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<p><b>OBJECTIVE</b>To evaluate the association between homocysteine level and prethrombotic status and long-term thromboembolic events in patients with primary hypertension.</p><p><b>METHODS</b>Results between 110 hypertensive patients with elevated homocysteine (HCY) level were compared with 110 hypertensive patients with normal HCY level which were enrolled from October 2003 to November 2009. Fibrinogen (FIB), viscosity, thrombomodulin (TM), granule membrane protein (GMP-140), prethrombin F1+2 fragment (F1+2), D-dimer fragment (D-Dimer) and antithrombin III (AT-III) were measured and correlated to HCY and prethrombotic state. The endpoints of the study were arterial and venous thromboembolic events. The variables linked with arterial and venous thromboembolic events were included in Cox proportional hazard models. The event-free survival was illustrated with Kaplan-Meier survival curves and compared by the Log-rank test.</p><p><b>RESULTS</b>The patients were followed up for 8-122 months (median follow-up time was 85 months). Compared with hypertensive patients with normal HCY, the plasma level of TM ((4.8±1.2) µg/L vs. (4.5±1.0) µg/L, P = 0.045), GMP-140 ((18.8±3.2) µg/L vs. (17.1±4.3) µg/L, P = 0.001), F1+2 ((1.2±0.4) nmol/L vs. (1.0±0.6) nmol/L, P = 0.004) were significantly higher while the plasma level of AT-III ((95.3±10.4) % vs. (98.6±10.6)%, P = 0.021) was significantly lower in hypertensive patients with elevated HCY level. FIB, viscosity of plasma and D-dimer were similar between the two groups. Multiple regression analyses indicated that HCY level was negatively correlated with AT-III (β = -0.199, P = 0.011) and positively correlated with age (β = 0.217, P = 0.04), female gender (β = 5.667, P = 0.001) and TM (β = 2.341, P = 0.003). Cox multivariate analysis revealed that age and HCY level were independent prognostic risk factors of thromboembolic events (OR 1.046, 95% CI 1.013-1.082, OR 1.052, 95% CI 1.027-1.078, respectively) (all P < 0.05). Kaplan-Meier curves showed that there was a significant difference in the event-free survival between the two groups (Log-rank test, P = 0.027).</p><p><b>CONCLUSIONS</b>Compared with normal HCY hypertensive patients, the levels of plasma prothrombin activators such as TM, GMP-140 and F1+2 were significant increased and anti-thrombin factor such as AT-III was significant decreased in hypertensive patients with elevated HCY. Old age and high HCY level were independent prognostic risk factors of thromboembolic events. The event-free survival in hypertensive patients with elevated HCY is lower than in hypertensive patients with normal HCY level.</p>
Subject(s)
Female , Humans , Case-Control Studies , Essential Hypertension , Fibrin Fibrinogen Degradation Products , Homocysteine , Blood , Hypertension , Kaplan-Meier Estimate , P-Selectin , Prognosis , Proportional Hazards Models , Regression Analysis , Risk Factors , ThromboembolismABSTRACT
To assess the safety and efficacy of the StarClose device following intra-aortic balloon pump [IABP] counterpulsation using 8-Fr femoral sheaths. From June 2008 to August 2012, 42 consecutive patients who received IABP implantation via common femoral artery [CFA] punctures with an 8-Fr sheath [which were then sealed with the StarClose Vascular Closure System at the bedside] were included in this retrospective single-arm study. All the patients underwent duplex control of the puncture site 24 h after deployment of the device, in order to determine the presence or absence of vascular complications including hematoma, pseudoaneurysm, arteriovenous fistula and arterial/venous thrombosis or stenosis. The safety end points were the vascular complications during the hospital stay, and the efficacy end points included device and procedure success. The procedure success rate was 92.9% [39/42] and the device success rate was 88.1% [37/42]. Major vascular complications occurred in 3 [7.1%] patients; 1 developed a massive hematoma >10 cm which was managed by blood transfusion and surgical reconstruction, and the other 2 developed pseudoaneurysm which was cured by ultrasound-guided thrombin injection or manual compression. Minor vascular complications occurred in 5 [11.9%] patients, including blood oozing in 2, hematoma <5 cm in 2 and severe pain in the remaining patient. CFA closure with the StarClose device was safe, feasible and effective in patients undergoing IABP support using 8-Fr sheath sizes
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The purpose of this study was to observe whether human peripheral dervied monouncleas cells (hMNCs) could participate in the regeneration process of the ischemic hearts in the way of differentiating into cardiomyocytes, vascular endothelial cells and smooth muscle cells. hMNCs were transplanted into the bodies of the mice with myocardial infarction through the tail vein injection. Hearts were harvested 2-12 weeks after injection then sliced up into frozen sections of 5 micron thickness. Double immunofluorescence staining was used to test the differentiation of the grafted cells into cardiomyocytes, smooth muscle cells and vascular endothelial cells which revealed that cells expressing both HLA and TNT, HLA and alpha-SMA, HLA and vWF existed in the hearts of the mice. According to the study, it is probable that hMNCs could participate in the regeneration process of the infarcted hearts in the way of differentiation.
