Histochemistry of microinfarcts in the mouse brain after injection of fluorescent microspheres into the common carotid artery

The mouse model of multiple cerebral infarctions,established by injecting fluorescent microspheres into the common carotid artery,is a recent development in animal models of cerebral ischemia.To investigate its effectiveness,mouse models of cerebral infarction were created by injecting fluorescent microspheres,45–53μm in diameter,into the common carotid artery.Six hours after modeling,fluorescent microspheres were observed directly through a fluorescence stereomicroscope,both on the brain surface and in brain sections.Changes in blood vessels,neurons and glial cells associated with microinfarcts were examined using fluorescence histochemistry and immunohistochemistry.The microspheres were distributed mainly in the cerebral cortex,striatum and hippocampus ipsilateral to the side of injection.Microinfarcts were found in the brain regions where the fluorescent microspheres were present.Here the lodged microspheres induced vascular and neuronal injury and the activation of astroglia and microglia.These histopathological changes indicate that this animal model of multiple cerebral infarctions effectively simulates the changes of various cell types observed in multifocal microinfarcts.This model is an effective,additional tool to study the pathogenesis of ischemic stroke and could be used to evaluate therapeutic interventions.This study was approved by the Animal Ethics Committee of the Institute of Acupuncture and Moxibustion,China Academy of Chinese Medical Sciences(approval No.D2021-03-16-1)on March 16,2021.

Comparison of invasive dynamic blood pressure between superior mesenteric artery and common carotid artery in rats

BACKGROUND: The purpose of this study was to identify the consistency of invasive dynamic blood pressure(BP) monitoring between the superior mesenteric artery(SMA) and the common carotid artery(CCA).METHODS: Eight male Sprague-Dawley rats were cannulated in SMA and CCA simultaneously for BP monitoring, respectively.The abdominal aorta was prepared for the induction of BP change through clamping/de-clamping by a microvascular clip.The dynamic BP monitoring was performed by a polygraph system.Systolic blood pressure(SBP), diastolic blood pressure(DBP), and mean arterial pressure(MAP) values would be recorded during different time periods: the baseline(T1), the increasing period after clamping(T2), the platform period during clamping(T3), the decreasing period after de-clamping(T4), and the final platform period(T5).Three trials were performed on each rat with 15-minute intervals between consecutive monitoring.RESULTS: Systolic BP showed no significant differences between SMA and CCA.However, significant difference was found in diastolic blood pressure except at T5(P=0.534).Mean arterial pressure of two arteries were significantly different only at T1(P=0.015).The strength of association was significantly high between BP measurements through SMA and CCA(P<0.001).The BlandAltman analyses showed that mean bias of MAP changed no more than 5 mmHg and standard deviation less than 8 mmHg during T2 and T4, respectively.CONCLUSION: The study indicates SMA might be an alternative site for invasive BP monitoring during abdominal aorta occlusion and release, especially in cerebrovascular-related research.

Congenital bilateral absence of the common carotid artery and internal carotid artery:a case report and literature review

Absence of the common carotid artery(CCA) and/or internal carotid artery (ICA ) is a kind of rare congenital anomaly. This paper reports one patient with bilateral absence of the CCA and ICA who suffered from cerebral infarction. And the relative literatures of the possible cause and collateral circulation were reviewed.

Lead to Elevate the Temperature and Speed of Emergency Rescue and Nursing Care of Common Carotid Artery Rupture and Massive Hemorrhage after Operation of Typical Esophageal Cancer

Objective:Objective To explore the first aid and nursing of patients with anastomotic fistula after radical resection of esophagus carcinoma complicated with major carotid hemorrhage.Methods:The clinical data of anastomotic fistula complicated with carotid artery rupture and massive hemorrhage after radical resection of typical esophageal carcinoma were analyzed and summarized.Results:Through the close cooperation of medical care,the rescue was successful.Conclusion:Earlier prevention observation,raising first aid consciousness and actively cooperating with doctors can improve the success rate of rescue.

