Anti-apoptotic agents for the treatment of vascular disease

Background: Recognition of the importance of apoptosis in atherosclerosis could lead to the development of new therapeutic strategies aimed at the reduction of apoptotic death. Many of the available therapeutic agents that have been shown to reduce the progression of the disease and the incidence or recurrence of acute coronary syndromes may have been active, at least in part, through reduction in apoptosis. Statins, antioxidants and thiazolidinediones are implicated in the amelioration of endothelial function, regulation of inflammatory status and downregulation of smooth muscle cell proliferation and migration. Objectives: To evaluate the anti-apoptotic properties of current atherosclerosis therapeutics. Methods: A thorough enquiry in MEDLINE, EMBASE, Cochrane and patent databases was carried out for important original and review articles in the field of vascular anti-apoptotic therapies. Results: Statins, antioxidants and other agents with nonspecific anti-apoptotic properties are effective in preventing adverse cardiovascular events. However, more research in the field of targeted anti-apoptotic therapies may revolutionize therapeutic strategies against atherosclerosis.     

腔内技术治疗血管损伤进展

血管损伤的诊断和治疗不断发展,手术治疗日渐成熟;对损伤血管的处理不再是单纯结扎,随着治疗动脉粥样硬化疾病的腔内技术逐步应用到血管损伤上,对血管损伤的治疗产生了重要影响。腔内技术在血管损伤治疗的优势日渐凸显,较好地解决了某些血管损伤的治疗难题。随着腔内技术广泛应用,医务工作者也应该熟悉腔内技术并发症。这对医务工作者更好地处理血管损伤有重要意义。目前腔内技术治疗血管损伤仍存在一定不确定性,需要更进一步研究。     

开腹胆囊切除术复杂情况的评估与对策

目的 总结开腹胆囊切除术(OC)中可能出现的复杂情况和处理对策,以降低风险,减少手术并发症.方法 分析我院行OC的56例患者的临床资料,并回顾手术操作过程.结果 OC术中所见复杂情况包括坏疽性胆囊炎、急性胆囊炎伴胆囊穿孔、萎缩性胆囊炎(合并Mirriz综合征、胆囊内瘘)、残留胆囊等.OC中行顺行法6例,逆行法5例,顺逆结合法26例,其余19例根据术中情况灵活机动地行个体化手术.56例患者中有55例经OC治愈,且无胆瘘、胆道副损伤等并发症发生,另1例胆囊癌行姑息性手术,术后恢复顺利.结论 术前综合分析患者的临床资料,评估手术难度,制定合理对策,术中采用灵活机动的个体化方法显露胆囊及三管关系,是应对OC术中复杂情况的关键措施.     

Bioresorbable drug-eluting scaffolds for treatment of vascular disease

ABSTRACT

Introduction: Theoretical advantages of fully bioresorbable scaffold (BRS) stem from transient vessel support without rigid caging. Therefore, it could reduce long-term adverse events associated with the presence of foreign materials.

Areas covered: This article will provide an overview of: drug-eluting BRS for various applications in the treatment of vascular disease; The mechanisms of active agent release from such scaffolds; currently available drug-eluting BRS and their future applications are also discussed.

Expert opinion: The current BRS have been developed in order to achieve optimal vascular patency while providing long-term safety. The clinical efficacy and safety of BRS in coronary treatment have been reported as equal to that of the current metallic drug eluting stents in simple lesions. The application of BRS can potentially be expanded to other vascular beds. The research in bioengineering for the appropriate materials should not only focus on biocompatibility but also should be tailored according to the sites of implantation, which may require different strength and supporting period. The ultimate goal in this field is to develop a biocompatible device that provides equivalent and complementary therapy to other devices, and is able to disappear when the mechanical support and drug delivery are no longer required.     

下肢动脉硬化闭塞症的DSA诊断与血管腔内治疗

目的探讨下肢动脉硬化闭塞症(ASO)数字减影血管造影(DSA)检查及血管腔内治疗的疗效。方法对下肢ASO患者的病变肢体先行DSA检查,评估血管狭窄程度、闭塞情况和侧枝循环形成情况,采用球囊扩张和支架植入进行血管腔内治疗。结果 19例患者中,22条肢体有明显病变,血管狭窄大于40%;球囊扩张和支架植入治疗14例,治疗后造影显示血管再通;18条肢体明显好转,2条肢体部分好转,2条肢体无效,总有效率90.9%。结论 DSA能准确评价缺血肢体的血运情况,对手术方案的确定有重要指导意义。血管内治疗对于下肢ASO患者疗效肯定,安全可行。     

The treatment of abdominal aortic aneurysms by use of endovascular prosthesis and classic vascular prosthesis

The abdominal aortic aneurysm is a dilatation of infrarenal part of aorta. Its ethiology is still unknown. An infection and congenital disorders of conjunctive tissue are regarded as the main risc factors. Other factors could be a perimural thrombus and elastin and colagen degradation. It's not proved that atheromatosis is a risc factor. The disease concerns mainly the old males. Not treated aneurysm grows until rupture. The aneurysms are usually asympthomatic. Majority of them are found incidentally. Ultrasonography and computed tomography are used to extended diagnosis. The open surgery or endovascular surgery are only possible ways of treatment. The aneurysm with diameter over 55 milimeters, sympthomatic or rupted is an indication for surgery. The aim of the open surgery is implantation of the vascular prosthesis into retroperitoneal space. Endovascular method consist in placement of stent-graft in the lumen of aneurysm through small incision in a peripherial vessel. Stent-graft consists of metal chassis covered by classic vascular prosthesis. This method still requires the long-term assessment.     

