Background:Baicalin(BC)and geniposide(GD)are effective components of natural remedies,and studies have shown that they protect against cerebral ischemic stroke(CIS).Transient receptor potential vanilloid 4(TRPV4)is a ...Background:Baicalin(BC)and geniposide(GD)are effective components of natural remedies,and studies have shown that they protect against cerebral ischemic stroke(CIS).Transient receptor potential vanilloid 4(TRPV4)is a calcium-permeable channel that plays important roles in vascular function and vasodilation.However,no studies are available on the effect of BC/GD on the TRPV4 channel and rat cerebral basilar artery(CBA).This study examined the effect of the combination of BC/GD(7:3)on cerebral vascular function after CIS.Methods:We used western blotting to determine TRPV4 protein levels and live cell fluorescence Ca 2+imaging and patch clamp to determine how BC/GD activates TRPV4 channels.Isolated vessel experiments were used to observe the dilatory effects of BC/GD on CBA under different conditions.Laser Doppler imaging was used to measure cerebral blood flow in rats.Triphenyl tetrazolium chloride and Nissl stainings were used to determine the infarct area in the rat brain and neuronal damage,respectively.Results:BC/GD significantly boosted TRPV4 protein levels in vascular smooth muscle cells(VSMCs)during oxygen-glucose deprivation and increased[Ca 2+]i in TRPV4-HEK 293 cells and VSMCs.This effect was not observed in vector-HEK 293 cells.In patch clamp experiments,BC/GD increased Ca 2+currents in TRPV4-HEK 293 cells,whereas no significant changes were observed in vector-HEK 293 cells.BC/GD dilated CBA contractions induced by U46619 and KCl,with a concentration-dependent increase of the dilatory effect.In the middle cerebral artery occlusion model,cerebral blood flow in the ischemic side significantly decreased,whereas BC/GD intervention significantly increased cerebral blood perfusion in the ischemic side,reduced the infarct area,and improved neurological function scores and neuronal damage.Conclusion:BC/GD activates the TRPV4 channel,leading to Ca ^(2+) influx,which in turn activates the intermediate conductance calcium-activated potassium channels channel to regulate vasodilation in vascular smooth muscle.展开更多
BACKGROUND Bilateral internal mammary arteries(BIMAs)as the most advanced surgical option for coronary artery bypass grafting(CABG)are usually recommended for younger patients without traditional risk factors.This stu...BACKGROUND Bilateral internal mammary arteries(BIMAs)as the most advanced surgical option for coronary artery bypass grafting(CABG)are usually recommended for younger patients without traditional risk factors.This study compares outcomes in propensity score-matched patients aged over 70 years who received BIMAs versus those who received a single internal mammary artery(SIMA).METHODS From 2013 to 2024,8123 patients underwent primary CABG for multivessel coronary artery disease at our institution.BIMA grafting was performed in 1233 patients(15.17%),with in situ BIMA grafting in 290 patients(3.57%).For in situ BIMA group,the right internal mammary artery was used to revascularize the right coronary artery,while the left internal mammary artery was utilized for the left anterior descending artery.BIMA patients aged over 70 years(n=79)were compared with SIMA patients(n=79)using propensity score matching.Primary outcome was all-cause mortality at 30 days and 8 years.Secondary outcomes included length of hospital stay,incidence of postoperative major adverse cardiovascular and cerebrovascular events,sternal wound infection and the need for subsequent percutaneous revascularization.RESULTS There was no difference in immediate postoperative primary and secondary outcomes.Mean follow-up was 8.3±1.0 years with an 8-year freedom from death of 67.08%±1.1%in the BIMA group versus 58.22%±0.9%in the SIMA group(P<0.05).CONCLUSIONS BIMAs as in situ grafts can be successfully used in CABG for patients aged 70 years and older.Consequently,the refined techniques for constructing internal mammary artery grafts used in this study challenge traditionally accepted limitations regarding the use of BIMAs.展开更多
Myocardial infarction with nonobstructive coronary arteries is a unique presentation of acute coronary syndrome occurring in patients without significant coronary artery disease.Its pathophysiology involves atheroscle...Myocardial infarction with nonobstructive coronary arteries is a unique presentation of acute coronary syndrome occurring in patients without significant coronary artery disease.Its pathophysiology involves atherosclerotic and nonatherosclerotic mechanisms such as plaque erosion,coronary microvascular dysfunction,vasospasm,spontaneous coronary artery dissection,autoimmune and inflammatory diseases,and myocardial oxygen supply-demand imbalance.A systematic approach to diagnosis is needed due to the diverse range of underlying causes.Cardiac troponins confirm the myocardial injury and coronary angiography rules out significant obstruction.Cardiac magnetic resonance imaging differentiates ischemic from nonischemic causes,and additional investigations,such as intravascular ultrasound,optical coherence tomography,and provocative testing,play a role in identifying the etiology to guide management strategies.Atherosclerotic cases require antiplatelet therapy and statins,vasospastic cases respond to calcium channel blockers,spontaneous coronary artery dissection is typically managed conservatively,and coronary microvascular dysfunction may require vasodilators.Lifestyle modifications and cardiac rehabilitation are essential for improving outcomes.The prognosis of patients experiencing recurrent events despite treatment is uncertain,but long-term outcomes depend on the etiology,highlighting the need for personalized management.Future research should focus on refining diagnostic protocols and identifying optimal therapeutic strategies.Randomized controlled trials are necessary to establish evidence-based treatments for different subtypes of myocardial infarction with nonobstructive coronary arteries.展开更多
Congenitally corrected transposition of the great arteries(CCTGA)is a rare congenital heart disease characterized by atrioventricular,ventriculoarterial,and conduction system discordance,commonly accompanied by atriov...Congenitally corrected transposition of the great arteries(CCTGA)is a rare congenital heart disease characterized by atrioventricular,ventriculoarterial,and conduction system discordance,commonly accompanied by atrioventricular block(AVB).Pacing in patients with CCTGA and AVB(both pediatric and adult)poses challenges in strategy selection,procedural complexity,and clinical decision-making due to limited evidence.Conventional morphological left ventricular pacing is widely adopted but may induce ventricular dyssynchrony,heart failure,and tricuspid valve dysfunction.While cardiac resynchronization therapy serves as an upgrade for pacing-induced cardiomyopathy and heart failure,its application may be limited by coronary sinus anatomical variations and uncertain clinical outcomes.His bundle pacing is rarely reported due to the variation of the His bundle and high pacing threshold.The superficial,wide,multi-branched left bundle branch favors left bundle branch pacing,though delayed systemic right ventricle(sRV)activation may cause ventricular dyssynchrony and impair sRV function.Right bundle branch pacing offers a novel alternative for pacing therapy.Conduction system pacing-optimized cardiac resynchronization therapy is preferred in those with evidence of intrinsic ventricular conduction dysfunction.This narrative review synthesizes current evidence on pacing strategies for CCTGA with AVB,integrating anatomical and pathophysiological insights to evaluate physiological pacing strategies,while highlighting critical knowledge gaps to guide future research.展开更多
BACKGROUND The topography between the common carotid artery(CA),internal CA,and external CA(ECA)with the greater horn of the hyoid bone(GHHB)is of particular importance for anatomists,radiologists and neck surgeons.AI...BACKGROUND The topography between the common carotid artery(CA),internal CA,and external CA(ECA)with the greater horn of the hyoid bone(GHHB)is of particular importance for anatomists,radiologists and neck surgeons.AIM To investigate these topographical relationships emphasizing anatomical classification,sexual dimorphism,and clinical significance.METHODS A retrospective study was performed on 224 computed tomography angiographies from a cohort comprising 161 male and 63 female patients,with a mean age of 63.2 years.Multiplanar and three-dimensional reconstructions were executed utilizing Horos software.The spatial relationships between the CA and hyoid bone were categorized based on the 12-type classification system delineated by Manta et al in 2023.The data were subsequently stratified by sex and laterality.RESULTS Type 0(no arterial contact with the GHHB)was the most common configuration(46.9%),followed by type VI(ECA lateral to GHHB,23.9%)and type VIII(internal CA and ECA lateral to GHHB,13.2%).Bilateral symmetry was present in 54.02%of cases,mainly in males.Statistically significant sex-based differences were found(P=0.012),while laterality was not significant(P=0.779).CONCLUSION Carotid–hyoid topography displays significant anatomical variation with clinically essential patterns.Non-null variants,such as types VI and VIII,may increase the risk of dynamic carotid compression,especially in younger patients with cryptogenic cerebrovascular symptoms.Recognizing these variants during preoperative imaging is crucial to minimize surgical risk and inform patient care.展开更多
