Beneficial effects of acute trans-resveratrol supplementation in treated hypertensive patients with endothelial dysfunction

Endothelial dysfunction is a surrogate marker of cardiovascular risk. Resveratrol is known to improve endothelial function in animals, however, clinical trials are limited. We hypothesized that the acute trans-resveratrol supplementation improves endothelial function in treated hypertensive patients with endothelial dysfunction. Twenty-four hypertensive patients between 45 and 65 years-old with baseline endothelial dysfunction were enrolled in a randomized, cross-over, double-blind, placebo-controlled trial. Individuals received either a single dose of trans-resveratrol (300 mg) or placebo and were crossed-over after a one-week washout period. Blood pressure (BP) measurements, aortic systolic blood pressure (SBP) and brachial flow-mediated dilation (FMD) were performed before and 1.5 hours after the intervention. FMD was significantly increased in women (4.2 ± 0.5 vs 7.1 ± 1.3%, p = 0.026) but not in men (4.4 ± 0.9 vs 4.9 ± 0.8%, p = 0.588) in the trans-resveratrol group. There was no statistical difference between baseline and final values of brachial BP and also no changes in aortic SBP. Patients with higher low-density lipoprotein (LDL) cholesterol had better FMD response to trans-resveratrol than patients with lower LDL cholesterol (7.4 ± 1.2 vs 4.3 ± 1.0%, p = 0.004). Our study demonstrated that the acute supplementation of trans-resveratrol promoted an improvement in endothelial function, especially in women and those with higher LDL-cholesterol, despite no changes in BP.

List of Abbreviation: Aix: augmentation index; AP: augmentation pressure; BP: blood pressure; BMI: body Mass Index; CVD: cardiovascular disease; FMD: flow-mediated dilation; FRS: Framingham Risk Score; HDL: high-density lipoprotein; LDL: low-density lipoprotein; NO: nitric oxide; SPSS: Statistical Package for Social Sciences; ROS: reactive oxygen species; SBP: systolic blood pressure; TG: triglycerides.     

老年人下肢深静脉血栓形成的临床特点

目的 总结老年人下肢静脉深血栓形成(DVT)的临床特点.方法 分析180例老年人DVT的发病情况、危险因素、并发症和疗效,并与同期收治的144例非老年人DVT病例资料对比.结果 老年人DVT以60～69岁年龄段最多[91例(50.5%)],其次为70～79岁[73例(40.5%)].前5位危险因素是大手术后(27.8%)、恶性肿瘤(15.0%)、外伤骨折(7.8%)、脑血管病后遗症(7.2%)、长期卧床(5.0%).并存Cockett综合征43例(49.4%),其中髂总静脉闭塞6例(14.0%)、狭窄>50%21例(48.8%)、狭窄<50%16例(37.2%).急性期DVT的取栓术疗效优于系统溶栓,非急性期两种方法 疗效差异无统计学意义.老年人与非老年人的近、远期疗效差异无统计学意义.结论 老年人易患DVT,恶性肿瘤和脑血管病后遗症是与老年人DVT相关的危险因素.对于老年人急性期DVT,取栓术的近、远期疗效优于系统溶栓.     

Higher central fat mass and lower peripheral lean mass are independent determinants of endothelial dysfunction in the elderly: The Hoorn study

Objective

To investigate whether an adverse body composition is associated with endothelial dysfunction (ED) and the extent to which any such association could be explained by low-grade inflammation (LGI) and/or insulin resistance (HOMA2-IR).

Methods

We studied 475 individuals from the Hoorn Study [mean (range) age, 68.9 (60–87) years, 245 women). Body composition was assessed by whole body dual-energy absorptiometry. Endothelial dysfunction was measured functionally, by flow-mediated dilation (FMD) and by circulating biomarkers. Associations were examined with multiple linear regression models and mediation analyses according to the ab product of coefficients method.

