The Third Universal Definition of Myocardial Infarction(MI) requires cardiac myocyte necrosis with an increase and/or a decrease in a patient's plasma of cardiac troponin(cT n) with at least one cT n measurement g...The Third Universal Definition of Myocardial Infarction(MI) requires cardiac myocyte necrosis with an increase and/or a decrease in a patient's plasma of cardiac troponin(cT n) with at least one cT n measurement greater than the 99 th percentile of the upper normal reference limit during:(1) symptoms of myocardialischemia;(2) new significant electrocardiogram(ECG) ST-segment/T-wave changes or left bundle branch block;(3) the development of pathological ECG Q waves;(4) new loss of viable myocardium or regional wall motion abnormality identified by an imaging procedure; or(5) identification of intracoronary thrombus by angiography or autopsy.Myocardial infarction,when diagnosed,is now classified into five types.Detection of a rise and a fall of troponin are essential to the diagnosis of acute MI.However,high sensitivity troponin assays can increase the sensitivity but decrease the specificity of MI diagnosis.The ECG remains a cornerstone in the diagnosis of MI and should be frequently repeated,especially if the initial ECG is not diagnostic of MI.There have been significant advances in adjunctive pharmacotherapy,procedural techniques and stent technology in the treatment of patients with MIs.The routine use of antiplatelet agents such as clopidogrel,prasugrel or ticagrelor,in addition to aspirin,reduces patient morbidity and mortality.Percutaneous coronary intervention(PCI) in a timely manner is the primary treatment of patients with acute ST segment elevation MI.Drug eluting coronary stents are safe and beneficial with primary coronary intervention.Treatment with direct thrombin inhibitors during PCI is non-inferior to unfractionated heparin and glycoprotein Ⅱb/Ⅲa receptor antagonists and is associated with a significant reduction in bleeding.The intra-coronary use of a glycoprotein Ⅱb/Ⅲa antagonist can reduce infarct size.Pre- and post-conditioning techniques can provide additional cardioprotection.However,the incidence and mortality due to MI continues to be high despite all these recent advances.The ini展开更多
In this study, the cardioprotective mechanism of the combination of notoginseng total saponins and safflower total flavonoids（CNS） was investigated due to its excellently efficacy against myocardial infarction（MI）...In this study, the cardioprotective mechanism of the combination of notoginseng total saponins and safflower total flavonoids（CNS） was investigated due to its excellently efficacy against myocardial infarction（MI） in rats. After the left anterior descending coronary artery（LADCA） ligation, rats were orally administered with CNS for 7 consecutive days. CNS prevented MI-induced pathophysiological changes and significantly decreased plasma levels of myocardial enzymes, including creatine kinase MB isoenzyme（CK-MB）, lactate dehydrogenase（LDH） and aspartate aminotransferase（AST）. Further investigation revealed that CNS attenuated the production of inflammatory factors in plasma, including tumor necrosis factor-alpha（TNF-α）, interleukin-6（IL-6） and interleukin-1β（IL-1β）. Moreover, CNS treatment decreased the expression of caspase-3 at the mR NA level in infarct tissue. Our findings demonstrated that the anti-inflammatory and anti-apoptotic properties of CNS might confer its cardioprotection against MI in rats.展开更多
Pulmonary arteriovenous malformation (PAVM), which is asymptomatic in most cases, is often identified in patients with central nervous system disorders such as brain abscesses and/or cerebral infarctions. We have repo...Pulmonary arteriovenous malformation (PAVM), which is asymptomatic in most cases, is often identified in patients with central nervous system disorders such as brain abscesses and/or cerebral infarctions. We have reported a patient with idiopathic multiple PAVM identified at the onset of cerebral infarction. A 69-year-old woman visited the Department of Neuropathic Internal Medicine at our hospital with chief complaints of numbness in her left hand and a feeling of weakness. The patient was given a diagnosis of subacute cerebral infarction. Multiple old lacunar infarctions were also observed in the deep white matter of the left frontal lobe. Chest computed tomography showed multiple nodular structures, mainly in the right lower lung field (S8), as well as continuous arteries and veins at the site;thus, the patient was finally diagnosed with multiple PAVM. Right lower thoracoscopic lobectomy was performed, as is typical surgical practice in such cases. The patient had a favorable postoperative course, and had no recurrence of cerebral infarction. Although the patient’s lesions were mainly restricted to S8, the fact that there were multiple lesions deemed a lobectomy as the appropriate course of treatment. This case emphasizes that attention should be paid to cases of multiple PAVM since cerebral infarction may arise from the disease.展开更多