Background The efficacy of percutaneous transluminal angioplasty and stenting(PTAS)relative to medical management in treating symptomatic intracranial arterial stenosis(ICAS)varies based on the qualifying artery.This ...Background The efficacy of percutaneous transluminal angioplasty and stenting(PTAS)relative to medical management in treating symptomatic intracranial arterial stenosis(ICAS)varies based on the qualifying artery.This study aims to evaluate PTAS compared with medical therapy alone in cases of ICAS involving the internal carotid artery(ICA),middle cerebral artery(MCA),vertebral artery(VA)and basilar artery(BA).Methods This study involves a thorough pooled analysis of individual patient data from two randomised controlled trials,evaluating the efficacy of PTAS in comparison to medical management for symptomatic ICAS with different qualifying arteries.The primary outcome was stroke or death within 30 days postenrolment,or stroke in the region of the qualifying artery beyond 30 days through 1 year.A methodology based on intention-to-treat was employed,and HR accompanied by 95%CIs were used to convey risk estimates.Results The data of 809 individuals were collected from Stenting vs Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis trial and China Angioplasty and Stenting for Symptomatic Intracranial Severe Stenosis trial.Four hundred were designated for PTAS,while 409 were assigned to medical therapy alone.For the primary outcome,patients with symptomatic BA stenosis had a significantly higher risk of receiving PTAS compared with medical therapy(17.17%vs 7.77%;9.40;HR,2.38(1.03 to 5.52);p=0.04).However,PTAS had no significant difference in patients with symptomatic ICA(26.67%vs 16.67%;HR,1.68(0.78 to 3.62);p=0.19),MCA(8.28%vs 9.79%;HR,0.85(0.42 to 1.74);p=0.66)and VA stenosis(9.52%vs 10.71%;HR,0.91(0.32 to 2.62);p=0.86)compared with medical therapy.Conclusions PTAS significantly increases the risk of both short-term and long-term stroke in patients with symptomatic BA stenosis.Without significant technological advancements to mitigate these risks,PTAS offers limited benefits.For symptomatic ICA,MCA and VA stenosis,PTAS provided no significant advantage.展开更多
Background:The efficacy of balloon angioplasty for treating peripheral artery disease is influenced by various factors,some of them not yet totally understood.This study aimed to evaluate the role of elastin content i...Background:The efficacy of balloon angioplasty for treating peripheral artery disease is influenced by various factors,some of them not yet totally understood.This study aimed to evaluate the role of elastin content in vascular responses 28 days postangioplasty using uncoated and paclitaxel-coated balloons with the same platform in femoral arteries of a healthy porcine model.Methods:Eight animals underwent balloon angioplasty on the external and internal branches of femoral arteries.Histopathologic evaluation was conducted at follow-up to assess the elastin content,vascular damage,morphological features,and neointimal formation.Results:The elastin content was significantly higher in the external than in the internal femoral artery(p=0.0014).After balloon angioplasty,it was inversely correlated with vascular injury score(ρ=−0.4510,p=0.0096),neointimal inflammation(ρ=−0.3352,p=0.0607),transmural(ρ=−0.4474,p=0.0103)and circumferential(ρ=−0.4591,p=0.0082)smooth muscle cell loss,presence of proteoglycans(ρ=−0.5172,p=0.0024),fibrin deposition(ρ=−0.3496,p=0.0499),and adventitial fibrosis(ρ=−0.6229,p=0.0002).Neointimal formation inhibition with paclitaxel was evident only in arteries with disruption of the internal elastic lamina,with a significant smaller neointimal area in arteries treated with paclitaxel-coated balloons compared to uncoated balloons(median[Q1–Q3]:10.25[7.49–15.64]vs.24.44[18.96–30.52],p=0.0434).Conclusions:Elastin content varies between branches of the femoral artery and significantly influences the integrity of the internal elastic lamina,the vessel's adaptive response,and paclitaxel efficacy after balloon angioplasty.展开更多
Objective:This study aimed to investigate the anatomy of the accessory pudendal artery(APA)in Asian men and to describe APA preservation techniques during robot-assisted radical prostatectomy(RARP).Methods:APA was def...Objective:This study aimed to investigate the anatomy of the accessory pudendal artery(APA)in Asian men and to describe APA preservation techniques during robot-assisted radical prostatectomy(RARP).Methods:APA was defined as“any artery located in the periprostatic region running parallel to the dorsal vascular complex and extending caudally toward the anterior perineum”.The anatomical variations of the APA were reviewed in 589 consecutive Japanese men who underwent conventional RARP at our institution between April 2019 and November 2023,including the number,laterality,side,size,and local distribution(apical vs.lateral).The apical APA emerges near the prostatic apical region,whereas the lateral APA courses along the lateral aspect of the prostate.They are further classified as the prostatic,fascial,and pubic APAs.Our APA identification and preservation techniques were described based on this classification.Results:Of the 589 Japanese men,299(51%)men were with one or more APAs:169 with one APA,115 with two APAs,14 with three APAs,and one with four APAs;and a total of 445 APAs were found.Approximately 97% of the APAs(432/445)were preserved.More lateral APAs were found than apical APAs(243/589[41%]vs.79/589[13%];p<0.001).Lateral APAs had a higher proportion of large-caliber arteries than apical APAs(59/359[16%]vs.1/86[1.2%];p<0.001),particularly prostatic and fascial APAs(14/59[24%]and 40/163[25%],respectively).Conclusion:This study identified anatomical variations of APAs in Japanese men and demonstrated that nearly all could be preserved during RARP.Further research is needed to evaluate the clinical benefits of APA preservation.展开更多
Arterial stenosis is a critical condition with increasing prevalence among pediatric patients and young adults,making its investigation highly significant.Despite extensive studies on blood flow dynamics,limited resea...Arterial stenosis is a critical condition with increasing prevalence among pediatric patients and young adults,making its investigation highly significant.Despite extensive studies on blood flow dynamics,limited research addresses the combined effects of nanoparticles and arterial curvature on unsteady pulsatile flow through multiple stenoses.This study aims to analyze the influence of nanoparticles on blood flow characteristics in realistic curved arteries with mild to severe overlapped constrictions.Using curvilinear coordinates,the thermal energy and momentum equations for nanoparticle-laden blood were derived,and numerical results were obtained through an explicit finite difference method.Key findings reveal that nanoparticle injections reduce blood temperature intensity,while arterial curvature strongly affects flow symmetry.Moreover,temperature,axial velocity,wall shear stress,and volumetric flow rate decrease significantly in severe stenosis compared to mild and moderate cases.These results provide new insights into nanoparticle-assisted blood flow under complex stenotic conditions and may contribute to improved diagnostic and therapeutic strategies for cardiovascular diseases.展开更多
Objective To review and analyze the surgical results of arterial switch operations in complete D-transposition of the great arteries （TGA）. Methods A total of 113 patients underwent arterial switch operation from Ja...Objective To review and analyze the surgical results of arterial switch operations in complete D-transposition of the great arteries （TGA）. Methods A total of 113 patients underwent arterial switch operation from Jan. 2001 to Dec. 2005. There were 60 patients with transposition of the great arteries and intact ventricular septum （TGA/IVS） and 53 patients with transposition of the great arteries and ventricular septal defect （TGA/VSD）. The lowest body weight was 2. 3 kg and the smallest age was 6 h. The arterial switch operation was performed under deep hypothermia with circulatory arrest and low-flow perfusion. Results The total mortality was 9. 73%. There were 5 deaths in TGA/IVS （8.3%）, 6 deaths in TGA/VSD （ 11.3% ）. With the development of surgical technique, peri-operative management and cardiopulmonary bypass, the total mortality significantly decreased from 16. 65% in the early times to 5. 5% lately. Conclusion The vital risk of the operation is coronary artery malformation. The incidence of coronary artery malformation is higher in TGA/VSD than in TGA/ [VS. The positional relationship of the great arteries does not affect the results of the operation. The arterial switch operation should be prevented when the pressure ratio between the left and right ventricle is less than 0.6, otherwise it is great likely to cause severe low cardiac output postoperatively.展开更多
