Lower Extremity Artery Disease and Cognitive Impairment

Background The association between cerebrovascular disease and cognitive impairment is well known, but the impact of lower extremity arterial disease (LEAD) on neuropsychological performance is less established. Objectives The aim of this study was to investigate the influence of LEAD on cognitive impairment. Materials and Methods A total of 20 patients with LEAD, classified by Fountain’s stage IIB, qualified for revascularization surgery has been included in this prospective study. Neuropsychological assessments have been done using MoCA and CANTAB test. Fifteen patients qualified for hernia surgery, without peripheral artery disease served as a control group. Linear regression model has been applied to assess the connection between LEAD and cognitive impairment. Results Differences between the study groups reach significance in both MoCA and CANTAB test. In MoCA test, patients with LEAD had lower levels of performance in attention (p = 0.0254), visuospatial/executive (p = 0.0343) and delayed recall (p = 0.0032). The mean MoCA score was below 26 points. In CANTAB test, patients with LEAD performed worse in visual memory and learning. After adjusted for common cerebrovascular risk factors, LEAD was significantly correlated with cognitive impairment defined as MoCA score < 26 points. Conclusions Lower extremity artery disease is associated with cognitive impairment independently of cerebrovascular risk factors.

Influencing Factors for Complication with Aneurysm Rupture of the Fetal Posterior Communicating Artery After Clipping Through the Lateral Supraorbital Approach and Prognosis

Background To explore the influencing factors for complication with aneurysm rupture of the fetal posterior communicating artery after clipping through the lateral supraorbital (LSO) approach and prognosis. Methods A total of 119 patients with posterior communicating artery aneurysm (PCoAA) accompanied by fetal posterior cerebral artery (fPCA), who underwent clipping through the LSO approach from January 2014 to December 2019, were selected. They were aged 50–70 years old, (60.5 ± 13.7) on average. The treatment outcome, incidence of complications and follow-up results were analyzed. Based on the follow-up results, univariate comparative analysis was conducted for the clinical data of patients with good or poor prognosis. The statistically significant factors were incorporated into multivariate Cox regression analysis, and the nomogram prediction model for prognosis was established. The accuracy of the model was assessed using the Hosmer–Lemeshow goodness-of-fit test. Results Clipping through the LSO approach was successful in all cases. Perioperative complications occurred in 41 patients. According to the follow-up results, 89 patients had good prognosis, while 30 had poor prognosis. Age of > 65 years old, history of hypertension, high Hunt–Hess grade and high modified Fisher grade were independent risk factors for the poor prognosis of patients with PCoAA accompanied by fPCA after clipping through the LSO approach. The results obtained by the established model were consistent with the actual ones. Conclusion Age, history of hypertension, Hunt–Hess grade and modified Fisher grade are independent risk factors for the prognosis of patients with PCoAA accompanied by fPCA after clipping through the LSO approach.

Fatty Liver Index is Positively Associated with Arterial Stiffness in a Chinese Cohort Undergoing Health Assessment

Objective Nonalcoholic fatty fiver disease (NAFLD) is a metabolic liver injury closely related to insulin resistance. Fatty liver index (FLI) can be used as a surrogate marker and is a validated index for NAFLD. This study aimed to explore the relationship between FLI and arterial stiffness in a Chinese population. Methods From December 2017 to March 2019, 402 inpatients (mean age 51.12 ± 11.95 years) were recruited for cardiovascular disease screening at Ruijin Hospital North, Shanghai. Measurement of brachial systolic, diastolic, mean, and pulse pressure was done with cuff sphygmomanometry and carotid-femoral pulse wave velocity (cfPWV) was measured (SphygmoCor) to assess arterial stiffness. Results Subjects were divided into three groups according to their FLI < 30, normal; 30–59, intermediate fatty liver index; ≥ 60, NAFLD. The proportion of subjects with hepatic steatosis (FLI ≥ 60), intermediate FLI (30–59), and no steatosis (FLI < 30) was 34.4%, 31.8%, and 33.8%, respectively. The male population (53.9%) had significantly higher FLI levels (p < 0.05). Subjects with FLI ≥ 60 had higher cfPWV (8.41 ± 1.77 m/s) than those with FLI < 30 (7.81 ± 1.83 m/s; p = 0.006). cfPWV was positively correlated with logFLI (r = 0.168, p = 0.001). After adjusting for age, sex, body mass index, mean arterial blood pressure, glucose, cholesterol, heart rate, and glomerular filtration rate (eGFR), FLI remained positively associated with cfPWV (β = 0.097, p = 0.024). Conclusion cfPWV, as a measure of arterial stiffness, is higher in the NAFLD group when compared to that in normal groups. Fatty liver index is positively associated with arterial stiffness in a Chinese population.

Investigation of Hemodynamic Receptors of the Internal Carotid Artery Segments

Objectives Internal carotid artery (ICA), the main artery of the brain, passes through the cavernous sinus (CS) which forms one of these venous pools. During this transition, while there is arterial blood in the lumen of ICA, its outer surface is in contact with venous blood from the brain. Herein, we aimed to detect the receptor differences of ICA in this highly specialized anatomical region of the skull base. Methods We performed the study on 10 human cadavers and searched CGRPR, TRP12, ASIC3 and ACTHR receptors via immunostaining using laser scanning confocal microscopy. Results We determined TRP12 receptor positive in the tunica media and tunica adventitia layers of the cavernous segment of ICA. We did not detect similar positivity in the cervical part of the ICA. In the receptor scan we made in terms of CGRPR, while we detected positivity in the tunica media layer of the cavernous segment, we found positivity in the tunica intima layer of the cervicalis segment of the ICA. We did not detect any positivity for ASIC3 and ACTHR receptors in both parts of the ICA. Conclusions As a result, we observed various differences in receptors between ICA segments. While the outer surface of the ICA in the cervical region did not show any receptor positivity, we detected TRP12 receptor positivity along the tissue contour of vessel in the CS. We assume that it may provide a new perspective on pathologies of the CS/ICA and preservation of brain hemodynamics for clinicians.

