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1.
Zhongguo Zhong Yao Za Zhi ; 45(17): 4246-4253, 2020 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-33164410

RESUMO

To explore the effect of Xiaoji Recipe on the stability of carotid artery vulnerable plaque in elderly patients with type 2 diabetes mellitus and type H hypertension(Qi-Yin deficiency with phlegm stagnation). From January 2017 to April 2019, in Endocrinology Department for Outpatients and Inpatients of the First Affiliated Hospital of Henan University of Chinese Medicine, 125 elderly patients with type 2 diabetes mellitus and type H hypertension with carotid artery vulnerable plaque(Qi-Yin deficiency with phlegm stagnation) were selected. According to the numerical table method, the patients were randomly divided into the control group(63 cases, including 56 cases completed) and Xiaoji group(62 cases, including 58 cases completed). Both groups were given control diet, hypoglycemic, hypotensive and symptomatic therapies. The control group was given Rosuvastatin Calcium Tablets 20 mg·d~(-1) before sleep. The Xiaojie group were given Ruisuvastatin Calcium Tablets 10 mg·d~(-1) before sleep, plus Xiaoji Recipe at the same time. Both groups were treated for 6 months. The number of vulnerable plaques, carotid intima-media thickness(IMT) and plaque thickness were detected by color Doppler ultrasound before and after treatment, in order to calculate IMT integral and improved Crouse integral. Meanwhile, lipid metabolism indexes, including total cholesterol(TC), triacylglycerol(TG), low-density lipoprotein cholesterol(LDL-C), high-density lipoprotein cholesterol(HDL-C) and lipoprotein a(LPa). And plaque stability indexes, including hypersensitive c-reactive protein(hs-CRP), matrix metalloproteinase-9(MMP-9), oxidized low-density lipoprotein(ox-LDL), Ⅰ type platelet depolymerization protein binding protein base sequence of metalloproteinases(ADAMTS-Ⅰ) and homocysteine(Hcy) were detected. To evaluate the 6-month curative effect on TCM syndrome, the patients were followed up for 6 months for adverse cardiovascular and cerebrovascular events and adverse drug reactions. After 6 months of treatment, the efficacy on Xiaoji group was better than that of the control group(Z=-2.600, P=0.009). The significant efficiency of the Xiaoji group was higher than that of the control group(χ~2=6.039, P=0.014). The total effective rate of the Xiaoji group was higher than that of the control group(χ~2=4.564, P=0.033). The number of vulnerable plaques form indexes(IMT, IMT integral, plaque thickness, improved Crouse integral), blood lipid metabolism indexes(TC, TG, LDL-C, HDL-C, LPa) and plaque stability indexes(hs-CRP, MMP-9, ox-LDL, ADAMTS-Ⅰ, Hcy) were significantly improved than before treatment in both groups of patients(P<0.01). Compared with the control group, the Xiaoji group showed more obvious improvement(P<0.01). The incidence of adverse cardiovascular and cerebrovascular events in the Xiaoji group was lower than that in the control group within 6 months after treatment(χ~2=4.566, P=0.033). The incidence of adverse drug reactions in the Xiaoji group was lower than that in the control group(χ~2=4.465, P=0.035). This indicated that Xiaoji Recipe combined with small-dose Rosuvastatin Calcium(10 mg·d~(-1)) was safe and effective in the treatment of elderly patients of type 2 diabetes mellitus with type H hypertension and vulnerable carotid artery plaque(Qi-Yin deficiency with phlegm stagnation), and superior to the single high-dose Risovastatin Calcium(20 mg·d~(-1)) regimen. It can reverse carotid plaque, and reduce the activity of vulnerable plaque and the incidence of adverse cardiovascular and cerebrovascular events and adverse drug reactions.


Assuntos
Estenose das Carótidas , Diabetes Mellitus Tipo 2 , Hipertensão , Idoso , Artérias Carótidas/diagnóstico por imagem , Espessura Intima-Media Carotídea , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Medicamentos de Ervas Chinesas , Humanos , Hipertensão/tratamento farmacológico
2.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 45(9): 1089-1095, 2020.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-33051423