AIM To examine the efficacy and safety of the 6 French(6F) Rotarex~S catheter system in patients with acute limb ischemia(ALI) involving thromboembolic occlusion of the proximal and mid-crural vessels.METHODS The fi...AIM To examine the efficacy and safety of the 6 French(6F) Rotarex~S catheter system in patients with acute limb ischemia(ALI) involving thromboembolic occlusion of the proximal and mid-crural vessels.METHODS The files of patients in our department with ALI between 2015 and 2017 were examined. In seven patients, the Rotarex~S catheter was used in the proximal segment of the crural arteries. Data related to the clinical examination, Doppler sonography, angiography and followup from these patients were further used for analysis.RESULTS Two patients(29%) had thrombotic occlusion of the common femoral artery, and the remaining five exhibited thrombosis of the superficial femoral artery and popliteal artery. Mechanical thrombectomy was performed in all cases using a 6F Rotarex~S catheter. Additional Rotarex~S catheter thrombectomy due to remaining thrombus formation with no reflow was performed in the anterior tibial artery in two of seven cases(29%), in the tibiofibular tract and posterior tibial artery in two of seven cases(29%) and in the tibiofibular tract and fibular artery in the remaining three of seven cases(43%). Ischemic symptoms resolved promptly in all, and none of the patients experienced a procedural complication, such as crural vessel dissection, perforation or thrombus embolization.CONCLUSION Mechanical debulking using the 6F Rotarex~S catheter system may be a safe and effective treatment option in case of thrombotic or thromboembolic occlusion of the proximal and mid-portion of crural arteries.展开更多
Acute myocardial infarction with normal coronary arteries is a well known condition,which is typically diagnosed in young patients.Coronary vasospasm,inherited,acquired or malignancy-induced hypercoagulable state,coll...Acute myocardial infarction with normal coronary arteries is a well known condition,which is typically diagnosed in young patients.Coronary vasospasm,inherited,acquired or malignancy-induced hypercoagulable state,collagen vascular disease and coronary arterial embolism have been considered as underlying etiologic factors.An association between migraine with aura and increased risk of ischemic stroke,angina and myocardial infarction has been demonstrated in studies.Patients with migraine and especially with aura should be followed closely against cardiovascular events even if they are young and do not have traditional risk factors.展开更多
Acute coronary syndromes constitute a variety of myocardial injury presentations that include a subset of patients presenting with myocardial infarction with non-obstructive coronary arteries(MINOCA).This acute corona...Acute coronary syndromes constitute a variety of myocardial injury presentations that include a subset of patients presenting with myocardial infarction with non-obstructive coronary arteries(MINOCA).This acute coronary syndrome differs from type 1 myocardial infarction(MI)regarding patient characteristics,presentation,physiopathology,management,treatment,and prognosis.Two-thirds of MINOCA subjects present ST-segment elevation;MINOCA patients are younger,are more often female and tend to have fewer cardiovascular risk factors.Moreover,MINOCA is a working diagnosis,and defining the aetiologic mechanism is relevant because it affects patient care and prognosis.In the absence of relevant coronary artery disease,myocardial ischaemia might be triggered by an acute event in epicardial coronary arteries,coronary microcirculation,or both.Epicardial causes of MINOCA include coronary plaque disruption,coronary dissection,and coronary spasm.Microvascular MINOCA mechanisms involve microvascular coronary spasm,takotsubo syndrome(TTS),myocarditis,and coronary thromboembolism.Coronary angiography with non-significant coronary stenosis and left ventriculography are first-line tests in the differential study of MINOCA patients.The diagnostic arsenal includes invasive and non-invasive techniques.Medical history and echocardiography can help indicate vasospasm or thrombosis,if one finite coronary territory is affected,or specify TTS if apical ballooning is present.Intravascular ultrasound,optical coherence tomography,and provocative testing are encouraged.Cardiac magnetic resonance is a cornerstone in myocarditis diagnosis.MINOCA is not a benign diagnosis,and its polymorphic forms differ in prognosis.MINOCA care varies across centres,and future multi-centre clinical trials with standardized criteria may have a positive impact on defining optimal cardiovascular care for MINOCA patients.展开更多
Objective: To quantify the changes in blood glucose, blood lipids, blood pressure, and the intima-media thickness (IMT) of large arteries in patients with new-onset type 2 diabetes mellitus who received either intensi...Objective: To quantify the changes in blood glucose, blood lipids, blood pressure, and the intima-media thickness (IMT) of large arteries in patients with new-onset type 2 diabetes mellitus who received either intensive multifactorial treatment or conventional treatment. Methods: Two-hundred and ten patients with new-onset type 2 diabetes mellitus were randomly assigned to two groups: an intensive treatment group (n=110) and a conventional treatment group (n=100). Fasting blood glucose (FBG), glycosylated hemoglobin A1c (HbA1c), blood pressure, blood lipids [total cholesterol (TC), triglyceride (TG), low-density lipoprotein C (LDL-C), and high-density lipoprotein C (HDL-C)], and IMTs of large arteries (carotid, iliac, and femoral arteries) were determined before and at one and two years after starting treatment. The patients in the conventional treatment group received routine diabetes management in our outpatient department. Targets were established for patients in the intensive treatment group. Their blood glucose, blood lipids, and blood pressure levels were regularly monitored and therapeutic regimens were adjusted for those whose measurements did not meet the target values until all the parameters met the established targets. Within-group and between-group differences were evaluated. Results: A significantly greater percentage of patients in the intensive treatment group had LDL-C levels that reached the target value one year after starting treatment than those in the conventional treatment group (52.04% vs. 33.33%, P<0.05). No significant differences were found be- tween groups for FBG, HbA1c, blood pressure, TG, TC, or HDL-C. The percentages of patients with TG (51.02% vs. 34.48%), TC (52.04% vs. 33.33%), and LDL-C (61.22% vs. 43.67%) who met the respective target values in the in- tensive treatment group were all significantly higher than the corresponding percentages in the conventional treatment group two years after starting treatment (P<0.05). There were no significant differences in the percentages of patients with FBG, HbA1c, and blood pressure values meeting the respective targets between the groups at the two-year follow- up. One year after starting treatment, the LDL-C level, diastolic blood pressure (DBP), and the IMTs of the femoral and iliac arteries of the intensive treatment group were significantly lower compared to those of the conventional treatment group (P<0.05), although there was no significant difference in other metabolic parameters. Two years after starting treatment, the TC, LDL-C, blood pressure [systolic blood pressure (SBP) and DBP], and the IMTs of the carotid and femoral arteries of the intensive treatment group were significantly lower than those of the conventional treatment group (P<0.05). No significant differences in other metabolic parameters existed between the two groups two years after starting treatment. Conclusions: Early comprehensive and intensive treatment of type 2 diabetes mellitus can delay or even reverse the increase in IMT of large arteries. Lowering blood pressure and blood lipid regulation in patients with type 2 diabetes mellitus have great significance in decreasing the risk of diabetes-related macrovascular lesions.展开更多
