Comparison of deposits of versican, biglycan and decorin in saphenous vein and internal thoracic, radial and coronary arteries: correlation to patency

BACKGROUND: Matrix proteoglycans versican, biglycan and decorin are important determinants of vessel-wall structure and pathology. Thickened myxoid intimas typical of restenosis and early atherosclerosis are enriched in versican and biglycan, proteoglycans that promote proliferation and migration of smooth muscle cells and bind lipoproteins. In contrast, compact fibrous intimas are characterized by decorin. OBJECTIVE: To compare the distribution patterns of these matrix proteoglycans, and changes induced by organ culture in coronary artery, saphenous vein, internal thoracic artery (ITA), and radial artery, and correlate differences to patency. METHODS: Vessels were collected at the time of bypass surgery and heart transplantation and either fixed for immunohistochemistry or prepared for organ culture. Vessels in culture were labelled with [3H]-glucosamine and processed for autoradiography and immunohistochemistry. Distribution patterns for proteoglycans and radio-labelling were determined morphometrically. RESULTS: Distribution profiles in coronary artery and saphenous vein were similar, with relatively high levels of subendothelial versican and biglycan and low levels of decorin. In culture subendothelial incorporation of [3H]-glucosamine and immunostaining for versican and biglycan, but not decorin, were significantly increased. In contrast, the thin intima of the ITA was relatively enriched in decorin compared with the medial layers and in culture intimal staining for decorin increased markedly compared with a modest increase for biglycan and no change for versican. There was an even distribution in radial artery of all three proteoglycans across the intima without subendothelial accumulations. In culture there was an increase in staining intensity for proteoglycans of the radial artery. Neither the ITA nor radial artery exhibited an increase in subendothelial incorporation of [3H]-glucosamine in culture. CONCLUSIONS: The distributions of proteoglycans, and responses to culture correlate to the known differences in patency between grafted saphenous vein and ITA and predict that the radial artery will outperform the saphenous vein but might not be as good as the ITA for long-term patency.     

原发性高血压患者脉压与颈动脉内膜中层厚度的关系

目的观察原发性高血压患者脉压与颈动脉内膜中层厚度的相关性。方法测量139例高血压患者的脉压,根据脉压(PP)分为三组:PP1组:PP≤60mmHg;PP2组:60mmPP≤80mmHg;PP3组:PP80mmHg;用多普勒超声检查颈动脉内膜中层厚度。比较两组内膜中层厚度的差异。分析内膜中层厚度和脉压的相关性。结果不同脉压组的颈动脉内膜中层厚度差异有统计学意义(P0.01),脉压与颈动脉内膜中层厚度有较好的相关性。结论:原发性高血压患者的脉压与颈动脉内膜中层厚度明显相关。     

壳聚糖止血敷料止血装置在经桡动脉冠状动脉介入治疗术后的临床应用

目的 对比分析一种新型壳聚糖止血敷料止血装置在经桡动脉冠状动脉介入治疗（PCI）术后的临床应用.方法 选取2011年2月～2012年6月我院心内科因胸痛原因住院的患者包括急性冠脉综合征（不稳定性心绞痛、非ST段抬高心肌梗死、急性心肌梗死）、稳定心绞痛的患者3165例.其中冠脉造影1959例（其中经排除标准及经股动脉途径而不计入250例）,经桡动脉行介入治疗1206例（其中经排除标准及经股动脉途径和反关脉而不计入135例）,共计2780例入选.将入选病例随机分为2组,普通桡动脉止血板组1390例和壳聚糖止血敷料止血装置组1390例.观察术后即刻及出院时桡动脉主、次终点事件.主要终点包括：出血、血肿、假性动脉瘤、前臂疼痛或不适、桡动脉内膜损伤、桡动脉闭塞、桡动脉内膜直径等.次要终点包括压迫时间、压迫止血效果、患者依从性和满意度.结果 壳聚糖止血敷料止血装置组总血管并发症明显低于普通桡动脉止血板组（P＜0.01）,所需压迫时间明显缩短（P＜0.01）,治疗满意度明显较高（P＜0.01）.结论 壳聚糖止血敷料止血装置能够减少血管总并发症,减少压迫时间,提高患者术后满意度,对桡动脉内膜有一定保护作用.     

