Improve Blood Flow Research Articles

Nimodipine Reduces Dysfunction and Demyelination in Models of Multiple Sclerosis.

ObjectiveTreatment of relapses in multiple sclerosis (MS) has not advanced beyond steroid use, which reduces acute loss of function, but has little effect on residual disability. Acute loss of function in an MS model (experimental autoimmune encephalomyelitis [EAE]) is partly due to central nervous system (CNS) hypoxia, and function can promptly improve upon breathing oxygen. Here, we investigate the cause of the hypoxia and whether it is due to a deficit in oxygen supply arising from impaired vascular perfusion. We also explore whether the CNS‐selective vasodilating agent, nimodipine, may provide a therapy to restore function, and protect from demyelination in 2 MS models.MethodsA variety of methods have been used to measure basic cardiovascular physiology, spinal oxygenation, mitochondrial function, and tissue perfusion in EAE.ResultsWe report that the tissue hypoxia in EAE is associated with a profound hypoperfusion of the inflamed spinal cord. Treatment with nimodipine restores spinal oxygenation and can rapidly improve function. Nimodipine therapy also reduces demyelination in both EAE and a model of the early MS lesion.InterpretationLoss of function in EAE, and demyelination in EAE, and the model of the early MS lesion, seem to be due, at least in part, to tissue hypoxia due to local spinal hypoperfusion. Therapy to improve blood flow not only protects neurological function but also reduces demyelination. We conclude that nimodipine could be repurposed to offer substantial clinical benefit in MS. ANN NEUROL 2020 ANN NEUROL 2020;88:123–136

A REVIEW ON POTENTIAL PROPERTIES AND THERAPEUTIC APPLICATIONS OF LYCOPENE

The present review is based mainly on papers published between 2000 and 2011 and gives information about the properties of the carotenoid lycopene in chemical and biological systems and its possible role in preventing cardiovascular diseases (CVD). The main aim of this report is to highlight its role as an antioxidant, also reported are bioactive properties that may influence the development of foam cells and protection against endothelial cell damage. The paper will also examine recent observations that lycopene may improve blood flow and reduce inflammatory responses. Lycopene possesses antioxidant properties in vitro, and some epidemiological studies have reported protective effects against the progression of CVD. The oxidation of human low density lipoproteins (LDL) is a fundamental mechanism in the initiation of atherosclerosis. A beneficial role of lycopene as antioxidant in the prevention of CVD is suggested but the data are still controversial. Lycopene is believed to be the most potent carotenoid antioxidant in vitro. Tissue culture experiments and animal studies support potential cardioprotective effects for lycopene and other carotenoids in the blood. Most studies showed beneficial effects of lycopene to individuals who are antioxidant-deficient like elderly patients, or humans exposed to higher levels of oxidative stress like smokers, diabetics, hemodialysis patients and acute myocardial infarction patients. By defining the right population and combining antioxidant potentials of lycopene with vitamins and other bioactive plant compounds, the beneficial role of lycopene in CVD can be clarified in future studies.
 Keywords: Atherosclerosis, isomerization, in vitro, in vivo, LDL oxidatin

The Lipopeptide MALP-2 Promotes Collateral Growth.

Beyond their role in pathogen recognition and the initiation of immune defense, Toll-like receptors (TLRs) are known to be involved in various vascular processes in health and disease. We investigated the potential of the lipopeptide and TLR2/6 ligand macrophage activating protein of 2-kDA (MALP-2) to promote blood flow recovery in mice. Hypercholesterolemic apolipoprotein E (Apoe)-deficient mice were subjected to microsurgical ligation of the femoral artery. MALP-2 significantly improved blood flow recovery at early time points (three and seven days), as assessed by repeated laser speckle imaging, and increased the growth of pre-existing collateral arteries in the upper hind limb, along with intimal endothelial cell proliferation in the collateral wall and pericollateral macrophage accumulation. In addition, MALP-2 increased capillary density in the lower hind limb. MALP-2 enhanced endothelial nitric oxide synthase (eNOS) phosphorylation and nitric oxide (NO) release from endothelial cells and improved the experimental vasorelaxation of mesenteric arteries ex vivo. In vitro, MALP-2 led to the up-regulated expression of major endothelial adhesion molecules as well as their leukocyte integrin receptors and consequently enhanced the endothelial adhesion of leukocytes. Using the experimental approach of femoral artery ligation (FAL), we achieved promising results with MALP-2 to promote peripheral blood flow recovery by collateral artery growth.

