A computed tomography algorithm for crossing coronary chronic total occlusions: riding on the wave of the proximal cap and distal vessel segment

With wider adoption of coronary computed tomography angiography (coronary CTA), chronic total occlusions (CTOs) are being increasingly identified and characterised by non-invasive angiography. In particular, the ability of coronary CTA to clearly delineate atherosclerotic plaque, as well as to display three-dimensional vessel trajectories, has garnered particular attention in the context of preprocedural planning and periprocedural guidance of CTO percutaneous coronary intervention (PCI). Single CTO features and combined scoring systems derived from CTA (mostly exceeding the diagnostic performance of the angiographic J‑CTO score) have been used to predict time-efficient guidewire crossing, and thus grade the CTO difficulty level prior to PCI. In addition, the introduction of three-dimensional CTA/fluoroscopy co-registration for periprocedural navigation during CTO PCI offers the unprecedented opportunity to resolve proximal cap ambiguity and clearly visualise the distal CTO segment, thereby potentially influencing CTO PCI strategies and techniques. In this review, the potential advantages of non-invasive evaluation of CTO by coronary CTA are described, and a CTA-based hybrid algorithm is introduced for further enhancing the efficiency of CTO PCI. Further studies are clearly needed to verify the proposed approach. However, several luminary operators have already implemented coronary CTA for planning and periprocedural guidance of CTO interventions using the hybrid algorithm.

     

IMPROV-ED trial: eHealth programme for faster recovery and reduced healthcare utilisation after CABG

Netherlands Heart Journal - After coronary artery bypass grafting (CABG), healthcare utilisation is high and is partly unplanned. eHealth applications have been proposed to reduce healthcare...     

他汀类药物对中老年男性冠心病患者肠道菌群的影响

目的探讨他汀类药物对中老年男性稳定型冠心病患者肠道菌群的影响,为临床冠心病的二级预防提供参考。方法选择64例经皮冠状动脉介入治疗术后坚持服用中等强度他汀类药物的男性稳定型冠心病患者为研究对象。患者年龄55～74岁,均不合并糖尿病。根据研究期间患者低密度脂蛋白胆固醇(LDL-C)水平分为血脂未达标组(NSG组,LDL-C≥1.8 mmol/L)与血脂达标组(SG组,LDL-C1.8 mmol/L)。比较两组患者一般临床情况,治疗前后血糖、血脂水平,同时应用16S rRNA测序分析技术对两组患者肠道菌群进行分析。结果两组患者一般临床情况及他汀类药物治疗前患者血糖、血脂水平差异均无统计学意义(均P0.05)。治疗后,NSG组患者总胆固醇、LDL-C、三酰甘油水平均明显高于SG组;同时NSG组患者治疗后空腹血糖水平明显高于治疗前(均P0.05)。Alpha多样性分析显示,NSG组患者肠道菌群多样性低于SG组(P0.05)。LEfSe分析显示,SG组患者肠道Verrucomicrobia、Verrucomicrobiae、Verrucomicrobiales、Verrucomicrobiaceae、Akkermansias、Akkermansia muciniphila、Subdoligranulum和uncultured_Christensenellaceae_bacterium数量明显高于NSG组,而uncultured_Veillonellaceae_bacterium及Prevotella_stercorea的丰度显著低于NSG组。结论中等强度他汀类药物对男性中老年稳定型冠心病患者的疗效与肠道菌群存在一定关系,主要表现为治疗后LDL-C未达标者肠道脂代谢有益菌Akkermansia muciniphila及Subdoligranulum丰度明显减少。     

Expressions of E2 and E7-HPV16 proteins in pre-malignant and malignant lesions of the uterine cervix

