Constriction Of Lumen Research Articles

Combined CO2 Laser Vaporization and Bleomycin Injection to Treat Huge Adult Laryngeal Vascular Anomalies: Innovative Application of CO2 Laser in Otolaryngology.

The aim of this study was to assess the value of CO2 laser vaporization in treating huge adult laryngeal vascular anomalies (HALVAs) by combining it with bleomycin injection. This study retrospectively reviewed the records of 13 adult patients who underwent 18 different procedures. Methods to treatHALVAs include traditional bleomycin injectionand CO2 laser vaporization combined with bleomycin injection between September 2009 andJanuary 2023. Treatment results were evaluatedby the grade of lumen constriction. A total of five males and eight females, with an average age of 46.3 years (range, 22-66 years), were included in the study. The huge adult laryngeal vascular anomalies in our study were greater than 1633.71 mm3, and the long diameters of the bases were longer than 15 mm. Compared with the bleomycin injection-only group, the results with the CO2 laser vaporization and bleomycin injection combined were better. Both bleomycin injection and CO2 laser vaporization are safe treatment methods. Their combination may produce better results for huge adult laryngeal vascular anomalies.

The Degree of Capillary Absorption Reduction as a Parameter to Classify the Effectiveness of Secondary Horizontal Waterproofing

The dampness of the ground floors in buildings is generally a consequence of capillary rise of groundwater caused by the absence, damage or technical deterioration of the horizontal waterproofing of the masonry. Capillary absorption and damp transport are determined by the wetting properties of water relative to the material, as well as the structure and distribution of pores in the material. Chemical (injection) methods of secondary horizontal waterproofing are based on the technology of introducing injection liquid into the masonry section, which forms a lock which relies on the mechanism of capillary lumen constriction, hydrophilization, capillary sealing or a combined effect. A vital outcome of secondary horizontal waterproofing in a wall using the injection method is not only limited absorption but also its changed dynamics. The research paper describes the procedure leading to determining a criterion that allows to classify injection agents in terms of their impact on inhibiting capillary transport of damp in construction partitions.

The Treatment of Adult Laryngeal Hemangiomas Located on the Arytenoids: Excision vs. Chemotherapy.

To evaluate and compare the results of the excision and bleomycin injection treatment methods for adult laryngeal hemangiomas (ALHs) located on the arytenoids. Twenty-six ALH patients in 29 different cases were enrolled in the study at our department between June 2012 and March 2021. Some patients were treated more than once. Twenty-nine cases of ALH treated with either bleomycin injection or excision were studied to assess the efficacy of both treatments. A lumen constriction score (from 1 to 4) was used to evaluate the therapeutic effect three months later. The ALHs in the ALH excision group were resected successfully, and the ALHs did not recur. The mean lumen constriction score for the bleomycin injection group was 2.95. The lumen constriction score for the ALH excision group was higher than that of the bleomycin injection group. Both bleomycin injection and excision are safe and effective treatments for ALHs located on the arytenoids. On the condition that the ALH is well exposed and can be completely removed, ALH excision surgery is the preferable method to treat ALHs located on the arytenoids.

Ameboma mimicking hepatic flexure colon carcinoma: A case report

Introduction and Importance: Ameboma frequently manifests as a segmental and concentric mucosal lesion in the gastrointestinal tract, causing lumen constriction and obstructive symptoms, and can occur as a single or multiple occurrences in the colon. Case Presentation: A 30-year-old woman presented to our hospital’s Department of General Surgery clinic with complaints of right upper quadrant abdominal pain, mild abdominal distension, nausea, vomiting, and constipation for one month. As a result of the investigation, an exploratory laparotomy was performed, a hepatic flexure colon mass was identified, and a right hemicolectomy was performed. An ameboma was found in the pathology report. Clinical Discussion: Ameboma mimics colon carcinoma and other gastrointestinal diseases, such as tuberculosis and Crohn’s disease. As a result of publishing this case, we hope to raise the awareness of clinicians working in endemic regions regarding differential diagnosis. Conclusion: In cases of perforation or obstruction, colorectal amoebiasis requires immediate surgery. Before starting therapy, the patient’s medical history must be analysed and a diagnosis made.