Effect of Dietary Nicotinamide Mononucleotide (NMN) on Function and Mechanics of Skeletal Muscle Arteries from Aged Mice

Ageing is associated with a decline in vascular function and increased risk of cardiovascular disease. Dietary NMN, an NAD+ precursor, increases muscle vascularity, blood flow and exercise performance in aged mice 1. This study determined the effects of dietary NMN on endothelium‐dependent dilation (EDD) and vascular stiffness in skeletal muscle arteries isolated from aged mice. Male and female C57BL/6J mice received NMN (400 mg/kg) in drinking water for 8–10 weeks; mice were ~97 weeks old at the end of the treatment period. Segments of the saphenous and gracilis muscle arteries (SA and GMA respectively) were removed. Functional responses were examined using pressure myography. SA and some GMA were pre‐constricted with phenylephrine. Pressure‐induced myogenic tone was enhanced in GMA from NMN‐treated male mice. NMN treatment enhanced EDD in the GMA of both male and female mice as measured by a leftward shift in the pEC50 of acetylcholine concentration‐response curves. EDD in the SA from either sex was not altered by NMN treatment. NMN treatment also did not affect responses to the endothelium‐independent vasodilator sodium nitroprusside in either artery, from either sex. The nitric oxide synthase (NOS) inhibitor L‐NAME (100 μM) strongly inhibited EDD in the SA but caused only minor inhibition of EDD in the GMA, from both sexes. In the GMA from both sexes, EDD was significantly inhibited by blockers of Ca2+‐sensitive K+ channels (KCa). Analysis of relative EC50‐shift suggested intermediate‐conductance‐KCa (IKCa)‐mediated vasodilation was enhanced in the GMA from NMN‐treated mice. Stress‐strain relationships were obtained from arteries under passive conditions, over the pressure‐range 5–120 mmHg. Analysis of these relationships showed NMN treatment increased compliance of GMA, but not SA, from both sexes. SA from female mice were less compliant than SA from male mice, regardless of NMN treatment. These studies suggest NMN treatment can enhance EDD, decrease arterial stiffness and improve blood flow autoregulation in small resistance (GMA) arteries, but not larger conduit (SA) arteries in skeletal muscle from aged mice. The increased EDD may be due to increased IKCa‐mediated vasodilation, but not increased nitric oxide‐mediated effects. These changes may contribute to the enhanced muscle blood flow and exercise performance observed in aged NMN‐treated mice.

Stimulator of Interferon Genes (STING) Regulates Endothelial Healing and Reendothelialization Following Angioplasty‐Mediated Vascular Injury

Angioplasty and stent implantation are common clinical interventions to improve blood flow in Peripheral Artery Disease, which is rising in prevalence in America. However, these interventions result in vascular endothelial damage, leading to the activation of signaling pathways that can have a major effect on short‐ and long‐term vessel health. We hypothesized that endothelial cell‐intrinsic Stimulator of Interferon Genes (STING), a crucial regulator of immune responses triggered by pathogen or self‐derived DNA, regulates reendothelialization and healing in response to vascular injury. To study whether STING‐mediated reendothelialization was an endothelial cell specific effect, in vitro wound healing assay was performed on WT and STING deficient primary mouse heart endothelial cells (MHEC) using live imaging and quantification with Cytation and IncuCyte. We found that, while WT MHEC completely covered the scratch area within 24 hours of initial scratch, only 75.59% ± 5.8 of the initial wound was healed in STING deficient MHEC monolayers. Furthermore, our in vivo experiments using the wire injury‐mediated experimental model of angioplasty in mice followed by Evans Blue Dye staining to distinguish the areas with denuded endothelium, demonstrate a decrease in reendothelialization in injured carotid arteries in STING deficient mice as compared to WT mice five days post injury (43.57% ± 9.79 area reendothelialized vs 95.16% ± 2.77, respectively). Seven days post wire injury, WT carotid arteries were completely healed, in contrast to those of STING deficient mice that remained unhealed (67.74% ± 5.80 of reendothelialized vessel area). Additionally, multi‐parameter flow cytometry analysis of the enzymatically digested arteries from the seven days post wire injury group demonstrated an increase in myeloid cell infiltration in WT mice, which was not observed in either the injured STING deficient arteries or in the uninjured contralateral WT carotid arteries, indicating an early localized and differential immune response likely affecting long term vascular remodeling. Our results support that endothelial STING contributes to endothelial healing in vitro and in vivo, and that myeloid cell infiltration in the carotid arteries is required for reendothelialization and may be responsible for lack of healing in STING deficient mice. Ongoing experiments aim to definitively quantify temporal recruitment of immune cells over the course of reendothelialization and chronic vascular remodeling following wire injury and the mechanisms involved in short‐ and long‐term vascular health.Support or Funding InformationThis work was supported by the NIH‐RO1‐HL123658

Kalman Filter-Based Microbubble Tracking for Robust Super-Resolution Ultrasound Microvessel Imaging.

