Vessels In Women Research Articles

Sex-specific inequalities in the use of drug-coated balloons for small coronary artery disease: a report from the BASKET-SMALL 2 trial

Background and objectivesRecent data have established non-inferiority of drug-coated balloons (DCB) compared to drug-eluting stents (DES) for treatment of small-vessel coronary artery disease. Since coronary vessels in women might have anatomical and pathophysiological particularities, the safety of the DCB strategy among women compared to men needs to be assessed in more detail.MethodsIn BASKET-SMALL 2, patients with de novo lesions in coronary vessels < 3 mm and an indication for percutaneous coronary intervention were randomly allocated (1:1) to DCB vs. DES after successful lesion preparation. The primary objective of the randomized trial was to establish non-inferiority of DCB vs. DES regarding major adverse cardiac events (MACE; i.e., cardiac death, non-fatal myocardial infarction, and target vessel revascularization) after 12 months. The aim of the current sub-analysis is to evaluate whether the DCB strategy is equally safe among women and men after 12 and 36 months.ResultsAmong 758 randomized patients, 382 were assigned to DCB (23% women) and 376 to DES (30% women). In general, women were older, had more often diabetes mellitus and renal insufficiency, and presented more often with an acute coronary syndrome, whereas men were more often smokers, had multivessel disease and a previous history of acute myocardial infarction, and received a treatment with a statin. After 3 years, the primary clinical end point was not significantly different between groups (13% women vs. 16% men, HR 0.82; 95% CI 0.52−1.30; p = 0.40). There was no interaction between sex and coronary intervention strategy regarding MACE at 36 months (10% women vs. 16% men in DCB, 16% women vs. 15% men in DES; pinteraction = 0.31).ConclusionIn small native coronary artery disease, there was no statistically significant effect of sex on the difference between DCB and DES regarding MACE up to 36 months.Clinical trial registrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT01574534.Graphical abstractCAD coronary artery disease, MACE major adverse cardiovascular events, HR Hazard ratio, DCB drug-coated balloon, DES drug-eluting stent

Sex-specific Inequalities in the Treatment of Severely Calcified Coronary Lesions: A Sub-analysis of the PREPARE-CALC Trial.

Background: Coronary vessels in women may have anatomical and histological particularities. The aim of this study was to investigate sex-specific characteristics and outcomes of patients with calcified coronary arteries in the Prepare-CALC (Comparison of Strategies to Prepare Severely Calcified Coronary Lesions) trial. Methods: The Prepare-CALC trial randomised patients with severe coronary calcification to coronary lesion preparation either using modified balloons (MB; cutting or scoring) or rotational atherectomy (RA). Results: Of 200 randomised patients, 24% were women. Strategy success in general was similar between women (93.8%) and men (88.2%; p=0.27). For men, strategy success was significantly more common with an RA-based strategy than an MB-based strategy (98.7% in the RA group versus 77.3% in the MB group, p<0.001), whereas for women there was no evidence of a significant difference in strategy success between RA and MB (95.7% in the RA group versus 92% in the MB group, p>0.99, p for interaction between sex and treatment strategy=0.03). Overall, significant complications such as death, MI, stent thrombosis, bypass operation and perforations were rare and did not differ significantly by gender or treatment strategy. Plaque rupture and disrupted calcified nodules were more common in women. Conclusion: In a well-defined patient population with severely calcified coronary arteries, lesion preparation with an RA-strategy was superior to an MB-strategy in men. For women, both RA and MB strategies appear to have a similar success rate, although definitive conclusions are limited due to the small number of women in the trial.

Is the pace of decline in cardiovascular mortality decelerating in Spain?

