Myocardial perfusion echocardiography and coronary microvascular dysfunction

Our understanding of coronary syndromes has evolved in the last two decades out of the obstructive atherosclerosis of epicardial coronary arteries paradigm to include anatomo-functional abnormalities of coronary microcirculation. No current diagnostic technique allows direct visualization of coronary microcirculation,but functional assessments of this circulation are possible. This represents a challenge in cardiology. Myocardial contrast echocardiography(MCE) was a breakthrough in echocardiography several years ago that claimed the capability to detect myocardial perfusion abnormalities and quantify coronary blood flow. Research demonstrated that the integration of quantitative MCE and fractional flow reserve improved the definition of ischemic burden and the relative contribution of collaterals in non-critical coronary stenosis. MCE identified no-reflow and low-flow within and around myocardial infarction,respectively,and predicted the potential functional recovery of stunned myocardium using appropriate interventions. MCE exhibited diagnostic performances that were comparable to positron emission tomography in microvascular reserve and microvascular dysfunction in angina patients. Overall,MCE improved echocardiographic evaluations of ischemic heart disease in daily clinical practice,but the approval of regulatory authorities is lacking.

Role of Vascular Endothelial Growth Factor-C during Stem Cell Therapy Using Autologous Bone Marrow Mononuclear Cells in Patients with Lower Limb Lymphedema

Introduction: Vascular endothelial growth factor-C (VEGF-C) is the primary lymphangiogenic factor that stimulates lymphangiogenesis by signaling via specific receptor, vascular endothelial growth factor receptor 3 (VEGFR3). This study was conducted to evaluate the change in the level of VEGF-C before and after autologous bone marrow mononuclear cell transplantation for treatment of Lower limb lymphedema. Patient and methods: Forty patients with lower limb lymphedema were divided into two groups. Group I included 20 patients with chronic lower limb lymphedema who underwent autologous bone marrow mononuclear cell transplantation. Group II included 20 patients with chronic lower limb lymphedema who were exposed only to compression therapy as a control group. VEGF-C level in the diseased limbs was measured in both groups at the beginning of the study then 3 and 6 months respectively. Results: Group I included 20 patients, 8 patients were male (40%) and 12 patients were females (60%) with mean age 29.5 ± 12.15 while group II included 20, 10 patients were male (50%) and 10 patients were females (50%) with mean age 39.5 ± 11.5. In group I, the specimens were taken at 3 and 6 months after transplantation showed a marked decrease in the VEGF-C level with statistically significant p value, 0.02 and 0.001 respectively. In group II the level of VEGF-C after compression therapy alone at 3 and 6 months interval showed fluctuation with statistically non-significant p value, 0.64 and 0.55 respectively. Conclusion: VEGF-C is essential for regulation of lymphangiogenesis. The level of VEGF-C was found elevated in patients with lymphedema and decrease after autologous mononuclear bone marrow cells, however these results were statically non-significant.

A prediction of in vivo mechanical stresses in blood vessels using thermal expansion method and its application to hypertension and vascular stenosis

Mechanical stimuli play critical roles in cardiovascular diseases,in which in vivo stresses in blood vessels present a great challenge to predict.Based on the structural-thermal coupled finite element method,we propose a thermal expansion method to estimate stresses in multi-layer blood vessels under healthy and pathological conditions.The proposed method provides a relatively simple and convenient means to predict reliable in vivo mechanical stresses with accurate residual stress.The method is first verified with the opening-up process and the pressure-radius responses for single and multi-layer vessel models.It is then applied to study the stress variation in a human carotid artery at different hypertension stages and in a plaque of vascular stenosis.Our results show that specific or optimal residual stresses exist for different blood pressures,which helps form a homogeneous stress distribution across vessel walls.High elastic shear stress is identified on the shoulder of the plaque,which contributes to the tearing effect in plaque rupture.The present study indicates that the proposed numerical method is a capable and efficient in vivo stress evaluation of patient-specific blood vessels for clinical purposes.

