Restoration Of Blood Circulation Research Articles

Role of blood flow in intracanal pressure: a novel theory of carpal tunnel syndrome etiology

Carpal tunnel syndrome is the most common compressive neuropathy of the upper extremity. It is believed that the cause of carpal tunnel syndrome is an increase in intracanal pressure, which leads to disruption of the blood supply to the median nerve and the occurrence of neurological disorders. The level of interstitial pressure is an indicator that describes the state of the microvasculature of the surrounding tissues. However, the question of the influence of changes in blood flow on the development of carpal tunnel syndrome still remains open. Purpose: to study the role of blood flow in the formation of intracanal pressure and the development of carpal tunnel syndrome. Objectives of the study: 1. To evaluate pressure levels in the carpal tunnel in patients with carpal tunnel syndrome and in healthy volunteers; 2. To study changes in pressure in the carpal tunnel in the absence of blood circulation in the limb in patients with carpal tunnel syndrome and in healthy volunteers; 3. To assess changes in carpal tunnel pressure before and after median nerve decompression in patients with carpal tunnel syndrome. We studied 40 people of both sexes aged from 21 to 82 years (mean age 50.1 years), divided into 2 groups. Group I included 20 patients with an established diagnosis of primary carpal tunnel syndrome. Group II, the control group, included 20 healthy volunteers. All participants had interstitial pressure measured in the carpal tunnel. In group I, the patients with carpal tunnel syndrome, 4 measurements were performed: before the start of surgery before a tourniquet was applied, 5 minutes after the tourniquet was applied (in the absence of blood circulation), then intraoperatively after decompression was performed in the conditions of a tourniquet applied and 5 minutes after its removal and restoration of blood circulation. In group II, 2 measurements were taken: before applying the tourniquet and after removing it. It was revealed that with carpal tunnel syndrome, the pressure inside the tunnel increased from 8 mm Hg normally to 24.5 mm Hg. When decompression is performed in patients with primary compressive neuropathy of the median nerve, a significant decrease in pressure in the carpal tunnel is observed from 24.5 mm Hg to 8 mm Hg. Even a short-term cessation of blood circulation in the upper limb leads to an increase in pressure inside the carpal tunnel.

Endogenous FGF21 attenuates blood-brain barrier disruption in penumbra after delayed recanalization in MCAO rats through FGFR1/PI3K/Akt pathway.

Restoration of blood circulation within "time window" is the principal treating goal for treating acute ischemic stroke. Previous studies revealed that delayed recanalization might cause serious ischemia/reperfusion injury. However, plenty of evidences showed delayed recanalization improved neurological outcomes in acute ischemic stroke. This study aims to explore the role of delayed recanalization on blood-brain barrier (BBB) in the penumbra (surrounding ischemic core) and neurological outcomes after middle cerebral artery occlusion (MCAO). Recanalization was performed on the 3rd day after MCAO. BBB disruption was tested by Western blotting, Evans blue dye, and immunofluorescence staining. Infarct volume and neurological outcomes were evaluated on the 7th day after MCAO. The expression of fibroblast growth factor 21 (FGF21), fibroblast growth factor receptor 1 (FGFR1), phosphatidylinositol-3-kinase (PI3K), and serine/threonine kinase (Akt) in the penumbra were observed by immunofluorescence staining and/or Western blotting. The extraversion of Evans blue, IgG, and albumin increased surrounding ischemic core after MCAO, but significantly decreased after recanalization. The expression of Claudin-5, Occludin, and zona occludens 1 (ZO-1) decreased surrounding ischemic core after MCAO, but significantly increased after recanalization. Infarct volume reduced and neurological outcomes improved following recanalization (on the 7th day after MCAO). The expressions of Claudin-5, Occludin, and ZO-1 decreased surrounding ischemic core following MCAO, which were up-regulated corresponding to the increases of FGF21, p-FGFR1, PI3K, and p-Akt after recanalization. Intra-cerebroventricular injection of FGFR1 inhibitor SU5402 down-regulated the expression of PI3K, p-Akt, Occludin, Claudin-5, and ZO-1 in the penumbra, which weakened the beneficial effects of recanalization on neurological outcomes after MCAO. Delayed recanalization on the 3rd day after MCAO increases endogenous FGF21 in the penumbra and activates FGFR1/PI3K/Akt pathway, which attenuates BBB disruption in the penumbra and improves neurobehavior in MCAO rats.

