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Photochemically induced thalamus infarction impairs cognition in a mouse model

Stroke & Vascular Neurology 2023年第6期8卷 444-452,I0001,I0002页

作者： Chen Zhang Shiping Li Yongjun Wang Jiong Shi Department of Neurology Beijing Tiantan HospitalCapital Medical UniversityBeijingChina China National Clinical Research Center for Neurological Diseases BeijingChina Advanced Innovation Center for Human Brain Protection Capital Medical UniversityBeijingChina

Background Small subcortical infarcts account for up to 25%of ischaemic strokes.Thalamus is one of the subcortical structures that commonly manifest with lacunar infarcts on MRI of the brain.Studies have shown that thalamus infarction is associated with cognitive decline.However,due to the lack of proper animal models,little is known about the mechanism.We aimed to establish a focal thalamus infarction model,characterise the infarct lesion and assess functional effects.Methods Male C57BL/6J mice were anaesthetised,and Rose Bengal dye was injected through the tail vein.The right thalamus was illuminated with green laser light by stereotactic implantation of optic fibre.Characteristics of the infarct and lesion evolution were evaluated by histological analysis and 7T MRI at various times.The cognitive and neurological functions were assessed by behavioural tests.Retrograde tracing was performed to analyse neural connections.Results An ischaemic lesion with small vessel occlusion was observed in the thalamus.It became a small circumscribed infarct with reactive astrocytes accumulated in the infarct periphery on day 21.The mice with thalamic infarction demonstrated impaired learning and memory without significant neurological deficits.Retrogradely labelled neurons in the retrosplenial granular cortex were reduced.Conclusion This study established a mouse model of thalamic lacunar infarction that exhibits cognitive impairment.Neural connection dysfunctions may play a potential role in post-stroke cognitive impairment.This model helps to clarify the pathophysiology of post-stroke cognitive impairment and to develop potential therapies.

关键词： infarction thalamus impaired

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Incidence,predictors and prognosis of acute kidney injury in acute ST-segment elevation myocardial infarction patients undergoing emergent coronary angiography/primary percutaneous coronary intervention

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Journal of Geriatric Cardiology 2023年第2期20卷 139-149页

作者： Jing TAN Ying-Hua ZHANG Jin SI Ke-Ling XIAO Qi HUA Jing LI Department of Cardiology Xuanwu HospitalCapital Medical UniversityBeijingChina Department of Geriatric Medicine Xuanwu HospitalCapital Medical UniversityNational Clinical Research Center for Geriatric DiseasesBeijingChina

BACKGROUND Acute kidney injury(AKI) after coronary angiography(CAG) and primary percutaneous coronary intervention(PPCI) is frequently observed, and often interpreted as contrast induced-AKI. This study aimed to investigate the incidence, predictors and outcomes of AKI in acute ST-segment elevation myocardial infarction(STEMI) patients undergoing emergent CAG/PPCI using the control group of STEMI patients who were not exposed to contrast agents within the first 72 h.METHODS We performed a retrospective analysis of 1670 STEMI patients. Of them, 673 patients underwent emergent CAG/PPCI, and 997 patients treated with thrombolysis or no reperfusion therapy who were not exposed to contrast material during the first 72 h. AKI was defined as an increase of serum creatinine ≥ 44.2 mmol/L or ≥ 25% from baseline within 72 h. Patents were then followed up for the occurrence of all-cause mortality for 40 months(interquartile range: 24–55 months).RESULTS After propensity score matching, 505 pairs of patients were matched. Overall, the incidence of AKI was 27.4%, and AKI rates were not significantly different in patients with and without emergent CAG/PPCI procedure(27.5% vs. 27.3%, P = 0.944). Multivariate logistic regression analysis identified that the independent predictors of AKI were female, elevated interleukin-6 level,decreased lymphocyte count, left ventricular ejection fraction < 50% and use of diuretics in patients with emergent CAG/PPCI. Patients with AKI than those without AKI experienced higher incidence of acute heart failure with Killip class Ⅲ(9.4% vs. 3.3%, P =0.005;15.2% vs. 6.8%, P = 0.003, respectively) and mortality(5.8% vs. 1.4%, P = 0.014;12.3% vs. 4.6%, P = 0.002, respectively) in patients with and without emergent CAG/PPCI. Multivariate Cox regression analysis confirmed that AKI was independently associated with long-term mortality rate at 40 months follow-up in patients with and without emergent CAG/PPCI(HR = 1.867, 95% CI:1.086–3.210, P = 0.024;HR = 1.700, 95% CI: 1.219–2.370, P = 0.002, respectively

