Intermittent Occlusion Research Articles

Extending the golden hour for Zone 1 resuscitative endovascular balloon occlusion of the aorta: Improved survival and reperfusion injury with intermittent versus continuous resuscitative endovascular balloon occlusion of the aorta of the aorta in a porcine severe truncal hemorrhage model.

Noncompressible hemorrhage can be controlled using resuscitative endovascular balloon occlusion of the aorta (REBOA). Prolonged ischemia limits REBOA application during Zone 1 deployment. Intermittent inflation/deflation may effectively mitigate this problem. A lethal abdominal vascular injury was created in 28 swines. Animals were randomized to controls (n = 7), 60 minutes full REBOA (FR, n = 5), time-based intermittent REBOA (iRT, n = 7), and pressure-based REBOA (iRP, n = 9). Intermittent groups had an initial inflation for 15 minutes, followed by 10-minute inflation: 3-minute deflation cycles (iRT), or an inflate/deflate schedule based on mean arterial pressure (MAP) less than 40 mm Hg (iRP). Experiments were concluded after 120 minutes or death (MAP < 20 mm Hg). Intermittent REBOA animals all survived to 120 minutes versus 15 minutes for controls and 63 minutes for FR (p < 0.001). After 60 minutes, FR animals were more hypotensive (MAP 20 mm Hg vs. 80 mm Hg [iRP] and 100 mm Hg [iRT]; p < 0.001), had lower cardiac output (1.06 mL/min vs. 5.1 L/min [iRP] and 8.2 L/min [iRT]; p < 0.001), higher lactate (12.5 mg/dL vs. 8.5 mg/dL [iRP], p = 0.02), and decreased clot firmness on rotational thromboelastometry than iRP/T (64 mm vs. 69 mm [iRP] and 69 mm [iRT], p = 0.04). Acidosis was worse in iRT versus iRP at 120 minutes (pH 7.28 vs. pH 7.12; p = 0.02), improved lactate (11.9 mg/dL vs. 16.3 mg/dL; p = 0.04), and decreased whole blood resuscitation (452 mL vs. 646 mL, p = 0.05). Blood loss (clot weight) was higher in controls (2.0 kg) versus iRT and iRP (1.16 kg and 1.23 kg; p < 0.01) and not different from FR (0.87 kg; p = 0.10). Intermittent REBOA can maintain supraceliac hemorrhage control while decreasing distal ischemia in a swine model. Prolonged survival times, decreased acidosis, and lower resuscitation requirements indicate that this technique could potentially extend Zone 1 REBOA deployment times. Schedules based on MAP may be superior to time-based regimens.

Characteristic of objective compliance with intermittent occlusion therapy glasses

Intermittent occlusion therapy (IO-therapy) glasses (at 30-second opaque/transparent intervals) avoid the need for an adhesive patch, potentially improving compliance. Our previous clinical trial supports the effectiveness of this new device for amblyopia treatment.(Wang et al 2016) However, there was no objective compliance measured for these glasses, which limits understanding of the dose-response for this treatment. This study reports pilot data of a microsensor to monitor objective compliance with IO-therapy glasses.

Intermittent aortic balloon occlusion combined with cesarean section for the treatment of patients with placenta previa complicated by placenta accreta: A retrospective study.

To compare the efficacy of cesarean section (CS) combined with intermittent aortic balloon occlusion with that of CS alone for treating patients with placenta previa complicated by placenta accreta. Forty-five patients with placenta previa complicated by placenta accreta who underwent CS were retrospectively studied. Twenty-two patients had undergone CS combined with intermittent aortic balloon occlusion (combination group) and 23 patients received conventional hemostatic support only (control group). The postpartum hemorrhage, transfusion requirements, operation time and recovery time, and the ability to preserve the uterus and fertility were analyzed. Intermittent aortic balloon occlusion significantly decreased the volume of blood loss in the combination group relative to the control group (597 ± 359 mL vs 2687 ± 575 mL; P < 0.001), and transfusion requirements were also reduced (498 ±195 mL vs 2390 ±789 mL; P <0.001). We observed shorter operation time in the combination group relative to the control group (63.8 ± 12.3 min vs 118.8 ± 22.4 min; P < 0.001), and fewer patients required uterine cavity stuffing followed by uterine artery embolization (n = 2 vs n = 10; P <0.05), uterine artery ligation (n = 1 vs n = 9; P < 0.05), and hysterectomy (n = 0 vs n =7; P < 0.05). Intermittent aortic balloon occlusion may control postpartum hemorrhage in pregnancies complicated by placenta accreta, and improve the postoperative conditions.

