-
Nature Aug 2022After cessation of blood flow or similar ischaemic exposures, deleterious molecular cascades commence in mammalian cells, eventually leading to their death. Yet with...
After cessation of blood flow or similar ischaemic exposures, deleterious molecular cascades commence in mammalian cells, eventually leading to their death. Yet with targeted interventions, these processes can be mitigated or reversed, even minutes or hours post mortem, as also reported in the isolated porcine brain using BrainEx technology. To date, translating single-organ interventions to intact, whole-body applications remains hampered by circulatory and multisystem physiological challenges. Here we describe OrganEx, an adaptation of the BrainEx extracorporeal pulsatile-perfusion system and cytoprotective perfusate for porcine whole-body settings. After 1 h of warm ischaemia, OrganEx application preserved tissue integrity, decreased cell death and restored selected molecular and cellular processes across multiple vital organs. Commensurately, single-nucleus transcriptomic analysis revealed organ- and cell-type-specific gene expression patterns that are reflective of specific molecular and cellular repair processes. Our analysis comprises a comprehensive resource of cell-type-specific changes during defined ischaemic intervals and perfusion interventions spanning multiple organs, and it reveals an underappreciated potential for cellular recovery after prolonged whole-body warm ischaemia in a large mammal.
Topics: Animals; Cell Death; Cell Survival; Cytoprotection; Gene Expression Profiling; Ischemia; Organ Specificity; Perfusion; Swine; Warm Ischemia
PubMed: 35922506
DOI: 10.1038/s41586-022-05016-1 -
British Journal of Hospital Medicine... May 2022Aneurysms are associated with significant complications if not diagnosed and managed appropriately. Popliteal arterial aneurysms are the most common peripheral aneurysm,...
Aneurysms are associated with significant complications if not diagnosed and managed appropriately. Popliteal arterial aneurysms are the most common peripheral aneurysm, and can cause pain, nerve compression, ischaemia and limb loss. Vascular surgery is an emerging specialty under the remit of general surgery, with the primary objectives of preventing death and limb loss. This article summarises the epidemiology, investigation and management of popliteal arterial aneurysms for vascular and non-vascular trainees.
Topics: Aneurysm; Humans; Ischemia; Popliteal Artery
PubMed: 35653317
DOI: 10.12968/hmed.2021.0572 -
Intensive Care Medicine Apr 2024
Topics: Humans; Mesenteric Ischemia; Acute Disease; Ischemia
PubMed: 38478026
DOI: 10.1007/s00134-024-07363-1 -
The British Journal of Surgery Aug 2023
Topics: Humans; Mesenteric Ischemia; Mesenteric Veins; Ischemia; Mesenteric Vascular Occlusion; Acute Disease
PubMed: 36748996
DOI: 10.1093/bjs/znad021 -
Oxidative Medicine and Cellular... 2015The development of the cardiopulmonary bypass (CPB) revolutionized cardiac surgery and contributed immensely to improved patients outcomes. CPB is associated with the... (Review)
Review
The development of the cardiopulmonary bypass (CPB) revolutionized cardiac surgery and contributed immensely to improved patients outcomes. CPB is associated with the activation of different coagulation, proinflammatory, survival cascades and altered redox state. Haemolysis, ischaemia, and perfusion injury and neutrophils activation during CPB play a pivotal role in oxidative stress and the associated activation of proinflammatory and proapoptotic signalling pathways which can affect the function and recovery of multiple organs such as the myocardium, lungs, and kidneys and influence clinical outcomes. The administration of agents with antioxidant properties during surgery either intravenously or in the cardioplegia solution may reduce ROS burst and oxidative stress during CPB. Alternatively, the use of modified circuits such as minibypass can modify both proinflammatory responses and oxidative stress.
