Mechanism of Zhongfeng Xingnao Decoction in improving microcirculatory disorders in cerebral hemorrhage based on network pharmacology and molecular docking techniques / 中国中药杂志

This study aimed to explore the mechanism of Zhongfeng Xingnao Decoction(ZFXN) in intervening microcirculatory di-sorders in cerebral hemorrhage by network pharmacology and molecular docking techniques. The information on the components of ZFXN was obtained through the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform(TCMSP) database, and the predicted targets of chemical components were obtained from PubChem and SwissTargetPrediction. The relevant targets of cerebral hemorrhage and microcirculatory disorders were collected from the GeneCards database, and the common targets of the components and diseases were analyzed by the Database for Annotation, Visualization, and Integrated Discovery(DAVID) for Gene Ontology(GO) and Kyoto Encyclopedia of Genes and Genomes(KEGG) enrichment analyses. Visualization of the correlation network was carried out using Cytoscape software to further screen important chemical components for molecular docking prediction with disease targets. The animal experiment validation was performed using modified neurological severity score(mNSS), enzyme-linked immunosorbent assay(ELISA), quantitative real-time polymerase chain reaction(qRT-PCR), immunofluorescence, and Western blot to detect the effects of ZFXN intervention in mice with cerebral hemorrhage. The results showed that there were 31 chemical components and 856 targets in the four drugs contained in ZFXN, 173 targets for microcirculatory disorders in cerebral hemorrhage, and 57 common targets for diseases and components. The enrichment analysis showed that common targets were mainly involved in biological processes, such as cell proliferation and apoptosis, and signaling pathways, such as tumor pathway, viral infection, phosphoinositide-3-kinase/protein kinase B(PI3K/AKT) signaling pathway, and mitogen-activated protein kinase(MAPK) signaling pathway. Molecular docking results revealed that the common components β-sitosterol of Rhei Radix et Rhizoma, Notoginseng Radix et Rhizoma, and Ginseng Radix et Rhizoma Rubra showed good docking with proto-oncogene tyrosine-protein kinase(SRC), signal transducer and activator of transcription 3(STAT3), phosphoinositide-3-kinase catalytic alpha polypeptide gene(PIK3CA), recombinant protein tyrosine phosphatase non receptor type 11(PTPN11), AKT1, epidermal growth factor receptor(EGFR), calcium adhesion-associated protein beta 1(CTNNB1), vascular endothelial growth factor A(VEGFA), and tumor protein p53(TP53). Moreover, sennoside E of Rhei Radix et Rhizoma showed good docking with MAPK1. The results revealed that the ZFXN relieved the neural injury in mice with cerebral hemorrhage, decreased the expression of S100 calcium-binding protein B(S100β), neuron specific enolase(NSE), matrix metalloproteinase 9(MMP9), tumor necrosis factor α(TNF-α), interleukin 1β(IL-1β), SRC, EGFR, CTNNB1, VEGFA, TP53, glial fibrillary acidic protein(GFAP), and leukocyte differentiation antigen 86(CD86), and increased the expression of p-PI3K, p-AKT, and zona occludens 1(ZO-1). The results indicate that ZFXN may inhibit neuronal apoptosis and inflammatory response through PI3K/AKT/p53 pathway to protect the blood-brain barrier, thereby slowing down microcirculatory impairment in cerebral hemorrhage.

Research Progress of Coronary Physiological Evaluation Development in 2021 / 医用生物力学

Cardiovascular disease is one of the most serious diseases endangering human life and health. In China, 2 out of every 5 people die of cardiovascular diseases. Myocardial ischemia is one of the important cardiovascular diseases. Fractional flow reserve (FFR) is used to quantify myocardial ischemia in epicardial stenoses. Index of microvascular resistance (IMR) is an invasive index for quantitative evaluation of coronary microcirculation. Traditional FFR and IMR measurements rely on guide wires to perform interventional measurements under the maximum hyperemia state,so as to assist the diagnosis of myocardial ischemia clinically. Coronary angiography-derived FFR and IMR without using invasive pressure-wire measurement, hyperemic stimulus and contraindications can assist the diagnosis and treatment of percutaneous coronary intervention by fast simultaneous calculation of FFR and IMR. In this review, the research progress of coronary angiography-derived FFR and IMR as well as other coronary physiological evaluation in recent years were summarized. It is of great clinical value to further study the combination of coronary angiography-derived FFR and IMR in functional research of coronary circulation from macro to micro.

