An-Gong-Niu-Huang-Wan (AGNHW) regulates cerebral blood flow by improving hypoperfusion, cerebrovascular reactivity and microcirculation disturbances after stroke.

BACKGROUND: The restoration of cerebrovascular regulation and improvement of cerebral blood flow in ischaemic regions are crucial for improving the clinical prognosis after stroke. An-Gong-Niu-Huang-Wan (AGNHW) is a famous traditional compound Chinese medicine that has been used for over 220 years to treat acute ischaemic stroke; however, its role in the regulation of cerebral blood flow is still unclear. The aim of the present study was to investigate the regulatory effect of AGNHW on cerebral blood flow and microcirculation after ischaemic stroke and to elucidate the underlying mechanisms involved. METHODS: Male C57BL/6 mice were subjected to distal middle cerebral artery occlusion (dMCAO) and randomly assigned to the sham, MCAO, or AGNHW groups. AGNHW was administered intragastrically 1 h after dMCAO. The rotarod test was utilized to evaluate behavioural function; TTC was used to determine the infarct volume; and ischaemic injury was assessed by detecting brain levels of SOD, MDA and NO. Then, cortical perfusion and acetazolamide-induced cerebrovascular reactivity were assessed using laser speckle contrast imaging, and the velocity and flux of red blood cells in cortical capillaries were detected using two-photon laser scanning microscopy. In addition, we employed RNA-Seq to identify variations in gene expression profiles and assessed endothelium-dependent changes in microcirculatory dysfunction by measuring vasoactive mediator levels. RESULTS: AGNHW significantly increased cerebral blood flow, reduced the infarct volume, and promoted functional recovery after cerebral ischaemia. AGNHW increased the velocity and flux of red blood cells in capillaries and improved cerebrovascular reactivity in the ischaemic cortex. Furthermore, AGNHW regulated endothelium-dependent microcirculation, as evidenced by decreases in the expression of endothelins (Edn1, Edn3 and Ednrb) and the ratios of brain and serum TXB2/6-keto-PGF1α and ET-1/CGRP. CONCLUSIONS: AGNHW improved cerebral hypoperfusion, regulated cerebrovascular reactivity and attenuated microcirculatory dysfunction within the ischaemic cortex after stroke. This outstanding effect was achieved by modulating the expression of genes related to vascular endothelial cell function and regulating endothelium-dependent vasoactive mediators.

Diagnosis and treatment of diabetic foot ulcer complicated with lower extremity vasculopathy: Consensus recommendation from the Chinese Medical Association (CMA), Chinese Medical Doctor Association (CMDA).

Diabetic foot ulcer complicated with lower extremity vasculopathy is highly prevalent, slow healing and have a poor prognosis. The final progression leads to amputation, or may even be life-threatening, seriously affecting patients' quality of life. The treatment of lower extremity vasculopathy is the focus of clinical practice and is vital to improving the healing process of diabetic foot ulcers. Recently, a number of clinical trials on diabetic foot ulcers with lower extremity vasculopathy have been reported. A joint group of Chinese Medical Association (CMA) and Chinese Medical Doctor Association (CMDA) expert representatives reviewed and reached a consensus on the guidelines for the clinical diagnosis and treatment of this kind of disease. These guidelines are based on evidence from the literature and cover the pathogenesis of diabetic foot ulcers complicated with lower extremity vasculopathy and the application of new treatment approaches. These guidelines have been put forward to guide practitioners on the best approaches for screening, diagnosing and treating diabetic foot ulcers with lower extremity vasculopathy, with the aim of providing optimal, evidence-based management for medical personnel working with diabetic foot wound repair and treatment.

Effect of optimized thrombus aspiration on myocardial perfusion and prognosis in acute ST-segment elevation myocardial infarction patients with primary percutaneous coronary intervention.

