Comparison of biochemical, functional and structural aspects of arterial wall properties in elderly men

OBJECTIVE: A variety of methods are available to assess arterial wall properties. The aim of this study was to investigate the relationship between some of the biochemical, functional and structural measurements of arterial wall characteristics. MATERIAL AND METHODS: The study comprised 563 elderly men at high risk of coronary heart disease. Circulating levels of intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), E-selectin, von Willebrand factor (vWF) and tissue-type plasminogen activator antigen (tPAag) were compared with pulse wave velocity (PWV) measured by finger photoplethysmography and intima-media thickness (IMT) and plaque score of the common carotid artery. RESULTS: Levels of ICAM-1 were significantly correlated with plaque score (r = 0.17, p<0.001). Levels of vWF were significantly correlated with plaque score (r = 0.11, p = 0.009) and PWV (r = 0.12, p = 0.007), and levels of tPAag were significantly correlated with PWV (r = 0.16, p<0.001). These associations, although generally weak, remained statistically significant after adjustment for relevant cardiovascular risk factors. PWV did not correlate significantly with IMT or plaque score. CONCLUSIONS: The limited intercorrelation between biochemical, functional and structural measurements of arterial wall properties observed in the present population indicate that the various methods reflect different aspects of the atherosclerotic process.     

Inflammation and oxidative stress are associated differently with endothelial function and arterial stiffness in healthy subjects and in patients with atherosclerosis

Inflammation and oxidative stress (OxS) play key roles in atherogenesis; however, their causal relationship is not yet completely understood. Much attention has been given to the possibility that inflammation is a primary process of atherosclerosis and that OxS may be a by‐product of the inflammatory process. We hypothesized, accordingly, that chronic systemic inflammation affects endothelial vasomotor function in the subclinical condition, whereas oxidative modifications are more involved in the structural stiffening of the arteries in atherosclerosis. The aim of our study was to test this hypothesis. Endothelial function and arterial stiffness were assessed non‐invasively by pulse wave analysis, and blood/urinary samples were taken in 39 patients with peripheral arterial disease as well as in 34 controls. The patients showed significantly reduced endothelial function index (EFI) and increased augmentation index (AIx), as well as higher estimated aortic pulse wave velocity (PWV) and elevated values of the intercellular adhesion molecule‐1 (ICAM‐1), high sensitivity C‐reactive protein, myeloperoxidase and urinary 8‐iso‐prostaglandin F_2a (F₂‐IsoPs). There was an inverse association between EFI and ICAM‐1 (R = ?0.44, p = 0.009) in the controls, but not in the patients. Augmentation index and estimated aortic PWV correlated with F₂‐IsoPs only in the patients (R = 0.5, p = 0.001; R = ?0.43, p = 0.006, respectively). After controlling for potential confounders, these associations remained significant. The study demonstrates that impairment of endothelial vasomotor capacity is affected by degree of inflammation in the subclinical condition, whereas arterial stiffening is determined by level of oxidative modifications in atherosclerosis.     

超声造影评估累及颈总动脉的多发性大动脉炎的活动性

目的 观察超声造影（CEUS）评估累及颈总动脉的多发性大动脉炎（TA）活动性的价值。方法 纳入30例TA累及颈总动脉患者，根据美国国立卫生研究院（NIH）标准将其分为活动期组（n=12）及非活动期组（n=18）；对比观察2组常规超声参数，包括颈总动脉内-中膜厚度（IMT）、收缩期峰值血流速度（PSV）、舒张末期血流速度（EDV）及阻力指数（RI），以及CEUS参数，包括颈总动脉壁血管化分级、增强程度（EI）、峰值强度（DPI）及达峰时间（TTP）和实验室指标[白细胞（WBC）计数、C反应蛋白（CRP）、红细胞沉降率（ESR）、红细胞分布宽度（RDW）及血小板压积（PCT）]，分析CEUS评估累及颈总动脉的TA活动性的价值。结果 活动期组患者年龄小于非活动期组（t=-2.37，P=0.02），而WBC计数、CRP、颈总动脉壁IMT、血管化分级、EI及DPI均高于非活动期组（P均>0.05）。EI、DPI均与CRP呈弱正相关（r=0.28、0.27，P=0.03、0.04），与IMT呈低度正相关（r=0.39、0.41，P均<0.01），而与动脉壁血管化分级呈中度正相关（r=0.63、0.76，P均<0.01）。根据CEUS参数（动脉壁血管化分级、EI、DPI）及联合参数（EI+IMT、EI+CRP）判断活动期TA的曲线下面积大于CRP、ESR及IMT等（P均<0.05）。结论 CEUS可用于评估累及颈总动脉的TA的活动性。     