Results

After adjustment for age, sex, glucose metabolism status, prior cardiovascular disease and lifestyle factors, total and central fat mass were positively associated with the ED score [β = 0.16 (95% CI 0.04–0.29) and β = 0.18 (0.05–0.31), respectively] and inversely, although not statistically significantly, with FMD. Peripheral fat mass was not associated with the ED score or FMD. There was a significant favourable association between peripheral lean mass and FMD [β = 0.13 (0.00–0.26)], but not with the ED score. The association between total and central fat mass and the ED score was, to a great extent, mediated by LGI and HOMA2-IR. In contrast, LGI or HOMA2-IR did not mediate the association between peripheral lean mass and FMD.

Conclusion

Higher levels of central, but not peripheral fat mass were adversely associated with ED, which was attributable to body composition-related LGI and insulin resistance. In contrast, peripheral lean mass was beneficially associated with ED, but this seemed to be unrelated to LGI or insulin resistance.     

肢体静脉血栓形成与肺动脉栓塞的关系探讨

目的 研究肢体静脉血栓形成与肺动脉栓塞的关系。方法 对１９９６～１９９８年间,１００例肢体静脉血栓形成患的肺动脉形成患的肺动脉栓塞发生以及与静脉血栓的部位、患年龄、伴随疾病的关系进行分析。结果 １００例肢体静脉血栓形成的患中４５％（４５／１００）发生肺动脉栓塞,４％（２／４５）发生致死性肺动脉栓塞。结论 肺动脉栓塞高发于肢体静脉血栓形成的患,应引起充分注意。     

深静脉血栓形成103例临床分析

目的 提高对深静脉血栓形成（ＤＶＴ）和肺栓塞（ＰＥ）的认识,了解二者的关系。方法 对１０４３例ＤＶＴ病例做一回顾性分析。结果 ＤＶＴ与ＰＥ关系密切,ＤＶＴ病例中ＰＥ的发生率为４４．７％。有危险因素者占８８．３％,最常见的危险因素为长期卧床（２ ６．２％）     

老年人急性脑梗死合并下肢深静脉血栓形成30例临床分析

目的 总结老年人急性脑梗死合并下肢深静脉血栓(DVT)的治疗经验. 方法 对30例老年急性脑梗死合并DVT患者(脑梗死组)与31例单纯DVT老年患者(对照组)进行比较.治疗方法均为制动3 d;同时应用低分子肝素钙(商品名:博璞青)0.4 ml(100 IU/kg),皮下注射,12 h皮下注射1次,用药14 d.应用低分子肝素钙第10天加口服华法林,并根据国际标准化比率(INR)调整华法林的用量,为防止老年人发生出血,INR控制在2.0～2.5;并辅以输注低分子右旋糖酐500mg/d,14 d. 结果 所有患肢水肿明显减轻,治愈及无效均为0,两组均无肺梗死.但脑梗死组发生脑出血4例,此4例年龄均大于80岁,出血发牛时间在应用低分子肝素钙3～7 d,及时停用抗凝药,给予降颅压,3例痊愈,1例因颅内大出血合并肺部感染而死亡.对照组无死亡. 结论 对年龄大于80岁的急性脑梗死合并DVT患者应用低分子肝素抗凝治疗应谨慎.     

老年人急性肠系膜静脉血栓形成的诊断与治疗

目的 探讨老年人急性肠系膜静脉血栓形成的临床特点及诊治方法.方法回顾性分析10例老年人急性肠系膜静脉血栓形成的临床特点、诊治方法及预后.结果10例均表现为不同程度的上腹痛,同时伴有恶心、呕吐和血便等;体检：腹部柔软,无固定压痛点,胚鸣音消失或减弱.入院诊断时均误诊为胰腺炎、阑尾炎或肠梗阻等.2例经超声检查、8例经CT检查而确诊,2例同时进行了血管造影.经手术治疗8例,其中5例治愈,3例死亡,死于中毒性休克1例,多器官功能衰竭2例;介入溶栓治疗2例,均治愈.结论老年人急性肠系膜静脉血栓形成临床表现复杂多样,极易误诊且病死率高,应提高对本病认识,早期正确的诊断是治疗本病的关键.手术治疗是主要方法,无肠坏死者可以进行介入溶栓治疗.     