Index of microcirculatory resistance: state-of-the-art and potential applications in computational simulation of coronary artery disease / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

The dysfunction of coronary microcirculation is an important cause of coronary artery disease (CAD). The index of microcirculatory resistance (IMR) is a quantitative evaluation of coronary microcirculatory function, which provides a significant reference for the prediction, diagnosis, treatment, and prognosis of CAD. IMR also plays a key role in investigating the interaction between epicardial and microcirculatory dysfunctions, and is closely associated with coronary hemodynamic parameters such as flow rate, distal coronary pressure, and aortic pressure, which have been widely applied in computational studies of CAD. However, there is currently a lack of consensus across studies on the normal and pathological ranges of IMR. The relationships between IMR and coronary hemodynamic parameters have not been accurately quantified, which limits the application of IMR in computational CAD studies. In this paper, we discuss the research gaps between IMR and its potential applications in the computational simulation of CAD. Computational simulation based on the combination of IMR and other hemodynamic parameters is a promising technology to improve the diagnosis and guide clinical trials of CAD.

Effects of Danhong Injection () on Peri-Procedural Myocardial Injury and Microcirculatory Resistance in Patients with Unstable Angina Undergoing Elective Percutaneous Coronary Intervention: A Pilot Randomized Study / 中国结合医学杂志

OBJECTIVE@#To evaluate the effect of Danhong Injection (, DH) on the index of microcirculatory resistance (IMR) and myocardial injury in patients with unstable angina undergoing elective percutaneous coronary intervention (PCI).@*METHODS@#Seventy-eight patients with unstable angina were randomly divided into DH group (39 cases) and the control group (39 cases) during elective PCI. Randomization was performed using a random-number table. The DH group received DH at a dosage of 40 mL (mixed with 250 mL saline, covered by a light-proof bag, intravenous drip) during PCI and daily for 7 consecutive days, while the control group only received the same dosage of saline. Both groups received standardized treatment. The IMR and fractional flow reserve (FFR) were measured at maximal hyperemia before and after PCI. Myocardial markers, including myoglobin, creatine kinase (CK), creatine kinase MB (CK-MB), and coronary troponin T (cTnT) values were measured at baseline and 24 h after PCI.@*RESULTS@#Among the 78 patients enrolled, the baseline and procedural characteristics were similar between the two groups. There was no significant difference in pre-PCI myocardial markers and coronary physiological indexes between the two groups. However, post-PCI CK and CK-MB levels in the DH group were significantly lower than those in the control group (111.97 ± 80.97 vs. 165.47 ± 102.99, P=0.013; 13.08 ± 6.90 vs. 19.75 ± 15.49, P=0.016). Post-PCI myoglobin and cTNT-positive tend to be lower in the DH group than in the control group but did not reach statistical significance (88.07 ± 52.36 vs. 108.13 ± 90.94, P=0.52; 2.56% vs.7.69%, P=0.065). Compared with the control group, the post-IMR levels of the DH group tended to decrease, but there was no statistical difference (20.73 ± 13.15 vs. 26.37 ± 12.31, P=0.05). There were no statistical differences in post-FFR in both groups. The peri-procedural myocardial injury of the DH group was significantly lower than that of the control group (2.56% vs. 15.38%, P=0.025). During the 30-d follow-up period, no major adverse cardiovascular events occurred in either group.@*CONCLUSION@#This study demonstrated benefit of DH in reducing myocardial injury and potential preserving microvascular function in patients with unstable angina undergoing elective PCI.

Clinical value of conventional ultrasound and contrast-enhanced ultrasound in evaluating donor liver quality in liver transplantation / 器官移植

At present, a large quantity of patients with end-stage liver diseases are still waiting for liver transplantation. Evaluation of donor liver quality with rapid, convenient, non-invasive and accurate methods plays a pivotal role in improving the prognosis and quality of life of liver transplant recipients. No standard evaluation criteria of donor liver quality have been established in clinical practice. Comprehensive evaluation methods have been primarily adopted, including clinical parameters of donors, laboratory examination, imaging examination and pathological examination, etc. Conventional ultrasound and contrast-enhanced ultrasound may evaluate the quality of donor liver before liver transplantation and predict the incidence of complications after liver transplantation, which are of significant application prospect in liver transplantation. In this article, the basic methods and research progress on conventional ultrasound and contrast-enhanced ultrasound in evaluating the vascular variation of donor liver, micro-circulatory perfusion of liver parenchyma, degree of steatosis of donor liver, degree of fibrosis of donor liver, volume and quality of donor liver were reviewed, aiming to provide more methods and ideas for clinical evaluation of donor liver quality.

