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【肾动脉狭窄和单侧局灶性和节段性肾小球硬化。】
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DOI：10.1016/s0272-6386(97)90469-8
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BACKGROUND & AIMS: Focal and segmental sclerosed lesions in the glomeruli are found in several pathological entities and more often are found in the corticomedullary junction where renal blood flow and filtration pressure is maximal. Experimental data suggest that hyperfiltration injury results in focal and segmental glomerulosclerosis (FSGS). In keeping with this concept, malignant hypertension is a known cause of nephrotic-range proteinuria and nephrotic syndrome pathalobically represented by FSGS. We report a case of unilateral renal artery stenosis associated with nephrotic syndrome and FSGS in the contralateral kidney only. The kidney with the stenosed renal artery showed normal glomeruli with juxtaglomerular hyperplasia, suggesting that protection from hyperfiltration injury was provided by the presence of high-grade stenosis. Serum creatinine concentration, blood pressure, and proteinuria normalized after aorto-renal bypass surgery. This case shows the importance of hemodynamic factors on the pathogenesis of secondary FSGS and the progression of renal disease.
背景与目标： 在几个病理实体中发现了肾小球的局灶性和节段性硬化病变，更常见于肾肾血流和滤过压力最大的皮质肾交界处。实验数据表明，超滤损伤可导致局灶性和节段性肾小球硬化（FSGS）。与这个概念一致，恶性高血压是FSGS病态性代表的肾病范围蛋白尿和肾病综合征的已知病因。我们报道了仅在对侧肾脏中伴有肾病综合征和FSGS的单侧肾动脉狭窄的病例。肾动脉狭窄的肾脏显示肾小球正常，并伴有肾小球增生，提示存在高度狭窄可防止过度滤过损伤。主动脉-肾脏搭桥手术后，血清肌酐浓度，血压和蛋白尿恢复正常。该病例表明血液动力学因素对继发性FSGS的发病机理和肾脏疾病进展的重要性。
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【血管内超声记录的血栓覆盖在不稳定型心绞痛和急性心肌梗死的冠状动脉中的小动脉粥样斑块上。】
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DOI：10.1016/s0002-9149(97)00199-9
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BACKGROUND & AIMS: Rupture of atheromatous plaques leading to acute coronary syndromes usually occur in lipid-reach and well-developed coronary lesions. We describe 2 unusual patients with acute coronary syndromes in whom there was angiographic and intravascular ultrasound evidence of an intraluminal thrombus overlying a small, nonocclusive plaque in an enlarged coronary artery.
背景与目标： 导致急性冠状动脉综合征的动脉粥样斑块破裂通常发生在脂质接触和发展良好的冠状动脉病变中。我们描述了2例急性冠状动脉综合征的不寻常患者，其中有血管造影和血管内超声证据显示腔内血栓覆盖在扩大的冠状动脉中的小块非闭塞性斑块上。
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【当代心肌梗塞溶栓治疗后出血的发生率和预测因素。闭塞性冠状动脉（GUSTO）I研究者的链激酶和组织纤溶酶原激活剂的全球利用。】
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DOI：10.1161/01.cir.95.11.2508
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BACKGROUND & AIMS: BACKGROUND:Although the benefit of thrombolytic therapy in reducing mortality in acute myocardial infarction is well established, the types of bleeding and risk factors for bleeding are less well described in large trials.
METHODS AND RESULTS:We analyzed the baseline characteristics, outcomes, and incidence of bleeding by location, severity, and treatment assignment among 41,021 patients in the GUSTO-I trial of thrombolysis for acute myocardial infarction. Of the 40,903 patients for whom there were complete data, 1.2% suffered severe bleeding and 11.4% experienced moderate hemorrhage at a variety of sites. The most common sources of bleeding were procedure related. The thrombolytic regimen was strongly related to the incidence of bleeding; comparatively more bleeding was seen with the therapies of streptokinase plus intravenous heparin and the streptokinase and tissue plasminogen activator plus intravenous heparin combination. In multivariate analysis, the four most powerful independent predictors of hemorrhage were older age, lighter body weight, female sex, and African ancestry; they remained the most important predictors of bleeding when multivariate analysis was performed on patients who did not undergo invasive procedures. The presence of serious hemorrhage was associated with other undesirable outcomes (recurrent events, left ventricular dysfunction, arrhythmia, or stroke).
