Background Although particulate matter, with diameters 〈 2.5 μm （PM2.5） and 〈 10 μm （PM10）, and other pollutants have been associated with cardiovascular morbidity and mortality, the effect of pollutants on ac...Background Although particulate matter, with diameters 〈 2.5 μm （PM2.5） and 〈 10 μm （PM10）, and other pollutants have been associated with cardiovascular morbidity and mortality, the effect of pollutants on acute myocardial infarctions （AMIs） has rarely been investigated in Asia, especially in Shanghai, China. Methods Between 1 November 2013 and 27 April 2014, 972 patients from the Pudong District, Shanghai City, were assessed by the Emergency Medical Service. A case-crossover design was used to analyze exposure to air pollution and the AMI risk. Exposures to PM2.5, PM10, nitrogen dioxide （NO2）, sulphurdioxide （SO2）, and carbon monoxide （CO） were based on the mean urban background levels. The associations among AMI admissions, the included pollutants, temperature, and relative humidity were analyzed using correlation and logistic regression. Results The urban background levels of PM2.5, PM10 and CO were associated with an increased risk of AMI, unlike NO2 and SO2 levels. The OR （95% CI） for AMI were 1.16 （1.03-1.29）, 1.05 （1.01-1.16）, 0.82 （0.75-1.02）, 0.87 （0.63-1.95）, and 1.08 （1.02-1.21） for PM2.5, PM10, NO2, SO2, and CO, respectively. Increases in the air quality index （AQI） were associated with more AMI occurrences. There was no correlation between fluctuations in temperature and relative humidity with AMI hospital admissions. Conclusions Short-term exposure to moderate-serious pollution levels is associated with increased risk of AMI. Increased PM2.5, PM10 and CO levels are related to increased AMI admissions.展开更多
Variceal bleeding is the most serious complication of portal hypertension,and it accounts for approximately one fifth to one third of all deaths in liver cirrhosis patients.Currently,endoscopic treatment remains the p...Variceal bleeding is the most serious complication of portal hypertension,and it accounts for approximately one fifth to one third of all deaths in liver cirrhosis patients.Currently,endoscopic treatment remains the predominant method for the prevention and treatment of variceal bleeding.Endoscopic treatments include band ligation and injection sclerotherapy.Injection sclerotherapy with N-butyl-2-cyanoacrylate has been successfully used to treat variceal bleeding.Although injection sclerotherapy with N-butyl-2-cyanoacrylate provides effective treatment for variceal bleeding,injection of N-butyl-2-cyanoacrylate is associated with a variety of complications,including systemic embolization.Herein,we report a case of cerebral and splenic infarctions after the injection of N-butyl-2-cyanoacrylate to treat esophageal variceal bleeding.展开更多
Purpose: A type 2 myocardial infarction (MI) is due to ischemia from increased oxygen demand or decreased supply. It is not an infrequent complication following non-cardiac surgery or in the setting of acute medical i...Purpose: A type 2 myocardial infarction (MI) is due to ischemia from increased oxygen demand or decreased supply. It is not an infrequent complication following non-cardiac surgery or in the setting of acute medical illness. The purpose of this study was to determine whether type 2 MIs had a worse prognosis than a type 1 MI. Methods: The hospital database of a large terti-ary-level academic medical center was queried for all patients with a troponin I ≥ 1.6 ng/mL during a one-year period. The outcomes of patients with a type 2 MI were compared to those with a type 1 MI. Results: This retrospective study found that a type 2 MI is more lethal than the usual type 1 MI, particularly among women and the elderly. There was no statistical difference in outcomes between those that occurred in the post-operative setting compared to those that occurred in the setting of acute medical illness. Conclusions: Type 2 MIs are common and are associated with increased mortality, as compared with type 1 MIs. To date, no guidelines exist for the management of this type of MI. Further research into underlying mechanisms resulting in type 2 MI as well as potential treatment strategies is needed.展开更多
We report on silent brain infarction (SBI) and leuko- araiosis (LA) of 23 patients with clinically diagnosed “first-ever” acute ischemic lacunar stroke. The lacunar syndromes were pure motor hemiparesis (10), pure s...We report on silent brain infarction (SBI) and leuko- araiosis (LA) of 23 patients with clinically diagnosed “first-ever” acute ischemic lacunar stroke. The lacunar syndromes were pure motor hemiparesis (10), pure sensory syndrome (2), ataxic hemiparesis (3), dysarthria clumsy hand syndrome (3), and sensory- motor deficit (5). Nineteen out of the 23 patients presented with completed strokes on arrival to the hospital, and 4 (17%) developed evolving-stroke within 24 hours of stroke onset. A lacune corresponded to the acute stroke could be found in all patients on brain magnetic resonance imaging (MRI), and in 18 (78%) on brain computed tomography (CT). MRI showed additional subclinical or asymptomatic “silent brain infarctions or lacunes” (SBI) in 19 (83%) of 23 patients, and leuko-araiosis (LA) of moderate to severe degree (> grade 2) was present in 61% of patients although dementia was absent. Hypertension is the risk factor in 78% of cases followed by diabetes mellitus, smoking, and elevated plasma cholesterol level. Independence of the types of lacunar syndromes, patients with hypertension and diabetes mellitus are associated with high grade LA. None with normal blood pressure and plasma glucose had grade 3 or grade 4 LA (p < 0.05). In conclusion, evolving-stroke occurs in one- fifth of patients with “first-ever” lacunar infarct within the first 24 hours of stroke onset. SBI was found in 83% of cases. Hypertension and diabetes mellitus are associated with additional SBI and high grade LA. The severity of leuko-araiosis per se dictates the cerebrovascular risks.展开更多
<strong>Introduction:</strong> Malignant middle cerebral artery (MCA) infarction is a devastating entity that is associated with up to 80% mortality. Decompressive Hemicraniectomy has been utilized to trea...<strong>Introduction:</strong> Malignant middle cerebral artery (MCA) infarction is a devastating entity that is associated with up to 80% mortality. Decompressive Hemicraniectomy has been utilized to treat brain swelling and mass effect secondary to these infarctions in an attempt to improve functional outcome. <strong>Aim: </strong>To evaluate the functional outcome of decompressive hemicraniectomy in management of malignant MCA infarctions. <strong>Methods: </strong>The study included 30 patients with malignant MCA infarctions operated upon by decompressive hemicraniectomy and duroplasty with pericranium or fascia lata graft in the period from June 2016 to January 2019. Pre-operative neurological condition, associated morbidity, location and extent of the infarction were assessed. Surgery was performed within 48 hours of the onset of stroke or 12 hours within deterioration of conscious level. Pre-operative CT scan as well as sequential post-operative CT was done. Functional outcome was assessed by the modified Rankin Scale (mRS) at the time of discharge and 3 months following surgery. <strong>Results: </strong>The study included 18 males and 12 females with a mean age of 54.7 years. The pre-operative GCS was <8 (5 - 7) in 11 patients and 8 or higher (8 - 13) in 19 patients. Good functional outcome (mRS 0 - 3) was achieved in 13 (43.3%) cases while poor outcome (mRS 4 - 5) occurred in 8 (26.7%) cases and mortality (mRS 6) occurred in 9 (30%) cases. <strong>Conclusion:</strong> Decompressive hemicraniectomy improves functional outcome in cases of malignant MCA infarction. Pre-operative GCS, age, volume of infarction, degree of midline shift, timing of surgery and associated morbidity are the most important factors affecting the outcome.展开更多
