Acupuncture at Shuigou(GV26) shows good clinical efficacy for treating stroke, but its mechanism remains poorly understood. In this study, a cerebral infarction model of ischemia/reperfusion injury received electroacu...Acupuncture at Shuigou(GV26) shows good clinical efficacy for treating stroke, but its mechanism remains poorly understood. In this study, a cerebral infarction model of ischemia/reperfusion injury received electroacupuncture at GV26(15 Hz and 1 m A, continuous wave [biphasic pulses], for 5 minutes). Electroacupuncture effectively promoted regional cerebral blood flow on the infarct and non-infarct sides, increased infarct lesions, lectin, and number of blood vessels, upregulated von Willebrand factor and cell proliferation marker Ki67 expression, and diminished neurological severity score. These findings confirm that electroacupuncture at GV26 promotes establishment of collateral circulation and angiogenesis, and improves neurological function.展开更多
AIM:To study characteristics of collateral circulation of gastric varices (GVs) with 64-row multidetector computer tomography portal venography (MDCTPV).METHODS:64-row MDCTPV with a slice thickness of 0.625 mm and a s...AIM:To study characteristics of collateral circulation of gastric varices (GVs) with 64-row multidetector computer tomography portal venography (MDCTPV).METHODS:64-row MDCTPV with a slice thickness of 0.625 mm and a scanning field from 2 cm above the tracheal bifurcation to the lower edge of the kidney was performed in 86 patients with GVS diagnosed by endoscopy. The computed tomography protocol included unenhanced,arterial and portal vein phases. The MDCTPV was performed on an AW4.3 workstation. GVs were classified into three types according to Sarin's Classification. The afferent and efferent veins of each type of GV were observed.RESULTS:The afferent venous drainage originated mostly from the left gastric vein alone (LGV) (28/86,32.59%),or the LGV more than the posterior gastric vein/short gastric vein [LGV > posterior gastric vein/short gastric vein (PGV/SGV)] (22/86,25.58%),as seen by MDCTPV. The most common efferent venousdrainage was via the azygos vein to the superior vena cava (53/86,61.63%),or via the gastric/splenorenal shunt (37/86,43.02%) or inferior phrenic vein (8/86,9.30%) to the inferior vena cava. In patients with gastroesophageal varices type 1,the afferent venous drainage of GV mainly originated from the LGV or LGV > PGV/SGV (43/48,89.58%),and the efferent venous drainage was mainly via the azygos vein to the super vena cava (43/48,89.58%),as well as via the gastric/splenorenal shunt (8/48,16.67%) or inferior phrenic vein (3/48,6.25%) to the inferior vena cava. In patients with gastroesophageal varices type 2,the afferent venous drainage of the GV mostly came from the PGV/SGV more than the LGV (PGV/SGV > LGV) (8/16,50%),and the efferent venous drainage was via the azygos vein (10/16,62.50%) and gastric/splenorenal shunt (9/16,56.25%). In patients with isolated gastric varices,the main afferent venous drainage was via the PGV/SGV alone (16/22,72.73%),and the efferent venous drainage was mainly via the gastric/splenorenal shunt (20/22,90.91%),as well as the inferior phrenic vein (3/23) to the inferior vena cava. CONCLUSION:MDCTPV can clearly display the afferent and efferent veins of all types of GV,and it could provide useful reference information for the clinical management of GV bleeding.展开更多
BACKGROUND Congenital coronary artery fistula can lead to symptoms of chest tightness,chest pain,or exertional dyspnea,which is a congenital vascular malformation that should not be ignored.Patients who have such malf...BACKGROUND Congenital coronary artery fistula can lead to symptoms of chest tightness,chest pain,or exertional dyspnea,which is a congenital vascular malformation that should not be ignored.Patients who have such malformations are frequently observed with different concurrent abnormal anatomic structures.Collateral circulation may have a positive effect on improving the patients'symptoms.CASE SUMMARY A 53-year-old female experienced episodic chest discomfort for the past month with symptoms manifesting when she was agitated or overexerted.After a positive treadmill test,the patient underwent coronary angiography.“Ghostlike”intermittent appearance of coronary ventricular fistula and collateral branching were observed.The patient was diagnosed with a right coronary ventricular fistula and collateral circulation.CONCLUSION This case shows the likelihood of collateral circulation in patients with coronary artery fistula.This may provide medical staff with novel solutions to treat insufficiency of myocardial blood supply induced by cardiovascular malformations.展开更多
