CXCR4+ and SDF-1+ Bone Marrow Cells Are Mobilized into the Blood Stream in Acute Myocardial Infarction and Acute Ischemia

Cell therapy has shown beneficial effects on ventricular function and tissue regeneration in patients with acute and chronic myocardial infarction, although with diverse grades of variability in the results, possibly by proportion, subtype and cell cycle status. Objective: Identify and phenotypically characterize, via CXCR4 and SDF-1 expression, the bone marrow cell subpopulations that are mobilized into the bloodstream in patients with Acute Myocardial Infarction (AMI) and Acute Ischemia (AI) such as acute angina and Chronic Ischemia (CI) such as chronic stable angina, and also determine the cell cycle status of these cells. Method: Patients with AMI and AI were recruited in the ICCU, and patients with CI in the departments of cardiology and cardiovascular surgery. The quantification of cellular subpopulations was made by cytofluorometry with a FACS caliburcyto fluorometry (Becton Dickinson) with specific FITC-labeled anti human monoclonal antibodies against CD34, CD133, CD117, CD48, CXCR4, SDF-1 and Ki67 (Becton Dickinson). Serum concentration of IL-6 and IL-8 were determined by a sequential solid phase chemiluminescent assay performed in a SIEMENS IMMULITE 1000 Analyzer. Statistical analysis was made with the SPSS version 20.0 for Windows. A p value 3/ml) than that in AI (9.2 ± 1.3 × 103/ml) and CI (6.6 ± 1.1 × 103/ml) patients (p p = 0.22 to 0.39), but interestingly in AMI and AI patients, cells were CXCR4+ in almost half of these mobilized cells, although the proportion was significantly higher in AMI patients (46.8% ± 7.1% to 55.7% ± 6.3% vs 23% ± 1.6% to 28.4% ± 2.1%, p = 0.03 to 0.05). A similar behavior was observed with the Ki67 antibody (29.9% ± 2.1% to 36.1% ± 6.3% vs 10% ± 1.2% to 24% ± 1.1%, p = 0.001 to 0.05). Bivariate analysis of the results showed a significant correlation of the cell proportion in AMI but not in AI and CI patients (p = 0.001 to 0.05;0.12 to 0.87 and 0.17 to 0.92 respectively). The amount of myocardial tissue infarcted did not show any correlation with the amount of cellular subpopulations mobilized to peripheral blood (r = 0.10 to 0.20;p = 0.21 to 0.64) from the bone marrow. Conclusion: The proportion of cellular subpopulations with regenerative potential mobilized to circulation during an event of Acute Myocardial Infarction is significantly higher than during an event of acute angina and chronic stable angina, with a significant proportion of mobilized cells that expressed CXCR4, most of which were already in some of the cell cycle phases.

Acute mesenteric ischemia after cardio-pulmonary bypass surgery

Acute mesenteric ischemia (AMI) is a highly-lethal surgical emergency. Several pathophysiologic events (arterial obstruction, venous thrombosis and diffuse vasospasm) lead to a sudden decrease in mesenteric blood flow. Ischemia/reperfusion syndrome of the intestine is responsible for systemic abnormalities, leading to multi-organ failure and death. Early diagnosis is difficult because the clinical presentation is subtle, and the biological and radiological diagnostic tools lack sensitivity and specificity. Therapeutic options vary from conservative resuscitation, medical treatment, endovascular techniques and surgical resection and revascularization. A high index of suspicion is required for diagnosis, and prompt treatment is the only hope of reducing the mortality rate. Studies are in progress to provide more accurate diagnostic tools for early diagnosis. AMI can complicate the post-operative course of patients following cardio-pulmonary bypass (CPB). Several factors contribute to the systemic hypo-perfusion state, which is the most frequent pathophysiologic event. In this particular setting, the clinical presentation of AMI can be misleading, while the laboratory and radiological diagnostic tests often produce inconclusive results. The management strategies are controversial, but early treatment is critical for saving lives. Based on the experience of our team, we consider prompt exploratory laparotomy, irrespective of the results of the diagnostic tests, isthe only way to provide objective assessment and adequate treatment, leading to dramatic reduction in the mortality rate.

