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Background@#and Purpose To examine the clinical and safety outcomes after endovascular treatment (EVT) for acute basilar artery occlusion (BAO) with different anesthetic modalities. @*Methods@#This was a retrospective analysis using data from the Endovascular Treatment for Acute Basilar Artery Occlusion (ATTENTION) registry. Patients were divided into two groups defined by anesthetic modality performed during EVT: general anesthesia (GA) or non-general anesthesia (non-GA). The association between anesthetic management and clinical outcomes was evaluated in a propensity score matched (PSM) cohort and an inverse probability of treatment weighting (IPTW) cohort to adjust for imbalances between the two groups. @*Results@#Our analytic sample included 1,672 patients from 48 centers. The anesthetic modality was GA in 769 (46.0%) and non-GA in 903 (54.0%) patients. In our primary analysis with the PSM-based cohort, non-GA was comparable to GA concerning the primary outcome (adjusted common odds ratio [acOR], 1.01; 95% confidence interval [CI], 0.82 to 1.25; P=0.91). Mortality at 90 days was 38.4% in the GA group and 35.8% in the non-GA group (adjusted risk ratio, 0.95; 95% CI, 0.83 to 1.08; P=0.44). In our secondary analysis with the IPTW-based cohort, the anesthetic modality was significantly associated with the distribution of modified Rankin Scale at 90 days (acOR: 1.45 [95% CI: 1.20 to 1.75]). @*Conclusion@#In this nationally-representative observational study, acute ischemic stroke patients due to BAO undergoing EVT without GA had similar clinical and safety outcomes compared with patients treated with GA. These findings provide the basis for large-scale randomized controlled trials to test whether anesthetic management provides meaningful clinical effects for patients undergoing EVT.
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OBJECTIVE： To study the improvement effects of Z-guggulsterone （Z-GL） combined with acetyl-11-keto-β- boswellic acid （AKBA） on cerebral ischemia-reperfusion injury model rats. METHODS： Male SD rats were randomly divided into sham operation group， model group， Z-GL+AKBA low-dose and high-dose groups （25， 50 mg/kg）， with 10 rats in each group. Except for sham operation group， middle cerebral artery occlusion/reperfusion injury model was induced by suture method in other groups. Administration groups were given relevant medicine intragastrically after reperfusion； sham operation group and model groups were given constant volume of DMSO intragastrically， every 12 h， for consecutive 7 d. The neurological deficits were evaluated with modified Longa score； HE staining was performed to observe the pathological changes of cerebral tissue in rats； the area of cerebral infarction was measured by TTC， and the percentage of cerebral infarction area； TUNEL staining was performed to detect apoptotic neurons. The expression of CD34， VEGF and DLL4 were detected by immunofluoresence and immunoblotting assay， respectively. RESULTS： Compared with sham operation group， the number of cortical cells in the model group decreased and arranged irregularly， with obvious infarct area and obvious decrease of neovascularization； the neurological deficit score， the percentage of cerebral infarction area and TUNEL positive cells increased significantly， while the expression of CD34， VEGF and DLL4 decreased significantly （P＜0.05 or P＜0.01）. Compared with model group， the above symptoms of the rats in each administration group were significantly improved， the neurological deficit score， the percentage of cerebral infarction area and the number of TUNEL positive cells were significantly reduced； the expression levels of CD34， VEGF and DLL4 were significantly increased； the neurological deficit score， the percentage of cerebral infarction area and the number of TUNEL positive cells in Z-GL+AKBA high-dose group were significantly lower or less than low dose group； the expression of CD34 and DLL4 in high-dose group was significantly higher than low-dose group （P＜0.05 or P＜0.01）. CONCLUSIONS： Z-GL combined with AKBA can relieve neurological deficit and cerebral injury of cerebral ischemia-reperfusion injury model rats， which may be related to promoting angiogenesis and up-regulating the expression of VEGF and DLL4 protein， with a certain dose-dependent effect.
