Enhanced external counterpulsation(EECP)is able to treat myocardial ischemia,which is usually caused by coronary artery stenosis.However,the underlying mechanisms regarding why this technique is effective in treating ...Enhanced external counterpulsation(EECP)is able to treat myocardial ischemia,which is usually caused by coronary artery stenosis.However,the underlying mechanisms regarding why this technique is effective in treating myocardial ischemia remains unclear and there is no patient-specific counterpulsation mode for different rates of coronary artery stenosis in clinic.This study sought to investigate the hemodynamic effect of varied coronary artery stenosis rates when using EECP and the necessity of adopting targeted counterpulsation mode to consider different rates of coronary artery stenosis.Three 3-dimensional(3D)coronary models with different stenosis rates,including 55%(Model 1),65%(Model 2),and 75%(Model 3),were generated,then coupled with a 0-dimensional(0D)lumped parametric model of the blood circulatory system.EECP was applied to the 0D/3D coupled models to study the hemodynamic response of the coronary artery.Under the same counterpulsation mode,the ratio of diastolic blood pressure to systolic blood pressure of 3 models during counterpulsation was 1.4,and the cardiac output and coronary artery flow rate increased significantly.The low wall shear stress(WSS)and high oscillatory shear index(OSI)areas were mainly located at the posterior end of the stenosis and coronary artery bifurcation.Moreover,with an increase in the rate of coronary artery stenosis,the increased percentage of flow rate through the coronary artery stenosis and area-averaged WSS decreased.The geometric multiscale model in this study can be used to effectively simulate the hemodynamic characteristics of cardiovascular system following the application of EECP.Local precise hemodynamic effect of the coronary artery stenosis can be observed.It was found from the hemodynamic factors that the coronary artery with lower stenosis rate more likely led to better vascular endothelial remodeling.Thus,it is necessary to adopt patient-specific counterpulsation mode accounting for different condition of coronary artery stenosis.展开更多
Introduction In the United States, there are about 17.6 million patients suffer from symptomatic coronary artery disease （CAD）, affecting 7.9% of adults ≥ 20 years of age.1 An estimated 10.2 million patients have ...Introduction In the United States, there are about 17.6 million patients suffer from symptomatic coronary artery disease （CAD）, affecting 7.9% of adults ≥ 20 years of age.1 An estimated 10.2 million patients have angina, and 500,000 patients will develop new angina pectoris each year. 1 A subset of angina patients are categorized as refractory when symptoms continue despite optimal medical therapy and revascularization.Routine daily activities become impossible without experiencing chest pain in this patient population.2展开更多
Objective To examine if the skin microvascular bed is altered and can be modified by enhanced external counterpulsation(EECP)in patients with chronic refractory angina.Methods Twenty patients diagnosed with refractory...Objective To examine if the skin microvascular bed is altered and can be modified by enhanced external counterpulsation(EECP)in patients with chronic refractory angina.Methods Twenty patients diagnosed with refractory angina were divided into EECP(n=10)or no EECP(n=10)groups.The data were compared to matched healthy subjects(n=20).The cutaneous forearm microvascular blood flow was measured by Laser-Doppler flowmetry.The vascular responsiveness to iontophoretic administration of acetylcholine(ACh),sodium nitroprusside(SNP)and local skin warming were studied.Measurements of Canadian Cardiovascular Society(CCS)-class,blood pressure and plasma samples were registered.Results EECP patients showed reduced CCS-class compared to no EECP(P<0.05).Both EECP and no EECP(P<0.05)groups had decreased systolic blood pressure(SBP)as compared to SBP at baseline(P<0.05).There was no difference in resting blood flow between the two refractory groups at baseline as well as after EECP and seven weeks of follow-up.Responses to heating,the responses to ACh and SNP in the cutaneous microcirculation were lower in both groups of refractory angina patients as compared to healthy subjects(P<0.05).EECP patients corresponded positively to the treatment shown by reduced plasma level of soluble interleukin-2 receptor and CCS-class.Conclusions Refractory angina patients have reduced responsiveness in their cutaneous microcirculation to ACh,SNP and heat compared to healthy subjects.Although EECP reduced the CCS-class,this effect was not associated with improvements in responsiveness of the cutaneous microcirculation.展开更多
