Acute ischemic Stroke combined with Stanford type A aortic dissection: A case report and literature review.

BACKGROUND: Acute aortic dissection (AAD) is a high mortality disease that can lead to acute ischemic strokes (AIS). Some of the patients with AAD combined with AIS initially present with neurological symptoms, which can easily lead to missed or delayed AAD diagnosis. This is attributed to the lack of physician awareness or the urgency of patient thrombolysis. Intravenous administration of thrombolytic therapy (IVT) for AAD is associated with poor prognostic outcomes. We report a patient with AIS combined with AAD who developed a massive cerebral infarction after receiving IVT for a missed AAD diagnosis. CASE SUMMARY: A 49-year-old man was admitted to a local hospital with an acute onset of left-sided limb weakness accompanied by slurred speech. The patient had a history of hypertension that was not regularly treated with medication. Physical examination revealed incomplete mixed aphasia and left limb hemiparesis. Cranial computed tomography (CT) scan showed bilateral basal ganglia and lateral ventricular paraventricular infarct lesions. The patient was diagnosed with AIS and was administered with IVT. After IVT, patient's muscle strength and consciousness deteriorated. From the local hospital, he was referred to our hospital for further treatment. Emergency head and neck CT angiography (CTA) scans were performed. Results showed multiple cerebral infarctions, and aortic dissection in the ascending aorta, innominate artery, as well as in the right common carotid artery. Then, the CTA of thoracoabdominal aorta was performed, which revealed a Stanford type A aortic dissection and aortic dissection extending from the aortic root to the left external iliac artery. Laceration was located in the lesser curvature of the aortic arch. AAD complicated with AIS was considered, and the patient was immediately subjected to cardiovascular surgery for treatment. The next day, the patient underwent aortic arch and ascending aortic replacement and aortic valvuloplasty. CONCLUSION: Clinical manifestations for AAD combined with AIS are diverse. Some patients may not exhibit typical chest or back pains. Therefore, patients should be carefully evaluated to exclude AAD before administering IVT in order to avoid adverse consequences.

Spontaneous rupture of the branches of left subclavian artery: A case report and review of the literatures.

RATIONALE: Spontaneous rupture of the branches of left subclavian artery (LSA) without any obvious risk factors is rare. PATIENT CONCERNS: A 51-year-old female patient without history of trauma and hypertension complained about left chest pain. DIAGNOSES: A chest Computed tomography (CT) scan revealed a large pleural effusion (PE) in the left thorax cavity and hemothorax was confirmed by thoracentesis. INTERVENTIONS: The patient underwent surgery. OUTCOMES: spontaneous rupture of the branches of LSAwas confirmed. LESSONS: The patient recovered well and discharged after timely treatments. The unusual possibility should be paid attention in mind in acute chest pain cases.

Successful treatment of an acute infective endocarditis secondary to fish bone penetrating into left atrium caused by Granulicatella adiacens and Candida albicans: A case report.

RATIONAL: Infective endocarditis caused by a foreign body of the upper digestive tract is rare. We report a rare case of Granulicatella adiacens and Candida albicans coinfection acute endocarditis combined with systematic embolization caused by a fish bone from the esophagus penetrating into the left atrium. PATIENT CONCERN: A 42-year-old woman was admitted to our hospital because of fever, abdominal pain, headache, and right limb weakness. DIAGNOSES: Clinical examination indicated endocarditis and systemic embolisms secondary to a fish bone from the esophagus penetrating into the left atrium. The emergency surgery confirmed the diagnosis. Cultures of blood and vegetation show G adiacens and C albicans. INTERVENTIONS: Antimicrobial therapy lasted 6 weeks after surgery. OUTCOMES: The patient was discharged with excellent condition7 weeks after hospitalization and was well when followed 6 months later. LESSONS: The successful treatment of this patient combines quick diagnosis, timely surgery, and effective antimicrobial regimen. This rare possibility should be kept up in mind in acute infective endocarditis cases.

Construction of phospholamban antisense RNA recombinant adeno-associated virus vector and its effects in rat cardiomyocytes.

