超声造影与B型超声对人颈动脉内膜-中层厚度及斑块的诊断价值分析

摘要 目的：探讨超声造影（CEUS）与B型超声在诊断人颈动脉内膜-中层厚度（CIMT）及斑块中的临床应用价值。方法：选取2018年10月至2022年12月内蒙古自治区人民医院健康体检者142例,均行颈动脉B型超声和CEUS成像检查。记录左右侧颈动脉各分段点CIMT近壁和远壁值,然后取平均值。采用半定量的方法进行评分,以确定在B型超声和CEUS成像过程中的CIMT可视化。比较B型超声和CEUS成像技术对斑块检出的差异。根据CIMT平均值进行进一步分组,分析CIMT与亚临床左心功能障碍之间的关系。结果：在B型超声成像上,左右侧颈动脉CIMT远壁的可视化评分均明显高于CIMT近壁,差异有统计学意义（P＜0.05）;在CEUS成像上,左右侧颈动脉CIMT远壁的可视化评分均高于CIMT近壁,差异有统计学意义（P＜0.05）。与B型超声成像模式对比,在CEUS成像模式中左右侧颈动脉CIMT远壁和近壁的可视化评分均得到显著提高,差异有统计学意义（P＜0.05）。142例健康体检者中,B型超声总共检测出271个斑块,CEUS总共检测出293个斑块,斑块检出率组间比较差异有统计学意义（P＜0.05）。随着CIMT平均值的逐渐增大,LVM逐渐减小,LVGLS逐渐增大,差异有统计学意义（P＜0.05）。CIMT平均值的大小与LVEDD、LVESD和LVEF差异无统计学意义（P＞0.05）。结论：CEUS改善了CIMT的可视化,并能更好地检测出颈动脉斑块（主要为低回声斑块）,对预测心血管疾病的发生有一定临床价值。     

Fine structure of baroreceptor terminals in the carotid sinus of guinea pigs and mice

Summary A light and electron microscopic study was undertaken on the baroreceptor axon terminals in the carotid sinus of guinea pigs and mice, using serial semithin and thin sections.Together with their enveloping Schwann cells, numerous lanceolate axon terminals are organized into a well-defined discoid end organ, referred to as the baroreceptor unit. Baroreceptor units measure 100 to 150 m in diameter and are arranged in a hexagonal pattern. These end organs represent free branched lanceolate mechanoreceptors of complex type (Andres and von Düring, 1973) which belong to the main group of stretch receptors.In the guinea pig the lanceolate terminals enter the media and approach the innermost layers near the intima. In the mouse the terminals are seen to spread in the adventitia and along the medio-adventitial border. Only a few of them penetrate the external elastic layer. Species differences concerning the localization and extent of these visceral mechanoreceptors are discussed, as well as the modified architecture of the sinus wall in the receptor area (elastic segment).Lanceolate terminals form beaded varicosities which are equipped with finger-like or lamellar axoplasmic protrusions. These projections contain a well-differentiated receptor matrix. They are attached to collagen and elastic fibers. The varicosities include densely packed mitochondria, neurotubules, profiles of axoplasmic reticulum, clear and granular vesicles, and striking accumulations of glycogen particles, lamellated bodies and lysosomes. Four types of varicosities are discerned according to their main axoplasmic components. Various types of these varicosities occur within an individual lanceolate terminal.The adrenergic innervation of the carotid sinus was studied by fluorescence histochemistry. In guinea pigs a multilayered wide-meshed plexus of fluorescent fibers occurs in the adventitia where it is closely related to baroreceptor stem fibers. However, adrenergic axons do not enter the media. In mice fluorescent fibers are extremely rare in the adventitia of the carotid sinus.Dedicated to Prof. Dr. Drs.h.c. W. Bargmann on the occasion of his 70th birthdaySupported by a grant from the Deutsche Forschungsgemeinschaft Nr. Bo/525-1. These results were presented in part at the 17. Tagung der Deutschen Gesellschaft für Elektronenmikroskopie, Berlin, Sept. 21.–26., 1975     

Clinical data analysis of telmisartan for hypertension management in Indian population

It is of interest to evaluate the clinical characteristics, treatment patterns, clinical effectiveness, and safety of telmisartan as a monotherapy or as part of combination therapy in Indian adults (>18 years old) with hypertension. All patients were receiving telmisartan as monotherapy, or as a combination therapy for hypertension management. Demographics, risk factors, existing comorbidity, and ongoing medical therapies were retrieved from the patients’ medical records. A total of 8607 patients with hypertension (median age, 51.0 years) were part of the study. The gender distribution suggested, 5534(64.3%) patients were male, and 3073 (35.7%) were female patients. The excess salt intake (39.0%) was the most common risk factor according to the results. The analysis revealed telmisartan dual therapy (57.9%) as the most prescribed therapy, followed by monotherapy (32.5%), and triple therapy (9.6%). Further, telmisartan 40mg (21.3%) and telmisartan 40mg plus amlodipine 5mg (17.6%) were the most commonly prescribed therapies. The data suggested that only 17.2% of patients required dose titration. The mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) (mmHg) were significantly decreased with monotherapy (mean change: 19.8 [15.1] mmHg and 8.8[8.2] mmHg), dual therapy (mean change: 23.7 [16.6] mmHg and 10.3[8.5] mmHg), and triple therapy (mean change: 28.6 [19.0] mmHg and 12.1[10.8] mmHg) after the treatment (P<0.001). A total of 98.4% of the patients were compliant, and 97.6% achieved the target blood pressure goal with telmisartan-based therapy. There were 157 adverse events reported altogether. The Physicians'' global evaluation of efficacy and tolerability showed the majority of the patients receiving telmisartan-based therapy on a good to excellent scale. Telmisartan used as a monotherapeutic agent or as a part of combination therapy was successful and effective in reducing blood pressure and achieving the blood pressure target. Irrespective of the patient’s age, duration, and stages of hypertension, the study resulted in a good to excellent scale in efficacy and tolerability in the Indian patients having hypertension.     

