Effect of Salvia Miltiorrhiza Polyphenolic Acid Combined with Salvia Miltiorrhiza Ligustrazine Injection on Cognitive Function in Patients with Cerebral Infarction

Objective: To investigate the effect of salvia miltiorrhiza polyphenolic acid combined with salvia miltiorrhiza ligustrazine injection on cognitive function in patients with cerebral infarction. Methods: 60 patients with cerebral infarction from December 2017 to December 2019 were randomly divided into control group (n = 30) and observation group (n = 30) by random number table method. The control group was treated with salvia miltiorrhiza ligustrazine injection, and the observation group was treated with salvia miltiorrhiza polyphenolic acid on the basis of the control group. After 4-week treatment, the effect of the patients was evaluated, and the hemorheological level, cognitive function and drug safety of the two groups were compared. Results: The levels of high blood and low shear viscosity, high whole blood and plasma viscosity in the observation group were lower than those in the control group 4 weeks after treatment (P<0.05); the cognitive function scores in the observation group were higher than those in the control group 2 and 4 weeks after treatment (P<0.05); the incidence rates of liver and kidney function damage, mild diarrhea, dizziness and somnolence, nausea and vomiting, and blood pressure fluctuation in the treatment of the two groups had no statistical significance (P>0.05). Conclusion: The combination of salvia miltiorrhiza polyphenolic acid and salvia miltiorrhiza ligustrazine injection can improve the hemorheology of patients with cerebral infarction. It is helpful to improve the cognitive function of patients. The drug is safe and worthy of being popularized.

Isolated Intraventricular Hemorrhage after Carotid Artery Stenting

Cerebral intraventricular hemorrhage (IVH) is an extremely rare complication of carotid artery stenting (CAS). Fully dilated terminal arteries of a chronic, severely stenosed proximal artery could be ruptured by impaired autoregulation of cerebral blood flow. Hyperperfusion syndrome can occur even if there is no blood pressure fluctuation during the CAS. We report a case of an isolated IVH that occurred hours after CAS.

The Complexity of Blood Pressure Fluctuation Mediated the Effects of Hypertension on Walking Speed in Older Adults

Background: Older adults with hypertension often had diminished walking performance. The underlying mechanism through which hypertension affects walking performance, however, has not been fully understood. We here measured the complexity of the continuous systolic (SBP) and diastolic (DBP) blood pressure fluctuation, grade of white matter lesions (WMLs), and cognitive function and used structural equation modeling (SEM) to examine the interrelationships between hypertension, BP complexity, WMLs, cognitive function, and walking speed in single- and dual-task conditions.Methods: A total of 152 older adults with age &gt; 60 years (90 hypertensive and 62 normotensive participants) completed one MRI scan of brain structure, a finger BP assessment of at least 10 min, Mini-Mental State Examination (MMSE) to assess cognitive function, and 10-meter walking tests in single (i.e., normal walking) and dual tasks (i.e., walking while performing a serial subtraction of three from a random three-digit number). The grade of WMLs was assessed using the total score of Fazekas scale; the complexity of SBP and DBP was measured using multiscale entropy (MSE), and the walking performance was assessed by walking speed in single- and dual-task conditions.Results: As compared to normotensives, hypertensive older adults had significantly slower walking speed, lower complexity of SBP and DBP, greater grade of WMLs, and poorer cognitive function (p &lt; 0.03). Those with lower BP complexity (β &gt; 0.31, p &lt; 0.003), greater WML grade (β &lt; −0.39, p &lt; 0.0002), and/or poorer cognitive function (β &lt; −0.39, p &lt; 0.0001) had slower walking speed in single- and/or dual-task conditions. The SEM model demonstrated significant total effects of hypertension on walking speed, and such effects were mediated by BP complexity only, or BP complexity, WML grade, and cognitive function together.Conclusion: This study demonstrates the cross-sectional association between the complexity of continuous beat-to-beat BP fluctuation, WML grade, cognitive function, and walking speed in hypertensive and normotensive older adults, revealing a potential mechanism that hypertension may affect walking performance in older adults through diminished BP complexity, increased WML grade, and decreased cognitive function, and BP complexity is an important factor for such effects. Future longitudinal studies are warranted to confirm the findings in this study.

