BACKGROUND:Ischemic stroke refers to a disorder in the blood supply to a local area of brain tissue for various reasons and is characterized by high morbidity,mortality,and disability.Early reperfusion of brain tissue...BACKGROUND:Ischemic stroke refers to a disorder in the blood supply to a local area of brain tissue for various reasons and is characterized by high morbidity,mortality,and disability.Early reperfusion of brain tissue at risk of injury is crucial for the treatment of acute ischemic stroke.The purpose of this study was to evaluate comfort levels in managing acute stroke patients with hypoxemia who required endotracheal intubation after multidisciplinary in situ simulation training and to shorten the door-to-image time.METHODS:This quality improvement project utilized a comprehensive multidisciplinary in situ simulation exercise.A total of 53 participants completed the two-day in situ simulation training.The main outcome was the self-reported comfort levels of participants in managing acute stroke patients with hypoxemia requiring endotracheal intubation before and after simulation training.A 5-point Likert scale was used to measure participant comfort.A paired-sample t-test was used to compare the mean self-reported comfort scores of participants,as well as the endotracheal intubation time and door-to-image time on the fi rst and second days of in situ simulation training.The door-to-image time before and after the training was also recorded.RESULTS:The findings indicated that in situ simulation training could enhance participant comfort when managing acute stroke patients with hypoxemia who required endotracheal intubation and shorten door-to-image time.For the emergency management of hypoxemia or tracheal intubation,the mean post-training self-reported comfort score was signifi cantly higher than the mean pre-training comfort score(hypoxemia:4.53±0.64 vs.3.62±0.69,t=-11.046,P<0.001;tracheal intubation:3.98±0.72 vs.3.43±0.72,t=-6.940,P<0.001).We also observed a decrease in the tracheal intubation and door-to-image time and a decreasing trend in the door-to-image time,which continued after the training.CONCLUSION:Our study demonstrates that the implementation of in situ simulation training in a clinical environment with a multidisciplinary approach may improve the ability and confi dence of stroke team members,optimize the fi rst-aid process,and eff ectively shorten the door-to-image time of stroke patients with emergency complications.展开更多
BACKGROUND:Cerebral stroke is a disease with a high disability rate and a high fatality rate.This study was undertaken to assess the risk of stroke associated pneumonia(SAP) in patients with ischemic stroke using A2DS...BACKGROUND:Cerebral stroke is a disease with a high disability rate and a high fatality rate.This study was undertaken to assess the risk of stroke associated pneumonia(SAP) in patients with ischemic stroke using A2DS2 score.METHODS:Altogether 1 279 patients with ischemic stroke who were treated in our department from 2009 to 2011 were retrospectively analyzed with A2DS2 score. A2DS2 score was calculated as follows:age ≥75 years=1,atrial fi brillation=1,dysphagia=2,male sex=1; stroke severity:NIHSS score 0–4=0,5–15=3,≥16=5. The patients were divided into three groups according to A2DS2 score:620 in score 0 group,383 in score 1–9 group,and 276 in score ≥10 group. The three groups were comparatively analyzed. The diagnostic criteria for SAP were as follows:newly emerging lesions or progressively infiltrating lesions on post-stroke chest images combined with more than two of the following clinical symptoms of infection:(1) fever ≥38 °C;(2) newly occurred cough,productive cough or exacerbation of preexisting respiratory tract symptoms with or without chest pain;(3) signs of pulmonary consolidation and/or wet rales;(4) peripheral white blood cell count ≥10×109/L or ≤4×109/L with or without nuclear shift to left,while excluding some diseases with clinical manifestations similar to pneumonia,such as tuberculosis,pulmonary tumors,non-infectious interstitial lung disease,pulmonary edema,pulmonary embolism and atelectasis. The incidence and mortality of SAP as well as the correlation with ischemic stroke site were analyzed in the three groups respectively. Mean± standard deviation was used to represent measurement data with normal distribution and Student's t test was used. The chi-square test was used to calculate the percentage for enumeration data.RESULTS:The incidence of SAP was significantly higher in the A2DS2 score≥10 group than that in the score 1–9 and score 0 groups(71.7% vs. 22.7%,71.7% vs. 3.7%,respectively),whereas the mortality in the score≥10 group was significantly higher than that in the score 1–9 and score 0 groups(16.7% vs. 4.96%,16.7% vs. 0.3%,respectively). The incidences of cerebral infarction in posterior circulation and cross-MCA,ACA distribution areas were signif icantly higher than those in the SAP group and in the non-SAP group(35.1% vs.10.1%,11.4% vs. 7.5%,respectively). The incidence of non-fermentative bacteria infection was signifi cantly increased in the score≥10 group.CONCLUSIONS:A2DS2 score provides a basis for risk stratifi cation of SAP. The prevention of SAP needs to be strengthened in acute ischemic stroke patients with a A2DS2 score≥10.展开更多
Background Elevated homocysteine （Hcy） has been reported to be associated with cardiovascular events in atrial fibrillation （AF） pa- tients, while the age-related expression pattern of plasma Hcy in AF remains unk...Background Elevated homocysteine （Hcy） has been reported to be associated with cardiovascular events in atrial fibrillation （AF） pa- tients, while the age-related expression pattern of plasma Hcy in AF remains unknown. The study was aimed to investigate the effect of ad- vanced age on plasma Hcy levels and its association with ischemic stroke in non-valvular AF patients. Methods A total of 2562 consecu- tive patients with non-valvular AF and 535 controls were enrolled and divided into six age groups. Plasma Hcy levels were analyzed among different age groups, and the effect of advanced age on Hcy was investigated. Results Plasma Hcy levels did not show any difference among groups aged below 65 years, while it increased sharply in patients aged 65-74 years and aged over 75 years （15.7 ±4.6 μmol/L, 17.1 ±4.9 μmol/L, both P 〈 0.01 compared with the first four age groups）. Hcy was much higher in AF patients than in controls at the same age group （all P 〈 0.05）. The proportion of patients with hyperhomocysteinemia increased gradually with age from 32.3%, 29.2%, 31.2%, 32.4%, 45.9%, to 51.4% in six age groups. The concentration of Hcy in AF patients with ischemic stroke increased progressively with age, and was higher than those without stroke at the same age. Logistic regression analysis demonstrated that age 65-74 years [odds ratios （OR）： 1.742, 95% confidence interval （CI）： 1.223-2.482, P = 0.002] and age ≥ 75 years （OR： 2.637, 95% CI： 1.605-4.335, P 〈 0.001） were significantly independent predictors of elevated plasma Hcy levels. Conclusions Advanced age was significantly associated with elevated Hcy levels, which may provide a possible explanation for the progressive increase in ischemic stroke especially in elderly AF patients.展开更多
Objective To examine whether ischemic preconditioning (IPC) can protect neuron against delayed death in CA1 subfield of hippocampus following reperfusion of a lethal ischemia in rats, and explore the role of p53 and b...Objective To examine whether ischemic preconditioning (IPC) can protect neuron against delayed death in CA1 subfield of hippocampus following reperfusion of a lethal ischemia in rats, and explore the role of p53 and bax in this process. Methods We examined the effect of IPC on delayed neuron death, neuron apoptosis, expressions of p53 and bax gene in the CA1 area of hippocampus in the rats using HE staining, flow cytometry, RT-PCR, and immunohistochemistry technique. Results IPC enhanced the quantity of survival cells in the CA1 region of hippocampus (216±9 cells/0.72 mm2 vs. 30±5 cells/0.72 mm2, P<0.01), decreased the percentages of apoptotic neurons of hippocampus caused by ischemia/reperfusion (2.06%±0.21% vs. 4.27%±0.08%, P<0.01), and weakened the expressions of p53 and bax gene of hippocampus compared with ischemia/reperfusion without IPC. Conclusion IPC can protect the neurons in the CA1 region of hippocampus against apoptosis caused by ische- mia/reperfusion, and this process may be related to the reduced expressions of p53 and bax.展开更多
1 Introduction Ischemic heart disease is caused by atherosclerotic and/or thrombotic obstruction of coronary arteries. Clinical spec- trum of ischemic heart disease expands from asymptomatic atherosclerosis of corona...1 Introduction Ischemic heart disease is caused by atherosclerotic and/or thrombotic obstruction of coronary arteries. Clinical spec- trum of ischemic heart disease expands from asymptomatic atherosclerosis of coronary arteries to acute coronary syn- dromes （ACS） including unstable angina, acute myocardial infarction （non-ST elevation myocardial infarction and ST elevation myocardial infarction）. Stable ischemic heart dis- ease （SIHD） refers to patients with known or suspected SIHD who have no recent or acute changes in their symp- tomatic status, suggesting no active thrombotic process is underway.展开更多
