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1.
Clin Plast Surg ; 49(1): 191-195, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782136

RESUMO

Nonsurgical rhinoplasty is increasing in popularity, and when used appropriately, can be less costly and have less downtime than surgical rhinoplasty. It can offer patients a means of seeing how they would feel about a surgical rhinoplasty later. Injection can be safe but patients should still be counseled regarding the rare, possible risks of tissue loss and potentially irreversible tissue ischemia and irreversible blindness. Treatment with hyaluronidase can be partially effective when signs and symptoms are caught early; however, avoidance is still the best medicine along with seeking an experienced, qualified rhinoplasty plastic surgeon.


Assuntos
Rinoplastia , Humanos , Isquemia , Nariz/cirurgia
2.
Vasa ; 50(6): 462-467, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34743586

RESUMO

Background: There is limited information regarding the effects of air pollutants, such as nitrogen oxides (NOx), nitric oxide (NO2), nitrous oxide (NO) and particulate matter with a diameter smaller than 10 µm (PM10), on acute limb ischaemia (ALI), a peripheral arterial disease (PAD) often with a poor clinical outcome. Patients and methods: We conducted an 18-year retrospective cohort study using routinely collected healthcare records from Ninewells Hospital, Dundee, and Perth Royal Infirmary, in Tayside, Scotland, UK from 2000 to 2017. ALI hospitalisation events and deaths were linked to daily NOx, NO2, NO and PM10 levels extracted from publicly available data over this same time period. Distributed lag models were used to estimate risk ratios for ALI hospitalisation and for ALI mortality, adjusting for temperature, humidity, day of the week, month and public holiday. Results: 5,608 hospital admissions in 2,697 patients were identified over the study period (mean age 71.2 years, ±11.1). NOx and NO were associated with an increase of ALI hospital admissions on days of exposure to pollutant (p=.018), while PM10 was associated with a cumulative (lag 0-9 days) increase (p=.027) of ALI hospital admissions in our study. There was no increase of ALI mortality associated with pollution levels. Conclusions: ALI hospital admissions were positively associated with ambient NOx and NO on day of high measured pollution levels and a cumulative effect was seen with PM10.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Idoso , Poluentes Atmosféricos/análise , Poluentes Atmosféricos/toxicidade , Poluição do Ar/análise , Poluição do Ar/estatística & dados numéricos , Humanos , Isquemia/diagnóstico , Isquemia/epidemiologia , Material Particulado/análise , Material Particulado/toxicidade , Estudos Retrospectivos
3.
Zhonghua Yi Xue Za Zhi ; 101(41): 3411-3416, 2021 Nov 09.
Artigo em Chinês | MEDLINE | ID: mdl-34758545

RESUMO

Objective: To compare and evaluate the diagnostic performance of visual evaluation and CT maximal density relative enhancement value in the diagnosis of intestinal ischemia complication in patients with closed loop obstruction and to explore the feasibility of CT maximal density relative enhancement value in quantifying the degrees of intestinal ischemia. Methods: The clinical and CT imaging data of 82 patients, 46 males and 36 females, aged from 19 to 78(52±18) years, with closed loop obstruction were retrospectively analyzed in the First Affiliated Hospital of Zhengzhou University from July 2017 to July 2019. All patients were classified into three groups: necrosis group (28 cases), ischemia group (22 cases), non-ischemia group(32 cases) using clinicopathologic results as reference standard. CT visual evaluation was performed by two experienced radiologists. The sensitivity, specificity, positive and negative predictive values and accuracy of the two observers were calculated respectively. The inter-observer agreement was analyzed by kappa analysis. Maximal density relative enhancement value was defined as the difference CT value of an ROI at dilated obstructed loops between contrast-enhanced and unenhanced CT images. The differences among groups were compared by one-way analysis of variance. Diagnostic performances were evaluated by receiver operating characteristic (ROC) curve analysis. Results: The sensitivity, specificity, positive and negative predictive values and accuracy of observer1 were 62.0%, 87.5%, 88.6%, 59.6%, 72.0%, and 58.0%, 93.8%, 93.5%, 58.8%, 72.0%for observer2, respectively. The kappa value of inter-observer agreement was 0.747. The unenhanced CT value of necrosis group, ischemia group and non-ischemia group was (53.7±9.7), (45.7±7.2) and (44.7±7.0) HU, enhanced CT value was (60.5±10.1), (65.0±11.6) and (87.0±15.8) HU, relative enhancement value was(6.8±8.4), (19.2±12.4) and(44.7±16.2)HU, respectively. All had a statistical difference among three groups (all P<0.05). The unenhanced CT value of necrosis group was higher than that of ischemia group and un-ischemia group (both P<0.05). The enhanced CT value of non-ischemia group was higher than that of ischemia group and necrosis (both P<0.05). The relative enhancement value all had a significant difference between groups (all P<0.05). Taking maximal density relative enhancement value below 19.5 HU as diagnosis threshold, the sensitivity, specificity and area under curve(AUC) were 96.9%, 74.0% and 0.947, respectively. Taking enhanced CT value below 66.5 HU as diagnosis threshold, the sensitivity, specificity and AUC were 93.8%, 60.0% and 0.903, respectively; the sensitivity was higher than that of objective visual evaluation. Conclusion: Maximal density relative enhancement value can quantize the bowel wall enhancement, and is a more reliable way in the diagnosis of intestinal ischemia than visual evaluation.