Objective: To investigate the impact of optimized thrombus aspiration on myocardial perfusion, prognosis, and safety in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention(primary PCI). Methods: A total of 129 patients with STEMI were randomly allocated into control group (Subgroup A and B) and experimental group(Subgroup C and D). Control group received percutaneous transluminal coronary angioplasty (PTCA),thrombus aspiration and primary PCI. Experimental group received optimized thrombus aspiration and primary PCI. The number of thrombus aspiration was less than 4 times in Subgroup A and C. The number of thrombus aspiration was performed more than 4 times in Subgroups B and D. The classification of thrombi extracted, the TIMI flow grade, the incidence of no-reflow and slow flow, cTFC, TPI and CK-MB at 12 h and 24 h after stenting, ST segment resolution of ECG after stenting, NT-proBNP, LVEFat 24 h, 30 days and 180 days after stenting were compared between groups. The incidence of intraoperative and postoperative bleeding complications, stroke events and major cardiovascular events (MACE) were recorded and compared between groups. Results: The classification of thrombi extracted in the experimental group was higher than that in the control group. The TIMI flow grade of the experimental group was better than the control group after thrombus aspiration. After stenting, the advantage still existed, but the difference was not statistically significant. On cTFC, the experimental group was lower than the control group, but the difference was not statistically significant; After stenting the experimental group was significantly lower than the control group. The CK-MB at 12 h and 24 h of the experimental group was lower than the control group. After thrombus aspiration the incidence of no-reflow in the experimental group was significantly lower than that in the control group; after stenting the incidence of no-reflow in the experimental group was still lower than the control group, but no statistically difference. After thrombus aspiration and stenting the incidence of slow flow in the experimental group were lower than that in the control group. After stenting, NT-proBNP at 24 h was lower in the experimental group than that in the control group, However, there was no statistical difference; after stenting, The NT-proBNP in the experimental group was lower than that in the control group at 30 days and 180 days. After stenting, LVEF of the experimental group was significantly higher than the control group at 24 h and 30 days; superiority remained after 180 days but no statistical difference. There was no statistical difference between two groups for intraoperative and postoperative bleeding complications, stroke events, and MACE events. In Subgroup analysis,there was no significant difference in the classification of thrombi extracted, TIMI flow grade, cTFC, CK-MB,NT-proBNP and LVEF between group C and D, but group A was better than group B. Analysis of variance showed that the optimal number of suction was 4-5 times. Conclusions: Optimized thrombus aspiration can significantly improve myocardial perfusion and short-term and medium-term prognosis of STEMI patients after PCI, and reduce the incidence of slow flow and no-reflow. The optimal suction times were 4-5 times. Traditional aspiration method with more aspiration times is harmful to cardiac prognosis. Thrombus aspiration does not increase the incidence of stroke events and is safe.Clinical Trial Registration: identifier, ChiCTR2300073410.

Fluid metabolic pathways after subarachnoid hemorrhage.

Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating cerebrovascular disease with high mortality and morbidity. In recent years, a large number of studies have focused on the mechanism of early brain injury (EBI) and delayed cerebral ischemia (DCI), including vasospasm, neurotoxicity of hematoma and neuroinflammatory storm, after aSAH. Despite considerable efforts, no novel drugs have significantly improved the prognosis of patients in phase III clinical trials, indicating the need to further re-examine the multifactorial pathophysiological process that occurs after aSAH. The complex pathogenesis is reflected by the destruction of the dynamic balance of the energy metabolism in the nervous system after aSAH, which prevents the maintenance of normal neural function. This review focuses on the fluid metabolic pathways of the central nervous system (CNS), starting with ruptured aneurysms, and discusses the dysfunction of blood circulation, cerebrospinal fluid (CSF) circulation and the glymphatic system during disease progression. It also proposes a hypothesis on the metabolic disorder mechanism and potential therapeutic targets for aSAH patients. Cover Image for this issue: https://doi.org/10.1111/jnc.15384.

