Ischemic Group Research Articles

The Value of Naples Prognostic Score in Predicting Ischemia on Myocardial Perfusion Scintigraphy

Objectives: Naples prognostic score (NPS) is a recently established score that measures inflammation and nutritional conditions. This score includes lymphocyte-to-monocyte ratio, neutrophil-to-lymphocyte ratio, total cholesterol levels, and serum albumin levels. Initial studies have shown that the NPS score has more prognostic value than other inflammatory parameters in some cancer diseases. Recently, the association of the NPS score with various cardiovascular diseases has started to be evaluated. The association between ischemia in myocardial perfusion scanning and the Naples score has not yet been investigated. In this study, we evaluated if the NPS may help predict ischemia in myocardial perfusion scanning. Methods: This study included a total of 110 patients. All patients underwent myocardial perfusion scintigraphy (MPS) at the nuclear medicine department, with dipyridamole or adenosine administered as the pharmaceutical stressor. The subjects were divided into two groups according to the presence or absence of ischemia on gated single-photon emission computed tomography (SPECT) MPI. Laboratory values within the past month before MPS were obtained from digital records for both groups. The NPS was calculated for each group. Laboratory values and NPSs of the groups were compared. Results: All individuals in the trial had gated SPECT MPI. The average age of individuals was 59.8±11.1 years, with 62 patients (56%) being male. Subjects were divided into two groups according to the presence or absence of ischemia on gated SPECT MPI. Table 1 displays the demographics of the whole study population. Based on the laboratory data (Table 2), there was no significant difference in the demographic features of the groups. The ischemia group had significantly higher levels of white blood cell count (cells/ μL), neutrophil count (cells/µL), hemoglobin (g/dL), CRP (mg/L), and NPS (8.6±2.2, 7.7±1.9, p=0.040; 5.0±2.1, 4.1±1.3, p=0.014; 12.6±1.7, 13.4±1.8, p=0.025; 8.2±2.0, 7.9±2.0, p=0.004; 2.6±1.0, 1.5). Other laboratory results did not differ across the groups. Conclusion: Our findings indicated an association between NPS and the detection of ischemia in MPS. NPS is an independent variable for diagnosing myocardial ischemia in stable coronary artery disease patients.

Oscillatory potential findings in patients with acute ischaemic central retinal vein occlusion

AimsTo explore the sensitive components of full-field electroretinography (ERG) as indicators of retina function at the onset of acute ischaemic central retinal vein occlusion (CRVO).Methods11 patients (11 eyes) with ischaemic...

Etiology and Outcomes of Patients with Extreme Hyperbilirubinemia in Korea: A Retrospective Cohort Study.

Extreme hyperbilirubinemia is occasionally observed in intensive care unit (ICU) and non-ICU settings. This study examined the etiologies of extreme hyperbilirubinemia (bilirubin level ≥12 mg/dL) and the factors associated with the 30-day mortality. This retrospective observational cohort study identified 439 patients with extreme hyperbilirubinemia at the Gyeongsang National University Changwon Hospital between 2016 and 2020. The patients were classified into three groups and 11 diseases according to their etiology. The risk factors associated with 30-day mortality at the baseline were investigated using the Cox proportional hazards model. Of 439 patients with extreme hyperbilirubinemia, 287, 78, and 74 were in the liver cirrhosis/malignancy group, the ischemic injury group, and the benign hepatobiliary-pancreatic etiological group, respectively, with corresponding 30-day mortality rates of 42.9%, 76.9%, and 17.6%. The most common disease leading to hyperbilirubinemia was a pancreatobiliary malignancy (28.7%), followed by liver cirrhosis (17.3%), hepatocellular carcinoma (10.9%), and liver metastases (8.4%). The etiologies of hyperbilirubinemia, obstructive jaundice, infection, albumin level, creatinine level, and prothrombin time-international normalized ratio were independently associated with the 30-day mortality. This study suggests three etiologies of extreme hyperbilirubinemia in the ICU and non-ICU settings. The prognosis of patients with extreme hyperbilirubinemia depends largely on the etiology and the presence of obstructive jaundice.

Developing and Validating a Nomogram Model for Predicting Ischemic Stroke Risk.

