Arteriosclerotic Changes Research Articles

In-vivo MRI Reveals Changes to Intracerebral Vasculature Caliber in HIV Infection.

Objective: To characterize cerebral arterial remodeling in HIV-infected (HIV+) individuals in-vivo, and to study its clinical and immunological associations.Methods: T2*-weighted magnetic resonance imagining sequences was used to determine cross-sectional area (vascular caliber) of the anterior (A1 segment) and middle (M1 segment) cerebral arteries in HIV- (control) and HIV+ subjects on antiretroviral therapy. Correlations of A1 caliber with clinical, demographic parameters, and immunological markers in cerebrospinal fluid (CSF) were determined using multivariable analyses.Results: A1 and M1 calibers from 22 HIV- control subjects (age: median 48.5 years, range 22-60 years, 55% male) and 61 HIV+ subjects (age: median 53 years, range 25–60 years, 67% male) were studied. ANCOVA, adjusting for ethnicity and sex (age was not correlated with M1 or A1 caliber in either group), revealed that HIV+ subjects had larger caliber in the A1 segment than HIV- subjects (4.95 ± 0.14 mm2, and 4.47 ± 0.21 mm2 respectively, p = 0.048), but caliber of the M1 segment did not differ among the groups (7.21 ± 0.14 mm2 and 7.09 ± 0.23 mm2 respectively, p = 0.65). In the HIV+ cohort, longer disease duration and higher current CD4 T-cell count were associated with reduced A1 caliber (r =−0.42 and −0.33 respectively, p < 0.05). In addition, increase in cardiovascular disease risk (CVD risk) was associated with a decrease in A1 caliber in the HIV group (r = −0.35, p < 0.05).Conclusions: This cross-sectional study reveals an increase in A1 caliber in the HIV+ cohort, compared to control subjects, which is especially prominent in early phase of the disease. This increase in caliber may be associated with acute pathological processes in HIV during the initial stages of infection resulting in loss of compliance or thinning of the arterial wall. At later stages, such changes may be confounded by arteriosclerotic changes that are common in later stages of HIV infection. This study suggests there is extensive vessel remodeling in various stages of infection. Long-term longitudinal follow-up of this cohort is planned to further verify this hypothesis and to better understand this MRI marker of intracranial vascular caliber.

Arterial stiffness and haemodynamic regulation in adolescent anorexia nervosa versus obesity.

Cardiovascular complications contribute to higher morbidity and mortality in patients with anorexia nervosa. We aimed to study biomarkers of cardiovascular risk in anorexic, normal-weight, and obese adolescents with focus on complex cardiovascular autonomic regulation and early arteriosclerotic damage. We examined 20 adolescent girls with anorexia nervosa, 20 obese girls, and 20 healthy normal-weight controls. Collected data: body composition analysis, 5 min recordings of R-R intervals and beat-to-beat blood pressure (BP), and arterial stiffness evaluated using cardio-ankle vascular index (CAVI). Evaluated parameters: beat-to-beat heart rate and BP variability, haemodynamic parameters (total peripheral resistance (TPR) cardiac output), CAVI, and anthropometric indices, including novel body roundness index (BRI). Adolescents with anorexia nervosa had increased CAVI associated with lower arterial constriction indexed by low-frequency band of BP variability compared with normal-weight peers (p = 0.03, p = 0.04, respectively) and obese adolescents (p < 0.01, p = 0.01, respectively). After normalization of CAVI and TPR by BRI, the relationship between CAVI and TPR was significant for all groups with the highest slope in the anorexia nervosa group (R2 = 0.724, p < 0.01). This is the first study revealing early arteriosclerotic damage in anorexic girls with increased CAVI. Complex analysis of cardiovascular autonomic regulation, and early arteriosclerotic, hemodynamic, and anthropometric changes in spectrum anorexia nervosa, normal weight, and obesity could help to understand the mechanisms of increased cardiovascular risk in malnutrition. Novelty Girls with anorexia nervosa showed signs of early arteriosclerotic damage indexed by CAVI. Insufficient sympathetic cardiovascular control was found already in adolescents with anorexia nervosa. The effect of body composition on CAVI was best predicted by novel body roundness index.

Potential role of Anitschkow cells in cardiovascular disease in human and veterinary medicine: A review of the literature.