A novel very simple laparoscopic hepatic inflow occlusion apparatus for laparoscopic liver surgery.

Control of bleeding is extremely important for laparoscopic liver resection. We introduce a new and operationally simple laparoscopic hepatic inflow occlusion apparatus (LHIOA) and its successful application in laparoscopic surgery for patients with cirrhosis. The self-designed LHIOA was constructed using a tracheal catheter (7.5#) and infusion set. The tracheal catheter and infusion set were trimmed to 30 and 70cm, to serve as an occlusion tube and occlusion tape, respectively. After establishment of pneumoperitoneum, the occlusion tape was inserted to encircle the hepatoduodenal ligament. The occlusion tube was then introduced and the ends of the occlusion tape were pulled out of it to occlude the hepatic inflow. Under intermittent vascular occlusion with the LHIOA, the liver parenchyma was transected using an ultrasonic scalpel and monopolar electrocoagulation. Outcomes of the application of the LHIOA in hepatocellular carcinoma patients with cirrhosis (LHIOA group, n = 46) were compared with patients undergoing laparoscopic hepatectomy without LHIOA (non-LHIOA group, n = 46), using one-to-one propensity case-matched analysis. The LHIOA effectively occluded the hepatic inflow while showing no damage to the hepatoduodenal ligament. The time required for presetting the LHIOA is 6.8 ± 0.6min. The conversion rate in the non-LHIOA group was 13.0% while there was no conversion in the occlusion group (P < 0.001). The median blood loss of patients in the LHIOA group (60ml, range 50-200ml) was significantly less than that of patients in the non-LHIOA group (250ml, range 100-800) (P < 0.001). Transfusion was required in 8 patients in the non-LHIOA group while no transfusion was required in the LHIOA group. The median operative time in the LHIOA group (157min, range 80-217min) was significantly shorter than that in the non-LHIOA group (204min, range 105-278min) (P < 0.001). The new LHIOA is effective, safe, and simple. It can significantly reduce conversion rate, blood loss, and operative time. It facilitates laparoscopic liver resection and is recommended for use.

Abstract 137: Right Cerebral Insufficiency Associated with Right Aortic Arch with Mirror-Image Branching: a Case Study

We report a case of right cerebral insufficiency in a 65-year-old woman with right aortic arch with mirror-image branching. The patient was found to have intermittent occlusion at the origin of the right common carotid artery between the aortic arch and the sternoclavicular joint. Duplex showed intermittent bizarre carotid artery waveforms directly related to patient positioning. The patient underwent a transposition of the right common carotid to the right subclavian artery with subsequent resolution of symptoms. Right aortic arch with mirror-image branching can rarely present with right cerebral insufficiency due to intermittent mechanical occlusion of the right common carotid artery.

Impact of ageing on the deleterious effects caused to the large arteries by intermittent hypoxia in mice

The Obstructive Sleep Apnea Syndrome (OSAS) features intermittent upper airway occlusions during sleep, leading to intermittent hypoxia (IH) and blood oxygen desaturation. OSAS affects up to 38% of the population (up to 49% in the elderly), and mainly concerns males. OSAS has severe detrimental effects on the cardiovascular system, such as hypertension and increased risk of cardiac infarct. In this study, we assessed the impact of ageing on the IH-induced deleterious effects in the aorta of aged and adult (24 and 6 months old) mice, male and female, exposed to IH (8 hours/day, 1 minute cycles, alternating 30 s at 21% O 2 and 30 s at 5% O 2 in 6 months old and 10% O 2 in 24 months old mice) or normoxia (21% O 2 ) for 14 days. Using the techniques of pressure-arteriography and two-photon microscopy, we have shown that both IH and age affect the mechanical and structural properties of the aorta, with gender-dependent characteristics. IH and ageing induce disruptions in and disorganization of the aortic elastic fibres, although differently in males and females. While IH and age increase the aorta diameter in both gender, they generally decrease aortic thickness and increase rigidity in females only, while, in males, the impacts of hypoxia are different as a function of age. The aortic reactivity is also differentially impacted by IH as a function of gender and age, with a higher acetylcholine-induced vasodilation in IH aged females and a higher phenylephrine(PE)-induced constriction in IH adult males. The latter fits with the higher PE-induced increase in intracellular calcium level that we measured in cultured vascular smooth muscle cells from IH adult males. These results emphasize on the fact that OSAS has different impacts on the mouse cardiovascular system, depending on both age and gender. These new findings should be verified in patients, in order to optimize the therapeutic strategy for each age and gender groups.