AIM: To construct a recombinant adeno-associated virus (rAAV) vector containing gene encoding phospholamban antisense RNA (asPLB), and analyse its effect on expression of PLB, expression and activity of sarco-endoplasmic reticulum Ca2+-ATPase (SERCA), and the change of intracellular free Ca2+ concentration ([Ca2+]i) in rat cardiomyocytes. METHODS: The target gene encoding PLB antisense RNA was inserted inversely into the adeno-associated virus plasmid pAAV-MCS digested by corresponding restricted endonuclease enzyme. The recombinant plasmid and pAAV-RC and pHelper were co-transfected into 293 cell. At the same time, a viral production positive control (rAAV-LacZ) and negative control were performed. The recombinant viruses were used to transfect the cultured rat cardiomyocytes. Site beta-Galactosidase staining were performed to observe the transfer efficiency. Reverse transcription-PCR and Western blot were used to determine the mRNA and protein expression of PLB and SERCA. The activity of SERCA and the [Ca2+]i were measured. RESULTS: The rAAV vectors were constructed successfully and were transfected into rat cardiomyocytes effectively. The PLB mRNA and protein expression were reduced in rat cardiomyocytes transfected by rAAV-asPLB compared with controls. The activity of SERCA was increased. In rest state, the level of [Ca2+]i in the rAAV-asPLB transfected group decreased. The level of [Ca2+]i increased when induced by isoproterenol. CONCLUSION: AAV-asPLB vector was constructed successfully, which disrupted the expression of PLB, enhanced the activity of SERCA, reduced the resting [Ca2+]i, and improved the cardiac function.

[Alterations of expression of G protein-inositol phosphates pathway-related genes in essential hypertension: experiment with spontaneously hypertensive rats].

OBJECTIVE: To investigate the changes of G protein-inositol phosphates pathway-related genes and evaluate the role of such changes in the pathogenesis of essential hypertension. METHODS: The pressures of the caudal arteries and body weights of 30 spontaneous hypertensive rats (SHRs), 7 two-week-old, 7 4-week-old, 6 six-week-old, 6 eight-week-old, 6 ten-week-old, and 6 twelve-week-old, and 38 normotensive Wistar-Kyoto (WKY) rats, 6 two-week-old, 6 four-week-old, 6 six-week-old, 6 six-week-old, 6 eight-week-old, 7 ten-week-old, and 7 twelve-week-old, were measured. Then the rats were killed and their hearts, aortas, livers, and kidneys were taken out. 294 specimens of total RNA were obtained from the tissues of ventricle of heart, aortic smooth muscle, liver and kidney. RNA array was used to determine the mRNA levels of G proteins G11 and Gq, and phospholipase C-beta (PLCbeta). RESULTS: The systolic blood pressures of the 6, 8, 10, and 12-week-old SHRs were 158 mm Hg +/- 8 mm Hg, 174 mm Hg +/- 4 mm Hg, 198 mm Hg +/- 13 mm Hg, and 217 mm Hg +/- 9 mm Hg respectively, all significantly higher than those of the age-matched WKY rats (109 mm Hg +/- 6 mm Hg, 128 mm Hg +/- 5 mm Hg,142 mm Hg +/- 4 mm Hg, and 141 mm Hg +/- 5 mm Hg respectively, all P <0.01). The cardiosomatic ratios of the 10- and 12-week-old SHRs were both significantly higher than those of the age-matched WKY rats (both P < 0.01). The G11 mRNA levels in the heart tissue of the 4, 6, 8, 10, and 12-week-old SHRs were 1.42 +/- 0.35, 1.87 +/- 0.40, 1.96 +/- 0.24, 2.09 +/- 0.38, and 2.34 +/- 0.45, all significantly higher than those of the age-matched WKY rats (1.05 +/- 0.18, 1.25 +/- 0.37, 1.26 +/- 0.35, 1.45 +/- 0.30, and 1.51 +/- 0.42 respectively, P < 0.05 or P < 0.01). The Gq mRNA levels of the 4, 6, 8, 10, and 12-week-old SHRs were 1.12 +/- 0.21, 1.30 +/- 0.26, 1.45 +/- 0.35, 1.77 +/- 0.42, and 2.05 +/- 0.46, respectively, all significantly higher than those of the age-matched WKY rats (0.88 +/- 0.09, 0.96 +/- 0.10, 1.03 +/- 0.10, 1.21 +/- 0.38, and 1.29 +/- 0.39 respectively, P < 0.05 or P < 0.01). Similar results were found in the G11 and Gq mRNA levels of the aorta and kidney tissues. The levels of PLCbeta expression in the heart and kidney tissues of the 4, 6, 6, 8, 10, and 12-week-old SHRs were all significantly increased (P <0.05 or P <0.01). Galpha, Gq, and PLCbeta were not significantly expressed in the liver. PLCbeta was hardly found in the aorta. CONCLUSION: Increase of the expression of G protein-inositol phosphates pathway-related genes is an important molecular biological mechanism in the pathogenesis and development of essential hypertension.