Computational fluid dynamics model of laryngotracheal stenosis and correlation to pulmonary function measures

3D models of airway lumens were created from CT scans of 19 patients with laryngotracheal stenosis. Computational fluid dynamics (CFD) simulations were completed for each, and results were compared to measured peak inspiratory flow rate, grade of lumen constriction, and measures of airway geometry. Results demonstrate flow resistance and shear stress correlate with degree of lumen constriction and absolute cross-sectional area as well as flow rate. Flow recirculation depends on airway constriction but does not vary with flow rate. Resistance and wall shear stress did not correlate well with functional measures. Flow recirculation did differ between subjects with higher functional measures and subjects with lower functional measures. This analysis provides mathematical models to predict airway resistance, wall shear stress, and flow reversal according lumen constriction and inspiratory flow rate. It suggests aerodynamic factors such as flow recirculation play a role in differences in functional performance between patients with similar airway measures.

Melatonin inhibits vascular smooth muscle cell proliferation and apoptosis through upregulation of Sestrin2.

Excessive vascular smooth muscle cell (VSMC) proliferation contributes to the development of atherosclerosis and restenosis. Furthermore, apoptosis of VSMCs accelerates plaque rupture in the atherosclerotic vessels. Therefore, a strategy that regulates both VSMC proliferation and apoptosis is essential for the development of novel pharmacological tools for the treatment of atherosclerosis. Despite mounting evidence supporting the benefits of melatonin in diverse metabolic diseases, the role of melatonin in VSMC growth remains largely unknown. The present study revealed that melatonin inhibited both proliferation and apoptosis of primary cultured rat VSMCs. Melatonin induced mitochondrial energetic stress in VSMCs and subsequent induction of Sestrin2 via C/EBPβ. Melatonin-induced Sestrin2 suppressed mTORC1 activity in VSMCs, contributing to suppression of VSMC proliferation. Additionally, melatonin-induced upregulation of Sestrin2 blocked apoptosis by preventing excessive ROS generation. The results demonstrated that melatonin controlled VSMC proliferation and apoptosis via Sestrin2-mediated inhibition of mTORC1 and ROS scavenging. Therefore, melatonin should be considered as a lead compound for therapies aimed at preventing vessel lumen constriction during the course of atherosclerosis and restenosis.

Immunohistochemical Characterization of PepT1 and Ghrelin in Gastrointestinal Tract of Zebrafish: Effects of Spirulina Vegetarian Diet on the Neuroendocrine System Cells After Alimentary Stress.

Gastrointestinal function in vertebrates is influenced by stressors, such as fasting and refeeding, different types of diet and hormonal factors. The aim of this paper was to analyze the effect of a Spirulina (Arthrospira platensis) diet, a microalga known for its nutraceutical properties, on the gastrointestinal tract of zebrafish (Danio rerio) regarding expression of oligopeptide transporter 1 (PepT1) and ghrelin (GHR). Food deprivation and refeeding was investigated to elucidate expression of PepT1 and GHR at a gastrointestinal level and the zebrafish compensatory mechanism. PepT1 is responsible for absorbing di- and tripeptides through a brush border membrane of intestinal mucosa. GHR is a brain-gut peptide in fish and mammals, stimulating growth hormone secretion and regulating appetite. Samples were taken after 2 and 5 days of specimen fasting, and 2 and 5 days of refeeding with Sera Spirulina tabs, in which the major constituent is Spirulina sp. (50.2% protein). Morphological and immunohistochemical analysis of PepT1 and GHR were carried out. Control specimen intestinal tract showed normal morphology of the digestive tract. Fasting caused fold structural changes and intestinal lumen constriction. Immunohistochemical analysis showed a PepT1 level reduction after fasting and an increase after refeeding, reaching very high levels after 5 days, compared to controls. GHR levels increased after food deprivation and gradually decreased after refeeding. Increased expression of PepT1 in refeeding fish suggests a compensatory physiological mechanism, as does the increase in GHR levels in fasting fish followed by a reduction after refeeding. A compensatory mechanism may be induced by fasting and refeeding and by a higher protein Spirulina diet. The microalga, for its nutraceutical properties, is an excellent candidate for animal breeding and human diet.