Endovascular Repair of an Infected Broken Pseudoaneurysm of the Extracranial Internal Carotid Artery

The formation of pseudoaneurysms after carotid endarterectomy is extremely rare. Treating those pseudoaneuryms is necessary because of the risks for continued expansion, rupture and distal embolism. Traditional surgical repair of carotid artery pseudoaneurysms is associated with a high morbidity and mortality. An endovascular approach to these infected pseudoaneurysms limits the risk for operative damage to surrounding structures and potential blood loss.

Analysis of the Onco-Vascular Approach in Retroperitoneal Sarcoma with Vascular Involvement

Background: Due to the limited number of clinical series and the lack of multi-institutional or national registries concerning retroperitoneal sarcoma (RPS) extending to major arterio-venous structures, the short and long-term benefits following concomitant resection of these major structures are still antagonistic. Objective: To present our institutional experience with RPS tumors, to assess their vascular involvement and to analyze the outcomes of onco-vascular approach. Patients and methods: A retrospective review of our institutional RPS patients’ clinical charts was performed. All consecutive adult patients surgically treated for RPS were included. Resection of RPS tumors was followed by histopathological examination for grading. Types of vascular involvement were assessed preoperatively. RPS tumors were resected en bloc together with blood vessels according to the type of vascular involvement and the surgical standards. Results: This study included 14 patients;8 males (57%) and 6 females (43%) with RPS. Vascular resection was performed in all patients. Adherent structures were resected in 43%. Resection was performed for 29% RPSs with arterial venous involvement, 14% with only arterial involvement, and 57% with only venous involvement. All RPSs were classified as high-grade lesions, and 64% showed secondarily major vessels involvement. 43% of patients were treated by arterial resection. 80% had venous involvement. Venous resections were followed by venous reconstruction in all patients with both arterial and venous involvement. The morbidity rate was 43% while the mortality rate was 7%. Conclusion: Complete resection with clear margins is important for long-term survival in patients with retroperitoneal soft tissue sarcomas.

Cardiovascular injuries and SARS-COV-2 infection:focus on elderly people

The novel coronavirus disease(COVID-19)has hit the healthcare system worldwide.The risk of severe infection and mortality increases with advancing age,especially in subjects with comorbidities such as cardiovascular disease,hypertension,diabetes,obesity and cancer.Moreover,cardiovascular complications such as myocardial injury,heart failure and thromboembolism are frequently observed in COVID-19 cases,and several biomarkers(troponin,NTpro BNP and D-Dimer)have been identified as prognostic indicators of disease severity and worst outcome.Currently,there is no specific therapy against SARS-Co V-2,although many medications are under investigation.The aim of this review will be to explore the intertwined relationship between COVID-19 disease and the cardiovascular system,focusing on elderly population.The available supportive treatments along with the related concerns in elderly patients,due to their comorbidities and polypharmacotherapy,will be explored.

Survival after surgery for acute type A aortic dissection in octogenarians

Objective To evaluate the benefits of surgical repair acute type A aortic dissection(ATAAD)on survival of octogenarians.Methods Patients who underwent surgery for acute ATAAD from the multicenter European Registry of Type A Aortic Dissection(ERTAAD)were the subjects of the present analysis.Results 326(8.4%)patients were aged≥80 years.Among 280 propensity score matched pairs,in-hospital mortality was 30.0%in patients aged≥80 years and 20.0%in younger patients(P=0.006),while 10-year mortality were 93.2%and 48.0%,respectively(P<0.001).The hazard of mortality was higher among octogenarians up to two years after surgery,but it became comparable to that of younger patients up to 5 years.Among patients who survived 3 months after surgery,10-year relative survival was 0.77 in patients aged<80 years,and 0.46 in patients aged≥80 years.Relative survival of octogenarians decreased markedly 5 years after surgery.Age≥85 years,glomerular filtration rate,preoperative invasive ventilation,preoperative mesenteric mal-perfusion and aortic root replacement were independent predictors of in-hospital mortality among octogenarians(AUC=0.792;E:O ratio=0.991;CITL=0.016;slope=1.096).An additive score was developed.A risk score≤1 was observed in 68.4%of patients,and their in-hospital mortality was 20.9%.Conclusions Provided a thoughtful patient selection,surgery may provide a survival benefit in patients aged≥80 years with ATAAD that,when compared to younger patients and the general population,may last up to 5 years after the procedure.These findings have significant epidemiologic and clinical relevance because of the increasing longevity of the population of the Western countries.