RESUMO

OBJECTIVES: To investigate the effect of cardiopulmonary bypass (CPB) with different perfusion flow on carotid artery blood by using the carotid artery ultrasound. METHODS: Forty-five adult patients during Dec. 2014 to Jan. 2015 scheduled for heart valve replacement or ventricular septal defect repair were randomly divided into 3 groups (n=15) according to different perfusion flow during CPB: A Group 1 [(62±2) mL/(kg·min)], a Group 2 [(72±2) mL/(kg·min)], and a Group 3 [(82±2) mL/(kg·min)]. The diameter of the common carotid artery (CCAD), the peak velocity of the common carotid artery (CCAV),the flow of the common carotid artery (CCAF), the diameter of the internal carotid artery (ICAD), the peak velocity of the internal carotid artery (ICAV) and the flow of the internal carotid artery (ICAF) were measured at the responding time points before the anesthesia induction (T1), after the anesthesia induction (T2), 10 min into CPB (T3), 20 min into CPB (T4), 40 min into CPB (T5), 60 min into CPB(T6), 20 min after CPB ending (T7) by doppler ultrasonography, respectively. The hemoglobin (Hb) and lactic acid were compared at the time before CPB(P1),the time when temperature was decreased to the lowest during CPB (P2), the time when temperature was reheated to 35 ℃ (P3), 20 min after CPB was ended (P4), 2 hours after CPB was ended (P5) by α-steady method. The parameters of CPB and hemodynamic parameters at each time point and postoperative condition were recorded. RESULTS: There was no significant difference in Hb and lactic acid between the three groups (all P>0.05). For intra-group comparison, the Hb concentration at P2-P5 was lower than that at P1 (all P<0.05), and the Hb concentration was the lowest at P2 and P3. The level of lactic acid at P3-P5 was higher than those at P1 (all P<0.05).There were no significant differences in measurement of carotid artery between the left and right sides of the patients at T1 (all P>0.05). There was no significant difference in CCAV and CCAF among the 3 groups (both P>0.05). For intra-group comparison, the CCAV at T2-T6 was significantly lower than that at T1 (P<0.05), and higher at T7 than that at T2-T6 (all P<0.05), but it was still significantly lower than that at T1 (P<0.05). The difference of CCAF between T2-T5 and T1 was significant (all P<0.05). ICAV of G1 was lower than G3 at T3 (P<0.05). ICAV of G1 was lower than G2, and G2 was lower that G3 at T4 (both P<0.05). ICAV of G1 was lower than G2 at T6 (P<0.05). For intra-group comparison, the ICAV at T2 was significantly lower than that at T1 (P<0.05), and that at T3-T6 was significantly lower than that at T1 and T2 (all P<0.05). At T3-T6, ICAF of G1 was lower than that of G3 (all P<0.05). For intra-group comparison, ICAF at T2-T6 was significantly lower than that at T1 (all P<0.05). At T4, perfusion flow was positively correlated with CCAF, ICAV and ICAV (all P<0.05). None of the patients had obvious motor, sensory, or consciousness disturbance, and no neurological complications.There was no significant difference in postoperative hospital stay, postoperative ICU time, and postoperative extubation time among the 3 groups (all P>0.05). CONCLUSIONS: Different perfusion flows of CPB have different effects on carotids hemodynamics.There is correlation between carotids hemodynamics and perfusion flow. Carotid ultrasound examination can be used to evaluate cardiac output.


Assuntos
Ponte Cardiopulmonar , Artérias Carótidas , Adulto , Artérias Carótidas/diagnóstico por imagem , Artéria Carótida Primitiva/diagnóstico por imagem , Artéria Carótida Primitiva/cirurgia , Hemodinâmica , Humanos , Perfusão
3.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2043-2046, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018406

RESUMO

Segmentation of carotid vessel wall is required in vessel wall volume (VWV) and local vessel-wall-plus-plaque thickness (VWT) quantification of the carotid artery. Manual segmentation of the vessel wall is time-consuming and prone to interobserver variability. In this paper, we proposed a convolutional neural network (CNN) to segment the common carotid artery (CCA) from 3D carotid ultrasound images. The proposed CNN involves three U-Nets that segmented the 3D ultrasound (3DUS) images in the axial, lateral and frontal orientations. The segmentation maps generated by three U-Nets were consolidated by a novel segmentation average network (SAN) we proposed in this paper. The experimental results show that the proposed CNN improved the segmentation accuracies. Compared to only using U-Net alone, the proposed CNN improved the Dice similarity coefficient (DSC) for vessel wall segmentation from 64.8% to 67.5%, the sensitivity from 63.8% to 70.5%, and the area under receiver operator characteristic curve (AUC) from 0.89 to 0.94.


