• 【外周静脉疾病与动脉内皮功能障碍的关系: 概念验证研究。】 复制标题 收藏 收藏
    DOI:10.1258/phleb.2012.012048 复制DOI
    作者列表:Moro L,Pedone C,Serino FM,Incalzi RA
    BACKGROUND & AIMS: :The objective of the study was to evaluate the association between peripheral venous disease (PVD) and arterial endothelial dysfunction (ED). Arterial and venous diseases have been always considered as two completely different entities, but the recent discovery of a relationship between arterial and venous thrombosis have challenged this assumption. ED, considered to be an early process in the pathophysiology of atherosclerotic disease, could represent a common pathogenetic background. We studied 39 healthy volunteers (median age: 34 years; men: 25.6%). PVD was diagnosed using ultrasound examination, arterial ED using flow-mediated dilation (FMD) and FMD normalized for the peak shear rate (nFMD). Compared with controls, participants with PVD had a lower FMD (15.2 versus 23.4%, P < 0.001) and nFMD (12.7 × 10(-3) versus 19 × 10(-3)/second, P < 0.001). People with the most clinically evident disease had the worst endothelial function. In conclusion, our findings, if confirmed in larger population, might corroborate the idea that venous and arterial disease could have common causes.
    背景与目标: : 该研究的目的是评估外周静脉疾病 (PVD) 与动脉内皮功能障碍 (ED) 之间的关系。动脉和静脉疾病一直被认为是两个完全不同的实体,但是最近发现动脉和静脉血栓形成之间的关系对这一假设提出了挑战。ED被认为是动脉粥样硬化疾病病理生理的早期过程,可能代表了共同的发病背景。我们研究了39名健康志愿者 (中位年龄: 34岁; 男性: 25.6%)。使用超声检查诊断PVD,使用血流介导的扩张 (FMD) 进行动脉ED,并针对峰值剪切速率 (nFMD) 标准化FMD。与对照组相比,PVD参与者的FMD (15.2 vs 23.4%,P <0.001) 和nFMD (12.7 × 10(-3) vs 19 × 10(-3)/秒,P <0.001) 较低。临床上最明显的疾病患者的内皮功能最差。总之,如果在更多人群中得到证实,我们的发现可能证实了静脉和动脉疾病可能具有共同原因的观点。
  • 【血浆中瘦素和脂联素的单次或连续测量对肺动脉高压有预后价值吗?】 复制标题 收藏 收藏
    DOI:10.1177/2045893217717219 复制DOI
    作者列表:Tonelli AR,Fares WH,Dakkak W,Rao Y,Zhou X,Dweik RA
    BACKGROUND & AIMS: :Leptin (a neuroendocrine peptide that enhances metabolism and acts on the hypothalamus to suppress appetite) and adiponectin (a protein that has insulin-sensitizing, anti-inflammatory, and antiproliferative properties) are involved in the pathobiology of pulmonary arterial hypertension (PAH). We hypothesized that plasma leptin and adiponectin as well as the leptin/adiponectin ratio are abnormal in PAH patients and their levels track with disease severity and functional changes during follow-up. We tested this hypothesis in a cohort of patients included in the 16-week, international, multicenter, double-blind, placebo-controlled FREEDOM-C2 study. Blood was collected at baseline and week 16 in 178 out of 310 randomized patients with PAH. Baseline plasma leptin and adiponectin concentrations were 25 ± 31 ng/mL and 7.8 ± 6.1 ug/mL, respectively. Leptin, adiponectin, and leptin/adiponectin (mean ± SD) changes at 16 week were of small magnitude. Leptin at baseline was significantly associated with older age, higher BMI, higher Borg dyspnea index, and lower NT-pro BNP. Women had higher levels of leptin than men (30.5 ± 33.2 versus 7.2 ± 6.4 ng/mL), even when adjusting for background therapy and etiology (linear regression: β = 21.8, P < 0.001). Adiponectin was negatively associated with BMI and positively associated with NT-pro BNP. Changes in leptin, adiponectin, and leptin/adiponectin ratio adjusted for weight at 16 weeks did not predict functional class, distance walk in 6 min or survival at one, two, three, or four years. Plasma leptin and adiponectin at baseline and their change at 16-week do not appear to significantly impact prognosis in PAH.
