Newly recruited human monocytes have a preserved responsiveness towards bacterial peptides in terms of CD11b up-regulation and intracellular hydrogen peroxide production

The transmigration of peripheral human monocytes to the interstitium is a fundamental step in the host-defence mechanism against infections. Little is known about the state of function of in vivo transmigrated interstitial monocytes prior to differentiation into macrophages and dendritic cells. We hypothesized that newly recruited interstitial monocytes have a preserved responsiveness against bacterial-related peptides, giving them a specific role in the immediate defence against invading pathogens. In order to test this hypothesis, we explored the responsiveness of in vivo transmigrated as well as peripheral monocytes, in terms of CD11b expression and H(2)O(2) production towards the bacterial-related peptide formylmethionylleucylphenylalanine (fMLP) by the use of a skin chamber technique. In addition, we analysed the concentration of interleukin (IL)-8, monocyte chemotactic protein-1 (MCP-1) and tumour necrosis factor (TNF)-alpha in the skin blister exudates and in the circulation. We demonstrate that in vivo-transmigrated monocytes had a fivefold higher CD11b expression compared to monocytes obtained from the peripheral circulation. fMLP exposure induced a significantly higher CD11b expression on transmigrated cells compared to peripheral monocytes. In addition, newly recruited monocytes had a preserved H(2)O(2) production. The interstitial concentration of IL-8, MCP-1 and TNF-alpha was significantly higher in blister exudates compared to that in the peripheral circulation. Thus, in vivo transmigrated human monocytes preserve their capacity to respond towards bacterial peptides in terms of CD11b up-regulation and H(2)O(2) generation. These data strengthen a role for newly recruited interstitial human monocytes in the immediate defence against invading pathogens.     

Disparate ability of murine CD8alpha- and CD8alpha+ dendritic cell subsets to traverse endothelium is not determined by differential CD11b expression

Upon Ag uptake and response to maturation stimuli, dendritic cells (DC) are directed through lymphatic or blood vessel endothelium to T cell areas of secondary lymphoid tissues by the constitutively expressed CC chemokines CCL19 and CCL21. We have shown that mature (m) murine CD8alpha+ DC exhibit poorer migratory ability to these chemokines than classic CD8alpha- DC by quantifying their in vitro chemotaxis through unmodified Transwell filters. We hypothesized that lower surface expression (compared to CD8alpha- mDC) of the adhesion molecule CD11b on CD8alpha+ DC might limit their ability to adhere to filter pores in vitro and/or endothelium in vitro/in vivo. To test the role of this and/or other adhesion molecules (CD11a, CD31, CD54 and CD62L) in regulating murine DC subset migration, we used specific mAbs to block their function and quantified their migration through resting or tumour necrosis factor (TNF)-alpha-activated endothelial cell (EC) layered-Transwell filters. Both CD8alpha+ and CD8alpha- subsets migrated through resting EC (albeit less than in the absence of EC) in response to CCL19 and CCL21, and migration through TNF-alpha-activated EC was enhanced. In contrast to reports concerning human DC, transendothelial migration of the murine DC subsets was not dependent on CD11b, CD31, or CD62L expression by these cells. CD54 and CD11a, however, were at least partly involved in DC/EC interactions. This is the first report to examine adhesion molecules involved in transendothelial migration of murine DC subsets.     

Up-regulation of ICAM-1, CD11a/CD18 and CD11c/CD18 on human THP-1 monocytes stimulated by Streptococcus suis serotype 2

Streptococcus suis serotype 2 is known to be a major pathogen of swine, causing mainly meningitis. It is also a zoonotic agent leading predominantly to meningitis in humans working in close contact with pigs. In this study, we investigated the ability of S. suis to up-regulate the expression of adhesion molecules involved in inflammation, using an enzyme-linked immunosorbent assay. S. suis serotype 2 stimulated the up-regulation of the expression of intercellular adhesion molecule-1 (ICAM-1, CD54), CD11a/CD18 and CD11c/CD18 on human THP-1 monocytes, but did not change that of ICAM-1, vascular cell adhesion molecule-1 (VCAM-1, CD106) and E-selectin (CD62E) on human endothelial cells. The up-regulation of adhesion molecules was time- and bacterial concentration-dependent, and cell wall components were largely responsible for such stimulation. To a lesser extent, purified haemolysin of S. suis also stimulated adhesion molecule expression. Stimulation of monocytes with strains of different origin showed that there was no clear tendency for human strains to induce a higher expression of adhesion molecules than strains from diseased pigs. Finally, monocytes stimulated with S. suis also showed an increase in adherence to endothelial cells. Hence, S. suis is capable of up-regulating important adhesion molecules involved in inflammation, which may result in an increased leucocyte recruitment into sites of infection, thus providing a possible mechanism for some of the inflammatory features of meningitis caused by this pathogen.     