Plasma aldosterone levels and aldosterone-to-renin ratios are associated with endothelial dysfunction in young to middle-aged subjects

Objective

Small clinical studies suggested a role for aldosterone in the development of endothelial dysfunction. We investigated whether the plasma aldosterone concentration (PAC) or the aldosterone-to-renin ratio (ARR) were associated with decreased endothelial function as measured by flow-mediated dilation (FMD) of the brachial artery in the general population.

Methods

Our study population comprised 972 participants from the Study of Health in Pomerania, who were not treated with antihypertensive medication. We performed age-stratified (<50 and ≥50 years) ordinal logistic regression analyses. FMD was categorised as decreased (1st quintile), moderate (2nd–4th quintile), or increased (5th quintile). PAC and ARR were divided into low, moderate, and high values according to age- and sex-specific tertiles. All models were re-calculated for 871 subjects with PAC and ARR within the study-specific reference ranges. Odds ratios (OR) and 95% confidence intervals (CI) are presented.

Results

Subjects <50 years with high PAC (OR 1.60; 95% CI 1.07–2.38) or ARR (OR 1.81; 95% CI 1.21–2.73) had higher odds for decreased FMD than subjects with low PAC or ARR, respectively. Similar results were obtained in analyses restricted to subjects with PAC and ARR within the reference range. High-normal PAC (OR 1.62; 95% CI 1.07–2.47) or ARR (OR 1.62; 95% CI 1.05–2.50) was associated with higher odds for decreased FMD when compared with low-normal PAC or ARR, respectively. These associations were not observed in subjects ≥50 years.

Conclusions

High and high-normal PAC or ARR contribute to an impaired FMD and subsequently the progression of subclinical atherosclerosis in young to middle-aged subjects.     

Association of asymptomatic hyperuricemia and endothelial dysfunction in psoriatic arthritis

IntroductionCardiovascular disease is an increasingly recognized contributor to excess morbidity and mortality in psoriatic arthritis (PsA). Traditional cardiovascular risk factors do not adequately account for the extent of cardiovascular disease in PsA.Aim of the workTo examine the prevalence of subclinical atherosclerosis in patients with PsA to emphasize the potential role of serum uric acid on endothelial dysfunction, as an early predictor for atherosclerosis in PsA patients.Patients and methodsThis study included 60 PsA patients as well as 60 age and sex matched healthy controls. Assay of serum uric acid, interleukin-6 (IL-6) and soluble intercellular adhesion molecule-1 (sICAM-1) was done for all patients and controls. Patients were subjected to psoriasis area severity index (PASI) and assessment of disease activity. Patients and controls underwent brachial flow-mediated dilatation (FMD) assessment by color duplex sonography to determine endothelial dysfunction as well as extracranial carotid arteries assessment by high-resolution B-mode ultrasound to measure the common carotid intima-media thickness (CIMT) and the detection of atheromatous plaques.ResultsPsA patients have a high significant difference in CIMT, FMD of the brachial artery and mean levels of serum uric acid compared to healthy controls (p < 0.001). PsA patients with hyperuricemia have a high significant difference in CIMT and FMD of the brachial artery than those with normal serum uric acid. Serum uric acid levels showed a high significant positive correlation with each of CIMT, disease duration, markers of inflammation (ESR, CRP, IL-6, sICAM-1), disease activity score in 28 joints (DAS 28) and PASI (r = 0.71, 0.893, 0.956, 0.858, 0.853, 0.877, 0.907, 0.847, respectively, as p < 0.001). A high significant negative correlation was found between serum uric acid levels and FMD of the brachial artery as r = ?0.634, p < 0.001.ConclusionPatients with PsA have a high prevalence of subclinical atherosclerosis dependent on serum uric acid, suggesting that chronic systemic inflammation and endothelial dysfunction appear to be the link between asymptomatic hyperuricemia and atherosclerosis. Therefore, proper control of serum uric acid may play a preventive role in the development of atherosclerosis in PsA patients.     