Activation of coagulation during treatment with haemodialysis

Objective. Inflammation plays an essential role in the atherosclerotic process. Cellular adhesion molecules (CAMs) such as E‐selectin, intercellular adhesion molecule‐1 (ICAM‐1) and vascular cell adhesion molecule‐1 (VCAM‐1) are involved in the rolling, adhesion and extravasation of monocytes and T‐lymphocytes into the atherosclerotic plaque. In the present study the effect of physical exercise and pravastatin (40?mg daily) on serum levels of CAMs and a possible role of adipose tissue in regulating serum levels of CAMs were investigated. Material and methods. The study was designed as an unmasked randomized 2×2 factorial trial of 12 weeks duration in 32 subjects with the metabolic syndrome. Changes from baseline were studied, and correlations between changes in CAMs, anthropometric measures, regional fat distribution, glycaemic control and the adipocytokine tumour necrosis factor‐α (TNF‐α) and adiponectin were investigated. Results. No significant changes in CAMs were observed in any of the intervention groups. However, when examining the whole study population regardless of intervention, changes in serum E‐selectin were significantly correlated to changes in body mass index (r?=?0.48, p?=?0.006), waist circumference (r?=?0.48, p?=?0.006), fasting glucose (r?=?0.43, p?=?0.02) and HbA1c (r?=?0.45, p?=?0.01), but not to changes in visceral fat, subcutaneous fat, TNF‐α or adiponectin. Conclusion. Changes in glycaemic control and obesity, rather than regional fat distribution, seem to influence the levels of E‐selectin in subjects with the metabolic syndrome.     

Association of thyrotropin with arterial pulse wave velocity in young adults: The Cardiovascular Risk in Young Finns Study

Abstract

Objective. Limited data are available regarding the relationship of thyrotropin (TSH) and arterial pulse wave velocity (PWV) at population level. Therefore, we conducted the present study to determine whether TSH is related to PWV assessed in young adulthood. Methods. The study population consisted of 1598 Finnish white young adults (aged 30–45 years, 47.4% males) who had TSH, traditional cardiovascular risk factors, and PWV measured in 2007. PWV measurements were performed using a whole-body impedance cardiography device. Results. In bivariate association analyses, TSH level was significantly associated with body mass index (BMI), smoking, diastolic blood pressure, triglyceride and insulin levels (p < 0.001). In multivariable regression model, TSH (β = 0.055, p = 0.015) was associated with PWV when adjusted with age (β = 0.295, p < 0.001) and sex (β = 0.345, p < 0.001). The association of TSH with PWV was however diluted to non-significant after further adjustment with traditional risk factors (β = 0.027, p = 0.218 for TSH). Conclusion. Serum TSH was associated with PWV on population level when adjusted with age and sex. This association was diluted when cardiovascular risk factors were added in the model, suggesting that the association of thyroid hormone on arterial stiffening is not independent of changes in the traditional risk factor levels.     

Quantification of aortic stiffness in stroke patients using 4D flow MRI in comparison with transesophageal echocardiography