Hemodynamics Modify Collagen Deposition in the Early Embryonic Chicken Heart Outflow Tract.

Blood flow is critical for normal cardiac development. Hemodynamic stimuli outside of normal ranges can lead to overt cardiac defects, but how early heart tissue remodels in response to altered hemodynamics is poorly understood. This study investigated changes in tissue collagen in response to hemodynamic overload in the chicken embryonic heart outflow tract (OFT) during tubular heart stages (HH18 to HH24, ~24 h). A suture tied around the OFT at HH18 was tightened to constrict the lumen for ~24 h (constriction range at HH24: 15–60%). Expression of fibril collagens I and III and fibril organizing collagens VI and XIV were quantified at the gene and protein levels via qPCR and quantitative immunofluorescence. Collagen I was slightly elevated upstream of the band and in the cushions in banded versus control OFTs. Changes in collagen III were not observed. Collagen VI deposition was elevated downstream of the band, but not overall. Collagen XIV deposition increased throughout the OFT, and strongly correlated to lumen constriction. Interestingly, organization of collagen I fibrils was observed for the tighter banded embryos in regions that also showed increase in collagen XIV deposition, suggesting a potentially key role for collagens I and XIV in the structural adaptation of embryonic heart tissue to hemodynamic overload.

Lactate dehydrogenase-A is indispensable for vascular smooth muscle cell proliferation and migration

The proliferation and migration of vascular smooth muscle cells (VSMCs) have been implicated in the pathogenesis of atherosclerosis. Increased aerobic glycolysis is a key feature of cellular phenotypes including cancer and immune cells. However, the role of aerobic glycolysis in the atherogenic phenotype of VSMCs remains largely unknown. Here, we investigated the role of lactate dehydrogenase-A (LDHA), which is a key enzyme for glycolysis, in the proliferation and migration of VSMCs. Activation of primary rat VSMCs with fetal bovine serum (FBS) or platelet-derived growth factor (PDGF) increased their proliferation and migration, glycolytic activity, and expression of LDHA. Wound healing and transwell migration assays demonstrated that small interfering RNA-mediated knockdown of LDHA and pharmacological inhibition of LDHA by oxamate both effectively inhibited VSMC proliferation and migration. Inhibition of LDHA activity by oxamate reduced PDGF-stimulated glucose uptake, lactate production, and ATP production. Taken together, this study shows that enhanced glycolysis in PDGF- or FBS-stimulated VSMCs plays an important role in their proliferation and migration and suggests that LDHA is a potential therapeutic target to prevent vessel lumen constriction during the course of atherosclerosis and restenosis.

Abstract 13969: Effect of Endothelial Shear Stress on the Serial Changes of Vein Grafts Assessed by Optical Coherence Tomography during the First Year After Coronary Artery Bypass Graft Surgery: Analysis from the CABG-PRO Study

