Myocardial pathologies are major causes of morbidity and mortality worldwide. Early detection of loss of cellular integrity and expansion in extracellular volume(ECV) in myocardium is critical to initiate effective tr...Myocardial pathologies are major causes of morbidity and mortality worldwide. Early detection of loss of cellular integrity and expansion in extracellular volume(ECV) in myocardium is critical to initiate effective treatment. The three compartments in healthy myocardium are: intravascular(approximately 10% of tissue volume), interstitium(approximately 15%) and intracellular(approximately 75%). Myocardial cells, fibroblasts and vascular endothelial/smooth muscle cells represent intracellular compartment and the main proteins in the interstitium are types Ⅰ/Ⅲ collagens. Microscopic studies have shown that expansion of ECV is an important feature of diffuse physiologic fibrosis(e.g., aging and obesity) and pathologic fibrosis [heart failure, aortic valve disease, hypertrophic cardiomyopathy, myocarditis, dilated cardiomyopathy, amyloidosis, congenital heart disease, aortic stenosis, restrictive cardiomyopathy(hypereosinophilic and idiopathic types), arrythmogenic right ventricular dysplasia and hypertension]. This review addresses recent advances in measuring of ECV in ischemic and non-ischemic myocardial pathologies. Magnetic resonance imaging(MRI) has the ability to characterize tissue proton relaxation times(T1, T2, and T2*). Proton relaxation times reflect the physical and chemical environments of water protons in myocardium. Delayed contrast enhanced-MRI(DE-MRI) and multi-detector computed tomography(DE-MDCT) demonstrated hyper-enhanced infarct, hypo-enhanced microvascular obstruction zone and moderately enhanced peri-infarct zone, but are limited for visualizing diffuse fibrosis and patchy microinfarct despite the increase in ECV. ECV can be measured on equilibrium contrast enhanced MRI/MDCT and MRI longitudinal relaxation time mapping. Equilibrium contrast enhanced MRI/MDCT and MRI T1 mapping is currently used, but at a lower scale, as an alternative to invasive sub-endomyocardial biopsies to eliminate the need for anesthesia, coronary catheterization and possibility of tissue sampling error. Similar to delayed contrast enhancement, equilibrium contrast enhanced MRI/MDCT and T1 mapping is completely noninvasive and may play a specialized role in diagnosis of subclinical and other myocardial pathologies. DE-MRI and when T1-mapping demonstrated sub-epicardium, sub-endocardial and patchy mid-myocardial enhancement in myocarditis, Behcet's disease and sarcoidosis, respectively. Furthermore, recent studies showed that the combined technique of cine, T2-weighted and DE-MRI technique has high diagnostic accuracy for detecting myocarditis. When the tomographic techniques are coupled with myocardial perfusion and left ventricular function they can provide valuable information on the progression of myocardial pathologies and effectiveness of new therapies.展开更多
Cardiogenic shock is the leading cause of death among patients hospitalized with acute myocardial infarction （MI）. Understanding the mechanisms for acute pump failure is therefore important. The aim of this study is...Cardiogenic shock is the leading cause of death among patients hospitalized with acute myocardial infarction （MI）. Understanding the mechanisms for acute pump failure is therefore important. The aim of this study is to examine in an acute MI dog model whether mitochondrial bio-energetic function within non-ischemic wall regions are associated with pump failure. Anterior MI was produced in dogs via ligation of left anterior descending （LAD） coronary artery, that resulted in an infract size of about 30% of the left ventricular wall. Measurements ofhemodynamic status, mitochondrial function, free radical production and mitochondrial uncoupling protein 3 （UCP3） expression were determined over 24 h period. Hemodynamic measurements revealed a 〉 50% reduction in cardiac output at 24 h post infarction when compared to baseline. Biopsy samples were obtained from the posterior non-ischemic wall during acute infarction. ADP/O ratios for isolated mitochondria from non-ischemic myocardium at 6 h and 24 h were decreased when compared to the ADP/O ratios within the same samples with and without palmitic acid （PA）. GTP inhibition of （PA）-stimulated state 4 respiration in isolated mitochondria from the non-ischemic wall increased by 7% and 33% at 6 h and 24 h post-infarction respectively when compared to sham and pre-infarction samples. This would suggest that the mitochondria are uncoupled and this is supported by an associated increase in UCP3 expression observed on western blots from these same biopsy samples. Blood samples from the coronary sinus measured by electron paramagnetic resonance （EPR） methods showed an increase in reactive oxygen species （ROS） over baseline at 6 h and 24 h post-infarction. In conclusion, mitochondrial bio-energetic ADP/O ratios as a result of acute infarction are abnormal within the non-ischemic wall. Mitochondria appear to be energetically uncoupled and this is associated with declining pump function. Free radical production may be associated with the induction of uncoupling proteins in the mitochondria.展开更多