Serum Biomarkers and Classification and Regression Trees Can Discriminate Symptomatic from Asymptomatic Carotid Artery Disease Patients

Objective To assess biomarkers between symptomatic and asymptomatic patients, and to construct a classification and regression tree (CART) algorithm for their discrimination. Patients and Methods 136 patients were enrolled. They were symptomatic (high risk) (N = 82, stenosis degree ≥ 50%, proven to be responsible for ischemic stroke the last six months) and asymptomatic (low risk) (N = 54, stenosis degree ≤ 50%). Levels of fibrinogen, matrix metalloproteinase-1 (MMP-1), tissue inhibitor of metalloproteinase-1 (TIMP-1), soluble intercellular adhesion molecule (SiCAM), soluble vascular cell adhesion molecule (SvCAM), adiponectin and insulin were measured on a Luminex 3D platform and their differences were evaluated; subsequently, a CART model was created and evaluated. Results All measured biomarkers, except adiponectin, had significantly higher levels in symptomatic patients. The constructed CART prognostic model had 97.6% discrimination accuracy on symptomatic patients and 79.6% on asymptomatic, while the overall accuracy was 90.4%. Moreover, the population was split into training and test sets for CART validation. Conclusion Significant differences were found in the biomarkers between symptomatic and asymptomatic patients. The CART model proved to be a simple decision-making algorithm linked with risk probabilities and provided evidence to identify and, therefore, treat patients being at high risk for cardiovascular disease.

Therapeutic Effects of Microsurgical Clipping at Different Time Points on Intracranial Aneurysm and Prognostic Factors

Background Microsurgical clipping is effective for treating early rupture hemorrhage in intracranial aneurysm (IA) patients. We aimed to evaluate the therapeutic effects of microsurgical clipping at different time points on IA and to explore prognostic factors. Methods A total of 102 eligible patients were divided into good prognosis group (n = 87) and poor prognosis group (n = 15) according to Glasgow Outcome Scale (GOS) scores at discharge. The effects of microsurgical clipping at different time points (within 24 h, 48 h and 72 h) were compared. The incidence rates of postoperative complications in patients with different Hunt–Hess grades were compared. Prognostic factors were determined by multivariate logistic regression analysis. The nomogram prediction model was established based on independent risk factors and validated. Results The good recovery and success rates of complete aneurysm clipping were significantly higher in patients undergoing surgery within 24 h after rupture. The incidence rate of complications was significantly higher in patients with Hunt–Hess grade IV. Good and poor prognosis groups had significantly different age, history of hypertension, preoperative intracranial hematoma volume, aneurysm size, preoperative Hunt–Hess grade, later surgery, postoperative complications and National Institute of Health Stroke Scale (NIHSS) score, as independent risk factors for prognosis. The nomogram model predicted that poor prognosis rate was 14.71%. Conclusion Timing (within 24 h after rupture) microsurgical clipping benefits the prognosis of IA patients. Age, history of hypertension, preoperative intracranial hematoma volume, aneurysm size, preoperative Hunt–Hess grade, later surgery, postoperative complications and NIHSS score are independent risk factors for poor prognosis.

MicroRNA-320a-3p Signatures as a Satisfactory Predictor of Acute Coronary Syndrome and Attenuates Inflammation by Targeting X-Linked Inhibitor of Apoptosis Protein

Acute coronary syndrome (ACS) is a heart disease with a high mortality rate. Recently, more and more evidence illustrated that microRNAs (miRNA) participated in regulating the occurrence of heart disease. This study aimed to detect the level of serum miR-320a-3p in patients with ACS, predict its possibility as a candidate gene for diagnosis, and explore its potential mechanism in the regulation of ACS. 139 ACS patients and 126 controls were recruited in this study. The expression level of miR-320a-3p was determined by qRT-PCR. The predictive value in ACS was assessed by receiver operating characteristic (ROC) curve. Enzyme-linked immunosorbent assay (ELISA) was used to measure the protein expression levels of inflammatory factors. The downstream targets of miR-320a-3p were verified by luciferase reporter gene assay. In ACS patients and rat models, the expression level of serum miR-320a-3p was significantly increased. ROC curve revealed that abnormal expression of miR-320a-3p was of diagnostic value for ACS. In an in vivo rat model, down-regulation of miR-320a-3p inhibited the production of von Willebrand factor (vWF), Heart fatty acid-binding protein (H-FABP), interleukin-1β (IL-1β), IL-6, and tumor necrosis factor-α (TNF-α). In other words, down-regulation of miR-320a-3p reduced rat vascular endothelial injury and inflammation. X-linked inhibitor of apoptosis protein (XIAP) was determined to be a direct target of miR-320a-3p. miR-320a-3p is useful for the diagnosis of ACS. Animal experiments confirmed that up-regulated miR-320a-3p promoted vascular endothelial injury and inflammatory response by targeting XIAP, thus promoting the development of ACS. MiR-320a-3p may be a new breakthrough in the diagnosis and treatment of ACS.