Assuntos
Obstrução Intestinal , Isquemia Mesentérica , Meios de Contraste , Feminino , Humanos , Obstrução Intestinal/diagnóstico por imagem , Intestino Delgado , Isquemia/diagnóstico por imagem , Masculino , Estudos Retrospectivos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X
4.
BMC Ophthalmol ; 21(1): 393, 2021 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-34781913

RESUMO

BACKGROUND: To evaluate quantitative changes in iris blood circulation in patients with ischemic risk. METHODS: This observational case-control study included 79 patients with diabetic retinopathy (DR) and retinal vein occlusion (RVO). The RVO group included 21 patients; the monocular proliferative diabetic retinopathy (PDR) group included 19 patients; the nondiabetic retinopathy (NDR) group included 18 patients; and the healthy control group included 21 healthy controls. In the RVO group, we analyzed RVO affected eyes, RVO contralateral eyes, and healthy control eyes. We also compared eyes with PDR and contralateral eyes without PDR, patients with diabetes mellitus (DM) without DR, and healthy control eyes. The microvascular networks of the iris and retina were analyzed using optical coherence tomography angiography. The analysis included vessel area density (VAD) and vessel skeleton density (VSD) of iris and retina. RESULTS: In the RVO group, the VAD and VSD of iris in the affected eye were higher than those in contralateral and healthy control eyes, and the VAD and VSD of contralateral eyes were higher than those of healthy control eyes. The retinal blood flow of the RVO eyes was less than that of the contralateral and healthy control eyes, but there were no difference between the contralateral eyes and healthy control eyes. The VAD and VSD of iris in PDR were larger than nonproliferative diabetic retinopathy (NPDR) and the NPDR were larger than NDR. There were no differences between NDR and healthy control eyes. Also, there were no differences among the four groups with respect to retinal blood flow. CONCLUSIONS: Compared with the retina, iris blood circulation quantitative analysis data seem to be more sensitive to ischemia and may be used as a new predictor of ischemic disease, even if further research is needed to better understand the clinical value and importance of this analysis. TRIAL REGISTRATION: The trial is registered with the clinical trial registration number nct03631108 .


Assuntos
Retinopatia Diabética , Vasos Retinianos , Estudos de Casos e Controles , Angiofluoresceinografia , Humanos , Iris/diagnóstico por imagem , Isquemia , Vasos Retinianos/diagnóstico por imagem
5.
Medicina (Kaunas) ; 57(11)2021 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-34833395