Objectives: To study the effect of sulfotanshinone sodium (SS) injection in the treatment of non-ischemic retinal vein occlusion (RVO). Methods: Sixty-two RVO patients treated in our hospital between Jan. 2013 and Oct...Objectives: To study the effect of sulfotanshinone sodium (SS) injection in the treatment of non-ischemic retinal vein occlusion (RVO). Methods: Sixty-two RVO patients treated in our hospital between Jan. 2013 and Oct. 2014 were randomly divided into Control Group (30 patients;Bendazol tablets) and Treatment Group (32 patients, Bendazol tablets + SS injections), each with a follow-up period of 6 months. Statistical analysis was then performed on changes in visual acuity, central retinal thickness (CRT) and retinal circulation time (RCT) before and after the treatment. Results: After treatment, both Control Group and Treatment Group witnessed an improvement on visual acuity (Control Group: t = 2.103, p = 0.044;Treatment Group: t = 8.021, p = 0.000). Visual acuity could be greatly improved in Treatment Group when compared with Control Group, with significant differences (p < 0.01). Macular edema could be greatly relieved in Treatment Group measured by CRT (t = 2.571, p = 0.007) while the difference was of no statistical significance in Control Group (t = 1.016, p = 0.070). RCT were remarkably shortened in both groups (Control Group: t = 43.83, p = 0.000;Treatment Group: t = 27.34, p = 0.000), and when compared with Control group, the changes in Treatment Group were more significant (p < 0.05). Conclusion: SS injection could effectively improve the therapeutic effect in patients with non-ischemic retinal vein occlusion.展开更多
Objective To investigate the clinical effects of thread-dragging therapy on gangrene of non-ischemic diabetic foot ulcers(NIDFU).Methods A total of 136 patients with NIDFU were recruited from the Department of Periphe...Objective To investigate the clinical effects of thread-dragging therapy on gangrene of non-ischemic diabetic foot ulcers(NIDFU).Methods A total of 136 patients with NIDFU were recruited from the Department of Peripheral Vascular Surgery,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine between June 21,2021 and February 1,2023,and randomized into an intervention group and a control group,with 68 cases in each group.Both groups received basic treatment.The intervention group was treated with thread-dragging therapy,while the control group was treated with debridement combined with routine dressing changes after surgery.Both groups were treated continuously for 2 months.The amputation rates and changes in the ulcer area were compared between the groups.The inflammatory response index including peripheral white blood cells(WBCs),neutrophil percentage(NEUT%),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),procalcitonin(PCT),and interleukin 6(IL-6)were compared between the two groups.Results After treatment,the ulcer areas in the intervention group were significantly smaller than that of the control group(8.50±3.88 cm^(2) vs.10.11±4.61 cm^(2),P<0.05).The amputation rates of the two groups were not statistically significant(4.4%vs.5.9%,P>0.05).Differences of WBCs count,CRP,and ESR before and after therapy in the intervention group were better than the control group(P<0.05).However,there were no significant differences in changes of NEUT%,PCT,and IL-6 between the two groups(P>0.05).Conclusion Thread-dragging therapy may be effective in the treatment of NIDFU,with the additional advantages of less tissue damage after healing.(Registration No.ChiCTR2100047496)展开更多
Dermal fillers have been commonly used for the filling of facial rhytids.As the use of dermal fillers has grown,so has the incidence of non-ischemic complications.These complications range from edema,bruising,and eryt...Dermal fillers have been commonly used for the filling of facial rhytids.As the use of dermal fillers has grown,so has the incidence of non-ischemic complications.These complications range from edema,bruising,and erythema to more complex conditions such as delayed hypersensitivity nodules and biofilms.This article sought to review the causes of various non-ischemic complications,discuss their risk factors,and review management techniques.Certain predisposing factors to delayed hypersensitivity nodules,such as Vycross technology,a history of viral illness,or coronavirus disease 19(COVID-19)infections,are discussed in detail in this review.Prevention techniques such as patient counseling,elucidating certain patient history(viral illness,dental procedures),the use of aseptic technique,and procedural factors are also discussed.Understanding appropriate management for these complications can also help in treatment.Imaging,such as ultrasound,computed tomography(CT)and magnetic resonance imaging(MRI),has taken on a larger role in the management of non-ischemic complications.展开更多
