Difference analysis of Doppler ultrasound blood flow of Cunkou (radial artery) pulse, Renying (carotid artery) pulse, and Fuyang (anterior tibial artery) pulse.

OBJECTIVE: To analyze the Doppler ultrasound blood flow of Renying (carotid artery) pulse, Cunkou (radial artery) pulse, and Fuyang (anterior tibial artery) pulse in the normal group and the functional constipation with gastrointestinal heat (FCGH) group, and to compare and explore the differences of Renying, Cunkou and Fuyang pulses. METHODS: Sixty normal subjects and 60 patients with gastrointestinal heat constipation were collected in the department of ultrasound, Beijing Anzhen Hospital, Capital Medical University. Doppler ultrasound was used to observe the blood flow indexes including maximum systolic velocity (Vp), maximum diastolic velocity (Vd), mean velocity (Vm), pulse index (PI), resistance index (RI), vascular diameter (D), and circulation blood flow cycle (ET) of Renying pulse, Cunkou pulse and Fuyang pulse in the normal group and patients with gastrointestinal heat constipation. The differences of these three pulses were compared between the normal group and the FCGH group. RESULTS: The PI, Vp, Vm, RI, and D of the three pulses in the normal group were statistically significant different ( < 0.01). In the comparison of Doppler flow diagram of three pulses in the FCGH group, there were significant differences in PI, Vd, Vp, Vm, RI, and D ( < 0.01). CONCLUSION: Under normal conditions, the indexes of Renying pulse Doppler flow diagram, Cunkou pulse Doppler flow diagram, and Fuyang pulse Doppler flow diagram are significantly different. In the FCGH group, most of the indexes of Renying pulse Doppler flow diagram, Cunkou pulse Doppler flow diagram, and Fuyang pulse Doppler flow diagram are different. This result verified the necessity of simultaneous examinations of all Renying, Cunkou, and Fuyang pulses in modern Chinese medicine.

Multi-Level Lower Extremity Arterial Revascularization Via Retrograde Pedal Access Under Local Anesthesia in a Patient With Severe Cardiopulmonary Comorbidities: A Case Report.

BACKGROUND: Chronic limb-threatening ischemia is a severe form of peripheral artery disease that leads to high rates of amputation and mortality if left untreated. Bypass surgery and antegrade endovascular revascularization through femoral artery access from either side are accepted as conventional treatment modalities for critical limb ischemia. The retrograde pedal access revascularization is an alternative treatment modality useful in specific clinical scenarios; however, these indications have not been well described in literature. This case report highlights the use of retrograde pedal access approach as primary treatment modality in a patient with an extensive comorbidities precluding general anesthesia nor supine positioning. CASE PRESENTATION: The patient is a 60-year-old female with multiple severe cardiopulmonary comorbidities presenting with dry gangrene of the right great toe. Her comorbidities and inability to tolerate supine positioning precluded her from receiving open surgery, general anesthesia or monitored sedation, or percutaneous femoral access. Rather, the patient underwent ankle block and retrograde endovascular revascularization via dorsalis pedis artery access without post-operative complications. DISCUSSION: The prevalence of comorbidities related to peripheral artery disease is increasing and with it the number of patients who are not optimal candidates for conventional treatment methods for critical limb ischemia. The retrograde pedal access revascularization as initial treatment modality offers these patients an alternative limb salvaging treatment option.

Resistance training with blood flow restriction: Impact on the muscle strength and body composition in people living with HIV/AIDS.

