Gender differences in workplace violence against physicians and nurses in Latin America: a survey from the Interamerican Society of Cardiology.

OBJECTIVES: To evaluate gender differences in workplace violence (WPV) against physicians and nurses in Latin America. STUDY DESIGN: Cross-sectional study. METHODS: A cross-sectional electronic survey was conducted between January 11 and February 28, 2022. A prespecified gender analysis was performed. RESULTS: Among the 3056 responses to the electronic survey, 57% were women, 81.6% were physicians, and 18.4% were nurses. At least one act of violence was experienced by 59.2% of respondents, with verbal violence being the most common (97.5%). Women experienced more WPV than men (65.8% vs 50.4%; P < 0.001; odds ratio [OR]: 1.89; 95% confidence interval [CI]: 1.63-2.19). Women were more likely to report at least one episode of WPV per week (19.2% vs 11.9%, P < 0.001), to request for psychological help (14.5% vs 9%, P = 0.001) and to experience more psychosomatic symptoms. In addition, women were more likely to report having considered changing their job after an aggression (57.6% vs 51.3%, P = 0.011) and even leaving their job (33% vs 25.7%, P = 0.001). In a multivariate analysis, being a woman (OR: 1.76), working in emergency departments (OR: 1.99), and with COVID-19 patients (OR: 3.3) were independently associated with more aggressive interactions, while older age (OR: 0.95) and working in a private setting (OR: 0.62) implied lower risk. CONCLUSIONS: Women are more likely to experience WPV and to report more psychosomatic symptoms after the event. Preventive measures are urgently needed, with a special focus on high-risk groups such as women.

SARC-F and SARC-CalF Scores as Mortality Risk Factors in Older Men with Cancer: A Longitudinal Study from Peru.

OBJECTIVES: We aimed to evaluate the role of SARC-F and SARC-CalF scores as risk factors for mortality in adults over 60 years of age with cancer of the Centro Médico Naval (CEMENA) in Callao, Peru during 2012-2015. METHODS: We performed a secondary analysis of data from a prospective cohort carried out from September 2012 to February 2013 in the Geriatrics Department of CEMENA. The outcome variable was mortality at two years of follow-up, while the exposure variable was the risk of sarcopenia assessed using the SARC-F and SARC-CalF scales. We carried out Cox proportional-hazards models to assess the role of SARC-F and SARC-CalF scores as risk factors for mortality. We estimated crude (cHR) and adjusted (aHR) hazard ratios (HR) with their respective 95% confidence intervals (95%CI). Likewise, we calculated the area under the curve (AUC) of both exposure variables in relation to mortality. RESULTS: We analyzed data from 922 elderly men with cancer; 43.1% (n=397) were between 60 and 70 years old. 21.5% (n=198) and 45.7% (n=421) were at risk of sarcopenia according to SARC-F and SARC-CalF, respectively, while the incidence of mortality was 22.9% (n=211). In the adjusted Cox regression model, we found that the risk of sarcopenia measured by SARC-F (aHR=2.51; 95%CI: 1.40-2.77) and SARC-CalF (aHR=2.04; 95%CI: 1.55-4.02) was associated with a higher risk of death in older men with cancer. In the diagnostic performance analysis, we found that the AUC for mortality prediction was 0.71 (95%CI: 0.68-0.75) for SARC-F and 0.80 (95%CI: 0.78-0.82) for SARC-CalF. CONCLUSIONS: The risk of sarcopenia evaluated by SARC-F and SARC-CalF scores was associated with an increased risk of mortality in older men with cancer. Both scales proved to be useful and accessible instruments for the identification of groups at risk of mortality.

Lack of association between angiotensin-converting enzyme genotype and muscle strength in Peruvian older people.

Aging can be associated with decreasing muscle strength, and related factors are comorbidities, sex, physical activity, and possibly genetic factors. Among genetic factors the renin-angiotensin system is of interest, but data on the Peruvian population is lacking. The objective of our study was to evaluate the association of grip strength and angiotensin convertase enzyme (ACE) polymorphism in Peruvian older people. A cross-sectional study in a convenience sample of 104 participants over 60 years in Lima, Perú, with analysis of the ACE polymorphism, was performed. We studied 104 participants, 46 men (44,2%) and 58 women (55,8%), with a mean age and standard deviation (SD) of 73,7 (7,4) years, range between 60-90 years. The frequency of D/D, I/D and I/I genotypes was 12,7; 43,7 and 43,7% respectively. The genotype distribution of ACE polymorphism agreed with the Hardy-Weinberg equilibrium (p=0,746). The mean (SD) of grip strength in the D/D, I/D and I/I polymorphisms were 24,8 (7,2); 22,8 (7,2) and 23,4 (7,6) kg respectively; no significant difference was observed (p=0,41) between genetic groups. In this small convenience sample of older Peruvians, no association was found between grip strength and ACE genotype.

