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简介：ObjectivesTotestthehypothesesthatbonemorphogeneticprotein(BMP)signalingpathwaycomponentsareexpressedinarterialendothelialcells(ECs)andthatBMPsignalinginfluencesendothelialcell(EC)proliferation.MethodsWeusedcellcultureandRT-PCRtodeterminedmRNAexpressionofBMPreceptors(BMPR)-IA,-IB,andII,Smads1,4,5,6,and7,andinculturedhumancoronaryarteryECsatbaselineandafterstimulationwithBMP2(300ng/mLfor6hr),non-radioactivecellproliferationtoexaminecellproliferation.ResultsProteasomeinhibitionhasbeenpreviouslyshowntoenhanceBMPsignalingbypreventingdegradationofBMPpathwaycomponents.Therefore,identicalexperimentswerealsoperformedinthepresenceoftheproteasomeinhibitorepoxomicin.ECsexpressedmRNAforBMPRsIAandII,Smads1,4,5,6,7,andstimulationwitheitherBMP2orepoxomicinresultedinasignificantincreaseinECproliferationmeasuredafter48hoursinadose-dependentfashion.Proliferationwasaccompaniedbyamarkedincreaseinproliferatingcellnuclearantigen(PCNA)expression.Toxicitywasobservedathighdosesofepoxomicin.ConclusionsAllmajorBMPsignalingmoleculesareexpressedbyvascularECsandexpressionoftheseareaffectedbybothBMP2andepoxomicin.BMP2mayregulateECproliferation,suggestingapossibleroleinvascularhomeostasisandvascularpathologiesinvolvingECdenudationorproliferation.

简介：Sex-specificdifferencesintheepidemiologyandpathophysiologyofcoronaryarterydiseaseandischemicheartdiseasearenowwellrecognized.Womenwithanginamoreoftenhavenonobstructivecoronaryarterydisease(NOCAD)comparedwithmen.Thispatientpopulationcarriesasignificantriskoffuturecardiovasculareventsthatisnotcommonlyappreciated,oftenleadingtodelayeddiagnosisandtreatment.WhilecoronarymicrovasculardysfunctionplaysacentralroleinthepathophysiologyofNOCADinwomen,othermechanismsofmyocardialischemiaarenowrecognized.RiskfactorssuchashypertensionandobesitydisparatelyaffectwomenandarelikelytoaccountforasignificantproportionofNOCADinthecomingyears.VascularinflammationisanimportantpathophysiologicpathwayinNOCADandisapotentialtherapeutictarget.CoronaryCTangiographyprovidesacomprehensiveassessmentofcoronaryanatomyandplaquemorphologyandisareasonablescreeningtestofchoiceforNOCAD.

简介：BackgroundIncreasedlevelofglycatedhemoglobin(HbA1c)isassociatedwithhigherincidenceofcoronaryarterydisease(CAD)inthediabetics.However,therelationshipbetweenHbA1candtheriskofcoronaryarterystenosisinthenon-diabeticsiscontroversial.MethodsAretrospectiveresearchwasconductedon338enrolledparticipantswhohaveundergone2timesofcoronaryangiographicexaminationwithinthepastyear.Clinicalandlaboratoryvariablesattheinitialandthesecondtimeofadmissionwerecollected.AccordingtotheinitialmedianHbA1clevel,allparticipantsweredividedintotwogroupsnamedlowerandhighergroups.TherelationshipbetweenHbA1clevelandtheriskofcoronaryarterystenosisovertimewasevaluated.ResultsTheinitialvaluesofHbA1cinloweranduppergroupswere5.78±0.35%and6.21±0.32%(P<0.05).Ascomparedtothelowergroup,thepercentagesofmaleandsmokingparticipants,andtheserumlevelofCRPweresignificantlyhigherinthehighergroup(P<0.05).Othertraditionalriskfactorswerecomparablebetweenthetwogroups.Therewere54.2%and55.2%participantswithsinglevesselstenosis,and45.8%and44.8%withmultiplevesselstenoses,respectivelyinthetwogroupswithoutsignificantdifference.Thesecondtimeofadmission,were308.5±25.4days(lowergroup)and300.7±30.1days(highergroup)fromtheinitialadmission.AlthoughnosignificantchangesofHbA1clevelwereobservedwhencomparedtoinitial,HbA1clevelinthehighergroupwasstillsignificantlyhigherincomparisontothelowergroup(6.24±0.39%vs.5.80±0.36%,P=0.008).Thepercentageofnewcoronaryarterystenosis(≥50%stenosis)washigherinthehighergroupthanthatinthelowergroup(41.7%vs.32.3%,P<0.001).MultivariateregressionanalysessuggestedthatHbA1cremainedindependentfactorassociatedwithcoronaryarterystenosesafterextensiveadjustmentforriskfactors.ConclusionInthenondiabetics,increasedbaselineHbA1clevelportendstheriskofcorona

