Endovascular Recanalization of Native Chronic Total Occlusions in Patients with Failed Lower-Extremity Bypass Grafts

PurposeTo investigate the feasibility, safety, and outcome of endovascular recanalization of native chronic total occlusions (CTOs) in patients with failed lower-extremity bypass grafts.Materials and MethodsRetrospective review of 19 limbs in 18 patients with failed lower-extremity bypass grafts that underwent recanalization of native arterial occlusions between February 2009 and April 2013 was performed. Nine of the limbs presented with acute ischemia and 10 presented with chronic ischemia, including eight with critical limb ischemia and two with disabling claudication.ResultsThe mean patency of the failed bypass grafts (63% venous) was 27 months. All limbs had Transatlantic Inter-Society Consensus class D lesions involving the native circulation. Technical success of the endovascular recanalization procedure was achieved in all but one limb (95%). The mean ankle brachial indices before and after treatment were 0.34 and 0.73, respectively. There were no major complications or emergency amputations. Mean patient follow-up was 64 weeks, and two patients were lost to follow-up. Primary patency rates at 3, 6, and 12 months were 87%, 48%, and 16%, respectively. Successful secondary procedures were performed in seven patients, with secondary patency rates at 3, 6, and 12 months of 88%, 73%, and 44%, respectively. Limb salvage rates at 12 and 24 months were 94% and 65%, and amputation-free survival rates at 12 and 24 months were 87% and 60%, respectively.ConclusionsEndovascular recanalization of native CTOs in patients with failed lower-extremity bypass grafts is technically feasible and safe and results in acceptable limb salvage.     

血清同型半胱氨酸及踝臂指数水平与冠心病病变程度的相关性研究

目的观察冠心病（CHD）患者踝臂指数（ABI）、血清同型半胱氨酸（HCY）水平,探讨ABI和HCY与冠心病患者冠脉病变程度之间的相关性。方法选取拟诊CHD行冠状动脉造影术患者152例,根据冠脉造影结果分为冠心病组（114例）和非冠心病组（38例）,根据病变程度又将冠心病组分为单支病变组、双支病变组和多支病变组。所有入组个体分别测定其ABI值,同时取患者空腹肘静脉血测定HCY。结果与非冠心病组相比,冠心病组血清HCY升高,差异有统计学意义（P〈0．05）,ABI值无差异（P〉0．05）;冠心病组中多支病变组、双支病变组的HCY值高于单支病变组,多支病变组的ABI值低于单支病变组,冠状动脉严重病变组的ABI值异常率和HCY异常率均高于非严重病变组,差异均具有统计学意义（P〈0．05）。结论血清HCY升高和ABI值降低与冠心病的发病及冠脉病变程度有关,联合应用ABI及HCY对冠心病及冠脉病变严重程度的评估具有重要作用。     

High-sensitivity C-reactive protein at different stages of atherosclerosis: results of the INVADE study

Evidence on the role of high-sensitivity C-reactive protein (hsCRP) at different stages of atherosclerosis is limited. We therefore analyzed the relationship between hsCRP and measures of subclinical and advanced atherosclerosis in a population-based sample of the INVADE study (n = 3,092, >55 years). The parameters of interest were IMT, ABI, and the stage of atherosclerosis. Differences between participants with normal and pathological hsCRP were analyzed by t test for independent samples or Fishers’ exact test. Differences of hsCRP between IMT quartiles, ABI quartiles, and different stages of atherosclerosis were analyzed by one-way ANOVA. Adjusted stepwise multiple linear regression analysis (IMT and ABI) and adjusted analysis of variance (stage of atherosclerosis) were performed, including significant baseline parameters as covariates. ANOVA showed significant differences of hsCRP among IMT quartiles, ABI quartiles, and patients with and without atherosclerosis. The adjusted analyses confirmed that the effects of IMT, ABI, and atherosclerosis on hsCRP were independent from other significant baseline parameters, but did not yield a significant difference between subclinical and advanced stages of atherosclerosis. The present analysis indicates an independent relationship between hsCRP and both IMT and ABI as measures of subclinical atherosclerosis. The comparison of subclinical and advanced stages of atherosclerosis yielded no significant difference, indicating that hsCRP is sensitive to identify vascular risk patients, but not suited to monitor progression of the disease.     