慢性脑、脊髓静脉功能不全——一种新近认识的血管疾病

慢性脑、脊髓静脉功能不全(CCSVI)是指中枢神经系统静脉回流功能异常或障碍的一种状态,是一种新近被认识的中枢神经系统血管性疾病,类似于下肢静脉功能不全的病理生理变化。CCSVI异常的脑部静脉血流触发炎症反应,导致静脉屏障受损、铁沉积、免疫炎症反应增强等,造成白质脱髓鞘的病理变化,可能是多发性硬化的病因之一。最新的研究表明,应用血管腔内技术干预CCSVI,有望成为治疗多发性硬化的一种新方法。

Midterm results of periprosthetic coiling embolization in high-risk patients

Background:With increasing interest in the prevention of typeⅡendoleaks(EⅡ),the aim of this study was to report midterm results on the intraoperative coiling embolization of the periprosthetic aneurysmal sac in patients at high-risk of EⅡ.Methods:A retrospective review study was conducted with 124 patients with infrarenal abdominal aortic aneurysm who accorded with the inclusion criteria,including 66 patients who underwent standard endovascular aortic aneurysm repair(Group A)and 58 patients who underwent aneurysmal sac coiling embolization(Group B).Baseline data and follow-up results were analyzed.Results:A mean of 2.84±1.45 coils(range 1-9)were used in Group B.The general incidence of an EⅡwas 15.32%(19/124)at a mean follow-up time of 46.60±15.14 months,with 22.7%(15/66)in Group A and 6.9%(4/58)in Group B(χ~2=5.62;P=0.018).Logistic multivariate analysis revealed that the independent risk factors of an EII were no sac embolization and a sac volume≥128 cm^3.The Kaplan-Meier subgroup analysis showed no difference in regard to the rate of freedom from EⅡbetween the two groups either with a larger or smaller sac.Conclusions:These results suggest that periprosthetic coiling embolization in patients at high-risk of EⅡis safe and effective in the prevention of EⅡ.The preventive effect seemed to be weakened when the sac volumes were taken into consideration at midterm follow-up.

Comparison of in-vial exhaust method versus conventional exhaust method in the injection of COVID-19 vaccine

Objective:The objective of the study was to compare the application effects of in-vial exhaust method and conventional exhaust method in the process of coronavirus disease 2019 vaccine injection.Materials and Methods:Using convenient sampling method,102 vaccines were selected as experiment group during the process of vaccine injection,and the in-vial exhaust method was used.One hundred and five vaccines were selected as the control group and the conventional exhaust method was adopted.The incidence of vaccine solution spillage and exhausting time in the two groups during exhaust were observed.Results:The incidence of solution spillage in the experiment group was lower than that in the control group(0 vs.6.67%,P<0.05).The exhausting time of the experiment group was shorter than that of the control group([15.12±4.43]s vs.[22.74±6.53]s,P<0.05).Conclusion:Implementing the in-vial exhaust method in the vaccine injection can effectively reduce the incidence of solution spillage,reduce nucleic acid contamination,and ensure that the vaccine is injected at the prescribed dose.Moreover,the operation is simple and easy,which improves the nurse’s vaccination efficiency,and has a higher promotion and application value.

Rotarex mechanical thrombectomy in renal artery thrombosis:A case report

BACKGROUND Acute renal artery thrombosis is a relatively rare disease.Early diagnosis and emergent treatment can prevent the loss of renal function and the development of hypertension.CASE SUMMARY We report a patient with acute renal artery thrombosis who presented to our hospital with acute-onset right flank pain and was treated by percutaneous mechanical thrombectomy using the Rotarex device.After 2 mo,right kidney function had recovered slightly.CONCLUSION Renal artery thrombosis may lead to loss of renal function and the development of hypertension.Rotarex mechanical thrombectomy may be a viable treatment option for rapid recanalization of the renal artery in patients with renal artery thrombosis.

