Salvage of ischemic digits using a lateral arm fascial flap

Four patients underwent microvascular transfer of a lateral arm fascial flap to salvage severely ischemic digits by means of induction of neovascularization. The cause of the digital ischemia was direct trauma (crush injury) in one patient and chronic embolic phenomena (proximal arterial occlusion) in three patients. None of the patients had responded to traditional therapy, including treatment with one or more of the following: anticoagulation, lytic therapy, oral vasodilators, digital sympathectomy, and vein bypass grafting. Each patient underwent noninvasive (Doppler ultrasound, digital pressures, digital temperatures, vascular refill) and invasive (angiogram) vascular assessment preoperatively. After microvascular transfer of the lateral arm fascial flap, all patients reported symptomatic relief, and objective improvements were documented by both noninvasive and invasive assessment criteria. One patient developed a seroma at the donor site; another experienced a late complication of thrombosis of the flap after his wound dehisced. A 6-month follow-up evaluation demonstrated neovascular collateralization and stable improvement without regression in the remaining patients. The authors present their clinical experience and propose a treatment algorithm for patients with chronic digital ischemia.     

Myocardial ischemia--association with perioperative cardiac morbidity.

The development of ambulatory electrocardiographic recorders and analysers and the application of transesophageal echocardiography in the mid-1980''s enabled investigators to quantify and describe the occurrence of silent as well as symptomatic ischemia in the perioperative period. Several technical advances which have recently occurred in ECG monitoring include the use of miniaturized digital computing equipment to store and analyze data. In addition, real time ST-segment analysis has become widely available on multicomponent monitors in both the operating room and intensive care units. The incidence of perioperative myocardial ischemia depends on the patient population, the surgical procedure, and the monitoring technique used. Several studies in the early 1990''s have shown that cardiac morbidity in patients undergoing major, noncardiac surgery is best predicted by postoperative myocardial ischemia, rather than tradition preoperative clinical predictors. Long duration postoperative ischemia may be the factor most significantly associated with adverse cardiac outcome. Postoperative pain, physiological and emotional stress may all combine to cause tachycardia, hypertension, increase in cardiac output, and fluid shifts which, in high risk patients, might result in subendocardial ischemia and eventual myocardial infarction. If postoperative myocardial ischemia is the cause of late postoperative myocardial infarction in patients undergoing non-cardiac surgery, then treatment of postoperative myocardial ischemia should reduce morbidity. In addition, reducing pain and stress and avoiding postoperative hypoxemia might prevent postoperative myocardial ischemia and minimize the need for extensive preoperative cardiac evaluation.     

The effect of intravenous tissue-type plasminogen activator in a rat model of embolic cerebral ischemia

Thrombolytic agents may be useful in the treatment of cerebral ischemia caused by arterial thrombosis or embolic occlusion. A trial of intravenous human tissue-type plasminogen activator (rt-PA) was carried out in seven male Sprague-Dawley rats subjected to embolic cerebral ischemia, with eight control animals. One-hour-old autogenous blood clot was injected into the internal carotid artery. A 30-minute infusion of 10 micrograms/kg/minute of rt-PA or saline followed. Areas of ischemia at two hours post-embolization were assessed by digital image processing of serial iodo-14C-antipyrine autoradiographic images. The volumes of "no-flow" (NF) and "low-flow" (LF) regions were calculated. One animal in each group suffered no detectable ischemia; the remainder had well-defined regions of middle and posterior cerebral artery ischemia. No animal sustained a hemorrhagic lesion. Treatment produced no noticeable effect on the patency of cervical vessels. Total NF and LF volumes were less for the treated group but did not reach statistical significance by t-test. In middle cerebral distribution sections, however, LF volume was significantly less (p less than 0.05) for treated animals (150 vs. 191 mm3), primarily due to a more significant decrease in LF volume in the anterior-middle cerebral overlap zone (47 vs. 90 mm3; p less than 0.025). Fibrinogen levels were not altered by drug treatment (p greater than 0.30).     

