Molecular imaging of atherosclerosis

Techniques are being developed for clinical molecular imaging of atherosclerosis to identify and characterize vulnerable plaques in each vascular territory. Molecular imaging encompasses multiple imaging modalities that depict cellular and subcellular processes. Molecular imaging can provide a “virtual histology” noninvasively about atherosclerotic disease, characterizing vascular lesions with markers of inflammation, angiogenesis, lipid metabolism, and more.     

Noninvasive atherosclerosis imaging for predicting cardiovascular events and assessing therapeutic interventions

Noninvasive assessment of atherosclerosis offers an opportunity to provide individual cardiovascular risk management and an opportunity to monitor the efficacy of therapy targeted toward atherosclerosis. The three imaging modalities that currently hold the most promise at the clinical and research levels are ultrasound for carotid intima-media thickness, computed tomography for coronary artery calcification, and magnetic resonance imaging for carotid and aortic plaque imaging. The following review describes the evidence that validates each technique as a surrogate marker of atherosclerosis, with an emphasis on cardiovascular events and the progression of disease. Both the particular strengths and limitations of each imaging modality are discussed.     

Early atherosclerosis in childhood: diagnostic approaches and therapeutic strategies

The long preclinical phase of atherosclerosis involves the interaction of genetic and environmental factors that modulate the progression of disease from early life. Injury to the endothelium is a critical step in atherosclerotic process. Conventional and novel risk factors for coronary artery disease operate from early in life. Noninvasive methods, using mostly ultrasound techniques, have enabled the assessment of early functional and structural arterial disease progression even from the first decade of life. These measures have been shown to be good surrogate markers for atherosclerotic disease progression and future clinical cardiovascular events. Lifestyle and dietary modifications as well as pharmacological interventions have beneficial effects in prevention and restoration of the early arterial changes.     

Molecular and cellular imaging of atherosclerosis: emerging applications

Molecular imaging studies have shed light on important biological aspects of atherosclerosis, and are now entering the clinical arena for the detection of clinical atheroma. This review first discusses fundamental principles regarding the rationale for and development of molecular imaging technologies for investigating atherosclerosis. Next, we highlight clinically promising imaging strategies that illuminate key biological aspects of atherosclerosis, including macrophage activity, protease activity, lipoprotein presence, apoptosis, and angiogenesis. We envision that several molecular imaging approaches will become important adjuncts to the clinical management of high-risk atherosclerosis.     

Molecular and cellular imaging of atherosclerosis: emerging applications.

Molecular imaging studies have shed light on important biological aspects of atherosclerosis, and are now entering the clinical arena for the detection of clinical atheroma. This review first discusses fundamental principles regarding the rationale for and development of molecular imaging technologies for investigating atherosclerosis. Next, we highlight clinically promising imaging strategies that illuminate key biological aspects of atherosclerosis, including macrophage activity, protease activity, lipoprotein presence, apoptosis, and angiogenesis. We envision that several molecular imaging approaches will become important adjuncts to the clinical management of high-risk atherosclerosis.     

Emerging diagnostic and therapeutic molecular imaging applications in vascular disease

Assessment of vascular disease has evolved from mere indirect and direct measurements of luminal stenosis to sophisticated imaging methods to depict millimeter structural changes of the vasculature. In the near future, the emergence of multimodal molecular imaging strategies may enable robust therapeutic and diagnostic ('theragnostic') approaches to vascular diseases that comprehensively consider structural, functional, biological and genomic characteristics of the disease in individualized risk assessment, early diagnosis and delivery of targeted interventions.This review presents a summary of recent preclinical and clinical developments in molecular imaging and theragnostic applications covering diverse atherosclerosis events such as endothelial activation, macrophage inflammatory activity, plaque neovascularization and arterial thrombosis. The main focus is on molecular targets designed for imaging platforms commonly used in clinical medicine including magnetic resonance, computed tomography and positron emission tomography. A special emphasis is given to vascular ultrasound applications, considering the important role this imaging platform plays in the clinical and research practice of the vascular medicine specialty.     

ERCP诊治指南（2010版）（二）

胆管良恶性狭窄的ERCP诊治 一、胆管狭窄的ERCP诊断 1．良性和恶性胆管狭窄在临床上一般均以梗阻性黄疸和（或）胆管炎为主要表现,通过血液检验和一线的影像学检查（如腹部超声、CT、MRI或MRCP等）,通常可确立诊断。ERCP作为二线的检查手段,在对于上述检查仍不能确诊或已确诊需要介入治疗时使用,不建议单纯实施ERCP诊断。     

Molecular imaging of coronary atherosclerosis and myocardial infarction: considerations for the bench and perspectives for the clinic

Membrane-shed submicron microparticles (MPs) are released after cell activation or apoptosis. High levels of MPs circulate in the blood of patients with atherothrombotic diseases, where they could serve as a useful biomarker of vascular injury and a potential predictor of cardiovascular mortality and major adverse cardiovascular events. Atherosclerotic lesions also accumulate large numbers of MPs of leukocyte, smooth muscle cell, endothelial, and erythrocyte origin. A large body of evidence supports the role of MPs at different steps of atherosclerosis development, progression, and complications. Circulating MPs impair the atheroprotective function of the vascular endothelium, at least partly, by decreased nitric oxide synthesis. Plaque MPs favor local inflammation by augmenting the expression of adhesion molecule, such as intercellular adhesion molecule -1 at the surface of endothelial cell, and monocyte recruitment within the lesion. In addition, plaque MPs stimulate angiogenesis, a key event in the transition from stable to unstable lesions. MPs also may promote local cell apoptosis, leading to the release and accumulation of new MPs, and thus creating a vicious circle. Furthermore, highly thrombogenic plaque MPs could increase thrombus formation at the time of rupture, together with circulating MPs released in this context by activated platelets and leukocytes. Finally, MPs also could participate in repairing the consequences of arterial occlusion and tissue ischemia by promoting postischemic neovascularization.     