Assuntos
Artérias Carótidas , Imageamento Tridimensional , Artérias Carótidas/diagnóstico por imagem , Artéria Carótida Primitiva/diagnóstico por imagem , Ultrassonografia , Ultrassonografia Doppler
4.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2125-2128, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018426

RESUMO

We propose an automated method for the segmentation of lumen intima layer of the common carotid artery in longitudinal mode ultrasound images. The method is hybrid, in the sense that a coarse segmentation is first achieved by optimizing a locally defined contrast function of an active oblong considering its five degrees-of-freedom, and subsequently the fine segmentation and delineation of the carotid artery are achieved by post-processing the portion of the ultrasound image spanned by the annulus region of the optimally fitted active oblong. The post-processing includes median filtering and Canny edge detection to retain the lumen intima representative points followed by a smooth curve fitting technique to delineate the lumen intima boundary. The algorithm has been validated on 84 longitudinal mode carotid artery ultrasound images provided by the Signal Processing laboratory, Brno university. The proposed technique results in an average accuracy and Dice similarity index of 98.9% and 95.2%, respectively.


Assuntos
Algoritmos , Artéria Carótida Primitiva , Artérias Carótidas/diagnóstico por imagem , Artéria Carótida Primitiva/diagnóstico por imagem , Túnica Íntima/diagnóstico por imagem , Ultrassonografia
5.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2408-2411, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018492

RESUMO

The scope of this paper is to present a new carotid vessel segmentation algorithm implementing the U-net based convolutional neural network architecture. With carotid atherosclerosis being the major cause of stroke in Europe, new methods that can provide more accurate image segmentation of the carotid arterial tree and plaque tissue can help improve early diagnosis, prevention and treatment of carotid disease. Herein, we present a novel methodology combining the U-net model and morphological active contours in an iterative framework that accurately segments the carotid lumen and outer wall. The method automatically produces a 3D meshed model of the carotid bifurcation and smaller branches, using multispectral MR image series obtained from two clinical centres of the TAXINOMISIS study. As indicated by a validation study, the algorithm succeeds high accuracy (99.1% for lumen area and 92.6% for the perimeter) for lumen segmentation. The proposed algorithm will be used in the TAXINOMISIS study to obtain more accurate 3D vessel models for improved computational fluid dynamics simulations and the development of models of atherosclerotic plaque progression.


Assuntos
Aprendizado Profundo , Imageamento Tridimensional , Artérias Carótidas/diagnóstico por imagem , Europa (Continente) , Imagem por Ressonância Magnética
6.
PLoS One ; 15(9): e0239447, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32991605

RESUMO

The paper deals with the impact of chosen geometric and material factors on maximal stresses in carotid atherosclerotic plaque calculated using patient-specific finite element models. These stresses are believed to be decisive for the plaque vulnerability but all applied models suffer from inaccuracy of input data, especially when obtained in vivo only. One hundred computational models based on ex vivo MRI are used to investigate the impact of wall thickness, MRI slice thickness, lipid core and fibrous tissue stiffness, and media anisotropy on the calculated peak plaque and peak cap stresses. The investigated factors are taken as continuous in the range based on published experimental results, only the impact of anisotropy is evaluated by comparison with a corresponding isotropic model. Design of Experiment concept is applied to assess the statistical significance of these investigated factors representing uncertainties in the input data of the model. The results show that consideration of realistic properties of arterial wall in the model is decisive for the stress evaluation; assignment of properties of fibrous tissue even to media and adventitia layers as done in some studies may induce up to eightfold overestimation of peak stress. The impact of MRI slice thickness may play a key role when local thin fibrous cap is present. Anisotropy of media layer is insignificant, and the stiffness of fibrous tissue and lipid core may become significant in some combinations.


Assuntos
Artérias Carótidas/patologia , Fenômenos Mecânicos , Modelagem Computacional Específica para o Paciente , Placa Aterosclerótica/patologia , Fenômenos Biomecânicos , Artérias Carótidas/diagnóstico por imagem , Análise de Elementos Finitos , Humanos , Imagem por Ressonância Magnética , Modelos Cardiovasculares , Placa Aterosclerótica/diagnóstico por imagem
7.
Medicine (Baltimore) ; 99(35): e21907, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871924

RESUMO

BACKGROUND: Superb microvascular imaging (SMI) is a novel Doppler technique that depicts low velocity blood flow without the use of a contrast agent. Studies suggested that SMI may or may not detect neovascularization of carotid plaque with accuracy comparable to contrast-enhanced ultrasound. To gain clarity, a meta-analysis to systematically review and synthesize relevant data on the SMI for the detection of intraplaque neovascularization was undertaken. METHODS: We will search PubMed, Web of Science, Cochrane Library, and Chinese biomedical databases from their inceptions to the June 31, 2020, without language restrictions. Two authors will independently carry out searching literature records, scanning titles and abstracts, full texts, collecting data, and assessing risk of bias. Review Manager 5.2 and Stata14.0 software will be used for data analysis. RESULTS: This systematic review will investigate whether SMI is feasible on the detection of intraplaque neovascularization compared with contrast-enhanced ultrasound. CONCLUSION: Its findings will provide helpful evidence for the feasibility of SMI on the detection of intraplaque neovascularization. SYSTEMATIC REVIEW REGISTRATION: INPLASY202070097.


