Contradictory Shear Stress Distribution Prevents Restenosis after Provisional Stenting for Bifurcation Lesions

Background: Endothelial shear stress is one of the local hemodynamic factors suspected in the development of coronary atherosclerosis in bifurcation lesions. In patients with provisional stenting, the endothelial shear stress (SS) distribution is unknown. Objective: The aim of this study was to investigate the magnitude and distribution of the SS of coronary bifurcation lesions stenting by the provisional approach. Methods: Ten consecutive patients were included in this study. Quantitative coronary analysis, flow study, and three‐dimensional computational analysis with the aid of the commercial software CD STAR‐CCM+ were done before and after the provisional stenting procedure and also 8 months later. Results: Clinical and angiographic follow‐up were available in all patients. No patient had a side branch (SB) stent. At the 8‐month follow‐up, no major adverse cardiac event (MACE) occurred. There was also no clinical and angiographic restenosis. Before PCI, the distal main vessel (MV)‐lateral, and the SB‐lateral subsegments had relative nonsignificant lower SS value (4.08 ± 2.78 Pa and 4.35 ± 5.04 Pa, respectively) when compared to other segments. After 8‐month follow‐up, sustained decreased SS value was shown in the distal MV‐lateral segment (4.08 ± 2.78–1.68 ± 1.65 Pa), when compared with significantly increased SS value in the SB‐lateral subsegment 4.35 ± 5.04–16.50 ± 40.45 Pa). The explanation is that after stenting in the MV, the flow was redistributed immediately after percutaneous coronary intervention (PCI) and reversed back to its original 8 months later. However, the growth of the fibrous tissue causing in‐stent restenosis (ISR) is prohibited by sirolimus on the stent struts. In contrast, in a branch opened up by plain old balloon angioplasty (POBA), the flow did not change much, the flow could even be worse because it is shifted to the MV after the cross‐sectional area of the MV improved by stenting. However, thanks to POBA, there is increased fibrous tissue formation, enough to increase the SS and prevent further accumulation of cell and cholesterol needed for more restenosis. Conclusion: In the provisional approach, low endothelial SS correlated with no restenosis for patients who underwent stenting of the MV, while a contradictory combination of high SS and no restenosis was seen in the SB after only POBA. The mechanism of prevention of restenosis in the SB is by increasing the SS while in the MV, the mechanism of prevention of ISR is secondary to sirolimus on the stents struts. (J Interven Cardiol 2010;23:319–329)     

丙型肝炎病毒核心蛋白基因的表达载体构建及在酵母中的表达

目的：为探讨丙型肝炎病毒（HCV）核心（core）蛋白的功能，在真核生物酵母细胞中表达HCV核心蛋白基因。方法：用多聚酶链反应（PCR）的方法在HCV全长质粒pBRTM／HCV为膜板扩增HCV核心蛋白基因，克隆到pGEM－T载体中，双酶切后回收连接到酵母表达质粒pGBKT7中表达。提取酵母蛋白质，进行十二烷基磺酸钠－聚丙烯酰胺凝胶电泳（SDS－PAGE）和Western免疫印迹分析。结果：成功构建HCV核心蛋白基因酵母表达载体，Western免疫印迹显示了HCV核心蛋白在酵母细胞中表达。表达产物在胞内存在，分子量22000ku左右。结论：HCV核心蛋白在酵母中表达成功。     

THE USE OF RISPERIDONE IN SEVERELY DEMENTED PATIENTS WITH PERSISTENT VOCALIZATIONS

Objective. The hypothesis being tested was that low doses of risperidone would diminish persistent, purposeless vocalizations in two severely demented geriatric women. A secondary hypothesis was that the severe tardive dyskinesia observed in one patient would improve after risperidone treatment. Design. An intrasubject on–off–on design was employed. Setting. A chronic care facility in Canada. Subjects. Two inpatients with DSM-IV (American Psychiatric Association) diagnosis of combined Alzheimer–vascular dementia. Measures. Nursing assessment of frequency of vocalizations, Extrapyramidal System Rating Scale (ESRS) and Folstein Mini Mental State Examination (MMSE). Results. With risperidone treatment, the vocalizations diminished to less than 20% of baseline ratings. For the patient with dyskinesia, ESRS dyskinetic movement scores decreased (baseline=27; after risperidone 8 weeks=16). No change was observed for the MMSE. Conclusions. The findings support the main hypothesis. The secondary hypothesis was also supported. Further studies of larger numbers of subjects are required to substantiate these preliminary findings. © 1997 by John Wiley & Sons, Ltd.     

