Correlation between intracoronary thrombus components and coronary blood flow after percutaneous coronary intervention for acute myocardial infarction at different onset time

BACKGROUND Acute myocardial infarction(AMI)is a leading cause of mortality.Early reperfusion to restore blood flow is crucial to successful treatment.In the current reperfusion regimen,an increasing number of patients have benefited from direct percutaneous coronary intervention(PCI).In order to understand whether there is a correlation between the components of coronary thrombosis and the absence of reflow or slow blood flow after coronary stent implantation in direct PCI,we collected data on direct PCI cases in our hospital between January 2016 and November 2018.AIM To investigate the correlation between intracoronary thrombus components and coronary blood flow after stent implantation in direct PCI in AMI.METHODS We enrolled 154 patients(85 male and 69 female,aged 36–81 years)with direct PCI who underwent thrombus catheter aspiration within<3,3–6 or 6–12 h of onset of AMI between January 2016 and November 2018.The thrombus was removed for pathological examination under a microscope.The patients of the three groups according to the onset time of AMI were further divided into those with a white or red thrombus.The thrombolysis in myocardial infarction(TIMI)blood flow after stent implantation was recorded based on digital subtraction angiography during PCI.The number of patients with no-reflow and slow blood flow in each group was counted.Statistical analysis was performed based on data such as onset time,TIMI blood flow.RESULTS There were significant differences in thrombus components between the patients with acute ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction(P<0.01).In the group with PCI<3 h after onset of AMI,there was no significant difference in the incidence of no-reflow and slow-flow between the white and red thrombus groups.In the groups with PCI 3-6 and 6-12 h after onset of AMI,there was a significant difference in the incidence of no-reflow and slow-flow between the white and red thrombus groups(P<0.01).There was a significant correlation between the onset time of AMI and the occurrences of no-reflow and slow blood flow during PCI(P<0.01).CONCLUSION In direct PCI,the onset time of AMI and color of coronary thrombus are often used to predict whether there will be no reflow or slow blood flow after stent implantation.

Hyperbaric oxygen therapy for cerebral blood flow and electroencephalogram in patients with acute cerebral infarction Choice for therapeutic occasion

BACKGROUND： Hyperbaric oxygen （HBO） therapy increases blood oxygen content, changes cerebral blood flow （CBF） and cerebral metabolism. Its therapeutic effects on cerebrovascular disease have been fully confirmed, but the occasion for HBO therapy is still unclear. OBJECTIVE： To observe the therapeutic effects of HBO therapy at different time on CBF and electroencephalogram （EEG） in patients with acute cerebral infarction （CI）. DESIGN： Randomized controlled trial. SETTING： Department of Neurology, Shidong Hospital, Yangpu District of Shanghai. PARTICIPANTS： Ninety-six inpatients with acute CI, admitted to Department of Neurology, Shidong Hospital, Yangpu District of Shanghai from January 2001 to December 2006, were involved in this experiment. The involved participants met the diagnosis criteria of acute CI and confirmed by skull CT or MRI. They all were patients with moderate CI （16- 30 points） according to neurologic deficit score formulated by Chinese Medical Association. Informed consents of detected items and therapeutic regimen were obtained from all the involved participants. They were randomized into two groups with 48 in each： early-stage treatment group and advanced-stage treatment group. Among the 48 patients in the early-stage treatment group, 21 male and 27 female, aged 53 -68 years, 22 patients were found with basal ganglia infarction, 10 with brain lobe infarction, 16 with multiple infarction, 27 accompanied with hypertension and 2 accompanied with diabetes meUitus. Among the 48 patients in the advanced-stage treatment group, 23 male and 25 female, aged 52 - 71 years, 25 patients were found with basal ganglia infarction, 10 with brain lobe infarction, 12 with multiple infarction, 1 with brain stem infarction, 28 accompanied with hypertension and 1 accompanied with diabetes mellitus. METHODS： After admission, patients of two groups received routine drug treatment. ① Patients in the early-stage treatment group and advanced-stage treatment group began to receive HBO therapy within one week of CI and 4 weeks after CI, respectively. The total course of treatment both was 2 weeks. EEG examination was carried out before and after therapy, and CBF was determined with ^133Xe inhalation.② Assessment criteria of curative effects： Basically cured： neurologic symptoms and body signs disappeared, could work and do housework; Markedly effective： score of neurologic deficit was decreased by over 21 points, could manage himself/herself partially; Effective： score of neurologic deficit was decreased by 8 to 12 points; Non-effective： Score was increased or decreased less than 8 points, neurologic deficit was worsened, even died. Total effective rate = （number of cured＋number of markedly effective＋number of effective）/ number of total cases ×100%. ③ t test and Chi-square test were used for comparing the difference of measurement data and enumeration data respectively, and Ridit analysis was used for comparing the difference of clinical curative effects. MAIN OUTCOME MEASURES： ① Comparison of EEG and CBF of patients from two groups before and after treatment. ②Comparison of post-treatment neurologic deficit of patients between two groups. RESULTS： All the involved 96 patients with CI participated in the final analysis. ① Clinical symptoms of patients from two groups after therapy were significantly improved as compared with those before therapy, and curative effects of early treatment group were better than those of advanced treatment group （ U = 1.99, P 〈 0.05 ） . ②After treatment, CBF in each region of brains, except for that in parietal lobe of patients in the advanced-stage treatment group, was significantly improved （P 〈 0.05 - 0.01）; The improvement of CBF of patients in the early-stage treatment group was more obvious than that in the early-stage treatment group （P 〈 0.05 - 0.01）. ③ The abnormal rate of EEF of patients from early-stage treatment group and advanced-stage treatment group before treatment was 94% and 96%, respectively. After treatment, improvement rate of EEG of patients in the early-stage treatment groulp was 95%, which was significantly different from that in the advanced-stage treatment group （82%, x^2=4.32, P 〈 0.05 ） CONCLUSION： HBO therapy both at early and advanced stages of CI （within 1 week and 4 weeks after CI attack） can improve CBF and EEG of patients with early CI, especially.