RESUMO

Background and Objectives: It is of great importance to obtain information about the severity of ischemic damage and duration of testicular torsion for an effective treatment strategy. Nucleolar-organizing regions (NORs) are sites of the ribosomal genes composed of ribosomal DNA and proteins. Post-silver staining NORs are termed "AgNOR". Since AgNORs clearly reveals the self-renewal potential of cells damaged in ischemic events, we performed the current study. Materials and Methods: The study was carried out in four groups as control, sham, early, and late T/D. In the surgical groups, testes were corrected after a 4-h ischemia period. Testicular tissue samples were taken on the third day after detorsion in group 1, 2, 3, and on the tenth day after detorsion in group 4. TUNEL and silver stainings were applied to all samples. Results: The differences were significant among the groups for both mean AgNOR number and total AgNOR area/total nuclear area (TAA/TNA). Moreover, the differences between control and early torsion-detorsion (T/D), between control and late T/D, between sham and early T/D, between sham and late T/D, and between early T/D and late were statistically significant for AgNOR amount. Furthermore, statistically significant differences among the groups for an average number of apoptotic cells per tubule and the percentage of apoptotic tubule values were detected. Discussion: The apoptotic index gives the ratio of cells that are damaged and will die in a programmed way and cells that remain intact, rather than show the viability of the returning testicle. However, by measuring cells that regenerate with AgNOR, we can show not only those that survive but also cells that can repair themselves. Conclusion: AgNOR proteins are usable for the early observation of ischemic injury levels. The amount of AgNOR protein can enlighten us about the extent of testicular damage after T/D treatment. It may also help the physician in the development of effective treatment strategies for cases.


Assuntos
Torção do Cordão Espermático , Biomarcadores , Humanos , Marcação In Situ das Extremidades Cortadas , Isquemia , Masculino , Região Organizadora do Nucléolo
6.
BMC Ophthalmol ; 21(1): 409, 2021 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-34837998

RESUMO

BACKGROUND: Sjögren's syndrome may be a risk factor for carotid artery stenosis. Bilateral common carotid artery occlusion (BCCAO) in a patient with Sjögren's syndrome was not reported before. In this report, we describe a female with Sjögren's syndrome who had acute visual loss due to ocular ischemic syndrome (OIS) with BCCAO. CASE PRESENTATION: A 50-year-old female with Sjögren's syndrome visited our clinic with acute visual loss in the left eye. The best corrected visual acuity (BCVA) was 2/100 in the left eye, and the intraocular pressure (IOP) was normal in both eyes. Ocular ischemic change was observed during the ophthalmic examination. Aortography and computed tomography angiography (CTA) showed nearly total occlusion of the bilateral CCA. Thus, OIS with BCCAO was diagnosed. The vision in the left eye improved to 30/100 after carotid artery stenting for the left common carotid artery. CONCLUSIONS: BCCAO may be present in patients with Sjögren's syndrome. Large vessel abnormalities should be considered when acute visual loss is found in a patient with Sjögren's syndrome.


Assuntos
Estenose das Carótidas , Síndrome de Sjogren , Artéria Carótida Primitiva , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico , Olho , Feminino , Humanos , Isquemia , Pessoa de Meia-Idade , Síndrome de Sjogren/complicações , Síndrome de Sjogren/diagnóstico
7.
J Med Case Rep ; 15(1): 563, 2021 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-34809725

RESUMO

BACKGROUND: Coronavirus disease 2019, caused by the severe acute respiratory syndrome coronavirus 2, has a broad clinical spectrum, from asymptomatic to multi-organ dysfunction. Acute cerebrovascular events associated with coronavirus disease 2019 are mainly due to the severe acute respiratory syndrome coronavirus 2-induced prothrombotic state. Bilateral basal ganglia ischemia is rarely reported. CASE PRESENTATION: We report the case of a 64-year-old Asian (Pakistani) gentleman who presented initially with fever, cough, and shortness of breath, likely due to respiratory involvement by severe acute respiratory syndrome coronavirus 2. Later, he developed bilateral lower limb pain, followed by confusion and decreased level of consciousness. Accentuated large hypodense opacities were seen in the left and right basal ganglia, with mass effects on the left frontal horn. CONCLUSION: This case demonstrates the importance of neuroimaging in the effective management of patients with neurological signs associated with coronavirus disease 2019.


