Efficacy and hemodynamic analysis of complex symptomatic middle cerebral artery stenosis after Solitaire stent implantation / 中国脑血管病杂志

Objective To analyze the efficacy and hemodynamic changes in patients with complex symptomatic middle cerebral artery stenosis after Solitaire AB stent implantation.Methods From June 2013 to June 2016,7 consecutive patients with complex symptomatic middle cerebral artery stenosis treated with Solitaire stents at the Department of Neurology,the Third People's Hospital of Hubei Province were enrolled retrospectively.The stenosis rate ≥70% was confirmed by digital subtraction angiography (DSA).Of the 7 patients,5 were male and 2 were female,with an average age of 70±8 years.The general data of the patients were documented,including clinical symptoms,modified Rankin scale(mRS)score,stenosis degree,vascular pathways LMA classification and Mori typing for stenosis,and postoperative residual stenosis or restenosis.The hemodynamic parameters at day 1,7,and 3 months before and after procedure were compared.Results All patients were successfully implanted with the Solitaire AB stents.(1) Of the 7 patients,the Mori type A of stenosis lesions was in 4 cases,B in 2 cases,and C in 1 case.The LMA typing of vascular approaches were Type Ⅲ in 3 cases,type Ⅱ in 4 cases.The preoperative stenosis rate was 80±7%,the residual stenosis rate was 24±13%,and there were no operation-related complications.No ischemic events occurred during the follow-up period.(2) Before stent implantation and at 1 d,7 d,and 3 months after procedure,the peak systolic velocity (PSV) were 297±41,144±34,145±27,and 143±40 cm/s,respectively,the end diastolic velocity (EDV) were 159±22,68±16,68±14,and 66±17 cm/s,respectively,and the pulse index (PI) were 0.67±0.06,0.80±0.08,0.80±0.07,and 0.82±0.06,respectively.PSV,EDV,and PI at 1 d,7 d,and 3 months were improved compared with before procedure (all P0.05).Conclusions Initial analysis showed that no procedure-related complications were observed in the treatment of vascular tortuosity and complex middle cerebral artery stenosis with the Solitaire stents.The short-term curative effect is exact;However,it still needs to be validated further.

The clinical value of olfactory functional magnetic resonance imaging in early diagnosis of Alzheimer's disease / 中国基层医药

Objective To investigate the clinical value of olfactory functional magnetic resonance imaging in early diagnosis of Alzheimer's disease (AD).Methods 43 patients with mild cognitive impairment were selected,in the same period,49 cases of patients with AD were selected as the AD patients group,and 53 normal populations were selected as the control group.The neuropsychological of all cases were assessed by using MMSE scale,MoCA scale and CDR Scale.Siemens 3.0T MRI machines were used according to event -related design approach for olfactory cor-tex conducted fMRI scans.The matlab7.0 and SPM8 data preprocessing tools were used to image analysis.The prima-ry olfactory cortex volumes and activation voxels numbers of the three groups were compared.The correlations of acti-vation voxels numbers and primary olfactory cortex volumes and neuropsychological scores were analyzed.Results The primary olfactory cortex volumes of the control group,patients with mild cognitive impairment and AD patients were (3 846 ±517)mm3 ,(2 863 ±367)mm3 and (2 214 ±283)mm3 ,respectively,pairwise comparison,the control group >mild cognitive impairment >AD patients,the differences were statistically significant (compared with the con-trol group,t =16.835 and 34.716,compared with mild cognitive impairment group,t =19.753,P mild cognitive impairment >AD patients,the differences were statistically significant (compared with the control group,t =47.916 and 72.954,compared with mild cognitive impairment group,t =37.382,P <0.05).Partial correlation analysis showed that the activation voxels num-bers of the three groups were positively correlated with primary olfactory cortex volume,MMSE score and MOCA score (r =0.397,0.462 and 0.494,all P <0.05).Conclusion Olfactory fMRI in patients with AD might reflect the changes in the entorhinal cortex caused by pathological changes.It could provide clues and information for the early diagnosis of AD.

Influence of atorvastatin on ischemic adverse events following cerebral middle artery stent implantation: A 12-month follow-up in 24 cases / 中国组织工程研究