Effect of the Principle of Activating Blood Circulation to Break Stasis on GMP-140 and D_2 Dimer in Patients with Acute Cerebral Infarction

Objective: To explore the clinical efficacy of the principle of activating blood circulation to break stasis (ABCBS) and its influence on platelet membranous protein particle (GMP-140) and D 2 dimer (D-dimer) before and after treatment. Methods: Eighty-eight patients with blood stasis syndrome (BSS) of acute cerebral infarction (ACI) were randomly divided into two groups, both of which were treated with conventional treatment, i.e. with western medicine (WM), with Salvia injection added through intravenously dripping.One of the two groups was used as the control and the other group as the treated group who had ABCBS herbs orally taken in addition. The duration of treatment course for both groups was 3 weeks. Results: There were changes in both groups over clinical symptoms, nerve function deficit scoring and GMP-140, D-dimer, but the treated group showed significantly better than that of the control group, ( P <0.05). Conclusion: ABCBS principle could serve as an important auxiliary treating method for BSS of ACI, as it can effectively alter the blood of ACI patients which was viscous, condense, coagulant and aggregating.

Effects of tanshinone Ⅱ sodium sulfonate plus cinepazide maleate on the hemorrheologic indexes and blood lipids in patients with acute cerebral infarction

BACKGROUND： The severity of cerebral infarction is associated with the increase of blood viscosity caused by hyperfibrinogenemia and hyperlipidemia, etc. Thus it has become one of the target for treating cerebral infarction to decrease blood viscosity by integrated Chinese and western medicine. OBJECTIVE： To investigate the influence and clinical therapeutic effects of cinepazide maleate combined with tanshinone Ⅱ A sodium sulfonate on the hemorrheologic indexes and blood lipids of patients with acute cerebral infarction, and compare the results with those of simple cinepazide maleate treatment. DESIGN： A non-randomized case-controlled observation. SETTINGS： Hebei North University; the Second Affiliated Hospitals of Hebei North University; the Third Affiliated Hospitals of Hebei North University, PARTICIPANTS： Eighty-six inpatients with cerebral infarction were selected from the infirmary, the Second and Third Affiliated Hospitals of Hebei North University from September 2004 to October 2006. They were all diagnosed to have acute cerebral infarction by CT or MRI, and accorded with the diagnostic standards for acute cerebral infarction set by the Fourth National Academic Meeting for Cerebrovascular Disease in 1995. Meanwhile, 40 teachers and medical staff of voluntary physical examinees were selected as the control group. Informed contents were obtained from all the patients and their relatives. METHODS： The patients were divided into combined treatment group （n=43） and simple treatment group （n=3）. In the combined treatment group, the patients were administrated with 160 mg cinepazide maleate injection （Beijing Four-ring Pharmaceutical, Co.,Ltd, No. H200220125; 80 mg/2 mL） added in 5% glucose, and 40 mg tanshinone Ⅱ sodium sulfonate （Shanghai No.1 Biochemical ＆ Pharmaceutical Co.,Ltd., No. H31022558, 10 mg/2 mL） added in 250 mL normal saline. In the simple treatment group, the patients were only administrated with cinepazide maleate 320 mg added in 5% glucose or 250 mL normal saline. They were treated for 1 or 2 courses, once a day, and 14 days as a course. The patients were detected before treatment and at 14 and 28 days after treatment respectively. ① Determination of hemorrheologic indexes： Whole blood viscosity was determined with LBY-N6B automatic hemorrheologic meter; Plasma viscosity with LBY-F200B automatic plasma viscosity meter; Volume of fibrinogen was determined by the method of 12.5% sodium nitrate depositing biuret reaction. ② Determination of blood lipids： The serum levels of total cholesterol （TC）, triglyceride （TG）, low density lipoprotein cholesterol （LDL-C） and high density lipoprotein cholesterol （HDL-C） were determined. ③ Severity of neurological deficit： The total score of neurological deficit score （NDS） ranged from 0 to 45 points, 0 - 15 points was taken as mild, 16 - 30 points as moderate and 31 - 45 points as severe.④ Evaluation of curative effects： Generally cured： NDS decreased by 91% - 100%, and disabled severity of grade 0; Significantly improved： NDS decreased by 46% - 90%, and disabled severity of grades 1 - 3; Improved： NDS decreased by 18% - 45%; No change： NDS decreased by less than 18%; Aggravated： NDS increased by more than 18%. Generally cured and significant improved were taken as significant effect. ⑤ The adverse events and side effects after medication were observed. MAIN OUTCOME MEASURES： ① Results of hemorrheologic indexes and blood lipids; ② NDS results in the combined treatment group and simple treatment group; ③ Therapeutic effects and adverse events. RESULTS： All the 86 patients with cerebral infarction and 40 healthy controls were involved in the analysis of results. ① Results of hemorrheologic indexes and blood lipids： The hemorrheologic indexes and blood lipids before treatment were manifested as abnormalities to different extents in both the combined treatment group and simple treatment group; The hemorrheologic indexes after treatment were obviously improved in both groups. But the hemorrheologic indexes were improved more obviously in the combined treatment group as compared with those in the simple treatment group （P 〈 0.05）; The levels of TC, TG and LDL-C after treatment in the combined treatment group were obviously lowered （P 〈 0.05）, whereas those in the simple treatment group were not significantly changed （P 〉 0.05）. ② NDS results： The NDS scores at 14 and 28 days after treatment in the combined treatment group [（6.23±2.34）, （4.27± 1.83） points] were obviously lower than those in the simple treatment group [（8.76±3.41）, （6.65±2.49） points, P 〈 0.05]. ③ Therapeutic effects and side effects： The total significant effective rates in the combined treatment group and simple treatment group were 93% and 81% respectively. In the combined treatment group, 1 case suffered from palpitation, dizziness and agrypnia. In the simple treatment group, 1 case suffered from palpitation, dizziness and agrypnia, 1 case had itch of skin. All the above symptoms disappeared gradually after the transfusing speed was adjusted to be slower. No drug withdrawal occurred in the patients due to the adverse events. CONCLUSION： Cinepazide maleate combined with tanshinon can obviously improve the abnormalities of hemorrheologic indexes and blood lipids and nerve function in patients with acute cerebral infarction, and its curative effect is faster than that of simple cinepazide maleate treatment.

