BACKGROUND Cerebral apoplexy patients are prone to cognitive impairment,and it is very important to choose appropriate treatment methods to improve their cognitive impairment after stroke.AIM To evaluate the effects o...BACKGROUND Cerebral apoplexy patients are prone to cognitive impairment,and it is very important to choose appropriate treatment methods to improve their cognitive impairment after stroke.AIM To evaluate the effects of enhanced external counterpulsation(EECP)in con-junction with atorvastatin on cognitive function,neurotransmitter levels,and the repair of brain tissue damage in patients with cognitive impairment due to stroke.METHODS In this retrospective study,data from 60 patients with poststroke cognitive impairment due to stroke who were treated in our hospital from February 2021 to July 2022 were analyzed and divided into a treatment group(n=30)and a control group(n=30)according to the different nursing methods applied.Patients in the treatment group received EECP in addition to atorvastatin,while those in the control group received atorvastatin alone.Mini-Mental State Examination(MMSE),Montreal Cognitive Assessment(MoCA)and activities of daily living(ADL)scale scores were compared between the two groups.Additionally,the two groups were compared in terms of serum acetylcholine(ACh),acetylcholin-esterase(AChE),nitric oxide(NO),endothelin-1(ET-1),β2-microglobulin(β2-MG),glial fibrillary acidic protein(GFAP),and visinin-like protein 1(VILIP-1)in the serum.Blood flow measurements from the anterior cerebral artery(ACA),middle cerebral artery(MCA)and posterior cerebral artery(PCA)were compared between the two groups before and after treatment,and the pulsatility index(PI)and resistance index(RI)of each artery were determined.RESULTS MMSE,MoCA,and ADL scores all improved in both groups following treatment,with the study group showing more improvement than the control group(P<0.05).After treatment,there were statistically significant increases in both ACh and NO levels,whereas decreases occurred in AChE,ET-1,β2-MG,VILIP-1,and GFAP,levels and the PI and RI of the left-ACA,right-ACA,left-MCA,right-MCA,left-PCA,and right-PCA.The study group showed greater gains in all metrics than the control group(P<0.05).CONCLUSION EECP combined with atorvastatin is effective in the treatment of cognitive impairment after stroke and can effectively improve the cognitive function,neurotransmitter levels,and brain tissue damage status of patients.展开更多
Cardiac recovery from cardiogenic shock(CS) and end-stage chronic heart failure(HF) remains anoften insurmountable therapeutic challenge. The counterpulsation technique exerts numerous beneficial effects on systemic h...Cardiac recovery from cardiogenic shock(CS) and end-stage chronic heart failure(HF) remains anoften insurmountable therapeutic challenge. The counterpulsation technique exerts numerous beneficial effects on systemic hemodynamics and left ventricular mechanoenergetics, rendering it attractive for promoting myocardial recovery in both acute and chronic HF. Although a recent clinical trial has questioned the clinical effectiveness of short-term hemodynamic support with intra-aortic balloon pump(IABP, the main representative of the counterpulsation technique) in CS complicating myocardial infarction, the issue remains open to further investigation. Moreover, preliminary data suggest that long-term IABP support in patients with end-stage HF is safe and may mediate recovery of left- or/and right-sided cardiac function, facilitating long-term weaning from mechanical support or enabling the application of other permanent, life-saving solutions. The potential of long-term counterpulsation could possibly be enhanced by implementation of novel, fully implantable counterpulsation devices.展开更多
Enhanced external counterpulsation(EECP)is able to treat myocardial ischemia,which is usually caused by coronary artery stenosis.However,the underlying mechanisms regarding why this technique is effective in treating ...Enhanced external counterpulsation(EECP)is able to treat myocardial ischemia,which is usually caused by coronary artery stenosis.However,the underlying mechanisms regarding why this technique is effective in treating myocardial ischemia remains unclear and there is no patient-specific counterpulsation mode for different rates of coronary artery stenosis in clinic.This study sought to investigate the hemodynamic effect of varied coronary artery stenosis rates when using EECP and the necessity of adopting targeted counterpulsation mode to consider different rates of coronary artery stenosis.Three 3-dimensional(3D)coronary