(151) Plasma Proteomic Signature of Human Heart Transplant Recipients After Restoration of Blood Circulation and Its Relationship to Graft Outcome

(151) Plasma Proteomic Signature of Human Heart Transplant Recipients After Restoration of Blood Circulation and Its Relationship to Graft Outcome

Circulatory condition in kidney patients with purulent pyelonephritis

Relevance. Urinary tract infections are among the most common infectiousdiseases encountered in the practice of doctors of various specialties, both at the outpatient and hospital stages. In recent years, there has been an increase in the incidence of acute pyelonephritis. The management of patients with acute complicated pyelonephritis requires further study aimed at optimizing the diagnostic algorithm and treatment methods. Objective. Studying the state of blood circulation in the kidney in patients with purulent pyelonephritis and improving the quality of treatment of these patients by introducing our own developed methodology. Materials and methods. In the Regional clinical hospital (Barnaul city, Russia), in the conditions of the urological department, the author personally examined and operated on 30 patients with purulent pyelonephritis according to his own method with an established diagnosis of purulent pyelonephritis. On the first day, all patients underwent retroperitoneoscopic decapsulation of the kidney on the affected side in combination with regional arterial infusion of alprostadil for 3 days. All patients underwent general clinical examination, multispiral computed tomography (MSCT) of the kidneys with bolus contrast enhancement, duplex scanning of renal vessels, and morphological examination of the material before and after the operation. Results. In all cases, the postoperative period proceeded favorably with a shorter treatment time. On the first day after surgery, patients noted a decrease in the intensity of pain in the area of the affected kidney. When comping the data of MSCT of the kidneys with bolus contrast, obtained in patients before treatment, the disappearance of foci of destruction in the kidney and a pronounced restoration of the previously lost blood flow of the kidney on the side of the lesion in the early stages are determined. Nephrectomy was not performed in any case. Conclusion. Each of the stages of the proposed method for the treatment of acute purulent pyelonephritis is an integral part of the technique as a whole; each stage is necessary to influence its level of the vascular bed and parenchyma in the area of its microabscesses and zones of infection. The method allows to achieve restoration of blood circulation in the kidney with the opening of antibiotics access to the organ parenchyma.

Results of surgical treatment in patients, suffering diabetes mellitus and chronic critical ischemia of lower extremity, taking into account the data of intraoperative debitometry