Assuntos
Artérias Carótidas/diagnóstico por imagem , Artérias Carótidas/patologia , Metanálise como Assunto , Neovascularização Patológica/diagnóstico por imagem , Placa Aterosclerótica/diagnóstico por imagem , Placa Aterosclerótica/patologia , Revisões Sistemáticas como Assunto , Velocidade do Fluxo Sanguíneo , Meios de Contraste , Estudos de Viabilidade , Humanos , Aumento da Imagem/métodos , Microvasos/diagnóstico por imagem , Ultrassonografia/métodos
8.
PLoS One ; 15(9): e0237856, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32877415

RESUMO

BACKGROUND AND PURPOSE: MR contrast-enhanced techniques are undergoing increased scrutiny since the FDA applied a warning for gadolinium-based MR contrast agents due to gadolinium deposition within multiple organ systems. While CE-MRA provides excellent image quality, is it required in a screening carotid study? This study compares 2D TOF and 3D TOF MRA vs. CE-MRA in defining carotid stenosis in a large clinical patient population, and with multiple readers with varying experience. MATERIALS AND METHODS: 200 consecutive patients had their carotid bifurcations evaluated with 2D TOF, 3D TOF and CE-MRA sequences by 6 board-certified neuroradiologists. Stenosis and quality of examinations were defined for each study. Inter-rater reliability was assessed using two-way random effects intraclass correlation coefficients. Intra-reader reliability was computed via weighted Cohen's κ. Weighted Cohen's κ were also computed to assess agreement in stenosis ratings between enhanced images and unenhanced images. RESULTS: Agreement between unenhanced and enhanced ratings was substantial with a pooled weighted κ of 0.733 (0.628-0.811). For 5 of the 6 readers, the combination of unenhanced 2D TOF and 3D TOF showed better agreement with contrast-enhanced than either 2D TOF or 3D TOF alone. Intra-reader reliability was substantial. CONCLUSIONS: The combination of 2D TOF and 3D TOF MRA showed substantial agreement with CE-MRA regarding degree of carotid stenosis in this large outpatient population across multiple readers of varying experience. Given the scrutiny that GBCA are undergoing due to concerns regarding CNS and soft tissue deposition, it seems prudent to reserve CE-MRA for cases which are not satisfactorily answered by the nonenhanced study or other noninvasive examinations.


Assuntos
Artérias Carótidas/diagnóstico por imagem , Meios de Contraste/química , Imageamento Tridimensional , Angiografia por Ressonância Magnética , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes
9.
J Med Vasc ; 45(5): 260-267, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32862983

RESUMO

OBJECTIVE: Carotid endarterectomy has traditionally been the strategy for the surgical management of carotid stenosis. Alongside the usual techniques, this study presents another technique: endarterectomy with systematized resection-anastomosis. MATERIAL AND METHODS: A retrospective study from January 2006 to December 2018, included all patients managed for carotid stenosis at Meaux hospital with the "endarterectomy with systematized resection-anastomosis" technique. The perioperative death and stroke rate were evaluated according to the judgment criterion "homolateral ischemic stroke and any stroke or perioperative death". Statistical analysis of the data was performed using SPSS software. RESULTS: For 415 carotids operated, we identified 240 managed with this technique. The average age was 71.7±9.6 years, 70% men and 30% women. The main cardiovascular risk factor was hypertension (76.7%), 24.2% of patients had an ischemic heart disease history, 43.7% homolateral ischemic stroke and 29% transient ischemic attack. Bilateral lesions were diagnosed in 6.2% of patients and 7.5% had contralateral occlusion. Carotid stenosis was symptomatic in 52.9% of patients. The average stenosis rate observed was 82.9±8.1% on computed tomography angiogram and 83.7±7.7% on magnetic resonance angiogram. The shunt was used in 45.4% of procedures. The average length of stay was 5.9±2.3 days. All patients had satisfactory results in terms of patency and anatomical appearance on the 1st check. In the post-operative period during the first month, complications occurred in 12.5% of patients (1.6% acute coronary syndrome, 0.8% neurological event, 0.8% death, 0.4% infection, 12.1% hematoma, 1.6% recovery for bleeding). The overall perioperative death and stroke rate was 2.6%. Myocardial infarction and sepsis were the causes of death for the 2 patients in the peri operative period. The mean duration of follow-up was 21.2 months, without any restenosis or occurrence of neurological complications. One patient died beyond the 1st month of follow-up without established cause, and the overall mortality rate was 1.3%. CONCLUSION: Thromboendarterectomy with "systematized" anastomosis resection represents an angioplasty method for carotid stenosis surgical management under visual control.