渤海湾地区红腹滨鹬迁徙动态的初步研究

红腹滨鹬(Calidris canutus)繁殖于环北极地区,属长距离迁徙鸟类,我国黄渤海地区是其在东亚-澳大利西亚迁徙路线上重要的停歇地。2003~2004年,通过对渤海湾北部双龙河口(东经118°21′,北纬37°2′)及其附近地区红腹滨鹬的种群调查,发现其迁徙高峰期出现在4月底到6月初,峰值为2004年5月15日的3 814只;2004年北迁时期,记录到佩戴有澳大利亚和新西兰脚旗的红腹滨鹬17只次,证实在澳大利亚西北部、东南部以及新西兰等3个地区越冬的2个红腹滨鹬亚种都在北迁时使用渤海湾作为其停歇地。     

Human leg design: optimal axial alignment under constraints

Alignment of joints with respect to the leg axis reduces the moment arm of external forces and therefore joint torques. Moreover, it affects the gearing of muscle forces and displacements. Thus, it influences tissue stress, cost of support and locomotion, and stability. Assuming that alignment is of general advantage we propose a mathematical criterion quantifying the axial alignment using the static torque equilibrium of a three-segment leg. Using this criterion derived from joint torque minimisation we asked for optimal leg designs (segment lengths and joint angles) at varied leg lengths. The trivial straight is best solution is excluded and the configuration space is restricted by geometrical constraints such as the ground contact. For different total leg lengths we could identify different optimal segment length combinations and appropriately adjusted joint angles. The extended human leg configuration characterised by a short foot and a combination of unequal ankle and knee angles emerges as a global optimum from our analysis. For crouched configurations allowing for larger leg extensions an angle symmetrical 1:1:1 segment length combination is best. The plantigrade optimum is enforced by the requirement of the distal segment (foot) being shorter than the opposite outer segment (thigh), as well as by the ground contact constraint. Different (e.g. digitigrade) geometries might be of advantage in different biological contexts with different constraints. The fact that small mammals use a crouched equal segment design implies that other locomotor requirements such as stability, strain rates, and acceleration distance per step might dominate.Send offprint requests to: M. Günther (Tübingen)     

Thermosediminibacter oceani gen. nov., sp. nov. and Thermosediminibacter litoriperuensis sp. nov., new anaerobic thermophilic bacteria isolated from Peru Margin

A new group of anaerobic thermophilic bacteria was isolated from enrichment cultures obtained from deep sea sediments of Peru Margin collected during Leg 201 of the Ocean Drilling Program. A total of ten isolates were obtained from cores of 1–2 m below seafloor (mbsf) incubated at 60°C: three isolates came from the sediment 426 m below sea level with a surface temperature of 9°C (Site 1227), one from 252 m below sea level with a temperature of 12°C (Site 1228), and six isolates under sulfate-reducing condition from the lower slope of the Peru Trench (Site 1230). Strain JW/IW-1228P from the Site 1228 and strain JW/YJL-1230-7/2 from the Site 1230 were chosen as representatives of the two identified clades. Based on the 16S rDNA sequence analysis, these isolates represent a novel group with Thermovenabulum and Caldanaerobacter as their closest relatives. The temperature range for growth was 52–76°C with an optimum at around 68°C for JW/IW-1228P and 43–76°C with an optimum at around 64°C for JW/YJL-1230-7/2. The pH^25C range for growth was from 6.3 to 9.3 with an optimum at 7.5 for JW/IW-1228P and from 5 to 9.5 with an optimum at 7.9–8.4 for JW/YJL-1230-7/2. The salinity range for growth was from 0% to 6% (w/v) for JW/IW-1228P and from 0% to 4.5% (w/v) for JW/YJL-1230-7/2. The G+C content of the DNA was 50 mol% for both JW/IW-1228P and JW/YJL-1230-7/2. DNA–DNA hybridization yielded 52% similarity between the two strains. According to 16S rRNA gene sequence analysis, the isolates are located within the family, Thermoanaerobacteriaceae. Based on their morphological and physiological properties and phylogenetic analysis, it is proposed that strain JW/IW-1228P^T is placed into a novel taxa, Thermosediminibacter oceani, gen. nov., sp. nov. (DSM 16646^T=ATCC BAA-1034^T), and JW/YJL-1230-7/2^T into Thermosediminibacter litoriperuensis sp. nov. (DSM 16647^T =ATCC BAA-1035^T).An erratum to this article can be found at     

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.