In patients whose vision is irreparably damaged, one might consider an endoscopic approach to lesions of the lateral orbital apex. Approach in patients with intact vision should be handled with caution because of possible traction of the optic nerve.
Metformin in diabetics at-risk for abdominal aortic aneurysm or diagnosed with abdominal aortic aneurysm does not seem to alter the peripheral inflammatory environment.
The influence of repeated high intensity electromagnetic stimulation of the brain on cortical activity, cortical blood flow, blood pressure and heart rate has been investigated in the cat, to evaluate the safety of the method. The observations have been made in preparations under propofol anaesthesia before, during and after periods of anoxia. Electromagnetic stimulation of the brain evoked activity in descending motor pathways and was recorded by activity in the median nerve and by muscle twitches. Following repeated series of high intensity stimulation there were no systematic changes in somatosensory evoked potentials or background EEG, nor were there signs of epileptogenic activity during electromagnetic stimulation, before, during or after periods of anoxia. No systematic changes in cortical blood flow, blood pressure or heart rate were observed during electromagnetic stimulation, before or after periods of anoxia. In conclusion, no acute adverse consequences following electromagnetic stimulation in the normal and anoxic cat brain were demonstrated.
Introduction:
Here we present a composite of proteomic, cellular, and radiological analyses that define the mechanisms by which autologous concentrated bone marrow mononuclear cells (cBMNC) promote limb preservation in patients with critical limb ischemia.
Methods:
CD45
+
, CD34
+
, CD105
+
, and VEGFR-2
+
cells were enumerated using fluorescent activated cell sorting (FACS) from aliquots of the cBMNC from each patient enrolled in the Phase III MOBILE TRIAL. Direct limb perfusion was measured with Positron Emission Tomography/Computed Tomography (PET/CT) with radiolabeled water (
15
H20). Anterior tibialis muscle (ATM) into which cBMNC was injected prior to below knee amputation in the Phase I CHAMP trial were collected for capillary density and proteomic analyses.
Results:
There were no differences in the number of CD45
+
(636 ± 388 vs. 868 ± 699 x 10
6
, p= 0.279), VEGFR-2
+
(0.4 ± 0.8 vs. 0.3 ± 0.6 x10
6
, p=0.757) and CD34
+
(21 ± 13 vs. 35 ± 30 x 10
6
, p= 0.156) cells in the cBMNC product injected in those patients undergoing amputation and those with a preserved limb (n=90). There was a significant association between CD105
+
(7 ± 4 vs. 16 ± 13 x 10
6
, p= 0.05) cells in patients and freedom from amputation. A Blood Perfusion Index (
BPI
) was calculated by comparing the ratio of H2O
15
peak tracer uptake level of the untreated: treated leg with an increase from 0.38 at baseline to 0.54 (42%) at 12 weeks (n=4, p< 0.05). There was an increase in CD31
+
capillaries in the ATM after injection of cBMNC. ATM specimen also showed increases in VEGF-A, angiopoietin-2, and MMP-9 compared to the untreated specimen.
Conclusion:
This first in man analyses provides conclusive evidence that cBMNC improves limb perfusion via capillary formation. This study suggests that bone marrow cell mediated angiogenesis may be dependent on CD105
+
mesenchymal progenitor cells.
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