Anitschkow cells (AC) are a peculiar type of stromal cells observed in myocardium, cardiac valves and coronary vessels wall whose origin, characterization and role remain controversial. In human heart, they represent a histological hallmark of Aschoff nodules in rheumatic fever, but they have also been observed in other myocardial pathologies. Firstly, they have been considered a myocyte-derived cells, but light microscopy, immunohistochemical and ultrastructural studies pointed out that a macrophagic/histiocytic origin cannot be excluded. Many authors also reported extracardiac AC or an Anitschkow nuclear pattern, thus suggesting that these cells may represent a chromatin pattern rather than a specific cell type. In veterinary medicine, AC were described in myocarditis, myocardial necrosis, degenerative and inflammatory endocardial diseases of several species. Recently, AC have been observed in intramural coronary arteries of different animals (including cattle and fish) affected by arteriosclerotic processes. Stress related to the intensive livestock farming could represent a mechanotransduction promoting factor of arteriosclerotic changes allowing the development of Anitschkow chromatin pattern. Further studies both in human and veterinary medicine are needed to confirm the origin and role of these peculiar cells.

Significance of the pulsatility index in the evaluation of hemodynamic changes in peripheral arterial circulation in the obese treated with orlistat

Background/Aim. Prolonged hyperinsulinemia accelerates the process of endothelial dysfunction and arteriosclerotic changes affecting the development of cardiovascular and cerebrovascular diseases. There are various measuring techniques for the evaluation of early functional changes in the arterial wall such as: flow-mediated endothelium-dependent vasodilation, impulse wave analysis, intima-media thickness assessment, venous plethysmography and so on; however, each has certain limitations in results interpretation. The aim of this study was to indicate the association of the pulsatility index (PI) that shows peripheral arterial contractility, with the changes in metabolic parameters under insulin resistance conditions. Methods. The study included a total of 30 healthy obese subjects with the values of body mass index more than 30 kg/m2, randomized with double blind design into two groups: placebo and orlistat. The extent of insulin sensitivity was calculated on the basis of glycemia and insulinemia values using an appropriate formula. Results. The obtained results suggest a statistically significant improvement in the PI index in the orlistat group (p &lt; 0.002), while there was no such improvement in the placebo group. Conclusion. The results obtained in this study indicate the improvement in insulin sensitivity within early arteriosclerosis is a significantly favorable effect of orlistat on peripheral arterial circulation additionally supported by the reduction in levels of lipid fractions, especially triglycerides. Early hemodynamic changes under conditions of the reduced insulin resistance are characterized by the increase in arterial wall contractility evaluated by the PI determination.

Role of adipose tissue and skeletal muscle in macrovascular atherosclerotic occlusive disease-peripheral arterial disease and carotid artery disease

Purpose/Background/ObjectiveCarotid artery disease (CAD) and peripheral arterial disease (PAD) are non-cardiac manifestations of atherosclerotic disease, which are less extensively studied. Presently, adipose tissue (AT) and skeletal muscle (SM) are considered endocrine organs, producing cytokines with vascular effects 1,2,3,4,5,6,7. Main objective is to clarify the role of AT and SM in several stages of atherosclerotic occlusive disease (CAD and PAD), and its connection with arteriosclerotic changes in other territories. Secondary objective: to study the evolution of these parameters after revascularization and after carotid endarterectomy.MethodsStudy Groups (Fig 1): control- without macrovascular atherosclerotic disease eligible for elective varicose veins surgery with inguinal approach. Study group 1- with PAD, confirmed by ankle-brachial index, with or without indication to revascularization. Study group 2- with CAD with or without indication to endarterectomy. We will determine the quantity, endocrine functionand histologyof SM and AT (in groups submitted to surgery). The groups will be evaluated at admission, 3 and 6 months (Fig 2).Expected ResultsThe quantity of AT compartments (visceral, subcutaneous and perivascular) and SM will be determined with transvers abdominal CT scan at the level of 3th vertebra. The endocrine function will be evaluated measuring the myokines and adipokines in blood sample. During the surgery we will collect samples of AT (visceral, subcutaneous and perivascular), SM and artery for histology. We will determine the type, number and size of present cell and vascularization. Additional Central Hemodynamicdata will be obtained from carotid Doppler ultrasound, carotid femoral-pulse wave velocity; peripheral central pulse pressure; anthropometric and muscle mass measurements will be performed.ConclusionWe hope to correlate the atherosclerotic and arteriosclerotic phenotypes with SM and AT characteristics, as well as indexes of sarcopenia.