The Absorb bioresorbable vascular scaffold for the treatment of coronary artery disease

ABSTRACT

Introduction: Every decade the field of interventional cardiology is revolutionized by new technology. The fully bioresorbable everolimus-eluting scaffold (ABSORB BVS) technology would preserve the benefits of metallic stents by sealing balloon-induced dissections, avoiding elastic recoil and vessel occlusion. The polymeric scaffold would be resorbed to restore the natural integrity of the vessel, superseding the consequence of the permanent presence of a foreign body in the coronary artery.

Areas covered: This technology evaluation focuses on the clinical evidence for the use of bioresorbable everolimus-eluting scaffold for the treatment of coronary artery disease.

Expert opinion: The current generation of the bioresorbable scaffold has structural and mechanical limitations that might preclude the widespread use in clinical practice. The strut thickness (150 µm) limits deliverability and creates laminar flow disruptions that might be the nidus of an increased rate of scaffold thrombosis. In the next generation of bioresorbable scaffolds, the resorption process should be faster and in particular, strut thickness must be reduced. This will probably represent a significant step forward in an attempt to increase the efficacy and safety profile of the device and achieve a similar performance with the current generation drug-eluting stent even in complex scenarios.     

Current status of endothelin blockade for the treatment of cardiovascular and pulmonary vascular disease

With recognition of the significant role of the endothelin system in cardiovascular and pulmonary vascular diseases, attention has turned to the therapeutic application of agents that antagonize this system. Three strategies can be employed: dual endothelin receptor (ETA and ETB) antagonism, selective ETA antagonism and inhibition of endothelin-converting enzymes. The first two strategies have been evaluated in late-phase clinical trials, with mixed results. The use of the dual endothelin receptor antagonist bosentan in pulmonary arterial hypertension has been successful. Available data are less compelling, but nonetheless promising, for the use of bosentan in digital ulceration secondary to systemic sclerosis, and tezosentan (another dual receptor blocker) in acute heart failure. Both types of receptor antagonists, however, have been evaluated in systemic hypertension and chronic systolic heart failure and are unlikely to be further developed in these areas. For the treatment of hypertension, their (moderate) efficacy and safety/tolerability profiles appear no more favorable than existing antihypertensive agents. In terms of treatment for chronic heart failure, these agents appear to offer no further benefit over standard therapy for the treatment of chronic heart failure, and in fact, may be associated with poorer outcomes. The complexity of the endothelin system and its diverse roles in multiple disease states will ensure its position as a target for drug development.     

胸腔镜与开胸手术治疗先天性心脏病的对照研究

目的：观察研究胸腔镜与传统开胸手术治疗先天性心脏病的临床治疗效果。方法：选取我院收治的先天性心脏病患者56例，根据监护人或患者意愿分为腔镜组26例和传统组30例，腔镜组施行完全胸腔镜下手术，传统组采用常规直视下开胸手术。观察比较两组患者的升主动脉阻断时间、体外循环时间、术后呼吸机辅助呼吸时间、术后住院时间、手术时间、胸腔引流量和术后并发症等。结果：腔镜组胸腔引流量和术后住院时间明显优于开胸组（P〈0.05），而两组其它各方面的比较无统计学意义（P＞0.05）；经随访两组患者心功能均I级。结论：全胸腔镜下治疗先天性心脏病，可减少创伤、缩短住院时间、并具有显著美容效果等优点，值得临床推广应用。     

糖尿病性下肢血管病变的诊治分析

目的：探讨糖尿病性下肢血管病变临床诊断及治疗效果。方法：选择本院2009年1月～2011年1月收治的糖尿病性下肢血管病变患者120例,明确诊断后,随机分为4组,各30例,分别采取基础、中医、内科及外科治疗,对各组临床效果进行回顾性比较分析。结果：内科治疗优于其他组治疗效果,差异有统计学意义（P〈0.05）。结论：及早诊断、积极防治糖尿病性下肢血管病变,采取以内科为主的综合治疗方法,可降低患肢截肢率,明显提高患者生命质量。     

Optimising the treatment of hyperphosphatemia and vascular calcification in chronic kidney disease

Accelerated atherosclerosis and vascular calcifications (VC) play a central role in the pathogenesis of cardiovascular disease in chronic kidney disease (CKD) patients. Mineral metabolism disorders and increased serum calcium-phosphate product have been recently investigated as inducing factors of cardiovascular calcification. In fact, cardiovascular disease in renal failure appears greatly associated with bone metabolism alterations. Recently, the treatment of hyperphosphatemia in CKD patients changed from either calcium- or aluminium-based phosphate-binders to new free-calcium and aluminium phosphate binders, such as sevelamer hydrochloride and lanthanum carbonate. Therefore, control of serum phosphate in CKD patients becomes crucial in preventing increases in calcium-phosphate product, secondary hyperparathyroidism and ultimately VC.     