In vivo whole‐blood T2 versus HbO2 calibration by modulating blood oxygenation level in the femoral vein through intermittent cuff occlusion

To investigate the feasibility of estimating calibration constants (K and T2o ) in vivo for converting whole-blood T2 to blood hemoglobin oxygen saturation (HbO2 ) according to the Luz-Meiboom model, 1/T2=1/T2o+K(1-HbO2)2, where K and T2o are relaxivity and transverse relaxation time of fully saturated blood, respectively. A range of HbO2 values was achieved in the superficial femoral vein with intermittent cuff occlusion in seven healthy adults (four males) to establish a calibration curve between blood T2 and HbO2 at 1.5T. HbO2 was derived via MR susceptometry, a technique previously validated, and the transverse relaxation time was quantified with an optimized T2 -prepared balanced steady-state free precession pulse sequence. To evaluate the accuracy of the in vivo calibration method, T2 and HbO2 were quantified in the superior sagittal sinus in six additional subjects and compared with susceptometry. Two sets of gender-specific calibration constants were derived, one for each gender corresponding to hematocrits of 0.47 ± 0.02 for males and 0.38 ± 0.01 for females, yielding K/T2o = 41 Hz/260 ms and 26 Hz/280 ms, respectively. The in vivo calibration returned physiologically plausible superior sagittal sinus SvO2 values (65 ± 5% HbO2 ), and there was no significant difference between the results from the two methods (average difference -0.3% HbO2 ). The results show feasibility of performing in vivo calibration for converting whole-blood T2 to HbO2 . The proposed approach bypasses the involved and cumbersome processes associated with in vitro calibration. Magn Reson Med 79:2290-2296, 2018. © 2017 International Society for Magnetic Resonance in Medicine.