Introduction and objectivesTo update the information on mortality from cardiovascular diseases and assess recent trends in Spain. MethodsDeaths from cardiovascular diseases (codes I20-I25, I50, I05-I09, I00-I02, I26-I49, I51, I52, I60-I69, I10-I15, and I70-I79 of the 10th revision of the International Classification of Diseases and Causes of Death) were obtained from the National Statistics Institute. Trends were analyzed using Joinpoint regression models. The results revealed the years (periods) composing each trend, as well as the annual percent change for each of them. The direction and magnitude of recent trends (last available 5-year period) were assessed by using the average annual percent change. ResultsThe decline in mortality rates from cardiovascular diseases slowed from −3.7% and −4.0% in 1999-2013 to −1.7% and −2.2% since 2013 in men and women, respectively. During the study period (1999-2018) all the analyzed causes decreased significantly. Nevertheless, recent trends differed according to age, sex, and the cause analyzed. Truncated rates (35-64 years) slowed (cardiovascular disease and stroke in men and ischemic heart disease in both sexes), stabilized (cardiovascular disease, stroke, and other heart diseases in women, and blood vessel disease in men), or increased (other diseases of the heart in men and diseases of the blood vessels in women). ConclusionsIn Spain, as in other countries, the reduction in mortality rates from cardiovascular diseases slowed (overall rates for both sexes and truncated in men) or stabilized (truncated rates in women) from 2014 to 2018.

Функциональное состояние сосудистой стенки и плазменного звена гемостаза у женщин раннего постменопаузального периода на фоне длительной менопаузальной гормональной терапии

Цель исследования: оценка изменений функциональной активности сосудистой стенки и плазменного звена гемостаза у женщин раннего постменопаузального периода на фоне длительной низкодозовой менопаузальной гормональной терапии (МГТ). Материалы и методы: Обследовано 162 женщины в ранней постменопаузе. В основную группу вошли 84 пациентки, которым была назначена низкодозовая МГТ: 1 мг 17β-эстрадиола (E2) и 2 мг дроспиренона (ДРСП) — препарат Анжелик® (Байер Фарма, Германия). Контрольную группу составили 78 женщин, не получавших МГТ. Длительность наблюдения составила 5,2 [4,8; 5,7] лет. Исследовали антитромбогенную активность сосудистой стенки, лабораторные маркеры эндотелиальной дисфункции. Результаты: Несмотря на увеличение агрегационной активности тромбоцитов и более низкие значения активности антитромбина III у женщин на фоне МГТ, не было отмечено увеличения риска развития венозного тромбоза и эмболий, ишемического инсульта и случаев острого коронарного синдрома. К окончанию наблюдения установлено снижение антиагрегационного потенциала сосудистой стенки, более выраженное у женщин группы кон-троля. У женщин, принимавших МГТ, выявлено снижение концентрации фибриногена крови к окончанию исследования. На фоне МГТ отмечено значимое возрастание уровня метаболитов оксида азота, снижение уровней эндотелина-1 и асимметричного диметиларгинина к 12 мес наблюдения, но в дальнейшем отмечено повышение их уровней, не достигшее исходных значений. Заключение: Изменения функциональной активности эндотелия свидетельствуют об отсутствии негативного влияния на эндотелий сосудов длительной низкодозовой МГТ (1 мг E2/2 мг ДРСП). Objectives: to assess changes in the functional activity of the vascular wall and plasma hemostasis in women of early postmenopausal period under long-term low-dose menopausal hormone therapy (MHT). Patients/Methods: We examined 162 women in early postmenopause. The main group included 84 patients; they were prescribed a low-dose MHT: 1 mg of 17β-estradiol (E2) and 2 mg of drospirenone (DRSP) — Angelique® (Bayer Pharma, Germany). The control group consisted of 78 women did not taking MHT. The duration of observation was 5.2 [4.8; 5.7] years. Antithrombogenic activity of the vascular wall and laboratory markers of endothelial dysfunction were examined. Results: In women taking MHT we found increasing of platelet aggregation activity and lower antithrombin III activity, but did not reveal increased risk of venous thrombosis and embolism, ischemic stroke, and cases of acute coronary syndrome. By the end of observation decreasing of antiplatelet potential of the vascular wall, more expressed in women of the control group, was noted. In women taking MHT, blood fi brinogen concentration decreased by the end of the study. After 12 months of observation in women taking MHT we revealed significant increasing of nitric oxide metabolites, decreasing of endothelin-1 and asymmetric dimethylarginine; later their levels increased but did not reach the initial values. Conclusions: Changes in endothelial functional activity showed no adverse effect of long-term low-dose MHT (1 mg E2/DRSP 2 mg) on the vascular endothelium.