[Expression of NOS III mRNA in different tissues of spontaneously hypertensive rats using RNA array].

OBJECTIVE: To evaluate the expression of nitric oxide synthase III (NOS III) mRNA in the heart, aorta, kidney and liver of spontaneously hypertensive rats (SHR). METHODS: Two hundred and ninety-four total RNA samples were obtained from the tissues of ventricle, aortic smooth muscle, kidney and liver of SHR and normotensive rats (Wistar-Kyoto rats, WKY). RNA array was used to determine the mRNA levels of NOS III of the two groups. RESULTS: Compared with WKY, the systolic blood pressure increased significantly in SHR at 6-week-old, 8-week-old, 10-week-old and 12-week-old [(158.50 +/-7.69 vs 108.67 +/-5.89) mmHg, (174.33 +/-4.46 vs 128.50 +/-4.97) mmHg, (198.00 +/-13.45 vs 142.00 +/-3.58) mmHg, (216.67 +/-8.91 vs 141.17 +/-4.92) mmHg, P<0.01], and the ventricle/body weight ratio was significant higher at 10-week-old and 12-week-old [(4.08 +/-0.17 vs 3.59 +/-0.11, 4.05 +/-0.18 vs 3.40 +/-0.19)mg/g, P<0.01]. In the heart tissue and the kidney, the mRNA levels of NOS III were significantly increased at 6-week-old, 8-week-old, 10-week-old and 12-week-old (1.12 +/-0.18 vs 0.90 +/- 0.15, 1.46 +/- 0.34 vs 1.06 +/-0.18, 1.66 +/- 0.31 vs 1.21 +/- 0.30, 1.98 +/- 0.40 vs 1.31 +/-0.38, P <0.05) and at 4-week-old, 6-week-old, 8-week-old, 10-week-old and 12-week-old (1.10 +/- 0.21 vs 0.81 +/-0.11, 1.28 +/-0.18 vs 0.95 +/-0.13,1.31 +/-0.23 vs 0.99 +/-0.23, 1.70 +/-0.30 vs 1.08 +/-0.25, 1.83 +/-0.33 vs 1.15 +/-0.20, P<0.05 or P<0.01), respectively. There was no significant difference of the NOS III expression in the liver and no significant signals were detected in the aortic smooth muscle. CONCLUSION: The results provide the evidence of the increased expression of NOS III in different tissues in SHR and suggests the progressive nature of essential hypertension.

Effects of atorvastatin on vascular remodeling in spontaneously hypertensive rats.

OBJECTIVE: To investigate the structural changes of aorta, and evaluate the effects of atorvastatin on the remodeling of thoracic aorta in spontaneously hypertensive rats (SHR). METHODS: Twelve eight-week-old SHR were randomized into atorvastatin treated group (ATV group, n=6) and distilled water group (DW group, n=6); Wistar-Kyoto rats (WKY) were used as normal controls. Atorvastatin was administered to ATV group for 10 weeks by gavage in mixture with distilled water (1 ml); the latter two groups were given the same amount of distilled water by gavage for 10 weeks. Systolic blood pressure of caudal artery was examined before and after treatment, and serum concentrations of total cholesterol, triglycerides and HDL-C were measured. Wall thickness, media thickness, medial cross-sectional area and lumen diameter of thoracic aorta were assessed with computed video processing. RESULTS: Systolic blood pressure in ATV group was markedly lower than that in DW group (P<0.01). Compared with DW group and WKY group, serum concentrations of total cholesterol, triglycerides and HDL-C in ATV group were significantly lower (P<0.01,P<0.05). Wall thickness, media thickness, and medial cross-sectional area to lumen ratio in DW group were significantly higher than those in WKY group and ATV group (P<0.01,P<0.05), but no such difference was found between WKY group and ATV group (P>0.05). CONCLUSION: Vascular structural changes of aorta are due to the alteration of the vessel wall in early stage of SHR. Atorvastatin can markedly improve vascular remodeling.