Something is not anymore there

A 86 years old man, with past medical history of hypertension, ischemic cardiomyopathy and gallstones, that refused the cholecystectomy a year ago, was seen at the emergency room because dark vomiting and confusion that began two days ago, the physical examination was unremarkable, the blood tests revealed: haemoglobin 12 g/L, 11.350 cells/mm3 leucocytes, protein c reactive 10.58 mg/L (normal value 5 mg/L), normal liver function, 1.9 mg/dL of creatinine and 252 mg/dL of urea. The abdominal X-ray showed some hydroaereus levels in the small bowel. He was admitted in the Internal Medicine ward, a nasogastric tube was placed, intravenous hydration was started and neuroleptics were administrated. At the ward the patient stays hemodynamically stable, without new episodes of vomiting nor confusion and the nasogastric tube drainage was minimum, he was able to drink without any symptoms after 48 h. In the 4th day, his general condition worsened because vomiting and abdominal pain appeared, these symptoms relieved with fasting and antiemetics drugs. An abdominal computerized tomography (CT) scan was performed. What is the diagnosis? The image in the panel A shows a big gallstone, panels B & C show pneumobilia (thin arrow) and the gallstone in the terminal jejunum (thick arrow) (Fig. 1). The gallstone ileus is an infrequent condition, its incidence varies from 0.5 to 4% [[1]Aguilar-espinosa F. Sangrado de tubo digestivo y delirium, retos en el diagnóstico de íleo biliar: reporte de un caso y revisión de bibliografía.Cirugía y Cirujanos. 2017; 299: 2-6Google Scholar], it's caused by a fistula that connects the gallbladder with the gastrointestinal tract. Almost 80% of affected have medical history of gallstones, symptoms are diverse as intermittent intestinal occlusion, vomiting, upper digestive haemorrhage, and diffuse abdominal pain. The Rigler's triad that consists in: gas in the biliary tree, small intestine occlusion and gallstone in the intestinal lumen, is usefull to confirm the diagnosis. This entity is more frequent in patients over 65 years old [[2]Sahsamanis G. Maltezos K. Dimas P. Tassos A. Mouchasiris C. Bowel obstruction and perforation due to a large gallstone. A case report.Int J Surg Case Rep. 2016; 26: 193-196Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar]. The mortality is about 15–30% and depends on the timely diagnosis. The commonest complications are: intestinal occlusion, and perforation due to the gallstone in the gut [1Aguilar-espinosa F. Sangrado de tubo digestivo y delirium, retos en el diagnóstico de íleo biliar: reporte de un caso y revisión de bibliografía.Cirugía y Cirujanos. 2017; 299: 2-6Google Scholar, 2Sahsamanis G. Maltezos K. Dimas P. Tassos A. Mouchasiris C. Bowel obstruction and perforation due to a large gallstone. A case report.Int J Surg Case Rep. 2016; 26: 193-196Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar]. This patient was undergone to laparotomy with enterotomy and gallstone extraction, he recovered well without complication with spontaneous healing of the fistula, as other cases reported [[3]Neary P.M. Dowdall J.F. Evolution of entero-biliary fistula following gallstone ileus management.BMJ Case Rep. 2012; 2012: 1-2Crossref Scopus (3) Google Scholar]. The authors want call attention about this entity that can be misdiagnosed because the unspecific symptoms can lead to major complication, and the Internal Medicine ward physicians must keep in mind this illness in order to do a timely diagnosis.

Principles, insights, and potential pitfalls of the noninvasive determination of muscle oxidative capacity by near-infrared spectroscopy.

Skeletal muscle oxidative capacity is highly plastic, strongly associated with whole-body aerobic capacity (16, 18) and state of health. Loss of muscle oxidative capacity is associated with physical inactivity, aging and chronic disease (17), and has been implicated in the pathophysiology of obesity and diabetes (21). Evaluating these changes has traditionally been limited to invasive or costly assessments (biopsy or ³¹P MRS). To address this, Hamaoka and colleagues developed an innovative, non-invasive approach using near-infrared spectroscopy (NIRS) to quantitatively measure muscle oxygen consumption (mVO₂; 12) and use this to infer muscle oxidative capacity based on the mVO₂ recovery rate constant (k) (23; later modified 26). This technique has been subsequently used to interpret relative differences in oxidative capacity across a wide range of muscles, ages and disease states (Figure 1C). The purpose of this Viewpoint is to open a discussion on the principles, insights and potential pitfalls of using NIRS to measure k and infer muscle oxidative capacity.

Photoplethysmography for blood volumes and oxygenation changes during intermittent vascular occlusions

Photoplethysmography (PPG) is an optical technique that measures blood volume variations. The main application of dual-wavelength PPG is pulse oximetry, in which the arterial oxygen saturation (SpO_2) is calculated noninvasively. However, the PPG waveform contains other significant physiological information that can be used in conjunction to SpO_2 for the assessment of oxygenation and blood volumes changes. This paper investigates the use of near infrared spectroscopy (NIRS) processing techniques for extracting relative concentration changes of oxygenated (DeltaHbO_2), reduced (DeltaHHb) and total haemoglobin (DeltatHb) from dual-wavelength PPG signals during intermittent pressure-increasing vascular occlusions. A reflectance PPG sensor was attached on the left forearm of nineteen (n = 19) volunteers, along with a reference NIRS sensor positioned on the same forearm, above the left brachioradialis. The investigation protocol consisted of seven intermittent and pressure-increasing vascular occlusions. Relative changes in haemoglobin concentrations were obtained by applying the modified Beer–Lambert law to PPG signals, while oxygenation changes were estimated by the difference between red and infrared attenuations of DC PPGs (A_{Ox} = DeltaA_{IR} − DeltaA_R) and by the conventional SpO_2. The DeltaHbO_2, DeltaHHb, DeltatHb from the PPG signals indicated significant changes in perfusion induced by either partial and complete occlusions (p < 0.05). The trends in the variables extracted from PPG showed good correlation with the same parameters measured by the reference NIRS monitor. Bland and Altman analysis of agreement between PPG and NIRS showed underestimation of the magnitude of changes by the PPG. A_{Ox} indicated significant changes for occlusion pressures exceeding 20 mmHg (p < 0.05) and correlation with tissue oxygenation changes measured by NIRS, while SpO_2 had significant changes after 40 mmHg (p < 0.05). Relative changes in haemoglobin concentrations can be estimated from PPG signals and they showed a good level of accuracy in the detection of perfusion and oxygenation changes induced by different degrees of intermittent vascular occlusions. These results can open up to new applications of the PPG waveform in the detection of blood volumes and oxygenation changes.

