Search Results (1,312)

Background: Despite advances in the management of coronary disease, the incidence of sudden cardiac death (SCD) in the context of coronary artery disease (CAD) remains significant and unpredictable. We investigated the patient and angiographic characteristics, and predictors of long-term outcomes, of patients presenting with cardiac arrest in the context of acute coronary occlusion, to elucidate possible mechanisms of ventricular arrhythmia. Methods: A total of 127 consecutive patients presenting to a tertiary cardiac centre with pulseless ventricular tachycardia or ventricular fibrillation during acute myocardial infarction (AMI) were compared to 100 patients with uncomplicated AMI (Cohort A). We also compared a separate group comprising 20 patients with acute RCA occlusion complicated by cardiac arrest and 24 patients with uncomplicated inferior STEMI (Cohort B). Results: In Cohort A, there was a higher incidence of proximal lesions in the arrest group (55% vs. 41%, p < 0.05). There was an almost equivalent incidence of both LAD and non-LAD (RCA/Cx) infarcts presenting with cardiac arrest. In the non-LAD arrest patients, sinoatrial nodal artery (SANa) involvement was seen in 77%, compared with 33% in non-arrest patients (p < 0.005). In Cohort B, involvement of the SANa or conus artery (CA) was found in 74% of arrest versus 21% of non-arrest patients (p < 0.005). Cohort A patients were followed up for 3.8 to 8.7 years, and at the end of this period, 22% of arrest patients and 16% of non-arrest patients were deceased. Mortality <30 days was highest in the arrest group (43% vs. 7%, p < 0.05). Beyond 30 days, there were no differences in all-cause mortality between arrest and non-arrest patients. There were more cardiac causes of death in the arrest group (54% vs. 20%, p < 0.05). Conclusions: VT/VF arrest due to acute coronary occlusion was more common in those with proximal disease and there was an increased incidence of SANa and/or CA involvement in non-LAD infarcts. Short-term mortality was higher in patients with cardiac arrest post-AMI, but beyond 30 days there was no significant difference. Full article

Background: Chronic ischemic stroke presents a significant challenge in neurology, with limited therapeutic options available for long-term recovery. During cerebral infarction, anti-inflammatory phenotype microglia/macrophages produce anti-inflammatory cytokines and neurotrophic factors that facilitate the process of brain repair. However, obtaining sufficient anti-inflammatory microglia/macrophages from the human central nervous system is challenging. Bone marrow-derived inducible microglia-like cells (BM-iMGs) with an anti-inflammatory microglial phenotype were explored to induce neuroprotective properties. Here, we transplanted BM-iMGs into the brain of middle cerebral artery occlusion (MCAO) model male mice to explore their potential for treating chronic ischemic stroke. Methods: Bone marrow-derived mononuclear cells (BM-MNCs) were isolated from green fluorescent protein mice and incubated with granulocyte–macrophage colony-stimulating factor (GM-CSF) and IL-4 to induce BM-iMGs with an anti-inflammatory phenotype. BM-iMGs were transplanted into the brains of mice on day 14 after MCAO, and behavioral tests, histology, cerebral blood flow, and gene expression were evaluated. Results: An intracranial injection of BM-iMGs promoted neurobehavioral recovery, reduced neuronal cell loss, suppressed neuroinflammatory astrocytic and microglial responses in the brain, and increased cortical surface cerebral blood flow in MCAO mice. Furthermore, neuroprotective genes were upregulated, whereas proinflammatory genes were downregulated. Conclusions: The intracranial injection of BM-iMG cells shows significant potential as a novel therapy for chronic ischemic stroke. Full article

