AIM:To investigate the difference in risk factors between non-arteritic anterior ischaemic optic neuropathy(NAION)and central retinal artery occlusion(CRAO)and develop a predictive diagnostic nomogram.METHODS:The stud...AIM:To investigate the difference in risk factors between non-arteritic anterior ischaemic optic neuropathy(NAION)and central retinal artery occlusion(CRAO)and develop a predictive diagnostic nomogram.METHODS:The study included 37 patients with monocular NAION,20 with monocular CRAO,and 24 with hypertension.Gender,age,and systemic diseases were recorded.Blood routine,lipids,hemorheology,carotid and brachial artery doppler ultrasound,and echocardiography were collected.The optic disc area,cup area,and cup-to-disc ratio(C/D)of the unaffected eye in the NAION and CRAO group and the right eye in the hypertension group were measured.RESULTS:The carotid artery intimal medial thickness(C-IMT)of the affected side of the CRAO group was thicker(P=0.039)and its flow-mediated dilation(FMD)was lower(P=0.049)than the NAION group.Compared with hypertension patients,NAION patients had higher whole blood reduced viscosity low-shear(WBRV-L)and erythrocyte aggregation index(EAI;P=0.045,0.037),and CRAO patients had higher index of rigidity of erythrocyte(IR)and erythrocyte deformation index(EDI;P=0.004,0.001).The optic cup and the C/D of the NAION group were smaller than the other two groups(P<0.0001).The diagnostic prediction model showed high diagnostic specificity(83.7%)and sensitivity(85.6%),which was highly related to hypertension,the C-IMT of the affected side,FMD,platelet(PLT),EAI,and C/D.CONCLUSION:CRAO patients show thicker C-IMT and worse endothelial function than NAION.NAION and CRAO may be related to abnormal hemorheology.A small cup and small C/D may be involved in NAION.The diagnostic nomogram can be used to preliminarily identify NAION and CRAO.展开更多
Objective: This study aimed to evaluate the efficacy of trimetazidine on exercise capacity via a six-minute walk test in patients with ischaemic cardiomyopathy and also evaluate the effect of trimetazidine on left ven...Objective: This study aimed to evaluate the efficacy of trimetazidine on exercise capacity via a six-minute walk test in patients with ischaemic cardiomyopathy and also evaluate the effect of trimetazidine on left ventricular function via echocardiography in the same population. Methods: This prospective observational study, conducted at the National Institute of Cardiovascular Diseases in Dhaka, Bangladesh, enrolled 200 patients with ischaemic cardiomyopathy and a depressed left ventricular ejection fraction (LVEF Results: In this study (n = 200) of ischaemic cardiomyopathy patients, the mean age was 58 years, with 76% of the patients being male. All study subjects received GDMT (Guideline-Directed Medical Therapy) for angina and heart failure. Those who received the modified released form of trimetazidine developed lesions during the 1st and 2nd follow-ups, during which the LVEF, LVIDd, and six-minute walk distance significantly improved (p Conclusion: The findings of the present study demonstrated that the addition of modified-release trimetazidine to GDMT can improve exercise capacity and left ventricular function in patients with ischaemic cardiomyopathy.展开更多
Liver transplantation (LT) is the best treatment for end-stage hepatic failure, with an excellent survival rates over the last decade. Biliary complications after LT pose a major challenge especially with the increasi...Liver transplantation (LT) is the best treatment for end-stage hepatic failure, with an excellent survival rates over the last decade. Biliary complications after LT pose a major challenge especially with the increasing number of procured organs after circulatory death. Ischaemic cholangiopathy (IC) is a set of disorders characterized by multiple diffuse strictures affecting the graft biliary system in the absence of hepatic artery thrombosis or stenosis. It commonly presents with cholestasis and cholangitis resulting in higher readmission rates, longer length of stay, repeated therapeutic interventions, and eventually re-transplantation with consequent effects on the patient’s quality of life and increased health care costs. The pathogenesis of IC is unclear and exhibits a higher prevalence with prolonged ischaemia time, donation after circulatory death (DCD), rejection, and cytomegalovirus infection. The majority of IC occurs within 12 mo after LT. Prolonged warm ischaemic times predispose to a profound injury with a subsequently higher prevalence of IC. Biliary complications and IC rates are between 16% and 29% in DCD grafts compared to between 3% and 17% in donation after brain death (DBD) grafts. The majority of ischaemic biliary lesions occur within 30 d in DCD compared to 90 d in DBD grafts following transplantation. However, there are many other risk factors for IC that should be considered. The benefits of DCD in expanding the donor pool are hindered by the higher incidence of IC with increased rates of re-transplantation. Careful donor selection and procurement might help to optimize the utilization of DCD grafts.展开更多
Liver ischaemic preconditioning （IPC） is known to protect the liver from the detrimental effects of ischaemic-reperfusion injury （IRI）, which contributes significantly to the morbidity and mortality following majo...Liver ischaemic preconditioning （IPC） is known to protect the liver from the detrimental effects of ischaemic-reperfusion injury （IRI）, which contributes significantly to the morbidity and mortality following major liver surgery. Recent studies have focused on the role of IPC in liver regeneration, the precise mechanism of which are not completely understood. This review discusses the current understanding of the mechanism of liver regeneration and the role of IPC in this setting. Relevant articles were reviewed from the published literature using the Medline database. The search was performed using the keywords ＂liver＂, ＂ischaemic reperfusion＇, ＂ischaemic preconditioning＂, ＂regeneration＂, ＂hepatectomy＂ and ＂transplantation＂. The underlying mechanism of liver regeneration is a complex process involving the interaction of cytokines, growth factors and the metabolic demand of the liver. IPC, through various mediators, promotes liver regeneration by up-regulating growth-promoting factors and suppresses growth-inhibiting factors as well as damaging stresses. The increased understanding of the cellular mechanisms involved in IPC will enable the development of alternative treatment modalities aimed at promoting liver regeneration following major liver resection and transplantation.展开更多
<strong>Background:</strong> Hypokalemia is seen on regular basis in medical emergency. The definition of hypokalemia is serum potassium level below 3.5 mmol/L, meanwhile severe hypokalemia is serum potass...<strong>Background:</strong> Hypokalemia is seen on regular basis in medical emergency. The definition of hypokalemia is serum potassium level below 3.5 mmol/L, meanwhile severe hypokalemia is serum potassium level below 2.5 mmol/L [1]. Patient with hypokalemia can present with wide range of presentation including musculoskeletal complaints from numbness to acute paralysis. Severe hypokalemia has tendency to progress to intestinal paralysis and respiratory failure. In some cases of hypokalemia, cardiovascular system can also be affected causing cardiac arrhythmias and heart failure [2]. <strong>Aim:</strong> This case report is to highlight that severe hypokalaemia can present with ECG changes mimicking acute coronary syndrome (ACS) which was fully resolved with correction of potassium level. <strong>Methods:</strong> We report a case of 84 years old Chinese man with underlying triple vessel disease presented with generalised body weakness for 2 days. ECG on arrival noted changes suggestive of ACS with ST segment depression in lead V4-V6 with first degree heart block, however patient had no ischemic symptoms and the potassium level was severe low at 1.6 mmol/L (3.5 - 5.1 mmol/L). He was correctly not treated for ACS. <strong>Outcomes:</strong> Repeated ECG post fast intravenous potassium correction noted complete resolution of the ST segment depression and first degree heart block. Patient discharged well from hospital four days later with potassium level of 3.8 mmol/L. <strong>Conclusions:</strong> Severe hypokalemia with asymptomatic ECG of ACS changes can safely be treated as a single entity clinical emergency with good resolution and no complication after normalizing potassium level.展开更多