Objective To study prognostic characteristics of cardiac troponin I （cTnI） elevation in acute ischemic stroke. Methods We retrospectively studied patients （n = 248） with acute ischemic stroke, acute ST-segment ele...Objective To study prognostic characteristics of cardiac troponin I （cTnI） elevation in acute ischemic stroke. Methods We retrospectively studied patients （n = 248） with acute ischemic stroke, acute ST-segment elevation myocardial infarction, and acute non-ST-elevation myocardial infarction who were treated between January 2013 and October 2015. Baseline demographic data and changes in cTnI levels among these three groups were compared. Patients with acute ischemic stroke were assigned to either the cTnI elevation group （cTnI 〉 0.034 ng/mL） or the no cTnI elevation group （cTnI ≤ 0.034 ng/mL）. Logistic regression analysis was used to identify risk factors associated with elevated serum cTnI in patients with acute ischemic stroke. Moreover, the duration of hospital stay and incidence of major cardiovascular outcomes were compared in patients with acute ischemic stroke, with or without elevated cTnI. Results In this study population of patients with acute ischemic stroke （n = 178）, acute ST-segment elevation myocardial infarction （n = 35）, and acute non-ST-elevation myocardial infarction （n = 35）, patients with acute ischemic stroke with elevated cTnI comprised 18.54% of subjects. Patients with elevated cTnI were older and more likely to have a history of hypertension. In addition, these patients had higher levels of inflammatory markers, reduced renal functions, increased D-dimer levels, higher NIH stroke scores, and lower left ventricular ejection fractions. Logistic regression analysis showed that both percentage of neutrophil and NIH stroke scores were elevated; estimated glomerular filtration rate and left ventricular ejection fraction were decreased in patients with acute ischemic stroke who had elevated cTnI, and they had more frequent major cardiovascular events during hospital stay. Conclusion Elevated cTnI detected in patients with acute ischemic stroke, indicated a greater likelihood of poor short-term prognosis during hospital stay.展开更多
Dear editor, Following its entrance into the human body through inhalation, carbon monoxide （CO） forms carboxyhemoglobin （COHb） by binding to hemoglobin （Hb） within the blood. Massive ischemic tissue necrosis oc...Dear editor, Following its entrance into the human body through inhalation, carbon monoxide （CO） forms carboxyhemoglobin （COHb） by binding to hemoglobin （Hb） within the blood. Massive ischemic tissue necrosis occurs in 0.5%-1% of cases with CO poisoning. The affinity of CO to Hb is 200-250 times more when compared to the affinity of oxygen. As a result of CO binding to Hb, oxygen delivery to the tissues is reduced, and tissue hypoxia develops. This affects mostly the brain and heart, which are the organs with the highest demand for oxygen.展开更多
Objectives To study the relationship between plasma hemoglobin concentration and estimated glomerular filtration rate （eGFR） in elderly patients with ischemic cardiomyopathy （ICM）.Methods Clinical data of patients...Objectives To study the relationship between plasma hemoglobin concentration and estimated glomerular filtration rate （eGFR） in elderly patients with ischemic cardiomyopathy （ICM）.Methods Clinical data of patients with coronary heart disease who were discharged from The First Affiliated Hospital,Chongqing Medical University between 2005 and 2007 were analyzed retrospectively. Echocardiography results,plasma hemoglobin and creatinine concentration were abstracted from the medical records.The study included 235 Chinese Hart patients with age 60 years and older with angiography confirmed coronary heart disease,silent myocardial ischemia or angina pectoris,of whom 154 had ICM defined as left ventricular end-diastolic diameter （LVDd）,male≥56 mm,female≥51 mm （63. 51±7.70 mm） measured by M-mode echocardiography.The differences in plasma hemoglobin concentration were analyzed retrospec- tively between patients with and without ICM,and between patients with an eGFR【60 ml·min<sup>-1</sup>·1.73m<sup>-2</sup> and those with an eGFR≥60 ml·min<sup>-1</sup>·1.73m<sup>-2</sup>.Results There were no significant differences in plasma hemoglobin concentration and eGFR between ICM and non-ICM group (118.49±20.52 g·L<sup>-1</sup> vs.115.80±23.32 g·L<sup>-1</sup> and 75.13±24.21 ml·min<sup>-1</sup>·1.73m<sup>-2</sup> vs.79.09±28.41 ml·min<sup>- 1</sup>·1.73m<sup>-2</sup>,respectively,both P】0.05).However,in both ICM and non-ICM groups,plasma hemoglobin concentration was lower in those with an eGFR【60 ml·min<sup>-1</sup>·1.73m<sup>-2</sup> compared with compared with those with an eGFR≥60 ml·min<sup>-1</sup>·1.73m<sup>-2</sup> group (112. 29±18.61 g·L<sup>-1</sup> vs.119.92±20.74L<sup>-1</sup>,P【0.05);plasma hemoglobin concentration was related positively to eGFR.Conclusions There were no significant changes in plasma hemoglobin concentration and eGFR;however,plasma hemoglobin concentration was related to eGFR significantly positively in elderly patients with ICM due to coronary heart展开更多
Objective The -455 G/A(HaeIII)polymorphism of β-fibrinogen gene influences levels of plasma fibrinogen. We further investigated whether it influences the risk of ischemic cerebrovascular disease. Methods We accumulat...Objective The -455 G/A(HaeIII)polymorphism of β-fibrinogen gene influences levels of plasma fibrinogen. We further investigated whether it influences the risk of ischemic cerebrovascular disease. Methods We accumulated 134 acute ischemic cerebrovascular disease(ICVD)cases and compared their -455 G/A status with a control group(n = 166). The β-fibrinogen gene -455 G/A polymorphism was analyzed for all subjects by PCR-RFLP with the restrictive enzyme HaeIII. Results Plasma fibrinogen was higher in AA homozygous participants(341 mg/dL)than in partici-pants carrying the G allele: GA(290 mg/dL), GG(298 mg/dL)in the control group. Plasma fibrinogen was also higher in AA homozygous patients(353 mg/dL)than in cases carrying the G allele: GA(287 mg/dL), GG(302 mg/dL)in the ICVD group. However, there was no significant association between β-fibrinogen gene -455 G/A polymorphism and ICVD group. Conclusions Although a small effect cannot be excluded, β-fibrinogen gene -455 G/A polymor-phism is an independent predictor of plasma fibrinogen, but not of ischemic cerebrovascular disease.展开更多
BACKGROUND: This systematic review aims to investigate the prediction value of diffusion tensor imaging for motor function recovery of ischemic stroke patients.METHODS: Cochrane Central Register of Controlled Trials(C...BACKGROUND: This systematic review aims to investigate the prediction value of diffusion tensor imaging for motor function recovery of ischemic stroke patients.METHODS: Cochrane Central Register of Controlled Trials(CENTRAL)(the Cochrane Library 2016, Issue 9), Pub Med, Embase, Clarivate Analytics, Scopus, CINAHL, Chinese Biomedical Literature Database, China National Knowledge Infrastructure and Google Scholar were searched for either motor recovery or corticospinal tract integrity by diffusion tensor imaging in different stroke phase from January 1, 1970, to October 31, 2016. The study design and participants were subjected to metrological analysis. Correlation coeffi cient(r) was used for evaluating the relationship between fractional anisotropy(FA) and motor function outcome. Correlation coeffi cient values were extracted from each study, and 95% confidence intervals(CIs) were calculated by Fisher's z transformation. Meta-analysis was conducted by STATA software.RESULTS: Fifteen studies with a total of 414 patients were included. Meta-analysis showed that FA in the subacute phase had the signifi cant correlation with motor function outcome(ES=0.75, 95%CI 0.62–0.87), which showed moderate quality based on GRADE system. The weight correlation coeffi cient revealed that an effect size(ES) of FA in acute phase and chronic phase was 0.51(95%CI 0.33–0.68) and 0.62(95%CI 0.47–0.77) respectively.CONCLUSION: This meta-analysis reveals that FA in the subacute phase after ischemic stroke is a good predictor for functional motor recovery, which shows moderate quality based on the GRADE system.展开更多
