Tracheal agenesis with broncho-esophageal fistula in VACTERL / TACRD association

Tracheal agenesis (TA) is an extremely rare malformation. We report here autopsy findings in a case of TA with bronchoesophageal fistula of Floyd type III. The other malformations present included laryngeal atresia, Right lung hypolobulation, ventricular septal defect in membranous portion, bilateral cystic renal dysplasia, spleninculus, Meckel''s diverticulum, and imperforate anus. The constellations of malformations present in our case have overlapping features with Vertebral anomalies, Anal atresia, Cardiovascular anomalies, Tracheo-esophageal fistula, Esophageal atresia, Renal anomalies, Limb anomalies and Tracheal atresia or laryngo tracheal atresia, Cardiac anomalies, Renal anomalies, Duodenal atresia association described previously in the literature.     

Blood pressure changes validate phase related external suction, a controlled method for stimulation of human baroreceptors

Phase related external suction (PRES), a new controlled method for manipulating activity in human baroreceptors, applies precisely timed bursts of suction and pressure within the cardiac cycle through an external neck cuff. Seven healthy adult men participated in 32 pseudo-random trials of baroreceptor stimulation and inhibition. Blood pressure was assessed both intra-arterially and with a noninvasive device. In the present study, PRES baroreceptor stimulation elicited invasively measured blood pressure decreases of about 2.5 mmHg (0.33 kPa) and heart rate decreases of about 5 beats · min^–1, while baroreceptor inhibition increased invasively measured blood pressure by about 1.5 mmHg (0.20 kPa) and heart rate about 2.5 beats · min^–1. It was concluded that PRES is an effective method for baroreceptor manipulation with weaker size effect but better control of nonspecific factors in human subjects than other baroreceptor manipulation techniques. The noninvasive blood pressure measurement device was less sensitive to experimental variation than was the invasive device.     

Arteriovenous anastomoses in the cat carotid body

Summary In artery surrounding areas in the periphery of the carotid body of the cat we found arteriovenous anastomoses differing in respect to their character. So far, it is not yet to decide the frequency of their occurrence and their functional significance. The anastomoses were demonstrated by light microscopy of serial sections and by scanning electron microscopy with a more developed corrosion casting technique.

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Zusammenfassung In den arteriennahen, peripheren Bereichen des Glomus caroticum der Katze wurden arteriovenöse Verbindungen nachgewiesen, die ihrem Charakter nach unterschiedlich sind. Es ist allerdings noch nicht zu entscheiden, ob derartige Anastomosen regelmäßig vorkommen und wie sie funktionieren. Die beschriebenen Gefäßverbindungen konnten lichtmikroskopisch anhand von histologischen Serienschnitten und mit Hilfe einer weiterentwickelten Korrosionstechnik im Rasterelektronenmikroskop dargestellt werden.

     

Immunofluorescent and structural features of cells in the intervascular stroma of the amphibian carotid labyrinth

Summary The amphibian carotid labyrinth consists of a pars cavernosa, the main chamber of which is in communication with both the base of the external carotid artery, and the vessels of the labyrinthine pars capillaris. On the walls of the main chamber is a network of thick strands of connective tissue and modified smooth muscle cells surrounding the openings into the p. capillaris. These openings lead into wide-diameter atrial vessels, which in turn branch to form the short narrow-diameter vessels. The short vessels form the major component of the labyrinth. A few extremely narrow-diameter vessels are also present. The short vessels open into the roots of the internal carotid artery on the ventral aspect of the carotid labyrinth. The intervascular stroma of the p. capillaris contains numerous stellate and bipolar cells. These cells give a positive response to an immunofluorescent technique specific for smooth muscle myosin and tropomyosin. As the ultrastructural features of these cells are comparable in many respects to smooth muscle, they have been designated as modified smooth muscle cells. It is proposed that these cells act in both an active and passive fashion in maintaining the luminal dimensions of the short vessels relatively constant.     

Racial differences in the burden of coronary artery calcium and carotid intima media thickness between Blacks and Whites

Background

Identification of racial differences in the burden and correlates of carotid intima media thickness (CIMT) and coronary artery calcium (CAC) may provide the basis for the development of race-specific cardiovascular disease (CVD) risk prediction algorithms.