Assuntos
Artérias Carótidas/cirurgia , Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica , Isquemia Encefálica/etiologia , Artérias Carótidas/diagnóstico por imagem , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/mortalidade , Endarterectomia das Carótidas/efeitos adversos , Endarterectomia das Carótidas/mortalidade , Feminino , Humanos , Ataque Isquêmico Transitório/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Fatores de Tempo , Resultado do Tratamento
10.
Nat Commun ; 11(1): 3851, 2020 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-32737314

RESUMO

Intravascular imaging has emerged as a valuable tool for the treatment of coronary and peripheral artery disease; however, no solution is available for safe and reliable use in the tortuous vascular anatomy of the brain. Endovascular treatment of stroke is delivered under image guidance with insufficient resolution to adequately assess underlying arterial pathology and therapeutic devices. High-resolution imaging, enabling surgeons to visualize cerebral arteries' microstructure and micron-level features of neurovascular devices, would have a profound impact in the research, diagnosis, and treatment of cerebrovascular diseases. Here, we present a neurovascular high-frequency optical coherence tomography (HF-OCT) system, including an imaging console and an endoscopic probe designed to rapidly acquire volumetric microscopy data at a resolution approaching 10 microns in tortuous cerebrovascular anatomies. Using a combination of in vitro, ex vivo, and in vivo models, the feasibility of HF-OCT for cerebrovascular imaging was demonstrated.


Assuntos
Artéria Basilar/diagnóstico por imagem , Artérias Carótidas/diagnóstico por imagem , Artérias Cerebrais/diagnóstico por imagem , Microscopia/métodos , Tomografia de Coerência Óptica/métodos , Artéria Vertebral/diagnóstico por imagem , Angiografia/instrumentação , Angiografia/métodos , Animais , Cadáver , Circulação Cerebrovascular/fisiologia , Humanos , Microscopia/instrumentação , Suínos , Tomografia de Coerência Óptica/instrumentação
11.
Ann Afr Med ; 19(3): 170-175, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32820728

RESUMO

Introduction: Doppler sonography of the cervical segment of the carotid arteries is becoming a popular tool for evaluating atherosclerosis of the carotid artery. We present the audit of findings on carotid ultrasound examination among patients with clinical suspicion and risks for cerebrovascular disease and possible correlates in Northern Nigeria. Materials and Methods: We performed carotid ultrasound examination on all patients referred for screening and clinical suspicion of cerebrovascular disease within the year 2017. The patients' characteristics, risk factors, presence of atheroma and characteristic of the atheroma, degree of stenotic disease as well as the presence of incidental ultrasound findings were reviewed and documented. Results: Out of the 62 patients, 55 (88.7%) of them had various degrees and types of atheromatous plaques in different segments of the cervical carotid arteries, whereas 7 (11.3%) were normal. The predominant risk factor was smoking followed by diabetes mellitus, whereas the highest indication for the scan was transient ischemic attack. Incidental thyroid lesions such as nodules and cysts were encountered in 14 (22.6%) of the patients. There is a statistically significant difference between sex and age with the side of lesion, degree of stenosis, segment involved, and type of atheromatous plaque. Conclusion: There is a statistically significant difference between sex and age with the side of lesion, degree of stenosis, segment involved, and type of atheromatous plaque. About one-fifth of our patients had incidental thyroid lesions. Therefore, routine screening of population at risk is highly recommended.


Assuntos
Artérias Carótidas/diagnóstico por imagem , Placa Aterosclerótica/diagnóstico por imagem , Fumar/efeitos adversos , Ultrassonografia Doppler/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Espessura Intima-Media Carotídea , Estenose das Carótidas/complicações , Estenose das Carótidas/epidemiologia , Feminino , Humanos , Masculino , Auditoria Médica , Pessoa de Meia-Idade , Nigéria , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico
14.
Nutr Metab Cardiovasc Dis ; 30(9): 1492-1499, 2020 08 28.
Artigo em Inglês | MEDLINE | ID: mdl-32620336

