BACKGROUND & AIMS: PURPOSE:To assess the technical feasibility, thrombogenicity, and biocompatibility of a new biodegradable poly-L-lactic acid (PLLA) anastomotic stent. METHODS:A polytetrafluoroethylene bifurcated graft was implanted in 17 pigs through a midline abdominal incision. After transverse graft incision, 17 316L stainless steel stents and 17 PLLA stents were randomly implanted at both iliac anastomotic sites and deployed with a 6-mm balloon under direct vision without angiography. Intended follow-up was 1 week in 6 pigs receiving oral acetylsalicylic acid (ASA) and in 7 pigs receiving ASA/clopidogrel; 4 pigs receiving ASA/clopidogrel were followed for 6 weeks. At the end of the study, the segments containing the stents were surgically explanted and processed for histology to measure the mean luminal diameter, intimal thickness, and the vascular injury and inflammation scores. RESULTS:Initial technical success of stent placement was achieved in all animals without rupture of the suture. Two pigs died (unrelated to the stent) at 3 days after operation (1 in groups A and B). At 1 week, all PLLA stents showed thrombotic occlusion with the use of ASA alone. In contrast, all PLLA stents remained patent with concurrent administration of ASA/clopidogrel. All metal stents were patent regardless of the antiplatelet regimen. The mean luminal diameter of patent PLLA stents (4.13+/-0.17 mm) was comparable to metal stents (4.27+/-0.35 mm, p=0.78) at 1 week, but significantly diminished at 6 weeks (3.21+/-0.44 versus 4.19+/-0.18 mm, p=0.005). Histological analysis showed no signs of excessive recoil. PLLA stents induced a higher inflammation score (1.79+/-0.56) and more intimal hyperplasia (0.34+/-0.11 mm) compared to metal stents [1.27+/-0.44 mm (p<0.001) and 0.18+/-0.04 mm (p=0.006), respectively] at 6 weeks. Vascular injury was comparable between PLLA and metal stents. CONCLUSION:Biodegradable PLLA stents showed higher thrombogenicity and reduced patency compared to metal stents during early follow-up. Although ASA and clopidogrel prevented thrombotic occlusion, the increased inflammatory response and neointima formation remain major concerns of PLLA stents. A solution to this problem might be the incorporation of anti-inflammatory drugs into the PLLA stent.

背景与目标： 目的：评估新型可生物降解的聚-L-乳酸（PLLA）吻合支架的技术可行性，血栓形成性和生物相容性。
方法：通过腹部中线切口将聚四氟乙烯分叉移植物植入17只猪。横向移植后，将17个316L不锈钢支架和17个PLLA支架随机植入两个both吻合部位，并在不进行血管造影的情况下在直视下用6毫米球囊展开。预期的随访结果是：6头接受口服乙酰水杨酸（ASA）的猪和7头接受ASA /氯吡格雷的猪。对4只接受ASA /氯吡格雷的猪进行了6周的随访。在研究结束时，将包含支架的节段进行外科手术切除并进行组织学处理，以测量平均腔直径，内膜厚度以及血管损伤和炎症评分。
结果：在所有动物中均未发生缝线破裂的情况下，支架植入取得了初步的技术成功。手术后3天有2头猪死亡（与支架无关）（A和B组为1只）。在第1周，仅使用ASA时，所有PLLA支架均显示血栓闭塞。相反，所有PLLA支架在同时使用ASA /氯吡格雷的情况下仍保持专利。无论抗血小板方案如何，所有金属支架均已获得专利。专利PLLA支架的平均腔直径（4.13 /-0.17 mm）在1周时可与金属支架（4.27 /-0.35 mm，p = 0.78）相媲美，但在6周时显着减小（3.21 // 0.44对4.19 /-） 0.18毫米，p = 0.005）。组织学分析显示没有过度后坐的迹象。与金属支架[1.27 /-0.44 mm（p <0.001）和0.18 /-0.04 mm（p = 0.006）相比，PLLA支架引起更高的炎症评分（1.79 /-0.56）和更多的内膜增生（0.34 /-0.11 mm）。分别]在6周。 PLLA和金属支架之间的血管损伤相当。
结论：在早期随访中，与金属支架相比，可生物降解的PLLA支架显示出更高的血栓形成性和通畅性降低。尽管ASA和氯吡格雷预防了血栓闭塞，但炎症反应和新内膜形成的增加仍然是PLLA支架的主要关注点。解决该问题的方法可能是将抗炎药掺入PLLA支架中。