血管内皮生长因子基因转染对犬肾动脉内膜损伤后的作用

目的:观察血管内皮生长因子(VEGF)基因转染肾动脉内膜后的表达,以及对肾动脉内膜损伤后的作用。方法:利用分子生物学技术,将pcD2/VEGF121真核表达质粒及pcD2空载质粒转化大肠杆菌XL1-Blue,大量提取质粒。试验犬14只采用自身对照方法将左右肾动脉随机分为治疗侧和对照侧。行双侧肾动脉造影,将PTCA球囊送入肾动脉中段加压并拉伤动脉内膜,再将涂布pcD2/VEGF121质粒及pcD2空载质粒的球囊分别导入治疗侧及对照侧损伤段动脉加压维持5min,以使基因转染动脉内膜。分别于术后1、6及10周行肾动脉造影后将犬处死,取损伤段肾动脉,制成病理切片进行HE染色及免疫组织化学染色,观察肾动脉内膜的变化和VEGF蛋白的表达,在电镜下观察动脉内膜的超微结构变化,以判断VEGF基因对犬肾动脉损伤后的作用。结果:肾动脉造影结果显示术后6周双侧肾动脉较术前均轻度狭窄,术后10周狭窄程度更明显,但治疗侧和对照侧之间狭窄程度差异无统计学意义;HE染色显示术后6周双侧肾动脉内膜较术前均轻度增生,10周时增生程度更明显,但治疗侧和对照侧肾动脉内膜增生程度均差异无统计学意义。免疫组织化学染色显示1周时,治疗侧肾动脉内膜及平滑肌的VEGF蛋白表达量明显高于对照侧,6周时仍有差异,但其差异减小;电镜显示:与对照侧比较,术后10周治疗侧动脉内膜覆盖较完全。结论:VEGF基因转染动脉壁后可以促进损伤动脉的内膜化,但不能阻止动脉内膜的过度增生及动脉损伤后形成的狭窄。     

The Role of Carotid Intimal Thickness Testing and Risk Prediction in the Development of Coronary Atherosclerosis

Carotid ultrasonography is a safe and available noninvasive diagnostic tool that provides information about the carotid arteries’ characteristics and may be used for early detection of coronary artery disease as well as cardiovascular and stroke event risk stratifications. We performed a systematic search of articles discussing carotid ultrasonography in the English literature recorded in PubMed from 2010 to September 2012. Generally, the studies showed that internal carotid artery intima–media thickness is a more powerful variable than common carotid artery intima–media thickness. Moreover, the presence of carotid plaque and plaque volumes are more reliable and accurate estimators of coronary artery disease and risk of a stroke or cardiovascular event than intima–media thickness.     

Inflammatory-immunological cellular reaction in intima of the aorta and pulmonary artery and development of atherosclerosis

AIM: To assess morphological manifestations of inflammation at initial stages of atherosclerosis development in intima of the aorta and pulmonary artery both in its intact (lipid free) zones and those with lipoidosis. METHODS: Histological, histochemical and immune cytochemical methods with the use of monoclonal antibodies to monocytes/macrophages (CD-11) and T-lymphocytes (CD-4, CD-5, CD-8) were applied for the study of cellular elements in membranous preparations of intima and transverse cross-sections of the aorta and pulmonary artery from 64 apparently healthy persons aged 4 months-49 years who died of accidental causes. RESULTS: Signs of inflammatory cellular reaction (infiltration with monocytes/macrophages) were permanently present in aortic and pulmonary artery intima and progressed with age. This cellular reaction was consistently accompanied by infiltration of intima with mast cells. Compared with intact intima infiltration with lymphocytes/monocytes was more pronounced in zones with lipoidosis where helper-lymphocytes prevailed among T-cells and number of monocytes/macrophages was substantially increased. CONCLUSION: Mononuclear cellular infiltration with participation of mast cells was persistently present in aortic and pulmonary artery intima and obviously preceded its atherosclerotic changes. However there was no straightforward relationship between severity of this reaction and development of atherosclerosis in the aorta and especially in pulmonary artery.     