疑诊肺栓塞患者337例中合并下肢深静脉血栓的发生率

目的 评价疑诊肺栓塞患者中合并下肢深静脉血栓的发生率.方法 顺序收集2004年1月至2006年6月在北京首都医科大学附属朝阳医院和宁夏医学院附属医院内疑诊肺栓塞的患者,进行CT肺动脉造影(CTPA)联合下肢CT静脉造影检查(CTV)或CTPA联合下肢静脉超声检查.分析肺栓塞患者中合并下肢深静脉血栓的发生率以及下肢深静脉血栓的发生部位有无不同.采用SPSS 11.5统计软件进行数据分析,描述性结果采用频数分析法,组间比较采用卡方检验.结果 共337例患者纳入研究,男189例,女148例,中位年龄62岁,范围19～84岁.CTPA诊断肺栓塞者144例,CTV和下肢超声检查诊断下肢深静脉血栓患者100例.肺栓塞患者合并下肢深静脉血栓的发生率为44%(63/144),其中76%(48/63)发生于近端深静脉内;而下肢深静脉血栓形成患者中合并肺栓塞的发生率为63%(63/100).结论 无论肺栓塞患者合并下肢深静脉血栓,还是下肢深静脉血栓患者合并肺栓塞的发生率均很高,有必要同时进行肺动脉和下肢深静脉检查.     

Beetroot juice improves in overweight and slightly obese men postprandial endothelial function after consumption of a mixed meal

Background

Through effects on nitric oxide (NO) bioavailability, endothelial function is improved after the intake of beetroot juice–which is rich in inorganic nitrate-, but decreased after the intake of a meal.

Objective

The objective of this study was to examine if beetroot juice could counteract the impairment of endothelial function associated with the ingestion of a mixed meal.

Methods

Twenty healthy overweight and slightly obese men with a BMI between 28 and 35 kg/m² received in random order a mixed meal providing 56.6 g of fat with beetroot juice or a control drink. The beetroot juice (140 mL) provided approximately 500 mg dietary nitrate. Flow-mediated dilation (FMD) of the brachial artery was measured before and 2 h after meal consumption. Blood was sampled at regular intervals.

Results

Postprandial changes in serum triacylglycerol (TAG) (P = 0.69), plasma glucose (P = 0.84) and insulin (P = 0.67) concentrations were comparable between the meals. After consumption of beetroot juice, the postprandial impairment in FMD following a standardized mixed meal was improved (P = 0.030) compared with the control drink (−0.37 ± 2.92% versus −1.56 ± 2.90%). Following beetroot juice consumption, plasma concentrations of the circulating NO pool were higher at T60, T120, and T240 (P < 0.001 at all time points).

Conclusion

In healthy overweight and slightly obese men a single dose of beetroot juice attenuates the postprandial impairment of FMD following a mixed meal, possibly through increases in plasma NO concentrations.     

急性下肢深静脉血栓形成腔内治疗的疗效分析

目的:探讨腔内治疗急性下肢深静脉血栓形成的疗效。方法:分析2009年1月年至2011年5月,采用导管溶栓和支架治疗16例急性下肢深静脉血栓形成的临床资料,采用静脉节段性病变评分和静脉临床程度评分评估手术疗效。结果:16例患者中,中央型静脉血栓14例,混合型下肢深静脉血栓形成2例。合并髂静脉压迫综合征11例。病史中位数为5 d(范围1～14 d)。患者均行静脉导管溶栓,其中12例接受髂静脉支架。随访中位数为6个月(范围1～24个月),术后30 d静脉通畅程度评分平均(1.38±0.90)分,低于术前〔(5.5±2.6)分;P=0.001〕,术前静脉临床程度评分平均(4.69±0.7)分,术后1个月、6个月静脉临床程度评分分别为(1.44±1.27)分、(1.42±0.9)分,低于术前(P=0.001,P<0.01)。术后1个月,6个月髂静脉支架通畅率均为83%。结论:选择性腔内治疗急性下肢深静脉血栓可显著改善患者临床症状,远期疗效有待进一步确定。     

