Spasm Group Research Articles

Correlation between bony structures of the posterior cranial fossa and the occurrence of hemifacial spasm.

To quantitatively study the measurement data related to the bony posterior cranial fossa and explore the correlation between bony posterior cranial fossa morphology and the occurrence of hemifacial spasm. A total of 50 patients with hemifacial spasm who attended the Department of Neurosurgery of China-Japan Friendship Hospital from October 2021 to February 2022 were included, and 60 patients with minor head trauma excluding skull fracture and intracranial abnormalities were included as controls. Cranial multilayer spiral CTs (MSCTs) were performed in both groups, and multiplanar reconstruction (MPR) was used as a postprocessing method to measure data related to the posterior cranial fossa in both groups. Compared with the control group, the anteroposterior diameter (labeled AB) and the height (labeled BE) of the bony posterior cranial fossa, the anteroposterior diameter of the foramen magnum (labeled BC), the length of the clivus (labeled AB), and the length of the posterior occipital (labeled CD) in the HFS group were all reduced, and the differences were statistically significant. BE is positively correlated with AB and CD, with a stronger correlation observed between BE and AB (r = 0.487, p < 0.01). AB is negatively correlated with AD (r = -0.473, p < 0.01). The remaining correlations between the data were not statistically significant. There was no overlap in the 95% confidence interval for any of the measurements between the hemifacial spasm group and the control group. There is a correlation between the posterior cranial fossa and hemifacial spasm.

Assessment of Depression and Anxiety After Botulinum Toxin Injection Treatment in Patients with Hemifacial Spasm and Blepharospasm

Objective: The aim of this study was to investigate the relationship between depression and anxiety due to the current clinical situation, disease duration and age, and the change in post-treatment parameters in patients with hemifacial spasm (HS) and blepharospasm (BS) receiving botulinum toxin therapy (BTT). Materials and methods: 125 hemifacial spasm patients, 14 blepharospasm patients and 70 healthy volunteers were included in the study as control group. Beck depression and Beck anxiety scales were applied to the patient and control groups. The test was repeated in the patient group 4 weeks after BTT treatment. Results: The Beck anxiety and Beck depression scale scores of the case group were higher before treatment compared to the control group. Beck anxiety and Beck depression scores decreased after treatment in both HS and BS patients. Among the groups, the post-treatment Beck Anxiety score in the blepharospasm group was statistically significantly lower than in the hemifacial spasm group. The depression scale score increased with increasing disease duration in the case group. Anxiety and depression scores were lower in older patients. Beck depression and Beck anxiety scores of the patients improved with BTT treatment. Conclusion: Since HS and BS cause physical problems in the facial muscles, it also negatively affects the functional status and emotional state of the patients. This disease is often accompanied by anxiety and/or depression. After CT treatment, functional muscle problems are corrected in HS and BS patients, providing positive effects on mood as well as the treatment of the disease and correcting the anxiety and depression findings related to the disease.

A nomogram model for the occurrence of bladder spasm after TURP in patients with prostate enlargement based on serum prostacyclin and 5-hydroxytryptamine and clinical characteristics.

With the development of analytical methods, mathematical models based on humoral biomarkers have become more widely used in the medical field. This study aims to investigate the risk factors associated with the occurrence of bladder spasm after transurethral resection of the prostate (TURP) in patients with prostate enlargement, and then construct a nomogram model. Two hundred and forty-two patients with prostate enlargement who underwent TURP were included. Patients were divided into Spasm group (n=65) and non-spasm group (n=177) according to whether they had bladder spasm after surgery. Serum prostacyclin (PGI2) and 5-hydroxytryptamine (5-HT) levels were measured by enzyme-linked immunoassay. Univariate and multivariate logistic regression were used to analyze the risk factors. Postoperative serum PGI2 and 5-HT levels were higher in patients in the Spasm group compared with the Non-spasm group (P<0.05). Preoperative anxiety, drainage tube obstruction, and elevated postoperative levels of PGI2 and 5-HT were independent risk factors for bladder spasm after TURP (P<0.05). The C-index of the model was 0.978 (0.959-0.997), with a χ2 = 4.438 (p = 0.816) for Hosmer-Lemeshow goodness-of-fit test. The ROC curve to assess the discrimination of the nomogram model showed an AUC of 0.978 (0.959-0.997). Preoperative anxiety, drainage tube obstruction, and elevated postoperative serum PGI2 and 5-HT levels are independent risk factors for bladder spasm after TURP. The nomogram model based on the aforementioned independent risk factors had good discrimination and predictive abilities, which may provide a high guidance value for predicting the occurrence of bladder spasm in clinical practice.