Assuntos
COVID-19 , Gânglios da Base , Febre , Humanos , Isquemia , Masculino , Pessoa de Meia-Idade , SARS-CoV-2
8.
Zhongguo Ying Yong Sheng Li Xue Za Zhi ; 37(5): 543-547, 2021 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-34816670

RESUMO

Objective: To investigate the effects of moxibustion on the behavioral performance, brain morphological structure of mice with hypoxia-ischemia brain injury and to explore its mechanisms. Methods: One hundred and six ICR mice were randomly divided into three groups, sham group (n=23), model group (n=46) and moxibustion-treated group (n=37). Neonatal hypoxic-ischemia brain injury was induced by ligation of common carotid artery followed by hypoxia (8% oxygen, 100 min), and pups in the moxibustion-treated group were administered suspended moxibustion on the Dazhui points (GV14) at a height of approximately 2 cm over a hairless area of the skin once a day for 4 days (i.e. at 2, 24, 48 and 72 hours after hypoxia-ischemia procedure). Behavioral tests were used to evaluate behavioral performance. HE staining was used to observe brain morphological structure. Western blot was used to detect the expression of SOD2 protein, and spectrophotometry was used to determine the content of MDA in the ipsilateral brain. Results: Mouse pups in sham group showed that the behavioral performance was normal, the brain tissue cells were densely and neatly arranged, the expression of SOD2 and the level of MDA in the brain tissues were normal. Compared with sham group, mouse pups in the HI model group exhibited a significant longer latency to complete the righting reflex, geotaxis reflex, cliff avoidance (P<0.05) and a marked shorter latency to complete the grip test (P<0.05); and the HI model group had dramatic brain morphological changes showing missing regions, decreased expression of SOD2 protein (P<0.05) and increased level of MDA in the brain. Compared with HI model group, mouse pups in the moxibustion-treated group exhibited a significant shorter latency to complete the righting reflex, geotaxis reflex, cliff avoidance test (P<0.05) and a marked longer latency to complete the grip test (P<0.05); and the moxibustion-treated group had less brain morphological changes, increased expression of SOD2 protein (P<0.05) and decreased level of MDA in the brain (P<0.05) . Conclusion: Moxibustion could improve behavioral performance and attenuate hypoxia-ischemia brain injury, which might be related to increasing the expression of SOD2 protein and decreasing the content of MDA, thus enhancing the anti-oxidative ability.


Assuntos
Lesões Encefálicas , Hipóxia-Isquemia Encefálica , Moxibustão , Animais , Animais Recém-Nascidos , Encéfalo , Hipóxia , Hipóxia-Isquemia Encefálica/terapia , Isquemia , Camundongos , Camundongos Endogâmicos ICR
9.
Harefuah ; 160(11): 721-723, 2021 Nov.
Artigo em Hebraico | MEDLINE | ID: mdl-34817136

RESUMO

INTRODUCTION: Hair tourniquet syndrome, AKA hair thread tourniquet or hair strangulation occurs among infants. A human hair or a thread strangulates a body appendage, resulting in obstruction of blood and lymph flow. If not recognized early it may cause tissue necrosis and rarely, require amputation. AIMS: Revealing the discrepancy between incidence and documentation in practice. Understanding the challenges standing in the way of the clinician while admitting a patient. METHODS: A retrospective study. The hospital's archive was searched for the period between the years 2008 to 2018. According to the ICD9 system this phenomenon is termed "external constriction caused by hair". Upon questioning, doctors had admitted having trouble finding the right diagnosis while digitally documenting a patient. The archive was searched twice - firstly, by the correct ICD9 code. Secondly, a general search was performed reviewing all 0-1 year-old patients' files. RESULTS: By researching the ICD9 code, 7 files were found. On the second search, 41 files were found, among them only 5 files were documented properly according to the ICD9 system. CONCLUSIONS: The majority (87.8%) of patients suffered from hair strangulation syndrome were not documented properly. Lack of documentation is a result of the digital difficulty finding the right diagnosis. DISCUSSION: Hair strangulation syndrome is not as rare as may be concluded basing on existing data. Clinicians must include it in the differential diagnosis when admitting a patient with the relevant symptoms or an agitated infant with no clear cause. Adjusting the digital systems in Israeli hospitals should be considered.