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OBJECTIVE:To study the protective effect and mechanism of astragaloside Ⅳ on D-galactose(D-gal)-induced primary cardiomyocytes apoptosis. METHODS:Wistar neonatal rat primary cardiomyocytes were isolated and cultured. The cardiomyocytes were divided into normal control group(DMEM high glucose medium without serum),D-gal group(DMEM high glucose medium without serum containing 5 g/L D-gal)and astragaloside Ⅳ low-concentration,medium-concentration and high-concentration groups(after cultured with DMEM high glucose medium without serum containing 25,50,100 μg/mL astragaloside Ⅳ for 1 h,and then replaced with DMEM high glucose medium without serum containing corresponding concentration of astragaloside Ⅳ and 5 g/L D-gal). Cardiomyocytes activity was detected by CCK-8 kit after cultured for 48 h.The apoptosis level was detected by Hoechst staining(cultured for 24 h)and flow cytometry(cultured for 48 h). The mRNA expressions of apoptosis related factors(Bcl-2,Bax,Caspase-3)and ANP in cardiomyocytes were detected by RT-PCR after cultured for 24 h. RESULTS:Compared with normal control group,the activity of cardiomyocytes,mRNA level of Bcl-2 and ratio of Bcl-2/Bax were decreased in D-gal group,while apoptosis rate and mRNA levels of Bax,Caspase-3 and ANP were increased, with statistical significance(P<0.05 or P<0.01). Compared with D-gal group,the activity of cardiomyocytes,mRNA level of Bcl-2 and ratio of Bcl-2/Bax were increased in astragaloside Ⅳ groups,while apoptosis rate and mRNA levels of Bax,Caspase-3 and ANP were decreased,with statistical significance(P<0.05 or P<0.01),and in concentration-dependent manner. CONCLUSIONS:Astragaloside Ⅳ can protect D-gal induced primary cardiomyocytes from apoptosis,the mechanism of which may be associated with the increase of Bcl-2/Bax ratio and the decrease of mRNA expressions of Caspase-3 and ANP.
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Objective:To establish two differential gene expression profiles of qi-deficiency and blood stasis syndrome before or after safflower injection treatment by using gene chip technology;compared and analyzed to ensure the effective genes that are responsible for the therapeutic effects of safflower injection against qi-deficiency and blood stasis syndrome in rats.Furthermore,speculated the effect mechanism of the therapeutic genes.Methods:Fifteen SD rats were randomly divided into 3 groups (n=5):control group,model group,and medication group.Qi-deficiency and blood stasis model was established by subjecting the rats to hunger and fatigue for two weeks.After a week of the modeling,safflower injection (100 mg/kg/d) was administered daily via the tail vein for 7 days in medication group,and the rats in model group were injected with saline of the same volume.Control group received normal feeding.At the end of the experiment,rats were killed and whole blood was collected to evaluate the blood stream change and extract mRNAs in blood samples.Qualified mRNAs were reverse transcribed into cDNA which was then used in gene chip hybridization.The genes regulated by safflower injection were determined by the fluorescence signal and the functional mechanisms of safflower injection were confirmed by further querying genealogy databases and reviewing literatures.Results:After two weeks of the modeling,the whole blood viscosity under various shear rates was significantly increased in the model rats which showed faint,blood stasis and weight loss,indicating that the model is made successfully.The increased whole blood viscosity and qi-deficiency and blood stasis syndrome were obviously reversed by safflower injection treatment.Compared with the control group,252 genes up-regulated while 54 genes down-regulated in model group;compared with the model group,196 genes up-regulated while 32 genes down-regulated.Among these,16 differentially expressed genes were involved in inflammation and immune response.Conclusions:Safflower injection was effective in treating qi deficiency and blood stasis syndrome,which was achieved by regulating inflammation related genes.