Integrated transportation and land use studies are of major interest to planners because they consider the interaction between transportation development and land use change. Quantifying the impact of transport infras...Integrated transportation and land use studies are of major interest to planners because they consider the interaction between transportation development and land use change. Quantifying the impact of transport infrastructure on land use change is necessary for evaluating the role of transportation development in the process of land use and land cover change in the urban-rural fringe. Taking Qixia District of Nanjing City, Jiangsu Province, China as a typical urban-rural fringe area, this paper analyzes the patterns and charac- teristics of land use change along three major transportation arteries using land use data from 2000 and 2008. We examine the spatial differentiation and gradient of land use pattern around railway, expressway, and highway corridors to investigate whether land use change in the urban-rural fringe is related to distance from transportation arteries and to clarify the varying impacts of different forms of transport infrastructure on land use patterns. We find that construction land generally tends to be located close to major transportation arteries, and that railways have the most obvious influence on land use change in the urban-rural fringe, while the impact of expressways was not significant. We conclude that there exists a causal relationship between the presence of transportation arteries and land use change in the urban-rural fringe, but this relationship varies across different types of linear transnort infrastrncnlre.展开更多
Reduced cavernosal arterial inflow has been hypothesized to be the likely cause of erectile dysfunction after kidney transplants in recipients revascularized through end-to-end anastomosis to the internal lilac artery...Reduced cavernosal arterial inflow has been hypothesized to be the likely cause of erectile dysfunction after kidney transplants in recipients revascularized through end-to-end anastomosis to the internal lilac artery, suggesting that end-to-side anastomosis at the external iliac artery is preferable. The aim of this study was to prospectively evaluate the effect of the use of the external iliac artery on erectile function, hormone profiles and penile blood flow by evaluating changes in penile colour Doppler ultrasound parameters in a consecutive series of 22 recipients before and after end-to-side external lilac artery transplantation. The mean International Index of Erectile Function-Erectile Function （IIEF-EF） domain score decreased significantly 3 months after transplant （18.09±6.33 vs. 22.50±7.09, P=O.01）. The reduction in peak systolic velocity （PSV） was significant for the cavernous artery homolateral to the side of transplant （42.60±18.77 vs. 52.01±19.91, P=0.01）. The mean postoperative end diastolic velocity （EDV） did not differ significantly from the preoperative value （P=0.74）. No statistical differences were found in the serum levels of testosterone or prolactin. Kidney grafts anastomosed at the external lilac artery produced significant （P=0.01） reductions in arterial inflow at the homolateral cavernosal artery that remained above the normal threshold. Whether these haemodynamic changes can explain the worsening of postoperative erectile function remains to be proven.展开更多
AIM To assess the arrhythmic determinants and prognosis of patients presenting with myocardial infarction and nonobstructive coronary arteries(MINOCA)with normal ejection fraction(EF).METHODS This is an observational ...AIM To assess the arrhythmic determinants and prognosis of patients presenting with myocardial infarction and nonobstructive coronary arteries(MINOCA)with normal ejection fraction(EF).METHODS This is an observational analysis of 131 MINOCA patients with normal EF.Three cardiac magnetic resonance(CMR)diagnosis classes were recognized according to the late gadolinium enhancement(LGE)pattern:Myocardial infarction(MI)(n=34),myocarditis(n=47),and"no LGE"(n=50).Ventricular events occurring during hospitalization were recorded and the entire population was followed-up at 1 year.RESULTS Ventricular arrhythmia was observed in 18(13.8%)patients during hospitalization.The"no LGE"patients experienced fewer ventricular events than the MI and myocarditis patients[4.0%vs 26.5%and 14.9%,respectively(P=0.013)].There was no significant difference between the MI and myocarditis groups.On multivariate analysis,LGE transmural extent[OR=1.52(1.08-2.15),P=0.017]and ST-segment elevation[OR=4.65(1.61-13.40),P=0.004]were independent predictors of ventricular arrhythmic events,irrespective of the diagnosis class.Finally,no patient experienced sudden cardiac death or ventricular arrhythmia recurrence at 1-year.CONCLUSION MINOCA patients with normal EF presented no 1-year cardiovascular events,irrespective of the CMR diagnosis class.LGE transmural extent and ST segment elevation at admission are risk markers of ventricular arrhythmia during hospitalization.展开更多
Objective：To evaluate the imageologic characteristics of the bronchial arteries （BAs） in primary lung cancer （PLC）with multidetector CT （MDCT）angiography. Methods： Thin-section enhanced CT scanning （with an T...Objective：To evaluate the imageologic characteristics of the bronchial arteries （BAs） in primary lung cancer （PLC）with multidetector CT （MDCT）angiography. Methods： Thin-section enhanced CT scanning （with an Toshiba Aquilion 16 scanner） was performed in 164 PLC patients, of whom 123 were confirmed by pathology and the remaining 41 were confirmed by typical radiological and clinical findings. Another 46 patients with normal thoracic CT presentations were served as control. Three-dimensional （3D） images of the BAs were processed at workstation （Vitrea 2, Vital Corp, USA）. Spatial anatomical characters of the BAs were observed using volume rendering （VR） and multiplanar reconstruction （MPR） or maximum intensity projection （MIP）. Results： At least one bronchial artery was displayed clearly on VR in 152 （92.7%） of the 164 PLC patients and 32 （69.6%） of the 46 controls. There were 48. 92% of the right BAs originating from the descending aorta and 46. 24% from the right intercostal artery. 97.53% of the left BAs originated from the descending aorta, and 94.87% of the common trunk from the descending aorta. There were 10 distribution patterns of the BAs, with one on the right and one on the left predominating （48. 68%）. More BA branches were found to reach far from the segmental bronchi or enter into the lesions in the PLC group than those in the control group （25.8% vs 1.7% ）, and also the ipsilateral side of the PLC than the contralateral side （40% vs 8. 8%）. The diameter and the total transaxial areas of the BAs on the ipsilateral side of the PLC lesions were significantly larger than those on the contralateral side or those of the control group （P〈0. 05）. Conclusion：The anatomic characters and pathologic changes can be depicted in vivo stereographically and clearly by CTA with volumetric 3D rendering. Dilation of the BAs and increase of total blood flow in patients with PLC can be evaluated quantitatively, which may be useful in the diagnosis and assessment of PLC, and have the potential to increase the safety and effect of interventional therapy.展开更多
Summary： The measurement of coronary flow velocity reserve （CFVR） by transthoracic Doppler echocardiography （TTDE） with invasive intracoronary Doppler flow wire technique （ICD） was validated and the pathologica...Summary： The measurement of coronary flow velocity reserve （CFVR） by transthoracic Doppler echocardiography （TTDE） with invasive intracoronary Doppler flow wire technique （ICD） was validated and the pathological factors which influence CFVR in patients with angiographically normal coronary arteries were analyzed. CFVR was determined successfully in left anterior descending artery （LAD） in 37 of 40 patients with angiographically normal coronary arteries （men 22, women 15, age 20-75 years, mean age 54±12 years）. Coronary flow velocity was measured in the distal LAD by TTDE with contrast enhancement at baseline and during intravenous adenosine infusion of 110 μg/ kg per min within 48 h after ICD technique. Average peak velocity at baseline （APVb）, average peak velocity during hyperemia （APVh） and CFVR determined from TTDE were correlated closely with those from ICD measurements （APVb： y= 0. 64x＋ 5. 04, r=0. 86, P〈0. 001; APVh： y=0. 63x＋14. 36, r=0.82, P〈0.001; CFVR： y=0.65xq-0.92, r=0.88, P〈0.001）. For CFVR measurements, the mean differences between TTDE and ICD methods were 0. 12±0.39. CFVR in patients with history of hypertension was significantly lower than that in patients without history of hypertension （P〈0.05）. Intravascular ultrasound （IVUS） was performed in 34 patients. Plaque formation was found in LAD by IVUS in 17 （50%） patients. No significant difference in CFVR was found between the patients without plaque formation （3. 11±0. 49） and those with plaque formation （2. 76±0.53, P=0. 056）. It is suggested that TTDE with contrast enhancement provides reliable measurement of APV and CFVR in the distal I.AD. The early stage of atherosclerosis could be detected by IVUS, which may be normal in angiography. CFVR is impaired in patients with history of hypertension compared with that in patients without history of hypertension.展开更多
基金supported by the Chinese Medicine"Dual Chain Integration"Young and Middle-aged Scientific Research and Innovation Teams(No.2022-SLRH-YQ-006)the Key R&D Programme Projects of Xianyang Municipality(No.L2023-ZDYF-SF-014)+1 种基金the Shaanxi University of Traditional Chinese Medicine Science,Education and Research Collaborative Educational Achievement Transformation Project(No.2024KC03)the open research topic from the Key Laboratory of Neurological Diseases in Traditional Chinese Medicine,Shaanxi Province(No.KF202315).