Contrast microbubble (MB)-based super-resolution ultrasound microvessel imaging (SR-UMI) overcomes the compromise in conventional ultrasound imaging between spatial resolution and penetration depth and has been successfully applied to a wide range of clinical applications. However, clinical translation of SR-UMI remains challenging due to the limited number of MBs detected within a given accumulation time. Here, we propose a Kalman filter-based method for robust MB tracking and improved blood flow speed measurement with reduced numbers of MBs. An acceleration constraint and a direction constraint for MB movement were developed to control the quality of the estimated MB trajectory. An adaptive interpolation approach was developed to inpaint the missing microvessel signal based on the estimated local blood flow speed, facilitating more robust depiction of microvasculature with a limited amount of MBs. The proposed method was validated on an ex ovo chorioallantoic membrane and an in vivo rabbit kidney. Results demonstrated improved imaging performance on both microvessel density maps and blood flow speed maps. With the proposed method, the percentage of microvessel filling in a selected blood vessel at a given accumulation period was increased from 28.17% to 74.45%. A similar SR-UMI performance was achieved with MB numbers reduced by 85.96%, compared to that with the original MB number. The results indicate that the proposed method substantially improves the robustness of SR-UMI under a clinically relevant imaging scenario where SR-UMI is challenged by a limited MB accumulation time, reduced number of MBs, lowered imaging frame rate, and degraded signal-to-noise ratio.

Relationship Between Exercise and Alzheimer's Disease: A Narrative Literature Review.

This narrative review aimed to summarize evidence regarding the responses to exercise among patients with preclinical Alzheimer’s disease (AD) and the effectiveness of long-term exercise interventions in improving cognitive function and neuropsychiatric symptoms. We performed a narrative review of existing literature on the effectiveness of long-term exercise interventions in improving cognitive function and neuropsychiatric symptoms in patients with AD. Patients with AD who presented with long-term exercise interventions appeared to have improved blood flow, increased hippocampal volume, and improved neurogenesis. Most prospective studies have proven that physical inactivity is one of the most common preventable risk factors for developing AD and that higher physical activity levels are associated with a reduced risk of AD development. Physical exercise seems to be effective in improving several neuropsychiatric symptoms of AD, notably cognitive function. Compared with medications, exercise has been shown to have fewer side effects and better adherence.

Thymosin β4-Enhancing Therapeutic Efficacy of Human Adipose-Derived Stem Cells in Mouse Ischemic Hindlimb Model.

Thymosin β4 (Tβ4) is a G-actin sequestering protein that contributes to diverse cellular activities, such as migration and angiogenesis. In this study, the beneficial effects of combined cell therapy with Tβ4 and human adipose-derived stem cells (hASCs) in a mouse ischemic hindlimb model were investigated. We observed that exogenous treatment with Tβ4 enhanced endogenous TMSB4X mRNA expression and promoted morphological changes (increased cell length) in hASCs. Interestingly, Tβ4 induced the active state of hASCs by up-regulating intracellular signaling pathways including the PI3K/AKT/mTOR and MAPK/ERK pathways. Treatment with Tβ4 significantly increased cell migration and sprouting from microbeads. Moreover, additional treatment with Tβ4 promoted the endothelial differentiation potential of hASCs by up-regulating various angiogenic genes. To evaluate the in vivo effects of the Tβ4-hASCs combination on vessel recruitment, dorsal window chambers were transplanted, and the co-treated mice were found to have a significantly increased number of microvessel branches. Transplantation of hASCs in combination with Tβ4 was found to improve blood flow and attenuate limb or foot loss post-ischemia compared to transplantation with hASCs alone. Taken together, the therapeutic application of hASCs combined with Tβ4 could be effective in enhancing endothelial differentiation and vascularization for treating hindlimb ischemia.