1225名公务员PWV/ABI检测分析与运动干预对策

[目的]分析公务员动脉机能状况并探讨运动干预对策。[方法]选择40～59岁在职公务员1225名,采用动脉硬化检测仪测定baPWV和ABI,同时测定身高、体重、BMI、体适能。[结果]baPWV男子集中于1100～1500cm/s范围,女子则集中于1000～1300cm/s范围;随年龄的增长,PWV和ABI也增加,并具有相关(P﹤0.001);身材高的人,PWV较低,并具有相关(P﹤0.01);BMI高的人,PWV更高,并具有相关(P﹤0.01);体适能与PWV呈一定的负相关,表现为体适能好的人PWV略低;相同年龄组男性的baPWV均高于女性(P﹤0.01);超过10%的男子和超过3%的女子在baPWV检测中有异常;有1%左右的人在ABI上出现异常。[结论]公务员的PWV在年龄和性别上有差异,而ABI有年龄的差异;baPWV集中于1000～1500cm/s范围;公务员应注意运动,增强身体能力和机能,从而降低PWV,预防心血管事件。     

Impaired Brachial Flow-Mediated Dilatation May Predict Symptomatic Intracranial Arterial Dissections

Background and Purpose

Spontaneous intracranial arterial dissections are characterized by the sudden disruption of the internal elastic lamina in the intracranial arteries. The purpose of our retrospective study was to investigate whether patients with nontraumatic intracranial arterial dissections had normal endothelial function.

Longitudinal recovery of local neuronal activity and consciousness level in acquired brain injury

Decreased brain activity in the default mode network, particularly in the precuneus (PCU), has been consistently shown in acquired brain injury (ABI) patients. However, it is unclear whether resting‐state brain activity recovers longitudinally in ABI patients and whether functional activity restoration is associated with improvements in consciousness level. Here, resting‐state fMRI data were acquired from 23 ABI patients and 30 age‐ and gender‐matched controls with two longitudinal observations for each participant. The fMRI data were analyzed using amplitude of low‐frequency fluctuation (ALFF) to measure the fluctuation strength of local spontaneous activity, and seed‐based functional connectivity was used to measure functional relationship with the seed region in the whole brain. The level of consciousness was assessed using the Glasgow Coma Scale (GCS) and Coma Recovery Scale‐Revised (CRS‐R) on both scanning days of the patients. Interaction effect between the two groups and two scans in ALFF was observed in the PCU, which was driven by restored ALFF in the ABI, while a stable ALFF in the control group. Moreover, restoration of ALFF in the PCU correlated with improvements in both the CRS‐R and GCS. Specifically, recovery of ALFF in the PCU primarily reflected the signals of the slow‐4 frequency band (0.027–0.073 Hz). Based on the functional connectivity maps of the PCU, we observed a nonsignificant interaction effect or correlation with consciousness level. These findings suggest local activity in the PCU but possibly not its functional connectivity, is related to the longitudinal changes in behavioral responsiveness in ABI. Hum Brain Mapp 38:3579–3591, 2017. © 2017 Wiley Periodicals, Inc.     

踝肱指数在糖尿病大血管病变中的应用

目的：评价踝肱指数（Ankle brachial pressure index，ABI）在糖尿病大血管并发症中的应用。方法：查阅国内外有关文献并进行综述。结果：踝肱指数异常是糖尿病，心、脑血管病变及外周血管病变强有力的独立预测因子。结论：踝肱指数是糖尿病大血管病变的有效检测指标。     

The role of tissue factor pathway inhibitor in atherosclerosis and arterial thrombosis

