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Critical ischaemia

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https://www.readbyqxmd.com/read/29786412/the-use-of-scoring-balloons-in-the-superficial-femoral-artery
#1
Simon Bays
Percutaneous transluminal angioplasty and stenting is becoming increasingly the first line treatment for patients with both claudication and critical limb ischaemia instead of surgery, with the aim of returning the patient's quality of life in the former and preventing amputation. Drug eluting technologies have seen a large surge in popularity in recent years, and significant patient benefits have been seen with the use of drug eluting stents and balloons over the use of plain balloon angioplasty. Unfortunately in many patients with arterial disease there is significant vessel wall calcification - this can theoretically be a barrier to drug delivery, and can also be a contributing factor to flow limiting dissection and the subsequent need for bail out stenting...
May 22, 2018: Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/29780895/salvage-procedure-using-a-chimney-endograft-for-early-cerebral-ischaemia-after-hybrid-aortic-arch-repair-of-a-primary-aorto-bronchial-fistula
#2
M Cappelle, V Coppin, H Thieren, G Maleux, I Fourneau
Introduction: Hybrid aortic arch repair for the treatment of aorto-bronchial fistulas has been suggested as a safe alternative to open repair. However, surgical morbidity and mortality are still significant and re-intervention is sometimes inevitable. Report: Successful rescue by a hybrid approach is reported in a 76 year old woman who was transferred from another centre with recurrent episodes of left hemiplegia shortly after debranching of the supra-aortic vessels and thoracic aortic stent grafting for an aorto-bronchial fistula associated with a true aneurysm at the level of origin of the left subclavian artery...
2018: EJVES Short Reports
https://www.readbyqxmd.com/read/29776002/the-chaos-of-hospitalisation-for-patients-with-critical-limb-ischaemia-approaching-major-amputation
#3
Susan Monaro, Sandra West, Jana Pinkova, Janice Gullick
AIMS AND OBJECTIVES: To illuminate the hospital experience for patients and families when major amputation has been advised for critical limb ischaemia (CLI). BACKGROUND: CLI creates significant burden to the health system and the family, particularly as the person with CLI approaches amputation. Major amputation is often offered as a late intervention for CLI in response to the marked deterioration of an ischaemic limb, and functional decline from reduced mobility, intractable pain, infection and/or toxaemia...
May 18, 2018: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/29774532/the-fetus-at-the-tipping-point-modifying-the-outcome-of-fetal-asphyxia
#4
Simerdeep K Dhillon, Christopher A Lear, Robert Galinsky, Guido Wassink, Joanne O Davidson, Sandra Juul, Nicola J Robertson, Alistair J Gunn, Laura Bennet
Brain injury around birth is associated with nearly half of all cases of cerebral palsy. Although brain injury is multifactorial, particularly after preterm birth, acute hypoxia-ischaemia is a major contributor to injury. It is now well established that the severity of injury after HI is determined by a dynamic balance between injurious and protective processes. In addition, mothers who are at risk of premature delivery have high rates of diabetes and antepartum infection/inflammation and are almost universally given treatments such as antenatal glucocorticoids and magnesium sulphate to reduce the risk of death and complications after preterm birth...
May 17, 2018: Journal of Physiology
https://www.readbyqxmd.com/read/29772453/the-roles-of-cypa-and-cd147-in-cardiac-remodelling
#5
REVIEW
Hongyan Su, Yi Yang
Cyclophilin A (CyPA), an abundantly expressed protein belonging to the immunophilin family, is involved in a variety of physiological and pathological activities together with its extracellular receptor, CD147. Many studies have provided compelling evidence supporting critical roles of CyPA in immune and infectious diseases and malignant tumours. Recent studies have revealed that both CyPA and CD147 strongly promote cardiovascular inflammation, myocardial ischaemia-reperfusion injury, and myocardial remodelling processes...
May 14, 2018: Experimental and Molecular Pathology
https://www.readbyqxmd.com/read/29736612/themes-that-determine-quality-of-life-in-patients-with-peripheral-arterial-disease-a-systematic-review
#6
REVIEW
Ahmed Aber, Elizabeth Lumley, Patrick Phillips, Helen Buckley Woods, Georgina Jones, Jonathan Michaels
OBJECTIVES: The aim of this study was to identify domains that determine quality of life in patients with peripheral arterial disease and find the patient-reported outcome measures that can examine the identified themes. METHODS: A systematic review of all the main six databases was undertaken to identify primary qualitative studies reporting on the health and/or quality of life of patients with peripheral arterial disease. The quality of studies was assessed using the Critical Appraisal Skills Program criteria...