Increased CD11b expression on polymorphonuclear leucocytes and cytokine profiles in patients with Kawasaki disease

Clinical evidence implicates polymorphonuclear leucocytes in the pathogenesis of vasculitis in Kawasaki disease. We examined modulation of expression of adhesion molecules (CD11b and CD62L) on polymorphonuclear leucocytes and how this expression is related to serum cytokine concentrations. In 18 patients with Kawasaki disease and 15 control subjects, adhesion molecule expression was determined by two-colour immunofluorescence staining of blood leucocytes and flow cytometry. Eight cytokines and chemokines were also measured. In patients with Kawasaki disease, mean fluorescence intensity for CD11b before giving intravenous immunoglobulin was significantly higher than in normal subjects (P<0 x 005). After intravenous immunoglobulin, mean fluorescence intensity for CD11b decreased significantly. With coronary artery lesions present, mean CD11b fluorescence intensity was significantly higher than without coronary artery lesions (P=0 x 005 before intravenous immunoglobulin; P=0 x 024 after intravenous immunoglobulin). No differences were seen in CD62L expression on polymorphonuclear leucocytes between patients with Kawasaki disease and normal subjects. CD11b expression on polymorphonuclear leucocytes correlated positively with serum interleukin (IL)-6, IL-10, granulocyte colony-stimulating factor, percentage of neutrophils among white cells and C-reactive protein. Polymorphonuclear leucocytes from patients with Kawasaki disease showed increased CD11b expression, which was associated with increased serum cytokines and appeared to be related to coronary artery lesions.     

Different expression of adhesion molecules and tetraspanins of monocytes of patients with atopic eczema

BACKGROUND: Atopic eczema (AE) and psoriasis vulgaris (Pso) represent the most frequent chronic inflammatory skin diseases, which have a high number of characteristics in common but differ in their clinical picture and immunological background. A shared feature of both AE and Pso is a high recruitment of distinct proinflammatory cells from the blood into the skin at the initiation of the disease. A multistep adhesion cascade via different adhesion receptors consisting of 'tethering' and 'rolling' mediated by selectins, alpha-integrins and beta-integrins and the 'arrest' of the cells is initiated during this process. AIMS OF THE STUDY: To evaluate the expression of adhesion molecules and tetraspanins of monocytes of patients with AE and Pso in comparison with healthy controls. METHODS: We analysed the expression of adhesion molecules and tetraspanins on monocytes freshly isolated from the peripheral blood of patients with AE (n = 40) and Pso (n = 65) during exacerbation of their disease in comparison with healthy, non-atopic controls (n = 50). RESULTS: A high number of similarities between monocytes of patients with AE and patients with Pso, and disease-related differences in the expression of CD62L, CD62P, CD11a, CD11b, CD11c, CD49b, CD49d, CD49e and CD18 and the tetraspanins CD9, CD53, CD63 and CD151, which were elevated on monocytes of patients with AE could be observed. CONCLUSION: A distinct expression pattern of adhesion molecules and tetraspanins on monocytes of patients with AE and Pso might influence the recruitment process of inflammatory precursor cells and facilitate new approaches for therapeutic strategies aimed at interrupting the very earliest steps of the fateful recruitment process.     

NLRP3 and downstream cytokine expression elevated in the monocytes of patients with coronary artery disease

Introduction

Pattern recognition receptor (PRR)-mediated signaling pathways have recently been elucidated to bridge the innate immune system and atherosclerosis. NLRP3 is among the family members of NOD-like receptors (NLRs), a type of PRRs. At present, most studies about the NLRP3 inflammasome focus on animal models and immune cells. Limited information is available regarding the role of NLRP3 in patients with coronary artery disease (CAD).

Material and methods

In this study, we observed the expression of NLRP3 and downstream cytokines in patients with CAD by ELISA, real-time qPCR and Western blot.