The aim of the study was to compare the impact of 12-week resistance training with blood flow restriction (GRTBFR) versus, traditional resistance training (GTRT) and non-training on the muscle strength and body composition HIV/AIDS participants. Muscle strength was tested at baseline, and on the 6th, 21st and 36th training sessions, using maximal repetition test. Pre- and post-intervention body composition changes were measured by dual-energy X-ray absorptiometry. Resistance training was undertaken three times a week comprising bilateral elbow extension and flexion exercises, unilateral flexion and bilateral knee extension. Changes in strength and body composition (pre- and post-intervention) between groups were evaluated by mixed models of repeated measures, and by paired and unpaired comparisons, considering the Effect Size. All groups were similar at baseline for muscle strength and body composition. Post-intervention, the training groups showed similar, statistically significant increases in muscle strength (GRTBFR=25.7-57.4%; GTRT=24.5-52.3%) and skeletal muscle tissue (GRTBFR=8.4%; GTRT=8.3%). There was also a significant change in body fat (p=0.023-0.043), with significant effect sizes for strength and skeletal muscle tissue (0.41-2.27), respectively. These results suggest that both resistance training interventions promoted muscle hypertrophy, body fat reduction and positive impact on muscle strength in people living with HIV/AIDS. Resistance training with blood flow restriction proved to be an effective alternative to include patients with marked physical weakness, unable to engage in regular strength training programme.ClinicalTrials.gov identifier: NCT02783417.

The efficacy and safety of Chinese herbal medicine Shen-Qi Hua-Yu formula in patients with diabetic lower extremity artery disease: Study protocol of a multi-center, randomized, double-blind, placebo-controlled trial.

BACKGROUND: Lower extremity artery disease (LEAD) is greatly harmful to Type 2 Diabetes Mellitus patients. Traditional Chinese Medicine (TCM) is an alternative therapy to delay the development of macrovascular diseases, but the existing evidence of its efficacy, safety and mechanism of action is insufficient. We report a study protocol of a multi-center, randomized, double-blind, placebo-controlled trial that aims to use well-designed clinical trial to evaluate the efficacy and safety of Chinese herbal medicine (CHM) Shen-Qi Hua-Yu formula, and to explore efficacy mechanism of the TCM granules and the biomarkers of TCM syndrome. METHODS: This is a multi-center, double-blind, randomized, and placebo-controlled study that randomized 120 participants into 2 groups. The treatment group will receive TCM granules and conventional medicine, while the control group will receive placebo in addition to conventional medicine. Two groups will receive 12-week treatment and 48-week follow-up, with a total of 13 visits. Primary efficacy outcomes included ankle brachial index. Secondary efficacy outcomes included fasting plasma glucose, blood lipid, hemorheology indexes, advanced glycation end products, the inner diameter, peak systolic velocity, end diastolic velocity and mean average velocity of the anterior tibial artery, posterior tibial artery and dorsalis pedis artery, and TCM syndrome score. The safety and endpoint outcomes will be evaluated in this trial. The study will explain the biological therapeutic mechanism of Shen-Qi Hua-Yu formula for diabetic LEAD, and try to use Isobaric tags for Relative and Absolute Quantitation (iTRAQ) and Western blot to screen biomarkers of characteristic diagnosis and clinical efficiency evaluation of the TCM syndrome. DISCUSSION: This study is a multi-center, randomized, double-blind, placebo-controlled trial to evaluate the efficacy and safety of CHM in patients with diabetic LEAD, and to interpret the therapeutic mechanism of Shen-Qi Hua-Yu formula in treatment of diabetic LEAD through proteomics technology, and to screen biomarkers with characteristics of TCM diagnosis and clinical efficacy evaluation. On the other hand, to our knowledge, this study may be the first trial of CHM formulas to observe cardiovascular outcomes through long-term follow-up for the treatment of diabetic LEAD, which is of great value. TRIAL REGISTRATION: This study is registered on the Chinese Clinical Trial Registry: ChiCTR1900026372.

Changes in Skin Perfusion Pressure After Hyperbaric Oxygen Therapy Following Revascularization in Patients With Critical Limb Ischemia: A Preliminary Study.