Does the intracoronary pressure differ according to two types (diffuse or focal) of coronary spasm?

Several reports show that two types of coronary vasospasm (diffuse and focal spasm) are associated with the severity or prognosis of coronary spasm in patients with vasospastic angina (VSA). It is unclear whether intracoronary pressure differs between the two spasm types. To investigate such relationships using a pressure wire during the spasm provocation test (SPT) in patients with VSA. Eighty-seven patients with VSA (average age: 67 years; 50 men, 37 women) underwent SPT. During the SPT, a pressure wire was advanced into the distal portion of the right coronary artery and left anterior descending coronary artery, and the ratio of the intracoronary pressure to the aortic pressure (Pd/Pa) was continuously monitored. An SPT was performed using acetylcholine (ACh), and the presence of coronary spasm was defined as the presence of > 90% arterial narrowing in response to an ACh infusion, with the usual chest symptoms and/or ischemic ECG changes. Focal spasm was defined as total or subtotal spasm within one segment of the AHA classification, while diffuse spasm was defined as > 90% spasm with two or more segments. Among 87 patients, the frequencies of metabolic syndrome and having coronary atherosclerosis were higher in the focal group (n = 33) than in the diffuse spasm group (n = 54, P < 0.05). In the vessel analyses, in these 134 spastic segments, diffuse and focal spasms were detected in 100 and 34 vessels, respectively. The Pd/Pa at baseline was similar in both groups (diffuse: 0.96 ± 0.05, focal: 0.95 ± 0.05, P = 0.35); however, the Pd/Pa during coronary spasm was lower in focal spastic vessels (0.66 ± 0.20) than in diffuse spastic vessels (0.76 ± 0.11, P < 0.01), and the reduction in Pd/Pa during an SPT was also lower in focal spastic vessels (-0.29 ± 0.20) than in diffuse spastic vessels (-0.18 ± 0.11, P < 0.01). The presence of focal spasm was a significant factor responsible for reduction in Pd/Pa during SPT. These findings suggest that focal spasm may be more severe than diffuse spasm, judging from the intracoronary pressure during coronary spasm.

Increased cerebrospinal fluid S100B protein levels in patients with trigeminal neuralgia and hemifacial spasm.

The pathophysiology of neurovascular compression syndrome has not been fully elucidated, and cerebrospinal fluid levels of nerve tissue-related markers involved in this disorder have not yet been reported. We measured cerebrospinal fluid levels of S100B protein, neuron-specific enolase, and myelin basic protein in 21 patients with trigeminal neuralgia, 9 patients with hemifacial spasms, and 10 patients with non-ruptured intracranial aneurysms (control). Cerebrospinal fluid levels of these markers were determined using commercially available assay kits. Both trigeminal neuralgia and hemifacial spasm groups showed significantly increased cerebrospinal fluid levels of S100B compared with the control group (1120 [IQR 391-1420], 766 [IQR 583-1500], and 255 [IQR 190-285] pg/mL, respectively; p = 0.001). There were no statistically significant differences in cerebrospinal fluid levels of neuron-specific enolase or myelin basic protein among the groups. Cerebrospinal fluid S100B levels were significantly higher in patients with trigeminal neuralgia and hemifacial spasm than in controls, which suggests the involvement of S100B in the underlying pathophysiology of neurovascular compression syndrome.

Association Study of Apolipoprotein E Gene Polymorphism With Incidence and Delayed Resolution of Hemifacial Spasm.