Results

We found that NLRP3 and downstream cytokines were coupled with increasing severity of CAD and a dynamic variation exists in patients with acute myocardial infarction. We also found that NLRP3 was correlated with Gensini score, indicating that NLRP3 might be relevant not only for the severity of CAD but also for the severity of coronary atherosclerosis.

Conclusions

This study provides a new theoretical basis for innate immune participation in atherosclerosis development and highlights the potential of the NLRP3 inflammasome as a target for prevention and treatment of CAD.     

Effects of combination therapy with celecoxib and doxycycline on neointimal hyperplasia and inflammatory biomarkers in coronary artery disease patients treated with bare metal stents

Purpose

Cyclooxygenase (COX)-2 and matrix metalloproteinase (MMP)-9 play a key role in the pathogenesis of in-stent restenosis. We investigated the effect of a short-term therapy of celecoxib, a COX-2 inhibitor, with or without doxycycline, an MMP inhibitor, after coronary stenting on inflammatory biomarkers and neointimal hyperplasia.

Materials and Methods

A total of 75 patients (86 lesions) treated with bare metal stents were randomized into three groups: 1) combination therapy (200 mg celecoxib and 20 mg doxycycline, both twice daily), 2) celecoxib (200 mg twice daily) only, and 3) non-therapy control. Celecoxib and doxycycline were administered for 3 weeks after coronary stenting. The primary endpoint was neointimal volume obstruction by intravascular ultrasound (IVUS) at 6 months. The secondary endpoints included clinical outcomes, angiographic data, and changes in blood levels of inflammatory biomarkers.

Results

Follow-up IVUS revealed no significant difference in the neointimal volume obstruction among the three treatment groups. There was no difference in cardiac deaths, myocardial infarctions, target lesion revascularization or stent thrombosis among the groups. Blood levels of high-sensitivity C-reactive protein, soluble CD40 ligand, and MMP-9 varied widely 48 hours and 3 weeks after coronary stenting, however, they did not show any significant difference among the groups.

Conclusion

Our study failed to demonstrate any beneficial effects of the short-term therapy with celecoxib and doxycycline or with celecoxib alone in the suppression of inflammatory biomarkers or in the inhibition of neointimal hyperplasia. Large scale randomized trials are necessary to define the role of anti-inflammatory therapy in the inhibition of neointimal hyperplasia.     

冠心病冠状动脉搭桥术前后心电图变化的研究

目的探讨冠心病人冠状动脉搭桥术(CABG)前后心电图的变化。方法通过25例冠心病CAGB患者术前与术后7天、14天、21天及30天阶段比较心电图的动态变化。结果与术前(4.5±2.3天)比较,ST段压低>1.0mm。T波低平、双向和倒置第一周显著增多,此后ST段压低者减少到术前水平,T波低平、双向和倒置非常显著地减少。结论冠心病患者CABG后出现一过性ST段压低变化,T波低平、双向和倒置,此后上述改变逐渐减少至恢复到术前水平。     

Early and long-term prognosis of patients with coronary artery disease treated with percutaneous coronary interventions in 2005. Experience of single large-volume PCI center

PurposeThe progress which has been made in interventional cardiology contributes to the gradual improvement of the results of CHD (coronary heart disease) therapy. The aim of the study was the assessment of early and long-term prognosis in all the patients with CHD treated invasively in one large-volume PCI center in 2005.Material and Methods1390 consecutive patients with CHD treated with PCI in 2005 were included in the analysis. Patients with ST-elevation myocardial infarction (STEMI) accounted for 50% of cases, patients with stable angina (SA) amounted to 25%, and patients with non-ST elevation acute coronary syndromes (NSTE-ACS) constituted 25%. Mean follow-up was 738 (±237) days.ResultsThe highest mortality during the hospitalization was noted within the STEMI group(SA vs. NSTE-ACS vs. STEMI; 0% vs. 0.3% vs. 4.1%, respectively; p<0.001). The highest mortality during a 2-year follow-up was also observed in the STEMI group (SA vs. NSTE-ACS vs. STEMI, 6.3% vs. 8.5% vs. 13.8%, respectively; p<0.001). Multiple regression model showed that independent risk factors for death during the follow-up were: age, glycaemia at admission, heart rate, blood pressure, ejection fraction, STEMI, ineffective PCI (R=0.3613; F(10.131)=19.672; p<0.0001 for the model).ConclusionsThe highest relative increase of mortality after the discharge of patients with CHD undergoing PCI referred to the patients with NSTE-ACS. However, in the real life PCI practice STEMI patients have the worst hospital and long-term prognosis. Well recognized risk factors for death in patients with CHD are still of great importance in negative prognosis of patients undergoing PCI.     

