BACKGROUND & AIMS: -2

背景与目标： -2

BACKGROUND & AIMS: OBJECTIVES:To optimize a simple flowcytometric technique for Prenatal diagnosis (PND) for Leukocyte adhesions defect (LAD-I) on cordocentesis sample at 18 wk gestation. METHODS:Normal reference ranges for expression of CD18/CD11-integrins in neutrophils and lymphocytes at 18 wk of gestation were established by flowcytometry. PND for LAD-I was then performed on the cordocentesis samples in three 'at risk' pregnancies after ruling out maternal contamination. RESULTS:CD18 and CD11a expression on fetal lymphocytes were found to be the most useful parameters for PND of LAD-I. All the three fetuses tested showed normal expression of CD18/CD11-integrins and thus were unaffected. This was confirmed by testing the cord blood (CB) samples after delivery and normal growth and absence of serious infections on follow-up. CONCLUSIONS:Flowcytometry offers a rapid and sensitive technique for PND of LAD-I in the absence of facilities for molecular diagnosis. Obstetricians, even in developing countries with modest facilities, can offer considerable relief for the families.

背景与目标： 目的：为了优化一种简单的流式细胞术技术，以进行18周妊娠时脐带穿刺样本上白细胞粘附缺陷（LAD-I）的产前诊断（PND）。
方法：通过流式细胞术确定妊娠18周时中性粒细胞和淋巴细胞中CD18 / CD11整合素表达的正常参考范围。在排除孕产妇污染后，对脐带穿刺样本进行了三次“有风险”妊娠的PND。
结果：发现胎儿淋巴细胞上的CD18和CD11a表达是LAD-1 PND最有用的参数。测试的所有三个胎儿均显示CD18 / CD11整合素正常表达，因此不受影响。通过在分娩，正常生长后进行脐带血（CB）样品测试以及随访中没有严重感染，可以证实这一点。
结论：流式细胞术为LAD-1的PND提供了一种快速而灵敏的技术，而没有分子诊断的便利。产科医生，即使在设施有限的发展中国家，也可以为家庭提供很大的帮助。

BACKGROUND & AIMS: :Leukocyte adhesion deficiency 1 (LAD-1) is caused by defects in the β2 integrin subunit. We studied 18 missense mutations, 14 of which fail to support the surface expression of the β2 integrins. Integrins with the β2-G150D mutation fail to bind ligands, possibly due to the failure of the α1 segment of the βI domain to assume an α-helical structure. Integrins with the β2-G716A mutation are not maintained in their resting states, and the patient has the severe phenotype of LAD-1. The β2-S453N and β2-P648L mutants support the expression of integrins and adhesion functions. They should be re-classified as polymorphic variants.

背景与目标： ：白细胞粘附缺乏症1（LAD-1）是由β2整联蛋白亚基的缺陷引起的。我们研究了18个错义突变，其中14个不能支持β2整合素的表面表达。具有β2-G150D突变的整联蛋白不能结合配体，这可能是由于βI结构域的α1区段无法呈现α螺旋结构所致。具有β2-G716A突变的整联蛋白不能保持在静止状态，并且患者具有严重的LAD-1表型。 β2-S453N和β2-P648L突变体支持整合素的表达和粘附功能。应该将它们重新分类为多态变体。

BACKGROUND & AIMS: PURPOSE:We have evaluated thoracic conformation of patients in order to derive a numeric value predictive of an increased dose to left anterior descending coronary artery (LAD), critical structure for the development of late radio induced cardiac morbidity. METHODS:We have evaluated 91 patients (36-88 years) affected by breast cancer stage I-II (Tis-T1-2 N0-1), undergoing adjuvant radiotherapy with conventional fractionation. For each patient on CT images was measured the distance between the back face of the sternum (manubrium) and the anterior face of body of the corresponding vertebra (a), and the distance measured on the line at 45° between the vertebral body of the same vertebra and the back face of the rib corresponding (b). The a/b ratio showed values between 0.626 and 1.123. We used the median value (0.821) as cut-off to divide the patients in two groups. We calculated in both groups: Volume (Vol) heart, Vol LAD with an expansion of 0.6 mm; Dmean LAD (Gy); Dmax LAD (Gy); V10-V20-V30 (%) LAD and we correlated these values with parametric and non-parametric tests. RESULTS:The Pearson test has showed a statistically significant correlation between Vol breast and V10, V20, V30 with borderline significance (p = 0.006; p = 0.02; p = 0.05). The data were confirmed by testing non-parametric Kendall (tau = 0.004; tau = 0.015; tau = 0.016) and Spearman (rho = 0.003; rho = 0.016; rho = 0.015). We conducted categorizing into quartiles of breast volume and evaluated the correlation with a/b. We have found a significative correlation (p = 0.01) between small Vol breast (≤660.23 cc) and a/b < 0.0821 and greater Vol breast (>660.23 cc) with a/b > 0.0821. From the evaluation of the distribution of V10 in the two groups taking account of the Dmean ≤5 or >5 significance was found with a/b; Chi square 0.009 (0.01). Values ≤5 were observed in women with a/b < 0.0821. Values >5 in women with a/b > 0.0821. CONCLUSIONS:The geometric conformity of chest thorax considering a/b and the value of 0.0821 can reveals an important parameter in the selection of patients suitable for radiation therapy on left breast in order to evaluate the risk of late cardiac events. This consideration during treatment planning can change the technique or the set-up allowing the development of a customized plan.