In vivo observation of cerebral microcirculation after experimental subarachnoid hemorrhage in mice.

Acute brain injury caused by subarachnoid hemorrhage is the major cause of poor prognosis. The pathology of subarachnoid hemorrhage likely involves major morphological changes in the microcirculation. However, previous studies primarily used fixed tissue or delayed injury models. Therefore, in the present study, we used in vivo imaging to observe the dynamic changes in cerebral microcirculation after subarachnoid hemorrhage. Subarachnoid hemorrhage was induced by perforation of the bifurcation of the middle cerebral and anterior cerebral arteries in male C57/BL6 mice. The diameter of pial arterioles and venules was measured by in vivo fluorescence microscopy at different time points within 180 minutes after subarachnoid hemorrhage. Cerebral blood flow was examined and leukocyte adhesion/albumin extravasation was determined at different time points before and after subarachnoid hemorrhage. Cerebral pial microcirculation was abnormal and cerebral blood flow was reduced after subarachnoid hemorrhage. Acute vasoconstriction occurred predominantly in the arterioles instead of the venules. A progressive increase in the number of adherent leukocytes in venules and substantial albumin extravasation were observed between 10 and 180 minutes after subarachnoid hemorrhage. These results show that major changes in microcirculation occur in the early stage of subarachnoid hemorrhage. Our findings may promote the development of novel therapeutic strategies for the early treatment of subarachnoid hemorrhage.

Evaluation of the rationality of clinical medication in diabetic microcirculation disorder / 实用医学杂志

Objective To study the rationality about the application of clinical medication for diabetic microcirculation disorderturbance in a general hospital of level Ⅱ in Changshu. Methods Three hundred and fifty-nine patients with T2DM who received the clinical pathway treatment were enrolled in this study in a general hospital of level II in Changshu from July to December 2016. The statistical analysis was performed on the clinical application of microcirculation-improving drugs. The selection of microcirculation-improving drugs ,the drug utilization index(DUI),the intensity of microcirculation-improving drugs and the rate of drug combination were used as the evaluation criteria. Results The utilization rate of microcirculation-improving drugs was 94.43 %,and the combination rate was 73.75 %.The selection of microcirculation-improving drugs was the traditional Chinese medicine injections which activated blood circulation and vasodilators,with the DUI ranged from 0.9 to 1.1,and the intensity of microcirculation-improving drugs was 177.82 DDD. Conclusion The application of the clinical medication for the diabetic microcirculation disturbance was not standard,as a result,the indications of medication were not clear,and the indications of drug combination were not controlled strictly,the therapeutic regimen was unreasonable,and further management should be strengthened.

The relationship between the expression of hypoxia-induciable factor-1α and changes of hepatitis microcirculation in patients with chronic hepatitis B / 中国基层医药

Objective To explore the relationship between the expression of Hypoxia-induciable factor-1α (HIF-1α) and changes of hepatitis microcimulation in patients with chronic hepatitis B (CHB).Methods 120 patients with CHB were studied. The expression of HIF-1 α was observed by immunohistochemistry and the morphotogic changes were observed with transmission eletron microscope. Results Stenosis, blockage, dilataltion, capillarization of hepatic sinusoids were the main morphotogic changes of liver. The expression of HIF-1α was positive or stronger positive. There is a positive correlation between the expression of HIF-1α and microcirculation disturbance of liver.Conclusion The disturbance of liver with CHB could exacerbate the dysbolism of nutrient substance and oxygen between hepatic cells and blood circulation. Hypoxia of hepatic cells was an important reason of the liver's pathological changes.