Exploration of cardiac rehabilitation nursing for elderly patients with myocardial infarction based on individualized cardiac rehabilitation

BACKGROUND Myocardial infarction is a high-risk condition prevalent among the elderly population,often leading to adverse clinical manifestations such as reduced cardiopulmonary function,anxiety,and depression post-surgery.Consequently,cardiac rehabilitation holds immense importance in mitigating these complications.AIM To evaluate the effect of individualized cardiac rehabilitation on blood pressure variability(BPV)and baroreflex sensitivity(BRS)in elderly patients with myocardial infarction.METHODS A cohort of 74 elderly patients diagnosed with myocardial infarction and admitted to our hospital between January 2021 and January 2022 were subjected to random selection.Subsequently,all patients were divided into two groups,namely the research group(n=37)and the control group(n=37),utilizing the number table method.The control group received conventional drug treatment and nursing guidance intervention,while the study group underwent individualized cardiac rehabilitation in addition to the interventions received by the control group.All patients were continuously intervened for 12 wk,and the BPV of these two groups in the 1st wk(T0),the 4th wk(T1)and the 12th wk(T2)were compared,BRS,changes in cardiopulmonary function measures,and adverse cardiovascular events.RESULTS Of 24 h diastolic BPV,24 h systolic BPV,carbon dioxide ventilation equivalent slope of the research group were lower than those of the control group at T1 and T2,BRS,peak heart rate and systolic blood pressure product,1 min heart rate recovery were higher than those of the control group,and the incidence of adverse events in the research group was lower than that of the control group,the difference was statistically significant(P<0.05).CONCLUSION In this study,we found that after individualized cardiac rehabilitation in elderly patients with myocardial infarction,BPV and BRS can be effectively improved,cardiac function is significantly enhanced,and a better prognosis is obtained.

Blood Pressure Balance as a Marker for Early Detection of Cerebral Infarction and a Criterion for Inclusion/Exclusion from Acupuncture Treatment

Background: Early detection of cerebral infarction (CI) by home acupuncturists might be helpful in reducing stroke mortality. We compared vital signs of patients who developed CI and those who did not to ascertain if blood pressure balance is a useful marker for the early detection of CI and for distinguishing cases with potentially effective/ineffective acupuncture treatment. Methods: In this retrospective study, vital signs such as body temperature, pulse, and blood pressure, were simultaneously obtained from the right and left arms of patients who received weekly acupuncture treatment. We focused on the differences between values obtained from the right and left arms (the balance) and compared the values of patients who developed CI [CI (+)] (n = 18) and those of age-/gender-matched patients who did not [CI (−)] (n = 18). Results: Left/right blood pressure was significantly more unbalanced in the CI (+) group than in the CI (−) group, especially immediately before the onset of CI. Moreover, all CIs occurred on the side with a lower blood pressure. Discussion and Conclusions: Blood pressure balance might aid in the early detection of CI and to determine whether treatment with traditional or modern medicine is more appropriate. Acupuncture may thus help maintain patients’ quality of life.

Effects of emergency hyperbaric oxygen therapy on nerve injury, angiogenesis and cerebral blood perfusion in patients with acute cerebral infarction

Objective:To explore the effects of emergency hyperbaric oxygen therapy on nerve injury, angiogenesis and cerebral blood perfusion in patients with acute cerebral infarction.Methods:A total of118 patients with acute cerebral infarction who were treated in the hospital between April 2015 and October 2017 were selected as study subjects and divided into hyperbaric oxygen group (n=59) and control group (n=59) by random number table method. Control group received conventional therapy, hyperbaric oxygen group received conventional therapy combined with hyperbaric oxygen therapy, and both groups were treated for 2 weeks. The differences in nerve injury, angiogenesis and cerebral blood perfusion were compared between the two groups before and after treatment.Results: Differences in nerve injury, angiogenesis and cerebral perfusion were not significant between the two groups immediately after diagnosis. After 2 weeks of treatment, serum nerve injury indexes IGF-1, Copeptin, PAO, AQP4 and H-FABP contents of hyperbaric oxygen group were lower than those of control group;serum angiogenesis indexes PEDF, Ang-1 and VEGF contents were higher than those of control group whereas ES content was lower than that of control group;stenotic-side cerebral blood perfusion parameters CBF and CBV levels were higher than those of control group whereas TTP level was lower than that of control group.Conclusion: Emergency hyperbaric oxygen therapy can effectively reduce nerve injury, promote cerebral angiogenesis and increase cerebral blood perfusion in patients with acute cerebral infarction.