背景与目标： 目的：我们评估了患者的胸廓结构，以得出预测左前降支冠状动脉（LAD）剂量增加的数值，该数字是晚期放射性诱发的心脏病的关键结构。
方法：我们评估了91例（36-88岁）受乳腺癌I-II期（Tis-T1-2 N0-1）影响的患者，他们接受了常规分流的辅助放疗。对于每位CT图像上的患者，测量胸骨背面（手掌）与相应椎骨的身体前表面之间的距离（a），并在距椎骨的椎体之间45°线上测量的距离相同的椎骨与肋骨的背面相对应（b）。 a / b比显示为0.626至1.123之间的值。我们使用中位数（0.821）作为临界值，将患者分为两组。我们对两组进行了计算：心脏的体积（Vol），扩展的0.6 mm的LAD体积; Dmean LAD（Gy）; Dmax LAD（Gy）; V10-V20-V30（％）LAD，我们将这些值与参数测试和非参数测试相关联。
结果：Pearson检验显示Vol乳腺与V10，V20，V30之间具有统计学显着相关性，具有临界意义（p = 0.006; p = 0.02; p = 0.05）。通过测试非参数Kendall（tau = 0.004; tau = 0.015; tau = 0.016）和Spearman（rho = 0.003; rho = 0.016; rho = 0.015）确认数据。我们对乳房体积的四分位数进行了分类，并评估了与a / b的相关性。我们发现小体积乳房（≤660.23cc）与a / b <0.0821和较大体积乳房（> 660.23 cc）与a / b> 0.0821之间存在显着相关性（p = 0.01）。通过评估Dmean≤5或> 5的显着性，从两组中V10的分布评估中，发现a / b；卡方0.009（0.01）。在a / b <0.0821的女性中观察到的值≤5。 A / b> 0.0821的女性的值> 5。
结论：考虑到a / b和0.0821的值，胸廓的几何一致性可以为选择适合左胸放射治疗的患者选择一个重要参数，以评估晚期心脏事件的风险。治疗计划期间的考虑因素可能会更改技术或设置，从而允许制定自定义计划。

BACKGROUND & AIMS: OBJECTIVE:Outcomes and treatment costs for coronary artery disease involving the left anterior descending coronary artery (LAD) are influenced by the type of treatment, which can be either isolated minimally invasive revascularization of the LAD using the internal thoracic artery (ITA) (MIDCAB) or percutaneous coronary intervention (PCI) on the LAD. This retrospective study sought to evaluate long-term survival, freedom from re-intervention and cost analysis after MIDCAB compared to PCI on the LAD. METHODS:Between 2006 and 2012, from a total of 561 patients, 106 consecutive patients with LAD stenosis underwent a MIDCAB procedure whereas 100 patients underwent elective PCI. Urgent and emergent cases were excluded from the present study (n = 355). Detailed analysis of the outcome data was performed for both groups. A Kaplan-Meier survival estimation with up to 10-year follow-up was applied for both groups for survival analysis and freedom from re-intervention. RESULTS:There were no statistically significant differences in terms of clinically relevant baseline characteristics. The outcome in the MIDCAB group was superior regarding long-term overall survival, accounting for 100% versus 92.8% at 1 year, 98.5% versus 82.1% at 6 years and 79.6% versus 61.5% at 10 years (Log Rank (Mantel-Cox) p = 0.011) and freedom from re-intervention at 10 years (97.2% vs. 86.7%, Log Rank (Mantel-Cox) p = 0.001). Intensive care unit (ICU) stay (p = 0.020) and total hospital stay (p<0.001) were significantly longer in the MIDCAB group, which was also associated with higher in-hospital costs (10,879 € vs. 4009 €, p<0.001). CONCLUSIONS:Whereas patients undergoing MIDCAB remained longer on ICU and in hospital, causing higher costs, this procedure was associated with a significantly lower incidence of repeat revascularization and significantly lower mortality compared to PCI on the LAD.