To quantify stiffness of the descending aorta (DAo) in stroke patients using 4D flow MRI and compare results with transesophageal echocardiography (TEE). 48 acute stroke patients undergoing 4D flow MRI and TEE were included. Intima-media-thickness (IMT) was measured in the DAo and the aorta was scrutinized for atherosclerotic plaques using TEE. Stiffness of the DAo was determined by (a) 4D flow MRI at 3 T by calculating pulse wave velocity (PWV) and by (b) TEE calculating arterial strain, stiffness index, and distensibility coefficient. Mean IMT was 1.43?±?1.75. 7 (14.6%) subjects had no sign of atherosclerosis, 10 (20.8%) had IMT-thickening or plaques?<?4 mm, and 31 (66.7%) had at least one large and/or complex plaque in the aorta. Increased IMT significantly correlated (p?<?0.001) with increased DAo stiffness in MRI (PWV r?=?0.66) and in TEE (strain r?=?0.57, stiffness index r?=?0.64, distensibility coefficient r?=?0.57). Patients with at least IMT-thickening had significantly higher stiffness values compared to patients without atherosclerosis. However, no difference was observed between patients with plaques?<?4 mm and patients with plaques?≥?4 mm. PWV and TEE parameters of stiffness correlated significantly [strain (r?=???0.36; p?=?0.011), stiffness index (r?=?0.51; p?=?0.002), and distensibility coefficient (r?=???0.59; p?<?0.001)]. 4D flow MRI and TEE-based parameters of aortic stiffness were associated with markers of atherosclerosis such as IMT-thickness and presence of plaques. We believe that 4D flow MRI is a promising tool for future studies of aortic atherosclerosis, due to its longer coverage of the aorta and non-invasiveness.     

Associations of Renal Augmented Velocity Index with Arterial Stiffness,Carotid Intima–Media Thickness and Blood Pressure,in Comparison with Renal Resistive Index

The augmented velocity index (Avi) is a new Doppler index associated with arterial stiffness. We examined associations of renal Avi with blood pressure (BP), aortic stiffness and carotid intima–media thickness (IMT), and compared its performance with that of resistive index (RI). One hundred forty-seven volunteers were recruited. Renal Avi had significant positive correlations with systolic BP (r = 0.37, p < 0.001), diastolic BP (r = 0.2, p = 0.016), mean arterial pressure (r = 0.29, p < 0.001), pulse pressure (r = 0.31, p < 0.001), carotid–femoral pulse wave velocity (r = 0.49, p < 0.001) and carotid IMT (r = 0.23, p = 0.005). RI correlated positively with pulse pressure (r = 0.3, p < 0.001) only. After adjustments for co-variables, the associations remained similar. Patients with abnormal BP values (≥130/80 mm Hg), IMT and aortic stiffness (≥1 standard deviation of mean value) had higher Avi than those with normal values, but not RI. In conclusion, renal Avi had stronger associations with BP, arterial stiffness and carotid IMT than RI in apparently healthy volunteers, and was significantly increased in abnormal patients.     

Retinopathy in type 2 diabetes mellitus is associated with increased intima‐media thickness and endothelial dysfunction

Background Microangioathy and macroangiopathy in type 2 diabetes mellitus (T2DM) frequently coexist. Both types of vascular complications share traditional risk factors. It is not clear whether the presence of microangiopathy, such as diabetic retinopathy (DR), constitutes a predictor of atherosclerosis in T2DM. Here we described the search for the association between DR and intima‐media thickness (IMT) in T2DM. We also compared endothelial function in subjects with and without DR. Material and methods We examined 182 consecutive patients with T2DM for at least 5 years (mean age at examination 56·3 ± 6·52 years). We assessed (i) IMT of carotid artery by ultrasound and (ii) endothelial function by flow‐mediated dilatation (FMD) method as well as by measurement of concentrations of von Willebrand factor (vWF) and s‐ICAM‐1. All patients underwent ophthalmological examination. Statistical analysis included Student's, Mann–Whitney, chi‐square, Fisher tests and multiple regression. Results DR was found in 71 (39·0%) subjects. IMT was higher in patients with DR than those without DR (0·87 mm vs. 0·79 mm, respectively, P = 0·0001). FMD was lower in the complication group than in subjects without DR (8·38% vs. 10·45%, respectively, P = 0·0023). Concentrations of s‐ICAM‐1 and vWF were not different between the groups. In multiple regression analysis, DR was among the predictors of increased IMT (P = 0·016) and decreased FMD (P = 0·002). We did not find a significant association of DR with vWF and s‐ICAM‐1 (P = 0·09 and P = 0·11, respectively). Conclusions DR is associated with increased IMT and endothelial dysfunction in T2DM. Impaired endothelial function may be a common denominator of pathogenesis of microvascular complications and atherosclerosis in T2DM.     