This study aimed at assessing the relationship between executive functions and left sided hemiplegia due to non hemorrhagic supratentorial infarction in elderly Egyptians. It is considered a case control study which w...This study aimed at assessing the relationship between executive functions and left sided hemiplegia due to non hemorrhagic supratentorial infarction in elderly Egyptians. It is considered a case control study which was conducted among 90 elderly participants, who were divided into two groups: a case group, 45 cases with cerebral infarctions of 6 months duration or more, and a control group who did not have previous cerebral infarctions. Both groups were selected from Ain shams University Hospital. Each participant was subjected to comprehensive geriatric assessment, executive functions assessment using, block design test, digit span, letter verbal fluency test, animal verbal fluency test and clock drawing test, and then a Computed Tomography (CT) brain was performed. It was found that cases were suffering from more functional impairment than controls, and have had significant lower scores in Mini Mental Status Examination (MMSE) (P < 0.01). Significant difference was found between both groups as regards performance of executive function tests (P < 0.05). Significant effect of Parietal lobe infarctions was found on Block Design Test, Digit Span Test, Animal Verbal Fluency and Clock Drawing Test (P value < 0.05). Conclusion: There was a significant difference between cases and controls as regards their performance in cognitive and executive function tests.展开更多
In multiple trauma, blunt carotid artery injuries (BCAIs) have occasionally been reported. However, bilateral blunt carotid artery occlusions (Grade 4 BCAIs) associated with multiple trauma are rare, and delays in dia...In multiple trauma, blunt carotid artery injuries (BCAIs) have occasionally been reported. However, bilateral blunt carotid artery occlusions (Grade 4 BCAIs) associated with multiple trauma are rare, and delays in diagnosis and treatment result in a lethal outcome. Here, we report our experience with bilateral carotid artery occlusions. A 76-year-old female suffered multiple traumas in a motor vehicle accident. On arrival at our hospital, she presented in a coma, with left mydriasis and unreactive pupils. Computed tomography (CT) showed bifrontal intracranial epidural hematoma and fractures of the facial bone and anterior skull base, and osteoplastic craniotomy was urgently undertaken for the epidural hematoma. However, the comatose state and unreactive pupils persisted during the post-operative course. Serial head CT findings showed progressive bilateral ischemic changes, and radiological examinations revealed bilateral internal carotid artery occlusions. We speculated that bilateral Grade 4 BCAIs had induced progressive cerebral infarctions. The patient partially responded to anticoagulation therapy with heparin infusion, but died of multiple organ failure on day 15. When bilateral progressive ischemic changes are observed in a patient with severe traumatic brain injury, bilateral Grade 4 BCAIs should be considered in the differential diagnosis. CT angiography as part of whole-body CT at admission may be effective for preventing delays in diagnosis and treatment of bilateral Grade 4 BCAIs.展开更多
目的探讨孤立性脑桥梗死的临床和影像学特征以及早期运动障碍进展（progressive motor deficits，PMD）和短期预后的影响因素。方法对初次发病24h内入院的86例孤立性脑桥梗死患者进行回顾性分析，根据梗死灶最大直径和部位分为脑桥旁正...目的探讨孤立性脑桥梗死的临床和影像学特征以及早期运动障碍进展（progressive motor deficits，PMD）和短期预后的影响因素。方法对初次发病24h内入院的86例孤立性脑桥梗死患者进行回顾性分析，根据梗死灶最大直径和部位分为脑桥旁正中梗死（pararl-ledian pontine infarction，PPI）和脑桥腔隙性梗死（lacunar pontine infarction，LPI），根据早期PMD情况分为PMD组和无PMD组，根据出院时改良Rankin量表（modified Rankin Scale，mRS）评分分为转归不良组（mRS评分〉2分）和转归良好组（mRS评分≤2分），对不同病例组的临床和影像学特征进行比较。结果PPI组（n=35）高脂血症（57．14％对33．33％；X^2=4．80，P=0．028）、偏瘫（97．14％对72．55％；X^2=8．718，P=0．003）、基底动脉狭窄（45．71％对17．65％；X^2=7．930，P=0．005）和出院时转归不良（54．29％对31．37％；X^2=4．515，P=0．034）患者构成比以及基线美国国立卫生研究院卒中量表（National Institutes of Health Strokescale，NIHSS）评分[（6．00±2．39）分对（4．61±3．41）分；t=2．087，P=0．040]均显著性高于LPI组（n=51）。PMD组（n=22）基线舒张压水平[（97．82±15．61）minHg对（89．55±12．23）mmHg，1mmHg=0．133kPa；t=2．258，P=0．031]以及PPI（63．64％对32．81％；X^2=6．445，P=0．011）和基底动脉狭窄（59．10％对18．75％；X^2=12．922，P=0．000）的构成比均显著性高于无PMD组（n=64）。转归不良组（n=35）基线NIHSS评分[（6．80±2．63）分对（3．73±2．55）分；t=5．426，P=0．000]和空腹血糖水平[（9．40±5．15）mmol／L对（6．56±2．69）mmol／L；t=2．985，P=0．004]以及PPI患者构成比（54．29％对31．37％；X2=4．515，P=0．034）均显著性高于转归良好组（n=51）。多变量logistic回归分析显示，基底动脉狭窄是PPI发病[优势比（oddsratio，OR）3．801，95％可信区间（confi展开更多