The relationship between endothelial function in the brachial artery and intima plus media thickening of the coronary arteries in patients with chest pain syndrome

Endothelial dysfunction precedes the development of clinical atherosclerosis. A decrease in endothelium-derived nitric oxide activity shows impaired vasodilator function and causes arterial intimal hyperplasia or thickening. Others and we have reported the close relation of endothelial function in brachial artery and coronary artery. To compare the flow-mediated endothelium-dependent vasodilation (FMD) in brachial artery and the intima+media area in coronary artery, we measured brachial artery vasodilator response following transient occlusion with high resolution ultrasound transducer and intima+media area in coronary arteries with intravascular ultrasound in 25 patients with normal coronary angiograms (age 61.6+/-8.7 years old, men 14 and women 11). FMD was measured at least 7 days after the cessation of all vasodilators. The mean FMD of 25 patients was 3.83+/-2.38%, the mean intima+media area in coronary arteries of 25 patients was 39.9+/-15.5% of total vessel wall. FMD has a close negative relation with the largest percent intima+media area (r=-0.77, p<0.01). Especially, the patients whose FMD was less than 3.83% had larger percent intima+media area than those whose FMD was 3.83% or more (48.7+/-10.7% versus 30.3+/-14.2%, p<0.01). There is an intima+media thickening even in the patients who had normal coronary angiograms, and that the percent intima+media area correlated with FMD. The measurement of FMD is useful for screening the coronary artery intima+media thickening noninvasively. The pathogenesis of acute coronary syndrome has been reported to be the plaque rupture even in the patients with normal coronary angiograms. Thus, we must pay much attention in the patients with impaired FMD even in the normal coronary angiograms.     

颈动脉超声检查在缺血性脑卒中患者中的应用价值

目的：探讨颈动脉超声检查在缺血性脑卒中患者中的应用价值。方法选取2013年6—12月在我院接受颈动脉超声检查的缺血性脑卒中患者83例为观察组,同期在我院体检健康者50例为对照组。两组受试者均接受颈动脉超声检查,观察颈动脉狭窄情况、颈动脉中层内膜厚度及斑块性质等。结果对照组受试者中发现颈动脉狭窄9例（18.0％）,颈动脉内膜增厚2例（4.0％）,未发现易损斑块;观察组患者中发现颈动脉狭窄47例（56.6％）,颈动脉内膜增厚35例（42.2％）,易损斑块31例（37.3％）。观察组颈动脉狭窄、颈动脉内膜增厚及易损斑块检出率均高于对照组（ P＜0.05）。结论颈动脉超声检查对缺血性脑卒中患者颈动脉异常检出率较高,对缺血性脑卒中有一定的早期筛查价值。     

Menopausal estrogen therapy counteracts normal aging effects on intima thickness, media thickness and intima/media ratio in carotid and femoral arteries. An investigation using noninvasive high-frequency ultrasound

BACKGROUND: Estrogen therapy that is started at the time of menopause seems to protect against the development of atherosclerosis and cardiovascular diseases, in contrast to the initial increased cardiovascular risk when hormone therapy is initiated in older women. With increased aging and degree of atherosclerosis, the thickness of the artery intima increases and that of the media decreases. These changes can be noninvasively estimated using high-frequency ultrasound. METHODS AND RESULTS: The thickness of carotid and femoral artery intima and media was assessed, using noninvasive high-frequency ultrasound (25MHz). Long-term estrogen users (mean treatment duration 20 years) had a significantly thinner mean carotid intima layer (-25%; P=0.0002), a thicker media layer (+74%; P=0.0002) and a substantially lower intima/media thickness ratio (-54%; P<0.0001) than 17 age-matched nonusers, with values closer to those in 20 premenopausal women. Similar but less pronounced differences between the postmenopausal groups were found for the femoral artery. CONCLUSIONS: A preserved thin artery wall intima and a low intima/media thickness ratio, at values close to those in young women might be partially responsible for the beneficial cardiovascular effects of estrogen therapy when it is initiated at the time of menopause.     

