大鼠颈总动脉与脑膜中动脉粘弹性测试

以生物力学的观点研究大鼠颈总动脉与脑膜中动脉应力松弛和蠕变粘弹性行为,为临床提供生物力学参数。对大鼠颈总动脉与脑膜中动脉进行拉伸应力松弛、蠕变实验。得出了颈总动脉与脑膜中动脉拉伸应力松弛、蠕变实验数据和曲线,以一元线性回归分析的方法处理实验数据,得出了大鼠颈总动脉与脑膜中动脉归一化应力松弛函数、蠕变函数数据和曲线及两组试样实验数据的回归系数c、d和ab、值。结果表明:脑膜中动脉应力松弛、蠕变7200s应力松弛量、蠕变量显著大于颈总动脉(P<0.05)。     

腭扁桃体血管的应用解剖

在30例已固定的成人尸体头部标本上观察了腭扁桃体的动脉、静脉及其毗邻关系。腭降动脉及腭升动脉腭支主要分布于扁桃体的上极和上部;咽升动脉及腭升动脉主干分布于扁桃体的中部;面动脉主干及舌动脉则主要分布于扁桃体的下部和下极。以上各动脉分支均穿过咽上缩肌直接分带于扁桃体。腭扁桃体静脉先于其被膜下形成静脉网,再汇集成1～5支扁桃体静脉,后分别流入扁桃体旁静脉、咽静脉和舌静脉内。     

儿茶素对鹌鹑实验性动脉粥样硬化的影响

用高脂饲料诱发鹌鹑动脉粥样硬化，观察了儿茶素对动物粥样硬化模型的影响。将30只雄性30天龄鹌鹑随机分成3组，每组10只。对照组（N）给予普通饲料；高脂组（L）给予高脂饲料；儿茶素防治组（L＋)给予高脂饲料的同时喂以儿茶素水制剂。以上各组均喂养3个月后全部处死，取血清、肝脏检测相关指标，并做冰冻切片及电镜切片进行评价。结果显示儿茶素防治组与高脂组相比，鹌鹑血清TC、TG、LDL－C、MDA和Fru水平显著下降（P＜0．01），血清SOD活性、HDL－C、NO2^-/NO3^-含量和肝脏SOD、ALT、AST活性及NO2^-/NO3^-含量都显著升高（P＜0．01）。说明儿茶素具有明显的调节血脂、抗脂质过氧化、减轻脂肪肝、降低果糖胺及抵抗动脉粥样硬化的作用。     

Percutaneous transluminal coronary angioplasty - Histopathological analysis of nine necropsy cases

Summary From 1982 to 1984 nine of 300 patients undergoing transluminal coronary angioplasty died. The nine coronary arteries and one saphenous aorto-coronary by-pass graft affected by angioplasty were studied by light microscopy. The following types of lesions were found, frequently in association: rupture of the plaque, circumscribed or reaching to the intimal layer or extending beyond it, dissections (fissures) between arterial layers, intra-plaque haemorrhage, plaque emboli and thrombosis. In two cases the therapeutic approach was considered to be clinically and pathologically successful; the patients survived 24 h (case 6) and forty days (case 4). Case 6 which presented recent lesions indicative of success showed, in contrast with the other non-successful cases, rupture affecting not only the initimal layer but also deeper structures of the arterial wall. There were also more extensive fissures. Case 4 which presented late alterations indicative of success showed a plaque fracture whose borders were kept apart by fibrous tissue. In conclusion, we believe that angioplasty allows the re-establishment of arterial blood flow by provoking deep intimal and medial rupture producing a small fissure between the arterial layers and a widening of the lumen; in cases with good late results these alterations cicatrize leaving a wider arterial lumen.     

不同机制大动脉粥样硬化型脑卒中基线特征和血管内治疗后结局比较

目的 本研究旨在比较颅内大血管伴/不伴同侧颈内动脉闭塞的大动脉粥样硬化型脑卒中患者基线特征以及行血管内治疗后结局的差异。方法 对DIRECT-MT亚组进行回顾性分析,以比较前循环大动脉粥样硬化（large-artery atherosclerosis,LAA）型卒中串联闭塞和颅内闭塞接受血管内治疗（endovascular treatment,EVT）的患者的基线特征和预后,分析不同机制学特征（动脉粥样硬化或动脉-动脉栓塞）对临床结局的影响。结果 LAA型卒中患者共108例,其中串联闭塞63例,颅内闭塞45例。颅内闭塞组患者高血压史率高于串联闭塞组（77.8% vs. 52.4%, P=0.007）。颅内闭塞组闭塞部位最常见于大脑中动脉M1段（88.6%）,而串联闭塞组颅内闭塞主要位于颈内动脉颅内段（49.2%）和大脑中动脉M1段（49.2%）（P＜0.001）。两组患者在年龄、性别、术前抗栓、他汀类药物的使用,卒中、房颤、吸烟史,基线mRS、NIHSS评分,是否静脉溶栓,侧枝循环,以及救治流程时间差异均无统计学意义（P均＞0.05）。90天mRS 0-2分的患者比例两组差异无统计学意义（53.3% vs. 41.9%, P=0.243）。颅内闭塞组术后成功再灌注率高于串联闭塞组（93.3% vs. 77.4%, P=0.026）,但术后24-72小时血管再通的比例前组低于后组（57.1% vs. 77.2%, P=0.034）。最终梗死体积,颅内闭塞组小于串联闭塞组（20.1 vs. 34.5, P=0.025）。术后NIHSS评分,90天EQ-5D-5L评分和BI指数等其他次要结局,两组间差异无统计学意义（P均＞0.05）。两组在90天内的死亡率,发生的无症状性和症状性颅内出血率,5-7天时在另外的血管区域新发脑梗死,以及新流域栓塞的患者百分比相似,差异无统计学意义（P均＞0.05）。结论 动脉粥样硬化导致的串联闭塞相较于孤立颅内闭塞,末次造影成功再灌注率较低,梗死体积更大,但术后24-72小时再通率更高,且神经功能良好预后率以及不良事件发生率均与颅内闭塞相仿。     

Serotonin antagonists and vascular protection

Summary There is very suggestive evidence for a role of serotonin release from platelets in the mechanisms for platelet aggregation, arterial thrombosis, and arterial spasm. These effects are mediated via the 5HT₂ receptor and are specifically antagonized by ketanserin. The recently published PACK study was a randomized controlled trial of the effects of ketanserin in patients with intermittent claudication. The purpose of the trial was to discover whether ketanserin treatment would reduce the incidence of atherosclerotic complications such as myocardial infarction or stroke. An unexpected adverse interaction between ketanserin and potassium-losing diuretics was observed, causing an excess of deaths in the group taking this combination of drugs. The intention-to-treat analysis showed no overall difference between ketanserin and placebo in terms of cardiovascular complications. Withdrawal of patients taking potassium-losing diuretics left insufficient numbers of patients in the study to answer the original question. However, the on-treatment analysis excluding those taking the combination suggested strongly, although did not prove, that ketanserin reduced thrombotic episodes by about 25%. It is concluded that the risks of interactions between many drugs and potassium-losing diuretics make the use of the latter undesirable. Further studies on ketanserin, possibly combined with thromboxane A₂ inhibitors, seem highly desirable.