Ischemic Necrosis Research Articles

The effect of Ranolazine on random pattern skin flap survival in rats

Objective: Flap surgery is widely used in the field of plastic surgery for defect reconstruction. The most important problem of this surgery is ischemic necrosis which may occur in the distal of the flap. For this reason, studies have been conducted to develop many treatment methods to solve this problem. Our study aimed to investigate the effects of different doses of ranolazine, a selective late sodium current blocker, on the viability of skin flaps prepared from the back of the rat. Material and Methods: A total of 32 rats, including 8 rats in each group, were included in the study. A random patterned caudal base 3x9 cm width : length modified McFarlane skin flap was elevated from the backs of all rats and adapted back to its place For 7 days postoperatively, 1 cc of saline was added to the control group (Group A), and 45 mg/kg, 90 mg/kg, and 180 mg/kg of ranolazine were added to the study groups (Group B, C, D), respectively, and administered daily with gastric lavage On the 7th postoperative day, photographs were taken to evaluate the viability of the flaps and scintigraphic evaluations were made. After the rats were sacrificed, the flaps were separated from their bases and evaluated histopathologically. Results: As a result of the evaluations, the viable flap area was calculated as 12.7548 cm2 for Group A, 14.9533 cm2, 16.494 cm2 and 16.7599 cm2 for Groups B, C and D, respectively, and a statistically significant difference was found between the groups (P = 0.00 <0.05 ). The viable flap area percentages were calculated as 57.486% for Group A, 68.908% for Group B, 70.174% for Group C and 74.603% for Group D, and a statistically significant difference was found between the groups (P = 0.00 <0.05). As a result of scintigraphic evaluation, the viable flap area was found to be 61.57% for Group A, 71.04% for Group B, 70.21% for Group C and 73.85% for Group D, and a statistically significant difference was found between the groups (P = 0.03 <0.05). Histopathological evaluation revealed a decrease in the flaps' inflammation, edema and necrosis scores with the increasing drug dose. Conclusion: As a result, although flap viability increased with increasing doses in the group given ranolazine, more detailed studies are needed before it can be used clinically.

Pathologic copulatory lock in a genetically engineered laboratory mouse breeding pair.

A breeding pair of genetically engineered laboratory mice (Mus musculus) presented in apparent copulatory lock (coital tie). After anesthetizing the animals, gentle traction was used to separate the pair at which point a vaginal prolapse was detected and the penis was covered with black, firm, dry crusts and noted to have a solid pale, tan, firm cylindrical mass adhering to its glans. The vaginal prolapse was reduced and the female was returned to its cage. The male mouse had a severely distended bladder which could not be expressed and was euthanized. Histopathologic examination of the distal two-thirds of the penis revealed diffuse, acute coagulative necrosis. The mass adhered to the distal penis was a homogenous granular eosinophilic material consistent with a copulatory plug. While copulatory plugs and locks have been described in some rodent species, they have not been reported in laboratory mice. While the cause of the adherence of the plug to the penis could not be determined, we hypothesize that its adherence to both the penis and the vagina led to the lock and subsequently to ischemic necrosis of the distal penis.

A RARE CAUSE OF HYPOPITUITARISM - SHEEHAN SYNDROME

Sheehan syndrome is a rare complication of post-partum hemorrhage causing post-partum ischemic necrosis of the pituitary gland. It is a disease with declining incidence, more prevalent in developing countries. The incidence of Sheehan syndrome is 1 in 100,000 births. It was first described by a British pathologist Harold Leeming Sheehan in 1937.We present the case of a 42 year old female who presented with bilateral knee pain for 4 years, on over-the-counter steroids. She gave a history of lactational failure and secondary amenorrhea following childbirth. Her investigations revealed central hypothyroidism and she was diagnosed as Sheehan syndrome.

Clinical effect of magnetic compression anastomosis on ureterostenosis after kidney transplantation.

Clinical effect of magnetic compression anastomosis on ureterostenosis after kidney transplantation.