Higuchi dimension of digital images

There exist several methods for calculating the fractal dimension of objects represented as 2D digital images. For example, Box counting, Minkowski dilation or Fourier analysis can be employed. However, there appear to be some limitations. It is not possible to calculate only the fractal dimension of an irregular region of interest in an image or to perform the calculations in a particular direction along a line on an arbitrary angle through the image. The calculations must be made for the whole image. In this paper, a new method to overcome these limitations is proposed. 2D images are appropriately prepared in order to apply 1D signal analyses, originally developed to investigate nonlinear time series. The Higuchi dimension of these 1D signals is calculated using Higuchi's algorithm, and it is shown that both regions of interests and directional dependencies can be evaluated independently of the whole picture. A thorough validation of the proposed technique and a comparison of the new method to the Fourier dimension, a common two dimensional method for digital images, are given. The main result is that Higuchi's algorithm allows a direction dependent as well as direction independent analysis. Actual values for the fractal dimensions are reliable and an effective treatment of regions of interests is possible. Moreover, the proposed method is not restricted to Higuchi's algorithm, as any 1D method of analysis, can be applied.     

Computer modeling of spatial-time distribution of metabolite concentrations in phantoms of biological objects by example of rat brain pial

A method for quantitative assessment of the metabolite concentrations in digital phantoms of the biological objects has been proposed. The objects under consideration are expected to have a complex geometry of diffusive sources. We present an algorithm for calculation of non-steady state gradients of the diffusing compounds under their constant border concentration. The algorithm is based on the analytical solutions for a centrally symmetric spherical source. Spatial-time distribution of metabolites is considered by the example of glucose diffusion around blood vessels in the rat brain pial. It was shown that glucose level in the tissue was increased after glycine treatment and under condition of other biological system parameters to be unchanged.     

Three successful digital replantations in a patient after 84, 86, and 94 hours of cold ischemia time

Three successful digital replantations were performed on a patient after 84, 86, and 94 hours of prolonged cold ischemia time. Both the intraoperative and postoperative courses were smooth. Functional evaluation 8 months after operation revealed a normal speed of sensory recovery and nail growth. The atrophic changes in all three replants are mild. Total active movement was 45, 100, and 70 degrees in the replanted left thumb, left index finger, and right thumb, respectively. There is no cold intolerance. The overall functional result is satisfactory. Replantation of an amputated digit that is properly cooled immediately after injury should be attempted in selected patients even after prolonged ischemia time.     

Morphological Characterization of Mycobacterium tuberculosis in a MODS Culture for an Automatic Diagnostics through Pattern Recognition

Tuberculosis control efforts are hampered by a mismatch in diagnostic technology: modern optimal diagnostic tests are least available in poor areas where they are needed most. Lack of adequate early diagnostics and MDR detection is a critical problem in control efforts.The Microscopic Observation Drug Susceptibility (MODS) assay uses visual recognition of cording patterns from Mycobacterium tuberculosis (MTB) to diagnose tuberculosis infection and drug susceptibility directly from a sputum sample in 7–10 days with a low cost.An important limitation that laboratories in the developing world face in MODS implementation is the presence of permanent technical staff with expertise in reading MODS.We developed a pattern recognition algorithm to automatically interpret MODS results from digital images. The algorithm using image processing, feature extraction and pattern recognition determined geometrical and illumination features used in an object-model and a photo-model to classify TB-positive images. 765 MODS digital photos were processed. The single-object model identified MTB (96.9% sensitivity and 96.3% specificity) and was able to discriminate non-tuberculous mycobacteria with a high specificity (97.1% M. avium, 99.1% M. chelonae, and 93.8% M. kansasii). The photo model identified TB-positive samples with 99.1% sensitivity and 99.7% specificity.This algorithm is a valuable tool that will enable automatic remote diagnosis using Internet or cellphone telephony. The use of this algorithm and its further implementation in a telediagnostics platform will contribute to both faster TB detection and MDR TB determination leading to an earlier initiation of appropriate treatment.     

