Low plasma HDL-c, a vascular risk factor in high risk patients independent of LDL-c

Background High concentrations of high density lipoprotein‐cholesterol (HDL‐c) are associated with lower cardiovascular risk, but it is not known whether this is also the case in the presence of intensive low density lipoprotein‐cholesterol (LDL‐C) therapy. In this study, we determined the relationship between HDL‐c and new non‐fatal or fatal vascular events in patients with various manifestations of clinical evident vascular disease and evaluated whether this relationship is modified by LDL‐c levels. Materials and methods Prospective single centre, cohort study of 3837 patients with a history or recent diagnosis of clinical manifest vascular disease (coronary, cerebrovascular, peripheral arterial disease or abdominal aortic aneurysm) The relationship between HDL‐c quintiles and time to a new event (myocardial infarction, ischaemic stroke, vascular death) was quantified with Cox‐regression models and adjusted for potential confounders (age, gender, body mass index, type 2 diabetes, triglycerides, smoking, use of alcohol and lipid‐lowering therapy). Effect modification of LDL‐c was assessed with interaction terms. Results During a median follow up of 3·3 (range 0·1–9·5) years, a total of 465 first new events occurred. Compared with the lowest quintile, the upper quintile of HDL‐c levels was associated with a lower risk for new events; Hazard Ratio 0·61 (95% CI 0·43–0·86) irrespective of the localisation of vascular disease and use of lipid‐lowering medication. Higher HDL‐c levels were associated with comparably lower risks for vascular events in patients with LDL‐c levels above and below 2·5 mmol L^?1 (P‐values for interaction > 0·05). Conclusions Patients with various clinical manifestations of vascular diseases in the highest HDL‐c quintile have a lower risk for vascular events compared with patients in the lowest HDL‐c quintile. Further, the current results expand the evidence by showing that also in a cohort of patients with various localisations of clinical evident vascular disease, in which statins were widely used, higher HDL‐c levels confer a lower risk for developing new vascular events, irrespective of the localisation of vascular disease, use of lipid‐lowering medication and plasma LDL‐c concentration.     

Posttraumatic Arteriovenous Malformation of the Face: A Case Report

Background

Head and neck arteriovenous malformations (AVMs) are reported to occur in 0.1% of the population. Extracranial AVMs account for only 8.1% of head and neck AVMs. Of these, traumatically acquired AVMs of the face are generally reported as quite rare. When secondary to trauma, the lesion is usually supplied by a single vessel, as compared to the multiple vessels often seen with congenital etiology.

Objectives

Understanding of regional anatomy is paramount when assessing and managing facial injuries. As an integral health care provider for the facial trauma patient, it is the responsibility of the emergency physician to recognize this rare pathologic lesion necessary to coordinate surgical management of the traumatic AVM.

Case Report

We present a case report of a patient who sustained a facial laceration complicated by the development of a vascular malformation. The facial laceration in this case report highlights the complexity of wound evaluation and management when treating patients in the emergency department.

Conclusion

Traumatic AVMs are quite rare in the head and neck and are mostly seen in the extremities. Although rare, they have been reported after typical facial trauma as well as elective surgical procedures. The management of such lesions may include selective embolization or surgical exploration with ligation. Emergency physicians and facial trauma surgeons are challenged with recognizing and treating these rare but very real vascular lesions. It is our hope that this case report provides an overview of posttraumatic AVMs in the head and neck.     

联合血管切除重建在肝门部胆管癌根治术中的应用进展

外科根治性切除目前仍然是肝门部胆管癌最为有效且唯一有可能达到根治目的 的治疗策略.既往认为肿瘤浸润门静脉或肝动脉被认为是手术禁忌证,是阻碍手术达到肿瘤阴性切缘(R0切除)关键因素.但随着血管外科技术的发展和提高,这些禁忌已经部分被突破.目前合并门静脉切除重建的肝门部胆管癌根治术的安全性和效果已得到充分肯定,有利于患者的...     