Study on component-target-pathway multiple interactive network to reveal mechanism of Salvia miltiorrhiza in treatment of microcirculation disturbance / 中草药

Objective: To explore the mechanism of Salvia miltiorrhiza in treatment of microcirculatory disturbance based on network pharmacology. Methods: The targets of S. miltiorrhiza’s active components for treatment of microcirculatory disturbance were screened and predicted by utilizing TCMSP, PubChem Search, Genecards database and Swiss target prediction online tool. Cytoscape 3.3.0 software was adopted to construct an active component-microcirculatory disturbance target network. The protein-protein interaction (PPI) network was established by using STRING database. DAVID database was used to analyze metabolism pathway in target gene ontology (GO) biological process, Kyoto encyclopedia of genes and gnomes (KEGG). Results: Totally 65 active components of S. miltiorrhiza and nine related targets were screened. GO and KEGG pathway enrichment analysis revealed that active components of S. miltiorrhiza participated in oxidation-reduction process, cellular calcium ion homeostasis and other biological processes, and S. miltiorrhiza may regulate VEGF signaling pathway, cholinergic synapse signal transduction, oxytocin signaling pathway, aldosterone-regulated sodium reabsorption pathway and so on. Conclusion: This study reflects the characteristics of multi-components, multi-targets, and multi-pathways of S. miltiorrhiza in the treatment of microcirculation disturbance, which may provide new ideas and methodology for further research on the treatment of microcirculatory disturbance using S. miltiorrhiza.

Value of index of microcirculatory resistance for early prediction of periprocedural myocardial microcirculatory injury after percutaneous coronary intervention in patients with coronary heart disease / 中华心血管病杂志

Objective@#To explore the value of index of microcirculatory resistance (IMR) for early prediction of periprocedural myocardial injury (PMI) in patients with stable angina pectoris (SAP) and acute coronary syndrome (ACS) after PCI.@*Methods@#It was a prospective study. One hundred and sixty-four patients who had single coronary lesion were consecutively enrolled from May 2014 to December 2017 at Nanjing Hospital affiliated to Nanjing Medical University. According to clinical manifestation, patients were divided into SAP group (n=81) and ACS group (n=83). IMR was determined by thermal dilution with pressure guide wire. Basic clinical characteristics, coronary angiographic results, PCI procedural details, IMR after PCI, ΔIMR (IMR=post-PCI-IMR pre-PCI), levels of myocardial biomarkers before and after PCI were compared between the two groups. Multivariate logistic regression was used to analyze the relation of PMI with IMR and ΔIMR, and the predictive ability was evaluated by receiver operating characteristic (ROC).@*Results@#The levels of total cholesterol and low density lipoprotein cholesterol were significantly higher in ACS group than in SAP group (P<0.05), other clinical data at baseline were similar between the two groups (P>0.05). Quantitative coronary angiography (QCA) results and PCI related data were also similar between the two groups before PCI (P>0.05). Values of mean transit time (Tmn) of intracoronary injection with room temperature saline, post-PCI IMR and ΔIMR were significantly higher in ACS group than in SAP group after PCI (P<0.05). Plasma creatine kinase isoenzyme-MB difference (ΔCK-MB) (ΔCK-MB=CK-MB post-PCI-CK-MB pre-PCI) and cardiac troponin-I (cTnI) difference (ΔcTnI=cTnI post-PCI-cTnI pre-PCI) were significantly larger in ACS group than in SAP group (P<0.05). Multivariate logistic regression analysis showed that coronary artery disease (CHD) type (SAP and ACS) (OR=1.301, 95%CI 1.083-1.562), age (OR=1.007, 95%CI 1.000-1.013), ΔIMR (OR=1.009, 95%CI 1.000-1.017) and post-PCI IMR (OR=1.008, 95%CI 1.001-1.014) were independent predictors of PMI (P<0.05). The area under the ROC curve (AUC) of ΔIMR was 0.763 to predict PMI (P<0.05), the optimum cut-off value of ΔIMR was 5.485 with 70.0% sensitivity and 77.4% specificity. ΔIMR was positively correlated with ΔcTnI (r=0.592, P<0.05).@*Conclusions@#ΔIMR serves as an early predictor of PMI in CHD patients after PCI. As compared with SAP patients, ACS patients are more likely to develop PMI.

