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Abstract Introduction: A high incidence of cardiovascular disease (CVD) events and premature mortality is observed in patients with chronic kidney disease (CKD). Thus, new biomarkers that may help predict the development of CVD in early stages of CKD are being investigated along with other traditional risk factors. Objective: To investigate cathepsin S as an early biomarker for CVD in patients with CKD. Methods: A total of 64 patients with CKD were included and classified into 2 groups: CKD patients with established CVD and CKD patients with non-established CVD. All patients were submitted to routine investigations including complete blood count, random blood sugar, glycated hemoglobin (HbA1c), serum electrolytes, urea, creatinine, total protein, total albumin, calcium total, phosphorous, uric acid, vitamin D, parathormone, lipid profile, liver function test, measurement of serum cathepsin S (Cat S), and 2D Echo of the heart. Results: The level of serum Cat S was increased in CKD patients with CVD (p <0.05) as well as in later stages of CKD (p <0.05). CVD was also more common in patients in early stage CKD. In early stages CKD, Cat S and CVD were positively correlated. Conclusion: These findings suggest that serum Cat S might be useful as an early biomarker for CVD in CKD patients.
Resumo Introdução: Uma alta incidência de eventos de doença cardiovascular (DCV) e mortalidade prematura é observada em pacientes com doença renal crônica (DRC). Assim, novos biomarcadores que podem ajudar a prever o desenvolvimento de DCV nos estágios iniciais da DRC estão sendo investigados juntamente com outros fatores de risco tradicionais. Objetivo: Investigar a catepsina S como um biomarcador precoce para DCV em pacientes com DRC. Métodos: Um total de 64 pacientes com DRC foram incluídos e classificados em 2 grupos: pacientes com DRC com DCV estabelecida e pacientes com DRC com DCV não estabelecida. Todos os pacientes foram submetidos a investigações de rotina incluindo hemograma completo, glicemia aleatória, hemoglobina glicada (HbA1C), eletrólitos séricos, ureia, creatinina, proteína total, albumina total, cálcio total, fósforo, ácido úrico, vitamina D, paratormônio, perfil lipídico, teste de função hepática, medição da catepsina S sérica (Cat S), e Eco 2D do coração. Resultados: O nível de Cat S sérica esteve aumentado em pacientes com DRC com DCV (p <0,05), bem como em estágios posteriores da DRC (p <0,05). A DCV também foi mais comum em pacientes com DRC em estágio inicial. Em estágios iniciais da DRC, a Cat S e a DCV foram positivamente correlacionadas. Conclusão: Estes achados sugerem que a Cat S sérica pode ser útil como um biomarcador precoce para DCV em pacientes com DRC.
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Background: Type 2 diabetes mellitus (T2DM) is a complex disorder which is caused by a composite combination of genetic, epigenetic, and environmental factors. One of the most contributing quantitative risk factors is family history. The prevalence of peripheral arterial disease (PAD) in T2DM ranges from 20% to 30% and the lifetime risk of developing diabetes is up to 40% if either of parents is type 2 diabetic. Aim and Objectives: The aim of the study was to know whether non-diabetic offsprings of diabetic parents having chances of becoming diabetic and to have PAD in future part of life. Material and Methods: Taking all inclusion and exclusion criteria into consideration, 50 offsprings of diagnosed diabetic parents (>5 years) were taken as cases, and 50 healthy age-matched offsprings were taken from non-diabetic parents as controls. A thorough physical and systemic examination were done. After getting informed written consent, anthropometric measurements, FBS, PPBS, HbA1c, were measured. By taking ankle systolic blood pressure (SBP) and brachial SBP, ankle-brachial pressure index (ABPI) was calculated using a hand held vascular Doppler. Statistical analysis was done by Student’s t-test in SPSS software. Results: The mean HbA1c (%) level for controls was 5.68 ± 0.35 and for cases was 5.85 ± 0.44 with a P-value of 0.035 (significant). Similarly mean values for ankle SBP (mm Hg) were 148.4 ± 17.33 in controls and 159.8 ± 23.66 in cases with a P-value 0.0071 (significant). About 32% of controls and 50% of cases showed a non-compressible ABPI (ncABPI) arteries of >1.3, whereas only 2% of cases showed a typical ABPI of PAD, that is, <0.9. Conclusion: HbA1c being slightly higher in cases as compared to controls, points toward some ongoing dysregulation of blood glucose levels. With a ncABPI ratio being more in cases than in controls, our study showed that offsprings of diabetic parents are at more risk to develop atherosclerotic related complications such as PAD and CVD in future.
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Objective:To investigate the influence of abnormal blood pressure circadian rhythms and the morning surge on aortic stiffness in elderly patients with isolated systolic hypertension(ISH).Methods:A total of 300 untreated elderly(≥60 years)patients with ISH were enrolled.24-hour ambulatory blood pressure was measured by using a non-invasive portable ambulatory sphygmomanometer with an inflatable cuff.Brachial-ankle pulse wave velocity(baPWV)and the ankle-brachial pressure index(ABI)were measured by using an automated device.Patients were divided into the dipper(n=95), no-dipper(n=177)and extreme dipper(n=28)groups according to the rate of nocturnal blood pressure reduction.They were also divided into the morning surge(n=88)and no morning surge(n=212)groups according to the morning blood pressure surge(MBPS). Differences between the groups were compared.Correlations between the parameters were calculated by partial correlation analyses.The effects on baPWV and ABI were calculated by multiple linear regression analyses.Results:baPWV was higher in the extreme dipper group than in the dipper and no dipper groups[(1 402±234)cm/s vs.(1 467±114)cm/s vs.(1 538±140)cm/s, P<0.01], while ABI values were lower in the extreme dipper group than in the dipper group(0.98±0.10 vs.1.05±0.12, P<0.01)and the no dipper group(0.98±0.10 vs.1.03±0.12, P<0.05). Moreover, baPWV[(1 508±170)cm/s vs.(1 430±163)cm/s, P<0.01]was higher while ABI values(0.98±0.13 vs.1.06±0.11, P<0.01)were lower in the morning surge group than in the no morning surge group.baPWV was positively correlated with daytime Systolic blood pressure(dSBP)( r=0.169, P<0.01), 24 hSBPCV( r=0.143, P<0.05), and MBPS( r=0.157, P<0.01), while ABI was negatively correlated with dSBP( r=-0.146, P=0.011)and MBPS( r=-0.321, P<0.01). Age( P<0.01), dSBP( P<0.05)and 24 h systolic blood pressure variation coefficient( P<0.05)were independent factors for baPWV, while dSBP and MBPS were independent factors for ABI(all P<0.01). Conclusions:Abnormal blood pressure circadian rhythms and the morning surge are associated with increased aortic stiffness in elderly patients with ISH.
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Objective:To investigate the application of side branch protection technique in interventional treatment of intracranial arteriosclerosis stenosis.Methods:We reviewed the patients who underwent interventional treatment of intracranial arteriosclerosis stenosis from November 2018 to May 2021 in Affiliated Drum Tower Hospital of Nanjing University Medical School, and analyzed the role of side branch protection technique in the prevention and treatment of complications. Relevant evaluation indicators including: (1) imaging: patency of blood flow in target vessels and branch vessels; (2) clinical presentation: ischemic stroke or transient ischemic attack (TIA) events within 72 hours and one month follow-up results.Results:A total of 9 patients underwent side branch protection during interventional treatment for intracranial arteriosclerosis stenosis, the blood flow of target vessels was improved obviously after operation, and the blood flow of the affected branches was not affected; no stroke or TIA events occurred in 72 hours after operation and one month follow up.Conclusions:Proper application of side branch protection technique can reduce the perioperative complications effectively during the interventional treatment for intracranial arteriosclerosis stenosis.
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OBJECTIVE@#To detect whether Danlou Tablet (DLT) regulates the hypoxia-induced factor (HIF)-1α-angiopoietin-like 4 (Angptl4) mRNA signaling pathway and explore the role of DLT in treating chronic intermittent hypoxia (CIH)-induced dyslipidemia and arteriosclerosis.@*METHODS@#The mature adipocytes were obtained from 3T3-L1 cell culturation and allocated into 8 groups including control groups (Groups 1 and 5, 0.1 mL of cell culture grade water); DLT groups (Groups 2 and 6, 0.1 mL of 1,000 µg/mL DLT submicron powder solution); dimethyloxalylglycine (DMOG) groups (Groups 3 and 7, DMOG and 0.1 mL of cell culture grade water); DMOG plus DLT groups (Groups 4 and 8, DMOG and 0.1 mL of 1,000 µg/mL DLT submicron powder solution). Groups 1-4 used mature adipocytes and groups 5-8 used HIF-1 α-siRNA lentivirus-transfected mature adipocytes. After 24-h treatment, real-time polymerase chain reaction and Western blot were employed to determine the mRNA and protein expression levels of HIF-1 α and Angptl4. In animal experiments, the CIH model in ApoE-/- mice was established. Sixteen mice were complete randomly divided into 4 groups including sham group, CIH model group [intermittent hypoxia and normal saline (2 mL/time) gavage once a day]; Angptl4 Ab group [intermittent hypoxia and Angptl4 antibody (30 mg/kg) intraperitoneally injected every week]; DLT group [intermittent hypoxia and DLT (250 mg/kg) once a day], 4 mice in each group. After 4-week treatment, enzyme linked immunosorbent assay was used to detect the expression levels of serum total cholesterol (TC) and triglyceride (TG). Hematoxylin-eosin and CD68 staining were used to observe the morphological properties of arterial plaques.@*RESULTS@#Angptl4 expression was dependent on HIF-1 α, with a reduction in mRNA expression and no response in protein level to DMOG or DLT treatment in relation to siHIF-1 α -transfected cells. DLT inhibited HIF-1 α and Angptl4 mRNA expression (P<0.05 or P<0.01) and reduced HIF-1 α and Angptl4 protein expressions with DMOG in mature adipocytes (all P<0.01), as the effect on HIF-1 α protein also existed in the presence of siHIF-1 α (P<0.01). ApoE-/- mice treated with CIH had increased TG and TC levels (all P<0.01) and atherosclerotic plaque. Angptl4 antibody and DLT both reduce TG and TC levels (all P<0.01), as well as reducing atherosclerotic plaque areas, narrowing arterial wall thickness and alleviating atherosclerotic lesion symptoms to some extent.@*CONCLUSION@#DLT had positive effects in improving dyslipidemia and arteriosclerosis by inhibiting Angptl4 protein level through HIF-1 α-Angptl4 mRNA signaling pathway.
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Animals , Mice , Angiopoietin-Like Protein 4/genetics , Apolipoproteins E , Atherosclerosis/metabolism , Drugs, Chinese Herbal , Dyslipidemias/genetics , Hypoxia/metabolism , Hypoxia-Inducible Factor 1, alpha Subunit/metabolism , Plaque, Atherosclerotic , Powders , RNA, Messenger/genetics , Signal Transduction , Triglycerides , WaterABSTRACT
Objective:To investigate the short-term and long-term efficacy of endovascular stent therapy for lower extremity atherosclerotic occlusive disease.Methods:Eighty patients with lower extremity atherosclerotic occlusive disease who received treatment in Lishui Central People's Hospital from January 2020 to January 2021 were included in this study. They were randomly divided into control and observation groups, with 40 patients in each group. The control group received lower extremity artery bypass grafting, and the observation group received endovascular stent therapy. Clinical efficacy, ankle-brachial index, claudication distance, blood flow dynamics of dorsalis artery, nerve conduction velocity of the lower extremities, and postoperative complications were compared between the two groups in the short-term and 1-year follow-ups.Results:Total response rate in the observation group was 87.5% (35/40), which was significantly higher than 67.5% (27/40) in the control group ( Z = 2.00, P < 0.05). At 1-year follow-up, total response rate in the observation group was 70.0% (28/40), which was slightly, but not significantly, higher than 47.5% (19/40) in the control group ( Z = 1.77, P > 0.05). After treatment, the ankle-brachial index and claudication distance in the observation group were significantly higher than those in the control group ( t = 3.34, 8.30, both P < 0.001). The diameter, peak velocity and blood flow of dorsal foot artery in the observation group were significantly superior to those in the control group ( t = 6.98, 4.46, 5.95, all P < 0.001). Lower extremity nerve conduction velocity in the observation group was significantly higher than that in the control group ( t = 3.01, 3.70, both P < 0.05). The incidence of postoperative complications in the observation group was slightly, but not significantly, lower than that in the control group [5.0% (2/40) vs. 15.0% (6/40), P > 0.05]. Conclusion:Compared with lower extremity artery bypass grafting, endovascular stent therapy has good short-term and long-term efficacy in the treatment of lower extremity atherosclerotic occlusive disease. Endovascular stent therapy can increase ankle-brachial index and claudication distance, improve the hemodynamic indexes of dorsalis pedis artery, increase lower extremity nerve conduction velocity and has a few complications.
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Objective:To correlate acute ischemic stroke with leukoaraiosis with intracranial and extracranial artery stenosis.Methods:A total of 300 patients with acute ischemic stroke admitted to Shaoxing Second Hospital from January to December 2017 were included in this study. All patients underwent magnetic resonance (MRI) examination. According to the examination results, these patients were divided into control (acute ischemic stroke, n = 100) and acute ischemic stroke with leukoaraiosis, n = 200). Carotid artery plaque size and blood sugar level were recorded in each group. Intracranial and extracranial large artery stenosis rates were compared between the two groups. Severity of leukoaraiosis was correlated with intracranial and extracranial artery stenosis. Results:The percentage of patients developing hypertension in the observation group was significantly higher than that in the control group [66.0% (132/200) vs. 44.0% (44/100), χ2 = 13.31, P < 0.01]. The incidence of coronary heart disease in the observation group was significantly higher than that in the control group [49.0% (98/200) vs. 31.0% (31/100), χ2 = 8.81, P < 0.01]. The incidence of carotid artery plaque in the observation group was significantly higher than that in the control group [49.5% (99/200) vs. 34.0% (34/100), χ2 = 6.49, P = 0.01]. The incidence of carotid artery stenosis in the observation group was significantly higher than that in the control group [23.5% (47/200) vs. 12.0% (12/100), χ2 = 5.58, P = 0.01]. There was no significant difference in the incidence of anterior cerebral artery stenosis between observation and control groups [5.5% (11/200) vs. 4.0% (4/100), χ2 = 0.32, P = 0.57]. The size of carotid artery plaque in the observation group was significantly larger than that in the control group [(1.86 ± 0.42) cm vs. (1.39 ± 0.27) cm, t = 10.18, P < 0.01]. The incidence of intracranial and extracranial artery stenosis in the observation group was significantly higher than that in the control group [41.0% (82/200) vs. 24.0% (24/100), χ2 = 8.43, P < 0.01]. The severity of leukoaraiosis was positively correlated with the degree of intracranial and extracranial artery stenosis ( r = 0.79, P < 0.01). Conclusion:Patients with acute ischemic stroke with leukoaraiosis have a high intracranial and extracranial artery stenosis and the severity of leukoaraiosis is positively correlated with intracranial and extracranial artery stenosis.
