Background/Aims: Determining the levels of oral health and the quality of dental care are fundamental to building concepts of oral health. This study aims to assess toothbrushing techniques using a technical and physi...Background/Aims: Determining the levels of oral health and the quality of dental care are fundamental to building concepts of oral health. This study aims to assess toothbrushing techniques using a technical and physical model, clarifying how children and pre-adults learn to brush their teeth. Materials and Methods: Data were recorded from 23 participants, both male and female of various ages, using a proposed electronic toothbrush equipped with X-Y-Z axes pathways. The data, collected before and after training experiments, were processed with MATLAB to generate plots for the three axes. Results: The study revealed that most parameter values, such as Mean Difference Between Amplitudes (MAV, 6.00), Wilson Amplitude (WAMP, 179.419), and Average Amplitude Coupling (AAC, 1.270), decreased from before to after the experiments. Furthermore, the average overall epoch lengths (AVG) showed a 75% reduction in movement amplitude between the two experiments. Conclusion: Dentist observations indicated which brushing methods were acceptable or not. Analytical values suggest that individuals learn the toothbrushing technique effectively, and medical observations clearly demonstrate the success of the proposed method.展开更多
Objective:To explore the molecular mechanisms of isoliquiritigenin in stabilizing atherosclerotic plaques by activating PPAR-γsignal pathway to regulate ox-LDL metabolism.Methods:The ApoE-/-mice AS carotid plaque mod...Objective:To explore the molecular mechanisms of isoliquiritigenin in stabilizing atherosclerotic plaques by activating PPAR-γsignal pathway to regulate ox-LDL metabolism.Methods:The ApoE-/-mice AS carotid plaque model was prepared by using high fat diet and right perivascular carotid collar placement(PCCP).ApoE-/-mice were randomly divided into the model group and the isoliquiritigenin group after PCCP.C57BL/6J mice were used for the control group.High fat diet continued feeding for 8 weeks after PCCP to establish the AS model.Automatic biochemical analyzer was used to test levels of total cholesterol(TC),triacylglyceride(TG),low-density lipoprotein cholesterol(LDL-C)and high-density lipoprotein cholesterol(HDL-C).ELISA was used to measure oxidized low-density lipoprotein(ox-LDL)in serum.Hematoxylin-eosin(HE)staining was used to observe the pathological pattern of the carotid artery,and then calculated the carotid parameters.Oil red O staining was used for lipid determination,Masson staining was used to determine collagen content,MOMA-2 andα-SMA immunohistochemical staining were used to determine macrophages and smooth muscle cells,and to calculate the vulnerability index.Western blot was used to detected the expression of PPAR-γ,LXR-α,FABP-4,MMP-2 and MMP-9 in mice arteries.Results:Compared with the normal group,TC、TG、LDL-C、HDL-C and ox-LDL were increased in the model group.Compared with the model group,TC、TG、LDL-C and ox-LDL were reduced,and there was no significant change in HDL-C of the isoliquiritigenin group.Compared with the normal group,intima thickness(IT),intima/media thickness(IT/MT),plaque area(PA),and plaque area/lumen area(PA/LA)of carotid arteries were increased,the content of lipid and MOMA-2 in plaques was increased,collagen andα-SMA content decreased,and the vulnerability index was higher in the model group.The expression of PPAR-γand LXR-αwere reduced and the expression of FABP-4,MMP-2 and MMP-9 were increased in the model group.Compared with the model group,carotid IT,IT/MT,PA,and PA/LA were reduced,the content of lipid and MOMA-2 in plaques was decreased,collagen andα-SMA content were increased,and the vulnerability index was decreased in the isoliquiritigenin group.PPAR-γand LXR-αexpression were increased,FABP-4,MMP-2 and MMP-9 expression were decreased significantly in the isoliquiritigenin group.Conclusion:Isoliquiritigenin can exert anti-AS effects by activating PPAR-γ,up-regulating LXR-α,reducing FABP-4 expression,reducing ox-LDL,reducing the protein expression of MMP-2 and MMP-9,decreasing plaque vulnerability index,and increasing plaque stability.展开更多
The Commemorative Plaque Industry thrives at the hands of the local craftsmen in Ghana. Techniques, methods, tools, and materials used as handed to them by their previous masters have remained the same over the years....The Commemorative Plaque Industry thrives at the hands of the local craftsmen in Ghana. Techniques, methods, tools, and materials used as handed to them by their previous masters have remained the same over the years. As a result, plaques produced had peculiar problems such as text fading, degrading the actual effect of the plaques. Additionally, metals once widely used for making plaques devoid of text fading in the industry seem to have lost their relevance due to metal plaque theft, rust on metal plaques, and the continuous rise in metal prices. This research uses descriptive, experimental, and case studies of the qualitative research method to examine the problems associated with locally produced commemorative plaques. A total of hundred (100) artisans, including metal scrap dealers, and plaque buyers, were selected for the study. Direct observation and face-to-face interviews were conducted with the local craftsmen, art lecturers and students, scrap dealers, and plaque buyers who were purposively sampled for the study. The study revealed that existing materials like ceramic and aluminium could be integrated innovatively to produce commemorative plaques devoid of text fading;a corrosion-resistant text could be made using anodized or coated metals used in smaller quantities to reduce costs while also making them unattractive for theft and lastly, silicone sealant was found to be a viable option for permanently inscribing text on porcelain bases. The results clarify and underline the necessity to grow the local plaque industry in terms of plaque production as another essential basis to assure high-quality plaques with no text fading that will survive for generations to serve their intended purpose.展开更多
Objective Compare the morphology of atherosclerotic plaquesmgiographically and histopathologically in acute myocardialmfarction m order to accumulate experience in recognizing plaquerupture and thrombus by angiogrames...Objective Compare the morphology of atherosclerotic plaquesmgiographically and histopathologically in acute myocardialmfarction m order to accumulate experience in recognizing plaquerupture and thrombus by angiogrames.Material and methods 16postmortem cases of acute myocardial infarction were studied.The coronary arteries were romoved en block,filled with barium the lumen and ridiographed.Then the arteries wereontinuously insetted and routin HE sections were made.Results 16 cases had plaque ruptures and thrombi.Among the total98 blocks,21 had plaque ruptures on which 20 thrombiccur(95.23%).while the other 777 unrupured blocks had only 2hrombi(0.25%).The difference was significant(p【0.001).Therupture mostly occur on unstable plaques.The ruptured plaqueswith thrombi had different angiographical morphology withunruptured plaques.The former had irregular borders andunraluminal lucencies;while the Iatter had smooth borders and nointraluminal lucencies.Conclusions Plaque ruprure withthrumbus was the major cause of acute myocardial infarction andthe ruptured plaques with thrombus had different angiographicalapperances with unruptured plaques.展开更多