经食管多普勒定量估测冠状动脉血管阻力及血管储备

应用经食管多普勒超声心动图（ＴＥＥ）对３０例冠状动脉造影患者测量注射潘生丁前后左前降支平均舒张期血流率（Ｖｃｏｒ）、冠脉血管阻力（Ｒｃｏｒ）和冠脉血管储备（ＣＶＲ）。静息状态正常组与狭窄各组平均动脉压（ＭＡＰ）、Ｖｃｏｒ和Ｒｃｏｒ无显著差异。注射潘生丁后狭窄各组较对照组的Ｒｃｏｒ显著增加、Ｖｃｏｒ和ＣＶＲ显著降低而ＭＡＰ基本不变；ＰＤＳ＜７５％与≥７５％组的注药后Ｒｃｏｒ和ＣＶＲ无显著差异，血管狭窄积分（ＡＳＩ）＜１．５ｃｍ与≥１．５ｃｍ组两指标差异显著。注药后的Ｒｃｏｒ与ＡＳＩ成正相关（ｒ＝０．６３，Ｐ＜０．０１），与ＰＤＳ不相关；ＣＶＲ与ＡＳＩ和ＰＤＳ成较好的负相关（ｒ＝－０．８２，－０．５２）。本研究为冠状动脉病变功能严重度的定量估价提供了参考依据。     

Fibroblast activation in vascular inflammation

Summary. Vascular inflammation is implicated in both local and systemic inflammatory conditions. Endothelial activation and leukocyte extravasation are key events in vascular inflammation. Lately, the role of the stromal microenvironment as a source of proinflammatory stimuli has become increasingly appreciated. Stromal fibroblasts produce cytokines, growth factors and proteases that trigger and maintain acute and chronic inflammatory conditions. Fibroblasts have been associated with connective tissue pathologies such as scar formation and fibrosis, but recent research has also connected them with vascular dysfunctions. Fibroblasts are able to modulate endothelial cell functions in a paracrine manner, including proinflammatory activation and promotion of angiogenesis. They are also able to activate and attract leukocytes. Stromal fibroblasts can thus cause a proinflammatory switch in endothelial cells, and promote leukocyte infiltration into tissues. New insights in the role of adventitial fibroblasts have further strengthened the link between stromal fibroblasts and proinflammatory vascular functions. This review focuses on the role of fibroblasts in inducing and maintaining vascular inflammation, and describes recent findings and concepts in the field, along with examples of pathologic implications.     

混合性痴呆与血管性痴呆的临床特点对比分析

【目的】提高对混合痴采（MD）和血管性痴呆（VD）二者的鉴别能力。【方法】MD患者与VD患者各60例,对两组患者进行检查,分析比较其神经心理及影像学的不同表现及特点。【结果】轻度痴呆患者长谷川氏痴呆评定量表检查中,远记忆、近记忆计算力、识记评分中,MI）组显著低于VD组（P〈O．01）;轻度痴呆患者BEHAVE—AD评定量表痴呆的心理和行为症状严重程度比较中,MD组行为紊乱及情感障碍明显较VD组严重（P〈0．01）;两组患者影像学检查对比,MD组的外侧裂、脑沟较VD组明显增宽,脑叶的局灶性病灶出现率显著高于VD组,3、4级脑白质疏松出现率显著低于VD组。【结论]MD及VD病人的神经心理及影像学改变各有其特点,据此有助于两种疾病的鉴别。     

心脏介入治疗后应用Boomerang^TM血管封堵器局部血管并发症的观察

目的探讨心脏介入治疗患者应用Boomerang^TM血管封堵器封堵股动脉后血管并发症的发生情况。方法选择心脏介入治疗后采用封堵器的病例60例为观察组，常规手工压迫止血75例为对照组，观察比较两组止血成功率及局部血管并发症。结果观察组全部封堵成功，发生小血肿1例，血管并发症发生率2％；对照组发生各种血管并发症共8例，发生率11％，观察组效果优于对照组（P〈0．05）。结论Boomerang^TM血管封堵器应用于心脏介入治疗后，封堵股动脉的止血成功率高，血管并发症发生率低，提高了患者的舒适度。     