Objective. To analyze the results of surgical treatment of patients, suffering diabetes mellitus, ischemic form of diabetic foot syndrome and chronic critical ischemia of the lower extremity, caused by stenotic-occlusive affection of femoral arterial and popliteo-tibial segments, taking into account the data of intraoperative debitometry.
 Materials and metods. Results of surgical treatment were analyzed in 67 patients, suffering diabetes mellitus Type II, ischemic form of diabetic foot syndrome and chronic critical ischemia of the lower extremity, caused by stenotic-occlusive affection of femoral arterial and popliteo-tibial segments in 1 and 12 mo. In all the patients a femoro-popliteal shunting without intervention on the popliteo-tibial segment was performed. In accordance to the results obtained during intraoperative debitometry, the patients were distributed into three Groups: Group I - 22 patients with the shunt debit more than 60 ml/min, Group II - 25 patients with the shunt debit 30-60 ml/min, and Group III - 20 patients with the shunt debit lesser than 30 ml/min. In thrombosis of primary zone of arterial reconstruction a reoperation was conducted - a hybrid arterial reconstruction of the popliteo-tibial (thrombectomy from shunt and the balloon angioplasty) segment arteries.
 Results. In a Group I (n=22) a primary passability of the arterial reconstruction zone in 1mo was observed in 20 (90.9%), and in 12 mo - in 17 (77.3%) patients; in Group II (n=25) - accordingly, in 19 (76%) and 14 (56%) patients; in Group III (n=20) - accordingly, in 9 (45%) and 4 (20%).
 Thronbosis in the arterial reconstruction zone was diagnosed during a year in 32 patients, of them during first month after primary shunting - in 19 (59.4%), during further 11 mo - in 13 (40.6%) patients. After reoperation for thrombosis of the arterial reconstruction zone, consisting of a hybrid arterial reconstruction, secondary passability of the arterial reconstruction zone during 12 mo was observed in 24 (75%) of 32 patients. While restoration of outflow from popliteal artery into one tibial artery (n=23) during 12 mo a rethrombosis of the arterial reconstructive zone have occurred in 7 patients, secondary passability of the arterial reconstruction zone during 12 mo was observed in 16 (69.6%) patients. While restoration of outflow from popliteal artery into two tibial arteries (n=9) during 12 mo rethrombosis of the arterial reconstruction zone have occurred in 1 patient, secondary passability of the arterial reconstruction zone during 12 mo was observed in 8 (88.9%) patients.
 Conclusion. In combined stenotic-occlusive affection of femoral arterial segment and arteries of popliteo-tibial segment the isolated restoration of passability and femoral arterial segment without intervention on arteries of popliteo-tibial segment necessitates taking into account the intraoperative debitometry data with determination of the shunt debit constitutes an effective diagnostic method, the data of which may help to adjust a differentiated approach to tactics of surgical treatment in patients, suffering diabetes mellitus, chronic critical ischemia of the lower extremity, caused by stenotic-occlusive affection of femoral arterial segment and arteries of popliteo-tibial segment.
 The shunt debit bordering value, in presence of which the isolated restoration of the femoral arterial segment passability is possible, constitutes the indices higher than 60 ml/min, further intervention on the popliteo-tibial segment arteries is indicated only in the patients with the shunt thrombosis; while in the shunt debit 30-60 ml/min a reconstruction stage of the popliteo-tibial segment arteries after restoration of the femoral arterial segment passability may be postponed and performed on second stage of the procedure; while the shunt debit lesser than 30 ml/min - a simultaneous reconstruction of femoral segment and of the popliteo-tibial arteries, using performance of a hybrid arterial reconstruction, is necessary. The last is effective method of restoration of blood circulation in patients, suffering diabetes mellitus and chronic critical ischemia of the lower extremity, caused by stenotic-occlusive affection of femoral arterial segment and arteries of popliteo-tibial segment, and in accordance to the results adduced (index of the arterial reconstruction zone passability during 12 mo have constituted 75%) do not differ trustworthily from result of reconstruction of arterial segment in patients of Group I: the shunt debit more than 60 ml/min, while index of the arterial reconstruction zone passability during 12 mo constitutes 77.3% (p>0.05).
 While thrombosis of primary zone of arterial reconstruction the addition of thrombectomy from the shunt by restoration of the main blood flow from popliteal into two tibial arteries, using the balloon angioplasty, demonstrates a trustworthy best index of secondary passability of the arterial reconstruction zone in 12 mo - 88.9%, comparing with index of secondary passability of the arterial reconstruction zone in 12 mo after restoration of the main blood flow from popliteal artery into one tibial artery - 69.6% (p< 0.05).

PHENOMENON OF DEMIKHOV. In the Sklifosovsky Institute (1960–1986). Demichow W. Die experimentelle Transplantation lebenswichtiger Organe. Berlin: VEB Verlag Volk und Gesundheit, 1963

The article has discussed V.P. Demikhov's views on a homoplastic transplantation of tissues and organs in 1963 and his achievements in experimental transplantation by that time. The authors first translated the monograph Die experimentelle Transplantation lebenswichtiger Organe (1963) from German into Russian and presented V.P. Demikhov's Preface to it. In this text, having critically analyzed the current provisions in the field of immunobiology, V.P. Demikhov came to the conclusion that a number of his achievements contradicted those provisions and did not fit into the framework of existing immunobiological laws. In 1963, confessing the primacy of function over structure, V.P. Demikhov believed that the restoration of blood circulation in transplanted organs played the main role in their survival, and the subsequent functioning of the transplanted organ for a long time meant its engraftment. In this text V.P. Demikhov for the first time substantiated the model of a “physiological organism” he had invented for reviving a human in a state of agony, for creating a bank of organs, growing it in infants and rejuvenating the elderly.Authors declare no conflict of interest.