May 8, 2018: Patient
https://www.readbyqxmd.com/read/29704386/autologous-mononuclear-cells-from-different-sources-are-seen-to-improve-wound-healing-in-patients-with-haematological-malignancies
#7
W F Wan Jamaludin, F Mohamad Yusoff, N A Ismail, M R Mohd Idris, S Palaniappan, C K K Ng, N Abdullah, S Z A Zaider, S F S Abdul Wahid
INTRODUCTION: Immunosuppressive state due to haematological malignancies and chemotherapy may cause disruption to wound healing despite optimum conventional treatment and standard wound dressing. Non-healing wounds are predisposed to infection whereas chemotherapy dose reductions or interruptions are associated with poor survival. BACKGROUND: Mononuclear cells contain progenitor cells including haematopoietic and mesenchymal stem cells, endothelial progenitor cells and fibroblasts which facilitate wound healing through cytokines, growth factor secretions, cell-cell interactions and provision of extracellular matrix scaffolding...
April 2018: Malaysian Journal of Pathology
https://www.readbyqxmd.com/read/29701412/functional-popliteal-artery-entrapment-syndrome
#8
Luis Gamas, João Rocha Neves, Luís Machado, Ricardo Ferreira, Pedro Paz Dias, José Teixeira
INTRODUCTION: Popliteal artery entrapment is an uncommon syndrome, caused by extrinsic compression of the popliteal artery by muscular or tendinous structures. It occurs mainly in young individuals, with no atherosclerostic risk factors, and a mean age of presentation of 20 to 40 years, and has higher prevalence in males (83% of patients). Clinical presentation depends on the degree of arterial lesion, the most common being intermittent claudication, with critical ischemia being frequent...
July 2017: Revista Portuguesa de Cirurgia Cardio-torácica e Vascular
https://www.readbyqxmd.com/read/29688209/-hybrid-intervention-for-an-atherosclerotic-lesion-of-arteries-of-the-iliofemoral-segment
#9
K A Kireev, A A Fokin, D V Rodnianskiĭ
The article describes a clinical case report regarding a successfully performed hybrid intervention in a patient presenting with critical ischaemia of a lower limb and an atherosclerotic lesion of arteries of the iliofemoral segment. Endovascular reconstruction in an isolated manner turned out to be impossible for both technical and anatomical reasons, whereas open reconstruction required two surgical accesses, an extended scope of the operation, and the use of a synthetic graft. Using a hybrid approach favourably contributed to adequate restoration of blood flow in the ischaemized limb, a decrease in the traumatic nature of the intervention, and also ensured angiographic control over the state of the operated arterial segment...
2018: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
https://www.readbyqxmd.com/read/29688198/-hybrid-surgical-treatment-of-a-multilevel-lesion-of-lower-limb-arteries
#10
P D Puzdriak, V V Shlomin, E A Shloĭdo, M A Ivanov, Iu P Didenko, I V Kas'ianov, P B Bondarenko, N Iu Grebenkina, T B Rakhmatillaev
The study was aimed at assessing immediate postoperative and remote results of hybrid surgical treatment of patients with a multilevel lesion of lower-limb arteries. Described herein is the authors' experience with simultaneous hybrid surgical management of 48 patients, including 43 subjects with a multilevel lesion of arteries of the lower extremities. There were 40 men and 8 women, with the average age amounting to 65.8±7.9 years. Of these, 30 patients suffered from stage II-b chronic arterial insufficiency (CAI), 11 had stage III CAI and 7 had stage IV CAI according to A...
2018: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
https://www.readbyqxmd.com/read/29668855/the-negative-ultraslow-potential-electrophysiological-correlate-of-infarction-in-the-human-cortex
#11
Janos Lückl, Coline L Lemale, Vasilis Kola, Viktor Horst, Uldus Khojasteh, Ana I Oliveira-Ferreira, Sebastian Major, Maren K L Winkler, Eun-Jeung Kang, Karl Schoknecht, Peter Martus, Jed A Hartings, Johannes Woitzik, Jens P Dreier
Spreading depolarizations are characterized by abrupt, near-complete breakdown of the transmembrane ion gradients, neuronal oedema, mitochondrial depolarization, glutamate excitotoxicity and activity loss (depression). Spreading depolarization induces either transient hyperperfusion in normal tissue; or hypoperfusion (inverse coupling = spreading ischaemia) in tissue at risk for progressive injury. The concept of the spreading depolarization continuum is critical since many spreading depolarizations have intermediate characteristics, as opposed to the two extremes of spreading depolarization in either severely ischaemic or normal tissue...