BACKGROUND Discontinued application of statins may be related to adverse cardiovascular events.However,it is unclear whether different statins administration methods have effects on coronary artery plaques.AIM To eval...BACKGROUND Discontinued application of statins may be related to adverse cardiovascular events.However,it is unclear whether different statins administration methods have effects on coronary artery plaques.AIM To evaluate the effects of different statins application methods on plaques in patients with coronary atherosclerosis.METHODS A total of 100 patients diagnosed with atherosclerotic plaque by coronary artery computed tomography were continuously selected and divided into three groups according to different statins administration methods(discontinued application group,n=32;intermittent application group,n=39;sustained application group,n=29).The effects of the different statins application methods on coronary atherosclerotic plaque were assessed.RESULTS The volume change and rate of change of the most severe plaques were significantly reduced in the sustained application group(P≤0.001).The volume change of the most severe plaques correlated positively with low-density lipoprotein(LDL-C)levels only in the sustained application group(R=0.362,P=0.013).There were no changes in plaques or LDL-C levels in the intermittent and discontinued application groups.CONCLUSION Continuous application of statins is effective for controlling plaque progression,whereas discontinued or intermittent administration of statins is not conducive to controlling plaques.Only with continuous statins administration can a reduction in LDL-C levels result in plaque volume shrinkage.展开更多
BACKGROUND Myocardial bridging(MB)is increasingly recognized to stimulate atherogenesis,which may contribute to an acute coronary syndrome.Stenting the coronary segment with MB has been recognized to have an increased...BACKGROUND Myocardial bridging(MB)is increasingly recognized to stimulate atherogenesis,which may contribute to an acute coronary syndrome.Stenting the coronary segment with MB has been recognized to have an increased risk of in-stent restenosis,stent fracture and coronary perforation.The safety and efficacy of stenting the culprit lesion with overlaying MB in ST elevation myocardial infarction(STEMI)as primary reperfusion therapy has not been established.CASE SUMMARY We reported a patient who presented with inferior STEMI with a culprit lesion of an acute thrombotic occlusion in the right coronary artery and thrombolysis and thrombin inhibition in myocardial infarction 0 flow.After the stent placement during primary percutaneous coronary intervention,intravascular ultrasound revealed MB overlying the stented segment where heavy atherosclerotic plaque were present.Likely due to the combination of plaque herniation or prolapse caused by MB,as well as local increased inflammation and thrombogenicity,acute stent thrombosis occurred at this region,which led to acute stent failure.The patient required an emergent repeated cardiac catheterization and placing a second layer of stent to enhance the radial strength and reduce the inter-strut space.CONCLUSION Plaque herniation or prolapse after stenting a MB segment in STEMI is a potential etiology for acute stent failure.展开更多
The degree of vessel lumen narrowing is an independent predictor of ischemic stroke. New developments in carotid plaque morphology imaging (MR, CT), may bring new insights to the relationship between carotid atheroscl...The degree of vessel lumen narrowing is an independent predictor of ischemic stroke. New developments in carotid plaque morphology imaging (MR, CT), may bring new insights to the relationship between carotid atherosclerotic disease and stroke risk. Our aim is to review the stroke risk in a symptomatic patient with moderate carotid stenosis by CT imaging and histopathology. A 72-year-old patient with low ABCD2 scores TIA and moderate left internal carotid stenosis (50% by carotid ultrasound), was discharged with an optimized medical therapy. Four months later, he presented an ischemic stroke in the left frontal area. Carotid angiography showed a 60% stenosis in the left-internal carotid artery with a regular surface. CT plaque imaging detected a thin fibrous cap with calcification and an intraplaque hemorrhage (high-risk plaque). These findings were confirmed in the histolopathological study of the atherosclerotic plaque performed after the endarterectomy. After 1 year of follow-up, the patient returned independently to his daily activities. We propose, in this study, the inclusion of noninvasive plaque imaging in the evaluation of acute TIA with moderate carotid stenosis to better select patients with higher risk of stroke recurrence.展开更多
AIM: To establish whether virulence factor genes vacA and cagA are present in Helicobacter pylori (H. pylori) retrieved from gastric mucosa and dental plaque in pa-tients with dyspepsia. METHODS: Cumulative dental pla...AIM: To establish whether virulence factor genes vacA and cagA are present in Helicobacter pylori (H. pylori) retrieved from gastric mucosa and dental plaque in pa-tients with dyspepsia. METHODS: Cumulative dental plaque specimens and gastric biopsies were submitted to histological exami-nation, rapid urease test and polymerase chain reac-tion (PCR) assays to detect the presence of cagA and vacA polymorphisms.RESULTS: Detection of H. pylori from dental plaque and gastric biopsy samples was greater by PCR com-pared to histological examination and the rapid ure-ase test. DNA from H. pylori was detected in 96% of gastric mucosa samples and in 72% of dental plaque samples. Sixty-three (89%) of 71 dental plaque sam-ples that were H. pylori-positive also exhibited identical vacA and cagA genotypes in gastric mucosa. The most common genotype was vacAs1bm1 and cagA positive, either in dental plaque or gastric mucosa. These viru-lent H. pylori isolates were involved in the severity of clinical outcome.CONCLUSION: These pathogenic strains were found simultaneously in dental plaque and gastric mucosa, which suggests that gastric infection is correlated with the presence of H. pylori in the mouth.展开更多
Helicobacter pylori(H.pylori)infection is one of the most common bacterial infections in humans.Although H.pylori may be detected in the stomach of approximately half of the world’s population,the mechanisms of trans...Helicobacter pylori(H.pylori)infection is one of the most common bacterial infections in humans.Although H.pylori may be detected in the stomach of approximately half of the world’s population,the mechanisms of transmission of the microorganism from individual to individual are not yet clear.Transmission of H.pylori could occur through iatrogenic,fecal-oral,and oral-oral routes,and through food and water.The microorganism may be transmitted orally and has been detected in dental plaque and saliva.However,the role of the oral cavity in the transmission and recurrence of H.pylori infection has been the subject of debate.A large number of studies investigating the role of oral hygiene and periodontal disease in H.pylori infection have varied significantly in terms of their methodology and sample population,resulting in a wide variation in the reported results.Nevertheless,recent studies have not only shown that the microorganism can be detected fairly consistently from the oral cavity but also demonstrated that the chances of recurrence of H.pylori infection is more likely among patients who harbor the organism in the oral cavity.Furthermore,initial results from clinical trials have shown that H.pylori-positive dyspeptic patients may benefit from periodontal therapy.This paper attempts to review the current body of evidence regarding the role of dental plaque,saliva,and periodontal disease in H.pylori infection.展开更多