Carotid-subclavian bypass and endovascular aortic repair of Kommerell’s diverticulum with aberrant left subclavian artery:A case report

BACKGROUND Kommerell’s diverticulum(KD)with aberrant left subclavian artery is a rare congenital deformity and also has very little research literature about it(35%of case study).There are three types of aortic arch diverticulum.Even literature concerning the treatment options are limited.CASE SUMMARY We present a case report of a 50-year-old male with KD in the right aortic arch with aberrant left subclavian artery.We conducted a total endovascular repair procedure,which is innovative and will spread more light in the medical world.Our patient has no past medical history and is a non-smoker and non-alcoholic.Patient presented with shortness of breath,chest pain and dizziness for six months.Blood tests were done and computerized tomography(CT)angiogram of the chest confirmed the diagnosis,illustrating showed a 3.9 cm KD.On Day 1,the CT angiogram showed mild dilatation of the thoracic aorta,adjacent esophagus,trachea was compressed and displaced.Surgery was planned as the treatment modality.Carotid-Subclavian artery bypass and endovascular aortic repair was conducted.We used prolene 5-0 C1 sutures to precisely anastomose a 6-mm Dacron graft to the left subclavian artery.Haemostasis was secured and wounds were closed.Protamine was administered and patient was shifted to intensive care unit.Post-operative,patient responded favorably and was discharged.Regular follow-up is done.CONCLUSION The procedure we performed is novel.This will help the cardio-thoracic surgeons a better insight about the full procedures we conducted,thereby bringing more light and better treatment options in managing KD with aberrant subclavian artery.

Asymptomatic traumatic common carotid artery dissection

Common carotid artery （CCA） dissection is a rare emergency condition. Early diagnosis of these cases is important to prevent the ischemic emergencies. We presented a CCA dissection case, who was admitted to the hospital after taken out from under rubble with satisfactory outcome.

Penetrating neck injury： Collaterals for another life after ligation of common carotid artery and subclavian artery

Neck, being not protected by skeleton, is vulnerable to external trauma and injury which involves blood vessels, trachea, esophagus and other endocrine and nervous system organs. Vascular injuries can not only cause potentially, life-threatening hemorrhage but also need profound surgical expertise in man- agement. Development of collateral circulation in neck is well known： however, there is scarcity of literature on the role of collateral formation in neck trauma. Here, we present a unique case of pene- trating gunshot injury to neck with right common carotid and right subclavian artery injury with hemorrhagic shock managed with ligation of these vessels as a life-saving procedure. The patient pre- sented ~ith no neurological or motor de~,cits in immediate postoperative period owing to the collateral circulation between right vertebral artery and right common carotid and right subclavian artery.

Study on intraluminal embolization with microcoils treating traumatic pseudoaneurysms in common carotid artery in rabbits

Objective: To evaluate the long-term effect of endovascular occlusion with microcoils on traumatic pseudoaneurysms (TPAs) in the common carotid artery in rabbits.Methods: TPAs in the right common carotid artery were surgically made in 16 rabbits. At 3-4 weeks after operation, the survived 12 models were randomly divided into a control group (n=3) with no treatment and an experimental group (n=9), in which TPAs were intraluminally embolized with microcoils and corresponding therapy was given. Three months after embolization, the TPAs were examined with digital subtraction angiography and pathology. Results: The 3 rabbits in the control group all died of rupture of TPA. Among the 9 TPAs occluded with microcoils, 4 were completely occluded, 4 were partially occluded, and 1 was excluded due to the microcoils migrating into the parent artery. Three months after embolization, the 4 TPAs which were completely occluded remained obliterated as determined by digital subtraction angiographic findings. The parent artery remained unobstructed and the structure of the TPAs were replaced by a mass of scar tissues. The 4 TPAs which were partially occluded remained unruptured and the microcoils were compressed.Conclusions: The lumen in TPA can be completely occluded by microcoils and the parent artery is unblocked. Partial occlusion of the lumen can also prevent the rupture of TPA.

Surgical treatment for traumatic transection of left common carotid artery

Injury to the supraaortic artery is a rare event, with poor prognosis and high mortality.1 Improvement of the outcome may lie on the combination of several aspects, including better pre-hospital care, use of emergency cardiopulmonary bypass （CPB）, improved surgical techniques and facilities, and advanced postoperative intensive care. Some researchers emphasized the importance of emergency CPB in the treatment and thought that it was responsible mainly for the improved outcome.2-6 However, there exists controversies about it.7-9 In this article, we reported that a patient with life-threatening hemorrhage due to traumatic transection of the left common carotid artery, who was admitted to our hospital in July 2003, was treated successfully with operations with help of emergency CPB and systemic hypothermia.