Ischemic stroke is one of the leading causes of death worldwide,and effective treatment strategies in the chronic phase of this disease remain insufficient.Homeostasis of metals in the brain plays an important role in...Ischemic stroke is one of the leading causes of death worldwide,and effective treatment strategies in the chronic phase of this disease remain insufficient.Homeostasis of metals in the brain plays an important role in maintaining normal brain function.However,the dynamic spatial distributions of iron,zinc,calcium,potassium,and copper in a rat brain following ischemic stroke and the association between structural distribution and function remain to be elucidated.In this study,we used a synchrotron radiation-based micro-X-ray fluorescence technique to image element mapping changes in special rat brain regions after ischemic stroke,showing the distribution characteristics of iron,zinc,calcium,potassium,and copper.We demonstrated,for the first time,the consistent dynamic spatial distributions of metal elements at a series of time points(3 h,4.5 h,6 h,12 h,1 d,3 d,5 d,7 d,10 d,14 d,28 d)after brain ischemia,which revealed that the homeostasis of iron,zinc,calcium,potassium,and copper in the brain was disturbed with distinctive change trends,providing clear insights in understanding the underlying pathogenesis of stroke from a novel perspective,thus laying the foundation of further developing new drug targets for stroke treatment.展开更多
Background Chronic heart failure （CHF） is life-threatening without timely or effective intervention. In this study, we investigated the association between QT dispersion corrected for heart rate （cQTd） and heart f...Background Chronic heart failure （CHF） is life-threatening without timely or effective intervention. In this study, we investigated the association between QT dispersion corrected for heart rate （cQTd） and heart function in patients with CHF. Methods From January 2013 to December 2015, we continuously enrolled 240 patients categorized as New York Heart Association functional class （NYHA） III-IV with a left ventricular ejection fraction （LVEF） 〈 40%. Based on the etiology, the patients were divided into a dilated cardiomyopathy （DCM） group （n = 120） and an ischemic cardiomyopathy （ICM） group （n = 120）. Then, based on the cQTd width, the ICM group was divided into two subgroups： a QS group （cQTd ≤60 ms, n = 70） and a QL group （cQTd 〉 60 ms, n = 50）. All patients were examined by echocardiography and 12-lead electrocardiography （ECG） at 1, 3, 6, and 12 months after enrollment. Results After one year of optimized medical treatment, patients in both groups showed significant improvement in LVEF and NYHA classification from baseline. However, the cQTd in the ICM group, especially the QL, was significantly shorter than that in the DCM group at each time point. In addition, the cQTd was negatively correlated with LVEF and 6-min walking test and positively correlated with NYHA class in the ICM group. Conclusions The present findings clearly demonstrate that cQTd is a meaningful parameter for assessing heart function in the follow-up of ICM patients.展开更多
ObjectiveTo assess the in vivo dynamic blood flow features of posterior optic nerve head (ONH) in rat model of nonarteritic anterior ischemic optic neuropathy (rNAION). MethodsrNAION was established with Rose Bengal a...ObjectiveTo assess the in vivo dynamic blood flow features of posterior optic nerve head (ONH) in rat model of nonarteritic anterior ischemic optic neuropathy (rNAION). MethodsrNAION was established with Rose Bengal and argon green laser in Sprague-Dawley rats. Fundus photography and fundus fluorescein angiography (FFA) were performed to assess the dynamic changes of optic disc in morphology in 90 days and in blood perfusion in 3 hours after the induction of disease. Histological examinations were performed to evaluate the success of modeling. Thedynamic blood flow kinetics of posterior ONH in rNAION were measured by Laser Doppler Flowmetry (LDF) on the day 3, 7, 14, 21, and 40 after the disease induction. One-way ANOVA, Student'st-test and Bonferroni adjustment were used for multiple comparisons of kinetic measurements of blood flow. ResultsOptic disc edema and subsequent resolution associated with the development of optic disc pallor were observed in rNAION. FFA showed that the optic disc was hypofluorescence in the early phase and hyperfluorescence in the late phase. Histological studies suggested edema and loosened tissues of ONH, loss of retinal ganglion cells (RGCs), optic nerve substance and gliosis. Compared to the naive rats, the blood flow kinetics of posterior ONH in rNAION significant reduced at each time point after modeling (F=175.06,P<0.0001). The reductions were specifically remarkable in 14 days after the disease induction (AllP<0.01). Conclusions Continuous blood perfusion reduction was found in rNAION, with significant alteration in 14 days after disease induction. Our results provided important information for understanding the hemodynamic changes in rNAION.展开更多
Objective To compare the influence of different sulfonylureas on the myocardial protection effect of ischemic preconditioning (IPC) in isolated rat hearts, and ATP-sensitive potassium channel current (IKATP) of rat ve...Objective To compare the influence of different sulfonylureas on the myocardial protection effect of ischemic preconditioning (IPC) in isolated rat hearts, and ATP-sensitive potassium channel current (IKATP) of rat ventricular myocytes. Methods Isolated Langendorff perfused rat hearts were randomly assigned to five groups: (1) control group, (2) IPC group, (3) IPC+glibenclamide (GLB, 10 μmol/L) group, (4) IPC+glimepiride (GLM, 10 μmol/L) group, (5) IPC+gliclazide (GLC, 50 μmol/L) group. IPC was defined as 3 cycles of 5-minute zero-flow global ischemia followed by 5-minute reperfusion. The haemodynamic parameters and the infarct size of each isolated heart were recorded. And the sarcolemmal IKATP of dissociated ventricular myocytes reperfused with 10 μmol/L GLB, 1 μmol/L GLM, and 1 μmol/L GLC was recorded with single-pipette whole-cell voltage clamp under simulated ischemic condition. Results The infarct sizes of rat hearts in IPC (23.7%±1.3%), IPC+GLM (24.6%±1.0%), and IPC+GLC (33.1%±1.3%) groups were all significantly smaller than that in control group (43.3%±1.8%; P<0.01, n=6). The infarct size of rat hearts in IPC+GLB group (40.4%±1.4%) was significantly larger than that in IPC group (P<0.01, n=6). Under simulated ischemic condition, GLB (10 μmol/L) decreased IKATP from 20.65±7.80 to 9.09±0.10 pA/pF (P<0.01, n=6), GLM (1 μmol/L) did not significantly inhibit IKATP (n=6), and GLC (1 μmol/L) decreased IKATP from 16.73±0.97 to 11.18±3.56 pA/pF(P<0.05, n=6). Conclusions GLM has less effect on myocardial protection of IPC than GLB and GLC. Blockage of sarcolemmal ATP-sensitive potassium channels in myocardium might play an important role in diminishing IPC-induced protection of GLM, GLB, and GLC.展开更多
BACKGROUND:S100B protein in patients with cardiac arrest,hemorrhagic shock and other causes of global cerebral ischemic injury will be dramatically increased.Ischemic brain injury may elevate the level of serum S100 B...BACKGROUND:S100B protein in patients with cardiac arrest,hemorrhagic shock and other causes of global cerebral ischemic injury will be dramatically increased.Ischemic brain injury may elevate the level of serum S100 B protein and the severity of brain damage.METHODS:This article is a critical and descriptive review on S100 B protein in serum after ischemic brain injury.We searched Pubmed database with key words or terms such as "S100B protein", "cardiac arrest", "hemorrhagic shock" and "ischemia reperfusion injury" appeared in the last five years.RESULTS:S100B protein in patients with cardiac arrest,hemorrhagic shock and other causes of ischemic brain injury will be dramatically increased.Ischemic brain injury elevated the level of serum S100 B protein,and the severity of brain damage.CONCLUSION:The level of S100 B protein in serum is elevated after ischemic brain injury,but its mechanism is unclear.展开更多
Objective To investigate whether admission time was associated with the delay of reperfusion therapy and in-hospital death in patients with ST-elevation myocardial infarction （STEMI）. Methods All patients with STEMI...Objective To investigate whether admission time was associated with the delay of reperfusion therapy and in-hospital death in patients with ST-elevation myocardial infarction （STEMI）. Methods All patients with STEMI who were admitted to the emergency depart- ment and underwent primary percutaneous coronary intervention at Peking University People＇s Hospital between April 2012 and March 2015 were included. We examined differences in clinical characteristics, total ischemic time, and in-hospital death between patients admitted during off-hours and those admitted during regular hours. Multivariate logistic regression was used to estimate the relationship between off-hours admission and clinical outcome. Results The sample comprised 184 and 105 patients with STEMI admitted to hospital during off-hours and regular hours, respectively. Total ischemic and onset-to-door times were significantly shorter in patients admitted during off-hours than among those admitted during regular hours （all P 〈 0.05）. Door-to-balloon （DTB） time, the rate of DTB time 〈 90 min, and in-hospital death were comparable between groups. Multivariate logistic regression showed that age and creatinine level, but not off-hours admission, were associated independently with increased in-hospital death. Conclusions Off-hours admission did not result in delayed reperfusion therapy or increased in-hospital mortality in patients with STEMI. Further efforts should focus on identifying pivotal factors associated with the pre-hospital and in-hospital delay of reperfusion therapy, and implementing quality improvement initiatives for reperfusion programs.展开更多