简介：AbstractPurpose:To explore the diagnosis and treatment of traumatic external carotid branch pseudoaneurysms.Methods:Eleven cases of traumatic external carotid artery branch pseudoaneurysms were admitted in our hospital. Digital subtraction angiography was performed in all patients. It revealed that the pseudoaneurysms originated from the internal maxillary artery in 5 cases, superficial temporal artery in 5 cases and occipital artery in 1 case. Five cases of internal maxillary artery pseudoaneurysms and 2 cases of superficial temporal artery pseudoaneurysms were treated by embolization; the other 3 cases were surgically resected.Results:Complete cessation of nasal bleeding was achieved in all the 5 pseudoaneurysms of internal maxillary artery after the endovascular therapies. Scalp bleeding stopped and scalp defect healed up in 2 patients with superficial temporal artery pseudoaneurysms treated by interventional therapy. All patients were followed up for 0.5-2.0 years without recurrence of nosebleed and scalp lump.Conclusion:For patients with repeated severe epistaxis after craniocerebral injury, digital subtraction angiography should be performed as soon as possible to confirm traumatic pseudoaneurysm. Endovascular therapy is an effective method for traumatic internal maxillary artery pseudoaneurysms. For patients with scalp injuries and pulsatile lumps, further examinations including digital subtraction angiography should be performed to confirm the diagnosis. Surgical treatment or endovascular therapy for scalp traumatic pseudoaneurysm is effective.

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简介：AbstractObjective:Endoscopic approaches for sinus and skull base surgery are increasing in popularity. The objective of this narrative review is to characterize risk factors for internal carotid artery injury in endoscopic endonasal surgery (EES), highlight preventative measures, and illustrate key management principles.Data Sources:Comprehensive literature review.Methods:Relevant literature was reviewed using PubMed/MEDLINE.Results:Carotid artery injury in EES is rare, with most studies reporting an incidence below 0.1%. Anatomic aberrancies, wide dissection margins, as well as specific provider and hospital factors, may increase the risk of injury. Multidisciplinary teams, comprehensive preoperative imaging, patient risk assessment, and formal training in vascular emergencies may reduce the risk. Management protocols should emphasize proper visualization of the injury site, fluid replacement, rapid packing, angiography, and endovascular techniques to achieve hemostasis.Conclusions:While EES is a relatively safe procedure, carotid artery injury is a devastating complication that warrants full consideration in surgical planning. Important preventative measures include identifying patients with notable risk factors and obtaining preoperative imaging. Multidisciplinary teams and management protocols are ultimately necessary to reduce morbidity and mortality.