Effects of AiQingHua oil on microcirculation disturbance and alopecia mice model

PurposeStudy the effect of AiQingHua (AQH) oil on auricle microcirculation disorder mice caused by epinephrine and the effect of promote hair regeneration in mice with pathological alopecia caused by testosterone. Methods: Model of auricle microcirculation disorder in mice induced by intravenous injection of epinephrine hydrochloride (10 mg/kg), observed the auricle capillary vein and arteriole diameter, blood flow velocity and the amount of capillary opening before and 2 min after injection. The model of alopecia was established in mice induced by testosterone, the mold-making process was also externally applied to the drug for 21 consecutive days. On the day when the hair began to grow, the hair growth status was graded every four days. The serum levels of testosterone (T) and estradiol (E2) were measured on 21 d. The alopecia part of the skin was taken and the pathological changes were observed. Results: Compared with the blank group, minoxidil tincture group and the large and small dosage of AQH oil group can expand the diameter of auricle capillary vein and arteriole, increase the number of capillary opening and improve blood flow of mice with auricle microcirculation disorder. All mice in each group had hair growth from the 8th day of administration. Hair growth score in each administration group was superior to the model group on the 12th day, the 16th day and the 20th day. Each administration group can reduce the serum T and E2 level of mice with hair loss to different degrees, and reduce the ratio of T/E2, and improve the number of hair follicles, sebaceous glands and sweat glands in hair loss area. Conclusion: AQH oil can improve the microcirculation of mice and promote hair regeneration in mice with hair loss.

Oxidative stress status in hypertensive patients on amlodipine treatment

Background: Oxidative stress may contribute to the etiology of hypertension in humans. Oxidative stress is an imbalance between reactive oxygen species (ROS) and antioxidant defense mechanisms, causing damage to biological macromolecules and dysregulation of normal metabolism and physiology. Amlodipine as an antihypertensive agent is a long-acting calcium channel blocker that dilates blood vessels and improves blood flow. The aim of this study was to assess the oxidative stress in hypertensive patients on Amlodipine treatment through the assessment of salivary Malondialdehyde (MDA) and superoxide dismutase (SOD) as a marker of oxidative stress.
 Material and method: 60 individuals were included in this study, divided into two groups; the first group composed of 30 hypertensive patients on Amlodipine antihypertensive agent. The second group, the control group, composed of 30 healthy subjects without any systemic disease and with almost healthy oral hygiene. Intraoral examination was done for each individual and salivary samples were collected with the salivary flow rate (F/R) which was calculated in ml per minute and pH was measured by pH meter. Salivary MDA and SOD were analyzed by using ELISA kit based on the principle of competitive enzyme immunoassay technique; the concentrations of markers were measured by spectrophotometer at 450nm in a microplate reader.
 Results: Salivary MDA was significantly higher in hypertensive patients compared to control, while salivary SOD was significantly lower in patients than control group. Salivary flow rate and pH was significantly lower in patients as compared to the control group.
 Conclusions: There is a relation between oxidative stress and hypertension. Salivary MDA and SOD can be used as potential marker for monitoring patients with Hypertension.
 Keywords: hypertension, Oxidative stress, Amlodipine, MDA and SOD

Inhibition of myeloperoxidase increases revascularization and improves blood flow in a diabetic mouse model of hindlimb ischaemia.

Objective:Diabetes mellitus is a significant risk factor for peripheral artery disease. Diabetes mellitus induces chronic states of oxidative stress and vascular inflammation that increase neutrophil activation and release of myeloperoxidase. The goal of this study is to determine whether inhibiting myeloperoxidase reduces oxidative stress and neutrophil infiltration, increases vascularization, and improves blood flow in a diabetic murine model of hindlimb ischaemia.Methods:Leptin receptor–deficient (db/db) mice were subjected to hindlimb ischaemia. Ischaemic mice were treated with N-acetyl-lysyltyrosylcysteine-amide (KYC) to inhibit myeloperoxidase. After ligating the femoral artery, effects of treatments were determined with respect to hindlimb blood flow, neutrophil infiltration, oxidative damage, and the capability of hindlimb extracellular matrix to support human endothelial cell proliferation and migration.Results:KYC treatment improved hindlimb blood flow at 7 and 14 days in db/db mice; decreased the formation of advanced glycation end products, 4-hydroxynonenal, and 3-chlorotyrosine; reduced neutrophil infiltration into the hindlimbs; and improved the ability of hindlimb extracellular matrix from db/db mice to support endothelial cell proliferation and migration.Conclusion:These results demonstrate that inhibiting myeloperoxidase reduces oxidative stress in ischaemic hindlimbs of db/db mice, which improves blood flow and reduces neutrophil infiltration such that hindlimb extracellular matrix from db/db mice supports endothelial cell proliferation and migration.

