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Objective:To investigate the effect of astragaloside Ⅳ(AST Ⅳ)and Notoginseng total saponins (NTS) combined with bone marrow mesenchymal stem cell (BMSC) transplantation on neural repair and angiogenesis in rats with cerebral ischemia. Method:The rats were randomly divided into a sham operation group, a model group, low- and high-dose AST Ⅳ + NTS groups, a BMSC infusion group, and low- and high-dose BMSC infusion+AST Ⅳ (10 and 20 mg·kg<sup>-1</sup>) + NTS group (25, 50 mg·kg<sup>-1</sup>). BMSCs were isolated and purified by whole bone marrow adherent culture. The positive expression of surface markers of BMSCs (CD29, CD90, CD34, and CD45) was detected by flow cytometry. The focal cerebral ischemia model was established by middle cerebral artery occlusion (MCAO). The PKH26-labeled BMSCs were injected into the tail vein of rats in the BMSC infusion group, once a day. The rats in the combination groups received BMSC injection once a day and intragastric administration of drugs twice a day. Other groups were administered twice a day by gavage. The sham operation group and the model group received the same amount of normal saline. Symptoms and signs of neurological deficits were assessed by the Longa method and the cerebral infarction rate was determined by TTC staining. The survival and vascularization [double positive expression of PKH26/vascular endothelial growth factor (VEGF)] after transplantation of BMSCs were observed by the immunofluorescence method. The protein expression of Ang1 and TGF-<italic>β</italic><sub>1</sub> was measured by Western blot. Result:BMSCs were properly isolated and cultured. The identification of surface markers CD29, CD90, CD34, and CD45 was consistent with the characteristics of BMSCs. The neurological deficit score and cerebral infarction rate of the model group were significantly increased (<italic>P</italic><0.01). All drugs and cell transplantation could alleviate the above pathological changes in varying degrees. The strongest effect was observed in high-dose BMSC infusion+AST Ⅳ+NTS group (<italic>P</italic><0.01), which was superior to those in the AST Ⅳ+NTS groups or the BMSC infusion group. BMSC injection helped cells survive in the ischemic brain tissues and promoted angiogenesis, and this effect could be enhanced by the combination with drugs. After cerebral ischemia, the expression of Ang1 and TGF-<italic>β</italic><sub>1</sub> was increased, and the effect in the BMSC infusion+AST Ⅳ+NTS groups was the strongest (<italic>P</italic><0.01). Conclusion:AST Ⅳ combined with NTS can promote the survival of transplanted BMSCs and facilitate angiogenesis after target repair of damaged blood vessels after cerebral ischemia. The mechanism may be related to the improvement of the local microenvironment in the brain after cerebral ischemia and the promotion of the survival and differentiation of transplanted stem cells.
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Objective:To explore the effects of Huatan Tongluo Decoction (HTTLD) on the morphology and function of brain tissues and intestine in rats with cerebral ischemia/reperfusion based on the gut-brain axis. Method:Sixty SPF male rats were randomly divided into a sham operation group, a model group, high- (28.66 g·kg<sup>-1</sup>), medium- (14.33 g·kg<sup>-1</sup>), and low-dose (7.16 g·kg<sup>-1</sup>) HTTLD groups, and an edaravone (4 g·kg<sup>-1</sup>)+<italic>Clostridium butyricum</italic> (5.0×10<sup>8</sup> cfu·mL<sup>-1</sup>) group. The model was established by focal cerebral ischemia/reperfusion in rats. The drugs were administered by gavage. The brain tissue injury was determined by neurological deficit score and 2,3,5-triphenyl tetrazolium chloride (TTC) staining. The effect of cerebral ischemia/reperfusion on intestinal motility was assessed by the propulsion rate of small intestine. The intestinal mucosal cell damage was evaluated by the pathomorphological examination of the duodenal mucosa. Enzyme-linked immunosorbent assay (ELISA) was used to determine the content of <italic>D</italic>-lactate (<italic>D</italic>-LAC), diamine oxidase (DAO), and bacterial endotoxin (lipopolysaccharide, LPS) in serum. Western blot was used to detect the expression of Occludin, Claudin-5, and zonula occludens 1 (ZO-1) in the