Common carotid arterial thrombosis associated with ulcerative colitis

A 26-year-old woman with ulcerative colitis was transferred to our hospital with left hemiparesis due to cerebral infarction. Cervical ultrasonography and magnetic resonance imaging angiography revealed thrombosis at the right common carotid artery and the right internal carotid artery. Antithrombotic and anticoagulant therapies were commenced. After about 2 wk of the treatment, the frequency of her diarrhea increased. She underwent emergency subtotal colectomy, but 10 d later an abundant hemorrhage from the remnant rectum occurred, so the remnant rectum was resected and an ileal pouch anal anastomosis was performed. Antithrombotic and anticoagulant therapies were continued, but neither her neurological status nor magnetic resonance imaging angiography findings showed subsequent changes. She was discharged 3 mon after operation. This is a rare case of common carotid arterial thrombosis occurring as a complication of ulcerative colitis, in which antithrombotic and anticoagulant therapies are considered to provoke a deterioration of the patient’s bowel disease.

Cerebral blood flow volume measurements of the carotid artery and ipsilateral branches using two-dimensional phase-contrast magnetic resonance angiography

The optimal velocity encoding of phase-contrast magnetic resonance angiography （PC MRA） in measuring cerebral blood flow volume （BFV） ranges from 60 to 80 cm/s. To verify the accuracy of two-dimensional （2D） PC MRA, the present study localized the region of interest at blood vessels of the neck using PC MRA based on three-dimensional time-of-flight sequences, and the velocity encoding was set to 80 cm/s. Results of the measurements showed that the error rate was 7.0±6.0% in the estimation of BFV in the internal carotid artery, the external carotid artery and the ipsilateral common carotid artery. There was no significant difference, and a significant correlation in BFV between internal carotid artery ＋ external carotid artery and ipsilateral common carotid artery. In addition, the BFV of the common carotid artery was correlated with that of the ipsilateral internal carotid artery. The main error was attributed to the external carotid artery and its branches. Therefore, after selecting the appropriate scanning parameters and protocols, 2D PC MRA is more accurate in the determination of BFV in the carotid arteries.

Resveratrol improves cognition and reduces oxidative stress in rats with vascular dementia

Resveratrol possesses beneficial biological effects, which include anti-oxidant, anti-inflammatory and anti-carcinogenic properties. Recently, resveratrol has been shown to exhibit neuroprotective effects in models of Parkinson＇s disease, cerebral ischemia and Alzheimer＇s disease. However, its effects on vascular dementia remain unclear. The present study established a rat model of vascular dementia using permanent bilateral common carotid artery occlusion. At 8-12 weeks after model induction, rats were intragastrically administered 25 mg/kg resveratrol daily. Our results found that resveratrol shortened the escape latency and escape distances in the Morris water maze, and pro- longed the time spent percentage and swimming distance percentage in the target quadrant during the probe test, indicating that resveratrol improved learning and memory ability in vascular dementia rats. Further experiments found that resveratrol decreased malonyldialdehyde levels, and increased superoxide dismutase activity and glutathione levels in the hippocampus and cerebral cortex of vascular dementia rats. These results confirmed that the neuroprotective effects of resveratrol on vascular dementia were associated with its anti-oxidant properties.

Single low shear stress results in atherosclerosis in vivo

Objective: Whether single low shear stress can result in atherosclerosis without hyperliposis-diet in vivo or not is unknown. Methods: Based on an electromagnetic blood flow meter and a method to determine the pulsatile shear stress from blood flow rate waveform and its software,we developed an in vivo pulsatile blood flow rate-shear stress determining system.The left external carotid arteries of 20 adult New Zealand white rabbits were ligated and the rabbits were fed with a standard chow for 2,4,8 or 12 weeks,then the common carotid arteries of 2 sides in each rabbit were harvested for morphologic test. Results: The ligation reduced pulsatile shear stress of left common carotid significantly,for example,τ_ mean changed from(21.16±7.17) dynes/cm 2 to(3.13±2.28) dynes/cm 2(p=2.176E-21),meanwhile,the pulsatile shear stress of right common carotid did not change significantly,which lasted more than 12 weeks.Atherosclerotic plaques were found after 8 and 12 weeks in pulsatile-low-shear-stress left(not normal-shear-stress right) common carotid arteries.Conclusion:Single pulsatile low shear stress can result in atherosclerosis.It supports the pulsatile low shear stress(not hypolipidemia) is the key risk factor for atherosclerosis.