Hyperbaric oxygen (HBO) therapy promotes wound healing in patients with ischemic disease; however, HBO-induced changes in skin peripheral circulation have not been evaluated in clinical practice. Here, we investigated these changes in patients with critical limb ischemia (CLI), with a focus on the angiosome of crural blood vessels with blood flow improved by endovascular therapy (EVT). Six patients with CLI and ulcers who were treated with HBO after EVT (7 limbs; 1 patient had ulcers in the bilateral limbs) and 3 healthy subjects (6 limbs) were enrolled. HBO therapy was performed at 2 atm under 100% oxygen for 90 min per session. Skin perfusion pressure (SPP) was measured in the dorsum and sole of the foot 1 hour before (pre-SPP) and after (post-SPP) HBO therapy. ΔSPP was calculated as post-SPP minus pre-SPP. SPP measurement regions were divided into those that did (direct region) and did not (indirect region) correspond to the vascular angiosome in which angiography findings of the crus were improved after EVT; i.e., when the anterior tibial artery was effectively treated with EVT, the dorsum was the direct region and the sole was the indirect region, and vice versa when the posterior tibial artery was treated. In the direct, indirect, and healthy subject groups, the ΔSPPs were 20.5±8.7 (p=0.002), -6.4±10.9, and -15.1±18.1 (p=0.014), respectively; that of the direct group was significantly greater than that of the other groups. These results suggest that short-term improvement of the peripheral circulation by HBO therapy was significant in patients with successful revascularization.

[Comparison of efficacy of rivaroxaban and warfarin after open operations on the infrainguinal segment]. / Sravnenie éffektivnosti rivaroksabana i varfarina posle otkrytykh operatsii na infraingvinal'nom segmente.

The authors analysed oral anticoagulant agents prescribed in the postoperative period to patients after endured reconstructive operative intervention on arteries of the femorotibial segment. The study included a total of 104 patients subjected to femoropopliteal or femorotibial bypass grafting using an autologous vein or a prosthesis. Depending on the prescribed anticoagulation agent, the patients were subdivided into two groups. Group One patients (n=43) in the postoperative period received rivaroxaban, and Group Two patients (n=61) took warfarin. Efficacy of therapy was evaluated by the frequency of haemorrhage and thromboses in the early and remote postoperative periods. The findings of the immediate postoperative period demonstrated comparable rates of haemorrhagic complications, early thromboses and redo interventions in both Groups (p=0.7). The duration of long-term postoperative period varied from 3 months to 5 years. No statistically significant differences in patency of the performed reconstructions were revealed between the groups. The 3-year primary assisted patency rate in the rivaroxaban group and warfarin group amounted to 89 and 80%, respectively. The incidence of haemorrhagic complications in the postoperative period was insignificant in the studied groups. Hence, rivaroxaban may be prescribed in the early and remote postoperative period to patients who underwent open reconstructive operative intervention on arteries of the infrainguinal zone.

Free posterior tibial artery perforator flap for 2-stage tracheal reconstruction in patients after resection of well-differentiated thyroid carcinoma invading the trachea.

BACKGROUND: The present study was conducted to explore the efficacy of using a free posterior tibial artery perforator flap (FPTAPF) for trachea reconstruction after resection of well-differentiated thyroid carcinoma (WDTC) invading the trachea. METHODS: We retrospectively collected and analyzed clinical and surgical data from 14 patients who underwent tracheal reconstruction using a FPTAPF after resection of WDTC invading the trachea between August 2014 and July 2017. RESULTS: Satisfactory tracheal structure and functional recovery were obtained in 11 of the 14 patients. One patient had breathing difficulties after tracheostomy closure tests because of bilateral recurrent laryngeal nerve damage caused by disease invasion. Tracheostomy incision was not closed in 2 patients because they received postoperative adjuvant radioactive iodine 131 treatment. CONCLUSION: Satisfactory tracheal reconstruction results were achieved in patients with resection of WDTC invading the trachea, indicating that a FPTAPF is a safe and reliable choice for management.

Blood flow differences in cun-kou (radial) artery and anterior tibial artery: normal people vs patients with chronic gastritis.