Planned second-look laparoscopy in the management of acute mesenteric ischemia

AIM： To investigate the role of second-look laparoscopy in patients with acute mesenteric ischemia （AMI）. METHODS： Between January 2000 and November 2005, 71 patients were operated for the treatment of AMI. The indications for a second-look were low flow state, bowel resection and anastomosis or mesenteric thromboembolectomy performed during the first operation. Regardless of the clinical course of patients, the second-look laparoscopic examination was performed 72 h post-operatively at the bed side in the ICU or operating room. RESULTS： The average time of admission to the hospital after the initation of syrnptoms was 3 d （range, 5 h-9 d）. In 14 patients, laparotomy was performed. In 11 patients, small and/or large bowel necrosis was detected and initial resection and anastomosis were conducted. A low flow state was observed in two patients and superior mesenteric artery thromboembolectomy with small bowel resection was performed in one patient. In 13 patients, a second-look laparoscopic examination revealed normal bowel viability, but in one patient, intestinal necrosis was detected. In two of the patients, a third operation was necessary to correct anastomotic leakage. The overall complication rate was 42.8%, and in-hospital mortality rate was 57.1% （n = 6）. CONCLUSION： Second-look laparoscopy is a minimally invasive, technically simple procedure that is performed for diagnostic as well as therapeutic purposes. The simplicity and ease of this method may encourage wider application to benefit more patients. However, the timing of a second-look procedure is unclear particularly in a patient with anastomosis.

Multidisciplinary management of acute mesenteric ischemia:Surgery and endovascular intervention

Acute mesenteric ischemia(AMI)is a rare cause of the“acute abdomen”,characterized by impaired blood flow to the intestine.The principle of treatment is restoration of perfusion to ischemic bowel and resection of any necrotic intestine.Surgery and endovascular intervention are two complementary approaches to mesenteric ischemia.Endovascular intervention is not an alternative to the surgical approach,but it has the potential to improve the prognosis of patients with AMI when judiciously combined with a surgical approach.Due to the need for emergent treatment of patients with acute mesenteric ischemia,the treatment strategy needs to be modified for each facility.This review aims to highlight cutting-edge studies and provide reasonable treatment strategies for patients with acute mesenteric ischemia based on available evidence.

Multimodal imaging in acute retinal ischemia: spectral domain OCT, OCT-angiography and fundus autofluorescence

AIM： To describe retinal findings of various imaging modalities in acute retinal ischemia. METHODS： Fluorescein angiography（FA）, spectral domain optical coherence tomography（SD-OCT）, OCTangiography（OCT-A） and fundus autofluorescence（FAF） images of 13 patients（mean age 64y, range 28-86y） with acute retinal ischemia were evaluated. Six suffered from branch arterial occlusion, 2 had a central retinal artery occlusion, 2 had a combined arteriovenous occlusions, 1 patient had a retrobulbar arterial compression by an orbital haemangioma and 2 patients showed an ocular ischemic syndrome.RESULTS： All patients showed increased reflectivity and thickening of the ischemic retinal tissue. In 10 out of 13 patients SD-OCT revealed an additional highly reflective band located within or above the outer plexiform layer. Morphological characteristics were a decreasing intensity with distance from the fovea, partially segmental occurrence and manifestation limited in time. OCT-A showed a loss of flow signal in the superficial and deep capillary plexus at the affected areas. Reduced flow signal was detected underneath the regions with retinal edema. FAF showed areas of altered signal intensity at the posterior pole. The regions of decreased FAF signal corresponded to peri-venous regions. CONCLUSION： Multimodal imaging modalities in retinal ischemia yield characteristic findings and valuable diagnostic information. Conventional OCT identifies hyperreflectivity and thickening and a mid-retinal hyperreflective band is frequently observed. OCT-A examination reveals demarcation of the ischemic retinal area on the vascular level. FAF shows decreased fluorescence signal in areas of retinal edema often corresponding to peri-venous regions.