文摘Background:Baicalin(BC)and geniposide(GD)are effective components of natural remedies,and studies have shown that they protect against cerebral ischemic stroke(CIS).Transient receptor potential vanilloid 4(TRPV4)is a calcium-permeable channel that plays important roles in vascular function and vasodilation.However,no studies are available on the effect of BC/GD on the TRPV4 channel and rat cerebral basilar artery(CBA).This study examined the effect of the combination of BC/GD(7:3)on cerebral vascular function after CIS.Methods:We used western blotting to determine TRPV4 protein levels and live cell fluorescence Ca 2+imaging and patch clamp to determine how BC/GD activates TRPV4 channels.Isolated vessel experiments were used to observe the dilatory effects of BC/GD on CBA under different conditions.Laser Doppler imaging was used to measure cerebral blood flow in rats.Triphenyl tetrazolium chloride and Nissl stainings were used to determine the infarct area in the rat brain and neuronal damage,respectively.Results:BC/GD significantly boosted TRPV4 protein levels in vascular smooth muscle cells(VSMCs)during oxygen-glucose deprivation and increased[Ca 2+]i in TRPV4-HEK 293 cells and VSMCs.This effect was not observed in vector-HEK 293 cells.In patch clamp experiments,BC/GD increased Ca 2+currents in TRPV4-HEK 293 cells,whereas no significant changes were observed in vector-HEK 293 cells.BC/GD dilated CBA contractions induced by U46619 and KCl,with a concentration-dependent increase of the dilatory effect.In the middle cerebral artery occlusion model,cerebral blood flow in the ischemic side significantly decreased,whereas BC/GD intervention significantly increased cerebral blood perfusion in the ischemic side,reduced the infarct area,and improved neurological function scores and neuronal damage.Conclusion:BC/GD activates the TRPV4 channel,leading to Ca ^(2+) influx,which in turn activates the intermediate conductance calcium-activated potassium channels channel to regulate vasodilation in vascular smooth muscle.
文摘BACKGROUND Bilateral internal mammary arteries(BIMAs)as the most advanced surgical option for coronary artery bypass grafting(CABG)are usually recommended for younger patients without traditional risk factors.This study compares outcomes in propensity score-matched patients aged over 70 years who received BIMAs versus those who received a single internal mammary artery(SIMA).METHODS From 2013 to 2024,8123 patients underwent primary CABG for multivessel coronary artery disease at our institution.BIMA grafting was performed in 1233 patients(15.17%),with in situ BIMA grafting in 290 patients(3.57%).For in situ BIMA group,the right internal mammary artery was used to revascularize the right coronary artery,while the left internal mammary artery was utilized for the left anterior descending artery.BIMA patients aged over 70 years(n=79)were compared with SIMA patients(n=79)using propensity score matching.Primary outcome was all-cause mortality at 30 days and 8 years.Secondary outcomes included length of hospital stay,incidence of postoperative major adverse cardiovascular and cerebrovascular events,sternal wound infection and the need for subsequent percutaneous revascularization.RESULTS There was no difference in immediate postoperative primary and secondary outcomes.Mean follow-up was 8.3±1.0 years with an 8-year freedom from death of 67.08%±1.1%in the BIMA group versus 58.22%±0.9%in the SIMA group(P<0.05).CONCLUSIONS BIMAs as in situ grafts can be successfully used in CABG for patients aged 70 years and older.Consequently,the refined techniques for constructing internal mammary artery grafts used in this study challenge traditionally accepted limitations regarding the use of BIMAs.
文摘Myocardial infarction with nonobstructive coronary arteries is a unique presentation of acute coronary syndrome occurring in patients without significant coronary artery disease.Its pathophysiology involves atherosclerotic and nonatherosclerotic mechanisms such as plaque erosion,coronary microvascular dysfunction,vasospasm,spontaneous coronary artery dissection,autoimmune and inflammatory diseases,and myocardial oxygen supply-demand imbalance.A systematic approach to diagnosis is needed due to the diverse range of underlying causes.Cardiac troponins confirm the myocardial injury and coronary angiography rules out significant obstruction.Cardiac magnetic resonance imaging differentiates ischemic from nonischemic causes,and additional investigations,such as intravascular ultrasound,optical coherence tomography,and provocative testing,play a role in identifying the etiology to guide management strategies.Atherosclerotic cases require antiplatelet therapy and statins,vasospastic cases respond to calcium channel blockers,spontaneous coronary artery dissection is typically managed conservatively,and coronary microvascular dysfunction may require vasodilators.Lifestyle modifications and cardiac rehabilitation are essential for improving outcomes.The prognosis of patients experiencing recurrent events despite treatment is uncertain,but long-term outcomes depend on the etiology,highlighting the need for personalized management.Future research should focus on refining diagnostic protocols and identifying optimal therapeutic strategies.Randomized controlled trials are necessary to establish evidence-based treatments for different subtypes of myocardial infarction with nonobstructive coronary arteries.
文摘Congenitally corrected transposition of the great arteries(CCTGA)is a rare congenital heart disease characterized by atrioventricular,ventriculoarterial,and conduction system discordance,commonly accompanied by atrioventricular block(AVB).Pacing in patients with CCTGA and AVB(both pediatric and adult)poses challenges in strategy selection,procedural complexity,and clinical decision-making due to limited evidence.Conventional morphological left ventricular pacing is widely adopted but may induce ventricular dyssynchrony,heart failure,and tricuspid valve dysfunction.While cardiac resynchronization therapy serves as an upgrade for pacing-induced cardiomyopathy and heart failure,its application may be limited by coronary sinus anatomical variations and uncertain clinical outcomes.His bundle pacing is rarely reported due to the variation of the His bundle and high pacing threshold.The superficial,wide,multi-branched left bundle branch favors left bundle branch pacing,though delayed systemic right ventricle(sRV)activation may cause ventricular dyssynchrony and impair sRV function.Right bundle branch pacing offers a novel alternative for pacing therapy.Conduction system pacing-optimized cardiac resynchronization therapy is preferred in those with evidence of intrinsic ventricular conduction dysfunction.This narrative review synthesizes current evidence on pacing strategies for CCTGA with AVB,integrating anatomical and pathophysiological insights to evaluate physiological pacing strategies,while highlighting critical knowledge gaps to guide future research.
