Distal Radial Artery Approach to Prevent Radial Artery Occlusion Trial

ObjectivesThe aim of this study was to compare the rate of proximal radial artery occlusion (RAO) with Doppler ultrasound between distal and conventional radial access 24 h and 30 days after a transradial coronary procedure.BackgroundThe use of distal radial access to prevent proximal RAO (PRAO) in the proximal segment at 24 h and 30 days after a procedure, compared with conventional radial access, is unknown.MethodsThis was a prospective, comparative, longitudinal, randomized study. A total of 282 patients were randomized to either proximal radial access (n = 142) or distal radial access (n = 140) to evaluate the superiority of the distal approach in the prevention of PRAO with Doppler ultrasound 24 h and 30 days after a transradial coronary procedure.ResultsIn the per protocol analysis, the rates of PRAO at 24 h and 30 days were 8.4% and 5.6% in the proximal group and 0.7% and 0.7% in the distal group, respectively (24 h: odds ratio [OR]: 12.8; 95% confidence interval [CI]: 1.6 to 100.0; p = 0.002; 30 days: OR: 8.2; 95% CI: 1.0 to 67.2; p = 0.019). In an intention-to-treat analysis, the 24-h and 30-day rates of PRAO were 8.8% and 6.4% for proximal radial access and 1.2% and 0.6% in the distal radial access group (24 h: OR: 7.4; 95% CI: 1.6 to 34.3; p = 0.003; 30 days: OR: 10.6; 95% CI: 1.3 to 86.4; p = 0.007).ConclusionsDistal radial access prevents RAO in the proximal segment at 24 h and 30 days after the procedure compared with conventional radial access.     

In vivo tomographic assessment of the heart and blood vessels with intravascular ultrasound

Intravascular ultrasound (IVUS) has emerged from being a research tool to becoming an intrinsic part of modern invasive cardiology mainly due to imaging micro anatomy in vivo. For the first time, it is possible to base therapeutic decisions not only on lumenograms but also on vessel wall assessment. IVUS has both diagnostic and intervention associated potential. The diagnostic strength of IVUS is its ability to describe compensatory coronary artery enlargement as a response to arteriosclerosis, to assess intermediate lesions, and to reveal occult left main stem disease and angiographically “silent” arteriosclerosis. The intervention associated potential of IVUS is the optimal device selection, i.e., rotablators in calcified lesions or atherectomy devices in large plaque burden. The effects of PTCA on vessel wall morphology can be studied in great detail and the effect on luminal gain can be assessed. Several groups have shown that the residual plaque area (“plaque burden”) even after angiographically successful PTCA still lies in the range of 60%. A significant reduction in this number may influence long-term outcome after PTCA. Minimal luminal area and residual plaque area after PTCA seem to be indicators of restenosis, while the presence or absence of dissections seems to be less predictive. The main mechanism of restenosis after PTCA is vessel shrinkage, not intimal hyperplasia. Intravascular monitoring of stent expansion led to high-pressure stent deployment with a significant increase in post-procedural luminal diameters and the ability to withhold anticoagulation in patients with optimal stent deployment. In pulmonary and aortic diseases, IVUS contributed significantly to the understanding of aortic dissection and pulmonary hypertension. Additionally, with intracardiac ultrasound left and right ventricular function can be assessed. Intracardiac ultrasound has gained clinical usefulness for guiding transcatheter ablation in patients with conduction system abnormalities. In the future, integrated devices, such as balloons on IVUS catheters, steerable catheters, integrated flow and pressure transducers, tissue characterization, and 0.018” IVUS guide wires will further enhance the usefulness of IVUS. Received: 6 May 1997, Returned for revision: 4 July 1997, Revision received: 29 January 1998, Accepted: 17 February 1998     

Intravascular ultrasound as a guiding modality for mechanical atherectomy and laser ablation

One of the most compelling practical applications for intravascular ultrasound imaging is in enhancing the safety and efficacy of the second-generation catheter devices designed to ablate or remove plaque. Initial studies have shown that intravascular ultrasound is well suited to demonstrate the amount of atheroma present in a vessel, and the distribution within the vessel wall at any given point. Further clinical studies are required to determine whether more complete debulking of atheroma, guided by ultrasound imaging, has a favorable impact in reducing the rates of acute closure and restenosis following the procedure.     

The Evaluation of a Compassion-Focused Therapy Group for Couples Experiencing a Dementia Diagnosis

Objectives: This study evaluated the effectiveness of a Compassion-Focused Therapy (CFT) group on reducing anxiety, depression, and respiratory rate (RR) in people with dementia (PwD) and their spouses, and improving quality of life (QoL) of PwD.