CONCLUSIONS:Important predictors of bleeding in this population are increased age, lighter weight, female sex, African ancestry, and experiencing invasive procedures. Other nonhemorrhagic adverse clinical outcomes were associated with moderate and severe bleeding, which was in turn associated with increased length of hospital stay and mortality at 30 days.
背景与目标： 背景：尽管溶栓治疗在降低急性心肌梗死死亡率方面的益处已广为人知，但在大型试验中对出血的类型和出血的危险因素的描述却很少。
< strong>方法和结果：我们在GUSTO-I急性心肌梗塞溶栓试验的GUSTO-I试验中，对41,021例患者的基线特征，结局和出血发生率，位置，严重程度和治疗方案进行了分析。在有完整数据的40,903名患者中，有1.2％出现严重出血，11.4％的患者在不同部位出现中度出血。最常见的出血来源与手术有关。溶栓方案与出血发生率密切相关。链激酶加静脉肝素，链激酶和组织纤溶酶原激活剂加肝素联合治疗的出血量相对较多。在多变量分析中，出血的四个最有力的独立预测因子是年龄大，体重轻，女性和非洲血统。当对未进行侵入性治疗的患者进行多变量分析时，它们仍然是出血的最重要预测指标。严重出血的存在与其他不良后果（复发事件，左心室功能障碍，心律不齐或中风）相关。
结论：该人群出血的重要预测因素是年龄增加，体重减轻，女性性别，非洲血统和经历侵入性程序。其他非出血性不良临床预后与中度和重度出血有关，这又与住院天数的延长和30天病死率有关。
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【用可生物降解的聚-L-丙交酯支架进行动脉吻合支架：1和6周后的初步研究。】
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DOI：10.1583/05-1726MR.1
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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。 -
【门静脉和肝动脉多普勒超声参数在肝硬化和门静脉高压症诊断中的价值。】
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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。 -
【硬皮病中的P波振幅和肺动脉压。】
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DOI：10.1016/j.jelectrocard.2006.01.004
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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。 -
【胎儿左，右肺动脉的多普勒检查与胎儿位置和胎龄的关系：方法学研究]】
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DOI：10.1055/s-2007-1000509
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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。
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【使用MR数字减影血管造影评估儿童颅内病变的血液供应。】
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DOI：10.1007/s00247-006-0268-1
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BACKGROUND & AIMS: BACKGROUND:MR digital subtraction angiography (MR-DSA) is a contrast-enhanced MR angiographic sequence that enables time-resolved evaluation of the cerebral circulation. OBJECTIVE:We describe the feasibility and technical success of our attempts at MR-DSA for the assessment of intracranial pathology in children. MATERIALS AND METHODS:We performed MR-DSA in 15 children (age range 5 days to 16 years) referred for MR imaging because of known or suspected intracranial pathology that required a dynamic assessment of the cerebral vasculature. MR-DSA consisted of a thick (6-10 mm) slice-selective RF-spoiled fast gradient-echo sequence (RF-FAST) acquired before and during passage of an intravenously administered bolus of Gd-DTPA. The images were subtracted and viewed as a cine loop. RESULTS:MR-DSA was performed successfully in all patients. High-flow lesions were shown in four patients; these included vein of Galen aneurysmal malformation, dural fistula, and two partially treated arteriovenous malformations (AVMs). Low-flow lesions were seen in three patients, all of which were tumours. Normal flow was confirmed in eight patients including two with successfully treated AVMs, and in three patients with cavernomas. CONCLUSION:Our early experience suggests that MR-DSA is a realistic, non-invasive alternative to catheter angiography in certain clinical settings.背景与目标： 背景：MR数字减影血管造影（MR-DSA）是一种对比增强的MR血管造影序列，可对脑循环进行时间分辨评估。
目的：我们描述了MR-DSA评估儿童颅内病理的尝试的可行性和技术成功。