Topics: Animals; Antioxidants; Cardiopulmonary Bypass; Humans; Inflammation; Ischemia; Neutrophil Activation; Oxidative Stress; Reactive Oxygen Species
PubMed: 25722792
DOI: 10.1155/2015/189863 -
EuroIntervention : Journal of EuroPCR... Sep 2021
Topics: Hemorrhage; Humans; Ischemia
PubMed: 34554092
DOI: 10.4244/EIJV17I7A93 -
Biochimica Et Biophysica Acta.... Mar 2020The classical cannabinoid receptors CB1 and CB2 as well as the cannabinoid-sensitive receptor GPR55 are widely distributed throughout the mammalian body. In the... (Review)
Review
The classical cannabinoid receptors CB1 and CB2 as well as the cannabinoid-sensitive receptor GPR55 are widely distributed throughout the mammalian body. In the cardiovascular field, CB1 and CB2 crucially impact on diseases characterized by inflammatory processes, such as atherosclerosis and acute myocardial infarction. Both receptors and their endogenous ligands anandamide and 2-arachidonoylglycerol are up-regulated in the ischaemic heart in humans and animal models. Pharmacological and genetic interventions with CB1 and CB2 vitally affect acute ischaemia-induced cardiac inflammation. Herein, CB1 rather aggravates the inflammatory response whereas CB2 mitigates inflammation via directly affecting immune cell attraction, macrophage polarization and lymphocyte clusters in the pericardial adipose tissue. Furthermore, cannabinoids and their receptors affect numerous cardiac risk factors. In this context, cannabis consumption is debated to trigger arrhythmias and even myocardial infarction. Moreover, CB1 activation is linked to impaired lipid and glucose metabolism and therefore obesity and diabetes, while its antagonism leads to the reduction of plasma triglycerides, low-density lipoprotein cholesterol, leptin, insulin and glucose. On the other hand, activation of cannabinoid-sensitive receptors can also counteract unfavourable predictors for cardiovascular diseases. In particular, hypertension can be mitigated via CB1 agonism and impaired adrenoceptor responsiveness prevented by functional GPR55. Taken together, current insights identify the cannabinoid system as promising target not only to therapeutically interfere with the vasculature, but also to affect the heart as target organ. This review discusses current knowledge regarding a direct cardiac role of the cannabinoid system and points out its feasible therapeutic manipulation in the ischaemic myocardium.
Topics: Adipose Tissue; Cannabinoids; Heart; Humans; Inflammation; Ischemia; Marijuana Smoking; Myocardial Infarction; Receptor, Cannabinoid, CB1; Receptor, Cannabinoid, CB2; Receptors, Cannabinoid
PubMed: 30890410
DOI: 10.1016/j.bbamcr.2019.03.009 -
International Journal of Clinical... Dec 2021Gastrointestinal complications of COVID-19 have been reported over the last year. One such manifestation is bowel ischaemia. This study thus aims to provide a more... (Review)
Review
BACKGROUND
Gastrointestinal complications of COVID-19 have been reported over the last year. One such manifestation is bowel ischaemia. This study thus aims to provide a more holistic review of our current understanding of COVID-19-induced bowel ischaemia.
METHOD AND RESULTS
A meticulous search was performed using different keywords in PubMed and Google Scholar. Fifty-two articles were included in our study after applying inclusion and exclusion criteria and performing the qualitative assessment of the studies. A total of 25 702 patients were included in our study after the completion of the qualitative assessment.
DISCUSSION
The common symptoms of GIT in COVID-19 patients are as diarrhoea, vomiting, nausea and abdominal pain. The mechanism of bowel ischaemia is associated with the formation of emboli which is related to COVID-19's high affinity for angiotensin-converting enzyme-2 on enterocytes, affecting the superior mesenteric vessels. Clinically, patients present with abdominal pain and vomiting. CT angiography of the abdomen and pelvis showed acute intestinal ischaemia (mesenteric). Management is usually initiated with gastric decompression, fluid resuscitation, and haemodynamic support. Surgical intervention is also sought.
CONCLUSION
Intestinal ischaemia presenting in patients with COVID-19 has to be considered when symptoms of severe abdominal pain are present. More research and guidelines are required to triage patients with COVID-19 to suspect intestinal ischaemia and to help in diagnosis and management.
Topics: COVID-19; Gastrointestinal Diseases; Humans; Ischemia; Mesenteric Ischemia; SARS-CoV-2
PubMed: 34605117
DOI: 10.1111/ijcp.14930 -
European Journal of Vascular and... Nov 2020
Topics: Amputation, Surgical; Cohort Studies; Humans; Ischemia; Peripheral Vascular Diseases; United Kingdom
PubMed: 32978051
DOI: 10.1016/j.ejvs.2020.08.029 -
Asian Journal of Andrology May 2013Tourniquets are commonly used in penile surgery to achieve a bloodless operating field or produce artificial erections intraoperatively. Several techniques have been... (Review)
Review
Tourniquets are commonly used in penile surgery to achieve a bloodless operating field or produce artificial erections intraoperatively. Several techniques have been described, but there is a paucity of data and a lack of guidelines to direct their safe use. In penile surgery, it is the local rather than systemic effects of tourniquet use that are the main concern. Tourniquet time should be kept to a minimum, as the limited data available suggests that reperfusion injury can occur even after short periods of ischaemia. High risk groups such as diabetics and arteriopaths are at particular risk. Further studies are needed to determine safe tourniquet times and pressures.
Topics: Humans; Ischemia; Male; Penis; Practice Guidelines as Topic; Reperfusion Injury; Time Factors; Tourniquets
PubMed: 23542140
DOI: 10.1038/aja.2012.164