Study of a Novel Small Caliber Vascular Graft in a Canine Model with Optical and Scanning Electron Microscopy

A novel biological small-diameter vascular graft was evaluated in a canine model. 3 cm long segments with 4 mm I.D. were implanted end-to-end in the carotid position of 12 dogs for 6 months. Color Doppler sonography was performed at the first week post-operation, and angiography was then administered to 9 grafts at 4th week, 12th week and 24th week respectively to monitor the graft pantency and blood flow characteristics. Vascular samples containing the grafts were collected at 1st week, 8th week, 12th week and 24th week after implantation. Morphological changes of the grafts were observed by optical and scanning electron microscopic (SEM) studies and compared with that of the original prosthesis and the normal host vessel. All grafts were patent throughout the experiment except one graft. Histopathology and SEM demonstrated both a nearly complete inner capsule of varied thickness lining the graft luminal surface and connective tissue adventitia formation at one-week post-operation. The neointima became confluent at 8 weeks and then compact but had no signs of hyperplasia up to 12 weeks; meanwhile on the neointimal surface newly grown endothelial-like cells were migrating from the stoma to the middle portion. The grafts also illustrated endothelialization in many “islands” in the mid-segment luminal surface of the grafts. In addition, the closer distance the cells towards the stoma were, the more morphological similarity the cells with the normal endothelial were. Taken together, the biological vascular graft remained patent for 24 weeks as a carotid prosthesis, characterized by the early and complete neointima formation plus endothelialization starting before 12 weeks post grafting. Therefore, the graft seems suitable for reconstruction of vascular lesions in dogs. Further studies may be carried out to extend the graft application for the clinical use.

Information entropy-based fitting of the disease trajectory of brain ischemia-induced vascular cognitive impairment

The present study investigated the disease trajectory of vascular cognitive impairment using the entropy of information in a neural network mathematical simulation based on the free radical and excitatory amino acids theories. Glutamate, malondialdehyde, and inducible nitric oxide synthase content was significantly elevated, but acetylcholine, catalase, superoxide dismutase, glutathione peroxidase and constitutive nitric oxide synthase content was significantly decreased in our vascular cognitive impairment model. The fitting curves for each factor were obtained using Matlab software. Nineteen, 30 and 49 days post ischemia were the main output time frames of the influence of these seven factors. Our results demonstrated that vascular cognitive impairment involves multiple factors. These factors include excitatory amino acid toxicity and nitric oxide toxicity. These toxicities disrupt the dynamic equilibrium of the production and removal of oxygen free radicals after cerebral ischemia, reducing the ability to clear oxygen free radicals and worsening brain injury.

Voltage-dependent potassium channel Kv4.2 promotes neurogenesis and alleviates isch⁃emic stroke impairments