关键词： patients coronary infarction

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Thirty-day outcomes of in-hospital multi-vessel versus culpritonly revascularization strategy for ST-segment elevation myocardial infarction with multivessel coronary disease

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Journal of Geriatric Cardiology 2023年第7期20卷 485-494页

作者： Yu-Xi LI Bei-Ning WANG Fang-Fang FAN Yan ZHANG Jie JIANG Jian-Ping LI Ya-Ling HAN Yong Huo CCC investigators Department of Cardiology Peking University First HospitalBeijingChina Cardiovascular Research Institute and Department of Cardiology General Hospital of Northern Theater CommandShenyangLiaoningChina 不详

BACKGROUND Many studies have demonstrated the benefit of complete multivessel revascularization versus culprit-only intervention in patients of ST-segment elevation myocardial infarction(STEMI)and multivessel coronary artery disease.However,only a few single-center retrospective studies were performed on small Chinese cohorts.Our study aims to demonstrate the advantage of multivessel percutaneous intervention(PCI)strategy on 30-day in-hospital outcomes to patients with STEMI and multivessel disease in larger Chinese population.METHODS From the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome(CCC-ACS)project,5935 patients with STEMI and multivessel disease undergoing PCI and hospitalized for fewer than 30 days were analyzed.After 5:1 propensity score matching,3577 patients with culprit-only PCI and 877 with in-hospital multivessel PCI were included.The primary outcome was major adverse cardiovascular and cerebrovascular event(MACCE),defined as a composite of myocardial infarction,all-cause death,stent thrombosis,heart failure,and stroke.RESULTS Multivariable logistic regression analysis revealed that in-hospital multivessel PCI was associated with lower risk of 30-day MACCE(adjusted OR=0.75,95%CI:0.57-0.98,P=0.032)than culprit-only PCI and conferred no increased risk of allcause death,myocardial infarction,stent thrombosis,stroke,or bleeding.Subgroup analysis showed that MACCE reduction was observed more often from patients with trans-femoral access(OR=0.34,95%CI:0.15-0.74)than with trans-radial access(OR=0.87,95%CI:0.66-1.16,P for interaction=0.017).CONCLUSIONS The in-hospital multivessel PCI strategy was associated with a lower risk of 30-day MACCE than culprit-only PCI in patients with STEMI and multivessel coronary artery disease.

关键词： infarction coronary myocardial

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Molecular Mechanism of Electroacupuncture Regulating Cerebral Arterial Contractile Protein in Rats with Cerebral infarction Based on MLCK Pathway

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Chinese Journal of Integrative Medicine 2023年第1期29卷 61-68页

作者： LI Jing ZHANG Min HE Ying DU Yuan-hao ZHANG Xue-zhu Rainer Georgi Bernhard Kolberg Xu Yan-long Institute of Acupuncture and Moxibustion First Teaching Hospital of Tianjin University of Traditional Chinese MedicineNational Clinical Research Center for Chinese Medicine Acupuncture and MoxibustionTianjin300193China Max Planck Institute for Medical Research Heidelberg69120Germany Uniklinik Mannheim Mannheim68167Germany Department of Acupuncture and Moxibustion Gansu Provincial Hospital of Traditional Chinese MedicineLanzhou730050China

Objective To explore the effect of electroacupuncture(EA)intervention on the vasoconstriction of cerebral artery smooth muscle cells after cerebral infarction.Methods Male Wistar rats were randomly divided into 3 groups by a random number table:the model group(n=24),the EA group(n=24),and the normal group(n=6).The model and the EA groups were divided into different time subgroups at 0.5,1,3,and 6 h after middle cerebral artery occlusion(MCAO),with 6 rats in each subgroup.MCAO model was established using intraluminal suture occlusion method.The EA group was given EA treatment at acupoint Shuigou(GV 26)instantly after MCAO for 20 min.The contents of cerebrovascular smooth muscle MLCK,the 3 subunits of myosin light chain phosphatase(MLCP)MYPT1,PP1c-δand M20,as well as myosin-ATPase activity were detected using immunohistochemistry and Western blotting.Results The overall expression level of the MYPT1 and PP1c-δin the model group was significantly higher(P0.05),and the other subgroups were still significantly higher than the normal group(Pinfarction time within 6 h after infarction.Conclusion EA intervention can inhibit contraction of cerebral vascular smooth muscle cells and regulate smooth muscle relaxation by regulating MLCK pathway.