材料与方法：由于已知或疑似颅内病理，需要动态评估脑血管，我们对15例接受MR成像的儿童（年龄范围5天至16岁）进行了MR-DSA检查。 MR-DSA由厚的（6-10 mm）切片选择性RF破坏的快速梯度回波序列（RF-FAST）组成，在静脉内给予Gd-DTPA推注之前和期间均已获得。减去图像并将其视为电影循环。
结果：所有患者均成功进行了MR-DSA检查。四名患者出现高流量病灶。其中包括Galen动脉瘤畸形静脉，硬脑膜瘘和两个经过部分治疗的动静脉畸形（AVM）。在三名患者中均发现了低流量病变，所有这些都是肿瘤。在八名患者中确认了正常血流，其中包括两名成功治疗过的AVM和三名患有海绵状瘤的患者。
结论：我们的早期经验表明，在某些临床情况下，MR-DSA是导管血管造影术的一种现实的，非侵入性的替代方法。 -
【舒张颈动脉纵向壁运动对衰老和冠状动脉疾病状态均敏感，而与动脉僵硬度无关。】
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DOI：10.1016/j.ultrasmedbio.2017.04.026
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BACKGROUND & AIMS: :We investigated the ability of systolic and diastolic carotid artery longitudinal wall motion (CALM) to delineate expected differences in arterial health in individuals representing a range of both age and health status. We recruited 161 younger healthy adults (aged 24 ± 5 y), 51 older healthy adults (aged 70 ± 5 y) and 14 adults with coronary artery disease (aged 67 ± 8 y) for resting assessment of CALM and arterial stiffness. All CALM parameters were reduced in the old healthy adults and adults with coronary artery disease compared with the young healthy adults (p < 0.01), with diastolic velocity and maximum diastolic acceleration being further reduced in the adults with coronary artery disease than in the older healthy adults (p < 0.01). Diastolic CALM parameters were more strongly related to age (β range: -0.46 to -0.53) than systolic CALM parameters (β range: -0.24 to -0.44). In contrast to previous examinations of a variety of CALM parameters, diastolic CALM may provide superior promise in terms of characterizing arterial wall properties, with additional sensitivity to cardiovascular disease status.背景与目标： ：我们研究了代表年龄和健康状况范围的个体的收缩和舒张颈动脉纵向壁运动（CALM）描绘动脉健康预期差异的能力。我们招募了161名较年轻的健康成年人（24岁±5岁），51名较健康的成年人（70±5岁）和14名患有冠状动脉疾病的成年人（67±8岁）进行了CALM和动脉僵硬度的静息评估。与年轻健康成年人相比，老年健康成年人和患有冠状动脉疾病的成年人的所有CALM参数均降低（p <0.01），与老年健康成年人相比，冠状动脉疾病的成年人的舒张速度和最大舒张加速进一步降低成人（p <0.01）。舒张期CALM参数与年龄（β范围：-0.46至-0.53）的相关性比收缩期CALM参数（β范围：-0.24至-0.44）更密切。与以前对各种CALM参数的检查相比，舒张期CALM在表征动脉壁特性方面可能具有更好的前景，并且对心血管疾病的状态更加敏感。
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【自发性颅内低血压后小剂量硬膜外补血后的膀胱和肠功能障碍。】
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DOI：10.1016/j.jocn.2012.02.022
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BACKGROUND & AIMS: :Epidural blood patch (EBP) is an effective procedure for the treatment of spontaneous intracranial hypotension (SIH). Neurological compromise following EBP, although rare, is recognized as a serious potential complication. We describe a 33-year-old female patient in whom long-term bladder and bowel dysfunction developed following a small volume (10 mL) EBP to treat SIH. We also discuss the possible pathophysiological mechanisms related to this complication in the postprocedure setting.背景与目标： ：硬膜外补血（EBP）是治疗自发性颅内低血压（SIH）的有效方法。 EBP后的神经功能损害虽然很少见，但被认为是严重的潜在并发症。我们描述了一名33岁的女性患者，在该患者中，小剂量（10 mL）EBP治疗SIH后会出现长期的膀胱和肠功能障碍。我们还将讨论与术后并发症相关的可能的病理生理机制。
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【在荷兰心胸外科中心接受离体冠状动脉旁路移植术的患者的围手术期抗血小板治疗。】
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DOI：10.1007/s12471-017-1006-z