models with different stenosis rates,including 55%(Model 1),65%(Model 2),and 75%(Model 3),were generated,then coupled with a 0-dimensional(0D)lumped parametric model of the blood circulatory system.EECP was applied to the 0D/3D coupled models to study the hemodynamic response of the coronary artery.Under the same counterpulsation mode,the ratio of diastolic blood pressure to systolic blood pressure of 3 models during counterpulsation was 1.4,and the cardiac output and coronary artery flow rate increased significantly.The low wall shear stress(WSS)and high oscillatory shear index(OSI)areas were mainly located at the posterior end of the stenosis and coronary artery bifurcation.Moreover,with an increase in the rate of coronary artery stenosis,the increased percentage of flow rate through the coronary artery stenosis and area-averaged WSS decreased.The geometric multiscale model in this study can be used to effectively simulate the hemodynamic characteristics of cardiovascular system following the application of EECP.Local precise hemodynamic effect of the coronary artery stenosis can be observed.It was found from the hemodynamic factors that the coronary artery with lower stenosis rate more likely led to better vascular endothelial remodeling.Thus,it is necessary to adopt patient-specific counterpulsation mode accounting for different condition of coronary artery stenosis.展开更多
Objective To examine if the skin microvascular bed is altered and can be modified by enhanced external counterpulsation(EECP)in patients with chronic refractory angina.Methods Twenty patients diagnosed with refractory...Objective To examine if the skin microvascular bed is altered and can be modified by enhanced external counterpulsation(EECP)in patients with chronic refractory angina.Methods Twenty patients diagnosed with refractory angina were divided into EECP(n=10)or no EECP(n=10)groups.The data were compared to matched healthy subjects(n=20).The cutaneous forearm microvascular blood flow was measured by Laser-Doppler flowmetry.The vascular responsiveness to iontophoretic administration of acetylcholine(ACh),sodium nitroprusside(SNP)and local skin warming were studied.Measurements of Canadian Cardiovascular Society(CCS)-class,blood pressure and plasma samples were registered.Results EECP patients showed reduced CCS-class compared to no EECP(P<0.05).Both EECP and no EECP(P<0.05)groups had decreased systolic blood pressure(SBP)as compared to SBP at baseline(P<0.05).There was no difference in resting blood flow between the two refractory groups at baseline as well as after EECP and seven weeks of follow-up.Responses to heating,the responses to ACh and SNP in the cutaneous microcirculation were lower in both groups of refractory angina patients as compared to healthy subjects(P<0.05).EECP patients corresponded positively to the treatment shown by reduced plasma level of soluble interleukin-2 receptor and CCS-class.Conclusions Refractory angina patients have reduced responsiveness in their cutaneous microcirculation to ACh,SNP and heat compared to healthy subjects.Although EECP reduced the CCS-class,this effect was not associated with improvements in responsiveness of the cutaneous microcirculation.展开更多
Objective:To analyze the clinical efficacy and safety of external counterpulsation combined with lipoic acid in the treatment of patients with type 2 diabetic foot of grade 0-2.Methods:62 patients with diabetic foot f...Objective:To analyze the clinical efficacy and safety of external counterpulsation combined with lipoic acid in the treatment of patients with type 2 diabetic foot of grade 0-2.Methods:62 patients with diabetic foot from January 2019 to October 2020 were selected and divided into control group and external counterpulsation group according to different treatment schemes,31 cases in each group.The control group was given intravenous lipoic acid,and the external counterpulsation group was given external counterpulsation combined with intravenous lipoic acid.The clinical efficacy and adverse reactions of the two groups were compared,and the blood flow parameters,ankle brachial index and common peroneal nerve conduction velocity of the two groups before and after treatment were compared.Results:The total effective rate of the treatment group(93.54%)was significantly higher than that of the control group(48.38%)(P<0.05).After treatment,the vessel diameter of dorsalis pedis artery(2.552±0.024mm)and ankle brachial index(0.923±0.036)in ECP group were significantly higher than those in control group(1.864±0.020)and ankle brachial index(0.843±0.030)(P<0.05).After the control