OBJECTIVE: To explore the blood flow differences in cun-kou (radial) artery and anterior tibial artery between normal people and patients with chronic gastritis. METHODS: Using doppler ultrasonography, blood flow charts [peak systolic velocity (VP), maximum blood flow velocity in diastole (VD), mean blood flow velocity (VM), pulse index (PI), resistance index (RI), blood vessel diameter (D), vessel volume (SV), circulation blood flow periodic time (ET)] measured by at cun-kou (radial) artery and anterior tibial artery in normal group (n = 30) and chronic gastritis group (n = 30) in department of ultrasound, Beijing Anzhen hospital, capital medical university. RESULTS: In the doppler flow charts of the normal group, there were statistically significant differences in VD, VM, D, RI, SV, ET between cun-kou artery and anterior tibial artery (P < 0.05), and there were more statistically significant differences in PI between cun-kou artery and anterior tibial artery (P < 0.01). In the comparison of doppler flow charts in the chronic gastritis group, there were statistically significant differences in VD, VM, D, RI, SV, ET between cun-kou artery and anterior tibial artery (P < 0.05), and there were more statistically significant differences in PI between cun-kou artery and anterior tibial artery (P < 0.01). In the comparison of doppler flow charts between normal group and chronic gastritis group, there were statistically significant differences in SV, ET between normal group and chronic gastritis group (P < 0.05), and there were more statistically significant differences in PI between normal group and chronic gastritis group (P < 0.01). CONCLUSION: Based on the differences in doppler flow charts between the normal group and the chronic gastritis group, the doppler flow charts of cun-kou artery and anterior tibial artery were not only proved to be significantly different, but also provided quantitative objective indexes for the study of cun-kou artery and anterior tibial artery doppler flow charts of normal people and chronic gastritis patients. This study also proves that the doppler flow chart of the anterior tibial pulse is of great significance for the diagnosis of chronic gastritis.

Augmentation of arterial blood velocity with electrostimulation in patients with critical limb ischemia unsuitable for revascularization.

Aim This pilot study aimed to reveal whether combination of electrostimulation with iloprost treatment achieves better results compared to iloprost alone in patients with critical limb ischemia. Material and methods Patients were randomized into Group 1 ( n = 11, mean age: 65.3 ± 4.2 years, received iloprost infusion protocol alone) or Group 2 ( n = 11, mean age: 62.9 ± 6.7, received iloprost infusion plus standardized protocol of peroneal nerve electrostimulation). Electrostimulation was delivered with 1 Hz frequency, 27 mA current, and 200 ms pulse width. Peak blood flow velocities in the anterior and posterior tibialis arteries were measured with duplex ultrasound. Results There was a slight insignificant increase in blood velocity in anterior tibialis artery in Group 1 (from 17.6 ± 13.0 to 18.6 ± 13.1, p = 0.57), whereas the increase in Group 2 was marked (from 23.8 ± 18.3 to 32.2 ± 19.7, p = 0.01). Blood velocity in posterior tibialis artery also increased in both groups, but it was not of statistical significance. No significant difference was found between two groups in regard to final pulse oximetry oxygen saturation levels. Conclusion Electrostimulation of the peroneal nerve caused a substantial increase in anterior tibialis artery blood velocity when used as an adjunct to medical therapy in patients with critical limb ischemia.

[Effects of needle retaining at Zusanli (ST 36) on hemodynamic change of anterior tibial artery].

OBJECTIVE: To observe the effects of needle retaining on hemodynamic change and investigate the significance of retaining needle. METHODS: Manual acupuncture was performed at the left Zusanli (ST 36) of 26 healthy adult volunteers who have not receiued acupuncture. 26 cases were randomly divided into a needle retaining group and a quick needling group, 13 cases in each group. Hemodynamic parameters of the anterior tibial artery were observed with color Doppler ultrasound before needling and 0, 1, 2, 3, 4 and 5 minutes after needle manipulation. Hemodynamic parameters were also compared between the two groups 0, 1, 2, 3, 4 and 5 minutes after needle manipulation. RESULTS: There were no significant difference in V(max) and Vm between 0, 1, 2, 3, 4 and 5 minutes after needling manipulation (all P > 0.05). CONCLUSION: Needle retaining can not change regional hemodynamic.