关键词： infarction vasomotor MLCK pathway Shuigou(GV 26) electroacupuncture

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Mechanical circulatory support in cardiogenic shock and post-myocardial infarction mechanical complications

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Journal of Geriatric Cardiology 2022年第2期19卷 130-136页

作者： Daniel Rob Jan Bělohlávek nd Department of Medicine-Department of Cardiovascular Medicine First Faculty of MedicineCharles University and General University HospitalPragueCzech Republic

Despite advanced therapies,the mortality of patients with myocardial infarction(MI)complicated by cardiogenic shock(CS)remains around 50%.Mechanical complications of MI are rare nowadays but associated with high mortality in patients who present with CS.Different treatment strategies and mechanical circulatory support(MCS)devices have been increasingly used to improve the grim prognosis of refractory CS.This article discusses current evidence regarding the use of MCS in MI complicated by CS,ventricular septal rupture,free wall rupture and acute mitral regurgitation.Device selection should be tailored according to the cause and severity of CS.Early MCS initiation and multidisciplinary team cooperation is mandatory for good results.MCS associated bleeding remains a major complication and an obstacle to better outcomes.Ongoing prospective randomized trials will improve current knowledge regarding MCS indications,timing,and patient selection in the coming years.

关键词： mortality infarction rupture

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Pre-hospital delay in patients with acute myocardial infarction in China:findings from the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome(CCC-ACS)project

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Journal of Geriatric Cardiology 2022年第4期19卷 276-283页

作者： Dan-Qing HU Yong-Chen HAO Jun LIU Na YANG Yi-Qian YANG Zhao-Qing SUN Dong ZHAO Jing LIU Department of Epidemiology Beijing Anzhen HospitalCapital Medical UniversityBeijing Institute of HeartLung and Blood Vessel DiseasesBeijingChina

OBJECTIVE To describe the duration of the pre-hospital delay time and identify factors associated with prolonged pre-hospital delay in patients with acute myocardial infarction(AMI)in China.METHODS Data were collected from November 2014 to December 2019 as part of the Improving Care for Cardiovascular Dis-ease in China-Acute Coronary Syndrome(CCC-ACS)project.A total of 33,386 patients with AMI admitted to the index hospitals were included in this study.Two-level logistic regression was conducted to explore the factors associated with the pre-hospital delay and the associations between different pre-hospital delay and in-hospital outcomes.RESULTS Of the 33,386 patients with AMI,70.7%of patients arrived at hospital≥2 h after symptom onset.Old age,female,ru-ral medical insurance,symptom onset at early dawn,and non-use of an ambulance predicted a prolonged pre-hospital delay(all Pinfarction(STEMI)(all P<0.05).A pre-hospital delay of≥2 h was associated with an increased risk of mortality[odds ratio(OR)=1.36,95%CI:1.09-1.69,P=0.006]and major adverse cardiovascular events(OR=1.22,95%CI:1.02-1.47,P=0.033)in patients with STEMI compared with a pre-hospital delay of<2 h.CONCLUSIONS Prolonged pre-hospital delay is associated with adverse in-hospital outcomes in patients with STEMI in China.Our study identifies that patient characteristics,symptom onset time,and type of transportation are associated with pre-hospital delay time,and provides focuses for quality improvement.

关键词： patients infarction admitted

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Efficacy of comprehensive remote ischemic conditioning in elderly patients with acute ST-segment elevation myocardial infarction underwent primary percutaneous coronary intervention

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Journal of Geriatric Cardiology 2022年第6期19卷 435-444页

作者： Yan-Ling WANG Qi YANG Cheng-Yan HU Yan-Yan CHU Zheng SUN Huan ZHAO Zhi LIU Department of Cardiology Xuanwu HospitalCapital Medical UniversityBeijingChina Department of Radiology Chaoyang HospitalCapital Medical UniversityBeijingChina Department of Radiology Xuanwu HospitalCapital Medical UniversityBeijingChina