Introduction: Saphenous vein grafts (SVGs) have high rates of both early (≤ 1 year) and late failure following coronary arterial bypass graft surgery (CABG). Hypothesis: Endothelial shear stress (ESS) is a critical determinant of the natural history of coronary atherosclerosis, but the influence on the structural changes of SVGs has not been studied. We evaluated the effect of ESS on the serial anatomic outcomes of SVGs assessed by optical coherence tomography (OCT) during the first postoperative year. Methods: We performed 3-dimensional SVG reconstruction in 8 SVGs using fusion of angiographic and OCT data 5-7 days after surgery (baseline) and at 12-month follow-up. Baseline ESS was assessed using computational fluid dynamics. The reconstructed SVGs were divided in consecutive 3-mm segments (n=181), and we assessed the association of baseline ESS with the anatomic outcomes in the corresponding segments at follow-up: change in lumen area and plaque burden, and neointimal area at follow-up. Baseline ESS was categorized according to the tertiles of the ESS frequency distribution. Results: Median baseline ESS in SVGs was 0.48 Pa [IQR: 0.37-0.61 Pa]). Baseline low ESS was associated with: (i) the largest decrease in lumen area (low ESS category: -8.72±0.95 mm2 vs. moderate ESS category: -5.67±0.95 mm2 vs. high ESS category: -3.64±0.95 mm2; p<0.001 low vs moderate and high ESS category), (ii) the largest increase in plaque burden (low ESS category: 24.3±3.4% vs. moderate ESS category: 22.6±3.4% vs. high ESS category: 20.9±3.4%; p=0.011 low vs high ESS category), and (iii) the largest neointimal area at 12 months (low ESS category: 4.02±0.45 mm2 vs. moderate ESS category: 3.65±0.45 mm2 vs. high ESS category: -3.57±0.45 mm2; p=0.020 low vs moderate ESS category, and p=0.009 low vs high ESS category). Conclusions: SVG areas with the lowest local ESS develop the largest lumen constriction, plaque burden increase and neointima formation. These findings provide important insights into the pathogenesis of early SVG failure.

Abstract 18608: Serial Quantitative Coronary Analyses for the Evaluation of One-Year Changes in Grafts and Native Vessels After a Coronary Artery Bypass Surgery: Insights From the Cardiac Catheterization for Bypass Graft Patency Rate Optimization (CABG-PRO) Study

Background: Left internal mammary arteries (LIMAs) and saphenous vein grafts (SVGs) are widely used for coronary artery bypass surgery (CABG), but there is limited information on the post-CABG remodeling of these vessels, as well as the bypassed native coronary arteries. We aimed to investigate the serial changes in lumen dimensions of SVGs, LIMAs and the bypassed native arteries in humans. Methods: Thirteen consecutive patients with recent CABG enrolled in our study and underwent angiography immediately after the surgery and one year later. Quantitative coronary analysis (using CAAS Workstation 5.11 software) was performed in 12 LIMAs, 26 SVGs and 59 native coronary arteries that were bypassed. Results: Mean age was 60.8±5.8 years and all the study patients were men while the initial clinical presentation was stable angina (76.9%). Compared to immediately post CABG, at 12 month follow-up angiography the minimal, maximal and mean SVG lumen diameters of the SVGs significantly decreased: (2.83±0.87mm vs 1.99±0.79mm, p<0.0001; 5.10±1.52mm vs 3.82±1.20mm, p<0.0001; 3.96±1.22mm vs 2.75±0.97mm, p<0.0001; respectively). No significant differences were observed in the baseline and follow-up measurements of LIMA grafts (minimal lumen diameter 1.31± 0.78mm vs 0.86±0.72mm, p=0.17; maximal lumen diameter 2.74±1.25mm vs 2.28mm±1.52, p=0.31; mean lumen diameter 0.62±0.45mm vs 1.02±1.12mm, p=0.24) and the native coronary vessels (minimal lumen diameter 0.76±0.40mm vs 0.82±0.46mm, p=0.31; maximal lumen diameter 2.88±0.99mm vs 3.07±1.18mm, p=0.09; mean lumen diameter 1.84±0.65mm vs 1.86±0.76mm, p=0.74). Conclusions: During the first year post CABG SVGs undergo significant negative remodeling, inferred by lumen constriction, which is not observed in LIMA grafts and the grafted native coronary arteries. The impact of this negative remodeling on clinical outcomes remains to be determined.

