Exploring Spinal Cord Protection by Remote Ischemic Preconditioning: An Experimental Study Johanna Herajärvi, MD, Tuomas Anttila, MB, Henna Sarja, MB,

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Presentation transcript:

Exploring Spinal Cord Protection by Remote Ischemic Preconditioning: An Experimental Study Johanna Herajärvi, MD, Tuomas Anttila, MB, Henna Sarja, MB, Caius Mustonen, MB, Henri Haapanen, MD, Tuomas Mäkelä, MD, PhD, Fredrik Yannopoulos, MD, PhD, Tuomo Starck, PhD, Mika Kallio, MD, PhD, Hannu Tuominen, MD, PhD, Ulla Puistola, MD, PhD, Peeter Karihtala, MD, PhD, Kai Kiviluoma, MD, PhD, Vesa Anttila, MD, PhD, Tatu Juvonen, MD, PhD The Annals of Thoracic Surgery Volume 103, Issue 3, Pages 804-811 (March 2017) DOI: 10.1016/j.athoracsur.2016.06.084 Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 A simplified study protocol. Anesthesia induction, hemodynamic monitoring, thoracotomies, dissection of segmental arteries (SAs), and cranial procedures of motor-evoked potential (MEP) monitoring were performed before baseline measurements. A 15-minute interval (FLUSH) was conducted before spinal cord ischemia. (RIPC = remote ischemic preconditioning.) The Annals of Thoracic Surgery 2017 103, 804-811DOI: (10.1016/j.athoracsur.2016.06.084) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Motor evoked potential (MEP) response. The definitions of the onset latency, peak latency, peak-to-peak amplitude, baseline-to-peak amplitude, and duration are shown as lines with arrows. The Annals of Thoracic Surgery 2017 103, 804-811DOI: (10.1016/j.athoracsur.2016.06.084) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Representative photomicrographs (at original magnification ×40) of the spinal cord: (A) the anterior horn. Immunohistochemical stainings of nuclear factor erythroid 2-related factor 2 in the cytoplasm show the clear difference between the (B) control group (0 = negative) and (C) the remote ischemic preconditioning group (3 = very strongly positive). The Annals of Thoracic Surgery 2017 103, 804-811DOI: (10.1016/j.athoracsur.2016.06.084) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Peak-to-peak amplitude changes in the (A) left hind limb and (B) right hind limb compared with the baseline (BL) values in the remote ischemic preconditioning (RIPC) group and the control (CTRL) group. The difference is statistically significant at the time point after RIPC (post RIPC). (B) In the right hind limb, statistically significant differences are also recorded after occlusion of the left subclavian artery (ASUB) and 15 minutes postoperatively. 3SA, 6SA, and 9SA stand for the specific time points with the number of occluded segmental arteries. POP indicates postoperative time points with minutes. Values are shown as medians and 25th and 75th percentiles. *p < 0.05 at single time point by Student t test/Mann-Whitney U test. The Annals of Thoracic Surgery 2017 103, 804-811DOI: (10.1016/j.athoracsur.2016.06.084) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions