The way of intravenous drug abuse is to puncture the peripheral blood vessels and inject the drug directly into the blood. Therefore, this method has an impact on the peripheral artery and venous system of the users, and can cause a variety of peripheral vascular diseases, such as phlebitis, deep vein thrombosis, chronic venous insufficiency, phlebangioma, atherosclerosis, acute arterial ischemia, pseudoaneurysm, etc. However, due to the particularity of drug abusers, the vascular complications caused by intravenous drug abuse have not attracted enough attention. This paper reviewed the types and pathogenesis of peripheral vascular diseases caused by intravenous drug abuse, so as to improve the clinical understanding of peripheral vascular diseases caused by intravenous drug abuse, improve the prognosis of patients, reduce occupational exposure of medical staff, and play a certain role in social warning.
Objective To explore the methods of early diagnosis of arteriosclerosis obliterans of lower extremity (ASOLE). Methods The related literatures on ASOLE detection means adopted clinically were reviewed, and their advantages and disadvantages were compared.Results Asymptomatic ASOLE could be discovered by determination of ankle brachial index (ABI) and toe brachial index (TBI), which was a good index for arterial function assessment of lower extremity. Pulse wave velocity (PWV) was more vulnerable and less sensitive than ABI, and therefore more suitable for screening of a large sample. ASI was an index to assess arterial structure and function, and it had a good correlation with PWV. Flow-mediated dilation (FMD) was a measurement evaluating the function of endothelial cell; Pulse wave measurement was simple, sensitive, and its result was reliable. Color Doppler ultrasonography could localizate the lesion and determine the degree of stenosis at the same time. Multiple-slice CT angiography (MSCTA) was more accurate than color Doppler ultrasonography, but its inherent shortcomings, such as nephrotoxicity of contrast agent, was still need to be resolved. 3D-contrast enhancement magnetic resonance angiography (CEMRA) had little nephrotoxicity, but a combination of other imaging methods was necessary. Microcirculation detections required high consistency of the measurement environment, but they were simple, sensitive and noninvasive, and therefore could be used for screening of ASO. Conclusion Publicity and education of highrisk groups, and reasonable selection of all kinds of detection means, are helpful to improve the early diagnosis of ASOLE.
Objective To review research advances in atherosclerosis of removal mechanisms of apoptotic cells.Method The literatures about the removal mechanisms of the apoptotic cells were reviewed．Results The removal factors of apoptotic cells， such as transglutaminase 2， milk fat globule-EGF-factor 8， complement system，c-Mer proto-oncogene tyrosine protein kinase，and Fas，might cause the lipid core of the atherosclerotic plaque if one of them was defective phagocytic clearance．Conclusion How to remove the surplus of the phagocytosis and study the common pathways of the downstream signal of its receptor were the future direction of development．
ObjectiveTo systematically review the safety and validity of the treatment of intracranial atherosclerosis diseases (ICAD) by using Wingspan stents, and to provide the reference for clinical practice and research. MethodsDatabases such as the PubMed, The Cochrane Library, EMbase, Cochrane Central Register of Controlled Trials, CBM, CNKI and VIP were searched for studies concerning the safety and validity of the treatment of intracranial atherosclerosis diseases (ICAD) by using Wingspan stents from January 1st, 2005 to January 10th, 2014. Randomized controlled trials (RCTs), non-randomized controlled trials, case-control studies, cohort studies and case series were all included. Two reviewers independently screened literature according to inclusion and exclusion criteria, extracted data. Then, meta-analysis was performed by using the R software. ResultsA total of 34 studies (2 RCTs, 22 cohort studies, and 10 case-control studies) involving 2 511 patients were included. The results of meta-analysis showed that:operation success rates was 96.75% (95%CI 95.82% to 97.48%), 30 day rates of the end point events was 8.75% (95%CI 7.61% to 10.04%), 1 year rates of the end point events was 13% (95%CI 11.47% to 14.70%), total mortality was 2.98% (95%CI 2.16% to 4.10%), incidence of in-stent restenosis was 21.76% (95%CI 18.27% to 25.71%), the ratio of the patients with symptomatic restenosis and total patients was 6.50% (95%CI 4.89% to 8.60%), and the ratio of the patients with symptomatic restenosis and total patients with restenosis was 26.06% (95%CI 19.94% to 33.29%). ConclusionCurrent evidence shows that treatment of ICAD by using Wingspan stents is effective and safe. However, this conclusion should be approved by further higher quality RCTs.