Objective: This study investigates the correlation between Apolipoprotein E gene (APOE) polymorphism and the incidence and delayed resolution of hemifacial spasms.Methods: The APOE genotypes of 151 patients with hemifacial spasm and 73 control cases were determined by cleaved amplification polymorphism sequence-tagged sites. The distribution of three APOE alleles (ε2, ε3, and ε4) in two groups and the delayed resolution rate in 6 genotypes were calculated and statistically analyzed.Results: The proportion of patients with APOE ε3/ε4 genotype in the hemifacial spasm group (25.17%) was significantly higher than that in the control group (12.33%) (P = 0.027). In terms of allele frequency, the proportion of the APOE ε4 allele in the hemifacial spasm group (15.56%) was significantly higher than that in the control group (6.85%) (P = 0.009). Meanwhile, the proportion of APOE ε4 allele carriers in the hemifacial spasm group (29.80%) was significantly higher than that in the control group (13.7%) (P = 0.009). Logistic regression analysis showed that the ε4 allele significantly increased the incidence of hemifacial spasm (OR 2.675, 95%CI 1.260-5.678, P = 0.010). Among the 32 patients with a delayed resolution, the ε3/ε3 and ε3/ε4 had the highest proportion in 6 genotypes. The delayed resolution rate of APOE ε3/ε4 (34.21%) was significantly higher than APOE ε3/ε3 (17.78%) (P < 0.05). The delayed resolution rate of APOE ε4 carriers was the highest (33.33%) in the 3 allele carriers, but there was no significant difference among the 3 allele carriers (P = 0.065).Conclusion: The polymorphism of APOE is relevant to the incidence rate of hemifacial spasms. APOE ε4 allele increases the incidence of hemifacial spasm. The APOE ε4 allele may promote the occurrence of delayed resolution.

Evaluation of 40 hemifacial spasm patients with MR angiography of the brain and vertebral artery dominance in the etiology of hemifacial spasm

Objectives: Hemifacial spasm is characterised by involuntary, rhythmic, tonic or clonic contractions originating from the facial nerve and occurring intermittently in unilateral facial muscles. The most commonly reported cause of hemifacial spasm is the compression of the facial nerve at its root exit/ entry zone by an ectatic or aberrant blood vessel, leading to local demyelination. In this study, we compared magnetic resonance angiography (MRA) findings from patients with hemifacial spasm and controls to determine whether vertebral artery dominance is part of the aetiology of this condition. Methods: This retrospective case-control study was conducted with data from 40 patients with hemifacial spasm who received botulinum toxin injections and for whom MRA findings were accessible, and 42 patients of similar age and sex who presented with symptoms of nonspecific headache in the outpatient neurology clinic. Magnetic resonance imaging and unenhanced time-of-flight MRA examinations from the study and control groups were evaluated. Results: A dominant vertebral artery was present in 52.2% of patients in the hemifacial spasm group and 33.3% of those in the control group, but this difference was not significant (p = 0.079). Conclusions: The lack of significant results supporting our hypothesis may be attributable to the small study population. Further studies with larger groups are warranted.

Risk factors for recurrence after drug withdrawal in childhood epilepsy

BackgroundSeveral studies have been conducted to determine the risk of recurrence after withdrawal of antiepileptic drugs (AEDs) in recent years. There is no consensus concerning the circumstances affecting discontinuation of AEDs. This study was designed to determine the recurrence rate of epilepsy after withdrawal of AEDs and the risk factors related with recurrence. MethodsChildren with epilepsy onset between 1 month and 16 years of age who were followed up at least 3 years after AED treatment withdrawal were enrolled. Patients were classified into groups according to defined risk factors for recurrence. ResultsA total of 284 patients, 137 (48.2%) girls and 147 (51.8%) boys were included, and seizures recurred after withdrawal in 51 patients (18%). Thirty-three (64.7%) patients had recurrence in the first year after withdrawal. The recurrence risk was calculated based on the electro-clinical syndromes classification; the recurrence risk was the highest in the juvenile myoclonic/absence group and lowest in the benign infantile seizure group. No recurrence was observed in the infantile spasm group. Data evaluated by multivariable analysis showed that having the structural-metabolic and unknown epilepsy and <3 years seizure free period before withdrawal of AEDs were the main risk factors for recurrence after AED withdrawal in our study. ConclusionWe suggest a seizure-free period of at least 3 years under AED medication and we must be cautious in patients with structural-metabolic and unknown epilepsy before AED withdrawal.