Homocysteine mediated decrease in bone blood flow and remodeling: role of folic acid.

Deficiencies in folate lead to increased serum concentrations of homocysteine (Hcy), which is known as hyperhomocysteinemia (HHcy), is associated with bone disorders. Although, Hcy accumulates collagen in bone and contribute to decrease in bone strength. The mechanism of Hcy induced bone loss and remodeling is unclear. Therefore, the present study was aimed to determine the role of folic acid (FA) in genetically HHcy-associated decrease in bone blood flow and remodeling. Wild type (WT) and cystathionine-ß-synthase heterozygous (CBS+/-) mice were used in this study and supplemented with or without FA (300 mg/kg, Hcy reducing agent) in drinking water for 6 weeks. The tibial bone blood flow was measured by laser Doppler and ultrasonic flow probe method. The tibial bone density (BD) was assessed by dual energy X-ray absorptiometry. The bone homogenates were analyzed for oxidative stress, NOX-4 as oxidative marker and thioredoxin-1 (Trx-1) as anti-oxidant marker, bone remodeling (MMP-9) and bio-availability of nitric oxide (eNOS/iNOS/NO) by Western blot method. The results suggested that there was decrease in tibial blood flow in CBS+/- mice. The BD was also reduced in CBS+/- mice. There was an increase in NOX-4, iNOS, MMP-9 protein as well as MMP-9 activity in CBS+/- mice and decrease in Trx-1, eNOS protein levels, in part by decreasing NO bio-availability in CBS+/- mice. Interestingly, these effects were ameliorated by FA and suggested that FA supplementation may have therapeutic potential against genetically HHcy induced bone loss.

Effects of needle retaining at Zusanli (ST 36) on hemodynamic change of anterior tibial artery / 中国针灸

<p><b>OBJECTIVE</b>To observe the effects of needle retaining on hemodynamic change and investigate the significance of retaining needle.</p><p><b>METHODS</b>Manual acupuncture was performed at the left Zusanli (ST 36) of 26 healthy adult volunteers who have not receiued acupuncture. 26 cases were randomly divided into a needle retaining group and a quick needling group, 13 cases in each group. Hemodynamic parameters of the anterior tibial artery were observed with color Doppler ultrasound before needling and 0, 1, 2, 3, 4 and 5 minutes after needle manipulation. Hemodynamic parameters were also compared between the two groups 0, 1, 2, 3, 4 and 5 minutes after needle manipulation.</p><p><b>RESULTS</b>There were no significant difference in V(max) and Vm between 0, 1, 2, 3, 4 and 5 minutes after needling manipulation (all P > 0.05).</p><p><b>CONCLUSION</b>Needle retaining can not change regional hemodynamic.</p>

[Effect of tongmal recipe on atherosclerosis in patients with early lower extremity arteriopathy caused by type 2 diabetes mellitus].

OBJECTIVE: To observe the effect of Tongmai Recipe (TMR) on atherosclerosis (AS) in patients with early lower extremity arteriopathy disease (LEAD) caused by type 2 diabetes mellitus (T2DM). METHODS: Patients were randomly assigned to two groups. The 23 patients in the treatment group were treated by TMR and the 22 in the control group were given Cilostazo, all for 3 months. Before and after treatment, lower extremity vascular color Doppler image, blood levels of glucose, insulin, serum matrix metalloproteinase-9 (MMP-9) and interleukin-6 (IL-6) were measured. RESULTS: The thickness of AS plaque and that of arterial intima-media obviously reduced (P < 0.01 and P < 0.05), insulin sensitivity improved noticeably (P < 0.01), and serum levels of MMP-9 and IL-6 lowered obviously (P < 0.05) in the treatment group after treatment, but these indexes were unchanged in the control group statistically. CONCLUSION: TMR has remarkable action in reducing the thickness of AS plaque and intima-media of artery, its mechanism might be related with improving of insulin sensitivity and anti-inflammatory reaction, and reducing of serum MMP-9 level as well in patients.

