Long-pulsed ultrasound-mediated microbubble thrombolysis in a rat model of microvascular obstruction

In up to 30% patients who experience acute myocardial infarction, successful recanalization of the epicardial coronary artery cannot provide adequate microvascular reperfusion. In this study, we sought to determine whether long-pulsed ultrasound (US)-mediated microbubble (MB) cavitation was useful for the treatment of microvascular obstruction, and the therapeutic effects were compared within different long-pulse-length and short-pulsed US. Microvascular obstruction model was established by injecting micro-thrombi into common iliac artery of a rat’s hind limb. About 1 MHz US with different long pulse lengths (ranging from 100 to 50,000 cycles) was delivered, compared to short pulse (5 cycles). The control group was given MB only without therapeutic US. Contrast perfusion images were performed at baseline, emboli, and 1, 5, 10 min post-embolization, and peak plateau video intensity (A) was obtained to evaluate the therapeutic effects. Long-tone-burst US showed better thrombolytic effects than short-pulsed US (1,000, 5,000 cycles >500 cycles, >5 cycles, and control) (P < 0.01). 1,000 cycles group showed the optimal thrombolytic effect, but microvascular hemorrhage was observed in 50,000 cycles group. In conclusion, long-tone-burst US-enhanced MB therapy mediated successful thrombolysis and may offer a powerful approach for the treatment for microvascular obstruction within a certain pulse length

Association between the stress–hyperglycemia ratio and all‐cause mortality in community‐dwelling populations: An analysis of the National Health and Nutrition Examination Survey (NHANES) 1999–2014

Abstract Background Reportedly, the stress–hyperglycemia ratio (SHR) is closely associated with poor prognosis in patients with severe acute disease. However, the community‐dwelling may also be in a state of stress due to environmental exposure. Our study aimed to explore the association between SHR and all‐cause mortality in the community‐dwelling population. Methods A total of 18 480 participants were included out of 82 091 from the NHANES 1999–2014 survey. The Kaplan–Meier survival analyses were used to assess the disparities in survival rates based on SHR, and the log‐rank test was employed to investigate the distinctions between groups. The multivariate Cox regression analysis and restricted cubic spline (RCS) analysis were performed to assess the association of SHR with all‐cause mortality. A subgroup analysis was also conducted. Results A total of 3188 deaths occurred during a median follow‐up period of 11.0 (7.7; 15.4) years. The highest risk for all‐cause mortality was observed when SHR≤ 0.843 or SHR ≥0.986 (log‐rank p < .001). After adjusting for the confounding factors, compared with subjects in the second SHR quartile (Q2), participants in the highest (Q4, adjusted hazard ratio [HR] 1.49, 95% confidence interval [CI] 1.28–1.73) and lowest quartiles (Q1, adjusted HR 1.37, 95% CI 1.16–1.60) have a higher probability of all‐cause death. The RCS observed a dose‐response U‐shaped association between SHR and all‐cause mortality. The U‐shaped association between SHR and all‐cause mortality was similar across subgroup analysis. Conclusions The SHR was significantly associated with all‐cause mortality in the community‐dwelling population, and the relationship was U‐shaped