Continuous production of the E7 protein from different types of high risk human papilloma virus (HPV) is required for progression of malignancy. We developed antibodies against HPV type 16 E7 and E2 proteins to evaluate their utility as markers for diagnosis during early stages of cervical cancer. Forty biopsies from uterine cervices were diagnosed as low grade intraepithelial lesion (LSIL), high grade intraepithelial lesion (HSIL), squamous carcinoma (SC), in situ adenocarcinoma (ISA) and invasive adenocarcinoma (AC), all of which were infected with HPV 16. Immunohistochemistry was used to investigate the expressions of E7 and E2 (both from HPV 16) and p16. P16 was expressed in eight of 12 LSILs, in all HSILs, in 16 of 18 SC and in all ACs. E2 was expressed in six of 12 LSILs. E7 was positive in eight of 12 LSILs and in all HSIL and carcinomas. The expressions of E2 and E7 of HPV16 related to p16 expression confirmed the value of the viral oncogenic proteins as complementary to histology and support the carcinogenic model of the uterine cervix, because HPVDNA integration into cellular DNA implies the destruction of the gene encoding E2, which suppresses the expression of the E6 and E7 oncoproteins. E2 from HPV16 could be marker for LSILs, while E7 could be a marker for progression of LSILs to HSILs in patients infected by HPV16, because viral typing has little positive predictive value.     

SOD3 R231G polymorphism associated with coronary artery disease and myocardial infarction. The Ludwigshafen Risk and Cardiovascular Health (LURIC) study

This study examined the superoxide dismutase 3 (SOD3) R231G polymorphism in relation to the severity of coronary artery disease (CAD) and the risk of myocardial infarction (MI) in 3211 individuals; 94.4% of study participants were homozygous for SOD3 231RR and 5.5% were heterozygous for SOD3 231RG. The odds ratios of the RG and GG genotype (adjusted for age, gender and for conventional cardiovascular risk factors) were 2.02 (95% CI, 1.23–3.33, p=0.005) for the highest vs the lowest Friesinger coronary score and 1.40 (95% CI, 1.02–1.92, p=0.037) for MI, respectively. Further the SOD3 RG and GG genotype was associated with lower alpha-tocopherol levels than the wild type SOD3 RR genotype. It is concluded that the SOD3 231RG and GG genotype is associated with lower alpha-tocopherol levels and the severity of CAD and the risk of MI.     

Changes in anti-heat shock protein 27 antibody and C-reactive protein levels following cardiac surgery and their association with cardiac function in patients with cardiovascular disease

The relationship between serum anti-heat shock protein (Hsp)27 antibody and high sensitive C-reactive protein (hs-CRP) levels and indices of cardiac function were investigated in patients undergoing coronary artery bypass grafting (CABG) or heart valve replacement. The changes in anti-Hsp27 antibody titers and hs-CRP levels were compared among patients undergoing off-pump and on-pump CABG or valvular heart replacement. Fifty-three patients underwent off-pump, on-pump CABG, and heart valvular replacement in each group. Serum anti-Hsp27 titers and hs-CRP values were measured 24 h before and after the operation and at discharge. Echocardiography was performed before surgery and before discharge. The results were compared with values from 83 healthy controls. hs-CRP levels increased and anti-Hsp27 antibody decreased following surgery (P < 0.001 and P < 0.05, respectively), although these changes were independent of operative procedure (P = 0.361 and P = 0.120, respectively). Anti-Hsp27 antibody levels were higher at the time of discharge (P = 0.016). Only in coronary patients were anti-Hsp27 antibody levels negatively associated with E/E′ (r = −0.268, P = 0.022), a marker of pulmonary capillary wedge pressure. In conclusions, anti-Hsp27 antibody levels are associated with indices of cardiac function in coronary patients. Cardiopulmonary bypass had no significant effect on the induction of changes in anti-Hsp27 levels. Moreover, anti-Hsp27 antibody levels fell in all groups postoperatively; this may be due to the formation of immune complexes of antigen–antibody, and antibody levels were higher at the time of discharge.

Electronic supplementary material

The online version of this article (doi:10.1007/s12192-012-0358-y) contains supplementary material, which is available to authorized users.     