BACKGROUND Hepatic infarctions(HI)are ischemic events of the liver in which a disruption in the blood flow to the hepatocytes leads to focal ischemia and necrosis.Most HI are due to occlusive events in the liver’s bl...BACKGROUND Hepatic infarctions(HI)are ischemic events of the liver in which a disruption in the blood flow to the hepatocytes leads to focal ischemia and necrosis.Most HI are due to occlusive events in the liver’s blood vessels,but non-occlusive HI may occur.They are associated with disruption of microvasculature,such as in diabetic ketoacidosis.While HI usually presents as peripheral lesions with clear borders,irregular nodular lesions may occur,indistinguishable from liver neoplasms and presenting a diagnostic challenge.CASE SUMMARY We report a case of multiple extensive HI in a patient with poorly controlled diabetes mellitus,who first presented to the emergency room with diabetic ketoacidosis.He then developed jaundice,thrombocytopenia,and a marked elevation of serum aminotransferases.An ultrasound of the liver showed the presence of multiple irregular lesions.Further investigation with a computerized tomography scan confirmed the presence of multiple hypoattenuating nodules with irregular borders and heterogeneous appearance.These lesions were considered highly suggestive of a primary neoplasm of the liver.While the patient was clinically stable,his bilirubin levels remained persistently elevated,and he underwent an ultrasound-guided percutaneous biopsy of the largest lesion.Biopsy results revealed extensive ischemic necrosis of hepatocytes,with no signs of associated malignancy.Three months after the symptoms,the patient showed great improvement in all clinical and laboratory parameters and extensive regression of the lesions on imaging exams.CONCLUSION This case highlights that diabetic ketoacidosis can cause non-occlusive HI,possibly presenting as nodular lesions indistinguishable from neoplasms.展开更多
BACKGROUND Pheochromocytoma is a rare catecholamines-secreting tumor arising from chromaffin cells in the adrenal medulla.It classically presents with paroxysmal hypertension,headaches,palpitations,sweating,and metabo...BACKGROUND Pheochromocytoma is a rare catecholamines-secreting tumor arising from chromaffin cells in the adrenal medulla.It classically presents with paroxysmal hypertension,headaches,palpitations,sweating,and metabolic disorders.Atypical presentations such as acute myocardial infarction,heart failure,cardiomyopathy,stroke,and transient erythrocytosis have been infrequently documented.CASE SUMMARY We describe the case of a 72-year-old man diagnosed with pheochromocytoma presenting with non-ST segment elevation myocardial infarction,heart failure,and transient erythrocytosis with nonobstructed coronary arteries.This was his second heart attack.The patient was previously diagnosed with myocardial infarction,and an immense mass was found on the left adrenal gland 3 years prior.Based on clinical and laboratory findings,a diagnosis of pheochromocytoma was confirmed.His coronary angiogram showed nonobstructed coronary arteries except for a myocardial bridge in the left anterior descending branch.This was a form of type-2 myocardial infarction.The myocardial cell lesions were caused by sudden secretion of catecholamines by the pheochromocytoma.Even more atypically,his hemoglobin level was obviously elevated at admission,but after a few days of treatment with an alpha-adrenergic receptor blocker,it dropped to normal levels without additional treatment.CONCLUSION Pheochromocytoma may be a cause of acute myocardial infarction,heart failure,and transient erythrocytosis.展开更多
In 1974, in Nature, we hypothesized that removal of cytokines can be effective in the treatment of certain inflammatory diseases, e.g., rheumatoid arthritis (RA). We call this approach anticytokino-therapy. Later it w...In 1974, in Nature, we hypothesized that removal of cytokines can be effective in the treatment of certain inflammatory diseases, e.g., rheumatoid arthritis (RA). We call this approach anticytokino-therapy. Later it was shown that neutralization of pro-inflammatory cytokines, such as tumor necrosis factor alpha (TNF-α), interferon alpha (IFN-α), interferon gamma (IFN-γ), and interleukin 6 (IL-6), leads to a good therapeutic effect. Anticytokinotherapy is currently used around the world for the treatment of rheumatoid arthritis, psoriasis, psoriatic arthritis, and other Th-1-mediated inflammatory diseases. Pro-inflammatory cytokines have also been found in other conditions (myocardial infarctions, strokes, chronic pain syndromes, etc.). This leads us to believe that hyper- production of pro-inflammatory cytokines forms a basis of a variety of pathological conditions and represents a uniform response of the organism to a wide variety of insults in any part of the body. Thus, we propose to add monoclonal antibodies to (or other blockers of) pro-inflammatory cytokines to the treatment regimens for myocardial infarctions, strokes, and possibly other Th-1-mediated diseases.展开更多
Background: Timely management determines the prognosis of patients admitted for acute coronary syndrome with persistent ST-segment elevation (STEMI). Coronavirus COVID-19 appeared in China, in Wuhan in December 2019,&...Background: Timely management determines the prognosis of patients admitted for acute coronary syndrome with persistent ST-segment elevation (STEMI). Coronavirus COVID-19 appeared in China, in Wuhan in December 2019, </span><span style="font-family:Verdana;">which</span><span style="font-family:Verdana;"> has spread at a lightning speed across the planet earth, becoming a pandemic. Senegal, as well as countries around the world, has also been affected by this pandemic, which has had a strong impact on all its sectors of activity, particularly the health system. The objective of this study was to identify and evaluate the factors that increase the time required to treat myocardial infarctions, received late at H?pital Aristide le Dantec and to assess the impact of the Covid-19 pandemic on these delays. Results: A total of 25 patients were included: 17 patients in pre-pandemic period and 8 patients in pandemic period. The predominance was male with a sex ratio of 2.5. The mean age was 59.20 years.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">Hypertension was the leading risk factor with a prevalence of 60% followed by sedentary lifestyle (48%). Typical chest pain was the most frequent clinical symptom found on admission (80%) followed by nausea and vomiting (40%). The first medical contact took place in a hospital in most patients (44%) and was made by a general practitioner (64%). The majority of patients (76%) were referred to the cardiology department. The personal car was the most frequently used means of transportation for our patients (60%). The average distance by car between the place of occurrence and the hospital was 22.6 km with extremes of 3.30 and 36 km. The average travel time from the place of occurrence to the cardiology department was 43 min 30</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">s with extremes of 11 and 57 min. When comparing the results according to the COVID-19 pandemic, a decrease in the number of incident cases is noted. Before the pandemic, a consultation in multiple units was noted in the majority of cases (41%) before admission. During COVID-19, the majority of patients (62.5%) had consulted only one site. The average time from pain to first medical contact was 06</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">h</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">30 min before the COVID-19 pandemic and 42</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">h</span><span style="font-size:10pt;font-family:""></span><span style="font-family:Verdana;">06 min during the COVID-19 pandemic. The mean time to electrocardiogram recording was 14</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">h</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">30 min before the Covid-19 pandemic and 27</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">h 22 min during the Covid-19 pandemic. Conclusion: There are significant delays in the management of STEMI patients. They are attributable to both the patients and the system. The main factors of system delay found in our study were the delay in ECG recording, its interpretation, and the organization of transfer via a medical ambulance. The Covid-19 disease has globally aggravated these delays that were already present before the pandemic. Consequent measures must be taken to reduce these delays that determine the vital prognosis of STEMI patients.展开更多