Method: Sixty-four participants completed six weekly CFT sessions. Baseline and post-intervention assessments were analyzed using t-tests and Reliability Change Index.

Results: Mean baseline and post-assessment anxiety and depression scores fell in the ‘normal range’; although a significant reduction in depression with moderate effect was observed for PwD. Fifty-seven percent of PwD with borderline to abnormal baseline scores showed clinically significant improvement in anxiety and depression. For spouses, 80% showed clinically significant improvement in depression and 50% in anxiety. RR reduced for PwD and spouses with large and medium effects respectively. QoL of PwD improved with a large effect.

Conclusions: CFT appears effective in improving QoL and depression in PwD and reducing RR in PwD and spouses. CFT reduces anxiety and depression in most PwD and spouses with borderline to abnormal symptoms.

Clinical Implications: This study indicates benefits of a group-CFT intervention delivered to people with a range of dementia diagnosis and their spouses. The service should investigate whether individuals in greater distress are not accessing the group and improve engagement.     

颈动脉粥样硬化与脑梗死相关性的超声研究

颈动脉粥样硬化是导致脑梗死的常见原因。许多临床试验从颈动脉粥样硬化患者超声表现的不同角度探讨了相应参数与脑梗死及其亚型之间的相关性。颈动脉粥样硬化在脑梗死发病机制中的作用仍然存在许多争论,需要进一步研究。     

LOW MOLECULAR WEIGHT IgM IN B CELL LYMPHOPROLIFERATIVE DISORDERS

Circulating low molecular weight (LMW) IgM was demonstrated in five of 38 patients with B cell lymphoproliferative disorders. These five patients all had malignant disease and could be subdivided into two groups. In the first group were three patients, each with an associated serum IgM paraprotein; two had Waldenstrom's macroglobulinemia. and one lymphocytic lymphoma. The two patients of the second group did not have IgM paraproteins; one had lymphocytic lymphoma and one chronic lymphocytic leukemia. Both these patients also had acquired C1 esterase inhibitor deficiency, a previously recognised association with circulating LMW IgM. None of the 16 patients with benign IgM macroglobulinemia had circulating LMW IgM. In those positive sera with LMW IgM this moiety contributed between 10.5% and 37.5% of the total IgM. There was no apparent association between LMW IgM and total IgM levels, kappallambda typing or the presence of Bence Jones proteinuria. but rheumatoid factor, immune complexes and cryoglobulins occurred in many of the sera which contained LMW IgM. Pokeweed mitogen stimulated peripheral blood mononuclear cells from two patients with circulating LMW IgM secreted considerable quantities of this moiety in vitrobut this did not occur in two patients with benign IgM macroglobulinemia. We conclude that LMW IgM is found in the malignant but riot the benign forms of B cell lymphoproliferative disorders and is frequently associated with other serological abnormalities. The basic abnormality causing defective IgM polymerisation in these disorders is obscure.     

彩色多谱勒超声对原发性高血压患者血管内皮功能的评价

目的探讨彩色多谱勒超声(CDU)评价高血压患者血管内皮功能的临床意义。方法将50例原发性高血压患者分为Ⅰ(低/中危组)、Ⅱ(高/极高危组)两个实验组,并设对照组Ⅲ,实验组患者给予卡维地洛(Carvedilol)治疗12周,用CDU测定治疗前后基础状态下、反应性充血时和含服硝酸甘油后肱动脉内径及血流量变化。结果(1)原发性高血压患者反应性充血时肱动脉内径的扩张程度及血流量与正常对照组相比有显著性差异;(2)原发性高血压患者卡维地洛治疗12周后反应性充血时肱动脉内径扩张程度及血流量与治疗前相比显著改善。结论应用CDU可较准确、简便、有效地评价高血压患者血管内皮功能,并对临床药物治疗效果的评定也有一定参考价值。     

经支气管镜气道内超声诊断的临床应用

传统气管镜和图像检查方法在确定肺癌纵隔淋巴结分期和外周小结节病变定性诊断上明显不足.往往需要纵隔镜及胸腔镜等有创方法来进一步确诊和评估分期.经支气管镜气道内超声检奁(endobronchial ultrasonograghy,EBUS)和超声下经支气管穿刺活检(endobronchial ultrasound transbronchial needle aspiration,EBUS-TBNA)是一种新的检查手段,利用超声探头通过支气管镜进入气道进行超声探测和获取病理的一种方法.该方法能大大拓展气管镜的视野,使其完全超越了气道壁的限制.采用EBUS和EBUS-TBNA对于纵隔肿瘤诊断和肺癌分期及判断肺癌患者有无纵隔转移有望代替纵隔镜和开胸探查,为肺癌和其他肺部病变提供新的检查方法.