Background and purpose: Clinically, the ability to identify individuals at risk of ischemic stroke remains limited. This study aimed to develop a nomogram model for predicting the risk of acute ischemic stroke. Methods: In this study, we conducted a retrospective analysis on patients who visited the Department of Neurology, collecting important information including clinical records, demographic characteristics, and complete hematological tests. Participants were randomly divided into training and internal validation sets in a 7:3 ratio. Based on their diagnosis, patients were categorized as having or not having ischemic stroke (ischemic and non-ischemic stroke groups). Subsequently, in the training set, key predictive variables were identified through multivariate logistic regression and least absolute shrinkage and selection operator (LASSO) regression methods, and a nomogram model was constructed accordingly. The model was then evaluated on the internal validation set and an independent external validation set through area under the receiver operating characteristic curve (AUC-ROC) analysis, a Hosmer-Lemeshow goodness-of-fit test, and decision curve analysis (DCA) to verify its predictive efficacy and clinical applicability. Results: Eight predictors were identified: age, smoking status, hypertension, diabetes, atrial fibrillation, stroke history, white blood cell count, and vitamin B12 levels. Based on these factors, a nomogram with high predictive accuracy was constructed. The model demonstrated good predictive performance, with an AUC-ROC of 0.760 (95% confidence interval [CI]: 0.736-0.784). The AUC-ROC values for internal and external validation were 0.768 (95% CI: 0.732-0.804) and 0.732 (95% CI: 0.688-0.777), respectively, proving the model's capability to predict the risk of ischemic stroke effectively. Calibration and DCA confirmed its clinical value. Conclusions: We constructed a nomogram based on eight variables, effectively quantifying the risk of ischemic stroke.

Reduced ischemia‐reperfusion oxidative stress injury by melatonin and N‐acetylcysteine in the male rat brain

Middle cerebral artery occlusion (MCAO) is a model for inducing ischemic stroke in rodents, leading to devastating brain damage. Oxidative stress (OS) plays a crucial role in the pathogenesis of ischemia. In this study, the effect of melatonin and N-acetylcysteine on ischemia-reperfusion-induced oxidative stress injury in the cerebral cortex of male rats was investigated. 30 male Wistar rats were divided into sham, ischemic, NAC, melatonin and NAC + melatonin groups. All groups, except the sham group, underwent MCAO on the left side, and the treatment groups received intraperitoneal injections of either 50 mg/kg N-acetylcysteine (NAC) or 5 mg/kg melatonin or a combination of both 24 and 48 hours later. At 24 and 72 hours after surgery, the animals were examined for sensory and motor activity. The cerebral cortex was dissected after sacrificing the rats, infarct volume estimated and the concentrations of glutathione peroxidase (GPx), superoxide dismutase (SOD), catalase (CAT), malondialdehyde (MDA) and nuclear factor erythroid-2 related factor 2 (Nrf2) were analyzed by enzyme-linked immunosorbent assay (ELISA). The results indicate that the NAC + melatonin group exhibited elevated sensory-motor activity and a reduced infarct volume rate in comparison to the ischemic group (p≤ 0.05). Compared to the ischemic group, the NAC + melatonin group showed a significant increase in SOD concentration and a significant decrease in MDA (p≤ 0.05). It can therefore be concluded that the simultaneous administration of NAC and melatonin can reduce the cerebral infarction volume, and improve neurological functions by modulating SOD and MDA.

Establishment and evaluation of a stable and reliable rat model of peritoneal adhesions

BackgroundIn this study, we aimed to establish a stable and standardized animal model of peritoneal adhesions. MethodsForty-eight male Sprague–Dawley rats were randomly divided (n = 12 each) into blank control, classic cecum sidewall, ischemic button, and cecum–sidewall suture groups. The modified American Fertility Society adhesion score was used on postoperative day 7 to evaluate adhesions. Sixty male Sprague–Dawley rats were used to dynamically observe the adhesion characteristics of cecum–sidewall ischemic injury suture model at different time points (n = 60, randomly divided into groups a–e with 12 rats each). The modified American Fertility Society and Zühlke histologic scoring systems, hematoxylin-eosin staining, Masson staining, and computed tomography of the abdomen were used to evaluate adhesions on postoperative days 1, 3, 5, 7, and 14. ResultsNo peritoneal adhesions were observed in the blank control group on postoperative day 7. In the classic cecum sidewall group, 8 rats had inconsistent adhesions, which had a modified American Fertility Society adhesion score of 2.25 ± 1.96. All rats in the ischemic button and cecum–sidewall suture groups developed significant adhesions with modified American Fertility Society scores of 3.08 ± 1.31 and 4.67 ± 0.78, respectively. When the modified American Fertility Society score was used, statistically significant differences were observed between the classic cecum sidewall groups and cecum–sidewall suture groups and between the ischemic button groups and cecum–sidewall suture groups. All animals in groups a–e developed adhesions; adhesion scores increased gradually with time. ConclusionsThe cecum–sidewall ischemic injury suture model is a stable and standardized animal model of peritoneal adhesions.