Objective: To study the prevalence of silent cerebral infarction in Type II diabetes mellitus. Patients and Methods: The study was a prospective on 80 patients recruited from neurology, endocrine outpatient clinics. P...Objective: To study the prevalence of silent cerebral infarction in Type II diabetes mellitus. Patients and Methods: The study was a prospective on 80 patients recruited from neurology, endocrine outpatient clinics. Patients were type II diabetics as described by the American Diabetes Association, 2011 criteria. All patients underwent full metabolic profiles to diagnose diabetes mellitus and MRI brain scans to detect cerebral infarction. Results: Silent cerebral infarctions were detected in 60% of patients (48/80 patients) predominately along periventricular white matter area and subcortical areas (Basal ganglia, Thalamus). Conclusion: Asymptomatic Type II diabetes mellitus patients could have vascular cerebral changes without neurological symptoms. MRI brain scans could be recommended as routine diagnosis (if possible) for early cerebral infarct detection in type II diabetic patients.展开更多
Coronary embolism secondary to atrial fibrillation can lead to myocardial infarction independently of atherosclerotic coronary arteries. We encountered a patient repeatedly tortured by atrial fibrillation who presente...Coronary embolism secondary to atrial fibrillation can lead to myocardial infarction independently of atherosclerotic coronary arteries. We encountered a patient repeatedly tortured by atrial fibrillation who presented with recurrent myocardial infarctions with normal coronary anatomy and ischemic stroke. We were frustrated by repeated failures because of some probably inappropriate decisions.展开更多
Background and purpose The benefits of thrombolytic therapy before endovascular thrombectomy in cases of acute ischaemic stroke,with a large infarction volume,remain unclear.This analysis aims to evaluate the effectiv...Background and purpose The benefits of thrombolytic therapy before endovascular thrombectomy in cases of acute ischaemic stroke,with a large infarction volume,remain unclear.This analysis aims to evaluate the effectiveness and safety of bridging therapy and endovascular therapy among patients with large cerebral infarctions.Methods In this post-hoc analysis of the multicentre prospective study of ANGEL-ASPECT(Acute Anterior Circulation Large Vessel Occlusive Patients with a Large Infarct Core),participants were divided into two groups:an endovascular therapy group and a bridging therapy group.The primary outcome was the modified Rankin Scale(mRS)score at 90 days.The primary safety outcome was symptomatic intracranial haemorrhage.Ordinal logistic regression was performed to compare the primary endpoint between the two groups.Subgroup analyses were conducted to further explore potential risk factors associated with the outcomes.Results 122 patients were included,of whom 77(63%)underwent endovascular therapy and 45(37%)underwent bridging therapy.The median scores on mRS at 90 days of the bridging therapy group and the endovascular therapy group were 3(2-5)and 4(2-6),with no significant differences(common OR 1.36;95%CI 0.71 to 2.61).Symptomatic intracranial haemorrhage was reported in three patients who were in the endovascular and bridging therapy groups(relative risk(RR)1.71;95%CI 0.36 to 8.12).The mortality between two groups did not differ(RR 0.75;95%CI 0.37 to 1.54).Conclusions Our study indicated that endovascular therapy alone might be a viable option for patients with large cerebral infarctions,displaying no noticeable disparity in outcomes compared with bridging therapy.展开更多
Stroke,particularly ischemic stroke,is the leading cause of long-term disability and mortality worldwide.It occurs due to the occlusion of the cerebral arteries,which significantly reduces the delivery of blood,oxygen...Stroke,particularly ischemic stroke,is the leading cause of long-term disability and mortality worldwide.It occurs due to the occlusion of the cerebral arteries,which significantly reduces the delivery of blood,oxygen,and essential nutrients to brain tissues.This deprivation triggers a cascade of cellular events that ultimately leads to neuronal death.Recent studies have clarified the multifactorial pathogenesis of ischemic stroke,highlighting the roles of energy failure,excitotoxicity,oxidative stress,neuroinflammation,and apoptosis.This review aimed to provide a comprehensive insight into the fundamental mechanisms driving neuronal death triggered by ischemia and to examine the progress of neuroprotective therapeutic approaches designed to mitigate neuronal loss and promote neurological recovery after a stroke.Additionally,we explored widely accepted findings regarding the potential pathways implicated in neuronal death during ischemic stroke,including the interplay of apoptosis,autophagy,pyroptosis,ferroptosis,and necrosis,which collectively influence neuronal fate.We also discussed advancements in neuroprotective therapeutics,encompassing a range of interventions from pharmacological modulation to stem cell-based therapies,aimed at reducing neuronal injury and enhancing functional recovery following ischemic stroke.Despite these advancements,challenges remain in translating mechanistic insights into effective clinical therapies.Although neuroprotective strategies have shown promise in preclinical models,their efficacy in human trials has been inconsistent,often due to the complex pathology of ischemic stroke and the timing of interventions.In conclusion,this review synthesizes mechanistic insights into the intricate interplay of molecular and cellular pathways driving neuronal death post-ischemia.It sheds light on cutting-edge advancements in potential neuroprotective therapeutics,underscores the promise of regenerative medicine,and offers a forward-looking perspective on potential clinical breakthroughs.The ongoing evolution of precision-targeted interventions is expected to significantly enhance preventative strategies and improve clinical outcomes.展开更多
Exogenous neural stem cell transplantation has become one of the most promising treatment methods for chronic stroke.Recent studies have shown that most ischemia-reperfusion model rats recover spontaneously after inju...Exogenous neural stem cell transplantation has become one of the most promising treatment methods for chronic stroke.Recent studies have shown that most ischemia-reperfusion model rats recover spontaneously after injury,which limits the ability to observe long-term behavioral recovery.Here,we used a severe stroke rat model with 150 minutes of ischemia,which produced severe behavioral deficiencies that persisted at 12 weeks,to study the therapeutic effect of neural stem cells on neural restoration in chronic stroke.Our study showed that stroke model rats treated with human neural stem cells had long-term sustained recovery of motor function,reduced infarction volume,long-term human neural stem cell survival,and improved local inflammatory environment and angiogenesis.We also demonstrated that transplanted human neural stem cells differentiated into mature neurons in vivo,formed stable functional synaptic connections with host neurons,and exhibited the electrophysiological properties of functional mature neurons,indicating that they replaced the damaged host neurons.The findings showed that human fetal-derived neural stem cells had long-term effects for neurological recovery in a model of severe stroke,which suggests that human neural stem cells-based therapy may be effective for repairing damaged neural circuits in stroke patients.展开更多
