Lumen Stenosis Research Articles

Effects of YM155 on the proliferation and apoptosis of pulmonary artery smooth muscle cells in a rat model of high pulmonary blood flow-induced pulmonary arterial hypertension

ABSTRACT Introduction Proliferation and apoptosis of pulmonary artery smooth muscle cells (PASMCs) play an important role in the occurrence and development of pulmonary arterial hypertension (PAH). The purpose of this study was to investigate the effects of survivin inhibitor YM155 on the proliferation and apoptosis of PASMCs in rats with PAH induced by high pulmonary blood flow. Methods Thirty male Sprague-Dawley (SD) rats were randomly divided into control, model, and YM155 intervention groups. A rat model of PAH induced by high pulmonary blood flow was established, and it was confirmed by assessments of right-ventricular pressure (RVP) and right ventricular hypertrophy index (RVHI). Immunohistochemical staining and western blot analysis were used to detect the expression of survivin, and the proliferation and apoptosis of PASMCs. Lastly, the effects of in vivo treatment of YM155 were tested. Results The increased expression of survivin mRNA and protein were observed in the model group, accompanied by pulmonary arteriolar wall thickening, lumen stenosis, and perivascular inflammatory cell infiltration. Elevated expression of survivin and pulmonary vascular remodeling were significantly mitigated after YM155 treatment. Specifically, the YM155 intervention group had a significantly lower PASMC proliferation rate and a higher PASMC apoptotic rate. Conclusion YM155 suppressed PASMC proliferation and promoted PASMC apoptosis by inhibiting survivin expression and thereby reducing pulmonary vascular remodeling in high pulmonary blood flow-induced PAH in vivo.

Analysis of Factors Influencing Restenosis after Percutaneous Transluminal Angioplasty

Introduction: This study aimed to analyse the influencing factors of arteriovenous fistula (AVF) ultrasound-guided restenosis after percutaneous transluminal angioplasty (PTA). Methods: This was a retrospective trial. The clinical data and ultrasound examination data of patients in maintenance haemodialysis who received ultrasound-guided PTA for AVF stenosis at our hospital from January 2018 to December 2020 were retrospectively analysed. The fistula patency and the relationship between age, dialysis age, fistula service age, combined hypertension, diabetes, hypoproteinaemia, stenosis type, fistula location, and patency rate after the operation were evaluated. Results: A total of 128 participants were evaluated. The results showed that being over 65 years old, with complications from hypertension, diabetes, and hypoproteinaemia, are all risk factors affecting the patency of postoperative internal fistulas. Compared with lumen stenosis, the patency rate of hyperplastic endothelial stenosis (p = 0.014) and thrombotic stenosis (p = 0.017) was lower, and the difference was statistically significant. The patency rate of the mixed site (p = 0.010), the anastomotic site (p = 0.041), and the cephalic vein near the anastomotic site (p = 0.018) was lower than the forearm cephalic vein, and the difference was statistically significant. Conclusion: Age, hypertension complications, diabetes complications, hypoproteinaemia, and the type and location of the AVF stenosis were essential for vascular patency of internal fistulas after PTA. Other risk factors of restenosis after PTA still need further research.

Immunomodulatory effects of icariin in a myocardial infarction mouse model

ABSTRACT Myocardial infarction (MI) is a prevalent cardiovascular disease defined by myocardial ischemia and hypoxic damage caused by plaque rupture, thrombosis, lumen stenosis, or blockage in the coronary artery. However, the development of emergency percutaneous coronary interventional therapy has enabled the rapid restoration of blood perfusion to ischemic myocardium and the rescue of dying myocardium cells. Some dying myocardium cells have caused irreversible damage and impaired cardiac function recovery in recent years. Icariin has been utilized to treat various ailments as a natural chemical extract. In this study, we employed a variety of approaches to observe MI, including western blotting, quantitative RT–PCR, immunohistochemistry, and flow cytometric analysis using icariin. As demonstrated by the research findings, icariin may prevent MI-induced cell apoptosis. This is accomplished by inhibiting proinflammatory factors via the Nrf2/HO-1 signaling pathways. These data imply that icariin may be an effective treatment for MI.