duodenum. Result:After cerebral ischemia/reperfusion, rats developed neurological deficit symptoms. The neurological deficit score in the model group was higher than that in the sham operation group (<italic>P<</italic>0.01). Compared with the model group, the high- and medium-dose HTTLD groups could relieve the symptoms of neurological deficits and lower neurological deficit scores (<italic>P<</italic>0.01). The results of TTC staining showed that the model group presented obvious infarcts in brain tissues compared with the sham operation group (<italic>P<</italic>0.01). The cerebral infarction volumes of HTTLD groups were reduced compared with that in the model group (<italic>P<</italic>0.01), especially the high-dose HTTLD group, and the effect was dose-dependent. Furthermore, the propulsion rate of small intestine in the model group was significantly reduced compared with that in the sham operation group (<italic>P<</italic>0.01). Compared with the model group, HTTLD groups could increase propulsion rates of small intestine (<italic>P<</italic>0.01), especially the high-dose HTTLD group, and the effect was dose-dependent. After cerebral ischemia/reperfusion, obvious duodenal mucosal damage could be observed, which was relieved after the administration of HTTLD. Western blot results showed that the protein expression of ZO-1, Occludin, and Claudin-5 in the model group was reduced compared with that in the sham operation group (<italic>P<</italic>0.01). Compared with the model group, the HTTLD groups could up-regulate the expression of ZO-1, Occludin, and Claudin-5 to varying degrees (<italic>P<</italic>0.05, <italic>P<</italic>0.01), especially the high-dose HTTLD group. ELISA showed that the serum <italic>D</italic>-LAC, DAO, and LPS of the model group were elevated compared with those in the sham operation group (<italic>P<</italic>0.01). Compared with the model group, the HTTLD groups showed reduced <italic>D</italic>-LAC and DAO (<italic>P<</italic>0.05, <italic>P<</italic>0.01), and the medium- and high-dose HTTLD groups showed reduced LPS (<italic>P<</italic>0.05, <italic>P<</italic>0.01), especially the high-dose HTTLD group. Conclusion:After cerebral ischemia/reperfusion, the rats showed damaged brain tissues, neurological dysfunction, intestinal mucosal injury, weakened intestinal motility, and destroyed the intestinal mucosal barrier. HTTLD can protect against brain-gut axis injury after cerebral ischemia/reperfusion by reducing the damage on brain tissues and gastrointestinal mucosa, relieving the symptoms of neurological deficits, promoting gastrointestinal motility, improving intestinal barrier function, and reducing the release of intestinal bacterial metabolites or poisons.
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BACKGROUND: This retrospective study aimed to investigate the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) and albumin for 30-day mortality in patients with postoperative acute pulmonary embolism (PAPE). METHODS: We retrospectively reviewed the medical records of 101 patients with PAPE admitted from September 1, 2012, to March 31, 2019. The characteristics, surgical information, admission examination data and mortality within 30 days after PAPE were obtained from our electronic medical recording system and follow-up. The associations between the NLR, PLR, and other predictors and 30-day mortality were analyzed with univariate and multivariate analyses. Then, the nomogram including the independent predictors was established and evaluated. RESULTS: Twenty-four patients died within 30 days, corresponding to a 30-day mortality rate of 23.8%. The results of the multivariate analysis indicated that both the NLR and albumin were independent predictors for 30-day mortality in patients with PAPE. The probability of death increased by approximately 17.1% (OR = 1.171, 95% CI: 1.073-1.277, P = 0.000) with a one-unit increase in the NLR, and the probability of death decreased by approximately 15.4% (OR = 0.846, 95% CI: 0.762c-0.939, P = 0.002) with a one-unit increase in albumin. The area under the curve of the nomogram was 0.888 (95% CI: 0.812-0.964). CONCLUSION: Our findings showed that an elevated NLR and decreased albumin were related to poor prognosis in patients with PAPE. The NLR and albumin were independent prognostic factors for PAPE.