Background:Myocardial infarction(MI)remains a major global public health challenge.Although advances in reperfusion therapy have reduced acute mortality,post-infarction cardiac remodeling continues to pose a substanti...Background:Myocardial infarction(MI)remains a major global public health challenge.Although advances in reperfusion therapy have reduced acute mortality,post-infarction cardiac remodeling continues to pose a substantial threat to long-term cardiovascular health.Oxidative stress and the ensuing inflammatory response are key drivers of this pathological process,leading to cardiomyocyte death,myocardial fibrosis,and functional impairment.Among the regulatory pathways involved,the kelch-like ECH-associated protein 1(Keap1)/nuclear factor erythroid 2-related factor 2(Nrf2)axis has emerged as a critical therapeutic target for mitigating post-MI cardiac injury.Methods:A murine MI model was established by permanent ligation of the left anterior descending coronary artery.Mice received oral Tongxinbi formula(TXB)at low,medium,or high doses(9/18/36 g/kg)once daily for 28 days.Cardiac function was assessed by echocardiography;myocardial fibrosis by Masson’s trichrome;and endothelial integrity by CD31 immunofluorescence.Plasma markers of endothelial function and inflammation were quantified.In vitro,oxidative stress was induced by H2O2 in vascular endothelial cells and cardiomyocytes,followed by treatment with TXB drug-containing serum.Western blot and RT-qPCR were used to measure components of the Keap1/Nrf2 pathway;ELISA quantified oxidative stress and inflammatory indices.Conditioned-medium experiments evaluated endothelial cell–mediated paracrine protection of cardiomyocytes.Results:TXB significantly improved cardiac function and reduced myocardial fibrosis after MI,in association with preservation of microvascular structure and systemic attenuation of oxidative stress and inflammation.In vitro,TXB activated the endothelial Keap1/Nrf2 pathway,enhanced cellular antioxidant defenses,increased VEGF secretion,and,via endothelial cell-mediated paracrine signaling,alleviated cardiomyocyte injury under oxidative stress.Conclusion:TXB exerts anti-fibrotic and cardioprotective effects by activating Nrf2 signaling and engaging endothelial-mediated paracrine mechanisms,collectively mitigating oxidative stress and inflammation in the post-MI setting.展开更多
Background and purpose The relationship of high-sensitive C-reactive protein(hs-CRP)levels and infarction numbers with the prognosis of stroke is uncertain.This study evaluated the association of different hs-CRP leve...Background and purpose The relationship of high-sensitive C-reactive protein(hs-CRP)levels and infarction numbers with the prognosis of stroke is uncertain.This study evaluated the association of different hs-CRP levels and infarction numbers with the prognosis of acute minor ischaemic stroke or transient ischaemic attack(TIA).Methods A subset of 807 patients with both hs-CRP measurement and baseline MRI was included from the Clopidogrel in High-risk Patients with Acute Non-disabling Cerebrovascular Events trial.The primary efficacy outcome was the occurrence of an ischaemic stroke at the 1-year follow-up.Infarction numbers were classified as multiple acute infarctions(MAIs),single acute infarction and no acute infarction(NAI).The association between different hs-CRP levels with different infarction numbers and the risk of any outcome was analysed using multivariable Cox regression models.Results Among the 807 patients,84(10.4%)patients had a recurrent ischaemic stroke within 1 year.After adjustment for conventional confounding factors,patients with both elevated hs-CRP levels and MAIs were associated with approximately 4.7-fold of risk of ischaemic stroke within 1 year(16.7% vs 3.5%,HR 4.68,95% CI 1.54 to 14.23,p=0.007),compared with those with non-elevated hs-CRP levels and NAI.Similar results were observed for the composite events.Conclusions Combined elevated hs-CRP levels and MAIs may increase 1-year stroke risk stratification efficiency in patients with minor ischaemic stroke or TIA compared with using those markers alone,which indicated that the combination of inflammatory and imaging markers might improve the effectiveness of risk stratification concerning minor ischaemic stroke or TIA.展开更多
Purpose The aim of this study was to investigate whether skeletal muscle-derived follistatin-like 1(FSTL1)reaches the heart and exerts the angiogenetic function in rats suffering myocardial infarctions(MI)after exerci...Purpose The aim of this study was to investigate whether skeletal muscle-derived follistatin-like 1(FSTL1)reaches the heart and exerts the angiogenetic function in rats suffering myocardial infarctions(MI)after exercise intervention.Methods Forty-eight male adult Sprague-Dawley rats were randomly divided into four groups.MI was provoked by ligation of left anterior descending coronary artery.MI rats underwent adeno-associated virus injection of FST1 in tibialis anterior muscle and 4 weeks of resistance exercise via a tail-suspended incremental weight-climbing method(0-75%body weight,daily load increased by 10%;1 h/day,5 day/w).Heart function was evaluated by hemodynamics including LVSP,LVEDP and±dP/dt max;the cross-sectional area of muscle cells and myocardium fibrosis were analyzed by DiI and Masson’s stain-ing,respectively;the FSTL1 expression,endothelial cell proliferation and angiogenesis were visualized by immunofluores-cence staining;and protein expression was quantified by Western blotting.Results Resistance exercise reverted MI-induced skeletal muscle atrophy,increased muscle FSTL1 expression and stimulated skeletal muscle derived FSTL1 entering into the MI heart via blood circulation.The overexpression of skeletal muscle FSTL1 improved myocardial endothelial cell proliferation,increased small vessel density in the fibrotic border,inhibited myocardial fibrosis and improved heart function in the MI rats after the exercise intervention.Meanwhile,DIP2A-PI3K-Akt-mTOR,Erk1/2 and TGFβ-Smad2/3 pathways were activated in the myocardium.Conclusion Resistance exercise stimulates skeletal muscle derived FSTL1 to reach the myocardium which makes a positive contribution to cardioprotection in MI rat.展开更多
To the Editor:The complications of pheochromocytoma caused by barely controlled hypertension and the overproduction of catecholamine can reduce patients’life expectancy and quality of life.Herein,we report a case of ...To the Editor:The complications of pheochromocytoma caused by barely controlled hypertension and the overproduction of catecholamine can reduce patients’life expectancy and quality of life.Herein,we report a case of bilateral multiple renal infarctions on computed tomography(CT)scan related to pheochromocytoma,which achieved complete relief on follow-up after tumor removal.A 47-year-old male with a 3-year history of uncontrolled hypertension(the highest value recorded was 210/160 mmHg)and intermittent severe headache,pallor,and sweating presented to our hospital on April 15,2014.He did not monitor his blood pressure regularly but occasionally took dihydropyridine calcium-channel blockers.展开更多
Background: Decompressive craniectomy (DC) has been the classical management for malignant middle cerebral artery infarctions (mMCAI) in clinical practice. However, the association between DC and mMCAI remains unclear...Background: Decompressive craniectomy (DC) has been the classical management for malignant middle cerebral artery infarctions (mMCAI) in clinical practice. However, the association between DC and mMCAI remains unclear. This review went to evaluate the efficacy of DC in treating mMCAI patients. Methods: Studies were entirely searched since the foundation dates of multiple databases to June 2016. All major databases were involved, including Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, and other sources. the bias risk of studies involved were evaluated. Modified Rankin Scale was defined as Primary outcome, Odds Ratio and 95% confidence intervals was taken as measurements. T2 (tau-squared) test, I2 test, and chi-square tests were used for statistical heterogeneity evaluation for each meta-analysis result, followed by fixed-effect model. Mantel-haenszel method was used in the process of summary estimations. All of the meta-analysis was conducted by Review Manager 5.3.Results & Conclusion: One thousand one hundred forty-five records of data were critically identified and collected through databases and 14 studies were finally involved. Result suggested that DC can ameliorate the suboptimal outcome of mMCAI patients.展开更多