大剂量阿托伐他汀对冠心病合并高尿酸血症PCI术后Scr、hsCRP及NGAL的影响

摘要目的：探讨大剂量阿托伐他汀对冠心病合并高尿酸血症PCI术后scr、hsCRP及NGAL的影响。方法：选取2010年6月至2012年6月间于我院接受诊断和治疗的冠心病合并高尿酸血症患者64例,随机分为观察组与对照组,每组32例。观察组给予大剂量阿托伐他汀治疗,对照组给予常规剂量阿托伐他汀治疗。结果：两组患者治疗前Scr、hsCRP及NGAL水平之间相互比较无显著性差异（P〉0．05）。观察组患者术后24hhsCRP水平为（6．7±1．5）m∥L,72hhsCRP水平回落至（5．7±1．0）mg门L,均明显低于对照组（P〈0．05）。观察组患者术后24hNGAL水平为（59．1±12．3）ng／L,72hNGAL水平回落至（47．8±10_3）ngm,均明显低于对照组（P〈0．05）。观察组心脏不良事件发生率明显低于对照组（P〈O．05）。结论：大剂量阿托伐他汀对于冠心病合并高尿酸血症患者PCI术后有一定的肾脏保护作用,且其安全性良好。     

Reglα蛋白表达在胃癌及癌前病变组织中的变化

目的：观察再生基因1α（Regeneration gene 1α,Regla）在胃癌前病变组织及胃癌组织中的表达变化,探讨Reglot在胃粘膜癌变中发挥的作用,为临床诊治提供理论基础。方法：收集2011年1月-2012年12月在我院接受胃镜活检的患者胃粘膜组织,病理确诊为浅表性胃炎的为正常组,中度以上萎缩及肠化的为癌前病变组及胃腺癌即胃癌组。采用荧光定量PCR的方法检测三组胃粘膜组织中Regla的mRNA表达情况。结果：Reglet的mRNA表达在正常组、癌变组及胃癌组织中呈进行性升高;胃癌组中,低分化及印戒细胞癌和Ⅳ期胃癌患者的Reg1α表达升高最为明显;Regla在不同分化程度的胃癌组织间表达无显著差异;Regla在Ⅳ期胃癌中的表达显著高于I／II期;差异均具有统计学意义（P〈0．05）。结论：作为一种生长因子Regla可能参与了胃粘膜癌变的过程,并且Reglet的高表达可能与胃癌的预后相关。     

The exocyst subunit Exo70B1 is involved in the immune response of Arabidopsis thaliana to different pathogens and cell death

Components of the vesicle trafficking machinery are central to the immune response in plants. The role of vesicle trafficking during pre-invasive penetration resistance has been well documented. However, emerging evidence also implicates vesicle trafficking in early immune signaling. Here we report that Exo70B1, a subunit of the exocyst complex which mediates early tethering during exocytosis is involved in resistance. We show that exo70B1 mutants display pathogen-specific immuno-compromised phenotypes. We also show that exo70B1 mutants display lesion-mimic cell death, which in combination with the reduced responsiveness to pathogen-associated molecular patterns (PAMPs) results in complex immunity-related phenotypes.     

Myocardial bridging: what have we learned in the past and will new diagnostic modalities provide new insights?

The clinical significance of myocardial bridging has been a subject of discussion and controversy since the introduction of coronary arteriography (CAG) in the early 1960s. More recently computed tomography coronary angiography (CTCA) has made it possible to visualise the overlying muscular bands and appears to have a higher sensitivity for detecting myocardial bridging than CAG. Combining CTCA with invasive techniques such as CAG should make it possible to improve our understanding of the pathophysiology of myocardial bridging and to provide answers to hitherto unresolved questions. This paper critically reviews the outcomes of previous studies and defines remaining questions that should be answered to optimise the management of the presumably fast growing number of patients in whom a diagnosis of myocardial bridging has been made.