外周动脉腔内超声显像的形态学研究

血管内超声是利用安装在心导管顶端的微型超声探头从管腔内观察血管形态学的新技术，为了解其对人体动脉实时显像的能力及定量定性的准确性，在自行设计的实验模型装置上的对９段经生理压力固定的人离体外周动脉进行超声显像，然后将血管组织对应切片观察，对比二者结果发现：（１）血管内超声可准确测定动脉腔面积，周长，直径和厚度等重要参数，与组织学测值相关系数均在０．９５以上（Ｐ〈０．００１）；（２）肌性和弹性动脉组织     

血管内超声弹性成像研究进展

自1997年有学者将组织力学属性测定与血管内超声成像结合以后,血管内超声弹性成像(IVUSE)技术的发展方兴未艾.IVUSE是利用血管自身的搏动产生腔内压差,通过分析压缩前后的超声图像获取血管和斑块的应变、弹性模量等弹性参数进行成像.介绍了血管内超声弹性成像技术的成像原理,并根据成像参数的不同对IVUSE分2大类介绍其计算方法和目前进展情况,最后对此技术的发展趋势进行了展望.     

低强度脉冲超声对大鼠急性肌腱损伤早期血管生成的影响及机制

背景:越来越多研究表明,低强度脉冲超声可以促进急性肌腱损伤的愈合,但其具体机制尚不清楚。目的:观察低强度脉冲超声对急性肌腱损伤后早期血管生成的影响,并检测与血管内皮生长因子相关信号通路的调控关系,进而揭示其潜在作用机制。方法:8-12周龄SPF级雄性SD大鼠局部注射Ⅰ型胶原酶3 d建立急性跟腱损伤动物模型,随机分为超声组和对照组。超声组每日使用有效辐射面积为1 cm^(2)的超声小探头垂直于跟腱部位进行低强度脉冲超声治疗,对照组不干预。治疗2周后进行超声影像学检查,观察肌腱早期愈合情况;治疗1,2周后行苏木精-伊红染色和CD31免疫组织化学染色观察组织血管数量变化,Western blot和qRT-PCR检测跟腱组织中血管内皮生长因子相关信号通路分子的表达。结果与结论:①灰阶超声显示:超声组较对照组跟腱更为连续,回声强度更低且较为均匀,肌腱厚度明显降低(P<0.05);②苏木精-伊红染色和CD31免疫组织化学结果一致显示:治疗2周后,超声组的新生血管数量明显较同期对照组增多(P<0.05);③Western blot和qRT-PCR结果显示:治疗2周后超声组跟腱中血管内皮生长因子、Yes相关蛋白、血管生成素2、富含半胱氨酸的血管生成素诱导物61的蛋白和mRNA表达均显著高于对照组(P<0.05);④结果表明:低强度脉冲超声通过上调血管内皮生长因子表达显著增加了急性肌腱损伤早期血管生成数量,加速了肌腱愈合。     

皮下植入聚乳酸/明胶/碳纤维多孔导电凝胶的生物相容性研究

目的 采用小鼠皮下植入方法评价聚乳酸/明胶/碳纤维多孔导电凝胶(PG@CF)的生物相容性。方法 将灭菌后的材料植入健康小鼠皮下,应用免疫组化与免疫荧光染色方法对支架周围组织的形态、炎症细胞浸润度、胶原纤维沉积厚度和平均新生血管面积进行观察与统计。结果 多孔导电凝胶植入体内后可保持多孔结构;植入后28 d内,凝胶周围的炎症细胞浸润厚度和胶原沉积厚度均低于对照材料,其包囊中的平均血管面积显著高于对照材料。结论 与对照材料相比,多孔导电凝胶引起的异物反应程度较低。本研究可为该导电凝胶在组织修复中的安全应用提供参考。     

舌乳头微血管和周围组织图像分析及其组织通道探讨

目的:分析舌乳头血管及其周围组织的图像和组织学,进而探讨舌乳头组织通道的形态学基础。方法:用Image-ProPlus医学图像系统测量正常舌及水肿舌的上皮层厚度、微血管袢顶到上皮层的距离、固有层和血管的面积以及上皮层和固有层色泽的RGB值,并进行组织切片观察。结果:两组舌微血管袢顶到上皮层均有一定距离,水肿组大于正常组,水肿组微血管在固有层内所占的面积明显小于正常组;上皮层和固有层的RGB值有较大差别,固有层G、B曲线的起伏与血管密度的多少相关。舌组织形态学显示上皮层细胞外间隙与固有层内均质样结构相通。结论:舌固有层内微血管袢顶到上皮层有一定空间,存在着弥散分布的有腔无壁的组织通道。     