Study on the relationship between preoperative evaluation, operation and prognosis of microvascular decompression for the treatment of hemifacial spasm

Objective: To investigate the relationship between preoperative evaluation, surgery and prognosis of microvascular decompression (MVD) for the treatment of hemifacial spasm (HFS). Methods: The clinical data of 128 HFS patients treated with MVD in the department of neurosurgery of Taizhou Hospital of Zhejiang Province were retrospectively analyzed. According to the SMC grading system, the patients were divided into general spasm group and severe spasm group, and the clinical characteristics, offending vessel, prognosis and surgical complications of the two groups were compared. Results: In the general spasm group,the age at MVD was (48.6±10.6) years, the disease duration was (4.2±3.3) years;while in the severe spasm group,the age at MVD was (51.8±9.9) years, the disease duration was (8.1±4.5) years;the differences of age and disease duration between the two groups were statistically significant (P<0.05).In the general spasm group, there were 41 cases in which the offending vessel were AICA, 21 cases were PICA, 1 case was VA, 63 cases were single offending vessel, and 7 cases were multiple offending vessels. In the severe spasm group, there were 29 cases in which the offending vessel were AICA, 13 cases were PICA, 2 cases were VA, the total of 44 cases were single offending vessel and 14 cases were multiple offending vessels.There was a significant difference in the proportion of multiple offending vessels in the two groups, and the difference was statistically significant (P<0.05).Patients in the two groups were followed up for 12 to 32 months after surgery, and the difference in effective rate and recurrence rate was not statistically significant (P>0.05).Some kinds of postoperative complications were different between the two groups, the incidence of postoperative delayed facial paralysis was statistically significant (P<0.05), and the other complications were not statistically significant (P>0.05). Conclusion: Compared with the general spasm group, the patients in the severe spasm group were older, with longer disease duration, higher probability of multiple offending vessels and higher incidence of postoperative delayed facial paralysis. Therefore, preoperative SMC grading is helpful for the evaluation and prediction of intraoperative and postoperative conditions, which is worthy of wide clinical application.

Histidine-rich Glycoprotein Could Be an Early Predictor of Vasospasm after Aneurysmal Subarachnoid Hemorrhage.

Cerebral vasospasm (CVS) is a major contributor to the high morbidity and mortality of aneurysmal subarachnoid hemorrhage (aSAH) patients. We measured histidine-rich glycoprotein (HRG), a new biomarker of aSAH, in cerebrospinal fluid (CSF) to investigate whether HRG might be an early predictor of CVS. A total of seven controls and 14 aSAH patients (8 males, 6 females aged 53.4±15.4 years) were enrolled, and serial CSF and serum samples were taken. We allocated these samples to three phases (T1-T3) and measured HRG, interleukin (IL)-6, fibrinopeptide A (FpA), and 8-hydroxy-2'-deoxyguanosine (8OHdG) in the CSF, and the HRG in serum. We also examined the release of HRG in rat blood incubated in artificial CSF. In contrast to the other biomarkers examined, the change in the CSF HRG concentration was significantly different between the nonspasm and spasm groups (p<0.01). The rat blood/CSF model revealed a time course similar to that of the human CSF samples in the non-spasm group. HRG thus appears to have the potential to become an early predictor of CVS. In addition, the interaction of HRG with IL-6, FpA, and 8OHdG may form the pathology of CVS.

The multi-vessel and diffuse coronary spasm is a risk factor for persistent angina in patients received anti-angina medication.

Coronary artery spasm (CAS) is known to be a risk factor for cardiovascular events. However, there is limited data whether the multi-vessel and diffuse spasm (MVDS) is related to more adverse clinical outcomes compared to the Non-MVDS. The aim of this study is to evaluate the impact of the MVDS on clinical outcomes during a 3-year clinical follow-up period.A total 2797 patients underwent coronary angiography (CAG) with acetylcholine (ACH) provocation test from Nov 2004 to Oct 2010 were enrolled. It is a single-center, observational, prospective, all-comers registry designed to reflect the “real world” practic. The patients were divided into the 3 groups; the negative spasm (NS) group (n = 1188), the Non-MVDS group (n = 1081), and the MVDS group (n = 528). The incidence of major adverse cardiac events (MACE) and recurrent angina was evaluated up to 3 years. To minimize confounding factors, multivariable Cox-proportional hazards regression analysis was performed.In the 3-year clinical follow-up, the incidence of total death, myocardial infarction, de novo percutaneous coronary intervention (PCI), cerebrovascular accident and MACE were similar among the 3 groups. However, recurrent angina occurred more frequently in the MVDS group than in the NS group (hazard ratio [HR], 1.96; 95% confidence interval [CI], 1.27–3.02; P = .002). Recurrence angina between the MVDS group and the Non-MVDS group was not statistically significant (HR, 1.36; 95% CI, 0.91–2.03; P = .129).In this study, although the incidence of major adverse cardiovascular events were not different regardless of spasm type, the MVDS was associated with higher incidence of recurrent chest pain requiring repeat CAG during the 3-year follow-up period, suggesting more intensive optimal medical therapy with close clinical follow up would be necessary for this particular subset of patients.

