Acute Circulatory Disturbances Research Articles

Role of COX6C and NDUFB3 in septic shock and stroke.

Septic shock is a clinical syndrome characterized by acute circulatory disturbance. Stroke is an acute cerebrovascular disease caused by brain tissue damage. However, the relationship of COX6C and NDUFB3 to them is unclear. The stroke dataset GSE58294 and the septic shock dataset GSE15491 were downloaded from the gene expression omnibus database. Screening of differentially expressed genes (DEGs), weighted gene co-expression network analysis, construction and analysis of protein-protein interaction network, functional enrichment analysis, gene set enrichment analysis, immune infiltration analysis, and comparative toxicogenomics database (CTD) analysis were performed. Gene expression heat map was drawn. TargetScan screened miRNAs regulating central DEGs. A total of 664 DEGs were obtained. Gene ontology analysis showed that they were mainly enriched in leukocyte activation, intracellular vesicle, neutrophil activation, and cytokine receptor activity. According to Kyoto Encyclopedia of Genes and Genomes analysis, they are mainly enriched in metabolic pathways, phagosomes, and Staphylococcus aureus infection. Core genes (UQCRQ, USMG5 [ATP5MD], COX6C, NDUFB3, ATP5L [ATP5MG], COX7C, NDUFA1, NDUFA4) were highly expressed in septic shock and stroke samples. CTD analysis found that eight core genes are associated with liver enlargement, inflammation, proliferation, fibrosis, and necrosis. COX6C and NDUFB3 genes are highly expressed in septic shock and stroke. The higher the COX6C and NDUFB3 genes, the worse the prognosis.

STATUS OF INDICATORS OF PROTEO- AND FIBRINOLYTIC ACTIVITY IN THE LUNGS OF RATS WITH DIABETES COMPLICATED BY ISCHEMIA-REPERFUSION OF THE BRAIN IN THE DYNAMICS OF ITS COURSE

The purpose of the work – to investigate the state of proteo- and fibrinolytic activity inthe lungs of rats with type 2 diabetes and under the conditions of its complication by acutecerebral blood circulation in the basin of the carotid arteries.Materials and methods. In rats with four-month-old type 2 diabetes was simulatedbilateral carotid ischemia for 20 min. In lung homogenates, indicators of proteo- andfibrinolytic activity were determined after 1 hour from the beginning of reperfusion andon the 12th day of the postischemic period.The results. In the lungs of rats without diabetes after 20-minute ischemia with one-hourreperfusion, indicators of proteolytic and fibrinolytic activity decrease; on the 12th dayof the postischemic period, the reversion of the reaction to ischemia occurs – during thisperiod, the studied indicators exceed the control values. In rats with diabetes, higherrates of lysis of low- and high-molecular- weight proteins and a lower rate of collagenlysis were found than in animals of the control group. Ischemia- reperfusion of the brainagainst the background of diabetes mellitus reduces the lysis of high molecular weightproteins in the lungs and does not affect the rest of the investigated indicators of proteoand fibrinolytic activity in both periods of observation.Conclusions. 1. Diabetes mellitus increases the lysis of low- and high-molecular proteinsand reduces the lysis of collagen in the lungs of rats. 2. In contrast to rats of the controlgroup, in rats with diabetes, the response of proteo- and fibrinolytic indicators in the lungsto acute circulatory disturbance in the carotid arteries basin is limited by a decrease inthe lysis of high-molecular weight proteins in both periods of observation.