Prevention and treatment of aortic graft infection

Prosthetic vascular graft infection remains one of the most challenging surgical problems for vascular surgeons. This condition is classically associated with high morbidity and mortality rates. Accurate diagnosis of a vascular graft infection can typically be made based on a thorough history and physical examination; although, infrequently, an extensive radiological evaluation is necessary to establish the clinical finding. Complete graft excision and extra-anatomic bypass grafting remains a commonly accepted surgical treatment strategy. Recent clinical data have supported other treatment modalities, including the use of in situ antibiotic-impregnated graft replacement, in situ allograft replacement and in situ autologous graft replacement. This article will review the pathobiology of aortic graft infection, as well as methods to prevent a prosthetic graft infection. Furthermore, various surgical treatment modalities of aortic graft infection will be discussed.     

Intraoperative Sonography During Carotid Endarterectomy

Carotid endarterectomy is a commonly performed procedure for prevention of stroke related to carotid stenosis. Intraoperative sonography is used to identify potentially correctable technical defects during carotid endarterectomy. The main risk of endarterectomy is perioperative stroke, and great effort has been put into trying to reduce this risk through various surgical techniques and evaluation of the surgical bed. Postoperative carotid thrombosis, or thombo‐embolization from the arterectomy site, remains a common cause of perioperative stroke and is often related to technical defects in the arterial reconstruction procedure. Re‐exploration and repair of any imperfections have the potential to improve outcomes. Intraoperative imaging can identify potentially occult lesions, provide the option for correction, and thus reduce chance of stroke. Familiarity with the spectrum of intraoperative sonographic findings helps correctly identify residual intimal dissection flaps, plaque, thrombi, and stenosis, which may require immediate surgical revision. Our objective is to illustrate the spectrum of intraoperative findings and their importance.     

失血性休克大鼠血管平滑肌钙敏感性变化及其在休克双相血管反应性变化中的作用

目的观察失血性休克后血管平滑肌钙敏感性是否存在双相变化,以及钙敏感性的双相变化与血管反应性双相变化的关系。方法取失血性休克大鼠肠系膜上动脉(SMA),采用离体血管环张力测定技术,观察在失血性休克后不同时间点(休克即刻、休克30min、休克1h、休克2h)大鼠SMA血管环对梯度浓度去甲肾上腺素(NE)的收缩反应性,以及在去极化状态下(120mmol/LK+)血管环对梯度浓度钙的收缩反应性变化(钙敏感性),分析血管反应性变化与钙敏感性变化的关系;同时观察钙敏感性增强剂血管紧张素(Ang)和钙敏感性抑制剂胰岛素对血管反应性的影响。结果休克早期(即休克即刻和休克30min时)SMA对NE和钙的反应性明显升高,量效曲线明显左移,最大收缩力(Emax)明显升高(P均<0.05);随着休克时间的延长,血管环对NE和钙的反应性均逐渐下降,到休克2h均已明显降低,其量效曲线明显右移,E-max明显降低(P<0.05或P<0.01);休克后不同时间点血管反应性变化与钙敏感性变化呈显著正相关(r=0.9624,P<0.05)。具有钙敏感性增强作用的Ang(1×10-9mol/L)可明显升高休克2h血管环对NE和钙的反应性(P<0.05或P<0.01),而有钙敏感性抑制作用的胰岛素则可降低休克早期(休克即刻)血管环对NE和钙的反应性(P<0.05或P<0.01)。结论失血性休克血管平滑肌细胞存在钙敏感性的双相变化,血管平滑肌细胞钙敏感性双相变化在失血性休克血管反应性的双相变化中起重要作用。     

Reproducibility of blood oxygen level‐dependent signal changes with end‐tidal carbon dioxide alterations