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BACKGROUND & AIMS: BACKGROUND:International guidelines do not provide uniform recommendations regarding the use of antiplatelet treatment in the perioperative period in patients undergoing coronary artery bypass grafting (CABG). METHODS:A questionnaire was sent to all 16 cardiothoracic centres in the Netherlands to determine which antiplatelet treatment is used in the perioperative setting. Furthermore, a single-centre prospective observational cohort study was performed which included all patients undergoing isolated CABG in July 2014. RESULTS:Eleven centres responded to the survey. Acetylsalicylic acid monotherapy was discontinued before surgery in 6 centres. In patients with an acute coronary syndrome receiving dual antiplatelet therapy (DAPT), most centres discontinued the P2Y12 inhibitor preoperatively. DAPT was restarted after surgery in 4 centres. However, 6 centres continued DAPT in patients who had undergone coronary stenting within one month of surgery. In patients with coronary stents, variation in the management of antiplatelet therapy increased in proportion to the interval between stenting and surgery. A total of 70 patients were included in the registry. Acetylsalicylic acid monotherapy was discontinued in 51% of patients and restarted in all patients. P2Y12 inhibitor treatment was discontinued before surgery in 70% of patients and re-initiated after CABG in 29%. CONCLUSIONS:Major differences were observed in the preoperative and postoperative management of antiplatelet treatment between different Dutch cardiothoracic centres and within a single centre. Part of this variation is probably due to lack of evidence and differences between the current guidelines; however, many of the strategies were not in accordance with any of these guidelines.背景与目标： 背景：国际指南并未就接受冠状动脉旁路移植术（CABG）的患者在围手术期使用抗血小板治疗提供统一的建议。
方法：将问卷调查表发送到荷兰的所有16个心电图中心，以确定围手术期使用哪种抗血小板治疗。此外，2014年7月进行了一项单中心前瞻性观察队列研究，其中包括所有接受孤立CABG的患者。
结果：11个中心对调查进行了答复。手术前6中心停用乙酰水杨酸单药治疗。在接受双重抗血小板治疗（DAPT）的急性冠状动脉综合征患者中，大多数中心在术前停用P2Y12抑制剂。在4个中心手术后，DAPT重新开始。但是，在手术后一个月内接受冠状动脉支架置入术的患者中，有6个中心继续进行DAPT。在冠状动脉支架患者中，抗血小板治疗管理的差异与支架置入和手术间隔的比例成正比。注册表中总共包括70名患者。乙酰水杨酸单药治疗在51％的患者中终止，并在所有患者中重新开始。 70％的患者在手术前中断了P2Y12抑制剂治疗，而29％的患者在CABG后重新开始治疗。
结论：在荷兰不同的心胸中心之间和单个中心内，在抗血小板治疗的术前和术后处理中观察到主要差异。这种变化的部分原因可能是由于缺乏证据以及当前准则之间的差异；但是，许多策略都不符合这些准则中的任何一项。 -
【2岁儿童出现肺动脉悬带和气管支气管。】
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DOI：10.5761/atcs.cr.12.01971
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BACKGROUND & AIMS: :Pulmonary artery sling is an incomplete vascular ring, the result of the left pulmonary artery arising from the right pulmonary artery and effectively constricting the airway, and it usually presents within the first weeks to months of life. We report a surgical correction of tracheal stenosis for a two-year-old patient associated with pulmonary artery sling and tracheal broncus.背景与目标： ：肺动脉悬带是不完全的血管环，是左肺动脉产生于右肺动脉并有效收缩气道的结果，通常出现在生命的最初几周至几个月内。我们报告了一名与肺动脉吊带和气管支气管相关的两岁患者的气管狭窄的手术矫正。
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【TGF-β/ miR-155 / c-Ski的机制调节人冠状动脉内皮细胞的内皮-间质转化。】
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DOI：10.1042/BSR20160603
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BACKGROUND & AIMS: :Human coronary artery endothelial cells (HCAECs) have the potential to undergo fibrogenic endothelial-mesenchymal transition (EndMT), which results in matrix-producing fibroblasts and thereby contributes to the pathogenesis of cardiac fibrosis. Recently, the profibrotic cytokine transforming growth factor-β (TGF-β) is shown to be the crucial pathogenic driver which has been verified to induce EndMT. C-Ski is an important regulator of TGF-β signaling. However, the detailed role of c-Ski and the molecular mechanisms by which