AIM:To assess neovascularization within human ca-rotid atherosclerotic soft plaques in patients with isch-emic stroke.METHODS:Eighty-one patients with ischemic stroke and 95 patients without stroke who had soft athero...AIM:To assess neovascularization within human ca-rotid atherosclerotic soft plaques in patients with isch-emic stroke.METHODS:Eighty-one patients with ischemic stroke and 95 patients without stroke who had soft athero-sclerotic plaques in the internal carotid artery were studied.The thickest soft plaque in each patient was examined using contrast-enhanced ultrasound.Time-intensity curves were collected from 5 s to 3 min after contrast injection.The neovascularization within the plaques in the internal carotid artery was evaluated using the ACQ software built into the scanner by 2 of the experienced investigators who were blinded to the clinical history of the patients.RESULTS:Ischemic stroke was present in 7 of 33 patients(21%) with grade Ⅰ plaque,in 14 of 51 pa-tients(28%) with grade Ⅱ plaque,in 26 of 43 patients(61%) with grade Ⅲ plaque,and in 34 of 49 patients(69%) with grade Ⅳ plaque(P < 0.001 comparing grade Ⅳ plaque with grade I plaque and with grade Ⅱ plaque and P = 0.001 comparing grade Ⅲ plaque with grade Ⅰ plaque and with grade Ⅱ plaque).Analysis of the time intensity curves revealed that patients with ischemic stroke had a significantly higher intensity of enhancement(IE) than those without ischemic stroke(P < 0.01).The wash-in time(WT) of plaque was signifi-cantly shorter in stroke patients(P < 0.05).The sensi-tivity and specificity for IE in the plaque were 82% and 80%,respectively,and for WT were 68% and 74%,respectively.There was no significant difference in the peak intensity or time to peak between the 2 groups.CONCLUSION:This study shows that the higher the grade of plaque enhancement,the higher the risk of ischemic stroke.The data suggest that the presence of neovascularization is a marker for unstable plaque.展开更多
The vasa vasorum of carotid artery plaque is a novel marker of accurately evaluating the vulnerability of carotid artery plaque, which was associated with symptomatic cerebrovascular and cardiovascular disease. The pr...The vasa vasorum of carotid artery plaque is a novel marker of accurately evaluating the vulnerability of carotid artery plaque, which was associated with symptomatic cerebrovascular and cardiovascular disease. The presence of ultrasound contrast agents in carotid artery plaque represents the presence of the vasa vasorum in carotid artery plaque because the ultrasoundcontrast agents are strict intravascular tracers. Therefore, contrast-enhanced ultrasound(CEUS) is a novel and safe imaging modality for evaluating the vasa vasorum in carotid artery plaque. However, there are some issues that needs to be assessed to embody fully the clinical utility of the vasa vasorum in carotid artery plaque with CEUS.展开更多
BACKGROUND Unstable carotid atherosclerotic plaques are prone to cause ischemic stroke.Contrast-enhanced ultrasound(CEUS) is the primary method of assessing plaque stability, but CEUS cannot be a method for screening ...BACKGROUND Unstable carotid atherosclerotic plaques are prone to cause ischemic stroke.Contrast-enhanced ultrasound(CEUS) is the primary method of assessing plaque stability, but CEUS cannot be a method for screening for unstable plaque. The emergence of superb micro-vascular imaging(SMI) offers the possibility of clinically screening for unstable plaque AIM To investigate the value of SMI in predicting ischemic stroke in patients with carotid atherosclerotic plaques.METHODS Patients with carotid atherosclerotic plaques(luminal stenosis of 50%-70%) were enrolled into the present study. All patients received conservative medication.The patient's clinical baseline data, serological data, CEUS and SMI data were analyzed. All patients underwent a 3-year follow-up. The follow-up endpoint was the occurrence of ischemic stroke and patients were divided into stroke group and non-stroke group according to whether the prognosis occurred or not.Subsequently, the difference in clinical data was compared, the correlation of SMI and CEUS was analyzed, and multiple Cox regression and receiver operating characteristic curve were applied to investigate the value of SMI and CEUS in predicting cerebral arterial thrombosis in three years.RESULTS In this study, 43 patients were enrolled in the stroke group and 82 patients were enrolled in the non-stroke group. Cox regression revealed that SMI level(P =0.013) and enhancement intensity(P = 0.032) were the independent factors influencing ischemic stroke. There was a positive correlation between SMI level and enhancement intensity(r = 0.737, P = 0.000). The area under curve of SMI level predicting ischemic stroke was 0.878. The best diagnostic point was ≥ level Ⅱ, and its sensitivity and specificity was 86.05% and 79.27%. The area under curve of enhancement intensity predicting ischemic stroke was 0.890. The best diagnostic point was 9.92 db, and its sensitivity and specificity was 88.37% and89.02%. As the SMI level gradually increased, the incidence of ischemic stroke increased gradually(X^2 = 108.931, P = 0.000).CONCLUSION SMI can be used as a non-invasive method of screening for unstable plaques and may help prevent ischemic stroke.展开更多
Objective:To study the expression of miR-126 and miR-223 in platelet of rabbit arterial plaque models,and explore its correlation with plaque morphology.Methods:Rabbit arterial plaque models were established,periphera...Objective:To study the expression of miR-126 and miR-223 in platelet of rabbit arterial plaque models,and explore its correlation with plaque morphology.Methods:Rabbit arterial plaque models were established,peripheral blood of models and control animals was collected.Plaque morphologies were divided into typeⅠ.typeⅡand typeⅢbased on angiography plaque morphology and Ambrose method.Platelet isolation kit was applied to isolate and purify peripheral blood platelets,CD45 immunomagnetic beads were used to remove the residual white blood cells.The miRNAs of platelets was extracted by miRNA Isolation Kit,and expressions of miR-126 and miR-223 of the platelets samples were detected by Real-time PCR.The correlation between plaque morphology and platelet-associated miR-126 and miR-223 expressions were analyzed.Expressions of target gene VCAM-1 and P2Y12 receptors of miR-126 and miR-223 in the atherosclerosis plaque of rabbit model were detected by Western blot.Results:Relative expression levels of miR-126 and miR-223 in the model group were 0.27±0.10 and 0.71±0.14,respectively.Plaque morphology was divided into typesⅠ,ⅡandⅢ;and miR-126 and miR-223 expression levels were detected in each type.Expression levels of miR-126 in each type were 0.42±0.07,0.17±0.11 and 0.22±0.15,respectively;and expression levels of miR-223 in each type are 0.68±0.02,0.57±0.06 and 0.88±0.10.respectively.Relative to the control group,miR-126 and miR-223 known target genes in VCAM-1 and P2Y12receptors increased platelets in rabbit atherosclerotic plaque models(P<0.05).Conclusions:Relative to normal control animals,miR-126 and miR-223 platelets were reduced in the rabbit atherosclerotic plaque model group(P<0.05).In the typeⅡplaque morphology group,miR-126 was greatly reduced;and there is no significant correlation between miR-223 and plaque morphology.展开更多