¿Se está desacelerando el ritmo de disminución de la mortalidad cardiovascular en España?

Introduction and objectivesTo update the information on mortality from cardiovascular diseases and assess recent trends in Spain. MethodsDeaths from cardiovascular diseases (codes I20-I25, I50, I05-I09, I00-I02, I26-I49, I51, I52, I60-I69, I10-I15, and I70-I79 of the 10th revision of the International Classification of Diseases and Causes of Death) were obtained from the National Statistics Institute. Trends were analyzed using Joinpoint regression models. The results revealed the years (periods) composing each trend, as well as the annual percent change for each of them. The direction and magnitude of recent trends (last available 5-year period) were assessed by using the average annual percent change. ResultsThe decline in mortality rates from cardiovascular diseases slowed from −3.7% and −4.0% in 1999-2013 to −1.7% and −2.2% since 2013 in men and women, respectively. During the study period (1999-2018) all the analyzed causes decreased significantly. Nevertheless, recent trends differed according to age, sex, and the cause analyzed. Truncated rates (35-64 years) slowed (cardiovascular disease and stroke in men and ischemic heart disease in both sexes), stabilized (cardiovascular disease, stroke, and other heart diseases in women, and blood vessel disease in men), or increased (other diseases of the heart in men and diseases of the blood vessels in women). ConclusionsIn Spain, as in other countries, the reduction in mortality rates from cardiovascular diseases slowed (overall rates for both sexes and truncated in men) or stabilized (truncated rates in women) from 2014 to 2018.

UTERINE FIBROIDS IMPACT ON FERTILITY AND PREGNANCY OUTCOME

The clinical confirmation of the relationship between uterine leiomyoma and female infertility is of interest to scholars. The aim of our research was to study obstetric history and the level of sex hormones in women of reproductive age with leiomyoma. Materials and methods. The main group consisted of 90 women of reproductive age with uterine leiomyoma, the control group - 45 healthy women. Gynaecological and obstetric history, hormone content in peripheral blood and pelvic vessels (estradiol, progesterone) were analysed. Statistical processing of clinical material was performed using Microsoft Excel, Statistica 7.0, and Statistica 8.0 for Windows. Results. The frequency of infertility in the surveyed women with LM was 18.9 %. One in three patients in the main group (33.3 %) did not give birth, which was statistically different from the healthy women group. In this case, 25.6 % of women in the main group did not use any methods of contraception. It was found that 51.11 % of patients with LM had threatened miscarriage in their history, 37.5 % – complicated delivery. Pathological changes in the concentrations of estradiol and progesterone in the preferential blood and blood vessels of women with fibroids have been identified. We have found that the content of sex hormones in the local bloodstream has a reliable relationship with the location of the myomatous node. Conclusion. The obtained results may indicate that leiomyoma contributes to the reduction of fertility. This is evidenced by the fact that women with LM are more likely to have the risk of miscarriage, complicated delivery and delivery by caesarean section, including complicated one. The findings have made a significant contribution to the further development of effective strategies for the prevention and treatment of infertility in women with fibrotic uterine lesions.

Gender differences in the diagnostic performance of machine learning coronary CT angiography-derived fractional flow reserve -results from the MACHINE registry