BACKGROUND Remote ischemic conditioning(RIC)is used to protect against myocardial injury.However,there is no adequate evidence for comprehensive RIC in elderly patients with ST-segment elevation myocardial infarction(STEMI).This study aimed to test whether comprehensive RIC,started pre-primary percutaneous coronary intervention(PPCI)and repeated daily on 1-30 days post-PPCI,can improve myocardial salvage index(SI),left ventricular ejection fraction(LVEF),Kansas City Cardiomyopathy Questionnaire Clinical Summary Score(KCCQ-CSS)and 6-min walk test distance(6MWD)in elderly patients with acute STEMI during 12 months follow-up.METHODS 328 consenting elderly patients were randomized to receive standard PPCI plus comprehensive RIC(the treatment group)or standard PPCI(the control group).SI at 5-7 days after PPCI,LVEF,left ventricular end-diastolic volume index(LVEDVI),left ventricular end-systolic volume index(LVESVI),KCCQ-CSS,6MWD and adverse events rates were measured and assessed.RESULTS SI was significantly higher in the treatment group[interquartile range(IQR):0.38-0.66,P=0.037].There were no significant differences in major adverse events at 12 months.Although the differences of LVEDVI,LVESVI and LVEF between the treatment group and the control group did not reach statistical significance at 6 months and 12 months,LVEF tended to be higher,LVEDVI tended to be lower in the treatment group.The KCCQ-CSS was significantly higher in the treatment group at 1 month(IQR:46.5-87,P=0.001)and 12 months(IQR:55-93,P=0.008).There was significant difference in 6MWD between the treatment group and the control group(IQR:258-360 vs.IQR:250-345,P=0.002)at 1 month and(IQR:360-445 vs.IQR:345-432,P=0.035)at 12 months.A modest correlation was found between SI and LVEF(r=0.452,P<0.01),KCCQ-CSS(r=0.440,P<0.01)and 6MWD(r=0.384,P<0.01)respectively at 12 months.CONCLUSIONS The comprehensive RIC can improve SI,KCCQ-CSS and 6MWD.It may be an adjunctive therapy to PPCI in elderly patients with STEMI.

关键词： patients infarction coronary

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Early cisternal fibrinolysis is more effective than rescue spasmolysis for the prevention of delayed infarction after subarachnoid haemorrhage

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Stroke & Vascular Neurology 2022年第2期7卷 108-113页

作者： Roland Roelz Christian Scheiwe Jürgen Grauvogel Istvan Csok Volker Arnd Coenen Jürgen Beck Peter C Reinacher Department of Neurosurgery Medical Center-University of FreiburgFreiburgGermany Department of Stereotactic and Functional Neurosurgery Medical Center-University of FreiburgFaculty of MedicineFreiburgGermany Fraunhofer Institute for Laser Technology(ILT) AachenGermany

Background To compare the efficacy of two different concepts of cisternal therapy—PREVENTIVE fibrinolysis plus on-demand spasmolysis versus RESCUE spasmolysis—for the prevention of cerebral vasospasm(CVS)and delayed cerebral infarction(DCI)in patients with aneurysmal subarachnoid haemorrhage(aSAH).Methods Retrospective analysis of 84 aSAH patients selected for cisternal therapy for DCI prevention.66 high-risk patients received PREVENTIVE cisternal therapy to enhance blood clearance.Either stereotactic catheter ventriculocisternostomy(STX-VCS)or intraoperative placement of a cisterno-ventriculostomy catheter(CVC),followed by fibrinolytic cisternal lavage using urokinase was performed.In case of vasospasm,nimodipine was applied intrathecally.22 low-risk patients who developed CVS against expectations were selected for STX-VCS as RESCUE intervention for cisternal spasmolysis with nimodipine.Rates of DCI and mean flow velocities of daily transcranial Doppler(TCD)ultrasonographies were evaluated.Results Despite a higher prespecified DCI risk,patients selected for PREVENTIVE intervention primarily aiming at blood clearance had a lower DCI rate compared with patients selected for intrathecal spasmolysis as a RESCUE therapy(11.3%vs 18.2%).After intrathecal treatment onset,CVS(TCD>160 cm/s)occurred in 45%of patients with PREVENTIVE and 77%of patients with RESCUE therapy(p=0.013).A stronger response of CVS to intrathecal nimodipine was observed in patients with PREVENTIVE intervention as the mean CVS duration after start of intrathecal nimodipine was 3.2 days compared with 5.8 days in patients with RESCUE therapy(p=0.026).Conclusions PREVENTIVE cisternal therapy directed at blood clearance is more effective for the prevention of CVS and delayed infarction compared with cisternal RESCUE spasmolysis.