Frailty and Vulnerability as Predictors of Chemotherapy Toxicity in Older Adults: A Longitudinal Study in Peru.

BACKGROUND: Multiple markers are used to assess frailty and vulnerability, conditions associated with the development of chemotherapy toxicity (CTT). However, there is still no consensus on which condition has stronger association with this adverse effect of chemotherapy in the elderly. OBJECTIVES: To evaluate the association between frailty and vulnerability with the development of CTT in oncogeriatric patients. DESIGN, SETTING, AND PARTICIPANTS: Through a retrospective cohort, a secondary database of 496 male oncogeriatric military patients treated at the Geriatrics Service of the Naval Medical Centre of Peru during 2013-2015 was analyzed. MEASUREMENTS: With prior informed consent, the presence of frailty, assessed by Fried Phenotype; and vulnerability, assessed by the Vulnerable Elders Survey-13 (VES-13) and G-8, was determined. The follow-up of patients in chemotherapy was performed every 8 weeks, to determine the development of CTT (according to the Common Terminology Criteria for Adverse Events v4.0). In addition, we included sociodemographic characteristics, medical background information and functional assessment variables. The data collected was encoded and imported into STATA v14.0 statistical package for analysis. Multivariate analysis was performed using crude and adjusted Cox regression models. The reported measure was the hazard ratio (HR) with their respective 95% confidence intervals (95%CI). RESULTS: The average age was 79.2 ± 4.3 years. 129 (26.01%) developed CTT during follow-up. Similarly, 129 older adults (26.01%) were positive for frailty according to Fried phenotype; 101 (20.36%) were positive for vulnerability with VES-13, and 112 (22.58%) with G-8. In the adjusted Cox model, by type of cancer and adverse effects, a statistically significant association was found between the 3 scales evaluated and the development of CTT, with the Fried Phenotype as the scale with the strongest association (HR=2.01; 95%CI: 1.04-4.90). CONCLUSIONS: The frailty and vulnerability in the elderly are conditions associated with the development of CTT. The Fried phenotype was the scale with the most significant association with the outcome studied.

Bromatological characteristics of fillet fish of Leporinus agassizi and Leporinus fasciatus (Pisces: Characidae) in its natural habitat / Características bromatológicas de filetes de Leporinus agassizy Leporinus fasciatus (Pisces: Characidae) en su hábitat natural

ABSTRACT Bromatological parameters in 39 Warakú verdadero (Leporinus agassizi) and 21 Warakú pinima (Leporinus fasciatus) fillets were analyzed at three different sites of the Vaupés River, Colombia sampled during a hydrobiological cycle. The bromatological parameters did not shown significant differences in relation to the sites and season of capture. At point 3 and during the descending water season Leporinus agassizi had the highest values for dry matter (25.24%), protein (19.82%) and ash (2.16%). The highest lipid value for this species was found in low waters at point 1 (2.93%). Leporinus fasciatus showed the highest levels of dry matter (25.19%) and ash (2.16%) at point 3 during ascendant and high waters, respectively. The bromatological parameters tends to vary regarding the time of year. It was possible to determined that these fish species have great potential for continental aquaculture thus constituting a healthy food model.

RESUMEN Se analizaron los parámetros bromatológicos de 39 filetes de Warakú verdadero (Leporinus agassizi) y 21 filetes de Warakú pinima (Leporinus fasciatus) muestreados durante un ciclo hidrológico en tres puntos diferentes del Rio Vaupés, Colombia. Los parámetros evaluados no presentaron diferencias significativas en relación al sitio y época de captura. En el punto 3 y durante la temporada de aguas descendentes Leporinus agassizi tuvo los valores más altos para materia seca (25,24%), proteína (19,82%) y cenizas (2,16%). Los mayores niveles de lípidos para esta especie fueron encontrados en aguas bajas del punto 1 (2,93%). Leporinus fasciatus presentó los niveles más altos de materia seca (25,19%) y cenizas (2,16%) en el punto 3 durante la temporada de aguas ascendentes y altas, respectivamente. Las variables bromatológicas tendieron a variar de acuerdo con la época del año. Fue posible determinar que estas especies de peces poseen un gran potencial para la acuicultura de aguas continentales constituyendo así un modelo de alimentación saludable.

Effects of storage time on the motility, mortality and calcium levels of Atlantic salmon Salmo salar spermatozoa.

This study estimates spermatozoa mortality, morphology, motility and intracellular calcium levels in Atlantic salmon Salmo salar milt after prolonged storage. Milt samples were preserved at 4° C for 25 days and then evaluated for mortality. Motility remained high for the first 3 days and the mortality was low during the first 5 days of storage. A decrease of >50% in calcium content was observed after 5 days of storage. When spermatozoa were activated, calcium levels increased >200% in relative fluorescence units (RFU); this rate of increase was lost when the samples were stored for extended periods of time and was only partially manifested in a zero calcium solution. The results suggest that in vitro storage of S. salar spermatozoa at 4° C for a period of 3 days preserves motility and limits mortality to levels similar to those of fresh spermatozoa. This method also maintains intracellular calcium storage critical for spermatozoa performance.

Effect of aracnotoxin from Latrodectus mactans on bovine sperm function: modulatory action of bovine oviduct cells and their secretions.

Latrodectus mactans' aracnotoxin (Atx) induces changes in sperm function that could be used as a co-adjuvant in male contraceptive barrier methods. This effect includes the suppression of intracellular reactive oxygen species (ROS), an event necessary for capacitation, chemotaxis and acrosome reaction (AR). The sperm that are not trapped by the barrier method can reach the oviduct before fertilisation and be exposed to the secretions of the oviducts. This study evaluated the effect of bovine tubal explants (TU) and conditioned media (CM) from the ampullar and isthmal regions on spermatozoa exposed to Atx. Thawed bovine sperm were incubated with Atx, TU and CM from the ampullar and isthmal regions for 4 h and then DNA integrity, intracellular ROS and lysophosphatidylcholine-induced AR were determined. Spermatozoa exposed to Atx and co-incubated with TU and CM for 4 h produced an increase in sperm DNA damage, a decrease in ROS production and a decrease in %AR, compared with the control. A similar result was obtained from the co-incubation of spermatozoa with Atx. In conclusion, the effect of Atx is not modified by tubal cells or their secretions and this opens the door to future studies to evaluate the application of synthetic peptides obtained from Atx as a co-adjuvant of contraceptive barrier methods.

Tetrahydrohyperforin prevents cognitive deficit, Aß deposition, tau phosphorylation and synaptotoxicity in the APPswe/PSEN1ΔE9 model of Alzheimer's disease: a possible effect on APP processing.

Alzheimer's disease (AD) is a neurodegenerative disorder characterized by a progressive deterioration of cognitive abilities, amyloid-ß peptide (Aß) accumulation and synaptic alterations. Previous studies indicated that hyperforin, a component of the St John's Wort, prevents Aß neurotoxicity and some behavioral impairments in a rat model of AD. In this study we examined the ability of tetrahydrohyperforin (IDN5607), a stable hyperforin derivative, to prevent the cognitive deficit and synaptic impairment in an in vivo model of AD. In double transgenic APPswe/PSEN1ΔE9 mice, IDN5706 improves memory and prevents the impairment of synaptic plasticity in a dose-dependent manner, inducing a recovery of long-term potentiation. In agreement with these findings, IDN5706 prevented the decrease in synaptic proteins in hippocampus and cortex. In addition, decreased levels of tau hyperphosphorylation, astrogliosis, and total fibrillar and oligomeric forms of Aß were determined in double transgenic mice treated with IDN5706. In cultured cells, IDN5706 decreased the proteolytic processing of the amyloid precursor protein that leads to Aß peptide generation. These findings indicate that IDN5706 ameliorates AD neuropathology and could be considered of therapeutic relevance in AD treatment.

Initial 200 cases of carotid artery stenting using a reversal-of-flow cerebral protection device.