Changes of the microcirculatory blood perfusion at "Feishu" (BL 13) in the COPD rats / 中国针灸

OBJECTIVE@#To observe the change of the specificity of the microcirculatory blood perfusion at the area of "Feishu" (BL 13) in the rats of chronic obstructive pulmonary disease (COPD).@*METHODS@#According to the random number table, 60 Wistar rats were divided into a 29 d model No. 1 group (C1 group), a 29 d normal control No.1 group (N1 group), a 89 d model No.2 group (C2 group) and a 89 d normal control No. 2 group (N2 group), 15 rats in each one. In the C1 and C2 groups, the smoking and intratracheal drops of endotoxin were used in combination to prepare COPD model. The rats were fed normally in the N1 and N2 groups. "Feishu" (BL 13), "Xinshu" (BL 15), the lateral site of "Feishu" (BL 13) and the lateral site of "Xinshu" (BL 15) were selected as the monitoring points. The pericam perfusion speckle imager (PeriCam PSI System) was adopted to monitor the microcirculatory perfusion unit (PU) at the monitoring points before and in 29 d and 89 d after modeling separately.@*RESULTS@#Before modeling, the differences in PU were not significant at each monitoring point in comparison among the 4 groups and the differences were not significant among "Feishu" (BL 13) and "Xinshu" (BL 15) as well as their lateral sites (all >0.05). After modeling, PU was increased at each monitoring point in the C1 and C2 groups (all <0.05). PU in the C1 group was higher than the N1 group and that in the C2 group was lower than the N2 group, PU at each monitoring point in the C1 group were higher than the C2 group, indicating the significant differences (all <0.05). In the C1 and C2 groups, the specific change occurred, in which PU at "Feishu" (BL 13) was higher than its lateral site. But such specific change did not happen in the N1 and N2 groups.@*CONCLUSION@#PU at "Feishu" (BL 13) presents the specific change relevant with the sickness duration in the COPD rats.

Clinical study of traditional Chinese medicine anti-inflammatory mixture for the microcirculation disturbance in patients with sepsis targetting at vascular endothelium / 国际中医中药杂志

Objective To observe the clinical effect of traditional Chinese medicine inflammatory mixture on vascular endothelial cell injury, mcrocirculation disorder and organ dysfunction in sepsis. Methods 73 patients with sepsis were randomly divided into two groups: Anti-inflammatory mixture-treated group (40 cases) and control group (33 cases). Routine medicine therapy was given in both groups.Additionally, in the Anti-inflammatory mixture-treated group, 100 ml Anti-inflammatory mixture was given By oral or nasal feeding, every 12 hours for consecutive 7 days. Vascular endothelial injury index (Soluble thrombomodulin,Vascular endothelial growth factor-2, endothelial specific molecule-1), mcrocirculation disorder index (arterial blood lactate, central venous oxygen saturation, total vessel density, perfused vessel density, proportion of perfused vessels, microcirculatory flow index) of two group patients before and after therapy were observed and the sequential organ failure score (SOFA) was recorded before and after treatment. Results After treatment, the indexes of vascular endothelial injury sTM (12.37 ± 5.08 μg/L vs. 18.77 ± 6.88 μg/L, t=3.448), VEGF-2 [45.6 ng/L (14.3, 112.5) vs. 52.4 ng/L (17.2, 123.6), Z=4.009], ESM-1 (15.54 ± 4.09 ng/ml vs. 17.64 ± 6.79 ng/ml, t=-1.551), Lac (2.6 ± 1.2 mmol/L vs. 3.7 ± 1.8 mmol/L, t=4.115) and SOFA (4.1 ± 1.7 vs. 6.1 ± 3.2, t=-2.118) in anti-inflammatory mixture group decreased significantly than those in the control group. but the ScvO2(0.719 ± 0.243 vs. 0.603 ± 0.201, t=-2.773), PVD (14.8 ± 5.8 mm/mm2 vs. 13.1±5.1 mm/mm2, t=-5.114), PPV (59.1% ± 22.5% vs. 53.9% ± 20.6%, t=1.779), MFI (9.4 ± 4.6 vs. 7.2 ± 2.2, t=4.339) in the anti-inflammatory mixture group were significantly higher than those in the control group. Correlation analysis showed that the sTM and PPV were significantly negatively correlated (r=-0.875, P＜0.01), ESM-1 was significantly negatively correlated with PVD, PPV and MFI (r=-0.877, P＜0.01; r=-0.799, P＜0.01; r=-0.821, P＜0.01) and ESM-1 and SOFA were significantly positively correlated (r=0.840, P＜0.01). Conclusions Anti-inflammatory mixture of Chinese medicine has a certain therapeutic effect on sepsis by protecting vascular endothelial cell function.