Genetic variations of the apolipoprotein B gene in Turkish patients with coronary artery disease

Background:?The results of studies that clarify the association of genetic markers at the apolipoprotein B (apo?B) gene (EcoRI and XbaI polymorphisms) with coronary artery disease (CAD) are not consistent and suggest that the effect is context dependent (dependent on ethnicity and sex). The present study represents the first investigation of the apo B gene polymorphisms in Turkish patients with CAD and their influence on lipid levels.

Aim:?The study investigated the association of apo B gene EcoRI and XbaI polymorphisms with CAD and with variation in lipid levels (total cholesterol (T-Chol), high-density lipoprotein cholesterol (HDL-Chol), low-density lipoprotein cholesterol (LDL-Chol), and triacylglycerol (TAG)).

Subjects and methods:?The study group was composed of 150 individuals with angiographically documented CAD and 100 angiographically proven to be healthy controls. PCR-RFLP was used to determine the DNA polymorphisms of the apo B gene.

Results:?The frequencies of apo B genotypes detected with EcoRI (AA, AG, GG) and XbaI (CC, CT, TT) did not differ significantly between case and control subjects. A significant association between EcoRI genotypes and T-Chol (p?≤?0.05), and LDL-Chol (p?≤?0.001) was observed only in CAD patients. Patients with the AA genotype had higher levels of serum T-Chol and LDL-Chol compared with AG. With logistic regression analysis the XbaI TT genotype was found to be associated with CAD prevention. However, no significant differences in lipid variables were determined for the XbaI polymorphisms in the patients with CAD.

Conclusions:?Apo B EcoRI genotypes were not found as risk factors for CAD, whereas XbaI TT genotype was detected to prevent against CAD in our study group.

Résumé. Arrière plan: Les résultats des études qui clarifient l’association des marqueurs génétiques du gène B (apo B) de l’alipoprotéine (polymorphismes EcoRI et XbaI) avec la maladie coronarienne (MC), ne sont pas satisfaisants et suggèrent que l’effet est dépendant du contexte (dépendance par rapport au sexe et à l’ethnicité). Cette étude est la première recherche sur les polymorphismes EcoRI et XbaI du gène apo B chez des patients turcs souffrant de MC et sur leur influence sur les niveaux lipidiques.

But: L’étude explore l’association des polymorphismes EcoRI et XbaI du gène apo B avec la MC et avec la variation des niveaux lipidiques?: cholestérol total (Chol-T), cholestérol de lipoprotéines de haute densité (Chol-LHD), cholestérol de lipoprotéines de basse densité (Chol-LBD) et glycéroltriacyl (GTA)

Sujets et méthodes. Le groupe étudié est composé de 150 individus présentant une angiographie de MC et de 100 individus a angiographie saine. La technique de RFLP-PCR a été utilisée pour déterminer les polymorphismes d’ADN du gène apo B.

Résultats: Les fréquences des génotypes de apo B détectées avec EcoRI (AA, AG, GG) et XbaI (CC, CT, TT) ne diffèrent pas significativement entre patients et contrôles. Une association significative entre génotypes EcoRI et Chol-T (p?≤?0,05) ainsi qu’avec Chol-LBD (p?≤?0,001) n’a été observée que chez les patients à MC. Les patients de génotype AA ont un niveau plus élevé que ceux de génotype AG pour les niveaux de Chol-T et de Chol-LBD dans le sérum. Par analyse de régression logistique, on trouve que le génotype XbaI TT est associé à la prévention de la MC. On n’a cependant pas trouvé de différence significative des variables lipidiques qui serait déterminée par les polymorphismes XbaI chez les patients MC.

Conclusion: Les génotypes apo B EcoRI n’apparaissent pas être des facteurs de risque pour la MC, tandis qu’il apparaît que le génotype XbaI TT protège de la MC dans le groupe étudié.

Zusammenfassung. Hintergrund: Die Ergebnisse von Studien, die die Beziehung zwischen genetischen Markern auf dem Apolipoprotein B (Apo B)-Gen und koronarer Herzkrankheit (coronary artery disease, CAD) klären, sind nicht vereinbar und legen nahe, dass der Einfluss vom Zusammenhang abhängt (je nach ethnischer Zugehörigkeit und Geschlecht). Die vorliegende Studie ist die erste Untersuchung von Apo B-Gen-Polymorphismen und ihrem Einfluss auf Lipidspiegel bei Türkischen Patienten mit CAD.