Do not use epinephrine in digital blocks: myth or truth?

The purpose of this study was to examine the role for epinephrine augmentation of digital block anesthesia by safely prolonging its duration of action and providing a temporary hemostatic effect. After obtaining approval from the review board of the authors' institution, 60 digital block procedures were performed in a prospective randomized double-blinded study. The digital blocks were performed using the dorsal approach. All anesthetics were delivered to treat either posttraumatic injuries or elective conditions. Of the 60 digital block procedures, 31 were randomized to lidocaine with epinephrine and 29 to plain lidocaine. Of the procedures performed using lidocaine with epinephrine, one patient required an additional injection versus five of the patients who were given plain lidocaine (p = 0.098). The need for control of bleeding required digital tourniquet use in 20 of 29 block procedures with plain lidocaine and in 9 of 31 procedures using lidocaine with epinephrine (p < 0.002). Two patients experienced complications after plain lidocaine blocks, while no complications occurred after lidocaine with epinephrine blocks (p = 0.23). By prolonging lidocaine's duration of action, epinephrine may prevent the need for an additional injection and prolong post-procedure pain relief. This study demonstrated that the temporary hemostatic effect of epinephrine decreased the need for, and thus the potential risk of, using a digital tourniquet (p < 0.002). As the temporary vasoconstrictor effect is reversible, the threat of complication from vasoconstrictor-induced ischemia is theoretical.     

脂肪干细胞治疗下肢缺血的研究进展

下肢缺血性疾病是临床常见的严重危害中老年人健康的疾病之一。目前，临床针对下肢缺血性疾病的治疗方法多样，但远 期疗效欠佳，对于肢体严重缺血的患者往往需要进行截肢处理。脂肪干细胞（adipose-derived stemcells, ADSCs）作为再生医学用 于治疗下肢缺血的种子细胞具有广阔的应用前景。本文将对ADSCs 治疗下肢缺血的研究进展进行综述。     

An approach to determine myocardial ischemia by hidden Markov models

A hidden Markov model (HMM) of electrocardiogram (ECG) signal is presented for detection of myocardial ischemia. The time domain signals that are recorded by the ECG before and during the episode of local ischemia were pre-processed to produce input sequences, which is needed for the model training. The model is also verified by test data, and the results show that the models have certain function for the detection of myocardial ischemia. The algorithm based on HMM provides a possible approach for the timely, rapid and automatic diagnosis of myocardial ischemia, and also can be used in portable medical diagnostic equipment in the future.     

An approach to determine myocardial ischemia by hidden Markov models

A hidden Markov model (HMM) of electrocardiogram (ECG) signal is presented for detection of myocardial ischemia. The time domain signals that are recorded by the ECG before and during the episode of local ischemia were pre-processed to produce input sequences, which is needed for the model training. The model is also verified by test data, and the results show that the models have certain function for the detection of myocardial ischemia. The algorithm based on HMM provides a possible approach for the timely, rapid and automatic diagnosis of myocardial ischemia, and also can be used in portable medical diagnostic equipment in the future.     

Electron spin resonance and spin trapping technique provide direct evidence that edaravone prevents acute ischemia-reperfusion injury of the liver by limiting free radical-mediated tissue damage

A novel free radical scavenger, 3-methyl-1-phenyl-2-pyrazolin-5-one (edaravone), is used for the treatment of acute ischemic stroke and is protective in several animal models of organ injury. We tested whether edaravone is protective against acute liver warm ischemia/reperfusion injury in the rat by acting as a radical scavenger. When edaravone was administered prior to ischemia and at the time of initiation of the reperfusion, liver injury was markedly reduced. Production of oxidants in the liver in this model was assessed in vivo by spin-trapping/electron spin resonance (ESR) spectroscopy. Ischemia/reperfusion caused an increase in free radical adducts rapidly, an effect markedly blocked by edaravone. Furthermore, edaravone treatment blunted ischemia/reperfusion-induced elevation in pro-inflammatory cytokines, infiltration of leukocytes and lipid peroxidation in the liver. These results demonstrate that edaravone is an effective blocker of free radicals in vivo in the liver after ischemia/reperfusion, leading to prevention of organ injury by limiting the deleterious effects of free radicals.     