Assuntos
Cabelo , Torniquetes , Documentação , Humanos , Incidência , Lactente , Recém-Nascido , Isquemia , Estudos Retrospectivos
10.
Ther Adv Cardiovasc Dis ; 135: 17539447211046953, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34796770

RESUMO

BACKGROUND: Our aim was to review the current literature of the use of directional atherectomy (DA) in the treatment of lower extremity critical-limb ischemia. METHODS: A search for relevant literature was performed in PubMed and PubMed Central on 16 April 2020, sorted by best match. Three searches across two databases were performed. Articles were included that contained clinical and procedural data of DA interventions in lower extremity critical-limb ischemia patients. All studies that were systematic reviews were excluded. RESULTS: Eleven papers were included in this review. Papers were examined under several parameters: primary patency and secondary patency, limb salvage/amputation, technical/procedural success, complications/periprocedural events, and mean lesion length. Primary and secondary patency rates ranged from 56.3% to 95.0% and 76.4% to 100%, respectively. Limb salvage rates ranged from 69% to 100%. Lesion lengths were highly varied, representing a broad population, ranging from 30 ± 33 mm to 142.4 ± 107.9 mm. CONCLUSIONS: DA may be a useful tool in the treatment of lower extremity critical-limb ischemia.


Assuntos
Isquemia , Doença Arterial Periférica , Aterectomia/efeitos adversos , Humanos , Isquemia/diagnóstico , Isquemia/cirurgia , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/cirurgia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Grau de Desobstrução Vascular
11.
Acta Cir Bras ; 36(9): e360903, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34755763

RESUMO

PURPOSE: To evaluate if the perconditioning affects the antioxidant capacity in mesenteric ischemia and reperfusion injury. METHODS: Twenty-one Wistar rats were assigned into three groups, as follows: Sham, IR and rPER. The animals were subjected to mesenteric ischemia for 30 min. rPER consisted of three cycles of 5-min hindlimb ischemia followed by 5 min hindlimb perfusion at the same time to mesenteric ischemic period. After 5 minutes, blood and 5 cm of terminal ileum were harvested for thiobarbituric acid reactive substances (TBARS) and Trolox equivalent antioxidant capacity (TEAC) measurement. RESULTS: rPER technique was able to reduce intestinal tissue TBARS levels (p<0.0001), but no statistic difference was observed in blood levels between groups, although it was verified similar results in rPER and Sham group. rPER technique also enhanced TEAC levels in both blood (p = 0.0314) and intestinal tissue (p = 0.0139), compared to IR group. CONCLUSIONS: rPER appears as the most promising technique to avoid IR injury. This technique reduced TBARS levels in blood and intestinal tissue and promoted the maintenance of antioxidant defense in mesenteric acute injury.


Assuntos
Isquemia Mesentérica , Traumatismo por Reperfusão , Animais , Antioxidantes , Isquemia , Ratos , Ratos Wistar , Traumatismo por Reperfusão/prevenção & controle
12.
Acta Cir Bras ; 36(9): e360904, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34755764

RESUMO

PURPOSE: The protective effect of silibinin on kidney and lung parenchyma during hepatic ischemia/reperfusion injury (IRI) is explored. METHODS: Sixty-three Wistar rats were separated into three groups: sham; control (45 min IRI); and silibinin (200 µL silibinin administration after 45 min of ischemia and before reperfusion). Immunohistochemistry and real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR) were used to evaluate the expression levels of MMP2, MMP3, MMP9, and TIMP2 on kidney and lung. RESULTS: Comparing sham vs. control groups, confirmed that hepatic IRI increased both renal and lung MMP2, MMP3, MMP9 and TIMP2 expressions starting at 180 min (p<0.001). Comparison of the control vs. silibinin groups showed a statistically significant decrease in the expression levels of MMP2, MMP3, and MMP9 and increase of TIMP2 in kidney and lung parenchyma. The starting point of this decrease was at 120 min after reperfusion, both for kidney and lung parameters, and it was statistically significant at 240 min (p<0.001) for kidney, while silibinin showed a peak of lung protection at 180 min after hepatic reperfusion (p<0.001). CONCLUSIONS: Hepatic IRI causes distant kidney and lung damage, while a statistically significant protective action, both on kidney and lung parenchyma, is conveyed by the intravenous administration of silibinin.