Objective To investigate the therapeutic effectiveness of intracoronary implantation of autologous bone marrow mononuclear cells (BM-MNC) in miniswine model of reperfused myocardial infarction. Methods Sixteen miniswi...Objective To investigate the therapeutic effectiveness of intracoronary implantation of autologous bone marrow mononuclear cells (BM-MNC) in miniswine model of reperfused myocardial infarction. Methods Sixteen miniswine myocardial ischemic reperfusion injury models made by ligation of the distal one third segment of left anterior descending artery for 90 minutes were randomized into 2 groups. In BM-MNC group (n = 9), (3.54±0.90)×108 BM-MNC were intracoronary injected, and in the control group (n = 7), phosphate buffered saline was injected by the same way. Echocardiographic and hemodynamic results, vessel density, and myocardial infarction size were evaluated and compared before and 4 weeks after cell transplantation. Results In BM-MNC group, there were no differences between before and 4 weeks after transplantation in aspects of left ventricular ejection fraction (LVEF), interventricular septal thickness, left ventricular lateral and anterior septal wall thickness, cardiac output, or +dp/dtmax. In control group, LVEF, interventricular septal thickness, left ventricular lateral and anterior septal wall thickness, cardiac output, and +dp/dtmax decreased significantly 4 weeks after transplantation (P < 0.05). Left ventricular end-diastolic pressure and –dp/dtmax did not change significantly before and after cell transplantation in both groups. Capillary density in BM-MNC group was greater than that in control group [(13.39 ± 6.96)/high power field vs. (3.50 ± 1.90)/high power field, P < 0.05]. Infarction area assessed by tetrazolium red staining and the infarction percentage decreased in BM-MNC group compared with those in control group (P < 0.05). Conclusions Transplantation of BM-MNC into myocardium with ischemic reperfusion injury increases capillary density and decreases infarction area. It has significantly beneficial effect on cardiac systolic function rather than on diastolic function.展开更多
BACKGROUND: Weather conditions are thought to increase the risk of stroke occurrence. But their mechanism has not yet been clarified. We investigated possible relationships between ischemic stroke and weather conditio...BACKGROUND: Weather conditions are thought to increase the risk of stroke occurrence. But their mechanism has not yet been clarified. We investigated possible relationships between ischemic stroke and weather conditions including atmospheric pressure, temperature, relative humidity, and wind speed.METHODS: One hundred and twenty-eight patients with ischemic stroke who had been admitted to our hospital between January 1 and December 31, 2010 were enrolled in this study. We investigated the relationship between daily cases and weather conditions the same day or 1, 2, and 3 days before stroke.RESULTS: A negative correlation was found between maximum wind speed and daily cases 3 days before stroke. As the relationship between daily cases and changes of weather conditions in consecutive days was evaluated, a negative correlation was found between daily cases and change of atmospheric pressure in the last 24 hours.CONCLUSIONS: The maximum wind speed 3 days before stroke and change of atmospheric pressure in the last 24 hours were found to increase the cases of ischemic stroke. We recommend that individuals at risk of ischemic stroke should pay more attention to preventive measures, especially on days with low maximum wind speed, on subsequent 3 days, and on days with low atmospheric pressure in the last 24 hours.展开更多
Objective: To study the correlation between aquaporin-4 ( AQP4) expression and diffusion-weighted imaging ( DWI) in the process of ischemic brain edema for the molecular biologic mechanism of DWI. Methods: A total of ...Objective: To study the correlation between aquaporin-4 ( AQP4) expression and diffusion-weighted imaging ( DWI) in the process of ischemic brain edema for the molecular biologic mechanism of DWI. Methods: A total of 34 Wistar rats were divided into 8 groups randomly: Non-operated group (n = 4) , sham-operated group (n = 6) , and operated group, receiving right middle cerebral artery occlusion ( MCAO) for 15 and 30 min, and 1,3,6 and 24 h respectively (6 subgroups, n =4). All groups were imaged with DWI and T2WI. The apparent diffusion coefficient (ADC) , relevant density (rd) and relevant area (rs) of hyperintensity of the lesions on DWI and T2WI were measured. Relevant ADC (rADC) , relevant area of immunohistochemical staining for AQP4 (rS) , optical density of AQP4 hybridization (a) were calculated. After that the animals were sacrificed and perfused at different time intervals, correlations between DWI, ADC, and AQP4 expression (rS, a) in ischemic tissue was made. Results: There was a significant correlation between rS and a ( r = 0. 949 ). The abnormal high intensity was found in DWI of the ipsilateral MAC territory at 15 min after MCAO. The ADC value decreased quickly within 1 h after MCAO, the rd and rs of DWI increased rapidly and the expression of AQP4 increased quickly, too. However, there was no change on the T2WI. In the period of time (15 min - 1 h) , the AQP4 expression( a) had a strong relation to the rd and rs( r = 0. 914, 0. 895). With the progress of the time, the ADC value of MCAO decreased further to (2.1±0.6)×10-4 mm2/s at 3 h, and then followed an increased slowly till 24 h, but the rd and the rs as well as the expression of AQP4 continuously increased during the stage. The T2WI detected the lesion at the average time (1.4 h) after MCAO, and the rs of T2WI was less than that of DWI at the same time in the same layer (P < 0.05). Conclusion: The results imply that high expression of AQP4 may play a key role in ischemic brain edema. It is, certainly, one of the important reasons of the DWI molecular biologic mechanism in the cerebral ischemia.展开更多
BACKGROUND：Stroke is one of the leading causes of mortality and morbidity of vascular diseases, and its incidence maintains at a high level around the world. In China, stroke has been a major public health problem. B...BACKGROUND：Stroke is one of the leading causes of mortality and morbidity of vascular diseases, and its incidence maintains at a high level around the world. In China, stroke has been a major public health problem. Because the pathogenesis of ischemic stroke is different from that of hemorrhagic stroke, their clinical factors would not be the same. Therefore to investigate the different effects of various effect factors on ischemic versus hemorrhagic stroke and then to enhance the prevention are crucial to decrease the incidence.METHODS：A total of 692 patients, consisting of 540 ischemic stroke patients and 152 hemorrhagic stroke patients from East China, were included in this study. The related factors of stroke subtypes were collected and analyzed.RESULTS：The factors significantly associated with ischemic stroke as opposed to hemorrhagic stroke were family history of stroke, obesity, atherosclerotic plaque of the common carotid artery, atrial fibrillation, hyperfibrinogenemia, transient ischemic attack （TIA）, atherosclerotic plaque of the internal carotid artery, coronary heart, lower high-density lipoproteins （lower HDL）, increasing age, diabetes mellitus, and gender （male） （P〈0.05）. Leukocytosis, hypertension and family history of hypertension were the significant factors associated with hemorrhagic stroke versus ischemic stroke. Smoking, drinking, kidney diseases and lower HDL-C were the significant factors contributing to ischemic stroke in man. Obesity, family history of hypertension, family history of stroke, hypercholesteremia and myocardial ischemia were the significant factors for females with ischemic stroke.CONCLUSIONS：The most prominent factors for overall stroke in East China were hypertension, followed by higher pulse pressure and hypercholesteremia. The factors for ischemic and hemorrhagic stroke are not the same. Different effects of risk factors on stroke are found in male and female patients.展开更多
基金supported by Hangzhou Construction Fund of Key Medical Disciplines(OO20200265)Zhejiang Medical and Health Science and Technology Plan Project(2020KY687)+1 种基金Hangzhou Science and Technology Development Project(20200401B04)Hangzhou Biomedical and Health Industry Development Supporting Technology Projects(2021WJCY256).
