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[High altitude retinopathy: report of 3 cases]. J Fr Ophtalmol 2014; 37:629-34. [PMID: 25199490 DOI: 10.1016/j.jfo.2014.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 04/22/2014] [Accepted: 04/23/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE To report three cases of vision loss occurring at high altitude. OBSERVATIONS Three patients aged 27 to 52 years presented with scotoma and/or visual acuity deficit upon their return from high altitude expeditions above 6000 m. Fundus examination revealed multiple posterior pole hemorrhages, resolving completely by two months. DISCUSSION Exposure to hypobaric hypoxia at high altitude leads to adaptation mechanisms in order to maintain retinal oxygenation. Certain individuals have an inadequate autoregulatory response and develop signs of "high altitude retinopathy" (HAR), including retinal hemorrhages most often, with occasional vitreous hemorrhage, optic nerve head edema and retinal vein occlusion. The pathophysiology of HAR is not well understood. Identified risk factors include altitude above 4000 m, rapid ascent and personal susceptibility. Age and fitness are unrelated. Association with acute mountain sickness, high-altitude pulmonary edema and high-altitude cerebral edema is still controversial. CONCLUSION Retinal hemorrhages occurring after high-altitude hiking are an early manifestation of HAR and are part of high-altitude illness. HAR usually occurs at altitudes above 4000 m, is generally asymptomatic, and spontaneously regresses. A maladaptive autoregulatory response to hypobaric hypoxia appears to be the cause of HAR.
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Haidong L, Fang Y, Zhihong T, Huanwei S, Tiehui Z. Use of combinations of gum arabic, maltodextrin and soybean protein to microencapsulate ginkgo leaf extracts and its inhibitory effect on skeletal muscle injury. Carbohydr Polym 2012. [DOI: 10.1016/j.carbpol.2011.12.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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3
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Influence of a short-term acute ischemia and reperfusion on skeletal muscle metabolism and morphology in rabbits. Int J Angiol 2011. [DOI: 10.1007/bf02043467] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Barthelmes D, Bosch MM, Merz TM, Petrig BL, Truffer F, Bloch KE, Holmes TA, Cattin P, Hefti U, Sellner M, Sutter FKP, Maggiorini M, Landau K. Delayed appearance of high altitude retinal hemorrhages. PLoS One 2011; 6:e11532. [PMID: 21379571 PMCID: PMC3040733 DOI: 10.1371/journal.pone.0011532] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2010] [Accepted: 05/18/2010] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Retinal hemorrhages have been described as a component of high altitude retinopathy (HAR) in association with altitude illness. In this prospective high altitude study, we aimed to gain new insights into the pathophysiology of HAR and explored whether HAR could be a valid early indicator of altitude illness. METHODOLOGY/PRINCIPAL FINDINGS 28 mountaineers were randomly assigned to two ascent profiles during a research expedition to Mt. Muztagh Ata (7546 m/24,751 ft). Digital fundus photographs were taken prior to expedition at 490 m (1,607 ft), during expedition at 4497 m (14,750 ft = base camp), 5533 m (18,148 ft), 6265 m (20,549 ft), 6865 m (22,517 ft) and 4.5 months thereafter at 490 m. Number, size and time of occurrence of hemorrhages were recorded. Oxygen saturation (SpO₂) and hematocrit were also assessed. 79% of all climbers exhibited retinal hemorrhages during the expedition. Number and area of retinal bleeding increased moderately to medium altitudes (6265 m). Most retinal hemorrhages were detected after return to base camp from a high altitude. No post-expeditional ophthalmic sequelae were detected. Significant negative (SpO₂ Beta: -0.4, p<0.001) and positive (hematocrit Beta: 0.2, p = 0.002, time at altitude Beta: 0.33, p = 0.003) correlations with hemorrhages were found. CONCLUSIONS/SIGNIFICANCE When closely examined, a very large amount of climbers exhibit retinal hemorrhages during exposure to high altitudes. The incidence of retinal hemorrhages may be greater than previously appreciated as a definite time lag was observed between highest altitude reached and development of retinal bleeding. Retinal hemorrhages should not be considered warning signs of impending severe altitude illness due to their delayed appearance.