Coronary microvascular resistance and its relevant factors in patients with moderate coronary stenosis and chest pain / 中华内科杂志

Objective To evaluate the impact of cardiovascular risk factors on index of microvascular resistance (IMR)and coronary flow reserve (CFR) and to explore the characteristics of IMR and CFR and the relationship between IMR and angiographic features in patients with intermediate coronary stenosis and chest pain.Methods Fractional flow reserve (FFR),CFR,and IMR were measured in patients who underwent invasive coronary angiography with 40％-70％ stenosis by visual assessment.All patients with FFR＞0.75 were enrolled and grouped with the cut-off points of IMR≥25 and CFR≤2.0.Patients with IMR≥25 were group H,including two sub-groups (high IMR-low CFR,group H1 and high IMR-high CFR,group H2),while those with IMR＜25 were group N.The thrombolysis in myocardial infarction (TIMI) frame were counted.Results A total of 34 patients with FFR＞0.75 were enrolled with 61.8％(21 cases) of males and 38.2％ (13 cases) of females.The mean age was (57.3±8.1) years old.High IMR accounted for 47.1％ of all cases.There was significant difference between group H and N in TIMI frame (33.0 vs.20.8,P=0.031).There were significant differences between group H1 and H2 in homocysteine (17.8 μmol/L vs.12.0 μmol/L,P=0.005) and IMRcorr (58.0 vs.36.1,P=0.002).IMRcorrwas correlated to TIMI frame (r=0.40,P=0.012) for all cases.The sensitivity and specificity of inferring IMR≥35.3 by TIMI frame were 0.75 and 0.65 (P=0.049) with TIMI frame over 40.5.Conclusions High IMR may be one of the reasons for chest pain in patients with intermediate coronary stenosis.There is no correlation between vascular risk factors and IMR or CFR,while there is positive correlation between TIMI frame and IMR.The specificity is 65％ for inferring IMR rise with TIMI frame over 40.5.

"The Influence of Yijinjing ""Supporting Pile"" on Microcirculation Blood Perfusion Units on Du Meridian in Subjects with Yang-deficiency Constitution" / 中国运动医学杂志

Objective To observe the effect of Yijinjing Supporting Pile on the superficial microcirculation blood perfusion units (MBPU) on Du meridian in subjects with yang-deficiency constitution.Methods After the classification and determination of constitution according to the traditional Chinese medicine,19 volunteers (8 males and 11 females) with Yang-deficiency constitution were selected and provided with standard Yijinjing Supporting Pile training for 3 months.The laser Doppler flowmeter system was used to detect the superficial MBPU on the acupoints of Du meridian including Dazhui,Zhiyang and Mingmen,Results Before the training,the average MBPU value of Zhiyang was higher than Mingmen,but lower than Dazhui (P＜0.05,P＜0.01).After the training,the average MBPU value of all the acupoints increased significantly (P＜0.01).Conclusion Yijinjing Supporting Pilecan improve the superficial MBPU of Du meridian in subjects with Yang-deficiency constitution,and regulate the energy metabolism of the Du meridian.

Clinical Observation of Intravenous Drip of Alprostadil Combined with Acupuncture in the Treatment of Diabetic Foot Ulcer / 中国药房

OBJECTIVE:To investigate clinical efficacy of intravenous drip of alprostadil combined with acupuncture in the treatment of diabetic foot ulcer and its effects on inflammatory factors levels and wound microvascular density. METHODS:A total of 72 patients with diabetic foot ulcer in our hospital during May 2014 to Sept. 2015 were divided into observation group and con-trol group according to random number table,with 36 cases in each group. Control group was given Alprostadil injection 10μg add-ed into 250 mL 0.9% Sodium chloride injection intravenously,qd,on the basis of routine treatment as insulin. Observation group was additionally given acupuncture therapy (Sanyinjiao,Zusanli,Fenglong,Yanglingquan,Yinlingquan and other acupuncture points),qd,on the basis of control group. Treatment courses of 2 groups lasted for 3 weeks. Clinical efficacy,wound healing time,fasting blood glucose,urine microalbumin,inflammatory factors,wound microvascular density as well as the occurrence of ADR were compared between 2 groups. RESULTS:The total response rate of observation group(91.67%)was significantly higher than that of control group(72.22%),and wound healing time was significantly shorter than control group,with statistical signifi-cance(P0.05). After treatment,above indexes of 2 groups were significantly lower than before,and urine microalbumin and inflammatory factors of the observation group was significantly lower than the control group,with statisti-cal significance (P<0.05). 14,21 d after treatment,wound microvessel density of observation group was significantly higher those of control group,with statistical significance(P<0.05). No obvious ADR was found in 2 groups. CONCLUSIONS:Intrave-nous drip of Alprostadil combined with acupuncture can boost angiogenesis through mitigating inflammatory reactions,thus shorten the time of wound healing and enhance therapeutic efficacy.