The Tale of Two Challanges: Stem Cells and Diabetic Vasculopathy

Abstract Background Diabetes is a metabolic disorder highly linked to several systemic complications. Diabetic patients largely suffer from hyperglycemia-induced macro- and micro-vascular abnormalities. Accumulating data have suggested a beneficial role of endothelial progenitor cells in diabetic microvascular diseases. Objective We evaluated the possible therapeutic effect of injecting transformed human umbilical cord mesenchymal stem cells on cardiovascular and renal functions in old diabetic rats. Methods Thirty old (18-14 months) male Wistar albino rats weighing 300-350g were used in the present study. Diabetes was induced by intra-peritoneal streptozotocin injection. Rats were assigned (10/group) to Naive (received no treatment), diabetic control (injected with saline), and diabetic transformed mesenchymal stem cell treated (TMSCs). Measurement of blood pressure and doppler studies were performed, and blood samples were collected. Animals were then scarified and large and small vessels were collected for immunohistopathology. Results Anti-CD31 immuno-staining has shown successful homing of the injected transformed stem cells to the vascular endothelium. TMSCs treated group featured reduced systolic blood pressure, heart rate and pulse wave velocity when compared to control group. TMSCs treated group had lower serum level of vascular endothelial growth factor (VEGF), interleukin1β (IL-1β) and tumor necrosis factor alpha (TNFα). Renal function parameters (KIM-1 and cystatin C)) were significantly lower in TMSCs treated group. Renal artery doppler study revealed improved blood flow and reduced resistance in the TMSCs treated group when compared to the control group. Conclusion We show here that transformed mesenchymal stem cells could be a potential therapeutic approach against hyperglycemia-induced macro- and micro-vascular complications in aged diabetics.

Vasomodulation of peripheral blood flow by focused ultrasound potentiates improvement of diabetic neuropathy

ObjectiveEffective treatment methods for diabetic peripheral neuropathy are still lacking. Here, a focused ultrasound (FUS) technique was developed to improve blood flow in diabetic peripheral vessels and potentially treat diabetic...

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Pelvic floor muscle training: mechanisms of action for the improvement of genitourinary syndrome of menopause

Objective: This study aims to investigate the mechanism of action of pelvic floor muscle training (PFMT) for the improvement of the signs and symptoms of genitourinary syndrome of menopause (GSM) in postmenopausal women with GSM and urinary incontinence (UI).Methods: Twenty-nine women were included in the secondary analysis of a single-arm feasibility study. Using color Doppler ultrasound, the peak systolic velocity, time-averaged maximum velocity, and pulsatility index of the internal pudendal and dorsal clitoral arteries were measured at rest and after a pelvic floor muscle (PFM) contraction task. PFM function was assessed by dynamometry, and vulvovaginal tissue elasticity was measured using the Vaginal Atrophy Index.Results: PFMT significantly improved blood flow parameters in both arteries (p < 0.05) and significantly increased the speed of PFM relaxation after a contraction (p = 0.003). After the intervention, a marginally significant decrease in PFM tone was observed, as well as an increase in PFM strength (p = 0.060 and p = 0.051, respectively). Finally, improvements in skin elasticity and introitus width were observed as measured by the Vaginal Atrophy Index (p < 0.007).Conclusion: Our findings suggest that PFMT improves blood flow in vulvovaginal tissues, PFM relaxation capacity, and vulvovaginal tissue elasticity in postmenopausal women with GSM and UI.