group and the external counterpulsation group were treated,the levels of serum of VEGF,bFGF、IGF-1(85.479±4.239,148.27±14.25,62.33±3.75;94.163±8.917,200.88±14.58,81.35±1.08)was significantly higher than that before treatment(57.264±0.801,106.44±3.83,30.90±0.42;57.133±0.850,106.78±3.69,31.01±0.56),the levels of MMP-2(2.035±0.08,1.417±0.21)after treatment in the control group and the external counter stroke group after treatment(2.035±0.08,1.417±0.21)was significantly lower than that after treatment.The levels of VEGF,bFGF and IGF-1 in ECP group were significantly higher than those in control group,and MMP-2 was significantly lower than that in control group(P<0.05).Conclusion:The clinical effect of external counterpulsation combined with lipoic acid in the treatment of type 2 diabetic foot with grade 0-2 is significant,which can effectively improve the blood flow parameters of dorsal foot artery,ankle brachial index and common peroneal nerve conduction velocity,with less adverse reactions.展开更多
目的运用Meta分析评价增强型体外反搏治疗慢性心力衰竭患者的临床疗效。方法检索中文(中国知网、万方、维普、SinoMed)和英文(Cochrane Library、Embase、Web of Science、PubMed)数据库,收集增强型体外反搏治疗慢性心力衰竭的随机对照...目的运用Meta分析评价增强型体外反搏治疗慢性心力衰竭患者的临床疗效。方法检索中文(中国知网、万方、维普、SinoMed)和英文(Cochrane Library、Embase、Web of Science、PubMed)数据库,收集增强型体外反搏治疗慢性心力衰竭的随机对照试验(RCTs),筛选文献、提取数据后,采用Revman 5.4软件进行Meta分析,对数据采用亚组分析和敏感性分析,发表偏倚采用漏斗图评价。结果共纳入14篇RCTs,共1300例患者;依据不同疗程增强型体外反搏治疗慢性心力衰竭的临床疗效显示,与对照组相比,观察组患者治疗后的6分钟步行距离(6MWD)更远[MD(95%CI)=56.24(44.48~68.00),P<0.01]、N末端B型利钠肽原(NT-proBNP)水平更低[MD(95%CI)=-371.29(-642.63~-99.95),P<0.01]、左心室射血分数(LVEF)水平更高[MD(95%CI)=3.75(2.50~5.01),P<0.01],两组患者不良反应差异无统计学意义[OR(95%CI)=1.62(0.69~3.76),P>0.05]。结论增强型体外反搏治疗慢性心力衰竭患者的临床疗效较好,且安全可靠。展开更多
Objective To explore the effects of enhanced external counterpulsation(EECP)on the serum level of C-reactive protein and endothelin-1 in patients with cerebral ischemic stroke,to provide clinical evidence for the trea...Objective To explore the effects of enhanced external counterpulsation(EECP)on the serum level of C-reactive protein and endothelin-1 in patients with cerebral ischemic stroke,to provide clinical evidence for the treatment and secondary prevention of patients with serebral ischemic stroke.Methods Total 187 patients with ischemic stroke and enrolled measure the serum level展开更多
基金This study was approved by the Ethics Committee of Shengjing Hospital of China Medical University.
文摘BACKGROUND Cerebral apoplexy patients are prone to cognitive impairment,and it is very important to choose appropriate treatment methods to improve their cognitive impairment after stroke.AIM To evaluate the effects of enhanced external counterpulsation(EECP)in con-junction with atorvastatin on cognitive function,neurotransmitter levels,and the repair of brain tissue damage in patients with cognitive impairment due to stroke.METHODS In this retrospective study,data from 60 patients with poststroke cognitive impairment due to stroke who were treated in our hospital from February 2021 to July 2022 were analyzed and divided into a treatment group(n=30)and a control group(n=30)according to the different nursing methods applied.Patients in the treatment group received EECP in addition to atorvastatin,while those in the control group received atorvastatin alone.Mini-Mental State Examination(MMSE),Montreal Cognitive Assessment(MoCA)and activities of daily living(ADL)scale scores were compared between the two groups.Additionally,the two groups were compared in terms of serum acetylcholine(ACh),acetylcholin-esterase(AChE),nitric oxide(NO),endothelin-1(ET-1),β2-microglobulin(β2-MG),glial fibrillary acidic protein(GFAP),and visinin-like protein 1(VILIP-1)in the serum.Blood flow measurements from the anterior cerebral artery(ACA),middle cerebral artery(MCA)and posterior cerebral artery(PCA)were compared between the two groups before and after treatment,and the pulsatility index(PI)and resistance index(RI)of each artery were determined.RESULTS MMSE,MoCA,and ADL scores all improved in both groups following treatment,with the study group showing more improvement than the control group(P<0.05).After treatment,there were statistically significant increases in both ACh and NO levels,whereas decreases occurred in AChE,ET-1,β2-MG,VILIP-1,and GFAP,levels and the PI and RI of the left-ACA,right-ACA,left-MCA,right-MCA,left-PCA,and right-PCA.The study group showed greater gains in all metrics than the control group(P<0.05).CONCLUSION EECP combined with atorvastatin is effective in the treatment of cognitive impairment after stroke and can effectively improve the cognitive function,neurotransmitter levels,and brain tissue damage status of patients.