Large and medium sized artery abnormalities in untreated and treated hypothyroidism

BACKGROUND: Hypothyroidism is frequently accompanied by cardiac dysfunction,increased vascular resistance and a greater prevalence of hypertension.Whether this condition is also accompanied by alterations oflarge artery function and structure is not known, however. PATIENTS AND METHODS: We investigated radial artery compliance and wall thicknessas well as carotid artery compliance in 11 normotensive recentlydiagnosed and never treated hypothyroid patients. Fifteen euthyroidhealthy age- and sex-matched subjects served as controls. Nosubject had evidence of large artery atherosclerotic lesions.Carotid artery diameter was evaluated continuously by a B-Mmode device and carotid compliance obtained by the Reneman formula.Radial artery diameter and wall thickness were continuouslyacquired over the systodiastolic blood pressure range (beat-to-beatfinger measurement) by an echo-tracking device, and compliance(Langewouters formula) was expressed as the integral of thearea under the compliance/blood pressure curve normalized forpulse pressure. RESULTS: Patients with hypothyroidism showed greater radial wall thickness(+109%, P<0·01) and compliance (+58%, P<0·03)than controls. Carotid artery compliance was not different inthe two groups. In 10 hypothyroid patients L- tiroxine therapyfor 9·0±2·3 months did not change carotidartery function but markedly reduced radial artery wall thickness(–36%, P<0·05) and compliance (–20%, P<0·05). CONCLUSIONS: Hypothyroidism is associated with early arterial structuraland functional alterations, which involve more muscular thanelastic arteries. These alterations, however, are reversibleby hormonal replacement therapy.     

Radial artery compliance in response to mental stress in normotensive offspring of hypertensive parents.

OBJECTIVES: Compared to normal subjects hypertensive patients have an increased radial artery isobaric distensibility, contrasting with a decrease in elasticity of large arteries and systemic compliance. To address the question whether elasticity is increased in response to long-standing elevated blood pressure or is present at an early stage of the disease, we compared normotensive offspring of hypertensive parents with control subjects. Furthermore, enhanced sympathetic response to mental stress was demonstrated in individuals predisposed to hypertension and might contribute to the elevation of blood pressure via a peripheral mechanism. Thus, an abnormal vasoconstrictive response of the radial artery to psychological stress was sought in these subjects. DESIGN: The geometry and the elastic porperties of the radial artery were assessed in normotensive offspring of hypertensive and normotensiven parents at baseline and during mental stress. METHODS: A high-precision echo-tracking ultrasound device was combined with photoplethysmography for continuous measurement of radial artery diameter and isobaric distensibility in 18 normotensive offspring of parents with essential hypertension and 18 control subjects under resting conditions and during a 3-minute mental stress test. RESULTS: Baseline arterial distensibility and compliance were comparable in offspring of hypertensive and normotensive parents. During mental stress, blood pressure and heart rate increased similarly in both groups. Adrenergic activation did not alter the elastic properties of the radial artery in the individuals with a genetic predisposition to essential hypertension. CONCLUSIONS: There was no alteration in elastic properties of the radial artery in normotensiven individuals at genetic risk to develop arterial hypertension. Furthermore, mental stress did not abnormally increase the vascular tone of this medium-sized muscular artery in these subjects as compared to controls. This indicates that functional and/or structural vascular alterations do not precede a distinct rise in blood pressure or abnormal blood pressure reactivity in subjects prone to develop essential hypertension.     

Arterial intimal embrittlement. A possible factor in atherogenesis

Sections of aorta, coronary artery, basilar artery and vena cava were collected at autopsy. Macroscopically normal intimal specimens were removed by stripping. Intimal collagen was measured as hydroxyproline. Intimal film embrittlement was measured in vitro by a bursting volume distensibility test developed in our laboratory. There was an average increase of over 100% in the collagen content of apparently lesion-free human arterial intima on aging over a fifty-year period. This includes an increase of 113% for aortic intima, 49% increase for coronary artery intima, and an increase of 158% in collagen in basilar artery intima. In contrast the collagen level in the vena caval intima decreases on aging, by 42% in fifty years. The large increase in collagen in arterial intima is accompanied by a large increase in intimal embrittlement. The decreasing collagen content of the venous intima on aging results in increased distensibility. Increased aortic intimal film embrittlement (lower distensibility) correlates with age (R = 0.699), but even better with intimal collagen (R = 0.911), suggesting that aortic intimal collagen level is a more important determinant of intimal embrittlement than age. Men, older than 55, have significantly higher aortic intimal collagen levels than women. Embrittlement of arterial intima should make it more susceptible to injury under the pulsatile pressure of the blood. Decreased venous intimal collagen and greater distensibility on aging could be factors in the development of venous valvular insufficiency and varicose veins. However, our study of veins was performed primarily as a control in this instance. Fundamental elements in the atherogenic process are increased intimal collagen, increased intimal brittleness, endothelial injury, followed by intimal cell proliferation. In the vena caval intima on aging there is decreased collagen, increased intimal distensibility, no injury due to increased pulse or blood pressure, and, therefore, no cell proliferation and no intimal lesion.     