Optimising the treatment of hyperphosphatemia and vascular calcification in chronic kidney disease

Accelerated atherosclerosis and vascular calcifications (VC) play a central role in the pathogenesis of cardiovascular disease in chronic kidney disease (CKD) patients. Mineral metabolism disorders and increased serum calcium-phosphate product have been recently investigated as inducing factors of cardiovascular calcification. In fact, cardiovascular disease in renal failure appears greatly associated with bone metabolism alterations. Recently, the treatment of hyperphosphatemia in CKD patients changed from either calcium- or aluminium-based phosphate-binders to new free-calcium and aluminium phosphate binders, such as sevelamer hydrochloride and lanthanum carbonate. Therefore, control of serum phosphate in CKD patients becomes crucial in preventing increases in calcium-phosphate product, secondary hyperparathyroidism and ultimately VC.     

Perspectives in the treatment of Parkinson's disease: COMT inhibitors open up new treatment strategies

Catechol O-methyltransferase (COMT) inhibition has been proposed as a means to increase levodopa bioavailability in patients with Parkinson's disease, which may be useful in reducing the total dose of levodopa, diminishing its frequency of administration and, more importantly, improving fluctuations in the response to each individual dose of levodopa, which usually develop after chronic treatment. Entacapone is a potent, selective peripheral catechol O-methyltransferase inhibitor which effectively inhibits the O-methylation of levodopa, thus increasing its central bioavailability and potentiating its behavioral effects. In clinical trials in patients with Parkinson's disease, entacapone has prolonged and improved the therapeutic effect of levodopa combined with a dopa decarboxylase inhibitor. The new drug has increased the "on" time duration, decreased the "off" time duration and has reduced the total dose requirements of levodopa. Entacapone has shown optimal tolerability at the currently recommended doses, with the added benefit of a lower required dose of levodopa. This, in turn, improves the tolerability of levodopa and thus the overall tolerability of the treatment of advanced Parkinson's disease.     

颅外段血管疾病的外科治疗近况

<正> 颅外段血管疾病的种类较多,如颈动脉粥样硬化性狭窄或闭塞,颈动脉肿瘤,多发性大动脉炎等。不论何种疾病,由于其改变了颈部及头部血流动力学变化,导致脑部血供减少,从而引起一系列头部及神经系统症状,给患者造成了极大痛苦,甚至危及生命。手术仍是目前的主要治疗手段,近年来由于外科技术的提高及颈动脉转流管的应用,术后偏瘫、失语发生率及死亡率均明显下降。现将几种常见的颅外段血管疾病的外科治疗方法综述如下。     

针药结合治疗血管性痴呆临床观察

目的：探讨针药结合治疗血管性痴呆的临床效果,以进一步指导临床。方法：选取我院2010年1月-2013年12月收治入院的瘀血内阻型血管性痴呆患者68例,按照随机对照的原则,将患者分为观察组和对照组,每组各34例。对照组34例患者给予口服中药汤剂通窍活血汤加减进行治疗,而观察组在对照组的基础上给予针刺进行治疗,观察两组患者的临床治疗效果以及根据简易智能状态检查量表（MMSE）测评两组的认知功能情况。结果：观察组的临床效果明显高于对照组,差异显著,具有统计学意义（P〈0．05）。观察组的MMSE评分明显高于对照组,差异显著,具有统计学意义（P〈0．05）。结论：针药联合治疗血管性痴呆效果较好,能够明显改善患者的症状．值得临床推广应用。     

Focus on HDL: a new treatment paradigm for athero-thrombotic vascular disease

Atherosclerotic vascular disease is the leading cause of mortality and morbidity in much of the Western world. Although advances in lifestyle and risk factor modification, pharmacotherapy, endovascular interventions and surgery have considerably improved clinical outcome, 40 - 50% of adverse cardiovascular events continue to occur despite current strategies. A number of new targets for therapeutic exploitation are currently being investigated that include, among others, apolipoprotein A-I, the major structural component of high density lipoprotein (HDL) particle. The strong negative relationship between HDL-cholesterol levels and coronary heart disease in epidemiological studies, as well as data from experimental models suggest that HDL-based therapies could be an important new paradigm for prevention, treatment and reversal of atherosclerotic vascular disease.