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Affiliation(s)
- Daniel Barthelmes
- Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland
| | - Martina M. Bosch
- Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland
- * E-mail:
| | - Tobias M. Merz
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | | | | | - Konrad E. Bloch
- Pulmonary Division, University Hospital Zurich, Zurich, Switzerland
- Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Timothy A. Holmes
- Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland
| | - Philippe Cattin
- Medical Image Analysis Center (MIAC), University of Basel Faculty of Medicine, Basel, Switzerland
| | - Urs Hefti
- Department of Surgery, State Hospital Liestal, Liestal, Switzerland
| | - Miriam Sellner
- Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland
| | | | - Marco Maggiorini
- Medical Intensive Care Unit, University Hospital Zurich, Zurich, Switzerland
| | - Klara Landau
- Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland
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Neumayer C, Fügl A, Nanobashvili J, Blumer R, Punz A, Gruber H, Polterauer P, Huk I. Combined enzymatic and antioxidative treatment reduces ischemia-reperfusion injury in rabbit skeletal muscle. J Surg Res 2006; 133:150-8. [PMID: 16458926 DOI: 10.1016/j.jss.2005.12.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2005] [Revised: 12/05/2005] [Accepted: 12/07/2005] [Indexed: 11/22/2022]
Abstract
BACKGROUND Ischemia/reperfusion (I/R) injury is characterized by the production of oxygen-free radicals leading to disturbances in vasomotility (microvascular constriction) and microvascular permeability (interstitial edema formation). The objective was to evaluate the effect of the combined antioxidative and enzymatic preparation Phlogenzym on I/R injury of skeletal muscle. MATERIALS AND METHODS A rabbit hindlimb model of I/R (2.5/2 h) was used (IR group). Phlogenzym, containing rutin, trypsin, and bromelain, was applied enterally (60 mg/kg body weight) as a bolus 30 min prior to ischemia (Ph group). Sham-operated animals served as controls (CO group). Plasma malondialdehyde, potassium, and microvascular perfusion (monitored by laser flowmetry) were assessed. Histomorphometry and electron microscopy were performed from major adductor muscles. RESULTS Two hours after reperfusion, potassium levels were significantly elevated in IR compared to Ph group (6.7 +/- 1.2 versus 4.9 +/- 0.9 mmol/l, P < 0.006). Enhanced lipid peroxidation, apparent by increased plasma malondialdehyde levels, was ameliorated in the Ph group (1.0 +/- 0.1 versus 0.7 +/- 0.1 nmol/ml, P < 0.0001). No-reflow (reduction of blood flow by 62% in IR group) was not observed in the Ph group (P < 0.004). Phlogenzym treatment prevented microvascular constriction (17.6 +/- 2.3 versus 12.6 +/- 1.1 microm(2), P < 0.0001) and mollified interstitial edema (21.5 +/- 2.0 versus 26.0 +/- 3.7%, P < 0.017), resulting in mild ultrastructural alterations in contrast to pronounced sarcolemmal and mitochondrial damage in untreated rabbits. CONCLUSIONS Phlogenzym had a protective effect on skeletal muscle during I/R injury expressed by prevention of no-reflow and preservation of muscle tissue.
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Affiliation(s)
- Christoph Neumayer
- Department of Vascular Surgery, Medical University of Vienna, Vienna, Austria.