Muscle Oxidative Capacity Is Low In The Upper And Lower Limbs Of COPD Patients

Muscle atrophy, weakness and fatigability are characteristic of patients with chronic obstructive pulmonary disease (COPD), which contribute to dyspnea, exercise intolerance and morbidity. Comparisons between upper and lower limb performance suggests intrinsic differences in muscular adaptations between leg and arm muscles, with preserved biceps brachii endurance in COPD (Franssen et al. MSSE 37:2-9, 2005). We were therefore interested whether loss of muscle oxidative capacity was different between upper and lower limbs in COPD. PURPOSE: To compare muscle oxidative capacity in the upper and lower limbs between smokers with or without COPD. METHODS: 19 COPD patients (GOLD 2/3/4, n=7/6/6; FEV1%pred 44.1±18.7; M/F=14/5) and 18 smokers with normal spirometry (CON; M/F=14/4) volunteered. Non-dominant medial forearm and medial gastrocnemius oxidative capacity was assessed from the O2 consumption recovery rate constant (k) following brief muscle contractions using near-infrared spectroscopy with intermittent vascular occlusion. k was estimated from the mean of two repetitions. Differences were determined by 2-way ANOVA (group x limb). RESULTS: There was a significant main effect of group on muscle oxidative capacity (F=11.7, ηp2=0.14, p<0.001): COPD patients had significantly lower k in both upper and lower limb muscles (upper 1.01±0.17, lower 1.05±0.24 min-1) compared with CON (1.27±0.49, 1.49±0.67 min-1). However, there was no effect of limb (F=1.8, ηp2=0.03, p=0.18) and no group x limb interaction. CONCLUSION: We found that muscle oxidative capacity is lower in COPD than controls in both upper and lower limbs. Although, when compared to age- and sex-matched smokers with normal spirometry, k tended to be more reduced in the gastrocnemius (-30%) than the forearm (-20%) of COPD patients, this difference was not significant. Unlike previous findings, these data suggest that muscle mitochondrial function is systemically impaired in COPD patients, and not simply the result of inactivity-induced deconditioning; which is expected to manifest as greater impairments in lower limb than upper limb. The variables contributing to systemic deficiency in muscle oxidative capacity in COPD warrant further study. Supported by SNSF P300PB_167767; PERF; ATS Foundation/Breathe California of Los Angeles

Hypothermic perfusion with retrograde outflow during right hepatectomy is safe and feasible