    背景与目标: : 瘦素 (一种神经内分泌肽,可增强新陈代谢并作用于下丘脑以抑制食欲) 和脂联素 (一种具有胰岛素致敏,抗炎和抗增殖特性的蛋白质) 参与肺动脉高压 (PAH) 的病理生物学。我们假设PAH患者的血浆瘦素和脂联素以及瘦素/脂联素比率异常,并且它们的水平与随访期间的疾病严重程度和功能变化有关。我们在16周,国际,多中心,双盲,安慰剂对照FREEDOM-C2研究的患者队列中测试了这一假设。在310例PAH随机患者中,178例在基线和第16周采集血液。基线血浆瘦素和脂联素浓度分别为25   ±   31  ng/mL和7.8   ±   6.1 ug/mL。16周时瘦素、脂联素、瘦素/脂联素 (mean   ±  SD) 变化幅度较小。基线时瘦素与年龄较大、BMI较高、Borg呼吸困难指数和NT-pro BNP较低显著相关。即使在调整背景治疗和病因 (线性回归: β   =   21.8,p  <  0.001) 的情况下,女性的瘦素水平也高于男性 (30.5   ±   33.2对7.2   ±   6.4  ng/mL)。脂联素与BMI呈负相关,与NT-pro BNP呈正相关。瘦素,脂联素和瘦素/脂联素比在16周时根据体重调整后的变化不能预测功能等级,6  min的步行距离或1、2、3或4年的存活。基线时血浆瘦素和脂联素及其在16周时的变化似乎并未显着影响PAH的预后。
  • 【早期植入多个弹簧圈,以治疗持续性动脉导管不完全经导管闭塞后的严重溶血。】 复制标题 收藏 收藏
    DOI:10.1136/hrt.77.5.477 复制DOI
    作者列表:Cheung YF,Leung MP,Chau KT
    BACKGROUND & AIMS: An 18 month old girl with an angiographically measured ductus of 4.5 mm underwent transcatheter occlusion of the persistent arterial duct with a 17 mm Rashkind umbrella and an occluding spring coil. Severe intravascular haemolysis developed 20 hours later. Significant residual ductal leakage was noted and the residual duct measured 6 mm. Previous underestimation might have been related to ductal spasm as a catheter was placed across the duct before angiography. The haemolysis was abolished within 48 hours by a previously unreported approach of antegrade transcatheter closure of the residual duct by multiple spring coils.

    背景与目标: 一名18个月大的女孩,其血管造影测量的4.5毫米导管,用17毫米的Rashkind伞和阻塞的弹簧线圈经导管闭塞了持续性动脉导管。20小时后出现严重的血管内溶血。注意到明显的残余导管泄漏,并且6毫米测量了残余导管。先前的低估可能与导管痉挛有关,因为在血管造影之前将导管穿过导管放置。通过先前未报道的通过多个弹簧线圈顺行经导管闭合残余导管的方法,在48小时内消除了溶血。
  • 【胶原刚度调节细胞收缩和基质重塑基因表达。】 复制标题 收藏 收藏
    DOI:10.1002/jbm.a.31423 复制DOI
    作者列表:Karamichos D,Brown RA,Mudera V
    BACKGROUND & AIMS: :Cell-level mechanical and 3D spatial cues are essential to the organization and architecture of new tissues that form during growth, repair or in bioreactors. Fibroblast-seeded 3D collagen constructs have been used as bioartifical extracellular matrix (ECM) providing a 3D environment to embedded resident cells. As cells attach to scaffold fibrils, they generate quantifiable contractile forces which depend on cell type, cell attachment, cell density, growth factors, and matrix stiffness. The aim of this study was to quantify the cytomechanical and molecular responses of human dermal (HDF) and neonatal foreskin fibroblasts (HNFF) seeded in constructs of increased stiffness. We also tested the effect of blocking early attachment using serum starvation on these outputs. Constructs were placed under uniaxial strains of 0-10% to increase scaffold stiffness, prior to gel contraction, and force generation was monitored using a tensional culture force monitor (t-CFM). Increased matrix stiffness reduced generation of quantifiable cellular force (up to 70%) over 24 h in both cell types and delayed the onset of measurable contraction (upto sevenfold). The delay of measurable force generation was cell lineage dependent but not FCS dependent. Gene expression of MMP-2, TIMP-2, and collagen type III expression in HDFs were significantly upregulated in constructs of increased stiffness. HNFFs did not show any significant changes in these gene expressions indicating a lineage specific response.