Objective This study aimed to investigate the impact of glycemic control and diabetes duration on subsequent myocardial infarction(MI)in patients with both coronary heart disease(CHD)and type 2 diabetes(T2D).Methods W...Objective This study aimed to investigate the impact of glycemic control and diabetes duration on subsequent myocardial infarction(MI)in patients with both coronary heart disease(CHD)and type 2 diabetes(T2D).Methods We conducted a retrospective cohort study of 33,238 patients with both CHD and T2D in Shenzhen,China.Patients were categorized into 6 groups based on baseline fasting plasma glucose(FPG)levels and diabetes duration(from the date of diabetes diagnosis to the baseline date)to examine their combined effects on subsequent MI.Cox proportional hazards regression models were used,with further stratification by age,sex,and comorbidities to assess potential interactions.Results Over a median follow-up of 2.4 years,2,110 patients experienced MI.Compared to those with optimal glycemic control(FPG<6.1 mmol/L)and shorter diabetes duration(<10 years),the fullyadjusted hazard ratio(HR)(95%Confidence Interval[95%CI])for those with a diabetes duration of≥10 years and FPG>8.0 mmol/L was 1.93(95%CI:1.59,2.36).The combined effects of FPG and diabetes duration on MI were largely similar across different age,sex,and comorbidity groups,although the excess risk of MI associated with long-term diabetes appeared to be more pronounced among those with atrial fibrillation.Conclusion Our study indicates that glycemic control and diabetes duration significant influence the subsequent occurrence of MI in patients with both CHD and T2D.Tailored management strategies emphasizing strict glycemic control may be particularly beneficial for patients with longer diabetes duration and atrial fibrillation.展开更多
文摘Background Although particulate matter, with diameters 〈 2.5 μm （PM2.5） and 〈 10 μm （PM10）, and other pollutants have been associated with cardiovascular morbidity and mortality, the effect of pollutants on acute myocardial infarctions （AMIs） has rarely been investigated in Asia, especially in Shanghai, China. Methods Between 1 November 2013 and 27 April 2014, 972 patients from the Pudong District, Shanghai City, were assessed by the Emergency Medical Service. A case-crossover design was used to analyze exposure to air pollution and the AMI risk. Exposures to PM2.5, PM10, nitrogen dioxide （NO2）, sulphurdioxide （SO2）, and carbon monoxide （CO） were based on the mean urban background levels. The associations among AMI admissions, the included pollutants, temperature, and relative humidity were analyzed using correlation and logistic regression. Results The urban background levels of PM2.5, PM10 and CO were associated with an increased risk of AMI, unlike NO2 and SO2 levels. The OR （95% CI） for AMI were 1.16 （1.03-1.29）, 1.05 （1.01-1.16）, 0.82 （0.75-1.02）, 0.87 （0.63-1.95）, and 1.08 （1.02-1.21） for PM2.5, PM10, NO2, SO2, and CO, respectively. Increases in the air quality index （AQI） were associated with more AMI occurrences. There was no correlation between fluctuations in temperature and relative humidity with AMI hospital admissions. Conclusions Short-term exposure to moderate-serious pollution levels is associated with increased risk of AMI. Increased PM2.5, PM10 and CO levels are related to increased AMI admissions.
文摘Variceal bleeding is the most serious complication of portal hypertension,and it accounts for approximately one fifth to one third of all deaths in liver cirrhosis patients.Currently,endoscopic treatment remains the predominant method for the prevention and treatment of variceal bleeding.Endoscopic treatments include band ligation and injection sclerotherapy.Injection sclerotherapy with N-butyl-2-cyanoacrylate has been successfully used to treat variceal bleeding.Although injection sclerotherapy with N-butyl-2-cyanoacrylate provides effective treatment for variceal bleeding,injection of N-butyl-2-cyanoacrylate is associated with a variety of complications,including systemic embolization.Herein,we report a case of cerebral and splenic infarctions after the injection of N-butyl-2-cyanoacrylate to treat esophageal variceal bleeding.
文摘Purpose: A type 2 myocardial infarction (MI) is due to ischemia from increased oxygen demand or decreased supply. It is not an infrequent complication following non-cardiac surgery or in the setting of acute medical illness. The purpose of this study was to determine whether type 2 MIs had a worse prognosis than a type 1 MI. Methods: The hospital database of a large terti-ary-level academic medical center was queried for all patients with a troponin I ≥ 1.6 ng/mL during a one-year period. The outcomes of patients with a type 2 MI were compared to those with a type 1 MI. Results: This retrospective study found that a type 2 MI is more lethal than the usual type 1 MI, particularly among women and the elderly. There was no statistical difference in outcomes between those that occurred in the post-operative setting compared to those that occurred in the setting of acute medical illness. Conclusions: Type 2 MIs are common and are associated with increased mortality, as compared with type 1 MIs. To date, no guidelines exist for the management of this type of MI. Further research into underlying mechanisms resulting in type 2 MI as well as potential treatment strategies is needed.
文摘We report on silent brain infarction (SBI) and leuko- araiosis (LA) of 23 patients with clinically diagnosed “first-ever” acute ischemic lacunar stroke. The lacunar syndromes were pure motor hemiparesis (10), pure sensory syndrome (2), ataxic hemiparesis (3), dysarthria clumsy hand syndrome (3), and sensory- motor deficit (5). Nineteen out of the 23 patients presented with completed strokes on arrival to the hospital, and 4 (17%) developed evolving-stroke within 24 hours of stroke onset. A lacune corresponded to the acute stroke could be found in all patients on brain magnetic resonance imaging (MRI), and in 18 (78%) on brain computed tomography (CT). MRI showed additional subclinical or asymptomatic “silent brain infarctions or lacunes” (SBI) in 19 (83%) of 23 patients, and leuko-araiosis (LA) of moderate to severe degree (> grade 2) was present in 61% of patients although dementia was absent. Hypertension is the risk factor in 78% of cases followed by diabetes mellitus, smoking, and elevated plasma cholesterol level. Independence of the types of lacunar syndromes, patients with hypertension and diabetes mellitus are associated with high grade LA. None with normal blood pressure and plasma glucose had grade 3 or grade 4 LA (p < 0.05). In conclusion, evolving-stroke occurs in one- fifth of patients with “first-ever” lacunar infarct within the first 24 hours of stroke onset. SBI was found in 83% of cases. Hypertension and diabetes mellitus are associated with additional SBI and high grade LA. The severity of leuko-araiosis per se dictates the cerebrovascular risks.
文摘<strong>Introduction:</strong> Malignant middle cerebral artery (MCA) infarction is a devastating entity that is associated with up to 80% mortality. Decompressive Hemicraniectomy has been utilized to treat brain swelling and mass effect secondary to these infarctions in an attempt to improve functional outcome. <strong>Aim: </strong>To evaluate the functional outcome of decompressive hemicraniectomy in management of malignant MCA infarctions. <strong>Methods: </strong>The study included 30 patients with malignant MCA infarctions operated upon by decompressive hemicraniectomy and duroplasty with pericranium or fascia lata graft in the period from June 2016 to January 2019. Pre-operative neurological condition, associated morbidity, location and extent of the infarction were assessed. Surgery was performed within 48 hours of the onset of stroke or 12 hours within deterioration of conscious level. Pre-operative CT scan as well as sequential post-operative CT was done. Functional outcome was assessed by the modified Rankin Scale (mRS) at the time of discharge and 3 months following surgery. <strong>Results: </strong>The study included 18 males and 12 females with a mean age of 54.7 years. The pre-operative GCS was <8 (5 - 7) in 11 patients and 8 or higher (8 - 13) in 19 patients. Good functional outcome (mRS 0 - 3) was achieved in 13 (43.3%) cases while poor outcome (mRS 4 - 5) occurred in 8 (26.7%) cases and mortality (mRS 6) occurred in 9 (30%) cases. <strong>Conclusion:</strong> Decompressive hemicraniectomy improves functional outcome in cases of malignant MCA infarction. Pre-operative GCS, age, volume of infarction, degree of midline shift, timing of surgery and associated morbidity are the most important factors affecting the outcome.