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de Arruda MJC, Poggetti RS, Fontes B, Younes RN, Souza AL, Birolini D. Intestinal ischemia/reperfusion induces bronchial hyperreactivity and increases serum TNF-alpha in rats. Clinics (Sao Paulo) 2006; 61:21-8. [PMID: 16532221 DOI: 10.1590/s1807-59322006000100005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Intestinal or hepatic ischemia/reperfusion induces acute lung injury in animal models of multiple organ failure. Tumor necrosis factor (TNF)- alpha is involved in the underlying inflammatory mechanism of acute respiratory distress syndrome. Although the inflammatory cascade leading to acute respiratory distress syndrome has been extensively investigated, the mechanical components of acute respiratory distress syndrome are not fully understood. Our hypothesis is that splanchnic ischemia/reperfusion increases airway reactivity and serum TNF-alpha levels. OBJECTIVE To assess bronchial smooth muscle reactivity under methacholine stimulation, and to measure serum TNF-alpha levels following intestinal and/or hepatic ischemia/reperfusion in rats. METHOD Rats were subjected to 45 minutes of intestinal ischemia, or 20 minutes of hepatic ischemia, or to both (double ischemia), or sham procedures (control), followed by 120 minutes of reperfusion. The animals were then sacrificed, and the bronchial response to increasing methacholine molar concentrations (10(-7) to 3 x 10(-4)) was evaluated in an ex-vivo bronchial muscle preparation. Serum TNF-alpha was determined by the L929-cell bioassay. RESULTS Bronchial response (g/100 mg tissue) showed increased reactivity to increasing methacholine concentrations in the intestinal ischemia and double ischemia groups, but not in the hepatic ischemia group. Similarly, serum TNF-alpha (pg/mL) concentration was increased in the intestinal ischemia and double ischemia groups, but not in the hepatic ischemia group. CONCLUSION Intestinal ischemia, either isolated or associated with hepatic ischemia, increased bronchial smooth muscle reactivity, suggesting a possible role for bronchial constriction in respiratory dysfunction following splanchnic ischemia/reperfusion. This increase occurred in concomitance with serum TNF-alpha increase, but whether the increase in TNF-alpha caused this bronchial contractility remains to be determined.
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Affiliation(s)
- Marcio Jose Cristiano de Arruda
- Laboratory of Medical Investigation (LIM-62) of the Emergency Surgery Service, Hospital das Clinicas, São Paulo University Medical School--São Paulo/SP, Brazil
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Tsivitse SK, Mylona E, Peterson JM, Gunning WT, Pizza FX. Mechanical loading and injury induce human myotubes to release neutrophil chemoattractants. Am J Physiol Cell Physiol 2004; 288:C721-9. [PMID: 15548571 DOI: 10.1152/ajpcell.00237.2004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The purpose of this study was to 1) test the hypothesis that skeletal muscle cells (myotubes) after mechanical loading and/or injury are a source of soluble factors that promote neutrophil chemotaxis and superoxide anion (O(2)(-).) production and 2) determine whether mechanical loading and/or injury causes myotubes to release cytokines that are known to influence neutrophil responses [tumor necrosis factor-alpha (TNF-alpha), IL-8, and transforming growth factor-beta1 (TGF-beta1)]. Human myotubes were grown in culture and exposed to either a cyclic strain (0, 5, 10, 20, or 30% strain) or a scrape injury protocol. Protocols of 5, 10, and 20% strain did not cause injury, whereas 30% strain and scrape injury caused a modest and a high degree of injury, respectively. Conditioned media from strained myotubes promoted chemotaxis of human blood neutrophils and primed them for O(2)(-). production in a manner that was dependent on a threshold of strain and independent from injury. Neutrophil chemotaxis, but not priming, progressively increased with higher magnitudes of strain. Conditioned media only from scrape-injured myotubes increased O(2)(-). production from neutrophils. Concentrations of IL-8 and total TGF-beta1 in conditioned media were reduced by mechanical loading, whereas TNF-alpha and active TGF-beta1 concentrations were unaffected. In conclusion, skeletal muscle cells after mechanical loading and injury are an important source of soluble factors that differentially influence neutrophil chemotaxis and the stages of neutrophil-derived reactive oxygen species production. Neutrophil responses elicited by mechanical loading, however, did not parallel changes in the release of IL-8, TGF-beta1, or TNF-alpha from skeletal muscle cells.