Post-stroke Upper Limb Spasticity Incidence for Different Cerebral Infarction Site.

ObjectiveThe purpose of this study was to evaluate the incidence rate of post-stroke upper limb spasticity and its correlation with cerebral infarction site.MethodsA total of 498 inpatient and outpatient cases are included in the present study. The post-stroke upper limb spasticity rate of different cerebral infarction site was calculated.ResultsA total of 498 patients with cerebral infarction are enrolled in this study. Of these patients, 91 have dropped out and 407 have completed the study. Of the completed cases, 172 are in the spasm group and 235 are in the non-spasm group. The total incidence of upper limb spasticity is 34.5%. The incidences of upper extremity spasms are 12.5%, 20%, 22.5%, 35%, 40%, and 42.5% in 2 weeks, 1 month, 2 months, 3 months, 6 months, and 12 months, respectively. The incidence of upper extremity spasms increases with time. The incidences of upper limb spasticity are 12.1%, 63.3%, 58.5%, 9.4% and 8.3% when cerebral infarction occurs in the cortical and subcortical mixed areas, basal ganglia and internal capsule, cerebralcortex, brainstem and cerebellum respectively. The incidence of upper limb spasticity varies in different infarction sites (P < 0.05).ConclusionThe post-stroke upper limb spasticity rates were different according to the different cerebral infarction site. Patients with the ganglia and internal capsule infarctions had the highest risk of developing post-stroke upper limb spasticity.

Investigation of short-term resolution as a predictor of long-term cure of microvascular decompression in hemifacial spasm

Objective: To investigate whether the short-term relief of spasm (within 7 days) after microvascular decompression (MVD) for hemifacial spasm (HFS) can be used as a prognostic factor of long-term outcome (>6 months). Methods: The clinical characteristics and follow-up data (completely recorded) of 159 patients who had HFS and underwent microvascular decompression surgery in the first Affiliated Hospital of Fujian Medical University from August 2008 to May 2016 were analyzed retrospectively. The collected data focus on symptom relief in a time course: immediately after MVD, 7 days after MVD and the last follow-up (>6 months) by using Cohen-Albert grading. Results: In a total of 159 patients underwent MVD were followed up for more than 6 months.Compared to persist spasm group within 7 days after MVD, the cure rate was significantly higher in the spasm symptom relief group within 7 days after MVD (P<0.05). The cure rate of MVD (y) and the number of days within 7 days of relief (x) were highly relevant, y=-0.707x(2)+ 9.724x+ 67.442 (P<0.05). By using univariate Logistic regression analysis, we found that the prognostic factors of long-term curative effect were the symptom scale immediately after MVD and the average symptom scale in the 7 days after MVD (P<0.001). The incidence of delayed cure was 41.5%(66/159). Conclusion: In the 7 days after MVD, at least 1 day of symptom remission can predict the cure of HFS.

Decreased serum sodium levels predict symptomatic vasospasm in patients with subarachnoid hemorrhage

Background: Symptomatic vasospasm is a major cause of morbidity and mortality in subarachnoid hemorrhage patients. Hyponatremia and dehydration due to natriuresis after subarachnoid hemorrhage are related to symptomatic vasospasm. Therefore, most institutions are currently targeting euvolemia and eunatremia in subarachnoid hemorrhage patients to avoid complications. We retrospectively investigated the predictors of symptomatic vasospasm with respect to water and sodium homeostasis, while maintaining euvolemia and eunatremia after subarachnoid hemorrhage. Methods: We monitored changes in serum sodium levels, serum osmolarity, daily sodium intake, daily urine volume, and daily water balance for 14days after subarachnoid hemorrhage. Outcomes were assessed using the modified Rankin scale at 1month after subarachnoid hemorrhage. Results: Among 97 patients, 27 (27.8%) had symptomatic vasospasm. Patients with symptomatic vasospasm were older than those without symptomatic vasospasm; the occurrence of symptomatic vasospasm affected outcomes. Serum sodium levels were sequentially significantly decreased, but within the normal range from 1day before the occurrence of symptomatic vasospasm. Serum osmolarity of the spasm group was lower than that of the non-spasm group. Conclusions: Symptomatic vasospasm occurs more often in older patients and affects outcomes. A decrease in serum sodium levels occurs a day before symptomatic vasospasm. This observation may help predict symptomatic vasospasm.