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Intracranial artery stenosis is the main cause of ischemic stroke in China. Because of the high recurrence rate of stroke in these patients, the selected patients may benefit from interventional therapy. Therefore, risk stratification and evaluation of intracranial artery stenosis are helpful to determine the clinical treatment plan. High resolution magnetic resonance imaging can clearly show the characteristics of intracranial vascular wall, which is helpful to comprehensively evaluate intracranial vessels. This article reviews the characteristics of vulnerable plaque of intracranial atherosclerosis, the pathogenesis of stroke and the clinical application of high-resolution magnetic resonance imaging in intracranial artery stenosis.
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Objective:To investigate the correlation between serum magnesium and intracranial atherosclerotic stenosis (ICAS).Methods:The suspected patients with stroke treated in the Department of Neurology, Qingdao Municipal Hospital from January 2014 to June 2018 were retrospectively collected. The baseline characteristic data were collected and ICAS was evaluated by magnetic resonance angiography. Multivariate logistic regression model was used to analyze the independent correlation between serum magnesium and ICAS. Results:A total of 2 354 patients were enrolled, including 1 451 patients with acute ischemic stroke (ICAS n=416) and 903 patients with non-acute ischemic stroke (ICAS n=184). The median age of the overall study population was 67 years old (interquartile range, 60-77 years), 1 420 patients were male (60.30%), and the median serum magnesium was 0.86 mg/L (interquartile range, 0.81-0.92 mg/L). In patients with ischemic stroke, serum magnesium in the ICAS group was significantly lower than that in the non-ICAS group ( P=0.013); in patients with non-ischemic stroke, serum magnesium in the ICAS group tended to be lower than that in the non-ICAS group ( P=0.057). Multivariable logistic regression analysis showed that age (odds ratio [ OR] 1.020, 95% confidence interval [ CI] 1.010-1.030; P<0.001), hypertension ( OR 1.393, 95% CI 1.048-1.851; P=0.023) and diabetes ( OR 1.444, 95% CI 1.133-1.841; P=0.003) were the independent risk factors for ICAS in patients with ischemic stroke, while serum magnesium ( OR 0.252, 95% CI 0.064-0.996; P=0.049) was an independent protective factor of ICAS in patients with ischemic stroke. Conclusion:Lower serum magnesium is associated with higher risk of ICAS.
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Objective:To investigate the related factors of cerebral atherosclerotic stenosis in patients with ischemic stroke in Kashgar.Methods:Patients with ischemic stroke treated in the Department of Neurology, the First People’s Hospital of Kashgar Prefecture from January 2013 to September 2019 were retrospectively enrolled. According to the findings of head and neck angiography, they were divided into without artery stenosis group, only intracranial artery stenosis group, only extracranial artery stenosis group, and intracranial + extracranial artery stenosis group. Demographic and clinical data were compared among the groups. Multivariate logistic regression analysis was used to determine the independent risk factors for cerebral atherosclerotic stenosis. Results:A total of 2 054 patients with ischemic stroke were enrolled. Their age was 60.73±11.36 years, and 1 213 were men (59.1%). There were 973 patients (47.4%) in the without artery stenosis group, 493 (24.0%) in the only intracranial artery stenosis group, 367 (17.9%) in the only extracranial artery stenosis group, and 221 (10.8%) in the intracranial + extracranial artery stenosis group. The comparison among the groups showed that there were significant differences in age, hypertension, diabetes, coronary heart disease, lymphocyte count, leukocyte count, neutrophil count, blood sodium, blood magnesium, fructosamine, fasting blood glucose, albumin, globulin, low-density lipoprotein cholesterol, apolipoprotein B, apolipoprotein A, hypersensitive C-reactive protein, fibrinogen, and neutrophil-to-lymphocyte ratio. Multivariable logistic regression analysis showed that compared with the without arterial stenosis, older age (odds ratio [ OR] 1.01, 95% confidence interval [ CI] 1.003-1.02; P=0.011) and higher neutrophil count ( OR 1.11, 95% CI 1.06-1.16; P<0.001) were the independent risk factors for intracranial arterial stenosis; older age ( OR 1.04, 95% CI 1.02-1.05; P<0.001), complicated with coronary heart disease ( OR 1.43, 95% CI 1.00-2.04; P=0.048), higher low-density lipoprotein cholesterol ( OR 1.22, 95% CI 1.05-1.42; P=0.011) and fibrinogen (OR 1.26, 95% CI 1.07-1.47; P=0.004) were the independent risk factors for extracranial artery stenosis, and older age ( OR 1.06, 95% CI 1.05-1.08; P<0.001), complicated hypertension ( OR 1.85, 95% CI 1.27-2.69; P=0.001) and diabetes ( OR 1.80, 95% CI 1.22-2.66; P=0.003), higher neutrophil count ( OR 1.10, 95% CI 1.02-1.17; P=0.008), fructosamine ( OR 1.36, 95% CI 1.05-1.78; P=0.022) and low-density lipoprotein cholesterol ( OR 1.24, 95% CI 1.02-1.51; P=0.034) were the independent risk factors for intracranial + extracranial artery stenosis. Conclusion:There are some differences in the risk factors for intracranial and extracranial artery stenosis in patients with ischemic stroke in Kashgar Prefecture.
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Objective:To investigate the clinical characteristics of acute ischemic stroke with anterior circulation large vessel occlusion caused by cardioembolism (CE) and large artery atherosclerosis (LAA) and the efficacy of endovascular treatment.Methods:Patients with acute ischemic stroke caused by large vessel occlusion in anterior circulation and received endovascular treatment in the Stroke Center of the 971 st Hospital of the PLA Navy from April 2014 to April 2021 were retrospectively enrolled. The etiological classification of stroke was CE or LAA. According to the modified Rankin Scale score at 90 d after onset, the patients were divided into good outcome group (0-2) and poor outcome group (>2). The demographic and clinical data between the groups were compared. Multivariate logistic regression analysis was used to determine the independent influencing factors of clinical outcome. Results:A total of 106 patients were enrollded. Their age was 61.39±13.73 years and 70 (66.0%) were males. Seventy-four patients (69.8%) were in the CE group and 32 (30.2%) were in the LAA group. Sixty-six patients (62.3%) had good outcomes. Univariate analysis showed that there were significant differences in gender, age, smoking, systolic blood pressure, diastolic blood pressure, baseline National Institutes of Health Stroke Scale (NIHSS) score, time from onset to femoral artery puncture, time from puncture to vascular recanalization, and the number of retrieval attempts between the CE group and the LAA group (all P<0.05), and there were no significant differences in the incidences of poor outcome, hemorrhagic transformation, and symptomatic intracranial hemorrhage. There were significant differences in systolic blood pressure, diastolic blood pressure, baseline NIHSS score, time from onset to femoral artery puncture, and blood perfusion grade after treatment between the good outcome group and the poor outcome group (all P<0.05). Multivariable logistic regression analysis showed that higher systolic blood pressure (odds ratio [ OR] 1.046, 95% confidence interval [ CI] 1.014-1.078; P=0.004), higher baseline NIHSS score ( OR 1.117, 95% CI 1.037-1.203; P=0.003), longer time from onset to femoral artery puncture ( OR 1.008, 95% CI 1.001-1.015; P=0.019) and poor blood perfusion after treatment ( OR 8.042, 95% CI 1.532-42.215; P=0.014) were significantly and independently associated with the poor outcomes. Conclusions:Compared with LAA, CE do not increase the risks of hemorrhagic transformation and symptomatic intracranial hemorrhage. The safety and efficacy of the two are similar.
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Objective:To evaluate the mid-term clinical efficacy of drug-coated balloons (DCB)in the treatment of femoro-popliteal artery TASC Ⅱ C/D de novo stenosis and in-stent restenosis.Methods:A total of 126 patients with TASC Ⅱ C/D femoro-popliteal artery stenosis treated with DCB in Renji Hospital and Pudong New Area People's Hospital from December 2016 to August 2020 were retrospectively enrolled, including 74 cases of de novo stenosis (de novo group) and 52 cases of in-stent restenosis (ISR group). The clinical data and lesion characteristics were analyzed; the primary patency rate, primary-assisted patency rate, secondary patency rate, and the freedom from target lesion revascularization (f-TLR)rate were evaluated; the perioperative complications, mortality and amputation rate were compared between two groups. Kaplan-Meier method was used to evaluate the patency rate of target vessel lesions, and Cox regression analysis was used to evaluate the relative risk factors.Results:There were 6 patients died in each group during the followup period. The lesion length of the de novo and ISR groups were (21.25±12.64) cm and (34.71±12.02) cm, respectively( t=33.74, P<0.001). The popliteal artery involvement was 33.8% (25/74) in the de novo group and 15.4% (8/52) in the ISR group (χ 2=5.35, P=0.021). The operational success rate was 100.0% in both groups, and the perioperative complication rate was 6.8% (5/74) in the de novo group and 1.9% (1/52) in ISR group. The median follow-up time was 22 month and 17 months; the mean follow-up time were(19.78 ± 11.02) months and (20.02 ± 11.32) months in the de novo group and ISR group, respectively. The primary patency rates at 6, 12 and 24 months after intervention were 89.1%, 73.4%, 50.8% in the Denovo group, and 87.8%, 68.8%, 42.0% in the ISR group, respectively; the primary assisted patency rate was 90.7%, 78.4%, 62.8% in the de novo group, and 89.3%,77.1%, 62.8% in the ISR group, respectively; the secondary patency rate was 95.1%,95.1%, 88.7% in de novo group, and 94.9%, 88.9%, 84.3% in ISR group, respectively; the f-TLR rate was 97.3%, 88.6%, 79.2% in de novo group, and 90.0%, 77.7%, 74.7% in ISR group, respectively (all P>0.05). Cox regression analysis showed that P2 and P3 segment involvement of the popliteal artery were independent factors affecting the patency rate of target lesion. Conclusions:The mid-term clinical efficacy of DCB in the treatment of TASC Ⅱ C/D femoro-popliteal artery de novo stenosis and in-stent restenosis is satisfactory.
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Objective:To investigate the accuracy and reproducibility of a new method, Automatic Measurement of Arterial Stiffness(AMAS) system, for arterial stiffness automatic measurement based on regional pulse wave velocity (PWV).Methods:A total of 30 hypertensive patients who were hospitalized in the Department of Cardiology in Tangdu Hospital, Air Force Military Medical University from September 1 to 30, 2019 were enrolled as hypertensive group, while 30 healthy participants at the same time were collected as healthy group. Carotid-femoral PWV (cfPWV) was measured in all subjects by two independent observers using the conventional manual method and the AMAS system. The measurements were compared and the agreement was analyzed.Results:There was no significant difference of cfPWV between AMAS system and the manual method, and the intraclass correlation coefficient was 0.953 (95% CI=0.922-0.971). Bland-Altman plots showed good agreement [mean difference: -(0.08±0.40)m/s; limit of agreement: -0.87-0.71 m/s]. Time consumption for cfPWV measurement using the AMAS system was significantly less than that of conventional manual method, saving about 70% of the time. The cfPWV measured by AMAS showed good intra- and inter-observer reproducibility. Conclusions:AMAS system is accurate and reproducible in measuring arterial stiffness. It may provide a noninvasive, rapid, reliable approach for arterial stiffness evaluation in clinical settings.
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Objective:To investigate the relationship between wall shear stress (WSS) and the degree of lumen stenosis and plaque characteristics in patients with atherosclerotic stenosis in the middle brain.Methods:Thirty-four patients with moderate to severe unilateral middle cerebral artery stenosis in Nanjing First Hospital from June 2020 to June 2021 were analyzed retrospectively. All patients underwent routine magnetic resonance imaging and vascular wall imaging to obtain plaque parameters such as plaque area, remodeling mode and remodeling index. Based on magnetic resonance angiography, a computational fluid dynamics model was established to simulate the local hemodynamics near the lesion and quantify WSS. The patients were divided into high WSS group and low WSS group according to the median WSS. The differences of clinical baseline data, degree of lumen stenosis and plaque characteristics between the two groups were compared. Pearson correlation analysis was used to calculate the correlation between WSS and lumen stenosis and plaque characteristics.Results:A total of 34 patients were included in this study, 17 in the high WSS group and 17 in the low WSS group. Compared with the low WSS group, the plasma homocysteine level in the high WSS group was lower [(11.10±4.96) μmol/L vs (16.97±6.98) μmol/L, t=-2.83, P=0.010], the degree of stenosis was lower (0.56±0.05 vs 0.66±0.08, t=-4.54, P<0.001), and the proportion of positive lumen remodeling was higher (12/17 vs 4/17, P=0.015). Pearson correlation analysis showed that the degree of lumen stenosis was negatively correlated with WSS ( r=-0.44, P=0.011), and the plaque area was not correlated with WSS. Conclusions:WSS in middle cerebral artery stenosis is related to the degree of lumen stenosis and the mode of vascular remodeling. Higher WSS has poor stability, but lower WSS is more likely to cause lumen stenosis.
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Objective:To summarize the clinical efficiency of paclitaxel drug coated balloon (DCB) in femoral popliteal artery disease.Methods:Retrospective analysis was made on 125 patients (141 limbs) admitted from Jun 2016 to Jul 2019 for femoral popliteal disease treated with DCB.Results:Median follow-up time was 19 months. The average lesion length was (138±78) mm, with an overall cumulative primary patency rate of 81.4% and 60.8% at 12 and 24 months postoperatively and f-TLR rates of 90.1% and 83.0%, respectively. In a total of 109 primary lesions, subgroup analysis showed that among the TASC C/D primary lesions, the primary patency rate was significantly lower in those with combined severe calcification and the f-TLR rate in those with popliteal involved lesions. TASC grade C/D lesions, severe calcified lesions were independent risk factors for patency, while hypertension was an independent protective factor.In-stent restenosis (ISR) target lesions involving the popliteal segment had a significantly worse prognosis than ISR of the superficial femoral artery.Conclusion:DCB in the treatment of lower femoral popliteal artery lesions can achieve a satisfactory medium-term patency outcome, while the efficacy for complex lesions still needs further improvement.
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Objective:To compare the efficacy between drug-coated balloon (DCB) combined with bare metal stenting (BMS) and plain old balloon angioplasty (POBA) with BMS placement in the treatment of femoral-popliteal TASC D lesions.Methods:According to the Trans-Atlantic Inter-Society Consensus (TASC) D grade femoral-popliteal lesions as the standard, we enrolled 115 cases (120 limbs) receiving DCB combined with BMS (group DCB, 37 limbs in 36 cases) and POBA combined with BMS (group POBA, 83 limbs in 79 cases) from Jan 2017 to Mar 2020 to observe patency rate, freedom from clinical-drived target lesion reintervention rate (FCD-TLR) and complications.Results:The mean follow-up time was 18.1 months and the average occlusion length was (29.1±6.5)mm. In group DCB vs group POBA, the primary patency rates at 3-month, 9-month, 1-year and 2-year were 89.2% vs. 86.7%, 86.4% vs. 76.9%, 66.8% vs. 70.9% and 63.1% vs. 56.9%, respectively ( P=0.73); FCD-TLRs were 100.0% vs. 95.1%, 94.3% vs. 82.3% , 78.5% vs. 80.6% and 74.1% vs. 68.9% ( P=0.69), respectively. Conclusion:The benefit of DCB combined with BMS over POBA combined with BMS in improving the early primary patency rate and reducing FCD-TLR was not definite.
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Objective:To evaluate the safety and clinical efficacy of Neuroform EZ stent in the treatment of severe intracranial atherosclerotic stenosis (ICAS).Methods:A total of 36 patients with severe ICAS receiving Neuroform EZ stent angioplasty were retrospectively analyzed at Beijing Anzhen Hospital from July 2018 to January 2020. Digital subtraction angiography (DSA) before endovascular intervention confirmed the diagnosis. Follow-up information was reviewed by neurologists at 30 days and 6 months after the procedure. The primary endpoints were transient ischemic attack (TIA), ischemic or hemorrhagic stroke and death caused by any reason within 30 days.Results:The overall technical success rate was 100%. The median stenosis rate was reduced from 93.6%±4.5% to 18.8%±11.2% ( t=37.36, P<0.001).Primary endpoint event was not reported. During follow-up, one patient developed TIA and no death or ischemic stroke was observed. No in-stent restenosis at six months occurred. Conclusion:Neuroform EZ stent is safe and effective in patients with severe ICAS. However, perspective studies need to be operated for further validation via long-term follow-up.
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Objective:To explore the distribution characteristics of brachial-ankle pulse wave velocity (BaPWV) in adolescents.Methods:Cross sectional survey research.A total of 1 607 adolescents aged 12-17 years from 5 middle schools in the Haidian District, Beijing from June 2020 to May 2021 were enrolled for measuring their blood pressure, weight, height and the body mass index (BMI), including 782 males and 825 females.BaPWV was measured using an arteriosclerosis detector.They were divided by the age, sex and obesity.Differences of measurement data among multiple groups were compared by one-way ANOVA, followed by the LSD test, and those between groups were compared by the two-sample t-test.The correlation between BaPWV and other indexes was assessed by the Pearson correlation analysis. Results:The median level of BaPWV in adolescents aged 12-17 years increased with age, which was 982.50 cm/s in adolescents aged 12 years, and maximum 1 113.50 cm/s those aged 17 years.BaPWV in adolescents aged 12-17 years was positively correlated with age ( r=0.936, P=0.006). Subgrouped by the sex, the median BaPWV of male and female adolescents aged 12 years was 962.25 cm/s and 997.50 cm/s, respectively, which reached 1 122.50 cm/s and 1 096.00 cm/s in those aged 17 years, respectively.BaPWV of male and female adolescents was positively correlated with the age ( r=0.903, P=0.014; r=0.945, P=0.004). In male adolescents, BaPWV was positively correlated the systolic and diastolic blood pressure, age, weight, height, BMI( r=0.308, P<0.001; r=0.289, P<0.001; r=0.478, P<0.001; r=0.190, P<0.001; r=0.315, P<0.001; r=0.109, P=0.002). In female adolescents, BaPWV also was positively correlated the systolic and diastolic blood pressure, age, weight, height, BMI( r=0.340, P<0.001; r=0.285, P<0.001; r=0.379, P<0.001; r=0.115, P=0.001; r=0.170, P=0.001; r=0.097, P=0.014). In the overall population, BaPWV was statistically significant between the obese and normal groups ( t=-3.428, P=0.001). No significant difference in BaPWV between male and female adolescents aged 12-13 years was identified ( t=0.123, P=0.902 ), but it was significantly lower in female adolescents aged 14-15 years and 16-17 years than those of age-matched males( t=2.315, P=0.021; t=2.152, P=0.032). Conclusions:The median BaPWV level in adolescents aged 12-17 years, increases with the age.Systolic blood pressure, diastolic blood pressure, body weight, BMI, age and height are positively correlated with BaPWV in adolescents.Obesity can increase the stiffness of blood vessels, which is influenced by the sex.