Development of a Mouse Model to Evaluate the Influence of Exercise on Collateral Growth in PAD

Background: Exercise is established as a treatment option in PAD, even though the molecular mechanisms are not yet fully understood. An animal model was developed to evaluate collateral growth through exercise. Methods: 12 weeks old healthy C57BL/6 mice were compared to 18 wk. old ApoE-/- deficient mice, showing after 12 wk. of high caloric diet cardiovascular deficits. Ligation of the superficial femoral artery simulated acute limb occlusion. Both groups where exposed to freely accessible running wheels to evaluate training effects and in motion-restricting cages as control baseline. Hind limb perfusion was measured by LDPI pre- and postoperative at different points in time. At each of these points body weight was recorded as well as histological/morphometric Mm. adductores examinations were performed. Results: ApoE-/- mice showed significant macroscopic arteriosclerotic changes and an increase in body weight compared to BL6, but no differences of distances were observed. LDPI on BL6 did not show differences between training and resting. There was a continuous improvement in reperfusion to d14 to stabilize at 70% of baseline. ApoE showed significant differences between training and control on d7 on which this reperfusion stabilized at 70% of baseline. It was shown that there is a difference (p<0,05) of perfusion between the animal strains immediately postoperative as well as on d3 and d7. There is no difference in size of collateral arteries between the groups. A significant increase of macrophages and a higher endothelial monocyte activity can be seen in the first week in ApoE mice with training. Conclusion: The running wheels were accepted by both groups. Due to pre-existing cardiovascular deficiencies ApoE-/- mice were proven to be a suitable model to picture PAD. It was shown there is evidence that exercise significantly accelerates reperfusion through collateral growth, an increased endothelial proliferation activity and a higher accumulation of macrophages due to training.

Hypoperfusion of the Aortic Wall Secondary to Degeneration of Adventitial Vasa Vasorum Causes Abdominal Aortic Aneurysms.

An abdominal aortic aneurysm (AAA), which affects approximately 10% of Japanese men aged ≥ 65 years, is frequently associated with hypertension, dyslipidemia, and other lifestyle- related diseases. The development of an AAA is attributed to chronic inflammation concomitant with arteriosclerotic changes. However, an accurate pathomechanism associated with AAA remains uncertain, and questions such as why only a particular group/percentage of patients with arteriosclerosis develop aneurysms and how diabetes suppresses aneurysm development remain unanswered. We examined a novel mechanism to develop AAA based on histopathological findings following analysis of the human AAA tissues. Additionally, based on these findings, we developed a new animal model of AAA, in which the histopathological characteristics are similar to human AAA tissue. Recently, we identified stenosis of the vasa vasorum (VV) in aortic segments showing dilatation. The aorta is the largest artery in our circulatory system. Under physiological conditions, the inner layer of the aorta is nourished via direct diffusion of nutrients from the luminal blood flow, whereas the outer adventitia is primarily perfused by the VV. Therefore, hypoperfusion of the VV induces hypoxia and subsequent inflammation and tissue degeneration of the aortic wall, resulting in aneurysm formation. Based on these findings, we established an AAA animal model by reducing the blood flow through the VV to the aortic wall. AAA was successfully reproduced in our animal model. Histopathological findings in this model were indistinguishable from those observed in humans, and pronounced abnormality in lipid composition in blood vessel adventitia was also observed. Thus, hypoperfusion of the aortic wall appeared to be sufficient to cause inflammationinduced AAA. These findings may provide potential targets for novel therapeutics for the management of an AAA.

Night-time activation of the intrarenal renin-angiotensin system due to nocturnal hypertension is associated with renal arteriosclerosis in normotensive IgA nephropathy patients.