BACKGROUND & AIMS: OBJECTIVES:This prospective study was designed to assess the sensitivity and specificity of Doppler ultrasound parameters in the diagnosis of cirrhosis and portal hypertension. METHODS:Portal and hepatic arterial Doppler ultrasound was performed on 76 patients with cirrhosis and esophageal varices and on 73 age- and sex-matched controls. The parameters evaluated were portal venous velocity and hepatic arterial pulsatility index. The liver vascular index was calculated as the ratio of portal venous velocity to hepatic arterial pulsatility index. RESULTS:Portal venous velocity was significantly lower (11.0 +/- 2.4 vs 15.9 +/- 2.8 cm/s, p < 0.001) and hepatic arterial pulsatility index was significantly higher (1.28 +/- 0.18 vs 0.95 +/- 0.17,p < 0.001) in patients than in controls. Thus, the liver vascular index was significantly lower in patients than in controls (8.7 +/- 2.1 vs 17.2 +/- 4.3 cm/s, p < 0.001). The sensitivity and specificity of these parameters in the detection of cirrhosis and portal hypertension was then analyzed with the receiver operating characteristic curve. The best cut-off values were considered to be 13 cm/se of portal venous velocity and 1.1 of hepatic arterial pulsatility index, showing a sensitivity and specificity of 83, 85, 84, and 81%, respectively. The best cut-off value of the liver vascular index was 12 cm/s with a sensitivity and specificity of 97 and 93%, respectively. CONCLUSIONS:The liver vascular index is a high sensitive and specific Doppler ultrasound parameter in the diagnosis of cirrhosis and portal hypertension.

背景与目标： 目的：本前瞻性研究旨在评估多普勒超声参数在肝硬化和门静脉高压症诊断中的敏感性和特异性。
方法：对76例肝硬化和食管静脉曲张患者以及73例年龄和性别相匹配的对照者进行门静脉和肝动脉多普勒超声检查。评价的参数是门静脉速度和肝动脉搏动指数。肝血管指数计算为门静脉速度与肝动脉搏动指数之比。
结果：门静脉血流速度显着降低（11.0 /-2.4 vs 15.9 /-2.8 cm / s，p <0.001），肝动脉搏动指数显着升高（1.28 /-0.18 vs 0.95 /-0.17，p <0.001）患者比对照组。因此，患者的肝血管指数显着低于对照组（8.7 /-2.1对17.2 /-4.3 cm / s，p <0.001）。然后使用接收器工作特性曲线分析这些参数在检测肝硬化和门脉高压中的敏感性和特异性。最佳的临界值被认为是门静脉速度的13 cm / se和肝动脉搏动指数的1.1，分别显示出83％，85％，84％和81％的敏感性和特异性。肝血管指数的最佳临界值为12 cm / s，敏感性和特异性分别为97％和93％。
结论：肝血管指数是诊断肝硬化和门静脉高压症的高敏感度和特异性多普勒超声参数。

BACKGROUND & AIMS: BACKGROUND AND PURPOSE:Scleroderma is an immune-mediated disease characterized by excess deposition of collagen leading to microvascular occlusion. Morbidity and mortality are often secondary to pulmonary hypertension from injury to pulmonary microvasculature and interstitial lung disease. This study correlated P-wave findings on the 12-lead electrocardiogram (ECG) with mean pulmonary artery pressure (mPAP) measured by right heart catheterization in patients with scleroderma. METHODS:A retrospective review of 12-lead ECGs in 23 patients referred to a rheumatology clinic with the diagnosis of scleroderma was performed. Right heart catheterization was performed within 1 month of the resting ECG. RESULTS:Linear regression related P-wave amplitude in lead II with mPAP (r = 0.52, P = .011) This model was 73% sensitive and 67% specific for the presence or absence of elevated mPAP. CONCLUSIONS:P-wave amplitude analysis on the ECG may be helpful in the assessment of pulmonary hypertension in patients with scleroderma.

