Paeoniflorin attenuates oxidized low-density lipoprotein-induced apoptosis and adhesion molecule expression by autophagy enhancement in human umbilical vein endothelial cells.

Oxidized low-density lipoprotein (ox-LDL)-induced endothelial dysfunction is recognized as a driving force in the development of atherosclerosis (AS). Paeoniflorin (Pae), a typical traditional herbal medicine, possesses anti-inflammatory, antioxidative, antihyperglycaemic, and antiapoptotic properties. Our study aimed to investigate the effects of Pae on ox-LDL-induced injury of the human umbilical vein endothelial cells (HUVECs) and to explore its molecular mechanism. We found that ox-LDL stimulation inhibited cell viability, activated autophagy, and induced apoptosis and adhesion molecule expression in HUVECs. Pae rescued ox-LDL-induced viability reduction and enhanced the ox-LDL-induced autophagy activation in HUVECs. Pae inhibited ox-LDL-induced apoptosis and adhesion molecule expression by autophagy enhancement in HUVECs. In addition, inhibition of SIRT1 by EX-527 abolished the promoting effect of Pae on autophagy and restored the inhibitory effect of Pae on apoptosis and adhesion molecule expression in the presence of ox-LDL. In conclusion, Pae attenuated ox-LDL-induced apoptosis and adhesion molecule expression by autophagy enhancement via upregulation of SIRT1 in HUVECs, shedding light on the mechanism underlying the protective effect of Pae on ox-LDL-induced injury of HUVECs.

[Effects of Zhuang-medical thread moxibustion combined with needle-pricking on vascular oxidative stress injury in the rat].

OBJECTIVE: To observe the effect of Zhuang-medical thread moxibustion combined with needle-pricking on vascular oxidative stress injury in oxidative stress injury rats. METHODS: Eighty Wistar rats were randomly allocated to normal control, sham operation (sham), model, and combined treatment groups (n=20 in each group). The oxidative stress injury model was established by ligation of the left sciatic nerve to induce chronic constriction injury (CCI) pain stress stimulation. Zhuang-medical thread moxibustion was applied to bilateral "Zusanli" (ST 36), once a day for 3 weeks. Needle-pricking was applied to left "Yanglingquan" (GB 34) and left "Huantiao" (GB 30), once a day for 3 weeks except Sundays. Plasma 6-keto-PGF 1α, thromboxane B 2 (TXB 2), NO and ET contents were assayed by radioimmunoassay. COX-2 immunoactivity of the femoral artery was determined by immunohistochemistry, and pathological changes of the femoral artery were detected by H. E. staining. RESULTS: Compared with the control group, the levels of plasma 6-keto-PGF 1α and NO in the model group were significantly reduced (P<0.05), while those of plasma TXB 2 and ET and COX-2 expression in the femoral artery were obviously increased in the model group (P<0.01). After moxibustion plus needle-pricking treatment, CCI-induced decrease of plasma 6-keto-PGF 1α and NO contents, and increase of plasma TXB 2 and ET and COX-2 expression levels were obviously reversed (P<0.05, P<0.01). The tubal wall of the femoral artery in rats of the model group got thicker, while that of the combined treatment group was relatively thinner, suggesting an inhibition of vascular intimal hyperplasia after the treatment. CONCLUSION: Zhuang-medical thread moxibustion combined with needle-pricking of ST 36, GB 34 and GB 30 can reduce the expression of femoral artery COX-2 and regulate the balance of both plasma PGI 2/TXA 2 and plasma NO/ET in CCI-induced oxidative stress rats, which may contribute to its effect in suppressing oxidative stress-induced vascular intimal hyperplasia.

Cervical epidural steroid injections for the treatment of cervical spinal (neck) pain.

Cervical epidural steroid injections (CESI) are an accepted treatment for neck pain with a radicular component, and may be accomplished by using either transforaminal (CTFESI) or interlaminar (CILESI) approaches. CESIs are routinely performed using real-time fluoroscopic-guidance in conjunction with the injection of water soluble, iodine-based contrast media to enhance visualization of intravascular injections. Digital subtraction angiography (DSA) imaging is an adjuvant to fluoroscopic methods for visualizing blood vessels while performing spinal injections. However, as with any neuraxial procedure, various complications associated with CESIs have been reported. Complications are directly associated with the technical procedures of CESIs. Particulate steroids may have a prolonged duration of action but non-particulate steroids are safer for CESIs. Blunt-beveled needles are less likely than sharp-beveled needles to penetrate blood vessels to cause bleeding complications during CTFESI procedures. Small doses of local anesthetics appear to be safe and assist in identifying intravascular injections previously overlooked by conventional techniques.