AIM: Because embolic complications can occur during carotid angioplasty and stenting (CAS), a new device, the Parodi Anti-Emboli System (PAES) was developed to protect the brain from embolization. We describe our initial experience with this device. METHODS: Between September 1999 and December 2003, CAS was performed in 200 consecutive patients (146 men; mean age, 70.4 years) with symptomatic (52%) or asymptomatic (48%) severe carotid artery stenosis (>70%). De novo lesions were present in 169 patients, restenosis in 18, and radiation-induced stenosis in 13. Wallstents were inserted in all cases, with selective predilatation, and the PAES was employed during all CAS procedures. Patients were evaluated by a neurologist before and after CAS. Minor strokes, major or fatal strokes, and myocardial infarctions that occurred within 30 days of the procedure were recorded. RESULTS: The overall technical success rate for CAS using the PAES (with the PAES placed in position percutaneously) was 99%. The overall perioperative stroke and death rate was 1.5%. There were four transient neurologic events after CAS, three of which were related to hemodynamic instability and one to postoperative embolization. CONCLUSIONS: Our experience indicates that CAS using the PAES is safe and effective. The protection device may prevent the debris released by angioplasty from entering the cerebral circulation. Additional studies of this device are warranted.

Intra-aneurysmal pressure after incomplete endovascular exclusion.

PURPOSE: An endoleak results from the incomplete endovascular exclusion of an aneurysm. We developed an experimental model to analyze hemodynamic changes within the aneurysm sac in the presence of an endoleak, with and without a simulated open collateral branch. METHODS: With a latex aneurysm model connected to a pulsatile pump, pressures were measured simultaneously within the system (systemic pressure) and the aneurysm sac (intrasac pressure). The experiments were performed without endoleak (control group) and after creating a 3.5-mm (group 1), 4.5-mm (group 2), and 6-mm (group 3) diameter orifice in the endograft, simulating an endoleak. Pressures were also registered with and without a patent aneurysm side branch. RESULTS: In each endoleak group, the intrasac diastolic pressure (DP) and mean pressure (MP) were significantly higher than the systemic DP and MP (P =.01, P =.006, and P =.001, respectively), although the pressure curve was damped. The presence of an open side branch significantly reduced the intrasac DP and MP. CONCLUSION: In this model, intrasac pressures were significantly higher than systemic pressures in the presence of all endoleaks, even the smallest ones. Intrasac pressures higher than systemic pressure may pose a high risk for aneurysm rupture. Although patent side branches significantly reduce these pressures, the aggressive management of an endoleak should be pursued.

Modulation of adenosine transport by insulin in human umbilical artery smooth muscle cells from normal or gestational diabetic pregnancies.

1. Adenosine transport was measured in human cultured umbilical artery smooth muscle cells, isolated from non-diabetic or gestational diabetic pregnancies, under basal conditions and after pretreatment in vitro with insulin. 2. Adenosine transport in non-diabetic smooth muscle cells was significantly increased by insulin (half-maximal stimulation at 0.33 +/- 0.02 nM, 8 h) and characterized by a higher maximal rate (V(max)) for nitrobenzylthioinosine (NBMPR)-sensitive (es) saturable nucleoside transport (17 +/- 5 vs. 52 +/- 12 pmol (microg protein)(-1) min(-1), control vs. insulin, respectively) and maximal binding sites (B(max)) for [(3)H]NBMPR (0.66 +/- 0.07 vs. 1.1 +/- 0.1 fmol (microg protein)(-1), control vs. insulin, respectively), with no significant changes in Michaelis-Menten (K(m)) and dissociation (K(d)) constants. 3. In contrast, in smooth muscle cells from diabetic pregnancies, where the values of V(max) for adenosine transport (59 +/- 4 pmol (microg protein)(-1) min(-1)) and B(max) for [(3)H]NBMPR binding (1.62 +/- 0.16 fmol (microg protein)(-1)) were significantly elevated by comparison with non-diabetic cells, insulin treatment (1 nM, 8 h) reduced the V(max) for adenosine transport and B(max) for [(3)H]NBMPR binding to levels detected in non-diabetic cells. 4. In non-diabetic cells, the stimulatory effect of insulin on adenosine transport was mimicked by dibutyryl cGMP (100 nM) and reduced by inhibitors of phosphatidylinositol 3-kinase (10 nM wortmannin), nitric oxide synthase (100 microM N (G)-nitro-L-arginine methyl ester, L-NAME) or protein synthesis (1 microM cycloheximide), whereas inhibition of adenylyl cyclase (100 microM SQ-22536) had no effect. 5. Wortmannin or SQ-22536, but not L-NAME or cycloheximide, attenuated the inhibitory action of insulin on the diabetes-induced stimulation of adenosine transport. 6. Protein levels of inducible NO synthase (iNOS) were similar in non-diabetic and diabetic cells, but were increased by insulin (1 nM, 8 h) only in non-diabetic smooth muscle cells. 7. Our results suggest that adenosine transport via the es nucleoside transporter is modulated differentially by insulin in either cell type. Insulin increased adenosine transport in non-diabetic cells via NO and cGMP, but inhibited the diabetes-elevated adenosine transport via activation of adenylyl cyclase, suggesting that the biological actions of adenosine may be altered under conditions of sustained hyperglycaemia in uncontrolled diabetes.