Assuntos
Metaloproteinase 2 da Matriz , Traumatismo por Reperfusão , Animais , Isquemia , Rim , Pulmão , Metaloproteinase 3 da Matriz , Metaloproteinase 9 da Matriz , Ratos , Ratos Wistar , Traumatismo por Reperfusão/tratamento farmacológico , Traumatismo por Reperfusão/prevenção & controle , Silibina
13.
Acta Cir Bras ; 36(9): e360907, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34755767

RESUMO

PURPOSE: To assess the effects of adipocyte-derived stem cell (ASC)-injection on the survival of surgical flaps under ischemia in diabetic rats. METHODS: Diabetes was induced in 30 male Wistar rats using streptozotocin (55 mg/kg). After eight weeks, epigastric flap (EF) surgery was performed. The animals were divided into control (CG), medium-solution (MG), and ASC groups. The outcomes were: the survival area (SA), the survival/total area rate (S/TR), and expression levels (EL) of genes: C5ar1, Icam1, Nos2, Vegf-a. RESULTS: In the ASC group, compared to CG, we observed improved flap SA (CG-420 mm2 vs. ASC-720 mm2; p=0.003) was observed. The S/TR analysis was larger in the ASC group (78%) than the CG (45%). This study showed an increase in the Vegf-a EL in the ASC group (2.3) vs. CG (0.93, p=0.0008). The Nos2 EL increased four-fold in the ASC group compared to CG, and C5ar1 EL decreased almost two-fold in the ASC group vs. the CG (p=0.02). There was no difference among the groups regarding Icam1 EL. Compared to the MG, the ASC group had a bigger flap SA (720 mm2 vs. 301 mm2, respectively), a bigger S/TR (78% vs. 32%, p=0.06, respectively) and increased EL of Vegf-a (2.3 vs. 1.3, respectively). No difference between ASC-group and MG was seen regarding Nos2 (p=0.08) and C5ar1 (p=0.05). CONCLUSIONS: This study suggests that ASCs increase the survival of EF under IR in diabetic rats.


Assuntos
Diabetes Mellitus Experimental , Adipócitos , Tecido Adiposo , Animais , Isquemia , Masculino , Ratos , Ratos Wistar , Células-Tronco , Retalhos Cirúrgicos
14.
BMJ Case Rep ; 14(11)2021 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-34785513

RESUMO

Hypercoagulable and proinflammatory states induced by the novel coronavirus (SARS-CoV-2) lead to thrombotic and embolic events. In this case report, the authors describe how they successfully managed acute critical limb ischaemia in a patient of COVID-19 illness with severe pulmonary disease and high thrombus burden in the infrapopliteal arteries.


Assuntos
Arteriopatias Oclusivas , COVID-19 , Humanos , Isquemia/etiologia , Isquemia/cirurgia , SARS-CoV-2 , Trombectomia
16.
Zhonghua Yi Xue Za Zhi ; 101(43): 3559-3563, 2021 Nov 23.
Artigo em Chinês | MEDLINE | ID: mdl-34808748

RESUMO

Objective: To observe the clinical efficacy of spinal cord stimulation (SCS) in the treatment of diabetic foot (DF). Methods: Sixteen patients who were diagnosed with DF and treated with SCS from the Department of Pain Medicine of the First Affiliated Hospital, China Medical University from October 2015 to October 2018 were retrospectively analyzed. Visual analogue scale (VAS), 36-item short form health survey (SF-36), transcutaneous oxygen partial pressure (TcPO2) and skin temperature of lower limbs were compared before and after treatment, and the complications were recorded. Results: Among the 16 patients, 14 were equipped with implantable pulse generator (IPG). The VAS scores decreased significantly from 7.5±1.2 before treatment to 2.6±0.8, 2.0±0.7, 1.6±0.6, 1.0±0.9, 0.9±0.9 at 1 day, 1 week, 3 months, 6 months and 12 months after electrode implantation respectively (all P<0.05). At 12 months after treatment, the parameters of SF-36 were significantly different from those before treatment (all P<0.05). The TcPO2 was (23±5) mmHg before treatment and (38±6) mmHg at 1 week after treatment, with a statistical difference (P<0.05), and the temperature of lower limbs increased significantly (P<0.05). No serious complications were observed in all patients. Conclusion: SCS can relieve the pain of patients with DF, improve the microcirculation and blood supply of lower limbs, and thus promote the quality of life, with rare serious complications.