·AIM:To describe a case in which vitrectomy was required for vitreous hemorrhage and fibrovascular proliferation after laser-induced chorioretinal venous anastomosis (LCVA) for non-ischemic central retinal vein o...·AIM:To describe a case in which vitrectomy was required for vitreous hemorrhage and fibrovascular proliferation after laser-induced chorioretinal venous anastomosis (LCVA) for non-ischemic central retinal vein occlusion (CRVO).·METHODS:Observational case report.·RESULTS:A 72-year-old man complained of central scotoma in the left eye,and was diagnosed as suffering from non-ischemic CRVO.LCVA was performed in another hospital.Although favorable visual function was briefly maintained postoperatively,severe vitreous hemorrhage developed in his left eye,necessitating vitrectomy.·CONCLUSION:Considering that LCVA carries a risk of serious complications,we must apply this treatment with caution,especially in ethnic groups,such as the Japanese,in whom pigmentation reacts to photocoagulation excessively.·展开更多
Acute myocardial infarction （AMI） is the leading cause of death and disability worldwide. Timely reperfusion is the standard of care and results in decreased infarct size, improving patient survival and prognosis. H...Acute myocardial infarction （AMI） is the leading cause of death and disability worldwide. Timely reperfusion is the standard of care and results in decreased infarct size, improving patient survival and prognosis. However, 25% of patients proceed to develop heart failure （HF） after myocardial infarction （MI） and 50% of these will die within five years. Since the size of the infarct is the major predictor of the outcome, including the development of HF, therapies to improve myocardial salvage have great potential. Over the past three decades, a number of stimuli have been discovered that activate endogenous cardioprotective pathways. In ischemic preconditioning （IPC） and ischemic postconditioning, ischemia within the heart initiates the protection. Brief reversible episodes of ischemia in vascular beds remote from the heart can also trigger cardioprotection when applied before, during, or immediately after myocardial ischemia-- known as remote ischemic pre-, per-, and post-conditioning, respectively. Although the mechanism of remote ischemic preconditioning （RIPC） has not yet been fully elucidated, many mechanistic components are shared with IPC. The discovery of RIPC led to research into the use of remote non-ischemic stimuli including nerve stimulation （spinal and vagal）, and electroacupuncture （EA）. We discovered and, with others, have elucidated mechanistic aspects of a non- ischemic phenomenon we termed remote preconditioning of trauma （RPCT）. RPCT operates via neural stimulation of skin sensory nerves and has similarities and differences to nerve stimulation and EA conducted at acupoints. We show herein that RPCT can be mimicked using electrical stimulation of the abdominal midline （EA-like treatment） and that this modality of activating cardioprotection is powerful as both a preconditioning and a postconditioning stimulus （when applied at reperfusion）. Investigations of these cardioprotective phenomena have led to a more integrative understanding of mechanisms related to cardioprotection, and in the last five to ten years, it has become clear that the mechanisms are similar, whether induced by ischemic or non-ischemic stimuli. Taking together much of the data in the literature, we propose that all of these cardioprotective ＂conditioning＂ phenomena represent activation from different entry points of a cardiac conditioning network that converges upon specific mediators and effectors of myocardial cell survival, including NF-KB, Stat3/5, protein kinase C, bradykinin, and the mitoKA^P channel. Nervous system pathways may represent a novel mechanism for initiating conditioning of the heart and other organs. IPC and RIPC have proven difficult to translate clinically, as they have associated risks and cannot be used in some patients. Because of this, the use of neural and nociceptive stimuli is emerging as a potential non-ischemic and non-traumatic means to initiate cardiac conditioning. Clinical relevance is underscored by the demonstration of postconditioning with one of these modalities, supporting the conclusion that the development of pharmaceuticals and electroceuticals for this purpose is an area ripe for clinical development.展开更多
To summarize the nursing experience of a three-stage liver resection combined with ALPPS(associating liver partition and portal vein ligation for staged hepatectomy)and intraoperative isolated perfusion chemotherapy f...To summarize the nursing experience of a three-stage liver resection combined with ALPPS(associating liver partition and portal vein ligation for staged hepatectomy)and intraoperative isolated perfusion chemotherapy for a patient at a tertiary hospital in Shenzhen,China,in order to provide insights for the treatment of such cases in the future.This operation was conducted for the first time globally,presenting significant challenges and no prior nursing experience to reference.Through evidence-based thinking and literature review,preoperative multidisciplinary team(MDT)collaboration was implemented for the patient.This included psychological support,rehabilitation planning,preoperative exercise regimens,comprehensive nutritional interventions,standardized pain management,and close monitoring of the patient’s blood drug concentrations during the operation.Intraoperatively,prevention and observation of potential complications were prioritized.As a result of the MDT interventions,the patient did not experience any related complications or adverse events during the perioperative period and was successfully discharged after recovery.Follow-up examinations conducted one month,six months,and one year post-discharge revealed no tumor recurrence,with all outcomes being favorable.展开更多