April 16, 2018: Brain: a Journal of Neurology
https://www.readbyqxmd.com/read/29666943/the-gtn-patch-a-simple-and-effective-new-approach-to-cardioprotection
#12
Derek M Yellon, Zhenhe He, Rayomand Khambata, Amrita Ahluwalia, Sean M Davidson
There remains a significant un-met need to reduce the extent of myocardial injury caused by ischaemia and reperfusion injury in patients experiencing an ST-elevation MI. Although nitric oxide is central to many cardioprotective strategies currently undergoing investigation, cardioprotection from the delivery of nitrates/nitrites has been inconsistently observed. The route of administration appears to be a critical variable. The glyceryl trinitrate (GTN) patch is commonly used as a simple and practical means of delivering nitric oxide to patients with ischaemic heart disease, but whether acute cardioprotection can be achieved by application of a GTN patch has not been investigated before...
April 17, 2018: Basic Research in Cardiology
https://www.readbyqxmd.com/read/29658630/lumbar-sympathectomy-versus-prostanoids-for-critical-limb-ischaemia-due-to-non-reconstructable-peripheral-arterial-disease
#13
REVIEW
Indrani Sen, Sunil Agarwal, Prathap Tharyan, Rachel Forster
BACKGROUND: Peripheral arterial disease (PAD) is a common circulatory problem that can lead to reduced blood flow to the limbs, which may result in critical limb ischaemia (CLI), a painful manifestation that occurs when a person is at rest. The mainstay of treatment for CLI is surgical or endovascular repair. However, when these means of treatment are not suitable, due to anatomical reasons or comorbidities, treatment for pain is limited. Lumbar sympathectomy and prostanoids have both been shown to reduce pain from CLI in people who suffer from non-reconstructable PAD, but there is currently insufficient evidence to determine if one treatment is superior...
April 16, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29622512/cost-effectiveness-evaluation-of-heparin-coated-versus-standard-graft-for-bypass-surgery-in-peripheral-artery-disease-alongside-a-randomised-controlled-trial
#14
Marie K Villemoes, Jes S Lindholt, Kim C Houlind, Bo Gottschalksen, Christian N Petersen, Martin Rasmussen, Charlotte Wedel, Morten B Bramsen, Rikke Søgaard
OBJECTIVE/BACKGROUND: Heparin coating has recently been shown to reduce the risk of graft failure in arterial revascularisation, at least transiently. The aim of this study was to assess the cost-effectiveness of heparin coated versus standard polytetrafluoroethylene grafts for bypass surgery in peripheral artery disease from a long-term healthcare system perspective. METHODS: Cost-effectiveness evaluation was conducted alongside the Danish part of the Scandinavian Propaten trial in which 431 patients planned for femoro-femoral or femoro-popliteal bypass surgery were randomised to either type of graft and followed for 5 years...
April 2, 2018: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/29618155/von-willebrand-factor-aggravates-hepatic-ischemia-reperfusion-injury-by-promoting-neutrophil-recruitment-in-mice
#15
Yasuyuki Urisono, Asuka Sakata, Hideto Matsui, Shogo Kasuda, Shiro Ono, Kiyomi Yoshimoto, Kenji Nishio, Masayuki Sho, Masashi Akiyama, Toshiyuki Miyata, Kazuo Okuchi, Satoshi Nishimura, Mitsuhiko Sugimoto
Hepatic ischaemia-reperfusion (I/R) injury is a serious liver damage that critically influences the clinical outcome of liver surgery or transplantation. Since recent studies indicated the critical involvement of von Willebrand factor (VWF) in reperfusion injuries of brain and myocardium, we hypothesized that VWF-dependent thrombotic or inflammatory responses also play a role in hepatic I/R injury. Using a mouse model of hepatic I/R injury, we explored the functional relevance of the VWF-ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) axis in this pathologic condition...