Tissue factor pathway inhibitor (TFPI) is the main inhibitor of tissue factor (TF)-mediated coagulation. In atherosclerotic plaques TFPI co-localizes with TF, where it is believed to play an important role in attenuating TF activity. Findings in animal models such as TFPI knockout models and gene transfer models are consistent on the role of TFPI in arterial thrombosis as they reveal an active role for TFPI in attenuating arterial thrombus formation. In addition, ample experimental evidence exists indicating that TFPI has inhibitory effects on both smooth muscle cell migration and proliferation, both which are recognized as important pathological features in atherosclerosis development. Nonetheless, the clinical relevance of these antithrombotic and atheroprotective effects remains unclear. Paradoxically, the majority of clinical studies find increased instead of decreased TFPI antigen and activity levels in atherothrombotic disease, particularly in atherosclerosis and coronary artery disease (CAD). Increased TFPI levels in cardiovascular disease might result from complex interactions with established cardiovascular risk factors, such as hypercholesterolemia, diabetes and smoking. Moreover, it is postulated that increased TFPI levels reflect either the amount of endothelial perturbation and platelet activation, or a compensatory mechanism for the increased procoagulant state observed in cardiovascular disease. In all, the prognostic value of plasma TFPI in cardiovascular disease remains to be established. The current review focuses on TFPI in clinical studies of asymptomatic and symptomatic atherosclerosis, coronary artery disease and ischemic stroke, and discusses potential atheroprotective actions of TFPI.     

Nitinol Stent Versus Bypass in Long Femoropopliteal Lesions: 2-Year Results of a Randomized Controlled Trial

ObjectivesThis study sought to compare patency rates and clinical outcomes of nitinol stents and primary vein bypass in long femoropopliteal lesions.BackgroundAn endovascular-first strategy for long femoropopliteal lesions is widely recommended without sufficient data comparing it with bypass surgery. Nitinol stents are widely used as the standard endovascular therapy.MethodsA single-center randomized controlled trial was performed with the primary endpoints of technical success, primary and secondary patency. Secondary endpoints were limb salvage, survival, complications, and clinical improvement.ResultsA total of 110 limbs (55 per group) in 103 patients were treated. Baseline and lesion characteristics were similar, with a mean lesion length of 276 mm. Critical limb threatening ischemia was the indication for treatment in 49% of limbs in both groups. Technical success was achieved in 87% in the stent group. During a 2-year follow-up, patency rates, limb salvage, survival and complications showed no significant differences between both groups. At 24 months, primary and secondary patency rates for the stent group were 60% and 72% versus 56% and 73% in the bypass group, respectively. Clinical improvement was significantly better in the bypass group.ConclusionsThere were no significant differences regarding patency rates, limb salvage, survival, or complications after 2 years. Technical success and clinical improvement in the bypass group were significantly better, but the promising results of the stent group suggest that an endovascular-first strategy for femoropopliteal lesions up to 30 cm may be reasonable. Mid- as well as long-term results need to be awaited.     

The use of automated sequencing techniques to investigate the sequence selectivity of DNA-damaging agents

In this review, the use of automated DNA sequencing techniques to determine the sequence specificity of compounds that interact with DNA is discussed. The sequence specificity of a DNA-damaging agent is an essential element in determining the cellular mechanism of action of a drug. A number of DNA-damaging compounds are mutagenic, carcinogenic, as well as being widely used as cancer chemotherapeutic agents. The distribution of lesions in a sequence of DNA can give vital clues in the determination of the precise mechanism of interaction of the agent with DNA. The DNA sequence specificity of a number of DNA-damaging agents has been delineated using automated DNA sequencing technology, and these studies are discussed in this review. The current state-of-the-art methodology involves capillary electrophoresis with laser-induced fluorescence detection usually on an Applied Biosystems ABI 3730 capillary sequencer. This current technique has higher resolution, greater sensitivity, higher precision, more rapid separation times, is safer and easier to perform than previous methods. The two main methods to determine the DNA sequence selectivity of compounds that interact with DNA are described: end labelling and the polymerase stop assay. The interaction of the antitumour drug, bleomycin, with DNA is utilized to illustrate the recent technological advances.