Neutrophil respiratory burst activity and pro- and anti-inflammatory cytokines in AAA surgery: conventional versus endoluminal treatment.

PURPOSE: To examine the inflammatory impact of endovascular and conventional surgery of abdominal aortic aneurysm (AAA) as assessed by the activation of neutrophils and serum levels of pro- and anti-inflammatory cytokines. METHODS: Twenty-four patients undergoing AAA exclusion were treated with either endovascular (n = 14) or conventional (n=10) techniques. Clinical and hematological data, respiratory burst of neutrophils, and the expression of adhesion and activation molecules (CD18, CD11b, CD69, and HLA-DR) were analyzed by flow cytometry. The enzyme-linked immunosorbent assay technique was used to measure proinflammatory cytokine interleukin (IL)-8 and anti-inflammatory cytokines IL-1 receptor antagonist (IL-1RA) and transforming growth factor beta1 (TGF-beta1). RESULTS: All patients, most of whom had normal cytokine values before surgery, were successfully treated. No significant changes were found in surface antigens. Basal respiratory burst was quite heterogeneous; in all cases respiratory burst activity decreased after surgery and remained low throughout the observation period. Despite marked interpatient differences, IL-1RA and IL-8 increased after surgery, whereas TGF-beta1 decreased, although the variation achieved statistical significance only in the conventional group. Elevated IL-1RA returned to normal within 48 hours in the endoluminal group, whereas the level remained high in the conventional group in the last sample. CONCLUSIONS: Despite heterogeneity before surgery, the respiratory burst decreased for most of the patients regardless of the approach, and both techniques increased IL-1RA. Although both procedures seemed to decrease TGF-beta1, the difference was significant only with the conventional approach. IL-1RA levels fell toward basal values quicker in the endograft patients, suggesting that the endoluminal approach was less aggressive.

Initial evaluation of carotid angioplasty and stenting with three different cerebral protection devices.

OBJECTIVE: The purpose of the study was to assess the effectiveness of cerebral protection devices during carotid artery angioplasty and stent placement. METHODS: Between September 1998 and September 1999, carotid angioplasty and stenting were performed in 46 patients with symptomatic (39.1%) or asymptomatic (60.9%) severe carotid artery stenosis. Wallstents were used in all patients with selective predilatation. Cerebral protection devices were used in 25 of these patients. Primary end points were perioperative neurologic complications and mortality. Data were collected prospectively. RESULTS: The overall combined end point of all neurologic deficits and death rate was 4.34%. Two neurologic events (one transient ischemic attack and one minor stroke) occurred in the unprotected group (9.53%) versus none in the group with cerebral protection. This difference is not statistically significant. The mortality rate was 0% for both groups. On an intention to treat basis, the overall technical success rate for carotid angioplasty was 97.8%, and for placement of cerebral protection devices it was 100%. An important number of particles of different sizes were captured in all cases in which cerebral protection devices were used. CONCLUSION: Experience has shown that cerebral protection during carotid angioplasty and stenting is technically feasible and appears to be effective in preventing procedure-related neurologic complications. Further investigation is warranted.

Gadolinium-based contrast: an alternative contrast agent for endovascular interventions.

The radiocontrast substance gadoterate meglumine (Gd-DOTA) is used in magnetic resonance imaging. Because of its low rate of adverse drug reactions, we evaluated Gd-DOTA as an alternative contrast medium in diagnostic and therapeutic procedures. Twenty-three consecutive procedures were performed using undiluted contrast agent Gd-DOTA (376.9 mg/mL, Dotarem) in digital subtraction techniques. A dosage of 30-90 mL was used. Serum creatinine levels were registered before and at 24 and 48 hr after the procedure. Based on this limited experience, Gd-DOTA may be used as an alternative contrast agent in selected endovascular procedures, when iodine is contraindicated.