PD41-05 SECOND GENERATION TEMPORARY IMPLANTABLE NITINOL DEVICE (iTIND) IMPACT ON SERUM PSA LEVEL: RESULTS FROM a MULTICENTER PROSPECTIVE STUDY (MT-06-STUDY)

PD41-05 SECOND GENERATION TEMPORARY IMPLANTABLE NITINOL DEVICE (iTIND) IMPACT ON SERUM PSA LEVEL: RESULTS FROM a MULTICENTER PROSPECTIVE STUDY (MT-06-STUDY)

Efficacy of the modified Brisson+Devine procedure for the treatment of concealed penis.

This study was performed to evaluate the clinical efficacy of the modified Brisson+Devine procedure in the management of concealed penis. In this retrospective study, the medical data of 45 children diagnosed with concealed penis who underwent modified Brisson+Devine procedure in the Department of Urology of Anhui Provincial Children's Hospital between January 2019 and December 2021 were analyzed. Follow-up visits were performed at one, three, and six months postoperatively, and outcome measures included postoperative complications and parental satisfaction. All 45 children completed the surgery uneventfully. At 3-4 days after surgery, the penile dressing and the urinary catheter were removed. The patients were discharged 4-5 days postoperatively without ischemic necrosis of metastatic flaps. The follow-up visits spanned from 7 to 33 months, with a mean of 14.6 months. A statistically significant increase in the penile length after surgery was observed (p<0.05). The postoperative penile appearance was good, and the parents of the children had high treatment satisfaction (p<0.05). 38 children developed postoperative transferred flap edema, and the edema disappeared at 3 months postoperatively. The modified Brisson+ Devine procedure for concealed penis allows maximum use of the foreskin to improve the appearance of the penis and has a high safety profile by reducing postoperative complications, and provides high treatment satisfaction.

Bovine Ischaemic Teat Necrosis in dairy cattle: What we know so far

Bovine Ischaemic Teat Necrosis in dairy cattle: What we know so far

Both hyperglycemia and hyperuricemia aggravate acute kidney injury during cholesterol embolism syndrome despite opposite effects on kidney infarct size

Kidney cholesterol crystal embolism (CCE) occurs in advanced atherosclerosis and induces a thrombotic (micro)angiopathy, a drop in the glomerular filtration rate (GFR), and an ischemic kidney infarction with necroinflammation. We speculated that common metabolic comorbidities such as diabetes or hyperuricemia would independently modulate each of these distinct pathophysiological processes. To test this, experimental CCE was induced by injecting cholesterol crystals into the left kidney artery of mice and thrombotic angiopathy, GFR drop, and infarct size were analyzed after 24 hours in the presence of hyperglycemia (about 500 mg/dL) or hyperuricemia (about 8 mg/dL) or their absence. In healthy mice, unilateral CCE caused diffuse thrombotic angiopathy in interlobar, arcuate and interlobular arteries, followed by a 50% or less drop in GFR compared to baseline and a variable degree of ischemic kidney necrosis. Hyperglycemia but not hyperuricemia aggravated thrombotic angiopathy although both caused a GFR decline, albeit via different mechanisms. Hyperglycemia aggravated GFR loss by increasing necroinflammation and infarct size, while the antioxidative effects of hyperuricemia reasonably attenuated necroinflammation and infarct size but induced a diffuse vasoconstriction in affected and unaffected kidney tissue. Thus, both hyperglycemia or hyperuricemia aggravate CCE-induced acute kidney failure despite having opposite effects on ischemic necroinflammation and infarction.

Collocalia birds inspired Janus-structured bandage with strong wet tissue adhesion for rapid hemostasis and wound healing