    背景与目标: : 细胞水平的机械和3D空间线索对于在生长,修复或生物反应器中形成的新组织的组织和结构至关重要。成纤维细胞种子的3D胶原蛋白构建体已被用作生物人工细胞外基质 (ECM),为嵌入的常驻细胞提供3D环境。当细胞附着在支架原纤维上时,它们会产生可量化的收缩力,这取决于细胞类型,细胞附着,细胞密度,生长因子和基质刚度。这项研究的目的是量化接种在硬度增加的构建体中的人真皮 (HDF) 和新生儿包皮成纤维细胞 (HNFF) 的细胞机械和分子反应。我们还测试了使用血清饥饿阻断早期附着对这些输出的影响。在凝胶收缩之前,将构建体置于0-10% 的单轴应变下以增加支架刚度,并使用张力培养力监测器 (t-cfm) 监测力的产生。在两种细胞类型中,增加的基质刚度在24小时内减少了可量化的细胞力 (高达70%) 的产生,并延迟了可测量的收缩的开始 (高达7倍)。可测量的力产生的延迟与细胞谱系有关,但与FCS无关。在刚度增加的构建体中,HDFs中MMP-2,TIMP-2和III型胶原表达的基因表达显着上调。HNFFs在这些基因表达中未显示任何显着变化,表明谱系特异性反应。
  • 【磷酸盐粘合剂治疗对早期慢性肾脏病血管僵硬度的影响。】 复制标题 收藏 收藏
    DOI:10.1159/000353569 复制DOI
    作者列表:Seifert ME,de las Fuentes L,Rothstein M,Dietzen DJ,Bierhals AJ,Cheng SC,Ross W,Windus D,Dávila-Román VG,Hruska KA
    BACKGROUND & AIMS: BACKGROUND/AIMS:Cardiovascular disease (CVD) is increased in chronic kidney disease (CKD), and contributed to by the CKD-mineral bone disorder (CKD-MBD). CKD-MBD begins in early CKD and its vascular manifestations begin with vascular stiffness proceeding to increased carotid artery intima-media thickness (cIMT) and vascular calcification (VC). Phosphorus is associated with this progression and is considered a CVD risk factor in CKD. We hypothesized that modifying phosphorus balance with lanthanum carbonate (LaCO3) in early CKD would not produce hypophosphatemia and may affect vascular manifestations of CKD-MBD. METHODS:We randomized 38 subjects with normophosphatemic stage 3 CKD to a fixed dose of LaCO3 or matching placebo without adjusting dietary phosphorus in a 12-month randomized, double-blind, pilot and feasibility study. The primary outcome was the change in serum phosphorus. Secondary outcomes were changes in measures of phosphate homeostasis and vascular stiffness assessed by carotid-femoral pulse wave velocity (PWV), cIMT and VC over 12 months. RESULTS:There were no statistically significant differences between LaCO3 and placebo with respect to the change in serum phosphorus, urinary phosphorus, tubular reabsorption of phosphorus, PWV, cIMT, or VC. Biomarkers of the early CKD-MBD such as plasma fibroblast growth factor-23, Dickkopf-related protein 1 (DKK1), and sclerostin were increased 2- to 3-fold at baseline, but were not affected by LaCO3. CONCLUSION:Twelve months of LaCO3 had no effect on serum phosphorus and did not alter phosphate homeostasis, PWV, cIMT, VC, or biomarkers of CKD-MBD.
    背景与目标:
  • 【动脉内皮衍生的超极化: 在妊娠适应和并发症中的潜在作用。】 复制标题 收藏 收藏
    DOI:10.1097/FJC.0b013e31827b6367 复制DOI
    作者列表:Morton JS,Davidge ST
    BACKGROUND & AIMS: :Pregnancy encompasses substantial changes in vascular function to accommodate dramatic increases in blood volume and uteroplacental blood flow to the growing fetus. Despite increased hemodynamics, decreased peripheral resistance results in a reduction in mean arterial blood pressure. Vascular tone, and hence peripheral resistance, is determined by a delicate balance of constrictor and dilator capacities. In the normal physiological response to pregnancy, endothelial-derived hyperpolarization (EDH) has been shown to be a major contributor; both EDH and nitric oxide (NO) are predominantly involved in providing an increased vascular capacity for vasodilation. The ability of EDH and NO to adequately accommodate increased blood volume is tested in pathological states such as placental insufficiency or diabetes and both EDH and NO-dependent mechanisms seem to be impacted in these situations. Pregnancy complications also have an impact on the cardiovascular health of the offspring. In adult offspring born from complicated pregnancies, the data suggest that EDH mechanisms are largely maintained, whereas NO is commonly reduced. A diversity of EDH mechanisms may be useful in providing many targets for potential therapeutic avenues for compromised pregnancies; however, further research delineating the mechanisms of EDH and the interactions of NO and EDH, in normal and pathological pregnancies is required.