BACKGROUND: Intravascular stent implantation is one of the main methods for intra-extracranial artery stenosis. The safety and efficacy of stent implantation has been elevated, and symptoms or ischemic advert events with artery stenosis has been reduced. However, risks of thrombosis, cerebralhemorrhage, restenosis, and hyperperfusion still existed. OBJECTIVE: To investigate the influence of atorvastatin on ischemic adverse events following cerebral middle artery stent implantation.METHODS: Twenty-four patients received cerebral middle artery stent implantation were randomly divided into 2 groups. In the treatment group, patients were received atorvastatin 40 mg + plavix 75 mg + aspirin enteric-coated tablet 300 mg, once per day; in the control group, patients were received plavix 75 mg + aspirin enteric-coated tablet 300 rag, once per day. Ischemic adverse events, such as in-stent restenosis, transient ischemic attack, cerebral infarction, or re-interventional therapy were observed by transcranial Doppler, digital subtraction angiography, nuclear magnetic resonance imaging, diffusion weighted imaging, blood lipid level and C-reactive protein level examinations prior to and at months 1, 3, 6 and 12 after stent implantation.RESULTS AND CONCLUSION: Compared with the control group, the levels of blood lipid and C-reactive protein were obviously decreased at months 1, 3, 6 and 12 after treatment (P<0.05, P<0.01 ), with dramatically declined ischemic adverse events (P<0.05, P<0.01 ). Compared with before operation, the levels of blood lipid and C-reactive protein were decreased after operation in the treatment group (P<0.05, P<0.01). No server adverse events occurred in patients treated by atorvastatin, which showed 40 mg was safe for patients. The results revealed that atorvastatin combined with antiplatelet therapy can prevent ischemic adverse events following cerebral middle artery stent implantation.

Increased expression of endothelin receptors in human cirrhosis--relationship with splanchnic hemodynamics / 华中科技大学学报（医学）（英德文版）

The purpose of the present study was to assess the correlation that likely exists among increased portal pressure (Pp), portal blood flow quantity (Qp) and ETA and ETB receptor mRNA expression in human cirrhosis. In situ hybridization and reverse-transcription polymerase chain reactions (RT-PCR) were performed to determined the expression of ETA and ETB receptor mRNA in liver tissues from traumatic subjects (n = 10) and cirrhotic patients (n = 15) in whom hepatic hemodynamic values were measured. The expression of the two transcripts was significantly higher in liver samples of cirrhotic patients than in those obtained from traumatic subjects. It has shown that ETA receptor mRNA predominantly located in hepatic stellate cells (HSCs) and vascular smooth muscle cells of intrahepatic arteries and portal veins, ETB receptor mRNA in HSCs, sinusoidal endothelial cells and Kuppfer cells. There was a highly significant direct relationship between ETA and ETB receptor mRNA and Pp and Qp in cirrhotic patients. It suggests that liver paracrine endothelin system may be overactivated in human cirrhosis accompanied with increased expression of ETA and ETB receptor mRNA which may play an important role in the pathogenesis and maintenance of splanchnic hyperdynamics.

Increased expression of endothelin receptors in human cirrhosis--relationship with splanchnic hemodynamics / 华中科技大学学报（医学）（英德文版）

The purpose of the present study was to assess the correlation that likely exists among increased portal pressure (Pp), portal blood flow quantity (Qp) and ETA and ETB receptor mRNA expression in human cirrhosis. In situ hybridization and reverse-transcription polymerase chain reactions (RT-PCR) were performed to determined the expression of ETA and ETB receptor mRNA in liver tissues from traumatic subjects (n = 10) and cirrhotic patients (n = 15) in whom hepatic hemodynamic values were measured. The expression of the two transcripts was significantly higher in liver samples of cirrhotic patients than in those obtained from traumatic subjects. It has shown that ETA receptor mRNA predominantly located in hepatic stellate cells (HSCs) and vascular smooth muscle cells of intrahepatic arteries and portal veins, ETB receptor mRNA in HSCs, sinusoidal endothelial cells and Kuppfer cells. There was a highly significant direct relationship between ETA and ETB receptor mRNA and Pp and Qp in cirrhotic patients. It suggests that liver paracrine endothelin system may be overactivated in human cirrhosis accompanied with increased expression of ETA and ETB receptor mRNA which may play an important role in the pathogenesis and maintenance of splanchnic hyperdynamics.

Managiment of portal hypertension complicated with hyperthyroidism / 中国实用外科杂志

ObjectiveTo summarize the experience of managing portal hypertension( PHT) complicated with hyperthyroidism. Methods5 patients with hyperthyroidism complicated PHT were performed with splenectomy plus pericardial devascularization after preoperative management, and the experience of pre- and postoperative management was summarized. Results1 patient occurred postoperative thyroid crisis and was cured with tranquilizing, prenisone and sodium iodide;the other 4 went through perioperation safely. The preoperative WBC,RBC,Hb and Pt were(2.018±0.536)×109/L,(2.97±0.42)×1012/L,(87±15.6)g/L and (38.4±13.24)×109/L, respectively, which rose to (6.54±0.398)×109/L, (3.636±0.387)×1012/L, (108.6±9.633)g/L and (240.4±84.54)×109 /L, respectively after operation. WBC and platelets of all patients reached normal level postoperatively. ConclusionProper perioperative management ensures that patients with hyperthyroidism complicated PHT survive the splenectomy plus pericardial devascularization, which renders opportunity for treating hyperthyroidism with medicine or surgery.