Excimer laser revascularisation: current indications, applications and techniques

. The ultraviolet pulsed excimer laser (308 nm wavelength) is currently the only laser approved by the FDA for percutaneous intervention in patients with ischemic coronary artery disease. The clinical presentation of the treated patients varies from stable and unstable angina to acute myocardial infarction. Potential advantages of excimer laser revascularisation in acute coronary syndromes and in ischaemic obstructive peripheral vascular disease include concomitant plaque debulking and thrombus removal; absence of systemic lytic state; shortened thrombus clearing time and facilitation of adjunct balloon angioplasty and stenting. Improved understanding of laser–tissue interactions and positive clinical outcomes through the use of safe lasing techniques have led to expansion of indications/applications for laser angioplasty. These include stent restenosis, complex lesions and thrombotic stenoses, bifurcation lesions, balloon failure, total occlusions, focal saphenous vein graft lesions and peripheral arterial obstructions. The excimer laser can be effectively utilised in patients with depressed left ventricular ejection fraction and does not require implantation of a temporary pacemaker as no-reflow phenomenon and severe arrhythmias are rarely encountered. Careful case selection, proper utilisation of equipment and incorporation of efficient lasing techniques play a crucial role in effective and safe cardiovascular laser applications.     

高血压对心肌梗死患者凝血功能、斑块稳定性及心脑血管事件的影响

目的研究高血压对心肌梗死患者凝血功能、斑块稳定性及心脑血管事件的影响。方法回顾性研究2011年3月至2015年9月我院收治的146例心肌梗死患者的临床资料,按照是否伴有高血压分为观察组(伴有高血压,n=57)和对照组(不伴有高血压,n=89),统计两组患者D二聚体(D-D)和血浆纤维蛋白原(Fbg)水平,颈总动脉、颈总动脉分叉处斑块发生率及斑块类型,比较两组患者颈动脉斑块大小、厚度及血管中膜厚度及心脑血管事件发生情况。结果观察组Fbg、D-D水平与对照组比较均显著较高(P0.05)。观察组颈总动脉及分叉处斑块检出率均显著高于对照组(73.68%、14.04%VS 26.97%、2.23%);低回声斑块观察组与对照组比较显著较高(42.11%VS 26.97%)(P0.05)。观察组斑块大小、厚度及血管内中膜厚度与对照组比较明显较大(P0.05)。观察组心脑血管事件发生率73.68%与对照组26.97%比较差异显著(P0.05)。结论合并高血压的心梗患者因血液高凝状态显著,斑块稳定性差,发生心脑血管事件几率显著较高。     

双源螺旋CT诊断冠脉易损斑块的应用价值

目的分析6 4层双源螺旋CT(DSCT)与冠脉造影(CAG)在冠脉易损斑块中的诊断价值。方法选取2013年7月-2015年7月因典型症状于我院就诊的63例冠心病患者作为研究对象,分别作64层双源螺旋CT检查与冠脉造影检查,评估64层双源螺旋CT在冠脉易损斑块中的诊断价值。结果 DSCT检出冠脉狭窄病变141处,CAG检出156处,两者检出冠脉病变节段数对比差异无统计学意义(P0.05),以CAG作为标准,DSCT检测敏感度为93.6%,特异性为94.3%,阴性预测值为97.0%,阳性预测值为84.6%;DSCT检出稳定性心绞痛患者软斑块、纤维斑块、硬斑块分别占16.7%、26.7%、56.7%,其中软斑块所占比例显著低于不稳定型心绞痛组,硬斑块比例则显著高于不稳定型心绞痛组(P0.05);DSCT共检出156处冠脉斑块病变,与CAG检出率无差异,其中轻度、中度、重度狭窄分别为21处、66处与57处,轻度、中度狭窄均以软斑块为主,重度狭窄以硬斑块为主,重度组硬斑块所占比例显著高于轻中度狭窄组(P0.05)。结论DSCT对冠心病患者冠脉狭窄程度、斑块性质的诊断均有较高的准确性,与CAG有较高的符合度,对指导冠心病相关心血管并发症的防治有积极的价值。     

CT Findings in People Who Were Environmentally Exposed to Asbestos in Korea

Asbestos related pleuropulmonary disease has been emerging health problem for recent years. It can cause variable clinical symptoms and radiological abnormalities. However, there has been no report for their characteristics in subjects who were environmentally exposed to asbestos. We reviewed the CT images of 35 people who were environmentally exposed to asbestos in Chungnam province, Korea. The study result showed high incidence of pleural plaque and pulmonary fibrosis on chest CT (94% and 77%, respectively). The common CT findings of lung parenchymal lesions were as follows: centrilobular opacities (94%), subpleural dot-like or branching opacities (80%), interlobular septal thickening (57%), intralobular interstitial thickening (46%), parenchymal bands (43%) and subpleural curvilinear line (29%). There were no significant differences in the prevalence of pulmonary fibrosis and pleural plaques according to sex, age and duration of exposure. In conclusion, pleural plaque and pulmonary fibrosis are common asbestos-related CT finding in the exposed people. Asbestos related lung parenchymal CT findings in the participants with environmental exposure show similar to those observed in the occupational exposure.     