    背景与目标: : 怀孕包括血管功能的重大变化,以适应血容量和子宫胎盘血流量的急剧增加。尽管血流动力学增加,但外周阻力降低会导致平均动脉血压降低。血管张力以及外周阻力是由收缩器和扩张器能力的微妙平衡决定的。在对妊娠的正常生理反应中,内皮衍生的超极化 (EDH) 已被证明是主要的贡献者; EDH和一氧化氮 (NO) 都主要参与增加血管舒张能力。在病理状态 (例如胎盘功能不全或糖尿病) 中测试了EDH和NO充分适应增加的血容量的能力,在这些情况下,EDH和NO依赖性机制似乎都受到影响。妊娠并发症也会对后代的心血管健康产生影响。在复杂怀孕出生的成年后代中,数据表明EDH机制在很大程度上得以维持,而NO通常会减少。EDH机制的多样性可能有助于为受损妊娠的潜在治疗途径提供许多靶标; 但是,需要进一步研究描述正常和病理性妊娠中EDH的机制以及NO和EDH的相互作用。
  • 【结缔组织生长因子与肝脏硬度的相关性通过瞬时弹性成像在胆道闭锁中测量。】 复制标题 收藏 收藏
    DOI:10.1111/hepr.12015 复制DOI
    作者列表:Honsawek S,Udomsinprasert W,Chirathaworn C,Anomasiri W,Vejchapipat P,Poovorawan Y
    BACKGROUND & AIMS: AIM:Biliary atresia (BA) is a neonatal liver disease defined as chronic progressive fibrotic obliteration of extrahepatic bile ducts. The objective of this study was to determine the association of serum connective tissue growth factor (CTGF) with clinical outcome and liver stiffness measurement. METHODS:Eighty-two BA patients post-Kasai operation and 28 healthy controls were recruited. BA patients were categorized into two groups based on their portal hypertension (PH) status. Serum CTGF levels were determined by enzyme-linked immunosorbent assay. Liver stiffness scores were measured by transient elastography. RESULTS:BA patients had greater CTGF levels (905.9 ± 57.7 vs 238.3 ± 23.5 pg/mL, P < 0.001) and higher liver stiffness values than controls (28.2 ± 2.6 vs 5.0 ± 0.5 kPa, P < 0.001). Serum CTGF levels were remarkably elevated in BA patients with PH compared to those without PH (1092.4 ± 73.9 vs 582.6 ± 45.7 pg/mL, P < 0.001). Furthermore, BA patients with PH had significantly higher liver stiffness values compared to those without PH (37.3 ± 3.0 vs 10.6 ± 1.1 kPa, P < 0.001). Additionally, serum CTGF was positively correlated with liver stiffness (r = 0.875, P < 0.001) and total bilirubin (r = 0.462, P < 0.001). There was an inverse correlation between serum CTGF and serum albumin (r = -0.579, P < 0.001). CONCLUSION:High serum CTGF was associated with a poor outcome in BA patients. Accordingly, serum CTGF and transient elastography may serve as non-invasive biomarkers reflecting the disease severity in postoperative BA patients.
    背景与目标:
  • 【动脉壁低密度脂蛋白氧化动力学模型及其在动脉粥样硬化病变预测中的应用。】 复制标题 收藏 收藏
    DOI:10.1016/j.chemphyslip.2013.07.006 复制DOI
    作者列表:Karimi S,Dadvar M,Modarress H,Dabir B
    BACKGROUND & AIMS: :Oxidation of low-density lipoprotein (LDL) is one of the major factors in atherogenic process. Trapped oxidized LDL (Ox-LDL) in the subendothelial matrix is taken up by macrophage and leads to foam cell generation creating the first step in atherosclerosis development. Many researchers have studied LDL oxidation using in vitro cell-induced LDL oxidation model. The present study provides a kinetic model for LDL oxidation in intima layer that can be used in modeling of atherosclerotic lesions development. This is accomplished by considering lipid peroxidation kinetic in LDL through a system of elementary reactions. In comparison, characteristics of our proposed kinetic model are consistent with the results of previous experimental models from other researches. Furthermore, our proposed LDL oxidation model is added to the mass transfer equation in order to predict the LDL concentration distribution in intima layer which is usually difficult to measure experimentally. According to the results, LDL oxidation kinetic constant is an important parameter that affects LDL concentration in intima layer so that existence of antioxidants that is responsible for the reduction of initiating rates and prevention of radical formations, have increased the concentration of LDL in intima by reducing the LDL oxidation rate.