Distally based saphenous nerve-great saphenous veno-fasciocutaneous compound flap with nutrient vessels: microdissection and clinical application.

Improvements were made by us in several distally based pedicled flaps of the nutrient vessels of the saphenous nerve with lower rotation points. However, these flaps are still insufficient for trauma complicated by bone defects. Accordingly, we conducted a systematic study of the anatomic theory on distally based pedicled compound flaps of the nutrient vessels of the saphenous nerve and great saphenous vein with 30 lower limbs of adult cadavers injected with red gelatin through the femoral artery. It is found that the nutrient vessels of the saphenous nerve-great saphenous vein consist of arteria saphena, fascial cutaneous branches of the inferior medial genicular artery intermuscular spatium branches of the posterior tibial artery, osteocutaneous perforators, superior ankle perforators, medial anterior malleolus perforators, and fascial perforators of the ankle tunnel region. Musculocutaneous perforators of the interior gastrocnemius muscle also enter the nutrient vessels of cutaneous nerve-superficial vein. From May 2004 to February 2007, 23 cases of skin flaps for treating defective and infectious wound, 10 cases of musculocutaneous flaps for treating ulcus in the lower segment of the leg, medullitis, and exposure of bone, 3 cases for medial calcaneus medullitis, 7 cases of skeletal flaps for treating tibial defects and nonunion of calcaneal bone. In 2-15-month follow-ups all cases presented with survived flaps, and healed surfaces of the wound and the osteomyelitis. For cases of bone nonunion, it showed that the nonunion healed after 18 weeks, with recovery of work ability after year. Three types of the distally based pedicled flaps or compound flaps of vessels of different perforating branches can be designed for repairing tissue defects caused by trauma, such as bone defects in the distal leg, nonunion, large necrotic space as well as traumatic surface of the foot and ankle.

Fluoroscopy-Assisted Thromboembolectomy

PURPOSE: Acute limb ischemia continues to be a challenge with high amputation and mortality rates. Conventional thrombectomy allows rapidly removing thrombi, yet this is a blind procedure and it is prone to damage arteries during the operation. In 1996, operative fluoroscopy and over-the-wire (OTW) catheters were reported to allow safe removal of thrombus in patients with acute limb ischemia. We have recently adopted the procedure and we report on our results. METHODS: During the past one year, we treated 7 patients who had acute or subacute lower limb ischemia. Under general or local anesthesia, the femoral artery was exposed and a sheath was inserted. Under fluoroscopy, a guidewire was passed through the thrombus; then a Fogarty Thru-lumen catheter (TLC) was passed into the lesion and thrombectomy was performed. RESULTS: Four patients were female and three were male. Their ages ranged 55 to 79. The symptom duration was within 10 days for five patients, and 1 and 2 months for two others, respectively. The ischemic severity was class I in two patients, IIa in four and IIb in one. There were two iliac occlusions and five femoral-popliteal occlusions. The occlusion length ranged from 5 to 47 cm. Local anesthesia was done for 6 patients. Removal of thrombus was complete or nearly complete in 6 patients, and this was partial in 1 due to rupture of the posterior tibial artery. Additional balloon angioplasty was performed in one patient. All the symptoms resolved in all but one patient, who had persistent foot ischemia. One patient died 2 months later due to liver failure. CONCLUSION: Fluoroscopy-assisted thrombectomy was quite helpful for safely removing thrombi.