Intrarenal renin-angiotensin system (RAS) activation plays an important role in the development of hypertension and renal damage. However, the association between daytime and night-time intrarenal RAS activation and renal structural damage in normotensive IgA nephropathy patients is unclear. We investigated the relationships between urinary angiotensinogen (U-AGT) excretion, which reflects intrarenal RAS activity, and renal structural damage (i.e., endocapillary and mesangial cell hypercellularity, arteriolar hyalinosis and arteriosclerosis levels, and global glomerulosclerosis and tubulointerstitial fibrosis percentages) in 27 normotensive IgA nephropathy patients (age 39.2 ± 13.6 years, 10 men and 17 women, estimated glomerular filtration rate (eGFR) 74.0 ± 17.3 ml/min/1.73 m2, urinary protein excretion 0.58 ± 0.50 g/day, and U-AGT excretion 64.9 ± 100.6 μg/day). The arteriosclerosis level had a significant positive association with the daytime and night-time U-AGT excretion levels. By contrast, the endocapillary and mesangial cell hypercellularity and arteriolar hyalinosis levels and global glomerulosclerosis and tubulointerstitial fibrosis percentages did not correlate with the daytime and night-time U-AGT excretion levels. The daytime and night-time U-AGT excretion levels were higher in patients with arteriosclerotic changes than in patients without these changes. Multiple linear regression analysis revealed that the arteriosclerosis levels had a significant positive association with the U-AGT excretion levels at night after adjusting for age, sex, body mass index, and the eGFR. However, when diastolic BP was added as an independent variable, the relationship between U-AGT excretion and arteriosclerosis at night disappeared. In normotensive IgA nephropathy patients, intrarenal RAS activation at night due to nocturnal hypertension may be associated with arteriosclerosis.

Association between Vascular Lesion and Penile Erection Hardness in Japanese Patients with Erectile Dysfunction

Objective: Many erectile dysfunction (ED) cases are attributed to vascular endothelial dysfunction and impaired blood flow due to arteriosclerotic changes. In this study, we examined the association among the erection hardness score (EHS), pulse wave velocity (PWV), and the presence of carotid artery plaques. Subjects and Methods: The study enrolled 67 patients who visited our hospital with the chief complaint of ED. Based on the history at the first visit, 28 of the 67 patients were categorized into the EHS 3–4 group and the remaining 39 into the EHS 0–2 group. The two groups were retrospectively analyzed. Results: The PWV points were significantly higher in the EHS 0–2 group than in the EHS 3–4 group (P = 0.047). In consideration for error in age, the modified points (PWV at the first visit – reference PWV by age) were significantly higher in the EHS 0–2 group than in the EHS 3–4 group (P = 0.026). This group also showed a higher detection rate of plaques by carotid ultrasound (66.7%). Conclusion: This study showed that patients with lower points of EHS had higher PWV and were more likely to have carotid artery plaques. While ED has occasionally been considered as an early risk marker for the onset of cardiovascular events; this study suggests that the hardness of the penis can be an easier-to-measure and more sensitive index.

A novel case of renal pathergy reaction in a Beh\xe7et\u2019s disease patient complicated by IgA vasculitis

BackgroundA pathergy reaction is defined as a hyperreactivity of the skin in response to minimal trauma, which is important in the diagnosis of Behçet’s disease (BD). However, a pathergy reaction may not be restricted to the skin, and little is known about whether an invasive medical procedure can induce the reaction. Here we present a pathergy reaction induced by renal biopsy, an invasive procedure.Case presentationA 46-year-old man who was diagnosed with IgA vasculitis (IgAV) at the age of 38 was treated with prednisolone and mizoribine. However, complications such as common carotid arteritis or recurrent oral ulcer suggested the possibility of another pathophysiology. Later, increasing urine protein developed, suggesting disease aggravation. However, renal biopsy showed arteriosclerotic changes caused mainly by hypertension, negating exacerbation. After renal biopsy, his renal dysfunction and body temperature fluctuated, and detailed examinations revealed recurrent oral and genital ulcers and a folliculitis-like rash on his scrotum. Later, he complained of myodesopsia caused by hemorrhage in the ocular fundus due to occlusive vasculitis. Complete BD was diagnosed after development of the symptoms, and he was treated with prednisolone and colchicine.ConclusionCo-occurrence of BD with IgAV is very rare and may be associated with immune disorders. Interestingly, a renal biopsy revealed BD, which was masked by the presence of IgAV, and elucidated the etiology of the unexplainable symptoms. To the best of our knowledge, this is the first report of renal pathergy. This case enlightens clinicians to the fact that not only a needle stimulation but also an invasive procedure can cause a pathergy reaction.

Central Hemodynamics for Management of Arteriosclerotic Diseases.