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Affiliation(s)
- Susan K Tsivitse
- Department of Kinesiology, University. of Toledo, 2801 W. Bancroft St., Toledo, OH 43606, USA
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The effect of lidocaine on in vitro neutrophil and endothelial adhesion molecule expression induced by plasma obtained during tourniquet-induced ischaemia and reperfusion. Eur J Anaesthesiol 2004. [DOI: 10.1097/00003643-200411000-00010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Nanobashvili J, Neumayer C, Fügl A, Punz A, Blumer R, Prager M, Mittlböck M, Gruber H, Polterauer P, Roth E, Malinski T, Huk I. Ischemia/reperfusion injury of skeletal muscle: plasma taurine as a measure of tissue damage. Surgery 2003; 133:91-100. [PMID: 12563243 DOI: 10.1067/msy.2003.65] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cell membrane rupture by oxygen-derived free radicals is a systematic feature of ischemia/reperfusion (I/R) injury. High taurine concentration gradients in skeletal muscle prompted us to evaluate whether plasma taurine levels (pTau) are a useful marker of I/R injury after different periods of ischemia. METHODS Rabbits were randomly assigned to either 1 or 2.5 hours of hind-limb ischemia followed by 2 hours of reperfusion (groups IR1 [n = 12] and IR2.5 [n = 13], respectively). Corresponding sham groups (SHAM1 [n = 8] and SHAM2.5 [n = 9]) were used as controls. Analyzed parameters included histomorphometry and electron microscopy of skeletal muscle biopsies, pTau, and plasma level of malondialdehyde. Skeletal muscle function was assessed 3 weeks after I/R injury. RESULTS No significant morphologic changes were detectable at the end of ischemia. After reperfusion, mild interstitial edema with intact muscle cell membranes developed in IR1 group; pTau was not increased. IR2.5 group, by contrast, showed severe interstitial edema formation (interfiber area increased by 112%, P <.005), microvascular constriction (microvessel area decreased by 33%, P <.0005), and damage to the muscle cell membranes that was confirmed by the increased plasma malondialdehyde. pTau was higher than in the SHAM2.5 group (P <.0005). Pronounced cell damage in IR2.5 group resulted in impaired muscle function (maximal tetanic tension was reduced 2 times, P <.005) but not in IR1 group. CONCLUSION Skeletal muscle tolerates 1 h/2 h but not 2.5 h/2 h of I/R, the latter resulting in interstitial edema formation, microvascular constriction, and a late muscle dysfunction. Cell membrane rupture through stimulated lipid peroxidation promotes leakage of intracellular taurine, leading to increased pTau after reperfusion and may be considered as prognostically unfavorable in terms of organ function reversibility. In the rabbit model, pTau seems to be a sensitive marker of I/R injury to skeletal muscle.
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Affiliation(s)
- Joseph Nanobashvili
- Department of Vascular Surgery, Ludwig Boltzmann Research Institute for Interdisciplinary Vascular Medicine, University of Vienna Medical School, Vienna, Austria
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Kiely PD, Wang JC, Kelly CJ, Condron C, Watson RGK, Bouchier-Hayes DJ. Diethylmaleate, a pro-oxidant, attenuates experimental ischaemia-reperfusion-induced lung injury. Br J Surg 2002; 89:482-5. [PMID: 11952592 DOI: 10.1046/j.0007-1323.2001.02050.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Systemic ischaemia-reperfusion (IR) injury is in part an oxidant injury mediated by neutrophils. Diethylmaleate (DEM), an intracellular pro-oxidant agent, has been shown to alleviate neutrophil-mediated tissue injury. The aim of this study was to evaluate whether DEM could have a protective effect on neutrophil-mediated lung injury in an animal model of lower-torso IR. METHODS Sprague-Dawley rats (seven per group) were randomized into three groups. The control group underwent midline laparotomy only; the IR group underwent laparotomy and clamping of the infrarenal abdominal aorta for 30 min followed by 2 h of reperfusion; and the third group was pretreated with DEM 6 mmol/kg intraperitoneally 1 h before the IR insult. RESULTS IR resulted in a significant increase in both microvascular leakage and pulmonary neutrophil infiltration as measured by bronchoalveolar lavage protein concentration and pulmonary myeloperoxidase activity respectively. Pretreatment with DEM significantly attenuated both microvascular leakage and neutrophil infiltration. CONCLUSION Preconditioning with DEM protected against IR-induced lung injury. This protective effect raises the possibility of using pro-oxidants to prevent inflammatory injury.
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Affiliation(s)
- P D Kiely
- Department of Surgery, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland.