Comparative Brain Proteomic Analysis between Sham and Cerebral Ischemia Experimental Groups.

Sham control groups are essential in experimental animal studies to reduce the influence of surgical intervention. The intraluminal filament procedure is one of the most common models of middle cerebral artery occlusion (MCAO) used in the study of brain ischemia. However, a sham group is usually not included in the experimental design of these studies. In this study, we aimed to evaluate the relevance of the sham group by analyzing and comparing the brain protein profiles of the sham and MCAO groups. In the sham group, 98 dysregulated proteins were detected, compared to 171 in the ischemic group. Moreover, a comparative study of protein profiles revealed the existence of a pool of 57 proteins that appeared to be dysregulated in both sham and ischemic animals. These results indicated that the surgical procedure required for the intraluminal occlusion of the middle cerebral artery (MCA) induces changes in brain protein expression that are not associated with ischemic lesions. This study highlights the importance of including sham control groups in the experimental design, to ensure that surgical intervention does not affect the therapeutic target under study.

Effect of acute and chronic stress on memory impairment and hippocampal oxidative stress following global cerebral ischemia in adult male rats.

Stress, especially immobility stress, is quite common and one of the most important and influential risk factors in neurological disorders. This study aimed to investigate the effect of acute and chronic immobility stress on the level of cortical and hippocampal oxidative stress indicators and memory impairment following global cerebral ischemia. In this study, 48 male Wistar rats were randomly divided into 6 groups: 1, sham (S); 2, sham-acute stress (SSA); 3, sham-chronic stress (SSC); 4, ischemia (IS); 5, ischemia-acute stress (ISA); 6, ischemia-chronic stress (ISC). The Morris water maze (MWM) test was performed 14 days after surgery, and cortisol levels and oxidative stress factors such as malondialdehyde MDA and total thiol were measured. In the MWM test, the time to find the platform (latency time) in the ISC and IS groups significantly increased compared to the S group. The time spent in the target quarter in these two groups was significantly reduced compared to the S group on the day of the probe. The results showed a significant increase in cortisol levels and malondialdehyde concentration in the ISA, ISC, and IS groups compared to the S group, but there was no significant difference in total thiol concentration. No significant difference was observed in the level of oxidative stress factors in the cortex. Chronic immobility stress could reduce antioxidant factors in the hippocampus and exacerbate memory impairment caused by global ischemia.

“Pediatric Spontaneous Intracranial Dissecting Aneurysms: Impact of Ischemic and Hemorrhagic Manifestations on Endovascular Treatment Strategies - Insights from a Developing World Setting”

Pediatric spontaneous intracranial dissecting aneurysms (IDA) are rare, but systematic studies comparing hemorrhagic and ischemic presentations are lacking. This study addresses gaps in understanding their epidemiology, clinical presentation, management, and outcome. A retrospective analysis of 23 pediatric patients with nontraumatic IDA treated between July 2018 and December 2023 was conducted. Patients were divided into two groups based on presentation: hemorrhagic (n=16) and ischemic (n=7). Clinical data were analyzed, including demographics, radiological findings, treatment modalities, and outcomes. Clinical presentations varied, with limb weakness being more prevalent in hemorrhagic cases (p=0.014), while headache and seizures were more common in ischemic cases. Angiographic analysis revealed distinct patterns, with hemorrhagic cases showing more distal involvement on vessel segments with stenosis and dilatation (pearl string sign). At the same time, the ischemic group exhibited the double-lumen sign. Various treatments, including microsurgery and endovascular techniques, were utilized, with perioperative complications observed, including one mortality in a hemorrhagic case. Multiple regression analysis identified significant risk factors for perioperative complications, namely, the configuration of the dissecting aneurysm (p=0.016) and the type of presentation (p=0.0006). Long-term Glasgow Outcome Scores were comparable, but patients with hemorrhagic manifestations experienced prolonged hospital and ICU stays (p=0.001). Pediatric intracranial dissecting aneurysms, particularly hemorrhagic cases, are associated with severe neurological deficits and higher perioperative complications. Despite similar long-term outcomes, hemorrhagic cases require prolonged hospitalization, increasing treatment costs. Optimizing management strategies for pediatric ICDAs, especially those with hemorrhagic features, is essential to improve outcomes and reduce healthcare expenditures.