Treatment with nesiritide, a recombinant B-type natriuretic Peptide, reduces vascular remodeling following balloon-induced endothelial injuries in rabbits.

Re-stenosis or remodeling of coronary and peripheral arteries remains a major complication following balloon-angioplasty or stenting. This study was designed to investigate the effect of nesiritide, a recombinant B-type natriuretic peptide (BNP), on vascular remodeling following balloon-induced endothelial injuries. Twenty-eight male New Zealand rabbits were divided into nesiritide-treated (0.1 mg/kg/day, sc, for 4 weeks, n = 10), saline-treated control (n = 10) and sham-operated groups (n = 8). In the nesiritide and control groups, a balloon catheter was inserted to the right iliac artery to induce injuries. Vascular endothelial growth factor (VEGF) was measured by immunohistochemistry. The area under internal elastic membrane of the arterial wall (643.2 ± 134.1 vs 493.7 ± 139.3 µm(2), p < 0.05) and the area under external elastic membrane (1495.1 ± 204.9 vs 1265.9 ± 232.6 µm(2), p < 0.05) in the nesiritide group were greater than those in the control group, but were smaller than those in the sham-operated group (p < 0.05). The stenosis ratio was lower in the nesiritide group than in the control group (18.7 ± 7.7% vs 38.0 ± 8.3%, p < 0.01). Importantly, the VEGF expression rate was significantly lower in the nesiritide group than in the control group (42.2 ± 8.8% vs 56.1 ± 13.1%, p < 0.05), while there were no signs of VEGF expression in the non-injured arteries of the three groups. In conclusion, nesiritide treatment reduces the stenosis of the rabbit iliac artery following balloon-induced endothelial injuries probably by decreasing VEGF expression.

Vascular injuries caused by acupuncture.

AIM: To systematically review the literature on vascular injuries caused by acupuncture. METHOD: Systematic literature search in Medline and PubMed. RESULTS: Twentyone cases were identified and the majority developed symptoms in direct connection with the acupuncture treatment. Three patients died, two from pericardial tamponade and one from an aortoduodenal fistula. There were five more tamponades, seven pseudoaneurysms, two with ischaemia, two with venous thrombosis, one with compartment syndrome and one with bleeding. The two patients with ischaemia had remaining sequeleae. Information on follow-up was suboptimal with no information in nine patients. CONCLUSION: Vascular injuries are rare, bleeding and pseudoaneurysm dominating. Follow-up is insufficient in the hitherto published papers.

Nelson's wound: treatment of spinal cord injury in 19th and early 20th century military conflicts.

During the first half of the 19th century, warfare did not provide a background for a systematic analysis of spinal cord injury (SCI). Medical officers participating in the Peninsular and Crimean Wars emphasized the dismal prognosis of this injury, although authors of sketchy civil reports persuaded a few surgeons to operate on closed fractures. The American Medical and Surgical History of the War of the Rebellion was the first text to provide summary of results in 642 cases of gunshot wounds of the spine. The low incidence of this injury (0.26%) and the high mortality rate (55%) discouraged the use of surgery in these cases. Improvements in diagnoses and the introduction of x-ray studies in the latter half of the century enabled Sir G. H. Makins, during the Boer War, to recommend delayed intervention to remove bone or bullet fragments in incomplete injuries. The civil experiences of Elsberg and Frazier in the early 20th century promoted a meticulous approach to treatments, whereas efficient transport of injured soldiers during World War I increased the numbers of survivors. Open large wounds or cerebrospinal fluid leakage, signs of cord compression in recovering patients, delayed clinical deterioration, or intractable pain required surgical exploration. Wartime recommendations for urological and skin care prevented sepsis, and burgeoning pension systems provided specialized longterm rehabilitation. By the Armistice, the effective surgical treatment and postoperative care that had developed through decades of interaction between civil and military medicine helped reduce incidences of morbidity and dispel the hopelessness surrounding the combatant with an SCI.