基金Supported by Research facilities at the James A Haley VA Hospitalin part+3 种基金Grants from the Florida King Biomedical Research Programthe Muscular Dystrophy Associationthe Robert O Law Foundationthe Cornelius Foundation
文摘The Third Universal Definition of Myocardial Infarction(MI) requires cardiac myocyte necrosis with an increase and/or a decrease in a patient's plasma of cardiac troponin(cT n) with at least one cT n measurement greater than the 99 th percentile of the upper normal reference limit during:(1) symptoms of myocardialischemia;(2) new significant electrocardiogram(ECG) ST-segment/T-wave changes or left bundle branch block;(3) the development of pathological ECG Q waves;(4) new loss of viable myocardium or regional wall motion abnormality identified by an imaging procedure; or(5) identification of intracoronary thrombus by angiography or autopsy.Myocardial infarction,when diagnosed,is now classified into five types.Detection of a rise and a fall of troponin are essential to the diagnosis of acute MI.However,high sensitivity troponin assays can increase the sensitivity but decrease the specificity of MI diagnosis.The ECG remains a cornerstone in the diagnosis of MI and should be frequently repeated,especially if the initial ECG is not diagnostic of MI.There have been significant advances in adjunctive pharmacotherapy,procedural techniques and stent technology in the treatment of patients with MIs.The routine use of antiplatelet agents such as clopidogrel,prasugrel or ticagrelor,in addition to aspirin,reduces patient morbidity and mortality.Percutaneous coronary intervention(PCI) in a timely manner is the primary treatment of patients with acute ST segment elevation MI.Drug eluting coronary stents are safe and beneficial with primary coronary intervention.Treatment with direct thrombin inhibitors during PCI is non-inferior to unfractionated heparin and glycoprotein Ⅱb/Ⅲa receptor antagonists and is associated with a significant reduction in bleeding.The intra-coronary use of a glycoprotein Ⅱb/Ⅲa antagonist can reduce infarct size.Pre- and post-conditioning techniques can provide additional cardioprotection.However,the incidence and mortality due to MI continues to be high despite all these recent advances.The ini
基金National Natural Sciences Foundation of China(Grant No.81573684)
文摘In this study, the cardioprotective mechanism of the combination of notoginseng total saponins and safflower total flavonoids（CNS） was investigated due to its excellently efficacy against myocardial infarction（MI） in rats. After the left anterior descending coronary artery（LADCA） ligation, rats were orally administered with CNS for 7 consecutive days. CNS prevented MI-induced pathophysiological changes and significantly decreased plasma levels of myocardial enzymes, including creatine kinase MB isoenzyme（CK-MB）, lactate dehydrogenase（LDH） and aspartate aminotransferase（AST）. Further investigation revealed that CNS attenuated the production of inflammatory factors in plasma, including tumor necrosis factor-alpha（TNF-α）, interleukin-6（IL-6） and interleukin-1β（IL-1β）. Moreover, CNS treatment decreased the expression of caspase-3 at the mR NA level in infarct tissue. Our findings demonstrated that the anti-inflammatory and anti-apoptotic properties of CNS might confer its cardioprotection against MI in rats.
文摘Pulmonary arteriovenous malformation (PAVM), which is asymptomatic in most cases, is often identified in patients with central nervous system disorders such as brain abscesses and/or cerebral infarctions. We have reported a patient with idiopathic multiple PAVM identified at the onset of cerebral infarction. A 69-year-old woman visited the Department of Neuropathic Internal Medicine at our hospital with chief complaints of numbness in her left hand and a feeling of weakness. The patient was given a diagnosis of subacute cerebral infarction. Multiple old lacunar infarctions were also observed in the deep white matter of the left frontal lobe. Chest computed tomography showed multiple nodular structures, mainly in the right lower lung field (S8), as well as continuous arteries and veins at the site;thus, the patient was finally diagnosed with multiple PAVM. Right lower thoracoscopic lobectomy was performed, as is typical surgical practice in such cases. The patient had a favorable postoperative course, and had no recurrence of cerebral infarction. Although the patient’s lesions were mainly restricted to S8, the fact that there were multiple lesions deemed a lobectomy as the appropriate course of treatment. This case emphasizes that attention should be paid to cases of multiple PAVM since cerebral infarction may arise from the disease.