Imbalance of the hemocoagulation and fibrinolysis systems under conditions of diabetes mellitus complicated by acute circulatory disturbance in the pool of carotid arteries of rats

Introduction. Both cerebral ischemia and diabetes mellitus (DM) are evidenced to be associated with hypercoagulation state, though today the facts concerning hemocoagulation condition with diabetes mellitus complicated by cerebral ischemia-reperfusion are lacking. 
 The aim of the study. To examine the dynamics of interrelations between the pro-, anticoagulant and fibrinolytic parameters in rats with diabetes mellitus complicated by acute cerebral circulatory disturbance. 
 Results. At the early ischemic-reperfusion period activation of the pro-coagulant potential (decrease of prothrombin and thrombin time and increase of fibrinogen content) is found to be balanced by a reduced activity of XIII factor and an increase activity of antithrombin III in rats without diabetes mellitus. At the same period in rats with diabetes increase of the pro-coagulant potential is accompanied by the activation of XIII factor and a reduced activity of antithrombin III promoting clot formation. On the 12th day of the observation the parameters of the coagulation chain in the hemostasis system and antithrombin III return to the level of the control animals in rats without diabetes, but in rats with diabetes the factors of intensification of a thrombotic risk remain activated.
 At the early and late ischemic-reperfusion periods the parameters of blood fibrinolytic activity increase in rats without diabetes; in animals with diabetes mellitus the parameters of fibrinolytic activity remain without changes at the early period of observation (except decrease of a potential plasminogen activity), and they decrease on the 12th day of the post-ischemic period, which deteriorates conditions of thrombolysis. 
 Conclusions. Complication of diabetes mellitus by ischemic-reperfusion lesion of the brain results in imbalance in the hemocoagulation system at the expense of intensification of pro-coagulant mechanisms, and promotes inhibition of fibrinolytic processes with advanced changes in the dynamics of observation.

Possibilities for evaluating regional transcutaneous gas exchange in critical medicine. Message 2

This article presents changes in regional transcutaneous gas exchange (RTCGE) in chronic and acute severe circulatory disorders in the lower extremities in patients before, during anaesthesia and surgery, and in the immediate postoperative period. In 36 healthy and 146 patients with obliterating atherosclerosis of the vessels of the lower limbs (OAVLL) in different stages of before, during anaesthesia and surgery and in the immediate postoperative period, more than 600 studies of RTCGE were performed using the MX-6203 mass spectrometer and small containers developed with our participation. The following were determined: 1) the dependence of RTCGE on body part and age, OAVLL stage, the degree of acute circulatory disturbance in the limb and the effectiveness of surgical correction; 2) the effect of general, epidural anesthesia and analgesia on RTCGE, the patientʼs condition and peripheral circulation); 3) changes in RTCGE after sympathectomy and aorto-bifemoral bypass.

Expression of Vascular Endothelial Growth Factor in the Rat Cerebral Cortex after Blood Supply Disturbances and Immunocorrection of Their Consequences

In rats with acute circulatory disturbances in one of the brain hemispheres resulting from ligation of the a. carotis or microembolization of the cortical blood vessels after intra-arterial injection of suspension of adipocytes, the expression of vascular endothelial growth factor (VEGF) in the cortex of this hemisphere was temporarily decreased. This event can be considered a pathogenetic factor affecting the regenerative processes after ischemization of the cortex. Weakening of VEGF expression was probably a factor providing prolongation of the ischemia-induced degenerative phenomena. The use of an immunomodulator, Immunofan, decreased the intensity of drop in the VEGF expression after transitory cortical ischemia, and this led to more favorable conditions for postischemic recovery, decreased the intensity of neurodegenerative processes, and led to an increase in the number of gliocytes.

Autopsy report for chemical burns from cresol solution

Cresol, which is used as a disinfectant and insecticide, has erosive effects on epidermal and epithelial tissues in the body. Oral exposure causes gastrointestinal corrosive injuries as a direct chemical burn. We report herein a case of suicidal poisoning by ingestion of cresol solution. An octogenarian man with depression was found dead approximately 14h after exposure to less than 500mL of saponated cresol solution. Macroscopically, corrosive lesions such as red-to-brown-colored epithelium and edematous thickening of walls were seen in the skin, mouth, oral cavity, esophagus, and stomach. Histopathologically, coagulative necrosis and vascular dilatation were detected from mucosal to muscular layers in the esophagus, stomach, and duodenum. Congestive edema of the lungs, edematous changes in the brain, and proximal tubular necrosis of the kidneys were seen, suggesting acute circulatory disturbance due to shock. This human case offers valuable information on the direct irritation and shock induced by systemic exposure to corrosive substances.