OBJECTIVE Stroke has become the top ten leading cause of death in China.Isch⁃emic stroke accounts for 85%of stroke cases,and insufficiency of cerebral blood supply caused by atherosclerosis is one of the important causes of ischemic stroke.Therefore,it is of posi⁃tive significance to study the molecular mecha⁃nism of stroke injury caused by hypoperfusion in the search for drug targets.Voltage-dependent potassium channels are a family of potassium channels widely expressed in the central ner⁃vous system.However,their roles in neurogene⁃sis after stroke insults have not been clearly illus⁃trated.The purpose of this experiment is to explore the expression changes of different sub⁃families of voltage-dependent potassium chan⁃nels after the occurrence of ischemic stroke and their influence on neuroregeneration,to study the molecular mechanism of stroke injury caused by hypoperfusion,and to find potential targets for drug therapy of ischemic stroke.METHODS C57BL/6 mice aged 7-8 weeks and C17.2 cells were used in vivo and in vitro in the experiment.The mice in the experimental group were suf⁃fered from bilateral common carotid artery occlu⁃sion(BCCO)for 1 h and reperfusion for 7 d.In the control group,bilateral carotid artery was dis⁃sected without occlusion.Behavioral assay of suspension test were performed to assess the motor deficits of the mice.In this assay,the time of the first drop(latency),the number of drops within one minute(frequency),and the final scores were recorded as the results of athletic ability.A lower score indicated more severe motor damage of the mice.TTC staining was used to observe the cerebral infarction areas caused by ligation of bilateral common carotid arteries.After seven days,mice were sacrificed and brain tissue protein samples were collected for real-time quantitative PCR(RT-PCR)and Western blotting test to detect the changes of potassium channel subfamily expression levels in different brain regions.Neuronal injuries in all brain regions were detected using Nissl staining methods 7 d following model establishment.To detect the effects and the underlying mechanism of the related potassium channel on neurogene⁃sis,recombinant plasmids of the potassium chan⁃nels were transfected in cultured C17.2 neural stem cells.Afterwards,oxygen glucose depriva⁃tion experiments were performed.RESULTS Behavioral tests showed that BCCO can cause impaired motor performance.TTC staining showed that cerebral infarction existed in the stri⁃atum region,and the motor function decline caused by the injury in this region was consistent with the behavioral experiment results which veri⁃fied the effectiveness of our surgical operation.Nissl staining revealed a large amount of neuronal cell necrosis in the cortex and striatum regions,and dense neuronal cells in the lateral ventricular limbic region,suggesting that neurogenesis may have occurred in this region.The results of real-time quantitative RT-PCR showed that among the detected potassium channels distributed in the measured nervous system,the expression of voltage-dependent potassium channel Kv4.2 decreased significantly in all brain regions after stroke,suggesting that it may be involved in the pathological process of stroke.Immunohisto⁃chemical staining showed that there was neuro⁃genesis in the subgranular zone(SGZ)and sub⁃ventricular zone(SVZ)of the mice,and Kv4.2 expression was significantly changed in the regions,suggesting that it may be involved in the regulation of neuro regeneration after stroke.The transfected Kv4.2 plasmid enhanced the dif⁃ferentiation of the C17.2 neural stem cells to neu⁃rons and astrocytes under normoxia and the oxy⁃gen-glucose deprivation,suggesting that Kv4.2 may induce the differentiation of neural stem cells after stroke.Kv4.2 could induce the neural stem cells to differentiate into neurons in vitro and in vivo,and Western blotting assay showed that Kv4.2 could up-regulate the expression level of ERK1/2,p-ERK1/2,p-STAT3,NGF,p-TtkA,and BDNF.Moreover,the calcium ions and CAMKⅡwas also increased by Kv4.2 in vitro.CONCLUSION BCCO insults can induce the expressions of the potassium channels in the brains,among which the expression of Kv4.2 is down-regulated in the cerebral cortex,hippocam⁃pus and striatum.In vitro experiments confirmed that Kv4.2 can induce the differentiation of C17.2 neural stem cells into neurons and astrocytes under the condition of normoxia and oxygen-glucose deprivation.We concluded that Kv4.2 possibly promoted neurogenesis through ERK1/2/STAT3,NGF/TrkA,and Ca2+/CAMKⅡsignal pathways after stroke.Regulating the physiologi⁃cal functions of Kv4.2 channel might contribute to the rehabilitation of neuronal damage after stroke.

Effect of different types of laryngeal mask airway placement on the right internal jugular vein: A prospective randomized controlled trial