冠状动脉粥样硬化的超高速CT检测与病理学对照Ⅰ—钙化参数与？…

目的：探讨超高速ＣＴ检测的冠状动脉钙化与冠状动脉粥样硬化面积之间的关系。方法：从８例（年龄在４２－８４岁）压力灌注固定后的心脏标本中分离出２０支冠状动脉，拉直后，超高速ＣＴ扫描，每支冠状动脉分成相应的３ｍｍ血管段，组织切片，地衣红染色，Ｌｅｉｃａ图像分析仪上计算粥样硬化面积，结果：在血管、心脏水平，总的粥样硬化面积与钙化面积、钙化积分高度相关，在血管段水平，每个标本内粥样硬化面积与钙化面积，钙化积     

颈总动脉血管粥样斑块与颅内血流速度关系

观察颈总动脉血管粥样斑块与该血管颅内供血区动脉血流速度变化的关系；方法：颈部超声观察有粥样斑块，用经颅多普勒超声观察该血管颅内供血区血流速度的变化；结果：颈总动脉血管有粥样斑声，颅内供血区动脉血管出现异常的机率增加，且两有70％显示为高度相关。同时表明动脉内膜厚度改变较粥样斑块大小与血流速度异常相关明显；结论：颈总动脉粥样斑块可明显影响该血管颅内供血区动脉血管的血液供应，并显示出动脉内膜厚度改变较粥样斑块大小变化对颅内血管血流速度影响更敏感，     

丹参酮ⅡA纳米球对兔颈动脉球囊损伤后内膜增殖的抑制

制备丹参酮ⅡA纳米球．以用于观察局部灌注后对损伤血管内膜增殖的抑制。通过超声乳化法制备了PLGA包载的、载药量为1．55％土0．016％（mg／mg），平均粒径为119nm的丹参酮ⅡA纳米球，将其和空白纳米粒分别局部灌注于球囊损伤后的兔颈动脉内，对内膜增殖的情况进行分析。结果发现：28d丹参酮ⅡA纳米粒组与空白纳米粒组和动脉损伤模型组相比，内膜面积明显减少（P〈0．01）；空白纳米粒组与模型组的内膜面积比较，无明显变化（P=0．302）；内膜面积／中膜面积作为内膜增殖指数的指标，丹参酮ⅡA纳米粒组比动脉损伤模型组减少了39．7％。本实验成功地研制了丹参酮ⅡA纳米粒，局部灌注于内膜剥脱后的血管内，不仅证实了其组织相容性，而且显示出良好的局部摄取，以及显著抑制损伤血管内膜增殖的效应。     

基于血管内超声图像时空相关性的血流斑点去噪方法

血管内超声成像的优越成像方式使得它越来越广泛地被应用到冠心病的诊断和介入治疗中。但随着超声频率的提高，血流分子回波信号（即血流斑点噪声）也显著增强，这会降低管腔和管壁的对比度，加大医生辨别、测量管腔和斑块几何参数及物理参数的难度。我们提出了一种新颖的去噪方法，它利用血管内超声图像在时间、空间上的相关信息，即组织在时间、空间上的变化比血流小这一事实。实验结果表明该方法能显著地去除斑点噪声，增强管腔和管壁的对比度，更好地帮助医生区别血管壁和周围组织。     

肺癌组织内血管密度的X线解剖学研究及其临床意义

目的：定性和定量研究肺癌组织内肿瘤微血管密度。方法：对100例肺癌支气管动脉造影资料进行分析，并利用计算机图像处理系统进行肿瘤组织内支气管动脉的分支血管密度相对分布面积和相对平均灰度进行研究。结果：肺癌表现为血管结构异常和肿瘤血管染色；本组测得肿瘤微血管密度(MVD)中位值为60，MVD≥60％为多血供(N=19)、MVD为30％-60％为中血供(N=63)、MVD≤30％，为少血供(N=18)。肺癌组织内血管密度的X线解剖学资料有10种征像。结论：肺癌组织内血管密度值代表肺癌组织的供血范围局限，应考虑其它动脉参与肿瘤供血和介人治疗。     