Experimental Study of the Effect of Autonomic Nervous System on the Transmural Dispersion of Ventricular Repolarization under Acute Myocardial Ischemia in Vivo

The effect of the autonomic nerves on the transmural dispersion of ventricular repolarization(TDR)under acute myocardial ischemia in intact canine was investigated.Using the monophasic action potential(MAP)recording technique,MAPs of the epicardium(Epi),midmyocardium(Mid)and endocardium(Endo)were recorded simultaneously by specially designed plunge-needle electrodes at the left ventricular free wall under acute myocardial ischemia in 12 open-chest dogs.MAPD 90 and TDR among three myocardial layers as well as the incidence of the early afterdepolarization(EAD)before autonomic nervous stimulation and during autonomic nervous stimulation were compared.It was found that 10 min after acute myocardial ischemia,TDR was increased from 55±8 ms to 86±15 ms during sympathetic stimulation(P<0.01).The TDR(53±9 ms)during parasympathetic stimulation was not significantly different from that of the control(55±8 ms)(P>0.05).The EAD was elicited in the Mid of 2 dogs(16%)10 min after acute myocardial ischemia,but the EAD were elicited in the Mid of 7 dogs(58%)during sympathetic stimulation(P<0.01).It was concluded that:(1)Sympathetic stimulation can increase the transmural dispersion of repolari-zation and induce early afterdepolarizations in the Mid under acute myocardial ischemia,which provide the opportunity for the ventricular arrhythmia developing;(2)Parasympathetic stimulation has no significant effect on the transmural dispersion of repolarization under myocardial ischemia.

Changes in plasma calcitonin gene-related peptide and serum neuron specific enolase in rats with acute cerebral ischemia after low-frequency electrical stimulation with different waveforms and intensities

Following acute cerebral ischemia in rats, plasma calcitonin gene-related peptide decreased and the level of serum neuron specific enolase and the volume of the infarction increased. Square-wave and triangular-wave electrical stimulation with low or high intensities could increase the plasma calcitonin gene-related peptide, decrease the serum neuron specific enolase and reduce the infarction volume in the brain in rats with cerebral ischemia. There was no significant difference between different wave forms and intensities. The experimental findings indicate that low-frequency electrical stimulation with varying waveforms and intensities can treat acute cerebral ischemia in rats.

An Experimental Proton Magnetic Resonance Spectroscopy Analysis on Early Stage of Acute Focal Cerebral Ischemia

U sing different m odels of focal cerebral ischemia,the temporal and spatial rules of m etabolism and energy changes in the post- ischem ia brain tissue were measured by proton m agnet- ic resonance spectroscopy(1 HMRS) to provide valuable inform ation for judging the prognosis of a- cute focal cerebral ischemia and carrying out effective therapy.Nine healthy Sprague- Dawly rats (both sexes) were randomly divided into two groups:The rats in the group A(n=4 ) were occlud- ed with self- thrombus for1h;The rats in the group B(n=5 ) were occluded with thread- em boli for1h.The 1 H MRS at30 ,4 0 ,5 0 ,6 0 min respectively was examined and the m etabolic changes of NAA,Cho and L ac in the regions of interest were sem iquantitatively analyzed. The spectrum intregral calculus area ratio of NAA,Cho,L ac to Pcr+Cr was setas the criterion.The values of NAA· Cho in the regions of interest were declined gradually within 1h after ischem ia, especially,the ratio of Cho/ (Pcr+Cr) ,NAA/ (Pcr+Cr) at6 0 m in had significant difference with that at5 0 min(P<0 .0 5 ) .The ratio of L ac/ (Pcr+Cr) began to decrease at4 0 min from initial in- crease of L ac in both A and B groups.MR proton spectrum analysis was a non- invasive,directand com prehensive tool for the study of cellular metabolism and the status of the biochemical energy in acute ischem ia stroke.