背景与目标： 目的：涉及左冠状动脉前降支（LAD）的冠状动脉疾病的结果和治疗费用受治疗类型的影响，可以通过使用胸腔内动脉（ITA）（MIDCAB）隔离LAD的微创血运重建或在LAD上进行经皮冠状动脉介入治疗（PCI）。这项回顾性研究旨在评估与LAD上的PCI相比，MIDCAB后的长期生存率，免于再次干预的费用和成本分析。
方法：2006年至2012年，共561例患者中，连续106例LAD狭窄患者接受了MIDCAB手术，而100例患者接受了选择性PCI。紧急和紧急情况被排除在本研究之外（n = 355）。两组均对结果数据进行了详细分析。两组均采用长达10年随访的Kaplan-Meier生存估计，以进行生存分析和免于再次干预。
结果：就临床相关的基线特征而言，没有统计学上的显着差异。 MIDCAB组的长期总生存期优于100％vs.92.8％（1年），98.5％（62.1年），82.1％（79.6％）61.5％（10年）（Log Rank（Mantel-Cox ）p = 0.011）和10年免于再次干预的可能性（97.2％vs. 86.7％，Log Rank（Mantel-Cox）p = 0.001）。 MIDCAB组的重症监护病房（ICU）住院时间（p = 0.020）和总住院时间（p <0.001）明显更长，这也与住院费用较高相关（10,879€vs. 4009€，p <0.001 ）。
结论：尽管接受MIDCAB的患者在ICU和住院期间的住院时间更长，导致费用更高，但与LAD上的PCI相比，该手术与再次血运重建的发生率显着降低和死亡率显着降低有关。

BACKGROUND & AIMS: :In patients in whom the left internal mammary artery (LIMA) has been previously utilized, reoperative grafting of the left anterior descending (LAD) or diagonal coronary arteries can be performed through a left anterior small thoracotomy (LAST) approach, utilizing the subclavian artery as inflow source. In such cases, however, the left upper lobe of the lung and the lingula may exert unwanted traction on the newly constructed coronary graft. Herein, we describe a detail of technique that eliminates this inconvenience.

背景与目标： ：对于先前已使用左乳内动脉（LIMA）的患者，可通过锁骨下动脉通过左前小切口开胸术（LAST）进行左前降支（LAD）或对角冠状动脉的再植作为流入源。但是，在这种情况下，肺的左上叶和舌状部可能会对新构造的冠状动脉移植物施加不必要的牵引力。在此，我们描述消除这种不便之处的技术细节。

BACKGROUND & AIMS: :We have reported previously that the LAD-4 monoclonal antibody (mAb) directed against a fibronectin receptor (FNR) on RL-male-1 T lymphoma cells in BALB/c mice partially inhibited their migration to the liver. In the present study, we examined the mechanism by which another anti-FNR mAb, LAD-1, exerts its antitumourigenic effects. Administration of LAD-1 significantly prolonged survival of BALB/c mice challenged previously with RL-male-1 cells. LAD-1 enhanced phagocytosis of RL-male-1 cells by hepatic macrophages and clodronate-mediated macrophage depletion abrogated the antitumour activity of LAD-1. In vitro experiments revealed that a pan-caspase inhibitor, zVAD-fmk, did not affect the ability of LAD-1 to inhibit the proliferation of RL-male-1 cells. These data suggest that the antitumour effects of LAD-1 may be dependent on stimulation of tumour cell phagocytosis and are apoptosis-independent. Thus, LAD-1-induced phagocytosis of lymphoma cells by hepatic macrophages in mice may, at least in part, be responsible for the prolonged survival of the mice.