Myocardial Bridging in Etiology of Left Ventricular Dysfunction in Young Subjects

PP-006 Myocardial bridging is a congenital abnormality of coronary arteries which may cause anatomically constriction of coronary lumen. Thus it may hemodynamically disturb and restrict the coronary flow at diastole when the myocardial oxygen demand extremely increased. So it may underlie in the

Zerebrale Amyloidangiopathie – ein Update

Cerebral amyloid angiopathy (CAA) belongs to the group of amyloidoses and is characterised by the deposition and accumulation of beta-amyloid (Aβ) in small arterial vessels of the brain. Hereditary forms of CAA exist but sporadic CAA is much more frequent. Deposition of Aβ induces degenerative changes of the cerebral vascular system (thickening of the vessel wall, constriction of vascular lumen, microaneurysms, dissection) that trigger the development of the typical clinical presentation of CAA, that is spontaneous intracerebral haemorrhage. Apart from haemorrhages, also cerebral ischaemia, transient neurological symptoms, leukencephalopathy as well as cognitive decline and dementia can occur in association with CAA. The definite diagnosis of CAA is only possible by means of pathological examination, even though neuroimaging and clinical findings allow the diagnosis of a probable CAA. Currently, no specific causal therapy exists. Although CAA is located in the range of neurological diseases psychiatric symptoms might occur. In the review, we discuss epidemiological, pathogenetic, clinical and diagnostic aspects and possible psychiatric implications of CAA.

Characteristic clinical presentation and CSF biomarker pattern in cerebral small vessel disease

To be able to live a good, independent life cognitive functions need to be intact. Dementia, stroke and neuropsychiatric disorders are the major disorders underlying disability. Stroke is usually a consequence of an underlying vessel wall disease that has lasted for a longer period. This vessel wall disease is commonly silent or without prominent symptoms. Damage to the small penetrating arterioles of the brain, arteriolosclerosis, induced by aging and hypertension, as well as other factors such as diabetes and genetic vulnerability, plays an important role in the origin of white matter changes. The pathological vascular wall process leads to lumen constriction, impaired ability to change lumen diameter according to metabolic needs and possible ischemic–hypoxic tissue damage in the vulnerable vascular architectural terminal areas of the long penetrating arteries. The arteriolosclerotic blood vessels are associated with inflammation and remodelling of the extracellular matrix. Enzymes connected to this process have also been found to be involved in demyelination and blood brain barrier opening but also in the repair process of angiogenesis and neurogenesis. Biochemical changes reflecting these processes might be early indicators of small vessel disease and hence increase the knowledge about the disease characteristic mechanisms. Moreover, monitoring disease modifying treatment effects can be an important application for small vessel disease specific biochemical markers.

Cellular level characterization of capillary regression in inflammatory angiogenesis using an in vivo corneal model

In this study, we introduce a technique for repeated, microscopic observation of single regressing capillaries in vivo in inflamed murine corneas. Natural capillary regression was initiated by removal of inflammatory stimulus during an active pro-angiogenic phase, while the additional impact of anti-angiogenic treatment with triamcinolone or bevazicumab was investigated. Capillaries regressed naturally within 1 week and treatments did not further enhance the natural regression. Morphologically, early-phase regression was characterized by significant lumen narrowing and a significant reduction in CD11b+ myeloid cell infiltration of the extracellular matrix. By 1 week, vascular remodeling occurred concomitant with CD11b+CD68+KiM2R+ mature macrophage localization on capillary walls. Empty conduits without blood flow, positive for collagen IV and devoid of vascular endothelium and pericytes, were apparent in vivo and by 3 weeks were more numerous than perfused capillaries. By 3 weeks, macrophages aggregated around remaining perfused capillaries and were observed in apposition with degrading capillary segments. Abrupt termination of capillary sprouting in our regression model further revealed vascular endothelial abandonment of sprout tips and perfused capillary loop formation within a single angiogenic sprout, possibly as an intussusceptive response to cessation of the stimulus. Finally, we observed lumen constriction and macrophage localization on capillary walls in vivo in a clinical case of corneal capillary regression that paralleled findings in our murine model.

