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Critical ischaemia

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https://www.readbyqxmd.com/read/29128300/enteral-versus-parenteral-early-nutrition-in-ventilated-adults-with-shock-a-randomised-controlled-multicentre-open-label-parallel-group-study-nutrirea-2
#1
Jean Reignier, Julie Boisramé-Helms, Laurent Brisard, Jean-Baptiste Lascarrou, Ali Ait Hssain, Nadia Anguel, Laurent Argaud, Karim Asehnoune, Pierre Asfar, Frédéric Bellec, Vlad Botoc, Anne Bretagnol, Hoang-Nam Bui, Emmanuel Canet, Daniel Da Silva, Michael Darmon, Vincent Das, Jérôme Devaquet, Michel Djibre, Frédérique Ganster, Maité Garrouste-Orgeas, Stéphane Gaudry, Olivier Gontier, Claude Guérin, Bertrand Guidet, Christophe Guitton, Jean-Etienne Herbrecht, Jean-Claude Lacherade, Philippe Letocart, Frédéric Martino, Virginie Maxime, Emmanuelle Mercier, Jean-Paul Mira, Saad Nseir, Gael Piton, Jean-Pierre Quenot, Jack Richecoeur, Jean-Philippe Rigaud, René Robert, Nathalie Rolin, Carole Schwebel, Michel Sirodot, François Tinturier, Didier Thévenin, Bruno Giraudeau, Amélie Le Gouge
BACKGROUND: Whether the route of early feeding affects outcomes of patients with severe critical illnesses is controversial. We hypothesised that outcomes were better with early first-line enteral nutrition than with early first-line parenteral nutrition. METHODS: In this randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2 trial) done at 44 French intensive-care units (ICUs), adults (18 years or older) receiving invasive mechanical ventilation and vasopressor support for shock were randomly assigned (1:1) to either parenteral nutrition or enteral nutrition, both targeting normocaloric goals (20-25 kcal/kg per day), within 24 h after intubation...
November 8, 2017: Lancet
https://www.readbyqxmd.com/read/29122678/exosomes-and-cardioprotection-a-critical-analysis
#2
REVIEW
Sean M Davidson, Derek M Yellon
Exosomes are nano-sized vesicles released by numerous cell types that appear to have diverse beneficial effects on the injured heart. Studies using exosomes from stem cells or from the blood have indicated that they are able to protect the heart both in models of acute ischaemia and reperfusion, and during chronic ischaemia. In addition to decreasing initial infarct size, they are able to stimulate angiogenesis, reduce fibrosis and remodelling, alter immune cell function and improve long-term cardiac contractile function...
November 6, 2017: Molecular Aspects of Medicine
https://www.readbyqxmd.com/read/29116654/cardiovascular-and-all-cause-mortality-in-patients-with-intermittent-claudication-and-critical-limb-ischaemia
#3
S T W van Haelst, C Koopman, H M den Ruijter, F L Moll, F L Visseren, I Vaartjes, G J de Borst
BACKGROUND: The aim of this study was to evaluate absolute mortality risks and to determine whether changes in mortality risk occurred in patients with intermittent claudication (IC) or critical limb ischaemia (CLI) in the Netherlands between 1998 and 2010. METHODS: Data for patients treated between 1998 and 2010 were obtained from Dutch nationwide registers: the Hospital Discharge Register, Population Register and Cause of Death Register. The registers were used to obtain information regarding IC and CLI hospitalizations, co-morbidities, demographic factors, and date and cause of death...
November 8, 2017: British Journal of Surgery
https://www.readbyqxmd.com/read/29109739/a-case-of-polyarteritis-nodosa-presenting-as-rapidly-progressing-intermittent-claudication-of-right-leg
#4
Chathuranga Lakmal Fonseka, Sampath Rukshani Galappaththi, Dayakshi Abeyaratne, Nirmali Tissera, Lalith Wijayaratne
Background: Polyarteritis nodosa (PAN) is a medium vessel vasculitis which causes significant morbidity and mortality. Usually, it presents with constitutional symptoms with angiographic evidence of aneurysms or segmental stenosis of arteries of mesenteric or renal vasculature. It is exceedingly uncommon for PAN to present with symptomatic progressive intermittent claudication. Case Presentation: We describe a 60-year-old male who presented with rapidly progressive intermittent claudication of his right leg...