64排螺旋CT对冠状动脉粥样硬化斑块评价的临床研究

目的以冠状动脉节段为基础,对照冠状动脉血管内超声(IVUS)结果,评价64排螺旋CT(64-MSCT)检查冠状动脉粥样斑块的能力及准确性。方法选择2009年11月至2010年1月50例怀疑或确诊的冠心病患者,其中男性38例,女性12例;年龄42～74岁,平均年龄55岁。行64-MSCT成像,2周内行冠状动脉IVUS,对186个冠状动脉斑块的64-MSCT及IVUS图像行对照研究。IVUS根据斑块回声特点将斑块分为钙化斑块、纤维斑块、软斑块(包括纤维脂质和坏死核心),64-MSCT则测量斑块密度,以CT值表示。结果对照IVUS结果,MSCT对出现任何粥样硬化斑块节段的诊断灵敏度为93.2%,特异度为91.6%。非钙化斑块组斑块含有较多的纤维和纤维脂质成分,与钙化斑块组相比差异具有统计学意义。与非钙化斑块组相比,混合斑块组和钙化斑块组含有较多的坏死核心成分。结论 64-MSCT具有良好的检查冠状动脉粥样斑块的能力,64-MSCT与IVUS结果具有相关性。     

血管内超声与64排螺旋CT分析冠状动脉斑块的对比研究

目的对冠状动脉病变患者进行血管内超声(IVUS)和64排螺旋CT(64MDCT)检查,评价两种检查手段在冠状动脉病变诊断中的应用价值。方法 24例临床怀疑或诊断为冠心病的患者接受冠状动脉64MDCT检查,并应用其工作站相关后处理技术对冠状动脉粥样斑块进行评估分析。一周内实施冠状动脉内IVUS检查,对冠状动脉病变进行定性和定量分析。结果分析病变血管52支,其中左主干24支,前降支21支,左回旋5支,右冠状动脉2支。IVUS显示有斑块病变的血管段为60段,64MDCT显示有斑块病变的血管样本57段,其中3段病变64MDCT诊断正常而IVUS显示为斑块早期病变。64MDCT对出现任何粥样硬化斑块节段诊断的敏感性为96%,特异性为94.7%。IVUS与64MDCT的管腔面积,外弹力膜面积、斑块面积的相关系数r分别为0.79、0.83、0.81。结论 IVUS能准确判断冠状动脉斑块的大小和性质。64MDCT作为非侵入性方法亦能显示管壁斑块的构成,判断病变的类型及程度,具有一定的敏感性和准确率。     

Spontaneous plaque rupture and secondary thrombosis in apolipoprotein E-deficient and LDL receptor-deficient mice

Apolipoprotein E-deficient (apoE(-/-)) and LDL receptor-deficient (LDLR(-/-)) mice develop extensive atherosclerosis, but the occurrence of spontaneous plaque rupture and secondary thrombosis in these models has not been established. The goal of this study was to provide histological evidence of acute complications of atherosclerotic lesions in these mice and to assess their prevalence. Complications of atherosclerosis were initially studied in aortas of control mice which died during previous intervention studies. Coronary arteries and the aortic origin were then systematically assessed in serial sections through the heart of apoE(-/-) and LDLR(-/-) mice. Aortic plaque rupture and/or thrombi were seen in 3 of 82 untreated mice from past intervention studies. Screening of heart sections of 33 older apoE(-/-) mice (age 9-20 months) showed extensive atherosclerosis in one or more coronary arteries of 18 animals. In three coronary arteries, the presence of blood-filled channels within advanced atherosclerotic lesions suggested previous plaque disruption/thrombotic events followed by recanalization. In the aortic origin of the same mice, four deep plaque ruptures (or erosions reaching necrotic core areas) and a large thrombus originating from the core of a disrupted atherosclerotic lesion were observed. Although plaque ruptures/deep erosions were far less frequent than in human populations, these observations demonstrate that spontaneous plaque rupture and secondary thrombosis do occur in apoE(-/-) and LDLR(-/-) mice. These mice may therefore be suitable for studying factors contributing to thrombotic complications of atherosclerosis. However, the frequent absence of a clearly defined single fibrous cap in murine coronary lesions limits their usefulness as a model of fibrous cap rupture.     