Infective endocarditis as a rare cause for acute limb ischemia

Infective endocarditis （IE） occurs at a rate of approximately 1-7/100 000 people per year, and has a high morbidity and mortality despite advances in antibiotic and surgical treatments.

Acute mesenteric ischemia secondary to oral contraceptive-induced portomesenteric and splenic vein thrombosis:A case report

BACKGROUND Mesenteric ischemia represents an uncommon complication of splanchnic vein thrombosis,and it is less infrequently seen in young women using oral contraceptives.Diagnosis is often delayed in the emergency room;thus,surgical intervention may be inevitable and the absence of thrombus regression or collateral circulation may lead to further postoperative ischemia and a fatal outcome.CASE SUMMARY We report a 28-year-old female patient on oral contraceptives who presented with acute abdominal pain.Her physical examination findings were not consistent with her symptoms of severe pain and abdominal distention.These findings and her abnormal blood tests raised suspicion of acute mesenteric ischemia(AMI)induced by splanchnic vein thrombosis.Contrast-enhanced abdominal computed tomography revealed ischemia of the small intestine with portomesenteric and splenic vein thrombosis(PMSVT).We treated the case promptly by anticoagulation after diagnosis.We then performed delayed segmental bowel resection after thrombus regression and established collateral circulation guided by collaboration with a multidisciplinary team.The patient had an uneventful postoperative course and was discharged 14 d after surgery and took rivaroxaban orally for 6 mo.In subsequent follow-up to date,the patient has not complained of any other discomfort.CONCLUSION AMI induced by PMSVT should be considered in young women who are taking oral contraceptives and have acute abdominal pain.Prompt anticoagulation followed by surgery is an effective treatment strategy.

Acute mesenteric ischemia due to percutaneous coronary intervention:A case report

BACKGROUND Percutaneous coronary intervention(PCI) is extensively used to treat acute coronary syndromes(ACS).Acute mesenteric ischemia is a life-threatening disease if untreated.CASE SUMMARY An 81-year-old female presented with 3 d of lethargy and 1 d of dyspnea.On November 16,2021,the patient developed a coma.Her oxygen saturation dropped to 70%-80%,the patient was admitted to the intensive care unit for further treatment.Chest computed tomography(CT) showed chronic bronchitis,emphysema,and multiple lung infections.Abdominal CT scan showed no obvious abnormalities,but have severely calcified abdominal vessels.The patient received assisted ventilation,and vasoactive,and anti-infection drugs.Troponin level was elevated.Since the patient was in a coma,it could not be determined whether she had chest pain.The cardiologist assumed that the patient had developed ACS;therefore,the patient underwent PCI via the left femoral artery approach,and no obvious abnormalities were found in the left and right coronary arteries.On the second postoperative day,the patient presented with abdominal distension and decreased bowel sounds;constipation was considered and a glycerin enema was administered.On day 4,the patient suddenly lost consciousness,and had decreased blood pressure,abdominal wall swelling with increased tension,and absence of bowel sounds.An urgent abdominal CT scan revealed gas in her hepatic portal system with extensive bowel wall necrosis.The patient died on day 5 due to intractable shock.CONCLUSION The potential serious complications in patients undergoing PCI,especially the patients who are hemodynamically unstable and have severely calcified abdominal vessels,should all be considered.