2017: Case Reports in Medicine
https://www.readbyqxmd.com/read/29105269/the-impact-of-coronary-artery-disease-and-left-ventricular-ejection-fraction-on-the-prognosis-of-patients-with-peripheral-artery-disease
#5
Takuya Tsujimura, Osamu Iida, Takayuki Ishihara, Masashi Fujita, Masaharu Masuda, Shin Okamoto, Kiyonori Nanto, Takashi Kanda, Akihiro Sunaga, Mitsuyoshi Takahara, Masaaki Uematsu
The impact of the severity of coronary artery disease (CAD) and left ventricular ejection fraction (LVEF) on the prognosis of patients with peripheral artery disease (PAD) has not been systematically studied. We retrospectively analysed 622 patients with PAD (intermittent claudication (IC): n = 446; critical limb ischaemia (CLI): n = 176). The association of SYNTAX score and LVEF with mortality was analysed using the Cox proportional hazard model. In patients with IC, a high SYNTAX score was significantly associated with mortality, whereas reduced LVEF was significantly associated with mortality in patients with CLI...
November 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/29065790/surgical-and-endovascular-venous-arterialization-for-treatment-of-critical-limb-ischaemia
#6
Michael Lichtenberg, Michiel A Schreve, Roberto Ferraresi, Daniel A F van den Heuvel, Çagdas Ünlü, Vincent Cabane, Steven Kum
Patients with critical limb ischaemia have a poor life expectancy. Aggressive revascularization is accepted in order to preserve their independence in the final phase of their lives. Bypass surgery and more recently endovascular interventions with angioplasty and stenting have become the treatment of choice to prevent amputation and to resolve pain. However, as many as 20 % of patients with critical limb ischaemia are unsuitable candidates for a vascular intervention because of extensive occlusions of outflow in the crural and pedal vessels...
October 25, 2017: VASA. Zeitschrift Für Gefässkrankheiten
https://www.readbyqxmd.com/read/29064271/effects-of-extracorporeal-cardiopulmonary-resuscitation-on-neurological-and-cardiac-outcome-after-ischaemic-refractory-cardiac-arrest
#7
Francesca Cesana, Leonello Avalli, Laura Garatti, Anna Coppo, Stefano Righetti, Ivan Calchera, Elisabetta Scanziani, Paolo Cozzolino, Cristina Malafronte, Andrea Mauro, Federica Soffici, Endrit Sulmina, Veronica Bozzon, Elena Maggioni, Giuseppe Foti, Felice Achilli
BACKGROUND: Extracorporeal cardiopulmonary resuscitation is increasingly recognised as a rescue therapy for refractory cardiac arrest, nevertheless data are scanty about its effects on neurologic and cardiac outcome. The aim of this study is to compare clinical outcome in patients with cardiac arrest of ischaemic origin (i.e. critical coronary plaque during angiography) and return of spontaneous circulation during conventional cardiopulmonary resuscitation vs refractory cardiac arrest patients needing extracorporeal cardiopulmonary resuscitation...
October 1, 2017: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/29060154/long-term-monitoring-of-a-pressure-ulcer-risk-patient-using-thermal-images
#8
Stephanie L Bennett, Rafik Goubran, Frank Knoefel
Patients in an immobile state are susceptible to pressure ulcers, which are localized injuries to the skin and/or underlying tissues due to prolonged pressure. This paper builds upon a body of work examining in-hospital older adult patients at-risk of developing pedal pressure ulcers by examining thermal images of one patient, who was reporting pain in her right foot, over 112 days of a hospital stay. Thermal images of the patient's left and right heels and malleoli were subjected to image processing to remove noise and enhance contrast, region selection and feature extraction to observe changes in temperature over time...
July 2017: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/29057728/-a-multidisciplinary-approach-in-diabetic-foot-disease-is-mandatory
#9
J G van Baal, W B Aan de Stegge, N C Schaper
The history of two patients (66- and 53-year-old males) with diabetes and peripheral neuropathy illustrates the variety of clinical presentations and pitfalls in treatment of diabetic foot ulcers. Peripheral arterial disease and mechanical stress as a consequence of peripheral neuropathy are important risk factors for developing an ulcer and eventually loss of a limb. Revascularisation of the limb should be considered in the presence of critical limb ischaemia or in the presence of mild to severe ischaemia in combination with a deep infection...
