Risk Of Tissue Damage Research Articles

Comparison of outcomes between video laryngoscopy and flexible fiberoptic bronchoscopy for endotracheal intubation in adults with cervical neck immobilization: A systematic review and meta-analysis of randomized controlled trials.

Comparing the outcomes of video-laryngoscopy and flexible fiberoptic bronchoscopy for endotracheal intubation in patients with cervical spine immobilization. All of the comparative studies published in the PubMed, Cochrane Library, Medline, Web of Science, and EMBASE databases as of 8 Jan 2024 were included. All outcomes were analyzed using Review Manager 5.4. The primary outcomes were the successful first-attempt intubation rate, intubation time, heart rate after intubation, mean arterial pressure after intubation, overall intubation success rate, risk of tissue damage and sore throat. The meta-analysis included six randomized controlled studies with a total of 694 patients. The outcomes of the meta-analysis revealed that the use of video laryngoscopy was better than flexible fiberoptic bronchoscopy in terms of the successful first-attempt intubation rate (P<0.05) and intubation time (P<0.05) in patients with cervical spine immobilization. However, there were no statistically significant differences in heart rate after intubation, mean arterial pressure after intubation, overall intubation success rate, risk of tissue damage, or sore throat (all P>0.05) between the video laryngoscopy and flexible fiberoptic bronchoscopy groups. Compared with flexible fiberoptic bronchoscopy, video laryngoscopy has superior tracheal intubation performance in terms of the first-attempt success rate and intubation speed. This finding was observed in patients with cervical spine immobilization who utilized a cervical collar to simulate a difficult airway. Additionally, both types of scopes demonstrated similar complication rates. Current evidence suggests that video laryngoscopy is better suited than flexible fiberoptic bronchoscopy for endotracheal intubation in patients immobilized with a cervical collar. Systematic review protocol: CRD42024499868.

VASCULAR COMPLICATION AFTER LATERAL TEMPORAL LIFTING TECHNIQUE: A CASE REPORT

Vascular complication after lateral temporal lifting technique with hyaluronic acid-based fillers may result from arterial occlusion by direct injection into the artery or embolization with the product, which is usually immediately manifested by acute pain and scarlet-red spots due to hemorrhagic blisters. Vascular complication can also result from venous occlusion caused by external compression of the vessel with soft tissue filler. Vascular occlusion requires immediate treatment as the risk of tissue damage and skin necrosis increases with time. In this paper we consider a clinical case of vascular complication after the technique of lateral temporal lifting of hyaluronic acid, manifested by painfulness of the area of hyaluronic acid injection, Livedo reticularis, alopecia, and treatment of this patient for 3 months.

Comparison of video-stylet and conventional laryngoscope for endotracheal intubation in adults with cervical spine immobilization: A PRISMA-compliant meta-analysis.

Background:Although minimization of cervical spine motion by using a neck collar or manual in-line stabilization is recommended for urgent tracheal intubation (TI) in patients with known or suspected cervical spine injury (CSI), it may worsen glottic visualization. The overall performance of video-stylets during TI in patients with neck immobilization remains unclear. The current meta-analysis aimed at comparing the intubation outcomes of different video-stylets with those of conventional laryngoscopes in patients with cervical immobilization.Method:The databases of Embase, Medline, and the Cochrane Central Register of Controlled Trials were searched from inception to June 2021 to identify trials comparing intubation outcomes between video-stylets and conventional laryngoscopes. The primary outcome was first-pass success rate, while secondary outcomes included overall success rate, time to intubation, the risk of intubation-associated sore throat, or tissue damage.Results:Five randomized controlled trials published between 2007 and 2013 involving 487 participants, all in an operating room setting, were analyzed. The video-stylets investigated included Bonfils intubation fiberscope, Levitan FPS Scope, and Shikani optical stylet. There was no difference in first-pass success rate (risk ratio [RR] =1.08, 95% confidence interval [CI]: 0.89–1.31, P = .46], overall success rate (RR = 1.06, 95% CI: 0.93–1.22, P = .4), intubation time [mean difference = 4.53 seconds, 95% CI: –8.45 to 17.51, P = .49), and risk of tissue damage (RR = 0.46, 95% CI: 0.16–1.3, P = .14) between the 2 groups. The risk of sore throat was lower with video-stylets compared to that with laryngoscopes (RR = 0.45, 95% CI: 0.23–0.9, P = .02).Conclusion:Our results did not support the use of video-stylets as the first choice for patients with neck immobilization. Further studies are required to verify the efficacy of video-stylets in the nonoperating room setting.