Myocardial infarction and sudden cardiac death are frequently the first manifestation of coronary artery disease.For this reason,screening of asymptomatic coronary atherosclerosis has become an attractive field of res...Myocardial infarction and sudden cardiac death are frequently the first manifestation of coronary artery disease.For this reason,screening of asymptomatic coronary atherosclerosis has become an attractive field of research in cardiovascular medicine.Necropsy studies have described histopathological changes associated with the development of acute coronary events.In this regard,thin-cap fibroatheroma has been identified as the main vulnerable coronary plaque feature.Hence,many imaging techniques,such as coronary computed tomography,cardiac magnetic resonance or positron emission tomography,have tried to detect noninvasively these histomorphological characteristics with different approaches.In this article,we review the role of these diagnostic tools in the detection of vulnerable coronary plaque with particular interest in their advantages and limitations as well as the clinical implications of the derived findings.展开更多
Objective: To compare oral hygiene practices, education and social background, food intake and oral malodor of Algerian adults suffering from dental caries with normal controls, and to determine and compare the bacter...Objective: To compare oral hygiene practices, education and social background, food intake and oral malodor of Algerian adults suffering from dental caries with normal controls, and to determine and compare the bacterial composition of the supragingival plaques from the above-mentioned groups.Methods: Participants completed a questionnaire and were clinically examined for dental caries using decayed, missing and filled teeth index according to the criteria laid down by the World Health Organization. Supragingival plaque samples were collected from 50 caries-free adults(CF) and 50 caries-active adults(CA). Standard procedures of culture and identification of aerobic and anaerobic bacteria were used. Data were analyzed using Chi-square test.Results: A total of 117 bacterial strains were isolated from supragingival plaques in CF group subjects, 76(64.96%) of them belonged to 9 aerobic genera, and 41(35.04%) to 9anaerobic genera(P < 0.05). While in the second group, 199 strains were isolated, 119(59.80%) of the strains belonged to 10 aerobic genera and 80(40.20%) to 10 anaerobic bacteria(P < 0.05). Streptococcus mutans, Enterococcus faecium, Aerococcus viridans,Actinomyces meyeri, Lactobacillus acidophilus and Eubacterium limosum showed a significantly higher prevalence in the CA group(P < 0.05). The findings revealed that CA group had a high sugar intake(80%). A significantly higher frequency of tooth brushing(P < 0.000) and a significantly less self-reported oral malodor(P < 0.000) and tooth pain(P < 0.000) were found in CF group, while there was no association of socioeconomic levels and intake of meal snacks with dental caries.Conclusions: This study confirms the association of some aciduric bacteria with caries formation, and a direct association of sugar intake and cultural level with dental caries.Furthermore, oral hygiene practices minimize the prevalence of tooth decay.展开更多
Objective The objective of this study is to determine whether coronary atherosclerotic plaque composition is associated with cardiovascular disease(CVD) risk in Chinese adults. Methods We performed a cross-sectional a...Objective The objective of this study is to determine whether coronary atherosclerotic plaque composition is associated with cardiovascular disease(CVD) risk in Chinese adults. Methods We performed a cross-sectional analysis in 549 subjects without previous diagnosis or clinical symptoms of CVD in a community cohort of middle-aged Chinese adults. The participants underwent coronary computed tomography(CT) angiography for the evaluation of the presence and composition of coronary plaques. CVD risk was evaluated by the Framingham risk score(FRS) and the 10-year atherosclerotic cardiovascular disease(ASCVD) risk score. Results Among the 549 participants, 267(48.6%) had no coronary plaques, 201(36.6%) had noncalcified coronary plaques, and 81(14.8%) had calcified or mixed coronary plaques. The measures of CVD risk including FRS and ASCVD risk score and the likelihood of having elevated FRS significantly increased across the groups of participants without coronary plaques, with noncalcified coronary plaques, and with calcified or mixed coronary plaques. However, only calcified or mixed coronary plaques were significantly associated with an elevated ASCVD risk score [odds ratio(OR) 2.41; 95% confidence interval(CI) 1.09-5.32] compared with no coronary plaques, whereas no significant association was found for noncalcified coronary plaques and elevated ASCVD risk score(OR 1.25; 95% CI 0.71-2.21) after multivariable adjustment. Conclusion Calcified or mixed coronary plaques might be more associated with an elevated likelihood of having CVD than noncalcified coronary plaques.展开更多
Clinical application of bare metal stents is constrained by the occurrence of instent restenosis,mainly due to the complex biomechanical environment in the body.Numerical simulation method was used to evaluate the eff...Clinical application of bare metal stents is constrained by the occurrence of instent restenosis,mainly due to the complex biomechanical environment in the body.Numerical simulation method was used to evaluate the effect of plaque composition on stent performance in a carotid artery.CT angiography(CTA)data were used as a reference,and zero-load state of the carotid artery was used to establish a 3D stenotic artery model.Different plaque compositions,calcified and hypo-cellular were defined in Model 1 and Model 2,respectively.Interactions between the stents and arterial tissues within the stent crimping-expansion process were analyzed to explore the effects of plaque composition on the mechanical parameters of carotid stents.Goodman diagram and fatigue safety factor(FSF)were analyzed to explore the effects of plaque composition on fatigue performance of a carotid stent in the stent service process.In the stent crimping-expansion process,the von Mises stress in the stent and the dog-boning ratio in Model 1 were higher than that in Model 2.The calcified plaque prevented the stent from expanding the stenotic vessel to a pre-set diameter.Thus,the risk of rupture in the calcified plaque was higher than that in the hypo-cellular plaque.Plaque also affected the stress/strain in the vessel wall,which was observed to be lower in Model 1 than in Model 2.This indicated that calcified plaque could decrease the stress-induced injury of arterial tissues.Within the stent service process,the stents used in these two models were predicted to not fail under fatigue rupture as calculated by the Goodman diagram.Additionally,the points closer to the fatigue limit were generally observed at the inner bend of the stent crowns.The FSF of the stent in Model 1 was lower than that in Model 2.The stent operating in the presence of calcified plaques suffered high risk of fractures.Reliability and fatigue performance of the stent were found to be associated with plaque composition.Hence,this study may provide stent designers an approach toward enhancing the mechanical reliability of a stent.展开更多