Myocardial viability under various ischemic burdens in chronic total occlusions: A stress-cardiac magnetic resonance study

ObjectivesThis study aimed to analyze each myocardial segment's ischemic burden, scarring, function, and viability by late gadolinium enhancement (LGE) imaging and stress-MRI using adenosine. Materials and methodsSemi-quantitative and qualitative parameters of myocardial segments were obtained by stress-MRI. Moreover, segments without perfusion defect were defined as the no ischemic group, segments with a perfusion defect of ≤50% were defined as a low ischemic burden group, and segments with a perfusion defect of >50% were defined as a high ischemic burden group. “Segmental wall thickening (SWT)” was defined as the absolute difference between the end-diastolic and end-systolic wall thickness. Finally, viability was defined by dysfunctional myocardium (<3 ​mm segmental wall thickening [SWT]) and ≤50% late gadolinium enhancement (LGE). ResultsA total of 445 segments in the CTO territory were analyzed, scar tissue was found in the CTO territory, with LGE evident in 18.2% of CTO segments totaling >50%. Among the different ischemic burden groups, there were significant differences in LGE volume (p ​< ​0.01), and the trend of SWT was consistent with the degree of myocardial ischemia. The incidence of ≤50% LGE and viable myocardium was higher in segments of the no ischemia and low ischemic burden groups. However, there was no significant difference in the incidence of dysfunctional myocardial segments among the three groups (P ​> ​0.05). ConclusionsStress MRI parameters can accurately and detailly assess myocardial viability and function, so multi-parameter joint assessment of CTO patients by stress MRI may help in treatment decisions.

Profile of Stroke Patients Admitted to the Medicine Unit of Dhaka Medical College Hospital

Background &amp; objective: Stroke is a leading cause of death and a serious disability for adults. However, it is preventable and manageable, provided a complete updated profile (incidence, prevalence, and long-term outcome) of the disease is in our hands. The present study was therefore undertaken to assess the demographic, clinical characteristics, and outcome of the stroke patients admitted to the Dhaka Medical College Hospital. Methods: This descriptive cross-sectional study was conducted in the Department of Medicine, over a period of 12 months between January 2004 and December 2004 at the Dhaka Medical College Hospital (DMCH), Dhaka. The study sample consisted of 101 stroke patients who were admitted to the Green Medicine Unit of DMCH. However, stroke patients who were too severely debilitated or in a state of stupor were not allowed to participate in the study. Through pertinent clinical laboratory and imaging tests, stroke risk variables were evaluated. The outcome was evaluated in terms of the number of patients cured, died, or remained static. Result: There was no significant difference between ischemic and haemorrhagic stroke patients in terms of age (p = 0.658), sex (p = 0.276) and diurnal variation of its occurrence (p = 0.490). While diabetes mellitus and ischaemnic heart diseases were generally associated with haemorrhagic stroke (p = 0.039 and p = 0.056 respectively), hypertension was more or less common in ischemic stroke (p = 0.176). In both groups, hemiplegia was the most frequent cause of admission, after coma. While seizures were more common in the ischemia group, vomiting was a more common manifestation in the hemorrhagic group. The majority of patients in both groups maintained a steady pulse and normal blood pressure. The total cholesterol level was relatively greater in the ischemic group than in the hemorrhagic group. The mean HDL level in the hemorrhagic group was significantly higher than in the ischemic cohort. However, there was no appreciable difference in serum LDL and Tg levels across the groups. A substantial proportion of patients in both groups had to stay in the hospital for a brief period (10 or &lt; 10 days). After receiving treatment, nearly 85% of the patients in the hemorrhagic group and 76.3% of the patients in the ischemic group were cured; some 5.5% in the ischemic group and 4.3% in the haemorrhagic group died of the disease. Conclusion: The study concluded that smoking, uncontrolled hypertension, and diabetes mellitus are the three main risk factors for stroke. After a median treatment of 7 days, most patients in both the hemorrhagic and ischemic groups recovered, leaving a few to die of the disease. The risk of stroke can significantly be reduced by lowering blood pressure, treating diabetes, and giving up smoking. Ibrahim Card Med J 2023; 13 (1&amp;2): 47-52