Subject(s)
Animals , Humans , Mice , Cell Differentiation , Physiology , Leukocytes, Mononuclear , Transplantation , Mice, Nude , Myocardial Infarction , Pathology , Therapeutics , Myocytes, Cardiac , Cell Biology , Transplantation, HeterologousABSTRACT
Objective To explore whether combined olmesartan angiotensin Ⅱ receptor type 1 blocker(ARB) and angiotensin-converting enzyme inhibitor(ACEI) temocapril have synergistic effect on reversal of left ventricular hypertrophy (LVH) in stroke-prone spontaneously hypertensive rats (SHRsp). Methods Fourty-four SHRsps and 11 Wistar-Kyoto rats(WKY) were divided randomly into 5 groups:WKY-control group, SHRsp-control group, SHRsp-olmesartan 10 mg/(kg?d)group, SHRsp-temocapril 10 mg/(kg?d)group, and SHRsp-Olmesartan 3 mg/(kg?d)+temocapril 3 mg/(kg?d) group for 6 weeks. Hearts weight were measured and histologically studied. The mRNA expression of angiotensin Ⅱ receptor type 1(AT1R) and integrin ?1 in myocardium was detected by RT-PCR. Results Olmesartan, temocapril and the their combination significantly reduced systolic blood pressure in a similar magnitude. Combination therapy was shown not greater effect in reversal of LVH than by olmesartan alone, although the effect by both of them was greater than temocapril monotherapy. The mRNA levels of AT1R and integrin ?1 in SHRsp were significantly decreased by treatment with olmesartan, temocapril, or combination therapy. Olmesartan and combination therapy result in greater decreases in expression of AT1R and integrin ?1 mRNA in myocardium than that by temocapril. Conclusion Compared with olmesartan alone, the combination of ARS and ACEI didn't show synergistic effect on reversal of left ventricular hypertrophy as were down-regulation of AT1R and suppression of integrin ?1 mRNA in myocardium.
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Objective To investigate the changes of collagen types Ⅰ and Ⅲ, the effects of Oleum Curcumae Aromaticae oil injection on injuried rat arteries and collagen types Ⅰ and Ⅲ after balloon angioplasty Methods The left common carotid artery in rats was denuded with a balloon catheter The rats were killed 14 days after injury Cross sections stained with picrosirius red from the injuried segments were processed for distribution, arrangememt, amount, proportion of collagen type Ⅰ and type Ⅲ by polarizing microscope, and those stained with hematoxylin eosin for histological and morphological changes studied by computer assisted picture analysis system Results Fourteen days after balloon injury, collagen type Ⅰ and type Ⅲ of the model group were found mainly in adventitia, much more, thicker, brighter and more disordered than those of the sham operation group Compared with the model group, collagen type Ⅰ and type Ⅲ of the E Zhu You group were found mainly in adventitia, less, thinner, dimmer and more orderly Lumen area, EEL perimeter, IEL perimeter of the model group were decreased and the areas of collagen types Ⅰ and Ⅲ increased more significantly than those of the sham operation group Compared with the model group, maximal intimal thickness, neointima area, the areas of collagen type Ⅰ and Ⅲ of the E Zhu You group were decreased significantly which was not different from those of the sham operation group Lumen area, EEL perimeter and IEL perimeter were increased markedly up to those of the sham operation group The ratio of collagen subtypes Ⅰ/Ⅲ was not significantly different between the two of the three groups Conclusion The accumulation and derangement of collagen types Ⅰ and Ⅲ may be more important in restenosis than the ratio of collagen subtypes Ⅰ/Ⅲ We concluded that Oleum Curcumae Aromaticae oil injection inhibits neointimal formation and vascular remodeling after arterial injury by mechanisms involving collagen types Ⅰ and Ⅲ production and their arrangement
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Objective The aim was to investigate the manupulation and the localization of LV Lead, and to evaluate LV Lead usefulness in biventricular pacing.Methods 9 Patients with enlarged left ventricle, chronic heart failure, CLBBB and refractory to chemical therapy were selected in this study, including 8 males and 1 female. Coronary sinus venography was performed by injecting contrast medium retrogradely at coronary sinus ostium in 7 cases or antegradely into left coronary artery in 2 cases. LV lead was introduced to CS and localized at targeting vein of LV through a "peel away" guiding sheath, which was placed in CS via left subclavian vein route. Results Coronary sinus and its tributaris were clearly visualized by both antegrate cardiac venography and retrograte cardiac venography. 2187 leads were implanted into targeting veins through "peel away" guiding sheaths in 6 cases and directly introduced in 2 cases, while in other case the lead was inserted into coronary sinus directly after a failed procedure via a "peel away" guiding sheath. The leads were placed in great cardiac vein in 1 case, lateral LV vein in 2 cases, left posterior LV vein in 2 case and left posterolateral veins in 4 cases. The acute pacing and sensing thresholds measuered during the implanting procedure were in normal limits. 2187 leads were still fully functional without dislocalization during follow up of average 253 days. Conclusion CS and its tributaries can be clearly shown by antegrate and retrograte venographies. The introduction of 2187 left ventricular pacing is easily performed directly or through a preformed "peel away" guiding sheath. LV epicardium pacing by 2187 LV lead implanted through CS is feasible and reliable.
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Objective To observe the change of the levels of plasma anti-Ⅹa,anti-Ⅱa in acute coronary syndromes and the influence of low-molecular-weight heparin(LMWH)on plasma anti-Ⅹa and anti-Ⅱa levels.Methods Plasma anti-Ⅹa and anti-Ⅱa were measured with the specific chromogenic substrate in 24 patients with ACS and 10 healthy controls from Jan.2003 to Sep.2003.LMWHs were administrated to the ACS patients.Plasma anti-Ⅹa and anti-Ⅱa were measured immediately,and at 4 h,24 h,and day 7 after initial injection.Results Plasma anti-Ⅹa and anti-Ⅱa levels in ACS patients were significantly higher than those in controls(P