PurposeThis study investigated the impact of gender differences on the diagnostic performance of machine-learning based coronary CT angiography (cCTA)-derived fractional flow reserve (CT-FFRML) for the detection of lesion-specific ischemia. MethodFive centers enrolled 351 patients (73.5% male) with 525 vessels in the MACHINE (Machine leArning Based CT angiograpHy derIved FFR: a Multi-ceNtEr) registry. CT-FFRML and invasive FFR ≤ 0.80 were considered hemodynamically significant, whereas cCTA luminal stenosis ≥50% was considered obstructive. The diagnostic performance to assess lesion-specific ischemia in both men and women was assessed on a per-vessel basis. ResultsIn total, 398 vessels in men and 127 vessels in women were included. Compared to invasive FFR, CT-FFRML reached a sensitivity, specificity, positive predictive value, and negative predictive value of 78% (95%CI 72–84), 79% (95%CI 73–84), 75% (95%CI 69–79), and 82% (95%CI: 76–86) in men vs. 75% (95%CI 58–88), 81 (95%CI 72–89), 61% (95%CI 50–72) and 89% (95%CI 82–94) in women, respectively. CT-FFRML showed no statistically significant difference in the area under the receiver-operating characteristic curve (AUC) in men vs. women (AUC: 0.83 [95%CI 0.79–0.87] vs. 0.83 [95%CI 0.75–0.89], p = 0.89). CT-FFRML was not superior to cCTA alone [AUC: 0.83 (95%CI: 0.75–0.89) vs. 0.74 (95%CI: 0.65–0.81), p = 0.12] in women, but showed a statistically significant improvement in men [0.83 (95%CI: 0.79–0.87) vs. 0.76 (95%CI: 0.71–0.80), p = 0.007]. ConclusionsMachine-learning based CT-FFR performs equally in men and women with superior diagnostic performance over cCTA alone for the detection of lesion-specific ischemia.

Anatomical variations of the subscapular pedicle and its terminal branches: an anatomical study and a reappraisal in the light of current surgical approaches

While anatomical variations of the subscapular vessels are frequently encountered during axillary dissection, little is found in the literature. The aim of this cadaveric study was to define arterial and venous anatomical variations and frequencies of the subscapular vascular pedicle and its terminal/afferent vessels in women. We performed 80 dissections of the axillary region on forty female formalin-embalmed cadavers. Each anatomical arrangement was photographed and recorded on a scheme before analysis. We propose a new classification of the subscapular pedicle variations. We observed three types of subscapular arterial variation. The type Ia was the most frequent arrangement (71% of our dissections), the type Ib was observed in 11% and the type II in 18% of cases. We observed four types of subscapular venous variation. The type Ia was observed in 63% of cases, the type Ib in 14%, the type II in 14% and the type III in 10% of cases. This knowledge of the anatomical variation arrangement and frequencies of the subscapular vascular pedicle will assist the surgeon when dissecting the axillary region for malignant or reconstructive procedures.

The expression and function of KCNQ potassium channels in human chorionic plate arteries from women with normal pregnancies and pre-eclampsia.

Pre-eclampsia is associated with altered maternal and placental vascular reactivity. Kv7 channels (encoded by KCNQ 1–5 genes) are a potential contributor to the regulation of vascular tone in CPAs (chorionic plate arteries) during normal pregnancy. The aim of this study is to establish the expression profile of KCNQ subunits in CPAs taken from women with preeclampsia or normotensive women and to examine the functional relevance of the Kv7 channels on an altered expression profile of KCNQ subunits. The effects of Kv7 channel modulators on CPAs were investigated by tension measurement. Quantitative PCR experiments were used to analyze the expression of KCNQ genes. Western blotting and immunofluorescence were both used to analyze the protein expression of Kv7 channels. Finally, in CPAs from normotensive women, the Kv7 channel blocker XE991 increased arterial basal tone and U46619-induced contraction, and pre-contracted CPAs (10−7 M U46619) exhibited significant relaxation following treatment with Retigabine(Kv7.2–7.5 activator) and BMS-204352(Kv7.2–7.5 activator). However, ICA-27243(selective KCNQ2 and KCNQ3 activator) and ML277(selective KV7.1 activator) had no significant effect on tension in the pre-contracted CPAs. Conversely, compared with CPAs from normotensive women, the effects of XE991 on basal tone and agonist (U46619)-induced contractions in CPAs from women with preeclampsia were markedly attenuated. Moreover, the relaxation effects of Retigabine and BMS-204352 on pre-contracted CPA vessels from women with pre-eclampsia were also markedly down-regulated. Interestingly, the relaxation ability of ICA-27243 in pre-contracted CPA vessels in women with pre-eclampsia was enhanced. The mRNA of KCNQ3 was specifically up-regulated, whereas those for KCNQ4 and KCNQ5 were down-regulated in CPAs from women with pre-eclampsia compared with those in normotensive women. Similar observations were found in a subsequent analysis of protein expression of KCNQ genes 3–5. Thus, down-regulated Kv7 channel function in tension regulation of CPAs in women with pre-eclampsia could be associated with considerably altered expression profiles of Kv7 subunits.