ObjectiveTo systematically review the interventional effects of Simiao Yong'an decoction on atherosclerosis animal models.MethodsDatabase including CNKI, WanFang Data, VIP, PubMed, The Cochrane Library, and Web of Science were searched to collect animal experiments on atherosclerosis model intervention by Simiao Yong’an decoction from inception to October 2020. Two reviewers independently screened the literature, extracted data, and used the SYRCLE animal experiment bias risk assessment tool to evaluate risk bias of included studies, and then used RevMan 5.4.1 software for meta-analysis.ResultsA total of 14 animal experiments were included. The results of meta-analysis showed that compared with the blank model group, the Simiao Yong’an decoction group could reduce the aortic plaque area (SMD=−2.04, 95%CI −3.35 to −0.74), the ratio of aortic plaque to lumen area (SMD=−1.72, 95%CI −2.48 to −0.97), total cholesterol level (SMD=−0.97, 95 %CI −1.72 to −0.22), triglyceride level (SMD=−1.21, 95%CI −1.82 to −0.60), low-density lipoprotein cholesterol level (SMD=−1.82, 95%CI −3.12 to −1.53), tumor necrosis factor-α level (SMD=−3.36, 95%CI −4.21 to −2.52), monocyte chemotactic factor-1 level (SMD=−2.98, 95%CI −4.60 to −1.35) and C-reactive protein level (SMD=−0.60, 95%CI −1.08 to −0.11); however, in the high-density lipoprotein cholesterol level (SMD=0.66, 95%CI −0.10 to 1.42) and the level of interleukin 1 (SMD=−1.41, 95%CI −4.11 to 1.30), the differences were not statistically significant.ConclusionsThe existing evidence shows that the intervention of Simiao Yong’an decoction in the atherosclerosis model can reduce the aortic plaque area and the ratio of the aortic plaque to the lumen area, reduce total cholesterol, triglycerides, and low-density lipoprotein cholesterol levels, and reduce tumor necrosis factor-α, monocyte chemotactic factor-1, and C-reactive protein levels. Due to limited quality of included studies, more high quality studies are required to verify the above conclusions.
Objective To investigate and analyze the relationships among glucagon-like peptide-1 (GLP-1) level, chronic inflammation, and atherosclerosis in patients with non-alcoholic fatty liver disease (NAFLD). Methods From October 2016 to February 2017, using cross-sectional investigation, the GLP-1 level, chronic inflammation, and atherosclerosis were investigated in 80 subjects (40 NAFLD patients in NAFLD group, and 40 non-fatty liver disease participants in control group) who underwent physical examination at Xi’an Road Community Hospital. Results Compared with those in the control group, GLP-1 fasting level in patients with NAFLD [(9.09±1.03) vs. (9.15±1.06) pmol/L, P=0.807] and postprandial plasma GLP-1 [(15.96±3.37) vs. (17.46±4.76) pmol/L, P=0.108] had no changes. The correlations of GLP-1 level with chronic inflammation and insulin resistance (IR) were not significant either. The increased risk of carotid intima-media thickness related cardiovascular disease (CVD) in the NAFLD group was greater than that in the control group, and the difference was statistically significant [22 (55.0%)vs.13 (32.5%), P=0.043]. When the plasma lipoprotein-associated phospholipase A2 level increased, the risk of NAFLD increased [odd ratio (OR)=1.16, 95% confidence interval (CI) (1.02, 1.32), P=0.023]. Plasma ceramide kinase (CERK) in the NAFLD group was lower than that in the control group, and the difference was statistically significant [(12.36±2.45) vs. (18.33±3.71) ng/mL, P<0.001]. When the plasma CERK level of the fasting plasma was elevated, the risk of NAFLD decreased [OR=0.30, 95%CI (0.12, 0.78), P=0.014]. The homeostasis model assessment of insulin resistance (HOMA-IR) in the NAFLD group was higher than that in the control group, and the difference was statistically significant (2.46±2.53 vs. 1.11±0.66, P=0.002). The Matsuda index in the NAFLD group was less than that in the control group, and the difference was statistically significant (5.88±4.09 vs. 10.46±7.90, P=0.002). When HOMA-IR increased, the risk of NAFLD increased [OR=2.75, 95%CI (2.49, 3.12), P=0.036]. Conclusions Plasma GLP-1 level is not a sensitive indicator of chronic inflammation and IR in patients with NAFLD. Patients with NAFLD are in an increased risk of atherosclerosis and CVD. It suggests that NAFLD might be involved in chronic inflammation and IR. Chronic inflammation can cause IR, and then chronic inflammation and IR can cause NAFLD and subclinical atherosclerosis. In return for this, NAFLD increases chronic inflammation and IR.