背景与目标： ：我们先前曾报道过，针对BALB / c小鼠RL-male-1 T淋巴瘤细胞上纤连蛋白受体（FNR）的LAD-4单克隆抗体（mAb）部分抑制了它们向肝脏的迁移。在本研究中，我们研究了另一种抗FNR mAb LAD-1发挥其抗肿瘤作用的机制。 LAD-1的给药可显着延长先前用RL-male-1细胞攻击的BALB / c小鼠的存活期。 LAD-1通过肝巨噬细胞增强了RL-male-1细胞的吞噬作用，而氯膦酸盐介导的巨噬细胞耗竭则废除了LAD-1的抗肿瘤活性。体外实验表明，泛半胱天冬酶抑制剂zVAD-fmk不会影响LAD-1抑制RL-male-1细胞增殖的能力。这些数据表明，LAD-1的抗肿瘤作用可能取决于肿瘤细胞吞噬作用的刺激，并且与细胞凋亡无关。因此，LAD-1诱导的小鼠肝巨噬细胞对淋巴瘤细胞的吞噬作用可能至少部分是导致小鼠存活时间延长的原因。

BACKGROUND & AIMS: OBJECTIVE:Hypertrophic obstructive cardiomyopathy (HOCM) is still a serious problem that is characterized by an increasing hypertrophy of the cardiac muscle. The aim of this study was to investigate the hypothesis whether in HOCM the coronary flow reserve in the left anterior descending artery (LAD) is influenced by pharmacologic stimulation or stimulation using a pacemaker. PATIENTS AND METHODS:The study was carried out in 15 patients (6 male, 9 female) with the typical echocardiographic signs of HOCM without coronary artery disease. Using an intracoronary Doppler catheter the average peak velocity and the absolute coronary flow reserve were determined in the proximal, medial and distal part of the LAD under influence of Papaverine, Substance P and under pacemaker stimulation. The coronary square plane was calculated angiographically under the influence of Substance P. Moreover, the retrograde flow was studied and the coherence between the increase of the coronary square plane and the coronary flow reserve were investigated. For statistical analysis the mean value, the standard error of the mean, Spearman's correlation coefficient and the t-test were calculated. RESULTS:Under pharmacologic stimulation higher values in the average peak velocity were observed compared to pacemaker stimulation. A retrograde flow was observed in 8 out of 10 patients. The coronary flow reserve was higher under pharmacologic influence than under pacemaker stimulation. A coherence between the increase of the coronary square plane and the coronary flow reserve was not found. CONCLUSIONS:So far, from the published data concerning the characteristics of coronary flow in HOCM patients, only the retrograde flow was reproducible in our patient group. However, a decrease of the coronary flow reserve compared to a healthy control group of the literature could not be observed. Nevertheless ischemia in the subordinate vessels and on the base of microcirculation cannot be excluded.

背景与目标： 目的：肥厚性梗阻性心肌病（HOCM）仍然是一个严重的问题，其特征是心肌肥大增加。这项研究的目的是调查关于在HOCM中左前降支（LAD）中冠状动脉血流储备是否受到药理刺激或使用起搏器刺激的影响的假说。
患者与方法：本研究在15例具有典型HOCM超声心动图征象但无冠心病的患者（男6例，女9例）中进行。使用冠状动脉内多普勒导管，在罂粟碱，P物质和起搏器刺激下，测定LAD近端，内侧和远端的平均峰值速度和绝对冠状动脉血流储备。在物质P的影响下，通过血管造影计算冠状动脉正方形平面。此外，研究了逆行血流，并研究了冠状动脉正方形平面的增加与冠状动脉血流储备之间的相干性。为了进行统计分析，计算了平均值，平均值的标准误，Spearman相关系数和t检验。
结果：在药理刺激下，与起搏器刺激相比，观察到平均峰值速度更高的值。 10名患者中有8名观察到逆行血流。在药理作用下，冠状动脉血流储备高于在起搏器刺激下。没有发现冠状动脉正方形平面的增加与冠状动脉血流储备之间的一致性。
结论：到目前为止，从已发表的有关HOCM患者冠状动脉血流特征的数据来看，在我们的患者组中只有逆行血流是可再现的。然而，与健康对照组相比，没有观察到冠状动脉血流储备的减少。然而，不能排除从属血管和基于微循环的局部缺血。