Objective:To explore the clinical effects of PERMA combined with Otago exercise train-ing in reducing the risk of falls in stroke patients.Methods:A total of 56 stroke patients were randomly divided into a control gro...Objective:To explore the clinical effects of PERMA combined with Otago exercise train-ing in reducing the risk of falls in stroke patients.Methods:A total of 56 stroke patients were randomly divided into a control group(28 cases,receiving routine health education and rehabilitation training)and an observation group(28 cases,receiving PERMA com-bined with Otago exercise training).Fall efficacy scores,fall incidence,BI index,IWB score,neurological function rating,and treatment compliance were observed and com-pared between the two groups.Results:Before intervention,there was no significant difference in fall efficacy scores between the two groups(P>0.05).After intervention,the fall efficacy scores in the observation group were significantly higher than those in the control group before discharge,and at 1,2,and 3 months after discharge(P<0.05).Three months after discharge,the fall incidence was 7.14%(2 cases)in the control group and 0%(0 cases)in the observation group,with no statistically significant difference(P>0.05).The BI index and IWB score were significantly higher in the observation group than in the control group after intervention(P<0.05).Regarding neurological function,three months after discharge,the number of patients with grade 0 and grade 1 neurological func-tion ratings was higher in the observation group,while the number of patients with grade 2 ratings was lower compared to the control group(P<0.05).Treatment compliance scores in the observation group were significantly higher than those in the control group at 2 and 3 months after discharge(P<0.05).Conclusion:The application of PERMA com-bined with Otago exercise training is clinically effective in stroke patients.It significantly reduces the risk of falls,improves neurological function,enhances daily living abilities and subjective well-being,and increases intervention satisfaction,making it a suitable clinical intervention.展开更多
文摘Myocardial pathologies are major causes of morbidity and mortality worldwide. Early detection of loss of cellular integrity and expansion in extracellular volume(ECV) in myocardium is critical to initiate effective treatment. The three compartments in healthy myocardium are: intravascular(approximately 10% of tissue volume), interstitium(approximately 15%) and intracellular(approximately 75%). Myocardial cells, fibroblasts and vascular endothelial/smooth muscle cells represent intracellular compartment and the main proteins in the interstitium are types Ⅰ/Ⅲ collagens. Microscopic studies have shown that expansion of ECV is an important feature of diffuse physiologic fibrosis(e.g., aging and obesity) and pathologic fibrosis [heart failure, aortic valve disease, hypertrophic cardiomyopathy, myocarditis, dilated cardiomyopathy, amyloidosis, congenital heart disease, aortic stenosis, restrictive cardiomyopathy(hypereosinophilic and idiopathic types), arrythmogenic right ventricular dysplasia and hypertension]. This review addresses recent advances in measuring of ECV in ischemic and non-ischemic myocardial pathologies. Magnetic resonance imaging(MRI) has the ability to characterize tissue proton relaxation times(T1, T2, and T2*). Proton relaxation times reflect the physical and chemical environments of water protons in myocardium. Delayed contrast enhanced-MRI(DE-MRI) and multi-detector computed tomography(DE-MDCT) demonstrated hyper-enhanced infarct, hypo-enhanced microvascular obstruction zone and moderately enhanced peri-infarct zone, but are limited for visualizing diffuse fibrosis and patchy microinfarct despite the increase in ECV. ECV can be measured on equilibrium contrast enhanced MRI/MDCT and MRI longitudinal relaxation time mapping. Equilibrium contrast enhanced MRI/MDCT and MRI T1 mapping is currently used, but at a lower scale, as an alternative to invasive sub-endomyocardial biopsies to eliminate the need for anesthesia, coronary catheterization and possibility of tissue sampling error. Similar to delayed contrast enhancement, equilibrium contrast enhanced MRI/MDCT and T1 mapping is completely noninvasive and may play a specialized role in diagnosis of subclinical and other myocardial pathologies. DE-MRI and when T1-mapping demonstrated sub-epicardium, sub-endocardial and patchy mid-myocardial enhancement in myocarditis, Behcet's disease and sarcoidosis, respectively. Furthermore, recent studies showed that the combined technique of cine, T2-weighted and DE-MRI technique has high diagnostic accuracy for detecting myocarditis. When the tomographic techniques are coupled with myocardial perfusion and left ventricular function they can provide valuable information on the progression of myocardial pathologies and effectiveness of new therapies.