Transcutaneous oxygen pressure andits clinical significance in patients with type 2 diabetic peripheral neuropathy / 中国糖尿病杂志

Objective To evaluate the transcutaneous oxygen pressure (TcPO2 )and its clinical significance in patients with type 2 diabetic peripheral neuropathy (DPN). Methods A total of 222 hospitalized patients with type 2 diabetes mellitus (T2DM)from the Department of endocrinology of Lianyungang First People's Hospital in Jiangsu Province were enrolled in this study from October 2014 to September 2015.And 50 healthy controls were also selected in this study as control group (NC group). TcPO2 was tested in supine position in all the subjects by TCM400 TcPO2 detector. Patients with T2DM then were divided into two groups according to Nerve conduction velocity (NCV):DPN group (n = 102) and non-DPN group (NDPN group,n = 120).Anthropometric and metabolic parameters were assessed in each group. Results TcPO2 in supine positionwas lower in DPN group than in NC and NDPN group. TcPO2 was positively correlated with diabetes duration,TCSS scores,HbA1 c,SUA,FPG and NCV.Compared with normal TcPO2 group,the prevalence of DPN was increasedin low TcPO2 group,while NCV of motor nerve and sensory nerve were decreasedin low TcPO2 group.Logistic analysis showed that TcPO2 was an independent risk factor for DPN. Conclusion TcPO2 in supine position was decreased in patients with DPN,and is a risk factor for DPN,which may provides valuable information for DPN diagnosis.

Effect of Shenfu injection on microcirculation effect index in early-and middle-stage of cardiogenic shock rats / 中国药理学与毒理学杂志

OBJECTIVE Shenfu injection(SFI) is an effective treatment of cardiogenic shock, the pathology of the central link was microcirculation disturbance. However, whether the microcirculation status of the early- and mid-stage of cardiogenic shock has any difference is unclear. This study aimed to observe the effect of SFI on the microcirculatory disturbance in mesentery for early- and mid-stage of cardiogenic shock rat. METHODS The early- and mid-stage model of cardiogenic shock was estab?lished by ligating the ending or root of left anterior descending coronary arteries(LADCA). The rats were randomly divided into 9 groups, ie control group, early- stage model group, mid- stage model group, 3 early medicated groups and 3 mid medicated groups(the dosage was 1, 3.33, 10 mL·kg-1 SFI for cardiogenic shock rats of early- and mid-stage, respectively). Parameters in mesenteric microcircu?lation, such as velocity of RBCs in venules, diameters of venules, the count of leukocyte adhesion and vascular permeability which calculated by FITC-dextran leakage were observed through an Geneandi-M2 inverted intravital microscope and high-speed video camera system. RESULTS The cardiogenic shock induced by ligating the LADCA resulted in a number of responses in microcirculation, including a significant increase in the counts of adhesive leukocytes, narrowing of the vascular diameter, decrease in the velocity of RBCs and dextran efflux. All of the above parameters for early- stage cardiogenic shock rats were attenuated by the treatment with SFI, especially the dosage of 10 mL·kg-1. While SFI had no apparent time- effect on the vascular diameter and vascular permeability in mesentery for mid-stage cardiogenic shock rats. CONCLUSION The microcirculation status of the early- and mid-stage of cardiogenic shock rats were quite different. The efficacy of early treatment with SFI was more obvious than the mid administration, which could provide experimental and theoretical basis for the patients with cardiogenic shock in an earlier time.