Comparison of Rates of Progression of Coronary Atherosclerosis in Patients With Diabetes Mellitus Versus Those With the Metabolic Syndrome

Diabetes mellitus (DM) and metabolic syndrome (MS) are associated with adverse cardiovascular outcomes. However, the extent and progression of coronary atherosclerosis for these conditions have not been directly compared. Three thousand four hundred fifty-nine patients with coronary artery disease underwent serial evaluation of atheroma burden by intravascular ultrasound. Patients with DM, MS, or neither diagnosis were compared with regard to plaque burden, progression, and arterial remodeling. Among the 3 groups, patients with MS had the largest number of individual cardiovascular risk factors. Patients with DM demonstrated more extensive atherosclerosis burden with a greater percent atheroma volume compared to patients with MS or those with neither diagnosis (40.3 +/- 9.0%, 37.6 +/- 8.9%, and 38.1 +/- 9.1%, p <0.001) and total atheroma volume (198.3 +/- 85.9, 190.7 +/- 85.0, and 186.3 +/- 79.1 mm(3), p = 0.05). MS compared to neither diagnosis was accompanied by expansion of the external elastic membrane (501.3 +/- 174.3 vs 484.4 +/- 160.7 mm(3), p = 0.02), whereas DM was associated with lumen constriction (290.6 +/- 111.7 vs 298.1 +/- 105.5 mm(3), p <0.0001). On serial evaluation, DM, but not MS, was associated with greater progression of percent atheroma volume compared to neither diagnosis (+0.8 +/- 0.3, +0.3 +/- 0.2, and +0.1 +/- 0.2%, p <0.0001) and total atheroma volume (-1.0 +/- 1.8, -3.3 +/- 1.8, and -4.0 +/- 1.8 mm(3), p = 0.001). Meeting criteria for MS was not associated with greater disease progression in patients with DM. In conclusion, despite having fewer individual risk factors, DM is associated with greater plaque progression and more constrictive remodeling than MS. This finding highlights the deleterious effects of DM on the arterial wall independent of its associated metabolic abnormalities.

Timing of tensor and levator veli palatini force application determines eustachian tube resistance patterns during the forced-response test

Objectives The forced-response test (FRT) is used to assess eustachian tube (ET) function in patients with middle ear disease (otitis media). This test often documents a dynamic pattern of luminal dilation and constriction during swallowing which can be quantified as a function relating active tubal resistance with time. The goal of this study is to use a generalized finite element model (FEM) to test the hypothesis that the relative timing of muscle force application by the tensor veli palatini muscle (mTVP) and levator veli palatini muscle (mLVP) on the ET determines the form of active resistance functions. Methods Seven resistance waveforms were obtained during the FRT in five adult subjects. A 2D FEM of the ET was constructed from an adult histological specimen and viscoelastic tissue mechanical properties were specified based on measurements obtained in each subject. Least-squared regression routines were used to vary the timing and magnitude of mTVP and mLVP force applications to the ET in order to match the active resistance functions recorded during the FRT. Results Variation of muscle force timing and magnitude in the FEM simulations reproduced the seven active resistance waveforms with high fidelity. Early application of mTVP force in combination with mLVP force produced a waveform characterized by an initial dilation (low resistances) followed by lumen constriction (higher resistances), while delayed mTVP force application caused an initial lumen constriction followed by dilation. Conclusions These results indicate that the active resistance waveforms observed during the FRT reflect differences in the temporal pattern of mLVP and mTVP force application to the ET and emphasize that, like the mTVP, the mLVP functionally interacts with the ET. Results also indicate that in normal adults contraction of the mLVP promotes lumen constriction and that the initial lumen constriction is highly sensitive to the relative delay timing of mTVP and mLVP force application.

Human postmenopausal ovary--hormonally inactive fibrous connective tissue or more?