BACKGROUND In recent years, with the popularity of laryngeal mask airway(LMA) for the management of clinical anesthesia, the influence of the LMA on the position and blood flow of the internal jugular vein(IJV) has attracted an increasing amount of attention.AIM To investigate the effect of placement of different types of LMA(Supreme LMA,Guardian LMA, I-gel LMA) on the position and blood flow of the right IJV.METHODS This was a prospective randomized controlled trial. A total of 102 patients aged 18-75 years who were scheduled to undergo laparoscopic abdominal surgery with general anesthesia were randomly assigned to three groups: Supreme LMA(group 1), Guardian LMA(group 2), and I-gel LMA(group 3) groups. The main indicator was the overlap index(OI) of IJV and the common carotid artery(CCA)at the high, middle, and low points before and after the placement of the LMA.The second indicators were the proportion of ultrasound-simulated needle crossing the IJV and CCA, and the cross-sectional area and blood flow velocity of the IJV before and after placement of the LMA at the middle point.RESULTS Data from 100 patients were included in the statistical analysis. The OI increased significantly after placement of the LMA in the three groups at the three points(P< 0.01), except group 2 at the low point. In group 2 and group 3, the OI was lower than that in group 1 after LMA insertion at the high point(P < 0.0167). At the middle point, after LMA insertion, the proportion of simulated needle crossing the IJV significantly decreased in all three groups(P < 0.05), and the proportion in group 2 was higher than that in group 3(P < 0.0167). The proportion of simulated needle crossing the CCA or both the IJV and CCA significantly increased in group 1 and group 2(P < 0.05), which increased with no statistical significance in group 3. After LMA insertion, the cross-sectional area of the IJV significantly increased, while the blood flow velocity significantly decreased(P <0.01). There was no significant difference among the three groups.CONCLUSION The placement of Supreme, Guardian, and I-gel LMA can increase the OI, reduce the success rate of IJV puncture, increase the incidence of arterial puncture, and cause congestion of IJV. Type of LMA did not influence the difficulty of IJV puncture. Therefore when LMA is used, ultrasound is recommended to guide the IJV puncture.

Initial exploration of early carotid artery endothelial dysfunction in type 2 diabetes mellitus patients evaluated by ultrasound radio-frequency technique

Background The early endothelial dysfunction of carotid artery in patients with type 2 diabetes mellitus （T2DM） has been recognized. However, the feasibility and significance of carotid artery endothelial dysfunction detected by ultrasound radio-frequency technology has been seldom studied. Methods The 2D ultrasound images of the bilateral common carotid arteries from 112 cases of T2DM patients and 50 cases of normal subjects in our hospital were collected to measure intima-media thickness means （IMTm）, end-systolic inner diameter （Ds）, end-diastolic inner diameter （Dd）, resistance index （RI）, pulse index （PI）, and the systole/diastole ratio （S/D）. We also observed the variation of the intima-media thickness （IMT） as well as the elasticity indexes of the common carotid artery, such as the compliance coefficient （CC）, elasticity coefficient （13）, pulse wave velocity （PWV） and augmentation index （AIx） through instruments with built-in ultrasound radio-frequency techniques, including quantitative intima-media thickness （QIMT） and quantitative analysis of arterial stiffness （QAS）. The differences of the above-mentioned parameters between the two groups were analyzed. Results There were no statisti- cally significant differences in IMTm, Ds, Dd, RI, PI and S/D raito of the common carotid arteries between group T2DM and the normal group （P 〉 0.01）. The 13, PWV and AIx in group T2DM were remarkably high- er than those in the control group, with CC value being significantly lower than the later （P 〈 0.01 or 0.05）. Conclusion Ultrasound radio-frequency technique offers earlier and more effective evaluation of carotid artery endothelial dysfunction in T2DM patients when compared with conventional 2D ultrasound, establishing imaging foundation for the early prevention and treatment of cardio-cerebrovascular complications in T2DM patients.

Mechanism underlying the protective effect of Kaixin Jieyu Fang on vascular depression following cerebral white matter damage

The Chinese compound Kaixin fieyu Fang can be used to treat vascular depression; however, the underlying mechanism remains unclear. This study established a rat model of chronic cerebral ischemia-caused white matter damage by ligation of the bilateral common carotid arteries. Rats received daily intragastric administration of a suspension of Kaixin ]ieyu Fang powder. After 3, 7 and 21 days of treatment, the degree of white matter damage in the cerebral ischemia rat model was alleviated, Bcl-2 protein and mRNA expression in brain tissue increased, and Bax protein and mRNA expression decreased. These results indicate that Kaixin Jieyu Fang can alleviate cere- bral white matter damage, and the underlying mechanism is associated with regulation of Bcl-2/ Bax protein and mRNA expression, which is one of possible mechanism behind the protective effect of Kaixin Jieyu Fang against vascular depression.