Coronary microcirculation and short-term prognosis in patients with type 2 diabetes and poor glucose controls who underwent elective percutaneous coronary intervention for acute myocardial infarction / 中国介入心脏病学杂志

Objective To evaluate the status of microcirculation and to compare the short-term prognosis after elective PCI for AMI between patients with poorly controlled type2 diabetes and patients without type 2 diabetes. Methods According to the clinical history and HbA1c values,all patients were divided into 2 groups:diabetic group (group A,n=24) and non-diabetic group (group B,n=32).Basic clinical data, left ventricular end diastolic diameter (LVEDD) and left ventricular shot ejection fraction (LVEF)immediately and 3 months after operation measured by echocardiography and the result of coronary angiography were compared between the two groups. The rate of MACE 3 months after PCI was also compared. A pressure-temperature sensor wire was used to measure the index of microcirculation resistance(IMR)immediately after PCI. Results 1.The mean IMR value in group A was higher than group B(29.12±7.45)vs.(22.74±6.87);P=0.011.The HbA1c levels has positive correlation with the IMR value(r=0.324;P=0.048). 2. The mean LVEDD and the mean LVEF Rad no signifi cant diff erence between two groups before PCI. The mean LVEDD of group A at 3 months after PCI was significantly larger than group B(52.3±4.8)mm vs.(48.6±5.1)mm,P=0.019,the mean LVEF of group A 3 months post PCI was lower than that of group B(48.6±7.3)% vs.(56.1±4.7)%,P=0.003.The mean increase in LVEDD at 3 months after PCI in group A was higher than group B(4.1±6.3)mm vs.(0.8±4.4)mm, p=0.005 and the mean increase in LVEF in group A was significantly lower than in group B(–1.9±6.8)% vs. (4.3±5.4)%,P=0.007. 3. HbA1chad positive correlation with LVEDD(r=0.324,p=0.048)and its increase at 3 months postoperatively(r=–0.422,P=0.005).4. Risk estimation found type 2 diabetes was an independent risk factor for poor recovery of LVEF. The MACE rate was signifi cantly higher in Group A than in Group B(35.7% vs.9.4%,P=0.018).Conclusions Patients with type2 diabetes were more prone to suffer from coronary microcirculatory dysfunction and had poor recovery of cardiac function. Poorly controlled type 2 diabetes was an independent risk factor for poor recovery of cardiac function and short-term prognosis was worse in diabetic patients who had elective PCI.

Correlation Analysis between Morning Blood Pressure Surge and Coronary Microvascular dysfunction / 实用医学杂志

Objective To investigate the correlation between morning blood pressure surge and Coronary Microvascular Dysfunction.Methods 58 cases of patients with hypertension in our hospital were given 24 h ambu-latory blood pressure monitoring(ambulatory blood pressure monitoring,ABPM).The coronary microvascular dys-function was estimated by the index of microcirculatory resistance(IMR). All cases were given biochemical test-ing,included TCH,TG,HDL-c,LDL-c and SUA.Results According to whether ABMP was arise,the patient were divided into MBPS group(n=21)and the Non-MBPS group(n=37).24 h,day,night and morning peak of systolic blood pressure were significantly higher in the morning peak group than in the average morning peak group. Multiple linear regression analysis showed that,MBPS,24 h average systolic blood pressure,day average systolic blood pressure,night average systolic blood pressure,and age were independent risk factors for coronary artery disease.Conclusion Morning blood pressure surge is closely related to severity of coronary microcirculation dysfunction. It is an independent risk factor for coronary microcirculation dysfunction. To control the blood pres-sure in patients with hypertension effectively can reduce morning peak target organ damage.

Clinical study on microcirculation resistance index for predicting major adverse cardiac events after PCI operation in patients with ST segment elevation myocardial infarction / 重庆医学

Objective To investigate the clinical value of the index of microcirculation resistance(IMR) in the prediction of major adverse cardiac events after PCI in the patients with ST segment elevation myocardial infarction.Methods Forty-eight inpa tients with acute ST segment elevation myocardial infarction(STEMI) in the cardiology department CCU of our hospital from December 2013 to June 2015 were selected,including 38 males and 10 females,and divided into 3 groups according to the measured IMR value after PCI operation:the group A,IMR≤25(n=18);group B,IMR 25 ～ 32 (n =16);group C,IMR≥32 (n =14).Serum NT-ProBNP was collected,and the data in cardiac color ultrasound after PCI and at postoperative 1 year:left ventricular ejection fraction(LVEF) and left ventricular end diastolic diameter(LVEDD),and major adverse cardiac events within 1 years after PCI were also collected.Results The serum of concentrations NT-ProBNP were compared among the three groups[(2 734.83 ± 1 009.40) vs.(4 929.68±611.52) vs.(7 480.64±2 082.78)],and the difference among 3 groups was statistically significant (F=35.449,P=0.000).The difference of LVEF among the three groups had statistal significance[(54.00-±-5.99) vs.(52.31 ± 4.35)vs.(49.29 ±4.68),F=3.376,P=0.043)],and there was no statistical difference among the three groups in LVEDD(P＞0.05).The difference of LVEF at postoperative 1 year among 3 groups had statistical significance[(57.28 ± 5.21)vs.(54.43 ±3.69)vs.(46.43±5.33),F=16.744,P=0.000],and the difference of LVEDD (48.94±1.95)vs.(50.63±2.68)vs.(52.14±2.69) among 3 groups was statistically significant(F=6.875,P=0.002).The differences in the major adverse cardiac events,cases of cardiac death and cases of heart failure after postoperative 1 year among 3 groups were statistically significant(x2 value=6.707,P=0.035;x2 value=6.084,P=0.048);the occurrence of again ACS,again PCI and malignant arrhythmia had no statistical difference among 3 groups(P＞0.05).Conclusion Measurement of IMR after PCI in the patients with STEMI can effectively predict the heart function and the risk of major adverse cardiac events within 1 year.