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Neumayer C, Nanobashvili J, Fugl A, Blumer R, Punz A, Prager M, Gruber H, Polterauer P, Roth E, Huk I. alpha-Tocopherol Pretreatment Reduces Ischaemia/Reperfusion Injury in Rabbit Skeletal Muscle. Eur Surg 2002. [DOI: 10.1046/j.1563-2563.2002.02036.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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12
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Biernacki M, Bigda J, Jankowski K, Wozniak M, Sledziński Z. Increased serum levels of markers of oxidative stress during kidney transplantation. Transplant Proc 2002; 34:544-5. [PMID: 12009617 DOI: 10.1016/s0041-1345(01)02839-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- M Biernacki
- 1st Department of Surgery and Department of General Chemistry, Medical University of Gdańsk, Debinki 1, 80-221 Gdańsk, Poland
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Farooq MM, Serra A, Newman PJ, Cambria RA, Seabrook GR, Towne JB, Freischlag JA. PECAM-1/IgG attenuates peroxynitrite-mediated extremity reperfusion injury. J Vasc Surg 2001; 34:555-8. [PMID: 11533611 DOI: 10.1067/mva.2001.115813] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Neutrophil transendothelial migration, a key feature of skeletal muscle ischemia and reperfusion (I/R) injury, is mediated by the platelet endothelial cell adhesion molecule-1 (PECAM-1). Peroxynitrite anion, a toxic product of neutrophil superoxide anion and nitric oxide, contributes to oxidative skeletal muscle injury and can be quantified by measurement of protein tyrosine nitration after I/R. This study hypothesizes that administration of the PECAM-1/IgG antibody chimera will inhibit peroxynitrite-mediated injury after I/R. METHODS The study was composed of five groups: an I/R group (n = 4), a sham treatment group anesthetic control (n = 3), a treatment group receiving the PECAM-1/immunoglobulin G (IgG) antibody chimera with I/R (n = 9), a treatment group receiving human IgG with I/R as an antibody control (n = 6), and a treatment group receiving normal saline solution with I/R as a vehicle control (n = 5). The right hind limb in male New Zealand white rabbits was rendered ischemic by occluding the iliac and femoral arteries for 3 hours, followed by 2 hours of reperfusion (I/R). Sham-treated rabbits underwent arterial dissection without arterial occlusion. PECAM-1/IgG-treated rabbits and IgG-treated rabbits received an infusion of 1 mg/kg in normal saline solution 20 mL via an ear vein catheter during the last 5 minutes of ischemia and the first 15 minutes of reperfusion. Saline solution-treated rabbits similarly received normal saline solution 20 mL. The anterior tibialis muscle was harvested after reperfusion. Immunohistochemical staining for nitrotyrosine was performed with monoclonal antinitrotyrosine antibodies and fluorescently labeled secondary antibodies. Computed morphometric study was performed to calculate relative fluorescence scores for each histologic section. Averaged fluorescence scores were analyzed by one-way analysis of variance with Bonferroni post hoc comparison. RESULTS The averaged fluorescence scores (mean +/- SEM) for the sham-treated (2.88 +/- 0.78) and PECAM-1/IgG-treated (6.16 +/- 0.43) groups demonstrated a significant reduction in quantitative fluorescence compared with the IgG- (15.17 +/- 2.01) and saline solution-treated (17.46 +/- 3.71) control groups, and the I/R-treated (18.52 +/- 3.00) group, (P <.05). CONCLUSIONS These results suggest that PECAM-1/IgG diminishes peroxynitrite-mediated oxidative skeletal muscle injury by inhibiting neutrophil transendothelial migration and may therefore prove a useful therapeutic agent in the treatment of reperfusion injury.
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Affiliation(s)
- M M Farooq
- Department of Vascular Surgery, Medical College of Wisconsin, Milwaukee, USA.
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Chirurgische Gefäßmedizin der Zukunft: interdisziplinäre Strategien. Eur Surg 1999. [DOI: 10.1007/bf02620172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Barry MC, Wang JH, Kelly CJ, Sheehan SJ, Redmond HP, Bouchier-Hayes DJ. Plasma factors augment neutrophil and endothelial cell activation during aortic surgery. Eur J Vasc Endovasc Surg 1997; 13:381-7. [PMID: 9133990 DOI: 10.1016/s1078-5884(97)80080-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Lung injury following reperfusion results from endothelial damage caused by release of cytotoxic products by activated neutrophils (PMN) in the pulmonary microvasculature. This process is facilitated by the release of pro-inflammatory cytokines and arachidonic metabolites following the outset of reperfusion. This study aimed to evaluate the effect of plasma obtained before and after revascularisation on neutrophil and endothelial cell activation. Plasma (IR-plasma) was obtained from venous blood samples taken before and during aortic cross-clamping, and 5, 40 and 60 min following clamp removal in seven patients undergoing elective infrarenal aortic aneurysm resection. PMN from healthy volunteers (n = 5) were incubated with these plasma samples or with fMLP (N-formylmethionyl-leucyl-phenylalanine) as positive control for 30 min and assessed flow-cytometrically for CD11b expression. Human endothelial cells (ECV-304) were incubated with IR plasma for 2, 4 and 6 h or with tumour necrosis factor (TNF) (20 ng/ml) as positive control and assessed for ICAM-1 expression. Incubation with IR plasma resulted in a significant increase from pre-clamp in PMN CD11b expression. A similar trend was seen in endothelial cell ICAM-1 expression following 2 h incubation. These results indicate that reperfusion-induced endothelial dysfunction may be mediated by plasma factors released upon revascularisation which facilitate neutrophil-endothelial interaction through up-regulation of adhesion receptor expression.