Regular heart rhythm restoration after a period of asystole: modeling in experimental cardiology

Abstract Funding Acknowledgements Type of funding sources: None. Regular heart rhythm restoration after a period of asystole: modeling in experimental cardiology Purpose To study the arterial hemodynamics during the regular heart rhythm restoration after a period of asystole using the original device for modeling of intra-arterial circulation. Materials and methods We used the device for modeling of intra-arterial circulation made by us (Document of invention № RU 202780 U1). The main part of the device is rotameter glass tube - a prototype of human arterial vessel. Electric pump with various modes of work was connected into the closed system with rotameter by flexible silicone tubes. Inside the closed system we introduced an aqueous solution of glycerin diluted to have the same viscosity as the human blood. As indicators for studying the intra-arterial hemodynamics we used intravascular piezoelectric crystal pressure sensor connected to an oscilloscope, 5 mm long silk thread alternately installed inside the tube, and a dye - clerical ink. Results With the electric pump work modes, we were able to imitate the regular heart rhythm (RR) restoration after a period of asystole inside the device for modeling of intra-arterial circulation. We observed the speed of fluid increased in comparison with the RR with the pendency: if longer pause of asystole was than more speed increased. We observed the appearance of reflected, stand waves on the walls of rotameter during the spread of the pulse wave after the long asystole pause. We alternatively put the plastic diaphragm inside the rotameter with internal lumen stenosis of 70% with symmetrical and asymmetrical hole. The speed with a RR was 3.24 m/s, after the pause of asystole 1 s speed was 4.08 m/s, after the pause 2 s speed was 7.36 m/s, after the pause 3 s speed was 9.22 m/s. The pressure measured by piezoelectrical probe increased proportionally to the speed. Conclusion Intense mechanical effect of the pressure waves after the long period of asystole can cause the additional trauma of intima of arterial vessels that can lead to non-stability of atherosclerotic plaques, stimulating of endothelial dysfunction and as a result of atherosclerosis progression with further complications. Changes in hemodynamics we characterized by proposed concept of "hydraulic shock".

Research Progress in Delayed Bleeding after Endoscopic Submucosal Dissection of Early-Stage Gastrointestinal Cancer

Endoscopic submucosal dissection (ESD) has been widely used in the clinical treatment of early-stage and precancerous lesions of the digestive tract. Compared with traditional open surgery, the procedure has a number of advantages, including low postprocedural recurrence rate, the location and scope of lesions not posing much restrictions on the procedure, and quick patients recovery afterwards. The procedure has hence become one of the minimally-invasive procedures commonly performed with gastrointestinal endoscope. However, due to the influence of various factors, complications such as intraoperative and postoperative bleeding, perforation, electrocoagulation syndrome and lumen stenosis may occur. Delayed postoperative bleeding, in particular, may induce cardiovascular and other related diseases due to the insidious nature of its onset, resulting in serious consequences. It is critically important for the further development of ESD that we should acquire thorough understanding and mastery of the relevant influencing factors and preventive measures of delayed bleeding after ESD of early-stage gastrointestinal cancer. We herein summarized and discussed the latest research findings in the preventative and treatment measures.

A novel classification of tracheal defects and the reconstruction strategies: A retrospective study based on 106 cases.

The study aims to present a novel classification of tracheal defects and the corresponding reconstruction strategies. The retrospective study was designed to analyze patients with diagnosed primary or secondary tracheal tumors from 1991 to 2020. Surgical techniques, complications and prognosis were reviewed. Airway status and patient outcomes were the principal follow-up measures. Tracheal defects were classified into two plane sizes (vertical (V) and horizontal (H) planes). Vertical defects were further categorized into three groups based on their tracheal ring numbers (V1, ≤ 5 rings; V2, 6-10 rings; and V3, > 10 rings). Tracheal defects with horizontal plane size H1 and H2 represent defects less and more than one-half the circumference of trachea. Thus, suitable reconstruction strategies were planned primarily based on "V" and "H" classifications. The reconstruction strategies performed were sleeve resection followed by an end-to-end anastomosis, window resection with sternocleidomastoid myoperiosteal flap reconstruction, defects conversion with rotation anastomosis, and modified tracheostomy with secondary flap reconstruction. A total of 106 patients diagnosed with tracheal defects were enrolled in the study, of whom 59 patients underwent sleeve resection followed by end-to-end anastomosis; 40 patients received window resection alongside sternocleidomastoid (SCM) myoperiosteal flap reconstruction; five patients received converting defects with rotation anastomosis and two patients underwent modified tracheostomy with secondary stage flap reconstruction. Lumen stenosis occurred in three V2H1 defect cases and were treated by a second reconstruction surgery. Iatrogenic unilateral recurrent laryngeal nerve paralysis occurred in two patients with the V3H2 defect type, who were treated by temporary tracheotomy and partial vocal cord resection and extubated successfully during follow-up. All 106 patients achieved airway patency with adequate laryngeal function at the end of follow-up. No anastomotic dehiscence or bleeding occurred in any patient postoperatively. Though a significant number of multicenter studies concerning the reconstruction and classification of tracheal defects are needed, the study herein provides a novel classification of tracheal defects, which is primarily developed on the defect size. Therefore, the study might serve as a potential source for identifying suitable reconstruction strategies for practitioners.