Childhood priapism is a rare entity and there is currently no consensus regarding its contemporary management.The use of perioperative anticoagulation and open distal corporaglandular shunt procedure in the management...Childhood priapism is a rare entity and there is currently no consensus regarding its contemporary management.The use of perioperative anticoagulation and open distal corporaglandular shunt procedure in the management of childhood priapism has not been reported in the literature.We present a stuttering case of a 13-year-old boy who presented with idiopathic ischaemic priapism lasting 13 h in duration,which recurred despite corporal aspiration and alpha-adrenergic agonist injections,percutaneous distal shunt surgery,and revision of percutaneous distal shunt surgery.He was eventually successfully managed with perioperative subcutaneous enoxaparin,oral aspirin and clopidogrel in conjunction with an Al-Ghorab shunt,which led to sustained detumescence but with spontaneous morning erections.In paediatric patients with sustained childhood priaprism failing stepwise treatments,an Al-Ghorab shunt with perioperative anticoagulation is a viable option.展开更多
Ischaemic stroke is a debilitating disease with immense personal,societal and economic impact.Thrombolysis with recombinant tissue plasminogen activator remains the only approved pharmacotherapy for this disease.As ea...Ischaemic stroke is a debilitating disease with immense personal,societal and economic impact.Thrombolysis with recombinant tissue plasminogen activator remains the only approved pharmacotherapy for this disease.As each year less than 1%of eligible patients receive this therapy worldwide,efficacious new therapeutics are desperately needed.Emerging evidence suggest endothelial progenitor cells(EPCs),capable of repairing damaged vasculature,as one such therapeutics.However,questions regarding their optimal dose,delivery route and in vivo survivability remain largely unanswered.Outgrowth endothelial cells,generated in large numbers by ex vivo expansion of EPCs,enable effective assessment of these issues and may eventually serve as off-the-shelf therapeutics.Correlations between circulating EPC levels and stroke outcome imply that EPCs may also serve as clinical biomarkers for stroke.This viewpoint briefly evaluates the current evidence,pinpoints the gaps in the literature and proposes new directions for research.展开更多
Ischaemic stroke is one of the commonest causes of morbidity and mortality worldwide and around a fifth of events can be attributed to a cardioembolic source. This is typically due to atrial fibrillation(AF), the most...Ischaemic stroke is one of the commonest causes of morbidity and mortality worldwide and around a fifth of events can be attributed to a cardioembolic source. This is typically due to atrial fibrillation(AF), the most common sustained cardiac arrhythmia. However, AF can, at times, be difficult to detect due to a relative lack of symptoms and the fact that it can be paroxysmal in nature. Studies have shown that diagnosis of AF improves as the length of cardiac monitoring increases. However, prolonged cardiac monitoring is not a costeffective way of diagnosing AF. Therefore, an alternative approach may be to empirically anticoagulate individuals who are at high risk of stroke. This article summarises current evidence surrounding stroke risk prediction, the use of anticoagulation in the secondary prevention of stroke and its use in the primary prevention of stroke in high risk groups with the aim of determining whether empirical anticoagulation is a safe and effective strategy.展开更多
AIM:To evaluate whether narrowing of internal carotid artery siphon(ICAS)may increase the risk of developing non-arteritic anterior ischaemic optic neuropathy(NAION).METHODS:Totally 30 consecutive patients who had uni...AIM:To evaluate whether narrowing of internal carotid artery siphon(ICAS)may increase the risk of developing non-arteritic anterior ischaemic optic neuropathy(NAION).METHODS:Totally 30 consecutive patients who had unilateral NAION and 30 gender-matched control subjects were recruited in the present study.The diameter of ICAS of all the participants were measured using head-and-neck computed tomographic angiography(CTA).Color doppler flow imaging(CDI)was used to measure the haemodynamics parameters of ICAS and short posterior ciliary arteries(SPCAs)in all subjects.Comparison of parameters between the NAION patients and controls as well as between the two sides within the patients were performed.The correlation between the diameter of ICAS and NAION was analyzed.RESULTS:A comparison of parameters between the affected side of the NAION patients and the controls,including the diameter of ICAS,the resistance index(RI)of ICAS,the blood flow velocities of SPCAs and RI of SPCAs,showed significantly difference(P<0.01),while there was no significant difference in terms of the mean blood flow velocity(Vm)of ICAS;Similar results were found while comparing all the measurements of the affected and unaffected side of patients(P for RI of SPCAs<0.05).No marked difference was detected in nearly all parameters except for RI of ICAS and SPCAs between the unaffected side of the NAION patients and the controls(P<0.05).The diameter of ICAS were significantly positive correlated with both peak systolic velocity(PSV)of SPCAs and end diastolic velocity(EDV)of SPCAs in patients with NAION(r=0.514,P<0.01 and r=0.418,P<0.05,respectively).CONCLUSION:Narrowing of ICAS may increase the risk of developing NAION.展开更多
AIM: To evaluate the clinical presentations and visual outcomes of non-arteritic anterior ischaemic optic neuropathy (NAION).METHODS: A retrospective study was conducted involving 18 consecutive patients (20 eyes) wit...AIM: To evaluate the clinical presentations and visual outcomes of non-arteritic anterior ischaemic optic neuropathy (NAION).METHODS: A retrospective study was conducted involving 18 consecutive patients (20 eyes) with NAION attending Hospital Universiti Sains Malaysia from January 2005 until December 2009.RESULTS: Most patients were Malay (94.4%),and followed by Chinese (5.6 %).The female-to-male ratio was 3.5:1.The age of patients ranged from 36 to 85 years (mean,57.1 years).The main risk factors in systemic diseases were hypertension (55.5%),diabetes mellitus (44.4%),and ischaemic heart disease (11.1%).Most patients (77.8%) presented with acute loss of vision while gradual onset was in 22.3% of cases.Majority had visual acuity worse than 1/60 (80%).The most common fundoscopic findings were peripapillary splinter haemorrhage (90%),sectorial swollen optic disc (60%) and hyperemic disc (60%).During follow up,20% of the patients showed stabilization in visual acuity,and 80% showed worsening of vision.CONCLUSION: Majority of patients with NAION presented with acute poor vision involving middle-aged and elderly individuals.Hypertension and diabetes mellitus were among the main risk factors involved.NAION can lead to permanent visual loss despite treatment.展开更多
In spite of a documented reduction in incidence in highincome countries over the last decades, stroke is still a leading cause of death and disability worldwide. With the ageing of the population stroke-related econom...In spite of a documented reduction in incidence in highincome countries over the last decades, stroke is still a leading cause of death and disability worldwide. With the ageing of the population stroke-related economic burden is expected to increase, because of residual disability and its complications, such as cognitive impairment, high risk of falls and fractures, depression and epilepsy. Furthermore, because of the substantial rate of early and long-term vascular recurrences after the first event, secondary prevention after cerebral ischaemia is a crucial issue. This is even more important after minor stroke and transient ischaemic attack(TIA), in order to reduce the risk of potentially more severe and disabling events. To accomplish this aim, acute long-term medical and surgical treatments as well aslifestyle modifications are strongly recommended. However, apart from the well-established indications to thrombolysis, studies in acute phase after a first stroke or TIA are scarce and evidence is lacking. More trials are available for long-term secondary prevention with different classes of drugs, including antithrombotic medications for ischaemic events of arterial and cardiac origin, especially related to atrial fibrillation(antiplatelets and anticoagulants, respectively), lipid lowering agents(mainly statins), blood pressure lowering drugs, surgical and endovascular revascularization procedures.展开更多