ERCP诊治指南（2010版）（一）

自从1968年内镜下逆行胆胰管造影术（endoscopic retrograde cholangiopancreatography,ERCP）问世以来,尤其是1974年内镜下乳头括约肌切开术（endoscopic sphincterotomy,EST）的临床应用,ERCP已成为临床诊断和治疗胆胰疾病的重要手段。我国ERCP技术起步于1970年代,经过几代内镜工作者的不懈努力,目前已日益成熟和普及。     

ERCP诊治指南（2010版）（三）

胰腺疾病的ERCP诊治指南 一、ERCP对胰腺疾病的诊断作用 1．单纯胰管造影（ERP）对于慢性胰腺炎、自身免疫性胰腺炎、侵及主胰管的肿瘤病变具有较高的诊断价值,但对其他病变,尤其是仅累及胰腺实质或分支胰管的病变则敏感性较低。     

Molecular approaches for the treatment of atherosclerosis

Advances in vascular biology and the study of molecular pathophysiology have enabled the design and initial testing of therapeutic principles for cardiovascular intervention at the level of gene expression. This approach can offer an avenue to greatly impact the onset and progression of vascular disease at its roots. Early translations of basic research into human clinical protocols might provide novel alternatives for patients without traditional therapeutic options and might provide means of improving and prolonging the success of standard therapies. As the understanding of the genetic basis of vascular disease continues to grow and the tools for in vivo genetic manipulation continue to improve, vascular gene therapies might someday become a part of routine patient care.     

miRNA的差异表达在肠易激综合征诊断和治疗中的研究进展

微小RNA(MicroRNA,miRNA)的差异性表达与多种疾病的发生、发展相关,许多研究已证实miRNA在肠易激综合征(IBS)发病中也起着关键作用,据此提出某些特定的miRNA或将成为IBS特异性诊断和治疗的新工具。近年来发现微泡(Microvescles,MV)是机体内miRNA转运的关键媒介,因此在将来的研究中或许可以利用MV作为载体,向体内转染经沉默或过表达后的特殊miRNA。该文对miRNA在肠易激综合征诊断和治疗中的研究进展进行了综述。     

胰腺疾病内镜诊断与治疗现状

内镜逆行胰胆管造影术（ ERCP）诊断技术日趋成熟,已成为胰腺疾病诊断的重要手段,是胰腺分裂症诊断的唯一方法,近年来对内镜下收集胰液、细胞刷检、穿刺及活组织检查 (简称活检 )标本进行细胞学检查,极大地丰富了胰腺疾病内镜诊断手段。长海医院采用胰管细胞刷刷取细胞涂片并结合 ERCP对 27例患者进行研究,结果显示细胞学检查阳性率为 55.6％,特异性为 100％,敏感性为 65.2％,与 ERCP结合诊断正确率可达 100％,该诊断方法快速,经济实用,安全和准确性高。经胆总管腔内活检（ endobiliary forcep biopsy ,EFB）也有助于诊断…     

Unproven diagnostic and therapeutic techniques

Over the years, there have been many procedures that either have no diagnostic value for any allergic disease or are inappropriate for the diagnosis and treatment of allergy. These procedures fall into the category of unproven diagnostic and therapeutic techniques for allergy. Unfortunately, there are a very limited number of well-controlled investigations examining these various methods. While these tests may provide a superficial appearance of valid test, they have not been shown by controlled clinical trials to be reliable in the diagnosis and treatment of any allergic diseases. After reviewing the data, it is very clear that there is a need for more well-controlled scientific investigations examining all of these techniques. Until that data becomes available for scientific review and critique, these unproven diagnostic and therapeutic techniques should not be used in the evaluation of patients with suspected allergic disease.     

Molecular evidence for arterial repair in atherosclerosis

Atherosclerosis is a chronic inflammatory process and progresses through characteristic morphologic stages. We have shown previously that chronically injecting bone-marrow-derived vascular progenitor cells can effect arterial repair. This repair capacity depends on the age of the injected marrow cells, suggesting a progressive decline in progenitor cell function. We hypothesized that the progression of atherosclerosis coincides with the deteriorating repair capacity of the bone marrow. Here, we ascribe patterns of gene expression that accurately and reproducibly identify specific disease states in murine atherosclerosis. We then use these expression patterns to determine the point in the disease process at which the repair of arteries by competent bone marrow cells ceases to be efficient. We show that the loss of the molecular signature for competent repair is concurrent with the initiation of atherosclerotic lesions. This work provides a previously unreported comprehensive molecular data set using broad-based analysis that links the loss of successful repair with the progression of a chronic illness.     

从分子机制探讨肥胖致动脉粥样硬化

动脉粥样硬化是一慢性炎症反应,肥胖为其一独立危险因子.由于脂肪组织是体内大部分炎症反应因子的重要来源,这些炎症因子通过多种途径导致动脉内皮的损伤、细胞的迁移增殖和脂质的沉积.本文重点从分子机制对其进行阐述,以便为预防肥胖致动脉粥样硬化提供更多的新思路.