High-Risk Intracranial Atherosclerotic Stenosis Despite Aggressive Medical Treatment: Protocol for a Prospective Nested Case-Control Study

IntroductionIntracranial atherosclerotic disease (ICAD) is one of the most important etiologies of ischemic stroke, especially in Asia. Although medical treatment was recommended as the first-line therapy for ICAD, the recurrent stroke rate was still high in severe stenosis of ICAD despite aggressive medical treatment. Traditionally, the degree of luminal stenosis is used as the principal index for stroke risk stratification in patients with ICAD, while recent evidence suggested that symptomatic atherosclerotic plaques were characterized by plaque features and hemodynamics. This prospective, longitudinal, and nested case-control study aims to identify multimodal imaging predictors of high-risk patients with ICAD refractory to medical treatment and explore a refined risk stratification model based on the above multimodal imaging predictors.MethodsThis prospective, longitudinal, and nested case-control study includes 400 symptomatic patients with ICAD with 50–99% of stenosis treated with aggressive medical therapy. All patients who meet the eligibility criteria are assessed by multimodal imaging examination from three aspects, including lumen stenosis, plaque characteristics, and hemodynamic features. The enrolled patients receive aggressive medical management, including antiplatelet therapy and cardiovascular risk control. The primary outcome is ischemic stroke or death attributable to the lesion of the target vessel within 1 year. The secondary endpoints are (1) any stroke or death; (2) all-cause mortality; (3) any stroke out of the territory of the responsible lesion; (4) functional outcome with the modified Rankin Scale (mRS).Ethics and DisseminationThis study has been approved by the ethics committee of our center ([2021]083) and has been prospectively registered (Registration No: ChiCTR2100048832). Study findings will be disseminated through peer-reviewed publications and presentations at scientific meetings.

Diagnostic efficacy of CCTA and CT-FFR based on risk factors for myocardial ischemia

BackgroundCoronary artery coronary computed tomography angiography (CCTA) can observe the degree of coronary artery stenosis and fractional flow reserve (FFR) can diagnose hemodynamic abnormalities caused by coronary artery stenosis. However, noninvasive imaging examination that can both observe the above two methods at the same time has not yet been elucidated.ObjectiveTo investigate the diagnostic efficacy of CCTA and computed tomography-derived fractional flow reserve (CT-FFR) based on different risk factors for myocardial ischemia.MethodsPatients undergoing CCTA in our hospital from August 18, 2020 to April 28, 2021 were randomly selected, and the data were subjected to CT-FFR analysis. Vascular characteristics were measured, including total plaque volume, calcified plaque volume, non-calcified plaque volume, plaque length, and lumen stenosis, and the patients were categorized into a non-ischemia group (FFR > 0.8) and an ischemia group (FFR ≤ 0.8). Plaque characteristics were compared between the two groups, and logistic regression analysis was employed to explore the correlations between plaque characteristics and ischemic lesions.ResultsFrom a total of 122 patients enrolled in the study, there were 218 vascular branches with FFR > 0.8 and 174 vascular branches with FFR ≤ 0.8. There were significant group differences in total plaque volume, calcified plaque volume, plaque length, and lumen stenosis > 50% (n). The obtained data were as follows: non-ischemic group 10.57 (4.80, 259.65), ischemic group 14.87 (3.39, 424.45), Z = 9.772, p = 0.002, non-ischemic group 10.57 (0, 168.77), ischemic group 14.87 (0, 191.00), Z = 2.503, p ≤ 0.001), non-ischemic group 8.17 (37.05, 40.53), ischemic group 8.38 (56.66, 86.47), Z = 5.923, p = 0.016, and lumen stenosis > 50%, non-ischemic group 46, ischemic group 90, x2 = 14.77, p ≤ 0.001. The regression analysis results indicated that total plaque volume, calcified plaque volume, plaque length and lumen stenosis > 50% were risk factors for myocardial ischemia, with ORs and p values of (2.311, p = 0.002), (1.021, p = 0.004), (2.159, p < 0.001), and (0.181, p < 0.001), respectively.ConclusionTotal plaque volume, calcified plaque volume, plaque length and lumen stenosis > 50% are predictors for myocardial ischemia. Coronary artery CCTA combined with CT-FFR could simultaneously observe the anatomical stenosis and evaluate myocardial blood supply at the functional level. Thus, myocardial ischemia could be better diagnosed.