Identification of Clock Genes Related to Hypertension in Kidney From Spontaneously Hypertensive Rats

Background There is a diurnal variation in the blood pressure fluctuation of hypertension, and blood pressure fluctuation abnormality is considered to be an independent risk factor for organ damage including cardiovascular complications. In the current study, we tried to identify molecules responsible for blood pressure circadian rhythm formation under the control of the kidney biological clock in hypertension. Methods DNA microarray analysis was performed in kidneys from 5-week-old spontaneously hypertensive rats (SHRs)/Izm, stroke-prone SHR rats (SHRSP)/Izm, and Wistar Kyoto (WKY)/Izm rats. To detect variation, mouse tubular epithelial cells (TCMK-1) were stimulated with dexamethasone. We performed immunostaining and western blot analysis in the renal medulla of kidney from 5-week-old WKY rats and SHRs. Results We extracted 1,032 genes with E-box, a binding sequence for BMAL1 and CLOCK using a Gene Set Enrichment Analysis. In a microarray analysis, we identified 12 genes increased as more than 2-fold in the kidneys of SHRs and SHRSP in comparison to WKY rats. In a periodic regression analysis, phosphoribosyl pyrophosphate amidotransferase (Ppat) and fragile X mental retardation, autosomal homolog 1 (Fxr1) showed circadian rhythm. Immunocytochemistry revealed PPAT-positivity in nuclei and cytoplasm in the tubules, and FXR1-positivity in the cytoplasm of TCMK-1. In 5-week-old WKY rat and SHR kidneys, PPAT was localized in the nucleus and cytoplasm of the proximal and distal tubules, and FXR1 was localized to the cytoplasm of the proximal and distal tubules. Conclusions PPAT and FXR1 are pivotal molecules in the control of blood pressure circadian rhythm by the kidney in hypertension.

Anesthetic Experience of Patient with Lambl’s Excrescences

Lambl’s excrescences(LE) are mobile, thin, filiform structures that occur at sites of valve closure. LE are mostly asymptomatic but atheroma from LE may embolize to cerebrovascular arterial territory causing stroke. A 79 year old man with mechanical ileus of small bowel loop and pelvic mass scheduled for palliative enteroenterostomy. His transthoracic echocardiography showed a filiform hyperechoic mass attached to the tip of noncoronary cusp, suggestive of LE. To prevent cardioembolic stroke during perioperative period, we tried to prevent blood pressure fluctuation during surgery. Also we monitored regional cerebral oxygen saturation by cerebral/somatic oximeter for early detection of cerebral ischemia. A patient had no neurological changes and signs of cerebral infarction after surgery.

Intraoperative hypotension is associated with shortened overall survival after lung cancer surgery

Background: Intraoperative hypotension is associated with worse perioperative outcomes, but evidence is lacking regarding long-term survival after cancer surgery. Herein, we analyzed the association between intraoperative blood pressure fluctuation and overall survival after lung cancer surgery. Methods: In this retrospective cohort study, 676 patients who received lung cancer surgery between January 1, 2006 and December 31, 2009 were reviewed. Intraoperative hyper- and hypotension were defined according to their correlation with long-term survival. The primary endpoint was overall survival. The association between intraoperative blood pressure fluctuation and overall survival was analyzed with multivariable Cox proportional hazard models. Results: Long-term follow-ups were completed in 515 patients with a median duration of 5.2 years. The estimated 5-year survival rates were 66.5%, 61.3%, 56.5%, and 41.2% in patients with only hypertension (systolic blood pressure >140 mmHg for ³5 minutes), with both hyper- and hypotension (systolic blood pressure <100 mmHg for ³5 minutes), with neither hyper- nor hypotension, and with only hypotension during surgery, respectively. After adjusting confounding factors, intraoperative hypotension was significantly associated with shortened overall survival (compared with patients with only intraoperative hypertension, those with both hyper- and hypotension: hazard ratio [HR]1.033, 95% confidence interval [CI] 0.709 to 1.507, p=0.864; those with neither hyper- nor hypotension: HR 0.952, 95% CI 0.608 to 1.489, p=0.829; those with only hypotension: HR 1.736, 95% CI 1.218 to 2.475, p=0.002). Conclusions: For patients undergoing lung cancer surgery, intraoperative hypotension, but not hypertension, was associated with shortened overall survival.

Prediction of Blood Pressure after Induction of Anesthesia Using Deep Learning: A Feasibility Study

Anesthesia induction is associated with frequent blood pressure fluctuation such as hypotension and hypertension. If it is possible to precisely predict blood pressure a few minutes ahead, anesthesiologists can proactively give anesthetic management before patients develop hemodynamic problem. The objective of this study is to develop a real-time model for predicting 3-min-ahead blood pressure from the start of anesthesia induction to surgical incision. We used only vital signs and anesthesia-related data obtained during anesthesia-induction phase and designed a bidirectional recurrent neural network followed by fully connected layers. We conducted experiments on our collected data of 102 patients, and obtained mean absolute errors between 8.2 mmHg and 11.1 mmHg and standard deviation between 8.7 mmHg and 12.7 mmHg. The average elapsed time for prediction of a batch of 100 unseen data was about 26.56 milliseconds. We believe that this study shows feasibility of real-time prediction of future blood pressures, and the performance will be improved by collecting more data and finding better model structures.