Sıkma Kuvveti Uygulamadan Değişken Şekilli Yumuşak Dokuların Kavranması İçin Yeni Bir Laparoskopik Tutucu Tasarımı ve Uygulanabilirlik Testleri

Cerrahlar, Laparoskopik cerrahi sırasında yumuşak dokuları tutmak ve hareket ettirmek için tutucular kullanmaktadır. Bu tutucuların kavrama çeneleri, dokuların kaymaması için değişik yapılarda dişli yapıyasahiptirler. Dokuların tutucu çeneler arasında sıkıştırılması sonucunda doku hasarı riski oluşmaktadır. Bu çalışmada bu riskin ortadan kaldırılması için Bernoulli prensibi kullanılarak çalışan, dokuları sıkmadankaldırabilen yeni bir Laparoskopik tutucu tasarlanıp üretilerek deneysel çalışma ile uygulanabilirlik testleri yapılmıştır. Tutucu, doku ile arasında Bernoulli prensibi ile yüksek hava akış hızı ile vakum oluşturularakçalışmaktadır. Kaldırılan dokuların kuvvetli hava jetinden zarar görmemesi için eksenel yönde akan havanın akış yönünü değiştirmek amacıyla tutucu yüzey merkezine deflektör yerleştirilmiştir. Çalışma, Bernoulli prensibi ile çalışan bir tutucunun yumuşak ve esnek dokuların sıkıştırılmadan kaldırılması ve hareketi için uygulanabileceğini göstermiştir.

Tissue damage in herniated brain parenchyma into giant arachnoid granulations: demonstration with high resolution MRI

Brain herniation (BH) into arachnoid granulation has been remarkable in recent years. To evaluate the damage in herniated parenchyma into the giant arachnoid granulation (GAG) and to investigate the clinical-demographic importance of this damage. Patients with BH into GAG were retrospectively included in the study. Each of the patients had at least one high-resolution 3D magnetic resonance imaging (MRI) sequence. The arachnoid granulation dimensions, locations, and origin of herniated parenchyma were evaluated by two experienced radiologists. The demographic and symptomatic features of the patients were recorded from the hospital database. A total of 27 patients (21 females, 6 males; age range 6-71 years; mean age 41.3 years) were found to contain BH into GAG. It was most commonly seen in the transverse sinus (67%); the origin was most common in the cerebellar parenchyma (56%). Abnormal signal and morphology were detected in herniated parenchyma in 11 (47%) patients, atrophy in six, and atrophy and gliosis in five. The most common complaints were headache (47%), while other frequent symptoms were vertigo (15%) and blurred vision (11%). There was a statistically significant positive correlation between frequency of damage in herniated brain parenchyma and the maximal size of GAG (P<0.05). In patients with BH into GAG, parenchymal damage may be associated with various symptoms, such as headache and vertigo, although they have not been statistically proven. It is important to carefully evaluate hernia tissue, as the risk of tissue damage may increase in larger GAGs.

Microbubble-Mediated Ultrasound Outweighs Low-Intensity Pulsed Ultrasound on Osteogenesis and Neovascularization in a Rabbit Model of Steroid-Associated Osteonecrosis.