Powdered hemostatic agents, when encountered with high blood pressure bleeding, are prone to being washed away by the blood flow, and there is a risk of entering the blood vessel to cause thrombosis. Fibrous membrane hemostatic bandages have poor adhesion to the wound and require prolonged press to stop bleeding, which may lead to ischemic necrosis of the tissue. Here, inspired by Collocalia birds to prepare cubilose, we propose a technique that large-particles of self-gelling powders are poured upon nanofibers during the spinning flight path and get Janus composite nanofiber membrane in one step. This Janus structure is an asymmetric wettability structure. The hydrophilic side achieved blood coagulation within 1 min by concentrating coagulation factor. The hydrophobic side is 99.99% free of bacteria and prevents bleeding. In addition, this membrane material has strong adhesion and can gel at 5.3 s, especially it does not need to wipe up the blood on the wet tissue beforehand. It exhibits firm adhere to the bleeding site, and can withstand the bursting pressure of 176 mmHg, much higher than the normal systolic blood pressure of the human body. Compared with medical gauze and commercially available gelatin hemostatic sponges, the hemostasis time is reduced to 1/5 (1.16 ± 0.28 min) and the blood loss is reduced to 1/3 (111 ± 11 mg). Moreover, this membrane has potential to be prepared in a large scale because of electro-blown spinning, and is expected to become a new commercially available material for hemostasis in the future.

Research on biomechanical compatibility for a novel artificial anal sphincter with constant force.

Existing artificial anal sphincter studies have shown that biomechanical compatibility problem between artificial anal sphincter and rectum caused by long-term morphological changes of the tissue surrounding the implanted prosthesis can lead to device failure or tissue ischemic necrosis. In this article, a mechanical artificial anal sphincter with constant force clamping is designed based on the superelasticity of shape memory alloys, which improved the biomechanical compatibility of implantable artificial anal sphincter. Firstly, the anatomical structure and the biomechanical properties of the rectum are analyzed to obtain the size parameters and material parameters of the rectal model. Secondly, a novel artificial anal sphincter with constant force is designed to improve the biomechanical compatibility between the artificial sphincter and the rectum. Thirdly, the static analysis of artificial anal sphincter is carried out by finite element analysis. The simulation results show that the artificial anal sphincter can maintain a constant clamping force of 4N within a certain variation range of intestinal tissue thickness, which verifies the constant force characteristic of the artificial anal sphincter. The constant clamping force of the artificial anal sphincter to the rectum is 4N that is greater than the clamping force 3.99 N required to close the rectum, which verifies the effectiveness the artificial anal sphincter. The surface contact stress and the minimum principal stress of the rectum in the clamping state are less than the pressure threshold, which verifies the safety of the artificial anal sphincter. The novel artificial anal sphincter has better biomechanical compatibility and improves the mechanical match between artificial sphincter and intestinal tissue. This study may provide more reasonable and effective simulation data for in vivo experiments of artificial anal sphincter in future, which may provide theoretical and technical support for further research about clinical application of artificial anal sphincter.

Adrenaline auto-injector injuries: Practical considerations in emergency management in a tertiary hand surgery unit.

Adrenaline auto-injectors are the first line treatment for anaphylaxis in the community setting. Both anaphylaxis and auto-injector carriage are increasing in prevalence. Adrenaline auto-injector injuries are common and most often involve the hand or digits. Such injuries carry a risk of ischemic necrosis due to profound vasoconstriction, especially if there is undying vascular pathology such as Raynaud's disease. The effects can be readily reversed with local infiltration of phentolamine. A survey was circulated to 40 clinicians working in the emergency and hand surgery departments of a major urban center. Knowledge of adrenaline duration of action and its reversal (agent, dose and location in the hospital) was assessed. All clinicians working within the two departments were eligible for participation. Only 25% of clinicians surveyed were aware of the duration of action of adrenaline. Half were aware of the correct reversal agent and only 20% knew the correct dose. Only one person was aware of phentolamine's location within the hospital. There is relatively poor clinician knowledge surrounding adrenaline reversal and a lack of easily accessible information available about dosing and drug location within the hospital. Given the time dependent nature of adrenaline auto-injector injuries Emergency Departments should consider stocking phentolamine in an emergency drugs fridge within the department along with a dosing guide. This is likely to greatly reduce time from presentation to treatment and thus the chances of digital ischemia progressing to necrosis.