Reduced blood flow is the principle pathophysiologic event in acute ischernic stroke.Hence,flow augmentation is the most important goal in stroke management.Improvement of cerebral blood flow can be accomplished by pr...Reduced blood flow is the principle pathophysiologic event in acute ischernic stroke.Hence,flow augmentation is the most important goal in stroke management.Improvement of cerebral blood flow can be accomplished by proximal arterial recanalization or by other systemic approaches.Diastolic counterpulsation is a non-invasive method to improve the perfusion of heart,kidneys and brain.This review summarizes the history,possible mechanism and the role of external counterpulsation in ischemic stroke.展开更多
Objective:To analyze the clinical efficacy and safety of external counterpulsation combined with lipoic acid in the treatment of patients with type 2 diabetic foot of grade 0-2.Methods:62 patients with diabetic foot f...Objective:To analyze the clinical efficacy and safety of external counterpulsation combined with lipoic acid in the treatment of patients with type 2 diabetic foot of grade 0-2.Methods:62 patients with diabetic foot from January 2019 to October 2020 were selected and divided into control group and external counterpulsation group according to different treatment schemes,31 cases in each group.The control group was given intravenous lipoic acid,and the external counterpulsation group was given external counterpulsation combined with intravenous lipoic acid.The clinical efficacy and adverse reactions of the two groups were compared,and the blood flow parameters,ankle brachial index and common peroneal nerve conduction velocity of the two groups before and after treatment were compared.Results:The total effective rate of the treatment group(93.54%)was significantly higher than that of the control group(48.38%)(P<0.05).After treatment,the vessel diameter of dorsalis pedis artery(2.552±0.024mm)and ankle brachial index(0.923±0.036)in ECP group were significantly higher than those in control group(1.864±0.020)and ankle brachial index(0.843±0.030)(P<0.05).After the control group and the external counterpulsation group were treated,the levels of serum of VEGF,bFGF、IGF-1(85.479±4.239,148.27±14.25,62.33±3.75;94.163±8.917,200.88±14.58,81.35±1.08)was significantly higher than that before treatment(57.264±0.801,106.44±3.83,30.90±0.42;57.133±0.850,106.78±3.69,31.01±0.56),the levels of MMP-2(2.035±0.08,1.417±0.21)after treatment in the control group and the external counter stroke group after treatment(2.035±0.08,1.417±0.21)was significantly lower than that after treatment.The levels of VEGF,bFGF and IGF-1 in ECP group were significantly higher than those in control group,and MMP-2 was significantly lower than that in control group(P<0.05).Conclusion:The clinical effect of external counterpulsation combined with lipoic acid in the treatment of type 2 diabetic foot with grade 0-2 is significant,which can effectively improve the blood flow parameters of dorsal foot artery,ankle brachial index and common peroneal nerve conduction velocity,with less adverse reactions.展开更多
基金This research was supported by National Natural Science Foundation of China(11772016,11472022,11702008)Key Project of Science and Technology of Beijing Municipal Education Commission and Support Plan for High-level Faculties in Beijing Municipal Universities(CIT&TCD201804011).
文摘Enhanced external counterpulsation(EECP)is able to treat myocardial ischemia,which is usually caused by coronary artery stenosis.However,the underlying mechanisms regarding why this technique is effective in treating myocardial ischemia remains unclear and there is no patient-specific counterpulsation mode for different rates of coronary artery stenosis in clinic.This study sought to investigate the hemodynamic effect of varied coronary artery stenosis rates when using EECP and the necessity of adopting targeted counterpulsation mode to consider different rates of coronary artery stenosis.Three 3-dimensional(3D)coronary models with different stenosis rates,including 55%(Model 1),65%(Model 2),and 75%(Model 3),were generated,then coupled with a 0-dimensional(0D)lumped parametric model of the blood circulatory system.EECP was applied to the 0D/3D coupled models to study the hemodynamic response of the coronary artery.Under the same counterpulsation mode,the ratio of diastolic blood pressure to systolic blood pressure of 3 models during counterpulsation was 1.4,and the cardiac output and coronary artery flow rate increased significantly.The low wall shear stress(WSS)and high oscillatory shear index(OSI)areas were mainly located at the posterior end of the stenosis and coronary artery bifurcation.Moreover,with an increase in the rate of coronary artery stenosis,the increased percentage of flow rate through the coronary artery stenosis and area-averaged WSS decreased.The geometric multiscale model in this study can be used to effectively simulate the hemodynamic characteristics of cardiovascular system following the application of EECP.Local precise hemodynamic effect of the coronary artery stenosis can be observed.It was found from the hemodynamic factors that the coronary artery with lower stenosis rate more likely led to better vascular endothelial remodeling.Thus,it is necessary to adopt patient-specific counterpulsation mode accounting for different condition of coronary artery stenosis.