Assuntos
Diabetes Mellitus , Pé Diabético , Estimulação da Medula Espinal , Pé Diabético/terapia , Humanos , Isquemia , Qualidade de Vida , Estudos Retrospectivos , Medula Espinal , Resultado do Tratamento
17.
Orv Hetil ; 162(48): 1940-1945, 2021 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-34839275

RESUMO

Összefoglaló. A varicella zoster vírus (VZV-) fertozés típusos elso megjelenése a bárányhimlo, késobb a reaktiváció során a herpes zoster. Szemészeti tünet az V/I-es agyideget érinto zoster esetén gyakori. A legrettegettebb szemészeti manifesztáció az akut retinanekrózis, mely fulmináns lefolyású, és súlyos szöveti destrukciót, valamint jelentos funkcionális károsodást, gyakran vakságot hagy maga után. Központi idegrendszeri vascularis érintettség elofordulhat bárányhimlohöz társulóan vagy a késobbi reaktivációk során is, súlyos következményekhez vezetve. A Semmelweis Egyetem Szemészeti Klinikáján akut retinanekrózis tünetével érkezo 65 éves férfi esetét ismertetjük. Az Amerikai Szemorvostársaság (AAO) diagnosztikus kritériumainak mindenben megfelelo klinikai kép alapján azonnal indított adekvát dózisú antivirális kezelés mellett 3 nap múlva, contralateralis hemiparesis hátterében, a képalkotó vizsgálat ipsilateralis ischaemiás stroke-ot igazolt. Intraocularis mintából PCR-vizsgálat bizonyította a vírus jelenlétét. Liquormintában enyhe anti-VZV-IgA-pozitivitás mutatkozott. Az aktuális szemészeti betegség és a stroke társulásának hátterében az észlelt paraméterek, valamint a releváns irodalmi adatok alapján a varicella zoster vírus okozta vasculopathiát valószínusítettük. Gyermekkorban ez az ischaemiás stroke leggyakoribb oka, felnottkorban pedig az V/I-es agyideg herpeses érintettsége esetén négy és félszeres a kockázat stroke kialakulására. A VZV-reaktiváció okozta akut retinanekrózis és a stroke társulásának lehetosége, bár ismert a nemzetközi irodalomban, magyar szakirodalom tudomásunk szerint eddig nem tárgyalta, ez kiemeli esetünk közlésének jelentoségét. Orv Hetil. 2021; 162(48): 1940-1945. Summary. The typical first onset of varicella zoster virus (VZV) infection is chickenpox, later herpes zoster during reactivation. Ophthalmic symptoms are common in herpes zoster affecting the V/I cranial nerve. The most dreaded ophthalmic manifestation is acute retinal necrosis, which has a fulminant course and leaves severe tissue damage as well as significant functional impairment, often blindness. Vascular involvement in the central nervous system may occur in association with chickenpox or during subsequent reactivations leading to severe consequences. We report the case of a 65-year-old male patient with symptoms of acute retinal necrosis at the Department of Ophthalmology, Semmelweis University. The clinical picture fulfilled the diagnostic criteria of the American Academy of Ophthalmology (AAO) and after 3 days of the immediately initiated adequate therapy, contralateral hemiparesis appeared, that was confirmed as an ipsilateral stroke by imaging study. The PCR analysis of an intraocular sample confirmed the presence of VZV. Mild anti-VZV IgA positivity was observed in the cerebrospinal fluid sample. Based on the current ophthalmic disease, the associated stroke alongside with the relevant literature data, varicella zoster vasculopathy was probable. VZV vasculopathy is the most common cause of ischemic stroke in childhood and in adulthood herpetic involvement of the V/I cranial nerve elevates 4.5 times the risk of stroke formation. Though the possible association of acute retinal necrosis and stroke caused by VZV reactivation is known in the international literature, to the best of our knowledge it has not been discussed in Hungary so far, which highlights the importance of reporting our case. Orv Hetil. 2021; 162(48): 1940-1945.


Assuntos
Oftalmologia , Acidente Vascular Cerebral , Adulto , Idoso , Diagnóstico por Imagem , Humanos , Hungria , Isquemia , Masculino
18.
Emerg Med Clin North Am ; 39(4): 769-780, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34600636

RESUMO

Abdominal vascular emergencies are an uncommon entity in emergency medicine, but when they present, they are often catastrophic. These time-sensitive and life-threatening diagnoses are often hidden in nonspecific complaints such as nausea, vomiting, or flank pain, so the emergency physician must remain diligent and consider these in the differential diagnoses. The following is an overview of the more common of these abdominal vascular emergencies, in the hope that they help the Emergency Physician avoid the misdiagnosis and subsequent vascular catastrophe that would follow.