Venoarterial extracorporeal membrane oxygenation treatment for acute respiratory distress syndrome and non-occlusive mesenteric ischemia due to Pasteurella multocida-related sepsis with purpura fulminans: a case report

BackgroundPasteurella multocida-related sepsis can cause purpura fulminans (PF), a rare thrombotic disorder that often presents acutely and is potentially fatal. As a consequence of disseminated intravascular coagulation, this hematological emergency originates from micro-thrombotic occlusion of peripheral blood vessels and resulting circulatory failure. Thus far, no studies have reported the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) for saving lives in patients with worsening respiratory and circulatory failure. Moreover, the development of non-occlusive mesenteric ischemia after VA-ECMO has not yet been documented. Here, we describe the case of a 52-year-old female patient with PF and non-occlusive mesenteric ischemia due to Pasteurella multocida-related sepsis who received VA-ECMO.Case presentationA 52-year-old-female patient presented to the hospital with a week-long fever and worsening cough. Chest radiography findings revealed ground-glass opacity. We made a diagnosis of acute respiratory distress syndrome due to sepsis and initiated ventilatory management. Because respiratory and circulatory parameters were not maintained, VA-ECMO was introduced. After admission, ischemic findings were observed in the periphery of the extremities, and a diagnosis of PF was made. Pasteurella multocida was detected in blood cultures. On day 9, the sepsis was cured with antimicrobial treatment. The patient’s respiratory and circulatory status improved, and she was weaned off VA-ECMO. However, on day 16, her stable circulatory system collapsed again, and her abdominal pain worsened. We performed exploratory laparotomy and noted necrosis and perforation of the small intestine. As a result, partial resection of the small intestine was performed.ConclusionIn this case, VA-ECMO was used to maintain circulatory dynamics during septic shock in a patient with Pasteurella multocida infection who developed PF. Surgery was also performed for complicated ischemic necrosis of the intestinal tract, helping save the patient's life. This development illustrated the importance of paying attention to intestinal ischemia during intensive care.

Case report of avascular necrosis of the glans penis after PAE embolization

BackgroundProstate artery embolization (PAE) is a relatively safe and effective alternative method for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. The adverse events caused by PAE are primarily mild, including urinary tract infection, acute urinary retention, dysuria, fever, etc. Severe complications, such as nontarget organ embolism syndrome or penile glans ischemic necrosis, are rare. Here, we report a case of severe ischemic necrosis of the glans penis after PAE and review the literature.Case presentationAn 86-year-old male patient was admitted to the hospital due to progressive dysuria with gross hematuria. The patient underwent placement of a three-way urinary catheter to facilitate continuous bladder flushing, hemostasis, and rehydration. After admission, his hemoglobin decreased to 89 g/L. After an examination, the diagnosis was benign prostatic hyperplasia with bleeding. During communication with the patient regarding treatment, he requested prostate artery embolization due to his advanced age and concomitant disease status. He underwent bilateral prostate artery embolization under local anesthesia. His urine gradually turned clear. However, on the 6th day after embolization, the glans gradually showed ischemic changes. On the 10th day, there was partial necrosis and blackening of the glans. The glans completely healed, and the patient was able to urinate smoothly on the 60th day after local cleaning and debridement, the administration of pain relief, anti-inflammatory and anti-infection agents, and external application of burn ointment.ConclusionPenile glans ischemic necrosis after PAE is rare. The symptoms include pain, congestion, swelling, and cyanosis in the glans.

Apoptosis and myocardial infarction: role of ncRNAs and exosomal ncRNAs.

ncRNAs, particularly miRNAs, lncRNAs and circRNAs, are a group of RNAs which, although they do not encode proteins (however, recent evidence shows that certain circRNAs are translatable), play a major role in regulating gene expression and, therefore, affect multiple cellular processes, in particular apoptosis. Apoptosis is proven to mediate myocardial infarction physiopathology in addition to ischemic necrosis and, therefore, has recently gained great interest as a target to improve MI outcomes. The current work reviews studies that have assessed ncRNAs with the ability to promote or suppress apoptosis in the process of MI and, therefore, may introduce new therapeutic targets for MI treatment.