简介：Bothclinicalandpostmortemstudiesindicatethat,inhumans,thecarotidsinusofthecarotidarterybifur-cationisoneofthefavoredsitesforthegenesisanddevelop-mentofatheroscleroticlesions.Hemodynamicfactorshavebeensuggestedtobeimportantinatherogenesis.Tounderstandthecorrelationbetweenatherogenesisandfluiddynamicsinthecarotidsinus,thebloodflowinarterywassimulatednumerically.Inthosestudies,thepropertyofbloodwastreatedasanincompressible,Newtonianfluid.Infact,however,thebloodisacomplicatednon-Newtonianfluidwithshearthinningandviscoelasticproperties,especiallywhentheshearrateislow.Avarietyofnon-Newtonianmod-elshavebeenappliedinthenumericalstudies.Amongthem,theCassonequationwaswidelyused.However,theCas-sonequationagreeswellonlywhentheshearrateislessthan10s~(-1).Theflowfieldofthecarotidbifurcationusuallycoversawiderangeofshearrate.WethereforebelievethatitmaynotbesufficienttodescribethepropertyofbloodonlyusingtheCassonequationinthewholeflowfieldofthecarotidbifurcation.Inthepresentstudy,threedifferentbloodconstitutivemodels,namely,theNewtonian,theCas-sonandthehybridfluidconstitutivemodelswereusedintheflowsimulationofthehumancarotidbifurcation.Theresultswerecomparedamongthethreemodels.TheresultsshowedthattheNewtonianmodelandthehybridmodelhadverysimilardistributionsoftheaxialvelocity,secondaryflowandwallshearstress,buttheCassonmodelresultedinsignificantdifferencesinthesedistributionsfromtheothertwomod-els.ThisstudysuggeststhatitisnotappropriatetoonlyusetheCassonequationtosimulatethewholeflowfieldofthecarotidbifurcation,andontheotherhand,Newtonianfluidisagoodapproximationtobloodforflowsimulationsinthecarotidarterybifurcation.

简介：AbstractPurpose:To explore the significance of traditional vascular reconstruction and covered stent for limb salvage after subclavian artery injury.Methods:Patients with subclavian artery injury admitted to Beijing Jishuitan Hospital from January 2010 to December 2018 were retrospectively analyzed. All the injuries have been confirmed by intraoperative exploration, computed tomography angiography or digital subtraction angiography. Complete or partial amputation injuries were excluded. Mild artery defect or partial intimal damage was treated by inter-ventional implantation, while other patients received open surgeries, including direct suture of small defect less than 2 cm and transplantation with autologous vein or artificial blood when the defect was more than 2 cm. Patients were divided into open surgery group and stent implantation group based on the treatment they received. Patients were followed up at 2 weeks (first stage) and 6 months (second stage) after operation to investigate limb salvage. Student's t-test was used to compare the general data between two groups and Chi-square test to analyze the rate of limb salvage.Results:Altogether 50 cases of subclavian artery injury were treated, including 36 cases of open surgery and 14 cases of stent implantation. Combination of nerve injury was observed in 27 cases (75.0%) in open surgery group and 12 cases (85.7%) in stent implantation group. Amputation developed in 3 cases with open surgery and 1 case with stent implantation. Consequently the rate of successful limb salvage was respectively 91.7% (33/36) and 92.9% (13/14), revealing no significant difference (p > 0.05).Conclusion:Rapid reconstruction of blood circulation is crucial following subclavian artery injury, no matter what kinds of treatment strategies have been adopted. Interventional stent implantation can achieve a good effect for limb salvage.

简介：目的：观察推拿治疗椎动脉型颈椎病的临床疗效。方法：选取符合诊断标准的椎动脉型颈椎病患者157例，采用推拿治疗，每星期治疗3次，10次为1个疗程，治疗1～2个疗程。3个月后进行疗效的随访。治疗期间，暂停其他可能影响推拿治疗效果的治疗方法。结果：157例患者中，显效109例，好转26例，无效6例，失去随访16例，有效率86．6％。结论：推拿治疗椎动脉型颈椎病具有较好的疗效。