    背景与目标: : 低密度脂蛋白 (LDL) 的氧化是动脉粥样硬化过程的主要因素之一。内皮下基质中捕获的氧化LDL (Ox-LDL) 被巨噬细胞摄取,并导致泡沫细胞的产生,从而形成动脉粥样硬化发展的第一步。许多研究人员使用体外细胞诱导的LDL氧化模型研究了LDL氧化。本研究提供了内膜层LDL氧化的动力学模型,可用于模拟动脉粥样硬化病变的发展。这是通过通过基本反应系统考虑LDL中的脂质过氧化动力学来实现的。相比之下,我们提出的动力学模型的特征与其他研究的先前实验模型的结果一致。此外,我们提出的LDL氧化模型被添加到传质方程中,以预测内膜层中的LDL浓度分布,这通常很难通过实验进行测量。根据结果,LDL氧化动力学常数是影响内膜层中LDL浓度的重要参数,因此抗氧化剂的存在负责降低起始速率和防止自由基形成,通过降低LDL氧化速率来增加内膜中LDL的浓度。
  • 【缬沙坦可独立于降低血压而改善2型糖尿病的动脉僵硬度。】 复制标题 收藏 收藏
    DOI:10.1161/HYPERTENSIONAHA.108.111674 复制DOI
    作者列表:Karalliedde J,Smith A,DeAngelis L,Mirenda V,Kandra A,Botha J,Ferber P,Viberti G
    BACKGROUND & AIMS: :Increased arterial stiffness, as estimated from aortic pulse wave velocity (Ao-PWV), and albuminuria are independent predictors for cardiovascular disease in type 2 diabetes mellitus (T2DM). Whether angiotensin receptor blockers (ARBs), drugs with cardio-renal protective effects, improve Ao-PWV to a greater extent than other equipotent antihypertensive medications remains unclear. After a 4-week washout phase, we compared the effects of valsartan (n=66), an ARB, with that of amlodipine (n=65), a calcium channel blocker on Ao-PWV in 131 T2DM patients with pulse pressure (PP) >or=60 mm Hg and raised albumin excretion rate (AER) in a 24-week randomized, double-blind, parallel group study. Hydrochlorothiazide (HCTZ) 25 mg/d was added to valsartan 160 mg and amlodipine 5 mg/od uptitrated to 10 mg/od after 4 weeks to ensure equivalent BP control. After 24 weeks brachial and central aortic PP had fallen to a similar extent with attained mean (SD) brachial and central PP of 61.6 (13.6) and 47.3 (14.1) mm Hg in the valsartan/HCTZ group and 61.5 (12.2) and 47.3 (9.9) mm Hg in the amlodipine group, respectively. Ao-PWV showed a significantly greater reduction, mean (95% CI), -0.9 m/s (-1.4 to -0.3) for valsartan/HCTZ compared to amlodipine (P=0.002). AER fell significantly only with Val/HCTZ from 30.8(20.4, 46.5) to 18.2(12.5, 26.3) mcg/min, (P=0.01) with between treatment difference in favor of Val/HCTZ of -15.3mcg/min (P<0.001). Changes in AER and Ao-PWV were not correlated. Valsartan/HCTZ improves arterial stiffness and AER to a significantly greater extent than amlodipine despite similar central and brachial BP control. These 2 effects, which appear independent of each other, may explain the specific cardio-renal protective properties of ARBs.
    背景与目标: : 根据主动脉脉搏波速度 (Ao-PWV) 估计,动脉僵硬度增加和蛋白尿是2型糖尿病 (T2DM) 心血管疾病的独立预测因素。血管紧张素受体阻滞剂 (arb) 是具有心肺保护作用的药物,是否比其他同等降压药物在更大程度上改善Ao-PWV尚不清楚。经过4周的冲洗阶段,我们比较了缬沙坦 (n = 66) (ARB) 和氨氯地平 (n = 65) 的作用,在一项为期24周的随机,双盲,平行组研究中,131例脉压 (PP)> 或 = 60毫米Hg且白蛋白排泄率 (AER) 升高的T2DM患者的Ao-PWV钙通道阻滞剂。将氢氯噻嗪 (HCTZ) 25 mg/d添加至缬沙坦160 mg,并在4周后将氨氯地平5 mg/od上调至10 mg/od,以确保等效的BP控制。24周后,在缬沙坦/HCTZ组和61.5 (12.2) 和47.3 (9.9) mm Hg的平均 (SD) 肱动脉和中央PP下降到类似的程度,达到61.6 (13.6) 和47.3 (14.1) mm Hg在氨氯地平组,分别。与氨氯地平 (P = 0.002) 相比,缬沙坦/HCTZ的Ao-PWV降低幅度明显更大,平均 (95% CI),-0.9 m/s (-1.4至-0.3)。仅Val/HCTZ从30.8(20.4,46.5) 到18.2(12.5,26.3) mcg/min,AER显着下降 (P = 0.01),两种治疗之间的差异有利于Val/HCTZ为-15.3mcg/min (P<0.001)。AER和Ao-PWV的变化不相关。尽管中枢和肱动脉血压控制相似,但缬沙坦/HCTZ比氨氯地平在更大程度上改善了动脉僵硬度和AER。这两种作用似乎彼此独立,可以解释arb的特定心肺保护特性。
  • 【动脉高血压和中风预防: 最新进展。】 复制标题 收藏 收藏
    DOI:10.1080/10641960600549405 复制DOI
    作者列表:Bornstein N,Silvestrelli G,Caso V,Parnetti L
    BACKGROUND & AIMS: :High blood pressure (BP) is the most important modifiable risk factor for stroke and other vascular diseases. Evidence from randomized controlled trials supports the use of antihypertensive drugs to lower blood pressure for stroke prevention. There is some evidence that specific classes of antihypertensive drugs have different effects and/or their pharmacological actions differ in patient subgroups. This review evaluates the development of antihypertensive therapies and the latest studies of arterial hypertension and stroke prevention: HOPE trial (ramipril versus placebo), ALLHAT trial (CCB or/ and Angiotensin-Conventing enzyme Inhibitors (ACE-Is) versus diuretic), LIFE trial (losartan versus atenolol), and PROGRESS trial (perindopril or/and indapamide versus placebo). Despite the results of these relevant clinical trails, some aspects still remain unresolved. Future clinical trials on hypertension and stroke prevention should answer the following questions: Does lowering BP reduce stroke risk due to specific drug effect or class effect? Are angiotensin II receptor blockers (ARBs) better than ACE-Is? Should ACE-Is and ARBs be considered routinely for either high-risk stroke patients or patients with history of stroke or transient ischemic attack, irrespective of blood pressure? What is the role of lifestyle in BP control?
