冠心病患者冠脉支架术后发生再狭窄的危险因素回归分析

目的:探讨冠心病患者冠脉支架手术后发生再狭窄的危险因素,为提高临床治疗效果和改善预后提供指导。方法:回顾性分析2014年1月至2015年12月我院收治的226例行冠脉支架手术的冠心病患者临床病历资料,采用SPSS21.0分析冠脉再狭窄的发生情况及危险因素。结果:51例冠心病患者冠脉支架术后发生冠脉再狭窄(22.57%)。单因素分析显示,不同吸烟史、糖尿病史、脂蛋白a(Lp(a))水平、空腹血糖、尿素氮(BUN)、总胆红素、术前病变狭窄程度、植入支架支数、长度以及直径组冠心病患者的冠脉再狭窄发生率比较,差异有统计学意义(P0.05)。多因素Logistic回归分析,吸烟史、糖尿病史、Lp(a)水平、术前病变狭窄程度、植入支架支数、长度是冠心病患者冠脉支架术后再狭窄发生的独立危险因素,OR分别为2.261、1.944、3.593、2.798、2.449、3.823,差异有统计学意义(P0.05),植入支架直径是冠脉再狭窄发生的保护因素,OR为0.261,差异有统计学意义(P0.05)。结论:冠脉植入支架的总长度、数量,术前病变的狭窄程度、Lp(a)水平、糖尿病以及吸烟是冠心病患者冠脉支架术后发生再狭窄的独立危险因素,临床应不断优化支架并根据再狭窄的危险因素采取针对性的防治措施。     

The innate defense antimicrobial peptides hBD3 and RNase7 are induced in human umbilical vein endothelial cells by classical inflammatory cytokines but not Th17 cytokines

Antimicrobial peptides are multifunctional effector molecules of innate immunity. In this study we investigated whether endothelial cells actively contribute to innate defense mechanisms by expression of antimicrobial peptides. We therefore stimulated human umbilical vein endothelial cells (HUVEC) with inflammatory cytokines, Th17 cytokines, heat-inactivated bacteria, bacterial conditioned medium (BCM) of Staphylococcus aureus and Streptococcus sanguinis, and lipoteichoic acid (LTA). Stimulation with single cytokines induced discrete expression of human β-defensin 3 (hBD3) by IFN-γ or IL-1β and of ribonuclease 7 (RNase7) by TNF-α without any effects on LL-37 gene expression. Stronger hBD3 and RNase7 induction was observed after combined stimulation with IL-1β, TNF-α and IFN-γ and was confirmed by high hBD3 and RNase7 peptide levels in cell culture supernatants. In contrast, Th17 cytokines or stimulation with LTA did not result in AMP production. Moreover, only BCM of an invasive S. aureus bacteremia isolate induced hBD3 in HUVEC. We conclude that endothelial cells actively contribute to prevent dissemination of pathogens at the blood-tissue-barrier by production of AMPs that exhibit microbicidal and immunomodulatory functions. Further investigations should focus on tissue-specific AMP induction in different endothelial cell types, on pathogen-specific induction patterns and potentially involved pattern-recognition receptors of endothelial cells.     

Per-operative stent placement in the right pulmonary artery; a hybrid technique for the management of pulmonary artery branch stenosis at the time of pulmonary valve replacement in adult Fallot patients

After having undergone surgical correction at an early age, many patients with tetralogy of Fallot develop long-term complications including progressive pulmonary regurgitation and peripheral pulmonary stenosis. A high percentage of these patients need to undergo a second operation in their adolescence or early adulthood. If simultaneous treatment of both pulmonary regurgitation and peripheral pulmonary stenosis is warranted, a complete surgical approach has several disadvantages. We describe four cases of Fallot patients with severe pulmonary regurgitation and peripheral pulmonary stenosis who were treated using a hybrid approach involving surgical implantation of a pulmonary homograft and peroperative stenting of the pulmonary artery.     

Brain cooling maintenance with cooling cap following induction with intracarotid cold saline infusion: a quantitative model

Intracarotid cold saline infusion (ICSI) is potentially much faster than whole-body cooling and more effective than cooling caps in inducing therapeutic brain cooling. One drawback of ICSI is hemodilution and volume loading. We hypothesized that cooling caps could enhance brain cooling with ICSI and minimize hemodilution and volume loading. Six-hour-long simulations were performed in a 3D mathematical brain model. The Pennes bioheat equation was used to propagate brain temperature. Convective heat transfer through jugular venous return and the circle of Willis was simulated. Hemodilution and volume loading were modeled using a two-compartment saline infusion model. A feedback method of local brain temperature control was developed where ICSI flow rate was varied based on the rate of temperature change and the deviation of temperature to a target (32 °C) within a voxel in the treated region of brain. The simulations confirmed the inability of cooling caps alone to induce hypothermia. In the ICSI and the combination models (ICSI and cap), the control algorithm guided ICSI to quickly achieve and maintain the target temperature. The combination model had lower ICSI flow rates than the ICSI model resulting in a 55% reduction of infusion volume over a 6 h period and higher hematocrit values compared to the ICSI model. Moreover, in the combination model, the ICSI flow rate decreased to zero after 4 h, and hypothermia was subsequently maintained solely by the cooling cap. This is the first study supporting a role of cooling caps in therapeutic hypothermia in adults.     