Background:Coronary collateral circulation(CCC)plays a vital role in the myocardial blood supply,especially for ischemic myocardium.Evidence suggests that the visfatin and 25-hydroxyvitamin D_(3)[25(OH)D_(3)]levels ar...Background:Coronary collateral circulation(CCC)plays a vital role in the myocardial blood supply,especially for ischemic myocardium.Evidence suggests that the visfatin and 25-hydroxyvitamin D_(3)[25(OH)D_(3)]levels are related to the degree and incidence of vascular stenosis associated with coronary artery disease;however,few studies have evaluated the effect of visfatin and 25(OH)D_(3) on CCC development in patients with chronic total occlusion(CTO).This study aimed to evaluate the relationship between the serum visfatin and 25(OH)D_(3) levels and CCC in patients with CTO.Methods:A total of 189 patients with CTO confirmed by coronary angiography were included.CCC was graded from 0 to 3 according to the Rentrop-Cohen classification.Patients with grade 0 or grade 1 collateral development were in-cluded in the poor CCC group(n=82),whereas patients with grade 2 or grade 3 collateral development were included in the good CCC group(n=107).The serum visfatin and 25(OH)D_(3) levels were measured by ELISA.Results:The visfatin level was significantly higher in the poor CCC group than in the good CCC group,and the 25(OH)D_(3) level was significantly lower in the poor CCC group than in the good CCC group(P=0.000).Correlation analysis showed that the Rentrop grade was negatively correlated with the visfatin level(r=−0.692,P=0.000)but positively correlated with the 25(OH)D_(3) level(r=0.635,P=0.000).Logistic regression analysis showed that the vis-fatin and 25(OH)D_(3) levels were independent risk factors for CCC(odds ratio 1.597,95%confidence interval 1.300-1.961,P=0.000 and odds ratio 0.566,95%confidence interval 0.444-0.722,P=0.000,respectively).The visfatin and 25(OH)D_(3) levels can effectively predict the CCC status.Conclusion:Serum visfatin and 25(OH)D_(3) levels are related to CCC development and are independent predictors of poor CCC.展开更多
BACKGROUND Moyamoya disease(MMD)is a rare cause of acute stroke and transient ischemic attacks in children.We described clinical,diagnostic features and follow-ups of a young child with acute stroke.CASE SUMMARY We re...BACKGROUND Moyamoya disease(MMD)is a rare cause of acute stroke and transient ischemic attacks in children.We described clinical,diagnostic features and follow-ups of a young child with acute stroke.CASE SUMMARY We report a 4-year-old girl with left hemiparesis after an acute ischemic stroke.Her history was also significant for repeated left or right focal motor seizures,generalized tonic-clonic convulsions and transient ischemic attacks.Her magnetic resonance imaging and computed tomography(CT)of the brain and magnetic resonance angiography,CT angiography and venography on the cerebral vessels revealed evidence of bilateral fronto-parietal ischemic infarctions,occlusion of the right and left internal carotid arteries started at its bifurcation and non-visualization of right and left anterior and middle cerebral arteries.There was evidence of progression in angiography manifested as development of collaterals from the basal perforating vessels,increase in the extent of large intracranial arterial stenosis/occlusion and extensive collateral circulation with predominance from the posterior circulation.Physical and neurological evaluation and comprehensive laboratory investigations excluded an obvious comorbid disease or risk factor for the child’s condition.The diagnosis of MMD was highly suggested as a cause of the child’s steno-occlusive condition.She was treated symptomatically with levetiracetam,an antiepileptic medication.Aspirin was prescribed for secondary prevention.Her clinical manifestations were improved during the three years of follow-up.Revascularization surgery was postponed.CONCLUSION Up to our knowledge,this is the first report for MMD in a child in our country.The clinical improvement and the stabilization of the child’s condition over the 3 years of follow-up could be attributed to the rapid and extensive recruitment of collaterals and absence of risk factors or comorbidities.Revascularization surgery is highly recommended.展开更多
Fluid-attenuated inversion recovery(FLAIR) vascular hyperintensity(FVH) is used to assess leptomeningeal collateral circulation, but clinical outcomes of patients with FVH can be very different. The aim of the present...Fluid-attenuated inversion recovery(FLAIR) vascular hyperintensity(FVH) is used to assess leptomeningeal collateral circulation, but clinical outcomes of patients with FVH can be very different. The aim of the present study was to assess a FVH score and explore its relationship with clinical outcomes. Patients with acute ischemic stroke due to middle cerebral artery M1 occlusion underwent magnetic resonance imaging and were followed up at 10 days(National Institutes of Health Stroke Scale) and 90 days(modified Rankin Scale) to determine short-term clinical outcomes. Effective collateral circulation indirectly improved recovery of neurological function and short-term clinical outcome by extending the size of the pial penumbra and reducing infarct lesions. FVH score showed no correlation with 90-day functional clinical outcome and was not sufficient as an independent predictor of short-term clinical outcome.展开更多
基金supported by the National Natural Science Foundation of China,No.81303021
文摘Acupuncture at Shuigou(GV26) shows good clinical efficacy for treating stroke, but its mechanism remains poorly understood. In this study, a cerebral infarction model of ischemia/reperfusion injury received electroacupuncture at GV26(15 Hz and 1 m A, continuous wave [biphasic pulses], for 5 minutes). Electroacupuncture effectively promoted regional cerebral blood flow on the infarct and non-infarct sides, increased infarct lesions, lectin, and number of blood vessels, upregulated von Willebrand factor and cell proliferation marker Ki67 expression, and diminished neurological severity score. These findings confirm that electroacupuncture at GV26 promotes establishment of collateral circulation and angiogenesis, and improves neurological function.