文摘Cardiac recovery from cardiogenic shock(CS) and end-stage chronic heart failure(HF) remains anoften insurmountable therapeutic challenge. The counterpulsation technique exerts numerous beneficial effects on systemic hemodynamics and left ventricular mechanoenergetics, rendering it attractive for promoting myocardial recovery in both acute and chronic HF. Although a recent clinical trial has questioned the clinical effectiveness of short-term hemodynamic support with intra-aortic balloon pump(IABP, the main representative of the counterpulsation technique) in CS complicating myocardial infarction, the issue remains open to further investigation. Moreover, preliminary data suggest that long-term IABP support in patients with end-stage HF is safe and may mediate recovery of left- or/and right-sided cardiac function, facilitating long-term weaning from mechanical support or enabling the application of other permanent, life-saving solutions. The potential of long-term counterpulsation could possibly be enhanced by implementation of novel, fully implantable counterpulsation devices.
基金This research was supported by National Natural Science Foundation of China(11772016,11472022,11702008)Key Project of Science and Technology of Beijing Municipal Education Commission and Support Plan for High-level Faculties in Beijing Municipal Universities(CIT&TCD201804011).
文摘Enhanced external counterpulsation(EECP)is able to treat myocardial ischemia,which is usually caused by coronary artery stenosis.However,the underlying mechanisms regarding why this technique is effective in treating myocardial ischemia remains unclear and there is no patient-specific counterpulsation mode for different rates of coronary artery stenosis in clinic.This study sought to investigate the hemodynamic effect of varied coronary artery stenosis rates when using EECP and the necessity of adopting targeted counterpulsation mode to consider different rates of coronary artery stenosis.Three 3-dimensional(3D)coronary models with different stenosis rates,including 55%(Model 1),65%(Model 2),and 75%(Model 3),were generated,then coupled with a 0-dimensional(0D)lumped parametric model of the blood circulatory system.EECP was applied to the 0D/3D coupled models to study the hemodynamic response of the coronary artery.Under the same counterpulsation mode,the ratio of diastolic blood pressure to systolic blood pressure of 3 models during counterpulsation was 1.4,and the cardiac output and coronary artery flow rate increased significantly.The low wall shear stress(WSS)and high oscillatory shear index(OSI)areas were mainly located at the posterior end of the stenosis and coronary artery bifurcation.Moreover,with an increase in the rate of coronary artery stenosis,the increased percentage of flow rate through the coronary artery stenosis and area-averaged WSS decreased.The geometric multiscale model in this study can be used to effectively simulate the hemodynamic characteristics of cardiovascular system following the application of EECP.Local precise hemodynamic effect of the coronary artery stenosis can be observed.It was found from the hemodynamic factors that the coronary artery with lower stenosis rate more likely led to better vascular endothelial remodeling.Thus,it is necessary to adopt patient-specific counterpulsation mode accounting for different condition of coronary artery stenosis.
文摘Objective To examine if the skin microvascular bed is altered and can be modified by enhanced external counterpulsation(EECP)in patients with chronic refractory angina.Methods Twenty patients diagnosed with refractory angina were divided into EECP(n=10)or no EECP(n=10)groups.The data were compared to matched healthy subjects(n=20).The cutaneous forearm microvascular blood flow was measured by Laser-Doppler flowmetry.The vascular responsiveness to iontophoretic administration of acetylcholine(ACh),sodium nitroprusside(SNP)and local skin warming were studied.Measurements of Canadian Cardiovascular Society(CCS)-class,blood pressure and plasma samples were registered.Results EECP patients showed reduced CCS-class compared to no EECP(P<0.05).Both EECP and no EECP(P<0.05)groups had decreased systolic blood pressure(SBP)as compared to SBP at baseline(P<0.05).There was no difference in resting blood flow between the two refractory groups at baseline as well as after EECP and seven weeks of follow-up.Responses to heating,the responses to ACh and SNP in the cutaneous microcirculation were lower in both groups of refractory angina patients as compared to healthy subjects(P<0.05).EECP patients corresponded positively to the treatment shown by reduced plasma level of soluble interleukin-2 receptor and CCS-class.Conclusions Refractory angina patients have reduced responsiveness in their cutaneous microcirculation to ACh,SNP and heat compared to healthy subjects.Although EECP reduced the CCS-class,this effect was not associated with improvements in responsiveness of the cutaneous microcirculation.