Non-invasive Detection of Diffuse Intracranial Vertebrobasilar Artery Stenosis: A Prospective Comparison with Digital Subtraction Angiography

The aim of this study was to prospectively evaluate diffuse intracranial vertebrobasilar artery stenosis by ultrasonic examination with digital subtraction angiography as the reference. Five hundred forty-one vertebrobasilar arteries with a normal lumen or intracranial stenosis were enrolled. Peak systolic velocity, mean flow velocity and end-diastolic velocity (EDV) at the intracranial vertebrobasilar arteries and extracranial vertebral arteries (VAs) were measured. The resistance index (RI) at extracranial VAs and the difference between the RI of extracranial VAs and the RI of the extracranial internal carotid artery (RIica) were calculated. Compared with normal arteries, all stenotic arteries were divided into the high-velocity group (focal stenosis, multiple-segment stenosis and multiple-artery stenosis) and low-velocity group (critical stenosis and long stenosis). The consistency between ultrasonic examination and digital subtraction angiography for evaluation of vertebrobasilar arteries with multiple-segment stenosis and multiple-artery stenosis was not favorable when applying the widely used Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis criteria (κ=0.442 and 0.438, respectively). The optimal low-velocity criteria for identifying intracranial vertebrobasilar arteries with critical stenosis and long stenosis were determined by receiver operating characteristic curve analysis and were as follows: EDV ≤15 cm/s and RI ≥0.68 at the extracranial VA and RIica ≥0.10.

Effect of long-term intensive cholesterol control on the plaque progression in elderly based on CTA cohort study.

To investigate the long-term effects of intensive LDL cholesterol-lowering treatments on lumen stenosis severity, plaque calcification, spotty calcifications, percent calcified plaque volume (PCPV), and Agatston coronary artery calcium score (CACS) based on coronary computed tomography angiography (CCTA) in elderly patients. A total of 240 patients over 60 years old (comprising 754 lesions) who underwent serial CCTA were retrospectively enrolled in this 5-year cohort study. Patients were divided into three groups: an intensive lipid-lowering group, a lipid-lowering group, and a control group. The stenosis severity, plaque volume (PV), plaque composition, PCPV, and high-risk plaque (HRP) presence were quantitatively analyzed. The CACS was calculated at baseline and follow-up. All patients were male with an average age of 66.8 ± 5.8 years old. Over time, increases in the percentages of obstructive coronary lesions (p < 0.001) were observed. Compared with those at baseline, the percentage of obstructive lesions remained unchanged (p = 0.077), and the percentage of spotty calcifications significantly decreased (p < 0.05) at the follow-up CCTA scan in the intensive lipid-lowering group. Patients in the intensive lipid-lowering group demonstrated a higher progression in calcified PV, CACS, and PCPV (all p < 0.05), and a significantly greater attenuation in fibrous-fatty and lipid-rich PV (all p < 0.05) than patients in other groups. The PV and contents increased gradually with time in all groups. Intensive LDL-C lowering was associated with slower progression of stenosis severity and reduction of high-risk plaque features, with increased plaque calcification and higher progression in PCPV. Comprehensive serial plaque evaluations by CCTAs may contribute to further refinement of risk stratification and reasonable lipid-lowering treatment in elderly patients. • Intensive LDL-C lowering increased coronary calcification and percent calcified plaque volume progression. • Comprehensive serial plaque evaluations by serial CCTAs may help to refine risk stratification.

Novel brain computed tomography perfusion for cerebral malperfusion secondary to acute type A aortic dissection.