    背景与目标: : 高血压 (BP) 是中风和其他血管疾病最重要的可改变的危险因素。来自随机对照试验的证据支持使用抗高血压药物来降低血压以预防中风。有证据表明,特定类别的抗高血压药物在患者亚组中具有不同的作用和/或其药理作用不同。这篇综述评估了抗高血压疗法的发展以及动脉高血压和中风预防的最新研究: HOPE试验 (雷米普利与安慰剂),ALLHAT试验 (CCB或/和血管紧张素转换酶抑制剂 (ACE-Is) 与利尿剂),生命试验 (氯沙坦与阿替洛尔),和进展试验 (培哚普利或/和吲达帕胺与安慰剂)。尽管有这些相关临床试验的结果,但某些方面仍未解决。未来关于高血压和中风预防的临床试验应回答以下问题: 降低血压是否会因特定的药物效应或类别效应而降低中风风险?血管紧张素II受体阻滞剂 (arb) 比ACE-Is好吗?对于高危卒中患者或有卒中史或短暂性脑缺血发作史的患者,无论血压如何,是否应该常规考虑ACE-Is和arb?生活方式在控制血压中的作用是什么?
  • 【刚度参数 β 作为慢性血液透析患者4年全因死亡率的预测指标。】 复制标题 收藏 收藏
    DOI:10.1007/s10157-012-0674-7 复制DOI
    作者列表:Sato M,Ogawa T,Otsuka K,Ando Y,Nitta K
    BACKGROUND & AIMS: BACKGROUND:There is a lack of information on stiffness parameter β, an index of arterial stiffness, in hemodialysis (HD) patients. The aim of the present study was to investigate whether stiffness parameter β is predictive of the long-term mortality of chronic HD patients. METHODS:We measured biochemical parameters and the stiffness parameter β of 80 patients on maintenance HD therapy and followed their course for 4 years, and we enrolled 70 of these 80 patients in the study. We divided the 70 patients into tertiles according to their stiffness parameter β values, and conducted multivariate analyses to examine the impact of the tertiles on 4-year mortality. RESULTS:Older age and the presence of diabetes mellitus were found to be independently associated with higher stiffness parameter β values. Fifteen patients (21.4 %) died and 16 (22.9 %) experienced a new cardiovascular event during the follow-up period. The results of a Kaplan-Meier analysis revealed a significantly higher risk of all-cause mortality in the HD patients with highest stiffness parameter β values (p = 0.0106). According to the ROC curve, the cut-off level that yielded maximal sensitivity and specificity for predicting all-cause mortality was 10.1, and the sensitivity and specificity using the cut-off value were 69.2 and 70.2 %, respectively. CONCLUSION:The results of this study suggest that stiffness parameter β is a predictor of all-cause mortality in chronic HD patients.
