RESUMO
BACKGROUND: Hypoxia-inducible factor-1α (HIF-1α) is a transcription factor which maintains cellular homeostasis in response to hypoxia. It can trigger apoptosis while stimulating angiogenesis process and decrease neurological deficit after an ischemic stroke. Up until now, this protein complex has not been widely investigated especially in stroke patient. OBJECTIVE: Here, we examined the potential of HIF-1α as a marker for neuroplasticity process after ischemic stroke. METHODS: Serum HIF-1α were measured in acute ischemic stroke patients. National Institute of Health Stroke Scale (NIHSS) were assessed on the admission and discharge day (between days 7 and 14). Ischemic stroke divided into 2 groups: large vessel disease (LVD, n = 31) and small vessel disease (SVD, n = 27). Statistical significances were calculated with Spearman rank test. RESULTS: A total of 58 patients, 31 with large artery atherosclerosis LVD and 27 with small vessel disease (SVD) were included in this study. HIF-1α level in LVD group was 0.5225 ± 0.2459 ng/mL and in SVD group was 0.3815 ± 0.121 ng/mL. HIF-1α was higher (p = 0.004) in LVD group than in SVD group. The initial NIHSS score in LVD group was 15.46 ± 2.61 and discharge NIHSS score was 13.31 ± 3.449. Initial NIHSS score in SVD group was 6.07 ± 1.82 and the discharge NIHSS was 5.703 ± 1.7055. In both SVD and LVD group, HIF-1α were significantly correlated with initial NIHSS (both p < 0.001) and discharge NIHSS (p < 0.0383 r = 0.94, p < 0.001, r = 0.93, respectively). CONCLUSIONS: HIF-1α has a strong correlation with NIHSS and it may be used as predictor in acute ischemic stroke outcome.
RESUMO
Introduction: Degenerative disorder involving the acromioclavicular joint (ACJ) is quite common especially in the elderly. One of the surgical modalities of treatment of this disorder is the Mumford Procedure. Arthroscopic approach is preferred due to its reduced morbidity and faster post-operative recovery. One method utilizes the anteromedial and Neviaser portals, which allow direct and better visualization of the ACJ from the subacromial space. However, the dangers that may arise from incision and insertion of instruments through these portals are not fully understood. This cadaveric study was carried out to investigate the dangers that can arise from utilization of these portals and which structures are at risk during this procedure. Materials and Methods: Arthroscopic Mumford procedures were performed on 5 cadaver shoulders by a single surgeon utilizing the anteromedial and Neviaser portals. After marking each portals with methylene blue, dissection of nearby structures were carried out immediately after each procedure was completed. Important structures (subclavian artery as well as brachial plexus and its branches) were identified and the nearest measurements were made from each portal edges to these structures. Results: The anteromedial portal was noted to be closest to the suprascapular nerve (SSN) at 2.91 cm, while the Neviaser portal was noted to be closest also to the SSN at 1.60 cm. The suprascapular nerve was the structure most at risk during the Mumford procedure. The anteromedial portal was noted to be the most risky portal to utilize compared to the Neviaser portal. Conclusion: Extra precaution needs to be given to the anteromedial portal while performing an arthroscopic distal clavicle resection in view of the risk of injuring the suprascapular nerve of the affected limb.
