Biomimetic nanomedicines for precise atherosclerosis theranostics

Atherosclerosis (AS) is a leading cause of the life-threatening cardiovascular disease (CVD), creating an urgent need for efficient, biocompatible therapeutics for diagnosis and treatment. Biomimetic nanomedicines (bNMs) are moving closer to fulfilling this need, pushing back the frontier of nano-based drug delivery systems design. This review seeks to outline how these nanomedicines (NMs) might work to diagnose and treat atherosclerosis, to trace the trajectory of their development to date and in the coming years, and to provide a foundation for further discussion about atherosclerotic theranostics.

Effect of local unstable atherosclerotic plaque on plaque formation in the carotid artery and abdominal aorta of rabbits / 南方医科大学学报

OBJECTIVE@#To analyze the effect of local unstable atherosclerotic plaque on plaque formation in the carotid and aortic arteries of rabbits.@*METHODS@#Thirty New Zealand white rabbits were randomly divided into atherosclerosis model group, highfat diet feeding group, and normal chow feeding group (blank control group). In the model group, carotid artery balloon injury was induced after 4 weeks of high-fat diet feeding. Eight weeks later, all the rabbits were euthanized for histopathological examination of the carotid artery and abdominal aorta, and the mean intimal thickness and plaque to lumen area ratio were measured using image analysis software. Venous blood samples were collected from the rabbits for blood lipid analysis.@*RESULT@#At the ends of 4, 8 and 12 weeks, the rabbits in the model group and high-fat feeding group, but not those in the blank control group, all showed significant weight gain compared with their body weight at 0 week (P < 0.05). The mean intimal thickness was significantly greater in atherosclerosis model group than in the other two groups (P < 0.05). In atherosclerosis model group, the mean intimal thickness and plaque to lumen area ratio in the injured carotid artery were significantly greater than those in the contralateral carotid artery and abdominal aorta (P < 0.05). At the end of the 12 weeks, the levels of triglyceride (TG), total cholesterol (TC), low-density cholesterol (LDL-C), high-density cholesterol (HDL-C) and highsensitivity C-reactive protein (CRP) were all significantly higher in the model group and high-fat feeding group than in the blank control group (P < 0.05); the levels of TG, TC, LDL-C, or HDL-C did not differ significantly between the model group and high-fat feeding group (P>0.05), but the level of CRP was significantly higher in arteriosclerosis model group (P < 0.05).@*CONCLUSION@#Local unstable atherosclerotic plaque can increase the level of CRP and promote the formation of atherosclerotic plaques in the carotid artery and abdominal aorta in rabbits.

ANGIOKERATOMA: A RARE MANIFESTATION

Angiokeratoma shows dilatation of capillaries in the upper dermis and it also shows some epidermal changes, like- hyperkeratosis, papillomatosis, and thickening of epidermis or acanthosis .Clinical presentation of angiokeratoma includes plaques over the skin of lower limbs, mostly on the buttocks or thigh. It is usually identified clinically but a definitive diagnosis is made only on histopathological examination.A deeper biopsy of the lesion is empirically essential to make a concrete diagnosis as the characteristic changes seen in angiokeratoma, are limited to superficial dermis. Our case report has a 24 years old female presenting with unilateral, linear, bluish-black verrucous plaque on the back of left elbow.

Dermatosis neglecta

RESUMEN La dermatosis neglecta es una patología clínica, de etiología desconocida, asociada a la mala higiene, pudiendo afectar a personas de cualquier raza, edad y sexo. Se presenta generalmente como placas hiperpigmentadas, a veces verrugosas, dándole una apariencia seborreica, asintomáticas, en zonas de difícil acceso para la higiene, éstas tienen la característica de ser difícilmente removidas con jabón y agua.

ABSTRACT Dermatosis neglecta is a clinical pathology, of unknown etiology, associated with poor hygiene, that could affect people of any race, age and sex. It generally presents as hyperpigmented plaques, sometimes warty, giving it a seborrheic appearance, asymptomatic, in areas difficult to access for hygiene, these have the characteristic of being difficult to remove with soap and water.

Analysis of serum cholesterol, statins and atherosclerotic plaque in ruptured and unruptured intracranial aneurysm / Análise de colesterol sérico, estatina e placa aterosclerótica em aneurisma intracraniano roto e não roto

Introduction Intracranial aneurysm (IA) is a major healthcare concern. The use of statin to reduce serum cholesterol has shown evidence to reduce cardiovascular risk in various diseases, but the impact on IA has not been described. This study aims to determine whether statin use, and serum cholesterol levels interfere with outcomes after IA event. Methods A cohort of patients with IA was analyzed. Patients social and demographics data were collected.Modified Rankin scale (mRS) score after 6months of follow-up was the endpoint. The data regarding statins use, presence or not of atherosclerotic plaque in radiological images and serum cholesterol of 35 patients were included in our study. Linear regression models were used to determine the influence of those 6 variables in the clinical outcome. Results The prevalence of atherosclerotic plaque, high cholesterol and use of statins was 34.3%, 48.5%, and 14.2%, respectively. Statins and serum cholesterol did not impact the overall outcome,measured by mRS after 6 months (p>0.05), but did show different tendencies when separated by IA rupture status. Serum cholesterol shows na important association with rupture of aneurysm (p»0.0382). High cholesterol and use of statins show a tendency for worse outcome with ruptured aneurysm, and the opposite is true for unruptured aneurysm. The presence of atherosclerotic plaques was not related with worse outcomes. Conclusions Multiple and opposite mechanisms might be involved in the pathophysiology of IA. Ruptured aneurysms are associated with higher levels of serum cholesterol. Serum cholesterol and statins use were not correlated with worse outcomes, but further studies are important to clarify these relationships.

Introdução Aneurisma intracranial (AI) é uma grande preocupação para a saúde. Evidências apontam que o uso de estatina para reduzir o colesterol sérico diminui o risco cardiovascular em diversas doenças, mas o impacto em AI ainda não foi descrito. Este estudo almeja determinar se o uso de estatina e o nível sérico de colesterol interferem no desfecho clínico após a ocorrência de AIs. Métodos Uma coorte de pacientes com AI foi analisada. Os dados sociodemográficos dos pacientes foram coletados. Ao final de 6 meses de acompanhamento, aplicou-se a escala modificada de Rankin (mRS). Os dados sobre uso de estatina, existência de placa aterosclerótica em imagens radiológicas, e colesterol sérico de 35 pacientes foram incluídos no estudo. Modelos de regressão linear foram usados para determinar a influência dessas 6 variáveis nos desfechos clínicos. Resultados A prevalência de placa aterosclerótica, colesterol elevado, e uso de estatina foram respectivamente 34,3%, 48,5% e 14,2%. Estatina e colesterol sérico não impactaram nos desfechos medidos pela mRS em 6 meses (p > 0,05), mas mostraram diferentes tendências quando separados pelo estado de ruptura do AI. Colesterol sérico apresenta uma importante associação com ruptura de aneurisma (p » 0,0382). Colesterol elevado e uso de estatinas representam uma tendência a piores desfechos para aneurismas rompidos, e o oposto é verdade para os não rompidos. A presença de placa aterosclerótica não está relacionada com piores resultados. Conclusões Mecanismos múltiplos e opostos podem estar envolvidos na patofisio logia do AI. Aneurismas rompidos estão associados com maiores níveis de colesterol sérico. Colesterol sérico e estatinas não foram correlacionados com piores desfechos, mas mais estudos são importantes para clarificar a relação entre esses fatores

Relationship between lipoprotein (a) and subclinical carotid atherosclerosis in asymptomatic individuals

Abstract Background: This study aimed to evaluate the associations between Lipoprotein (a) ‒ Lp(a) levels and carotid Intima-Media Thickness (cIMT) and with carotid plaques in healthy subjects because of previous contradictory data. Methods: A total of 317 healthy normolipidemic subjects (20‒77 years old) were selected. The cIMT and atherosclerotic plaques were determined by B-mode ultrasonography. Mann-Whitney tests were performed to compare the groups according to Lp(a) levels and to explore the associations between Lp(a), carotid plaques, and cIMT, logistic and linear regression analyses were performed. Results: Studied population (51% females, median age 43 years old) presented carotid plaques and cIMT ≥ 0.9 mm in 23% and 18% of the participants, respectively. The group with Lp(a) levels > 30 mg/dL presented significantly higher age and atherosclerotic plaques. Indeed, multivariate linear regression analysis showed a significant association between Lp(a), age, and race. On the other hand, logistic regression analysis demonstrated that the subjects with Lp(a) > 30 mg/dL have a significantly high risk of carotid plaques. Conclusion: The data from the present study indicate that Lp(a) levels above 30 mg/dL contribute to the development of carotid plaques even in apparently healthy participants.

A study on alpha-terpineol in Alzheimer's disease with the use of rodent in vivo model, restraint stress effect and in vitro Amyloid beta fibrils

Abstract Alzheimer's disease (AD) is a neurological disorder in which the neuronal degeneration is associated with inflammatory processes and oxidative stress. Since alpha-terpineol was shown to possess antioxidant and anti-inflammatory effects, the administration of this compound was studied on a rat model of AD. To create this model, Aβ1-42 was injected into the hippocampus of male Wistar rats. Generated AD models were divided into simple AD models and AD models in which short-term immobilization stress was added. Preventive and therapeutic (post-AD induction) effects of alpha-terpineol consumption (100 mg/Kg) were subsequently investigated in AD models, which were compared with control groups. Biochemical factors (superoxide dismutase and malondialdehyde), histological manifestations (amyloid plaques and neuron counts) and possible memory impairment (shuttle-box experiment) were investigated in all groups. For the in vitro experiment, alpha-terpineol effect was checked on Aβ1-42 fibril formation. In preventive and therapeutic modes, alpha-terpineol consumption could improve neurogenesis and long-term memory while reducing amyloid plaque counts and ameliorating biochemical factors (higher levels of superoxide dismutase and malondialdehyde and reduced levels of MDA). In vitro, shorter fibrillar structures were formed in the presence of alpha-terpineol, which indicates an anti-amyloid effect for this compound. In conclusion, alpha-terpineol significantly counteracted AD consequences.

Prolonged luteal phase support with progesterone may increase papules and plaques of pregnancy frequency in pregnancies through in vitro fertilization

Abstract Background: Pruritic urticarial papules and plaques of pregnancy development may have a strong relationship with hormone treatments during in vitro fertilization and hormonal changes during pregnancy. Objectives: The aim of this study was to evaluate and compare the frequency of papules and plaques of pregnancy and related factors in in vitro fertilization pregnancies and spontaneous pregnancies. Methods: In this study, 517 in vitro fertilization pregnancies and 1253 spontaneous pregnancies were retrospectively reviewed for papules and plaques of pregnancy frequency. The diagnosis of papules and plaques of pregnancy was performed by referral to the dermatology department and according to the typical clinical manifestations of the disease. Results: The papules and plaques of pregnancy was more common in all in vitro fertilization pregnancies (including single pregnancies) than in spontaneous pregnancies. Age, Rh positivity, mother weight gain, onset of disease during gestation, duration of disease, birth weight and the frequency of male fetus were similar between the two groups (p > 0.05). The rate of multiple pregnancies was higher in in vitro fertilization pregnancies with papules and plaques of pregnancy than in vitro fertilization pregnancies without papules and plaques of pregnancy (p < 0.001). Duration of progesterone treatment was also significantly longer in in vitro fertilization pregnancies with papules and plaques of pregnancy compared to in vitro fertilization pregnancies without papules and plaques of pregnancy (p < 0.001). Study limitations: The limitations of the study were the retrospective and single-centered design. Conclusion: The results of this study indicate that increased progesterone dosage or prolonged treatment may play a role in the pathogenesis papules and plaques of pregnancy.

Hypolipidemic and anti-atherosclerogenic effects of aqueous extract of Ipomoea batatas leaves in diet-induced hypercholesterolemic rats / 中西医结合学报

OBJECTIVE@#Ipomoea batatas (L.) Lam. is a food plant used in African traditional medicine to treat cardiovascular diseases and related conditions. We assessed the hypolipidemic and anti-atherosclerogenic properties of the aqueous extract of I. batatas leaves in a rat model of diet-induced hypercholesterolemia.@*METHODS@#Hypercholesterolemia was induced in male Wistar rats by exclusive feeding with a cholesterol-enriched (1%) standard diet for four weeks. Then, rats were treated once daily (per os) with I. batatas extract at doses of 400, 500 and 600 mg/kg or with atorvastatin (2 mg/kg), for four weeks. Following treatment, animals were observed for another four weeks and then sacrificed. Aortas were excised and processed for histopathological studies, and blood glucose level and lipid profile were measured.@*RESULTS@#Hypercholesterolemic animals experienced a 21.5% faster increase in body weight, significant increases in blood glucose and blood lipids (148.94% triglycerides, 196.97% high-density lipoprotein cholesterol, 773.04% low-density lipoprotein cholesterol, 148.93% very low-density lipoprotein cholesterol and 210.42% total cholesterol), and increases in aorta thickness and atherosclerotic plaque sizes compared to rats fed standard diet. Treatment of hypercholesterolemic rats with the extract mitigated these alterations and restored blood glucose and blood lipid levels to normocholesterolemic values.@*CONCLUSION@#Our findings suggest that I. batatas leaves have hypolipidemic and anti-atherosclerogenic properties and justify their use in traditional medicine.

Histopathological Features and Clinical Variants of Biopsy Confirmed Psoriasis Cases in a Tertiary Care Setting in Kerala.

Psoriasis is a chronic, immune mediated, relapsing, papulosquamous disease having a high prevalence. Since it affects other organ systems such as musculoskeletal system, gastrointestinal system and the eye, it can lead to considerable disability. Although only rarely life threatening, it has high morbidity due to its chronicity and absence of cure. MethodsThis study was conducted over a period of 2 years in the Department of Pathology, Medical College, Thiruvananthapuram. A total of 217 skin biopsy specimens in which a clinical diagnosis / differential diagnosis of psoriasis was made, was studied during this period. Results108 cases out of 217 which were histopathologically diagnosed as psoriasis were studied in detail. Male predominance was noted in the study population. The mean duration of disease in this study was 6.69 yrs. Fifty percentage of the patients had associated comorbidities with hypertension outnumbering others. Among male patients, 26 (32.5 %) had the habit of smoking. The most common presentation was as erythematous scaly plaques, with pruritus being the second most common presentation. Histopathology proved to be conclusive of psoriasis in all cases. Hyperkeratosis was seen in all cases which was the most consistent histopathological feature. Confluent parakeratosis which is one of the characteristic features of psoriasis was seen in 62 (57.4 %) cases with the rest being focal. Other epidermal features studied were papillomatosis, hypogranulosis, suprapapillary thinning, and basal mitotic figures. Spongiosis was seen in 83 (76.9 %), exocytosis of neutrophils in 66 (61.1 %) and Munro’s micro abscess in 42 (38 %) cases. Dilated blood vessel was the most common dermal change observed, seen in 105 (97 %). Lymphocytes were the most frequent upper dermal inflammatory infiltrate observed. Oedema was seen in 5 (4.6 %) of cases. ConclusionsPsoriasiform lesions pose diagnostic dilemma to the treating clinician. To provide a clear-cut diagnosis, histopathological evaluation is essential. It is also important to differentiate between the different variants of psoriasis in the context of treatment. It has an important role in the follow up of psoriatic patients.

Effect of electroacupuncture on the expression of insulin signal pathway related proteins in hippocampus in mice with Alzheimer's disease / 中国针灸

OBJECTIVE@#To observe the effect of electroacupuncture (EA) on the expression of insulin phosphatidylinositol-3 kinase/glycogen synthetase kinase-3α (PI3K/GSK3α) signal pathway related proteins in the hippocampus in mice with Alzheimer's disease (AD), and to explore the regulatory mechanism of EA on improving the pathological characteristics of AD.@*METHODS@#Twelve male APP/PS1 double transgenic mice were randomly divided a model group and a treatment group, 6 mice in each group; another 6 wild-type male mice were taken as the control group. The mice in the treatment group were treated with EA (continuous wave, 2 Hz of frequency) at "Baihui" (GV 20) and bilateral "Shenshu" (BL 23), once a day; 7-day treatment was taken as a course of treatment, and 2 courses of treatment were given. The immunohistochemistry method and Western blot method were used to detect the distribution and expression level of hippocampal PI3K/GSK3α signal pathway related proteins P85α, P110α, GSK3α and pSGSK3α, and the number of hippocampal senile plaques (SP) was observed.@*RESULTS@#The proteins of P85α, P110α, GSK3α and pSGSK3α were mainly distributed in the cytoplasm of hippocampal neurons, and the GSK3α was also distributed in the axons of neurons in the model group and the treatment group. The immunohistochemistry results showed that the distribution level of GSK3α in the hippocampus in the model group was significantly higher than that in the control group (<0.001), and the distribution level of pSGSK3α, P85α and P110α was significantly decreased (<0.01, <0.001); compared with the model group, the distribution level of GSK3α in the hippocampus in the treatment group was significantly decreased (<0.001), and the distribution level of pSGSK3α, P85α and P110α in hippocampus was significantly increased (<0.05, <0.001). The Western blot results showed compared with the control group, the expression of pSGSK3α, P85α and P110α as well as the ratio of pSGSK3α/GSK3α in the hippocampus in the model group were significantly decreased (<0.001), and the expression of GSK3α was increased (<0.05); compared with the model group, the expression of pSGSK3α, P85α, P110α and the ratio of pSGSK3α/GSK3α in the hippocampus in the treatment group were significantly increased (<0.01, <0.001), and the expression of GSK3α was decreased (<0.05). Compared with the control group, the number of hippocampal SP in the model group was significantly increased (<0.001); compared with the model group, the number of hippocampal SP in the treatment group was significantly decreased (<0.01).@*CONCLUSION@#EA could effectively regulate the expression of PI3K/GSK3α signal pathway related proteins in the hippocampus in mice with AD, so as to reduce the formation and deposition of SP.

Atherosclerotic changes in aorta and coronary arteries at autopsy in North Indian population

Background: Cardiovascular disease (CVD) has become a ubiquitous cause of morbidity and a leading contributor to mortality in most countries. It has emerged as a major health burden worldwide with atherosclerosis being the major cause.Methods: 150 random cases of different age groups brought for postmortem examination in the Department of Forensic Medicine PGIMS, Rohtak. Heart was removed and examined after obtaining the consent of next of the kin of the deceased. Gross macroscopic changes were noted and microscopic changes examination was done and reported by preparation of slides in collaboration with Department of Pathology of the Institute.Results: The study group comprised of mostly males (70%) with mean age of 36.90±13.88 years. Almost half of them were in their third and fourth decade of life. 83 cases were found to have atherosclerosis and 25 of them belonged to the age group 40 to 49 years. 82 % of these cases were of male gender. Histopathological grading carried out displayed that Grade III lesions were maximum (27.5%) followed by grade IV lesions (19.0%) and in no section grade VIII lesions were seen.Conclusion: Atherosclerosis has emerged as a new epidemic affecting at a relatively younger age. This study would help in planning of preventive measures directed at the right population. Clinicians could take measures at an early stage to prevent the progression of the disease and will help forensic pathologists in dealing with opinion regarding cause of death.

Aterosclerosis carotídea en el infarto cerebral aterotrombótico del territorio vascular homónimo / Carotid atherosclerosis in atherothrombotic cerebral infarction of the homonymous vascular territory

Introducción: El eco-Doppler carotídeo es la prueba de elección en el estudio inicial y de seguimiento del ictus aterotrombótico. Objetivo: Describir los hallazgos ecográficos en ambos ejes carotídeos en pacientes con infarto cerebral aterotrombótico del territorio vascular homónimo. Métodos: Se realizó una investigación observacional con todos los pacientes (63), que acudieron al Hospital Militar Central "Dr. Carlos J. Finlay", entre octubre del 2012 y septiembre del 2013, con diagnóstico clínico y tomográfico de infarto cerebral aterotrombótico de territorio anterior, a los que se les realizó eco-Doppler carotídeo. Resultados: Se contabilizaron mayor cantidad de placas de ateromas en el eje carotídeo homolateral al ictus aterotrombótico (54,3 por ciento) y la gran mayoría de estos fueron inestables (98,4 por ciento). La placa tipo III (50 por ciento), la irregularidad del contorno (54,1 por ciento) y la estenosis menor del 49 por ciento (57,6 por ciento) fueron los hallazgos ecográficos que dominaron en el eje contralateral al infarto. En ambas carótidas también fueron las placas tipo III (47,1 por ciento), la irregularidad de los contornos (51,6 por ciento), las estenosis no significativas (54,3 por ciento) y la inestabilidad de estas (94,4 por ciento), las que predominaron. Conclusiones: La aterosclerosis carotídea en el ictus aterotrombótico describe mayoritariamente placas tipo III irregulares, que provocan estenosis menores del 49 por ciento en ambos ejes carotídeos y la inestabilidad es casi constante, con una incidencia ligeramente mayor en el eje carotídeo homolateral al infarto. La frecuencia del resto de las cualidades de las placas de ateromas enunciadas, domina levemente en el eje carotídeo contralateral(AU)

Introduction: Carotid echo-Doppler is the test of choice in the initial and follow-up study of atherothrombotic stroke. Objective: To describe echographic findings in both carotid axes in patients with atherothrombotic cerebral infarction of the homonymous vascular territory. Methods: Sixty-three patients underwent an observational and cross-sectional investigation at Dr. Carlos J. Finlay Central Military Hospital from October 2012 to September 2013. They have a clinical and tomographic diagnosis of atherothrombotic cerebral infarct from the previous territory and the underwent a carotid echo-Doppler. Results: We recorded higher number of atheromatous plaques in the homolateral carotid axis at atherothrombotic stroke (54.3 percent) and the majority was unstable (98.4 percent). Type III plate (50 percent), irregularity of the contour (54.1 percent) and less than 49 percent stenosis (57.6 percent) were the echographic findings that dominated the axis contralateral to the infarction. In both carotids, type III plaques (47.1 percent), irregularity of the contours (51.6 percent), non-significant stenosis (54.3 percent) and instability (94.4 percent) predominated. Conclusions: Carotid atherosclerosis in atherothrombotic stroke mostly describes the presence of irregular, type III plaques that cause stenosis of less than 49 percent in both carotid axes. The instability of them is almost constant, with a slightly higher incidence in the homolateral carotid axis to infarction. The frequency of the rest of the qualities of the listed atheromatous plaques slightly dominates in the contralateral carotid axis(AU)

Small interfering RNA delivery to the neurons near the amyloid plaques for improved treatment of Alzheimer׳s disease

Gene therapy represents a promising treatment for the Alzheimer׳s disease (AD). However, gene delivery specific to brain lesions through systemic administration remains big challenge. In our previous work, we have developed an siRNA nanocomplex able to be specifically delivered to the amyloid plaques through surface modification with both CGN peptide for the blood-brain barrier (BBB) penetration and QSH peptide for -amyloid binding. But, whether the as-designed nanocomplex could indeed improve the gene accumulation in the impaired neuron cells and ameliorate AD-associated symptoms remains further study. Herein, we prepared the nanocomplexes with an siRNA against -site amyloid precursor protein-cleaving enzyme 1 (BACE1), the rate-limiting enzyme of A production, as the therapeutic siRNA of AD. The nanocomplexes exhibited high distribution in the A deposits-enriched hippocampus, especially in the neurons near the amyloid plaques after intravenous administration. In APP/PS1 transgenic mice, the nanocomplexes down-regulated BACE1 in both mRNA and protein levels, as well as A and amyloid plaques to the level of wild-type mice. Moreover, the nanocomplexes significantly increased the level of synaptophysin and rescued memory loss of the AD transgenic mice without hematological or histological toxicity. Taken together, this work presented direct evidences that the design of precise gene delivery to the AD lesions markedly improves the therapeutic outcome.

Imaging and Spectral Characteristics of Amyloid Plaque Autofluorescence in Brain Slices from the APP/PS1 Mouse Model of Alzheimer's Disease / 神经科学通报·英文版

Amyloid deposits are one of the hallmark pathological lesions of Alzheimer's disease (AD). They can be visualized by thioflavin-S, silver impregnation, Congo red staining, and immunohistochemical reactions. However, that amyloid deposits generate blue autofluorescence (auto-F) has been ignored. Here, we report that visible light-induced auto-F of senile plaques (SPs) was detected and validated with conventional methods. Brain slices from APP/PS1 (amyloid precursor protein/presenilin 1) transgenic mice were mounted on slides, rinsed, coverslipped and observed for details of the imaging and spectral characteristics of the auto-F of SPs. Then the slices were treated with the above classic methods for comparative validation. We found that the SP auto-F was greatest under blue-violet excitation with a specific emission spectrum, and was much easier, more sensitive, and reliable than the classic methods. Because it does not damage slices, observation of auto-F can be combined with all post-staining techniques in slices and for brain-wide imaging in AD.

Effect of valsartan combined with statins on coronary heart disease and its effect on BNP and CRP / 国际检验医学杂志

Objective Investigate the effect of valsartan combined with statins on coronary heart disease and its effect on BNP and CRP.Methods 92cases of patients with coronary heart disease were selected, which were treated in hospital from March 2015to March 2017, and were divided into the study group (46cases) and control group (46cases) .The patients of all two groups were treated with conventional treatment.The patients of control group were treated with valsartan (40mg/d, oral;if no hypotension after 3days of treatment, the dose increased to 80mg/d) , and on the basis of control group, the patients of study group were treated with atorvastatin calcium capsules (20mg/d, in 0.5hafter dinner) .The patients of two groups were all treated for 6months in a row.Compare the adverse reactions and changes of the levels of blood lipids, coronary plaques, BNP, CRP and LVEF of two groups.Results After the appropriate treatment, the TG, TC, LDL-C levels of the study group were significantly lower than those of the control group, and the HDL-C, LVEF levels of the study group were significantly higher than those of the control group (P<0.05);the lipid plaque, fibrous plaque, calcified plaque, mixed plaque levels of the study group were significantly lower than those of the control group (P<0.05);The BNP, CRP levels of the study group were significantly lower than those of the control group (P<0.05);There were acute myocardial infarction, unstable angina, heart failure and other adverse events occurred in both two groups, and the difference was statistically significant between the two groups (P<0.05) .Conclusion Valsartan combined with statins in the treatment of patients with coronary heart disease can improve blood lipid levels, reduce coronal plaque area, inhibit inflammatory response, which makes it worthy of clinical promotion.