文摘BACKGROUND The topography between the common carotid artery(CA),internal CA,and external CA(ECA)with the greater horn of the hyoid bone(GHHB)is of particular importance for anatomists,radiologists and neck surgeons.AIM To investigate these topographical relationships emphasizing anatomical classification,sexual dimorphism,and clinical significance.METHODS A retrospective study was performed on 224 computed tomography angiographies from a cohort comprising 161 male and 63 female patients,with a mean age of 63.2 years.Multiplanar and three-dimensional reconstructions were executed utilizing Horos software.The spatial relationships between the CA and hyoid bone were categorized based on the 12-type classification system delineated by Manta et al in 2023.The data were subsequently stratified by sex and laterality.RESULTS Type 0(no arterial contact with the GHHB)was the most common configuration(46.9%),followed by type VI(ECA lateral to GHHB,23.9%)and type VIII(internal CA and ECA lateral to GHHB,13.2%).Bilateral symmetry was present in 54.02%of cases,mainly in males.Statistically significant sex-based differences were found(P=0.012),while laterality was not significant(P=0.779).CONCLUSION Carotid–hyoid topography displays significant anatomical variation with clinically essential patterns.Non-null variants,such as types VI and VIII,may increase the risk of dynamic carotid compression,especially in younger patients with cryptogenic cerebrovascular symptoms.Recognizing these variants during preoperative imaging is crucial to minimize surgical risk and inform patient care.
基金Beijing Hospitals Authority’s Ascent Plan(DFL20220702)National Natural Science Foundation of China(82101398).
文摘Background The efficacy of percutaneous transluminal angioplasty and stenting(PTAS)relative to medical management in treating symptomatic intracranial arterial stenosis(ICAS)varies based on the qualifying artery.This study aims to evaluate PTAS compared with medical therapy alone in cases of ICAS involving the internal carotid artery(ICA),middle cerebral artery(MCA),vertebral artery(VA)and basilar artery(BA).Methods This study involves a thorough pooled analysis of individual patient data from two randomised controlled trials,evaluating the efficacy of PTAS in comparison to medical management for symptomatic ICAS with different qualifying arteries.The primary outcome was stroke or death within 30 days postenrolment,or stroke in the region of the qualifying artery beyond 30 days through 1 year.A methodology based on intention-to-treat was employed,and HR accompanied by 95%CIs were used to convey risk estimates.Results The data of 809 individuals were collected from Stenting vs Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis trial and China Angioplasty and Stenting for Symptomatic Intracranial Severe Stenosis trial.Four hundred were designated for PTAS,while 409 were assigned to medical therapy alone.For the primary outcome,patients with symptomatic BA stenosis had a significantly higher risk of receiving PTAS compared with medical therapy(17.17%vs 7.77%;9.40;HR,2.38(1.03 to 5.52);p=0.04).However,PTAS had no significant difference in patients with symptomatic ICA(26.67%vs 16.67%;HR,1.68(0.78 to 3.62);p=0.19),MCA(8.28%vs 9.79%;HR,0.85(0.42 to 1.74);p=0.66)and VA stenosis(9.52%vs 10.71%;HR,0.91(0.32 to 2.62);p=0.86)compared with medical therapy.Conclusions PTAS significantly increases the risk of both short-term and long-term stroke in patients with symptomatic BA stenosis.Without significant technological advancements to mitigate these risks,PTAS offers limited benefits.For symptomatic ICA,MCA and VA stenosis,PTAS provided no significant advantage.
基金iVascular,S.L.U.,Camíde Can Ubach,11–Nave 3,08620 Sant Vicençdels Horts,Barcelona,Spain。
文摘Background:The efficacy of balloon angioplasty for treating peripheral artery disease is influenced by various factors,some of them not yet totally understood.This study aimed to evaluate the role of elastin content in vascular responses 28 days postangioplasty using uncoated and paclitaxel-coated balloons with the same platform in femoral arteries of a healthy porcine model.Methods:Eight animals underwent balloon angioplasty on the external and internal branches of femoral arteries.Histopathologic evaluation was conducted at follow-up to assess the elastin content,vascular damage,morphological features,and neointimal formation.Results:The elastin content was significantly higher in the external than in the internal femoral artery(p=0.0014).After balloon angioplasty,it was inversely correlated with vascular injury score(ρ=−0.4510,p=0.0096),neointimal inflammation(ρ=−0.3352,p=0.0607),transmural(ρ=−0.4474,p=0.0103)and circumferential(ρ=−0.4591,p=0.0082)smooth muscle cell loss,presence of proteoglycans(ρ=−0.5172,p=0.0024),fibrin deposition(ρ=−0.3496,p=0.0499),and adventitial fibrosis(ρ=−0.6229,p=0.0002).Neointimal formation inhibition with paclitaxel was evident only in arteries with disruption of the internal elastic lamina,with a significant smaller neointimal area in arteries treated with paclitaxel-coated balloons compared to uncoated balloons(median[Q1–Q3]:10.25[7.49–15.64]vs.24.44[18.96–30.52],p=0.0434).Conclusions:Elastin content varies between branches of the femoral artery and significantly influences the integrity of the internal elastic lamina,the vessel's adaptive response,and paclitaxel efficacy after balloon angioplasty.
文摘Objective:This study aimed to investigate the anatomy of the accessory pudendal artery(APA)in Asian men and to describe APA preservation techniques during robot-assisted radical prostatectomy(RARP).Methods:APA was defined as“any artery located in the periprostatic region running parallel to the dorsal vascular complex and extending caudally toward the anterior perineum”.The anatomical variations of the APA were reviewed in 589 consecutive Japanese men who underwent conventional RARP at our institution between April 2019 and November 2023,including the number,laterality,side,size,and local distribution(apical vs.lateral).The apical APA emerges near the prostatic apical region,whereas the lateral APA courses along the lateral aspect of the prostate.They are further classified as the prostatic,fascial,and pubic APAs.Our APA identification and preservation techniques were described based on this classification.Results:Of the 589 Japanese men,299(51%)men were with one or more APAs:169 with one APA,115 with two APAs,14 with three APAs,and one with four APAs;and a total of 445 APAs were found.Approximately 97% of the APAs(432/445)were preserved.More lateral APAs were found than apical APAs(243/589[41%]vs.79/589[13%];p<0.001).Lateral APAs had a higher proportion of large-caliber arteries than apical APAs(59/359[16%]vs.1/86[1.2%];p<0.001),particularly prostatic and fascial APAs(14/59[24%]and 40/163[25%],respectively).Conclusion:This study identified anatomical variations of APAs in Japanese men and demonstrated that nearly all could be preserved during RARP.Further research is needed to evaluate the clinical benefits of APA preservation.
文摘Arterial stenosis is a critical condition with increasing prevalence among pediatric patients and young adults,making its investigation highly significant.Despite extensive studies on blood flow dynamics,limited research addresses the combined effects of nanoparticles and arterial curvature on unsteady pulsatile flow through multiple stenoses.This study aims to analyze the influence of nanoparticles on blood flow characteristics in realistic curved arteries with mild to severe overlapped constrictions.Using curvilinear coordinates,the thermal energy and momentum equations for nanoparticle-laden blood were derived,and numerical results were obtained through an explicit finite difference method.Key findings reveal that nanoparticle injections reduce blood temperature intensity,while arterial curvature strongly affects flow symmetry.Moreover,temperature,axial velocity,wall shear stress,and volumetric flow rate decrease significantly in severe stenosis compared to mild and moderate cases.These results provide new insights into nanoparticle-assisted blood flow under complex stenotic conditions and may contribute to improved diagnostic and therapeutic strategies for cardiovascular diseases.