A metabolic index of ischemic injury for perfusion-recovery of cadaveric rat livers

With over 110,000 patients waiting for organ transplantation, the current crisis in organ transplantation is based on a lack of donors after brain-death (DBD). A very large alternative pool of donor organs that remain untapped are the donors after cardiac death (DCD), recovered after cardiac activity has ceased and therefore sustained some ischemic injury. Machine perfusion has been proposed as a novel modality of organ preservation and treatment to render such cadaveric organs, and in particular livers, transplantable. Two key issues that remain unaddressed are how to assess whether a DCD liver is damaged beyond repair, and whether machine perfusion has rendered an injured organ sufficiently viable for transplantation. In this work, we present a metabolic analysis of the transient responses of cadaveric rat livers during normothermic machine perfusion (NMP), and develop an index of ischemia that enables evaluation of the organ ischemic injury level. Further, we perform a discriminant analysis to construct a classification algorithm with >0.98 specificity to identify whether a given perfused liver is ischemic or fresh, in effect a precursor for an index of transplantability and a basis for the use of statistical process control measures for automated feedback control of treatment of ischemic injury in DCD livers. The analyses yield an index based on squared prediction error (SPE) as log(SPE) >1.35 indicating ischemia. The differences between metabolic functions of fresh and ischemic livers during perfusion are outlined and the metabolites that varied significantly for ischemic livers are identified as ornithine, arginine, albumin and tyrosine.     

Clinical assessment of treatment results for atherosclerotic ischemia of the lower extremities with intraarterial ozone injections]

Ten injections of O3 into femoral arteries were administered to 50 patients with atherosclerotic ischemia of the lower extremities and to 49 diabetic patients. All patients were assessed clinically with the ankle-arm index, measurement of intermittent claudication distance prior to and after the treatment. The treatment showed a significant improvement in both groups manifested by an increase in ankle-arm index, and prolongation of the intermittent claudication distance by more than twice. The treatment of atherosclerotic ischemia of the lower extremities with O3 is both valuable and safe.     

远端缺血后处理对脑缺血保护作用的研究进展

近20多年来人们对脑缺血损伤的保护研究很多,但真正能将脑缺血保护从基础研究应用到临床治疗的措施甚少。多数基础研究表明缺血预处理对大鼠脑缺血具有保护作用,然而由于脑缺血的不可预见性,研究者们将目标转向了缺血后处理。远端缺血后处理是指在非缺血器官交替实施短时间的缺血和再灌注后对缺血器官所产生的作用。由于脑组织本身对缺血的敏感,很难控制缺血后处理的程度,因此远端缺血后处理被应用到脑缺血的保护研究具有很强的临床应用价值,其机制可能与氧自由基、神经传导、蛋白质、内质网应激、Akt信号通路、线粒体途径、mitoKATP和阿片受体有关。本文主要就近几年远程缺血后处理对脑缺血保护的概念、实施方法、保护作用及分子机制做一综述。     