What does the liver tell us about the failing heart?

This editorial refers to ‘Liver function abnormalities, clinical profile, and outcome in acute decompensated heart failure’, by M. Nikolaou et al. , doi:10.1093/eurheartj/ehs332 The high metabolic activity of the liver results in a high perfusion rate of ∼1 mL/g/min. Under resting conditions, this is about a quarter of the bodýs total blood supply. The oxygen-rich blood of the hepatic artery contributes to about a quarter of the total liver perfusion that may rise substantially under conditions of excessive oxygen demand. The complex blood supply makes the liver extraordinarily vulnerable to acute circulatory disturbances. Both the severity and the pattern of hepatic injury depend on the relative contribution of passive congestion and diminished perfusion.1 Increased central venous pressure results in passive hepatic congestion and causes elevations of alkaline phosphatase (AP), γ-glutamyltransferase (GGT), and direct and indirect serum bilirubin. This ‘congestive hepatic injury’ is known as nutmeg liver on pathology. Decreased cardiac output with impaired organ perfusion is associated with acute centrilobular (zone 3 of the acinus) hepatocellular damage and necrosis. ‘Hepatic ischaemic injury’ results in elevations in serum aminotransferases ( Figure 1 ).2,3 Figure 1 Haemodynamic disturbances in heart failure and mechanisms resulting in different patterns of elevated liver enzymes. Congestive hepatic injury (left panel) and ischaemic hepatic injury (right panel). In contrast to acute perfusion abnormalities, prolonged and chronic haemodynamic disturbances may result in bridging fibrosis, ‘cardiac’ cirrhosis, and impaired hepatic function with decreased synthesis of coagulation factors and albumin. Hepatic congestion occurs without particular symptoms in most cases. Some patients may suffer from jaundice, stretching of the liver capsule with right upper quadrant discomfort, and ascites. Rare cases of congestive heart failure (HF) associated with fulminant hepatic failure have been reported. However, most such cases occur in the setting of superimposed cardiogenic shock and consecutive hepatic ischaemic injury.4 …

Ultrasound diagnostics during acute circulatory disturbance in the perioperative or intensive care setting

Acta Anaesthesiologica ScandinavicaVolume 56, Issue 7 p. 805-806 EDITORIAL Ultrasound diagnostics during acute circulatory disturbance in the perioperative or intensive care setting B. CHOLLEY, B. CHOLLEY Department of Anesthesiology and Intensive Care, Hôpital Européen Georges Pompidou, University Sorbonne Paris Cité, Paris, FranceSearch for more papers by this authorM. HANEY, M. HANEY Department of Anesthesiology and Intensive Care Medicine, University Hospital of Umeå, Umea, SwedenSearch for more papers by this author B. CHOLLEY, B. CHOLLEY Department of Anesthesiology and Intensive Care, Hôpital Européen Georges Pompidou, University Sorbonne Paris Cité, Paris, FranceSearch for more papers by this authorM. HANEY, M. HANEY Department of Anesthesiology and Intensive Care Medicine, University Hospital of Umeå, Umea, SwedenSearch for more papers by this author First published: 10 July 2012 https://doi.org/10.1111/j.1399-6576.2012.02715.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume56, Issue7August 2012Pages 805-806 RelatedInformation

State uvealblood flow in ischemicdiseases persons witheye in combination withocclusive-stenoticlesions of internalcarotid arteries

The study involved 48 people (48 eyes) at 49-76 years of age with acute circulatory disturbances in the arterial system of the organ of vision, including 28 women and 20 men. Hemodynamic parameters of the uveal blood flow by the rheoophthalmography method (ROG) and ultrasound duplex scanning of carotid vessels were studied. The rheoophthalmography method allows doctors to suggest the presence and the degree of ICA stricture formation by the degree of ROG index changing. The early diagnosis of carotid artery pathology will give a chance to approach the treatment subject differentially.