    背景与目标:
  • 【细胞力学,结构和功能受三维微环境的刚度调节。】 复制标题 收藏 收藏
    DOI:10.1016/j.bpj.2012.07.054 复制DOI
    作者列表:Chen J,Irianto J,Inamdar S,Pravincumar P,Lee DA,Bader DL,Knight MM
    BACKGROUND & AIMS: :This study adopts a combined computational and experimental approach to determine the mechanical, structural, and metabolic properties of isolated chondrocytes cultured within three-dimensional hydrogels. A series of linear elastic and hyperelastic finite-element models demonstrated that chondrocytes cultured for 24 h in gels for which the relaxation modulus is <5 kPa exhibit a cellular Young's modulus of ∼5 kPa. This is notably greater than that reported for isolated chondrocytes in suspension. The increase in cell modulus occurs over a 24-h period and is associated with an increase in the organization of the cortical actin cytoskeleton, which is known to regulate cell mechanics. However, there was a reduction in chromatin condensation, suggesting that changes in the nucleus mechanics may not be involved. Comparison of cells in 1% and 3% agarose showed that cells in the stiffer gels rapidly develop a higher Young's modulus of ∼20 kPa, sixfold greater than that observed in the softer gels. This was associated with higher levels of actin organization and chromatin condensation, but only after 24 h in culture. Further studies revealed that cells in stiffer gels synthesize less extracellular matrix over a 28-day culture period. Hence, this study demonstrates that the properties of the three-dimensional microenvironment regulate the mechanical, structural, and metabolic properties of living cells.
    背景与目标: : 本研究采用计算和实验相结合的方法来确定在三维水凝胶中培养的分离的软骨细胞的机械,结构和代谢特性。一系列线性弹性和超弹性有限元模型表明,在松弛模量 <5 kPa的凝胶中培养24小时的软骨细胞表现出5 kPa的细胞杨氏模量。这明显大于悬浮液中分离的软骨细胞的报道。细胞模量的增加发生在24小时内,并且与皮质肌动蛋白细胞骨架的组织增加有关,众所周知,皮质肌动蛋白细胞骨架可以调节细胞力学。但是,染色质浓缩减少,表明可能不涉及核力学的变化。1% 和3% 琼脂糖中细胞的比较表明,较硬的凝胶中的细胞迅速发展出约20 kpa的较高杨氏模量,比较软的凝胶中观察到的杨氏模量大六倍。这与较高水平的肌动蛋白组织和染色质浓缩有关,但仅在培养24小时后。进一步的研究表明,在28天的培养期内,较硬的凝胶中的细胞合成较少的细胞外基质。因此,这项研究表明,三维微环境的特性调节了活细胞的机械,结构和代谢特性。
  • 【左,右,近或远壁颈总动脉内膜中层厚度测量: 与心血管疾病和下肢动脉粥样硬化的关系。】 复制标题 收藏 收藏
    DOI:10.1016/s0895-4356(97)00059-0 复制DOI
    作者列表:Bots ML,de Jong PT,Hofman A,Grobbee DE
    BACKGROUND & AIMS: :We evaluated the differences in strength of the associations of prevalent cardiovascular disease and lower extremity arterial atherosclerosis to common carotid intima-media thickness, assessed by near wall measurements only, by far wall measurements only, and by the average of near and far wall measurements. The study was based on data from 1500 participants of the Rotterdam Study, a single-center-population-based prospective follow-up study among 7983 subjects, aged 55 years or over. Comparison of the strength of the associations of near wall intima-media thickness and of combined near and far wall intima-media thickness to cardiovascular disease and lower extremity arterial atherosclerosis revealed significantly stronger associations compared to associations observed for far wall intima-media thickness, in particular for stroke and lower extremity arterial disease. We conclude that near wall common carotid intima-media thickness measurement provides at least as good an indicator of atherosclerosis elsewhere and of cardiovascular risk as the far wall intima-media thickness measurement.