基金Supported by The Science Technology Program of Beijing Education Committee, No. KM200810025002
文摘AIM:To study characteristics of collateral circulation of gastric varices (GVs) with 64-row multidetector computer tomography portal venography (MDCTPV).METHODS:64-row MDCTPV with a slice thickness of 0.625 mm and a scanning field from 2 cm above the tracheal bifurcation to the lower edge of the kidney was performed in 86 patients with GVS diagnosed by endoscopy. The computed tomography protocol included unenhanced,arterial and portal vein phases. The MDCTPV was performed on an AW4.3 workstation. GVs were classified into three types according to Sarin's Classification. The afferent and efferent veins of each type of GV were observed.RESULTS:The afferent venous drainage originated mostly from the left gastric vein alone (LGV) (28/86,32.59%),or the LGV more than the posterior gastric vein/short gastric vein [LGV > posterior gastric vein/short gastric vein (PGV/SGV)] (22/86,25.58%),as seen by MDCTPV. The most common efferent venousdrainage was via the azygos vein to the superior vena cava (53/86,61.63%),or via the gastric/splenorenal shunt (37/86,43.02%) or inferior phrenic vein (8/86,9.30%) to the inferior vena cava. In patients with gastroesophageal varices type 1,the afferent venous drainage of GV mainly originated from the LGV or LGV > PGV/SGV (43/48,89.58%),and the efferent venous drainage was mainly via the azygos vein to the super vena cava (43/48,89.58%),as well as via the gastric/splenorenal shunt (8/48,16.67%) or inferior phrenic vein (3/48,6.25%) to the inferior vena cava. In patients with gastroesophageal varices type 2,the afferent venous drainage of the GV mostly came from the PGV/SGV more than the LGV (PGV/SGV > LGV) (8/16,50%),and the efferent venous drainage was via the azygos vein (10/16,62.50%) and gastric/splenorenal shunt (9/16,56.25%). In patients with isolated gastric varices,the main afferent venous drainage was via the PGV/SGV alone (16/22,72.73%),and the efferent venous drainage was mainly via the gastric/splenorenal shunt (20/22,90.91%),as well as the inferior phrenic vein (3/23) to the inferior vena cava. CONCLUSION:MDCTPV can clearly display the afferent and efferent veins of all types of GV,and it could provide useful reference information for the clinical management of GV bleeding.
基金Scientific Research Project of Guangdong Provincial Bureau of Traditional Chinese Medicine,NO.20212061Guangdong Province Basic and Applied Research Fund Project,NO.2020A1515110520.
文摘BACKGROUND Congenital coronary artery fistula can lead to symptoms of chest tightness,chest pain,or exertional dyspnea,which is a congenital vascular malformation that should not be ignored.Patients who have such malformations are frequently observed with different concurrent abnormal anatomic structures.Collateral circulation may have a positive effect on improving the patients'symptoms.CASE SUMMARY A 53-year-old female experienced episodic chest discomfort for the past month with symptoms manifesting when she was agitated or overexerted.After a positive treadmill test,the patient underwent coronary angiography.“Ghostlike”intermittent appearance of coronary ventricular fistula and collateral branching were observed.The patient was diagnosed with a right coronary ventricular fistula and collateral circulation.CONCLUSION This case shows the likelihood of collateral circulation in patients with coronary artery fistula.This may provide medical staff with novel solutions to treat insufficiency of myocardial blood supply induced by cardiovascular malformations.