背景与目标： 背景与目的：硬皮病是一种免疫介导的疾病，其特征在于胶原蛋白的过度沉积导致微血管闭塞。发病率和死亡率通常是继发于肺动脉高压的疾病，从损伤到肺微脉管系统和间质性肺疾病。这项研究将硬皮病患者的12导联心电图（ECG）上的P波发现与右心导管检查测得的平均肺动脉压（mPAP）相关联。
方法：回顾性分析23例转诊至风湿病诊所并诊断为硬皮病的患者的12导联心电图。静息ECG后1个月内进行右心导管检查。
结果：与mPAP的铅II线性回归相关的P波振幅（r = 0.52，P = .011）该模型对存在或不存在mPAP升高的敏感性为73％，特异性为67％。
结论：心电图的P波振幅分析可能有助于评估硬皮病患者的肺动脉高压。

BACKGROUND & AIMS: UNLABELLED:A Methodical Study:

AIM OF THE STUDY:To analyse the feasibility of colour and spectral Doppler assessment of blood flow in the fetal right (RPA) and left (LPA) main pulmonary arteries in relation to fetal position and to gestational age.

STUDY DESIGN:The fetal position was a priori divided into 3 types, depending on whether the fetal heart was visualised apically (Type 1), from the right side (Type 2) or from the left side (Type 3). Three groups A (19-25 weeks gestation), B (26-32) and C (33-39) including 33 consecutive pregnancies each, were examined to document the fetal position as well as the rate of the successful Doppler examinations of the RPA and/or LPA.

RESULTS:The fetal position Type 2 was most common throughout gestation (in group A = 42%, B = 36%, C = 51%) followed by the type 3 and then type 1. The rate of successful Doppler records from the RPA and LPA depended on the fetal position: In Type 2 RPA in 98%; in Type 3, LPA in 100%; but the apical approach was not effective (< 40%). Depending on gestational age, the success rates for a Doppler examination of at least one vessel were high (> 85%), whereas successful examination of both vessels was unlikely (12%).

CONCLUSIONS:In the second half of pregnancy, independent of fetal position, Doppler examination of at least one pulmonary artery is successful in most cases, whereas the assessment of both vessels is rather difficult.

背景与目标： UNLABELLED ：一项系统研究：

研究目标：分析彩色和光谱多普勒评估胎儿血流（RPA）的可行性）和左（LPA）主要肺动脉与胎儿位置和胎龄有关。

研究设计：胎儿位置是先验的，分为3种类型，具体取决于是否从右侧（2型）或左侧（3型）顶端可见胎儿心脏（类型1）。对三组A（妊娠19-25周），B（26-32）和C（33-39）组进行了检查，每个组连续33次怀孕，以记录胎儿的位置以及RPA的多普勒检查成功率和/或LPA。

结果：在整个妊娠期间，胎儿位置2型最为常见（A组为42％，B = 36％，C = 51％），其次是分别是3型和1型。RPA和LPA的多普勒记录成功率取决于胎儿的位置：在2型RPA中为98％。在类型3中，LPA为100％；但根尖手术方法无效（<40％）。根据胎龄，至少对一根血管进行多普勒检查的成功率较高（> 85％），而对两根血管进行多普勒检查的成功率均不高（12％）。

结论 strong>：在怀孕的后半段，不管胎儿的位置如何，在大多数情况下，多普勒检查至少一条肺动脉是成功的，而两条血管的评估却相当困难。