Microbubbles magnify the acoustic pressure of low-intensity pulsed ultrasound (LIPUS) and may enhance its bioeffect for diagnostic and therapeutic purposes. This study compared the effect of this novel microbubble-mediated ultrasound (MUS) with that of the traditional LIPUS on osteogenesis and neovascularization in a rabbit model of steroid-associated osteonecrosis. We hypothesized that MUS might outweigh LIPUS on promoting osteogenesis and neovascularization in steroid-associated osteonecrosis. The bilateral femoral head necrosis was induced by lipopolysaccharide and methylprednisolone in the rabbits. The indices of bone mineral density (BMD), trabecular number, maximal loading strength, and mineral apposition rate were analyzed, demonstrating that the animal model of steroid-associated osteonecrosis was successfully established. Both the MUS group (GM) and the LIPUS group (GL) were insonated 20 min daily for six weeks. GM received an extra intracapsular injection of microbubbles before insonation every other day. Fluorescence bone labeling, Micro-CT Analysis, biomechanical test, quantitative real-time PCR, Western blot analysis, and histological evaluation were performed for comparing GM with GL. The results demonstrated a 39% higher mineral apposition rate in GM compared with GL. The BMD and the maximal loading strength of femoral head of GM increased by 4.3% and 27.8% compared to those of GL, respectively. The mRNA and protein expression of BMP-2 and VEGF were also significantly higher in GM. The number of blood vessels of GM was 65% greater than that of GL. MUS is more potent than LIPUS in enhancing osteogenesis, neovascularization, and biomechanical strength of femoral head in the animal model of steroid-associated osteonecrosis. Without increasing the intensity of insonation or the risk of tissue damage, MUS is better for inhibiting the process of steroid-associated osteonecrosis.

Proteomic analysis of mitochondrial proteins in the guinea pig heart following long-term normobaric hyperoxia.

Normobaric hyperoxia is applied for the treatment of a wide variety of diseases and clinical conditions related to ischemia or hypoxia, but it can increase the risk of tissue damage and its efficiency is controversial. In the present study, we analyzed cardiac mitochondrial proteome derived from guinea pigs after 60h exposure to 100% molecular oxygen (NBO) or O2 enriched with oxygen cation (NBO+). Two-dimensional gel electrophoresis followed by MALDI-TOF/TOF mass spectrometry identified twenty-two different proteins (among them ten nonmitochondrial) that were overexpressed in NBO and/or NBO+ group. Identified proteins were mainly involved in cellular energy metabolism (tricarboxylic acid cycle, oxidative phosphorylation, glycolysis), cardioprotection against stress, control of mitochondrial function, muscle contraction, and oxygen transport. These findings support the viewpoint that hyperoxia is associated with cellular stress and suggest complex adaptive responses which probably contribute to maintain or improve intracellular ATP levels and contractile function of cardiomyocytes. In addition, the results suggest that hyperoxia-induced cellular stress may be partially attenuated by utilization of NBO+ treatment.

Shared control of a medical robot with haptic guidance.

Tele-operation of robotic surgery reduces the radiation exposure during the interventional radiological operations. However, endoscope vision without force feedback on the surgical tool increases the difficulty for precise manipulation and the risk of tissue damage. The shared control of vision and force provides a novel approach of enhanced control with haptic guidance, which could lead to subtle dexterity and better maneuvrability during MIS surgery. The paper provides an innovative shared control method for robotic minimally invasive surgery system, in which vision and haptic feedback are incorporated to provide guidance cues to the clinician during surgery. The incremental potential field (IPF) method is utilized to generate a guidance path based on the anatomy of tissue and surgical tool interaction. Haptic guidance is provided at the master end to assist the clinician during tele-operative surgical robotic task. The approach has been validated with path following and virtual tumor targeting experiments. The experiment results demonstrate that comparing with vision only guidance, the shared control with vision and haptics improved the accuracy and efficiency of surgical robotic manipulation, where the tool-position error distance and execution time are reduced. The validation experiment demonstrates that the shared control approach could help the surgical robot system provide stable assistance and precise performance to execute the designated surgical task. The methodology could also be implemented with other surgical robot with different surgical tools and applications.