A Bypassing Technique for the Remedy of Portal Hypertension through Extra Hepatic Portal Vein Obstruction by CFD Analysis

Extra-hepatic portal vein obstruction (EHPVO) is the blockage to the flow of blood in the portal vein before reaches to the liver. EHPVO is the common cause of portal hypertension in children in the most Asian countries. Examination reveals that the presence of block in the main portal vein may be responsible for the shrinkage of vein with manifold pernicious complication. The “shunt” policy is a fruitful source of restoration of the hepatic portal flow. This study shows that a new approach of bypassing (or shunting) to the blocked (thrombosed) region of the portal vein is a significant way of reducing portal hypertension and restoration of blood circulation. We studied EHPVO case through computational fluid dynamics (CFD) analysis by considering partial block formation and side to side shunt scheme inside the main portal vein. The constitutive equation for non-Newtonian fluidand energy equation are solved by control volume technique. Our study reveals that the shunting technique is strongly effective for the reconstitution of portal venous flow to the liver with lower tissue stress and rapid regression of clinical signs of portal hypertension. This new technique may potentially applicable for medication of EHPVO when shunting procedures are indicated.
 GANIT J. Bangladesh Math. Soc.Vol. 38 (2018) 89-104

Results of the post-registration clinical study "PARUS" on efficiency and safety assessment of Mydocalm-Richter for local injection therapy of a myofascial trigger zone.

The "PARUS" program included investigation of the analgesic, muscle relaxant and sedative effects of Mydocalm-Richter which acts as central muscle relaxant in patients with myofascial pain syndrome, taking into account its registered indication for use - the hypertonus and cross-striated muscle spasm. Fifty patients with myofascial trigger points, the mean age of 41.67±11.86 years, have been enrolled in the study. All patients had undergone clinical examination that allowed the diagnosis of myofascial pain syndrome. The intensity of pain syndrome was evaluated using the pain visual analogue scales and McGill pain questionnaire. Visualization of area in spasm and evaluation of blood circulation was carried out using the ultrasound scan of target muscle. In order to objectively evaluate any conceivable hypotensive and sedative effects of Mydocalm-Richter we used the orthostatic test, Schulte's test for attention span and perfor-mance distribution and Munsterberg's test for attention discrimination and concentration. The analgesic and muscle relaxant effects of Mydocalm-Richter become apparent by day 3 post-injection, and the muscle relaxation effect is reaching its maximum on day 10 post-injection. Cardiovascular function following administration of Mydocalm-Richter was evaluated using the orthostatic test which revealed good orthostatic tolerance. Single injection of tolperisone hydrochloride possessing a central muscle relaxant activity has no sedative effect and does not influence patient response time. The ultrasound examination data demonstrated the improvement and in some cases restoration of blood circulation in the myofascial trigger points. Clinical study "PARUS" conducted in patients with myofascial pain has demonstrated a positive muscle relaxant and analgesic effect of Mydocalm-Richter that resulted in restoration of peripheral circulation in the myofascial trigger pointsconfirmed by ultrasound examination. An important benefit of this drug product is the absence of sedative effect and arterial hypotension.

Andrological aspects of surgical treatment hernias inquinalis at men

The work is devoted blood-groove research testis at patients with inquinal hernia before operative treatment, and its influence on function testis. It is established that irrespective of time of disease, localisation and type, inquinal hernia causes considerable decrease in a blood-groove in testis and is accompanied by a hypostasis of a fabric of elements funiculi spermatic. Reotesticulography and ultrasonic Doppler research are informative methods of inspection of blood circulation testis at patients inquinale hernias. For 7-8 days after operation, irrespective of a way of a plastic inquinale the channel of infringement of haemodynamics in testis remain and demand the correction directed on restoration of blood circulation. Use of the developed algorithm of improvement of blood circulation testis after operation hernioplastic with appointment electrophoresis of lidase and laser irradiation allows to improve blood circulation in testis in 3 times, and to reduce a fabric hypostasis in 1,7 times.