The Prognostic Value of Red Cell Distribution Width in Critically Ill Cerebral Infarction Patients:A Retrospective Cohort Study

Objective:Red blood cell distribution width(RDW)has been utilized as a prognostic indicator for mortality risk assessment in cardiovascular and cerebrovascular patients.Nevertheless,the prognostic significance of RDW in critically ill patients with cerebral infarction is yet to be investigated.The objective of this study is to examine the association between RDW and the risk of all-cause mortality in cerebral infarction patients admitted to the intensive care unit(ICU).Method:A retrospective cohort study was conducted using the Medical Information Mart for Intensive Care IV 2.2(MIMIC-IV)intensive care dataset for data analysis.The main results were the all-cause mortality rates at 3 and 12 months of follow-up.Cumulative curves were plotted using the Kaplan-Meier method,and Cox proportional hazards analysis was used to examine the relationship between RDW and mortality rates in critically ill cerebral infarction patients.Results:The findings indicate that RDW serves as a significant prognostic factor for mortality risk in critically ill stroke patients,specifically at the 3 and 12-month follow-up periods.The observed correlation between increasing RDW levels and higher mortality rates among cerebral infarction patients further supports the potential utility of RDW as a predictive indicator.Conclusion:RDW emerges as an independent predictor of mortality risk during the 3 and 12-month follow-up periods for critically ill patients with cerebral infarction.

The correlation between different ABO blood group gene loci and the pathogenesis and prognosis of acute myocardial infarction

Objective: To assess the effect of different ABO blood group gene locus on severity and prognosis of acute myocardial infarction (AMI). Methods: 100 patients with AMI diagnosed in our hospital from June 2018 to June 2019 were selected as the myocardial infarction group. At the same time, 100 healthy patients with physical examination results in our hospital were selected as the control group. Single-nucleotide polymorphisms of peripheral blood ABO gene loci rs505922, rs579459, rs643434, rs651007, and rs8176743 were detected. The differences of ABO blood group gene loci in different groups were compared. The correlation between the distribution of ABO blood group gene loci and the incidence and prognosis of patients with AMI was analyzed. Results: 98 cases were included in the myocardial infarction group and 99 cases were included in the control group. Compared with the control group, the genotypes of rs643434 and rs651007 locus in the myocardial infarction group were statistically significant (P<0.05). Analysis under different genetic models , compared with the control group, the myocardial infarction group had a significant difference in the rs643434 gene dominant mode, rs651007 dominant mode and recessive mode (P<0.05). The dominant mode of rs643434 was correlated with Gensini score and TIMI grade. The dominant mode of rs651007 was correlated with Gensini score, TIMI grade and troponin.The recessive mode of rs651007 was correlated with Gensini score, and the differences were statistically significant (P < 0.05). The dominant mode of rs643434 was related to the occurrence of MACE, and the difference was statistically significant (P < 0.05).Conclusion: Different genetic models of ABO blood group genes rs643434 and rs651007 may be related to the condition and prognosis of AMI.

Effect of ultraviolet blood irradiation and oxygenation on nerve function and function of the red blood cell membrane pump in patients with acute cerebral infarction

BACKGROUND： Ultraviolet blood irradiation and oxygenation （UBIO） has obtained better clinical effect in treating acute cerebral infarction, but the mechanism underlying this effect remains unclear. OBJECTIVE： To observe the effect of UBIO on the nerve function and activities of K^＋-Na^＋-ATPase and Ca2^＋-Mg2^＋-ATPase activities on the red blood cell （RBC） membrane of patients with acute cerebral infarction. DESIGN： A randomized and controlled study.SETTING： Department of Neurology, Xiangfan Central Hospital.PARTICIPANTS： From January 2000 to December 2001, excluding those above 70 years old, 58 cases of 700 patients with acute cerebral infarction admitted in the Department of Neurology, Xiangfan Central Hospital, were recruited and divided into two groups according to the random number table： UBIO treated group （n=28）, including 17 males and 11 females, aged 40-68 years; and control group （n=30）, including 20 males and 10 females, aged 44-69 years. All the patients agreed to participate in the therapeutic program and detected items. The general informations were comparable without obvious differences between the two groups （P 〉 0.05）.METHODS： ① The patients in both groups received routine treatments, besides, those in the UBIO treated group were given UBIO treatment by using the XL-200 type therapeutic apparatus produced in Shijiazhuang, whose ultraviolet wave was set at 253.7 nm with the energy density of 0.568 J/m^2 per second, UBIO treatment started from the second day after admission, once every other day, with a single course consisting of 5-7 treatments. ② In the UBIO treated group, the venous blood was sampled before and after the first, third and the completion of the treatment course respectively, the venous blood was taken at each corresponding time point in the control group. After centrifugation of the blood at 10 000 rounds per minute, the RBC membrane was separated and then the activities of K^＋-Na^＋-ATPase and Ca2^＋-Mg2^＋-ATPase were detected by means of phosphorus determination.③ The nerve function was scored before and after treatment in both groups with European stroke scale, which included 13 items, the total score was 0-100 points, the higher the score, the better the nerve function. MAIN OUTCOME MEASURES ：①Score of European stroke scale before and after treatment in both groups.② Comparison of the activities of K^＋-Na^＋-ATPase and Ca2^＋-Mg2^＋-ATPase on RBC membrane between the two groups before treatment and after the first, third and the completion of the treatment. RESULTS： All the 58 patients with cerebral infarction were involved in the analysis of results.① The score of European stroke scale had no obvious difference between the two groups [（49.31±11.48）, （50.58±12.63）, P 〉 0.05], and it was obviously higher in the UBIO treated group than in the control group after treatment [84.66±13.75）, （77.05±11.17）, P 〈 0.05].②The activity of K^＋-Na^＋-ATPase on RBC membrane in the UBIO treated group was significantly increased after the first and third treatment as compared with before treatment [（31.56±19.25）, （27.64±15.83）, （17.67±13.83）, P 〈 0.01], it was still higher after the completion of the treatment than before treatment without obvious difference [（20.86±14.53）, P 〉 0.05]. After the first and third treatment, it was obviously higher in the UBIO treated group than in the control group [19.31±11.88）, （17.44±10.42）, P 〈 0.01]. ③ In the UBIO treated group, Ca2^＋-Mg2^＋-ATPase activity on RBC membrane significantly increased after the first treatment and remained higher than the pre-treatment level throughout the treatment [（27.49±14.72）, （17.41±4.82）, P 〈 0.01]. The activity of Ca2^＋-Mg2^＋-ATPase on RBC membrane was markedly higher in the UBIO treated group than in the control group after after the first, third and the completion of treatment respectively [（24.83±12.88）, （17.70±5.69）; （28.08±13.44）, （16.32±5.29）; （17.42±6.04）, P〈 0.05-0.01]. CONCLUSION： The effect of UBIO treatment against acute cerebral infarction may be mediated by the increased K^＋-Na^＋ ATPase and Ca2^＋-Mg2^＋-ATPase activities on RBC membrane, which enhances the RBC transformation ability so as to lower RBC aggregation and correct high blood viscosity.