In situ hypothermic perfusion during liver resection performed under vascular inflow occlusion decreases hepatic ischemia-reperfusion injury, but technical limitations have restricted its widespread use. In situ hypothermic perfusion with retrograde outflow circumvents these impediments and thus could extend the applicability of in situ hypothermic perfusion. The safety and feasibility of in situ hypothermic perfusion with retrograde outflow were analyzed in selected patients undergoing right (extended) hepatectomy and compared to intermittent vascular inflow occlusion, the gold standard method, in this randomized pilot study. Patients were first screened for parenchymal liver disease (exclusion criteria: steatosis ≥30%, cirrhosis, or cholestasis). Study participants were randomized intraoperatively to undergo in situ hypothermic perfusion with retrograde outflow (n=9) or intermittent vascular inflow occlusion (n=9). The target liver core temperature during in situ hypothermic perfusion with retrograde outflow was 28°C. The primary end point was ischemia-reperfusion injury (expressed by peak postoperative transaminase levels). Secondary outcomes included functional liver regeneration (assessed by hepatobiliary scintigraphy) and clinical outcomes. Peak transaminase levels, total bilirubin, and the international normalized ratio were similar between both groups, although a trend toward more rapid normalization of bilirubin levels was noted for the in situ hypothermic perfusion with retrograde outflow group. Functional liver regeneration as evaluated by hepatobiliary scintigraphy was improved on postoperative day 3 fafter in situ hypothermic perfusion with retrograde outflow but not after intermittent vascular inflow occlusion. Furthermore, in situ hypothermic perfusion with retrograde outflow (requiring continuous ischemia) was comparable to intermittent vascular inflow occlusion for all clinical outcomes, including postoperative complications and hospital stay. The use of in situ hypothermic perfusion with retrograde outflow appears to be safe and feasible in selected patients with healthy liver parenchyma and may benefit early functional liver regeneration. Future applications of in situ hypothermic perfusion with retrograde outflow include patients with damaged liver parenchyma who would require major hepatic resection with a prolonged vascular inflow occlusion duration.

Progress of liver resection for hepatocellular carcinoma in Taiwan.

Taiwan is a well-known endemic area of hepatitis B. Hepatocellular carcinoma (HCC) has consistently been the first or second highest cause of cancer death over the past 20 years. This review article describes the progress of liver resection for HCC in Taiwan in the past half century. The mortality rate for HCC resection was 15-30% in Taiwan in the 1970s. The rate decreased to 8-12% in the early 1990s, and it declined to <1-3% recently. The development of new operative instruments, and surgical techniques, increased knowledge of liver anatomy and pathophysiology after hepatectomy, and more precise patient selection have contributed to this improvement. The use of intermittent hepatic inflow blood occlusion, a restrictive blood transfusion policy and intraoperative ultrasonography, have also led to substantial improvements in resectability and safety for HCC resection in Taiwan. Advances in non-operative modalities for HCC treatment have also helped to improve long-term outcomes of HCC resection. Technical innovations have allowed the application of complex procedures such as mesohepatectomy, unroofing hepatectomy, major portal vein thrombectomy, hepatic vein reconstruction in resection of the cranial part with preservation of the caudal part of the liver, and inferior vena cava and right atrium tumor thrombectomy under cardiopulmonary bypass. In selected patients, including patients with end-stage renal failure, renal graft recipients, patients with portal hypertension, hypersplenic thrombocytopenia and/or associated gastroesophageal varices, octogenarian, ruptured HCC, recurrent HCC and metastatic HCC can also be resected with satisfactory survival benefits. We conclude that the results of liver resection for HCC in Taiwan are improving. The indications for HCC resection continue extending with lower the surgical risks and increasing the long-term survival rate.

Hepatic resection using ultrasonic surgical aspirator

Abstract Background Hepatic resections conducted for malignant tumors can be difficult because of the need to create cancer-free margins. Objectives To examine the outcome of hepatic resections after the introduction of a Cavitron Ultrasonic Surgical Aspirator (CUSA). Methods A retrospective study of patients who underwent hepatic resection by a single surgeon between April 1999 to March 2013. Results We included 101 patients with 104 hepatectomies. Most hepatic parenchymal transections were performed using a CUSA under intermittent hepatic inflow occlusion (Pringle maneuver). Thirty-five patients underwent a right hepatectomy, 11 a left hepatectomy, 6 a right hepatectomy and segment I resection, 6 a right lobectomy, and 46 underwent segmentectomies, wedge resections, or other types of hepatic resections. Biliary-enteric reconstruction with a Roux-en-Y limb of the jejunum to a hepatic duct of the hepatic remnant was performed in 28 patients. Operative time was 90–720 min (median 300 min, mean 327 ± 149 min). Operative blood transfusion was 0–17 units (median 3 units, mean 3.9 ± 3.6 units). Twenty-one hepatectomies were conducted without blood transfusion. Thirty-four postoperative complications occurred in 30 patients with a 9% reoperation rate. Perioperative mortality was 6%. Age, operative time, operative blood transfusion, reoperation, and complications were significantly associated with mortality. Conclusion Careful preoperative diagnosis and evaluation of patients, faultless surgical techniques, and excellent postoperative care are important to avoid potentially serious postoperative complications and mortality. The CUSA is an effective assisting device during hepatic parenchymal transection with a concomitant Pringle maneuver, apparently reducing operative blood loss.