The lesional state vector: a new approach to characterize atherosclerotic lesions

A new approach to study the atherosclerotic lesions (AL) applying a vectorial system is presented. The "lesional state vector" (LSV) is formed by using as vectors the three main types of AL, e.g. fatty streak, fibrous plaque and severe plaque (complicated and calcified considered together) as the coordinates. This vectorial representation is part of a biometric system described in 1982 by Carlevaro and Fernández-Britto, to characterize the AL in any vascular sector or group of patients. The LSV is a suitable tool to study the AL since it conserves all the information available as primary data and it is extremely useful for comparative studies applying different statistical techniques, including multivariate approaches. To demonstrate its advantage, we studied the coronary vessels (right, left anterior descending and left circumflex arteries), the cerebral arteries (circle of Willis) and the aorta (thoracic and abdominal segments) in 2,043 autopsies performed during 5 years (1981-1985). The patients were classified according to the primary cause of death, as high atherosclerotic (HAG) or low atherosclerotic groups (LAG), comprising 1,171 and 872 cases, respectively. Qualitative and quantitative gross analysis were done by a digitizer joined to a personal computer (NEC 9801, Japan). These data were processed on computer ES 1040, GDR. The statistical techniques applied (including the multivariate analysis) were those available in the Statistical Package for Social Sciences (SPSS). Applying the LSV to the arteries studied it was found that in the coronary arteries and in the circle of Willis, the severe plaque and the fibrous plaque played the most important roles, respectively. Graphic representation can make differentiation between HAG and LAG easy.(ABSTRACT TRUNCATED AT 250 WORDS)     

Endothelial expression of endothelial nitric oxide synthase and endothelin-1 in human coronary artery disease. Specific reference to underlying lesion.

Nitric oxide and endothelin-1 (ET-1) are two major endothelium-derived factors with opposing effects on the function and structure of the vessel wall. We investigated the endothelial expression of endothelial nitric oxide synthase (eNOS) and ET-1 in coronary artery disease (CAD) with special reference to the types of underlying lesions. Immunohistochemistry and in situ hybridization were performed in coronary arteries of heart transplant recipients with (n = 16) and without (n = 11) CAD. All coronary arteries from patients with CAD (n = 23) had concentric fibrous or advanced lesions, whereas most of the arteries (25 of 31) from patients with non-CAD showed normal appearance (myointimal thickening only) or eccentric lesions alone. Normal coronary segments consistently showed apparent endothelial immunoreactivity and mRNA signals for both eNOS and ET-1. In atherosclerotic coronary segments, endothelial expression of eNOS and ET-1 was reduced in most lesion sites, particularly in severe subendothelial lesions with dense fibrosis or macrophage accumulation, but not with smooth muscle cells only. Conversely apparent ET-1, compared with weak or focal eNOS signals, were more frequently seen in coronary segments with concentric severe lesions from CAD but not non-CAD patients. Immunoreactivity and mRNA signals for ET-1 were co-localized with those for ET converting enzyme-1 in the endothelium, as well as in the underlying macrophages and smooth muscle cells. These results indicate the presence of differential endothelial expression of eNOS and ET-1 in diseased human coronary arteries with severe concentric atherosclerotic lesions, a finding that was rare in atherosclerotic lesions of coronary arteries of non-CAD patients. Altered expression of endothelium-derived factors may contribute to abnormality of coronary vasomotor tone and the formation of subendothelial lesions in CAD.     