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/29053192/dissociation-of-nnos-from-psd-95-promotes-functional-recovery-after-cerebral-ischaemia-in-mice-through-reducing-excessive-tonic-gaba-release-from-reactive-astrocytes
#10
Yu-Hui Lin, Hai-Ying Liang, Ke Xu, Huan-Yu Ni, Jian Dong, Hui Xiao, Lei Chang, Hai-Yin Wu, Fei Li, Dong-Ya Zhu, Chun-Xia Luo
Mechanisms underlying functional recovery after stroke are little known, and effective drug intervention during the delayed stage is desirable. One potential drug target, the protein-protein interaction between neuronal nitric oxide synthase (nNOS) and postsynaptic density protein 95 (PSD-95), is critical to acute ischaemic damage and neurogenesis. We show that nNOS-PSD-95 dissociation induced by microinjection of a recombinant fusion protein Tat-nNOS-N1-133 or systemic administration of a small molecule ZL006 from days 4 to 10 after photothrombotic ischaemia in mice reduced excessive tonic inhibition in the peri-infarct cortex and ameliorated motor functional outcome...
October 20, 2017: Journal of Pathology
https://www.readbyqxmd.com/read/29026631/salmonella-typhimurium-gastroenteritis-leading-to-chronic-prosthetic-vascular-graft-infection
#11
Milo Cullinan, Michael Clarke, Tim Dallman, Steven Peart, Deborah Wilson, Daniel Weiand
Introduction. It is estimated up to 6 % of prosthetic vascular grafts become infected. Staphylococcus aureus is predominant in early infection and coagulase-negative staphylococci are predominant in late infections. Enterobacteriaceae cause 14-40 % of prosthetic vascular graft infections. This is, to our knowledge the first reported case of Salmonella gastroenteritis causing chronic prosthetic vascular graft infection (PVGI). Case presentation. A 57 years old lady presented with signs and symptoms of prosthetic vascular graft infection...
August 2017: JMM Case Reports
https://www.readbyqxmd.com/read/28971112/maggot-debridement-therapy-with-a-direct-dressing-can-cause-compression-injuries-in-patients-with-chronic-limb-ischemia
#12
Akio Nishijima, Naoto Yamamoto, Ryuichi Yoshida, Satoshi Yanagibayashi, Megumi Takikawa, Rie Hayasaka, Eri Maruyama, Junko Nishijima, Mitsuru Sekido
While there are no reports regarding dressing-associated iatrogenic skin ulcer as an adverse event of maggot debridement therapy (MDT), MDT is clinically used on patients with critical limb ischaemia with dermal fragility. Herein we report causes and counter measures for a case of iatrogenic skin ulcer induced by MDT dressing.
2017: Case Reports in Plastic Surgery & Hand Surgery
https://www.readbyqxmd.com/read/28958025/spinal-ischaemia-after-thoracic-endovascular-aortic-repair-with-left-subclavian-artery-sacrifice-is-there-a-critical-stent-graft-length
#13
Fabian A Kari, Babak Saravi, Sonja Krause, Luisa Puttfarcken, Karin Wittmann, Katharina Förster, Bartosz Rylski, Sven Maier, Ulrich Göbel, Matthias Siepe, Martin Czerny, Friedhelm Beyersdorf
OBJECTIVES: Thoracic endovascular aortic repair (TEVAR) is used for treatment of thoracic aortic pathologies, but the covered stent graft can induce spinal ischaemia depending on the length used. The left subclavian artery contributes to spinal cord collateralization and is frequently occluded by the stent graft. Our objective was to investigate the impact of covered stent graft length on the risk of spinal ischaemia in the setting of left subclavian artery sacrifice. METHODS: Twenty-six pigs (German country race, mean body weight 36 ± 4 kg) underwent simulated descending aortic TEVAR via left lateral thoracotomy, with left subclavian artery and thoracic segmental artery occlusion in normothermia...
August 24, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/28951554/endocytosis-and-lysosomal-degradation-of-glua2-3-ampars-in-response-to-oxygen-glucose-deprivation-in-hippocampal-but-not-cortical-neurons
#14
Zsombor Koszegi, Maria Fiuza, Jonathan G Hanley
Global cerebral ischemia results in oxygen and glucose deprivation (OGD) and consequent delayed cell death of vulnerable neurons, with hippocampal CA1 neurons more vulnerable than cortical neurons. Most AMPA receptors (AMPARs) are heteromeric complexes of subunits GluA1/GluA2 or GluA2/GluA3, and the presence of GluA2 renders AMPARs Ca(2+)-impermeable. In hippocampal CA1 neurons, OGD causes the synaptic expression of GluA2-lacking Ca(2+)-permeable AMPARs, contributing to toxic Ca(2+) influx. The loss of synaptic GluA2 is caused by rapid trafficking of GluA2-containing AMPARs from the cell surface, followed by a delayed reduction in GluA2 mRNA expression...