文摘BACKGROUND Hepatic infarctions(HI)are ischemic events of the liver in which a disruption in the blood flow to the hepatocytes leads to focal ischemia and necrosis.Most HI are due to occlusive events in the liver’s blood vessels,but non-occlusive HI may occur.They are associated with disruption of microvasculature,such as in diabetic ketoacidosis.While HI usually presents as peripheral lesions with clear borders,irregular nodular lesions may occur,indistinguishable from liver neoplasms and presenting a diagnostic challenge.CASE SUMMARY We report a case of multiple extensive HI in a patient with poorly controlled diabetes mellitus,who first presented to the emergency room with diabetic ketoacidosis.He then developed jaundice,thrombocytopenia,and a marked elevation of serum aminotransferases.An ultrasound of the liver showed the presence of multiple irregular lesions.Further investigation with a computerized tomography scan confirmed the presence of multiple hypoattenuating nodules with irregular borders and heterogeneous appearance.These lesions were considered highly suggestive of a primary neoplasm of the liver.While the patient was clinically stable,his bilirubin levels remained persistently elevated,and he underwent an ultrasound-guided percutaneous biopsy of the largest lesion.Biopsy results revealed extensive ischemic necrosis of hepatocytes,with no signs of associated malignancy.Three months after the symptoms,the patient showed great improvement in all clinical and laboratory parameters and extensive regression of the lesions on imaging exams.CONCLUSION This case highlights that diabetic ketoacidosis can cause non-occlusive HI,possibly presenting as nodular lesions indistinguishable from neoplasms.
基金Supported by Science and Technology Support Plan Project of Chengde,China,No.201701A072.
文摘BACKGROUND Pheochromocytoma is a rare catecholamines-secreting tumor arising from chromaffin cells in the adrenal medulla.It classically presents with paroxysmal hypertension,headaches,palpitations,sweating,and metabolic disorders.Atypical presentations such as acute myocardial infarction,heart failure,cardiomyopathy,stroke,and transient erythrocytosis have been infrequently documented.CASE SUMMARY We describe the case of a 72-year-old man diagnosed with pheochromocytoma presenting with non-ST segment elevation myocardial infarction,heart failure,and transient erythrocytosis with nonobstructed coronary arteries.This was his second heart attack.The patient was previously diagnosed with myocardial infarction,and an immense mass was found on the left adrenal gland 3 years prior.Based on clinical and laboratory findings,a diagnosis of pheochromocytoma was confirmed.His coronary angiogram showed nonobstructed coronary arteries except for a myocardial bridge in the left anterior descending branch.This was a form of type-2 myocardial infarction.The myocardial cell lesions were caused by sudden secretion of catecholamines by the pheochromocytoma.Even more atypically,his hemoglobin level was obviously elevated at admission,but after a few days of treatment with an alpha-adrenergic receptor blocker,it dropped to normal levels without additional treatment.CONCLUSION Pheochromocytoma may be a cause of acute myocardial infarction,heart failure,and transient erythrocytosis.
文摘In 1974, in Nature, we hypothesized that removal of cytokines can be effective in the treatment of certain inflammatory diseases, e.g., rheumatoid arthritis (RA). We call this approach anticytokino-therapy. Later it was shown that neutralization of pro-inflammatory cytokines, such as tumor necrosis factor alpha (TNF-α), interferon alpha (IFN-α), interferon gamma (IFN-γ), and interleukin 6 (IL-6), leads to a good therapeutic effect. Anticytokinotherapy is currently used around the world for the treatment of rheumatoid arthritis, psoriasis, psoriatic arthritis, and other Th-1-mediated inflammatory diseases. Pro-inflammatory cytokines have also been found in other conditions (myocardial infarctions, strokes, chronic pain syndromes, etc.). This leads us to believe that hyper- production of pro-inflammatory cytokines forms a basis of a variety of pathological conditions and represents a uniform response of the organism to a wide variety of insults in any part of the body. Thus, we propose to add monoclonal antibodies to (or other blockers of) pro-inflammatory cytokines to the treatment regimens for myocardial infarctions, strokes, and possibly other Th-1-mediated diseases.
文摘Background: Timely management determines the prognosis of patients admitted for acute coronary syndrome with persistent ST-segment elevation (STEMI). Coronavirus COVID-19 appeared in China, in Wuhan in December 2019, </span><span style="font-family:Verdana;">which</span><span style="font-family:Verdana;"> has spread at a lightning speed across the planet earth, becoming a pandemic. Senegal, as well as countries around the world, has also been affected by this pandemic, which has had a strong impact on all its sectors of activity, particularly the health system. The objective of this study was to identify and evaluate the factors that increase the time required to treat myocardial infarctions, received late at H?pital Aristide le Dantec and to assess the impact of the Covid-19 pandemic on these delays. Results: A total of 25 patients were included: 17 patients in pre-pandemic period and 8 patients in pandemic period. The predominance was male with a sex ratio of 2.5. The mean age was 59.20 years.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">Hypertension was the leading risk factor with a prevalence of 60% followed by sedentary lifestyle (48%). Typical chest pain was the most frequent clinical symptom found on admission (80%) followed by nausea and vomiting (40%). The first medical contact took place in a hospital in most patients (44%) and was made by a general practitioner (64%). The majority of patients (76%) were referred to the cardiology department. The personal car was the most frequently used means of transportation for our patients (60%). The average distance by car between the place of occurrence and the hospital was 22.6 km with extremes of 3.30 and 36 km. The average travel time from the place of occurrence to the cardiology department was 43 min 30</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">s with extremes of 11 and 57 min. When comparing the results according to the COVID-19 pandemic, a decrease in the number of incident cases is noted. Before the pandemic, a consultation in multiple units was noted in the majority of cases (41%) before admission. During COVID-19, the majority of patients (62.5%) had consulted only one site. The average time from pain to first medical contact was 06</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">h</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">30 min before the COVID-19 pandemic and 42</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">h</span><span style="font-size:10pt;font-family:""></span><span style="font-family:Verdana;">06 min during the COVID-19 pandemic. The mean time to electrocardiogram recording was 14</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">h</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">30 min before the Covid-19 pandemic and 27</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">h 22 min during the Covid-19 pandemic. Conclusion: There are significant delays in the management of STEMI patients. They are attributable to both the patients and the system. The main factors of system delay found in our study were the delay in ECG recording, its interpretation, and the organization of transfer via a medical ambulance. The Covid-19 disease has globally aggravated these delays that were already present before the pandemic. Consequent measures must be taken to reduce these delays that determine the vital prognosis of STEMI patients.
文摘Objective: To study the prevalence of silent cerebral infarction in Type II diabetes mellitus. Patients and Methods: The study was a prospective on 80 patients recruited from neurology, endocrine outpatient clinics. Patients were type II diabetics as described by the American Diabetes Association, 2011 criteria. All patients underwent full metabolic profiles to diagnose diabetes mellitus and MRI brain scans to detect cerebral infarction. Results: Silent cerebral infarctions were detected in 60% of patients (48/80 patients) predominately along periventricular white matter area and subcortical areas (Basal ganglia, Thalamus). Conclusion: Asymptomatic Type II diabetes mellitus patients could have vascular cerebral changes without neurological symptoms. MRI brain scans could be recommended as routine diagnosis (if possible) for early cerebral infarct detection in type II diabetic patients.
文摘Coronary embolism secondary to atrial fibrillation can lead to myocardial infarction independently of atherosclerotic coronary arteries. We encountered a patient repeatedly tortured by atrial fibrillation who presented with recurrent myocardial infarctions with normal coronary anatomy and ischemic stroke. We were frustrated by repeated failures because of some probably inappropriate decisions.