Ischemic stroke (IS) is the leading cause of disability and death worldwide, and its high incidence, disability and recurrence rates impose a heavy economic burden on families and society. Recent studies have shown that oxidative stress plays a key role in the pathophysiological mechanisms of ischemic stroke, not only participating in the onset and development of neuronal damage in the acute phase but also significantly influencing the long-term prognosis of ischemic stroke through molecular mechanisms, such as epigenetic modifications. However, the potential targets of oxidative stress-related genes in IS and their mechanisms of action remain to be elucidated. The aim of this study was to systematically analyse the function and significance of oxidative stress-related genes in IS. We obtained IS-related gene expression datasets from the GEO database and integrated known oxidative stress-related genes from the Genecards database for cross-analysis. Multidimensional feature screening using unsupervised consensus clustering and a series of machine learning algorithms led to the identification of the signature gene GPX7. The correlation between this gene and immune cell infiltration was assessed using MCPcounter and a potential therapeutic agent, glutathione, was identified. Binding was verified by molecular docking (MD) analysis. In addition, single-cell RNA sequencing data were analysed to further reveal expression in different cell types and its biological significance. Finally, we performed in vivo experiments using the Wistar rat middle cerebral artery occlusion (MCAO) model, and the results indicated that GPX7 plays a key role in IS, providing a new theoretical basis and potential intervention target for the precise treatment of IS. Full article

Disruption of the blood–brain barrier (BBB) accompanies many brain diseases, including stroke, neurodegenerative diseases, and brain tumors, leading to swelling, increased neuroinflammation, and neuronal death. In recent years, it has become clear that the c-Jun N-terminal kinase (JNK) signaling pathway is involved in disruption of the structural integrity of the BBB. Activation of the JNK signaling pathway has a negative effect on the functioning of the cellular elements of the neurovascular unit that form the BBB. The aim of this review is to assess the role of the JNK signaling pathway in the disruption of the structural integrity of the BBB in animal models of stroke (MCAO/R, middle cerebral artery occlusion with reperfusion), Alzheimer’s disease, and brain tumors and to analyze the effects of compounds of various natures that directly or indirectly affect the activity of the JNK signaling pathway. These compounds can reduce damage to the BBB and brain edema, reduce neuroinflammation and oxidative stress, reduce the expression of proapoptotic factors, and increase the expression of tight junction proteins. Certain compounds mitigate BBB dysfunction, being promising candidates for neuroprotective therapies. These agents exert their effects, in part, through inhibition of the c-Jun N-terminal kinase (JNK) signaling pathway, a mechanism linked to reduced neuronal damage and improved BBB integrity. Full article

(1) Background: Peripheral artery disease (PAD) and related conditions significantly impair walking ability. Previous studies demonstrated that passive lightweight exosuits can improve walking biomechanics. However, most of these devices focus on assisting hip flexion. The aim of this study was to investigate the effects of flexion and extension assistance on joint kinetics and muscle activation. We hypothesized that there would be an optimal combination of flexion and extension assistance for measured parameters. (2) Methods: Four patients with PAD and six healthy individuals walked on a treadmill while wearing a passive exosuit with adjustable hip flexion and extension assistance. Lower limbs’ power, moment, and muscle activation were recorded. (3) Results: We found that passive hip assistance effectively reduced hip kinetics in both healthy and PAD participants. We also found different effects between the groups, with the PAD group utilizing the exosuit to reduce plantarflexion kinetics and gastrocnemius activity. (4) Conclusions: These findings suggest that patients with PAD can leverage the exosuit to ameliorate impairment-specific deficits. Future research should explore more real-world applicability of passive exosuits. Full article

Medical students face significant challenges retaining complex information, such as interpreting ECGs for coronary artery occlusions, amidst demanding curricula. While artificial intelligence (AI) is increasingly used for medical image analysis, this study explored using generative AI (DALLE-3) to create mnemonic-based images to enhance human learning and retention of medical images, in particular, electrocardiograms (ECGs). This study is among the first to investigate generative AI as a tool not for automated diagnosis but as a human-centered educational aid designed to enhance long-term retention in complex visual tasks like ECG interpretation. We conducted a comparative study with 275 first-year medical students across six campuses; an experimental group (n = 40) received a lecture supplemented with AI-generated mnemonic ECG images, while control groups (n = 235) received standard lectures with traditional ECG diagrams. Student achievement and retention were assessed by course examinations, and student preference and engagement were measured using the Situational Interest Survey for Multimedia (SIS-M). Control groups showed a significant decline in scores on the relevant exam question over time, whereas the experimental group’s scores remained stable, indicating improved long-term retention. Experimental students also reported significantly higher situational interest in the mnemonic-based images over traditional images. AI-generated mnemonic images can effectively improve long-term retention of complex ECG interpretation skills and enhance student engagement and preference, highlighting generative AI’s potential as a valuable cognitive tool in image analysis during medical education. Full article