文摘Cardiogenic shock is the leading cause of death among patients hospitalized with acute myocardial infarction （MI）. Understanding the mechanisms for acute pump failure is therefore important. The aim of this study is to examine in an acute MI dog model whether mitochondrial bio-energetic function within non-ischemic wall regions are associated with pump failure. Anterior MI was produced in dogs via ligation of left anterior descending （LAD） coronary artery, that resulted in an infract size of about 30% of the left ventricular wall. Measurements ofhemodynamic status, mitochondrial function, free radical production and mitochondrial uncoupling protein 3 （UCP3） expression were determined over 24 h period. Hemodynamic measurements revealed a 〉 50% reduction in cardiac output at 24 h post infarction when compared to baseline. Biopsy samples were obtained from the posterior non-ischemic wall during acute infarction. ADP/O ratios for isolated mitochondria from non-ischemic myocardium at 6 h and 24 h were decreased when compared to the ADP/O ratios within the same samples with and without palmitic acid （PA）. GTP inhibition of （PA）-stimulated state 4 respiration in isolated mitochondria from the non-ischemic wall increased by 7% and 33% at 6 h and 24 h post-infarction respectively when compared to sham and pre-infarction samples. This would suggest that the mitochondria are uncoupled and this is supported by an associated increase in UCP3 expression observed on western blots from these same biopsy samples. Blood samples from the coronary sinus measured by electron paramagnetic resonance （EPR） methods showed an increase in reactive oxygen species （ROS） over baseline at 6 h and 24 h post-infarction. In conclusion, mitochondrial bio-energetic ADP/O ratios as a result of acute infarction are abnormal within the non-ischemic wall. Mitochondria appear to be energetically uncoupled and this is associated with declining pump function. Free radical production may be associated with the induction of uncoupling proteins in the mitochondria.
文摘Objectives: To study the effect of sulfotanshinone sodium (SS) injection in the treatment of non-ischemic retinal vein occlusion (RVO). Methods: Sixty-two RVO patients treated in our hospital between Jan. 2013 and Oct. 2014 were randomly divided into Control Group (30 patients;Bendazol tablets) and Treatment Group (32 patients, Bendazol tablets + SS injections), each with a follow-up period of 6 months. Statistical analysis was then performed on changes in visual acuity, central retinal thickness (CRT) and retinal circulation time (RCT) before and after the treatment. Results: After treatment, both Control Group and Treatment Group witnessed an improvement on visual acuity (Control Group: t = 2.103, p = 0.044;Treatment Group: t = 8.021, p = 0.000). Visual acuity could be greatly improved in Treatment Group when compared with Control Group, with significant differences (p < 0.01). Macular edema could be greatly relieved in Treatment Group measured by CRT (t = 2.571, p = 0.007) while the difference was of no statistical significance in Control Group (t = 1.016, p = 0.070). RCT were remarkably shortened in both groups (Control Group: t = 43.83, p = 0.000;Treatment Group: t = 27.34, p = 0.000), and when compared with Control group, the changes in Treatment Group were more significant (p < 0.05). Conclusion: SS injection could effectively improve the therapeutic effect in patients with non-ischemic retinal vein occlusion.