Objective:To screen risk factors for epilepsy after acute ischaemic stroke based on meta-analysis and cohort study and to establish a predictive model.Methods:Computer searches of MEDLINE,Embase,Cochrane library,Web o...Objective:To screen risk factors for epilepsy after acute ischaemic stroke based on meta-analysis and cohort study and to establish a predictive model.Methods:Computer searches of MEDLINE,Embase,Cochrane library,Web of Scinence,PubMed,CNKI,and WanFang Data data were conducted to collect literature on epilepsy after in acute ischemic stroke,from database creation to September 1,2022.The RRs and their 95%confidence intervals(CI)for risk factors for post stroke epilepsy were extracted for each study,and pooled estimates of the RRs and 95%CIs for each study were generated using either a random-effects model or a fixed-effects model.Beta coefficients for each risk factor were calculated based on the combined RR and their corresponding 95%CIs.The beta coefficients were multiplied by 10 and rounded.Results:Ten articles were identified for final inclusion in this meta-analysis,with a total of 141948 cases and 3702 cases of post stroke epilepsy.The risk factors included in the final risk prediction model were infarct size(RR 4.67,95%CI 1.41~15.47;P=0.01),stroke recuRRence(RR 2.48,95%CI 2.01~3.05;P<0.00001),stroke etiology(RR 1.70,95%CI 1.34~2.15;P<0.00001),stroke severity(RR 1.70,95%CI 1.34~2.15;P<0.00001),and stroke risk.stroke severity(RR 1.53,95%CI 1.39~1.70;P<0.00001),NIHSS score(RR 2.91,95%CI 1.64~5.61;P=0.0003),early-onset epilepsy(RR 5.62,95%CI 5.08~6.22;P<0.00001),cortical lesions(RR 3.83.95%CI 2.23~6.58;P<0.00001),total anterior circulation infarction(RR 18.94,95%CI 10.38~34.57;P<0.00001),partial anterior circulation infarction(RR 4.39,95%CI 2.29~8.40;P<0.00001),cardiovascular events(RR 1.78,95%CI 1.59~1.99;P<0.00001).Conclusion:Based on a systematic review and meta-analysis,we developed a simple risk prediction model for late epilepsy in baseline ischemic stroke that integrates clinical risk factors,including infarct size,stroke recurrence,stroke etiology,stroke severity,NIHSS score,early onset epilepsy,cortical lesions,stroke subtype,and cardiovascular events.展开更多
<strong>Purpose:</strong> Report of series of cases of cortical blindness that occurred after neonatal hypoxic-ischaemic by analysing its epidemiological frequency in black Africa. <strong>Methodolog...<strong>Purpose:</strong> Report of series of cases of cortical blindness that occurred after neonatal hypoxic-ischaemic by analysing its epidemiological frequency in black Africa. <strong>Methodology:</strong> This is the report of two clinical cases received in consultation on Monday 16<sup>th</sup> November 2020 and Thursday 7<sup>th</sup> January 2021 in the paediatric ophthalmology department of the IOTA-University Hospital. <strong>Results:</strong> They are two infants, aged 05 and 17 months respectively, who were brought in for consultation by their mother for lack of eye-tracking movement since birth. Both infants were born at term following a dystocic delivery. At birth, both infants had a very poor Apar score and were given a resuscitation treatment. The clinical examination coupled with the results of the paraclinical examinations allowed us to conclude at cortical blindness induced the neonatal hypoxic-ischaemic encephalopathy. Their therapeutic management, in collaboration with the neurologist, included the combination of piracetam suspension and Valproate sodium syrup. The evolution after three months of treatment is marked by the regression of epileptic seizures and the perception of light. <strong>Conclusion:</strong> In black Africa, neonatal hypoxic-ischaemic encephalopathy is the second leading cause of cortical blindness in children, after the neuromalaria sequels.展开更多
Objective:to explore the changes of the F-wave in the posterior tibial nerve of rabbits after different levels of lumbar spinal cord ischaemic injury and its correlation with motor function and the extent of lumbar sp...Objective:to explore the changes of the F-wave in the posterior tibial nerve of rabbits after different levels of lumbar spinal cord ischaemic injury and its correlation with motor function and the extent of lumbar spinal cord pathological damage.Methods:thirty New Zealand rabbits were randomly divided into 6 groups.The control group(n=5)was used to exclude the influence of anaesthesia and surgery on the F-wave.Different levels of lumbar arteries were ligated in the five experimental groups(n=5).The F-wave was recorded to observe the changes in the acute phase of spinal cord ischaemia.The correlation between the changes of the F-wave in the acute reversible phase and the motor function of the spinal cord was analysed.Motor functions were assessed after surgery and 2 d after vascular ligation.The specimens were taken 2 d after ligation for histopathologic observation.Results:the results for the control group indicated that anaesthesia and surgery did not affect the F-wave results.There was no statistically significant difference in the F-wave amplitudes and latency before and after ligation in the 1 and 2 level ligation groups.The F-wave changed immediately after ligation in the 3,4 and 5 ligation groups.The latency of the F-wave gradually extended,the amplitude of the F-wave gradually reduced.The amplitude variations of the F-wave were positively correlated with the motor function 2 d after ligation,there was a statistically significant difference.With the increase in the number of vascular ligation,the degree of destruction of the motor neurons in the anterior horn of the spinal cord in the pathological specimens increased.Conclusion:the F-waves in the posterior tibial nerve of rabbits were found to be sensitive to the lumbar spinal cord ischaemic injury and specific to predict motor function.展开更多
Ischaemic Heart Disease (IHD) or Coronary heart disease means that the heart is not getting enough blood and oxygen supply through the coronary arteries. The most common cause of this disease is the process of atheros...Ischaemic Heart Disease (IHD) or Coronary heart disease means that the heart is not getting enough blood and oxygen supply through the coronary arteries. The most common cause of this disease is the process of atherosclerosis in the coronary arteries. Although significant progress has been made in the management of ischaemic heart disease (IHD) The number of severe IHD patients is increasing. The treatment options for IHD <span lang="EN-US" style="font-family:Verdana;">have</span><span lang="EN-US" style="font-family:Verdana;"> not changed much over the last three decades</span><span lang="EN-US" style="font-family:Verdana;">,</span><span lang="EN-US" style="font-size:10pt;font-family:""> </span><span lang="EN-US" style="font-family:Verdana;">w</span><span lang="EN-US" style="font-family:Verdana;">hich </span><span lang="EN-US" style="font-family:Verdana;">is </span><span lang="EN-US" style="font-family:Verdana;">divided between medications, coronary Angioplasty and Coronary artery bypass surgery. Thus it was crucial to develop new, non-invasive therapeutic strategies in case of Failure of medical or interventional therapy or in case patient is not fit for surgery or angioplasty. In this study</span><span lang="EN-US" style="font-family:Verdana;">,</span><span lang="EN-US" style="font-family:Verdana;"> we are pleased to reveal a novel technique </span><span lang="EN-US" style="font-family:Verdana;">that</span><span lang="EN-US" style="font-family:Verdana;"> was carried out on </span><span lang="EN-US" style="font-family:Verdana;">a </span><span lang="EN-US" style="font-family:Verdana;">human model. We aimed to develop low-intensity pulsed ultrasound (LIPUS) therapy for the treatment of patients with Ischaemic Heart Disease. We have set up the inclusion and exclusion criteria, the treatment protocol of LIPUS on IHD patients. In this limited group of IHD patients, We found promising clinical results and improvement on myocardial functions.</span>展开更多