Ziel: Die Studie untersuchte die Beziehung von Apo B-Gen EcoRI- und XbaI-Polymorphismen mit CAD und mit der Schwankung der Lipidspiegel (Gesamtcholesterin (total cholesterol, T-Chol), High-density lipoprotein Cholesterin (HDL-Chol), Low-density lipoprotein Cholesterin (LDL-Chol) und Triacylglycerol (TAG)).

Probanden und Methoden: Die Studiengruppe bestand aus 150 Personen mit angiographisch dokumentierter CAD und 100 angiographisch gesicherten gesunden Kontrollen. PCR-RFLP wurden benutzt um DNS-Polymorphismen des Apo B-Gens zu bestimmen.

Ergebnisse: Die Häufigkeiten der Apo B-Genotypen, die mit EcoRI (AA, AG, GG) und XbaI (CC, CT, TT) bestimmt wurden, unterschieden nicht signifikant zwischen Patienten und Kontrollpersonen. Eine signifikante Beziehung zwischen EcoRI-Genotypen und T-Chol (p?≤?0,05) und LDL-Chol (p?≤?0,001) wurde nur bei CAD-Patienten beobachtet. Patienten mit dem Genotyp AA hatten höhere Serumspiegel von T-Chol und LDL-Chol, verglichen mit AG. Unter Verwendung einer logistischen Regressionsanalyse fand sich, dass der XbaI TT-Genotyp vor CAD schützt. Allerdings wurden keine signifikanten Unterschiede bei den Lipidvariablen hinsichtlich von XbaI-Polymorphismen bei Patienten mit CAD gefunden.

Zusammenfassung: Es wurde nicht gefunden, dass Apo B EcoRI-Genotypen Risikofaktoren für das Auftreten einer CAD darstellen, allerdings zeigte sich in unserer Studiengruppe, dass der XbaI TT-Genotyp gegen CAD schützt.

Resumen. Antecedentes: Los resultados de los estudios que tratan de aclarar la asociación de los marcadores genéticos en el gen de la apolipoproteína B (apo B) (polimorfismos EcoRI y XbaI) con la enfermedad arterial coronaria (EAC), no son consistentes y sugieren que el efecto depende del contexto (es dependiente de la etnicidad y del sexo). El presente estudio constituye la primera investigación sobre los polimorfismos del gen apo B en pacientes turcos con EAC y su influencia sobre los niveles lipídicos.

Objetivo: El estudio investigó la asociación de los polimorfismos EcoRI y XbaI del gen apo B con la EAC y con la variación en los niveles lipídicos (colesterol total (Col-T), colesterol asociado a lipoproteínas de alta densidad (Col-HDL), colesterol asociado a lipoproteínas de baja densidad (Col-LDL) y triacilglicerol (TAG)).

Sujetos y Métodos: El grupo estudiado estaba compuesto por 150 individuos con EAC documentada angiográficamente y 100 controles sanos, comprobados mediante un angiograma. Se utilizó la PCR-RFLP para determinar los polimorfismos del ADN del gen apo B.

Resultados: Las frecuencias de los genotipos apo B detectados con EcoRI (AA, AG, GG) y XbaI (CC, CT, TT) no diferían significativamente entre los casos y los controles. Se observó una asociación significativa entre los genotipos EcoRI y los niveles de Col-T (p?≤?0,05) y Col-LDL (p?≤?0,001), sólo en pacientes con EAC. Los pacientes con el genotipo AA tenían niveles más altos de Col-T y de Col-LDL séricos comparados con los de genotipo AG. Mediante un análisis de regresión logística se encontró que el genotipo XbaI TT estaba asociado con la prevención de la EAC. Sin embargo, en los pacientes con EAC no se encontraron diferencias significativas en las variables lipídicas para los polimorfismos XbaI.

Conclusiones: No se ha encontrado que los genotipos apo B EcoRI sean factores de riesgo para la EAC, mientras que se detectó que el genotipo XbaI TT prevenía contra la EAC en el grupo estudiado.     

Correlations between coronary plaque tissue composition assessed by virtual histology and blood levels of biomarkers for coronary artery disease

Purpose

We investigated correlations of coronary plaque composition determined by virtual histology (VH) intravascular ultrasound (IVUS) and blood levels of biomarkers that represent the vulnerability of coronary plaques.