OBJECTIVESThe management of acute type A aortic dissection with malperfusion syndrome remains challenging. To evaluate preoperative condition, symptoms might be subjective and objective evaluation of cerebral artery has not yet been established. For quantitative evaluation, this study focused on brain computed tomography perfusion (CTP), which has been recommended by several guidelines of acute ischaemic stroke.METHODSIn the last 2 years, 147 patients hospitalized due to acute type A aortic dissection were retrospectively reviewed. Among the 23 (16%) patients with cerebral malperfusion, 14 who underwent brain CTP (6 preoperative and 8 postoperative) were enrolled. CTP parameters, including regional blood flow and time to maximum, were automatically computed using RApid processing of Perfusion and Diffusion software. The median duration from the onset to hospital arrival was 129 (31–659) min.RESULTSAmong the 6 patients who underwent preoperative CTP, 4 with salvageable ischaemic lesion (penumbra: 8–735 ml) without massive irreversible ischaemic lesion (ischaemic core: 0–31 ml) achieved acceptable neurological outcomes after emergency aortic replacement regardless of preoperative neurological severity. In contrast, 2 patients with an ischaemic core of >50 ml (73, 51 ml) fell into a vegetative state or neurological death due to intracranial haemorrhage. CTP parameters guided postoperative blood pressure augmentation without additional supra-aortic vessel intervention in the 8 patients who underwent postoperative CTP, among whom 6 achieved normal neurological function regardless of common carotid true lumen stenosis severity.CONCLUSIONSCTP was able to detect irreversible ischaemic core, guide critical decisions in preoperative patients and aid in determining the blood pressure augmentation for postoperative management focusing on residual brain ischaemia.

Modeling of intra-arterial hemodynamics in main arteries atherosclerosis

Abstract Funding Acknowledgements Type of funding sources: None. Aim. To study intra-arterial hemodynamics of the main arteries in atherosclerosis using the original device for modeling of intra-arterial circulation. Material and methods. To study hemodynamics inside an arterial vessel, we used an original device developed by us for modeling of intra-arterial circulation (Document of invention № RU 202780 U1). The main part of the device is a prototype of an artery - a glass tube of a rotameter with a length of 365 mm, an inlet end with a diameter of 20 mm, an outlet end - 16.5 mm. Flexible silicone tubes are attached to the rotameter on both sides, with free ends connected to an electric pump, with various modes of work (imitation of pulse waves at the regular rhythm (RR), extrasystole (ES), atrial fibrillation (AF)). An aqueous solution of glycerin was introduced into a closed system diluted with water corresponding to the viscosity of the blood. A 5 mm long silk thread was alternately installed inside the tube, an intravascular piezoelectric crystal pressure sensor connected to an oscilloscope was injected with a dye - clerical ink. Plastic diaphragms 15 mm long with stenosis of the internal lumen of 50%, 70%, and 90% were alternately hermetically installed in the rotameter. Results. When imitating ES in the first post-extrasystolic contraction (1PEC), the speed of fluid flow through the diaphragms increased in the 1PEC in comparison with the RR. So, with a stenosis of 50%, the speed with a RR was 2.09 m/s, with an ES 0.03 m/s, with 1PEC 3.83 m/s; with 70% stenosis, the speed at RR 3.24 m/s, with ES 0.04 m/s, with 1PEC 5.26 m/s; with 90% stenosis, the speed at RR 8.96 m / s, with ES 0.10 m/s, with 1PEC 12.36 m/s. The pressure increased proportionally to the speed. We observed the appearance of reflected, standing waves in the edge zones of the diaphragm and a turbulent flow of liquid behind the diaphragm. Conclusion. These changes in hemodynamics are characterized by the concept of "hydraulic shock". Intense mechanical effect of 1PEC pressure waves in the marginal zones of the diaphragm can contribute to the further growth and progression of atherosclerosis in arterial vessels. Abstract Figure.

TAK1 accelerates transplant arteriosclerosis in rat aortic allografts by inducing autophagy in vascular smooth muscle cells

Background and aimsThe proliferation and migration of vascular smooth muscle cells (VSMCs) are fundamental hallmarks of vasculopathy. Transforming growth factor β-activated kinase-1 (TAK1) plays a crucial role in mediating cellular functions, including autophagy, which has been recently linked to the regulation of VSMC functions and the development of vasculopathy. This study aims to better dissect how TAK1 controls VSMC proliferation and migration. MethodsA rat model of graft arteriosclerosis was employed to explore the influence of TAK1 signaling activation on VSMC proliferation, migration, autophagy, and neointima formation in vivo. Knockdown and pharmacological inhibition of TAK1 were utilized in cultured VSMCs to investigate the mechanisms underlying the progression of VSMC proliferation and migration. ResultsIncreased phosphorylation of TAK1 (Thr-184/Thr-187) was examined in SMα-actin positive cells in the medial and neointimal lesions of aortic allografts. Lentivirus-mediated Tak1 shRNA transfection of aortic allografts robustly suppressed neointimal formation and lumen stenosis, as well as autophagy and cell proliferative responses. In cultured PDGF-BB-incubated VSMCs, genetic and pharmacological inhibition of TAK1 markedly attenuated autophagy activation, and blocked the progression of cell cycle, proliferation, and migration responses. ConclusionsActivation of TAK1 in VSMCs in the setting of aortic transplantation is an early and critical event in VSMC proliferation and migration, as well as neointima formation, because it controls autophagy activation, constituting a potential molecular mechanism and target for preventing transplant vasculopathy.