Background Stroke is a major cause of global mortality and disability.Currently,the treatment of acute ischaemic stroke through reperfusion has posed several challenges,raising the need for complementary options to pr...Background Stroke is a major cause of global mortality and disability.Currently,the treatment of acute ischaemic stroke through reperfusion has posed several challenges,raising the need for complementary options to protect the ischaemic penumbra.Recent investigations have indicated that certain epigenetic factors,specifically,histone deacetylases(HDACs)and sirtuins,can be promising for ischaemic stroke therapy,with recent studies suggesting that inhibitors of HDACs or sirtuins may provide neuronal protection after ischaemic stroke.However,the impact of specific HDAC/sirtuin isoforms on the survival of neuronal cells following stroke is still uncertain.This study aims to provide a comprehensive overview of the function of HDACs and their modulators in the treatment of acute ischaemic stroke.Methods This systematic review and meta-analysis will encompass animal intervention studies that explore the efficacy of modulation of HDACs and sirtuins in the acute phase of ischaemic stroke.The review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Electronic searches will be conducted in PubMed,Web of Science and Scopus,with subsequent screening by independent reviewers based on the established eligibility criteria.Methodological quality will be evaluated using the SYRCLE risk of bias tool.The primary outcomes will be infarct volume and functional response,with the secondary outcomes established a priori.Data pertaining to infarct volume will be used for random-effects meta-analysis.Additionally,a descriptive summary will be conducted for the functional response and secondary outcomes.Discussion No systematic review and meta-analysis on the treatment of ischaemic stroke through HDAC modulation has been conducted to date.A comprehensive analysis of the available literature on the relevant preclinical investigations can yield invaluable insights in discerning the most effective trials and in further standardisation of preclinical studies.展开更多
<strong>Introduction:</strong> Ischemic strokes represent a classic complication of infective endocarditis (IE) and are most often related to the fragmentation of valvular vegetation. In most cases, they o...<strong>Introduction:</strong> Ischemic strokes represent a classic complication of infective endocarditis (IE) and are most often related to the fragmentation of valvular vegetation. In most cases, they occur in the Sylvian territory and are related to<em> Staphylococcus aureus</em>. MRI can demonstrate, in addition to the AVCI image, cerebral microbleeds (CMBs) that are very suggestive of the diagnosis. We present the case of a patient who presented an ischemic stroke occurring in the context of infective endocarditis.<strong> Observation:</strong> A 32-year-old woman with no previous medical history initially presented with acute febrile headache, two weeks later she developed right hemiplegia with aphasia in the context of fever. Her general examination revealed lesions on the soles of her feet, in the form of nodules, infected in places, suggestive of Janeway nodules (characteristic of IE). The brain MRI showed an ischemic stroke in the Sylvian territory, with the presence of multiple microbleeds on the magnetic susceptibility sequences. The biological examination showed a severe inflammatory syndrome;the transthoracic echocardiography (TTE) confirmed the presence of vegetation on the aortic valve;and the blood cultures showed a <em>Staphylococcus aureus</em>. Antibiotic therapy was started, and the patient was transferred to the cardiology department. <strong>Discussion: </strong>Our observation has a double interest. The first is clinical due to the presence of plantar nodules (Janeway’s nodules) that are characteristic of IE which should orientate the diagnosis before the installation of the stroke, and the second is radiological and linked to the discovery of microbleeds. Their presence is increasingly reported in the literature, but their pathophysiology is not yet very clear. <strong>Conclusion:</strong> Stroke is the most frequent extracardiac complication during IE. The presence of microbleeds contributes to early diagnosis, especially in asymptomatic forms.展开更多
Background The benefit-risk profile of tenecteplase in the elderly patients with acute ischaemic stroke(AIS)is uncertain.We sought to investigate the efficacy and safety of 0.25 mg/kg tenecteplase compared with altepl...Background The benefit-risk profile of tenecteplase in the elderly patients with acute ischaemic stroke(AIS)is uncertain.We sought to investigate the efficacy and safety of 0.25 mg/kg tenecteplase compared with alteplase for AIS patients aged≥80 years.Methods We performed a post hoc analysis of the Tenecteplase Reperfusion Therapy in Acute Ischaemic Cerebrovascular Events-2 Trial,a randomised,phase 3,non-inferiority clinical trial.Disabling AIS patients aged≥80 years who initiated intravenous thrombolytics within 4.5 hours of symptom onset were enrolled from June 2021 to May 2022 across 53 centres in China and were randomly allocated to receive 0.25 mg/kg tenecteplase or 0.9 mg/kg alteplase.The primary efficacy outcome was the proportion of participants with a modified Rankin Scale(mRS)score of 0-1 at 90 days.Symptomatic intracranial haemorrhage(sICH)within 36 hours was the safety outcome.Results Of 137 participants,mRS 0-1 at 90 days occurred in 37(49.3%)of 75 in the tenecteplase group vs 20(33.9%)of 59 in the alteplase group(risk ratio(RR)1.47,95%CI 0.96 to 2.23).sICH within 36 hours was observed in 3(4.0%)of 76 in the tenecteplase group and two(3.3%)of 61 in the alteplase group(RR 1.30,95%CI 0.20 to 8.41).Conclusions The risk-benefit profile of tenecteplase thrombolysis was preserved in the elderly patients,which lends further support to intravenous 0.25 mg/kg tenecteplase as an alternative to alteplase in these patients.展开更多
Background Statins are essential for secondary prevention after ischaemic stroke(IS).However,statin intensity recommendations differ,and there is a concern about intracerebral haemorrhage(ICH).We studied the long-term...Background Statins are essential for secondary prevention after ischaemic stroke(IS).However,statin intensity recommendations differ,and there is a concern about intracerebral haemorrhage(ICH).We studied the long-term impacts of initial statin intensity following IS.Methods Consecutive patients using high-intensity,moderate-intensity or low-intensity statin early after IS(n=45512)were retrospectively studied using national registries in Finland.Differences were adjusted using multivariable regression.The primary outcome was all-cause death within 12-year follow-up(median 5.9 years).Secondary outcomes were recurrent IS,cardiovascular death and ICH studied using competing risk analyses.Results High-intensity therapy was initially used by 16.0%,moderate-intensity by 73.8%and low-intensity by 10.2%.Risk of death was lower with high-intensity versus moderate-intensity(adjusted HR(adj.HR)0.92;95%CI 0.87 to 0.97;number needed to treat(NNT)32.0),with moderate-intensity versus low-intensity(adj.HR 0.91;95%CI 0.87 to 0.95;NNT 27.5)and with high-intensity versus low-intensity(adj.HR 0.83;95%CI 0.78 to 0.89;NNT 14.6)statin.There was a dose-dependent association of initial statin intensity with a lower probability of recurrent IS(p<0.0001)and cardiovascular death(p<0.0001).The occurrence of ICH was not associated with initial statin intensity(p=0.646).Conclusions Following IS,more intense initial statin treatment is associated with improved long-term outcomes but not with the risk of ICH.These findings emphasise the importance of high statin intensity shortly after IS.展开更多
Background Previous studies have shown contradictory results between early application of antiplatelet therapy and intravenous thrombolysis(IVT)for mild acute ischaemic stroke(AIS),with National Institutes of Health S...Background Previous studies have shown contradictory results between early application of antiplatelet therapy and intravenous thrombolysis(IVT)for mild acute ischaemic stroke(AIS),with National Institutes of Health Stroke Scale score 0-5.Objective To compare the benefits and risks of antiplatelet therapy and IVT in patients with mild AIS.Methods A systematic search of MEDLINE,Embase and Cochrane Library was conducted from database inception until July 2023,without language restriction.Randomised clinical trials(RCTs)or observational studies were selected.The primary outcomes were 90-day functional outcomes,measured by the modified Rankin Scale(mRS)score.The protocol has been registered before data collection.Results Two RCTs and four observational studies with relatively low risk of bias that enrolled 3975 patients were analysed(2454 in antiplatelet therapy and 1521 in IVT therapy).There were no significant differences between antiplatelet therapy and IVT in 90-day functional outcomes(mRS 0-1,OR 1.08(95%CI 0.73 to 1.58);mRS 0-2,OR,1.04(95%CI 0.63 to 1.73)),death(OR,0.64(95%CI 0.19 to 2.13))and stroke recurrence(OR,0.71(95%CI 0.28 to 1.79)).Antiplatelet therapy was associated with a reduced risk of symptomatic intracranial haemorrhage(sICH)compared with IVT(OR,0.20(95%CI 0.06 to 0.69)).Conclusions Among patients with mild AIS,compared with IVT,early application of antiplatelet therapy was not significantly associated with improved functional outcomes,reduced death or stroke recurrence,but was significantly associated with a reduced risk of sICH.展开更多
基金the National Natural Science Foundation of China(No.82201200).