In Vitro Cytotoxicity of Two Categories of Dental Cements

ARTICLE INFO Background and Aim: Resin cements are used widely in restorative dentistry regard- less of their biocompatibility. The aim of this study was to compare the cytotoxicity of two categories of dental cements consisting of three chemically set cements (Fuji I, Fuji PLUS and Harvard) and two dual curing cements (BisCem and Duo-Link) by use of MTT assay. Methods and Materials: In this experimental study, four round-shaped samples of each specimen were placed in DMEM culture medium for 24, 48 and 72 hours. The extracts from each sample were applied on L929 mouse fibroblasts. At the end of each period, MTT assay was carried out to estimate the mitochondrial respiration. Data were analyzed by one-way analysis of variance (ANOVA) followed by Tukey's post- hoc test. The degree of cytotoxicity for each sample was determined according to the reference value of the control group. Results:Fuji I cement showed the least cytotoxicity while Harvard and BisCem ce- ments showed the highest cytotoxic effect. The differences were not significant com- pared to the positive control (distilled water). Conclusion: This study showed that dental cements are capable of eliciting biological response in gingival and pulpal cells. They present a potential risk of tissue damage which depends on the cement's brand and curing modes.

Reduced-order modeling of human body for brain hypothermia treatment

Brain hypothermia treatment (BHT) is an active therapy for severe brain injury. It makes the temperature of the brain track a given temperature input curve so as to reduce the risk of tissue damage. BHT requires a brain-temperature control system because of environmental disturbances and changes in the human body. The thermal models of the human body devised so far are usually of a very high order and are not suitable for controlling brain temperature. This paper presents a method of finding a reducedorder thermal model of the human body for use in BHT. It combines minimal realization and balanced realization. Unlike other methods, this method yields a reduced-order model that is based on system theory and that takes the frequency characteristics of human thermal sensation into account. It features high precision in the frequency band for BHT and is suitable for the control of brain temperature.

An evaluation of a novel alternating mattress and cushion technology.

Pressure ulcer prevention and management remain a challenge across all health-care settings, and the incidence and prevalence of pressure ulcers in nursing homes and residential homes continues to remain unknown. The use of suitable support surfaces has been found to be beneficial in the prevention and management of pressure ulcers. Carrying out a holistic assessment of the patient and recording the patient's at-risk score would help the clinician to determine the most suitable pressure-relieving surface for the patient. The clinician's clinical experience and judgment are also important. The Domus Auto (by APEX) mattress system and Dynamic Seat Cushion (by APEX) are effective dynamic, support surfaces in the prevention and management of pressure ulceration. They meet the recommendations by both national and international guidelines; they also partly fulfil the SSKIN bundle. From a four-week evaluation carried out in a nursing home, it has been demonstrated that, together with regular assessments and repositioning of the patients, these devices are useful tools in preventing patients' risk of tissue damage and improving the patients' quality of life.

Hypopharyngeal, Supraglottic and Subglottic Stenosis after 1 Week Intubation

Hypopharyngeal, Supraglottic and Subglottic Stenosis after 1 Week Intubation

Therapeutic plasma exchange as a therapeutic modality for the treatment of IVIG complications

Intravenous immunoglobulin (IVIG) is used for the treatment of a number of inflammatory conditions. Hemolysis due to passive transfer of blood group antibodies is a well recognized complication of IVIG therapy. Therapy is largely supportive and consists of blood product support and hemodialysis. We report the use of therapeutic plasma exchange (TPE) as adjunct therapy for three patients with complications attributed to IVIG. Two patients had hemolysis attributed to IVIG; one patient was blood group A and the other blood group O. The third patient was an orthotopic heart transplant recipient with a type A donor heart, and anti-A antibodies detected after infusion of IVIG for suspected antibody mediated rejection. Two patients had anti-A titers available that decreased after initiation of plasma exchange. The blood group O patient with hemolysis had a gradual stabilization of hemoglobin and resolution of the positive DAT. TPE may be useful therapy for patients with severe hemolysis caused by IVIG or at risk for tissue damage by blood group antibodies.