基金National Key Research and Development Projects:Demonstration Study on Early Identification(No.2018YFC2002500)。
文摘Objective:To analyze the clinical efficacy and safety of external counterpulsation combined with lipoic acid in the treatment of patients with type 2 diabetic foot of grade 0-2.Methods:62 patients with diabetic foot from January 2019 to October 2020 were selected and divided into control group and external counterpulsation group according to different treatment schemes,31 cases in each group.The control group was given intravenous lipoic acid,and the external counterpulsation group was given external counterpulsation combined with intravenous lipoic acid.The clinical efficacy and adverse reactions of the two groups were compared,and the blood flow parameters,ankle brachial index and common peroneal nerve conduction velocity of the two groups before and after treatment were compared.Results:The total effective rate of the treatment group(93.54%)was significantly higher than that of the control group(48.38%)(P<0.05).After treatment,the vessel diameter of dorsalis pedis artery(2.552±0.024mm)and ankle brachial index(0.923±0.036)in ECP group were significantly higher than those in control group(1.864±0.020)and ankle brachial index(0.843±0.030)(P<0.05).After the control group and the external counterpulsation group were treated,the levels of serum of VEGF,bFGF、IGF-1(85.479±4.239,148.27±14.25,62.33±3.75;94.163±8.917,200.88±14.58,81.35±1.08)was significantly higher than that before treatment(57.264±0.801,106.44±3.83,30.90±0.42;57.133±0.850,106.78±3.69,31.01±0.56),the levels of MMP-2(2.035±0.08,1.417±0.21)after treatment in the control group and the external counter stroke group after treatment(2.035±0.08,1.417±0.21)was significantly lower than that after treatment.The levels of VEGF,bFGF and IGF-1 in ECP group were significantly higher than those in control group,and MMP-2 was significantly lower than that in control group(P<0.05).Conclusion:The clinical effect of external counterpulsation combined with lipoic acid in the treatment of type 2 diabetic foot with grade 0-2 is significant,which can effectively improve the blood flow parameters of dorsal foot artery,ankle brachial index and common peroneal nerve conduction velocity,with less adverse reactions.
文摘目的运用Meta分析评价增强型体外反搏治疗慢性心力衰竭患者的临床疗效。方法检索中文(中国知网、万方、维普、SinoMed)和英文(Cochrane Library、Embase、Web of Science、PubMed)数据库,收集增强型体外反搏治疗慢性心力衰竭的随机对照试验(RCTs),筛选文献、提取数据后,采用Revman 5.4软件进行Meta分析,对数据采用亚组分析和敏感性分析,发表偏倚采用漏斗图评价。结果共纳入14篇RCTs,共1300例患者;依据不同疗程增强型体外反搏治疗慢性心力衰竭的临床疗效显示,与对照组相比,观察组患者治疗后的6分钟步行距离(6MWD)更远[MD(95%CI)=56.24(44.48~68.00),P<0.01]、N末端B型利钠肽原(NT-proBNP)水平更低[MD(95%CI)=-371.29(-642.63~-99.95),P<0.01]、左心室射血分数(LVEF)水平更高[MD(95%CI)=3.75(2.50~5.01),P<0.01],两组患者不良反应差异无统计学意义[OR(95%CI)=1.62(0.69~3.76),P>0.05]。结论增强型体外反搏治疗慢性心力衰竭患者的临床疗效较好,且安全可靠。
文摘Objective To explore the effects of enhanced external counterpulsation(EECP)on the serum level of C-reactive protein and endothelin-1 in patients with cerebral ischemic stroke,to provide clinical evidence for the treatment and secondary prevention of patients with serebral ischemic stroke.Methods Total 187 patients with ischemic stroke and enrolled measure the serum level