Hypercapnia has been utilized as a stimulus to elicit changes in cerebral blood flow (CBF). However, in many instances it has been delivered in a non‐controlled method that is often difficult to reproduce. The purpose of this study was to examine the within‐ and between‐visit reproducibility of blood oxygen level‐dependent (BOLD) signal changes to an iso‐oxic square wave alteration in end‐tidal carbon dioxide partial pressure (P_etCO₂). Two 3‐Tesla (3T) MRI scans were performed on the same visit, with two square wave alterations administered per scan. The protocol was repeated on a separate visit with minimum of 3 days between scanning sessions. P_etCO₂ was altered to stimulate changes in cerebral vascular reactivity (CVR), while P_etO₂ was held constant. Eleven subjects (six females; mean age 26·5 ± 5·7 years) completed the full testing protocol. Excellent within‐visit square wave reproducibility (ICC > 0·75) was observed. Similarly, square waves were reproducible between scanning sessions (ICC > 0·7). This study demonstrates BOLD signal changes in response to alterations in P_etCO₂ are reproducible both within‐ and between‐visit MRI scans.     

Potassium channels in vascular smooth muscle: a pathophysiological and pharmacological perspective

Potassium (K⁺) ion channel activity is an important determinant of vascular tone by regulating cell membrane potential (MP). Activation of K⁺ channels leads to membrane hyperpolarization and subsequently vasodilatation, while inhibition of the channels causes membrane depolarization and then vasoconstriction. So far five distinct types of K⁺ channels have been identified in vascular smooth muscle cells (VSMCs): Ca⁺²‐activated K⁺ channels (BK_Ca), voltage‐dependent K⁺ channels (K_V), ATP‐sensitive K⁺ channels (K_ATP), inward rectifier K⁺ channels (K_ir), and tandem two‐pore K⁺ channels (K₂P). The activity and expression of vascular K⁺ channels are changed during major vascular diseases such as hypertension, pulmonary hypertension, hypercholesterolemia, atherosclerosis, and diabetes mellitus. The defective function of K⁺ channels is commonly associated with impaired vascular responses and is likely to become as a result of changes in K⁺ channels during vascular diseases. Increased K⁺ channel function and expression may also help to compensate for increased abnormal vascular tone. There are many pharmacological and genotypic studies which were carried out on the subtypes of K⁺ channels expressed in variable amounts in different vascular beds. Modulation of K⁺ channel activity by molecular approaches and selective drug development may be a novel treatment modality for vascular dysfunction in the future. This review presents the basic properties, physiological functions, pathophysiological, and pharmacological roles of the five major classes of K⁺ channels that have been determined in VSMCs.     

Impact of exercise on retinal microvascular regulation measured by dynamic vessel analysis in healthy individuals

We assessed the acute impact of physical exercise on the retinal vessel diameter and the regulation of vasoconstriction and vasodilatation owing to flicker that has never been examined before. Forty young (mean age 24 years) healthy subjects (26 women and 14 men) had retinal examinations with dynamic vessel analysis prior and after (0.5, 1.5 and 2.5 h) intense exercise of 20 min. The measurements were always taken on continuous same eye, each with a 350-s permanent dynamic vascular analysis including three cycles of 20 s with 12.5-Hz flicker provocation of the retinal vessel analyser system (RVA) device. Blood pressure values were measured before and after the dynamic vessel analysis with a portable, automatic blood pressure monitor. Dynamic vessel analysis revealed that exercise had a substantial quickly and long-lasting effect on arterial and venous diameter (F = 30.38 and 35.85, P < 0.001) and arterial dilatation owing to flicker (F = 10.67, P < 0.005). The effect of flicker on arterial constriction was not significant for all time periods (F = 0.26). Friedman test revealed that arterial constriction to flicker was significantly increased at 30 and 90 min (χ(2) = 43.3 and 49.2, P < 0.001). Exercise had a significant effect on venous constriction and dilatation owing to flicker (F = 11.14, P < 0.001, F = 3.77, P < 0.05). Our results demonstrate that the expected impact of exercise can be accurately assessed with the RVA. We therefore suggest that the RVA is a valid instrument to assess early structural and functional alterations in the retinal vascular system.     