Evaluation of intima-media thickness and vascular elasticity of the common carotid artery in patients with isolated systolic hypertension using ultrasound radiofrequency-data technology

Background: Radiofrequency (RF) data technology is a newly developed method to evaluate vascular disease, especially subclinical atherosclerotic change. Data regarding predictors of intima‐media thickness (IMT) and vascular elasticity of the common carotid artery (CCA) in subjects with isolated systolic hypertension (ISH) using ultrasound RF‐data technology are scarce. Aims: We evaluated the change in IMT and vascular elasticity of the CCA in patients with ISH at an early phase using US RF‐data technology. Methods: Thirty‐nine patients with ISH and 41 age‐matched control subjects were the study population. The common carotid arterial systolic diameter (Ds), diastolic diameter (Dd), IMT, carotid distensibility (CD), local pulse wave velocity (PWVβ) and stiffness (β) were compared between the two groups, as were correlations between pulse pressure (PP) and parameters of vascular stiffness. Results: Common carotid arterial Ds, Dd, IMT, PWVβ and β increased whereas CD decreased more significantly in the ISH group than in age‐matched controls. The level of PP in the ISH group had significant positive correlations with PWVβ (r = 0·298, P<0·05) and β (r = 0·291, P<0·05), whereas significant correlations with CD were not observed. Conclusions: US RF‐data technology could be used to accurately and quantitatively evaluate increased IMT and decreased arterial elasticity of the CCA in patients with ISH compared with normal subjects.     

D-Glucose additive protects against osmotic-induced decrease in erythrocyte filterability

Objective. Oxidative modification of LDL (oxLDL) is important in atherogenesis and is proposed as a useful marker for identifying patients with coronary artery disease. Antibody to oxLDL (oxLDL Ab) is detected in human sera, although its biological significance is not well established. We aimed to measure oxLDL and oxLDL Ab in peripheral atherosclerotic disease (PAD) patients, and to examine the relation between them in an attempt to understand the role of oxLDL Ab. Total risk of atherosclerosis was estimated using the global risk assessment score (GRAS) calculated on the basis of age, total cholesterol, HDL cholesterol (HDL‐Chol), diabetes, hypertension and smoking. Material and methods. Twenty‐one patients aged 63.05±9.13 years, diagnosed by peripheric angiography as PAD, and 21 healthy controls aged 47.67±13.61 years took part in the study. Total LDL and HDL cholesterol levels were determined by enzymatic methods. Levels of circulating oxLDL were measured by monoclonal antibody 4E6‐based competition ELISA. IgG class oxLDL Ab titre was measured by ELISA. Results. Compared to healthy controls, PAD patients had higher levels of oxLDL (p<0.05), oxLDL Ab (p<0.05), LDL cholesterol (LDL‐Chol) (p<0.05), total cholesterol (p<0.05) and lower HDL‐Chol (p<0.05). OxLDL was found to be positively correlated with total cholesterol (r = 0.471, p<0.05) and LDL‐Chol (r = 0.614, p<0.01) and GRAS (r = 0.435, p<0.05) and negatively with HDL‐Chol (r = ?0.459, p<0.05), but not with oxLDL Ab in PAD patients. Conclusions. These findings might indicate that high LDL‐Chol levels influence the oxidation of LDL and that oxLDL is a possible marker of PAD. However, the role of oxLDL Ab in atherosclerosis remains controversial.     

Site-specific association between distal aortic pulse wave velocity and peripheral arterial stenosis severity: a prospective cardiovascular magnetic resonance study

Background

Vascular disease expression in one location may not be representative for disease severity in other vascular territories, however, strong correlation between disease expression and severity within the same vascular segment may be expected. Therefore, we hypothesized that aortic stiffening is more strongly associated with disease expression in a vascular territory directly linked to that aortic segment rather than in a more remote segment. We prospectively compared the association between aortic wall stiffness, expressed by pulse wave velocity (PWV), sampled in the distal aorta, with the severity of peripheral arterial occlusive disease (PAOD) as compared to atherosclerotic markers sampled in remote vascular territories such as PWV in the proximal aorta and the normalized wall index (NWI), representing the vessel wall thickness, of the left common carotid artery.

