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ObjectiveTo establish a mouse model of basilar artery dolichoectasia （BAD） and explore the mechanism of modified Tongqiao Huoxuetang （JTQHX） in regulating BAD via phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt） pathway. MethodSixty C57/BL6 female mice were randomized into sham operation （injected with 10 U·mL-1 inactivate elastase）， model， atorvastatin calcium tablets （2.6 mg·kg·d-1）， and low- and high-dose （crude drug 3.4， 17 g·kg-1·d-1， respectively） JTQHX groups. The mouse model of BAD was established by injection with 10 U·mL-1 elastase. After 14 days of modeling， the sham operation group and model group were administrated with equal volumes of pure water by gavage， and other groups with corresponding drugs for 2 months. The levels of interleukin-6 （IL-6） and calpain （LpA） in the serum were measured by enzyme-linked immunosorbent assay （ELISA）. Verhoeff 's Van Gieson （EVG） staining was employed to observe the pathological changes of blood vessels. Terminal-deoxynucleotidyl transferase mediated nick end labeling （TUNEL） was employed to examine the apoptosis rate of vascular smooth muscle cells （VSMCs）. Image Pro Plus was used to observe and calculate the curvature index， elongation length， percentage increase in vessel diameter， and curvature angle of the basilar artery vessels in mice. Western blot was employed to determine the expression levels of PI3K and Akt in the vascular tissue. ResultCompared with the sham operation group， the model group showed lowered IL-6 level （P<0.01）， no significant change in LpA level， increased apoptosis of VSMCs （P<0.01）， and increased curvature index， elongation length， percentage increase in vessel diameter， and curvature angle （P<0.01）. Furthermore， the modeling up-regulated the protein levels of PI3K and Akt in blood vessels （P<0.01） and aggravated the destruction of the inner elastic layer， atrophy of the muscular layer， and hyaline changes in the connective tissue of the medial membrane of the basilar artery wall. Compared with the model group， 2 months of treatment with JTQHX elevated the IL-6 level （P<0.01）， reduced the apoptosis of VSMCs （P<0.01）， decreased the curvature index， elongation length， percentage increase in vessel diameter， and curvature angle （P<0.05， P<0.01）， and down-regulated the protein levels of PI3K and Akt in blood vessels （P<0.01）. In addition， the treatment alleviated the destruction of the inner elastic layer， atrophy of the muscular layer， and hyaline changes in the connective tissue of the medial membrane of the basilar artery wall. ConclusionJTQHX inhibits the elongation， expansion， and curvature of basilar artery vessels and alleviates the pathological changes by reducing the apoptosis of VSMCs and down-regulating the expression of PI3K/Akt pathway.
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Persistent postural-perceptual dizziness (PPPD) is a chronic functional vestibular disease. Related studies have shown that PPPD patients often show high visual dependence in posture control or spatial orientation activities, and the symptoms are aggravated in visual motor stimulation or complex visual environment. The visual dependence of PPPD patients may be related to age factors, anxiety symptoms, visual-vestibular system interaction and neurotransmitter changes. A correct understanding of the relationship between vision and PPPD can provide more help for the clinical diagnosis and treatment of PPPD in the future. This article reviews the correlation and possible mechanism between visual factors and clinical symptoms of PPPD.
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Objective:To investigate the effect of magnetic resonance angiography (MRA) in evaluating the mouse model of vertebrobasilar dolichoectasia (VBD) induced by injection of elastase into cerebellomedullary cistern.Methods:Twenty-four male C57/BL6 mice were selected. The mice in the elastase group ( n=12) were injected in the cerebellomedullary cistern with 2.5 μl of phosphate buffer containing 25 mU elastase, and the mice in the saline control group ( n=12) were injected with the same volume of normal saline. MRA examination of the brains of living mice was performed 2 weeks after modeling. Successful modeling was defined as the basilar artery bending angle ≤170°, or the basilar artery bending length accounts for ≥10%, or the basilar artery deviated from the midline by more than 1 grade, or the percentage increase in artery diameter was ≥25%. Results:In the elastase group and the saline control group, 2 mice and 1 mouse did not wake up normally or died, respectively. The 11 surviving mice in the saline control group had no obvious vertebral artery and basilar artery abnormalities. The success rate of modeling in the 10 surviving mice in the elastase group was 80%, and the difference in the success rate between the two groups was statistically significant ( P<0.05). There were significant differences in mean basilar artery diameter (0.30 mm vs. 0.22 mm; P<0.05), mean basilar artery bending angle (115° vs. 170°; P<0.05), and proportion of mean basilar artery bending length (31% vs. 5%; P<0.05) of the surviving mice between the elastase group and the saline control group. Conclusion:MRA can better evaluate the mouse VBD model induced by elastase injection in the cerebellomedullary cistern.