PECAM1, COL4A2, PHACTR1, and LMOD1 Gene Polymorphisms in Patients with Unstable Angina.

Coronary artery disease (CAD) is a syndrome resulting from myocardial ischaemia of heterogeneous pathomechanism. Environmental and genetic factors contribute to its development. Atherosclerotic plaques that significantly narrow the lumen of coronary arteries cause symptoms of myocardial ischaemia. Acute coronary incidents are most often associated with plaque rupture or erosion accompanied by local activation of the coagulation system with thrombus formation. Plaque formation and stability are influenced by endothelial function and vascular smooth muscle cell function. In this study, we investigated the association between polymorphisms in genes affecting endothelial and vascular smooth muscle cell (VSMC) function and the occurrence of unstable angina pectoris. The aim of this study was to evaluate the association between the PECAM1 (rs1867624), COL4A2 (rs4773144), PHACTR1 (rs9349379) and LMOD1 (rs2820315) gene polymorphisms and the risk of unstable angina. The study included 232 patients with unstable angina diagnosed on the basis of clinical symptoms and coronary angiography and 144 healthy subjects with no significant coronary lumen stenosis at coronary angiography. There were no statistically significant differences in the distribution of COL4A2 rs4773144 and PECAM1 rs1867624 gene polymorphisms between patients with unstable angina and control subjects. In patients with unstable angina, there was an increased frequency of PHACTR1 rs9349379 G allele carriers (GG and AG genotypes) (GG+AG vs. AA, OR 1.71; 95% CI 1.10–2.66, p = 0.017) and carriers of the LMOD1 rs2820315 T allele (TT and CT genotypes) (TT+CT vs. CC, OR 1.65; 95% CI 1.09–2.51, p = 0.019) compared to the control group. The association between these alleles and unstable angina was confirmed by multivariate logistic regression analysis, in which the number of G (PHACTR1 rs9349379) and T (LMOD1 rs2820315) alleles was an independent risk factor for unstable angina. The results suggest an association between PHACTR1 rs9349379 and LMOD1 rs2820315 polymorphisms and the risk of unstable angina.

Improved Outcomes of Combined Main Branch Stenting and Side Branch Drug-Coated Balloon versus Two-Stent Strategy in Patients with Left Main Bifurcation Lesions.

Background Drug-eluting stent (DES) plus drug-coated balloon (DCB) is a safe and effective treatment strategy for coronary artery bifurcation lesions, but there is no report about this strategy being used for left main (LM) bifurcation lesions. We aim to explore the efficacy and safety of DES plus DCB in the treatment of LM bifurcation lesions. Methods A total of 100 patients diagnosed with LM bifurcation lesions by coronary angiography were retrospectively enrolled at our center from January 2018 to December 2019. They received either a two-stent strategy or a main branch (MB) stenting plus side branch (SB) DCB strategy and were accordingly divided into the 2-DES group and the DES + DCB group. Patients treated with DES + DCB were compared with a cohort of matched patients treated with a 2-DES strategy. Clinical data was collected and quantitative coronary analysis was performed. Results For immediate postoperative angiography, though the two groups had no differences in the minimal luminal diameter (MLD) and luminal stenosis of MB, the DES + DCB group had significantly lower SB ostial MLD and a higher degree of residual lumen stenosis than the 2-DES group (P < 0.05). At the time of follow-up, the SB ostial MLD of the DES + DCB group was higher than that of the 2-DES group, but lumen stenosis, late lumen loss (LLL), and LLL at the distal end of the left MB were all smaller than those of the 2-DES group (Ps < 0.05). Furthermore, the incidence of lumen restenosis and MACE between the two groups had no significance. Conclusion The combination of DES and DCB is relatively safe and effective for the treatment of LM bifurcation lesions, and this strategy seems to have advantages in reducing LLL at the SB ostium.

Efficacy of Wen-Dan Decoction in the treatment of patients with coronary heart disease: A protocol for systematic review and meta-analysis.