Proliferation and maturation of intratumoral blood vessels in women with malignant ovarian tumors assessed with cancer stem cells marker nestin and platelet derived growth factor PDGF-B.

Platelet-derived growth factor B (PDGF-B) and nestin have been suggested to be useful in the assessment of neoangiogenesis in malignant ovarian masses. We aimed to investigate a possible association of these markers with newly formed microcapillaries and perivascular cells in ovarian tumors. Microvessel density (MVD) and pericytes were studied in 82 women with ovarian neoplasms, including 7 benign cysts, 7 borderline masses, 64 epithelial ovarian cancers and 4 other malignant ovarian tumors. Immunohistochemical staining included antibodies to CD34, PDGF-B and nestin. Median values of CD34-positive and nestin-positive MVD were: 24,5 (range:17-32) and 21 (range: 12-31), respectively. No significant correlation between intratumoral CD-34 positive MVD and nestin-positive MVD was found. Benign and borderline lesions more frequently than malignant tumors displayed low or medium values of nestin-positive MVD (p = 0.01). Histological grading of malignant tumors was associated with nestin-positive MVD (p = 0.01). Nestin expression in tumor cells was not correlated with tumor grade or histological subtype. PDGF-B expression was found in tumor microves-sels in 72% of cases (59/82). High expression of PDGF in pericapillary cells was strongly associated with high expression of this marker in cancer cells (p = 0.007). Significant correlations between PDGF-B and nestin expression in malignant tumor microvessels were also found (p = 0.04). Nestin and PDGF-B expressions were strongly associated with high grade tumors when compared to low grade or benign masses. We conclude that the assessment of PDGF-B and nestin-positive MVD could be used to identify only highly active, angiogenic malignant ovarian masses, where tumor vasculature is formed.

PP.03.30] CENTRAL BLOOD PRESSURES AND ARTERIAL STIFFNESS ARE MUCH HIGHER IN HYPERTENSIVE WOMEN WITH MORE CARDIOVASCULAR RISK FACTORS DESPITE ADEQUATE TREATMENT

Objective: The high central pressure is an indicator of vascular risk, especially when they are higher than expected in hypertensive patients (HP). Despite various studies, few data has been written regarding PH who also have more cardiovascular risk factors (CVRF) in addition to high blood pressure (HTA) and are women. In the present study, we show the values of central pressures in hypertensive women without other CVRF compared with those who have more than 1 CVRF besides hypertension. Objectives: prospective observational open-label study to assess central systolic and diastolic pressures (CSBP, CDBP) and arterial stiffness of large and small vessels in women with hypertension without CVRF compared with those with more than one CVRF and well controlled HTA with peripheral measurements. Design and method: We studied two groups: Group A: 45 women without other CVRF HP (53 ± 6 years, BMI< = 25) and compared to Group: 65 women with hypertension and more than 1 CVRF (55 ± 4 years). We included only those taking ACE inhibitors, ARBs and diuretics to keep blood pressures (BP) below 140/90 in peripheral BP controls performed by their doctor. Not receiving other antihypertensive treatments were included. In all patients we studied CSBP, CDBP, augmentation index (AI) as well as the pulse wave velocity (PWV) and total peripheral vascular resistance (TPR). Results: The results were compared and are shown in the following table:* mean p < 0.05 Conclusions: According to our study, hypertensive women with more risk factors have the central pressures significantly higher than women without other CVRF, despite adequate control of peripheral arterial pressures, also presenting a much more higher arterial stiffness data at the level of small and large arteries, indicating that the approach to these patients must be done in a comprehensive manner and not only to the control of hypertension, to reduce vascular risk. There is also a tendency to show higher TPR although not significant in these patients.