September 26, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28923277/animal-models-of-ischaemic-stroke-and-characterisation-of-the-ischaemic-penumbra
#15
REVIEW
Christopher McCabe, Mariana M Arroja, Emma Reid, I Mhairi Macrae
Over the past forty years, animal models of focal cerebral ischaemia have allowed us to identify the critical cerebral blood flow thresholds responsible for irreversible cell death, electrical failure, inhibition of protein synthesis, energy depletion and thereby the lifespan of the potentially salvageable penumbra. They have allowed us to understand the intricate biochemical and molecular mechanisms within the 'ischaemic cascade' that initiate cell death in the first minutes, hours and days following stroke...
September 18, 2017: Neuropharmacology
https://www.readbyqxmd.com/read/28902825/-treatment-of-patients-with-critical-lower-limb-ischaemia-endovascular-methods-or-reconstructive-operations
#16
A V Gavrilenko, A A Kravchenko, A É Kotov, D V Shatalova
Presented herein is a review of the literature related to endovascular methods of treatment of patients with critical lower limb ischaemia. This is followed by comparative assessment of the outcomes of endovascular and open surgical interventions. Also covered are problems concerning appropriate therapeutic decision making, taking into consideration peculiarities of lower limb ischaemia and the state at the expense of insufficiency of inflow/outflow.
2017: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
https://www.readbyqxmd.com/read/28901690/hypothenar-hammer-syndrome-in-an-office-worker
#17
Fan Zhang, Yuranga Weerakkody, Patrik Tosenovsky
Hypothenar hammer syndrome (HHS) is an uncommon cause of unilateral Raynaud's phenomenon, splinter haemorrhages and hypothenar weakness. The typical patient is a male blue-collar worker who uses their hypothenar eminence to hammer objects as part of their work. The distal ulnar artery beyond Guyon's canal is superficial and vulnerable to blunt trauma. CTA and MRA are common initial investigations and can suggest the diagnosis. DSA is the gold standard imaging modality and offers therapeutic opportunities. Management is controversial, but unless there is critical digital ischaemia, conservative treatment is first line...
September 13, 2017: Journal of Medical Imaging and Radiation Oncology
https://www.readbyqxmd.com/read/28876693/continuation-of-feeds-in-the-unstable-burns-patient
#18
A L Rooi, A Muganza, E A Ndobe, M Nel
BACKGROUND: Early enteral nutrition (EEN) and the continuation of enteral nutrition (EN) are critical factors in burn patients, who typically have higher nutritional needs due to their post-injury hypercatabolic state and their additional need for nutrients to aid in the healing of wounds and skin grafts. In the critically ill patient, EN is the preferred mode of administration; however, controversy exists regarding the concomitant use of EN and intravenous vasopressor agents in the haemodynamically unstable patient...
June 2017: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28876565/pattern-and-distribution-of-peripheral-arterial-disease-in-diabetic-patients-with-critical-limb-ischemia-rutherford-clinical-category-4-6
#19
M J Motsumi, N G Naidoo
BACKGROUND: This study investigated the pattern and distribution of peripheral arterial disease in diabetic patients with critical limb ischaemia (CLI) and to stratify the findings according to the patients' risk factor profile, gender and age group. METHOD: We conducted a one-year prospective descriptive study (January 2014 to December 2014) at Groote Schuur Hospital, University of Cape Town. The research protocol and the informed consent were approved by the Institutional Review Board, and all subjects included in this study gave an informed consent...
September 2017: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28857508/systemic-tlr2-antibody-application-in-renal-ischaemia-and-reperfusion-injury-decreases-akt-phosphorylation-and-increases-apoptosis-in-the-mouse-kidney
#20
Anja Urbschat, Patrick Baer, Kai Zacharowski, Vera Sprunck, Bertram Scheller, Florian Raimann, Thorsten Jürgen Maier, Axel Hegele, Rainer Hofmann, Jan Mersmann
Acute kidney injury remains an important cause of renal dysfunction. In this context, toll-like receptors have been demonstrated to play a critical role in the induction of innate and inflammatory responses. Among these, toll-like receptor 2 (TLR2) is constitutively expressed in tubular epithelial cells of the kidney and is also known to mediate ischaemia reperfusion (IR) injury. Adult male C57BL/6JRj mice were randomized into 7 groups (n=8): A non-operative control group (CTRL) and 6 interventional groups in which mice were subjected to a 30-min...
August 30, 2017: Basic & Clinical Pharmacology & Toxicology
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