老年高血压患者颈动脉内膜斑块检出率及其影响因素分析

目的了解老年高血压病人颈动脉内膜斑块检出情况及其影响因素。方法整群选取老年高血压患者共328例,采用彩色多普勒超声显像仪检测所有对象的颈动脉内膜斑块情况并进行分级。利用病历记录获取性别、年龄、高血压病程、既往高血压控制情况、长期吸烟史、高血压家族史、脑卒中史等信息资料。结果颈动脉内膜斑块总检出率为77.4%,其中1级、2级和3级分别占32.0%、36.9%和8.5%(斑块分级)。累计有序Logistic回归单因素分析显示男性、高龄、血压控制不良、高血压病程长是斑块的危险因素,多因素分析显示斑块的主要危险因素为男性、高龄和血压控制不良。结论老年人高血压患者颈动脉内膜斑块检出率较高,男性病人、高龄、血压控制不良者是其中的高危人群。     

Discontinuities in the internal elastic lamina: a comparison of coronary and internal mammary arteries

The internal elastic lamina (iel.) of the anterior descending branch of the left coronary artery, and the internal mammary artery, were studied in 166 unselected subjects of different ages and races. The coronary artery showed substantial defects in the iel. even in the first few years of life, while the iel. of the mammary artery showed only minimal defects in all age groups. The defects in the iel. were associated with the presence of medial cells in the intima, and the thickness of the intima was correlated with the magnitude of the defects in the iel. (Correlation coefficient 0.95 for the coronary artery and 0.80 for the mammary artery). Small arteries involved in chronic inflammatory or neoplastic disease showed a similar relationship if the vessel were present in an edematous area. These vessels which do not usually show intimal thickening, displayed a thickened intima in the vicinity of defects of the iel. It is suggested that the pronounced difference in the incidence of arteriosclerosis between the coronary and internal mammary arteries is related to these defects in the internal elastic lamina.     

Correlation of modified allen test with Doppler ultrasonography

The feasibility of using modified Allen tests to evaluate arterial circulation in the forearm for possible radial artery grafting, and the correlation of these tests with Doppler ultrasonography, were examined. The hand circulation of 50 patients scheduled for coronary artery bypass grafting was assessed by plethysmography, pulse oximetry, and pencil Doppler, as well as Doppler ultrasonography. Flow, velocity, and diameter of the radial, ulnar, and snuffbox arteries were recorded, and radiological screening indices were evaluated to establish a standard set of criteria. The results of modified Allen tests by plethysmography and pulse oximetry demonstrated the dominance of the ulnar artery. The indices of flow x diameter and velocity x diameter, obtained from Doppler ultrasound measurements, confirmed the dominance of the ulnar artery. When compression was applied to the arteries sequentially, significant alterations were found. The arterial circulation in the forearm can be safely evaluated by the modified Allen tests with plethysmography, pulse oximetry, and pencil Doppler, as these results correlated with Doppler ultrasound.     

Purinergic receptor distribution in endothelial cells in blood vessels: a basis for selection of coronary artery grafts

Expression levels of the purinergic P2X receptor subunits (P2X(1) to P2X(7)) and P2Y(2) were examined in the endothelial cell layer of internal mammary artery (Ann. Thorac. Surg. 54 (1992) 652), radial artery (Ann. Thorac. Surg. 16 (1973) 111) and saphenous vein (Ann. Thorac. Surg. 20 (1975) 628) samples obtained at surgery for coronary artery bypass grafts using immunohistochemistry and confocal microscopy. Similar levels of P2X(1), P2X(2), P2X(3), P2X(7) and P2Y(2) were found in the endothelial cells in all vessels examined while the levels of P2X(5) and P2X(6) were uniformly lower. A clear difference was measured in P2X(4) expression between arteries and veins. Both radial and internal mammary arteries exhibited very low levels of P2X(4) whereas the level in the saphenous vein was 14.6 fold higher (P<0.0001), approaching that of the major receptor subtypes. These data showing strong expression of P2X(4) in veins have implications for the choice of vessels used in coronary artery bypass grafts given that P2X(4) is involved in calcium influx into endothelial cells, modulates blood vessel contractility and is up-regulated in situations involving intima proliferation suggesting vein grafts are more susceptible to developing atherosclerosis.     