Neuroradiological manifestations in hospitalized patients with COVID-19: An Italian national multicenter study on behalf of AINR (Associazione Italiana di Neuroradiologia) and SIRM (Società Italiana di Radiologia Medica).

This multicentric study aims to characterize and assess the occurrence of neuroradiological findings among patients with SARS-CoV-2 infection during the first Italian wave of the pandemic outbreak. Patients' data were collected between May 2020 and June 2020. Clinical and laboratory data, chest imaging, brain CT, and MRI imaging were included. Acquired data were centralized and analyzed in two hospitals: ASST Spedali Civili, Brescia, and IRRCS San Raffaele Research Hospital, Milan, Italy. COVID-19 patients were classified into two different subgroups, vascular and nonvascular. The vascular pattern was further divided into ischemic and hemorrhagic stroke groups. Four hundred and fifteen patients from 20 different Italian Centers were enrolled in the study. The most frequent symptom was focal neurological deficit, found in 143 patients (34.5%). The most frequent neuroradiological finding was ischemic stroke in 122 (29.4%) patients. Forty-four (10.6%) patients presented a cerebral hemorrhage. Forty-seven patients had non-stroke neuroimaging lesions (11.3%). The most common was PRES-like syndrome (28%), SWI hypointensities (22%), and encephalitis (19%). The stroke group had higher CAD risk (37.5% vs 20%, p = .016) and higher D-dimer levels (1875ng/mL vs 451ng/mL, p < .001) compared to the negative group. Our study describes the biggest cohort study in Italy on brain imaging of COVID-19 patients and confirms that COVID-19 patients are at risk of strokes, possibly due to a pro-thrombotic microenvironment. Moreover, apart from stroke, the other neuroradiological patterns described align with the ones reported worldwide.

Efficacy of Human Recombinant Growth Hormone in Females of a Non-Obese Hyperglycemic Mouse Model after Birth with Low Birth Weight.

We examined whether the administration of growth hormone (GH) improves insulin resistance in females of a non-obese hyperglycemic mouse model after birth with low birth weight (LBW), given that GH is known to increase muscle mass. The intrauterine Ischemia group underwent uterine artery occlusion for 15 min on day 16.5 of gestation. At 4 weeks of age, female mice in the Ischemia group were divided into the GH-treated (Ischemia-GH) and non-GH-treated (Ischemia) groups. At 8 weeks of age, the glucose metabolism, muscle pathology, and metabolome of liver were assessed. The insulin resistance index improved in the Ischemia-GH group compared with the Ischemia group (p = 0.034). The percentage of type 1 muscle fibers was higher in the Ischemia-GH group than the Ischemia group (p < 0.001); the muscle fiber type was altered by GH. In the liver, oxidative stress factors were reduced, and ATP production was increased in the Ischemia-GH group compared to the Ischemia group (p = 0.014), indicating the improved mitochondrial function of liver. GH administration is effective in improving insulin resistance by increasing the content of type 1 muscle fibers and improving mitochondrial function of liver in our non-obese hyperglycemic mouse model after birth with LBW.

Investigating the Pharmacological Mechanisms of Total Flavonoids from Eucommia ulmoides Oliver Leaves for Ischemic Stroke Protection.