Handy locoregional flaps for nasal reconstruction

BackgroundSkin lesions on the nose are common. Multiple surgical techniques have been used for nasal reconstruction. These options may be autogenous or alloplastic and can be performed in single or multiple stages. The choice of coverage depends on the nature of the lesion, location on the nose, and available donor sites. This study aimed to evaluate the surgical outcomes of using locoregional flaps for nasal reconstruction. MethodsA total of 27 patients underwent surgery. There were 9 men and 18 women, aged 7 months to 93 years. Four patients presented with involuting hemangioma, five patients with ischemic necrosis of the columella, and five patients with congenital nevus; the remaining 13 patients were previously diagnosed with basal cell carcinoma. Six techniques have been described for nasal reconstruction at our institution from 2016 to 2020. Most patients had basal cell carcinoma (n=13). Locoregional flaps and primary sutures were used for nasal reconstruction. ResultsThe complications were minimal. One patient had a superficial infection and one experienced postoperative bleeding. No recurrence was observed, and none of the patients asked for a second opinion. ConclusionRadical excision of tumors combined with analysis of nasal defects and nearby donor sites is essential for nasal reconstruction. The use of locoregional flaps leads to consistent and good aesthetic outcomes.

MANAGEMENT OF BULBAR URETHRAL ISCHEMIC NECROSIS FOLLOWING PELVIC FRACTURE URETHRAL INJURY REPAIR-A SINGLE CENTER EXPERIENCE

Aims &amp; Objectives:About 10% of pelvic fracture injuries are associated with urethral injury. Most of the urethral injuries are successfully repaired by progressive perineal anastomotic urethroplasty. Bulbar urethral ischemic necrosis is a devastating complication seen in 5-8% of failed PFUI repairs. The objective of this study is to present our experience in management of a bulbar urethral ischemic necrosis developed following PFUI repair. Materials &amp; methods:This is a retrospective study done at our institute, which includes data from feb,2003 to feb,2021. This is a descriptive statical analysis. Total 18 patients were managed using various surgical approaches and followed. Out of 18 patients seven patients underwent staged urethroplasty with Results &amp; Observations: success rate of 85.71%,four underwent pedicled preputial skin tube urethroplasty with success rate of 75%,one underwent non transecting augmented urethroplasty with success rate of 100%,three underwent augmented perineal urethrostomy, two underwent continent diversion procedures, one underwent augmented perineal skin tube perineal urethrostomy. Bulbar urethral ischemic necrosi Conclusions: s following PFUI repair although uncommon, is a devastating complication which can be salvaged by various surgical techniques. Type of procedure chosen depends on individual patient and outcomes vary for each type of procedure

Clinical characteristics and prognosis differences between isolated right and left ventricular myocardial infarction in the Chinese population: a retrospective study.

Acute myocardial infarction (AMI) is divided into left ventricular myocardial infarction (LVMI) and right ventricular myocardial infarction (RVMI) according to the regions of myocardial ischemic necrosis. Clinical characteristics, treatment strategies, and prognosis differences between isolated RVMI and LVMI have not been well characterized. This study aimed to explore this difference of patients with isolated RVMI and LVMI. This retrospective cohort study included 3,506 patients hospitalized with coronary angiography diagnosed type 1 myocardial infarction (MI). Characteristics of admission and treatment strategies were compared in patients with isolated RVMI and LVMI. COX proportional hazards models with and without inverse probability of treatment weighting (IPTW) adjustment were performed to estimate the difference in all-cause and cardiovascular mortality between the two groups. In this retrospective study, we found the frequency of isolated RVMI was significantly lower in the population than that of isolated LVMI (406 (11.6%) vs 3,100 (88.4%)). Patients with isolated RVMI have similar age, sex, and comorbidities to the patients with isolated LVMI. However, patients with isolated RVMI have lower heart rate and blood pressure, but higher rates of cardiogenic shock and atrioventricular block. It is noteworthy that patients with isolated RVMI are more likely to be complicated with the multivessel lesion. Patients with isolated RVMI have lower risk of all-cause mortality (HR 0.36; 95% CI [0.24-0.54], p < 0.001) and cardiovascular mortality (HR 0.37; 95% CI [0.22-0.62], p < 0.001) than patients with isolated LVMI. This study showed that patients with isolated RVMI and LVMI have similar baseline characteristics. However, the clinical manifestations were different in the isolated RVMI and LVMI patients. This study revealed a better prognosis of isolated RVMI patients compared to isolated LVMI, which indicates the ischemic region could be considered in AMI risk stratification models for better assessment of risk for adverse clinical events.