INCREASED EXPRESSION OF IL-15 IN THE SYNOVIUM OF PATIENTS WITH RHEUMATOID ARTHRITIS COMPARED WITH PATIENTS WITH YERSINIA-INDUCED ARTHRITIS AND OSTEOARTHRITIS

Recently, a new player in the cytokine network has been described that is produced by monocytes and can be detected in the rheumatoid synovium: interleukin-15 (IL-15). Since this cytokine may play a role in the accumulation and activation of T-cells, B-cells, and natural killer (NK) cells characteristic of synovial tissue (ST) from patients with rheumatoid arthritis (RA), the expression of IL-15 was studied in ST from RA patients in comparison with ST from patients with reactive arthritis (ReA) and osteoarthritis (OA) and the phenotype of IL-15-positive cells was determined. IL-15 expression was investigated by immunohistochemical analysis of ST from ten patients with RA, ten patients with Yersinia enterocolitica-induced ReA, and nine patients with OA. The immunohistological findings were quantified and the results obtained in the different patient groups were compared. To determine the phenotype of IL-15-expressing cells, double-labelling immunofluorescence was performed. The expression of IL-15 was significantly higher in ST from patients with RA than in ST from patients with ReA or OA. In double-label experiments, co-expression was observed with markers for macrophages, T-cells, and NK cells. The composition of the cellular infiltrate in the synovium of patients with RA might be partly explained by the specific increase in expression of IL-15 in rheumatoid ST. It can be speculated that IL-15 production by inflammatory cells other than macrophages may occur in the rheumatoid synovium. © 1997 by John Wiley & Sons, Ltd.     

孕龄对人工流产综合征发生率及出血量影响

目的研究孕龄对人工流产综合征发生率及术中出血量的影响。方法随机选择2000.2.1～2000.2.29在本院行人工流产术的患者120例,将其分为A组(孕龄<50天)及B组(孕龄≥50天),比较两组人工流产综合征发生率及术中出血量。结果A组发生人工流产综合征16例(16/61),B组2例(2/59),术中出血量A组为27.73＋17.70ml,B组为39.71＋28.44ml,两组间上述两个指标均有显著性差异(p<0.05)。结论孕龄是人工流产综合征发生率及术中出血量的影响因素。     

Estimation of Severity of Mitral Regurgitation by Digital Image Processing of Doppler Spectral Recordings

In order to test the hypothesis that the intensity of the regurgitant signal (RS) is indicative of severity of mitral regurgitation (MR), we digitized five well-defined MR envelopes in 19 patients and calculated the mean pixel intensity (MPI) of the MR envelope and that of the diastolic inflow signal (DIF) using an offline computer system. The mean age of the patients was 49 years (range 19–78 years). The intensity of the RS was expressed as a ratio of the MPI of DIF (RSI DIF). This ratio was compared to the severity of MR determined by left ventricular angiography (LV angio). The ratio of the RSI DIF correlated well with the angiographic severity of MR (r = 0.9). A ratio of < 0.6 identified patients with moderate to severe MR and a ratio of < 0.6 correlated with mild MR (grade I and II) by LV angio. Our data indicate that MR severity assessed by measurement of the intensity of the RS correlates well with the angiographic determination of MR.     

Prediction of Clinical Outcomes in Patients with Unprotected Left Main Trifurcation Lesions Treated by Drug‐Eluting Stents: Importance of 2‐Stent Technique and SYNTAX Score

Background: There were insufficient data on the prognosis of stenting for patients with trifurcated unprotected left main lesions (UPLMS). Methods: From the SPEED (stents for percutaneous treatment of coronary artery disease) registry of all percutaneous coronary interventions (PCI) for all types of UPLMS, data of 44 patients with trifurcated UPLMS were selected and analyzed. Results: Patients were divided into one‐stent (N = 23) or 2‐stent (N = 21) groups. Clinical follow‐up was available for 100%, and angiographic follow‐up at 8 month was available for 91.3%. There were no differences in myocardial infarction, cardiac death, and stent thrombosis between groups. However, the target lesion revascularization (TLR) and target vessel revascularization (TVR) in the 1‐stent group was lower when compared to the 2‐stent group (13.0% vs. 23.8%, P = 0.004; 13.0% vs. 28.6%, P = 0.003, respectively). Cumulative survival free from major adverse cardiovascular events (MACE) in the 1‐stent group was higher than the 2‐stent group (65.2% vs. 57.1%, P = 0.033). Analysis of the receiver operator curve (ROC) of the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score showed the area under the curve was 0.414 (standard error = 0.089, 95% CI 0.240–0.589, P = 0.348). Conclusions: In patients with trifurcated UPLMS, higher TLR/TVR and lower cumulative survival from MACE were seen in the 2‐stent group when compared to the 1‐stent group. The SYNTAX scoring system had no predictive value of outcomes for patients with stenting of trifurcated UPLMS. (J Interven Cardiol 2010;23:352–357)