Effect of tongmal recipe on atherosclerosis in patients with early lower extremity arteriopathy caused by type 2 diabetes mellitus / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To observe the effect of Tongmai Recipe (TMR) on atherosclerosis (AS) in patients with early lower extremity arteriopathy disease (LEAD) caused by type 2 diabetes mellitus (T2DM).</p><p><b>METHODS</b>Patients were randomly assigned to two groups. The 23 patients in the treatment group were treated by TMR and the 22 in the control group were given Cilostazo, all for 3 months. Before and after treatment, lower extremity vascular color Doppler image, blood levels of glucose, insulin, serum matrix metalloproteinase-9 (MMP-9) and interleukin-6 (IL-6) were measured.</p><p><b>RESULTS</b>The thickness of AS plaque and that of arterial intima-media obviously reduced (P < 0.01 and P < 0.05), insulin sensitivity improved noticeably (P < 0.01), and serum levels of MMP-9 and IL-6 lowered obviously (P < 0.05) in the treatment group after treatment, but these indexes were unchanged in the control group statistically.</p><p><b>CONCLUSION</b>TMR has remarkable action in reducing the thickness of AS plaque and intima-media of artery, its mechanism might be related with improving of insulin sensitivity and anti-inflammatory reaction, and reducing of serum MMP-9 level as well in patients.</p>

Measurement of tibial endothelial cell function after cigarette smoking, cessation of smoking and hyperbaric oxygen therapy.

SUMMARY: Cigarette smoking is hazardous to a range of human tissues. For instance, cigarette smoke inhalation has been proven to delay bone healing. This study analysed the effects of cigarette smoking on tibial vascular endothelium and blood flow using the bone-chamber model. The effects of smoking cessation and hyperbaric oxygen (HBO) on the damage caused by smoking were also compared. 54 adult New Zealand rabbits were divided into three groups. Group 1: control, Group 2: 1 week smoking, and Group 3: 6 weeks' smoking. This study on rabbits confirmed that both short-term and long-term cigarette smoking is dangerous to the bony vascular endothelium of the tibia. The vasodilatation caused by nitric oxide production was significantly attenuated in Group 2 and 3's tibia. Long-term smoking damaged the vascular endothelium more severely than short-term smoking (P<.01). Cessation of smoking effectively reduces the adverse effects of smoking when the cessation time equals the smoking time. HBO also effectively reduces the adverse effects of smoking.

Electrical stimulation-evoked resistance exercise therapy improves arterial health after chronic spinal cord injury.

STUDY DESIGN: Repeated measures training intervention. OBJECTIVES: To evaluate the effects of neuromuscular electrical stimulation (NMES)-induced resistance exercise therapy on lower extremity arterial health in individuals with chronic, complete spinal cord injury (SCI). We define "arterial health" using three surrogate markers: (a) resting diameter, (b) flow-mediated dilation (FMD), and (c) arterial range. SETTING: Department of Kinesiology, University of Georgia, USA. METHODS: We assessed five 36+/-5-year-old male individuals with chronic, complete SCI before, during, and after 18 weeks of training. The quadriceps femoris muscle group of both legs were trained twice a week with 4 x 10 repetitions of unilateral, dynamic knee extensions. The health of the posterior tibial artery was assessed using a B-mode ultrasound unit equipped with a high-resolution video capture device. Proximal occlusion was used to evoke ischemia for 5 min and then for 10 min. FMD was calculated using the peak diameter change (above rest) following 5 min occlusion. Arterial range was calculated using minimum (during occlusion) and maximum diameters (post 10 min occlusion). Hierarchical linear modeling accounted for the nested (repeated measures) experimental design. RESULTS: FMD improved from 0.08+/-0.11 mm (2.7%) to 0.18+/-0.15 mm (6.6%) (P=0.004), and arterial range improved from 0.36+/-0.28 to 0.94+/-0.40 mm (P=0.001), after 18 weeks of training. Resting diameter did not significantly change. CONCLUSIONS: Home-based, self-administered NMES resistance exercise therapy consisting of 80 contractions/week improved FMD and arterial range. This provides evidence that resistance exercise therapy can improve arterial health after SCI, which may reduce the risk of future cardiovascular disease.

Cavernous hemangioma of the foot and antecubital fossa: an alternative therapeutic option.

We present two cases of recurrent cavernous hemangiomas of the extremities. These conditions were initially treated unsuccessfully with surgical resection. After recurrence, the hemangiomas were treated by percutaneous transcatheter embolization. To the best of our knowledge, this is the first case report of treatment of cavernous hemangioma involving the extremities using an angiographically directed vascular embolization technique.