[Complications and side-effects of acupuncture]. / Uskladnennia ta pobichni efekty akypunktury.

In the review of the literature, an analysis of complications and adverse effects of acupuncture is given, ways for their prevention are outlined.

Quantification of temperature and injury response in thermal therapy and cryosurgery.

Research on thermal therapy--the heating of pathological tissue using energy source (radiofrequency, microwave, high-intensity focused ultrasound, or laser energy)--and cryosurgery--the freezing of pathological tissue using either liquid or gaseous cryogens--can be classified into two broad categories: basic science and clinical application. The basic science of thermal therapy and cryosurgery is an interdisciplinary research field involving both biology and engineering. Studies from the perspective of biology mainly focus on determining the thermally induced injury mechanisms at the macromolecular, cellular, and tissue (in vitro and in vivo) levels. Studies from the engineering perspective emphasize how to measure and predict the thermal and injury behavior using engineering tools. This article will give a detailed overview of studies relevant to the basic science of thermal therapy and cryosurgery from both the biology and engineering points of view. This includes the experimental observations of cellular and vascular alterations during and after thermal therapy/cryosurgery and the quantification of thermal histories and corresponding injuries using mathematical models.

[Acupuncture: complications, contraindications and informed consent]. / Akupunktur: Komplikationen, Kontraindikationen und Patientenaufklärung.

With the widespread usage of acupuncture, the number of reports about complications of this treatment increases. Harmless disturbances are common and include minor bleedings or haematomas, pain during insertion or after withdrawal of the needle, and skin symptoms. In every second acupuncture treatment, at least one of these complications occurs. Orthostatic dysregulations are relatively rare and can be observed in only 1% of patients. They can be prevented by treating the patient in a lying position, especially in the first treatment session. Stab injuries of internal organs most often affect the lungs, resulting in a pneumothorax. At least 23 cases have been published, 2 of them with fatal consequences. An inquiry of Norwegian doctors even suggests that until 1995 in Norway alone 250 cases of pneumothorax after acupuncture occurred. Stab injuries of other internal organs or the CNS are only described in case reports, but some of them had fatal consequences. Stab injuries of peripheral nerves or large vessels and systemic bacterial infections like sepsis or endocarditis are very rare but serious consequences have been described. The transmission of viral infections due to insufficiently sterilised acupuncture needles loses more and more importance. The incidence of local infections can possibly be influenced, but even in Europe this complication still occurs frequently. The overview of published complications leads to the contraindications of acupuncture. Disturbances of coagulation, immune deficiency, abnormal heart valves or prosthetic valves are the most important ones to name. Suggestions for obtaining informed consent may be helpful while performing clinical trials.

Rare but serious complications of acupuncture: traumatic lesions.

Acupuncture has a reputation among the public of being safe. Although recently performed prospective studies on the frequency of adverse effects of acupuncture found no severe complication, since 1965 many case reports of serious or even life-threatening incidents caused by acupuncture have appeared in the scientific literature. The most frequently reported complications are pneumothorax and lesions of the spinal cord. Severe injuries of peripheral nerves and blood vessels due to acupuncture seem to be very rare. Although case reports do not produce reliable data on the frequency of adverse events. information on sources of application errors can be extracted to increase the quality of acupuncture in education and therapy. All traumatic injuries described in this article could be avoided if practitioners had better anatomical knowledge, applied existing anatomical knowledge better, or both.

Traumatic complications of acupuncture. Therapists need to know human anatomy.

OBJECTIVES: To review the traumatic injuries that have been associated with acupuncture and to discuss how these adverse effects may be reduced by increased awareness of normal anatomy and anatomical variations. METHODS: Literature search accompanied by postmortem anatomical studies. RESULTS: Traumatic lesions after acupuncture have been described in thoracic and abdominal viscera, in the peripheral and central nervous systems, and in blood vessels. Deaths have been recorded from pneumothorax and cardiac tamponade. The anatomical structure of the body at several acupuncture points is such that needles can reach vulnerable structures. CONCLUSION: While the frequency of adverse effects of acupuncture is unknown and they may be rare, knowledge of normal anatomy and anatomical variations is essential for safe practice and should be reviewed by regulatory bodies and those responsible for training courses.