Can heart rate variability become a screening tool for anesthesia-related hypotension?

H EART rate variability (HRV) analysis as a diagnostic tool has been available for decades (1), and many have also learned about modern HRV analysis as a predictive or prognostic instrument for cardiological patients with diagnoses such as congestive heart failure or post-myocardial infarction (2). Numerous recent publications in the field of anesthesiology have presented findings concerning HRV as a potential tool for predicting acute circulatory disturbances, and particularly hypotension (3–11). As all in the field of anesthesiology and critical care medicine traditionally have in mind a central clinical theme to ‘avoid hypotension and hypoxia’ in all perioperative patients, it is relevant for the specialty to carefully study and try to establish validity for any diagnostic instruments which show promise in predicting circulatory disturbances, including hypotension. In this (12) and the previous issue (13) of Acta Anaesthesiologica Scandinavica, two studies are presented where HRV analysis is examined as a possible screening tool for anesthesia-related hypotension (12, 13). Both studies present findings where a preoperative HRV finding was associated with more hypotension during spinal anesthesia. The study by Hanss et al. (12) is a continuation in a series of studies in obstetrical patients, where they have systematically tested HRV parameters in relation to different parts of the peri-operative procedure in a highly selected patient group which is at high risk of hypotension. The study by Fujuwara et al. (13) includes use of a HRV analysis method which has different characteristics from the more commonly used fast Fourier transformation (FFT) method. Both studies provide information and experience which contribute to the process of evaluation and validation of HRV as a clinical tool for assessment of perioperative patients. The few studies published so far where HRV has been applied to predict hypotension can be regarded as preliminary studies within a new research area. Can hypotension during spinal anesthesia or other types of anesthesia be predicted from patterns in HRV? Moreover, is increased low frequency (LF) to high frequency HF power spectrum density ratio (LF/HF) a marker of an increased risk of hypotension, which is suggested by the findings in both studies in this issue? Is increased LF/HF caused by increased sympathetic activity, or is it mainly caused by reduced vagal outflow? Fujiwara et al. (13) also found that subjects with a low degree of randomness in their HRV seemed to be more susceptible to decreased blood pressure after spinal anesthesia. Although not specifically discussed in the paper, these subjects also had relatively low values of both LF and HF power, which was presented as absolute values. The latter finding could also indicate reduced vagal outflow in this subgroup. HRV results in this clinical anesthesia context are difficult to interpret because of several problems, some new, and some not so new (14). First, it is not clear exactly which phenomena in the body that HRV is measuring. Second, so far there are no findings to help to understand whether HRV is more useful in predicting hypotension then other already readily available (and much simpler) parameters. Including, for example, resting heart rate before spinal anesthesia. Third, some of the methodology is difficult to examine and understand. The first and perhaps most important issue concerns exactly which physiological or pathophysiological process HRV is assessing. Regulation of heart