Methods

Forty-two patients (23 men; mean age 64±10 years) underwent velocity-encoded cardiovascular magnetic resonance (CMR) in the proximal and distal aorta, whole-body contrast-enhanced MR angiography (CE-MRA) and carotid vessel wall imaging with black-blood CMR in the work-up for PAOD. Strength of associations between aortic stiffness, carotid NWI and peripheral vascular stenosis grade were assessed and evaluated with multiple linear regression.

Results

Stenosis severity correlated well with PWV in the distal aorta (Pearson r_P=0.64, p<0.001, Spearman r_S=0.65, p<0.001) but to a lesser extent with PWV in the proximal aorta (r_P=0.48, p=0.002, r_S=0.22, p=0.18). Carotid NWI was not associated with peripheral stenosis severity (r_P=0.17, p=0.28, r_S=0.14, p=0.37) nor with PWV in the proximal aorta (r_P=0.22, p=0.17) nor in the distal aorta (r_P=0.21, p=0.18). Correlation between stenosis severity and distal aortic PWV remained statistically significant after correction for age and gender.

Conclusions

Distal aortic wall stiffness is more directly related to peripheral arterial stenosis severity than markers from more remote vascular territories such as proximal aortic wall stiffness or carotid arterial wall thickness. Site-specific evaluation of vascular disease may be required for full vascular risk estimation.     

Echo-Tracking Technology Assessment of Carotid Artery Stiffness in Patients with Coronary Slow Flow

Coronary slow flow (CSF) in coronary angiography (CAG) is a well-recognized clinical entity. Previous studies have suggested that microvascular abnormalities and endothelial dysfunction are responsible for CSF. Accordingly, we hypothesized that the CSF phenomenon is a form of atherosclerosis including both small vessels and epicardial coronary arteries. The echo-tracking (ET) technique is a non-invasive detection method for early prediction of arterial atherosclerosis. Therefore, we investigated carotid elasticity with the ET technique in patients with CSF. Fifty patients with CSF and 50 patients with normal coronary artery blood flow, as determined by CAG, with a similar distribution of risk factors were recruited. The stiffness parameter (β), pressure–strain elastic modulus (E_p), arterial compliance (AC), augmentation index (AIx) and local pulse-wave velocity (PWV) were determined at the level of the bilateral common carotid artery (CCA) with using the ET technique. Levels of serum high-sensitivity C-reactive protein (hs-HSCRP) were determined for the two groups. β, E_p and PWV were significantly higher in the CSF group than in the control group (β: 11.4 ± 3.76 vs. 9.22 ± 3.28, p < 0.01; E_p: 153.44 ± 47.85 vs. 126.40 ± 43.32, p < 0.01; PWV: 7.26 ± 1.10 vs. 6.55 ± 1.02, p < 0.01), but AC was lower in the CSF group than in the control group (0.62 ± 0.20 vs. 0.74 ± 0.24, p < 0.01). The elasticity parameters of the bilateral common carotid artery did not significantly differ. The level of hs-HSCRP was correlated positively with β (r = 0.306, p = 0.015), E_p (r = 0.358, p = 0.005) and PWV (r = 0.306, p = 0.015), but negatively with AC (r = −0.236, p = 0.049). In conclusion, the ET technique is a simple practical method for evaluating carotid artery elasticity, and there is a significant correlation between carotid artery stiffness and level of hs-HSCRP in patients with CSF.     

Increased arterial stiffening and thickening in the paretic lower limb in patients with hemiparesis