c-Ski affects TGF-β-induced EndMT in HCAECs are not largely elucidated. In the present study, we treated HCAECs with TGF-β of different concentrations to induce EndMT. We found that overexpression of c-Ski in HCAECs either blocked EndMT via hindering Vimentin, Snail, Slug, and Twist expression while enhancing CD31 expression, with or without TGF-β treatment. In contrast, suppression of c-Ski further enhanced EndMT. Currently, miRNA expression disorder has been frequently reported associating with cardiac fibrosis. By using online tools, we regarded miR-155 as a candidate miRNA that could target c-Ski, which was verified using luciferase assays. C-Ski expression was negatively regulated by miR-155. TGF-β-induced EndMT was inhibited by miR-155 silence; the effect of TGF-β on Vimentin, CD31, Snail, Slug, and Twist could be partially restored by miR-155. Altogether, these findings will shed light on the role and mechanism by which miR-155 regulates TGF-β-induced HCAECs EndMT via c-Ski to affect cardiac fibrosis, and miR-155/c-Ski may represent novel biomarkers and therapeutic targets in the treatment of cardiac fibrosis.背景与目标： 人冠状动脉内皮细胞（HCAEC）有可能经历纤维化内皮-间质转化（EndMT），从而导致产生基质的成纤维细胞，从而有助于心脏纤维化的发病机理。最近，已证明原纤维化细胞因子转化生长因子-β（TGF-β）是关键的致病性驱动因子，已被证实可诱导EndMT。 C-Ski是TGF-β信号传导的重要调节剂。然而，在很大程度上没有阐明c-Ski的详细作用以及c-Ski影响HCAECs中TGF-β诱导的EndMT的分子机制。在本研究中，我们用不同浓度的TGF-β处理HCAEC，以诱导EndMT。我们发现，无论是否使用TGF-β处理，HCAEC中c-Ski的过表达要么通过阻碍波形蛋白，蜗牛，Slug和Twist的表达而阻断EndMT，同时增强CD31的表达。相反，抑制c-Ski进一步增强了EndMT。当前，miRNA表达障碍经常被报道与心脏纤维化有关。通过使用在线工具，我们将miR-155视为可以靶向c-Ski的候选miRNA，这已通过荧光素酶测定法进行了验证。 C-Ski表达受到miR-155的负调控。 TGF-β诱导的EndMT被miR-155沉默抑制； TGF-β对波形蛋白，CD31，蜗牛，Slug和Twist的作用可以被miR-155部分恢复。总之，这些发现将阐明miR-155通过c-Ski调节TGF-β诱导的HCAECs EndMT的作用和机制，从而影响心脏纤维化，而miR-155 / c-Ski可能代表了新型的生物标志物和治疗靶点。心脏纤维化的治疗。
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【运动心电图和th体层成像在糖尿病患者无症状冠状动脉疾病检测中的评估。】
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DOI：10.1136/hrt.63.1.7
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BACKGROUND & AIMS: :Thallium tomographic imaging and exercise electrocardiography were performed on 136 diabetic patients without symptoms of heart disease. Thirty three patients had post-exercise thallium defects and 19 had ST 1 mm greater than or equal to segment depression during exercise electrocardiography. Both tests were positive in 13 patients. Coronary angiography was subsequently performed on 33 patients with either scintigraphic and/or electrocardiographic evidence of myocardial ischaemia. Angiographically significant coronary artery disease (greater than or equal to 50% narrowing of the coronary artery lumen) was detected in 13 patients. Six patients had minimal coronary artery stenosis (less than 50%), and 14 had normal coronary arteries. Six patients refused cardiac catheterisation. In 14 out of 27 patients with post-exercise thallium defects coronary angiography did not show any coronary artery stenoses (positive predictive accuracy 48%). Exercise electrocardiography showed only one false positive result (positive predictive accuracy 94%) but failed to detect coronary artery disease in three patients with a positive scintigraphic result. The accuracy of a positive exercise electrocardiographic test seems to be better than that of a positive thallium tomographic scan for detecting asymptomatic coronary artery disease in diabetic patients. The high number of false positive thallium defects may be the result of technical features inherent in thallium tomography and/or the possible disease of the small intramyocardial arteries in diabetic patients.