Suitability of venous and arterial conduits used for coronary artery bypass grafting in conjunction with coronary disease risk factors

BACKGROUND/STUDY OBJECTIVES: We studied patients undergoing coronary artery bypass grafting. Risk factors for coronary disease were studied in conjunction with the histopathologic findings of the grafts prior to implantation. Our aim was to correlate the histologic condition of the grafts and evaluate the morphological changes in conjunction with existing risk factors. DESIGN/PATIENTS: In 10 candidates for surgical revascularization (nine males, mean age 60.8 years), the risk factor profile was studied (smoking, dyslipidaemia, hypertension, diabetes, family history) and the Body Mass Index was calculated. Of a total of 14 grafts, 10 were saphenous vein grafts and four left internal thoracic artery grafts. Histologic samples were studied under optical and electron microscopy. We studied the intima morphology and thickness, the width of the intercellular spaces, the texture of the subendothelial layer, the endothelial status, and the condition of the basal lamina. Histopathological changes were correlated with risk factors. RESULTS: Histopathological changes were observed in the wall structure of all grafts. The most important changes were found in the venous grafts, notably: intima thickening, existence of foam cells in the intima, widening of the intercellular spaces, subendothelial oedema, degeneration and detachment of endothelial cells, and wide multilayered basal lamina. The co-existence of two or more risk factors seems to exarcerbate morphological changes. CONCLUSION: Morphological changes are present principally in the walls of venous but also arterial conduits, even prior to implantation. These changes may be attributable to preparation techniques and preservation conditions of the grafts, but they could additionally be induced by coexisting risk factors. It is conceivable that these alterations could perhaps precipitate and accelerate atherosclerotic changes, inducing lumen narrowing or even occlusion of the graft postoperatively.     

茶多酚对兔颈总动脉血管成形术后再狭窄的影响

为探讨茶多酚对血管成形术后动脉中膜平滑肌增生及胶原增生的影响,以及与组织型纤溶酶原激活物和血管紧张素Ⅱ活性改变的关系,将雄性新西兰白兔30只随机分为对照组、低剂量茶多酚组和高剂量茶多酚组,用球囊导管剥脱右颈总动脉内皮,造成内皮及中膜损伤,分别在术前、术后3、7、11、14、22和28 d采动脉血应用酶联免疫法测血浆组织型纤溶酶原激活物活性及放射免疫法测血管紧张素Ⅱ血清水平,术后28 d处死动物并取右颈总动脉观察动脉中膜平滑肌和胶原增生程度.结果发现,高剂量茶多酚组组织型纤溶酶原激活物血浆活性为0.169±0.067 IU/L,低剂量茶多酚组为0.141±0.043 IU/L,对照组为0.126±0.043 IU/L,高剂量茶多酚组高于对照组和低剂量茶多酚组,差异具有显著性(P<0.05).高剂量茶多酚组血管紧张素Ⅱ血清水平为1 229±283 ng/L,低剂量茶多酚组为1 302±284 ng/L,对照组为1 309±263 ng/L,三组动物术后血管紧张素Ⅱ血清水平比较差异无显著性.高剂量茶多酚组动脉中膜胶原含量为50.1%+5.82%、低剂量茶多酚组为56.7%±2.3%,对照组为62.8%±2.1%,高剂量茶多酚组低于对照组及低剂量茶多酚组,差异具有显著性 (P<0.05);低剂量茶多酚组低于对照组,差异具有显著性(P<0.001).高剂量茶多酚组中膜平滑肌细胞计数为0.022±0.006/μm2,低剂量茶多酚组为0.034±0.008/μm2,对照组为0.033±0.007/μm2,高剂量茶多酚组低于对照组及低剂量茶多酚组,差异具有显著性(P<0.01).结果提示,高剂量茶多酚可提高血管成形术后血浆组织型纤溶酶原激活物活性,对血管紧张素Ⅱ血清水平无显著性影响,可抑制动脉中膜胶原及平滑肌细胞的增生,这可能有助于减轻或预防动脉血管成形术后再狭窄.