复发性和首发性脑梗死患者头颈部CT血管成像特点分析

目的 通过比较复发性脑梗死与首发性脑梗死患者CT血管成像（CTA）的特点,探讨复发性脑梗死患者可能的影响因素。方法 回顾分析140例复发性脑梗死患者和235例首发性脑梗死患者头颈部CTA检查结果,比较两组患者头颈部血管病变的特点。结果 复发性脑梗死患者头颈部动脉狭窄发生率明显高于首发性脑梗死患者（90.0%比64.7%;P＜0.01）,复发性脑梗死患者头颈部动脉中、重度狭窄发生率高于首发性脑梗死患者（分别为34.9%和45.2%比19.7%和15.8%;P＜0.01）,复发性脑梗死患者头颈部动脉斑块发生率明显高于首发性脑梗死患者（91.4%比66.4%;P＜0.01）,复发性脑梗死患者头颈部动脉软斑、溃疡斑发生率明显高于首发性脑梗死患者（分别为36.3%和48.0%比22.7%和37.3%;P＜0.05）。结论 复发性脑梗死与头颈部动脉狭窄及狭窄程度和不稳定性斑块有关,动脉狭窄的程度和斑块性质可能是引起复发性脑梗死的原因之一。     

冠状动脉CT血管成像预测冠状动脉斑块患者发生主要不良心脏事件的价值

目的 探讨冠状动脉CT血管成像（CCTA）预测冠状动脉斑块患者发生主要不良心脏事件（MACE）的价值。方法 对256例冠状动脉粥样硬化斑块患者行CCTA检查,于CCTA图像上定量评定冠状动脉管腔狭窄程度,并依据斑块成分进行分型。随访MACE发生情况,建立预测MACE的3个模型（模型1,冠状动脉狭窄程度分级;模型2,冠状动脉狭窄程度分级联合管壁斑块分型;模型3：冠状动脉狭窄程度分级联合管壁斑块分型和临床危险因素指标）,评估3个模型对MACE的预测效能。结果 256例病例中47例失访,最终随访209例患者。随访结束时,46例发生MACE。冠状动脉狭窄程度分级和斑块分型评估MACE发病风险的风险比分别为4.47、3.43,高于临床危险因素指标。模型2、模型3预测MACE的ROC曲线下面积明显大于模型1（P<0.05）,模型2和模型3预测MACE的ROC曲线下面积差异无统计学意义（P=0.076）。结论 CCTA可定量评估冠状动脉管腔狭窄程度并进行斑块分型,联合应用有助于提高MACE的预测效能。     

Fluoride concentration in supragingival dental plaque after a single intake or habitual consumption of fluoridated milk

The aim of this study was to evaluate the fluoride concentration in supragingival dental plaque after single and repeated intakes of fluoridated milk. The study group consisted of 22 schoolchildren, young adults and adults of both sexes, 8-41 years of age. After a 2-week fluoride depletion period and 3 days of plaque accumulation, 200 ml of fluoridated milk (1g F) was ingested along with a standardized lunch meal. Plaque samples were collected immediately before the intake and after 30, 120 and 240 min. From the adult participants (n = 9), additional samples were colleted after 12 and 18 h. After a fluoride-free washout period of at least 2 weeks, the whole experimental procedure was repeated after 4 consecutive daily intakes of fluoridated milk. The fluoride concentration was determined after micro-diffusion with a fluoride selective electrode. The results showed a statistically significant 3-fold increase of the plaque fluoride levels up to 4 h after the intake. At 12 and 18 h after the intake, the recorded levels went gradually back to baseline. There was no significant difference between the fluoride concentrations in the supragingival plaque after the single intake compared with the repeated intakes. In conclusion, the findings support the suggestion that milk is a suitable vehicle for local fluoride administration into the oral cavity, also when consumed together with a meal.     

健康体检者颈动脉粥样硬化斑块形成相关危险因素的研究

目的分析颈动脉粥样硬化斑块形成相关危险因素,以采取早期预防措施。方法对1256例体检者经超声检查颈动脉,测量颈动脉内-中膜厚度,分析体质量指数、高血压、血脂异常、糖尿病等与颈动脉硬化之间的关系。结果 1256例体检者,共检出颈动脉粥样硬化442例,其中高体质量指数组18例,血脂异常组41例,高血压组38例,高血压合并血脂异常组48例,糖尿病组23例,吸烟组29例,对照组8例。各危险组与对照组差异有统计学意义(P0.05),且高血压合并血脂异常、与单纯性高血压、血脂异常比较,差异有统计学意义(P0.05)。结论血脂异常是颈动脉硬化的主要危险因素之一,血脂异常及高血压两者同时存在可加重动脉粥样硬化。