The ovary undergoes several changes after the menopause. In this period, the main structural changes in both the cortex and medulla were observed. In the cortex, they included: 1) reduction of its thickness; 2) epithelial inclusions forming cysts; 3) blurring the line between medulla and cortex; 4) reduction of follicles number; 5) tendency to fragmentation of corpora albicantia; 6) surface epithelium invaginations. Whereas the changes in the medulla included: 1) fibrosis and scars in stroma; 2) architectonical changes in blood vessels with hyalinization of walls and constriction of lumen. The loss of follicles and several changes in the ovary are due to apoptotic processes. Despite age related atrophic changes, the postmenopausal ovary is not devoid of hormonal activity. Our results are coherent with the reports of other researchers, and reveal that postmenopausal ovary produces trace quantities of steroid hormones, mainly androgens, and confirm the presence of steroid receptors and activity of main enzymes involved in steroidogenesis process.

Detecting vulnerable plaque using peripheral blood: inflammatory and cellular markers.

The concept of the vulnerable patient has arrived. Enhanced diagnostic methods will eventually permit accurately finding and treating these patients and their disease. Clinical Cardiologists now recognize that coronary atherosclerosis is two pathophysiologically distinct syndromes: stable and unstable. Stable coronary syndromes result from fixed, severe stenoses limiting blood flow and causing secondary myocardial ischemia. The unstable acute coronary syndromes are frequently catastrophic and are pathophysiologically distinct. They result from different cell subsets causing vascular inflammatory syndromes rather than gradual lumen constriction by plaque. Though pathophysiologically distinct, they may show common pathophysiology when a ruptured plaque heals and progressively becomes a critical stenosis. For the present hs-CRP measurement is the strongest correlative factor for future clinical events due to arterial inflammation: myocardial infarction, unstable angina, stroke, and peripheral vascular disease in both diseased and apparently healthy, asymptomatic patients. The CRP plasma level also is the best risk assessment in patients with either stable or unstable angina, long term after myocardial infarction, and in patients undergoing revascularization therapies. One study showed the only independent cardiovascular risk indicators using multivariate, age adjusted and traditional risk analysis were CRP and Total/HDL cholesterol ratio. If CRP, IL-6, and ICAM-1 levels are added to lipid levels, risk assessment can be improved over lipids alone. The prevalence of high-risk subjects in the general population is low, amplifying diagnostic problems for vulnerable plaque. Since no test yet has high sensitivity or specificity, diagnostic errors are high, with many false positives and negatives. Sensitivity or specificity must be increased by developing a risk marker panel, or by simultaneously finding other markers that themselves are highly sensitive and specific for vulnerable plaque.

Alimentary and Respiratory Tract Lesions in Eight Medically Fragile Holstein Cattle with Bovine Leukocyte Adhesion Deficiency (BLAD)

Lesions in the alimentary tract were studied in eight medically fragile Holstein cattle homozygous for the bovine leukocyte adhesion deficiency (BLAD) allele as determined by polymerase chain reaction and restriction endonuclease analysis. These cattle received institutional medical care but died or were euthanatized because of chronic debilitation associated with diarrhea (6/8) and pneumonia (4/8). The six cattle with diarrhea had acute (n = 3) or chronic (n = 3) intestinal ulcers, but the other two remained relatively healthy for 3 years and did not develop intestinal tract ulcers. Ulcerated areas were present in the small intestine in six animals, and two of these also had ulcers in the large intestine. Ulcers were covered by thick exudates that, in chronic lesions, partially occluded the intestinal lumen. Intramural and serosal fibrosis also contributed to lumen constriction. Pseudomonas aeruginosa was isolated from the intestine of four cattle. Bovine viral disease virus and Salmonella were not isolated from the five cattle that were tested. Respiratory tract lesions consisted of dense infiltrates of neutrophils in bronchi, bronchioles, and alveoli. This study suggests that intestinal lesions are integral to the demise of BLAD cattle that receive intensive medical care and that neutrophils do infiltrate the lung and enter airway lumina, despite the adhesion deficiency.