Relationships Between Regional Lean Body Mass, Strength, and Vascular Function in Women

Central arterial stiffness is inversely related to upper body muscular strength in young men, suggesting there may be a link between skeletal muscle and arterial function. This relationship has not been explored in women. There are also age-related declines in muscular and vascular function; it is unclear if age mediates this potential relationship. PURPOSE: To examine the relationships between regional lean body mass, strength, arterial stiffness and microvascular blood flow measures in younger and older women. METHODS: Eighteen younger (18-25 years) and 17 older (50-64 years) women had measures of lean body mass (dual-energy x-ray absorptiometry), strength (sum of three upper body and three lower body assessments of one-repetition maximum, 1RM), central (aortic) and peripheral (femoral) pulse wave velocity (PWV), and forearm blood flow (resting flow, peak reactive hyperemia, and total hyperemia measured with venous occlusion plethysmography). Relationships between variables were tested using Pearsons correlation coefficients, with and without controlling for age. RESULTS: Central PWV (6.8+/-1.7 m/s) was correlated with strength (270.9+/-51.8 kg) (r=-0.532; p=0.002) but this relationship was not statistically significant when controlling for age (r=-0.077; p=0.696). Resting blood flow (2.74+/-1.15 ml/min/100ml) (r=0.456; p=0.009) and total hyperemia (75.1+/-30.1 AUC) (r=0.448; p=0.009) but not peak hyperemia (22.2+/-7.2 ml/min/100ml) (r=0.258; p=0.148) were significantly related to lean body mass (4.2+/-0.6 kg) in the arms. The relationships between resting forearm blood flow (r=0.469; p=0.012) as well as total hyperemia (r=0.471; p=0.011) and lean body mass in the arms remained significant when controlling for age. Peripheral PWV (9.0+/-1.5 m/s) was not related to measures of strength or lean body mass (p>0.05). CONCLUSIONS: These data suggest that central artery stiffness is related inversely to muscle strength but that this relationship appears to be due to the effects of age. Forearm microvascular function is related to regional lean body mass and this relationship appears to be independent of age. This suggests that the link between muscle mass and vascular function may be most apparent in the microvasculature and less apparent in large vessels in women.

Sidelining a Side Effect of Long-Acting Contraceptives

Long-acting injections or implants based on synthetic progesterone are highly effective as contraceptives. But a common side effect—abnormal uterine bleeding—reduces adherence to this method. A new study suggests that this bleeding occurs because of abnormalities in the vascular smooth muscle cells that surround arteries and veins [1]. Previous studies have shown that women receiving longacting progestin-only contraceptives have abnormal endometrial blood vessels; these blood vessels have thin walls and are excessively dilated. Umit Kayisli et al. took a closer look at such blood vessels in women treated with the injectable contraceptive Depo-Provera. Depo-Provera reduced the proliferation of vascular smooth muscle cells, as measured by a marker of cell division. Similar results were obtained in guinea pigs treated with Depo-Provera. The researchers next turned to cell-based experiments using vascular smooth muscle cells derived from the human female aorta—such cells express the progesterone receptor. They showed that either Depo-Provera or Implanon, which is used as an implant, could slow proliferation of these cells, as well as inhibit their migration in cell-based migration assays. Micorarray analysis identified hundreds of genes with altered transcription in response to these contraceptives—one gene down-regulated by both treatments encodes CCL2 (chemokine [C-C motif ligand 2]). CCL2 is known to promote proliferation of vascular smooth muscle cells through the transcription factor STAT1. Similarly, administering CCL2 could overcome the proliferation defect imposed by DepoProvera or Implanon, an effect that seemed to be mediated by STAT1. These findings open the door to in vivo experiments asking if administering CCL2 with long-acting contraceptives might rescue blood vessel defects and prevent bleeding.