Caval replacement with parietal peritoneum tube graft for septic thrombophlebitis after hepatectomy: A case report

BACKGROUND Caval vein thrombosis after hepatectomy is rare, although it increases mortality and morbidity. The evolution of this thrombosis into a septic thrombophlebitis responsible for persistent septicaemia after a hepatectomy has not been reported to date in the literature. We here report the management of a 54-year-old woman operated for a peripheral cholangiocarcinoma who developed a suppurated thrombophlebitis of the vena cava following a hepatectomy.CASE SUMMARY This patient was operated by left lobectomy extended to segment V with bile duct resection and Roux-en-Y hepaticojejunostomy. After the surgery, she developed Streptococcus anginosus, Escherichia coli, and Enterococcus faecium bacteraemias, as well as Candida albicans fungemia. A computed tomography scan revealed a bilioma which was percutaneously drained. Despite adequate antibiotic therapy,the patient's condition remained septic. A diagnosis of septic thrombophlebitis of the vena cava was made on post-operative day 25. The patient was then operated again for a surgical thrombectomy and complete caval reconstruction with a parietal peritoneum tube graft. Use of the peritoneum as a vascular graft is an inexpensive technique, it is readily and rapidly available, and it allows caval replacement in a septic area. Septic thrombophlebitis of the vena cava after hepatectomy has not been described previously and it warrants being added to the spectrum of potential complications of this procedure.CONCLUSION Septic thrombophlebitis of the vena cava was successfully treated with antibiotic and anticoagulation treatments, prompt surgical thrombectomy and caval reconstruction.

Prognostic Value of Cardiopulmonary Exercise Test in Elderly Women with Heart Failure and Reduced or Preserved Ejection Fraction

The prognostic role of cardiopulmonary exercise test (CPET) in elderly women with chronic heart failure (HF) has not yet been clarified. We assessed the incremental value of CPET variables for risk stratification in female HF patients with preserved or reduced left ventricular ejection fraction (LVEF). We prospectively followed up 131 female HF outpatients aged 72 [interquartile range 62 - 77] years after a symptom limited CPET. 34% had ischemic heart disease and 14% permanent atrial fibrillation, 24% were in NYHA class III. LVEF was 50% [interquartile range 36 - 62], peak oxygen consumption was 11.3 [interquartile range 9.2 - 13.5] ml/kg/min;the slope of the regression line relating ventilation to CO2 output was 33.9 [interquartile range 30.3 - 44.9];40% of patients showed exercise oscillatory breathing during CPET. During a median follow-up of 18 months [interquartile range 8 - 54], overall 39 patients (29.7%) met the combined end-point of cardiovascular mortality or HF admission using a time-to-first event approach. Moderate to severe mitral regurgitation, slope, exercise oscillatory breathing were independently associated to cardiovascular mortality or HF admission. When CPET ventilatory variables were added to clinical and echocardiographic parameters, prediction of the combined point improved significantly (AUC 0.755 (95% CI 0.662 to 0.832) vs 0.634 (95% CI 0.536 to 0.725), p = 0.016). In conclusion, among elderly female HF patients the CPET derived parameters EOB and VE/VCO2 slope emerged as strong prognostic markers, with additive predictive value to clinical and echocardiographic parameters in patients with both reduced and preserved LVEF.

Follow-up and multimodal imaging in long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency

Dear Editor, The deficit of 3-hydroxyacyl-CoA dehydrogenase （LCHAD）is a disease whose incidence is approximately 3 cases/100 000 births, with autosomal recessive inheritance.

Prognostic Factors of Mortality in Post-Myocardial Infarction Patients: A 24-Hour Rhythmic Holter Observational Study

Background: Heart dysfunction and sudden death are common complications in post-myocardial infarction. Purpose: This study aims to contribute to improving patient’s management by determining the factors correlated to the occurrence of left ventricular dysfunction or post-infarction sudden death. Method: It was a transversal, descriptive and analytical study conducted from January to October 2021. Results: The variables studied covered epidemiological, therapeutic and electrocardiographic aspects. There were 102 patients admitted for a recent revascularized myocardial infarction or not who had received a 24-hour ECG Holter after the acute phase of coronary event. The study population was predominantly men 88% versus 12% women with a sex ratio of 0.15. The discharge prescription was 74% antiarrhythmic, 91% platelet antiaggregator and 14% anticoagulant. Electrical abnormalities consisted of supraventricular extrasystoles in 45% of cases, ventricular extrasystoles in 61%, atrial fibrillation in 19% and supraventricular tachycardias in 11% (p Conclusion: The prognostic factors associated with the onset of post-infarction complications were ventricular arrhythmias (p .