Arteriosclerosis, particularly aortosclerosis, is the most critical risk factor associated with cardiovascular, cerebrovascular, and renal diseases. The pulsatile hemodynamics in the central aorta consists of blood pressure, flow, and stiffness and substantially differs from the peripheral hemodynamics in muscular arteries. Arteriosclerotic changes with age appear earlier in the elastic aorta, and age-dependent increases in central pulse pressure are more marked than those apparent from brachial pressure measurement. Central pressure can be affected by lifestyle habits, metabolic disorders, and endocrine and inflammatory diseases in a manner different from brachial pressure. Central pulse pressure widening due to aortic stiffening increases left ventricular afterload in systole and reduces coronary artery flow in diastole, predisposing aortosclerotic patients to myocardial hypertrophy and ischemia. The widened pulse pressure is also transmitted deep into low-impedance organs such as the brain and kidney, causing microvascular damage responsible for lacunar stroke and albuminuria. In addition, aortic stiffening increases aortic blood flow reversal, which can lead to retrograde embolic stroke and renal function deterioration. Central pressure has been shown to predict cardiovascular events in most previous studies and potentially serves as a surrogate marker for intervention. Quantitative and comprehensive evaluation of central hemodynamics is now available through various noninvasive pressure/flow measurement modalities. This review will focus on the clinical usefulness and mechanistic rationale of central hemodynamic measurements for cardiovascular risk management.

Relationships among Ocular Blood Flow Shown by Laser Speckle Flowgraphy, Retinal Arteriosclerotic Change, and Chorioretinal Circulation Time Obtained by Fluorescein Angiography.

Purpose. To determine the correlations among the mean blur rate (MBR) in the optic nerve head (ONH) shown by laser speckle flowgraphy (LSFG), retinal arteriosclerosis, and the circulation time obtained by fluorescein angiography (FA). Method. We evaluated 118 patients and assessed their time of choroidal flush, arm-to-retina time, and early and late phases of retinal circulation time (RT: sec) obtained by FA. The severity of retinal arteriosclerosis was classified according to the Scheie classification. The MBR values throughout the ONH (MBR-A), in the tissue (MBR-T), and in the vessels (MBR-V) were analyzed. Results. Patients with retinal vein occlusion (RVO) showed prolonged early and late phases of RT compared to other ocular diseases. Single and multiple regression analyses showed that the MBR-V and Scheie classification were significantly associated with both the choroidal flush and arm-to-retina times. The incidences of RVO and MVR-V were significantly associated with the early phase of RT, and the incidences of RVO, MBR-V, Scheie classification, and gender were revealed to be factors independently contributing to the late phase of RT. Conclusion. MBR-V in the ONH and retinal arteriosclerosis are important contributing factors for the circulation time of each stage obtained by FA.

Relation of serum homocysteine levels to cerebral artery calcification and atherosclerosis

Background and aimsElevated serum homocysteine level is known to be associated with increased risk of vascular event due to endothelial senescence. We investigated the association between serum homocysteine level and cerebral arteriosclerosis status including intracranial vascular calcification and atherosclerosis burden. MethodsWe identified 1193 consecutive patients (mean age = 68.6 ± 12.7, 537 female patients) who were admitted with acute cerebral infarction or transient ischemic attack from a single university medical center. The patients were categorized into three groups according to their serum homocysteine level. Cerebral artery calcification was assessed from the cavernous portion of both internal carotid arteries, and cerebral atherosclerosis burden was derived as the sum of stenosis degree of major intracranial arteries from brain computed tomography angiography. ResultsThe mean homocysteine level was 14.1 ± 6.2 μmol/L, and intracranial cerebral artery calcification was present in 974 patients (81.6%), with 339 cases of advanced calcification (28.4%). The prevalence of cerebral artery calcification, advanced cerebral artery calcification and cerebral atherosclerosis burden showed increasing tendency throughout the homocysteine tertiles. Multivariable logistic regression analysis including age, sex, vascular risk factors, serum C-reactive protein, estimated glomerular filtration rate and homocysteine tertile disclosed that the highest serum homocysteine tertile was an independent predictor of advanced cerebral artery calcification (odds ratio = 1.45, confidence interval = 1.02–2.05) and advanced cerebral atherosclerosis (odds ratio = 1.42, confidence interval = 1.01–1.99) compared to the lowest group. ConclusionsAn elevated serum homocysteine level was independently associated with intracranial arterial calcification and atherosclerosis burden. Future studies are warranted to test whether lowering serum homocysteine can delay cerebral arteriosclerotic changes.