Physiologic Evaluation of Microvascular Damage in Culprit Vessel After Successful Primary Percutaneous Coronary Intervention for ST-elevation Myocardial Infarction Patients

We investigated the importance of comprehensive physiologic assessment about culprit vessel in STEMI in estimating long-term clinical outcomes after complete revascularization. Comprehensive physiologic assessment provides additional information about microvascular function in coronary artery disease. This assessment includes three indices, fractional flow reserve (FFR), index of microcirculatory resistance (IMR) and coronary flow reserve (CFR). We have performed the comprehensive physiologic assessment in culprit vessels after successful primary PCI in STEMI patients. Both cases were thrombotic total occlusion in mid right coronary artery with inferior wall STEMI, successfully revascularized with stent implantation after thrombus suction. However, in post PCI physiologic assessment, one case showed overt microvascular damage. CFR was 1.1, and IMR was 75U, which was defined as a combined criterion of low CFR (<2.0) and high IMR (≥25U) in culprit vessel, but the other case showed 2.2 in CFR and 24U in IMR, which suggested no overt microvascular damage. Moreover, we can validate these findings by cardiac MR after primary PCI. Previous studies presented that the presence of overt microvascular damage was significantly associated with worse clinical outcome in patients with coronary artery disease. We suggest that comprehensive physiologic evaluation provides important information about the degree of microvascular damage and long-term clinical outcomes after complete revascularization in culprit vessel in STEMI.

Experimental Study of Surround Needling at Articular Six Meridians plus Finger (toe) Tip Bloodletting Therapy for Diabetic Peripheral Neuropathy / 上海针灸杂志

Objective To investigate the effect of surround needling at articular six meridians plus finger (toe) tip bloodletting therapy on sciatic nerve conduction velocity and lower limb microcirculatory flow in diabetic rats. Method The model was made with streptozotocin. The rats were allocated to model, methycobal, acupuncture and normal groups. The methycobal group received a muscular injection of 50 ?g/kg in the left and right lower limbs alternately, every other day. The acupuncture group received acupuncture at points Taixi(KI3), Kunlun(BL60) and Jiexi(ST41), once daily plus toe tip bloodletting. The normal and model groups were bound 30 min once every other day. Every group was treated for eight weeks. General condition was observed, and sciatic nerve conduction velocity and lower limb microcirculatory flow were measured in the rats before and after treatment. Result Compared with the normal group, sciatic nerve conduction velocity decreased in the other groups of rats (P<0.01). Compared with the model group, sciatic nerve conduction velocity was higher in every treatment group of rats (P<0.05). Conclusion Surround needling at articular six meridians plus finger (toe) tip bloodletting therapy can increase sciatic nerve conduction velocity and improve lower limb microcirculation.

Paying attention to the role of retinal microvascular changes in prognosis and management of systemic microvascular diseases / 中华实验眼科杂志

Being a part of the microcirculatoty system,retinal microvasculature may have similar morphology change as cardio-and cerebro-microvasculature under the pathological conditions.Although no study has proved that there exists causal relationship between retinal microvasculature change and cardiovascular diseases (CVD) , realizing their connection is extremely vital for ophthalmologists to evaluate the status of the systemic microcirculation, predict the occurrence of CVD, and proceed primary prevention by visible information of retinal microvascular alteration.In addition,for the patients suffering from retinal vascular occlusion,especially those with undiagnosed systemic diseases like CVD,ignoring systemic examinations may delay proper treatment and lead to the consequences of ill health.In conclusion, ophthalmologists should recognize the association of retinal microvasculature changes with systemic vascular diseases and provide useful information for primary prevention and early diagnosis and treatment of systemic vascular diseases.