文摘Objective To review and analyze the surgical results of arterial switch operations in complete D-transposition of the great arteries （TGA）. Methods A total of 113 patients underwent arterial switch operation from Jan. 2001 to Dec. 2005. There were 60 patients with transposition of the great arteries and intact ventricular septum （TGA/IVS） and 53 patients with transposition of the great arteries and ventricular septal defect （TGA/VSD）. The lowest body weight was 2. 3 kg and the smallest age was 6 h. The arterial switch operation was performed under deep hypothermia with circulatory arrest and low-flow perfusion. Results The total mortality was 9. 73%. There were 5 deaths in TGA/IVS （8.3%）, 6 deaths in TGA/VSD （ 11.3% ）. With the development of surgical technique, peri-operative management and cardiopulmonary bypass, the total mortality significantly decreased from 16. 65% in the early times to 5. 5% lately. Conclusion The vital risk of the operation is coronary artery malformation. The incidence of coronary artery malformation is higher in TGA/VSD than in TGA/ [VS. The positional relationship of the great arteries does not affect the results of the operation. The arterial switch operation should be prevented when the pressure ratio between the left and right ventricle is less than 0.6, otherwise it is great likely to cause severe low cardiac output postoperatively.
文摘AIM To examine the efficacy and safety of the 6 French(6F) Rotarex~S catheter system in patients with acute limb ischemia(ALI) involving thromboembolic occlusion of the proximal and mid-crural vessels.METHODS The files of patients in our department with ALI between 2015 and 2017 were examined. In seven patients, the Rotarex~S catheter was used in the proximal segment of the crural arteries. Data related to the clinical examination, Doppler sonography, angiography and followup from these patients were further used for analysis.RESULTS Two patients(29%) had thrombotic occlusion of the common femoral artery, and the remaining five exhibited thrombosis of the superficial femoral artery and popliteal artery. Mechanical thrombectomy was performed in all cases using a 6F Rotarex~S catheter. Additional Rotarex~S catheter thrombectomy due to remaining thrombus formation with no reflow was performed in the anterior tibial artery in two of seven cases(29%), in the tibiofibular tract and posterior tibial artery in two of seven cases(29%) and in the tibiofibular tract and fibular artery in the remaining three of seven cases(43%). Ischemic symptoms resolved promptly in all, and none of the patients experienced a procedural complication, such as crural vessel dissection, perforation or thrombus embolization.CONCLUSION Mechanical debulking using the 6F Rotarex~S catheter system may be a safe and effective treatment option in case of thrombotic or thromboembolic occlusion of the proximal and mid-portion of crural arteries.
文摘Acute myocardial infarction with normal coronary arteries is a well known condition,which is typically diagnosed in young patients.Coronary vasospasm,inherited,acquired or malignancy-induced hypercoagulable state,collagen vascular disease and coronary arterial embolism have been considered as underlying etiologic factors.An association between migraine with aura and increased risk of ischemic stroke,angina and myocardial infarction has been demonstrated in studies.Patients with migraine and especially with aura should be followed closely against cardiovascular events even if they are young and do not have traditional risk factors.
文摘Acute coronary syndromes constitute a variety of myocardial injury presentations that include a subset of patients presenting with myocardial infarction with non-obstructive coronary arteries(MINOCA).This acute coronary syndrome differs from type 1 myocardial infarction(MI)regarding patient characteristics,presentation,physiopathology,management,treatment,and prognosis.Two-thirds of MINOCA subjects present ST-segment elevation;MINOCA patients are younger,are more often female and tend to have fewer cardiovascular risk factors.Moreover,MINOCA is a working diagnosis,and defining the aetiologic mechanism is relevant because it affects patient care and prognosis.In the absence of relevant coronary artery disease,myocardial ischaemia might be triggered by an acute event in epicardial coronary arteries,coronary microcirculation,or both.Epicardial causes of MINOCA include coronary plaque disruption,coronary dissection,and coronary spasm.Microvascular MINOCA mechanisms involve microvascular coronary spasm,takotsubo syndrome(TTS),myocarditis,and coronary thromboembolism.Coronary angiography with non-significant coronary stenosis and left ventriculography are first-line tests in the differential study of MINOCA patients.The diagnostic arsenal includes invasive and non-invasive techniques.Medical history and echocardiography can help indicate vasospasm or thrombosis,if one finite coronary territory is affected,or specify TTS if apical ballooning is present.Intravascular ultrasound,optical coherence tomography,and provocative testing are encouraged.Cardiac magnetic resonance is a cornerstone in myocarditis diagnosis.MINOCA is not a benign diagnosis,and its polymorphic forms differ in prognosis.MINOCA care varies across centres,and future multi-centre clinical trials with standardized criteria may have a positive impact on defining optimal cardiovascular care for MINOCA patients.
基金Project(Nos.30700485 and 30771333)supported by the National Natural Science Foundation of Chinathe Zhejiang Provincial Natural Science Foundation of China(No.Y306641)the National Science & Technology Pillar Program in the Eleventh Five-Year Plan Period of China(No.2006BAI02B08)
文摘Objective: To quantify the changes in blood glucose, blood lipids, blood pressure, and the intima-media thickness (IMT) of large arteries in patients with new-onset type 2 diabetes mellitus who received either intensive multifactorial treatment or conventional treatment. Methods: Two-hundred and ten patients with new-onset type 2 diabetes mellitus were randomly assigned to two groups: an intensive treatment group (n=110) and a conventional treatment group (n=100). Fasting blood glucose (FBG), glycosylated hemoglobin A1c (HbA1c), blood pressure, blood lipids [total cholesterol (TC), triglyceride (TG), low-density lipoprotein C (LDL-C), and high-density lipoprotein C (HDL-C)], and IMTs of large arteries (carotid, iliac, and femoral arteries) were determined before and at one and two years after starting treatment. The patients in the conventional treatment group received routine diabetes management in our outpatient department. Targets were established for patients in the intensive treatment group. Their blood glucose, blood lipids, and blood pressure levels were regularly monitored and therapeutic regimens were adjusted for those whose measurements did not meet the target values until all the parameters met the established targets. Within-group and between-group differences were evaluated. Results: A significantly greater percentage of patients in the intensive treatment group had LDL-C levels that reached the target value one year after starting treatment than those in the conventional treatment group (52.04% vs. 33.33%, P<0.05). No significant differences were found be- tween groups for FBG, HbA1c, blood pressure, TG, TC, or HDL-C. The percentages of patients with TG (51.02% vs. 34.48%), TC (52.04% vs. 33.33%), and LDL-C (61.22% vs. 43.67%) who met the respective target values in the in- tensive treatment group were all significantly higher than the corresponding percentages in the conventional treatment group two years after starting treatment (P<0.05). There were no significant differences in the percentages of patients with FBG, HbA1c, and blood pressure values meeting the respective targets between the groups at the two-year follow- up. One year after starting treatment, the LDL-C level, diastolic blood pressure (DBP), and the IMTs of the femoral and iliac arteries of the intensive treatment group were significantly lower compared to those of the conventional treatment group (P<0.05), although there was no significant difference in other metabolic parameters. Two years after starting treatment, the TC, LDL-C, blood pressure [systolic blood pressure (SBP) and DBP], and the IMTs of the carotid and femoral arteries of the intensive treatment group were significantly lower than those of the conventional treatment group (P<0.05). No significant differences in other metabolic parameters existed between the two groups two years after starting treatment. Conclusions: Early comprehensive and intensive treatment of type 2 diabetes mellitus can delay or even reverse the increase in IMT of large arteries. Lowering blood pressure and blood lipid regulation in patients with type 2 diabetes mellitus have great significance in decreasing the risk of diabetes-related macrovascular lesions.