基金supported by the Science Foundation of AMHT(2018-LCYL-009)the Medical and Health Research Project of China Aerospace Science and Industry Corporation Ltd.(KYLX-56).
文摘Background:Coronary collateral circulation(CCC)plays a vital role in the myocardial blood supply,especially for ischemic myocardium.Evidence suggests that the visfatin and 25-hydroxyvitamin D_(3)[25(OH)D_(3)]levels are related to the degree and incidence of vascular stenosis associated with coronary artery disease;however,few studies have evaluated the effect of visfatin and 25(OH)D_(3) on CCC development in patients with chronic total occlusion(CTO).This study aimed to evaluate the relationship between the serum visfatin and 25(OH)D_(3) levels and CCC in patients with CTO.Methods:A total of 189 patients with CTO confirmed by coronary angiography were included.CCC was graded from 0 to 3 according to the Rentrop-Cohen classification.Patients with grade 0 or grade 1 collateral development were in-cluded in the poor CCC group(n=82),whereas patients with grade 2 or grade 3 collateral development were included in the good CCC group(n=107).The serum visfatin and 25(OH)D_(3) levels were measured by ELISA.Results:The visfatin level was significantly higher in the poor CCC group than in the good CCC group,and the 25(OH)D_(3) level was significantly lower in the poor CCC group than in the good CCC group(P=0.000).Correlation analysis showed that the Rentrop grade was negatively correlated with the visfatin level(r=−0.692,P=0.000)but positively correlated with the 25(OH)D_(3) level(r=0.635,P=0.000).Logistic regression analysis showed that the vis-fatin and 25(OH)D_(3) levels were independent risk factors for CCC(odds ratio 1.597,95%confidence interval 1.300-1.961,P=0.000 and odds ratio 0.566,95%confidence interval 0.444-0.722,P=0.000,respectively).The visfatin and 25(OH)D_(3) levels can effectively predict the CCC status.Conclusion:Serum visfatin and 25(OH)D_(3) levels are related to CCC development and are independent predictors of poor CCC.
文摘BACKGROUND Moyamoya disease(MMD)is a rare cause of acute stroke and transient ischemic attacks in children.We described clinical,diagnostic features and follow-ups of a young child with acute stroke.CASE SUMMARY We report a 4-year-old girl with left hemiparesis after an acute ischemic stroke.Her history was also significant for repeated left or right focal motor seizures,generalized tonic-clonic convulsions and transient ischemic attacks.Her magnetic resonance imaging and computed tomography(CT)of the brain and magnetic resonance angiography,CT angiography and venography on the cerebral vessels revealed evidence of bilateral fronto-parietal ischemic infarctions,occlusion of the right and left internal carotid arteries started at its bifurcation and non-visualization of right and left anterior and middle cerebral arteries.There was evidence of progression in angiography manifested as development of collaterals from the basal perforating vessels,increase in the extent of large intracranial arterial stenosis/occlusion and extensive collateral circulation with predominance from the posterior circulation.Physical and neurological evaluation and comprehensive laboratory investigations excluded an obvious comorbid disease or risk factor for the child’s condition.The diagnosis of MMD was highly suggested as a cause of the child’s steno-occlusive condition.She was treated symptomatically with levetiracetam,an antiepileptic medication.Aspirin was prescribed for secondary prevention.Her clinical manifestations were improved during the three years of follow-up.Revascularization surgery was postponed.CONCLUSION Up to our knowledge,this is the first report for MMD in a child in our country.The clinical improvement and the stabilization of the child’s condition over the 3 years of follow-up could be attributed to the rapid and extensive recruitment of collaterals and absence of risk factors or comorbidities.Revascularization surgery is highly recommended.
基金supported by the National Natural Science Foundation of China,No.81371521
文摘Fluid-attenuated inversion recovery(FLAIR) vascular hyperintensity(FVH) is used to assess leptomeningeal collateral circulation, but clinical outcomes of patients with FVH can be very different. The aim of the present study was to assess a FVH score and explore its relationship with clinical outcomes. Patients with acute ischemic stroke due to middle cerebral artery M1 occlusion underwent magnetic resonance imaging and were followed up at 10 days(National Institutes of Health Stroke Scale) and 90 days(modified Rankin Scale) to determine short-term clinical outcomes. Effective collateral circulation indirectly improved recovery of neurological function and short-term clinical outcome by extending the size of the pial penumbra and reducing infarct lesions. FVH score showed no correlation with 90-day functional clinical outcome and was not sufficient as an independent predictor of short-term clinical outcome.
