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Dyslipidemia is an important risk factor of atherosclerotic cardiovascular disease (ASCVD). Statins delay the occurrence and development of ASCVD, and reduce the risk of cardiovascular events and death. Due to safety concerns, there exist insufficient use of lipid-lowering agents and a high withdrawal rate of the agents in the elderly. To promote the prevention and treatment of ASCVD, this expert consensus is issued and focuses on the management of dyslipidemia of Chinese elderly basing on the clinical evidence of the use of lipid-lowering drugs by the elderly, and the lipid management guidelines and expert consensus recommendations at home and abroad.
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Objective:To summarize the experience of laparoscopic transabdominal preperitoneal hernia repair (TAPP) and to discuss its safety and feasibility.Methods:Data of 26 consecutive cases from January 2015 to March 2018 in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine were analyzed retrospectively. They were all males, aged (68.3±14.1) years, with a range from 57 to 86 years. Body mass index was (23.3±4.1) kg/m 2. Bathel indexwas 91.4±5.6. Intraoperative main procedures were done in accordance to Guideline of Standardized Operation for Laparoscopic Inguinal Hernia Repair. A drainage tube or catheter was not routinely placed intraoperatively. Patients were discharged but for any complaints. Observation data included intraoperative, postoperative and following-up data. The following-up period was more than 12 months by telephone or clinic. The long-term complications and the changes of Barthel index were observed. Paired sample t test was used to compare the changes of Barthel index before and after operation. Results:Of the 26 cases, none was converted to open procedure and no intra- or post-operative serious complications occurred. Occurrence of surgical site seroma was 17 (65.4%) cases. The operating time was (76.5±23.6) min. Intraoperative blood loss was (8.6±4.4) mL. The postoperative hospitalization was (2.3±1.2) d. Bathel index in 1 month postoperative was 96.9±3.2. It was higher statistically than that preoperative ( t=-6.968, P=0.000). Conclusions:TAPP in the treatment of huge inguinoscrotal hernia is safe and feasible. Mastering the anatomical characteristics and the according procedures is an important factor for successful operation.
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Objective To compare and analyze differences in macular thickness and to discuss the correlation between macular thickness and visual field mean defect (MD) in early and moderate,late pseudoexfoliation glaucoma (PXG) patients and normal control subjects.Methods A series of cases-observation study was adopted.Thirty-three early and moderate PXG patients (33 eyes) and 24 late PXG patients (24 eyes) were collected in the First Hospital of Shijiazhuang from May 2013 to May 2018.Meanwhile,34 age,gender and diopermatched healthy subjects (34 eyes) were included as normal control group.Spectral domain optical coherence tomography (SD-OCT) was used to measure macular thickness and volume in every quadrant.The correlation between the macular thickness and visual field MD were analyzed.This study followed the Helsinki declaration and was approved by the ethics committee of the First Hospital of Shijiazhuang.Written informed consent was obtained from each subject prior to any medical examination.Results The average macular thickness in normal control group,early and moderate PXG group and late PXG group were (305 ± 15),(297 ± 15) and (287 ± 17) μm,respectively;the average macular volume were (0.94 ± 0.05),(0.91 ± 0.05) and (0.89 ± 0.05) μm3,respectively.The macular thickness and volume differences between the 3 groups were statistically significant in nasal inner macula,superior inner macula,temporal inner macula,inferior inner macula,superior outer macula,temporal outer macula,inferior outer macula quadrants (Fthickness =4.226,9.335,12.133,10.115,11.298,8.243,12.142;all at P＜0.05.Fvolume =3.812,9.152,12.774,8.889,11.284,7.937,11.652;all at P＜0.05).The macular thickness of early and moderate PXG group in superior inner macula,temporal inner macula,inferior inner macula,superior outer macula and temporal outer macula quadrants were statistically thinner than those in the normal control group (all at P＜0.05);the macular thickness of late PXG group in inferior inner macula,temporal inner macula,superior outer macula and inferior outer macula quadrants were statistically thinner than those in the early and moderate PXG group (all at P＜0.05);the macular thickness of late PXG group in inner and outer rings were statistically thinner than those in the normal control group (all at P＜0.05).The macular thickness was not correlated with visual field MD in normal control group and the early and moderate PXG group in every quadrants (all at P＞0.05),but it was positively correlated with visual field MD in the late PXG group in nasal inner macula,superior outer macula and temporal inner macula quadrants (r =0.527,0.544,0.417;all at P＜0.05).Conclusions SD-0CT can quantify the macular thickness,and can be used an important reference index for the staging and follow-up of PXG combined with perimetry.
