle lesions. These results indicate that modifying ASCs to overexpress VEGF does not enhance the protective effect of ASCs, and that arteriolar proliferation plays a pivotal role in limiting the irreversible tissue damage of critical limb ischemia.

Anticoagulantes e bloqueios do neuroeixo / Anticoagulants and neuraxial blockade

O número de pacientes em uso de fármacos anticoagulantes ou que alteram a hemostasia tem aumentado em virtude da maior expectativa de vida da população, do advento de medicamentos mais seguros e do aumento na prevalência de doenças cardiovasculares. A anestesia por bloqueio do neuroeixo quando realizada nesses pacientes traz o risco de sangramento e hematoma espinhal. Apesar da incidência estimada de complicações hemorrágicas associadas a bloqueios neuroaxiais ser baixa, além de imprecisa, a gravidade de suas consequências torna imperativo o desenvolvimento de estratégias que aumentem a segurança no procedimento anestésico desses pacientes. Entretanto, as recomendações baseadas em evidências são fracas, pois se baseiam principalmente em relatos de casos, pequenos estudos e farmacocinética das drogas. Neste artigo, revisamos a literatura sobre técnicas neuroaxiais realizadas em pacientes em uso de drogas anticoagulantes e/ou que alteram a hemostasia, com o objetivo de auxiliar o anestesiologista no manejo mais seguro e de qualidade para os pacientes.

The number of patients using anticoagulants or drugs that alter hemostasis has increased because of increased life expectancy, advent of safer medicines, and increased prevalence of cardiovascular diseases. In these patients, anesthesia by neuraxial blockade brings the risk of bleeding and spinal hematoma. Despite the estimated incidence of hemorrhagic complications associated with neuraxial blockade being low and inaccurate, the gravity of its consequences makes the development ofstrategies that increase the safety in the anesthetic procedures in these patients imperative. However, evidence-based recommendations are weak because they are based primarily on case reports, small studies, and drugs pharmacokinetics. In this article, we reviewed the literature on neuraxial techniques performed in patients using anticoagulant drugs, and/or those that alter hemostasis, with the objective of assisting the anesthesiologist to improve the quality and safety in these patients? management.

Prevalência e fatores associados à enxaqueca nos estudantes da Faculdade de Medicina de Barbacena, MG - Brasil / Prevalence and factors associatedwith migraine in the students of theFaculty of Medicine of Barbacena, MG – Brazil

Introdução: a migrânea é tipo de cefaleia presente em 15 a 25% da população, sendo descritos vários fatores a ela associados e seu mecanismo primário ainda não foi elucidado.O diagnóstico correto é realizado a partir da aplicação de critérios determinados pela Sociedade Internacional de Cefaleias (SIC). Objetivo: identificar a prevalência de migrânea entre adultos jovens, mediante inquérito sobre cefaleia e fatores associados, entre estudantes de Faculdade de Medicina de Barbacena em Minas Gerais, e estratificação de todos os portadores de cefaleia pelos critérios diagnósticos da SIC. Método: foi aplicado em 420 estudantes um questionário-padrão cujos dados obtidos foram analisados de acordo com os critérios da SIC. Resultados: 90,2% dos entrevistados declararam cefaleia; destes, 8,5% foram classificados como portadores de migrânea. Entre os migranosos, a razão homem/mulher foi de 1:4, 60,6% caracterizaram a dor como latejante/pulsátil e 100% afirmaram duração entre quatro e 72 horas, crises uma ou mais vezes por mês e de intensidade moderada ou forte. Conclusão: a cefaleia foi encontrada em 90,2% dos estudantes, enquanto a migrânea teve prevalência de 8,5%. Os valores encontrados são semelhantes aos dados de trabalhos anteriormente publicados. O presente estudo também mostra que o conhecimento e a aplicação dos critérios diagnósticos da classificação internacional das cefaleias se fazem imprescindíveis para o correto diagnóstico e consequente terapêutica adequada da migrânea.

Introduction: migraine is a kind of headache in 15% to 25% of the Brazilian population. Several factors are associated to migraine, but its primary mechanism has not been elucidated yet. The correct diagnosis is achieved by applying the criteria established by the International Headache Society (IHS). Objective: to identify the prevalence of migraine among young adults through investigation of headache and associated factors among students of the Faculty of Medicine of Barbacena in Minas Gerais, and also stratification of all patients with headache according to criteria of SIC. Material and Methods: a standard questionnaire was applied to 420 students whose data were analyzed according to the criteria of SIC. Results: From the total, 90.2% of the interviewee declared headaches; and from these, 8.5% were classified as migraineurs. Among those with migraine, the female / male ratio was 1:4. A total of 60.6% characterized the pain as throbbing/pulsatile and 100% reported that the pain lasts four and 72 hours, and presented one or more episodes per month of moderate or strong intensity. Conclusion: headache was found in90.2% of the students, while the prevalence of migraine was found in 8.5%. These results are similar to those data previously published. The present study also shows that the knowledge and application of diagnostic criteria of international classification of headache is essential to establish the correct diagnosis and consequently appropriate treatment of migraine.