Subintimal recanalization. Indications, technique and results

This article gives an overview of the current importance of so-called subintimal recanalization in the lower extremities. The primary technical goal of endovascular interventions in the lower extremities is the endoluminal restoration of blood circulation from the iliac arteries into the feet. If endoluminal recanalization of e.g. high-grade flow-relevant stenoses or chronic total occlusion (CTO) is technically not possible, subintimal recanalization is a promising option and the only remaining minimally invasive alternative. During subintimal recanalization a channel is intentionally generated in the vessel wall (dissection) in order to bypass e. g. a chronic vascular occlusion over as short a distance as possible. The technical success rate for subintimal recanalization of CTO of the lower extremities is 65-100 %. Technical failure occurs in approximately 25 % using the catheter and wire technique and is caused in most cases by difficulties in reaching the true lumen after the subintimal passage (the so-called re-entry). Compared to conventional subintimal recanalization, in recent years so-called re-entry devices have expanded the technical possibilities and depending on the medical experience and training level of the physician, provide an improvement in the technical success rate, a lower complication rate, a reduction of fluoroscopy time and the amount of necessary contrast medium but also result in higher costs. Subintimal recanalization, whether carried out conventionally with a catheter and wire or using re-entry devices, of high-grade stenoses or CTO in the lower extremities provides a high technical success rate but requires an experienced and trained physician who is capable of operating the elaborate materials and mastering any possible complications.

Can matrix metalloproteinases be targeted in hepatic ischemia/reperfusion injury?

Can matrix metalloproteinases be targeted in hepatic ischemia/reperfusion injury?

Autofluorescence properties of rat liver under hypermetabolic conditions

Autofluorescence response to oxygen supply modulation has been investigated in livers of rats under the hypermetabolic state associated to a pathological condition-hyperthyroidism-that is known to enhance hepatocyte metabolic activities involving both NAD, i.e. oxidative pathways engaged in ATP synthesis, and NADP, i.e. reductive bio-synthesis and antioxidant functions. Experiments have been performed on rats in normal condition or submitted to long-term thyroxine (T(4)) administration. Histological inspection did not show any appreciable morphological alteration in liver parenchyma; biochemical analysis indicated an increase in both NADP(+) and NADPH contents. Autofluorescence properties have been monitored in vivo, via a fiber optic probe, on exposed livers both during induction of global ischemia and after restoration of blood circulation. Alteration of oxygen supply modulated liver autofluorescence properties, mainly as to NAD(P)H contribution, in dependence of changes in pyridine coenzymes redox state. With respect to euthyroid, hyperthyroid rat livers exhibited higher autofluorescence signals in all phases of the experiment, and a faster signal decay time upon reoxygenation. The results have been interpreted on the basis of a larger content of NADPH-the coenzyme not directly oxidized in respiratory processes and likely providing an almost constant autofluorescence background contribution-and of uncoupling effects facilitating the respiratory NADH oxidation, associated with the hyperthyroid condition. The results obtained in the liver hypermetabolic model provide interesting perspectives for a further improvement of the diagnostic implications of autofluorescence.