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Objective To observe the treatment of inflammatory myopathy-associatied cardiomyopathy and its impact on prognosis of disease.Methods In this single-center retrospective study,29 cases of inflammatory myopathy-associated cardiomyopathy were collected in Peking Union Medical College Hospital from 1999 to 2016.The clinical data and adverse events during follow up were documented.Among 29 patients there were 11 cases of polymyositis,8 cases of dermatomyositis,8 cases of overlap syndrome and 2 cases of nonspecific myositis.All the patients started with sufficiene prednisone (1-2 mg· kg-1· d-1).7 cases received intravenous immune globulin,while 12 cases were prescribed with steroid pulse therapy,16 cases with methotrexate,15 cases with cyclophosphamide,6 cases with cyclosporine A,while 11 cases with combination of immune suppressors (methotrexate plus cyclophosphamide or cyclosporine A).After a median follow up of 4.8 years (2 month to 15 years),14 cases died including 9 of cardiac death.Patients with cardiac deaths had lower usage percentages of intravenous gamma globulin (0 vs.7/20,P=0.05) and steroid pulse therapy (1/9 vs.11/20,P=0.043) than controls.Comparing with controls,patients in the group of adverse events were more prone to choose methotrexate alone rather than combination of immune suppressors (all-cause death:1/14 vs.8/15,P=0.014;cardiac death:0 vs.9/20,P=0.027).Kaplan-Meier survival analysis showed significant difference of survival rates between patients with combination of immune suppressors and controls (Log Rank x2=6.001,HR=7.58,P=0.014),as well as between patients with β receptor blockers and controls (Log Rank x2=4.589,HR=2.95,P=0.032).Conclusions We recommend a management strategy that emphasize both primary disease controlling and cardiac remodeling improvement in patients with inflammatory myopathy-associated cardiomyopathy.On the basis of sufficient glucocorticoids,intravenous gamma globulin,steroid pulse therapy,combination of methotrexate plus other immune suppressants,and β receptor blockers were worthy to be considered.
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Objective@#To observe the treatment of inflammatory myopathy-associatied cardiomyopathy and its impact on prognosis of disease.@*Methods@#In this single-center retrospective study, 29 cases of inflammatory myopathy-associated cardiomyopathy were collected in Peking Union Medical College Hospital from 1999 to 2016. The clinical data and adverse events during follow up were documented. Among 29 patients there were 11 cases of polymyositis, 8 cases of dermatomyositis, 8 cases of overlap syndrome and 2 cases of nonspecific myositis.All the patients started with sufficiene prednisone (1-2 mg·kg-1·d-1). 7 cases received intravenous immune globulin, while 12 cases were prescribed with steroid pulse therapy, 16 cases with methotrexate, 15 cases with cyclophosphamide, 6 cases with cyclosporine A, while 11 cases with combination of immune suppressors (methotrexate plus cyclophosphamide or cyclosporine A). After a median follow up of 4.8 years (2 month to 15 years), 14 cases died including 9 of cardiac death. Patients with cardiac deaths had lower usage percentages of intravenous gamma globulin (0 vs. 7/20, P=0.05) and steroid pulse therapy (1/9 vs. 11/20, P=0.043) than controls. Comparing with controls, patients in the group of adverse events were more prone to choose methotrexate alone rather than combination of immune suppressors (all-cause death: 1/14 vs. 8/15, P=0.014; cardiac death: 0 vs. 9/20, P=0.027). Kaplan-Meier survival analysis showed significant difference of survival rates between patients with combination of immune suppressors and controls (Log Rank χ2=6.001, HR=7.58, P=0.014), as well as between patients with β receptor blockers and controls (Log Rank χ2=4.589, HR=2.95, P=0.032).@*Conclusions@#We recommend a management strategy that emphasize both primary disease controlling and cardiac remodeling improvement in patients with inflammatory myopathy-associated cardiomyopathy. On the basis of sufficient glucocorticoids, intravenous gamma globulin, steroid pulse therapy, combination of methotrexate plus other immune suppressants, and β receptor blockers were worthy to be considered.