基金Supported by the Health and Family Planning Research Project of Pudong New Area Health Committee,Shanghai,China(No.PW2020E-4)。
文摘Objective To investigate the clinical effects of thread-dragging therapy on gangrene of non-ischemic diabetic foot ulcers(NIDFU).Methods A total of 136 patients with NIDFU were recruited from the Department of Peripheral Vascular Surgery,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine between June 21,2021 and February 1,2023,and randomized into an intervention group and a control group,with 68 cases in each group.Both groups received basic treatment.The intervention group was treated with thread-dragging therapy,while the control group was treated with debridement combined with routine dressing changes after surgery.Both groups were treated continuously for 2 months.The amputation rates and changes in the ulcer area were compared between the groups.The inflammatory response index including peripheral white blood cells(WBCs),neutrophil percentage(NEUT%),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),procalcitonin(PCT),and interleukin 6(IL-6)were compared between the two groups.Results After treatment,the ulcer areas in the intervention group were significantly smaller than that of the control group(8.50±3.88 cm^(2) vs.10.11±4.61 cm^(2),P<0.05).The amputation rates of the two groups were not statistically significant(4.4%vs.5.9%,P>0.05).Differences of WBCs count,CRP,and ESR before and after therapy in the intervention group were better than the control group(P<0.05).However,there were no significant differences in changes of NEUT%,PCT,and IL-6 between the two groups(P>0.05).Conclusion Thread-dragging therapy may be effective in the treatment of NIDFU,with the additional advantages of less tissue damage after healing.(Registration No.ChiCTR2100047496)
基金supported by an unrestricted Grant to the Department of Ophthalmology from Research to Prevent Blindness,New York,NY and the Keck School of Medicine Dean’s Research Scholar Award.
文摘Dermal fillers have been commonly used for the filling of facial rhytids.As the use of dermal fillers has grown,so has the incidence of non-ischemic complications.These complications range from edema,bruising,and erythema to more complex conditions such as delayed hypersensitivity nodules and biofilms.This article sought to review the causes of various non-ischemic complications,discuss their risk factors,and review management techniques.Certain predisposing factors to delayed hypersensitivity nodules,such as Vycross technology,a history of viral illness,or coronavirus disease 19(COVID-19)infections,are discussed in detail in this review.Prevention techniques such as patient counseling,elucidating certain patient history(viral illness,dental procedures),the use of aseptic technique,and procedural factors are also discussed.Understanding appropriate management for these complications can also help in treatment.Imaging,such as ultrasound,computed tomography(CT)and magnetic resonance imaging(MRI),has taken on a larger role in the management of non-ischemic complications.
文摘·AIM:To describe a case in which vitrectomy was required for vitreous hemorrhage and fibrovascular proliferation after laser-induced chorioretinal venous anastomosis (LCVA) for non-ischemic central retinal vein occlusion (CRVO).·METHODS:Observational case report.·RESULTS:A 72-year-old man complained of central scotoma in the left eye,and was diagnosed as suffering from non-ischemic CRVO.LCVA was performed in another hospital.Although favorable visual function was briefly maintained postoperatively,severe vitreous hemorrhage developed in his left eye,necessitating vitrectomy.·CONCLUSION:Considering that LCVA carries a risk of serious complications,we must apply this treatment with caution,especially in ethnic groups,such as the Japanese,in whom pigmentation reacts to photocoagulation excessively.·
基金supported by grants from the National Institutes of Health (NIHR01 HL091478) for W.Keith Jonesthe National Natural Science Foundation of China (81470425) for Xiaoping Ren
文摘Acute myocardial infarction （AMI） is the leading cause of death and disability worldwide. Timely reperfusion is the standard of care and results in decreased infarct size, improving patient survival and prognosis. However, 25% of patients proceed to develop heart failure （HF） after myocardial infarction （MI） and 50% of these will die within five years. Since the size of the infarct is the major predictor of the outcome, including the development of HF, therapies to improve myocardial salvage have great potential. Over the past three decades, a number of stimuli have been discovered that activate endogenous cardioprotective pathways. In ischemic preconditioning （IPC） and ischemic postconditioning, ischemia within the heart initiates the protection. Brief reversible episodes of ischemia in vascular beds remote from the heart can also trigger cardioprotection when applied before, during, or immediately after myocardial ischemia-- known as remote ischemic pre-, per-, and post-conditioning, respectively. Although the mechanism of remote ischemic preconditioning （RIPC） has not yet been fully elucidated, many mechanistic components are shared with IPC. The