    背景与目标: : 我们评估了流行的心血管疾病和下肢动脉粥样硬化与颈总动脉内膜中层厚度的相关性的强度差异,仅通过近壁测量,仅通过远壁测量以及近壁和远壁测量的平均值来评估。该研究基于鹿特丹研究的1500名参与者的数据,该研究是一项基于单中心人群的前瞻性随访研究,涉及7983名年龄在55岁或以上的受试者。比较近壁内膜-中膜厚度以及近壁和远壁内膜-中膜厚度与心血管疾病和下肢动脉粥样硬化的相关性,发现与观察到的远壁内膜-中膜厚度的相关性相比,相关性明显更强,特别是对于中风和下肢动脉疾病。我们得出的结论是,近壁颈总动脉内膜中层厚度的测量至少与远壁内膜中层厚度的测量一样,可以很好地指示其他地方的动脉粥样硬化和心血管风险。
  • 【肝细胞癌患者经导管动脉化疗栓塞后身体定位对背痛的影响和安全性: 一项随机对照研究。】 复制标题 收藏 收藏
    DOI:10.1016/j.ijnurstu.2020.103641 复制DOI
    作者列表:Chang KT,Liu CJ,Tsai HT,Hsu TP,Chen PT,Hu SH
    BACKGROUND & AIMS: BACKGROUND:People with hepatocellular carcinoma who undergo transcatheter arterial chemoembolization usually experience back pain due to lie supine for at least 4 hours to avoid bleeding and hematoma. Body positioning is an effective and safe method for decreasing back pain in people with transfemoral cardiac catheterization; however, its effects and safety among patients with high bleeding tendency are unknown. OBJECTIVE:To investigate whether body positioning could decrease back pain without increasing the chance of bleeding after transcatheter arterial chemoembolization. DESIGN:A single-blind randomized controlled trial (ClinicalTrials.gov No.: NCT03784469). METHODS:A total of 78 people with liver cancer who had undergone chemoembolization through the femoral artery were enrolled. Each person was randomly assigned to either the control or intervention group (each consisted of 39 participants). The control group received the usual care, remaining flat and lying in a supine position, whereas the intervention group had their positions changed in the second and fourth hour after chemoembolization. Participants' pain level was rated by using numerical rating scale -11 (score from 0 to 10), bleeding was measured by using volume of blood (cc.) in gauze and hematoma size in diameter (cm), and satisfaction was self-rated from 1 to 5. Repeated-measure analysis of variance (ANOVA) was used to compare the difference in pain levels over time within each group and independent t test to compare the mean difference of pain between groups at 5 endpoints, both methods with Bonferroni adjustment. Independent t test, chi-squared test, and Fisher's exact test compared postembolization discomfort, puncture sites bleeding, satisfaction between groups. RESULTS:Significant changes of pain levels over time in both intervention [F(2.93, 111.20)=7.64, p<.001] and control groups [F(2.66, 101.17)=20.55, p<.001]. The intervention group had a significantly lower mean pain score in the second hour (t = -2.838, p = .006) and fourth hour (t = -4.739, p < .001) when patients turning to the side than did the control group lying supine. Furthermore, patients in the intervention group had significantly higher satisfaction than did those in the control group (t = -2.422, p = .018). No hematoma and significant difference of post-procedural bleeding between groups. CONCLUSION:Changing patients' body positions in bed after transcatheter arterial chemoembolization is a safe and effective method of decreasing back pain, and increasing patients' satisfaction, without increasing the complications of bleeding and hematoma. Clinicians should change the positions of people with hepatocellular carcinoma 2 hours after they receive transcatheter arterial chemoembolization.
    背景与目标:
  • 【与HIV相关的肺动脉高压有关的介体。】 复制标题 收藏 收藏
    影响因子 :
    发表时间:2008-09-01
    来源期刊:AIDS
    DOI:10.1097/01.aids.0000327515.55041.da 复制DOI
    作者列表:Humbert M
    BACKGROUND & AIMS: :HIV-related pulmonary arterial hypertension (PAH) is one of the long-term complications of HIV infection that has become increasingly apparent in recent years. The clinical presentation and underlying pathology of PAH in HIV is similar to that in other forms of the disease, although there are data to suggest subtle differences, such as a greater inflammatory component in the HIV-related form. Advances continue to be made in defining the underlying pathogenesis of PAH, but the overall processes leading to vascular dysfunction and remodeling remain unclear. It would appear that PAH has a multifactorial etiology, with various risk factors--probably acting on an underlying genetic predisposition--that lead to the pulmonary vascular dysfunction that characterizes the disease. A range of growth factors, chemokines, cytokines and other inflammatory mediators, together with mediators involved in vasoconstriction and dilation, have been implicated in the pulmonary vascular remodeling resulting from this dysfunction. An increased understanding of the processes and factors involved in PAH has led to the development of new therapeutic strategies that have improved the management of various forms of PAH, including PAH associated with HIV (HIV-PAH). Recent results from studies into other potential mediators of PAH offer the possibility of new targets for therapy in this progressive and serious condition.
    背景与目标: : HIV相关的肺动脉高压 (PAH) 是HIV感染的长期并发症之一,近年来日益明显。HIV中PAH的临床表现和潜在病理与其他形式的疾病相似,尽管有数据表明存在细微差异,例如HIV相关形式中的炎症成分更大。在定义PAH的潜在发病机理方面继续取得进展,但导致血管功能障碍和重塑的总体过程尚不清楚。看来,PAH具有多因素病因,具有各种危险因素-可能作用于潜在的遗传易感性-导致该疾病的肺血管功能障碍。一系列生长因子,趋化因子,细胞因子和其他炎症介质,以及参与血管收缩和扩张的介质,都与这种功能障碍导致的肺血管重塑有关。对PAH所涉及的过程和因素的日益了解导致了新的治疗策略的发展,这些治疗策略改善了各种形式的PAH的管理,包括与HIV相关的PAH (HIV-PAH)。对PAH其他潜在介质的研究的最新结果为这种进行性和严重疾病的治疗提供了新的靶标。

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