Background: Acute mesenteric ischemia (AMI) is a potentially life-threatening condition that requires prompt diagnosis and treatment. The presence of air within the arterial lumen, particularly in the abdomen, is an uncommon finding with varied etiologies. This case report presents a unique instance of AMI with air in the superior mesenteric artery (SMA), highlighting the complexities in diagnosis and management. Case presentation: An 89-year-old male with a history of smoking, hypertension, dyslipidemia, and atrial fibrillation presented with chest pain and underwent coronary angiography for suspected anterior ST-elevation myocardial infarction (STEMI). Following successful thromboaspiration and admission to the coronary care unit, he developed severe abdominal pain. A contrast-enhanced computed tomography (CECT) scan revealed a thromboembolic occlusion in the SMA, along with air filling in the SMA and its branches. An endovascular thrombectomy was performed, but the patient died the next day due to complications related to AMI and metabolic acidosis. Conclusions: This case underscores the challenges in diagnosing and managing AMI, particularly when accompanied by unusual imaging findings such as air within the SMA. The presence of air in the arterial system raises questions about its origin and clinical significance in the context of AMI. Further research is needed to understand the mechanisms and implications of this rare phenomenon, which may have implications for refining diagnostic and therapeutic strategies for AMI. Full article

Moyamoya angiopathy (MMA) is a cerebrovascular disease determining chronic progressive steno-occlusion of the supraclinoid internal carotid arteries and their main branches. The pathogenesis of MMA remains largely unknown. Multiple sclerosis (MS) is a chronic, inflammatory, demyelinating disease of the central nervous system characterized by the progressive accumulation of focal demyelinating lesions, whose pathophysiology has been theorized but still incompletely understood. Beyond misdiagnoses due to mimicking features among the two disorders, MS coexisting with MMA have been previously, rarely, reported. Herein, we present two other cases of patients with MMA with a concomitant, previously missed, diagnosis of MS and discuss their overlapping features as a hint for a potentially shared pathophysiology. The finding of typical angiographic features enables MMA diagnosis, yet it does not allow us to rule out other potentially concomitant disorders affecting the CNS. The association may be easily missed if the clinical/neuroradiological picture is not carefully assessed. Cerebral spinal fluid analysis and spine neuroimaging should be suggested in all MMA patients with atypical MRI lesions. Full article

Ischemic stroke (IS) is a high-mortality, multi-complication cardiovascular disease. Reducing brain injury and promoting neuronal repair after IS onset remain important challenges for current treatments. Our team previously found that PAS840, an extract from Periplaneta americana (L.), protects nerve function; this study further uses LC-MS/MS and peptidomics to analyze PAS840’s components and network pharmacology to predict its ischemic stroke (IS) therapeutic targets. We then employed Transwell, a biochemical kit, real-time quantitative polymerase chain reaction (RT-qPCR), and transcriptomics to investigate PAS840’s effects on migration ability, oxidative stress levels, and cellular pathways in mouse microglial cells (BV-2) following oxygen–glucose deprivation/reoxygenation (OGD/R) injury. Finally, using Evans blue staining, immunohistochemical analysis, and RT-qPCR, we investigated PAS840’s effects on the blood–brain barrier, inflammation pathways, and neural function in a transient middle cerebral artery occlusion (tMCAO) rat model. PAS840 components target multiple IS pathways, effectively inhibit NF-κB/NLRP3/Caspase-1/IL-1β inflammasome pathway activation in BV-2 cells following OGD/R, reduce cellular oxidative stress, inflammation, and pyroptosis, and improve cell viability and migration ability. PAS840 decreases NF-κB/NLRP3/Caspase-1/IL-1β inflammasome pathway expression in tMCAO rat brains, reduces inflammation, activates BDNF/VGF/NGR1/Erbb4 neurotrophic factor and vascular endothelial growth factor pathways, enhances neuronal cell viability, and effectively protects and repairs the blood–brain barrier. Full article