The aim of this study was to explore how the total flavonoids from Eucommia ulmoides leaves (EULs) regulate ischemia-induced nerve damage, as well as the protective effects mediated by oxidative stress. The cell survival rate was significantly improved compared to the ischemic group (p < 0.05) after treatment with the total flavonoids of EULs. The levels of reactive oxygen species (ROS), lactate dehydrogenase (LDH), and malondialdehyde (MDA) decreased, while catalase (CAT) and glutathione (GSH) increased, indicating that the total flavonoids of EULs can significantly alleviate neurological damage caused by ischemic stroke by inhibiting oxidative stress (p < 0.01). The mRNA expression level of VEGF increased (p < 0.01), which was consistent with the protein expression results. Meanwhile, the protein expression of ERK and CCND1 increased (p < 0.01), suggesting that the total flavonoids of EULs could protect PC12 cells from ischemic injury via VEGF-related pathways. MCAO rat models indicated that the total flavonoids of EULs could reduce brain ischemia-reperfusion injury. In conclusion, this study demonstrates the potential mechanisms of the total flavonoids of EULs in treating ischemic stroke and their potential therapeutic effects in reducing ischemic injury, which provides useful information for ischemic stroke drug discovery.

Dobutamine stress cardiac magnetic resonance-feature tracking in assessment of myocardial ischemia and viability

BackgroundCardiovascular magnetic resonance-feature tracking (CMR-FT) is a novel quantitative objective noninvasive technique in the assessment of myocardial deformation. The purpose of that study was to assess the capability of the CMR-FT in the detection of myocardial ischemia and viability. We investigated 30 patients (n = 480 myocardial segments), with known or suspected coronary artery disease (CAD). Dobutamine stress cardiovascular magnetic resonance (DS-CMR) and late gadolinium enhancement (LGE) were used to identify the viable non-ischemic, ischemic, and non-viable myocardial segments. Cine images at rest were used to calculate the segmental radial (Err), circumferential (Ecc), and longitudinal (Ell) strain parameters by manual contouring of endocardial and epicardial borders using Segment Software.ResultsOf the 480 myocardial segments and based on the DS-CMR and LGE results, 338 segments were defined as viable non-ischemic (remote), 101 segments were viable ischemic, and 41 segments were non-viable. Rest segmental Ecc, Err, and Ell values were significantly impaired in the non-viable (mean ± SD = − 3.94 ± 4.99%, 11.81 ± 12.55%, and − 7.50 ± 6.96%, respectively) compared to both viable groups, p < 0.001. Ecc and Err significantly differentiated between the non-ischemic and ischemic groups (mean ± SD = − 19.14 ± 7.20% vs − 13.18 ± 8.57% and 44.03 ± 19.56% vs 32.79 ± 17.91% respectively), p < 0.001. However, Ell showed no statistical significance between them (mean ± SD = − 16.44 ± 8.78% vs − 16.12 ± 10.00%, p = 0.945).ConclusionsCMR-FT can differentiate between viable and non-viable as well as ischemic and non-ischemic myocardial segments. So, such a noninvasive technique has a promising additional objective diagnostic role in conjunction with CMR in ischemia and viability assessment or even may replace stress and LGE studies in the future.

Neuropeptide W protects against ovarian oxidative injury and reinforces ovarian steroidogenic activity via the upregulation of ERα expression.

The aim of this study was to investigate the protective effect of neuropeptide W (NPW) on ovarian ischemia-reperfusion-induced oxidative injury and ovarian steroid metabolism. Rats were randomly divided into control and ischemia groups that received either saline or NPW (0.1 or 5 μg/kg/day). Bilateral ovarian ischemia was performed for 3 h followed by a 72-h reperfusion. Blood, ovary, and uterus samples were collected for biochemical and histological assessments. Treatment with either dose of NPW alleviated oxidative injury of the ovaries with a significant suppression in free radical formation and decreased histopathological injury in both the ovarian and uterine tissues, along with reduced lipid peroxidation and neutrophil accumulation in the uterus. Moreover, NPW treatment reversed the decrease in aromatase expression with a concomitant reduction in the expression of the inactivity enzyme estrogen sulfotransferase. Also, downregulation of estrogen receptor-α (ERα) expression in the injured ovarian tissue was abolished by NPW treatment, which implicates that the protective effect of NPW on the female reproductive system may involve the upregulation of the ERα-mediated signaling pathway. Our study demonstrated for the first time that NPW protects against ovarian oxidative injury and reinforces ovarian steroidogenic activity, which is accompanied by the upregulation of ERα expression in the ovaries.