Review of the adaptation of skeletal muscle in intermittent claudication

Background: Despite awareness about the impact of intermittent claudication (IC) on mobility, balance and quality of life;the underlying pathophysiology and alterations in muscle architecture secondary to the disease are often overlooked. This review aimed to summarize the pathophysiological muscle changes present secondary to IC. Methods: The electronic databases, Medline, EMBASE, Cinahl and AMED, were searched for studies from 1967 to August 2011. Search terms included exercise, intermittent claudication and muscle. Studies about IC which were focused on muscle histology, muscle architecture, blood flow or changes with exercise were included. Results: Of 434 studies identified, 135 unique results were found. Only 78 of these were suitable from abstract review, of which 15 were unobtainable and a further nine were identified from hand-searching references. Studies in animal models demonstrated a predominance of type II muscle fibres and an improvement in animal exercise tolerance secondary to training. Exercise alone was never able to improve distances to that of healthy controls, however a lower limb fistula along with exercise did. Lower limb blood flow was demonstrated to be affected regionally, and most evident during exercise with a prolonged return to normal in patients with IC. At a cellular level, the myocytes metabolism increased in those with IC, but returned to normal post-revascularization. Conclusion: Treatment for claudicants includes either revascularization or exercise. Successful revascularization has demonstrated a return to normal muscle metabolism;the underlying physiological improvement secondary to exercise still requires clarification.

Impact of severe left ventricular dysfunction on mid-term mortality in elderly patients undergoing transcatheter aortic valve implantation

Background Whether patients with reduced left ventricular function present worse outcome after transcatheter aortic valve implantation （TAVI） is controversial. The aim of this study was to assess the impact of baseline severe impairment of left ventricular ejection fraction （LVEF） on mortality after TAVI. Methods Six-hundred-forty-nine patients with aortic stenosis underwent TAVI with the CoreValve system （92.8%） or the Edwards SAPIEN valve system （7.2%）. Baseline LVEF was measured by the echocardiographic Simpson method. The impact of LVEF 〈 30% on mortality was assessed by Cox regression. Results Patients with LVEF 〈 30% （n = 63）, as compared to those with LVEF 〉 30% （n = 586）, had a higher prevalence of NHYA class 〉 2 （P 〈 0.001） and presented with a higher Euroscore （P 〈 0.001）. Procedural success was similar in both groups （98.4% vs. 97.2%, P = 1）. After a median follow-up of 436 days （25^-75th percentile, 357-737 days）, all-cause mortality [23.8% vs. 23.7%, P = 0.87, hazard ratios （HR）： 0.96, 95% confidence intervals （CI）： 0.56-1.63] and cardiac mortality （19.1% vs. 17.6%, P = 0.89, HR： 1.04, 95% CI： 0.57-1.90） were similar in patients with LVEF 〈 30% as compared to those with LVEF 〉 30%. Thirty-day all-cause mortality was not significantly different between the two groups （11.1% vs. 6.3%, P = 0.14, HR： 1.81, 95% CI： 0.814.06）. Patients with LVEF 〈 30% had a trend toward higher risk of 30-day cardiac mortality （11.1% vs. 5.3%; P = 0.06, HR： 2.16, 95% CI： 0.95-4.90）, which disappeared after multivariable adjustment （P = 0.22）. Conclusions Baseline severe impairment of LVEF is not a predictor of increased short-term and mid-term mortality after TAVI. Selected patients with severe impairment of left ventricular function should not be denied TAVI.