基金Supported by Key Science&Technologies R&D Program of Lishui City(2023zdyf17)Zhejiang Provincial Medical and Health Key Science and Technology Program(WKJ-ZJ 2327).
文摘Background and purpose The benefits of thrombolytic therapy before endovascular thrombectomy in cases of acute ischaemic stroke,with a large infarction volume,remain unclear.This analysis aims to evaluate the effectiveness and safety of bridging therapy and endovascular therapy among patients with large cerebral infarctions.Methods In this post-hoc analysis of the multicentre prospective study of ANGEL-ASPECT(Acute Anterior Circulation Large Vessel Occlusive Patients with a Large Infarct Core),participants were divided into two groups:an endovascular therapy group and a bridging therapy group.The primary outcome was the modified Rankin Scale(mRS)score at 90 days.The primary safety outcome was symptomatic intracranial haemorrhage.Ordinal logistic regression was performed to compare the primary endpoint between the two groups.Subgroup analyses were conducted to further explore potential risk factors associated with the outcomes.Results 122 patients were included,of whom 77(63%)underwent endovascular therapy and 45(37%)underwent bridging therapy.The median scores on mRS at 90 days of the bridging therapy group and the endovascular therapy group were 3(2-5)and 4(2-6),with no significant differences(common OR 1.36;95%CI 0.71 to 2.61).Symptomatic intracranial haemorrhage was reported in three patients who were in the endovascular and bridging therapy groups(relative risk(RR)1.71;95%CI 0.36 to 8.12).The mortality between two groups did not differ(RR 0.75;95%CI 0.37 to 1.54).Conclusions Our study indicated that endovascular therapy alone might be a viable option for patients with large cerebral infarctions,displaying no noticeable disparity in outcomes compared with bridging therapy.
基金supported by the National Natural Science Foundation of China,Nos.82171387 and 31830111(both to SL).
文摘Stroke,particularly ischemic stroke,is the leading cause of long-term disability and mortality worldwide.It occurs due to the occlusion of the cerebral arteries,which significantly reduces the delivery of blood,oxygen,and essential nutrients to brain tissues.This deprivation triggers a cascade of cellular events that ultimately leads to neuronal death.Recent studies have clarified the multifactorial pathogenesis of ischemic stroke,highlighting the roles of energy failure,excitotoxicity,oxidative stress,neuroinflammation,and apoptosis.This review aimed to provide a comprehensive insight into the fundamental mechanisms driving neuronal death triggered by ischemia and to examine the progress of neuroprotective therapeutic approaches designed to mitigate neuronal loss and promote neurological recovery after a stroke.Additionally,we explored widely accepted findings regarding the potential pathways implicated in neuronal death during ischemic stroke,including the interplay of apoptosis,autophagy,pyroptosis,ferroptosis,and necrosis,which collectively influence neuronal fate.We also discussed advancements in neuroprotective therapeutics,encompassing a range of interventions from pharmacological modulation to stem cell-based therapies,aimed at reducing neuronal injury and enhancing functional recovery following ischemic stroke.Despite these advancements,challenges remain in translating mechanistic insights into effective clinical therapies.Although neuroprotective strategies have shown promise in preclinical models,their efficacy in human trials has been inconsistent,often due to the complex pathology of ischemic stroke and the timing of interventions.In conclusion,this review synthesizes mechanistic insights into the intricate interplay of molecular and cellular pathways driving neuronal death post-ischemia.It sheds light on cutting-edge advancements in potential neuroprotective therapeutics,underscores the promise of regenerative medicine,and offers a forward-looking perspective on potential clinical breakthroughs.The ongoing evolution of precision-targeted interventions is expected to significantly enhance preventative strategies and improve clinical outcomes.
文摘Exogenous neural stem cell transplantation has become one of the most promising treatment methods for chronic stroke.Recent studies have shown that most ischemia-reperfusion model rats recover spontaneously after injury,which limits the ability to observe long-term behavioral recovery.Here,we used a severe stroke rat model with 150 minutes of ischemia,which produced severe behavioral deficiencies that persisted at 12 weeks,to study the therapeutic effect of neural stem cells on neural restoration in chronic stroke.Our study showed that stroke model rats treated with human neural stem cells had long-term sustained recovery of motor function,reduced infarction volume,long-term human neural stem cell survival,and improved local inflammatory environment and angiogenesis.We also demonstrated that transplanted human neural stem cells differentiated into mature neurons in vivo,formed stable functional synaptic connections with host neurons,and exhibited the electrophysiological properties of functional mature neurons,indicating that they replaced the damaged host neurons.The findings showed that human fetal-derived neural stem cells had long-term effects for neurological recovery in a model of severe stroke,which suggests that human neural stem cells-based therapy may be effective for repairing damaged neural circuits in stroke patients.
基金the Major Special Project of Jiangsu Administration of Traditional Chinese Medicine(Project No.ZT202116)the Key R&D Project of Jiangsu Province(Project No.BE2020727)+2 种基金the Yangzhou Science and Technology Program(Project No.YZ2021062,YZ2024143 and YZ2024194)the Third Batch of Academic Mentorship Program for Senior TCM Experts in Jiangsu Province(Project No.2019028)the 2023 Jiangsu Pharmaceutical Association–Aosaikang Hospital Pharmacy Research Project(Project No.A202333).
文摘Background:Myocardial infarction(MI)remains a major global public health challenge.Although advances in reperfusion therapy have reduced acute mortality,post-infarction cardiac remodeling continues to pose a substantial threat to long-term cardiovascular health.Oxidative stress and the ensuing inflammatory response are key drivers of this pathological process,leading to cardiomyocyte death,myocardial fibrosis,and functional impairment.Among the regulatory pathways involved,the kelch-like ECH-associated protein 1(Keap1)/nuclear factor erythroid 2-related factor 2(Nrf2)axis has emerged as a critical therapeutic target for mitigating post-MI cardiac injury.Methods:A murine MI model was established by permanent ligation of the left anterior descending coronary artery.Mice received oral Tongxinbi formula(TXB)at low,medium,or high doses(9/18/36 g/kg)once daily for 28 days.Cardiac function was assessed by echocardiography;myocardial fibrosis by Masson’s trichrome;and endothelial integrity by CD31 immunofluorescence.Plasma markers of endothelial function and inflammation were quantified.In vitro,oxidative stress was induced by H2O2 in vascular endothelial cells and cardiomyocytes,followed by treatment with TXB drug-containing serum.Western blot and RT-qPCR were used to measure components of the Keap1/Nrf2 pathway;ELISA quantified oxidative stress and inflammatory indices.Conditioned-medium experiments evaluated endothelial cell–mediated paracrine protection of cardiomyocytes.Results:TXB significantly improved cardiac function and reduced myocardial fibrosis after MI,in association with preservation of microvascular structure and systemic attenuation of oxidative stress and inflammation.In vitro,TXB activated the endothelial Keap1/Nrf2 pathway,enhanced cellular antioxidant defenses,increased VEGF secretion,and,via endothelial cell-mediated paracrine signaling,alleviated cardiomyocyte injury under oxidative stress.Conclusion:TXB exerts anti-fibrotic and cardioprotective effects by activating Nrf2 signaling and engaging endothelial-mediated paracrine mechanisms,collectively mitigating oxidative stress and inflammation in the post-MI setting.