Materials and Methods

Pre- and postprocedural blood levels of high sensitivity C-reactive protein, soluble CD40 ligand (sCD40L), matrix metalloproteinase-9, and neopterin were measured in 70 patients with stable angina (SA) or unstable angina (UA) who were undergoing percutaneous coronary intervention (PCI) for single lesions. We evaluated the data for correlations between these biomarkers and necrotic core contents in PCI target lesions analyzed by VH.

Results

Clinical characteristics, IVUS, VH, and biomarker blood levels were not different between the SA and the UA group except for more frequent previous statin use (52.3% vs. 23.1%, p=0.017) and lower remodeling index in the SA group (0.98±0.09 vs. 1.10±0.070, p<0.001). Among the biomarkers evaluated, only pre-PCI neopterin level showed a weakly significant correlation with the absolute volume of the necrotic core (r=0.320, p=0.008). Pre- and post-PCI blood levels of sCD40L (r=0.220, p=0.072; r=0.231, p=0.062) and post-PCI blood level of neopterin (r=0.238, p=0.051) showed trends toward weakly positive correlations with the absolute volume of necrotic core.

Conclusion

We found a weakly positive correlation between the pre-PCI neopterin level and necrotic core volume in the PCI-target lesion. The clinical implications of our findings need to be investigated in further studies.     

Impact of diabetes on mortality and complications after coronary artery by-pass graft operation in patients with left main coronary artery disease

PurposeLeft main disease (LMD) is a severe form of coronary artery disease (CAD). Fifty percent of patients with LMD treated conservatively die within 3–5 years of diagnosis. The aim of the study was to assess the influence of type 2 diabetes on early and late (2-year) prognosis and the risk of complications after coronary artery by-pass graft (CABG) surgery in patients with LMD.Material/methodsWe enrolled 257 patients diagnosed with LMD. 169 (67%) underwent CABG, 19 (8%) percutaneous coronary intervention (PCI) without left main stem protection. 30 (12%) patients had CABG previously. Patients treated with CABG were divided into two groups – with and without diabetes. There were 43 (25.4%) patients with diabetes and 126 (74.6%) without diabetes.ResultsWe observed more complications with wound healing (40.5% vs. 12.8%, p < 0.001) and sternal dehiscence (23.8% vs. 4.0%, p < 0.001) after CABG in patients with diabetes. There were no differences in 7-day, 30-day, 3-month and 1-year mortality. 2-Year mortality was also similar in both groups (11.6% vs. 11.1%, p = 0.928). Patients with diabetes were more frequently hospitalized due to other reasons than angina (39.5% vs. 20.6%, p = 0.014).ConclusionsPatients with diabetes and LMD had more often complications with wound healing and sternal dehiscence after CABG than patients without diabetes. Type 2 diabetes did not influence early and late mortality in patients with LMD treated with cardiac surgery, but the presence of diabetes was associated with more frequent hospitalizations.     

冠心病介入治疗患者体外反搏的疗效探讨

目的探讨增强型体外反搏(enhancedexternalcouterpulsationEECP)对冠心病经皮冠状动脉介入治疗患者的疗效。方法经选择性冠状动脉造影确诊为冠心病且介入治疗成功的患者共469例,其中85例在药物治疗的基础上行体外反搏治疗(EECP组),另384例予单纯药物治疗(药物组)。临床随访6~72个月,部分行超声心动图和冠脉造影复查,比较两组随访病例临床终点事件、左室功能和造影结果的差异。结果(1)基线资料:对EECP组81例(95%)和药物组350例(91%)成功进行了随访,两组在临床资料、造影特征和介入治疗等方面差异均无统计学意义(P>0.05)。⑵临床终点事件:EECP组心绞痛复发率显著低于药物组(8·6%比17.4%,P<0.05);EECP组总的临床终点事件发生率明显低于药物组(18.5%比35.4%,P<0.01)。(3)超声心动图:两组基线室壁运动指数和左室射血分数相似,但复查时EECP组明显优于药物组(P<0.01)。⑷冠状动脉造影:两组再狭窄发生率差异无统计学意义P>0.05,但EECP组出现侧支循环患者数明显多于药物组(17.9%比5·1%,P<0.05),复查时病变血管参考内径[(3.29±0.61)mm比(3.06±0.50)mm,P<0.05]和支架内最小腔径[(3.02±0.59)mm比(2.67±0.62)mm,P<0.01]均显著大于药物组。结论对于介入治疗成功的冠心病患者,增强型体外反搏可减少心绞痛复发,改善预后和心功能,并可能有预防再狭窄的作用。     

Evaluation of a train-the-trainer program for stable coronary artery disease management in community settings: A pilot study

Objective

To evaluate the feasibility and effectiveness of conducting a train-the-trainer (TTT) program for stable coronary artery disease (SCAD) management in community settings.

