Current Use of Fractional Flow Reserve: A Nationwide Survey

Major medical society guidelines recommend the measurement of fractional flow reserve (FFR) as an aid in choosing percutaneous coronary intervention in patients with stable coronary artery disease. We investigated the measurement of FFR among interventionalists, analyzing operators'' attributes and decision-making processes to reveal differences in their applications of FFR and the reasons for those differences. An electronic survey study of 1,089 interventionalists was performed from 2 February through 6 March 2012, yielding 255 responses. Most respondents were >45 years old (58%), worked primarily in a community hospital (59%), and performed 10 to 30 cases per month (52%). More than half (145/253, 57%) used FFR measurement in less than one third of cases, and 39 of 253 (15%) never used it. There were no differences in use of FFR by age, practice location, or angiogram volume (P >0.05 for all). Respondents used FFR measurement more frequently than intravascular ultrasonography (73% vs 60%) to help guide the decision to stent (P <0.01). Operators reported that their primary reasons for not using FFR were lack of availability (47%) and problems with reimbursement (39%). There was no difference in FFR use by operator age, practice setting, or case volume.     

Quantification of arterial wall inhomogeneity size,distribution, and modulus contrast using FSI numerical pulse wave propagation

Changes in aortic wall material properties, such as stiffness, have been shown to accompany onset and progression of various cardiovascular pathologies. Pulse Wave velocity (PWV) and propagation along the aortic wall have been shown to depend on the wall stiffness (i.e. stiffer the wall, higher the PWV), and can potentially enhance the noninvasive diagnostic techniques. Conventional clinical methods involve a global examination of the pulse traveling between femoral and carotid arteries, to provide an average PWV estimate. Such methods may not prove effective in detecting focal wall changes as entailed by a range of cardiovascular diseases. A two-way-coupled fluid-structure interaction (FSI) simulation study of pulse wave propagation along inhomogeneous aortas with focal stiffening and softening has previously proved the model reliable. In this study, simulations are performed in inhomogeneous aortic walls with hard inclusions of different numbers, size and modulus in order to further characterize the effects of focal hardening on pulse wave propagation. Spatio-temporal maps of the wall displacement were used to analyze the regional pulse wave propagations and velocities. The findings showed that the quantitative markers – such as PWVs and r²s on the pre-inclusion forward, reflected and post-inclusion waves, and the width of the standing wave – as well as qualitative markers – such as diffracted reflection zone versus single reflection wave – allow the successful and reliable distinction between the changes in inclusion numbers, size and modulus. Future studies are needed to incorporate the wall softening and physiologically-relevant wall inhomogeneities such as those seen in calcifications or aneurysms.     

Gender aspects in skin diseases

Gender differences in medicine have been recognized in anatomy, physiology, as well as in epidemiology and manifestations of various diseases. With respect to skin disorders, males are generally more commonly afflicted with infectious diseases while women are more susceptible to psychosomatic problems, pigmentary disorders, certain hair diseases, and particularly autoimmune as well as allergic diseases. Significantly, more female sex‐associated dermatoses can be identified than the male sex‐associated dermatoses. Dermatoses in the genital area differ between men and women. Gender differences also exist in the occurrence and prognosis of certain skin malignancies. The mechanisms underlying gender differences in skin diseases remain largely unknown. Differences in the skin structure and physiology, effect of sex hormones, ethnic background, sociocultural behaviour and environmental factors may interact to exert the influences. A better understanding of gender differences in human health and diseases will allow the development of novel concepts for prevention, diagnosis and therapy of skin diseases.     

Radial augmentation index is related to cardiovascular risk in hemodialysis patients

Cardiovascular accidents related to atherosclerosis are the leading cause of death among hemodialysis patients, which makes continuous monitoring of their cardiovascular status crucial. Recently, a handy device for monitoring the augmentation index (AIx) in the radial artery was introduced in Japan, enabling the use of the AIx in addition to pulse wave velocity (PWV) in the management of hemodialysis patients. In this study the AIx, PWV, abdominal aortic calcification index (ACI), and left ventricular mass index (LVMI) were serially assessed in 108 hemodialysis patients. The radial AIx was monitored using a newly introduced tonometer (HEM-9010AI), and the interrelationships among the measured parameters and their contributions to the risk of cardiovascular accidents were evaluated. The radial AIx was significantly higher in hemodialysis patients than in healthy subjects (N = 50) and was well correlated with risk markers such as LVMI (r = 0.30, P = 0.019) and ACI (r = 0.38, P < 0.001), but not with PWV. Multiregression analysis showed that radial AIx was also significantly associated with LVMI, ACI and blood pressure; PWV was associated with other parameters such as age, blood pressure, and ACI. The AIx and ACI were both significantly increased in patients with cardiovascular complications. Although PWV was strongly increased in the hemodialysis patients, it failed to discriminate between these subgroups of high-risk patients. The radial AIx is closely associated with aortic calcification, cardiac hypertrophy, and a history of cardiovascular accidents in hemodialysis patients, and could be a useful marker for management of these patients.     

Medida do desempenho físico por testes de campo em programas de reabilitação cardiovascular: revisão sistemática e meta‐análise

Introduction

The literature concerning the effects of cardiac rehabilitation (CR) on field tests results is inconsistent.

中医肝脏生理与病理理论对于我国眼科学发展的意义

整体恒动观是中医核心理念。中医认为：肝主目;眼为五脏之精,肝为五脏之长;肝主疏泄,条畅情志;肝生血气,藏血藏魂;肝主血海、主谋略;肝生“相火”,萌发元阳;肝为将军之官,主攘外安内;肝主筋主动,为罴极之本;肝为泪。中医强调：百病从肝治;上医治未病;治病求本,以人为本。根据中医肝脏生理与病理理论,很多感染性与包括肿瘤的免疫性眼病、代谢性与退行性眼病、缺血性与出血性和血管增生性眼病、干眼症与全身病相关眼病都能够从根本上防治,减少甚至避免抗生素与免疫抑制剂等药物、激光与手术治疗,进而推动眼科医学模式变革,提高我国眼病防治科学水平。中医肝脏生理与病理理论能够对于我国以及世界眼科学的发展做出重大贡献。