A CASE OF PRIMARY TORSION OF THE GREATER OMENTUM

Primary torsion of the greater omentum in a rare entity as reported in 43 cases in Japan so far. This paper deals with such a case of primary torsion of the greater omentum. A 78-year-old man complaining of upper abdominal pain occurred during playing gate ball was admitted to another hospital with a diagnosis of intestinal obstruction. The patient was referred to the hospital because of persisting right lower quadrant pain and abdominal distension. ON admission an abdominal ultrasonography revealed biliary stone, dilatation of the common bile duct, and a 6×2.5cm oval tumor with a low echoic center. With a diagnosis of acute appendicitis and localized peritonitis, an emergency operation was performed. Upon laparotomy, the appendix lacked in inflammatory findings and a moderate volume of slightly bloody ascites was noted. So an exploration of the abdominal cavity was made after an appendectomy, when a tumor of the greater omentum dark red in color was found to adhere to the peritoneum above the navel. And a torsion twisted clockwise by 2.5 turns was seen in the neck of the omental tumor. The greater omentum below the torsion was resected including normal portion. Histopathologically acute circulatory disturbance in the entire fatty tissues was demonstrated. Forty-four cases including this one which have been reported in the Japanese literature are also reviewed.

Haemodynamic changes in circulatory function following cardiac surgery that requires urgent intervention

Appropriate and effective postoperative care of the patient following cardiac surgery requires a thorough assessment of the haemodynamic profile based on accurate measurement, skilled nursing observation and correct interpretation of the data. Abnormal haemodynamic variables reflect underlying complications which can be life threatening. Left and/or right ventricular failure and cardiogenic shock usually become manifest in the operating theatre after bypass. The management of these problems is usually well established by the time the patient is returned to the Critical Care Unit. In addition, there are a number of other acute circulatory disturbances which become manifest for the first time after the patient's return to the Critical Care Unit. The nurse's role in the early recognition and management of these problems is crucial. This paper highlights the importance of measurement and interpretation of haemodynamic parameters by the nurse in a post-operative cardiac critical care unit. Accurate haemodynamic monitoring leads to the early recognition of potential problems and facilitates appropriate clinical decisions. Central venous pressure (CVP), arterial blood pressure, cardiac output, left atrial pressure (LAP), and/or pulmonary capillary wedge pressure (PCWP) are the major variables which reflect the patient's cardiovascular status. Not all of these variables are measured in any one patient, but the accurate measurement of arterial blood pressure, and at least one filling pressure (e.g. CVP) is mandatory. Abnormal haemodynamic parameters are commonly associated with hypotension or hypertension of various causes. These will be discussed.

Sodium thiosulfate in the treatment of early postischemic disorders

Experiments were made in dogs weighing 15-25 kg with experimental tourniquet shock (35 dogs) and experimental myocardial infarction (29 dogs). Intravenous injection of sodium thiosulfate (500 mg/kg) exerted a marked therapeutic effect on cardio- and central hemodynamics under acute circulatory disturbances both in tourniquet shock and myocardial infarction. Sodium thiosulfate increased cardiac discharge, minute blood flow volume, the first derivative, the threshold of ventricular fibrillation, improved the heart work, decreased and normalized the general peripheral resistance. This effect is likely to be related to the stimulation of intracellular metabolism and antidote action of sodium thiosulfate against ischemic toxin.

FAT‐STORING CELLS (ITO'S CELL) OF HUMAN LIVER

An enzyme histochemical study was carried out on fat‐storing cells, which are distributed in the space of Disse of mammalian liver. The livers used for study consisted of human autopsy materials demonstrating either acute or chronic circulatory disturbance. Fat‐storing cells contain abundant glycogen, and demonstrate a marked γ‐glutamyl transpeptidase activity and a weak lactate dehydrogenase activity. It is highly probable that an active glyconeo‐genesis rather than glycogenolysis is being carried out in these cells. In acute circulatory disturbance, an elevated alkaline phosphatase activity is found in the wall of sinusoids. This phenomenon is a manifestation of activated capillary endothelial cells participating in the regeneration of liver parenchyma. On the other hand, in chronic congestive liver, elevated γ‐glutamyl transpeptidase activity in fat‐storing cells is concerned in the proliferation of fibers in the wall of sinusoids, and elevated pressure in sinusoids is considered to be the main factor in its increased activation.