Selective estrogen receptor activation prior to global cerebral ischemia in female rats impacts microglial activation and anxiety-like behaviors without effects on CA1 neuronal injury

Estrogen receptor (ER) activation by 17-ß estradiol (E2) can attenuate neuronal injury and behavioral impairments following global cerebral ischemia (GCI) in rodents. This study sought to further examine the discrete roles of ERs through characterization of the effects of selective ER activation on post-ischemic pro-inflammatory microglial activation, hippocampal neuronal injury, and anxiety-like behaviors. Forty-six ovariectomized (OVX) adult female Wistar rats received daily s.c injections (100 μg/kg/day) of propylpyrazole triol (PPT; ERα agonist), diarylpropionitrile (DPN; ERβ agonist), G-1 (G-protein coupled ER agonist; GPER), E2 (activating all receptors), or vehicle solution (VEH) for 21 days. After final injection, rats underwent GCI via 4-vessel occlusion (n=8 per group) or sham surgery (n=6, vehicle injections). The Open Field Test (OFT), Elevated Plus Maze (EPM), and Hole Board Test (HBT) assessed anxiety-like behaviors. Microglial activation (Iba1, CD68, CD86) in the basolateral amygdala (BLA), CA1 of the hippocampus, and paraventricular nucleus of the hypothalamus (PVN) was determined 8 days post-ischemia. Compared to sham rats, Iba1 activation and CA1 neuronal injury were increased in all ischemic groups except DPN-treated rats, with PPT-treated ischemic rats also showing increased PVN Iba1-ir expression. Behaviorally, VEH ischemic rats showed slightly elevated anxiety in the EPM compared to sham counterparts, with no significant effects of agonists. While no changes were observed in the OFT, emotion regulation via grooming in the HBT was increased in G-1 rats compared to E2 rats. Our findings support selective ER activation to regulate post-ischemic microglial activation and coping strategies in the HBT, despite minimal impact on hippocampal injury.

Is there a faster and easier method for assessing the severity of acute mesenteric ischemia?

Acute mesenteric ischemia (AMI) is a potentially fatal abdominal emergency. The estimation of the severity of AMI is of great importance since changes in disease severity may have different impacts on the treatment options. This study aims to define laboratory and radiological parameters that can successfully predict the severity of AMI. Data from 100 patients who were treated conservatively and underwent an operation with a diagnosis of AMI between the years 2010 and 2019 were reviewed. The patients were divided into 3 groups as those treated with a conservative approach (group 1), those with partial intestinal ischemia (group 2), and those with complete intestinal ischemia (group 3) according to the pathology results. Laboratory findings of the patients were recorded and matched with radiological findings. The white blood cell (WBC) count, neutrophil (NEUT) count, neutrophil/lymphocyte ratio, and C-reactive protein/albumin ratios were the considered distinctive parameters for distinguishing the third group from the first group. However, the same result cannot be applied to the first and the second groups since only the WBC and NEUT counts showed distinctive performance. The measurement of neutrophil/lymphocyte ratio, WBC, NEUT, and albumin levels can be used to predict the severity of AMI. We believe that evaluating these laboratory parameters will greatly prevent possible morbidity and mortality in the patient. Also, we were able to observe that the parameters used in predicting AMI severity can be verified with rapid and low-cost radiological imaging techniques.

Ischaemic and haemorrhagic risk distribution in real-life patients with acute coronary syndromes