人冠状动脉硫酸乙酰肝素蛋白聚糖的分布和变化与动脉粥样硬化形成的关系

目的：观察、探讨硫酸乙酰肝素蛋白聚糖在正常及有动脉粥样硬化病变的人冠状动脉内的分布和对巨噬细胞脂质摄入的影响及其与动脉粥样硬化形成的关系。方法：应用免疫组化染色观察正常和动脉粥样硬化病变的人冠状动脉内硫酸乙酰肝素蛋白聚糖的分布;应用酶－荧光法,检测培养的巨噬细胞内胆固醇含量。结果：（１）硫酸乙酰肝素蛋白聚糖主要分布于正常冠状动脉内膜近腔面的１／３处,多定位于内皮基底膜及内膜细胞的细胞膜周围;于动脉粥样硬化病变（脂纹及斑块）内其分布密度下降,尤其是在病变深层的泡沫细胞周围分布稀少。（２）硫酸乙酰肝素蛋白聚糖能抑制巨噬细胞内脂质的聚集。结论：动脉内膜中硫酸乙酰肝素蛋白聚糖分布的减少可能与巨噬细胞易于摄入脂质转变为泡沫细胞有关,对动脉粥样硬化早期病变的形成和发展可能具有重要作用。     

Atherosclerosis in Macaca mulatta: Histopathological,morphometric, and histochemical studies in aorta and coronary arteries of spontaneous and induced atherosclerosis

A comparative study of morphology, size, and histochemistry of the intimal lesions in aorta and coronary arteries of spontaneously occurring and cholesterol-induced atherosclerosis in rhesus monkeys has been carried out. A group of 30 normal monkeys was also investigated. Spontaneous atherosclerosis was noted in 10 of 55 adult monkeys autopsied serially; fatty streaks or atheroma in the aorta was noted in seven, fibrous plaque was noted in two, and diffuse intimal thickening was observed on one animal only. The coronary arteries showed fibrous intimal thickening without lipid in 8 of these 10 monkeys. There was fair to heavy deposition of acid mucopolysaccharides in the thickened intima along with proliferation of myointimal cells and collagen fibers. In the seven monkeys which were fed an atherogenic diet for 6 months, the aorta showed fatty streaking and atheroma in all animals. The coronary arteries also showed a variable degree of atherosclerosis but the lipid in the thickened intima was not marked. The atherosclerotic plaque height was not significantly greater than that in the spontaneous disease. These differences between spontaneously occurring and cholesterol-induced atherosclerosis in monkeys tend to indicate that the basic mechanism of lesion formation in the two states may be different.     

Is atherosclerosis increasing in Mexico City?

This report compares quantitative measures of atherosclerosis in aortas and coronaries from autopsies of deceased men from Mexico City collected during 1960 to 1964 and 1986 to 1987. The comparison of lesions in two different time periods provides an opportunity for determining whether the extent of atherosclerosis has changed over time in Mexico City. Three pathologists independently evaluated the extent of fatty streaks (FS), fibrous plaques (FP), calcified plaques (CA), and complicated lesions (CO) in 165 aortas and 120 sets of coronary arteries collected during 1986 to 1987 for comparison with similar gradings of 128 aortas and coronary arteries from the International Atherosclerosis Project in 1960 to 1964. Neither FS nor more advanced lesions differed significantly in either the descending thoracic or abdominal aorta between the two collection periods. In contrast, there were more extensive FP and raised atherosclerotic lesions (RL = FP + CA + CO) in the coronary artery segments evaluated in the younger age groups in 1986 to 1987 versus 1960 to 1964. Additional analyses, based on 75 pairs of aortas and 32 pairs of coronary arteries from age-matched cases, all regraded by the team of pathologists after blind coding, showed more FS in both aortic segments and more extensive involvement with RL in the three main branches of the coronary arteries in the more recent study. An overview of our findings suggests that atherosclerosis, particularly in the coronary arteries, is increasing in Mexico City. This hypothesis merits careful testing in parallel with consideration of possible changes in the risk factors that could be responsible for changes in extent of lesions.     

A novel active contour model for fully automated segmentation of intravascular ultrasound images: in vivo validation in human coronary arteries

The detection of lumen and media-adventitia borders in intravascular ultrasound (IVUS) images constitutes a necessary step for the quantitative assessment of atherosclerotic lesions. To date, most of the segmentation methods reported are either manual, or semi-automated, requiring user interaction at some extent, which increases the analysis time and detection errors. In this work, a fully automated approach for lumen and media-adventitia border detection is presented based on an active contour model, the initialization of which is performed via an analysis mechanism that takes advantage of the inherent morphologic characteristics of IVUS images. The in vivo validation of the proposed model in human coronary arteries revealed that it is a feasible approach, enabling accurate and rapid segmentation of multiple IVUS images.