Atherosclerosis has two key components, thickening and stiffening of arterial wall. These parameters are quantified ultrasonographically by IMT (intima-media thickness) and PWV (pulse wave velocity). In the present study, we determined the FA IMT (IMT of the bilateral femoral artery) and PWV of femoral-ankle (PWV fa) and brachial-ankle (PWV ba) segments in order to examine whether the degree of atherosclerosis is different between paretic and non-paretic lower limbs in 24 patients with hemiparesis. The values of PWV fa, PWV ba and FA IMT were all significantly greater on the paretic than the non-paretic side. Furthermore, significant decreases in masses of muscle, bone and fat, determined by dual-energy X-ray absorptiometry, were observed in paretic lower limbs compared with the non-paretic side. PWV fa correlated significantly and negatively with muscle mass ( r =-0.488, P =0.0004) and tended to correlate negatively with BMC (bone mineral content; r =-0.264, P =0.069) when statistical analyses were performed with the paretic and non-paretic sides together. Multiple regression analysis elucidated that the muscle mass was associated significantly with PWV fa and PWV ba, independent of age, duration after cerebrovascular accident, gender, bone and fat mass and FA IMT. The muscle mass was still associated with increased PWV fa and PWV ba when multivariate analysis was conducted independently in the paretic and non-paretic sides. In summary, our results indicated that arterial thickening and stiffening were greater on the paretic than the non-paretic side and suggested that a decrease of muscle mass might be associated with increased arterial stiffening in the paretic lower limb.     

Analysis of cardiovascular responses to passive head‐up tilt using continuous pulse wave analysis and impedance cardiography

Objective. To non‐invasively measure central haemodynamics, arterial stiffness, cardiac function and vascular resistance, with the subject in the supine position and during head‐up tilt, in order to examine the haemodynamic changes associated with alterations in the augmentation index, and to investigate repeatability and reproducibility of the measurement protocol. Material and methods. Thirty‐three healthy volunteers (21–51 years) were investigated using continuous pulse wave analysis from the radial artery with a tonometric sensor, whole‐body impedance cardiography and plethysmographic blood pressure (BP) recordings from the fingers. The measurements were performed with the subject supine and during passive head‐up tilt, and repeated during the same session and on four separate days. Results. During the head‐up tilt, diastolic BP (5.2±0.6?%), heart rate (27.6±1.9?%) and vascular resistance (12.5±1.7?%) increased (all p<0.05), while systolic BP (?3.2±0.6?%), aortic pulse pressure (?23.3±1.4?%), augmentation index (?11.6±0.7?%), aortic reflection time (?7.0±1.0?%), ejection duration (?21.4±0.7?%), stroke volume (?26.1±1.2?%) and cardiac output (?5.0±1.5?%) decreased (all p<0.05). Augmentation index at rest correlated with aortic systolic BP (r = 0.423), aortic reflection time (r = ?0.647), pulse wave velocity (r = 0.287) and age (r = 0.480). The change in augmentation index during head‐up tilt correlated with the change in aortic systolic BP (r = 0.469), aortic pulse pressure (r = 0.606), ejection duration (r = 0.374) and heart rate (r = ?0.445). According to Bland‐Altman and repeatability index analyses, repeatability and reproducibility of the measurements were good during the same session and on separate days. Conclusions. Combined pulse wave analysis and impedance cardiography with the subject in the supine position and during head‐up tilt is a repeatable and reproducible method for comprehensive investigation of the cardiovascular function.     

In vivo microvascular and macrovascular endothelial function is not associated with circulating dimethylarginines in patients with rheumatoid arthritis: a prospective analysis of the DRACCO cohort

Objectives: To examine associations between asymmetric (ADMA), symmetric dimethylarginine (SDMA) and ADMA:SDMA ratio with assessments of endothelial function and coronary artery perfusion in RA patients.

Methods: ADMA and SDMA levels were measured in 197 RA individuals [144 (77.4%) females, median age: 66 years (quartiles: 59–73)]. Patients underwent assessments of microvascular endothelium-dependent and endothelium-independent function, macrovascular endothelium-dependent and endothelium-independent function and vascular morphology (pulse wave analysis, carotid intima-media thickness (cIMT), and carotid plaque). Coronary perfusion was assessed by subendocardial viability ratio (SEVR).

Results: SEVR correlated with SDMA (r?=?0.172, p?=?0.026) and ADMA:SDMA (r = ?0.160, p?=?0.041) in univariable analysis, but not in multivariable analysis accounting for confounding factors. Neither ADMA:SDMA ratio nor SDMA were significantly correlated with microvascular or macrovascular endothelial function, or with arterial stiffness and cIMT. Within subgroup of patients (n?=?26) with high inflammatory markers, a post-hoc analysis showed that SDMA and the ADMA:SDMA ratio were significantly associated with endothelium-dependent microvascular function in univariable analysis, with Pearson’s r correlation coefficients of ?0.440 (p?=?0.031) and 0.511 (p?=?0.011), respectively. Similar finding were established between ADMA:SDMA ratio and arterial stiffness in univariable analysis, with Pearson’s r of 0.493, (p?=?0.024).