RESUMO

BACKGROUND AND AIMS: This study aimed to examine whether intraplaque neovascularization (IPN) of carotid plaques, as characterized by contrast-enhanced ultrasound (CEUS), is associated with atherosclerotic renal artery stenosis (ARAS) in patients with normal kidney function. METHODS AND RESULTS: We investigated carotid IPN using CEUS in 198 consecutive patients with normal kidney function with and without ARAS. IPN was graded on the basis of the presence and location of microbubbles within each plaque (0, no visible microbubbles in the plaque; 1, moderate microbubbles confined to the shoulder and/or adventitial side of the plaque; and 2, extensive microbubbles throughout the plaque). The grades of each plaque were averaged to obtain an overall score per patient. ARAS was determined angiographically. We found that a higher CEUS-assessed carotid IPN score was associated with ARAS (Odd Ratio, OR: 7.281; 95% Confidence Interval, 95% CI: 3.246-16.336; P < 0.001). Furthermore, an IPN score >1.75 predicted severe stenosis with a sensitivity of 81% and specificity of 58%. Compared with using the IPN score alone, the addition of the homocysteine (HCY) cutoff value (>22.5 mmol/L) resulted in a stronger predictive value (Area Under Curve, AUC: 0.893 vs 0.834; P < 0.001) for severe ARAS. CONCLUSION: Carotid plaque neovascularization combined with HCY levels is predictive of severe ARAS in patients with normal kidney function. CEUS-assessed carotid IPN is clinically useful for stratification of ARAS in patients with normal kidney function.


Assuntos
Artérias Carótidas/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Neovascularização Patológica , Placa Aterosclerótica , Obstrução da Artéria Renal/diagnóstico por imagem , Artéria Renal/diagnóstico por imagem , Ultrassonografia , Idoso , Biomarcadores/sangue , Estenose das Carótidas/sangue , Estenose das Carótidas/epidemiologia , Estenose das Carótidas/terapia , China/epidemiologia , Meios de Contraste/administração & dosagem , Feminino , Homocisteína/sangue , Humanos , Masculino , Microbolhas , Pessoa de Meia-Idade , Admissão do Paciente , Valor Preditivo dos Testes , Prevalência , Obstrução da Artéria Renal/sangue , Obstrução da Artéria Renal/epidemiologia , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença
15.
Artigo em Inglês | MEDLINE | ID: mdl-32630321

RESUMO

Carotid intima-media thickness (IMT), plaque, and stenosis are widely used as early surrogate markers of subclinical atherosclerosis and strong predictors of future deaths and cardiovascular events. Albuminuria is an indicator of generalized endothelial dysfunction that speeds up atherosclerosis. However, previous studies reporting these associations cannot rule out the confounding effect of albuminuria. We aimed to examine the independent and joint relationships between IMT markers and 10-year mortality in community-dwelling Taiwanese adults. This work was a community-based prospective cohort study consisting of 2956 adults aged at least 30 years recruited in 2007 and followed up through 2019. Cox proportional hazard regression models were used to examine associations of these subclinical atherosclerosis markers with mortality. During an average of 9.41 years of follow up, 242 deaths occurred. The mortality rate was 8.70 per 1000 person-years. Compared with those with carotid IMT less than 1.0 mm, persons with severely increased carotid IMT (≥2.0 mm) had an increased risk for death (hazard ratio (HR): 1.79; 95% confidence interval (CI): 1.07, 3.00). Compared with those without carotid plaque, persons with carotid plaque were more likely to have an increased risk for death (1.65; 1.21-2.32). Compared with those with carotid stenosis less than 25%, persons with carotid stenosis of 25-36% had a significant increased risk for death (1.57; 1.12-2.22). Considering these three IMT markers along with the traditional risk factors (c-statistic: 0.85) significantly increased their predictive ability of mortality compared with any individual variable's predictive ability (all p-values < 0.001 for comparisons of c-statistic values). Carotid IMT measures, including IMT thickness, carotid plaque, and carotid stenosis were significant independent predictors of mortality. Our study supports evidence of blood pressure-related media thickening markers to assess future mortality risks in Chinese adults of general population.