Abstract 3038: Intra-testicular transplantation of purified autologous stem cells for treatment of chemotherapy-induced male infertility

Abstract Post-chemotherapy-induced male infertility in patients with childhood cancers represents a major complication for long-term survivors. There is a significant risk for tissue damage in the seminiferous tubules, and subsequent impairment of spermatogenesis both in children and adult males who receive chemotherapy. These therapeutic regimens have deleterious effects on male fertility, resulting in the deficiency of functional spermatozoa. In adult males, fertility can be protected ahead of cancer treatment by cryopreservation of mature spermatozoa; however, this is not always possible in pre-puberty children. Autologous bone marrow stem cells (BMSCs) are suitable candidates for treating infertility after testicular exposure to low or moderate doses of chemotherapy due to their differentiation potentials into functional cell types that can promote spermatogenesis. In this report, we present a method for restoration of male fertility in post-chemotherapy cancer survivors, through intra-testicular transplantation of autologous, purified, bone marrow-derived CD34+/CD133+ stem cells. We isolated CD34+ and CD133+ cells from human bone marrow using the clinical-grade CliniMACSPLUS® Cell Purification System. CD34+/CD133+ cell populations were directly separated from MNCs collected from the bone marrow. Flow cytometry analyses for purified cell populations showed 94.5 (+3.2) % purities. CD34+/CD133+ purified populations were then injected intra-testicularly in patients on the same day of the procedure. Patients were then followed up for up to 5 years post-transplantation. No complications were reported in any patient in this study. Nine out of twenty seven patients (33%) showed pathological changes. Some cases developed spermatids in the testes (7%), while others developed fully mature spermatozoa (11%). Spermatocytes and sperms appeared in the seminal fluid in a few other cases after SCT (26%). Long term results yielded 6 natural pregnancies, 2 live births, and 1 successful IVF out of 3 (1/3) done for three couples. The advantage of using autologous adult BMSCs is in the generation of the patients' own biological offspring. Additionally these cells differentiate in vivo when placed in the gonad environment to spermatocytes, spermatids, and even mature spermatozoa. All together, this procedure minimizes the risk of genetic instability, since no propagation takes place in vitro (culture), avoids manipulation and epigenetic alteration, stabilizes the properties of the mature spermatozoa and produces a healthy offspring after transplantation. The introduction of purified, uncultured, un-manipulated, CD34+/CD133+ BMSCs into the testicles of infertile patients is a promising technique that may carry some hope for male infertility patients. Citation Format: Adeeb M. AlZoubi. Intra-testicular transplantation of purified autologous stem cells for treatment of chemotherapy-induced male infertility. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 3038. doi:10.1158/1538-7445.AM2014-3038

Endoscopic assisted orchiectomy in Herman's tortoises (Testudo hermanni sp.).

Male tortoises in captivity are often aggressive against other males or females, in particular during mating season related to hormonal influences (testosterone). Castration in males is the treatment of choice in many vertebrate species. A novel technique of minimal invasive castration is presented for Herman's tortoises (Testudo hermanni). The procedure was performed in ten mature males. An endoscope (2.7 mm/30° angled) was inserted into a prefemoral incision on each side. The testicle was resected after ligation of the gubernaculum testis and the spermatic cord using hemoclips. Each testicle could be removed in approximately 20 minutes. Complications like hemorrhage or damage of adjacent tissue did not occur and all animals recovered uneventfully. Using the bilateral prefemoral entrance offers an alternative option for orchiectomy in Herman's tortoises without dissection of the shell. Thus complications like hemorrhage or impaired wound healing followed by sequestration of the bone flap are prevented. Because of the anatomical settings and the risk of tissue damage and time consumption, a unilateral approach is not recommended. Fasting the animals is necessary due to the voluminous gastrointestinal tract of this herbivorous tortoise and emptying the urinary bladder provides more space for manipulations in the coelomic cavity and prevents clipping and cutting of adjacent organs. The magnification via the endoscope is beneficial for orientation in the coelomic cavity, which is formed by the extremely convex carapace. Without this equipment it is challenging to visualize the dorsocaudally located gonads through the relatively small incision and the inserted instruments might block the view at the surgical field. Administration of hemoclips achieved a good hemostasis and the testicles could be resected without major blood loss. The described technique is a gentle method for resection of the testicles in this species and can be adapted to other European tortoise species of equal size.