Penile Gangrene Following Use of Midodrine Hydrochloride for Hypotension in a Male Diabetic Patient Undergoing CAPD

A 74 year old diabetic nephropathy patient had symptomatic postural hypotension with normal left ventricular function. As there was no significant response to discontinuation of antihypertensives, he was started on midodrine hydrochloride, which led to a significant symptomatic improvement. After 3 weeks, he developed a gangrenous patch over his glans penis. A Doppler ultrasound showed deceased blood flow in the penile artery. The penile artery which was probably already undergoing arteriosclerotic changes, deteriorated further due to vasoconstriction. Midodrine hydrochloride has to be cautiously used in dialysis patients.

Does arteriosclerosis contribute to hemifacial spasm?

Hemifacial spasm (HFS) is caused by pulsative vascular compression of the root exit zone (REZ) of the facial nerve. However, the mechanism that causes the offending vessels to compress the REZ has not been clarified. Elongation of intracranial arteries due to arteriosclerosis is one possibility, but such arteriosclerotic changes are not observed very frequently among patients with HFS. The aim of the present study was to investigate whether arteriosclerotic changes would contribute to the pathogenesis of HFS. This study included 111 HFS patients, all of whom were Japanese. The prevalence rates of hypertension, hyperlipidemia, and diabetes mellitus were examined as risk factors of atherosclerosis, and the cardio-ankle vascular index (CAVI) was measured as an indicator of arteriosclerotic change. The severity of white matter lesions (WMLs) in HFS patients was measured by magnetic resonance imaging. These data were compared with data from healthy Japanese controls. The prevalence rates of the risk factors for atherosclerosis in the HFS patients were not higher than those in the general Japanese population. The CAVI scores for the HFS patients were similar to, or lower than those in the healthy controls for all age groups except 60 to 69-year-old men. The severity of WMLs in the HFS patients was not significantly worse than that in the controls. It is suggested that arteriosclerotic changes are not involved in the pathogenesis of HFS, and that vascular compression syndromes are attributable to anatomical features of the intracranial arteries and facial nerves formed during the prenatal stage.

Clinical characteristics and etiology of transient myoclonic state in the elderly

ObjectivesTo clarify clinical picture of transient myoclonic state in elderly patients. MethodsThe Aizawa Hospital database was searched to identify all patients with transient myoclonic state with or without asterixis between April 2006 and June 2013. Medical records, brain images and laboratory data including electroencephalograms and electromyograms were reviewed. ResultsWe found 26 patients: 10 women and 16 men, and their ages ranged from 56 to 96 years (79.7±9.9 years, mean±standard deviation). The affected sites of the myoclonic jerks were predominantly the lower face, neck and upper extremities. The myoclonus appeared at conscious resting condition, slightly exaggerated by posturing or action. Asterixis was observed in eight patients. Single myoclonic bursts were 1.70±0.94s long. The interval of myoclonic bursts was 4.47±2.44s. Single myoclonic bursts were composed of 9.5±2.5Hz myoclonic contractions, and single myoclonic contractions were 44.4±12.3ms in duration. Most of the patients suffered from chronic diseases, but they were basically independent in activity of daily living. Oral administration of clonazepam was effective. ConclusionsTransient myoclonic state has relatively stereotyped features. The pathophysiology may include some metabolic abnormality on a background of age-related arteriosclerotic changes. Its prognosis is benign, and prompt oral administration of clonazepam abolishes it. Further investigations will be needed to clarify its cause and pathophysiology.

Acute Mesenteric Ischemia after Recurrent Embolic Stroke

We report the case of a 76-year-old woman with acute mesenteric artery ischemia and atrial fibrillation after recurrent embolic strokes. She had sudden severe abdominal pain and vomiting, and was admitted to the hospital in coma and shock state. Accompanied with metabolic acidosis and multiple organic failures, she died at 13 hours after the onset. Pathological examination revealed that acute thrombotic occlusion of superior mesenteric artery, splenic artery and right celiac artery. The occluded arteries pathologically showed progressive arteriosclerotic change and secondary multiple thrombi. This case demonstrated that atrial fibrillation with recurrent embolic stroke could cause mesenteric artery ischemia, progressive thrombi of abdominal viscera and sudden death.