文摘BACKGROUND:Ischemic stroke refers to a disorder in the blood supply to a local area of brain tissue for various reasons and is characterized by high morbidity,mortality,and disability.Early reperfusion of brain tissue at risk of injury is crucial for the treatment of acute ischemic stroke.The purpose of this study was to evaluate comfort levels in managing acute stroke patients with hypoxemia who required endotracheal intubation after multidisciplinary in situ simulation training and to shorten the door-to-image time.METHODS:This quality improvement project utilized a comprehensive multidisciplinary in situ simulation exercise.A total of 53 participants completed the two-day in situ simulation training.The main outcome was the self-reported comfort levels of participants in managing acute stroke patients with hypoxemia requiring endotracheal intubation before and after simulation training.A 5-point Likert scale was used to measure participant comfort.A paired-sample t-test was used to compare the mean self-reported comfort scores of participants,as well as the endotracheal intubation time and door-to-image time on the fi rst and second days of in situ simulation training.The door-to-image time before and after the training was also recorded.RESULTS:The findings indicated that in situ simulation training could enhance participant comfort when managing acute stroke patients with hypoxemia who required endotracheal intubation and shorten door-to-image time.For the emergency management of hypoxemia or tracheal intubation,the mean post-training self-reported comfort score was signifi cantly higher than the mean pre-training comfort score(hypoxemia:4.53±0.64 vs.3.62±0.69,t=-11.046,P<0.001;tracheal intubation:3.98±0.72 vs.3.43±0.72,t=-6.940,P<0.001).We also observed a decrease in the tracheal intubation and door-to-image time and a decreasing trend in the door-to-image time,which continued after the training.CONCLUSION:Our study demonstrates that the implementation of in situ simulation training in a clinical environment with a multidisciplinary approach may improve the ability and confi dence of stroke team members,optimize the fi rst-aid process,and eff ectively shorten the door-to-image time of stroke patients with emergency complications.
文摘BACKGROUND:Cerebral stroke is a disease with a high disability rate and a high fatality rate.This study was undertaken to assess the risk of stroke associated pneumonia(SAP) in patients with ischemic stroke using A2DS2 score.METHODS:Altogether 1 279 patients with ischemic stroke who were treated in our department from 2009 to 2011 were retrospectively analyzed with A2DS2 score. A2DS2 score was calculated as follows:age ≥75 years=1,atrial fi brillation=1,dysphagia=2,male sex=1; stroke severity:NIHSS score 0–4=0,5–15=3,≥16=5. The patients were divided into three groups according to A2DS2 score:620 in score 0 group,383 in score 1–9 group,and 276 in score ≥10 group. The three groups were comparatively analyzed. The diagnostic criteria for SAP were as follows:newly emerging lesions or progressively infiltrating lesions on post-stroke chest images combined with more than two of the following clinical symptoms of infection:(1) fever ≥38 °C;(2) newly occurred cough,productive cough or exacerbation of preexisting respiratory tract symptoms with or without chest pain;(3) signs of pulmonary consolidation and/or wet rales;(4) peripheral white blood cell count ≥10×109/L or ≤4×109/L with or without nuclear shift to left,while excluding some diseases with clinical manifestations similar to pneumonia,such as tuberculosis,pulmonary tumors,non-infectious interstitial lung disease,pulmonary edema,pulmonary embolism and atelectasis. The incidence and mortality of SAP as well as the correlation with ischemic stroke site were analyzed in the three groups respectively. Mean± standard deviation was used to represent measurement data with normal distribution and Student's t test was used. The chi-square test was used to calculate the percentage for enumeration data.RESULTS:The incidence of SAP was significantly higher in the A2DS2 score≥10 group than that in the score 1–9 and score 0 groups(71.7% vs. 22.7%,71.7% vs. 3.7%,respectively),whereas the mortality in the score≥10 group was significantly higher than that in the score 1–9 and score 0 groups(16.7% vs. 4.96%,16.7% vs. 0.3%,respectively). The incidences of cerebral infarction in posterior circulation and cross-MCA,ACA distribution areas were signif icantly higher than those in the SAP group and in the non-SAP group(35.1% vs.10.1%,11.4% vs. 7.5%,respectively). The incidence of non-fermentative bacteria infection was signifi cantly increased in the score≥10 group.CONCLUSIONS:A2DS2 score provides a basis for risk stratifi cation of SAP. The prevention of SAP needs to be strengthened in acute ischemic stroke patients with a A2DS2 score≥10.
基金This work was supported by grants from the National Natural Science Foundation of China （No. 81670294, 81200141） Beijing Novel Program （No. 2011081, Z131103000413116）.
文摘Background Elevated homocysteine （Hcy） has been reported to be associated with cardiovascular events in atrial fibrillation （AF） pa- tients, while the age-related expression pattern of plasma Hcy in AF remains unknown. The study was aimed to investigate the effect of ad- vanced age on plasma Hcy levels and its association with ischemic stroke in non-valvular AF patients. Methods A total of 2562 consecu- tive patients with non-valvular AF and 535 controls were enrolled and divided into six age groups. Plasma Hcy levels were analyzed among different age groups, and the effect of advanced age on Hcy was investigated. Results Plasma Hcy levels did not show any difference among groups aged below 65 years, while it increased sharply in patients aged 65-74 years and aged over 75 years （15.7 ±4.6 μmol/L, 17.1 ±4.9 μmol/L, both P 〈 0.01 compared with the first four age groups）. Hcy was much higher in AF patients than in controls at the same age group （all P 〈 0.05）. The proportion of patients with hyperhomocysteinemia increased gradually with age from 32.3%, 29.2%, 31.2%, 32.4%, 45.9%, to 51.4% in six age groups. The concentration of Hcy in AF patients with ischemic stroke increased progressively with age, and was higher than those without stroke at the same age. Logistic regression analysis demonstrated that age 65-74 years [odds ratios （OR）： 1.742, 95% confidence interval （CI）： 1.223-2.482, P = 0.002] and age ≥ 75 years （OR： 2.637, 95% CI： 1.605-4.335, P 〈 0.001） were significantly independent predictors of elevated plasma Hcy levels. Conclusions Advanced age was significantly associated with elevated Hcy levels, which may provide a possible explanation for the progressive increase in ischemic stroke especially in elderly AF patients.
基金Supported by a grant from Shandong Natural Sciences Foundation(Y2005C96).