简介：ObjectivesTotestthefeasibilityoftheuseofhighthoracicepiduralanesthesiaasasoleanestheticinpatientsundergoingoffpumpcoronaryarterybypasssurgery,avoidinggeneralanesthesia.MethodsBetweenOctober2002toApril2003,twentyfivecasesunderwentbeatingheartcoronaryarteryrevascularizationwithoutendotrachealgeneralanesthesia,usinghighthoracicepiduralanesthesiaandanalgesia.Allthepatientsunderwentepiduralcatheterizationontheeveningbeforethesurgery.ResuitsThepatientsinallreceived71grafts(singlen=11,doublen=5,triplen=6,quadruplen=3).Sixpatientsunderwentrepeatcoronaryarterybypass.Exceptonewasconvertedtogeneralanesthesiaandcardiopulmonarybypass,theotherpatientsunderwentoff-pumpcoronaryarterybypassgraftsurgery,2patientsunderwentgraftingvialeftthoracotomy(MIDCAB)andtherestthroughmidsternotomy.Therewasnomortality.Meanlengthofstayintheintensivecareunitwas16.2(4.2hoursandhospitalwas3.0(1.2days.ConclusionsOurexperienceconfirmsthefeasibilityofperformingmuhiplecoronaryarterybypassesinconsciouspatientswithoutendotrachealgeneralanesthesia.

简介：Therestenosisaftercoronaryarterybypassgraft(CABG)isattributedtotheformationofintimalhyperplasia(IH)attheanastomosis,whichiscloselyrelatedtohemodynamicdependonthegeometricmodel.Inordertogiveareasonableassessmentofthesurgeryeffectandjudgethelong-termpatencyrate,thehemodynamicofCABGsurgeryprogramiscomparedwiththatofsurgerydesignofthejunctionanglechanged.Basedonin-vivoCTcoronaryangiographydatasets,theindividualgeometricmodelofCABGreconstructedinsteadofidealizedgeometricmodelsareappliedtosimulatetherealphysiologicalbloodflowutilizingpulsatileflowboundarywaveformsinthepresentstudy.Thesimulationresultsshowthatthemaximumwallshearrate(WSS)valueisatthebottomofanastomosis.Moreover,thestagnationzonegrowinggraduallywiththegreaterangledownstreamtheanastomosisispronetoformtheIH,whichisconsistentwithclinicalobservation.Itisprovedthatthesurgerybeingbettersuitedtomaintaingraftpatencyissuccessful.

简介：BackgroundPreviousstudieshavesuggestedthatpatientswithlowendothelialprogenitorcell(EPC)countsandimpairedendothelialcolonyformingactivityhaveahigherincidenceforcardiovasculareventscomparedtopatientswithhighEPCcountsandfavorablecolonyformingactivity.ThepathophysiologicalbasisforthisfindingmaybeaninsufficientendothelialcellrepairbyEPC.TheobjectiveofthisstudywastodeterminewhetherthenumberofEPCsinperipheralbloodwasassociatedwiththepresenceandseverityofangiographicstenosisinpatientsofthelatephaseafteracutemyocardialinfarction(AMI).MethodsOnehundredandonepatientsundergoingcardiaccatheterizationinourhospitalwereenrolledinthestudy.ThenumberofcirculatingEPCswasmeasuredbyafluorescent-activatedcellsorter(FACS).Patientswithacutecoronarysyndromeswereexcluded.ResultsComparedwithpatientswithnormalcoronaryartery,thenumberofcirculatingEPCswassignificantlyreducedamongpatientsinthelatephaseafterAMI(P<0.01).Wealsofoundthatcomparedwiththecontrolgroup,thenumberofEPCsofsingle-vesselstenosisgroupandmulti-vesselstenosisgroupweresignificantlyreduced(P=0.005;P=0.001).ConclusionsThenumberofEPCsintheperipheralbloodisdecreasedinpatientsofthelatephaseafterAMI.TheEPCsnumbercorrelatedwithangiographicstenosisseverity,whichsuggeststhatendothelialinjuryinthedeficientcirculatingEPCsmayaffecttheseverityoftheheartdisorderandtheclinicalpresentations.