The safety of autologous peripheral blood stem cell transplantation by intracoronory infusionin in patients with acute myocardial infarction

Objective Bone-marrow stem-cell transplantation has been shown to improve cardiac function in patients with AMI, but the safety of intracoronory infusion of autologous peripheral blood stem-cell(PBSCs) in patients with AMI is unknown. For this reason, we observe the feasibility and safety of PBSCs transplantation by intracoronory infusion in such patients.Method Fourty one patients with AMI were allocated to receive Granulocyte Colony-Stimulating Factor (G-CSF:Filgrastim,300 μg) with the dose of 300 μg-600 μg/day to mobilize the stem cell, and the duration of applying G-CSF was 5 days . On the sixth day, PBSCs were separated by Baxter CS 3000 blood cell separator into suspend liquid 57 ml. Then the suspend liquid was infused into the infarct related artery (IRA)by occluding the over the wire balloon and infusing artery through balloon center lumen. In the process of the intracoronary infusion of PBSCs, the complications should be observed, which were arrhythmias including of bradycardia, sinus arrest or atrial ventricular block, premature ventricular beats ,ventricular tachycardia, ventricular fibrillation; and hypotention, etc. Results There were total 10 cases with complications during the intracoronary infusion of PBSCs. The incidence of complications was 24.4%(10/41), including bradycardia is 2.4 %(1/41), sinus arrest or atrial ventricular block is 4.9%(2/41), ventricular fibrillation is 2.4 %( 1/41), hypotention is14.6 % (6 /41).Conclusions In patients with AMI, intracoronary infusion of PBSCs is feasible and safe.

Detection and significance of blood rheology and coagulation function index in elderly patients with type 2 diabetes mellitus complicated with cerebral infarction

Objective: To investigate the level of blood rheology and coagulation function in elderly patients with type 2 diabetes mellitus (T2DM) and cerebral infarction and its significance. Methods: A total of 81 elderly patients with T2DM and cerebral infarction were selected as the observation group, 80 cases of T2DM patients without cerebral infarction were selected as T2DM group, and 80 healthy elderly people as control group. According to the Adama classification, the patients in the observation group were divided into three groups: lacunar infarction group (n=28), small infarction group (n=39) and large infarction group (n=14). The blood rheology and coagulation function indexes levels among the groups were compared. Results: The single factor variance analysis showed that the differences of the high shear whole blood viscosity, plasma viscosity, low shear whole blood viscosity, APTT, PT, FIB and D-D levels among the control group were significant, T2DM group and observation group were statistically significant. Compared with the control group, the high shear whole blood viscosity, plasma viscosity, low shear whole blood viscosity, FIB and D-D levels in the T2DM group and observation group were significantly increased, PT and APTT were decreased sharply, and in the observation group high shear whole blood viscosity, plasma viscosity, low shear whole blood viscosity, FIB and D-D levels were significantly higher than that of T2DM group APTT, and PT were significantly lower than those of T2DM group. Lacunar infarction group, small infarction group and large infarction group with increased infarct size, with high shear whole blood viscosity, plasma viscosity, low shear whole blood viscosity, FIB and D-D levels were significantly increased, while APTT and PT were significantly decreased. Conclusion: T2DM and cerebral infarction patients with abnormal blood rheology and coagulation function, the index examination has important clinical value for cerebral infarction area evaluation.