Effect of electroacupuncture "Shenmen" on the expression of cAMP and cGMP in the myocardium, hippocampus and serum of rats with acute myocardial ischemia

Objective:Discussion on the protectiion of electroacupuncture"Shenmen"on heart and brain injury induced by acute myocardial ischemia in rats from the perspective of the expression of cyclic adenosine monophosphate(cAMP)and cyclic guanosine monophosphate(cGMP).Methods:Thirty male SD rats were randomly divided into normal group,model group,and electroacupuncture group.The electrocardiogram was recorded by the Powerlab 8-lead physiological recording system.The left anterior descending coronary artery was ligated to replicate the rat myocardial ischemia model.The acupuncture group was treated with electroacupuncture on the second day after the model was replicated.After the last electroacupuncture treatment,rat myocardium,hippocampus tissue and abdominal aortic blood were collected,and enzyme-linked immunosorbent assay was used to detect the levels of cAMP and cGMP in myocardium,hippocampus tissue and serum content.Results:Compared with the normal group,the cAMP content in the myocardial tissue of the model group was significantly increased,and the cAMP content in the hippocampus tissue and serum was significantly reduced;compared with the model group,the cAMP content in the myocardial tissue of the electroacupuncture group was decreased,and the hippocampus tissue Compared with the normal group,the content of cGMP in the myocardial tissue and serum of the model group increased,and the content of cGMP in the hippocampus decreased.Compared with the model group,the content of cGMP in the hippocampus of the electroacupuncture group was increased.The cGMP content increased,the serum cGMP content was significantly reduced,and the difference in the cGMP content in myocardial tissue was not statistically significant.Conclusion:Electroacupuncture at"Shenmen"acupoint can significantly improve the expression of cAMP,cGMP and myocardial cAMP in the serum and hippocampus of model rats with acute myocardial ischemia-induced heart and brain injury,but has a lower effect on myocardial cGMP content.

Effects of cluster needling of scalp acupuncture on neurofilament protein 200 and signal transducer and activator of transcription 3 in rats with acute cerebral ischemia

Objective:Cluster needling at scalp acupoints has showed satisfying effects with acute cerebral ischemia in clinic whereas the mechanisms are not yet clear completely.This study investigated the influence of cluster needling at scalp acupoints on neurological function,as well as on neurofilament protein 200(NF200)and signal transducer and activator of transcription 3(STAT3)expression,in rats with acute cerebral ischemia.Methods:Fifty-four Sprague-Dawley rats were randomly assigned in equal numbers to the false operation(group F),model(group M),or cluster needling scalp acupuncture(group C)groups.Each group was divided into three subgroups,of six rats each,by acupuncture treatment time(24 h,7 days,and 14 days).The rat local cerebral ischemia model was prepared using a modified suture occlusion method.Group C rats were treated by cluster needling scalp acupuncture,while groups F and M did not receive acupuncture treatment.Neurological effects were evaluated using the Longa score.NF200 and STAT3 expression were measured by western blotting.Results:At 24 h,there were no statistical difference between group C and group M in nerve function(P>.05).On days 7 and 14,nerve function scores in group C were significantly lower than that in group M(respectively were P<.05 and P<.01).In addition,on days 14,expression of NF200 was significantly higher in group C compared with group M(P<.05).Compared with group M,STAT3 expression was also higher in group C on days 7 and 14,although these differences were not statistically significant(both P>.05).Conclusion:Cluster needling scalp acupuncture were efficient in improving nerve function scores in rats with cerebral ischemia,and promoting the recovery of motor function.These improvements were associated with increases in NF200 and STAT3 expression.

Effects of electroacupuncture of acupoints of the neiguan and ximen on ischemic myocardium energy metabolism with acute myocardial ischemia rats