Gestosis: Ophthalmologic Peculiarities

The most interesting studies of perfusion-diffusion deficiency in the morpho-functional system mother-placenta-fetus available in women with pre-eclampsia and eclampsia are just described in this review. The main cause of vascular endothelium damage is vasospasm and an accelerated formation of free radicals in women’s with pre-eclampsia. The ophthalmological peculiarities mentioned in the article are such as follows: irregular spasm of small arterioles, including normal pregnancy cases, is usually described with a method of conjunctive vessels biomicroscopy. The most common method of ophthalmological examination is ophthalmoscopy. Pathologic changes of retina and retinal vessels in women with gestosis are most similar to the changes observed in the eyes of patients with essential hypertension. Pregnant women are in a group of risk because of arterial hypo- and hypertension, anemia and gestosis, providing the expressed deficiency of blood circulation of eye.

Fractional volume of placental vessels in women with diabetes using a novel stereological 3D power Doppler technique

ObjectivesIn maternal diabetes the placenta is large with abnormal vascular development and increased villous volume. We used a novel stereological 3D power Doppler ultrasound technique to investigate differences in-vivo in the placental fractional volume of power Doppler signal (FrVol-PD) between women with and without diabetes. MethodsWe recruited 17 pregnant women with pre-gestational diabetes and 20 controls, all with anterior placentae. Each subject had ultrasound scans (Voluson 730 Expert) every 4 weeks between 12 and 32 weeks gestation. 3D power Doppler data were acquired and the placenta manually outlined using VOCAL (4D View). Power Doppler signal within the resultant volume was counted in a 3D manner adapting the random but systematic techniques used in stereology. ResultsSubjects were of similar age, BMI and parity. From 16 weeks the mean (SD) placental FrVol-PD was higher in the non-diabetic than in the diabetic group: 16 weeks – 0.125 (0.03) versus 0.108 (0.03), 20 weeks – 0.144 (0.05) versus 0.104 (0.03), 24 weeks – 0.145 (0.05) versus 0.128 (0.03), 28 weeks – 0.159 (0.05) versus 0.133 (0.02) and 32 weeks – 0.154 (0.03) versus 0.123 (0.04). These differences were significant between control and diabetic subjects [F(1,35) = 4.737, p = 0.036] and across gestation [F(3,140) = 8.294, p < 0.001]. ConclusionUsing a novel stereological-based ultrasound technique we have demonstrated the reliability of this application in the placenta. This technique shows promise for non-invasive assessment of placental function: further studies are required to identify if structural changes in a diabetic placenta are accompanied by altered function, manifest as reduced perfusion demonstrable in-vivo.

Morphometric study of placental villi and vessels in women with mild hyperglycemia or gestational or overt diabetes

In this study, morphometric measures of placental terminal villi and villous vessels were compared in overt, as well as gestational diabetes mellitus, and mild hyperglycemia diagnosed by oral 100 g glucose tolerance test (100 g-OGTT) and glucose profile (GP). At delivery (gestational age ≥ 34 weeks) a total of 207 placentas were assigned to a control group ( n = 56) or to one of three groups complicated by mild hyperglycemia ( n = 51), gestational diabetes ( n = 59) and overt diabetes ( n = 41). Placenta samples were randomly selected for blind morphometric assessment with an image analyser. Morphometric measures obtained included area and number of terminal villi and their respective villous vessels. Statistical analyses were performed using the chi-square test, ANOVA and stepwise regression ( p ≤ 0.05). Glycemic means were 86.2 mg/dL in controls, 98.9 mg/dL in mild hyperglycemia, 114.1 mg/dL in gestational diabetes and 122.1 mg/dL in overt diabetes. Our results show that abnormal maternal glycemic levels may change the placental morphometric characteristics related to materno-fetal exchanges.