Characterization of 5-lipoxygenase inhibitors in biochemical and functional in vivo assays.

Several potent and selective inhibitors of 5-lipoxygenase (5-LO) have been recently developed with excellent activity in certain in vivo assays of leukotriene production. The efficacy of three such inhibitors that have been in clinical trials (zileuton, A-78773 and ZD2138) were evaluated in: 1) ex vivo whole blood assay, 2) dermal Arthus reaction, and 3) functional airway response. In addition, a model of eicosanoid production in rat lung was developed that provides a simple assay for evaluation of the biochemical efficacy of 5-LO inhibitors in the lung. Bronchoalveolar lavage of rat lung with calcium ionophore A23187 resulted in rapid and robust production of PGE2, 6-keto-PGF1 alpha, thromboxane (TxB2), and leukotriene B4 (LTB4). Supplementation of lavage fluid with archidonic acid markedly augmented production of all eicosanoids except LTB4. All three inhibitors were potent and selective blockers of LTB4 production in the ex vivo whole blood assay and in the dermal Arthus reaction. In contrast, higher doses of inhibitor were needed to block LTB4 production in the rat lung lavage model than were needed to block ex vivo whole blood LTB4 production when both end points were measured in the same animal. Similarly, zileuton and A-78733 were less effective in suppressing the functional airway response to antigen in sensitized guinea pigs, whereas both inhibitors were effective in suppressing LTB4 production in the ex vivo whole blood assay. These results demonstrate that different 5-LO inhibitors have markedly distinct efficacy for inhibition of leukotriene production, depending on the animal model.(ABSTRACT TRUNCATED AT 250 WORDS)

Salvage of the severely injured limb in children: a multidisciplinary approach.

Massive trauma to a limb, even in young children, may lead to loss of viability and function. A combination of open fracture with vascular, crush, and avulsion injury resulting in acute peripheral ischemia may place the extremity at risk of necrosis and imminent amputation. We suggest a combined, multidisciplinary approach that includes initial vascular repair and fractures fixation, with early institution of hyperbaric oxygen therapy.

Twenty-two years of office and outpatient laparoscopy: current techniques and why I chose them.

Since 1972 I have introduced the following technical modifications in outpatient laparoscopy under local anesthesia to improve safety, economy, and patient acceptability: avoiding the insufflating needle and sharp trocar in favor of open abdominal entry, using the Hasson cannula; introducing room air for insufflation instead of nitrous oxide or carbon dioxide; using the Hulka clip in place of tubal coagulation; making a single-incision, open surgical entry through the central umbilical fossa in obese patients; and completing fascial penetration with a blunt hemostat or Kelly clamp to minimize the risk of bowel or vessel injury.

Maintenance of patency after vascular trauma by topical irrigation with a peptide homologous to the carboxy-terminus of the fibrinogen gamma chain.

Synthetic peptides with amino acid sequences homologous to the carboxy-terminal sequence of the gamma chain of human fibrinogen were evaluated for their capacity to inhibit thrombus development. A 21-residue peptide effectively inhibited surface-mediated fibrin clot propagation in vitro. Since this effect was localized to the surface, we proceeded with in vivo evaluation, using site-specific topical application only. In a rat model of arterial trauma and microvascular repair, topical application of the 21-residue peptide significantly reduced the rate of thrombosis to 17%, as compared with a control rate of 83%; in comparison, a 12-residue homologue reduced the thrombosis rate only modestly to 61%, which was not significant compared with the control rate. These results indicate the feasibility of antithrombotic therapy with topically applied agents, an approach that may obviate the use of systemic anticoagulation in extremity-replantation surgery.

Frequency of accidental intravascular injection of local anesthetics in children.

Blood was aspirated in 1.7 percent of the cases, 3.1 percent of inferior alveolar block cases, and 2.2 percent of the cases where infiltration was used for the maxillary molars. It was in children eight to ten years of age that 67.2 percent of the positive aspirations occurred, although that age-group composed only 44.5 percent of the sample.