Objective:To observe the effect of Electroacupuncture of Acupoints of the Neiguan(PC6)and Ximen(PC4)on its myocardial energy metabolism with acute myocardial ischemia rats caused by coronary artery ligation.Methods:Forty standard Spargue-Dawely(SD)rats were divided into four groups randomly,namely,group of Neiguan,group of Ximen,model group,sham group.The group of rats of myocardial ischemia were induced by coronary ligation,and the model rat of acute myocardial ischemia was prepared.The sham group had no ligation of the needle.After anesthesia was awakened,acupuncture was applied bilateral at Neiguan and Ximen of the group of Neiguan and Ximen,once a day at a fixed time for 14 days.The rats of model group and the sham group were not given acupunctured,but use the samely methods of Neiguan and Ximen groups to grap the rats at the same time everyday.After 14 days the experiment was over,observed the pathological changes of myocardial tissue by HE staining,detected the levels of free fatty acid(FFA),adenosine triphosphate(ATP)content,and the activities of Na^(+)-K^(+)-ATPase according to the reagents´demand.Results:Pathological results showed that acupuncuted at Neiguan and Ximen could improve the ischemic cardiomyocyte injury.Compared with the sham group,the levels of FFA in model group were increased(p<0.01),the levels of ATP,the activities of Na^(+)-K^(+)-ATPase were all decreased(p<0.01);Compared with the model group,the levels of FFA were decreased(p<0.05,p<0.01),the levels of ATP,the activities of Na^(+)-K^(+)-ATPase were improved.Conclusion:Acupuncturing at the Pericardium Meridian can alleviate the cell injury by myocardial ischemia,and also can improve the myocardial energetic metabolism in acute myocardial ischemia.

Effect of Xingnaojing injection on penumbra transformation in rats with acute cerebral ischemia

Objective:To observe the effect of Xingnaojing injection on penumbra transformation in rats with acute cerebral ischemia.Methods:The rat model of middle cerebral artery occlusion(Middle cerebral artery occlusion,MCAO)was established by suture occlusion.Except the sham operation group,the other groups were randomly divided into model group and Xingnaojing group.The rats in Xingnaojing group were intraperitoneally injected with Xingnaojing injectionaccording to 0.18ml/100g,and the sham operation group and model group were given the same amount of normal saline respectively.24 hours after the establishment of the model,the morphological changes of neurons in the penumbra of the rats were observed by Nissl staining,the ultrastructural changes of neurovascular unit(Neurovascular unit,NVU)were observed by transmission electron microscope(Transmission electron microscope,TEM),and the apoptosis of the ischemic penumbra was detected by in situ apoptosis(TdT-mediated Dutp Nick-End Labeling,TUNEL).Magnetic resonance imaging was used to observe the ischemic evolution of the penumbra of the same rat at 4.5 h and 24 h,respectively.Results:Compared with the sham operation group,the number of neurons in the model group was significantly reduced,the structure of Nissl corpuscles was destroyed,the outline was blurred or disappeared,the pathological morphology of NVU ultrastructure was obviously damaged under transmission electron microscope,a large number of apoptotic cells could be seen in the model group by TUNEL staining(P<0.01),and magnetic resonance imaging showed that there was a large area infarction in the brain tissue of the model group.Compared with the model group,the pathomorphology of neurons and NVU ultrastructure in Xingnaojing group was significantly improved,the number of apoptotic cells was significantly decreased(P<0.01),and the loss rate of penumbra was significantly lower in Xingnaojing group(P<0.05).Conclusion:Xingnaojing injection can improve the state of neurons in ischemic penumbra,reduce the injury of glial cells and microvessels,inhibit apoptosis,promote the transformation of penumbra in rats with acute cerebral ischemia,and save part of penumbra to some extent.it has a certain protective effect on the brain tissue of penumbra in the acute stage of cerebral ischemia.

Surgical management of peritonitis secondary to acute superior mesenteric artery occlusion