Computer aided diagnosis of Coronary Artery Disease,Myocardial Infarction and carotid atherosclerosis using ultrasound images: A review

The diagnosis of Coronary Artery Disease (CAD), Myocardial Infarction (MI) and carotid atherosclerosis is of paramount importance, as these cardiovascular diseases may cause medical complications and large number of death. Ultrasound (US) is a widely used imaging modality, as it captures moving images and image features correlate well with results obtained from other imaging methods. Furthermore, US does not use ionizing radiation and it is economical when compared to other imaging modalities. However, reading US images takes time and the relationship between image and tissue composition is complex. Therefore, the diagnostic accuracy depends on both time taken to read the images and experience of the screening practitioner. Computer support tools can reduce the inter-operator variability with lower subject specific expertise, when appropriate processing methods are used. In the current review, we analysed automatic detection methods for the diagnosis of CAD, MI and carotid atherosclerosis based on thoracic and Intravascular Ultrasound (IVUS). We found that IVUS is more often used than thoracic US for CAD. But for MI and carotid atherosclerosis IVUS is still in the experimental stage. Furthermore, thoracic US is more often used than IVUS for computer aided diagnosis systems.     

Scalp,basal epidural and intravascular far-field recordings after median nerve stimulation: evidence for a separate N18a potential

Far-field somatosensory evoked potentials (SSEPs) after median nerve stimulation were recorded from scalp- (Fz), epidural(ED) and intravascular electrodes (basilar artery [Bas]) to study the nature of the controversial N18a component of the widespread N18 potential. In healthy volunteers frequently an N18a potential was recorded at Fz. Simultaneous Fz and ED recordings at the pontomesencephalic junction as well as Bas-recordings at the caudal basilar artery showed N18a components identical in latency and shape. With intravascular recordings the shapes differed between the top of the basilar artery and the caudal artery recordings. These findings support the existence of a separate N18a potential. The generator of the N18a is likely to be localized within the upper brainstem.     

关于“弱激光血管内照射疗法”的几个问题

本文从：１．关于“弱激光血管内照射疗法（ＩｎｔｒａｖａｃｕｌａｒＬｏｗ－Ｒｅａｃｔｉｏｎ－ｌｅｖｅｌＬａｓｅｒＩｒｒａｄｉａｔｉｏｎＴｈｅｒａｐｙＩＬＬＬＴ）的中、英文名称问题。２．该疗法引入我国的历史回顾。３．该疗法的临床效果与基础研究。４．该疗法与光量子疗法（ＵＢＩ）的比较。５．该疗法在我国面临的问题及展望等五个方面以较详实的材料对以Ｈｅ—Ｎｅ激光为代表的弱激光血管内照射疗法客观地进行阐述,并以笔者的研究实践及其认识为基础提出看法以期探讨,从而澄清目前国内对该疗法尚存在的某些混乱状况与模糊认识,使其作为弱激光的一种很有前途的临床疗法能走上健康发展的道路。     

Cerebroventricular and Intravascular Metabolism of [125I]Angiotensins in Rat

This study compared the metabolism of [125I]angiotensin II (AII), [125I]angiotensin III (AIII), and [125I]Sar1,Ile8-AII (SI-AII) in the vascular and cerebroventricular compartments. Using HPLC methods to monitor degradation the following t1/2 values were established in the vascular compartment: AII, 12.7 +/- 1.4 s; AIII, 16.3 +/- 0.7 s; and SI-AII, 100.7 +/- 7.3 s. HPLC analysis also revealed that [125I]AII is converted in an obligatory manner to [125I]AIII during its degradation sequence. Cerebrospinal fluid contained no degradative capacity for [125I]AII but exhibited a significant capacity to degrade [125I]AIII. A technique that combined the intra-cerebroventricular injection of [125I]angiotensins followed by focused microwave fixation to stop all peptidase activity was used to determine the half-life of [125I]angiotensins in the ventricular space. Results indicated very rapid metabolism of angiotensins with the following t1/2 values: AII, 23.0 s; and AIII, 7.7 s. This extremely rapid, differential, and sequential metabolism of AII and AIII in two relevant body fluid compartments underscores the need for caution when interpreting data derived from intravascular and intracerebroventricular application of angiotensins. In addition the faster metabolism of AIII than AII in the ventricular space indicates that the actual potency of AIII at central angiotensin receptors is being underestimated.     

The unique ultrastructure of high-endothelial venules in inguinal lymph nodes of the pig

Lymph nodes in pigs are unique in their inverted structure, with the medulla in the periphery and the cortex in central areas. Furthermore, in this species most migrating lymphocytes do not use the classical route via efferent lymphatics to leave the lymph node. High-endothelial venules (HEV) are the entry sites for lymphocytes and in pigs probably also the exit site for recirculating lymphocytes. Therefore, the blood vessels and especially the HEV of the pig superficial inguinal lymph node were investigated as to whether morphological peculiarities could be found in the vascular system, using vascular casting, transmission- and scanning electron microscopy. A thin layer of capillary network surrounded the periphery of the lymph node and HEV branched acutely. The endothelial cells of HEV possessed well developed cytoplasmic organelles, interdigitated with each other, and demonstrated local cell-cell contacts. There were unusual cells bridging the adluminal wall of HEV. These cells were called intravascular bridging cells. They were characterized by an often invaginated nucleus, few pinocytotic vesicles, many microvilli on the surface, wide, flat, cytoplasmic processes like a pseudopod, Weibel-Palade bodies and local cell-cell contacts with endothelial cells. The pseudopod-like processes ramified over the endothelial junctions and covered lymphocytes. Lymphocytes were seen in different phases of migration between endothelial cells and in the intercellular junctions. The previous functional studies on the peculiar route of lymphocyte recirculation in pig lymph nodes are extended by these morphological data, showing a unique structure of HEV in pigs.     

Life-threatening bilateral aorto-ostial coronary artery disease in an octogenarian

Aorto-ostial disease is difficult to approach percutaneously; therefore, a surgical option may be more desirable. We describe a case of an octogenarian in which the clinical arguments and technical approach have been summarised for a successful percutaneous therapeutic strategy. (Neth Heart J 2009;17:30-2.)