EFFICIENCY OF EARLY REHABILITATION OF PATIENTS AFTER ISCHEMIC STROKE

Introduction: the relevance of determining the effectiveness of early rehabilitation of patients after an ischemic stroke is high, as it solves a number of important medical and social problems of society.&#x0D; The aim: to determine the possibilities and effectiveness of early rehabilitation of patients after an ischemic stroke according to the data of literary sources.&#x0D; Materials and methods: the research was conducted based on the results of the analysis of the world results of scientific research and the existing mechanisms and documents of international societies for determining the possibilities and effectiveness of early rehabilitation of patients after an ischemic stroke. The search for scientific information was performed using domestic and foreign Internet resources of Google Scholar, PubMed, Medscape, Scopus and Web of Science databases, etc.&#x0D; The results of the study: It was determined that the primary and quite effective measure in the treatment of patients after an ischemic stroke is the early start of rehabilitation measures, which improves the survival of brain cells due to an increase in cerebral blood flow, which reduces ischemic necrosis of neurons and revitalizes part of neurons and significantly reduces the post-stroke level disability of patients. It was established that a significant yet undetermined issue in early rehabilitation is the effectiveness of early mobilization and its intensity, and the effectiveness of the rehabilitation strategy is entirely based on the correct combination of the time from the onset of the stroke and the intensity of mobilization&#x0D; Conclusions: the study determined that early rehabilitation intervention in ischemic stroke is significantly effective and economically feasible, and the effectiveness and feasibility of early intensive mobilization is currently a rather controversial issue.

Olecranon osteotomy approach for Dubberley type Ⅲ coronal fractures of the distal humerus

To retrospectively analyze the clinical efficacy of olecranon osteotomy approach in the treatment of Dubberley type Ⅲ coronal fractures of the distal humerus and summarize the treatment experience. From January 2016 to June 2020, 17 patients (5 males and 12 females) with Dubberley type Ⅲ coronal fractures of the distal humerus were treated by olecranon osteotomy approach. The age ranged from 37 to78 years old with an average of (58.5±12.9) years old. According to Dubberley classification, there were 5 cases of type Ⅲ A and 12 cases of type Ⅲ B. The curative effect was evaluated using the Borberg-Morrey elbow function score. The flexion, extension and rotation range of motion of the elbow joint, complications and postoperative imaging evaluation were recorded. All the 17 patients got bony union. The follow-up time ranged from 12 to 33 months with an average of (15.6±5.6) months. There was 1 case of ischemic necrosis of capitulum humeri, 2 cases of traumatic arthritis and 1 case of heterotopic ossification, 1 case of malunion of fracture. The range of motion was (114.80±19.50) °. The Broberg-Morrey score was 85.3±8.2, excellent in 5 cases, good in 9 cases, fair in 3 cases and poor in 0 case. Through olecranon osteotomy approach, the articular surface of distal humerus could be fully exposed, and the operation is convenient. Anatomical reduction and rigid fixation of the articular surface of distal humerus are the key factors for the succesful outcome.

Germline VWF/MPRIP and somatoplasm FGA variants synergically confer susceptibility to non-traumatic osteonecrosis of the femoral head

Non-traumatic osteonecrosis of the femoral head (ONFH) relies on multiple pathogenic factors, including intravascular coagulation, osteoporosis and lipid metabolism disorders. Despite extensively explored from various aspects, genetic mechanism underlying non-traumatic ONFH has not been fully elucidated. We randomly collected blood and necrotic tissue samples from 32 patients with non-traumatic ONFH as well as blood samples from 30 healthy individuals for whole exome sequencing (WES). Germline mutation and somatic mutation were analyzed to identify new potential pathogenic genes responsible for non-traumatic ONFH. Three genes might correlate with non-traumatic ONFH: VWF, MPRIP (germline mutations) and FGA (somatic mutations). Germline or somatic mutations in VWF, MPRIP and FGA correlate with intravascular coagulation, thrombosis, and consequently, ischemic necrosis of the femoral head.