BACKGROUND & AIMS: BACKGROUND/OBJECTIVES:Atherosclerosis is the main underlying pathology of coronary artery disease (CAD), which is the leading cause of mortality worldwide. Lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) is involved in multiple phases of vascular dysfunction, including endothelial dysfunction, atherosclerotic plaque formation, and destabilization. The purpose of the current study was to determine whether soluble LOX-1 is associated with proximal/mid and distal segment of the left anterior descending (LAD) artery lesion in patients with stable CAD. METHODS:Sixty-four patients with proximal/mid segment of the LAD lesions and 51 patients with distal segments of the LAD lesions were included in this study. Soluble LOX-1 levels were measured in all study subjects. RESULTS:Baseline characteristics of the two groups were similar. In stable CAD, patients with proximal/middle segment of the LAD lesions had significantly higher circulating soluble LOX-1 levels than patients with distal segments of the LAD lesions (1.07 ± 0.33 vs. 0.70 ± 0.17 ng/ml, p < 0.001). No correlation was found between plasma-soluble LOX-1 levels and fasting glucose, lipid profile. For predicting proximal/middle LAD lesions, the highest specificity (95,2%) and sensitivity (53,8%) levels were obtained at the cut-off value of 0.68. CONCLUSION:Our study demonstrated that serum-soluble LOX-1 levels were associated with proximal/mid segment of the LAD lesions. Furthermore, this study suggested soluble LOX-1 might be a useful biomarker of coronary plaque vulnerability in patients with stable CAD. Soluble LOX-1, the novel biochemical marker, may provide new insights into not only risk stratification but also therapeutic strategy for CAD.

背景与目标： 背景/目的：动脉粥样硬化是冠状动脉疾病（CAD）的主要潜在病理，是世界范围内导致死亡的主要原因。凝集素样氧化低密度脂蛋白受体1（LOX-1）参与血管功能障碍的多个阶段，包括内皮功能障碍，动脉粥样硬化斑块形成和不稳定。本研究的目的是确定在稳定型CAD患者中可溶性LOX-1是否与左前降支（LAD）动脉病变的近端/中段和远端段相关。
方法：本研究纳入了64例LAD病变近端/中段的患者和51例LAD病变远段的患者。在所有研究对象中测量可溶性LOX-1水平。
结果：两组的基线特征相似。在稳定的CAD中，LAD病变的近端/中段患者的循环可溶性LOX-1水平明显高于LAD病变的远端段患者（1.07±0.33 vs.0.70±0.17 ng / ml，p <0.001）。在血浆可溶性LOX-1水平与空腹血糖，血脂水平之间未发现相关性。为了预测近端/中间LAD病变，在0.68的临界值时获得了最高的特异性（95.2％）和敏感性（53.8％）。
结论：我们的研究表明，血清可溶性LOX-1水平与LAD病变的近端/中段有关。此外，这项研究表明可溶性LOX-1可能是稳定CAD患者冠状动脉斑块易损性的有用生物标志物。可溶性LOX-1是一种新颖的生化标记，不仅可以为风险分层提供新的见解，而且可以为CAD的治疗策略提供新的见解。

BACKGROUND & AIMS: :To our knowledge, this is the first report of primary percutaneous coronary intervention in a patient with a superdominant left circumflex artery, in which the entire right coronary artery myocardium territory is provided by the left circumflex. Coronary angiographic images of our 80-year-old male patient illustrate this anomaly. Single coronary arteries are among the most rare anatomic coronary anomalies, and the absence of right coronary artery ostium has been described as the rarest of these anomalies. Coronary events in such cases can be catastrophic due to the large amount of myocardium at risk.

背景与目标： ：据我们所知，这是首次对左旋支支气管动脉占主导的患者进行经皮冠状动脉介入治疗的首次报道，其中左旋支气管提供了整个右冠状动脉心肌区域。我们80岁的男性患者的冠状动脉造影照片说明了这种异常情况。单个冠状动脉是最罕见的解剖冠状动脉畸形，而右冠状动脉口的缺失是这些畸形中最罕见的。在这种情况下，由于大量的心肌处于危险之中，因此冠状动脉事件可能是灾难性的。

BACKGROUND & AIMS: :Research models of infarction and myocardial ischemia are essential to investigate the acute and chronic pathobiological and pathophysiological processes in myocardial ischemia and to develop and optimize future treatment. Two different methods of creating myocardial ischemia are performed in laboratory rodents. The first method is to create cryo infarction, a fast but inaccurate technique, where a cryo-pen is applied on the surface of the heart (1-3). Using this method the scientist can not guarantee that the cryo-scar leads to ischemia, also a vast myocardial injury is created that shows pathophysiological side effects that are not related to myocardial infarction. The second method is the permanent ligation of the left anterior descending artery (LAD). Here the LAD is ligated with one single stitch, forming an ischemia that can be seen almost immediately. By closing the LAD, no further blood flow is permitted in that area, while the surrounding myocardial tissue is nearly not affected. This surgical procedure imitates the pathobiological and pathophysiological aspects occurring in infarction-related myocardial ischemia. The method introduced in this video demonstrates the surgical procedure of a mouse infarction model by ligating the LAD. This model is convenient for pathobiological and pathophysiological as well as immunobiological studies on cardiac infarction. The shown technique provides high accuracy and correlates well with histological sections.