Modified Approach of Administering Cytostatics to the Lung: More Efficient Isolated Lung Perfusion

Isolated lung perfusion (ILuP) is an experimental technique for the treatment of pulmonary metastases. We hypothesized that part of the drug taken up by the lung during ILuP is washed out during the flush procedure. Therefore, we investigated gemcitabine uptake at different inflow concentrations, and the effect of delayed clamp release after ILuP on lung levels was studied. Thirty rats had ILuP during 30 minutes using gemcitabine perfusate levels of 1.3, 2.7, 4.0, 5.3, and 6.7 mg/mL. Another 37 rats underwent ILuP with gemcitabine perfusate levels of 6.7 mg/mL during 6 minutes followed by a 5-minute flush and 30 or 60 minutes of reperfusion, while two other groups had ILuP and delayed clamp release for 30 or 60 minutes followed by a 5-minute flush. All effluent and lung samples were stored for later analysis. Results were evaluated using Friedmann two-way analysis and two-way analysis of variance. At 6 minutes, steady-state of gemcitabine uptake was achieved for all inflow concentrations and a linear relation (r = 0.933, p < 0.0001) between effluent and lung levels was observed. Delayed clamp release resulted in significantly higher lung levels compared with immediate restoration of blood circulation after ILuP (456% at 30 minutes and 828% at 60 minutes). Effective gemcitabine lung levels are already achieved after 6 minutes of ILuP with 6.7 mg/mL followed by delayed clamp release during 30 minutes instead of the clinically applied 30 minutes ILuP.

Peculiarities of Cervical Spinal Cord Blood Supply

The peculiarities of cervical spinal cord blood supply were studied on 34 autopsied specimens. It was detected that both a. anterior spinalis, gone away from intracerebral zone of a. vertebralis and a. anterior radiculo-medullaris approaching the a. anterior spinalis system with C2-8 radicis played an equally important role in blood supply of the cervical spinal cord. The most significant importance had C5 left and C7 right a. radiculo-medullaris, that were noted in 65% of specimens. For cervical spinal cord the branching type of blood supply was more characteristic (67,7% of cases). In that type the number of a. radiculo-medullaris ranged from 2 to 8 (mean 4,4). That peculiarity significantly increases the probability of restoration of blood circulation in injury or other pathology of a. anterior spinalis.

Organ preservation solutions impair deformability of erythrocytes in vitro

Microcirculatory disturbances are observed frequently after restoration of the circulation in transplanted organ. The exact mechanisms responsible for impaired microcirculation during reperfusion are unknown. Erythrocyte deformability is an important factor maintaining the microcirculation. Red blood cells (RBC) (diameter 8 μm) passing through narrow capillaries (diameter 3–5 μm) undergo deformation due to shear stress present in the microcirculation. RBC with impaired deformability may even plug the capillaries. Immediately after completion a vascular anastomosis and restoration of blood circulation in the transplanted organ, RBC may be intimately exposed to the preservation solution. The aim of the present study was to investigate the effect of the preservation solution on deformability of RBC. Blood from five healthy volunteers was withdrawn by venipuncture from an antecubital vein. EDTA was used as an anticoagulant. RBC were isolated by 10-minute centrifugation (2500 rpm) to separate serum and buffy coat. RBC washed in normal saline were resuspended in autologous plasma, Bretschneider's histidine-tryptophan-ketoglutarate (HTK) or University of Wisconsin solution (UW) at an hematocrit of 20% for incubation at room temperature. After 30 minutes RBC deformability was measured using the shear stress diffractometer Rheodyn SSD to calculate the elongation indexes of RBC at various shear stresses. HTK caused a decrease in the deformability indices of erythrocytes at shear stresses from 0.3 to 1.2 Pa. Erythrocytes incubated with UW solution revealed a decrease in deformability index at all investigated shear stresses. HTK causes less deterioration of erythrocyte deformability compared to UW solution.

Metabolic and histological changes in the kidneys after 2 or 3 hours of ischemia and restoration of blood circulation up to 20 days

Die linke Kaninchenniere wurde einer Ischamie von 2 oder 3 Std ausgesetzt und die Erholung des Stoffwechsels nach Wiederdurchblutungszeiten von 3, 4 und 24 Std sowie von 6 und 20 Tagen durch Kontrolle des Gehalts an ATP, ADP, AMP, anorg. P, Glykogen, Glucose und MS verfolgt. In weiteren Versuchsserien bestimmten wir nach denselben Wiederdurchblutungszeiten das Ausmas der postischamischen Nierenschwellung und ermittelten nach Manifestationszeiten von 1, 6 und 20 Tagen histologische Veranderungen.