Man versus Machine: the importance of manual blood pressure measurement skills amongst registered nurses

Background: The manual recording of blood pressure is widely accepted to be more accurate than the recording of blood pressure using an automated device. Despite this many western healthcare systems have moved almost entirely to the automated recording of this important vital sign using oscillometric devices. Such devices may either fail to record the patient’s blood pressure in persistent hypotension or may give inaccurate readings in people with arteriosclerotic or atherosclerotic changes. This paper explores the importance of manual blood pressure recording, the availability of aneroid sphygmomanometers in UK hospitals and the maintenance of the skills of the workforce following initial nurse education.Methods: Using a survey of nursing students to explore what opportunities they have to practice manual blood pressures in the clinical setting, the paper explores the maintenance of skills following initial nurse education. The paper also describes the results of data collection, using unobtrusive methods, regarding the availability of aneroid sphygmomanometers in general and specialist hospital facilities in Northern England (UK). Data using both methods were collected in the spring of 2014.Results: The results suggest that despite most hospitals having some aneriod sphygmomanometers available (mean was 1 device for every 6 beds in acute, 1 device for every 3 beds in specialist hospitals and 1 device for every 12 beds in mental health) they were rarely used in clinical practice with only 35% of students reporting that they had undertaken a manual blood pressure in a clinical setting during the first year of their course. In addition, some hospitals had no aneroid devices and several others had no central record of location and regular calibration of such devices.Conclusions: The suggested infrequent use of aneroid devices raises a concern that nurses skills in manual blood pressure recording may be subject to decay over time. Given the importance of these skills in patient safety and, in ensuring accurate and effective care, failure to ensure adequate equipment and opportunities for skill maintenance could result in practitioners and hospitals being open to negligence claims

Abstract 59: New findings implicated in Coronary calcification in Chronic phase Kawasaki disease

Background: Kawasaki disease (KD) is a systemic vasculitis prevalent in infants and sometimes complicates coronary artery lesions (CALs). It has been well known that CALs gradually develop endothelial dysfunction, post-inflammatory arteriosclerotic changes, and finally coronary calcification. It has been also reported, recently, that vascular calcification is an active cell-driven process characterized by osteogenic differentiation of vascular smooth muscle cells, relating to the chronic inflammation and oxidative stress. In this study, in KD, we evaluated the possible implication of significant calcification prevalent in CALs to the long-term prognosis. Methods: We included 42 patients with a history of KD (age:18.3±6.7 year-old). The breakdown was 17 patients without CALs and 25 with CALs; 12 without calcification and 13 with calcification on multi-detector computed tomography. We measured %FMD as an endothelial function marker and hs-CRPs as an inflammatory marker, serum hydroperoxide and urinary 8-OHdG as oxidative stress markers, and the bone mineral density (BMD). Patients in CALs(-) group took no medicine and those in CALs(+) group were under antiplatelet and/or anticoagulant therapy, particularly, those with calcification were additionally administrated statin or ARB. Results: Values of %FMD in CALs(+) group were significantly lower compared with those in CALs(-) (p&lt;0.05), and values in those with calcification were still lower than those without calcification (p&lt;0.05). Values of hs-CRPs in CALs(+) group were significantly lower than those in CALs (p&lt;0.05). 8-OHdG values as oxidative stress marker in CALs(+) group were significantly lower than those in CALs(-) (p&lt;0.05). The BMD in CALs(+) group tended to be lower compared with the age-matched reference values (88.9±7.0% of normal). Conclusions: In KD chronic stage, the decreased %FMD may be an essential condition to occur coronary calcification. Decreased BMD in patients with coronary calcification suggested the possible existence of the skeletal and the vascular system in KD, similar to the mechanism of common vascular calcification.

Aberrant aneurysm of adult-type pulmonary sequestration: report of a case.

Aberrant pulmonary artery exposed by high-blood pressure over a long period in adult-type pulmonary sequestration can be susceptible to arteriosclerotic change and aneurysmal formation. Dividing this aneurysmal artery has a risk of stump leakage and aneurysm. We herein report a 64-year-old man with an aberrant aneurysm of intralobar pulmonary sequestration. Thoracoscopic resection of the sequestrated lung was performed uneventfully by prior endovascular occlusion of the aberrant aneurysm.