Background Effective treatment of non-ST-segment elevation acute coronary syndromes (NSTEACS) requires careful assessment of both ischaemic and bleeding risks. We aimed to analyse risk distribution and evaluate antiplatelet prescription behaviours in real-life settings. Methods Data from 1100 NSTEACS patients in Buenos Aires, Argentina, from the Buenos Aires I Registry, with a 15-month follow-up, were analysed. In-hospital and 6-month GRACE scores, CRUSADE, and Precise DAPT scores were calculated. Results The mean age was 65.4 ± 11.5 years with a majority being male (77.2%). In-hospital mortality was 2.7%, primarily due to cardiovascular causes (1.8%). Bleeding events occurred in 20.9% of patients, with 4.9% classified as ≥ BARC 3. Predominance of low bleeding (71.3%) and ischaemic (55.8%) risks on admission was observed. At 6 months, the low-risk Precise category (70.9%) and GRACE (44.1%) categories prevailed. Linear correlation analysis showed a moderately positive correlation (r = 0.61, p < .05) between ischaemic–haemorrhagic risks. Regarding the prescription of antiplatelet agents, in the low ischaemic–haemorrhagic risk group, there was a predominance of aspirin + clopidogrel (41.2%) over other high-potency antiplatelet regimens (aspirin + ticagrelor or prasugrel). In the low ischaemic and high haemorrhagic risk group, aspirin and clopidogrel were also predominant (58%). Conclusions Our analysis underscores the significant relationship between ischaemic and haemorrhagic risks during NSTEACS hospitalisation. Despite the majority of patients falling into the low-intermediate risk category, the prescription of P2Y12 inhibitors in real-life settings does not consistently align with these risks.

Scar tissue characterization to predict arrhythmia recurrence in patients undergoing ventricular tachycardia ablation: cardiac computed tomography compared with cardiac magnetic resonance

Abstract Background The role of imaging in evaluating patients undergoing ventricular tachycardia (VT) ablation is crucial for planning, procedural success, and clinical outcomes. In daily practice, cardiac computed tomography (CCT) assessing wall thinning and late iodine uptake (LI) and cardiac magnetic resonance (CMR) assessing late-gadolinium enhancement (LGE) are most commonly implemented. However, data comparing the two imaging modalities for scar tissue characterization is scarce. Aims To compare the performance of both imaging modalities for scar tissue characterization in ischemic (ICM) and non-ischemic (NICM) patients undergoing VT ablation and predict procedural outcomes. Methods In a retrospective analysis, consecutive patients undergoing both CCT and LGE-CMR before scheduled VT ablation were included. The presence and extent of scar was assessed by means of each imaging modality using dedicated softwares (MUSIC and ADAS). To compare scar distribution and agreement between the two modalities, a scar classification scheme was used for all 17 AHA segments: 0 points (no scar present), 1 point (scar &amp;lt;50% of total segment area), 2 points (scar representing 50-99% of total segment area) or 3 points (scar present in 100% of the segment area).&amp;lt;scar&amp;lt;100%)&amp;gt;&amp;lt;scar&amp;lt;100%&amp;gt; Results 36 patients (67±10 years; 97% male; LVEF 39±10%; 72% ischemic) undergoing CCT and LGE-CMR before scheduled VT ablation were included. In the ICM group, mean detected scar burden was higher than in the NICM group on LGE-CMR (total volume: 62.3±32.9g vs. 32.8±9.5g, p&amp;lt;0.001), using wall thinning model (WT)(mean scar area 69.0±45.6 cm2 vs. 23.4±23.6cm2, p=0.005) as well as LI (dense scar area: 39.2±28.1 cm2 vs. 11.0±6.3 cm2 , p=0.005). The absolute score difference per segment and patient between CCT and LGE-CMR was calculated and summed for all patients divided by the number of patients. Differences were more pronounced for NICM compared to ICM and LGE-CMR showed better concordance to LI than WT in both NICMP and ICM (Figure). Total procedure time was 205±68 min (ablation time 28±16 min; fluoroscopy time 15 ± 12 min). During a follow-up period of 19±7 months, 87 sustained VT episodes in 12 patients (33%) were documented. Three patients (8%) underwent a second VT ablation and one patient (3%) died during follow-up. In ICM, total scar volume on LGE-CMR and scar area on LI showed numerically higher predictive value for VT recurrence than total scar area by means of WT (AUC: LGE 0.76, LI 0.78 and WT 0.65 respectively), while in NICM scar characterization by means of WT yielded higher performance to predict VT recurrence than LI or LGE-CMR (AUC: LGE 0.67, LI 0.58, WT 0.83 respectively). Conclusions In patients undergoing VT ablation, both LGE-CMR and CCT are valuable for scar tissue characterization. Late iodine uptake on CCT showed a high concordance with LGE-CMR in both NICM and ICM.&amp;lt;/scar&amp;lt;100%&amp;gt;&amp;lt;/scar&amp;lt;100%)&amp;gt;