文摘Objective To examine whether ischemic preconditioning (IPC) can protect neuron against delayed death in CA1 subfield of hippocampus following reperfusion of a lethal ischemia in rats, and explore the role of p53 and bax in this process. Methods We examined the effect of IPC on delayed neuron death, neuron apoptosis, expressions of p53 and bax gene in the CA1 area of hippocampus in the rats using HE staining, flow cytometry, RT-PCR, and immunohistochemistry technique. Results IPC enhanced the quantity of survival cells in the CA1 region of hippocampus (216±9 cells/0.72 mm2 vs. 30±5 cells/0.72 mm2, P<0.01), decreased the percentages of apoptotic neurons of hippocampus caused by ischemia/reperfusion (2.06%±0.21% vs. 4.27%±0.08%, P<0.01), and weakened the expressions of p53 and bax gene of hippocampus compared with ischemia/reperfusion without IPC. Conclusion IPC can protect the neurons in the CA1 region of hippocampus against apoptosis caused by ische- mia/reperfusion, and this process may be related to the reduced expressions of p53 and bax.
文摘1 Introduction Ischemic heart disease is caused by atherosclerotic and/or thrombotic obstruction of coronary arteries. Clinical spec- trum of ischemic heart disease expands from asymptomatic atherosclerosis of coronary arteries to acute coronary syn- dromes （ACS） including unstable angina, acute myocardial infarction （non-ST elevation myocardial infarction and ST elevation myocardial infarction）. Stable ischemic heart dis- ease （SIHD） refers to patients with known or suspected SIHD who have no recent or acute changes in their symp- tomatic status, suggesting no active thrombotic process is underway.
文摘Objective To study prognostic characteristics of cardiac troponin I （cTnI） elevation in acute ischemic stroke. Methods We retrospectively studied patients （n = 248） with acute ischemic stroke, acute ST-segment elevation myocardial infarction, and acute non-ST-elevation myocardial infarction who were treated between January 2013 and October 2015. Baseline demographic data and changes in cTnI levels among these three groups were compared. Patients with acute ischemic stroke were assigned to either the cTnI elevation group （cTnI 〉 0.034 ng/mL） or the no cTnI elevation group （cTnI ≤ 0.034 ng/mL）. Logistic regression analysis was used to identify risk factors associated with elevated serum cTnI in patients with acute ischemic stroke. Moreover, the duration of hospital stay and incidence of major cardiovascular outcomes were compared in patients with acute ischemic stroke, with or without elevated cTnI. Results In this study population of patients with acute ischemic stroke （n = 178）, acute ST-segment elevation myocardial infarction （n = 35）, and acute non-ST-elevation myocardial infarction （n = 35）, patients with acute ischemic stroke with elevated cTnI comprised 18.54% of subjects. Patients with elevated cTnI were older and more likely to have a history of hypertension. In addition, these patients had higher levels of inflammatory markers, reduced renal functions, increased D-dimer levels, higher NIH stroke scores, and lower left ventricular ejection fractions. Logistic regression analysis showed that both percentage of neutrophil and NIH stroke scores were elevated; estimated glomerular filtration rate and left ventricular ejection fraction were decreased in patients with acute ischemic stroke who had elevated cTnI, and they had more frequent major cardiovascular events during hospital stay. Conclusion Elevated cTnI detected in patients with acute ischemic stroke, indicated a greater likelihood of poor short-term prognosis during hospital stay.
文摘Dear editor, Following its entrance into the human body through inhalation, carbon monoxide （CO） forms carboxyhemoglobin （COHb） by binding to hemoglobin （Hb） within the blood. Massive ischemic tissue necrosis occurs in 0.5%-1% of cases with CO poisoning. The affinity of CO to Hb is 200-250 times more when compared to the affinity of oxygen. As a result of CO binding to Hb, oxygen delivery to the tissues is reduced, and tissue hypoxia develops. This affects mostly the brain and heart, which are the organs with the highest demand for oxygen.
基金the Medical Science & Technology Research fund of Health Bureau of Chongqing City,China [No.2004(53)04-2-154]the Nature Science Research fund of Chongqing Science & Technology Com-mission of Chongqing City,China (No.CSTC,2007BB5276).
文摘Objectives To study the relationship between plasma hemoglobin concentration and estimated glomerular filtration rate （eGFR） in elderly patients with ischemic cardiomyopathy （ICM）.Methods Clinical data of patients with coronary heart disease who were discharged from The First Affiliated Hospital,Chongqing Medical University between 2005 and 2007 were analyzed retrospectively. Echocardiography results,plasma hemoglobin and creatinine concentration were abstracted from the medical records.The study included 235 Chinese Hart patients with age 60 years and older with angiography confirmed coronary heart disease,silent myocardial ischemia or angina pectoris,of whom 154 had ICM defined as left ventricular end-diastolic diameter （LVDd）,male≥56 mm,female≥51 mm （63. 51±7.70 mm） measured by M-mode echocardiography.The differences in plasma hemoglobin concentration were analyzed retrospec- tively between patients with and without ICM,and between patients with an eGFR【60 ml·min<sup>-1</sup>·1.73m<sup>-2</sup> and those with an eGFR≥60 ml·min<sup>-1</sup>·1.73m<sup>-2</sup>.Results There were no significant differences in plasma hemoglobin concentration and eGFR between ICM and non-ICM group (118.49±20.52 g·L<sup>-1</sup> vs.115.80±23.32 g·L<sup>-1</sup> and 75.13±24.21 ml·min<sup>-1</sup>·1.73m<sup>-2</sup> vs.79.09±28.41 ml·min<sup>- 1</sup>·1.73m<sup>-2</sup>,respectively,both P】0.05).However,in both ICM and non-ICM groups,plasma hemoglobin concentration was lower in those with an eGFR【60 ml·min<sup>-1</sup>·1.73m<sup>-2</sup> compared with compared with those with an eGFR≥60 ml·min<sup>-1</sup>·1.73m<sup>-2</sup> group (112. 29±18.61 g·L<sup>-1</sup> vs.119.92±20.74L<sup>-1</sup>,P【0.05);plasma hemoglobin concentration was related positively to eGFR.Conclusions There were no significant changes in plasma hemoglobin concentration and eGFR;however,plasma hemoglobin concentration was related to eGFR significantly positively in elderly patients with ICM due to coronary heart
文摘Objective The -455 G/A(HaeIII)polymorphism of β-fibrinogen gene influences levels of plasma fibrinogen. We further investigated whether it influences the risk of ischemic cerebrovascular disease. Methods We accumulated 134 acute ischemic cerebrovascular disease(ICVD)cases and compared their -455 G/A status with a control group(n = 166). The β-fibrinogen gene -455 G/A polymorphism was analyzed for all subjects by PCR-RFLP with the restrictive enzyme HaeIII. Results Plasma fibrinogen was higher in AA homozygous participants(341 mg/dL)than in partici-pants carrying the G allele: GA(290 mg/dL), GG(298 mg/dL)in the control group. Plasma fibrinogen was also higher in AA homozygous patients(353 mg/dL)than in cases carrying the G allele: GA(287 mg/dL), GG(302 mg/dL)in the ICVD group. However, there was no significant association between β-fibrinogen gene -455 G/A polymorphism and ICVD group. Conclusions Although a small effect cannot be excluded, β-fibrinogen gene -455 G/A polymor-phism is an independent predictor of plasma fibrinogen, but not of ischemic cerebrovascular disease.