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Affiliation(s)
- M C Barry
- Department of Surgery, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
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Barry MC, Kelly CJ, Abdih H, Watson RW, Stapleton P, Sheehan SJ, Redmond HP, Hayes DB. Differential effects of lower limb revascularisation on organ injury and the role of the amino acid taurine. Eur J Vasc Endovasc Surg 1997; 13:193-201. [PMID: 9091154 DOI: 10.1016/s1078-5884(97)80018-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Lower torso revascularisation following ischaemia results in a systemic inflammatory response. Endothelial barrier function is disrupted by neutrophil-derived proteases and oxidants. Taurine, an amino acid found in large quantities in neutrophils, is a powerful endogeneous anti-oxidant. The aims of this study were to investigate the systemic effects of reperfusion following lower limb revascularisation and to evaluate the role of taurine administration in preventing this injury. A rat model of aortic occlusion (30 min) followed by 2 h of reperfusion was used. Animals were randomised to one of three groups (n = 10 per group): control; ischaemia reperfusion untreated (IR) and taurine-treated. Taurine (4% solution) was administrated orally for 48 h prior to the experiment. Neutrophil infiltration and microvascular permeability were assessed by measuring tissue myeloperoxidase activity and wet/dry weights respectively in lung, liver, kidney, and in cardiac and skeletal muscle. Statistical analysis was by means of analysis of variance (ANOVA). Reperfusion resulted in pulmonary and renal microvascular injury as assessed by organ oedema. Hepatic tissue, skeletal and cardiac muscle were unaffected by lower limb revascularisation. Taurine was effective in preventing neutrophil-mediated pulmonary but not renal microvascular injury. These data suggest that, whilst reperfusion-induced pulmonary injury is predominantly neutrophil-mediated, agents other than neutrophil-derived oxidative metabolites, capable of independently causing organ injury through direct endothelial damage, are produced during reperfusion.
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Affiliation(s)
- M C Barry
- Department of Surgery, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
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Galley HF, Davies MJ, Webster NR. Xanthine oxidase activity and free radical generation in patients with sepsis syndrome. Crit Care Med 1996; 24:1649-53. [PMID: 8874300 DOI: 10.1097/00003246-199610000-00008] [Citation(s) in RCA: 108] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine xanthine oxidase activity, free radical concentrations, and lipid peroxidation in patients with sepsis syndrome compared with noninfected critically ill patients. DESIGN A prospective observational study. SETTING A nine-bed intensive care unit in a university teaching hospital trust. PATIENTS Fourteen consecutive patients who met the established criteria for sepsis syndrome with multiple organ dysfunction syndrome, and ten noninfected critically ill patients were studied. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Xanthine oxidase activity was increased in septic patients compared with both healthy volunteers (p < .01) and noninfected patients (p < .05), and was highest in the six patients who survived (p < .05). Lipid peroxides were increased in both septic patients (p < .001) and nonseptic controls (p < .001). Xanthine oxidase activity did not relate to the Acute Physiology and Chronic Health Evaluation (APACHE) II score or to the presence of organ dysfunction. The mean ascorbyl radical concentration (arbitrary units) determined by electron paramagnetic resonance following spin trapping was increased in patients compared with healthy subjects (p < .05). CONCLUSIONS Patients with sepsis have xanthine oxidase activation, high free-radical concentrations, and evidence of free radical damage. The finding that xanthine oxidase activity was lower in those patients who died, coupled with increased lactate concentrations implies more severe ischemia with incomplete reperfusion resulting in less xanthine oxidase "wash out" into the circulation. Increased ascorbyl radical concentrations may be due to an increased radical generation and oxidant scavenging, but appears to be unrelated to xanthine oxidase activity within the circulation.
