Effect of perioperative blood pressure variability on cerebral hyperperfusion syndrome after carotid artery stenting: A retrospective study.

OBJECTIVE: To investigate the effect of perioperative blood pressure variability on cerebral hyperperfusion syndrome after carotid artery stenting. METHODS: A retrospective analysis was conducted of data collected from 418 patients who underwent carotid artery stenting in Guangxi Zhuang Autonomous Region People's Hospital in China. The blood pressure data were collected during operation (after balloon dilation, before stent release, after stent release) and within 3 days after the operation. The blood pressure variability was evaluated by measuring the mean, maximum, minimum, max-min, standard deviation (SD) of systolic blood pressure (SBP) and diastolic blood pressure (DBP). The correlation between blood pressure variability and cerebral hyperperfusion syndrome was analysed. RESULTS: Blood pressure data from 418 patients were analysed. Twenty patients (4.8%) developed cerebral hyperperfusion syndrome. The parameters of blood pressure variability were divided into four groups according to quartile. After adjusting for age, symptomatic carotid stenosis, unilateral carotid stenosis, bilateral carotid stenosis, collateral circulation, diabetes mellitus and chronic kidney disease, multivariate analysis showed that SBPMax, SBPMin, SBPMax-Min, SBPCV, DBPSD, DBPMax, DBPMin, DBPMax-Min and DBPCV were associated with the occurrence of cerebral hyperperfusion syndrome (P < 0.05), respectively. CONCLUSION: This study suggests that blood pressure variability during the perioperative period may increase the risk of cerebral hyperperfusion syndrome.

Genetic Polymorphism of rs13306146 Affects α2AAR Expression and Associated With Postpartum Depressive Symptoms in Chinese Women Who Received Cesarean Section.

Postpartum depressive symptom (PDS) is a common psychological and mental disorder after giving birth. Our previous studies showing the application of dexmedetomidine, an α2-AR agonist, can significantly improve maternal sleep, as well as relieve and reduce the incidence of PDS. This study investigated the association between α2 A AR gene polymorphisms and PDS. A total of 568 cesarean section patients were enrolled; the incidence of PDS is 18.13% (103 with PDS, 465 with non-PDS). The Edinburgh Postpartum Depression Scale score ≥10 was used to diagnose PDS at 42 days after delivery. The single-nucleotide polymorphisms of α2AR were sequenced by pyrosequencing. The effect of rs13306146 A > G polymorphism on α2AR transcription and the regulation of miR-646 on α2AR expression were assessed by dual luciferase reporter assays or gene transfection. Increased stress during pregnancy, poor relationship between mother-in-law and daughter-in-law, spousal relationship, domestic violence, antenatal depression, self-harm ideation, and stressful life events were all associated with increased PDS incidence (p < 0.05). The logistic regression analysis found that the α2AAR rs13306146 polymorphism was associated with PDS after adjusting confounding variables. The transcriptional function of the α2AAR rs13306146 A allele was decreased compared with the G allele, and the α2AAR expression level was correspondingly decreased (p < 0.05), as the strongest binding ability of miR-646 to the α2AAR rs13306146 AA genotype. The effect of α2AAR rs13306146 A > G polymorphism may change the binding ability of miR-646 at the 3'UTR of the α2AAR gene, affecting the expression of α2AAR. This study supports the involvement of the norepinephrine system in the pathogenesis of PDS. Genotypes of α2AAR may be novel and useful biomarkers for PDS.

Down-regulated Na(+)/K(+)-ATPase activity in ischemic penumbra after focal cerebral ischemia/reperfusion in rats.

This study was aimed to examine whether the Na(+)/K(+) adenosine triphosphatase (Na(+)/K(+)-ATPase) activity in ischemic penumbra is associated with the pathogenesis of ischemia/reperfusion-induced brain injury. An experimental model of cerebral ischemia/reperfusion was made by transient middle cerebral artery occlusion (tMCAO) in rats and the changes of Na(+)/K(+)-ATPase activity in the ischemic penumbra was examined by Enzyme Assay Kit. Extensive infarction was observed in the frontal and parietal cortical and subcortical areas at 6 h, 24 h, 48 h, 3 d and 7 d after tMCAO. Enzyme Assay analyses revealed the activity of Na(+)/K(+)-ATPase was decreased in the ischemic penumbra of model rats after focal cerebral ischemia/reperfusion compared with sham-operated rats, and reduced to its minimum at 48 h, while the infarct volume was enlarged gradually. In addition, accompanied by increased brain water content, apoptosis-related bcl-2 and Bax proteins, apoptotic index and neurologic deficits Longa scores, but fluctuated the ratio of bcl-2/Bax. Correlation analysis showed that the infarct volume, apoptotic index, neurologic deficits Longa scores and brain water content were negatively related with Na(+)/K(+)-ATPase activity, while the ratio of bcl-2/Bax was positively related with Na(+)/K(+)-ATPase activity. Our results suggest that down-regulated Na(+)/K(+)-ATPase activity in ischemic penumbra might be involved in the pathogenesis of cerebral ischemia/reperfusion injury presumably through the imbalance ratio of bcl-2/Bax and neuronal apoptosis, and identify novel target for neuroprotective therapeutic intervention in cerebral ischemic disease.