精氨酸及其代谢产物对缺血性脑卒中的作用

摘要：缺血性脑卒中是成年人群致残、致死的重要原因之一,有效治疗手段和药物的匮乏是脑卒中致残的主要原因。精氨酸既是一种营养物质,又具有多种独特的生理与药理作用,在早产儿和严重应激状态下精氨酸在维持正氮平衡与正常生理功能方面发挥重要作用,常将精氨酸称为条件必需氨基酸。精氨酸是生物体合成多胺的前体物质,同时精氨酸代谢也产生高活性自由基一氧化氮。精氨酸代谢及其代谢产物的改变可对脑卒中产生多种影响,如线粒体功能破坏、钙离子通道紊乱、血脑屏障损伤等。本文综述了精氨酸及其代谢产物在缺血性脑卒中病理过程中的作用。深入的研究和探讨其损伤和保护的双重作用机制将为缺血性脑卒中的防御和治疗提供新的策略。     

Electron spin resonance and spin trapping technique provide direct evidence that edaravone prevents acute ischemia–reperfusion injury of the liver by limiting free radical-mediated tissue damage

A novel free radical scavenger, 3-methyl-1-phenyl-2-pyrazolin-5-one (edaravone), is used for the treatment of acute ischemic stroke and is protective in several animal models of organ injury. We tested whether edaravone is protective against acute liver warm ischemia/reperfusion injury in the rat by acting as a radical scavenger. When edaravone was administered prior to ischemia and at the time of initiation of the reperfusion, liver injury was markedly reduced. Production of oxidants in the liver in this model was assessed in vivo by spin-trapping/electron spin resonance (ESR) spectroscopy. Ischemia/reperfusion caused an increase in free radical adducts rapidly, an effect markedly blocked by edaravone. Furthermore, edaravone treatment blunted ischemia/reperfusion-induced elevation in pro-inflammatory cytokines, infiltration of leukocytes and lipid peroxidation in the liver. These results demonstrate that edaravone is an effective blocker of free radicals in vivo in the liver after ischemia/reperfusion, leading to prevention of organ injury by limiting the deleterious effects of free radicals.     

局灶性脑缺血损伤无创检测中EEG近似熵研究

局灶性脑缺血的早期无创诊断在临床实际中有着非常重要的意义。采用SD（Sparague-Dawley)大鼠建立了局灶性脑缺血的动物实验模型,记录了缺血前后缺血区域和正常区域的脑电信号EEG。由于近似熵复杂度算法所需时间序列长度较短,大大减少了脑电信号非平稳所带来的困难,且无需粗粒化,采用近似熵对局灶性缺血动物实验模型的脑电信号的复杂度进行了分析。结果发现缺血前后缺血与非缺血区域的近似熵均有着易于区分的特征,因此EEG信号的近似熵分析可以用于对局灶性缺血的脑损伤程度进行诊断,并区分损伤区域和非损伤区域,有望在临床中加以应用。     

高压氧对脑缺血再灌注海马CA_1区神经元凋亡作用的研究

目的和方法 :应用TUNEL检测技术 ,对沙土鼠前脑缺血 2 0min后再灌注 3d模型 ,用HBO治疗连续 3d。观察HBO作用下海马CA1区神经元凋亡变化 ,研讨HBO对脑缺血再灌注损伤的疗效及其机理 ,为临床应用HBO治疗疾病提供理论依据。结果 :沙土鼠脑缺血再灌注 3d后海马CA1区大量神经元凋亡 ,HBO治疗组凋亡细胞数明显减少 (P <0 .0 1) ,并以 0 .2 5MPaHBO治疗组为佳。结论 :HBO治疗对海马神经元损伤有保护作用 ,减少神经元凋亡 ,为高压氧治疗缺血性损伤的疗效机理之一     

Algorithm to estimate cell biovolume using image analyzed microscopy

This paper describes an algorithm for calculating the biovolume of cells with simple shapes, such as bacteria, flagellates, and simple ciliates, from a 2-dimensional digital image. The method can be adapted to any image analysis system which allows access to the binary cell image--(i.e., the pixels, or (x,y) points, composing the cell. The cell image is rotated to a standard orientation (horizontal), and a solid of revolution is calculated by digital integration. Verification and a critical assessment of the method are presented. The algorithm accounts for irregularities in cell shape that conventional methods based on length, width, and geometrical formulas do not.