Characteristics of the guinea pig oviduct estrogen receptor system

Reparative processes in the liver and the adrenal cortex of hemiadrenalectomized female rats, which sustained an acute circulatory disturbance as a result of orthostasis, were investigated by means of quantitative methods (cytometry, kariometry, nucleolometry, determination of cell content calculation of nucleo-cytoplasmic, nucleolo-nuclear ratios). Common features in regeneration of the organs under study were found. During the first days of the experiments the count of the dying cells increased and simultaneously the quantity of amitoses and binucleated cells in the liver grew. The cell composition of the organs was stabilized by the 15th day in the adrenal gland and by the 45th day in the liver. During the first week after orthostasis mitotic activity of epithelial cells rose in both the organs. Later the regeneration took place at the intracellular level (activation of the nuclear apparatus and hypertrophy of the cell cytoplasm).

Experimental pulmonary dystrophy

Mechanical stimulation of the superior cervical sympathetic ganglion in rats caused trophic pulmonary disturbances to develop by the 7th day. The changes could be diagnosed both macro- and microscopically, and took the form of acute circulatory disturbances and microfocal inflammatory processes. The changes were not always confined to the site of stimulation. A rise of the index K served as a criterion of the degree of pulmonary damage $$(K = \frac{{weight of lungs \cdot 100}}{{body weight}})$$ in the intact animals K=0.72±0.034, and in the experimental group the value was 1.01±0.025. Intramuscular injection of 10 mg per kg of hexamethonium daily for the whole observation period reduced the severity and incidence of pulmonary damage. In this group, K=0.76±0.026.

Histopathologic Effect of High-Energy-Particle Microbeams on the Visual Cortex of the Mouse Brain

A histopathologic study was made of the radiogenic lesions produced in the mouse visual cortex with highenergy-particle beams 1 mm, 0.250 mm, 0.075 mm, and 0.025 mm in diameter. Irradiation with the smallest microbeams results in a complete and definite destruction of nerve cell bodies only. Irradiated nerve fibers are not destroyed; neither is there permanent damage to vessels. Interstitial glia cells are partly preserved. The dosages necessary to produce such a lesion in 24 days are extremely high, 400,000 rads for a 0.025-mm beam. The threshold dose is very constant. This is in contrast to lesions produced by larger beams. Here, either total tissue necrosis results from the irradiatlon, or destruction of nerve cell bodies is very scant and patchy in distribution. Acute circulatory disturbances and delayed radiation damage of vessels are constant findings. The dosage required to produce a complete destruction of nerve cells withln 24 days is 14000 rads for 1-mm beams, but this dose also renders the other tlssue components necrotic. This threshold dose has a wide range from 9300 rads to 26000 rads. From the observations it is apparent that, the larger the irradiated tissue volume, the greater are the fluctuations in tissue radiosensitivity; andmore » that tissue radiosensitivity is inversely related to the tissue volume being irradiated. Radiosensitivity of mouse brain cortex to 1- mm beams seems to be largely determined by the radiosensitivity of the vascular apparatus; direct nerve cell necrosis by radiation appears to be of secondary importance but it is demonstrable. Wlth microbeam irradiation the radiosensitivity seems to be determined exclusively by the radiosensitivity of the nerve cells themselves.« less

THE PATHOLOGY OF FAT EMBOLISM

Fat embolism is an acute circulatory disturbance caused by trauma, manifested anatomically by the presence of fat globules within the vessels of the circulation and by certain secondary changes which these produce; clinically it is recognized by the presence of restlessness, dyspnea, delirium, coma and, frequently, death. The cause of fat embolism is always trauma. It may have been such a trauma as to have caused a fracture of bones, a type which is most likely to produce fat embolism; or it may be the trauma which has caused a blunt injury to adipose tissue, or a rupture of certain viscera rich in fat, such as the liver, although this type of case is comparatively rare; it may occur in certain surgical procedures where considerable trauma is employed in the forcible correction of bones and joints such as sometimes happens in the operation of osteoclasis. Osteomyelitis has been mentioned as