Background Coronary artery calcification is a well-known marker of atherosclerotic plaque burden.High-resolution intravascular optical coherence tomography(OCT)imaging has shown the potential to characterize the detai...Background Coronary artery calcification is a well-known marker of atherosclerotic plaque burden.High-resolution intravascular optical coherence tomography(OCT)imaging has shown the potential to characterize the details of coronary calcification in vivo.In routine clinical practice,it is a time-consuming and laborious task for clinicians to review the over 250 images in a single pullback.Besides,the imbalance label distribution within the entire pullbacks is another problem,which could lead to the failure of the classifier model.Given the success of deep learning methods with other imaging modalities,a thorough understanding of calcified plaque detection using Convolutional Neural Networks(CNNs)within pullbacks for future clinical decision was required.Methods All 33 IVOCT clinical pullbacks of 33 patients were taken from Affiliated Drum Tower Hospital,Nanjing University between December 2017 and December 2018.For ground-truth annotation,three trained experts determined the type of plaque that was present in a B-Scan.The experts assigned the labels'no calcified plaque','calcified plaque'for each OCT image.All experts were provided the all images for labeling.The final label was determined based on consensus between the experts,different opinions on the plaque type were resolved by asking the experts for a repetition of their evaluation.Before the implement of algorithm,all OCT images was resized to a resolution of 300×300,which matched the range used with standard architectures in the natural image domain.In the study,we randomly selected 26 pullbacks for training,the remaining data were testing.While,imbalance label distribution within entire pullbacks was great challenge for various CNNs architecture.In order to resolve the problem,we designed the following experiment.First,we fine-tuned twenty different CNNs architecture,including customize CNN architectures and pretrained CNN architectures.Considering the nature of OCT images,customize CNN architectures were designed that the layers were fewer than 25 layers.Then,three with good performance were selected and further deep fine-tuned to train three different models.The difference of CNNs was mainly in the model architecture,such as depth-based residual networks,width-based inception networks.Finally,the three CNN models were used to majority voting,the predicted labels were from the most voting.Areas under the receiver operating characteristic curve(ROC AUC)were used as the evaluation metric for the imbalance label distribution.Results The imbalance label distribution within pullbacks affected both convergence during the training phase and generalization of a CNN model.Different labels of OCT images could be classified with excellent performance by fine tuning parameters of CNN architectures.Overall,we find that our final result performed best with an accuracy of 90%of'calcified plaque'class,which the numbers were less than'no calcified plaque'class in one pullback.Conclusions The obtained results showed that the method is fast and effective to classify calcific plaques with imbalance label distribution in each pullback.The results suggest that the proposed method could be facilitating our understanding of coronary artery calcification in the process of atherosclerosis andhelping guide complex interventional strategies in coronary arteries with superficial calcification.展开更多
This study was undertaken to investigate the correlation of the enhancement degree on contrast-enhanced ultrasound(CEUS) with the histopathology of carotid plaques and the serum high sensitive C-reactive protein(hs-CR...This study was undertaken to investigate the correlation of the enhancement degree on contrast-enhanced ultrasound(CEUS) with the histopathology of carotid plaques and the serum high sensitive C-reactive protein(hs-CRP) levels in patients undergoing carotid endarterectomy(CEA). Carotid CEUS was performed preoperatively in 115 patients who would undergo CEA, and the enhancement degree of the carotid plaques was evaluated by both the visual semiquantitative analysis and the quantitative time-intensity curve analysis. Serum hs-CRP levels were detected using the particle-enhanced immunoturbidimetric assay also before the operation. Additionally, the carotid plaque samples were subjected to histopathological examination postoperatively. The density of neovessels and the number of macrophages in the plaques were assessed by immunohistochemistry. The results showed that among the 115 patients, grade 0 plaque contrast enhancement was noted in 35 patients, grade 1 in 48 patients and grade 2 in 32 patients. The degree of plaque enhancement, the density of neovessels, the number of macrophages, and the hs-CRP levels were highest in the grade 2 patients. Correlation analysis showed that the enhancement degree of the carotid plaques was closely related to the immunohistochemical parameters of the plaques and the serum hs-CRP levels. It was suggested that the carotid plaque enhancement on CEUS can be used to evaluate the vulnerability of carotid plaques.展开更多
Background Subintimal plaque modification(SPM) is often performed to restore antegrade flow and facilitate subsequent lesion recanalization. This study aimed to compare the safety and efficacy of modified SPM with tra...Background Subintimal plaque modification(SPM) is often performed to restore antegrade flow and facilitate subsequent lesion recanalization. This study aimed to compare the safety and efficacy of modified SPM with traditional SPM. Methods A total of 1454 consecutive patients who failed a chronic total occlusion percutaneous coronary intervention(CTO PCI) attempt and underwent SPM from January 2015 to December 2019 at our hospital were reviewed retrospectively. Fifty-four patients who underwent SPM finally were included in this study. We analyzed the outcomes of all the patients, and the primary endpoint was recanalization rate, which was defined as Thrombolysis in Myocardial Infarction(TIMI) grades 2-3 flow on angiography 30 to 90 days post-procedure. Results The baseline characteristics were similar between the two groups. In the follow-up, the recanalization rate was noticeably higher in the modified SPM group compared with the traditional SPM group(90.9% vs. 62.5%, P < 0.05). The proposed strategy in the modified group was more aggressive, including a larger balloon size(1.83 ± 0.30 vs. 2.48 ± 0.26 mm, P < 0.05) and longer subintimal angioplasty(0.59 ± 0.16 vs. 0.92 ± 0.12 mm, P < 0.05). Also, the common use of a Stingray balloon and guide catheter extension resulted in improvement of patients in the modified SMP group(12.5% vs. 100%, P < 0.05). Conclusion Modified SPM, which is associated with a high likelihood of successful recanalization, is an effective and safe CTO PCI bail out strategy.展开更多
文摘Background/Aims: Determining the levels of oral health and the quality of dental care are fundamental to building concepts of oral health. This study aims to assess toothbrushing techniques using a technical and physical model, clarifying how children and pre-adults learn to brush their teeth. Materials and Methods: Data were recorded from 23 participants, both male and female of various ages, using a proposed electronic toothbrush equipped with X-Y-Z axes pathways. The data, collected before and after training experiments, were processed with MATLAB to generate plots for the three axes. Results: The study revealed that most parameter values, such as Mean Difference Between Amplitudes (MAV, 6.00), Wilson Amplitude (WAMP, 179.419), and Average Amplitude Coupling (AAC, 1.270), decreased from before to after the experiments. Furthermore, the average overall epoch lengths (AVG) showed a 75% reduction in movement amplitude between the two experiments. Conclusion: Dentist observations indicated which brushing methods were acceptable or not. Analytical values suggest that individuals learn the toothbrushing technique effectively, and medical observations clearly demonstrate the success of the proposed method.