Reliability and validity of the Chinese version of the Work-FamilySchool Role Conflicts Scale among nurses

Objective:To translate and validate the Chinese version of the Work-Family-School Role Conflicts Scale(WFSRCs-S)among nurses with multiple roles.Methods:A sample of 233 registered nurses pursuing an advanced degree was recruited from 8 university hospitals in 5 cities in China from March to July 2016.The original scale of WFSRCs-S was translated into Chinese and revised to reflect cultural meaning,using standard translation methodology,and its reliability and validity were assessed.Results:The content validity index of the 12-item WFSRCs-S-Chinese was 0.83,and the item level of content validity index ranged from 0.79 to 1.00.The exploratory factor analysis yielded a three-factor solution(work-school-to-family role conflict,family-school-to-work role conflict,and work-family-toschool role conflict)and explained 71.9%of the total variance for WFSRCs-S-Chinese.The Cronbach's a coefficients for the total scale and the three sub-scales were 0.87,0.79,0.78,and 0.87.The confirmatory factor analysis revealed that the measurement model was satisfied,and the test-retest reliability of WFSRCs-S-Chinese was 0.85.The WFSRCs-S-Chinese score was positively associated with burnout(r=0.36,P<0.001)and negatively related to role-related social support(r=—0.18,P=0.046),thereby establishing concurrent validity.Conclusion:The reliability and construct validity of the WFSRCs-S-Chinese suggest that this scale could be useful to assess inter-role conflicts among nurses with multiple roles in China.

Uridine adenosine tetraphosphate acts as a pro-angiogenic factor in vitrothrough purinergic P2Y receptors

OBJECTIVE Uridine adenosine tetraphosphate(Up4A),a dinucleotide,contains both purine and pyrimidine moieties,and exerts its vascular influence via activation of purinergic receptors.Here,we aimed to investigate the effects of Up4 A on angiogenesis and the putative purinergic receptors(PR)involved in this process.METHODS Tubule formation assay was performed in 3D matrix system.In this assay,human umbilical vein endothelial cells(HUVECs)were co-cultured with pericytes with various Up4 A doses(0,1,2.5,5,10 and 20μmol·L-1)in the absence and presence of P2Y6 R antagonist MRS2578(10μmol·L-1)for 5d.Expression profile of PR subtypes and angiogenic factors was assessed in HUVECs by q-PCR with and without P2Y6 R antagonist.RESULTS No difference in initial tubule formation was detected between Up4 A stimulation and control conditions at day 2.In contrast,a significant increase in vascular density in response to Up4 A was observed at day 5.Up4 A at a dose of 2.5and 5μmol·L-1 promoted total tubule length(by-1.89 fold and-2.23fold),number of tubules(by-1.71 fold and-1.89fold)as well as number of junctions(by-2.24 fold and-2.80fold),all of which were inhibited by MRS2578.Further increase in Up4 A dose to10 and 20μmol·L-1 did not induce an increase in these vascular parameters as compared to non-treated controls.Moreover,Up4 A increased mRNA level of P2YRs(P2Y2R,P2Y4 R and P2Y6R)but not P2XR(P2X4R and P2X7R)or P1R(A2AR and A2BR),while Up4 A upregulated VEGFA and ANGPT1 but not VEGFR2,ANGPT2,Tie1 and Tie2at mRNA level.Transcriptional upregulation of P2 YRs and angiogenic factors by Up4 A was inhibited by MRS2578.CONCLUSION Up4 A is functionally capable of promoting tubule formation in vitro co-culture system.This process is likely mediated by activation of pyrimidine-favored P2 YRs but not P2 XR or P1 Rs,and involves stimulation of well known angiogenic factors.

Extra-anatomic aortic bypass for the treatment of a mycotic pseudoaneurysm after liver transplantation for hilar cholangiocarcinoma

Liver transplantation(LT) after neoadjuvant chemoradiotherapy in patients with unresectable hilar cholangiocarcinoma(HC) is an accepted treatment strategy [1]. Neoadjuvant therapy is associated with an increased risk of arterial and portal complications after LT [1,2]. In most cases, radiation therapy makes the use of the native hepatic artery inadvisable, and an aortic anastomosis is needed, either with or without a graft [2].