文摘BACKGROUND: This systematic review aims to investigate the prediction value of diffusion tensor imaging for motor function recovery of ischemic stroke patients.METHODS: Cochrane Central Register of Controlled Trials(CENTRAL)(the Cochrane Library 2016, Issue 9), Pub Med, Embase, Clarivate Analytics, Scopus, CINAHL, Chinese Biomedical Literature Database, China National Knowledge Infrastructure and Google Scholar were searched for either motor recovery or corticospinal tract integrity by diffusion tensor imaging in different stroke phase from January 1, 1970, to October 31, 2016. The study design and participants were subjected to metrological analysis. Correlation coeffi cient(r) was used for evaluating the relationship between fractional anisotropy(FA) and motor function outcome. Correlation coeffi cient values were extracted from each study, and 95% confidence intervals(CIs) were calculated by Fisher's z transformation. Meta-analysis was conducted by STATA software.RESULTS: Fifteen studies with a total of 414 patients were included. Meta-analysis showed that FA in the subacute phase had the signifi cant correlation with motor function outcome(ES=0.75, 95%CI 0.62–0.87), which showed moderate quality based on GRADE system. The weight correlation coeffi cient revealed that an effect size(ES) of FA in acute phase and chronic phase was 0.51(95%CI 0.33–0.68) and 0.62(95%CI 0.47–0.77) respectively.CONCLUSION: This meta-analysis reveals that FA in the subacute phase after ischemic stroke is a good predictor for functional motor recovery, which shows moderate quality based on the GRADE system.
基金This work was supported by the National Natural Science Foundation of China(No.81501025)the Natural Science Foundation of Hunan Province(Nos.2020JJ4134 and 2016JJ3174).
文摘Ischemic stroke is one of the leading causes of death worldwide,and effective treatment strategies in the chronic phase of this disease remain insufficient.Homeostasis of metals in the brain plays an important role in maintaining normal brain function.However,the dynamic spatial distributions of iron,zinc,calcium,potassium,and copper in a rat brain following ischemic stroke and the association between structural distribution and function remain to be elucidated.In this study,we used a synchrotron radiation-based micro-X-ray fluorescence technique to image element mapping changes in special rat brain regions after ischemic stroke,showing the distribution characteristics of iron,zinc,calcium,potassium,and copper.We demonstrated,for the first time,the consistent dynamic spatial distributions of metal elements at a series of time points(3 h,4.5 h,6 h,12 h,1 d,3 d,5 d,7 d,10 d,14 d,28 d)after brain ischemia,which revealed that the homeostasis of iron,zinc,calcium,potassium,and copper in the brain was disturbed with distinctive change trends,providing clear insights in understanding the underlying pathogenesis of stroke from a novel perspective,thus laying the foundation of further developing new drug targets for stroke treatment.
基金Acknowledgments This study was supported by the National Natural Science Foundation of China （No. 8130 1276） and the Heilongjiang Provincial Department of Education （No. 12541544）. The authors declare that there are no competing interests.
文摘Background Chronic heart failure （CHF） is life-threatening without timely or effective intervention. In this study, we investigated the association between QT dispersion corrected for heart rate （cQTd） and heart function in patients with CHF. Methods From January 2013 to December 2015, we continuously enrolled 240 patients categorized as New York Heart Association functional class （NYHA） III-IV with a left ventricular ejection fraction （LVEF） 〈 40%. Based on the etiology, the patients were divided into a dilated cardiomyopathy （DCM） group （n = 120） and an ischemic cardiomyopathy （ICM） group （n = 120）. Then, based on the cQTd width, the ICM group was divided into two subgroups： a QS group （cQTd ≤60 ms, n = 70） and a QL group （cQTd 〉 60 ms, n = 50）. All patients were examined by echocardiography and 12-lead electrocardiography （ECG） at 1, 3, 6, and 12 months after enrollment. Results After one year of optimized medical treatment, patients in both groups showed significant improvement in LVEF and NYHA classification from baseline. However, the cQTd in the ICM group, especially the QL, was significantly shorter than that in the DCM group at each time point. In addition, the cQTd was negatively correlated with LVEF and 6-min walking test and positively correlated with NYHA class in the ICM group. Conclusions The present findings clearly demonstrate that cQTd is a meaningful parameter for assessing heart function in the follow-up of ICM patients.
基金Fund supported by the National Natural Science Foundation (81670854).
文摘ObjectiveTo assess the in vivo dynamic blood flow features of posterior optic nerve head (ONH) in rat model of nonarteritic anterior ischemic optic neuropathy (rNAION). MethodsrNAION was established with Rose Bengal and argon green laser in Sprague-Dawley rats. Fundus photography and fundus fluorescein angiography (FFA) were performed to assess the dynamic changes of optic disc in morphology in 90 days and in blood perfusion in 3 hours after the induction of disease. Histological examinations were performed to evaluate the success of modeling. Thedynamic blood flow kinetics of posterior ONH in rNAION were measured by Laser Doppler Flowmetry (LDF) on the day 3, 7, 14, 21, and 40 after the disease induction. One-way ANOVA, Student'st-test and Bonferroni adjustment were used for multiple comparisons of kinetic measurements of blood flow. ResultsOptic disc edema and subsequent resolution associated with the development of optic disc pallor were observed in rNAION. FFA showed that the optic disc was hypofluorescence in the early phase and hyperfluorescence in the late phase. Histological studies suggested edema and loosened tissues of ONH, loss of retinal ganglion cells (RGCs), optic nerve substance and gliosis. Compared to the naive rats, the blood flow kinetics of posterior ONH in rNAION significant reduced at each time point after modeling (F=175.06,P<0.0001). The reductions were specifically remarkable in 14 days after the disease induction (AllP<0.01). Conclusions Continuous blood perfusion reduction was found in rNAION, with significant alteration in 14 days after disease induction. Our results provided important information for understanding the hemodynamic changes in rNAION.
基金Supported by Research Project of Science and Technology Commission of Shanghai (04DZ19507).
文摘Objective To compare the influence of different sulfonylureas on the myocardial protection effect of ischemic preconditioning (IPC) in isolated rat hearts, and ATP-sensitive potassium channel current (IKATP) of rat ventricular myocytes. Methods Isolated Langendorff perfused rat hearts were randomly assigned to five groups: (1) control group, (2) IPC group, (3) IPC+glibenclamide (GLB, 10 μmol/L) group, (4) IPC+glimepiride (GLM, 10 μmol/L) group, (5) IPC+gliclazide (GLC, 50 μmol/L) group. IPC was defined as 3 cycles of 5-minute zero-flow global ischemia followed by 5-minute reperfusion. The haemodynamic parameters and the infarct size of each isolated heart were recorded. And the sarcolemmal IKATP of dissociated ventricular myocytes reperfused with 10 μmol/L GLB, 1 μmol/L GLM, and 1 μmol/L GLC was recorded with single-pipette whole-cell voltage clamp under simulated ischemic condition. Results The infarct sizes of rat hearts in IPC (23.7%±1.3%), IPC+GLM (24.6%±1.0%), and IPC+GLC (33.1%±1.3%) groups were all significantly smaller than that in control group (43.3%±1.8%; P<0.01, n=6). The infarct size of rat hearts in IPC+GLB group (40.4%±1.4%) was significantly larger than that in IPC group (P<0.01, n=6). Under simulated ischemic condition, GLB (10 μmol/L) decreased IKATP from 20.65±7.80 to 9.09±0.10 pA/pF (P<0.01, n=6), GLM (1 μmol/L) did not significantly inhibit IKATP (n=6), and GLC (1 μmol/L) decreased IKATP from 16.73±0.97 to 11.18±3.56 pA/pF(P<0.05, n=6). Conclusions GLM has less effect on myocardial protection of IPC than GLB and GLC. Blockage of sarcolemmal ATP-sensitive potassium channels in myocardium might play an important role in diminishing IPC-induced protection of GLM, GLB, and GLC.
基金supported by a grant from 122 Project of Nanjing Military Command focusing on training(JQZD200905)
文摘BACKGROUND:S100B protein in patients with cardiac arrest,hemorrhagic shock and other causes of global cerebral ischemic injury will be dramatically increased.Ischemic brain injury may elevate the level of serum S100 B protein and the severity of brain damage.METHODS:This article is a critical and descriptive review on S100 B protein in serum after ischemic brain injury.We searched Pubmed database with key words or terms such as "S100B protein", "cardiac arrest", "hemorrhagic shock" and "ischemia reperfusion injury" appeared in the last five years.RESULTS:S100B protein in patients with cardiac arrest,hemorrhagic shock and other causes of ischemic brain injury will be dramatically increased.Ischemic brain injury elevated the level of serum S100 B protein,and the severity of brain damage.CONCLUSION:The level of S100 B protein in serum is elevated after ischemic brain injury,but its mechanism is unclear.