血管内支架置入治疗周围血管疾病的应用研究

目的：探讨血管内支架置入治疗周围血管疾病的应用价值。材料与方法：16例周围血管狭窄或闭塞的患者及2例外伤性周围血管损伤的患者。15例为髂动脉或股动脉动脉硬化所致的血管狭窄或闭塞，1例为左锁骨下动脉开口处动脉硬化所致的血管狭窄，1例为右肱动脉上段外伤性动脉瘤，1例为外伤性右锁骨下动－静脉瘘。16例周围血管狭窄或闭塞的患者，采用经皮穿刺溶栓治疗，球囊导管血管内成形（PTA）及血管内支架置入进行治疗，2例外伤性血管损伤的患者，采用经皮穿刺带膜血管内支架置入进行治疗。结果：18例患者经溶栓治疗，血管内成形（PTA）及血管内支架置入术治疗后，闭塞血管重新开通，损伤血管修复，血液动力学恢复正常。未发生并发症。结论：血管内支架置入治疗周围血管疾病具有较高的临床应用价值。     

Prognostic factors in rehabilitation of above knee amputees for vascular diseases

Purpose: This study was undertaken to predict rehabilitation potential and prognostic factors of patients undergoing above knee amputation for vascular diseases.

Method: In a prospective study on 144 patients consecutively admitted to our rehabilitation unit for above knee amputation, multiple regression analyses were used to assess the relationship between nine independent variables and a battery of outcome measures: the Rivermead Mobility Index (RMI) and Barthel Index (BI) effectiveness on discharge, length of hospital stay. Two multiple logistic regressions were performed, using as dependent variable the occurrence of good or partial autonomy in mobility, quantified as RMI scores.

Results: Advanced age was the most powerful prognostic factor influencing effectiveness expressed as both mobility (RMI) and BI. Patients aged < 65 years had a greater probability (odds ratio 2.92) of good autonomy in mobility than older patients. The absence of vascular impairment of the residual limb and timely admission to the rehabilitation hospital correlated positively with effectiveness of mobility. Conclusions: These findings indicate that relevant prognostic factors can be identified at the beginning of rehabilitation treatment.     

数字化静脉造影在下肢血管病中的应用

目的:评价数字化下肢静脉造影在诊断及治疗下肢静脉疾病中的价值。方法:选择临床疑诊为下肢静脉疾病患者352例423侧肢体,进行数字化下肢静脉造影检查。结果:352例423侧肢体的数字化下肢静脉造影均成功,其中阴性7例9侧肢体,阳性345例414侧肢体。下肢静脉各类疾病根据其主要征象分为:原发性下肢深静脉瓣膜功能不全203侧肢体,单纯性大隐静脉瓣膜功能不全36侧肢体,下肢深静脉血栓形成109侧肢体,髂静脉受压综合征38侧肢体,静脉畸形骨肥大综合征11侧肢体,下肢血管瘤17侧肢体。结论:数字化下肢静脉造影是诊断下肢血管病的首选检查方法,为临床治疗方案的选择及治疗效果的判定提供了可靠的依据,在诊治下肢血管病工作中值得推广。     

“Outside‐In” vs “Inside‐Out”: Revisiting Migraine's Vascular Hypothesis

The neurovascular contribution to migraine biogenesis should not be overlooked in the rush to embrace a central “generator.”     

二次谐波声学造影诊断先天性肝动脉—门静脉瘘的初步探讨

目的：探讨经静脉二次谐波声学造影诊断先天性肝动脉－门静脉瘘的可行性。方法：对4例彩色多普勒超声检查提示为先天性肝动脉－门静脉瘘患者,行经静脉二次谐波声学造影检查,并与X线血管造影对照。结果：造影剂经左前臂浅静脉注射后13－15s（平均14s)肝动脉显影,见门脉左、右支周围及其远侧有多个短条状强回声带,宽0．22－0．41cm。几乎与肝动脉显影的同时,门静脉左、右支内亦充满造影剂密集点状强回声,呈“脉冲”样反向流动。超声造影与X线血管造影结果相符。结论：经静脉二次谐波声学造影是诊断先天性肝动脉－门静脉瘘简便、准确的方法。