Diagnosis of acute arterial mesenteric ischemia in the early stages is now possible using modern computed tomography with intravenous contrast enhancement and imaging in the arterial and/or portal phase.Most patients have acute superior mesenteric artery(SMA)occlusion,and a large proportion of these patients will develop peritonitis prior to mesenteric revascularization,and explorative laparotomy will therefore be necessary to evaluate the extent and severity of intestinal ischemia,and to perform bowel resections.The establishment of a hybrid operating room in vascular units in hospitals is most important to be able to perform successful intestinal revascularization.This review outlines current frontline surgical strategies to improve survival and minimize bowel morbidity in patients with peritonitis secondary to acute SMA occlusion.Explorative laparotomy needs to be performed first.Curative treatment is based upon intestinal revascularization followed by bowel resection.If no vascular imaging has been carried out,SMA angiography is performed.In case of embolic occlusion of the SMA,open embolectomy is performed followed by angiography.In case of thrombotic occlusion,the occlusive lesion can be recanalized retrograde from an exposed SMA,the guidewire snared from either the femoral or brachial artery,and stented with standard devices from these access sites.Bowel resections and sometimes gall bladder removal due to transmural infarctions are performed at initial laparotomy,leaving definitive bowel reconstructions to a planned second look laparotomy,according to the principles of damage control surgery.Patients with peritonitis secondary to acute SMA occlusion should be managed by both the general and vascular surgeon,and a hybrid revascularization approach is of utmost importance to improve outcomes.

Nomogram for predicting transmural bowel infarction in patients with acute superior mesenteric venous thrombosis

BACKGROUND The prognosis of acute mesenteric ischemia(AMI)caused by superior mesenteric venous thrombosis(SMVT)remains undetermined and early detection of transmural bowel infarction(TBI)is crucial.The predisposition to develop TBI is of clinical concern,which can lead to fatal sepsis with hemodynamic instability and multi-organ failure.Early resection of necrotic bowel could improve the prognosis of AMI,however,accurate prediction of TBI remains a challenge for clinicians.When determining the eligibility for explorative laparotomy,the underlying risk factors for bowel infarction should be fully evaluated.AIM To develop and externally validate a nomogram for prediction of TBI in patients with acute SMVT.METHODS Consecutive data from 207 acute SMVT patients at the Wuhan Tongji Hospital and 89 patients at the Guangzhou Nanfang Hospital between July 2005 and December 2018 were included in this study.They were grouped as training and external validation cohort.The 207 cases(training cohort)from Tongji Hospital were divided into TBI and reversible intestinal ischemia groups based on the final therapeutic outcomes.Univariate and multivariate logistic regression analyses were conducted to identify independent risk factors for TBI using the training data,and a nomogram was subsequently developed.The performance of the nomogram was evaluated with respect to discrimination,calibration,and clinical usefulness in the training and external validation cohort.RESULTS Univariate and multivariate logistic regression analyses identified the following independent prognostic factors associated with TBI in the training cohort:The decreased bowel wall enhancement(OR=6.37,P<0.001),rebound tenderness(OR=7.14,P<0.001),serum lactate levels>2 mmol/L(OR=3.14,P=0.009)and previous history of deep venous thrombosis(OR=6.37,P<0.001).Incorporating these four factors,the nomogram achieved good calibration in the training set[area under the receiver operator characteristic curve(AUC)0.860;95%CI:0.771-0.925]and the external validation set(AUC 0.851;95%CI:0.796-0.897).The positive and negative predictive values(95%CIs)of the nomogram were calculated,resulting in positive predictive values of 54.55%(40.07%-68.29%)and 53.85%(43.66%-63.72%)and negative predictive values of 93.33%(82.14%-97.71%)and 92.24%(85.91%-95.86%)for the training and validation cohorts,respectively.Based on the nomogram,patients who had a Nomo-score of more than 90 were considered to have high risk for TBI.Decision curve analysis indicated that the nomogram was clinically useful.CONCLUSION The nomogram achieved an optimal prediction of TBI in patients with AMI.Using the model,the risk for an individual patient inclined to TBI can be assessed,thus providing a rational therapeutic choice.