背景与目标： ：梗塞和心肌缺血的研究模型对于调查心肌缺血的急，慢性病理生物学和病理生理过程以及制定和优化未来治疗至关重要。在实验室啮齿动物中进行了两种不同的产生心肌缺血的方法。第一种方法是制造冰冻梗塞，这是一种快速但不准确的技术，其中在心脏表面上使用冰冻笔（1-3）。使用这种方法，科学家无法保证低温疤痕会导致局部缺血，还会造成巨大的心肌损伤，这种损伤显示出与心肌梗塞无关的病理生理学副作用。第二种方法是永久结扎左前降支动脉（LAD）。在这里，LAD结扎了一个针脚，形成了几乎可以立即看到的局部缺血。通过关闭LAD，该区域将不允许进一步的血液流动，而周围的心肌组织几乎不会受到影响。该手术过程模仿了与梗塞相关的心肌缺血中发生的病理生物学和病理生理学方面。该视频中介绍的方法通过结扎LAD演示了小鼠梗塞模型的外科手术过程。该模型对于心脏梗死的病理生物学和病理生理以及免疫生物学研究是方便的。所示技术提供了很高的准确性，并与组织学切片很好地相关。

BACKGROUND & AIMS: :We report a case of GuideLiner catheter use during transradial intervention for selective coronary angiography of the distal left anterior descending artery (LAD), beyond the left internal mammary artery (LIMA) anastomosis. The lesion within the LAD was located distal to the anastomosis of a very tortuous LIMA, otherwise unable to be visualized due to competitive flow from the LIMA. Stenting by way of the LIMA could not be performed due to this severe tortuosity as well. Alternatively, performance of the intervention without GuideLiner assistance would have required dual access, with injections both through the LIMA graft and the native LAD for angiography and intervention. Use of the GuideLiner served the purpose of selective LAD angiography to visualize the lesion, as well as delivery of the stent through a proximally calcified LAD. Using this single transradial route allowed the intervention to be completed, while reducing complications due to multiple access sites.

背景与目标： ：我们报告了一例在经intervention动脉介入治疗期间对左前降支远侧动脉（LAD）进行选择性冠状动脉造影的案例，在左乳内动脉（LIMA）吻合之外使用了GuideLiner导管。 LAD内的病变位于非常曲折的LIMA吻合术的远端，否则由于来自LIMA的竞争性流而无法可视化。由于这种严重的曲折，也无法通过LIMA进行固定。或者，在没有GuideLiner协助的情况下进行干预将需要双重途径，同时通过LIMA移植物和天然LAD进行注射以进行血管造影和干预。 GuideLiner的使用用于选择性LAD血管造影以可视化病变，以及通过近端钙化LAD输送支架。使用这种单一的经radi动脉途径可以完成干预，同时减少由于多个进入部位而引起的并发症。

BACKGROUND & AIMS: :Following aortic valve replacement (AVR) and a single vessel bypass (SVG) to the left-anterior descending artery (LAD), the patient had a non-ST segment myocardial infarction with graft occlusion and underwent left internal mammary artery (LIMA) to SVG to LAD. When we evaluated her at our institution for ischemic symptoms, we were able to determine the probable sequence of events and the reason for her symptoms. Her AVR was interfering with normal flow into the left main with associated coronary steal from the distal LAD. The AVR had to be revised and the patient's symptoms improved.