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Objective To evaluate the relationship between the mechanism of simvastatin-induced improvement of permeability of pulmonary microcirculation and vascular endothelial growth factor α (VEGF-oα) in septic rats.Methods Eighty clean-grade healthy female Wistar rats,aged 49-63 days,weighing 200-250 g,were divided into 4 groups using a random number table method:control group (group C,n =8),sham operation group (group Sham,n =24),sepsis group (group Sep,n =24) and simvastatin group (group S,n =24).Sepsis was induced by cecal ligation and puncture (CLP) in anesthetized rats.Simvastatin 20 mg/kg was injected to the stomach once a day for two weeks before CLP in group S,and the equal volume of normal saline was given instead in the other groups.Rats were sacrificed after anesthesia in group C,and 8 rats selected at 6,24 and 48 h after CLP were sacrificed after anesthesia in the other three groups,and blood samples and lung specimens were collected.The concentrations of VEGF-α and intercellular adhesion molecule-1 (ICAM-1) in serum were measured by enzyme-linked immunosorbent assay.The wet/dry lung weight ratio (W/D ratio) was determined,and the expression of VEGF-α in lung tissues was detected by immunohistochemistry.Results Compared with group C,W/D ratio was significantly increased,the expression of VEGF-α was up-regulated,and the concentrations of serum ICAM-1 were increased in Sep and S groups,the concentration of serum VEGF-α was increased in group Sep (P＜0.05),no significant change was found in serum VEGF-α concentrations in group S,and no significant change was found in the parameters mentioned above in group Sham (P＞0.05).Compared with group Sep,W/D ratio was significantly decreased,the expression of VEGF-α was down-regulated,and the concentrations of serum VEGF-α and ICAM-1 were decreased in group S (P＜0.05).Conclusion The mechanism by which simvastatin improves permeability of pulmonary microcirculationis associated with the decreased level of VEGF-α in local lung tissues and peripheral blood of septic rats.
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Objective@#To evaluate the efficacy and safety of ivabradine for the treatment of Chinese patients with chronic heart failure based on the Chinese subgroup data of the systolic heart failure treatment with the If inhibitor ivabradine trial (SHIFT).@*Method@#A total of 6 558 stable outpatients who presented symptoms of heart failure, with a left ventricular ejection fraction (LVEF) ≤35%, sinus rhythms with a heart rate ≥70 bpm participated in the randomized, double-blind, placebo-controlled, international multicenter clinical study.The subset of Chinese patients with heart rate ≥75 bpm was enrolled in the post-hoc subgroup analyses.Patients were randomly allocated by computer-generated assignment through a telephone interactive voice response system to ivabradine group (starting dose 5 mg bid, which was then uptitrated to the maximum 7.5 mg bid) or matched placebo group.The clinical baseline characteristics of participants were obtained and analyzed.The primary outcome endpoint was a composite endpoint of cardiovascular death or hospitalization resulting from worsening HF.The primary safety endpoint included total incidence of adverse events during the study, bradycardia, and adverse visual reaction (phosphenes).@*Results@#A total of 49 Chinese centers enrolled a total of 225 patients with chronic heart failure, of whom, 106 patients were randomized to the ivabradine group and the other 119 patients to the placebo group, and the mean follow-up time was (15.6±5.1) months.By the end of the study, mean heart rate (71.0 bpm vs. 80.3 bpm, P<0.05) and incidence of the primary endpoint events (18.9% (20/106) vs. 31.9%(38/119), HR=0.56, 95%CI 0.33-0.97, P=0.039) were significantly lower, while the percentage of patients with improvement in heart functional class NYHA (53.8% (56/106) vs. 34.5% (41/119), P=0.006 1) was significantly higher in the ivabradine group than in the placebo group.The total number of adverse events (129 events, 49.6% PY) in the ivabradine group was lower than that in the placebo group (203 events, 50.8% PY). In the ivabradine group and the placebo group, there were respectively 2 patients (1.9%) and 0 patients experienced bradycardia, 3 patients (2.9%) and 1 patient (0.8%) experienced adverse visual reaction (phosphenes).@*Conclusions@#Ivabradine significantly reduced heart rate and improved the clinical outcomes and NYHA function class in Chinese patients with chronic heart failure, these beneficial effects are achieved without inducing remarkable adverse reactions.The results of Chinese subgroup analysis were thus consistent with the overall results of the SHIFT study.@*Clinical Trial Registry@#International standard randomized controlled trials registry, ISRCTN 70429960.