Evaluation of hepatocellular carcinoma using contrast-enhanced ultrasonography: correlation with microvessel morphology.

BACKGROUND: Contrast-enhanced ultrasonography (CEUS) is an important technique for depiction and assessment of tumor vascularity. This study aimed to explore the relationship between the morphological characteristics of tumor microvessels and enhancement patterns on CEUS in hepatocellular carcinoma (HCC). METHODS: Eighty patients with HCC underwent CEUS using SonoVue before hepatectomy. Contrast-enhanced ultrasonographic enhancement patterns and quantitative parameters were recorded. The tumor tissue sections were immunostained with human CD34 monoclonal antibody. The patients were classified into a point-line type group (n = 36) and a loop-strip type group (n = 44) according to microvessel morphology. The microvascular density (MVD) in the different types of microvessels was calculated. The relationship between enhancement patterns of HCC lesions and morphological characteristics of tumor microvessels was analyzed. RESULTS: The mean MVD in HCC was 22.4+/-3.5 per 0.2 mm2 in the point-line group, and 19.6+/-6.7 per 0.2 mm2 in the loop-strip group, and there was no significant difference between them (t = 0.948, P = 0.354). In the portal vein phase, hypoenhancement was significantly more frequent in HCC (X2 = 4.789, P = 0.029) in the loop-strip group (40/44, 90.9%) than in the point-line group (26/36, 72.2%). The time to hypo-enhancement in the loop-strip group (mean 64.84+/-26.16 seconds) was shorter than that in the point-line group (mean 78.39+/-28.72 seconds) (t = 2.247, P = 0.022). The time to hypo-enhancement was correlated with MVD in the loop-strip group (r = -0.648, P = 0.001). CONCLUSIONS: The enhancement patterns on CEUS are related to tumor microvascular morphology, and the type of microvascular morphology influences CEUS characterization. CEUS, an important noninvasive imaging technique, is used to evaluate microvascular morphology and angiogenesis, providing valuable information for antiangiogenic therapy in HCC.

[Expression and significance of NGX6 gene in human hepatocellular carcinoma].

OBJECTIVE: To examine the expression of NGX6 gene and to investigate its association with the clinico-pathological characteristics in hepatocellular carcinoma(HCC). METHODS: Samples from 45 patients were divided into the hepatocellular carcinoma tissue group and the matched paracancerous tissue group. Reverse transcription polymerase chain reaction(RT-PCR) was used to detect the expression of NGX6 gene in the hepatocellular carcinoma and the surrounding normal tissue specimens. RESULTS: The positive rates of NGX6 in the hepatocellular carcinoma and the matched paracancerous tissues were 35.5%(16/45)and 77.8%(35/45), and the ratios of NGX6/G3PDH mRNA were 0.245+/-0.060 and 0.352+/-0.113.There was significant difference in the 2 groups (P<0.05). The expression of NGX6 gene was related to TNM staging (chi2=6.106,P=0.042)and lymph node metastasis(chi2=5.237,P=0.022)in hepatocellular carcinoma. CONCLUSION: There is positive expression of NGX6 in the hepatocellular carcinoma and the matched paracancerous tissues. The low-expression or non-expression of NGX6 gene plays an important role in the gene transcription level in hepatocellular carcinoma.The expression of NGX6 gene is related with TNM staging and lymph node metastasis in hepatocellular carcinoma. Expression of NGX6 might be used as an early indicator of the occurrence and development of hepatocellular carcinoma.

[Contrast enhanced power Doppler in evaluating the angiogenesis in hepatocellular carcinoma].

OBJECTIVE: To evaluate the role of contrast enhanced power Doppler in evaluating tumor angiogenetic activity. METHODS: Thirty-two patients with hepatocellular carcinoma were analysed. Flow signals of hepatocellular carcinoma were observed by power Doppler imaging after the injection of contrast agent, and then the relative perfusion rate and blood flow were assessed. The microvessel density (MVD) and vascular endothelial growth factor(VEGF) were assessed by immunohistochemical method. The relationship between the relative perfusion rate,blood flow, MVD,VEGF was studied. RESULTS: The relative perfusion rate in the tissues with positive expression of VEGF was significantly higher than that in the tissues with negative expression of VEGF in hepatocellular carcinoma. There was correlation between the relative perfusion rate, blood flow grade and MVD(P<0.05). The expression of VEGF was positively related to the relative perfusion rate and blood flow grade(P<0.05). CONCLUSION: Contrast enhanced power Doppler is useful in evaluating the tumor angiogenetic activity.