Alteration at coagulation function in patients with severe acute pancreatitis / 中华急诊医学杂志

Objective To evaluate the changes of blood coagulation and their clinical significance in pa-tients with severe acute pancreatitis (SAP). Method Two hundred and seven patients with acute pancreatitis ad-mitted from January 2005 to Deeember 2008 in People' s Hospital, Peking University, were recruited in this study. Patients were divided into two groups, severe acute pancreatitis (53 cases) and mild acute pancreatitis (154 cas-es), according to the diagnostic criteria set by the Chinese Medical Association in 2004. Plasma coagulation pa-rameters including prothrombin time (PT), prothrombin activity (PTA), international normalized ratio (PT-INR), activated partial thromboplastin time (APTT), fibrinogen (FIB) and D-dimmer were redorded. Results Com-pared with MAP group, there were significant differences on PT, PTA, PT-INR, FIB, and D-dimmer in SAP group [in MAP group, (12.45 ± 1.13) s,(94.01±21.21)% ,(1.08±0.14),(4.81±1.86)g/L,340.38 ng/ mL, respectively;in SAP group, (13.08±1.47)s,(86.92±17.36) %, (1.14±0.20), (5.49±2.30)g/L, 943.82 ng/mL, respectively; P <0.05]. There was no significant difference on APTT between the two groups (P > 0.05). D-dimmer was correlated to the APACHE Ⅱ score , and it was also correlated to the SIRS score (P < 0.05). The rate of systemic inflammatory response syndrome (SIRS) and the mortality were higher in patients with SAP patients than those in the MAP patients (in SAP group, 35.5%, 5.6%, respectively; in MAP group, 10.4%, 0, respectively; P < 0.05). Conclusions Disorders of coagulation and microcirculation disturbances were observed in patients with severe acute pancreatitis. These alterations may be useful in the assessment of the disease severity and prognosis of patients with acute pancreatitis.

Experimental Study on Auricle Microcirculation of Mice Function of Extract Form Earthworm / 浙江中医药大学学报

ObjectiveTo investigate the protection of extract form earthworm a traditional Chinese medicine in auricle microcirculation disturbance in mice. MethodThe microcirculation disturbance in mice was brought by rapid injection of high molecule dextran. Observe the microvascular diameter,the blood flow speed,the blood fluid state and crossing net patency quantity of micrangium in mice before injection and after injection 10min,20min,30min with WX-9 microcirculation microscope and analytical system. ResultHigh and low dose of extract form earthworm could expend the diameter of the vein and artery of micrangium, quicken the blood flow speed,improve the blood fluid state,increase micrangium crossing net patefaction numbers. To compare with the control group, threr’s significant difference (P

Study on Anti-inflammation,Analgesia and Microcirculation Improvement Actions of Runingshuang / 中国药房

OBJECTIVE:To study the anti-inflammation,analgesia and microcirculation improvement actions of Runingshuang.METHODS:The animals were randomly divided into control group,Sanjierupi glue group and lose dose and high dose Runingshuang groups.The curative effects of the externally applied Runingshuang on dimethylbenzene-induced earlap turgescence and the agar-induced chronic granulomatous inflammation were monitored.And the analgesic effect of the intragastrically administered or externally applied Runingshuang and its antagonistic action in microcirculation disturbance caused by pituitrin were determined by glacial acetic acid writhing method and hot plate method.RESULTS:The inhibitory rate of high and low dosage of Runingshuang on the earlap turgescence caused by dimethylbenzene were 46.2%and 43.1%,respectively,which were significantly different as compared with the control group(P

Effect of Shujinhuoxuedingtong Wine on Microcircuiation of Experimental Mice / 中成药

The method for examining the microcirculation bloodflow of mice mesentery was used to evaluate the action of Shujinhuoxuedingtong wine against microcirculation disturbance caused by adrenaline. The result indicates that the wine can obviously improve the microcirculation function and is responsible for the antistatic action observed. The wine's effect is found to be superior to that of Shujinhuoxuedingtong Powder. The above fingings suggest that the wine have the action of promoting blood circulation to remove blood stasis and improving microcirculation and the effect of promoting the bloodflow perfusion quantity in tissue organs. It's effect is prior to that of powder.