Use of Alleviating Maneuvers for Periocular Facial Dystonias

Patients with benign essential blepharospasm or hemifacial spasm are known to use botulinum toxin injections and alleviating maneuvers to help control their symptoms. The clinical correlates between the use of botulinum toxin injections and the use of alleviating maneuvers are not well established. To determine whether the use of alleviating maneuvers for benign essential blepharospasm or hemifacial spasm correlates with disease severity or botulinum toxin treatment. A prospective cross-sectional observational study (designed in September 2013) of 74 patients with benign essential blepharospasm and 56 patients with hemifacial spasm who were consecutively recruited from adnexal clinics at Moorfields Eye Hospital (January-June 2014) to complete a questionnaire and undergo a clinical review. Data analysis was performed in December 2015. Prevalence and type of alleviating maneuvers used for blepharospasm and hemifacial spasm, dystonia severity, and dose and frequency of botulinum toxin injections. Of the 74 patients with blepharospasm, 39 (52.7%) used alleviating maneuvers (mean [SD] age, 70.4 [9.1] years); of the 56 patients with hemifacial spasm, 25 (44.6%) used alleviating maneuvers (mean [SD] age, 66.5 [12.7] years). The most commonly used maneuver was the touching of facial areas (35 of 64 patients [54.7%]); other maneuvers included covering the eyes (6 of 64 patients [9.4%]), singing (5 of 64 patients [7.8%]), and yawning (5 of 64 patients [7.8%]). Patients with blepharospasm who used alleviating maneuvers scored higher on the Jankovic Rating Scale (median score, 5 vs 4; Hodges-Lehmann median difference, 1 [95% CI, 0-2]; P = .01) and the Blepharospasm Disability Index severity score (median score, 11 vs 4; Hodges-Lehmann median difference, 4 [95% CI, 1-7]; P = .01) than patients with blepharospasm who did not use alleviating maneuvers. Patients with hemifacial spasm who used alleviating maneuvers scored higher on the 7-item Hemifacial Spasm Quality of Life scale (median score, 7 vs 3; Hodges-Lehmann median difference, 4 [95% CI, 1-7]; P = .01) and the SMC Severity Grading Scale (median score, 2 vs 2; Hodges-Lehmann median difference, 0 [95% CI, 0-1]; P = .03) than patients with hemifacial spasm who did not use alleviating maneuver. The severity of dystonia correlated with botulinum toxin treatment for patients with blepharospasm (r = 0.23; P = .049) and patients with hemifacial spasm (r = 0.45; P = .001). There was no difference found in botulinum toxin treatment between patients who used alleviating maneuvers and those who did not, in either the blepharospasm group (150 vs 125 units; Hodges-Lehmann median difference, 20 units [95% CI, -10 to 70 units]; P = .15) or the hemifacial spasm group (58 vs 60 units; Hodges-Lehmann median difference, 0 units [95% CI, -15 to 20 units]; P = .83). Half of the patients with periocular facial dystonias used alleviating maneuvers. Their use was associated with more severe disease but not with increased use of botulinum toxin. This may help to guide future therapies, such as advice on maneuver augmentation or tailored devices.

Traditional Chinese medicine Tongxinluo protects microvascular from arteriole spasm induced by norepinephrine in rats mesentery