基金National Natural Science Foundation of China(No.82274488,81874446)。
文摘Objective:To explore the molecular mechanisms of isoliquiritigenin in stabilizing atherosclerotic plaques by activating PPAR-γsignal pathway to regulate ox-LDL metabolism.Methods:The ApoE-/-mice AS carotid plaque model was prepared by using high fat diet and right perivascular carotid collar placement(PCCP).ApoE-/-mice were randomly divided into the model group and the isoliquiritigenin group after PCCP.C57BL/6J mice were used for the control group.High fat diet continued feeding for 8 weeks after PCCP to establish the AS model.Automatic biochemical analyzer was used to test levels of total cholesterol(TC),triacylglyceride(TG),low-density lipoprotein cholesterol(LDL-C)and high-density lipoprotein cholesterol(HDL-C).ELISA was used to measure oxidized low-density lipoprotein(ox-LDL)in serum.Hematoxylin-eosin(HE)staining was used to observe the pathological pattern of the carotid artery,and then calculated the carotid parameters.Oil red O staining was used for lipid determination,Masson staining was used to determine collagen content,MOMA-2 andα-SMA immunohistochemical staining were used to determine macrophages and smooth muscle cells,and to calculate the vulnerability index.Western blot was used to detected the expression of PPAR-γ,LXR-α,FABP-4,MMP-2 and MMP-9 in mice arteries.Results:Compared with the normal group,TC、TG、LDL-C、HDL-C and ox-LDL were increased in the model group.Compared with the model group,TC、TG、LDL-C and ox-LDL were reduced,and there was no significant change in HDL-C of the isoliquiritigenin group.Compared with the normal group,intima thickness(IT),intima/media thickness(IT/MT),plaque area(PA),and plaque area/lumen area(PA/LA)of carotid arteries were increased,the content of lipid and MOMA-2 in plaques was increased,collagen andα-SMA content decreased,and the vulnerability index was higher in the model group.The expression of PPAR-γand LXR-αwere reduced and the expression of FABP-4,MMP-2 and MMP-9 were increased in the model group.Compared with the model group,carotid IT,IT/MT,PA,and PA/LA were reduced,the content of lipid and MOMA-2 in plaques was decreased,collagen andα-SMA content were increased,and the vulnerability index was decreased in the isoliquiritigenin group.PPAR-γand LXR-αexpression were increased,FABP-4,MMP-2 and MMP-9 expression were decreased significantly in the isoliquiritigenin group.Conclusion:Isoliquiritigenin can exert anti-AS effects by activating PPAR-γ,up-regulating LXR-α,reducing FABP-4 expression,reducing ox-LDL,reducing the protein expression of MMP-2 and MMP-9,decreasing plaque vulnerability index,and increasing plaque stability.
文摘The Commemorative Plaque Industry thrives at the hands of the local craftsmen in Ghana. Techniques, methods, tools, and materials used as handed to them by their previous masters have remained the same over the years. As a result, plaques produced had peculiar problems such as text fading, degrading the actual effect of the plaques. Additionally, metals once widely used for making plaques devoid of text fading in the industry seem to have lost their relevance due to metal plaque theft, rust on metal plaques, and the continuous rise in metal prices. This research uses descriptive, experimental, and case studies of the qualitative research method to examine the problems associated with locally produced commemorative plaques. A total of hundred (100) artisans, including metal scrap dealers, and plaque buyers, were selected for the study. Direct observation and face-to-face interviews were conducted with the local craftsmen, art lecturers and students, scrap dealers, and plaque buyers who were purposively sampled for the study. The study revealed that existing materials like ceramic and aluminium could be integrated innovatively to produce commemorative plaques devoid of text fading;a corrosion-resistant text could be made using anodized or coated metals used in smaller quantities to reduce costs while also making them unattractive for theft and lastly, silicone sealant was found to be a viable option for permanently inscribing text on porcelain bases. The results clarify and underline the necessity to grow the local plaque industry in terms of plaque production as another essential basis to assure high-quality plaques with no text fading that will survive for generations to serve their intended purpose.
文摘Objective Compare the morphology of atherosclerotic plaquesmgiographically and histopathologically in acute myocardialmfarction m order to accumulate experience in recognizing plaquerupture and thrombus by angiogrames.Material and methods 16postmortem cases of acute myocardial infarction were studied.The coronary arteries were romoved en block,filled with barium the lumen and ridiographed.Then the arteries wereontinuously insetted and routin HE sections were made.Results 16 cases had plaque ruptures and thrombi.Among the total98 blocks,21 had plaque ruptures on which 20 thrombiccur(95.23%).while the other 777 unrupured blocks had only 2hrombi(0.25%).The difference was significant(p【0.001).Therupture mostly occur on unstable plaques.The ruptured plaqueswith thrombi had different angiographical morphology withunruptured plaques.The former had irregular borders andunraluminal lucencies;while the Iatter had smooth borders and nointraluminal lucencies.Conclusions Plaque ruprure withthrumbus was the major cause of acute myocardial infarction andthe ruptured plaques with thrombus had different angiographicalapperances with unruptured plaques.