背景与目标： ：在主动脉瓣置换术（AVR）和左前降支动脉（LAD）的单支血管旁路术（SVG）之后，患者患有非ST段心肌梗死并发生了移植物阻塞，并接受了左乳内动脉（LIMA） SVG到LAD。当我们在机构中评估她的缺血症状时，我们能够确定事件的可能顺序以及她出现症状的原因。她的AVR干扰了左主干的正常血流，并伴有远端LAD的冠状动脉窃取。必须修订AVR，并改善患者的症状。

BACKGROUND & AIMS: AIMS:Competitive flow from native coronary vessels is considered a major factor in the failure of coronary bypass grafts. However, the pathophysiological effects are not fully understood. Low and oscillatory wall shear stress (WSS) is known to induce endothelial dysfunction and vascular disease, like atherosclerosis and intimal hyperplasia. The aim was to investigate the impact of competitive flow on WSS in mammary artery bypass grafts. METHODS AND RESULTS:Using computational fluid dynamics, WSS was calculated in a left internal mammary artery (LIMA) graft to the left anterior descending artery in a three-dimensional in vivo porcine coronary artery bypass graft model. The following conditions were investigated: high competitive flow (non-significant coronary lesion), partial competitive flow (significant coronary lesion), and no competitive flow (totally occluded coronary vessel). Time-averaged WSS of LIMA at high, partial, and no competitive flow were 0.3-0.6, 0.6-3.0, and 0.9-3.0 Pa, respectively. Further, oscillatory WSS quantified as the oscillatory shear index (OSI) ranged from (maximum OSI = 0.5 equals zero net WSS) 0.15 to 0.35, <0.05, and <0.05, respectively. Thus, high competitive flow resulted in substantial oscillatory and low WSS. Moderate competitive flow resulted in WSS and OSI similar to the no competitive flow condition. CONCLUSION:Graft flow is highly dependent on the degree of competitive flow. High competitive flow was found to produce unfavourable WSS consistent with endothelial dysfunction and subsequent graft narrowing and failure. Partial competitive flow, however, may be better tolerated as it was found to be similar to the ideal condition of no competitive flow.

背景与目标： 目的：来自天然冠状血管的竞争性血流被认为是造成冠状动脉搭桥术失败的主要因素。但是，尚未完全了解其病理生理作用。低而振荡的壁切应力（WSS）会引起内皮功能障碍和血管疾病，例如动脉粥样硬化和内膜增生。目的是研究竞争流量对乳动脉旁路移植术中WSS的影响。
方法和结果：利用计算流体动力学，在三维体内猪冠状动脉旁路移植模型中，在左乳内动脉（LIMA）移植到左前降支中计算WSS。研究了以下情况：高竞争流量（非重大冠状动脉病变），部分竞争流量（重大冠状动脉病变）和无竞争流量（完全阻塞冠状动脉）。 LIMA在高流量，部分流量和无竞争流量下的时间平均WSS分别为0.3-0.6、0.6-3.0和0.9-3.0 Pa。此外，量化为振荡剪切指数（OSI）的振荡WSS分别在（最大OSI = 0.5等于零净WSS）0.15至0.35，<0.05和<0.05的范围内。因此，高竞争流量导致大量振荡和低WSS。中等竞争流量导致WSS和OSI类似于无竞争流量情况。
结论：移植物的流动高度依赖于竞争性流动的程度。发现高竞争流量产生不利的WSS，其与内皮功能障碍以及随后的移植物变窄和衰竭一致。但是，部分竞争性流可能被更好地容忍，因为它被发现与没有竞争性流的理想条件相似。

BACKGROUND & AIMS: :The case presented here is intended to raise awareness of two uncommon coronary angiographic findings in the clinical context of acute coronary syndrome. The prevalence of patients presenting with spontaneous coronary dissection as the underlying cause of an ST-elevation myocardial infarction is low. It is typically found in women, often occurring during the peripartum period. There is some debate as to whether spontaneous dissection could also be managed conservatively without coronary intervention. As for spontaneous dissection, knowledge of a culprit lesion within the distal left anterior descending artery (LAD) causing inferior ST elevation (wrap around of the LAD) is not prevalent. Patient characteristics and treatment options are discussed on the basis of the recent literature on both clinical entities.

背景与目标： ：这里介绍的病例旨在提高人们对急性冠脉综合征的临床背景中两个罕见的冠状动脉造影结果的认识。自发性冠状动脉夹层是ST抬高型心肌梗死的根本原因，其患病率较低。它通常在女性中发现，通常发生在围产期。关于是否可以在没有冠状动脉介入的情况下保守治疗自发性夹层，存在一些争议。至于自发性解剖，尚不了解导致左前降支远端远端（LAD）引起ST抬高较差（围绕LAD缠绕）的罪魁祸首。在有关这两种临床实体的最新文献的基础上讨论了患者的特征和治疗选择。