Severe Klebsiella pneumoniae pneumonia complicated by acute intra-abdominal multiple arterial thrombosis and bacterial embolism:A case report

BACKGROUND Klebsiella pneumoniae(K.pneumoniae)is a clinically common Gram-negative bacillus that can cause community-and hospital-acquired infections and lead to pneumonia,liver abscesses,bloodstream infections,and other infectious diseases;however,severe pneumonia caused by hypervirulent K.pneumoniae(hv Kp)complicated by acute intra-abdominal multiple arterial thrombosis and bacterial embolism is rarely seen in the clinical setting and has not been reported in the literature.CASE SUMMARY A 51-year-old man was hospitalized with fever and dyspnea.Persistent mild pain in the middle and upper abdomen began at dawn on the 3rd day following admission and developed into persistent severe pain in the left upper abdomen 8h later.Based on chest computed tomography(CT),bronchoscopy,bronchoalveolar lavage fluid metagenomic next-generation sequencing,abdominal aortic CT angiography(CTA),and culture of the superior mesenteric artery embolus,adult community-acquired severe hv Kp pneumonia complicated by acute intraabdominal multiple arterial thrombosis and bacterial embolism was diagnosed.Notably,he recovered and was discharged from the hospital after receiving effective meropenem anti-infection,endovascular contact thrombolytic,and systemic anticoagulant therapies and undergoing percutaneous thrombus aspiration.Ten days later,the patient returned to the hospital for abdominal CTA examination,which indicated blocked initial common pathway of the celiac trunk and superior mesenteric artery,and local stenosis.Therefore,celiac trunk artery stenting was performed in Chongqing Hospital,and postoperative recovery was good.CONCLUSION We report a case of hv Kp severe pneumonia complicated by acute intra-abdominal multiple arterial thrombosis and bacterial embolism and suggest that clinicians should consider the possibility of a Gram-negative bacillus infection and conduct effective pathogen detection in a timely fashion when managing patients with severe community-acquired pneumonia before obtaining bacteriologic and drug sensitivity results.At the same time,when patients have severe pulmonary infection complicated by severe abdominal pain,an acute mesenteric artery embolism should be considered to avoid delays in treatment.

Protective effects of Radix Cynanchum bungei on ischemia-induced neuronal and cognitive impairment in mice

OBJECTIVE To investigate the effects of Radix Cynanchum bungei extract(RCBE) on cerebral ischemia-reperfusion(I/R) and acute cerebral ischemia induced impairment in mice.METHODS I/R model was induced by bilateral carotid artery occlusion(BCAO)-reperfusion method and Y-maze learning and memory performance was assessed after reperfusion. Na^+-K^+-ATPase,Ca^(2+)-ATPase and SOD activity,as well as MDA content in mouse brain tissue were measured. Numbers of mouth-opening breaths of the isolated mouse head were observed in acute cerebral ischemia mice.RESULTS Learning and memory ability in mice with RCBE were improved significantly compared with model group. The activity of SOD,Na^+-K^+-ATPase and Ca^(2+)-ATPase were increased,while MDA contents decreased after RCBE(0.5,1.0 and 2.0 g·kg^(-1)) and piracetam(0.5 g·kg^(-1)) treatment compared with the model group. RCBE at all concentrations significantly prolonged the number of mouth-opening breaths of the isolated mouse head. CONCLUSION RCBE preconditioning exerts a marked neuroprotective effect on the ischemia brain,which is related to improve the learning and memory via regulating energy metabolism and anti-oxidation.

Ischemic bowel disease in 2021

Ischemic bowel disease(ISBODI)includes colon ischemia,acute mesenteric ischemia(AMI)and chronic mesenteric ischemia(CMI).Epidemiologically,colon ischemia is the most common type followed by AMI and CMI.There are various risk factors for the development of ISBODI.Abdominal pain is the common presenting symptom of each type.High clinical suspicion is essential in ordering appropriate tests.Imaging studies and colonoscopy with biopsy are the main diagnostic tests.Treatment varies from conservative measures to surgical resection and revascularization.Involvement of multidisciplinary team is essential in managing ISBODI.Although open surgery with revascularization plays an important role,recently there is an increasing interest in percutaneous endovascular treatment.