Globally, cardiovascular disease is a leading cause of disability and early death, affecting 422.7 million people and causing 17.9 million deaths (31% of global deaths) in 2015. Peripheral arterial disease, previously overlooked compared to coronary artery disease, is now recognised as a major contributor to cardiovascular morbidity and mortality, with distinct characteristics. After noninvasive methods, the femoropopliteal segment is frequently treated with revascularisation, which is recommended for claudication and chronic limb-threatening ischemia (CLTI). Challenges such as mechanical stresses, chronic occlusions, extensive plaque, and calcification affect procedural success and vessel patency. Innovations were needed to address these issues, and vascular drug delivery devices have become integral to endovascular treatment. We review the current literature concerning a diverse range of these devices in clinical use and their role in managing symptomatic patients. Full article

Oxidative stress due to increased reactive oxygen species (ROS) formation and/or inflammation is considered to play an important role in ischemic stroke injury. Leukemia inhibitory factor (LIF) has been shown to protect both oligodendrocytes and neurons from ischemia by upregulating endogenous anti-oxidants, though the effect of ischemia and the protective role of LIF treatment in mitochondrial function have not been studied. The goal of this study was to determine whether LIF protects ischemia-induced altered mitochondrial bioenergetics in reproductively senescent aged rats of both sexes (≥18 months old), approximately equivalent to the average age of human stroke patients. Animals were euthanized at 3 days after permanent middle cerebral artery occlusion (MCAO) surgery. We found that MCAO surgery significantly reduced mitochondrial oxidative phosphorylation in both the ipsilateral striatum and prefrontal cortex in male aged rats compared to their respective contralateral regions of the brain. MCAO injury showed mitochondrial bioenergetic dysfunction only in the striatum in female rats; however, the prefrontal cortex remained unaffected to the injury. LIF-treated rats significantly prevented mitochondrial dysfunction in the striatum in male rats compared to their vehicle-treated counterparts. Collectively, MCAO-induced mitochondrial dysfunction and LIF’s potential as a therapeutic biomolecule exhibited sex- and tissue-specific effects, varying between the striatum and prefrontal cortex in male and female rats. Full article

(1) Background: Ischemic stroke is a major global public-health concern with complex pathogenesis. Current treatment strategies face challenges. Low-intensity pulsed ultrasound stimulation (LIPUS), a non-invasive neuromodulation technology, shows promise in treating ischemic stroke, yet its underlying mechanisms lack in-depth investigation, especially in quantitative efficacy evaluation. (2) Methods: This study aimed to develop a neuromuscular functional coupling-based dynamic time warping (DTW) model to evaluate LIPUS’s neuroprotective effects in a mouse model of ischemic stroke. A bilateral carotid artery occlusion (BCAO) model in mice was established, and LIPUS treatment was given. Time- and frequency-domain analyses of local field potentials (LFPs) and electromyography (EMG) were conducted, and outcomes were quantified using a percentage-based scoring system. (3) Results: The BCAO+LIPUS group scored significantly higher than the BCAO group. (4) Conclusions: This study demonstrated that LIPUS is neuroprotective in BCAO mice and that the DTW-100 assessment evaluation model can quantify the neuroprotective effects of LIPUS. Full article