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Posterior circulation ischemic stroke can be manifested as isolated vertigo, and the posterior circulation small infarcts often show early negative diffusion-weighted imaging, which is likely to cause misdiagnosis and missed diagnosis. Summarizing the characteristics and screening strategies of these patients can provide help for timely diagnosis and selection of effective treatment strategies.
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Cerebral small vessel disease (CSVD) is mainly manifested as lacunar infarction or lacunar space, white matter hyperintensities (WMHs), enlarged perivascular space (EPVS), cerebral microbleeds, and brain atrophy in imaging examination. Studies have shown that WMHs in the frontal lobe, occipital lobe, lateral ventricle, and basal ganglia are the important causes of dizziness/vertigo. The frequency of dizziness/vertigo symptoms increases with the worsening of WMHs. In addition, subcortical infarction, EPVS, and brain atrophy are also closely associated with dizziness/vertigo. Nerve conduction pathway damage, inflammatory infiltrating damage, vestibular degenerative lesions, mental and psychological disorders, and insufficient perfusion of blood vessels associated with large/small vessel disease may be the important ways for triggering dizziness/vertigo in CSDV. Early identification and diagnosis of CSVD-related dizziness/vertigo may contribute to the targeted prevention and treatment.
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Objective To explore the effects of vertebral artery hypoplasia (VAH)on falsenegative rates with MRI in isolated acute vestibular syndrome (AIVS) patients with small posterior circulation small infarcts (infarct diameter ≤ 10 mm by DWI).Methods A total of 224 AIVS patients with at least one stroke risk factor (defined as high-risk AIVS)were consecutively recruited.Head impulse,nystagmus and test-of-skew(HINTS),brainstem auditory evoked potential (BAEP),and blink reflex(BR)were performed as soon as possible ahead of MRI.Another MRI was carried out in those with negative findings on the first imaging but suspected of a central lesion based on HINTS + BAEP + BR.Patients were divided into a VAH group and a non-VAH group.Results Of the 98 cases with posterior circulation infarcts,37 cases were small infarcts,including 16 in the VAH group(16/61,26.2％)and 21 in the non VAH group(21/163,12.9％),with a significant difference between the groups(x2 =4.58,P ＜ 0.05).Nine VAH patients (9/16,56.3 ％)and 4 non-VAH patients(4/21,19.0％)presented false negative results on cranial MRI-DWI,and the difference was also statistically significant(x2 =6.23,P＜0.001).HINTS + BAEP + BR showed a higher sensitivity than early MRI in identifying small infarcts(VAH group:100.0％ vs.44.0％ or 7/16,U=6.41,P＜0.001;non-VAH group:100.0％ vs.81.0％ or 17/21,U=4.46,P＜0.0S).V wave peak latency,Ⅲ-Ⅴ and Ⅰ-Ⅴ wave interpeak latency,and the latency of R1,R2,and R2' in the VAH group were longer than in the non-VAH group(each P＜0.05).Conclusions When VAH is present in high-risk AIVS patients,small infarcts are common,with high false-negative rates on MRI-DWI.HINTS + BAEP + BR may help identify small infarcts and thus improve diagnostic sensitivity.
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Objective According to the basic theory of Yin and Yang,acute urticaria should be treated with divergent medicine instead of convergence medicine.In order to prove the theory,we carry out the quantifiable and repeatability traditional Chinese medicine screening tests in acute urticaria patients,with double controls of experimental group (divergent Chinese medicine),control group (convergence Chinese medicine)end instrumental quality-control standard substance MEBE.Methods Germany MORA-Super bio-resonance instrument (medical mode) as adopted as objective index.32 cases of acute phase urticaria were selected and treated with divergent or convergence Chinese traditional medicine,to observe the results whether conform to traditional Chinese medicine basic theory of Yin and Yang (That is whether the acute phase urticaria should be treated with divergent Chinese medicine).Results Through the 32 cases repeat experiments,22 out of 23 kinds of Divergent Chinese medicine have been screened out in experimental group; while none has been screened out in 12 kinds of convergence Chinese medicine in control group.There was significant difference between two groups (P＜0.01).The result was entirely consistent with TCM basic theory of opposite relationship between yin and yang.The top five divergent Chinese medicines were divaricate saposhnikovia root,cicada slough,catnip,shrub chastetree rruit,and lily magnolia.Conclusion Treated acute urticaria with divergent Chinese medicine conforms to the basic theory of traditional Chinese medicine.
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By using CT, MRI as diagnostic measures for intracerebral granuloma. cysticercosis and tuberculous granuloma were excluded. Using penecillin as control, all cases were treated with Yanzhengxiao capsules. Results demonstrated that the total effective rate in the treatment group was 90%, with a cured rate of 61. 7%, that of the penicillin group. 53. 3% and 26. . 9% respectively with significant difference (P