文摘AIM:To investigate the difference in risk factors between non-arteritic anterior ischaemic optic neuropathy(NAION)and central retinal artery occlusion(CRAO)and develop a predictive diagnostic nomogram.METHODS:The study included 37 patients with monocular NAION,20 with monocular CRAO,and 24 with hypertension.Gender,age,and systemic diseases were recorded.Blood routine,lipids,hemorheology,carotid and brachial artery doppler ultrasound,and echocardiography were collected.The optic disc area,cup area,and cup-to-disc ratio(C/D)of the unaffected eye in the NAION and CRAO group and the right eye in the hypertension group were measured.RESULTS:The carotid artery intimal medial thickness(C-IMT)of the affected side of the CRAO group was thicker(P=0.039)and its flow-mediated dilation(FMD)was lower(P=0.049)than the NAION group.Compared with hypertension patients,NAION patients had higher whole blood reduced viscosity low-shear(WBRV-L)and erythrocyte aggregation index(EAI;P=0.045,0.037),and CRAO patients had higher index of rigidity of erythrocyte(IR)and erythrocyte deformation index(EDI;P=0.004,0.001).The optic cup and the C/D of the NAION group were smaller than the other two groups(P<0.0001).The diagnostic prediction model showed high diagnostic specificity(83.7%)and sensitivity(85.6%),which was highly related to hypertension,the C-IMT of the affected side,FMD,platelet(PLT),EAI,and C/D.CONCLUSION:CRAO patients show thicker C-IMT and worse endothelial function than NAION.NAION and CRAO may be related to abnormal hemorheology.A small cup and small C/D may be involved in NAION.The diagnostic nomogram can be used to preliminarily identify NAION and CRAO.
文摘Objective: This study aimed to evaluate the efficacy of trimetazidine on exercise capacity via a six-minute walk test in patients with ischaemic cardiomyopathy and also evaluate the effect of trimetazidine on left ventricular function via echocardiography in the same population. Methods: This prospective observational study, conducted at the National Institute of Cardiovascular Diseases in Dhaka, Bangladesh, enrolled 200 patients with ischaemic cardiomyopathy and a depressed left ventricular ejection fraction (LVEF Results: In this study (n = 200) of ischaemic cardiomyopathy patients, the mean age was 58 years, with 76% of the patients being male. All study subjects received GDMT (Guideline-Directed Medical Therapy) for angina and heart failure. Those who received the modified released form of trimetazidine developed lesions during the 1st and 2nd follow-ups, during which the LVEF, LVIDd, and six-minute walk distance significantly improved (p Conclusion: The findings of the present study demonstrated that the addition of modified-release trimetazidine to GDMT can improve exercise capacity and left ventricular function in patients with ischaemic cardiomyopathy.
文摘Liver transplantation (LT) is the best treatment for end-stage hepatic failure, with an excellent survival rates over the last decade. Biliary complications after LT pose a major challenge especially with the increasing number of procured organs after circulatory death. Ischaemic cholangiopathy (IC) is a set of disorders characterized by multiple diffuse strictures affecting the graft biliary system in the absence of hepatic artery thrombosis or stenosis. It commonly presents with cholestasis and cholangitis resulting in higher readmission rates, longer length of stay, repeated therapeutic interventions, and eventually re-transplantation with consequent effects on the patient’s quality of life and increased health care costs. The pathogenesis of IC is unclear and exhibits a higher prevalence with prolonged ischaemia time, donation after circulatory death (DCD), rejection, and cytomegalovirus infection. The majority of IC occurs within 12 mo after LT. Prolonged warm ischaemic times predispose to a profound injury with a subsequently higher prevalence of IC. Biliary complications and IC rates are between 16% and 29% in DCD grafts compared to between 3% and 17% in donation after brain death (DBD) grafts. The majority of ischaemic biliary lesions occur within 30 d in DCD compared to 90 d in DBD grafts following transplantation. However, there are many other risk factors for IC that should be considered. The benefits of DCD in expanding the donor pool are hindered by the higher incidence of IC with increased rates of re-transplantation. Careful donor selection and procurement might help to optimize the utilization of DCD grafts.
文摘Liver ischaemic preconditioning （IPC） is known to protect the liver from the detrimental effects of ischaemic-reperfusion injury （IRI）, which contributes significantly to the morbidity and mortality following major liver surgery. Recent studies have focused on the role of IPC in liver regeneration, the precise mechanism of which are not completely understood. This review discusses the current understanding of the mechanism of liver regeneration and the role of IPC in this setting. Relevant articles were reviewed from the published literature using the Medline database. The search was performed using the keywords ＂liver＂, ＂ischaemic reperfusion＇, ＂ischaemic preconditioning＂, ＂regeneration＂, ＂hepatectomy＂ and ＂transplantation＂. The underlying mechanism of liver regeneration is a complex process involving the interaction of cytokines, growth factors and the metabolic demand of the liver. IPC, through various mediators, promotes liver regeneration by up-regulating growth-promoting factors and suppresses growth-inhibiting factors as well as damaging stresses. The increased understanding of the cellular mechanisms involved in IPC will enable the development of alternative treatment modalities aimed at promoting liver regeneration following major liver resection and transplantation.
文摘<strong>Background:</strong> Hypokalemia is seen on regular basis in medical emergency. The definition of hypokalemia is serum potassium level below 3.5 mmol/L, meanwhile severe hypokalemia is serum potassium level below 2.5 mmol/L [1]. Patient with hypokalemia can present with wide range of presentation including musculoskeletal complaints from numbness to acute paralysis. Severe hypokalemia has tendency to progress to intestinal paralysis and respiratory failure. In some cases of hypokalemia, cardiovascular system can also be affected causing cardiac arrhythmias and heart failure [2]. <strong>Aim:</strong> This case report is to highlight that severe hypokalaemia can present with ECG changes mimicking acute coronary syndrome (ACS) which was fully resolved with correction of potassium level. <strong>Methods:</strong> We report a case of 84 years old Chinese man with underlying triple vessel disease presented with generalised body weakness for 2 days. ECG on arrival noted changes suggestive of ACS with ST segment depression in lead V4-V6 with first degree heart block, however patient had no ischemic symptoms and the potassium level was severe low at 1.6 mmol/L (3.5 - 5.1 mmol/L). He was correctly not treated for ACS. <strong>Outcomes:</strong> Repeated ECG post fast intravenous potassium correction noted complete resolution of the ST segment depression and first degree heart block. Patient discharged well from hospital four days later with potassium level of 3.8 mmol/L. <strong>Conclusions:</strong> Severe hypokalemia with asymptomatic ECG of ACS changes can safely be treated as a single entity clinical emergency with good resolution and no complication after normalizing potassium level.
