Correlation of oxidative stress and vascular endothelial dysfunction with hippocampal perfusion in atrial fibrillation patients with cognitive impairment.

Objectives: To evaluate the correlation of oxidative stress and vascular endothelial dysfunction with hippocampal perfusion in patients with atrial fibrillation and cognitive impairment. Methods: In total, 41 atrial fibrillation patients with cognitive impairment were compared to 45 atrial fibrillation patients without cognitive impairment. Oxidative stress, vascular endothelial dysfunction, hippocampal perfusion, and cognitive function were measured. Results: Serum level of oxidized low-density lipoprotein was significantly higher in the atrial fibrillation + cognitive impairment group than in the atrial fibrillation group. Serum levels of intercellular adhesion molecule-1 and vascular cell adhesion molecule-1 were significantly higher, and nitric oxide was lower, in the atrial fibrillation + cognitive impairment group than in the atrial fibrillation group. The regional cerebral blood volume, mean transit time, and time to peak were significantly higher in the atrial fibrillation + cognitive impairment group than in the atrial fibrillation group. Moreover, regional cerebral blood flow was significantly lower in the atrial fibrillation + cognitive impairment group than in the atrial fibrillation group. Age, left atrial diameter, and regional cerebral blood volume were negatively correlated with the cognitive function score in the atrial fibrillation + cognitive impairment group. Serum levels of oxidized low-density lipoprotein, regional cerebral blood volume, regional cerebral blood flow, mean transit time, and time to peak were significantly correlated with cognitive impairment in atrial fibrillation patients after multivariate logistic regression analysis. Conclusion: Hippocampal perfusion and oxidative stress were significantly correlated with cognitive impairment in atrial fibrillation patients.

The Correlation of Inflammation, Oxidative Stress, and Hippocampal Perfusion in Patients with Atrial Fibrillation.

Atrial fibrillation (AF) is closely related to abnormal cerebral blood flow. Inflammation and oxidative stress have always been important factors in the pathophysiology of AF. It remains unknown whether inflammation and oxidative stress are correlated to hippocampal perfusion in patients with AF.Sixty-three patients with AF with normal hippocampal blood perfusion (NHBP) were compared to 71 patients with AF with abnormal hippocampal blood perfusion (AHBP) using a case-control study design. The serum levels of inflammation and oxidative stress were measured. The hippocampal perfusion was detected. (1) The serum levels of high-sensitivity C-reactive protein (hs-CRP), interleukin 6 (IL-6), and oxidized low-density lipoprotein (ox-LDL) were statistically higher in the AHBP group than in the NHBP group. In the AHBP subgroup analysis, the serum levels of hs-CRP and IL-6 were statistically higher in patients with persistent AF than those with paroxysmal AF. (2) The relative cerebral blood volume (rCBV), mean transit time (MTT), and the time-to-peak (TTP) were statistically higher in the AHBP group than in the NHBP group. Moreover, cerebral blood flow (rCBF) was statistically lower in the AHBP group than in the NHBP group. (3) relative cerebral blood volume (rCBV), rCBF, MTT, and TTP were passively associated with serum hs-CRP and IL-6; rCBV, rCBF, and MTT were positively associated with ox-LDL. The serum levels of hs-CRP, IL-6, and ox-LDL were associated with AHBP in patients with AF after multivariate logistic regression analysis.Oxidative stress and inflammatory biomarkers were increased in patients with AF with AHBP, in which the serum levels of hs-CRP and IL-6 in the persistent AF group were statistically higher than those in the paroxysmal AF group. The serum levels of hs-CRP, IL-6, and ox-LDL were associated with AHBP in patients with AF.

Imaging with intracardiac echocardiography compared to transesophageal echocardiography during left atrial appendage occlusion.

We performed a meta-analysis comparing the procedural and outcomes data and related to left atrial appendage occlusion guided by intracardiac echocardiography (ICE) and transesophageal echocardiography (TEE) in nonvalvular atrial fibrillation patients. Technical success with ICE was significantly similar to that of TEE (odds ratio [OR] 1.38, 95% CI [0.62, 3.09], I2 = 0%, P = 0.43). The peri-procedural complications showed no significant difference between the two groups (OR 0.84, 95% CI [0.57, 1.23], I2 = 0%, P = 0.37). Mortality was similar in procedures using ICE vs TEE (OR 0.89, 95% CI [0.51, 1.57], I2 = 0%, P = 0.69). Landing zones, procedural time and fluoroscopic times between ICE and TEE showed no significant differences (MD 1.96, 95% CI [-0.01, 3.94], I2 = 90%, P = 0.05; MD -1.64, 95% CI [-13.45, 10.17], I2 =95%, P =0.79; and MD 0.49, 95% CI [-2.18, 3.16], I2 = 87%, P = 0.72, respectively). Imaging with ICE or TEE is associated with similar outcomes in left atrial appendage occlusion procedures.

[Treatment of avascular necrosis of femoral head by impacting granular bone grafting via window in femoral neck].

OBJECTIVE: To evaluate the clinical results of continuing skeletal traction and impaction granular bone grafting via window in femoral neck for the treatment of avascular necrosis of femoral head. METHODS: From August 2000 to October 2004, 23 patients (35 hips) with femoral head necrosis were treated by continuing skeletal traction and impacting granular bone grafting via bone window on femoral neck. There were 18 males, 5 females, with an average age of 32 years ranging from 19 to 52 years, which included 7 hips of stage II, 28 hips of stage III. All patients had various degrees of hip joint pain and suffered from limited hip motion. The necrotic bone, granulation tissue and hardening zone were completely cleaned via bone window on the femoral neck. The autogenous granular iliac bone was grafted, and impacted persistently. Skeletal traction through femur condyles was applied continually after the operations. The effects before and after operation were compared by the hip pain, function, joint activity and X-ray. RESULTS: Regular follow-up was carried out after the patients were dismissed from the hospital. The follow-up period was 6 months, 1 year, 2 years, 3 years, 4 years, 5 years respectively. According to Wang's standard, the average score was increased from (52.66 +/- 12.53) preoperatively to (88.94 +/- 5.84) preoperatively at half a year, (89.78 +/- 6.18) at 1 year, (86.37 +/- 7.46) at 2 years, (84.08 +/- 7.57) at 3 years, (83.76 +/- 8.08) at 4 years, and (76.83 +/- 8.98) at 5 years. Scores of operation were greatly increased and the difference had statistical significance. CONCLUSION: Continuing skeletal traction after the operation, completely cleaning the necrotic bone and impacting granular bone grafting via window on femoral neck can greatly raise the satisfactory rate of clinical effect and delay the progression of disease for avascular necrosis of femoral head.