置管溶栓术治疗下肢深静脉血栓的护理(附21例报告)

目的探讨置管溶栓术治疗下肢深静脉血栓的护理措施。方法对21例置管溶栓术后患者实施了针对性护理。结果21例患者均置管成功，术后均未发生溶栓导管并发症及出血倾向；症状与体征均有不同程度的好转。结论置管溶栓术治疗下肢深静脉血栓具有创伤小、安全性大、见效快等优点；术前、术后实施合理的护理是保证治疗成功的重要环节。     

临床评分和D-二聚体检查在下肢深静脉血栓中的应用

目的 评价临床Wells评分和(或)D-二聚体检查能否安全、可靠地排除或诊断下肢深静脉血栓(DVT).方法 回顾性收集两家医院疑诊DVT的住院患者,所有患者均在48 h内进行临床评价、D-二聚体检查和双侧下肢静脉加压超声检查.比较单独应用临床评分或D-二聚体检查,以及临床评分结合D-二聚体检查诊断DVT的敏感性、特异性、阳性预测值和阴性预测值.描述性资料采用频数分析,组间比较采用卡方检验,以P<0.05为差异有统计学意义.结果 共有274例患者纳入研究.以低度可能性为阴性结果,中、高度可能性为阳性结果,临床Wells评分诊断DVT的敏感性、特异性、阳性预测值和阴性预测值分别为78.4%、66.1%、52.3%和86.6%;以D-二聚体≥500μg/L为阳性结果,D-二聚体检查诊断DVT的敏感性、特异性、阳性预测值和阴性预测值分别为73.9%、66.1%、50.8%和84.2%;以低度可能性同时D-二聚体<500μg/L为阴性结果,中、高度可能性同时D-二聚体≥500μg/L为阳性结果,临床Wells评分结合D-二聚体检查诊断DVT的敏感性、特异性、阳性预测值和阴性预测值分别为88.3%、76.8%、67.1%和92.5%.结论 针对临床疑诊DVT的患者,单独应用临床Wells评分或D-二聚体检查,以诊断或排除DVT是不准确的;联合应用临床Wells评分和D-二聚体检查,才能对患者是否患有DVT作出较为准确的判断.     

经皮胭静脉穿刺诊治下肢深静脉血栓39例临床分析

目的探讨经皮胭静脉血流顺向性介入治疗下肢深静脉血栓的可行性。方法对39例下肢深静脉血栓患者经健侧股静脉置入下腔静脉滤器后，穿刺患侧胭静脉，以胭静脉为人路，行血管内溶栓、血栓消融器消融和（或）球囊成形及腔内支架置人术等治疗。结果经皮胭静脉穿刺均获成功，无严重并发症发生。结论以患侧胭静脉为人路，血流顺行性介入治疗下肢深静脉血栓操作简便，是一种安全有效的方法。     

Dose-related effect of statins in venous thrombosis risk reduction

Background

Atherosclerosis and venous thromboembolism share similar pathophysiology based on common inflammatory mediators. The dose-related effect of statin therapy in venous thromboembolism remains controversial. This study investigated whether the use of antiplatelet therapy and statins decrease the occurrence of venous thromboembolism in patients with atherosclerosis.

Methods

We conducted a retrospective cohort study reviewing 1795 consecutive patients with atherosclerosis admitted to a teaching hospital between 2005 and 2010. Patients who had been treated with anticoagulation therapy were excluded. Patients who either used statins for <2 months or never used them were allocated to the nonuser group.