Osteosíntesis interna en fracturas múltiples / Internal osteosynthesis in multiple fractures

Los accidentes automovilísticos, como traumas de alta energía, producen múltiples lesiones. Es objetivo de este trabajo describir la conducta seguida y la evolución de una paciente de 21 años de edad que, cuando viajaba de acompañante en una bicicleta con motor, fue impactada por un automóvil y proyectada a más de 20 m de distancia. Llegó al Hospital Militar Central "Dr. Carlos J. Finlay" en estado de shock hipovolémico agudo y con grandes deformidades en ambos miembros inferiores. Se constataron 13 fracturas; se trató el shock hipovolémico y fue operada de urgencia. Se le realizó la osteosíntesis interna con láminas AO auto compresivas. Posterior al tratamiento quirúrgico, tuvo varias complicaciones que fueron tratadas de forma oportuna y adecuada. La paciente evolucionó satisfactoriamente, con solo una discrepancia de longitud de 2 cm del miembro inferior derecho en relación con el izquierdo(AU)

ABSTRACT Automobile accidents, such as high-energy trauma, produce multiple injuries. The purpose of this paper is to describe the behavior and evolution of a 21-year-old patient who, when traveling as a passenger on a motorized bicycle, was hit by a car and projected more than 20 m away. He arrived at Dr. Carlos J. Finlay Central Military Hospital in an acute state of hypovolemic shock, with large deformities in both lower limbs. There were 13 fractures; hypovolemic shock was treated and he was operated on urgently. Internal osteosynthesis was performed with self-compressive AO sheets. After surgical treatment, he had several complications that were treated in a timely and properly. The patient evolved satisfactorily, with only a discrepancy of length of 2 cm of the right lower limb in relation to the left(AU)

RÉSUMÉ Les accidents de la circulation, impliquant des traumatismes à haute énergie, provoquent des lésions multiples. Le but de ce travail est de décrire le procédé suivi et l'évolution d'une patiente âgée de 21 ans ayant été heurtée par une voiture et projetée à une distance de plus de 20 mètres, quand elle voyageait à bicyclette à moteur comme accompagnatrice. Elle est arrivée à l'hôpital militaire «Dr. Carlos J. Finlay¼ en état de choc hypovolémique aigu et souffrant de grands traumatismes au niveau des membres inférieurs. Treize fractures ont été constatées; la patiente a été prise en charge pour le choc hypovolémique et opérée en urgence. Le geste chirurgical a consisté à une ostéosynthèse interne par plaques auto-compressives AO. Après l'intervention, les complications survenues ont été convenablement corrigées. L'évolution de la patiente a été satisfaisante, sauf une disparité de 2 cm de longueur du membre inférieur droit par rapport au gauche(AU)

Estomatitis Urémica como Complicación Oral de Insuficiencia Renal Crónica: Reporte de Caso y Revisión de la Literatura / Uremic Stomatitis as an Oral Complication of Chronic Renal Failure: Case Report and Literature Review

RESUMEN: La Estomatitis Urémica es una lesión oral poco frecuente que se presenta generalmente en pacientes con insuficiencia renal crónica avanzada o no tratada. A continuación, se reporta un caso clínico de un paciente masculino de 22 años de edad que acude a un servicio de urgencia con la presencia de placas blanquecinas indoloras en piso de boca, cara interna de mejilla, y lengua. Las probables causas, presentaciones clínicas, y manejo odontológico son discutidos.

ABSTRACT: Uremic stomatitis is a rare oral lesion that usually occurs in patients with advanced or untreated chronic renal failure. Here we report a case of a 22-year-old male patient who comes to an emergency department with the presence of painless whitish plaques on the floor of the mouth, internal cheek face, and tongue. Probable causes, clinical presentations, and dental management are discussed.

Effects of Herbal-cake-separated Moxibustion on Blood Lipid Protein Levels and Expression of Toll-like Receptor and Nuclear Factor Genes in Atherosclerotic Plaques in Hyperglycemia Rabbits / 针刺研究