关键词： prevention spasmolysis infarction

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Lactobacillus levels and prognosis of patients with acute myocardial infarction

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Journal of Geriatric Cardiology 2022年第2期19卷 101-114页

作者： Jing-Jing CAI Yin LIU Jie WANG Jing-Xian WANG Yuan WANG Shi-Bo XU Zhuang CUI Jing GAO Graduate School Tianjin Medical UniversityTianjinChina Department of Cardiology Xing’anmeng People’s HospitalInner MongoliaChina Clinical School of Thoracic Tianjin Medical UniversityTianjinChina Department of Cardiology Tianjin Chest HospitalTianjinChina School of Public Health Tianjin Medical UniversityTianjinChina Cardiovascular Institute Tianjin Chest HospitalTianjinChina

OBJECTIVE To explore the relationship between Lactobacillus and prognosis of acute myocardial infarction(AMI)patients treated by percutaneous coronary intervention(PCI)and its correlation with clinical parameters.METHODS Consecutive patients with AMI in the coronary care unit of Tianjin Chest Hospital in China who received emergency PCI between July 2017 and December 2018 were enrolled.Subjects’fecal 16 S r DNA gene sequencing data were analyzed and subjects were categorized into low,medium and high level groups according to stool Lactobacillus measurements.The primary endpoints were major adverse cardiac events.Cox regression analysis was used to analyze the relationship between Lactobacillus and prognosis.Spearman correlation analysis and trend tests were used to assess the relationship between Lactobacillus and the clinical indicators.RESULTS The data of 254 patients were included in the analysis.Mean age was 65.90±11.56 years,and 152 patients(59.84%)were male.Follow-up time was 652(548.25-753.00)days.Multivariate Cox regression analysis showed a significantly lower risk of major adverse cardiac events in patients with Lactobacillus>7.1 copies/g[adjusted hazard ratio(HR)=0.216,95%CI:0.094-0.493,Pinfarction(STEMI)(HR=0.217,95%CI:0.085-0.551,P=0.001).Lactobacillus was a protective factor for male smokers aged over 60 years whose brain natriuretic peptide was over 1,000 pg/m L.Spearman correlation analysis showed that Lactobacillus correlated negatively with white blood cells,neutrophils,high-sensitivity C-reactive protein,Troponin T,creatine kinase,creatine kinase-MB and brain natriuretic peptide(downward trend),and correlated positively with left ventricular ejection fraction(upward trend).CONCLUSIONS This study is the first to reveal the correlation between Lactobacillus and inflammation and myocardial damage after STEMI.STEMI patients,especially male smokers aged over

关键词： patients infarction prognosis

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Dl-3-n butylphthalide attenuates brain injury caused by cortical infarction accompanied by cranial venous drainage disturbance

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Stroke & Vascular Neurology 2022年第3期7卷 222-236页

作者： Kangping Song Xiuli Zeng Xiaomei Xie Rongxuan Zhu Jianye Liang Guobing Chen Li’an Huang Department of Neurology Jinan University First Affiliated HospitalGuangzhouChina Medical Imaging Center Jinan University First Affiliated HospitalGuangzhouChina Institute of Geriatric Immunology Medical college of Jinan UniversityGuangzhouChina

Background Cerebral venous disorder may have a harmful effect on ischaemic stroke;however,the underlying mechanism remains to be elucidated.Although Dl-3-n butylphthalide is a multitarget agent for antiischaemic stroke,its neuroprotective role in brain ischaemia accompanied by brain venous disturbance remains unclear.In this study,we induced cerebral venous disturbance by the occlusion of bilateral external jugular veins(EJVs)to explore the potential mechanism of the adverse effects of cerebrovenous disorders in cerebral infarction and explore the protective effect of Dl-3-n butylphthalide on cerebral infarction accompanied through cerebral venous disturbance.Methods Cerebral venous disturbance was induced in Sprague-Dawley rats through the permanent occlusion of bilateral EJVs,and cerebral ischaemic stroke was induced through the permanent occlusion of the right cortical branches of the middle cerebral artery.2,3,5-triphenyltetrazolium chloride staining,MRI,Evans blue extravasation and behavioural test were performed to evaluate infarction volume,cerebral blood flow(CBF),blood-brain barrier(BBB)integrity and neurological function.Immunofluorescence staining and western blot analysis were performed to detect loss of neuron,endothelial cells,pericytes and tight junctions.Results Bilateral EJVs occlusion did not cause cerebral infarction;however,it increased the infarction volume compared with the simple middle cerebral artery occlusion(MCAO)group,accompanied by severe neuron loss,worse neurological function,lower CBF,increased EJVs pressure,exacerbated Evans blue extravasation and brain oedema,as well as attenuated angiogenesis.Dl-3-n butylphthalide displayed a neuroprotective effect in rats with MCAO accompanied by EJVs occlusion by reducing neuron loss,accelerating CBF restoration,promoting angiogenesis and relieving BBB damage.Conclusion Bilateral EJVs occlusion did not significantly affect normal rats but aggravated brain damage in the case of ischaemic stroke.Dl-3-n butylphthalide treatment plays a neuroprote

关键词： protective infarction disturbance

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