Usefulness of Irradiated Polyglactin 910 (Vicryl Rapide) for Skin Suturing during Surgery for Lateral Ray Polydactyly of the Toes in Children.

Background:This study describes the use of a bioabsorbable suture for skin suturing during surgery for lateral ray polydactyly followed by favorable postoperative outcome without the need for postoperative suture removal.Methods:A 5-0 Vicryl Rapide suture was used for skin suturing during surgery for lateral ray polydactyly in 9 children (mean age, 12.4 mo). Children were allowed to walk and bathe 2 weeks after surgery when over-the-suture taping therapy was started.Results:In all cases, the Vicryl Rapide suture disappeared completely within 3 weeks of surgery, and no removal of residual suture was required. No postoperative complications, such as suture abscess, wound dehiscence, or ulcer, were observed. During a mean 24-month postoperative follow-up, no elevation of the interdigital space due to hypertrophic scarring or scar contracture was observed, and no revision surgery was required.Conclusions:Although the breaking strength of Vicryl Rapide declines within the first 10 days after surgery, this property will unlikely lead to postoperative wound dehiscence due to a relatively light load being applied to the lateral toes. The use of a bioabsorbable suture for skin suturing during surgery for lateral lay polydactyly is highly beneficial as it eliminates pain caused by suture removal and the risk of tissue damage while reducing the burden on medical staff.

P 107. Performance of electroconvulsive therapy in a patient with clipping of the middle intracerebral artery (Yasargil titanium clip) without major complications

Little is known regarding the risks of electroconvulsive therapy (ECT) in patients with clippings of intracerebral aneurysms. Currently, literature merely provides few anecdotal reports ( Najiar and Guttmacher, 1998 ) and manufacturers of such clipping systems (usually made of titanium) refrain from any suggestions concerning the safety during the performance of ECT. Thus, clinicians facing the coincidence of therapy-refractory depression (suggesting performance of ECT) and presence of intracerebral clips have to trade of possible benefits of ECT against theoretical risks in the complete absence of any guidelines or recommendations. Indeed, titanium is principally inert and the application of electric current should therefore not result in significant warming (with the risk of damaging surrounding brain tissue). However, the indication of ECT under these conditions must be confirmed meticulously. A case report is presented in order to to contribute to the available experience concerning this clinical situation. We present the case of a 55-year old female patient who successfully underwent clipping (Yasargil Titanium Clip, Aesculap®) of the left middle cerebral artery (MCA) due to MCA-aneurysm three years prior. The patient suffered from treatment-refractory major depressive disorder (recurrent type). Taking into account that various pharmacologic treatment attempts failed, ECT was considered. The patient was comprehensively informed about possible risks of the procedure related to the titanium clip. Before ECT CT-angiography was performed showing no re-development of the surgically treated aneurysm or development of new aneurysms. 12 cycles of right-unilateral ECT were performed without any complications despite ECT-related tachycardia. During ECT the patient was treated with esmolol. Subsequently, the patient’s clinical situation significantly improved. Though clear guidelines or suggestions of manufacturers of neurosurgical clips regarding safety during ECT are absent we did not observe any major complications during ECT in a patient with an intracerebral Yasargil titanium clip. However, the material behaviour of titanium during application of electric current remains to be studied systematically in order to rule out problematic warming with the risk of tissue damage.

Abstract 356: Effect of Long-Term Diet-Induced Hyperglycemia and Hyperlipidemia on Placenta Growth Factor Expression in Mouse Heart