The application of intermittent splenic artery occlusion for treating iatrogenic splenic injury: an animal experiment

Objective To evaluate the value of intermittent splenic artery occlusion in the treatment of iatrogenic splenic injury and the cause of ischemia reperfusion injury. Methods Experimental animals using dogs were divided into experimental group and control group according to whether the splenic artery was blocked. The animal model of iatrogenic splenic injury was established by general anesthesia. Experimental group was treated with intermittent splenic artery blockage combined with gelatin sponge oppression of the wound to stop bleeding. The first time of splenic artery occlusion was 15 min and continued for 10 min and for another 5 min if still bleeding. Then hemostatic effect after removing blocking and oppression was observed. Control group was only treated with gelatin sponge compression to stop bleeding. Blood samples and tissue samples were collected before blocking and after reperfusion for 2 hours in experimental group, and before compression and relieving the compression for 2 hours in control group. IL-1 (interleukin), SOD (superoxide disproportionation enzyme), MPO (myeloperoxidase), MDA (malondialdehyde) and caspase-3 (aspartame acid cysteine protease) were detected. Results The control group still had bleeding, while the experimental group had successfully stopped bleeding. Serum markers before and after occlusion in the experimental group were IL-1 (124.4±106.8 vs.121.2±105.1), SOD (4.7±2.7 vs.5.2±1.8) and MDA (8.8±6.5 vs10.8±7.5). There were no significant differences on serum markers in two groups after occlusion/oppression including IL-1 (121.2±105.1 vs. 162.8±73.8), SOD (5.2±1.8 vs. 4.7±2.8) and MDA (10.8±7.5 vs. 9.6±6.6) (P>0.05). Histological indicators before and after occlusion in the experimental group included MPO (0.62±0.23 vs. 0.68±0.21) and Caspase-3 (0.90±0.29 vs. 0.86±0.26), and there was no statistical difference on MPO (0.68±0.21 vs. 0.86±0.23 after two sets of experiments) and Caspase-3 level (0.86±0.26 vs.1.21±0.18) (P>0.05) in two groups after occlusion/oppression. Conclusion The therapeutic effect of intermittent splenic artery occlusion combined with gelatin sponge compression hemostasis is safe and effective and without obvious ischemia reperfusion injury. Key words: Iatrogenic splenic injury; Intermittent splenic artery occlusion; Animal experiment; Canine; Gelatin sponge

The effect of intermittent lower limb occlusion on recovery following exercise-induced muscle damage: A randomized controlled trial.

The purpose of this investigation was to examine the effectiveness of intermittent lower limb occlusion in augmenting recovery from exercise induced muscle damage (EIMD) in physically active males. Randomized controlled trial, double blind. Sixteen healthy recreationally active male participants were randomly assigned to an intermittent occlusion (OCC; n=8) or control (SHAM; n=8) group. The EIMD protocol comprised of 100 drop-jumps, from a 0.6m box. Indices of muscle damage were creatine kinase (CK), thigh-circumference (TC), muscle soreness (DOMS), counter-movement jump (CMJ) and maximal isometric voluntary contraction (MIVC). Measurements were assessed pre, 24h, 48h and 72h following exercise. There was a significant time effect for all indices of muscle damage suggesting EIMD was present following the exercise protocol. The decrease in MIVC was significantly attenuated in the OCC group compared to the SHAM group at 24 (90.4±10.7 vs. 81.5±6.7%), 48 (96.2±6.1 vs. 84.5±7.1%) and 72h (101.1±4.2 vs. 89.7±7.5%). The CK response was reduced in the OCC group at 24 (335±87 vs. 636±300 IU) and 48h (244±70 vs. 393±248 IU), compared to the SHAM group. DOMS was significantly lower in the OCC compared to the SHAM group at 24, 48 and 72h post EIMD. There was no effect of OCC on CMJ or TC. This investigation shows that intermittent lower limb occlusion administered after a damaging bout of exercise reduces indices of muscle damage and accelerates the recovery in physically active males.