Assuntos
Aterosclerose/epidemiologia , Espessura Intima-Media Carotídea , Estenose das Carótidas/epidemiologia , Adulto , Biomarcadores , Artérias Carótidas/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Humanos , Vida Independente , Estudos Prospectivos , Fatores de Risco , Taiwan
16.
Medicine (Baltimore) ; 99(28): e21048, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664117

RESUMO

A number of studies have evaluated the variable courses of facial artery. However, the results of these differed substantially from each other so not consistent relationships have yet been established. There has also yet to be a relevant study using conventional angiography.We assessed the variant branching pattern of the facial artery and its branches using conventional angiography.Two radiologists retrospectively reviewed 284 cases of angiographies of the external carotid artery in 198 patients. The courses of the facial artery and infraorbital branch of the maxillary artery were classified into 4 types and 2 types, according to the end branch.Among 284 cases of facial artery, type 1 (angular branch) made up 104 cases (36.6%), type 2 (lateral nasal branch) made up 138 cases (48.6%), type 3 (superior labial branch) made up 24 cases (8.5%), and type 4 (inferior labial branch) made up 18 cases (6.3%).Regarding the 284 total cases of maxillary artery, 163 cases (57.4%) had anastomosis with the angular artery or extended to the territory of the angular artery. In addition, 121 cases (42.6%) had nothing done in regard to the angular artery.The results may be helpful for avoiding complications related to facial and maxillary arteries during facial surgeries and cosmetic procedures.


Assuntos
Artérias/anatomia & histologia , Artérias/diagnóstico por imagem , Face/irrigação sanguínea , Face/diagnóstico por imagem , Angiografia , Artérias Carótidas/anatomia & histologia , Artérias Carótidas/diagnóstico por imagem , Humanos , Artéria Maxilar/anatomia & histologia , Artéria Maxilar/diagnóstico por imagem , Nariz/irrigação sanguínea , Nariz/diagnóstico por imagem , Estudos Retrospectivos
17.
AJNR Am J Neuroradiol ; 41(9): 1677-1682, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32616585

RESUMO

Coronavirus disease 2019 (COVID-19) is associated with a severe inflammatory response. Inflammation affects atherosclerotic plaque vulnerability and promotes a thrombogenic environment. We report a series of 6 patients with COVID-19 with acute ischemic stroke due to intraluminal carotid artery thrombus presenting during an 8-day period. Six patients were included (5 men) with a mean age of 65.8 years (range, 55-78 years). COVID-19 was diagnosed by detection of Severe Acute Respiratory Syndrome coronavirus 2 in 5 patients and was presumed due to typical clinical and imaging findings in 1 patient. All patients had vascular risk factors including diabetes (83%), hyperlipidemia (100%), and smoking (17%). Four patients presented with large infarcts with initial NIHSS scores of 24-30. During their hospitalization, all patients had elevated D-dimer and C-reactive protein levels, 5 patients had elevated lactate dehydrogenase and ferritin levels, 3 had elevated interleukin-6 levels, and 2 had elevated troponin levels. Inflammation related to COVID-19 may result in rupture of vulnerable atherosclerotic plaques, resulting in thrombosis and acute ischemic stroke.


Assuntos
Betacoronavirus , Isquemia Encefálica/etiologia , Artérias Carótidas/diagnóstico por imagem , Infecções por Coronavirus/complicações , Citocinas/imunologia , Pneumonia Viral/complicações , Acidente Vascular Cerebral/etiologia , Trombose/etiologia , Idoso , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/imunologia , Angiografia por Tomografia Computadorizada , Infecções por Coronavirus/imunologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/imunologia , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/imunologia , Trombose/diagnóstico por imagem , Trombose/imunologia
18.
Rev Med Chil ; 148(4): 496-499, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32730458

RESUMO

Background The ambulatory arterial stiffness index (AASI), derived from 24 h ambulatory blood pressure monitoring (ABPM) can be a good indicator of arterial stiffness. Aim To assess the correlation between AASI and brachial-ankle pulse wave velocity (baPWV), ankle-brachial index (ABI) and cardio-ankle vascular index (CAVI) in patients with type 2 diabetes mellitus without hypertension. Material and Methods Cross sectional study in 28 diabetic patients aged 49 ± 7 years (40% women). AASI was calculated as 1 minus the regression slope of diastolic on systolic blood pressure, using ABPM data. ABPM was measured in the arm using an oscillometric device. ABI was calculated as the ratio between ankle and brachial systolic blood pressure. CAVI was derived from pulse wave velocity using the Vasera VS-1000 device. Correlations were calculated using a bivariate Spearman correlation. Results The mean values for AASI, ABI, baPWV and CAVI were 0.39 ± 0.14, 1.14 ± 0.09, 15.15 ± 2.71 m/s and 7.60 ± 1.90, respectively. There was a significant negative correlation between AASI and ABI (r = -0.491, p < 0.01). Conclusions In these diabetic patients, there was an association between AASI, an arterial stiffness marker and ABI, an indicator for the presence of atherosclerosis.