文摘Childhood priapism is a rare entity and there is currently no consensus regarding its contemporary management.The use of perioperative anticoagulation and open distal corporaglandular shunt procedure in the management of childhood priapism has not been reported in the literature.We present a stuttering case of a 13-year-old boy who presented with idiopathic ischaemic priapism lasting 13 h in duration,which recurred despite corporal aspiration and alpha-adrenergic agonist injections,percutaneous distal shunt surgery,and revision of percutaneous distal shunt surgery.He was eventually successfully managed with perioperative subcutaneous enoxaparin,oral aspirin and clopidogrel in conjunction with an Al-Ghorab shunt,which led to sustained detumescence but with spontaneous morning erections.In paediatric patients with sustained childhood priaprism failing stepwise treatments,an Al-Ghorab shunt with perioperative anticoagulation is a viable option.
基金This work was supported by a grant to Dr.Ulvi Bayraktutan from the Dunhill Medical Trust(R459/0216)The funder had no role in study design,data collection and analysis,decision to publish or preparation of the manuscript.The contents are solely the responsibility of the author and do not necessarily represent the official views of the DMT.
文摘Ischaemic stroke is a debilitating disease with immense personal,societal and economic impact.Thrombolysis with recombinant tissue plasminogen activator remains the only approved pharmacotherapy for this disease.As each year less than 1%of eligible patients receive this therapy worldwide,efficacious new therapeutics are desperately needed.Emerging evidence suggest endothelial progenitor cells(EPCs),capable of repairing damaged vasculature,as one such therapeutics.However,questions regarding their optimal dose,delivery route and in vivo survivability remain largely unanswered.Outgrowth endothelial cells,generated in large numbers by ex vivo expansion of EPCs,enable effective assessment of these issues and may eventually serve as off-the-shelf therapeutics.Correlations between circulating EPC levels and stroke outcome imply that EPCs may also serve as clinical biomarkers for stroke.This viewpoint briefly evaluates the current evidence,pinpoints the gaps in the literature and proposes new directions for research.
文摘Ischaemic stroke is one of the commonest causes of morbidity and mortality worldwide and around a fifth of events can be attributed to a cardioembolic source. This is typically due to atrial fibrillation(AF), the most common sustained cardiac arrhythmia. However, AF can, at times, be difficult to detect due to a relative lack of symptoms and the fact that it can be paroxysmal in nature. Studies have shown that diagnosis of AF improves as the length of cardiac monitoring increases. However, prolonged cardiac monitoring is not a costeffective way of diagnosing AF. Therefore, an alternative approach may be to empirically anticoagulate individuals who are at high risk of stroke. This article summarises current evidence surrounding stroke risk prediction, the use of anticoagulation in the secondary prevention of stroke and its use in the primary prevention of stroke in high risk groups with the aim of determining whether empirical anticoagulation is a safe and effective strategy.
基金Supported by Start Funding of Beijing Friendship Hospital(No.yyqdkt2016-8)the Capital Health Research and Development of Special(No.2018-1-2021)。
文摘AIM:To evaluate whether narrowing of internal carotid artery siphon(ICAS)may increase the risk of developing non-arteritic anterior ischaemic optic neuropathy(NAION).METHODS:Totally 30 consecutive patients who had unilateral NAION and 30 gender-matched control subjects were recruited in the present study.The diameter of ICAS of all the participants were measured using head-and-neck computed tomographic angiography(CTA).Color doppler flow imaging(CDI)was used to measure the haemodynamics parameters of ICAS and short posterior ciliary arteries(SPCAs)in all subjects.Comparison of parameters between the NAION patients and controls as well as between the two sides within the patients were performed.The correlation between the diameter of ICAS and NAION was analyzed.RESULTS:A comparison of parameters between the affected side of the NAION patients and the controls,including the diameter of ICAS,the resistance index(RI)of ICAS,the blood flow velocities of SPCAs and RI of SPCAs,showed significantly difference(P<0.01),while there was no significant difference in terms of the mean blood flow velocity(Vm)of ICAS;Similar results were found while comparing all the measurements of the affected and unaffected side of patients(P for RI of SPCAs<0.05).No marked difference was detected in nearly all parameters except for RI of ICAS and SPCAs between the unaffected side of the NAION patients and the controls(P<0.05).The diameter of ICAS were significantly positive correlated with both peak systolic velocity(PSV)of SPCAs and end diastolic velocity(EDV)of SPCAs in patients with NAION(r=0.514,P<0.01 and r=0.418,P<0.05,respectively).CONCLUSION:Narrowing of ICAS may increase the risk of developing NAION.
文摘AIM: To evaluate the clinical presentations and visual outcomes of non-arteritic anterior ischaemic optic neuropathy (NAION).METHODS: A retrospective study was conducted involving 18 consecutive patients (20 eyes) with NAION attending Hospital Universiti Sains Malaysia from January 2005 until December 2009.RESULTS: Most patients were Malay (94.4%),and followed by Chinese (5.6 %).The female-to-male ratio was 3.5:1.The age of patients ranged from 36 to 85 years (mean,57.1 years).The main risk factors in systemic diseases were hypertension (55.5%),diabetes mellitus (44.4%),and ischaemic heart disease (11.1%).Most patients (77.8%) presented with acute loss of vision while gradual onset was in 22.3% of cases.Majority had visual acuity worse than 1/60 (80%).The most common fundoscopic findings were peripapillary splinter haemorrhage (90%),sectorial swollen optic disc (60%) and hyperemic disc (60%).During follow up,20% of the patients showed stabilization in visual acuity,and 80% showed worsening of vision.CONCLUSION: Majority of patients with NAION presented with acute poor vision involving middle-aged and elderly individuals.Hypertension and diabetes mellitus were among the main risk factors involved.NAION can lead to permanent visual loss despite treatment.
文摘In spite of a documented reduction in incidence in highincome countries over the last decades, stroke is still a leading cause of death and disability worldwide. With the ageing of the population stroke-related economic burden is expected to increase, because of residual disability and its complications, such as cognitive impairment, high risk of falls and fractures, depression and epilepsy. Furthermore, because of the substantial rate of early and long-term vascular recurrences after the first event, secondary prevention after cerebral ischaemia is a crucial issue. This is even more important after minor stroke and transient ischaemic attack(TIA), in order to reduce the risk of potentially more severe and disabling events. To accomplish this aim, acute long-term medical and surgical treatments as well aslifestyle modifications are strongly recommended. However, apart from the well-established indications to thrombolysis, studies in acute phase after a first stroke or TIA are scarce and evidence is lacking. More trials are available for long-term secondary prevention with different classes of drugs, including antithrombotic medications for ischaemic events of arterial and cardiac origin, especially related to atrial fibrillation(antiplatelets and anticoagulants, respectively), lipid lowering agents(mainly statins), blood pressure lowering drugs, surgical and endovascular revascularization procedures.