Methods

In the Heart Strategies Concentrating on Risk Evaluation (Heart SCORE) study, CIMT was measured by carotid ultrasonography in 792 individuals (35 % Black). CIMT >1 mm was considered significant. CAC was quantified by electron beam computed tomography in 776 individuals (46 % Black). CAC was considered significant if the Agatston score was >100. Cross-sectional associations between race, CIMT and CAC were assessed using logistic regression models.

Results

Blacks had greater CIMT (mean difference 0.033 mm, 95 % CI 0.005–0.06 mm; p = 0.02) and 1.5-fold (95 % CI 1.0–2.3) higher odds of having significant CIMT than Whites. Blacks had less CAC than Whites (mean Agatston score difference 66, [11–122]; p = 0.02) and 50 % lower odds of a significant CAC score compared with Whites (0.5 [0.3–0.7]). These associations were virtually unchanged after adjustment for CVD risk factors. Of the novel CVD risk markers assessed, small-dense low-density lipoprotein was independently associated with increased odds of significant CIMT, with the association being similar among Blacks and Whites (odds ratio [95 % CI]: 1.7 [1.2–2.5] and 1.4 [1.0–1.8] per 1-SD higher level, respectively). Interleukin-6 was significantly associated with CAC among Blacks (1.4 [1.0–2.0]).

Conclusion

Black race is independently associated with greater CIMT but less CAC than White race. CVD risk stratification strategies that incorporate these measures of subclinical atherosclerosis should consider race-specific algorithms.

Electronic supplementary material

The online version of this article (doi:10.1007/s12471-014-0610-4) contains supplementary material, which is available to authorized users.     

胰瘘发生假说到捆绑式胰肠吻合的临床运用

为避免术后胰瘘的发生,在过去的100年间提出了多种胰肠吻合重建方式,但哪种方法最好一直备受争议.胰肠吻合后吻合针距间存在可能的间隙,这个问题或许成为胰肠吻合口瘘的爆发点,而且存在贯穿浆肌层缝合的胰腺表面外露的吻合针眼,如果缝针贯穿胰管小分支,胰液可能从针眼流出.这一假说构成了捆绑式胰肠吻合的基础.捆绑式胰肠吻合是一种安全、有效的预防术后胰瘘的吻合方式.     

不保留导管的腮腺浅叶切除术后单纯负压加压预防涎瘘的研究

目的：涎瘘为腮腺病变术后常见的并发症,术后放置负压引流结合绷带加压包扎1周或2周时间,已经成为腮腺术后预防涎瘘的常规方法。本研究着重于评价单纯负压引流在腮腺手术后涎瘘预防的临床价值,并根据术后引流量、引流天数与涎瘘的关系,寻找最佳的拔管时机。方法：不保留腮腺导管的腮腺浅叶切除的腮腺疾病病人194例,分为传统加压组（第一组）和单纯负压组（第二组）,第一组病人拔除引流管后继续加压包扎,第二组病人拔管后不再加压包扎;记录术后涎瘘情况,对比两组涎瘘率的差异,同时分析单纯负压组引流量、引流天数与术后涎瘘的关系。结果：传统加压组涎瘘率（11．6％）与单纯负压组涎瘘率（15．5％）对比无统计学差异（P〉0．05）;单纯负压组,引流天数与涎瘘率对比无明显相关（P〉0．05）,而引流量少于20mL与（20-30）mL对比术后涎瘘率差异显著。结论：单纯负压引流能代替传统拔管后继续加压包扎预防涎瘘,从而避免了因绷带加压包扎引起的诸多并发症;另外,在评估拔管时机时,引流量比引流时间更重要,且引流量小于20mL可作为最佳的拔管时机,这可作为一个指导临床治疗的共识。     