Assuntos
Tornozelo/irrigação sanguínea , Artérias/fisiopatologia , Pressão Sanguínea/fisiologia , Artéria Braquial/fisiopatologia , Diabetes Mellitus Tipo 2/complicações , Rigidez Vascular/fisiologia , Adulto , Idoso , Índice Tornozelo-Braço , Monitorização Ambulatorial da Pressão Arterial , Artérias Carótidas/diagnóstico por imagem , Estudos Transversais , Diabetes Mellitus Tipo 2/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Análise de Onda de Pulso
19.
Am J Physiol Heart Circ Physiol ; 319(2): H370-H376, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32648822

RESUMO

Changes in the arterial baroreflex arc contribute to elevated sympathetic outflow and altered reflex control of blood pressure with human aging. Using ultrasound and sympathetic microneurography (muscle sympathetic nerve activity, MSNA) we investigated the relationships between aortic and carotid artery wall tension (indices of baroreceptor activation) and the vascular sympathetic baroreflex operating point (OP; MSNA burst incidence) in healthy, normotensive young (n = 27, 23 ± 3 yr) and middle-aged men (n = 22, 55 ± 4 yr). In young men, the OP was positively related to the magnitude and rate of unloading and time spent unloaded in the aortic artery (r = 0.56, 0.65, and 0.51, P = 0.02, 0.003, and 0.03), but not related to the magnitude or rate of unloading or time spent unloaded in the carotid artery (r = -0.32, -0.07, and 0.06, P = 0.25, 0.81, and 0.85). In contrast, in middle-aged men, the OP was not related to either the magnitude or rate of unloading or time spent unloaded in the aortic (r = 0.22, 0.21, and 0.27, P = 0.41, 0.43, and 0.31) or carotid artery (r = 0.06, 0.28, and -0.01; P = 0.48, 0.25, and 0.98). In conclusion, in young men, aortic unloading mechanics may play a role in determining the vascular sympathetic baroreflex OP. In contrast, in middle-aged men, barosensory vessel unloading mechanics do not appear to determine the vascular sympathetic baroreflex OP and, therefore, do not contribute to age-related arterial baroreflex resetting and increased resting MSNA.NEW & NOTEWORTHY We assessed the influence of barosensory vessel mechanics (magnitude and rate of unloading and time spent unloaded) as a surrogate for baroreceptor unloading. In young men, aortic unloading mechanics are important in regulating the operating point of the vascular sympathetic baroreflex, whereas in middle-aged men, these arterial mechanics do not influence this operating point. The age-related increase in resting muscle sympathetic nerve activity does not appear to be driven by altered baroreceptor input from stiffer barosensory vessels.


Assuntos
Envelhecimento , Aorta/inervação , Pressão Arterial , Barorreflexo , Artérias Carótidas/inervação , Músculo Esquelético/inervação , Pressorreceptores/fisiologia , Adulto , Fatores Etários , Aorta/diagnóstico por imagem , Artérias Carótidas/diagnóstico por imagem , Frequência Cardíaca , Homeostase , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Ultrassonografia , Adulto Jovem
20.
Nat Rev Rheumatol ; 16(7): 361-379, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32494054

RESUMO

Patients with rheumatoid arthritis (RA) are at high risk of developing cardiovascular disease (CVD). Inflammation has a pivotal role in the pathogenesis of CVD. RA is an inflammatory joint disease and, compared with the general population, patients with RA have approximately double the risk of atherosclerotic CVD, stroke, heart failure and atrial fibrillation. Although this high risk of CVD has been known for decades, patients with RA receive poorer primary and secondary CVD preventive care than other high-risk patients, and an unmet need exists for improved CVD preventive measures for patients with RA. This Review summarizes the evidence for atherosclerotic CVD in patients with RA and provides a contemporary analysis of what is known and what needs to be further clarified about recommendations for CVD prevention in patients with RA compared with the general population. The management of traditional CVD risk factors, including blood pressure, lipids, diabetes mellitus and lifestyle-related risk factors, as well as the effects of inflammation and the use of antirheumatic medication on CVD risk and risk management in patients with RA are discussed. The main aim is to provide a roadmap of atherosclerotic CVD risk management and prevention for patients with RA.


Assuntos
Antirreumáticos/efeitos adversos , Artrite Reumatoide/complicações , Aterosclerose/fisiopatologia , Doenças Cardiovasculares/prevenção & controle , Adulto , Idoso , Artrite Reumatoide/tratamento farmacológico , Fibrilação Atrial/epidemiologia , Artérias Carótidas/diagnóstico por imagem , Estudos de Casos e Controles , Interações Medicamentosas , Feminino , Insuficiência Cardíaca/epidemiologia , Humanos , Inflamação/patologia , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Ultrassonografia/métodos
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