ABSTRACT
Objective:To investigate the hemodynamic characteristics and dynamic cerebral autoregulation(dCA) of patients with severe carotid stenosis before carotid endarterectomy(CEA), and to analyze their correlations with hyperperfusion after CEA.Methods:A total of 63 patients with unilateral severe carotid artery atherosclerotic stenosis who underwent CEA were consecutively recruited prospectively in Xuanwu Hospital, Capital Medical University from January 2021 to August 2021. According to postoperative hyperperfusion, patients were divided into hyperperfusion group (13 cases) and non-hyperperfusion group (50 cases). The general clinical data and hemodynamic parameters were compared between the two groups. The dCA was evaluated by the transfer function analysis that measured the fluctuation amplitude of mean cerebral blood flow velocity(CBFV) with blood pressure change, the time difference of phase with blood pressure change, and the correlation between mean CBFV and blood pressure change. The value of dCA for predicting postoperative hyperperfusion was analyzed through the ROC curve and the area under the curve(AUC).Results:①The proportion of hypertension in hyperperfusion group was higher than that in non-hyperperfusion group ( P<0.05). ②The peak systolic velocity (PSV) at the stenosis lesion of the internal carotid artery, the end-diastolic velocity (EDV) at the stenosis lesion of the internal carotid artery and the ratio of PSV at the stenosis lesion of the internal carotid artery to the distal internal carotid artery in the hyperperfusion group were higher than the non-hyperperfusion group.And the PSV of the ipsilateral middle cerebral artery in the hyperperfusion group was lower than the non-hyperperfusion group (all P<0.05). ③In the very low-frequency and low-frequency region, the phase in the hyperperfusion group was lower than that in the non-hyperperfusion group (all P<0.05), while there was no significant difference in the high-frequency regions( P>0.05). In the three regions of very low-frequency, low-frequency and high-frequency, there were no significant differences in the gain and coherence between the two groups(all P>0.05). ④The best cutoff value of phase in the very low-frequency was 33.28 for predicting hyperperfusion after CEA (AUC=0.766, 95% CI=0.629-0.904, P=0.03), with the specificity of 0.700, and sensitivity of 0.846. Conclusions:There are differences in hemodynamics and dCA between the hyperperfusion group and the non-hyperperfusion group after CEA. The impaired preoperative dynamic cerebral autoregulation is an independent predictor of postoperative hyperperfusion.
ABSTRACT
Objective To explore the clinical curative effect of theTaohong-Siwu decoction combined with manipulation in the treatment of the acute phase of lumbar disc herniation (LDH) and its effect on serum inflammatory factors.Methods According to the random number table method, 102 patients with the acute phase of LDH were divided into control group and research group from May 2014 to September 2016, 51 cases in each group. Patients in control group were treated by traction and non-steroidal anti-inflammatory drug for a month, while patients in research group were treated by manipulation combined withTaohong-Siwu decoction for a month. After treatment, the overall efficacy was observed. The Visual analogous scale (VAS) and JOA scores were recorded before and after the treatment. The IL-1β, IL-6 and TNF-α levels of inflammatory factors were detected by enzyme-linked immunosorbent assay.Results The total effective rate of patients in research roup was significantly higher than that of the control group [90.20％ (46/51)vs. 43.14％ (22/51),χ2=19.329, P=0.006]. After treatment, the VAS scores of patients in both groups were significantly decreased, and JOA score increased markedly, which the differences were statistically significant (Ps<0.05). After treatment, the VAS score of research group was significantly lower than the control group (4.26 ± 0.56vs. 5.13 ± 0.87;t=4.843, P=0.027), and JOA score was significantly higher than the control group (18.42 ± 3.92vs.17.33 ± 4.21;t=5.127, P=0.022). After treatment, the IL-1β, IL-6 and TNF-α levels of of patients in the research group were significantly lower than those of the control group (0.57 ± 0.11μg/Lvs. 0.90 ± 0.13μg/L, 112.26 ± 15.17μg/Lvs. 130.38 ± 18.29μg/L, 2.01 ± 0.34μg/Lvs. 2.37 ± 0.51μg/L;t=5.429, 6.317, 5.011,P<0.05). ConclusionsThe Taohong-Siwu decoction combined with manipulation on treatment of the acute phase of LDH was effective. The combined therapy can improve the VAS score and JOA score, and reduce the levels of inflammatory cytokines.
ABSTRACT
Objective To explore the effects of gross saponins of Tribulus terrestris L.on inflammatory reaction and permeability of blood-brain barrier in rats following cerebral ischemia-reperfusion injury and their potential mechanisms. Methods Sixty SD rats were divided into sham operation group,model control group,gross saponins of Tribulus terrestris L.at low-dose (10 mg?kg-1 )and high-dose groups(30 mg?kg-1 ).Cerebral ischemia -reperfusion model was established with suture emboli method in middle cerebral artery of rats.Neural injury scores,the contents of Evans blue ( EB) and myeloperoxidase( MPO) activities in rat brain were measured 24 hours after the cerebral reperfusion post 2 h ischemia.Content of tumor necrosis factor-α (TNF-α) in rat brain was detected by ELISA; expression levels of matrix metalloproteinase-9(MMP-9) in rat brain was determined by Western blot. Results Compared to the model control group,the neurological deficit scores were significantly decreased(P<0.05),MPO activities and EB contents decreased(P< 0.05 or P< 0.01) in the treatment groups.The expression levels of TNF-α were significantly lower in the treatment groups(0.760±0.110) mg?g-1 and (0.670±0.073) mg?g-1 compared to (0.920±0.128) mg?g-1 in the model control group ( P< 0.05 or P< 0.01). The MMP-9 expression levels were (1.770± 0.181)% and(1.480±0.146)%,significantly lower than(2.200±0.186)% in the model control group(P<0.01). Conclusion Gross saponins of Tribulus terrestris L. exert neuroprotective effects on cerebral ischemia-reperfusion injury in rats through inhibiting the inflammatory reaction and decreasing the permeability of blood-brain barrier,which may be associated with the decrease of the TNF-α content and downregulation of the MMP-9 expression.