慢性缺氧对大鼠颈动脉体中wnt-1和β-catenin表达的影响

目的：观察慢性缺氧对大鼠颈动脉体（carotidbody,CB）中Wnt-1和β—catenin蛋白表达量的影响。方法：雄性SD大鼠40只,随机分为5组：正常氧组、慢性低压性缺氧1周、2周、3周和4周组。处理后,立即取出大鼠双侧CB,提取总蛋白,用westernblot法检测各组大鼠CB中Wnt-1和β-catenin表达量。结果：缺氧3周组和缺氧4周组之间Wnt-1的表达量无明显区别（P〉0．05）,而其余各组之间Wnt．1的表达量均具有统计学差异（P〈0．05）;相对于正常氧组,缺氧3周组大鼠CB中β-catenin的含量明显增加,有统计学意义（P〈0．05）。结论：本研究提示Wnt／β-catenin信号通路可能参与了慢性缺氧引起的颈动脉体干细胞增殖分化的过程。     

Oral a-tocopherol Supplementation Inhibits Lipid Oxidation in Established Human Atherosclerotic Lesions

Background: Much experimental evidence suggests that lipid oxidation is important in atherogenesis and in epidemiological studies dietary antioxidants appear protective against cardiovascular events. However, most large clinical trials failed to demonstrate benefit of oral antioxidant vitamin supplementation in high-risk subjects. This paradox questions whether ingestion of antioxidant vitamins significantly affects lipid oxidation within established atherosclerotic lesions. Methods and results: This placebo-controlled, double blind study of 104 carotid endarterectomy patients determined the effects of short-term α-tocopherol supplementation (500 IU/day) on lipid oxidation in plasma and advanced atherosclerotic lesions. In the 53 patients who received α-tocopherol there was a significant increase in plasma α-tocopherol concentrations (from 32.66±13.11 at baseline to 38.31±13.87 (mean±SD) μmol/l, p<0.01), a 40% increase (compared with placebo patients) in circulating LDL-associated α-tocopherol (p<0.0001), and their LDL was less susceptible to ex vivo oxidation than that of the placebo group (lag phase 115.3±28.2 and 104.4±15.7 min respectively, p<0.02). Although the mean cholesterol-standardised α-tocopherol concentration within lesions did not increase, α-tocopherol concentrations in lesions correlated significantly with those in plasma, suggesting that plasma α-tocopherol levels can influence lesion levels. There was a significant inverse correlation in lesions between cholesterol-standardised levels of α-tocopherol and 7β-hydroxycholesterol, a free radical oxidation product of cholesterol. Conclusions: These results suggest that within plasma and lesions α-tocopherol can act as an antioxidant. They may also explain why studies using <500 IU α-tocopherol/day failed to demonstrate benefit of antioxidant therapy. Better understanding of the pharmacodynamics of oral antioxidants is required to guide future clinical trials.     

急性脑梗死患者颈动脉斑块内新生血管超声造影评价及其与血脂指标和超敏C反应蛋白水平的关系研究

目的:探讨急性脑梗死患者颈动脉斑块内新生血管超声造影评价及其与血脂指标和超敏C反应蛋白水平的关系。方法:选取2018年6月到2019年6月期间我院收治的ACI患者186例,根据患者的颈动脉内中膜厚度(IMT)数值以及颈动脉斑块内新生血管超声造影情况将其分为无斑块组、稳定斑块组和易损斑块组。对比各组患者的总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、美国国立卫生研究院卒中量表(NIHSS)评分、改良的Rankin评分(m RS)、超敏C反应蛋白(hs-CRP)水平。结果:易损斑块组和稳定斑块组患者的TC、LDL-C、TG、hs-CRP水平均明显高于无斑块组(P<0.05),易损斑块组患者的LDL-C、hs-CRP水平均明显高于稳定斑块组(P<0.05),易损斑块组和稳定斑块组患者的NIHSS评分和m RS评分均明显高于无斑块组(P<0.05),易损斑块组患者的NIHSS评分和m RS评分均明显高于稳定斑块组(P<0.05),经Pearson分析显示,LDL-C、hs-CRP、NIHSS评分和m RS评分与斑块分级均呈正相关(P<0.05)。结论:颈动脉斑块内新生血管超声造影技术可有效评估ACI患者的斑块稳定性,ACI患者的斑块分级与脂代谢紊乱、机体的炎症反应以及患者病情严重程度和预后均存在一定的相关性。