文摘Objective To investigate whether admission time was associated with the delay of reperfusion therapy and in-hospital death in patients with ST-elevation myocardial infarction （STEMI）. Methods All patients with STEMI who were admitted to the emergency depart- ment and underwent primary percutaneous coronary intervention at Peking University People＇s Hospital between April 2012 and March 2015 were included. We examined differences in clinical characteristics, total ischemic time, and in-hospital death between patients admitted during off-hours and those admitted during regular hours. Multivariate logistic regression was used to estimate the relationship between off-hours admission and clinical outcome. Results The sample comprised 184 and 105 patients with STEMI admitted to hospital during off-hours and regular hours, respectively. Total ischemic and onset-to-door times were significantly shorter in patients admitted during off-hours than among those admitted during regular hours （all P 〈 0.05）. Door-to-balloon （DTB） time, the rate of DTB time 〈 90 min, and in-hospital death were comparable between groups. Multivariate logistic regression showed that age and creatinine level, but not off-hours admission, were associated independently with increased in-hospital death. Conclusions Off-hours admission did not result in delayed reperfusion therapy or increased in-hospital mortality in patients with STEMI. Further efforts should focus on identifying pivotal factors associated with the pre-hospital and in-hospital delay of reperfusion therapy, and implementing quality improvement initiatives for reperfusion programs.
文摘Objective To investigate the therapeutic effectiveness of intracoronary implantation of autologous bone marrow mononuclear cells (BM-MNC) in miniswine model of reperfused myocardial infarction. Methods Sixteen miniswine myocardial ischemic reperfusion injury models made by ligation of the distal one third segment of left anterior descending artery for 90 minutes were randomized into 2 groups. In BM-MNC group (n = 9), (3.54±0.90)×108 BM-MNC were intracoronary injected, and in the control group (n = 7), phosphate buffered saline was injected by the same way. Echocardiographic and hemodynamic results, vessel density, and myocardial infarction size were evaluated and compared before and 4 weeks after cell transplantation. Results In BM-MNC group, there were no differences between before and 4 weeks after transplantation in aspects of left ventricular ejection fraction (LVEF), interventricular septal thickness, left ventricular lateral and anterior septal wall thickness, cardiac output, or +dp/dtmax. In control group, LVEF, interventricular septal thickness, left ventricular lateral and anterior septal wall thickness, cardiac output, and +dp/dtmax decreased significantly 4 weeks after transplantation (P < 0.05). Left ventricular end-diastolic pressure and –dp/dtmax did not change significantly before and after cell transplantation in both groups. Capillary density in BM-MNC group was greater than that in control group [(13.39 ± 6.96)/high power field vs. (3.50 ± 1.90)/high power field, P < 0.05]. Infarction area assessed by tetrazolium red staining and the infarction percentage decreased in BM-MNC group compared with those in control group (P < 0.05). Conclusions Transplantation of BM-MNC into myocardium with ischemic reperfusion injury increases capillary density and decreases infarction area. It has significantly beneficial effect on cardiac systolic function rather than on diastolic function.
文摘BACKGROUND: Weather conditions are thought to increase the risk of stroke occurrence. But their mechanism has not yet been clarified. We investigated possible relationships between ischemic stroke and weather conditions including atmospheric pressure, temperature, relative humidity, and wind speed.METHODS: One hundred and twenty-eight patients with ischemic stroke who had been admitted to our hospital between January 1 and December 31, 2010 were enrolled in this study. We investigated the relationship between daily cases and weather conditions the same day or 1, 2, and 3 days before stroke.RESULTS: A negative correlation was found between maximum wind speed and daily cases 3 days before stroke. As the relationship between daily cases and changes of weather conditions in consecutive days was evaluated, a negative correlation was found between daily cases and change of atmospheric pressure in the last 24 hours.CONCLUSIONS: The maximum wind speed 3 days before stroke and change of atmospheric pressure in the last 24 hours were found to increase the cases of ischemic stroke. We recommend that individuals at risk of ischemic stroke should pay more attention to preventive measures, especially on days with low maximum wind speed, on subsequent 3 days, and on days with low atmospheric pressure in the last 24 hours.
基金Supported by the National Natural Science Foundation of China(No.30070247)
文摘Objective: To study the correlation between aquaporin-4 ( AQP4) expression and diffusion-weighted imaging ( DWI) in the process of ischemic brain edema for the molecular biologic mechanism of DWI. Methods: A total of 34 Wistar rats were divided into 8 groups randomly: Non-operated group (n = 4) , sham-operated group (n = 6) , and operated group, receiving right middle cerebral artery occlusion ( MCAO) for 15 and 30 min, and 1,3,6 and 24 h respectively (6 subgroups, n =4). All groups were imaged with DWI and T2WI. The apparent diffusion coefficient (ADC) , relevant density (rd) and relevant area (rs) of hyperintensity of the lesions on DWI and T2WI were measured. Relevant ADC (rADC) , relevant area of immunohistochemical staining for AQP4 (rS) , optical density of AQP4 hybridization (a) were calculated. After that the animals were sacrificed and perfused at different time intervals, correlations between DWI, ADC, and AQP4 expression (rS, a) in ischemic tissue was made. Results: There was a significant correlation between rS and a ( r = 0. 949 ). The abnormal high intensity was found in DWI of the ipsilateral MAC territory at 15 min after MCAO. The ADC value decreased quickly within 1 h after MCAO, the rd and rs of DWI increased rapidly and the expression of AQP4 increased quickly, too. However, there was no change on the T2WI. In the period of time (15 min - 1 h) , the AQP4 expression( a) had a strong relation to the rd and rs( r = 0. 914, 0. 895). With the progress of the time, the ADC value of MCAO decreased further to (2.1±0.6)×10-4 mm2/s at 3 h, and then followed an increased slowly till 24 h, but the rd and the rs as well as the expression of AQP4 continuously increased during the stage. The T2WI detected the lesion at the average time (1.4 h) after MCAO, and the rs of T2WI was less than that of DWI at the same time in the same layer (P < 0.05). Conclusion: The results imply that high expression of AQP4 may play a key role in ischemic brain edema. It is, certainly, one of the important reasons of the DWI molecular biologic mechanism in the cerebral ischemia.
文摘BACKGROUND：Stroke is one of the leading causes of mortality and morbidity of vascular diseases, and its incidence maintains at a high level around the world. In China, stroke has been a major public health problem. Because the pathogenesis of ischemic stroke is different from that of hemorrhagic stroke, their clinical factors would not be the same. Therefore to investigate the different effects of various effect factors on ischemic versus hemorrhagic stroke and then to enhance the prevention are crucial to decrease the incidence.METHODS：A total of 692 patients, consisting of 540 ischemic stroke patients and 152 hemorrhagic stroke patients from East China, were included in this study. The related factors of stroke subtypes were collected and analyzed.RESULTS：The factors significantly associated with ischemic stroke as opposed to hemorrhagic stroke were family history of stroke, obesity, atherosclerotic plaque of the common carotid artery, atrial fibrillation, hyperfibrinogenemia, transient ischemic attack （TIA）, atherosclerotic plaque of the internal carotid artery, coronary heart, lower high-density lipoproteins （lower HDL）, increasing age, diabetes mellitus, and gender （male） （P〈0.05）. Leukocytosis, hypertension and family history of hypertension were the significant factors associated with hemorrhagic stroke versus ischemic stroke. Smoking, drinking, kidney diseases and lower HDL-C were the significant factors contributing to ischemic stroke in man. Obesity, family history of hypertension, family history of stroke, hypercholesteremia and myocardial ischemia were the significant factors for females with ischemic stroke.CONCLUSIONS：The most prominent factors for overall stroke in East China were hypertension, followed by higher pulse pressure and hypercholesteremia. The factors for ischemic and hemorrhagic stroke are not the same. Different effects of risk factors on stroke are found in male and female patients.