文摘Introduction In the United States, there are about 17.6 million patients suffer from symptomatic coronary artery disease （CAD）, affecting 7.9% of adults ≥ 20 years of age.1 An estimated 10.2 million patients have angina, and 500,000 patients will develop new angina pectoris each year. 1 A subset of angina patients are categorized as refractory when symptoms continue despite optimal medical therapy and revascularization.Routine daily activities become impossible without experiencing chest pain in this patient population.2
文摘Objective To examine if the skin microvascular bed is altered and can be modified by enhanced external counterpulsation(EECP)in patients with chronic refractory angina.Methods Twenty patients diagnosed with refractory angina were divided into EECP(n=10)or no EECP(n=10)groups.The data were compared to matched healthy subjects(n=20).The cutaneous forearm microvascular blood flow was measured by Laser-Doppler flowmetry.The vascular responsiveness to iontophoretic administration of acetylcholine(ACh),sodium nitroprusside(SNP)and local skin warming were studied.Measurements of Canadian Cardiovascular Society(CCS)-class,blood pressure and plasma samples were registered.Results EECP patients showed reduced CCS-class compared to no EECP(P<0.05).Both EECP and no EECP(P<0.05)groups had decreased systolic blood pressure(SBP)as compared to SBP at baseline(P<0.05).There was no difference in resting blood flow between the two refractory groups at baseline as well as after EECP and seven weeks of follow-up.Responses to heating,the responses to ACh and SNP in the cutaneous microcirculation were lower in both groups of refractory angina patients as compared to healthy subjects(P<0.05).EECP patients corresponded positively to the treatment shown by reduced plasma level of soluble interleukin-2 receptor and CCS-class.Conclusions Refractory angina patients have reduced responsiveness in their cutaneous microcirculation to ACh,SNP and heat compared to healthy subjects.Although EECP reduced the CCS-class,this effect was not associated with improvements in responsiveness of the cutaneous microcirculation.
文摘Reduced blood flow is the principle pathophysiologic event in acute ischernic stroke.Hence,flow augmentation is the most important goal in stroke management.Improvement of cerebral blood flow can be accomplished by proximal arterial recanalization or by other systemic approaches.Diastolic counterpulsation is a non-invasive method to improve the perfusion of heart,kidneys and brain.This review summarizes the history,possible mechanism and the role of external counterpulsation in ischemic stroke.
基金National Key Research and Development Projects:Demonstration Study on Early Identification(No.2018YFC2002500)。
文摘Objective:To analyze the clinical efficacy and safety of external counterpulsation combined with lipoic acid in the treatment of patients with type 2 diabetic foot of grade 0-2.Methods:62 patients with diabetic foot from January 2019 to October 2020 were selected and divided into control group and external counterpulsation group according to different treatment schemes,31 cases in each group.The control group was given intravenous lipoic acid,and the external counterpulsation group was given external counterpulsation combined with intravenous lipoic acid.The clinical efficacy and adverse reactions of the two groups were compared,and the blood flow parameters,ankle brachial index and common peroneal nerve conduction velocity of the two groups before and after treatment were compared.Results:The total effective rate of the treatment group(93.54%)was significantly higher than that of the control group(48.38%)(P<0.05).After treatment,the vessel diameter of dorsalis pedis artery(2.552±0.024mm)and ankle brachial index(0.923±0.036)in ECP group were significantly higher than those in control group(1.864±0.020)and ankle brachial index(0.843±0.030)(P<0.05).After the control group and the external counterpulsation group were treated,the levels of serum of VEGF,bFGF、IGF-1(85.479±4.239,148.27±14.25,62.33±3.75;94.163±8.917,200.88±14.58,81.35±1.08)was significantly higher than that before treatment(57.264±0.801,106.44±3.83,30.90±0.42;57.133±0.850,106.78±3.69,31.01±0.56),the levels of MMP-2(2.035±0.08,1.417±0.21)after treatment in the control group and the external counter stroke group after treatment(2.035±0.08,1.417±0.21)was significantly lower than that after treatment.The levels of VEGF,bFGF and IGF-1 in ECP group were significantly higher than those in control group,and MMP-2 was significantly lower than that in control group(P<0.05).Conclusion:The clinical effect of external counterpulsation combined with lipoic acid in the treatment of type 2 diabetic foot with grade 0-2 is significant,which can effectively improve the blood flow parameters of dorsal foot artery,ankle brachial index and common peroneal nerve conduction velocity,with less adverse reactions.