Effects of different doses of ticagrelor on coronary blood flow, inflammatory response and myocardial enzyme spectrum in patients with acute myocardial infarction

Objective:To investigate the effects of different doses of ticagrelor on coronary blood flow, inflammatory response and myocardial enzyme spectrum in patients with acute myocardial infarction.Methods: A total of 180 patients with acute myocardial infarction who were treated in our hospital between December 2015 and March 2017 were reviewed and divided into the routine dose group (n=87) who accepted routine dose of ticagrelor therapy and loading dose group (n=93) who accepted loading dose of ticagrelor therapy. The differences in coronary blood flow, inflammatory response and myocardial enzyme spectrum were compared between the two groups before and after treatment.Results: Immediately after admission, there was no statistically significant difference in the coronary blood flow levels, inflammatory response and myocardial enzyme spectrum contents between the two groups. At 24 h after percutaneous coronary intervention (PCI), the coronary blood flow parameters SPV, DPV and CFVR levels in loading dose group were higher than those in routine dose group;serum inflammatory factors PCT, IL-6 and CRP contents were lower than those of routine dosage group;myocardial enzyme spectrum indexes cTnⅠ, LDH, HBDH and MB contents were lower than those of routine dose group.Conclusion: Loading dose of ticagrelor therapy before PCI can effectively optimize the coronary blood flow after PCI, reduce the systemic inflammatory response and protect the myocardial function in patients with acute myocardial infarction.

Monitoring the changes in plasm C-reactive protein,fibrinogen and blood white cell in patients with primary hypertension combined with acute cerebral infarction

BACKGROUND： Inflammatory reaction and the increased level of its accompanying active protein play an important role in the occurrence and development of cerebral infarction. C-reactive protein, fibrinogen and white blood cell, as the monitoring index of inflammatory reaction, are very important in the occurrence and development of acute cerebral infarction. OBJECTIVE： To make a comparison between patients with primary hypertension accompanied with acute cerebral infarction and with simple primary hypertension by observing the changes in plasma C-reactive protein and fibrinogen levels as well as white blood cell and differential counts and analyzing their significances. DESIGN ： Controlled observation SETTING ： Ward Building for VIP, Shenzhen Hospital, Peking University. PARTICIPANTS： Totally 133 patients with primary hypertension were selected from Ward Building for VIP, Shenzhen Hospital, Peking University during September 2003 to September 2005, The diagnostic criteria were based on the hypertension diagnosis criteria formulated by the 7^th World Health Organization-International Society of Hypertension Guidelines （WHO-ISH） in 1998. The informed consents were obtained from all the participants. The involved patients were assigned into two groups： primary hypertension group, in which, there were 65 patients with primary hypertension （ degree 2）, including 42 males and 23 females, with mean age of （61 ±14）years and mean blood pressure of （162.7±6.8）/（94.2±8.4） mm Hg （1 mm Hg =0.133 kPa）, and primary hypertension combined with cerebral infarction group, in which, there were 68 patients with primary hypertension combined with cerebral infarction （ meeting the diagnostic criteria formulated in the 4^th National Cerebrovascular Diseases Meeting in 1995 and diagnosed by skull CT or MRI to exclude the patients with lacunar infarction）, including 42 males and 26 females, with mean age of （56±15） years and mean blood pressure of （176.4±9.2）/（96.3±9.7） mm Hg. METHODS： Plasm C-reactive protein and fibrinogen levels, and white blood cell and differential counts of patients in the two groups were examined 24 hours after stroke. The above indexes were re-examined in the primary hypertension combined with cerebral infarction group 72 hours after stroke. White blood cell and differential counts were performed with laser method （East Asia FE-95001 RAM-1, Japan）. The level of C-reactive protein was measured with turbidimetry （BNII Automatic Systems For Analysis, USA）. The level of fibrinogen was measured with algorithm method when prothrombin time was normal and with Clauss method when prothrombin time was abnormal （ACL Automatic Coagulation Analyzer, USA）. MAIN OUTCOME MEASURES： The plasm C-reactive protein and flbrinogen levels, and white blood cell and differential counts 24 hours after stroke in two groups and 72 hours after stroke in primary hypertension combined with cerebral infarction group. RESULTS： All the 133 involved patients participated in the result analysis. The plasm C-reactive protein and fibrinogen levels, and white blood cell and neutrophil counts in patients with primary hypertension were all within the normal range. The plasm C-reactive protein and fibrinogen levels, and white blood cell and neu- trophil counts in patients with primary hypertension combined with cerebral infarction were significantly higher than those in patients with primary hypertension 24 hours after stroke and 72 hours after stroke respectively[24 hours after stroke：（32.12±11.76） mg/L vs. （5.02±3.21 ） mg/L;（4.64±0.75） g/L vs. （3.12±0.49） g/L; （9.32±81）×10^9 L^- 1 vs. （5.78±1.32）×10^9L^- 1 （7.85±2.38）×10^9 L^- 1 vs.（3.49±1.28）×10^9 L^-1,t =7.094, 5.759,4.106,5.491, respectively,all P〈 0.01; 72 hours after stroke： （47.62±18.43） mg/L vs. （32.12±11.76） mg/L; （5.08±0.82） g/L vs. （4.64±0.75） g/L, t =2.864,2.220, respectively, both P 〈 0.05]. CONCLUSION： The increase in fibrinogen level and white blood cell count are the important index in monitoring primary hypertension combined with acute cerebral infarction. The increase in plasm C-reactive protein and fibrinogen levels 72 hours after stroke indicates that plasma C-reactive protein and fibrinogen are very important in the development of disease.

