Anatomy of coarctation,hypoplastic and interrupted aortic arch: relevance to interventional/surgical treatment

Obstructive lesions in the aortic arch are comprised of discrete coarctation, tubular hypoplasia and interruption. This review discusses the anatomy of the lesions relevant to interventional treatment. Catheter intervention, using not only balloon angioplasty but also stent implantation for coarctation, has been developed over the past couple of decades as an alternative treatment to surgery. Several studies have reported long-term outcome and the benefits of surgery and catheter intervention for treating obstructive lesions in the aortic arch but more studies are needed for comparable evaluations. The development of imaging and further improvement of surgical and catheter intervention, such as hybrid intervention or new devices, will help in removing the obstruction safely.     

Use of the plasma triglyceride/high-density lipoprotein cholesterol ratio to identify cardiovascular disease in hypertensive subjects

This analysis evaluated the hypothesis that the plasma triglyceride (TG)/high–density lipoprotein cholesterol (HDL-C) concentration ratio can help identify patients with essential hypertension who are insulin–resistant, with the cardiovascular disease (CVD) risk profile associated with that defect. Data from a community–based study developed between 2003 and 2012 were used to compare CVD risk factors and outcome. Plasma TG/HDL-C cut–points of 2.5 (women) and 3.5 (men) subdivided normotensive (n = 574) and hypertensive (n = 373) subjects into “high” and “low” risk groups. Metabolic syndrome criteria (MetS) were also used to identify “high” and “low” risk groups. The baseline cardio–metabolic profile was significantly more adverse in 2003 in “high” risk subgroups, irrespective of BP classification or definition of risk (TG/HDL-C ratio vs. MetS criteria). Crude incidence of combined CVD events increased across risk groups, ranging from 1.9 in normotensive–low TG/HDL-C subjects to 19.9 in hypertensive–high TG/HDL-C ratio individuals (P for trends <.001). Adjusted hazard ratios for CVD events also increased with both hypertension and TG/HDL-C. Comparable findings were seen when CVD outcome was predicted by MetS criteria. The TG/HDL-C concentration ratio and the MetS criteria identify to a comparable degree hypertensive subjects who are at greatest cardio–metabolic risk and develop significantly more CVD.     

茚甲新治疗顽固性颅内高压的效果观察

目的探讨茚甲新治疗重型颅脑创伤后顽固性颅内高压的临床效果及可行性。方法选择36例重型颅脑创伤后出现顽固性颅内高压的患者，应用茚甲新治疗，比较治疗前后ICP、CCP以及大脑中动脉平均血流速率（VmMCA）的变化，并对患者进行随访评估预后。结果用药30、60、120min后的ICP水平低于用药前，CCP、VmMCA水平均高于用药前，差异均有统计学意义（P〈0．05），且持续静脉点滴期间平均ICP和CCP水平较之首剂量后变化不明显，6例患者应用茚甲新后ICP和CCP变化不明显，随访6个月生存率为为61．1％，预后良好率为27．8％。结论茚甲新对于顽固性颅内高压患者，可显著降低其ICP、增高CCP，对于改善此类患者的预后有积极的作用。