Background and Clinical Significance: Carotid stump syndrome (CSS) is a rare and unexpected cause of recurrent ischemic ipsilateral events in the carotid vascular territory despite the demonstrated occlusion of the internal carotid artery (ICA). It is believed to be caused by microemboli due to turbulent blood flow in the patent stump of the occluded ICA that passes through anastomotic channels and retrograde flow into the middle cerebral artery circulation. Case Presentation: We describe the case of a 65-year-old male patient who suffered multiple concurrent transient ischemic attacks (TIAs) with a totally occluded ipsilateral ICA revealed by computed tomography angiography (CTA). He was diagnosed with CSS, which required the safest therapeutic approach. A further investigation with digital subtraction angiography (DSA) was performed, and a trickle of blood flow was observed in the reportedly occluded ICA. The diagnosis of a true ICA occlusion was withdrawn, and a diagnosis of pseudo-occlusion was established, affecting the final treatment strategy. Therefore, the patient underwent an ipsilateral carotid endarterectomy (CEA), and he has remained asymptomatic since then. Conclusions: The differentiation between a pseudo-occlusion and a true ICA occlusion is essential in promptly managing acute recurrent ipsilateral ischemic strokes in the carotid vascular territory. A further investigation with DSA in cases with a totally occluded ICA using CTA is essential for excluding pseudo-occlusions in ipsilaterally symptomatic patients. Full article

Background/Objectives: Among the various types of masses that can cause compression, hematomas are a relatively common but often overlooked cause. Rheumatoid arthritis (RA) is associated with bleeding problems due to vascular inflammation, platelet dysfunction, impaired production of clotting factors, and medication use. Case Presentation: We report a case of a 76-year-old woman with RA who developed vascular and neurological symptoms in her right lower leg due to compression of the popliteal artery and tibial nerve by an organized hematoma in the popliteal fossa. She experienced swelling, pain, and plantar flexor weakness in the affected leg with no history of trauma. Magnetic resonance imaging revealed a mass measuring 1.2 × 1.0 × 3.0 cm in size in the right popliteal fossa that was in contact with the popliteal artery and tibial nerve on its posterolateral aspect. Electrodiagnostic examination revealed that the right tibial neuropathy developed most probably around the knee level. Surgical excision of the hematoma resulted in almost complete resolution of symptoms, and excisional biopsy disclosed findings of an organized hematoma. We confirmed that the patient’s symptoms were induced by compression of the popliteal artery and tibial nerve due to the organized hematoma in the right popliteal fossa. Conclusions: This case report emphasizes the importance of considering space-occupying lesions, such as organized hematomas, in patients with RA who develop neurological and vascular symptoms. Full article

Background: Early studies indicated that the high content of tanshinone IIA (T−IIA) and rosmarinic acid (RA) in Salvia castanea Diels f. Tomentosa Stib (SCT) gives them significant potential for development as therapeutic agents for ischemic stroke (IS). However, the extraction process and quality of the active ingredients from SCT are still big challenges, with present processes providing insufficient pharmacological effects. This study aims to identify the optimal extraction process and perform a quality characterization of the total tanshinones and phenolic acids extracted from SCT, as well as to elucidate the neuroprotective effect of these extracts. Methods: The extraction process was optimized using an orthogonal experimental design (OED), and quality characterization was performed using HPLC, UV, and LC-MS. The neuroprotective effect of the extracted tanshinones and phenolic acids was studied using the middle cerebral artery occlusion (MCAO) paradigm, and its underlying mechanism was revealed through RNA-seq analysis combined with network pharmacology. Results: The optimal extraction pressure of total tanshinones was 60 MPa, while the extraction temperature and time for total phenolic acids were 4 °C and 25 min, respectively. In these extracts, the total tanshinone and phenolic acid contents increased to 369.43 and 189.10 mg/g, respectively; 23 of the 19 tanshinones and 23 phenolic acids identified in this study have not been observed in previous studies. It was demonstrated that the combined extract had a promising neuroprotective effect against IS; RNA-seq combined with network pharmacology analysis indicated that the active compounds may regulate a series of core genes associated with signaling pathways to protect against IS. Conclusions: The combined SCT extract studied in this research exerted neuroprotective effects on IS. In general, these findings improve our preliminary understanding of the chemical composition and bioactivity of SCT. Full article