Comparison of the level of thrombus precursor protein in blood plasma between patients with acute cerebral infarction and healthy persons at different time

BACKGROUND： Thrombus precursor protein （TpP） is the index of thrombus activity level, and it is also early referencing index in detecting thrombus diseases. OBJECTIVE： To dynamically observe the changes of TpP level in blood plasma of patients with acute cerebral infarction at different time after onset, and to compare the differences of plasma TpP level between patients with acute cerebral infarction and healthy persons who received health examination. DESIGN： Controlled observation SETTING： Department of Neurology, Affiliated Hospital of Xuzhou Medical College PARTICIPANTS： Totally 58 patients with acute cerebral infarction who received the treatment in the Department of Neurology, Affiliated Hospital of Xuzhou Medical College between September 2004 and March 2005 were recruited in this study. They all met the diagnostic criteria revised by the 4^th National Conference of Cerebrovascular Disorders in 1995 and were diagnosed by clinical and skull CT and （or） MRI examinations. The patients included 33 male and 25 female aged from 36 to 87 years. Time to onset 〈 6 hours, 6 to 11 hours, 12 to 23 hours, 24 to 48 hours and 〉 48 hours were found in 10,11,14,10 and 13 patients respectively. Another 51 persons who homeochronously received the health body examination in our hospital were recruited, including 34 male and 17 female, aged 38 to 85 years, serving as control group. Patients with cardio-cerebrovascualr diseases or liver and kidney diseases were excluded. All the involved subjects were informed of the detected items. METHODS： About 4 mL venous blood was respectively taken from patients admitted to the hospital within 6 hours, 6 toll hours, 12 to 23 hours, 24 to 48 hours and more then 48 hours after onset, and healthy persons when receiving health examination. The level of TpP in blood plasma was measured with enzymelinked immunosorbent assay. MAIN OUTCOME MEASURES： ① Comparison of the level of plasma TpP between patients and controls;② Comparison of the level of plasma TpP of patients with acute cerebral infarction at different time after onset. RESULTS： Totally 58 patients with acute cerebral infarction and 51 persons who received health examination participated in the result analysis. ①Comparison of plasma TpP level between patients and controls： The plasma TpP level of patients with acute cerebral infarction was significantly higher than that of control group [（16.12±3.28）vs （5.38±1.36） mg/L, t= 20.993, P〈 0.01 ]. ② Comparison of plasma TpP level of patients with acute cerebral infarction at different time after onset： The level of plasma TpP was （12.06±3.06） mg/L within 6 hours, （15.11±3.42） mg/L at 6 to 11 hours, （20.63±4.05） mg/L at 12 to 23 hours, （16.15±3.50） mg/L at 24 to 48 hours and （11.88±3.11） mg/L at more than 48 hours after onset. It increased from the 6^th hour, reached the peak at the 12^th to 23^rd hours, maintained at very high level at the 48= hour and then gradually decreased and recovered to the level within 6 hours after onset. The level of plasma TpP of patients with acute cerebral infarction was signiticantly higher at the 12^th to 23^rd hours after onset and the 24^th to 48^th hours after onset than within 6 hours after onset （t = 13.385, P 〈 0.05）. CONCLUSION： ①The level of plasma TpP of patients with acute cerebral infarction is significantly higher than that of persons who received health examination.② Plasma TpP levels of patients with acute cerebral infarction change in wave manner at the different time after onset.

Effect of fasudil combined with conventional therapy on nerve and blood coagulation function as well as Hcy metabolism in patients with acute cerebral infarction

Objective:To analyze the effect of fasudil combined with conventional therapy on nerve and blood coagulation function as well as Hcy metabolism in patients with acute cerebral infarction. Methods:80 patients with acute cerebral infarction treated in our hospital between January 2013 and January 2013 were selected as the research subjects and divided into observation group (n = 40) and control group (n = 40) according to the random number table. Control group received conventional therapy and observation group received fasudil combined with conventional therapy. After 14 d of treatment, the levels of cerebral blood perfusion parameters, nerve function indexes, platelet function indexes and homocysteine (Hcy) of two groups of patients were determined.Results:After 14 d of treatment, middle cerebral artery and basilar artery peak systolic flow velocity (Vs), low diastolic flow velocity (Vd) and mean flow velocity (Vm) levels of observation group were higher than those of control group (P<0.05);serum nerve function indexes brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) content were higher than those of control group (P<0.05) while phosphatidic acid (PA), neuron-specific enolase (NSE), S100β protein (S100β), and substantia nigra divalent metal transporter 1 (DMT1) content were lower than those of control group (P<0.05);serum platelet function indexes platelet activation-dependent granule membrane protein-140 (GMP-140), fibrinogen receptor-1 (PAC-1), platelet activating factor (PAF) and platelet-derived growth factor BB (PDGF-BB) content were lower than those of control group (P<0.05);serum Hcy content was lower than that of control group (P<0.05).Conclusions:Fasudil combined with conventional therapy can optimize the nerve function and blood coagulation function in patients with acute cerebral infarction, and also plays a positive role in reducing Hcy levels.

Influence of Xiaoshuan enteric-coated capsules + aniracetam therapy on cerebral blood perfusion and nerve function in patients with convalescent cerebral infarction

Objective: To investigate the influence of Xiaoshuan enteric-coated capsules + aniracetam therapy on cerebral blood perfusion and nerve function in patients with convalescent cerebral infarction. Methods: A total of 177 cases of patients with convalescent cerebral infarction were retrospectively reviewed and then divided into the control group (n=109) and the Xiaoshuan enteric-coated capsules group (n=68). Control group received aniracetam therapy on the basis of routine treatment, and Xiaoshuan enteric-coated capsules group received Xiaoshuan enteric-coated capsules + aniracetam therapy on the basis of routine treatment. The differences in ultrasound cerebral blood perfusion parameter levels as well as serum neurotrophy index and nerve injury index contents were compared between the two groups. Results: Before treatment, there was no statistically significant difference in ultrasound cerebral blood perfusion parameter levels as well as serum neurotrophy index and nerve injury index contents between the two groups. After treatment, ultrasound cerebral blood perfusion parameters PSV and TMV levels in Xiaoshuan enteric-coated capsules group were higher than those in control group whereas RI level was lower than that in control group;serum neurotrophy indexes bFGF, BDNF and VEGF contents were higher than those of control group;serum nerve injury indexes GFAP, NSE, UCH-L1 and S100B contents were lower than those of control group. Conclusion: Xiaoshuan enteric-coated capsules + aniracetam therapy can significantly increase cerebral blood perfusion and optimize nerve function in patients with convalescent cerebral infarction.