Results

The final analysis included 1100 patients. The overall incidence of venous thromboembolism was 9.7%. Among statin users, 6.3% (54/861) developed venous thromboembolism, compared with 22.2% (53/239) in the nonuser group (hazard ratio [HR] 0.24; P <.001). After controlling for confounding factors, statin use was still associated with a lower risk of developing venous thromboembolism (HR 0.29; P <.001). High-dose statin use (average 50.9 mg/day) (HR 0.25; P <.001) lowered the risk of venous thromboembolism compared with standard-dose statins (average 22.2 mg/day) (HR 0.38; P <.001). Dual antiplatelet therapy with aspirin and clopidogrel decreased occurrence of venous thromboembolism (HR 0.19; P <.001). Interestingly, combined statins and antiplatelet therapy further reduced the occurrence of venous thromboembolism (HR 0.16; P <.001).

Conclusions

The use of statins and antiplatelet therapy is associated with a significant reduction in the occurrence of venous thromboembolism with a dose-related response of statins.     

经皮腘静脉穿刺诊治下肢深静脉血栓39例临床分析

目的探讨经皮腘静脉血流顺向性介入治疗下肢深静脉血栓的可行性。方法对39例下肢深静脉血栓患者经健侧股静脉置入下腔静脉滤器后,穿刺患侧腘静脉,以腘静脉为入路,行血管内溶栓、血栓消融器消融和(或)球囊成形及腔内支架置人术等治疗。结果经皮腘静脉穿刺均获成功,无严重并发症发生。结论以患侧腘静脉为入路,血流顺行性介入治疗下肢深静脉血栓操作简便,是一种安全有效的方法。     

急性肺血栓栓塞症患者溶栓抗凝治疗后深静脉血栓的变化

目的 观察急性肺血栓栓塞症(PTE)患者溶栓抗凝治疗后深静脉血栓(DVT)的变化.方法 从急性PTE溶栓与抗凝治疗多中心研究中选取确诊的于溶栓抗凝治疗前后行下肢静脉超声检查的PTE患者362例,观察治疗前后深静脉血栓的变化.结果溶栓抗凝治疗后14 d与治疗前相比,DVT明显减少(x2=22.667,P<0.001),但有11.6%的患者出现新发或再发DVT.溶栓治疗者血流改善率为56.5%,抗凝治疗者为47.8%,二者间差异无统计学意义(x2=1.435,P=0.231).3个月随访,有30.4%的患者DVT仍未恢复正常,另有10.4%的患者经超声检查发现DVT.结论 溶栓抗凝治疗后14 d,DVT的治愈率较低,新发或再发率较高,溶栓治疗的血流改善与抗凝治疗相仿.短期治疗尚不能显著改善DVT的预后.     

Effects of rituximab treatment on endothelial dysfunction, carotid atherosclerosis, and lipid profile in rheumatoid arthritis

Increased cardiovascular mortality has been associated with rheumatoid arthritis (RA). There have been reports indicating that tumor necrosis factor blockers may exert favorable but transient effects on lipid profile, flow-mediated vasodilation (FMD) of the brachial artery, and common carotid intima–media thickness (ccIMT) in RA. In this study, we assessed the effects of rituximab on FMD, ccIMT, and lipid profile. Five female RA patients received two infusions of 1000 mg rituximab i.v. High-resolution B-mode ultrasound was used to assess brachial FMD and ccIMT. We also determined plasma total cholesterol (TC), HDL-C, LDL-C, and triglyceride (Tg) levels. Assessments were performed at baseline, as well as at weeks 2, 6, and 16 after the first infusion. Rituximab (RTX) treatment resulted in a rapid and sustained improvement in FMD. The mean improvement was 30%, 22%, and 81% at weeks 2, 6, and 16, respectively. RTX had little effect on atherosclerosis within this short period of time; however, we observed 10%, 9%, and 2% decreases in ccIMT at weeks 2, 6, and 16, respectively. RTX therapy resulted in 3–11% decrease in TC, as well as 14–35% increase in HDL-C levels. Two infusions of RTX exerted early and sustained favorable effects on endothelial dysfunction, as well as plasma TC and HDL-C levels. RTX may also decrease ccIMT; however, longer follow-up is needed to assess the prolonged effects of RTX on vascular function and lipid profile in RA patients.