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简介：INTRODUCTIONWiththedevelopmentofeconomyandimprovementoflifequality,theincidencesofhypertension,hyper-cholesterolemia,diabetes,obesityandsmokinghavebeenincreasedinChina,whichhasledtoasignificantincreaseinthemorbidityandmortalityofcoronaryarterydisease(CAD)~1.SinceitwasintroducedintoChinain1984,coronaryintervention(PCI)hasdevelopedrapidlyandhasbecomethemajortreatmentofCADbecauseofitsuniquecharacteristicsofminimalinvasiveand

简介：AbstractBackground:Giant serpentine aneurysms (GSA) originate from saccular or spindle aneurysm, dissimilar from dissected aneurysm, that are defined as partially thrombosed giant aneurysms with tortuous internal vascular channel. The clinical and neuroradiologic characteristics are clarified and the mechanism of formation and the efficacy of double stent implantation in GSA are discussed.Case presentation:An 18-year-old man presented himself with a GSA arising from the internal cerebral artery (ICA). In addition, a mandibular aneurysm (MA) arose from the external cerebral artery (ECA). Success was achieved in treating GSA through endovascular treatment with double stents implanted in the parent artery, which were LEO stent and Tubridge flow diverter. After 1 year of follow-up, three-dimensional reconstruction of blood vessels revealed the disappearance of the serpentine access of GSA, which was found to be replaced with a roughly normal vascular structure.Conclusions:Double stent implantation has provided a feasible treatment option for giant serpentine internal carotid aneurysms and eliminated the possibility of causing collateral circulation occlusion. Therefore, it represents a simple and suitable treatment method for anatomical structure and operation.

简介：目的将从寄生于的网膜的动脉(POA)与血供应分析hepatocellular癌(HCC)的angiographic外观，并且经由POA评估技术可行性，安全和chemoembolization的治疗学的功效。

简介：Cerebralischemianotonlycausespathologicalchangesintheischemicareasbutalsoinducesaseriesofsecondarychangesinmoredistalbrainregions(suchasthecontralateralcerebralhemisphere).Theimpactofsupratentoriallesions,whicharethemostcommontypeoflesion,onthecontralateralcerebellumhasbeenstudiedinpatientsbypositronemissiontomography,singlephotonemissioncomputedtomography,magneticresonanceimaginganddiffusiontensorimaging.Inthepresentstudy,weinvestigatedmetabolitechangesinthecontralateralcerebralhemisphereaftersupratentorialunilateralischemiausingnuclearmagneticresonancespectroscopy-basedmetabonomics.Thepermanentmiddlecerebralarteryocclusionmodelofischemicstrokewasestablishedinrats.Ratswererandomlydividedintothemiddlecerebralarteryocclusion1-,3-,9-and24-hourgroupsandtheshamgroup.~1Hnuclearmagneticresonancespectroscopywasusedtodetectmetabolitesintheleftandrightcerebralhemispheres.Comparedwiththeshamgroup,theconcentrationsoflactate,alanine,γ-aminobutyricacid,cholineandglycineintheischemiccerebralhemispherewereincreasedintheacutestage,whiletheconcentrationsofN-acetylaspartate,creatinine,glutamateandaspartateweredecreased.Thisdemonstratesthatthereisanupregulationofanaerobicglycolysis(shownbytheincreaseinlactate),aperturbationofcholinemetabolism(suggestedbytheincreaseincholine),neuronalcelldamage(shownbythedecreaseinN-acetylaspartate)andneurotransmitterimbalance(evidencedbytheincreaseinγ-aminobutyricacidandglycineandbythedecreaseinglutamateandaspartate)intheacutestageofcerebralischemia.Inthecontralateralhemisphere,theconcentrationsoflactate,alanine,glycine,cholineandaspartatewereincreased,whiletheconcentrationsofγ-aminobutyricacid,glutamateandcreatinineweredecreased.Thissuggeststhatthereisadifferenceinthemetabolitechangesinducedbyischemicinjuryinthecontral

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