April 2018: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/29579246/high-sensitivity-cardiac-troponin-and-natriuretic-peptide-with-risk-of-lower-extremity-peripheral-artery-disease-the-atherosclerosis-risk-in-communities-aric-study
#16
Kunihiro Matsushita, Lucia Kwak, Chao Yang, Yuanjie Pang, Shoshana H Ballew, Yingying Sang, Ron C Hoogeveen, Bernard G Jaar, Elizabeth Selvin, Christie M Ballantyne, A Richey Sharrett, Aaron R Folsom, Gerardo Heiss, Josef Coresh, Alan T Hirsch
Aims: Cardiac troponin T (cTnT) is suggested as a predictor of amputation in patients with peripheral artery disease (PAD). However, cTnT-PAD association has not been systematically studied in a large study. This study evaluated the association of high-sensitivity cTnT (hs-cTnT) with PAD incidence and also explored whether natriuretic peptide (NT-proBNP), another representative cardiac marker, predicts PAD risk. Methods and results: Among 12 288 middle-aged adults, the associations of hs-cTnT and NT-proBNP with incident PAD (hospitalizations with PAD diagnosis or leg revascularization [cases with rest pain or tissue loss considered as critical limb ischaemia (CLI)]) were quantified with multivariable Cox regression models...
March 22, 2018: European Heart Journal
https://www.readbyqxmd.com/read/29557735/microarray-analysis-for-delineating-the-gene-expression-in-biopsies-of-gastrocnemius-muscle-of-patients-with-chronic-critical-limb-ischaemia-compared-with-non-ischaemic-controls
#17
Daniel Freund, Silke Brilloff, Tamer Ghazy, Stephan Kirschner, Gabor Gäbel, Irene Hinterseher, Norbert Weiss, Adrian Mahlmann
BACKGROUND: Microarray analysis has been carried out in this pilot study to compare delineated gene expression profiles in the biopsies of skeletal muscle taken from patients with chronic critical limb ischaemia (CLI) and non-ischaemic control subjects. PATIENTS AND METHODS: Biopsy of gastrocnemius muscle was obtained from six patients with unreconstructed CLI referred for surgical major amputation. As control, biopsies of six patients undergoing elective knee arthroplasty without evidence of peripheral arterial occlusive disease were taken...
March 20, 2018: VASA. Zeitschrift Für Gefässkrankheiten
https://www.readbyqxmd.com/read/29552935/structured-physical-assessment-of-arteriovenous-fistulae-in-haemodialysis-access-surveillance-a-missed-opportunity
#18
Victoria E Jackson, Helen Hurst, Sandip Mitra
INTRODUCTION: Arteriovenous fistulae remain the gold standard of vascular access in haemodialysis. There is currently no consensus on standardised methods of monitoring arteriovenous fistulae. Assessment techniques and practice remain widely variable. The purpose of this study is to determine whether existing evidence supports physical assessment as an effective tool and a good predictor of arteriovenous fistulae dysfunction to allow for timely intervention and improve outcomes. METHODS: A literature search was performed using CINAHL, PubMed, Medline and BNI databases and relevant search terms...
March 1, 2018: Journal of Vascular Access
https://www.readbyqxmd.com/read/29540162/ripk3-deficient-mice-were-not-protected-from-nephrotoxic-nephritis
#19
N R Hill, H T Cook, C D Pusey, R M Tarzi
BACKGROUND: Necrotizing glomerular lesions are a feature of severe glomerulonephritis. Unlike apoptosis, cellular necrosis has the potential to release damage-associated proteins into the microenvironment, thereby potentiating inflammation. Until recently necrosis was thought to be an unregulated cellular response to injury. However, recent evidence suggests that under certain circumstances receptor mediated necrosis occurs in response to death ligand signalling, one form of which is termed necroptosis...
March 14, 2018: BMC Nephrology
https://www.readbyqxmd.com/read/29532760/efficacy-and-safety-of-autologous-cell-based-therapy-in-patients-with-no-option-critical-limb-ischaemia-a-meta-analysis
#20
Fadilah S Abdul Wahid, Nor Azimah Ismail, Wan Fariza Wan Jamaludin, Nor Asiah Muhamad, Mohamad Azim Mohamad Idris, Nai Ming Lai
BACKGROUND: Revascularisation therapy is the current gold standard of care for critical limb ischemia (CLI), although a significant proportion of patients with CLI either are not fit for or do not respond well to this procedure. Recently, novel angiogenic therapies such as the use of autologous cellbased therapy (CBT) have been examined, but the results of individual trials were inconsistent. OBJECTIVE: To pool all published studies that compared the safety and efficacy of autologous CBT derived from different sources and phenotypes with non cell-based therapy (NCT) in CLI patients...
2018: Current Stem Cell Research & Therapy
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