Effects of Rotigaptide and RIC on Ischemia Reperfusion Injury in the In Vitro Rabbit Heart

Background: Remote Ischemic Preconditioning (rIPC) and the antiarrhythmic peptide analogue, Rotigaptide (ZP123), protects against myocardial ischemia-reperfusion injury through potentially similar mechanisms. We aimed to study whether the cardioprotective effects of Rotigaptide and rIPC interacts. Methods: We used male New Zealand White rabbit hearts mounted in a Langendorff system and exposed to 30 min of global no-flow ischemia and 120 min of reperfusion. A total of 48 rabbits were randomized into 6 groups: control (n=6), Rotigaptide (1 μM) before (n=9) or after (n=9) ischemia, rIPC (n=7), rIPC+Rotigaptide before (n=9) or after (n=8) ischemia. rIPC was induced by four cycles of 5-min ischemia and reperfusion on the left hind limb achieved by intermittent tourniquet occlusion. Primary endpoint was infarct size measured by tetrazolium staining. Results: rIPC reduced infarct size compared to controls. Rotigaptide alone did not affect infarct size irrespective of administration before ischemia or during reperfusion. The combination of rIPC and Rotigaptide before ischemia reduced infarct size, whereas the effect of rIPC was abrogated by Rotigaptide when administered during reperfusion. No significant changes in hemodynamic recovery were observed when compared to control group. Conclusion: In contrast to in vivo rIPC, in vitro Rotigaptide did not yield cardioprotection in our rabbit model, but Rotigaptide attenuated the effect of rIPC.

Nutcracker/SMA syndrome

It is also known as Wilkie's syndrome, cast syndrome, mesenteric root syndrome, chronic duodenal ileus and intermittent arterio-mesenteric occlusion. It is distinct from Nutcracker syndrome, which is the entrapment of the left renal vein between the AA and the SMA.

Ischemic time by the intermittent occlusion of hepatic inflow (Pringle’s maneuver) influences surgical outcome after hepatectomy

Title Ischemic time by the intermittent occlusion of hepatic inflow (Pringle’s maneuver) influences surgical outcome after hepatectomy Author(s) Nanashima, Atsushi; Sumida, Yorihisa; Murakami, Goushi; Sawai, Terumistu; Nagayasu, Takeshi Citation Acta medica Nagasakiensia, 60(3), pp.109-117; 2016 Issue Date 2016-04 URL http://hdl.handle.net/10069/36573 Right NAOSITE: Nagasaki University's Academic Output SITE

Exploring Spinal Cord Protection by Remote Ischemic Preconditioning: An Experimental Study

Paraplegia is one of the most severe complications occurring after the repair of thoracic and thoracoabdominal aortic aneurysms. Remote ischemic preconditioning (RIPC) has been shown to mitigate neurologic damage, and this study assessed its efficacy in preventing spinal cord ischemia. The study randomized 16 female pigs into an RIPC group (n= 8) and a control group (n= 8). The RIPC group underwent four cycles of 5-minute ischemia-reperfusion episodes by intermittent occlusion of the left iliac artery. All animals underwent systematic closure of the left subclavian artery and segmental arteries of the descending thoracic aorta to the level of diaphragm. Motor-evoked potential monitoring was performed in both hind limbs. Continuous electrocardiogram and hemodynamics were monitored, and pulmonary artery blood samples were collected. A neurologic assessment was performed 6 hours after the procedure. The thoracic and lumbar portions of the spinal cord were collected for histologic and immunohistochemical analysis. The bilateral motor-evoked potential amplitude responses were higher in the RIPC group (p < 0.05) than in the control group; the difference was detected already before spinal cord ischemia. Paraplegia occurred in 1 control animal. Immunohistochemical total scores of antioxidant response regulator nuclear factor erythroid 2-related factor 2 were better in the RIPC group (11.0; range, 8.5 to 14.0) than in the control group (5.2; range, 1.0 to 9.0; p= 0.023). RIPC induces electrophysiologic changes in the central nervous system that may confer spinal cord protection extending the resistance to ischemia. The significantly higher nuclear factor erythroid 2-related factor 2 scores suggest better neuronal cell protection against oxidative stress in the RIPC group.