Background:Coronary heart disease (CHD) is a heart disease caused by myocardial ischemia, hypoxia or necrosis due to stenosis or occlusion of lumen caused by coronary atherosclerosis. It belongs to ischemic cardiomyopathy and is more common in clinic. Previous studies have shown that Wen-Dan Decoction (WDD) is safe and effective, but there is a lack of systematic reviews. The purpose of this study is to systematically study the efficacy of WDD in the treatment of patients with CHD.Methods:We will search the following databases: PubMed, EMBASE, Web of Science, Central, Chinese databases China Biomedical Literature, Wanfang Chinese digital periodical and conference database (Wanfang Database), China National Knowledge Infrastructure database, and VIP Chinese Science and Technique Journals Database (VIP) from inception to August 2021. All published randomized controlled trials related to this study will be included. The ongoing or unpublished trials will be searched from National Institutes of Health clinical registry Clinical Trials, International Clinical Trials Registry Platform and the Chinese clinical trial registration platform. Two researchers separately screened the literature and extracted data. The primary outcome is total effective rate. The RevMan V5.3 will be used to evaluate literature and data analysis synthesis.Results:This study will provide a reliable evidence-based basis for the clinical application of WDD in the treatment of patients with CHD.Conclusion:The effectiveness of WDD for CHD will be evaluated.Unique INPLASY number:2021110001

Safety and Efficacy of Drug-Coated Balloons in Patients with Acute Coronary Syndromes and Vulnerable Plaque.

BackgroundPercutaneous coronary intervention (PCI) is the main treatment option for acute coronary syndromes (ACS) often related to the progression and rupture of vulnerable plaques. While drug-eluting stents (DES) are now routinely used in PCI, drug-coated balloons (DCB) are a new strategy to PCI and their practice in the treatment of ACS with vulnerable plaques has not been reported. This study aimed to evaluate the safety and efficacy of DCB in ACS complicated with vulnerable plaque lesions.Methods123 patients were retrospectively analyzed and diagnosed with ACS and given PCI in our Cardiology Department from December 2020 to July 2022. Vulnerable plaques were confirmed by intravenous ultrasound (IVUS) in all patients. According to individual treatment plan, patients were entered into either DCB (n = 55) or DES (n = 68) groups. The results of coronary angiography and IVUS before and immediately after percutaneous coronary intervention were analyzed. The occurrence of major adverse cardiovascular events (MACE) and the results of coronary angiography were also evaluated during follow-up.ResultsThere were no significant differences in baseline clinical characteristics, preoperative minimal luminal diameter (MLD), and preoperative diameter stenosis (DS) between the two groups. Also, there were no differences in IVUS plaque burden (PB), vessel area, and lumen area in the two groups before and immediately after PCI. The efficacy analysis showed that immediately after PCI, the DCB group had smaller MLD and higher degrees of lumen stenosis than the DES group (P < 0.05). However, during follow-up, no significant differences in MLD and DS were seen in two groups; relatively, late loss in luminal diameter（LLL）in the DCB group was smaller (P＜0.05). Safety analysis showed that during follow-up, 9 patients developed restenosis after DCB implantation while restenosis occurred in 10 patients with DES treatment, no statistical difference in the incidence of restenosis in the two groups. Besides, there was no statistical difference in the incidence of major adverse cardiac events（MACE）during hospitalization and follow-up in the DCB group (7.3% (4/55)) and the DES group (8.8% (6/68)).ConclusionDCB is safe and effective for ACS complicated with vulnerable plaque and has an advantage over DES in LLL.

Clinical presentation, risk factors, and coronary angiographic profile of very young adults (≤30 years) presenting with first acute myocardial infarction at a tertiary care center in Rajasthan, India

Introduction: Acute coronary syndrome (ACS) in very young adults with age ≤30 years is rare. In India, the prevalence of acute myocardial infarction (AMI) in this population is &lt;2%. ACS leads to significant effects on patient's psychology, morbidity, and increased financial burden when it occurs at this young age. Young patients with ACS on coronary angiography (CAG) show a relatively increased incidence of single-vessel disease and nonobstructive stenosis. Materials and Methods: This retrospective observational study was conducted at the Department of Cardiology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan. The medical records of very young adults (≤30 years of age) with first AMI between September 2019 to August 2021 were collected and analyzed. Results: Twenty-two very young adult patients aged ≤30 years were admitted with first AMI. Most of the patients were within the age group of 25–30 years. Mean patient age was 27.63 ± 2.03 years and 21 patients (95.4%) were men. Regarding the risk factors for coronary artery disease (CAD), smoking was the most common (54.5%) in young patients. Dyslipidemia and family history of premature CAD were present in 8 (36.3%) and 6 (27.2%) of patients. The most common symptom in patients was chest pain (90.9%). Obstructive CAD (vessel lumen stenosis ≥ 70%) was found in 18 (81.8%) patients. Conclusion: Very young adults presented with less extensive CAD as compared to elderly likely due to less atherosclerosis of the coronary arteries in them. The major modifiable risk factors in very young Indian population are smoking and dyslipidemia. Primary prevention by educating the public about the effects of smoking, unhealthy dietary habits, and sedentary lifestyle in early years of life may help to prevent the development of cardiac problems later in life.