文摘BACKGROUND Discontinued application of statins may be related to adverse cardiovascular events.However,it is unclear whether different statins administration methods have effects on coronary artery plaques.AIM To evaluate the effects of different statins application methods on plaques in patients with coronary atherosclerosis.METHODS A total of 100 patients diagnosed with atherosclerotic plaque by coronary artery computed tomography were continuously selected and divided into three groups according to different statins administration methods(discontinued application group,n=32;intermittent application group,n=39;sustained application group,n=29).The effects of the different statins application methods on coronary atherosclerotic plaque were assessed.RESULTS The volume change and rate of change of the most severe plaques were significantly reduced in the sustained application group(P≤0.001).The volume change of the most severe plaques correlated positively with low-density lipoprotein(LDL-C)levels only in the sustained application group(R=0.362,P=0.013).There were no changes in plaques or LDL-C levels in the intermittent and discontinued application groups.CONCLUSION Continuous application of statins is effective for controlling plaque progression,whereas discontinued or intermittent administration of statins is not conducive to controlling plaques.Only with continuous statins administration can a reduction in LDL-C levels result in plaque volume shrinkage.
文摘BACKGROUND Myocardial bridging(MB)is increasingly recognized to stimulate atherogenesis,which may contribute to an acute coronary syndrome.Stenting the coronary segment with MB has been recognized to have an increased risk of in-stent restenosis,stent fracture and coronary perforation.The safety and efficacy of stenting the culprit lesion with overlaying MB in ST elevation myocardial infarction(STEMI)as primary reperfusion therapy has not been established.CASE SUMMARY We reported a patient who presented with inferior STEMI with a culprit lesion of an acute thrombotic occlusion in the right coronary artery and thrombolysis and thrombin inhibition in myocardial infarction 0 flow.After the stent placement during primary percutaneous coronary intervention,intravascular ultrasound revealed MB overlying the stented segment where heavy atherosclerotic plaque were present.Likely due to the combination of plaque herniation or prolapse caused by MB,as well as local increased inflammation and thrombogenicity,acute stent thrombosis occurred at this region,which led to acute stent failure.The patient required an emergent repeated cardiac catheterization and placing a second layer of stent to enhance the radial strength and reduce the inter-strut space.CONCLUSION Plaque herniation or prolapse after stenting a MB segment in STEMI is a potential etiology for acute stent failure.
文摘The degree of vessel lumen narrowing is an independent predictor of ischemic stroke. New developments in carotid plaque morphology imaging (MR, CT), may bring new insights to the relationship between carotid atherosclerotic disease and stroke risk. Our aim is to review the stroke risk in a symptomatic patient with moderate carotid stenosis by CT imaging and histopathology. A 72-year-old patient with low ABCD2 scores TIA and moderate left internal carotid stenosis (50% by carotid ultrasound), was discharged with an optimized medical therapy. Four months later, he presented an ischemic stroke in the left frontal area. Carotid angiography showed a 60% stenosis in the left-internal carotid artery with a regular surface. CT plaque imaging detected a thin fibrous cap with calcification and an intraplaque hemorrhage (high-risk plaque). These findings were confirmed in the histolopathological study of the atherosclerotic plaque performed after the endarterectomy. After 1 year of follow-up, the patient returned independently to his daily activities. We propose, in this study, the inclusion of noninvasive plaque imaging in the evaluation of acute TIA with moderate carotid stenosis to better select patients with higher risk of stroke recurrence.
基金Supported by Coordenao de Aperfeioamento de Pessoal de Nível Superior and Federal University of Pará
文摘AIM: To establish whether virulence factor genes vacA and cagA are present in Helicobacter pylori (H. pylori) retrieved from gastric mucosa and dental plaque in pa-tients with dyspepsia. METHODS: Cumulative dental plaque specimens and gastric biopsies were submitted to histological exami-nation, rapid urease test and polymerase chain reac-tion (PCR) assays to detect the presence of cagA and vacA polymorphisms.RESULTS: Detection of H. pylori from dental plaque and gastric biopsy samples was greater by PCR com-pared to histological examination and the rapid ure-ase test. DNA from H. pylori was detected in 96% of gastric mucosa samples and in 72% of dental plaque samples. Sixty-three (89%) of 71 dental plaque sam-ples that were H. pylori-positive also exhibited identical vacA and cagA genotypes in gastric mucosa. The most common genotype was vacAs1bm1 and cagA positive, either in dental plaque or gastric mucosa. These viru-lent H. pylori isolates were involved in the severity of clinical outcome.CONCLUSION: These pathogenic strains were found simultaneously in dental plaque and gastric mucosa, which suggests that gastric infection is correlated with the presence of H. pylori in the mouth.
文摘Helicobacter pylori(H.pylori)infection is one of the most common bacterial infections in humans.Although H.pylori may be detected in the stomach of approximately half of the world’s population,the mechanisms of transmission of the microorganism from individual to individual are not yet clear.Transmission of H.pylori could occur through iatrogenic,fecal-oral,and oral-oral routes,and through food and water.The microorganism may be transmitted orally and has been detected in dental plaque and saliva.However,the role of the oral cavity in the transmission and recurrence of H.pylori infection has been the subject of debate.A large number of studies investigating the role of oral hygiene and periodontal disease in H.pylori infection have varied significantly in terms of their methodology and sample population,resulting in a wide variation in the reported results.Nevertheless,recent studies have not only shown that the microorganism can be detected fairly consistently from the oral cavity but also demonstrated that the chances of recurrence of H.pylori infection is more likely among patients who harbor the organism in the oral cavity.Furthermore,initial results from clinical trials have shown that H.pylori-positive dyspeptic patients may benefit from periodontal therapy.This paper attempts to review the current body of evidence regarding the role of dental plaque,saliva,and periodontal disease in H.pylori infection.
基金Supported by The Science and Technology Department of Zhejiang Province,No.2008C33012Zhejiang Nature Science Foundation,No.Y2080718
文摘AIM:To assess neovascularization within human ca-rotid atherosclerotic soft plaques in patients with isch-emic stroke.METHODS:Eighty-one patients with ischemic stroke and 95 patients without stroke who had soft athero-sclerotic plaques in the internal carotid artery were studied.The thickest soft plaque in each patient was examined using contrast-enhanced ultrasound.Time-intensity curves were collected from 5 s to 3 min after contrast injection.The neovascularization within the plaques in the internal carotid artery was evaluated using the ACQ software built into the scanner by 2 of the experienced investigators who were blinded to the clinical history of the patients.RESULTS:Ischemic stroke was present in 7 of 33 patients(21%) with grade Ⅰ plaque,in 14 of 51 pa-tients(28%) with grade Ⅱ plaque,in 26 of 43 patients(61%) with grade Ⅲ plaque,and in 34 of 49 patients(69%) with grade Ⅳ plaque(P < 0.001 comparing grade Ⅳ plaque with grade I plaque and with grade Ⅱ plaque and P = 0.001 comparing grade Ⅲ plaque with grade Ⅰ plaque and with grade Ⅱ plaque).Analysis of the time intensity curves revealed that patients with ischemic stroke had a significantly higher intensity of enhancement(IE) than those without ischemic stroke(P < 0.01).The wash-in time(WT) of plaque was signifi-cantly shorter in stroke patients(P < 0.05).The sensi-tivity and specificity for IE in the plaque were 82% and 80%,respectively,and for WT were 68% and 74%,respectively.There was no significant difference in the peak intensity or time to peak between the 2 groups.CONCLUSION:This study shows that the higher the grade of plaque enhancement,the higher the risk of ischemic stroke.The data suggest that the presence of neovascularization is a marker for unstable plaque.