Assuntos
Abdome/irrigação sanguínea , Erros de Diagnóstico/prevenção & controle , Traumatismos Abdominais/diagnóstico , Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Abdominal/cirurgia , Estenose da Valva Aórtica/diagnóstico , Arteriopatias Oclusivas/diagnóstico , Técnicas de Diagnóstico do Sistema Digestório , Medicina de Emergência , Humanos , Intestinos/irrigação sanguínea , Isquemia/diagnóstico , Isquemia/terapia , Isquemia Mesentérica/diagnóstico , Isquemia Mesentérica/terapia , Lesões do Sistema Vascular/diagnóstico
19.
Anal Chim Acta ; 1184: 339014, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34625264

RESUMO

The identification of ether-phosphatidylcholine (ether-PC) isomers, including alkyl-PC (PC(O-)) and plasmalogen-PC (PC(P-)), is technically challenging in MS/MS analysis, which hinders scientists from gaining a deeper understanding of such important lipids. In this study, we developed a sensitive and specific LC-MS/MS-MRM method to accurately identify PC(O-) and PC(P-). We first deciphered the specific fragmentation rules from LPC(O-) and LPC(P-) isomers, in which the product ion of LPC(P-) would be dominated by alkenyl ions (A). In contrast, LPC(O-) only provided a ring-structure fragment (R) without further fragmentation to the alkyl ion, showing completely different characteristics between LPC(O-) and LPC(P-) in negative ion mode. Next, to overcome the sensitivity issue, the MRM approach based on fragmentation rules was used to differentiate PC(O-) and PC(P-). The CE-optimized MRM method increased the alkenyl-to-ring ratio (A/R) between PC(O-) and PC(P-), in which A/R was almost equal to zero for PC(O-) but A/R ≥ 3 for PC(P-). This highly selective property of the CE-optimized MRM method provides accurate identification of PC(O-) and PC(P-) in whole blood samples. The proposed method was applied in primary neuronal cultures with oxygen-glucose deprivation (OGD) treatment to investigate the regulation of PCs under hypoxic stress. The results showed that the regulation of ether-PCs was mainly related to the sn-1 chain length, and the concentration changes of diacyl-PCs were highly dependent on the degree of unsaturation. In summary, the CE-optimized MRM method enables users to distinguish between PC(O-) and PC(P-) in a simple way.


Assuntos
Fosfatidilcolinas , Espectrometria de Massas em Tandem , Cromatografia Líquida , Éter , Éteres , Humanos , Isquemia , Espectrometria de Massas por Ionização por Electrospray
20.
F1000Res ; 10: 584, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34642600

RESUMO

Hypercoagulation is a hallmark of both the novel coronavirus disease (COVID-19) and type 2 diabetes mellitus (T2DM). It increases the risk for vascular thrombosis, including peripheral artery diseases. Among others, acute limb ischemia (ALI) is one of most common complications that requires immediate and prompt treatments to reduce morbidity and mortality. However, the complex interplay between COVID-19, T2DM and its complications (e.g., diabetic nephropathy), and ALI creates a great challenge in the management of the disease. Here, we present a case of a 59-year-old diabetic female with progressive pain in her left leg in the last five years, which was significantly intensified following COVID-19 diagnosis. Bluish coloration, numbness and functional impairments were observed during examinations with no palpable pulsation on left posterior tibial and dorsalis pedis arteries. The patient also had diabetic nephropathy (stage III), hypoalbuminemia, anemia and a urinary tract infection that complicated the management of the disease. Due to the excruciating pain and the worsening of the limb conditions, right leg revascularization and left leg amputation were performed at day 14 after admission. Following the surgeries, no more pain was observed and patient was discharged for further follow-up at the outpatient clinic.


Assuntos
COVID-19 , Diabetes Mellitus Tipo 2 , Nefropatias Diabéticas , Teste para COVID-19 , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Isquemia/etiologia , Pessoa de Meia-Idade , Prognóstico , SARS-CoV-2
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