基金National Science and Technology Major Project(Grant number:2017ZX09304018)National Natural Science Foundation of China(Grant number:81825007)+6 种基金Beijing Municipal Science and Technology Commission(Grant number:D171100003017001,D171100003017002)Beijing Outstanding Young Scientist Program(Grant number:BJJWZYJH01201910025030)Beijing Municipal Commission of Health and Family Planning(Grant number:No.2016-1-2041,SML20150502)the third batch of National Ten Thousand Talents PlanMinistry of Science and Technology of the People's Republic of China(Grant number:2016YFC0901002,2017YFC1307900,2017YFC1307905,2018YFC1311706,2018YFC1312903)Beijing Excellent Talents Training and Supporting-Top Youth Team by Beijing Municipal Science and Technology Commission(No.2016000021223TD03)Youth Beijing Scholar Program.
文摘Background and purpose The relationship of high-sensitive C-reactive protein(hs-CRP)levels and infarction numbers with the prognosis of stroke is uncertain.This study evaluated the association of different hs-CRP levels and infarction numbers with the prognosis of acute minor ischaemic stroke or transient ischaemic attack(TIA).Methods A subset of 807 patients with both hs-CRP measurement and baseline MRI was included from the Clopidogrel in High-risk Patients with Acute Non-disabling Cerebrovascular Events trial.The primary efficacy outcome was the occurrence of an ischaemic stroke at the 1-year follow-up.Infarction numbers were classified as multiple acute infarctions(MAIs),single acute infarction and no acute infarction(NAI).The association between different hs-CRP levels with different infarction numbers and the risk of any outcome was analysed using multivariable Cox regression models.Results Among the 807 patients,84(10.4%)patients had a recurrent ischaemic stroke within 1 year.After adjustment for conventional confounding factors,patients with both elevated hs-CRP levels and MAIs were associated with approximately 4.7-fold of risk of ischaemic stroke within 1 year(16.7% vs 3.5%,HR 4.68,95% CI 1.54 to 14.23,p=0.007),compared with those with non-elevated hs-CRP levels and NAI.Similar results were observed for the composite events.Conclusions Combined elevated hs-CRP levels and MAIs may increase 1-year stroke risk stratification efficiency in patients with minor ischaemic stroke or TIA compared with using those markers alone,which indicated that the combination of inflammatory and imaging markers might improve the effectiveness of risk stratification concerning minor ischaemic stroke or TIA.
基金supported by National Natural Science Foundation of China(No.31371199).
文摘Purpose The aim of this study was to investigate whether skeletal muscle-derived follistatin-like 1(FSTL1)reaches the heart and exerts the angiogenetic function in rats suffering myocardial infarctions(MI)after exercise intervention.Methods Forty-eight male adult Sprague-Dawley rats were randomly divided into four groups.MI was provoked by ligation of left anterior descending coronary artery.MI rats underwent adeno-associated virus injection of FST1 in tibialis anterior muscle and 4 weeks of resistance exercise via a tail-suspended incremental weight-climbing method(0-75%body weight,daily load increased by 10%;1 h/day,5 day/w).Heart function was evaluated by hemodynamics including LVSP,LVEDP and±dP/dt max;the cross-sectional area of muscle cells and myocardium fibrosis were analyzed by DiI and Masson’s stain-ing,respectively;the FSTL1 expression,endothelial cell proliferation and angiogenesis were visualized by immunofluores-cence staining;and protein expression was quantified by Western blotting.Results Resistance exercise reverted MI-induced skeletal muscle atrophy,increased muscle FSTL1 expression and stimulated skeletal muscle derived FSTL1 entering into the MI heart via blood circulation.The overexpression of skeletal muscle FSTL1 improved myocardial endothelial cell proliferation,increased small vessel density in the fibrotic border,inhibited myocardial fibrosis and improved heart function in the MI rats after the exercise intervention.Meanwhile,DIP2A-PI3K-Akt-mTOR,Erk1/2 and TGFβ-Smad2/3 pathways were activated in the myocardium.Conclusion Resistance exercise stimulates skeletal muscle derived FSTL1 to reach the myocardium which makes a positive contribution to cardioprotection in MI rat.
基金This work was supported by a grant from the Scientific Research Seed Fund of Peking University First Hospital.
文摘To the Editor:The complications of pheochromocytoma caused by barely controlled hypertension and the overproduction of catecholamine can reduce patients’life expectancy and quality of life.Herein,we report a case of bilateral multiple renal infarctions on computed tomography(CT)scan related to pheochromocytoma,which achieved complete relief on follow-up after tumor removal.A 47-year-old male with a 3-year history of uncontrolled hypertension(the highest value recorded was 210/160 mmHg)and intermittent severe headache,pallor,and sweating presented to our hospital on April 15,2014.He did not monitor his blood pressure regularly but occasionally took dihydropyridine calcium-channel blockers.
文摘Background: Decompressive craniectomy (DC) has been the classical management for malignant middle cerebral artery infarctions (mMCAI) in clinical practice. However, the association between DC and mMCAI remains unclear. This review went to evaluate the efficacy of DC in treating mMCAI patients. Methods: Studies were entirely searched since the foundation dates of multiple databases to June 2016. All major databases were involved, including Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, and other sources. the bias risk of studies involved were evaluated. Modified Rankin Scale was defined as Primary outcome, Odds Ratio and 95% confidence intervals was taken as measurements. T2 (tau-squared) test, I2 test, and chi-square tests were used for statistical heterogeneity evaluation for each meta-analysis result, followed by fixed-effect model. Mantel-haenszel method was used in the process of summary estimations. All of the meta-analysis was conducted by Review Manager 5.3.Results & Conclusion: One thousand one hundred forty-five records of data were critically identified and collected through databases and 14 studies were finally involved. Result suggested that DC can ameliorate the suboptimal outcome of mMCAI patients.
基金supported by the R&D project of Pazhou Lab(Huangpu)under Grant 2023K0610the National Natural Science Foundation of China(Grants 12126602)+4 种基金the National Natural Science Foundation of China(Grants 82030102)the Shenzhen Medical Research Fund(Grants C2302001)the Shenzhen Science and Technology Innovation Committee(No.ZDSYS20200810171403013)the Chinese Postdoctoral Science Foundation(No.2022M721463)the Ministry of Science and Technology of China(Grants 2022YFC3702703).
文摘Objective This study aimed to investigate the impact of glycemic control and diabetes duration on subsequent myocardial infarction(MI)in patients with both coronary heart disease(CHD)and type 2 diabetes(T2D).Methods We conducted a retrospective cohort study of 33,238 patients with both CHD and T2D in Shenzhen,China.Patients were categorized into 6 groups based on baseline fasting plasma glucose(FPG)levels and diabetes duration(from the date of diabetes diagnosis to the baseline date)to examine their combined effects on subsequent MI.Cox proportional hazards regression models were used,with further stratification by age,sex,and comorbidities to assess potential interactions.Results Over a median follow-up of 2.4 years,2,110 patients experienced MI.Compared to those with optimal glycemic control(FPG<6.1 mmol/L)and shorter diabetes duration(<10 years),the fullyadjusted hazard ratio(HR)(95%Confidence Interval[95%CI])for those with a diabetes duration of≥10 years and FPG>8.0 mmol/L was 1.93(95%CI:1.59,2.36).The combined effects of FPG and diabetes duration on MI were largely similar across different age,sex,and comorbidity groups,although the excess risk of MI associated with long-term diabetes appeared to be more pronounced among those with atrial fibrillation.Conclusion Our study indicates that glycemic control and diabetes duration significant influence the subsequent occurrence of MI in patients with both CHD and T2D.Tailored management strategies emphasizing strict glycemic control may be particularly beneficial for patients with longer diabetes duration and atrial fibrillation.