文摘This study aimed at assessing the relationship between executive functions and left sided hemiplegia due to non hemorrhagic supratentorial infarction in elderly Egyptians. It is considered a case control study which was conducted among 90 elderly participants, who were divided into two groups: a case group, 45 cases with cerebral infarctions of 6 months duration or more, and a control group who did not have previous cerebral infarctions. Both groups were selected from Ain shams University Hospital. Each participant was subjected to comprehensive geriatric assessment, executive functions assessment using, block design test, digit span, letter verbal fluency test, animal verbal fluency test and clock drawing test, and then a Computed Tomography (CT) brain was performed. It was found that cases were suffering from more functional impairment than controls, and have had significant lower scores in Mini Mental Status Examination (MMSE) (P < 0.01). Significant difference was found between both groups as regards performance of executive function tests (P < 0.05). Significant effect of Parietal lobe infarctions was found on Block Design Test, Digit Span Test, Animal Verbal Fluency and Clock Drawing Test (P value < 0.05). Conclusion: There was a significant difference between cases and controls as regards their performance in cognitive and executive function tests.
文摘In multiple trauma, blunt carotid artery injuries (BCAIs) have occasionally been reported. However, bilateral blunt carotid artery occlusions (Grade 4 BCAIs) associated with multiple trauma are rare, and delays in diagnosis and treatment result in a lethal outcome. Here, we report our experience with bilateral carotid artery occlusions. A 76-year-old female suffered multiple traumas in a motor vehicle accident. On arrival at our hospital, she presented in a coma, with left mydriasis and unreactive pupils. Computed tomography (CT) showed bifrontal intracranial epidural hematoma and fractures of the facial bone and anterior skull base, and osteoplastic craniotomy was urgently undertaken for the epidural hematoma. However, the comatose state and unreactive pupils persisted during the post-operative course. Serial head CT findings showed progressive bilateral ischemic changes, and radiological examinations revealed bilateral internal carotid artery occlusions. We speculated that bilateral Grade 4 BCAIs had induced progressive cerebral infarctions. The patient partially responded to anticoagulation therapy with heparin infusion, but died of multiple organ failure on day 15. When bilateral progressive ischemic changes are observed in a patient with severe traumatic brain injury, bilateral Grade 4 BCAIs should be considered in the differential diagnosis. CT angiography as part of whole-body CT at admission may be effective for preventing delays in diagnosis and treatment of bilateral Grade 4 BCAIs.
文摘目的探讨孤立性脑桥梗死的临床和影像学特征以及早期运动障碍进展（progressive motor deficits，PMD）和短期预后的影响因素。方法对初次发病24h内入院的86例孤立性脑桥梗死患者进行回顾性分析，根据梗死灶最大直径和部位分为脑桥旁正中梗死（pararl-ledian pontine infarction，PPI）和脑桥腔隙性梗死（lacunar pontine infarction，LPI），根据早期PMD情况分为PMD组和无PMD组，根据出院时改良Rankin量表（modified Rankin Scale，mRS）评分分为转归不良组（mRS评分〉2分）和转归良好组（mRS评分≤2分），对不同病例组的临床和影像学特征进行比较。结果PPI组（n=35）高脂血症（57．14％对33．33％；X^2=4．80，P=0．028）、偏瘫（97．14％对72．55％；X^2=8．718，P=0．003）、基底动脉狭窄（45．71％对17．65％；X^2=7．930，P=0．005）和出院时转归不良（54．29％对31．37％；X^2=4．515，P=0．034）患者构成比以及基线美国国立卫生研究院卒中量表（National Institutes of Health Strokescale，NIHSS）评分[（6．00±2．39）分对（4．61±3．41）分；t=2．087，P=0．040]均显著性高于LPI组（n=51）。PMD组（n=22）基线舒张压水平[（97．82±15．61）minHg对（89．55±12．23）mmHg，1mmHg=0．133kPa；t=2．258，P=0．031]以及PPI（63．64％对32．81％；X^2=6．445，P=0．011）和基底动脉狭窄（59．10％对18．75％；X^2=12．922，P=0．000）的构成比均显著性高于无PMD组（n=64）。转归不良组（n=35）基线NIHSS评分[（6．80±2．63）分对（3．73±2．55）分；t=5．426，P=0．000]和空腹血糖水平[（9．40±5．15）mmol／L对（6．56±2．69）mmol／L；t=2．985，P=0．004]以及PPI患者构成比（54．29％对31．37％；X2=4．515，P=0．034）均显著性高于转归良好组（n=51）。多变量logistic回归分析显示，基底动脉狭窄是PPI发病[优势比（oddsratio，OR）3．801，95％可信区间（confi