基金This study was supported by Hainan Provincial Key Research and Development Plan(ZDYF2021SHFZ092,ZDYF2022SHFZ109),Hainan Provincial Natural Science Foundation(822RC832)Hainan Provincial Clinical Medical Center(2021)Epilepsy Research Innovation Team of Hainan Medical College(2022)。
文摘Objective:To screen risk factors for epilepsy after acute ischaemic stroke based on meta-analysis and cohort study and to establish a predictive model.Methods:Computer searches of MEDLINE,Embase,Cochrane library,Web of Scinence,PubMed,CNKI,and WanFang Data data were conducted to collect literature on epilepsy after in acute ischemic stroke,from database creation to September 1,2022.The RRs and their 95%confidence intervals(CI)for risk factors for post stroke epilepsy were extracted for each study,and pooled estimates of the RRs and 95%CIs for each study were generated using either a random-effects model or a fixed-effects model.Beta coefficients for each risk factor were calculated based on the combined RR and their corresponding 95%CIs.The beta coefficients were multiplied by 10 and rounded.Results:Ten articles were identified for final inclusion in this meta-analysis,with a total of 141948 cases and 3702 cases of post stroke epilepsy.The risk factors included in the final risk prediction model were infarct size(RR 4.67,95%CI 1.41~15.47;P=0.01),stroke recuRRence(RR 2.48,95%CI 2.01~3.05;P<0.00001),stroke etiology(RR 1.70,95%CI 1.34~2.15;P<0.00001),stroke severity(RR 1.70,95%CI 1.34~2.15;P<0.00001),and stroke risk.stroke severity(RR 1.53,95%CI 1.39~1.70;P<0.00001),NIHSS score(RR 2.91,95%CI 1.64~5.61;P=0.0003),early-onset epilepsy(RR 5.62,95%CI 5.08~6.22;P<0.00001),cortical lesions(RR 3.83.95%CI 2.23~6.58;P<0.00001),total anterior circulation infarction(RR 18.94,95%CI 10.38~34.57;P<0.00001),partial anterior circulation infarction(RR 4.39,95%CI 2.29~8.40;P<0.00001),cardiovascular events(RR 1.78,95%CI 1.59~1.99;P<0.00001).Conclusion:Based on a systematic review and meta-analysis,we developed a simple risk prediction model for late epilepsy in baseline ischemic stroke that integrates clinical risk factors,including infarct size,stroke recurrence,stroke etiology,stroke severity,NIHSS score,early onset epilepsy,cortical lesions,stroke subtype,and cardiovascular events.
文摘<strong>Purpose:</strong> Report of series of cases of cortical blindness that occurred after neonatal hypoxic-ischaemic by analysing its epidemiological frequency in black Africa. <strong>Methodology:</strong> This is the report of two clinical cases received in consultation on Monday 16<sup>th</sup> November 2020 and Thursday 7<sup>th</sup> January 2021 in the paediatric ophthalmology department of the IOTA-University Hospital. <strong>Results:</strong> They are two infants, aged 05 and 17 months respectively, who were brought in for consultation by their mother for lack of eye-tracking movement since birth. Both infants were born at term following a dystocic delivery. At birth, both infants had a very poor Apar score and were given a resuscitation treatment. The clinical examination coupled with the results of the paraclinical examinations allowed us to conclude at cortical blindness induced the neonatal hypoxic-ischaemic encephalopathy. Their therapeutic management, in collaboration with the neurologist, included the combination of piracetam suspension and Valproate sodium syrup. The evolution after three months of treatment is marked by the regression of epileptic seizures and the perception of light. <strong>Conclusion:</strong> In black Africa, neonatal hypoxic-ischaemic encephalopathy is the second leading cause of cortical blindness in children, after the neuromalaria sequels.
基金This work was supported by the funds from the Medical and Health Science and Technology Development Project of Shandong Province,China(grant nos.2015WS0375 and 2019WS125)Scientific and Technological Project of Henan Province,China(grant nos.192102310114 and 192102310110).
文摘Objective:to explore the changes of the F-wave in the posterior tibial nerve of rabbits after different levels of lumbar spinal cord ischaemic injury and its correlation with motor function and the extent of lumbar spinal cord pathological damage.Methods:thirty New Zealand rabbits were randomly divided into 6 groups.The control group(n=5)was used to exclude the influence of anaesthesia and surgery on the F-wave.Different levels of lumbar arteries were ligated in the five experimental groups(n=5).The F-wave was recorded to observe the changes in the acute phase of spinal cord ischaemia.The correlation between the changes of the F-wave in the acute reversible phase and the motor function of the spinal cord was analysed.Motor functions were assessed after surgery and 2 d after vascular ligation.The specimens were taken 2 d after ligation for histopathologic observation.Results:the results for the control group indicated that anaesthesia and surgery did not affect the F-wave results.There was no statistically significant difference in the F-wave amplitudes and latency before and after ligation in the 1 and 2 level ligation groups.The F-wave changed immediately after ligation in the 3,4 and 5 ligation groups.The latency of the F-wave gradually extended,the amplitude of the F-wave gradually reduced.The amplitude variations of the F-wave were positively correlated with the motor function 2 d after ligation,there was a statistically significant difference.With the increase in the number of vascular ligation,the degree of destruction of the motor neurons in the anterior horn of the spinal cord in the pathological specimens increased.Conclusion:the F-waves in the posterior tibial nerve of rabbits were found to be sensitive to the lumbar spinal cord ischaemic injury and specific to predict motor function.
文摘Ischaemic Heart Disease (IHD) or Coronary heart disease means that the heart is not getting enough blood and oxygen supply through the coronary arteries. The most common cause of this disease is the process of atherosclerosis in the coronary arteries. Although significant progress has been made in the management of ischaemic heart disease (IHD) The number of severe IHD patients is increasing. The treatment options for IHD <span lang="EN-US" style="font-family:Verdana;">have</span><span lang="EN-US" style="font-family:Verdana;"> not changed much over the last three decades</span><span lang="EN-US" style="font-family:Verdana;">,</span><span lang="EN-US" style="font-size:10pt;font-family:""> </span><span lang="EN-US" style="font-family:Verdana;">w</span><span lang="EN-US" style="font-family:Verdana;">hich </span><span lang="EN-US" style="font-family:Verdana;">is </span><span lang="EN-US" style="font-family:Verdana;">divided between medications, coronary Angioplasty and Coronary artery bypass surgery. Thus it was crucial to develop new, non-invasive therapeutic strategies in case of Failure of medical or interventional therapy or in case patient is not fit for surgery or angioplasty. In this study</span><span lang="EN-US" style="font-family:Verdana;">,</span><span lang="EN-US" style="font-family:Verdana;"> we are pleased to reveal a novel technique </span><span lang="EN-US" style="font-family:Verdana;">that</span><span lang="EN-US" style="font-family:Verdana;"> was carried out on </span><span lang="EN-US" style="font-family:Verdana;">a </span><span lang="EN-US" style="font-family:Verdana;">human model. We aimed to develop low-intensity pulsed ultrasound (LIPUS) therapy for the treatment of patients with Ischaemic Heart Disease. We have set up the inclusion and exclusion criteria, the treatment protocol of LIPUS on IHD patients. In this limited group of IHD patients, We found promising clinical results and improvement on myocardial functions.</span>
文摘Background Stroke is a major cause of global mortality and disability.Currently,the treatment of acute ischaemic stroke through reperfusion has posed several challenges,raising the need for complementary options to protect the ischaemic penumbra.Recent investigations have indicated that certain epigenetic factors,specifically,histone deacetylases(HDACs)and sirtuins,can be promising for ischaemic stroke therapy,with recent studies suggesting that inhibitors of HDACs or sirtuins may provide neuronal protection after ischaemic stroke.However,the impact of specific HDAC/sirtuin isoforms on the survival of neuronal cells following stroke is still uncertain.This study aims to provide a comprehensive overview of the function of HDACs and their modulators in the treatment of acute ischaemic stroke.Methods This systematic review and meta-analysis will encompass animal intervention studies that explore the efficacy of modulation of HDACs and sirtuins in the acute phase of ischaemic stroke.The review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Electronic searches will be conducted in PubMed,Web of Science and Scopus,with subsequent screening by independent reviewers based on the established eligibility criteria.Methodological quality will be evaluated using the SYRCLE risk of bias tool.The primary outcomes will be infarct volume and functional response,with the secondary outcomes established a priori.Data pertaining to infarct volume will be used for random-effects meta-analysis.Additionally,a descriptive summary will be conducted for the functional response and secondary outcomes.Discussion No systematic review and meta-analysis on the treatment of ischaemic stroke through HDAC modulation has been conducted to date.A comprehensive analysis of the available literature on the relevant preclinical investigations can yield invaluable insights in discerning the most effective trials and in further standardisation of preclinical studies.