阿托伐他汀对冠心病患者外周血单核细胞/巨噬细胞清道夫受体的影响

目的：观察冠心病患者外周血单核细胞（PBMs）转化巨噬细胞清道夫受体活性及血清炎性因子(包括CRP、sICAM-1 、sVCAM-1)的变化及阿托伐他汀对清道夫受体活性的影响，探讨炎性因子水平与清道夫受体活性关系及他汀类药物稳定粥样硬化斑块的可能机制。 方法： 75例血脂正常冠心病患者分为稳定性心绞痛组、不稳定性心绞痛组、急性心肌梗死3组，29例健康人作为对照。测定所有观察对象血清C反应蛋白、可溶性细胞间黏附分子（sICAM-1）、血管细胞黏附分子（sVCAM-1）水平；并在体外分离培养PBMs并转化为巨噬细胞, 观察阿托伐他汀对其表达清道夫受体的影响。 结果： 巨噬细胞清道夫受体活性及血清C反应蛋白、sICAM-1、sVCAM-1水平，急性心肌梗死组>不稳定性心绞痛组>稳定性心绞痛组>对照组。阿托伐他汀能下调冠心病患者PBMs源性巨噬细胞清道夫受体活性。冠心病患者PBMs源性巨噬细胞清道夫受体活性与C反应蛋白、sICAM-1、sVCAM-1呈正相关。 结论： PBMs源性巨噬细胞清道夫受体活性可作为易损斑块活动程度的监测指标；阿托伐他汀可抑制冠心病患者血PBMs源性巨噬细胞清道夫受体活性。     

Comparing mortality and myocardial infarction between coronary artery bypass grafting and drug-eluting stenting in patients with diabetes mellitus and multivessel coronary artery disease: a meta-analysis

Introduction

We aim to compare the midterm outcomes between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in diabetic patients who had multivessel coronary artery diseases (CAD).

Material and methods

A comprehensive literature search was conducted to identify the related clinical studies with a follow-up for 1 year at least. The endpoints were death, myocardial infarction, and major adverse cardiac and cerebrovascular events (MACCE).

Results

Finally, the analysis of ten studies involving 5,264 patients showed that patients with CABG had worse baseline characteristics, a higher rate of stable angina pectoris, a higher percentage of triple-vessel disease, higher incidence of chronic total occlusion and a higher SYNTAX score. However, there was no significant difference in mortality between the two groups. Additionally, the rates of myocardial infarction and MACCE were markedly decreased in the CABG group.

Conclusions

The strategy of CABG is better than PCI for diabetic patients with multivessel CAD. The CABG can significantly reduce the rates of myocardial infarction and MACCE and is comparable in mortality despite the worse baseline characteristics.     

PET tracers and techniques for measuring myocardial blood flow in patients with coronary artery disease

Assessment of the relative distribution of myocardial flow with myocardial perfusion imaging （MPI） is meth- odologically limited to predict the presence or absence of flow-limited coronary artery disease （CAD）. This limi- tation may often occur, when obstructive lesions involve multiple epicardial coronary arteries or disease-related disturbances of the coronary circulation coexist at the microvascular level. Non-invasive assessment of myocar- dial blood flow in absolute units with position emission tomography （PET） has been positioned as the solution to improve CAD diagnosis and prediction of patient outcomes associated with risks for cardiac events. This article reviews technical and clinical aspects of myocardial blood flow quantitation with PET and discusses the practical consideration of this approach toward worldwide clinical utilization.     