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Affiliation(s)
- H F Galley
- Academic Unit of Anaesthesia and Intensive Care, University of Aberdeen, UK
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Summers ST, Konishi GP, Freischlag JA. No contralateral neutrophil (PMN) stimulation after rabbit hindlimb ischemia/reperfusion. Ann Vasc Surg 1995; 9:261-5. [PMID: 7632554 DOI: 10.1007/bf02135285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Polymorphonuclear neutrophils (PMNs) have been implicated as mediators of the reperfusion injury that occurs in skeletal muscle after ischemia. Our laboratory has previously shown that the venous effluent from rabbit hindlimbs that have undergone 2 or 3 hours of ischemia followed by 1 hour of reperfusion contains PMNs that demonstrate increased phagocytosis and chemotaxis when assayed. It was the purpose of this study to evaluate PMNs from the contralateral rabbit hindlimb utilizing the same periods of ischemia and reperfusion to determine whether this PMN-induced effect is localized to the ischemic limb. Rabbit hindlimbs were rendered ischemic by clamping the iliac and femoral arteries for 2 or 3 hours after ligating all pelvic collateral vessels. The ischemic limb was then allowed to reperfuse for 1 hour following removal of the clamps. Preischemia blood samples were obtained from an ear artery prior to placement of the clamps. A venous effluent sample was obtained to study PMNs from the contralateral limb after an ischemic period of either 2 or 3 hours and again after 1 hour of reperfusion. Phagocytosis and chemotaxis were measured and results were compared. No differences in phagocytosis or chemotaxis were observed in PMNs isolated from the contralateral limb after 2 and 3 hours of ischemia alone or ischemia followed by 1 hour of reperfusion in comparison with preischemia values. There were no significant alterations in phagocytosis or chemotaxis in PMNs obtained from the contralateral limb following ischemia/reperfusion.
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Affiliation(s)
- S T Summers
- Department of Surgery, Wadsworth VA Medical Center, Los Angeles, Calif., USA
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Summers ST, Zinner MJ, Freischlag JA. Production of endothelium-derived relaxing factor (EDRF) is compromised after ischemia and reperfusion. Am J Surg 1993; 166:216-20. [PMID: 8352418 DOI: 10.1016/s0002-9610(05)81059-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Rabbit hind limbs were subjected to 5 hours of ischemia with or without 1 hour of in vivo reperfusion, and the response of femoral artery segments to vasocontrictors and vasodilators was studied in vitro. The ability of endothelium-derived relaxing factor (EDRF)-dependent vasodilators to relax arterial segments was not altered after up to 5 hours of ischemia alone but was significantly decreased after 4 hours of ischemia if followed by 1 hour of in vivo reperfusion. Thus, we concluded that a specific injury occurs to endothelial cells after ischemia-reperfusion, which occurs solely during the reperfusion period.
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Dirnagl U, Ködel U, Pfister HW, Villringer A, Schleinkofer L, Einhäupl KM. Detection of brain free oxygen radical generated photons in vivo: preliminary results. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1993; 333:203-12. [PMID: 8395757 DOI: 10.1007/978-1-4899-2468-1_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- U Dirnagl
- Department of Neurology, University of Munich, Germany
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Valen G, Vaage J. Toxic oxygen metabolites and leukocytes in reperfusion injury. A review. SCANDINAVIAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY. SUPPLEMENTUM 1993; 41:19-29. [PMID: 8184290 DOI: 10.3109/14017439309100155] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Toxic oxygen metabolites (TOM) are generated by activated leukocytes and ischemic tissue upon reperfusion, and are cardiotoxic in vitro. Generation of TOM during reperfusion in vivo has been measured directly and indirectly. TOM contribute to myocardial stunning, causing systolic and diastolic dysfunction. TOM may also play a role in the pathogenesis of reperfusion arrhythmias. It is uncertain if TOM cause cell death during reperfusion. Inhibition of TOM with antioxidants may be important for myocardial protection during cardiac surgery.
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Affiliation(s)
- G Valen
- Department of Surgery, University of Tromsø, Norway
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