Conclusion: Dimethylarginines were not found to be significantly associated with several assessments of vascular function and morphology in patients with RA, however, post-hoc analysis indicates that there may be associations in patients with raised inflammatory markers. Our results suggest that dysregulated NO metabolism may not be the sole mechanism for the development of preclinical atherosclerosis in RA.     

Relationship between serum soluble E‐selectin levels and development of diabetic retinopathy in patients with type 2 diabetes

Objective. To investigate whether diabetic retinopathy is associated with serum soluble E‐selectin (ssE‐selectin) level in type 2 diabetic patients. Material and methods. Fifty‐six patients with type 2 diabetes classified as Groups A, B, C and D according to grade of retinopathy were enrolled in the study. Sixteen age‐ and gender‐matched healthy control subjects were also enrolled. Levels of ssE‐selectin were measured using enzyme‐linked immunosorbent assays (ELISAs) in all patients and control subjects. Clinical characteristics and ssE‐selectin levels were compared between the groups. Results. There was no statistically significant difference in ssE‐selectin levels between diabetic patients and non‐diabetic control subjects (p>0.05). There was also no statistically significant difference in levels of ss E‐selectin between diabetic subgroups (Groups A, B, C, D) (p>0.05). No correlation was found between ssE‐selectin level and HbA1c, or duration of diabetes in the whole group of diabetic patients (r = 0.10, p>0.05 and r = ?0.12, p>0.05, respectively). Conclusions. The study shows that no significant elevation of ssE‐selectin occurs in patients with type 2 diabetes in comparison with control subjects. Our results also indicate that there is no statistically significant correlation between ssE‐selectin level and the development or grade of diabetic retinopathy.     

Adhesion of T and B lymphocytes to mouse atherosclerotic aortas: Association with lesion topology and VCAM‐1 expression

Objective. Although T and B lymphocytes accumulate in atherosclerotic lesions and play a key role in their growth, the mechanisms involved in the adhesion and recruitment of T and B lymphocytes by the lesions have not been resolved. The aim of this study was to compare T and B lymphocyte adhesion to atherosclerotic arteries and to test the role of VCAM‐1 and ICAM‐1. Material and methods. T and B lymphocytes were labelled with red and green fluorescent dyes and incubated with freshly isolated aortas from apolipoprotein‐E‐deficient mice. In some experiments the aortas were pre‐incubated with specific monoclonal antibodies. After washing, the adhering cells were detected by confocal laser scanning microscopy. Results. The number of T and B lymphocytes that adhered to the aortic intimal surface was similar in both lesioned and non‐lesioned areas and in the shoulder region of the lesions. However, the adhesion of T and B lymphocytes was significantly higher in the shoulder regions compared with the lesioned (p<0.0001) and non‐lesioned areas of the aorta (p<0.0001). After pre‐incubation of the aortas with antibodies against VCAM‐1 or ICAM‐1, the lymphocyte adhesions in lesioned areas were 42 % (p = 0.04) and 55 % (p = 0.17), respectively, of those in lesioned areas that had been pre‐incubated with a control antibody. However, although VCAM‐1 protein expression was most pronounced in the shoulder region, the lymphocyte adhesions in the shoulder region and in non‐lesioned areas were unaffected by pre‐incubation with VCAM‐1 antibodies. Conclusions. The results suggest that adhesion of T and B lymphocytes to mouse aortic endothelium is similar, is affected by lesion topology and is dependent on VCAM‐1 expression over the core of atherosclerotic lesions.     