ObjectiveTo evaluate the safety and efficiency of SilverHawk plaque excision in treatment of sympto-matic infrapopliteal arterial occlusive disease (IPAD). MethodsThe clinical and follow-up data of 54 consecutive patients with IPAD underwent endovascular treatment from 2011 to 2013 in this hospital were analyzed retrospectively. There were 29 males and 25 females. The age was (65.8±4.5) years, the period was (25.1±3.3) months. All the patients were Fontaine gradeⅡb-Ⅳ. The patients were divided into plaque excision group (n=9) and angioplasty group (n=45) according to the treatment method. The rates of technical success, perioperative complications, limb salvage and reintervention were observed between two groups. Results①There were no significant differences in the gender, age, complications, ankle brachial index (ABI), outflow tract score, lesion length, and other clinical data between the 2 groups (P > 0.05).②The technical success rate had no significant difference between the plaque excision group and the angioplasty group[100% (9/9) versus 86.7% (39/45), P=0.574]. Six cases were failed because the guide wire could not pass through the diseased segment in 4 cases and there were 2 cases of serious residual stenosis in the angioplasty group.③There was no significant difference in the incidence of vascular complications between the 2 groups[11.1% (1/9) versus 11.1% (5/45), P=1.000].④The follow-up results:One case was received the carotid endarterectomy on 4 months after operation because of severe carotid artery stenosis, the lower limbs had no new onset of symptoms in the plaque excision group. One patient due to myocardial infarction was death on 3 months after operation, 2 patients due to pulmonary infection and heart failure were death on 4 months and 5 months after operation respectively in the angioplasty group. The limb salvage rates and reintervention rates on 6 months and 12 months after operation had no significant differences between the 2 groups (P> 0.05). The ABI and ABI average improvement also had no significant significances between the 2 groups (P > 0.05). ConclusionPlaque excision is a safe and acceptable method to treat symptomatic IPAD, and its efficacy is better than angioplasty.
In recent years, high-resolution magnetic resonance imaging (HRMRI) has become a useful clinical and research tool. HRMRI can be used to observe intracranial vascular wall lesions in vivo, providing more valuable pathophysiological information, and providing guidance for the diagnosis, differential diagnosis and prognosis of intracranial atherosclerosis. For stenotic intracranial atherosclerosis, the morphology of the vessel wall can effectively differentiate various vascular stenosis diseases. Further, plaque composition, vessel wall enhancement, remodel mode provide information of plaque vulnerability. For non-stenotic intracranial atherosclerosis, the location of the plaque can reveal the pathophysiological mechanism. In addition, HRMRI can show the lesion in lenticulostriate artery. Therefore, this article will summarize the clinical application of HRMRI.
ObjectiveTo summarize the progress on the injury mechanism of vascular endothelial cells in atherosclerosis.MethodsThe latest progress was reviewed in recent literatures.ResultsAll kinds of etiological factors have activated NF-kappa B and cytokines in the development of atherosclerosis, which lead to expression of cell adhesive molecules and adhesion of monocytes to vascular endothelial cells.A variety of inflammatory mediums are released, which can directly damage endothelial cells.Besides, the inflammatory mediums make monocytes and neutrophils attach to endothelial cells by immune mechanisms, which injure the endothelial cells more severely. Meanwhile the damaged membrance structure leads to the production of AECA which activates the complementary system. Then the vascular endothelial cell injury is aggravated and the development of atherosclerosis accelerated. ConclusionIt is very important to recognize the injury mechanism of vascular endothelial cells in the development of atherosclerosis for prevention and treatment of atherosclerosis.
Objective To provide the anatomical basis for detecting distal outflow tract in late atherosclerosis obliteration in lower extremities. Methods Ten lower extremities that were amputated above knees because of late atherosclerosis obliteration were used in this experiment. The blood vessels in the residual bodies were perfused to run blood vessel cast mould to observe the anatomical and pathological change of the popliteal artery, the anterior and posterior tibial arteries and their collateral vessels. The number and distribution of those collateral vessels were also observed. Results The popliteal artery, anterior and posterior tibial arteries were all occluded due to atherosclerosis. However, there were three types of those collateral arteries: ① Atheromatous plaque in bole stretched into collateral arteries and led to occlusion. ② Obliteration was only observed at the initial segment, with no obstruction at the distal end but extenuated. ③ The collateral arteries originated from the bole artery symmetrically, keeping communicative with each other through punctiform interspaces. The last two types were mainly distributed at the inferior segment of popliteal artery, the superior segment of anterior and posterior tibial arteries, forming vascular anastomosing network in the whole cnemis muscle group. Conclusion Un-obstructed collateral arteries in certain places can be still found, though atherosclerosis obliteration is formed in popliteal artery, anterior and posterior tibial arteries in lower extremities. Therefore, it may be possible to construct collateral outflow tracts if endo-membrane stripping operation is performed.