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OBJECTIVE:To study the improvement effect of Z-Guggulsterone(Z-GL)on blood coagulation and vascular endo-thelial functions of acute blood-stasis model rats and its mechanism. METHODS:40 rats were randomly divided into normal group,model group,positive group(Aspirin tablet,50 mg/kg)and Z-GL low-dose and high-dose groups(25,50 mg/kg),with 8 rats in each group. They were given relevant medicine intragastrically every 12 h,and normal group and model group were given constant volume of normal saline intragastrically for consecutive 7 times. After the fifth administration,except for normal group, those groups were given adrenalin hydrochloride subcutaneously+ice-cold water to induce acute blood-stasis model. Within 30 min after the last administration,aorta abdominalis sample were selected to detect the coagulation parameters [prothrombin time(PT), thrombin time (TT),activated partialthromboplastin time (APTT),fibrinogen (FIB)],and pathological changes of carotid artery were observed. Human umbilical vein endothelial cells (HUEVCs) were divided into blank group (normal saline),model group (normal saline) and Z-GL low-concentration and high-concentration groups (25,50 μmol/L). After culturing for 24 h,the cells were exposed to glucose and oxygen deprivation for 6 h in model group and Z-GL groups. The expression of p-eNOS protein was detected. Other cells were selected,grouped,administrated and treated as above cells,and the NO level of these cells were detect-ed. RESULTS:Compared with normal group,PT,TT and APTT were all shortened in model group,while FIB content was in-creased (P<0.01);vascular endothelium was injured,and endothelial cells fell off from the wall. Compared with model group, PT,TT and APTT were prolonged in administration groups,while FIB content was decreased(P<0.05 or P<0.01);vascular en-dothelium injury was relieved. Results of p-eNOS protein and NO levels determination showed that compared with model group, p-eNOS protein and NO levels were increased in Z-GL groups(P<0.05 or P<0.01). CONCLUSIONS:Z-GL can significantly im-prove coagulation and vascular endothelium functions of blood-stasis model rats,and its mechanism may be associated with the acti-vation of eNOS and the increase of NO level.
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Objective To explore the social support and characteristics of ecological executive function in adult patients with epilepsy,and their correlation.Methods Evaluate the social support and ecological executive function in 65 cases of adult epilepsy patients and 60 normal ones of the same gender,age group and educational level using the Social Support Rating Scale (SSRS) and the Behavior Rating Inventory of Executive Function-adult version (BRIEF-A).The date were statistically analyzed with independent sample t test,Pearson correlation analysis and multiple stepwise regression analysis.Results The scores of adult epilepsy patients in global executive composite,subjective support,objective support and support utilization of SSRS(respectively,37.01±6.74,19.51 ± ±4.77,7.18±2.73,7.45± 1.75) were lower than those of the control group(respectively,40.89±8.54,23.52±2.85,11.02±2.43,9.55±2.88).The scores of adult epilepsy patients in global executive composite (GEC),behavioral regulation index(BRI) and metacognition index(MI) of BRIEF(respectively,55.12± 10.49,53.74± 10.35,56.60± 10.99) were significantly higher than those of the control group (respectively,48.10± 6.3,47.18± 5.84,48.16± 6.23) (P＜0.01).SSRS scores,subjective support,objective support and support utilization were obviously negative to BRIEF scores,behavioral regulation index (BRI) and metacognition index (MI) (P＜ 0.01).Seizure type and SSRS scores were closely related to BRIEF (P＜0.01).Conclusion The epilepsy patients show a lack of social support and ecological executive function dysfunction.The lack of social support is significantly related with ecological executive dysfunction.
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Objective To explore features and relevant factors about the ecological executive function of children with idiopathic or cryptogenic epilepsy.Methods 50 children with idiopathic or cryptogenic epilepsy against were compared with 50 normal ones of the same gender,age group and educational level.All the subjects'parents completed the Behavior Rating Inventory of Executive Function(BRIEF).Results The scores of children with idiopathic or cryptogenic epilepsy in global executive composite (GEC),behavioral regulation index (BRI) and metacognition index (M I) of BRIEF (respectively,55.12± 10.49,53.74 ± 10.35,56.60 ± 10.99) were significantly higher than those of the control group (respectively,48.10 ± 6.35,47.18± 5.84,48.16 ± 6.23) (P＜ 0.01).Multiple stepwise linear regression analysis showed that 4 clinical features namely seizure type,gender,age and epilepsy control were closely related to BRIEF while factors such as educational level,outbreak age,course of disease,family history and antiepileptic drugs were not relevant to BRIEF.Conclusion The ecological executive function of children with idiopathic or cryptogenic epilepsy faulty and is affected by seizure type,gender,age,epilepsy control.
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Viral myocarditis is an acute or chronic inlfammatory disease of the myocardium and may progress to dilated cardiomyopathy (DCM) with life-threatening symptoms including heart failure, arrhythmias and sudden cardiac death. At present, the pathogenesis of viral myocarditis still remains unclear, so it is dififcult for clinicians to diagnose, treat and ifnd a speciifc biomarker. However, the pilot researches showed that pathogenesis of viral myocarditis was associated with genetic susceptibility. This article reviewed the above aspects.