OBJECTIVE: To observe the effect of herbal cake-separated moxibustion on blood lipid-apoprotein levels and the expression of Toll-like receptor 2 (TLR 2), TLR 4 and nuclear factor kappa B(NF-κB) mRNAs in atherosclerotic (AS) vulnerable plaques of hyperglycemia rabbits, so as to explore its mechanism underlying improvement of atherosclerosis. METHODS: Sixty New Zealand rabbits were randomly divided into 5 groups: control, model, direct moxibustion, herbal-cake-separated moxibustion and medication groups(n＝12 rabbits in each group). The AS vulnerable plaque model was established by high-fat forage feeding plus balloon-induced abdominal aorta injury and gene transfection of Ad 5-p 53 recombinant vector. Direct moxibustion or herbal-cake-separated moxibustion was applied to "Juque" (CV 14) and bilateral "Tianshu" (ST 25), "Fenglong" (ST 40), or bilateral "Xinshu" (BL 15), "Pishu" (BL 20) and "Ganshu" (BL 18) for 15－20 min every time. The medication group was treated by feeding Atorvastatin. All the treatments were conducted once daily for 8 weeks. Plasma total cholesterol(TC) and triglyceri-de(TG) contents were detected by enzyme method, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) contents detected by colorimetric determination, and plasma apolipoprotein A(Apo-A) and apolipoprotein B(Apo-B) levels determined by electrophoretic method. The pathological changes of vulnerable plaque and the aortic intima and media thickness were observed under light microscope after H．E. staining. The expression levels of TLR 2, TLR 4 and NF-κB mRNAs in AS plaques were determined by quantitative real-time PCR. RESULTS: After modeling, the levels of plasma TC, TG, LDL and Apo-B in the model group were remarkably increased (P0.05). CONCLUSION: Herbal-cake-separated moxibustion has a positive role in stabilizing AS vulnerable plaque in hyperglycemia rabbits, which may be associated with its effects in regulating blood lipid-apolipoprotein levels and inhibiting the expression of TLR 2, TLR 4 and NF-κB mRNAs in vulnerable plaques.

Kidney-reinforcing and Governor Vessel-regulating EA Intervention May Improve Learningmemory Possibly by Suppressing Formation of Senile Plaques in Hippocampus in APP/PS 1 Double Transgenic Alzheimer's Disease Mice / 针刺研究

OBJECTIVE: To observe the effect of electroacupuncture (EA) intervention on learning-memory ability and the expression of senile plaques (SP), amyloid precursor protein (APP), β-secretase 1(BACE 1) and insulin degrading enzyme (IDE) in the hippocampus in APP/presenilin 1 (PS 1) double transgenic Alzheimer's disease (AD) mice, so as to reveal its mechanisms underlying improvement of AD. METHODS: A total of 18 male APP/PS 1 double transgenic AD mice were randomly divided into model, EA-2-week and EA-3-week groups (n=6 in each). The control group was consisted of 6 male wild mice. EA (2 Hz, 2 mA) was applied to "Baihui" (GV 20) and bilateral "Shenshu" (BL 23) for 15 min, once a day, with 7 days being a therapeutic course, 2 or 3 courses altogether and with an one day's interval between every two courses. The spatial learning-memory ability was assessed using Morris water maze test during 5 days' training. The immunoactivity of SP in the hippocampus tissue was detected by immunohistochemistry, and the expression levels of APP, BACE 1 and IDE in the hippocampus were analyzed by Western blot. RESULTS: Following modeling, the escape latency and path length of hidden platform tests were significantly increased (P<0.01, P<0.05), and the platform crossing time of spatial probing test significantly decreased (P<0.01) in the model group compared with the control group. After EA intervention, the escape latency on the 5th day of training, and the path length on the 4th and 5th day of training in both EA-2-week and EA-3-week groups were significantly shorter relevant to the model group (P<0.01), and those of the EA-3-week group were considerably shorter than those of the EA-2-week group in the escape latency and path length (P<0.05, P<0.01). The platform crossing times of spatial probing test were significanthy increased in both EA-2-week and EA-3-week groups in comparison with the model group (P<0.01), and that of the EA-3-week group was considerably increased compared with the EA-2-week group (P<0.05). Immunohistochemical staining showed that the number of SP in the hippocampus was markedly increased in the model group compared with the control group (P<0.01), and was markedly reduced in both EA-2-week and EA-3-week groups (P<0.01), and that of the EA-3-week group was significantly decreased compared with the EA-2-week group (P<0.01). The expression levels of hippocampal APP and BACE 1 proteins were significantly higher in the model group than in the control group (P<0.01), and that of hippocampal IDE was markedly lower in the model group than in the control group (P<0.01). After EA, the increased expression levels of APP and BACE 1 proteins and the decreased expression level of IDE in the EA-2-week and EA-3-week groups were significantly inhibited (P<0.01). The effects of EA-3-week were significantly stronger than those of EA-2-week in down-regulating the expression of APP and BACE 1 proteins and up-regulating the expression of IDE (P<0.01, P<0.05). CONCLUSION: EA stimulation of GV 20 and BL 23 can improve the learning-memory ability in APP/PS 1 double transgenic AD mice, which may be related to its effects in down-regulating the expression of SP, APP and BACE 1 proteins and up-regulating the expression of IDE protein in the hippocampus.