超声极速成像技术评价冠状动脉慢血流患者颈动脉脉搏波传导速度

目的 采用超声极速成像技术（UF）评价冠状动脉慢血流（CSF）患者颈动脉脉搏波传导速度（PWV）。方法 收集临床诊断为CSF的患者34例（CSF组）和40例健康者（对照组）,进行颈动脉超声检查,测量颈总动脉的内径（D）、内-中膜厚度（IMT）及收缩期峰值血流速度（PSV）,同时采用UF技术测量颈总动脉前壁收缩起始时和结束时PWV（BS和ES）。结果 CSF组的BS和ES均大于对照组（P均<0.05）,而D、IMT及PSV差异均无统计学意义（P均>0.05）。结论 CSF患者的BS和ES增大,CSF可能是动脉硬化的早期表现。UF技术可准确、敏感检测早期动脉硬化。     

Pleural injury and pleurisy‐induced progelatinase B/proMMP‐9 is associated with markers of neutrophil degranulation

Objective. Progelatinase B/proMMP‐9 has recently been identified as an indicator of pleural inflammation, presumably originating from granulocytes. The aim of this study was to verify the origin of progelatinase B by simultaneous estimation of specific markers of neutrophil recruitment and activation in pleural effusions following induced pleurisy and pleural injury. Material and methods. Sixty‐three samples of pleural fluid from patients undergoing therapeutic talc pleurodesis (n = 8) and explorative thoracoscopy (n = 3) collected before and at different time intervals after the intervention were analyzed for progelatinase B and neutrophil gelatinase‐associated lipocalin (NGAL)‐gelatinase complex by substrate electrophoresis, for myeloperoxidase (MPO) and interleukin‐8 (IL‐8) by immunoadsorbent sandwich assay, as well as for leukocyte count, C‐reactive protein (CRP) and total protein (TP). Results. A significant increase in free and NGAL‐complexed progelatinase B, MPO and IL‐8 was recorded within 48?h following treatment in all subjects. Progelatinase B was strongly correlated with NGAL‐gelatinase complex (r = 0.88, p = 0.001), MPO (r = 0.81, p = 0.001), neutrophil count (r = 0.75, p = 0.01) and IL‐8 (r = 0.71, p = 0.001), but not with CRP and TP. Conclusions. The results support the neutrophil origin of the proenzyme, which confirms progelatinase B as an indicator of a local inflammatory reaction. Quantifying the inflammatory reaction may be helpful in the evaluation of both the technical variants of therapeutic pleurodesis and finer discrimination of paraneoplastic effusions.     

C‐reactive protein and tumor necrosis factor‐alpha in relation to insulin‐mediated glucose uptake,smoking and atherosclerosis

Objectives. To examine the hypothesis that serum concentration of C‐reactive protein (CRP) is inversely associated with insulin sensitivity and obesity, and that this may by mediated by tumor necrosis factor‐α (TNFα) and interleukin‐6 (IL‐6). Material and methods. Cross‐sectional, one‐center study of a population‐based sample of 58‐year‐old Swedish men (n = 98). Exclusion criteria were cardiovascular disease, clinical diabetes mellitus and/or continuous cardiovascular medication. Glucose infusion‐rate (euglycemic hyperinsulinemic clamp), adjusted for fat‐free mass, which together with total body fat was measured by dual‐energy X‐ray absorptiometry. Serum concentrations of CRP, TNFα, soluble TNFα receptor 2 (sTNFAR2), IL‐6 determined by ELISA. Ultrasound was used to measure intima‐media thickness (IMT) in both common carotid arteries, carotid bulbs and in the right femoral artery. Results. CRP was inversely associated with insulin sensitivity (r = ?0.28, p<0.01) and with total body fat (r = 0.31, p<0.01), but not independently of the TNFα and sTNFAR2 product. Serum CRP, TNFα, sTNFAR2, but not IL‐6, were associated with low insulin sensitivity, total body fat, abdominal obesity, hyperinsulinemia, hypertriglyceridemia, low HDL cholesterol and small LDL particles, i.e. the metabolic syndrome. These associations were independent of smoking and carotid and femoral artery IMT. Conclusions. Serum concentrations of CRP were related to insulin sensitivity and accompanying factors constituting the metabolic syndrome. The results indicate that this association may be mediated by adipose tissue and TNFα effects, the latter measured as the product of TNFα and sTNFAR2. This was a cross‐sectional study and causality cannot be proven.