Acute rupture of an aortic false aneurysm treated with a stent-graft.

PURPOSE: To report the use of an aortic endograft to treat a ruptured false aneurysm at the anastomosis of an aortofemoral bypass graft. METHODS AND RESULTS: A 68-year-old man with a 30-year-old aorto-right femoral bypass and multiple comorbidities was admitted to the hospital complaining of acute abdominal pain. Imaging identified a 60-mm ruptured aortic false aneurysm with associated retroperitoneal hematoma, a 9-cm right femoral false aneurysm, and a calcified 23-mm left common iliac aneurysm. Two slightly overlapping Vanguard straight stent-grafts were implanted in the aorta and left common iliac artery in an emergency procedure owing to the patient's high surgical risk. The anastomotic false aneurysm and the bypass were excluded. A left-to-right femorofemoral bypass was performed to re-establish flow to the right femoral artery with ligation of the external iliac artery. The patient recovered uneventfully. He remained well with a successful repair until his death of a myocardial infarction 6 months after the procedure. CONCLUSIONS: Endovascular grafting can be used successfully for the urgent treatment of aortic false aneurysm rupture.

Endovascular stent-graft treatment of traumatic arterial lesions.

Twenty-nine cases of post-traumatic false aneurysms and arteriovenous fistulas (AVF), with a mean follow-up of 24 months (1-65 months), are presented here. Diagnosis was established by color duplex and arteriogram. The time between injury and treatment varied between 3 days and 61 months. Endovascular treatment was accomplished using a covered Palmaz stent [vein, polytetrafluoroethylene (PTFE), or polyester], Corvita endoluminal graft, or a Wallgraft. Complimentary treatment of a branch injury was performed using a detachable balloon in one patient. The initial result was favorable for all patients. One case of asymptomatic stenosis of an iliac stent graft and three occlusions of the stent (one subclavian, one axillary, and one internal carotid) were registered during the follow-up period, and no clinical manifestations of the occlusions were reported. Endovascular treatment of post-traumatic false aneurysms and AVF appears to be a promising alternative for treatment of these lesions. Less pain and disability as well as rapid recovery time and lower cost after endovascular treatment compare favorably to the standard surgical technique.

Relocation of the iliac artery bifurcation to facilitate endoluminal treatment of abdominal aortic aneurysms.

PURPOSE: To report a surgical technique to preserve the internal iliac arteries (IIAs) and facilitate endovascular repair of abdominal aortic aneurysms (AAAs) with extensive iliac artery involvement. TECHNIQUE: A new iliac artery bifurcation is created surgically through an 8-cm lower left abdominal incision by implanting the IIA onto the distal external iliac artery either directly or by using a tube graft interposition. Careful technique is required to avoid embolic complications, but after relocating the bifurcation, aortic endografting can be performed, either simultaneously or staged, depending upon patient characteristics. CONCLUSIONS: Relocation of the iliac artery bifurcation appears to be a good alternative to preserve pelvic arterial flow in selected candidates for endoluminal AAA repair.

Carotid rupture and intraplaque hemorrhage: immunophenotype and role of cells involved.

BACKGROUND: A complete immunohistochemical characterization in complicated carotid plaques is still lacking. The cellular components of 165 carotid endarterectomy specimens were analyzed to assess their role in the pathogenesis of plaque rupture and intraplaque hemorrhage without rupture. METHODS AND RESULTS: The fibrous caps at the sites of plaque rupture showed CD68+ macrophages, T-lymphocytes, and scarce B-lymphocytes. Ruptured plaques showed mononuclear infiltrates in the caps, shoulders, and bases of the plaques in 85% of the cases. Only 46% of nonruptured plaques showed such infiltrates (P <.0001). Two types of lipid cores were recognized: avascular or mildly vascularized and highly vascularized. The vessels of the latter type reacted with CD31 and CD34. In 57.5% of the cases, the base and the shoulders of the plaques showed neoformed, CD34+ vessels, often surrounded by mononuclear infiltrates. Intraplaque hemorrhage without rupture had highly vascularized lipid cores in all cases. T-lymphocytes and macrophages were in close contact with neoformed vessels. CONCLUSIONS: Plaque rupture is characterized by mononuclear cell infiltration of the caps, whereas intraplaque hemorrhage without rupture is characterized by extensive vascularization of the plaque.