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[Summary] Type 2 diabetes is usually associated with overweight or obesity,hypertension,hyperlipidaemia and increased cardiovascular risk.Most of the anti-diabetic drugs mainly work on glucose-lowering,therefore would not bring benefits to the multiple metabolic abnormalities.In this article,the multiple effects of the anti-diabetic drug liraglutide on body weight,blood pressure,blood lipids,and cardiovascular system were summarised.
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The clinical data of 13 patients diagnosed as Takayasu's arteritis with cardiomyopathy in Peking Union Hospital were reviewed.Echocardiography showed cardiomegaly (left chambers mainly),diffuse weakened myocardial wall movement and reduced left ventricular ejection fraction.Dilated cardiomyopathy was diagnosed in two patients.Glucocorticoid and cyclophosphamide were the essential medication for treatment.One patient died,1 patient was aggravated and the disease condition in remaining 11 patients was stable or improved.Takayasu's arteritis with cardiomyopathy is a rare disease and it attacks younger people.It is difficult to identify at onset,and the disease deteriorates rapidly.Echocardiography should be performed earlier to evaluate the heart function for early diagnosis and treatment.Administration of large dose of glucocorticoid and cyclophosphamide at early stage may improve the prognosis.
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Objective To identify potential linkage of cholesterol efflux with the expressions of ATP-binding cas-sette receptor A1 (ABCA1), ABCG1 and scavenger receptor B1 (SR-B1) in monocytes derived macrophages of patients with type 2 diabetes mellitus. Methods and Results Blood was collected from subjects with or without type 2 diabetes mellitus. Peripheral blood monocytes were differentiated for 72 hours into macrophages, and cholesterol efflux assays, Real-time quantitative PCR and western blot were performed. Macrophages from patients with type 2 diabetes mellitus showed a reduction in cholesterol efllux. The mRNA and protein expressions of ABCG1 in macrophages from patients with type 2 diabetes mellitus were significantly reduced. In contrast, the expression of ABCA1 and SR-B1 was not significantly different in both control subjects and diabetic patients. In addition, cellular cholesterol efflux from macrophages to autologous serum and pool serum was significantly correlated with the expression of ABCG1. Conclusion ABCG1 expression and cholesterol efflux are reduced in patients with type 2 diabetes mellitus. This impaired cholesterol efflux significantly correlates with decreased expression of ABCG1.
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Objective This study was designed to investigate the clinical characteristics of systemic vasculitis with cardiac involvement.Methods Clinical information of 10 patients with systemic vasculitis complicated by myocardial vasculitis,selected from 181 small vessel vasculitis patients and 114 systemic vasculitis patients were analyzed.Results The clinical manifestations were varied significantly dependent on the etiology of small vessel vasculitis.It is usually djfficult to make the diagnosis because of the insidious onset,varied etiology and the undifferentiated manifestations of heart involvement.Echocardiography is commonly used in detecting and monitoring cardiac involvement.Glueocortieoid therapy can improve left ventricular systolic function dramatically when used properly.Conclusions The cardiac involvement of systemic vasculitis is quite rare.Dyspnea of various degrees and left ventricular systolic dysfunction ale the most common clinical findings.The earlier the establishment of diagnosis and institution of appopriate treatment,the better the prognosis.
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Objective To explain the effects of C-reactive protein(CRP) on lectin-like oxidized low density lipoprotein receptor-1 expression on THP-1 derived macrophages and the related signal transduction pathways.MethodsTHP-1 cells were differentiated into macrophages with the stimulation of PMA.THP-1 derived macrophages were incubated with CRP and co-incubated with inhibitors of NF-?B、AP-1 and MARK signal transduction pathways.The expression of LOX-1 antigen and mRNA was analyzed by ELISA and RT-PCR.Results CRP stimulated the expression of LOX-1 antigen and mRNA on macrophages in a dose-dependent manner.NF-?B inhibitor BAY11-7085 suppressed the inducible effects of CRP on LOX-1 expression.Conclusion CRP increased LOX-1 expression on THP-1 derived macrophages at transcription and post-transcription levels.The NF-?B signal transduction pathway may be involved in such process.