Background: Arteriole spasm (AS) served as a common pathogenesis of many diseases. Tongxinluo (TXL), a traditional Chinese formula, has been proved to benefit patients with diseases associated with AS. However, the effect of TXL on AS has not been elucidated, especially on the hemorheology of microcirculation. The aim of this study was to assess the protective function of TXL against AS on microcirculation in rats’ mesentery.Materials and Methods: Arteriole spasm model was established by local administration of norepinephrine in rats’ mesentery. Rats were randomized divided into five groups: sham group (local administration of normal saline), arteriole spasm group, TXL0.4+AS group, TXL0.8+AS group, TXL1.6+AS group. Drugs were administered orally daily for 7 days before modeling. Microcirculation was observed using an upright microscope and recorded to study the hemorheology changes, including spasm time, diameter changes, and arteriole blood flow. Mast cell degranulation was identified by vital staining with topical application of 0.1% toluidine blue. The serum samples were collected for detect of NO and ET-1.Results: Pre-administration of TXL markedly decreased arteriole spasm time, and indicated a dose-dependent effect. Pre-administration of TXL also indicates dose-dependent effect to maintain arteriole diameter in the presence of AS. Pretreatment with TXL significantly inhibited mast cell degranulation induced by AS, TXL also exert great beneficial protection on arteriole blood flow against AS. The serum level of NO and ET-1 had no obvious changes among each groups.Conclusion: AS caused microvascular dysfunction in rats’ mesentery. TXL had a beneficial effect against AS in the perspective of protecting microvascular function, indicated that TXL fight against AS through regulation on microcirculation.Keywords: Arteriole spasm; Tongxinluo; Rat mesentery; Norepinephrine; Theory of TCMAbbreviations: Tongxinluo (TXL); Arteriole spasm (AS); Traditional Chinese Medicine (TCM); Coronary artery spasm (CAS); Percutaneous coronary intervention (PCI).

TRADITIONAL CHINESE MEDICINE TONGXINLUO PROTECTS MICROVASCULAR FROM ARTERIOLE SPASM INDUCED BY NOREPINEPHRINE IN RATS MESENTERY

Background: Arteriole spasm (AS) served as a common pathogenesis of many diseases. Tongxinluo (TXL), a traditional Chinese&#x0D; formula, has been proved to benefit patients with diseases associated with AS. However, the effect of TXL on AS has not been&#x0D; elucidated, especially on the hemorheology of microcirculation. The aim of this study was to assess the protective function of TXL&#x0D; against AS on microcirculation in rats’ mesentery.&#x0D; Materials and Methods: Arteriole spasm model was established by local administration of norepinephrine in rats’ mesentery. Rats&#x0D; were randomized divided into five groups: sham group (local administration of normal saline), arteriole spasm group, TXL0.4+AS&#x0D; group, TXL0.8+AS group, TXL1.6+AS group. Drugs were administered orally daily for 7 days before modeling. Microcirculation&#x0D; was observed using an upright microscope and recorded to study the hemorheology changes, including spasm time, diameter&#x0D; changes, and arteriole blood flow. Mast cell degranulation was identified by vital staining with topical application of 0.1% toluidine&#x0D; blue. The serum samples were collected for detect of NO and ET-1.&#x0D; Results: Pre-administration of TXL markedly decreased arteriole spasm time, and indicated a dose-dependent effect.&#x0D; Pre-administration of TXL also indicates dose-dependent effect to maintain arteriole diameter in the presence of AS. Pretreatment&#x0D; with TXL significantly inhibited mast cell degranulation induced by AS, TXL also exert great beneficial protection on arteriole&#x0D; blood flow against AS. The serum level of NO and ET-1 had no obvious changes among each groups.&#x0D; Conclusion: AS caused microvascular dysfunction in rats’ mesentery. TXL had a beneficial effect against AS in the perspective of&#x0D; protecting microvascular function, indicated that TXL fight against AS through regulation on microcirculation.

Expressions of progestrone and dehydroepiandrosterone sulfate in serum and the influence of drug in 36 infantile with spasms

Objective To explore the serum levels of progestrone (Prog) and dehydroepiandrosterone sulfate (DHEAS), and the effect of sodium valproate (VPA) and lamotrigine (LTG) on the levels of Prog and DHEAS in infantile spasms. Methods A total of 36 cases of infantile spasms (spasms group) before treatment and 40 cases health infants (control group) were detected the serum Prog and DHEAS levels by electrochemiluminescence immunoassay, and were compared with 21 cases receiving monotherapy with VPA (VPA group), and 13 cases receiving therapy plus lamotrigine (LTG group) before and 4 months after treatment to observe the changes of sex hormone. Results There were no significant differences in Prog and log (DHEAS) (logarithmic transformation) levels between spasms group and control group (P>0.05). The serum Prog level of baby girls and baby boys were lower after treatment than those before treatment in VPA group respectively (t=2.603, 3.146; P=0.003, 0.008, respectively). The log (DHEAS) level of baby girls and baby boys were higher in LTG group after treatment than those before treatment respectively (t=3.185, 2.663; P=0.007, 0.041). Conclusion Infantile spasms would not influence the hormone metabolism, while VPA and LTG can influence the sex hormone. The hormone level should be monitored in the treatment. Key words: Infantile spasms; Progesterone; Dehydroepiandrosterone sulfate; Infant