Arteriogenesis (collateral artery remodeling) is a vital adaptation of the vasculature in response to occlusion which serves to improve O2 and nutrient delivery to distal tissue, thereby decreasing risk of tissue damage due to ischemia. Stimulation of arteriogenesis would be highly beneficial in diabetics, who are especially prone to develop ischemic cardiovascular disease. However, arteriogenesis is suppressed in diabetes by an undefined mechanism. Placenta growth factor (PLGF) is a key arteriogenic factor; thus, we hypothesized that decreased PLGF levels might contribute to impaired arteriogenesis in diabetes. To test this hypothesis, we utilized three mouse models of long term (6 mo) diet-induced metabolic dysfunction: hyperglycemic + hyperlipidemic (high fat fed C57BL/6; HG/HL, n=7), hyperlipidemic (low fat fed ApoE-/-; HL, n=5) and extremely hyperlipidemic (high fat fed ApoE-/-; EXHL, n=12). A normoglycemic + normolipidemic control group (low fat fed C57BL/6; CONT, n=9) was also studied. Both males and females were studied to identify gender differences. Mouse phenotype was confirmed by plasma cholesterol assay, intraperitoneal glucose tolerance testing, and body weight. Cardiac PLGF gene expression was decreased in both male and female EXHL (~50%, p&lt;0.01 and ~42%, p=0.09 respectively), compared to HL. PLGF mRNA was also decreased in male (~43%, p=0.06) but not female HG/HL, compared to CONT (n=5). This decrease was specific to PLGF, as mRNA for VEGFR1 (PLGF receptor) and the related growth factor VEGF-A was not affected by diet. We previously showed that PLGF is upregulated by low, physiological levels of hydrogen peroxide in vitro, suggesting that reactive oxygen species (ROS) signaling may be important in regulating PLGF. Since oxidative stress occurs in both hyperglycemia and hyperlipidemia, and arteriogenesis is known to be subject to a “redox window,” the inhibition of PLGF expression we observed may be mediated by oxidative stress. Plasma isoprostane levels confirmed that oxidative stress existed in HG/HL, HL, and EXHL compared to CONT. We conclude that hyperlipidemia is a key metabolic parameter influencing PLGF expression in cardiac tissue. Further studies to identify the role of oxidative stress in PLGF expression are needed.

A Literature Review of Pressure Ulcer Prevention: Weight Shift Activity, Cost of Pressure Care and Role of the Occupational Therapist

Introduction:Pressure ulcers are a major concern for those who spend a prolonged period of time sitting. Weight shifts are one prevention strategy used to reduce the risk of tissue damage. Currently, the prevalence of pressure ulcers is high, suggesting that concordance with preventative methods is poor. Occupational therapy focuses on the use of functional activity to promote health and wellbeing. The aim of this literature review was to evaluate the role of functional activity in reducing seated interface pressure.Method:A comprehensive search of nine electronic databases (AMED, CINAHL, Ovid MEDLINE, SportDiscus, EMBASE, British Nursing Index, Cochrane Library, Google Scholar and OTDBASE) was conducted between January 2000 and October 2011.Findings:From the 24 articles included in the review, there is limited evidence evaluating the role of functional activity and weight shifts in reducing seated interface pressure. Limited evidence suggests poor concordance with weight shifts, with wheelchair users repositioning on average once every 1–2 hours. The cost of pressure ulcer care is considerable, with an average annual cost of £1.7 billion in the United Kingdom. Occupational therapists have a key preventative role.Conclusion:Further research is needed to explore the role of functional activity and to determine the effectiveness of weight shift activity in reducing seated interface pressure.

Facets and mechanisms of adaptive pain behavior: predictive regulation and action

Neural mechanisms underlying nociception and pain perception are considered to serve the ultimate goal of limiting tissue damage. However, since pain usually occurs in complex environments and situations that call for elaborate control over behavior, simple avoidance is insufficient to explain a range of mammalian pain responses, especially in the presence of competing goals. In this integrative review we propose a Predictive Regulation and Action (PRA) model of acute pain processing. It emphasizes evidence that the nervous system is organized to anticipate potential pain and to adjust behavior before the risk of tissue damage becomes critical. Regulatory processes occur on many levels, and can be dynamically influenced by local interactions or by modulation from other brain areas in the network. The PRA model centers on neural substrates supporting the predictive nature of pain processing, as well as on finely-calibrated yet versatile regulatory processes that ultimately affect behavior. We outline several operational categories of pain behavior, from spinally-mediated reflexes to adaptive voluntary action, situated at various neural levels. An implication is that neural processes that track potential tissue damage in terms of behavioral consequences are an integral part of pain perception.