The immediate effects of kinesiology taping on cutaneous blood flow in healthy humans under resting conditions: A randomised controlled repeated-measures laboratory study

BackgroundKinesiology taping (KT) is used in musculoskeletal practice for preventive and rehabilitative purposes. It is claimed that KT improves blood flow in the microcirculation by creating skin convolutions and that this reduces swelling and facilitates healing of musculoskeletal injuries. There is a paucity of physiological studies evaluating the effect of KT on cutaneous blood microcirculation.ObjectivesThe purpose of this parallel-group controlled laboratory repeated measures design study was to evaluate the effects of KT on cutaneous blood microcirculation in healthy human adults using a dual wavelength (infrared and visible-red) laser Doppler Imaging (LDI) system. KT was compared with rigid taping and no taping controls to isolate the effects associated with the elasticity of KTMethodsForty-five healthy male and female human adults were allocated to one of the three interventions using constrained randomisation following the pre-intervention measurement: (i) KT (ii) ST (standard taping) (iii) NT (no taping). Cutaneous blood perfusion was measured using LDI in the ventral surface of forearm at pre-intervention, during-intervention and post-intervention in a normothermic environment at resting conditions.ResultsMixed ANOVA of both infrared and visible-red datasets revealed no statistically significant interaction between Intervention and Time. There was statistically significant main effect for Time but not Intervention.ConclusionKT does not increase cutaneous blood microcirculation in healthy human adults under resting physiological conditions in a normothermic environment. On the contrary, evidence suggests that taping, regardless of the elasticity in the tape, is associated with immediate reductions in cutaneous blood flow.

Net Absorption and Metabolism of β-Hydroxy- β-Methyl Butyrate during Late Gestation in a Pig Model.

The leucine metabolite, β-hydroxy-β-methyl butyrate (HMB), is widely used in human nutrition and animal production as a nutritional supplement. Although the HMB usage during late gestation has been demonstrated to have a positive effect on fetal development, knowledge on net absorption and metabolism of HMB and impact of HMB on branched chain amino acids (BCAAs) metabolism is lacking. To address this, we conducted a study using pigs during the perinatal period as a model organism. Eight-second parity sows were fitted with indwelling catheters in the femoral artery and in the portal, hepatic, femoral, and mesenteric veins. Eight hourly sets of blood samples were taken starting 30 min before the morning meal on day –10 and day –3 relative to parturition. Four control (CON) sows were fed a standard lactation diet from day –15 and throughout the experiment, and 4 HMB sows were fed the control diet supplemented with 15 mg Ca(HMB)2/kg body weight mixed in one third of the morning meal from day –10 until parturition. Blood gases, plasma metabolites, milk compositions, and apparent total tract digestibility of nutrients were measured. Arterial plasma concentrations of HMB (p < 0.001), Cys (p < 0.001), and Lys (p < 0.10) were increased in HMB supplemented sows, while arterial plasma triglycerides concentration was decreased (p < 0.05). The net portal recovery of Ala and Asp were increased in HMB sows (p < 0.05). Sows fed HMB had increased hepatic vein flow and net hepatic fluxes of Met, Asn, and Gln (p < 0.05). In contrast, the femoral extraction rates of Ala and Ser were decreased by dietary HMB supplementation (p < 0.05). Dietary HMB treatment and sampling time relative to feeding had an interaction on arterial concentrations, net portal fluxes, and femoral extraction rates of BCAAs. The net portal recovery of HMB was 88%, while 14% of supplemented HMB was excreted through urine and 4% through feces. Moreover, the gastrointestinal tract metabolized 8% while the liver metabolized 12%. Finally, 26% of the daily intake of HMB was secreted via colostrum at the day of farrowing. This study demonstrated that dietary HMB supplementation increased net uptake of amino acids and increased fatty acid oxidation through improving blood flow and insulin sensitivity during the late gestation. Most importantly, oral HMB administration could maintain a stable postprandial absorption and altered metabolism in BCAAs. Net portal flux of HMB at 5.5 to 6.5 h after feeding approached zero, indicating that HMB ideally should be administrated two or three times, daily.

IMPROVEMENT OF LEUKEMIC RETINOPATHY AFTER LEUKAPHERESIS IN CHRONIC MYELOGENOUS LEUKEMIA WITH LEUKOSTASIS

ABSTRACT &#x0D; Introduction: to report a case of bilateral leukemic retinopathy due to leukostasis that was successfully managed by leukapheresis.&#x0D; Case Presentation: 31-year-old male with mild visual disturbance was referred to ophthalmology department. He suffered from Chronic Myelogenous Leukemia (CML) with white blood cell (WBC) count 533.900/microL. He was started on hydroxyurea, allopurinol, and once leukapheresis. Ophthalmologic evaluation revealed visual acuity of 4/4 in the right eye and 4/6,3 in the left eye. Funduscopy examination showed the presence of bilateral papilledema, venous engorgement, tortuosity, and retinal hemorrhages. Then this patient continued with second leukapheresis.&#x0D; Result: Visual acuity, laboratory examination, and funduscopic finding was evaluated. His visual acuity was improved, papilledema and retinal blood vessels abnormality had markedly reduced concurring with the patient’s hematological remission. Decreasing WBC count after leukapheresis has improved blood flow that reflected from the retinal findings and visual acuity improvement. &#x0D; Conclusion: Leukapheresis treatment is sufficient to improved clinical condition for leukemic retinopathy caused by CML with leukostasis.&#x0D; Keywords: chronic myelogenous leukemia (CML), hyperleukocytosis, leukostasis, leukemic retinopathy