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Objective To investigate the potential change of cellular cholesterol efflux and the functional changes of ABCA1 on macrophages from diabetes animals. Methods High energy diet was given to golden hamster to make animal model of hyperlipidemia. Diabetes was induced by a single intraperitoneal injection of STZ (30 mg/kg). Macrophages were isolated and incubated with apoA-I or 8-br-cAMP in vitro. Cellular cholesterol content was measureal before and after treatment by HPLC. Results Intracellular cholesterol content of diabetic animals was higher than that in high energy diet and normal controls. Expression of ABCA1 mRNA was upregulated in diabetic group after incubation with apoA-I and cAMP. When macrophages were incubated with apoA-I, cholesterol efflux increased with the prolongation of incubation time.The amount of intracellular cholesterol efflux in 3 groups of animals showed the following relationship: diabetic animals exceed high energy diet fed animals, and the latter exceeds normal animals. Conclusion Intracellular lipid efflux depends mainly on the presence of extracellular apoA1 as well as membrane ABCA1 protein. The deposition of cholesterol in the macrophage of diabetic and insulin resistant animals may be related to the characteristic changes of quantity and function of apoA1 in these animals.
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Objective To identify potential linkage of cholesterol efflux with the expressions of ATP-binding cassette receptor A1(ABCA1),ABCG1 and scavenger receptor B1(SR-B1) in monocytes derived macrophages of patients with type 2 diabetes mellitus.Methods and Results Blood was collected from subjects with or without type 2 diabetes mellitus.Peripheral blood monocytes were differentiated for 72 hours into macrophages,and cholesterol efflux assays,Real-time quantitative PCR and western blot were performed.Macrophages from patients with type 2 diabetes mellitus showed a reduction in cholesterol efflux.The mRNA and protein expressions of ABCG1 in macrophages from patients with type 2 diabetes mellitus were significantly reduced.In contrast,the expression of ABCA1 and SR-B1 was not significantly different in both control subjects and diabetic patients.In addition,cellular cholesterol efflux from macrophages to autologous serum and pool serum was significantly correlated with the expression of ABCG1.Conclusion ABCG1 expression and cholesterol efflux are reduced in patients with type 2 diabetes mellitus.This impaired cholesterol efflux significantly correlates with decreased expression of ABCG1.
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Objective To examine the effects of high-density lipoprotein(HDL) and lipoprotein-deficient serum(LPDS) isolated from patients with type 2 diabetes mellitus on cholesterol efflux through human skin fibroblast(HSF) and human hepatoma cell line(HepG2).Methods and Results Blood was collected from 13 patients with type 2 diabetes mellitus and 17 healthy volunteers,HDL and LPDS were isolated.Cholesterol efflux assays,RT-PCR and Western blot were performed with HSF and HepG2 cells.The HepG2 cells showed a high expression of scavenger receptor B1(SR-B1) and lack of functional ATP-binding cassette receptor A1(ABCA1) and ATP-binding cassette receptor G1(ABCG1) while HSF cells express SR-B1 at very low level and have a high expression of ABCA1 pretreated with 22-OH cholesterol.The cholesterol efflux from HepG2 cells to HDL isolated from patients with diabetes decreased significantly as compared to controls.However,cholesterol efflux from HSF cells to LPDS was not different between groups.Conclusion The function of HDL involving cholesterol efflux in type 2 diabetes mellitus was impaired while cholesterol efflux induced by LPDS from HSF cells was maintained,suggesting that HDL plays a critical role in mediation of intracellular cholesterol accumulation and progression of atherosclerosis inpatients with type 2 diabetes.
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HDL or apolipoprotein A-Ⅰ,the major protein of HDL particles,protect host against vascular endothelial dysfunction.HDL binding to scavenger receptor-BI activates eNOS for increasing NO.SR-BI and Endothelial lipase(EL) play a critical role in the regulation of plasma HDL.Incubation of HDL with vascular endothelial cells promotes prostacyclin synthesis.Some proteins such as paraoxonase that cotransport with HDL in plasma,have antioxidant properties.HDL inhibits TNF-? dependent expression of adhesion molecules in vascular endothelial cells and interferes with apoptosis,proliferation and migration of vascular endothelial cells.