The eff ect of intracoronary administration of ergonovine on the contralateral coronary artery in a provocation test for the diagnosis of variant angina

Background Little is known about the effects of selective intracoronary administration of ergonovine into a coronary artery on the artery on the other side. This study aimed to evaluate the effect of intracoronarily administered ergonovine on the contralateral coronary artery.Subjects and methods From June 2011 to August 2013, coronary spasm provocation tests were performed in 85 consecutive patients using selective intracoronary administration of methylergometrine maleate (ER). The doses increased in a step-wise manner up to 60 μg for the left coronary artery (LCA) and up to 50 μg for the right coronary artery (RCA). The coronary artery diameters were measured and analysed by repeated-measures ANOVA.Results Twenty-four (28%) patients had a spasm-positive result. The mean diameter of the spasm segment in the contralateral artery decreased from 2.83 to 2.68 mm (5.1 ± 0.1% change, P< 0.001) in the negative spasm group and from 2.40 to 2.10 mm (11.1 ± 2.2% change, P= 0.001) in the positive spasm group. There were no serious procedure-related complications.Conclusions Intracoronary administration of ER resulted in a statistically significant decrease of lumen diameter of the contralateral coronary artery. However, from the clinical perspective, the extent of the decrease was relatively small and the test may be conducted safely unless there is a significant coronary artery luminal narrowing.

Abstract 13740: Significance of Chronic Low-Grade Inflammation and Diabetes Mellitus (DM) for Coronary Spasm Following Drug-Eluting Stent Implantation in Patients with Coronary Heart Disease (CHD)

Background: Coronary spasm is a manifestation of coronary endothelial dysfunction characterized by transient total or subtotal occlusion or severe diffuse vasoconstriction of an epicardial artery and contributes importantly to the pathogenesis of coronary heart disease (CHD). Coronary spasm and diabetes mellitus (DM) are reported to be associated with low-grade inflammation. However, it is unknown about the relation between chronic inflammation and DM in atherosclerotic high-risk patients following drug-eluting stent (DES) implantation. The aim was to examine the relation between coronary spasm and chronic inflammation or DM. Methods: We performed intracoronary acetylcholine test for coronary spasm provocation in 60 consecutive patients (41 male, age 69.1±9.1yrs) who had underwent new generation DES (cobalt-chromium everolimus-eluting stent, Xience (n=33); or biolimus-eluting stent, Nobori (n=27)) in left ascending coronary artery at 9 months before and examined plasma levels of tumor necrosis factor (TNF) α, interleukin-6 (IL-6), and high sensitivity C-reactive protein (hs-CRP) in the chronic phase without acute inflammation findings. Patients were divided into 3 groups: presence of both coronary spasm and DM (n=18), presence of each spasm or DM (n=31), and non-spasm and non-DM (n=11). Results: Coronary spasm was induced in 31 (51.6%) of 60 patients. Levels of TNFα, IL-6, and hs-CRP in spasm and DM group were increased compared with those in non-spasm and non-DM group (TNFα; 2.123±0.441 vs. 1.267±0.079 pg/ml, P=0.073: IL-6; 2.668±0.429 vs. 1.346±0.241 pg/ml, P=0.039: hs-CRP; 0.183±0.208 vs. 0.058±0.042 mg/dl, P=0.037). Levels of TNFα, IL-6, and hs-CRP in the each spasm or DM group were in between spasm / DM group and non-spasm / non-DM group, respectively (TNFα, 1.901±0.841pg/ml; IL-6, 2.125±0.651pg/ml; hs-CRP; 0.091±0.073mg/dl). Coronary spasm was not induced in statin-users among the total patients, and non-use of statin was associated with positive for coronary spasm (P=0.041) and increased inflammation levels. Conclusions: Coexistence of coronary spasm and DM in the chronic phase after new generation DES implantation may be associated with low-grade inflammation. The prevention of coronary spasm is related to the use of statin.