Effects of Lower Extremity Exercises on Ankle-Brachial Index Values among Type 2 Diabetes Mellitus Patients

BACKGROUND: Diabetes mellitus (DM) is caused by more complications. One complication that often occurs is peripheral vascular disease. An early diagnostic to assess peripheral vascular disease is very important; measurement of the ankle-brachial index (ABI) is one of the non-invasive measures to assess the peripheral vascular disease risk in primary care and to identify the effect of lower extremity joint movement exercises on ABI values in Type 2 DM (T2DM) patients.AIM: The aimed to determine the effect of lower extremity on Ankle-Brachial Index Value among Type 2 Diabetes Mellitus Patients.METHODS: The method used was a quasi-experimental pre- and post-test group design without a control group. The sample was 35 T2DM patients using a consecutive sampling technique. The interventions given were lower extremity joint movement exercises which were performed actively once a day, with each movement ten repetitions and for 4 weeks of observation.RESULTS: There was a significant difference between pre and post the lower extremity joint movement intervention toward the value of the left limb ABI with mean pre 0.93 and post 1.02 (p = 0.00) and the value of the ABI in the right limb ABI with mean pre 0.92 and post 1.01 (p = 0.00) in patients suffering from DM under 10 years. There was a significant difference between pre and post the lower extremity joint movement intervention toward the value of the left limb ABI with mean pre 0.89 and post 1.98 (p = 0.00) and the value of the ABI in the right limb ABI with mean pre 0.88 and post 0.96 (p = 0.00) in patients suffering from DM over 10 years.CONCLUSION: Joint exercise can improve blood flow throughout the body, so it is important for T2DM patients to do regular joint exercise so that it is beneficial in improving health and preventing disability.

Abstract TMP20: The Therapeutic Gas Carbon Monoxide (CO) Attenuates Vasospasm and Improve Neurobehavioral Function After SAH

Introduction: Subarachnoid hemorrhage (SAH) is one of the most devastating forms of hemorrhagic stroke and it is a serious medical condition caused by bleeding of a ruptured aneurysm. The etiopathology of the disease includes early brain injury, vasospasm, and delayed cerebral ischemia. Blood byproducts cause the walls of arteries to constrict and spasm. At physiological concentrations, we and others have reported that carbon monoxide (CO) has functional roles in neuroprotection through anti-inflammation, anti-oxidative stress, and improving blood flow. Hence, this study focuses on the safe noninvasive therapeutic strategy to treat SAH by using CO as therapeutic medical gas. Hypothesis: We propose that CO may prevent SAH by mitigating vasospasm, limiting brain injury and improving functional outcomes. Methods: SAH was induced in adult mice using the endovascular perforation method. Mice were treated either with 250ppm CO or medical Air (at the same flow rate) after 2h of SAH for 1h daily for 7d. Such CO administration protocol keeps carboxyhemoglobin within normal range. Neurobehavioral outcomes such as focal neurological deficit score, open field activity, and motor functions were monitored at day 1 and day 7. Data acquisition and statistical analysis were performed by an investigator blinded to the intervention. Results: At 7d after SAH, CO decreased neurological deficit score (47.4±10.5%, p&lt;0.05), and increased activity (30.0±9.1%, p&lt;0.05) and stereotypic counts (261.5±62.1%, p&lt;0.01) as compared to the air control group. No significant changes in motor function were observed in CO treated mice as compared to SAH at either day 1 or day 7). Of interest, there was a significant increase in CO treated group’s lumen area/wall thickness ratio in the middle cerebral artery (173.5±19.3%, p&lt;0.01) and trended to increase in the anterior cerebral artery (25.5±4.3%, p=0.58) at 7d. Conclusion: This is a first report to demonstrate that CO prevents delayed SAH-induced neurobehavioral deficits, which suggest that post-treatment with CO should be considered a therapeutic strategy against SAH.