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Objective:To explore the predictive value of ankle brachial index (ABI), HEART and thrombolysis in myocardial infarction (TIMI)scores for restenosis in patients with lower extremity arteriosclerosis obliterans (LEASO) after stent implantation.Methods:A retrospective study of 100 patients who were admitted to the Heyuan City People′s Hospital for stent implantation for LEASO from January 2015 to January 2020 and met the inclusion criteria were collected, and the patients were divided into restenosis group ( n=28) and patency group ( n=72) according to whether they were restenosis after operation. The clinical data of the two groups of patients were compared, including gender, age, disease course, history of cardiovascular and cerebrovascular diseases, smoking history, regular medication after surgery, number of stents, total length, bilateral lesions, total occlusion of lower extremities, length of vascular lesions, high-sensitivity C-reactive protein (hs-CRP), fasting blood glucose, triglyceride, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, total cholesterol, fibrinogen, hemoglobin, platelet count and red blood cell count, and ABI, HEART, TIMI scores were compared, the relationship between ABI, HEART and TIMI scores and postoperative restenosis was further analyzed. Measurement data were expressed as mean±standard deviation ( ± s), and two independent samples t-test was used for comparison between groups; enumeration data were compared between groups by Chi-square test. Based on independent risk factors in multivariate Logistic regression analysis, a nomogram prediction model was constructed using R 3.3.2 software and software package rms. Correlations were analyzed using bivariate Pearson linear correlation analysis. The receiver operating characteristic curve (ROC) was used to evaluate the predictive value of each score and nomogram model for postoperative restenosis, and the results were expressed as the area under the curve (AUC) and the 95% confidence interval (95% CI) of the area. Results:Patients in the restenosis group and the patency group had a history of smoking, the proportion of irregular postoperative medications, the number of implanted stents, the total length of implanted stents, hs-CRP, fibrinogen, total cholesterol, red blood cell count levels, and ABI, HEART, TIMI scores were significantly different ( P<0.05). Pearson correlation analysis showed that ABI score ( r=-0.527, P=0.001) was negatively correlated with postoperative restenosis, and the HEART score ( r=0.604, P=0.010) and TIMI score ( r=0.719, P=0.005) were positively correlated with postoperative restenosis. A history of smoking, irregular medication after surgery, number of implanted stents>2, total length of implanted stent>212 mm, hs-CRP>2 mg/L, fibrinogen>3.7 g/L, ABI score ≤0.58, HEART score>6.30, and TIMI score>4.30 were independent risk factors for postoperative restenosis. The ABI, HEART, and TIMI scores predict the AUC of the ROC curve for postoperative restenosis of 0.813, 0.789, and 0.798, cutoff points were 0.58, 6.30 and 4.30 score, sensitivities were 95.64%, 91.17% and 92.51%, specificities were 64.18%, 55.43% and 58.62%, respectively. The consistency index (C-index) and ROC curve AUC of the nomogram prediction model were 0.811 (95% CI: 0.721-0.901) and 0.818 (95% CI: 0.732-0.904), respectively, indicating a good degree of discrimination. Conclusions:ABI, HEART and TIMI scores are independent risk factors for restenosis after stent implantation in LEASO patients. ABI, HEART and TIMI scores can effectively predict the risk of restenosis after stent implantation in patients.
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Many studies have shown that endovascular recanalization is feasible for the treatment of non-acute symptomatic intracranial large artery occlusion. However, its incidence of perioperative complications is relatively high. Appropriate imaging evaluation can better observe the occluded segments of the vessels before procedure, thereby guiding the choice of clinical treatment.