discovery of RIPC led to research into the use of remote non-ischemic stimuli including nerve stimulation （spinal and vagal）, and electroacupuncture （EA）. We discovered and, with others, have elucidated mechanistic aspects of a non- ischemic phenomenon we termed remote preconditioning of trauma （RPCT）. RPCT operates via neural stimulation of skin sensory nerves and has similarities and differences to nerve stimulation and EA conducted at acupoints. We show herein that RPCT can be mimicked using electrical stimulation of the abdominal midline （EA-like treatment） and that this modality of activating cardioprotection is powerful as both a preconditioning and a postconditioning stimulus （when applied at reperfusion）. Investigations of these cardioprotective phenomena have led to a more integrative understanding of mechanisms related to cardioprotection, and in the last five to ten years, it has become clear that the mechanisms are similar, whether induced by ischemic or non-ischemic stimuli. Taking together much of the data in the literature, we propose that all of these cardioprotective ＂conditioning＂ phenomena represent activation from different entry points of a cardiac conditioning network that converges upon specific mediators and effectors of myocardial cell survival, including NF-KB, Stat3/5, protein kinase C, bradykinin, and the mitoKA^P channel. Nervous system pathways may represent a novel mechanism for initiating conditioning of the heart and other organs. IPC and RIPC have proven difficult to translate clinically, as they have associated risks and cannot be used in some patients. Because of this, the use of neural and nociceptive stimuli is emerging as a potential non-ischemic and non-traumatic means to initiate cardiac conditioning. Clinical relevance is underscored by the demonstration of postconditioning with one of these modalities, supporting the conclusion that the development of pharmaceuticals and electroceuticals for this purpose is an area ripe for clinical development.
文摘To summarize the nursing experience of a three-stage liver resection combined with ALPPS(associating liver partition and portal vein ligation for staged hepatectomy)and intraoperative isolated perfusion chemotherapy for a patient at a tertiary hospital in Shenzhen,China,in order to provide insights for the treatment of such cases in the future.This operation was conducted for the first time globally,presenting significant challenges and no prior nursing experience to reference.Through evidence-based thinking and literature review,preoperative multidisciplinary team(MDT)collaboration was implemented for the patient.This included psychological support,rehabilitation planning,preoperative exercise regimens,comprehensive nutritional interventions,standardized pain management,and close monitoring of the patient’s blood drug concentrations during the operation.Intraoperatively,prevention and observation of potential complications were prioritized.As a result of the MDT interventions,the patient did not experience any related complications or adverse events during the perioperative period and was successfully discharged after recovery.Follow-up examinations conducted one month,six months,and one year post-discharge revealed no tumor recurrence,with all outcomes being favorable.
文摘Objective:To explore the clinical effects of PERMA combined with Otago exercise train-ing in reducing the risk of falls in stroke patients.Methods:A total of 56 stroke patients were randomly divided into a control group(28 cases,receiving routine health education and rehabilitation training)and an observation group(28 cases,receiving PERMA com-bined with Otago exercise training).Fall efficacy scores,fall incidence,BI index,IWB score,neurological function rating,and treatment compliance were observed and com-pared between the two groups.Results:Before intervention,there was no significant difference in fall efficacy scores between the two groups(P>0.05).After intervention,the fall efficacy scores in the observation group were significantly higher than those in the control group before discharge,and at 1,2,and 3 months after discharge(P<0.05).Three months after discharge,the fall incidence was 7.14%(2 cases)in the control group and 0%(0 cases)in the observation group,with no statistically significant difference(P>0.05).The BI index and IWB score were significantly higher in the observation group than in the control group after intervention(P<0.05).Regarding neurological function,three months after discharge,the number of patients with grade 0 and grade 1 neurological func-tion ratings was higher in the observation group,while the number of patients with grade 2 ratings was lower compared to the control group(P<0.05).Treatment compliance scores in the observation group were significantly higher than those in the control group at 2 and 3 months after discharge(P<0.05).Conclusion:The application of PERMA com-bined with Otago exercise training is clinically effective in stroke patients.It significantly reduces the risk of falls,improves neurological function,enhances daily living abilities and subjective well-being,and increases intervention satisfaction,making it a suitable clinical intervention.