Trace elements, heavy metals and vitamin levels in patients with coronary artery disease

Aim: In the present study, we aimed to assess serum concentrations of zinc (Zn), copper (Cu), iron (Fe), cadmium (Cd), lead (Pb), manganese (Mn), vitamins A (retinol), D (cholecalciferol) and E (α-tocopherol) in patients with coronary artery disease (CAD) and to compare with healthy controls.Methods: A total of 30 CAD patients and 20 healthy subjects were included in this study. Atomic absorption spectrophotometry (UNICAM-929) was used to measure heavy metal and trace element concentrations. Serum α-tocopherol, retinol and cholecalciferol were measured simultaneously by high performance liquid chromatography (HPLC).Results: Demographic and baseline clinical characteristics were not statistically different between the groups. Serum concentrations of retinol (0.3521±0.1319 vs. 0.4313±0.0465 mmol/I, p=0.013), tocopherol (3.8630±1.3117 vs. 6.9124±1.0577 mmol/I, p<0.001), cholecalciferol (0.0209±0.0089 vs. 0.0304±0.0059 mmol/I, p<0.001) and Fe (0.5664±0.2360 vs. 1.0689±0,4452 µg/dI, p<0.001) were significantly lower in CAD patients. In addition, while not statistically significant serum Cu (1.0164±0.2672 vs. 1.1934±0.4164 µg/dI, p=0.073) concentrations were tended to be lower in patients with CAD, whereas serum lead (0.1449±0.0886 vs. 0.1019±0.0644 µg/dI, p=0.069) concentrations tended to be higher.Conclusions: Serum level of trace elements and vitamins may be changed in patients with CAD. In this relatively small study we found that serum levels of retinol, tocopherol, cholecalciferol, iron and copper may be lower whereas serum lead concentrations may be increased in patients with CAD.     

Microvascular endoglin (CD105) expression correlates with tissue markers for atherosclerotic plaque vulnerability in an ageing population with multivessel coronary artery disease

Li X, van der Meer J J, van der Loos C M, Ploegmakers H J P, de Boer O J, de Winter R J & van der Wal A C
(2012) Histopathology  61, 88–97 Microvascular endoglin (CD105) expression correlates with tissue markers for atherosclerotic plaque vulnerability in an ageing population with multivessel coronary artery disease Aims: Vulnerable atherosclerotic plaques are lesions with a high propensity to develop plaque disruption and superimposed thrombosis. No systematic studies have been carried out on tissue markers for plaque vulnerability throughout the entire coronary artery system at the end stages of coronary atherosclerosis. Methods and results: Nine autopsied patients (mean age 77 years) with angiographically severe trivascular coronary atherosclerosis were selected for this study. All visible lesions in postmortem coronary angiograms (n = 125) were histologically and immunohistochemically screened for the presence of intraplaque haemorrhages (activated) microvessels and inflammatory infiltrates. Intraplaque haemorrhages were observed in 76/125 plaques (61%). Chronic inflammation was found superficially in 59/125 plaques (47%) and deeply inside the plaque tissue in 103/125 plaques (83%). Microvessels were found in 100/125 lesions (80%), of which 58% showed endothelial expression of the vascular activation marker CD105. Moreover, microvascular CD105 positivity correlated positively with plaque haemorrhage and deeply seated plaque inflammation. Conclusions: Plaque inflammation and haemorrhages can be found at a high frequency throughout the coronary artery system of elderly patients with multivessel coronary atherosclerosis. Microvascular expression of endoglin (CD105), which correlates positively with both of these features of plaque vulnerability, can serve as a marker of the risk of developing coronary thrombotic complications.     

唐山汉族冠心病患者的指纹纹型分析

目的：研究冠心病患者的指纹纹型分布,并与正常人群指纹分布作比较,为临床医学提供基础皮纹学参数。 方法：对160 例唐山地区冠心病患者及160 例对照组人群印泥拓取法采集指纹,放大镜下鉴定。结果：冠心病患者 的指纹参数值为：斗形纹（W）占56.19%,箕形纹（L）占41.25%,弓形纹（A）占2.56%。A形纹多见于示指,其 次是中指;Lr 多见于示指;Lu 多见于小指;W多见于环指。冠心病患者示指箕形纹和弓形纹的频率较对照组具有 显著性差异。双手十指同纹型的频率为20%。一手五指纹型组合频率为OLW（65.31%）> 同型组合（26.25%）> ALO（4.69%）>ALW（3.75%）。对应手指纹型组合频率为W/W（ 49.13%）>L/L（ 33.00%）>L/W（13.00%）> A/L（3.50%）>A/A（1.25%）。患者组和对照组示指出现A/L 和L/W组合的频率差异显著,2 组中L/W和W/W组 合的频率差异显著。结论： 冠心病患者指纹纹型分布具有特异性,且男性和女性间差别不显著。