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Accumulated clinical trials have demonstrated the clinical efficacy of statins,which is closely associated with the magnitude of LDL-C reduction,in primary and secondary prevention of cardiovascular diseases.The concept of intensive LDL-C lowing has been widely accepted.Although statins are classified as a group of drugs with documented safety and tolerability,the potential risk profile in liver and skeleton muscle under the intensive treatment with large dose has drawn great attention.
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European Society of Cardiology guidelines on diagnosis and treatment of heart failure are among the mostly authorized international directing documents,applied widely in clinical practice,epidemiological researches and randomized clinical trials.The guidelines published in 2008 combined chronic and acute hear failure and made significant modifications in the definition,classification,diagnosis,pharmacological and non-pharmacological treatment of heart failure.Simplification of the recommendations and enhancement of the guidelines implication are also point of focusing.This article represents a brief review of the new guidelines,together with comparison with the previous edition and analysis of recommendations based on local clinical practice,to enhance the standardized management of heart failure in China. Abstract:Summ ary:European Soc iety of Card iology gu idelines on d iagnosis and treatm ent of heart failure are among the mostly au-thorized international d irecting docum ents,app lied w idely in c lin ical practice,ep idem iological researches and random ized c lin ical trials.The gu idelines pub lished in 2008 comb ined chron ic and acute hear failure and m ade sign ificant mod ifica-tions in the defin ition,c lassification,d iagnosis,pharm acological and non-pharm acological treatm ent of heart failure.S imp li-fication of the recomm endations and enhancem ent of the gu idelines imp lication are also point of focusing.Th is artic le re-presents a brief review of the new gu idelines,togetherw ith comparison w ith the previous ed ition and analysis of recomm en-dations based on local c lin ical practice,to enhance the standard ized m anagem ent of heart failure in Ch ina.
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Objective To analyze the clinical characteristics of large pulmonary vessel involvement in Behcet's diseaseMethods The clinical data of Behcet's disease patients with large pulmonary vessel involvement,who were treated in Peking Union Medical College Hospital from 1983 to 2008,were retrospectively analyzed.Results Thirteen patients had large pulmonary vessel involvement among a total of 418 patients with Behcet's disease.The 13 patients had a mean age of (37.5?12)years old,with 10(69.2%)having hemoptysis,8(61.5%)having dyspnea.Helical CT/CTPA showed that pulmonary vascular involvement included pulmonary arterial aneurysms(53.8%),pulmonary artery occlusion(46.2%),and pulmonary thrombi(46.2%).All the 13 patients were treated with steroid and immunosuppressant;five received steroid pulse therapy;and four received vascular intervention therapy.The mean follow-up was (3?1.6)years,with a follow-up rate of 92.5%.The 3-year survival rate was 83.9% for the 13 patients.Conclusion The manifestation of pulmonary vascular involvement in Behcet's disease is various,and the diagnosis mainly depends on the manifestations of CT pulmonary angiography.
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On the basis of complete blockade of endothelin-A (ET-A) receptor,the hemodynamic effects of further removal of endothelin-B receptor mediated effect with endothelin converting enzyme is not clear.We studied forearm vasodilation (with plethysmography) during a maximally effective dose of an ET-A receptor antagonist alone (brachial artery infusion of BQ123,36μg/min*100mL tissue for 25min) and during double blind,randomized,additional endothelin converting enzyme inhibition (phosphoramidon,20μg/min*100mL tissue for 15min,n=6) or placebo (n=6) in 12 patients with severe congestive heart failure (CHF).Baseline clinical characteristics in terms of age,NYHA grade,LVEF and medications are comparable between the two groups.As a study control,we carried out the same protocol in 12 normal volunteers.Forearm blood flow (FBF) increased similarly in patient with CHF and in normal volunteers after BQ123 over the 45 min observation period.There were significant further increases of FBF in both study populations after phosphoramidon infusion.While in placebo treated CHF patients during the additional 45min observation period,there is a decrease of FBF by a mean of 30% (mean difference between Phosph and Pla 57%,95% CI 43 to 72%,P＜0.001),which was greater than that in normal subjects.In patients with severe CHF as well as in normal volunteers,endothelin converting enzyme inhibition results in further vasodilation on the basis of ET-A receptor blockade alone,which suggests that ET-B receptor may play a role in maintaining vascular tong in human beings.