Uric acid in patients with angiographically documented coronary heart disease

Objective — High serum uric acid levels have been associated with coronary heart disease (CHD). Hyperuricaemia is known to be related to several of the established aetiologic risk factors of CHD, such as obesity, insulin resistance, raised serum triglycerides, and hypertension, but it is still uncertain whether this relationship may cause the association between CHD and uric acid.We have investigated whether uric acid was an independent risk factor for CHD.Methods and results —Two-hundred and ninety patients with suspected CHD referred to elective coronary angiography were enrolled. The association between angiographically detected coronary stenosis>50% in one or more of the 3major coronary arteries and uric acid levels was examined. A significant association between high uric acid levels and the presence of one or more diseased vessels in women (p=0.02) was observed, while no association was found in men (p=0.25). After adjustment for several possible confounders such as smoking, triglycerides, HDL cholesterol, and a diagnosis of diabetes mellitus the association among women disappeared.Conclusion — The results indicate that uric acid should not be viewed as an independent risk factor for CHD, but more likely as a biological marker reflecting other causative parameters.

Velamentous cord insertion and atypical variable decelerations with no accelerations

Objectives: To examine intrapartum fetal heart rate (FHR) patterns in the presence of velamentous cord insertion (VCI). Methods: The site of cord insertion was determined in 1460 women on antenatal ultrasonographic and postnatal examinations. Each of 24 women with pregnancies complicated with VCI was matched at the onset of labor with 10 women who had a normal pregnancy, and FHR patterns were analyzed for both cases and controls. Results: Compared with controls, cases of variable decelerations with no accelerations (VDNA) during the first and second stages of labor were more frequent in women with VCI (first stage: 25% vs. 5.1%, second stage: 65.0% vs. 21.7%, P < 0.001). The adjusted odds ratio associated with VDNA occurrence in women with VCI was 3.83 (95% confidence interval [CI]: 1.51–9.72, P = 0.005). The mean odds ratio associated with length of aberrant vessels in women with VCI plus VDNA was 1.38 (95% CI: 1.04–1.83, P = 0.026). Conclusion: Pregnancies complicated with VCI are associated with a higher rate of VDNA.

Effects of vasoactive agents on intracellular calcium and force in myometrial and subcutaneous resistance arteries isolated from preeclamptic, pregnant, and nonpregnant woman

Preeclampsia is a common and serious complication of pregnancy, characterized by maternal hypertension and proteinuria, placental insufficiency, and fetal growth restriction. The purpose of this study was to investigate whether intracellular Ca 2+ ([Ca 2+ ] i ) and contractile responses of vascular smooth muscle to vasoactive agents are altered in preeclampsia compared with normal pregnancy and the nonpregnant state. Subcutaneous and myometrial resistance arteries from women who had preeclampsia, normal pregnancy, and nonpregnant women were obtained at the time of cesarean section or hysterectomy. Arteries were mounted on an isometric myograph and loaded with the Ca 2+ indicator, fura-2AM, to permit simultaneous measurement of force and [Ca 2+ ] i . Reponses to endothelium-dependent relaxants (acetylcholine and substance P) and vasoconstrictors (depolarizing potassium solution, phenylephrine, and angiotensin II) were examined. The fall in [Ca 2+ ] i and relaxation in response to acetylcholine was significantly inhibited in both myometrial and subcutaneous arteries from preeclamptic women compared with arteries from nonpregnant or normal pregnant women. However, responses to substance P did not differ between the 3 groups. There were no significant differences in [Ca 2+ ] i or force responses to high potassium, phenylephrine, or angiotensin II in myometrial and subcutaneous resistance vessels in women with preeclampsia compared with normal pregnant women. However, force, but not [Ca 2+ ] i responses to angiotensin II, in subcutaneous vessels from normal pregnant and preeclamptic women were reduced compared with subcutaneous arteries from nonpregnant women, indicating that pregnancy is associated with a reduction in Ca 2+ sensitization in this tissue. A similar effect was not seen in myometrial arteries. Endothelial function is altered in preeclampsia, with loss of effect of acetylcholine, but not substance P. Vasoconstrictor reactivity is not increased in preeclampsia compared with uncomplicated normal pregnancy, and this is unlikely to be an explanation for the increased peripheral vascular resistance seen in preeclampsia.

Influence of Metabolic Syndrome on Blood Vessels in Women with Spinal Cord Injury

Influence of Metabolic Syndrome on Blood Vessels in Women with Spinal Cord Injury