基金Under the auspices of National Natural Science Foundation of China(No.40871255)Scientific Research Foundation of Graduate School of Nanjing University(No.2010CL12)
文摘Integrated transportation and land use studies are of major interest to planners because they consider the interaction between transportation development and land use change. Quantifying the impact of transport infrastructure on land use change is necessary for evaluating the role of transportation development in the process of land use and land cover change in the urban-rural fringe. Taking Qixia District of Nanjing City, Jiangsu Province, China as a typical urban-rural fringe area, this paper analyzes the patterns and charac- teristics of land use change along three major transportation arteries using land use data from 2000 and 2008. We examine the spatial differentiation and gradient of land use pattern around railway, expressway, and highway corridors to investigate whether land use change in the urban-rural fringe is related to distance from transportation arteries and to clarify the varying impacts of different forms of transport infrastructure on land use patterns. We find that construction land generally tends to be located close to major transportation arteries, and that railways have the most obvious influence on land use change in the urban-rural fringe, while the impact of expressways was not significant. We conclude that there exists a causal relationship between the presence of transportation arteries and land use change in the urban-rural fringe, but this relationship varies across different types of linear transnort infrastrncnlre.
文摘Reduced cavernosal arterial inflow has been hypothesized to be the likely cause of erectile dysfunction after kidney transplants in recipients revascularized through end-to-end anastomosis to the internal lilac artery, suggesting that end-to-side anastomosis at the external iliac artery is preferable. The aim of this study was to prospectively evaluate the effect of the use of the external iliac artery on erectile function, hormone profiles and penile blood flow by evaluating changes in penile colour Doppler ultrasound parameters in a consecutive series of 22 recipients before and after end-to-side external lilac artery transplantation. The mean International Index of Erectile Function-Erectile Function （IIEF-EF） domain score decreased significantly 3 months after transplant （18.09±6.33 vs. 22.50±7.09, P=O.01）. The reduction in peak systolic velocity （PSV） was significant for the cavernous artery homolateral to the side of transplant （42.60±18.77 vs. 52.01±19.91, P=0.01）. The mean postoperative end diastolic velocity （EDV） did not differ significantly from the preoperative value （P=0.74）. No statistical differences were found in the serum levels of testosterone or prolactin. Kidney grafts anastomosed at the external lilac artery produced significant （P=0.01） reductions in arterial inflow at the homolateral cavernosal artery that remained above the normal threshold. Whether these haemodynamic changes can explain the worsening of postoperative erectile function remains to be proven.
基金Supported by The French Federation of Cardiology(Fédération francaise de Cardiologie)
文摘AIM To assess the arrhythmic determinants and prognosis of patients presenting with myocardial infarction and nonobstructive coronary arteries(MINOCA)with normal ejection fraction(EF).METHODS This is an observational analysis of 131 MINOCA patients with normal EF.Three cardiac magnetic resonance(CMR)diagnosis classes were recognized according to the late gadolinium enhancement(LGE)pattern:Myocardial infarction(MI)(n=34),myocarditis(n=47),and"no LGE"(n=50).Ventricular events occurring during hospitalization were recorded and the entire population was followed-up at 1 year.RESULTS Ventricular arrhythmia was observed in 18(13.8%)patients during hospitalization.The"no LGE"patients experienced fewer ventricular events than the MI and myocarditis patients[4.0%vs 26.5%and 14.9%,respectively(P=0.013)].There was no significant difference between the MI and myocarditis groups.On multivariate analysis,LGE transmural extent[OR=1.52(1.08-2.15),P=0.017]and ST-segment elevation[OR=4.65(1.61-13.40),P=0.004]were independent predictors of ventricular arrhythmic events,irrespective of the diagnosis class.Finally,no patient experienced sudden cardiac death or ventricular arrhythmia recurrence at 1-year.CONCLUSION MINOCA patients with normal EF presented no 1-year cardiovascular events,irrespective of the CMR diagnosis class.LGE transmural extent and ST segment elevation at admission are risk markers of ventricular arrhythmia during hospitalization.
文摘Objective：To evaluate the imageologic characteristics of the bronchial arteries （BAs） in primary lung cancer （PLC）with multidetector CT （MDCT）angiography. Methods： Thin-section enhanced CT scanning （with an Toshiba Aquilion 16 scanner） was performed in 164 PLC patients, of whom 123 were confirmed by pathology and the remaining 41 were confirmed by typical radiological and clinical findings. Another 46 patients with normal thoracic CT presentations were served as control. Three-dimensional （3D） images of the BAs were processed at workstation （Vitrea 2, Vital Corp, USA）. Spatial anatomical characters of the BAs were observed using volume rendering （VR） and multiplanar reconstruction （MPR） or maximum intensity projection （MIP）. Results： At least one bronchial artery was displayed clearly on VR in 152 （92.7%） of the 164 PLC patients and 32 （69.6%） of the 46 controls. There were 48. 92% of the right BAs originating from the descending aorta and 46. 24% from the right intercostal artery. 97.53% of the left BAs originated from the descending aorta, and 94.87% of the common trunk from the descending aorta. There were 10 distribution patterns of the BAs, with one on the right and one on the left predominating （48. 68%）. More BA branches were found to reach far from the segmental bronchi or enter into the lesions in the PLC group than those in the control group （25.8% vs 1.7% ）, and also the ipsilateral side of the PLC than the contralateral side （40% vs 8. 8%）. The diameter and the total transaxial areas of the BAs on the ipsilateral side of the PLC lesions were significantly larger than those on the contralateral side or those of the control group （P〈0. 05）. Conclusion：The anatomic characters and pathologic changes can be depicted in vivo stereographically and clearly by CTA with volumetric 3D rendering. Dilation of the BAs and increase of total blood flow in patients with PLC can be evaluated quantitatively, which may be useful in the diagnosis and assessment of PLC, and have the potential to increase the safety and effect of interventional therapy.
文摘Summary： The measurement of coronary flow velocity reserve （CFVR） by transthoracic Doppler echocardiography （TTDE） with invasive intracoronary Doppler flow wire technique （ICD） was validated and the pathological factors which influence CFVR in patients with angiographically normal coronary arteries were analyzed. CFVR was determined successfully in left anterior descending artery （LAD） in 37 of 40 patients with angiographically normal coronary arteries （men 22, women 15, age 20-75 years, mean age 54±12 years）. Coronary flow velocity was measured in the distal LAD by TTDE with contrast enhancement at baseline and during intravenous adenosine infusion of 110 μg/ kg per min within 48 h after ICD technique. Average peak velocity at baseline （APVb）, average peak velocity during hyperemia （APVh） and CFVR determined from TTDE were correlated closely with those from ICD measurements （APVb： y= 0. 64x＋ 5. 04, r=0. 86, P〈0. 001; APVh： y=0. 63x＋14. 36, r=0.82, P〈0.001; CFVR： y=0.65xq-0.92, r=0.88, P〈0.001）. For CFVR measurements, the mean differences between TTDE and ICD methods were 0. 12±0.39. CFVR in patients with history of hypertension was significantly lower than that in patients without history of hypertension （P〈0.05）. Intravascular ultrasound （IVUS） was performed in 34 patients. Plaque formation was found in LAD by IVUS in 17 （50%） patients. No significant difference in CFVR was found between the patients without plaque formation （3. 11±0. 49） and those with plaque formation （2. 76±0.53, P=0. 056）. It is suggested that TTDE with contrast enhancement provides reliable measurement of APV and CFVR in the distal I.AD. The early stage of atherosclerosis could be detected by IVUS, which may be normal in angiography. CFVR is impaired in patients with history of hypertension compared with that in patients without history of hypertension.
