Analysis of clinical characteristics of in-stent reocclusions after coronary stenting for chronic total occlusions in elderly patients / 中华老年医学杂志

Objective:To investigate clinical characteristics for in-stent reocclusion lesions after coronary stent implantations in aged patients.Methods:229 patients diagnosed with chronic total reocclusions were recruited from Jan 2005 to Dec 2019 in this retrospective study.According to age, patients were divided into a 40-49 year-old group(n=60), a 50-59 year-old group(n=58), a 60-69 year-old group(n=55), and a 70-80 year-old group(n=56)to examine different lesion characteristics after coronary stent implantations.Results:In the 40-49 year-old group, the 50-59 year-old group, the 60-69 year-old group and the 70-80 year-old group, the rates of multi-vessel reocclusions were 11.6%, 15.5%, 21.8% and 25.0%, respectively( χ2=10.03, P=0.01). For each group, lesions with concurrent proximal and middle coronary reocclusions accounted for 8.3%, 12.0%, 30.9% and 35.7%, respectively( χ2=11.83, P=0.005); Reocclusions with severe coronary calcification accounted for 6.6%, 15.5%, 36.3% and 37.5%, respectively( χ2=11.56, P=0.006); Long coronary reocclusion lesions(36-47 mm)accounted for 15.0%, 17.2%, 21.8% and 25.0%, respectively( χ2=11.56, P=0.007); Coronary reocclusions with diffuse long calcified lesions accounted for 8.3%, 13.7%, 32.7% and 35.7%, respectively( χ2=10.80, P=0.01). Conclusions:The clinical characteristics of in-stent reocclusion lesions after coronary stent implantations include multiple chronic total coronary reocclusions, concurrent proximal and middle coronary reocclusions, heavily calcified coronary reocclusions, long coronary reocclusions and diffuse long calcified coronary reocclusions in aged patients.

Inhibitory effects of resveratrol on the proliferation, migration and angiogenesis of HUVECs through targeting mTORC2/Rictor / 基础医学与临床

Objective To investigate the effect of resveratrol on the proliferation, migration and angiogenic ability of HUVECs mediated by Rictor over-expression adenovirus.Methods The Rictor was obtained through PCR and cloned into GV314 plasmid to construct recombinant plasmid, then co-transfected 293T cells with helper plasmids to obtain Rictor overexpressing adenoviral particles(Ad-Rictor),the vector without target gene Ad-Null was set as the negative control group.Ad-Rictor and Ad-Null were infected HUVECs respectively,we also set up blank control group and resveratrol-intervention group(Ad-Rictor+Res). The expression of recombinant protein was detected by fluorescence microscopy and Western blot. CCK-8 assay,wound healing and matrigel assay were performed to as-sess the proliferation,migration and tube formation of HUVECs. Results We constructed Ad-Rictor and Ad-Null which may infect HUVECs and express Rictor protein efficiently. Ad-Rictor could significantly improve the prolifer-ation,migration and lumen formation (P<0.05), resveratrol intervention may significantly inhibit these functions induced by Ad-Rictor (P<0.05). Conclusions Resveratrol inhibits the proliferation, migration and angiopoietic ability of HUVECs through targeting mTORC2/Rictor.

Management of recurrent occlusion of lower limb arterial occlusions / 中华普通外科杂志

Objective To explore the experience in the treatment of postoperative reocclusion in patients of lower limb arterial occlusion.Methods From January 2007 to December 2011,clinical data were reviewed on 98 reocclusion episodes in 70 patients,who had been treated by graft bypass (30 patients),or angioplasty (15 patients) or both (25 patients).In this series,10 cases received conservative treatment and to the other 88 episodes reoperation was given,including thrombectomy alone in 15 episodes,and thrombectomy combined with microcatheter application for 13 episodes,and thrombectomy combined with angioplasty and microcatheter application for 60 episodes.Results Two patients died during follow-up period and 5 patients were lost to follow-up including 2 receiving conservative treatment.The other 63 patients were followed-up for 8 to 60 months,averaging (24 ± 5) months.The arterial patency in patients receiving reoperation treatment was 69.8％ (44 patients) and the amputation rate was 12.7％ (8 patients).Conclusions For postoperative recurrent arterial occlusion in patients of lower limb arterial occlusion,thrembectomy combined with angioplasty and microcatheter application may generate satisfactory results,

Progression of Acute Ischemic Infarction after a Hemostatic Therapy for Thrombolysis-Related Intracerebral Hemorrhage / 대한뇌졸중학회지

As thrombolysis for acute ischemic stroke is a double-edged sword, so could be the hemostatic treatment for thrombolysis-induced intracerebral hemorrhage. An 88-year-old woman with acute ischemic stroke presented with severe dysarthria and right hemiparesis. Her neurological symptoms rapidly improved after intravenous tissue plasminogen activator (t-PA) treatment. However, she became drowsy one hour after the intravenous t-PA treatment. Brain CT revealed a small right thalamic hemorrhage which was contralateral to the initial ischemic lesion. To prevent expansion of the hematoma, vitamine K was infused intravenously. Three hours after the infusion, conjugate eyeball deviation to the left side and right hemiplegia developed, which were likely to be resulted from reocclusion. Hemostatic therapy, such as vitamine K infusion, might be related to the worsening of cerebral ischemia after recanalization with t-PA.

Reocclusion and Hemorrhagic Transformation following Thrombolytic Therapy

In patients with acute ischemic stroke, early treatment with thrombolytic agents is thought to permit reperfusion to ischemic but still viable brain areas and to promote recovery of function. However, reocclusion and hemorrhagic transformation may occur after thrombolysis and these are major factors of no-improvement or deterioration despite the initial successful recanalization. Reocclusion occurs frequently during or immediately after successful recanalization, often silently. In the case of reocclusion, initial platelet-fibrin thrombi are converted into platelet-rich thrombi by platelet-mediated thrombotic mechanisms. Therefore, if can be effectively resolved by use of the platelet membrane glycoprotein IIb/IIIa receptor inhibitors such as abciximab. Hemorrhagic transformation (HT) is a well-known factor limiting the use of thrombolytics and negating the effect of the treatment. Recent studies demonstrate that loss of integrity of the blood-brain barrier in association with active proteolytic degradation of vascular extracellular matrix is a key molecular pathway leading to HT. Therapeutic strategies to prevent reocclusion and HT by use of agents that act against these mechanisms before or during thrombolysis are warranted to enhance the efficacy of reperfusion therapy in stroke.

Two Cases of Severe Neutropenia Associated with Ticlopidine

Ticlopidine is a powerful inhibitor of platelet aggregation which is induced by adenosine diphosphate. Ticlopidine has been shown to be effective in reducing combined stroke, myocardial infarction, reocclusion of coronary stent. The principal side effects of ticlopidine are severe neutropenia, rash and gastrointestinal upset. Recently, we experienced two cases of severe neutropenia associated with ticlopidine. One was administered ticlopidine to prevent subacute thrombosis after intracoronary stent implantation in unstable angina pectoris. Thirty days of therapy, her absolute neutrophil count (ANC) had dropped to 14/mm3 . The other patient was presented with recurrent episodes of cerebral infarction, for which he had undergone right carotid angiogram. The carotid angiogram demonstrated tight stenosis of right internal carotid artery. Carotid artery stenting was performed at right internal carotid artery without any complications. Twenty seven days of ticlopidine therapy, his ANC had dropped to 111/mm3. The ticlopidine was stopped, and they were given granulocyte-colony stim-ulating factor 250 microgram/day subcutaneous injection until their ANC was up to 1000/mm3. They were discharged with normal neutrophil count and no other complications.