Characterization of atherosclerotic plaques in blood vessels with low oxygenated blood and blood pressure (Pulmonary trunk): role of growth differentiation factor-15 (GDF-15)

BackgroundGrowth differentiation factor (GDF)-15 is linked to inflammation, cancer, and atherosclerosis. GDF-15 is expressed in most tissues but is extremely induced under pathological conditions. Elevated serum levels are suggested as a risk factor and a marker for cardiovascular diseases. However, the cellular sources and the effects of GDF-15 on the cardiovascular system have not been completely elucidated including progression, and morphology of atherosclerotic plaques. Thus, this work aimed to characterize the influence of GDF-15 deficiency on the morphology of atherosclerotic plaques in blood vessels with low-oxygen blood and low blood pressure as the pulmonary trunk (PT), in hypercholesterolemic ApoE−/− mice.MethodsGDF-15−/− ApoE−/− mice were generated by crossbreeding of ApoE−/−- and GDF-15−/− mice. After feeding a cholesterol-enriched diet (CED) for 20 weeks, samples of the brachiocephalic trunk (BT) and PT were dissected and lumen stenosis (LS) was measured. Furthermore, changes in the cellularity of the PT, amounts of apoptosis-, autophagy-, inflammation- and proliferation-relevant proteins were immunohisto-morphometrically analyzed. Additionally, we examined an atherosclerotic plaque in a human post mortem sample of the pulmonary artery.ResultsAfter CED the body weight of GDF-15−/−ApoE−/− was 22.9% higher than ApoE−/−. Double knockout mice showed also an 35.3% increase of plasma triglyceride levels, whereas plasma cholesterol was similar in both genotypes. LS in the BT and PT of GDF-15−/−ApoE−/− mice was significantly reduced by 19.0% and by 6.7% compared to ApoE−/−. Comparing LS in PT and BT of the same genotype revealed a significant 38.8% (ApoE−/−) or 26.4% (GDF-15−/−ApoE−/−) lower LS in the PT. Immunohistomorphometry of atherosclerotic lesions in PT of GDF-15−/−ApoE−/− revealed significantly increased levels (39.8% and 7.3%) of CD68 + macrophages (MΦ) and α-actin + smooth muscle cells than in ApoE−/−. The density of TUNEL + , apoptotic cells was significantly (32.9%) higher in plaques of PT of GDF-15−/−ApoE−/− than in ApoE−/−. Analysis of atherosclerotic lesion of a human pulmonary artery showed sm-α-actin, CD68+, TUNEL+, Ki67+, and APG5L/ATG+ cells as observed in PT. COX-2+ and IL-6+ immunoreactivities were predominantly located in endothelial cells and subendothelial space. In BT and PT of GDF15−/−ApoE−/− mice the necrotic area was 10% and 6.5% lower than in ApoE−/−. In BT and PT of GDF15−/−ApoE−/− we found 40% and 57% less unstable plaques than ApoE−/− mice.ConclusionsAtherosclerotic lesions occur in both, BT and PT, however, the size is smaller in PT, possibly due to the effect of the low-oxygen blood and/or lower blood pressure. GDF-15 is involved in atherosclerotic processes in BT and PT, although different mechanisms (e.g. apoptosis) in these two vessels seem to exist.

Gastropatia hipertrófica pilórica crônica: Revisão

There are two forms of chronic pyloric hypertrophic gastropathy (GHPC), the first one being of congenital origin, which is the benign pyloric muscle hypertrophy, where the increase in cell volume occurs in the cells of the muscle layer; and the second one being acquired, which consists of hypertrophy of the mucosa of the gastric antrum, where this increase occurs in the mucous layer; both cause delayed gastric emptying as it results in stenosis of the pyloric lumen. This work aims to bring the literature review of both forms of GHPC. The definitive diagnosis of both is made from complementary imaging exams, especially endoscopy and biopsy; it’s very important to make the differential diagnosis for other diseases that present similar clinical signs, where the main one is vomiting right after the meal. The treatment of choice is surgical correction using the pyloroplasty technique, which requires monitoring the patient in the post-surgical period and the prognosis is usually favorable.