文摘<strong>Introduction:</strong> Ischemic strokes represent a classic complication of infective endocarditis (IE) and are most often related to the fragmentation of valvular vegetation. In most cases, they occur in the Sylvian territory and are related to<em> Staphylococcus aureus</em>. MRI can demonstrate, in addition to the AVCI image, cerebral microbleeds (CMBs) that are very suggestive of the diagnosis. We present the case of a patient who presented an ischemic stroke occurring in the context of infective endocarditis.<strong> Observation:</strong> A 32-year-old woman with no previous medical history initially presented with acute febrile headache, two weeks later she developed right hemiplegia with aphasia in the context of fever. Her general examination revealed lesions on the soles of her feet, in the form of nodules, infected in places, suggestive of Janeway nodules (characteristic of IE). The brain MRI showed an ischemic stroke in the Sylvian territory, with the presence of multiple microbleeds on the magnetic susceptibility sequences. The biological examination showed a severe inflammatory syndrome;the transthoracic echocardiography (TTE) confirmed the presence of vegetation on the aortic valve;and the blood cultures showed a <em>Staphylococcus aureus</em>. Antibiotic therapy was started, and the patient was transferred to the cardiology department. <strong>Discussion: </strong>Our observation has a double interest. The first is clinical due to the presence of plantar nodules (Janeway’s nodules) that are characteristic of IE which should orientate the diagnosis before the installation of the stroke, and the second is radiological and linked to the discovery of microbleeds. Their presence is increasingly reported in the literature, but their pathophysiology is not yet very clear. <strong>Conclusion:</strong> Stroke is the most frequent extracardiac complication during IE. The presence of microbleeds contributes to early diagnosis, especially in asymptomatic forms.
基金funded by Beijing Municipal Science&Technology Committee(Z211100003521019)China Shijiazhuang Pharmaceutical Company Recomgen Pharmaceutical(Guangzhou)Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(2019-I2M 5-029)National Natural Science Foundation(82111530203,82171272).
文摘Background The benefit-risk profile of tenecteplase in the elderly patients with acute ischaemic stroke(AIS)is uncertain.We sought to investigate the efficacy and safety of 0.25 mg/kg tenecteplase compared with alteplase for AIS patients aged≥80 years.Methods We performed a post hoc analysis of the Tenecteplase Reperfusion Therapy in Acute Ischaemic Cerebrovascular Events-2 Trial,a randomised,phase 3,non-inferiority clinical trial.Disabling AIS patients aged≥80 years who initiated intravenous thrombolytics within 4.5 hours of symptom onset were enrolled from June 2021 to May 2022 across 53 centres in China and were randomly allocated to receive 0.25 mg/kg tenecteplase or 0.9 mg/kg alteplase.The primary efficacy outcome was the proportion of participants with a modified Rankin Scale(mRS)score of 0-1 at 90 days.Symptomatic intracranial haemorrhage(sICH)within 36 hours was the safety outcome.Results Of 137 participants,mRS 0-1 at 90 days occurred in 37(49.3%)of 75 in the tenecteplase group vs 20(33.9%)of 59 in the alteplase group(risk ratio(RR)1.47,95%CI 0.96 to 2.23).sICH within 36 hours was observed in 3(4.0%)of 76 in the tenecteplase group and two(3.3%)of 61 in the alteplase group(RR 1.30,95%CI 0.20 to 8.41).Conclusions The risk-benefit profile of tenecteplase thrombolysis was preserved in the elderly patients,which lends further support to intravenous 0.25 mg/kg tenecteplase as an alternative to alteplase in these patients.
基金supported by grant funding from the Finnish Foundation for Cardiovascular Research sr,and the Finnish State research funding.
文摘Background Statins are essential for secondary prevention after ischaemic stroke(IS).However,statin intensity recommendations differ,and there is a concern about intracerebral haemorrhage(ICH).We studied the long-term impacts of initial statin intensity following IS.Methods Consecutive patients using high-intensity,moderate-intensity or low-intensity statin early after IS(n=45512)were retrospectively studied using national registries in Finland.Differences were adjusted using multivariable regression.The primary outcome was all-cause death within 12-year follow-up(median 5.9 years).Secondary outcomes were recurrent IS,cardiovascular death and ICH studied using competing risk analyses.Results High-intensity therapy was initially used by 16.0%,moderate-intensity by 73.8%and low-intensity by 10.2%.Risk of death was lower with high-intensity versus moderate-intensity(adjusted HR(adj.HR)0.92;95%CI 0.87 to 0.97;number needed to treat(NNT)32.0),with moderate-intensity versus low-intensity(adj.HR 0.91;95%CI 0.87 to 0.95;NNT 27.5)and with high-intensity versus low-intensity(adj.HR 0.83;95%CI 0.78 to 0.89;NNT 14.6)statin.There was a dose-dependent association of initial statin intensity with a lower probability of recurrent IS(p<0.0001)and cardiovascular death(p<0.0001).The occurrence of ICH was not associated with initial statin intensity(p=0.646).Conclusions Following IS,more intense initial statin treatment is associated with improved long-term outcomes but not with the risk of ICH.These findings emphasise the importance of high statin intensity shortly after IS.
基金funded by the National Key R&D Program of China(2022YFC3501100).
文摘Background Previous studies have shown contradictory results between early application of antiplatelet therapy and intravenous thrombolysis(IVT)for mild acute ischaemic stroke(AIS),with National Institutes of Health Stroke Scale score 0-5.Objective To compare the benefits and risks of antiplatelet therapy and IVT in patients with mild AIS.Methods A systematic search of MEDLINE,Embase and Cochrane Library was conducted from database inception until July 2023,without language restriction.Randomised clinical trials(RCTs)or observational studies were selected.The primary outcomes were 90-day functional outcomes,measured by the modified Rankin Scale(mRS)score.The protocol has been registered before data collection.Results Two RCTs and four observational studies with relatively low risk of bias that enrolled 3975 patients were analysed(2454 in antiplatelet therapy and 1521 in IVT therapy).There were no significant differences between antiplatelet therapy and IVT in 90-day functional outcomes(mRS 0-1,OR 1.08(95%CI 0.73 to 1.58);mRS 0-2,OR,1.04(95%CI 0.63 to 1.73)),death(OR,0.64(95%CI 0.19 to 2.13))and stroke recurrence(OR,0.71(95%CI 0.28 to 1.79)).Antiplatelet therapy was associated with a reduced risk of symptomatic intracranial haemorrhage(sICH)compared with IVT(OR,0.20(95%CI 0.06 to 0.69)).Conclusions Among patients with mild AIS,compared with IVT,early application of antiplatelet therapy was not significantly associated with improved functional outcomes,reduced death or stroke recurrence,but was significantly associated with a reduced risk of sICH.