背景与目标： ：对136例无心脏病症状的糖尿病患者进行了to体层断层显像和运动心电图检查。在运动心电图检查中，有33例运动后al缺陷患者，其中19例ST大于或等于节段压低1 mm。两项测试均阳性13例。随后对33例有心肌缺血的闪烁显像和/或心电图证据的患者进行了冠状动脉造影。在13例患者中发现了具有血管造影意义的冠状动脉疾病（大于或等于50％的冠状动脉腔狭窄）。 6例患者的冠状动脉狭窄程度最小（少于50％），而14例具有正常的冠状动脉。六名患者拒绝心脏导管插入术。在运动后th缺陷的27例患者中，有14例冠状动脉造影未显示任何冠状动脉狭窄（阳性预测准确性为48％）。运动心电图检查仅显示一个假阳性结果（阳性预测准确率94％），但在3个闪烁显像结果阳性的患者中未能检测到冠心病。积极的运动心电图检查的准确性似乎比阳性的X线体层摄影检查的准确性要好，以检测糖尿病患者的无症状冠状动脉疾病。大量假阳性positive缺陷可能是may断层扫描固有的技术特征和/或糖尿病患者心肌小动脉可能的疾病的结果。
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【Kronos早期雌激素预防研究的女性与颈动脉内膜中层厚度和冠状动脉钙化相关的遗传多态性。】
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DOI：10.1152/physiolgenomics.00114.2012
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BACKGROUND & AIMS: :Menopausal hormone treatment (MHT) may limit progression of cardiovascular disease (CVD) but poses a thrombosis risk. To test targeted candidate gene variation for association with subclinical CVD defined by carotid artery intima-media thickness (CIMT) and coronary artery calcification (CAC), 610 women participating in the Kronos Early Estrogen Prevention Study (KEEPS), a clinical trial of MHT to prevent progression of CVD, were genotyped for 13,229 single nucleotide polymorphisms (SNPs) within 764 genes from anticoagulant, procoagulant, fibrinolytic, or innate immunity pathways. According to linear regression, proportion of European ancestry correlated negatively, but age at enrollment and pulse pressure correlated positively with CIMT. Adjusting for these variables, two SNPs, one on chromosome 2 for MAP4K4 gene (rs2236935, β = 0.037, P value = 2.36 × 10(-06)) and one on chromosome 5 for IL5 gene (rs739318, β = 0.051, P value = 5.02 × 10(-05)), associated positively with CIMT; two SNPs on chromosome 17 for CCL5 (rs4796119, β = -0.043, P value = 3.59 × 10(-05); rs2291299, β = -0.032, P value = 5.59 × 10(-05)) correlated negatively with CIMT; only rs2236935 remained significant after correcting for multiple testing. Using logistic regression, when we adjusted for waist circumference, two SNPs (rs11465886, IRAK2, chromosome 3, OR = 3.91, P value = 1.10 × 10(-04); and rs17751769, SERPINA1, chromosome 14, OR = 1.96, P value = 2.42 × 10(-04)) associated positively with a CAC score of >0 Agatston unit; one SNP (rs630014, ABO, OR = 0.51, P value = 2.51 × 10(-04)) associated negatively; none remained significant after correcting for multiple testing. Whether these SNPs associate with CIMT and CAC in women randomized to MHT remains to be determined.背景与目标： ：更年期激素治疗（MHT）可能会限制心血管疾病（CVD）的进展，但会带来血栓形成的风险。为了测试与颈动脉内膜中层厚度（CIMT）和冠状动脉钙化（CAC）定义的亚临床CVD相关的靶向候选基因变异，610名妇女参加了Kronos早期雌激素预防研究（KEEPS），这是一项MHT的临床试验为了预防CVD的进展，对来自抗凝，促凝，纤溶或先天免疫途径的764个基因中的13,229个单核苷酸多态性（SNP）进行了基因分型。根据线性回归，欧洲血统的比例呈负相关，而入学年龄和脉压与CIMT呈正相关。调整这些变量后，有两个SNP，一个在MAP4K4基因的2号染色体上（rs2236935，β= 0.037，P值= 2.36×10（-06）），一个在5号染色体上的IL5基因（rs739318，β= 0.051，P值） = 5.02×10（-05）），与CIMT正相关； CCL5在17号染色体上的两个SNP（rs4796119，β= -0.043，P值= 3.59×10（-05）; rs2291299，β= -0.032，P值= 5.59×10（-05））与CIMT呈负相关;更正了多个测试之后，只有rs2236935仍然很重要。使用Logistic回归，当我们调整腰围时，两个SNP（rs11465886，IRAK2、3号染色体，OR = 3.91，P值= 1.10×10（-04）;以及rs17751769，SERPINA1、14号染色体，OR = 1.96，P值= 2.42×10（-04））与CAC得分> 0 Agatston单位正相关;一个负相关的SNP（rs630014，ABO，OR = 0.51，P值= 2.51×10（-04））;校正多次测试后，没有一个保持显着水平。这些SNP是否与CIMT和CAC相关联，随机分为MHT患者。
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