The Safety of Autologous Peripheral Blood Stem Cell Transplantation by Intracoronory Infusion in Patients with Acute Myocardial Infarction

Objectives Bone-marrow stem-cell transplantation has been shown to improve cardiac function in patients with acute myocardial infarction (AMI) , but the safety of intracoronory infusion of autologous peripheral blood stem-cell (PBSCs) in patients with AMI is unknown. For this reason, we observe the feasibility and safety of PBSCs transplantation by intracoronory infusion in such patients. Methods 41 patients with AMI were allocated to receive granulocyte colony-stimulating factor (G- CSF: Filgrastim,300μg) with the dose of 300μg~ 600μg/day to mobilize the stem cell, and the duration of applying G-CSF was 5 days. On the sixth day, PBSCs were separated by Baxter CS 3000 blood cel 1 separator into suspend liquid 57 ml. Then the suspend liquid was infused into the infarct related artery (IRA) by occluding the over the wire balloon and infusing artery through balloon center lumen. In the process of the intracoronary infusion of PBSCs, the complications should be observed, which were arrhythmias including of bradycardia, sinus arrest or atrial ventricular block, premature ve. ntricular beats ,ven~icular tachycardia, ventricular fibrillation; and hypotention, etc. Results There were total 10 cases with complications during the intracoronary infusion of PBSCs. The incidence of complications was 24.4% (10/41), including bradyca- rdia was 2.4 % (1/41), sinus arrest or atrial ventri- cular block was 4.0% (2/41), ventricular fibrillation was 2.4 % (1/41), hypotention was 14.6 % (6/41). Conclusions In patients with AMI, intracoronary infusion of PBSCs is feasible and safe.

Use of acupuncture to treat cerebral infarction in the last 10 years A Scopus-based literature analysis

OBJECTIVE： To identify global research trends in the use of acupuncture to treat cerebral infarction. DATA RETRIEVAL： We performed a bibliometric analysis of studies on the use of acupuncture to treat cerebral infarction published during 2002-2011, retrieved from Scopus, using the key words of acupuncture and cerebral infarction or ischemic stroke. SELECTION CRITERIA： Inclusion criteria： peer-reviewed articles on the use of acupuncture to treat cerebral infarction indexed in Scopus and published between 2002 and 2011; types of publications were original research articles, reviews, meeting abstracts, proceedings papers, book chapters, editorial material, and news items. Exclusion criteria： articles that required manual searching or telephone access; documents that were not published in the public domain; and corrected papers. MAIN OUTCOME MEASURES： （a） Annual publication output; （b） language of publication; （c） type of publication; （d） key words of publication; （e） publication by research field; （f） publication by journal （g） publication by country and institution; （h） publication by author; （i） most-cited papers between 2002 and 2006; and （j） most-cited papers between 2007 and 2011. RESULTS： A total of 160 publications on the use of acupuncture to treat cerebral infarction from 2002-2011 were retrieved from Scopus. The number of publications increased gradually over the 10-year study period; most were written in Chinese or English. Articles and reviews constituted the major types. The most frequent key word used was acupuncture. The most prolific journals in this area were Zhongguo 7hen Jiu and the Chinese Journal of Clinical Rehabilitation. Of the 160 publications retrieved, half came from Chinese authors and institutions. Tianjin University of Traditional Chinese Medicine was the most prolific research institute. Two papers were cited 30 times; they were published in 2002 and 2009, respectively. CONCLUSION： In the field of neuroscience, there is little literature on acupuncture for cerebral infarction. The most-cited papers were cited 30 times in the past 3 years. We believe that, with advances in the study of mechanisms in neurobiology, research on acupuncture will also advance and will become the concern of more scholars.

Differences in the effect of intravenous alteplase thrombolysis and non-thrombolytic therapy on the neurological function in patients with acute cerebral infarction

Objective:To study the differences in the effect of intravenous alteplase thrombolysis and non-thrombolytic therapy on the neurological function in patients with acute cerebral infarction as well as the specific molecular mechanism.Methods:Patients with acute cerebral infarction who were treated in our hospital between April 2013 and May 2016 were selected and randomly divided into two groups, thrombolysis group received intravenous alteplase thrombolysis and non-thrombolysis group received conventional treatment. After treatment, transcranial color Doppler ultrasound was used to assess intracranial blood flow, and serum was collected to detect blood coagulation function indexes, nerve injury indexes and inflammatory stress response indexes.Results:1 week and 2 weeks after treatment, middle cerebral artery Vs, Vd and Vm levels of thrombolysis group were significantly higher than those of non-thrombolysis group;2 weeks after treatment, serum FVIII, VWF, S100β, NSE, GFAP, MBP, UCH-L1, TNF-α, IL-1β, MDA, AOPP and 8-OHdG content of thrombolysis group were significantly lower than those of control group while PT, TT and APTT were significantly higher than those of control group.Conclusion: Intravenous alteplase thrombolysis can improve cerebral blood perfusion and alleviate nerve injury in patients with acute cerebral infarction, and inhibiting blood coagulation process as well as oxidizing and inflammatory reaction is the molecular mechanism for alteplase to achieve therapeutic action.