文摘The vasa vasorum of carotid artery plaque is a novel marker of accurately evaluating the vulnerability of carotid artery plaque, which was associated with symptomatic cerebrovascular and cardiovascular disease. The presence of ultrasound contrast agents in carotid artery plaque represents the presence of the vasa vasorum in carotid artery plaque because the ultrasoundcontrast agents are strict intravascular tracers. Therefore, contrast-enhanced ultrasound(CEUS) is a novel and safe imaging modality for evaluating the vasa vasorum in carotid artery plaque. However, there are some issues that needs to be assessed to embody fully the clinical utility of the vasa vasorum in carotid artery plaque with CEUS.
基金Supported by Shanghai Jiading District Health and Family Planning Commission Health Planning Commission Scientific Research Project,No.KYXM,2015-KY-02
文摘BACKGROUND Unstable carotid atherosclerotic plaques are prone to cause ischemic stroke.Contrast-enhanced ultrasound(CEUS) is the primary method of assessing plaque stability, but CEUS cannot be a method for screening for unstable plaque. The emergence of superb micro-vascular imaging(SMI) offers the possibility of clinically screening for unstable plaque AIM To investigate the value of SMI in predicting ischemic stroke in patients with carotid atherosclerotic plaques.METHODS Patients with carotid atherosclerotic plaques(luminal stenosis of 50%-70%) were enrolled into the present study. All patients received conservative medication.The patient's clinical baseline data, serological data, CEUS and SMI data were analyzed. All patients underwent a 3-year follow-up. The follow-up endpoint was the occurrence of ischemic stroke and patients were divided into stroke group and non-stroke group according to whether the prognosis occurred or not.Subsequently, the difference in clinical data was compared, the correlation of SMI and CEUS was analyzed, and multiple Cox regression and receiver operating characteristic curve were applied to investigate the value of SMI and CEUS in predicting cerebral arterial thrombosis in three years.RESULTS In this study, 43 patients were enrolled in the stroke group and 82 patients were enrolled in the non-stroke group. Cox regression revealed that SMI level(P =0.013) and enhancement intensity(P = 0.032) were the independent factors influencing ischemic stroke. There was a positive correlation between SMI level and enhancement intensity(r = 0.737, P = 0.000). The area under curve of SMI level predicting ischemic stroke was 0.878. The best diagnostic point was ≥ level Ⅱ, and its sensitivity and specificity was 86.05% and 79.27%. The area under curve of enhancement intensity predicting ischemic stroke was 0.890. The best diagnostic point was 9.92 db, and its sensitivity and specificity was 88.37% and89.02%. As the SMI level gradually increased, the incidence of ischemic stroke increased gradually(X^2 = 108.931, P = 0.000).CONCLUSION SMI can be used as a non-invasive method of screening for unstable plaques and may help prevent ischemic stroke.
基金supported by scientific and technological project of Henan province.No:132102310095
文摘Objective:To study the expression of miR-126 and miR-223 in platelet of rabbit arterial plaque models,and explore its correlation with plaque morphology.Methods:Rabbit arterial plaque models were established,peripheral blood of models and control animals was collected.Plaque morphologies were divided into typeⅠ.typeⅡand typeⅢbased on angiography plaque morphology and Ambrose method.Platelet isolation kit was applied to isolate and purify peripheral blood platelets,CD45 immunomagnetic beads were used to remove the residual white blood cells.The miRNAs of platelets was extracted by miRNA Isolation Kit,and expressions of miR-126 and miR-223 of the platelets samples were detected by Real-time PCR.The correlation between plaque morphology and platelet-associated miR-126 and miR-223 expressions were analyzed.Expressions of target gene VCAM-1 and P2Y12 receptors of miR-126 and miR-223 in the atherosclerosis plaque of rabbit model were detected by Western blot.Results:Relative expression levels of miR-126 and miR-223 in the model group were 0.27±0.10 and 0.71±0.14,respectively.Plaque morphology was divided into typesⅠ,ⅡandⅢ;and miR-126 and miR-223 expression levels were detected in each type.Expression levels of miR-126 in each type were 0.42±0.07,0.17±0.11 and 0.22±0.15,respectively;and expression levels of miR-223 in each type are 0.68±0.02,0.57±0.06 and 0.88±0.10.respectively.Relative to the control group,miR-126 and miR-223 known target genes in VCAM-1 and P2Y12receptors increased platelets in rabbit atherosclerotic plaque models(P<0.05).Conclusions:Relative to normal control animals,miR-126 and miR-223 platelets were reduced in the rabbit atherosclerotic plaque model group(P<0.05).In the typeⅡplaque morphology group,miR-126 was greatly reduced;and there is no significant correlation between miR-223 and plaque morphology.
文摘Myocardial infarction and sudden cardiac death are frequently the first manifestation of coronary artery disease.For this reason,screening of asymptomatic coronary atherosclerosis has become an attractive field of research in cardiovascular medicine.Necropsy studies have described histopathological changes associated with the development of acute coronary events.In this regard,thin-cap fibroatheroma has been identified as the main vulnerable coronary plaque feature.Hence,many imaging techniques,such as coronary computed tomography,cardiac magnetic resonance or positron emission tomography,have tried to detect noninvasively these histomorphological characteristics with different approaches.In this article,we review the role of these diagnostic tools in the detection of vulnerable coronary plaque with particular interest in their advantages and limitations as well as the clinical implications of the derived findings.
基金Supported by the National Committee of Research Program and Assessment(Cnepru-code I02020130110)
文摘Objective: To compare oral hygiene practices, education and social background, food intake and oral malodor of Algerian adults suffering from dental caries with normal controls, and to determine and compare the bacterial composition of the supragingival plaques from the above-mentioned groups.Methods: Participants completed a questionnaire and were clinically examined for dental caries using decayed, missing and filled teeth index according to the criteria laid down by the World Health Organization. Supragingival plaque samples were collected from 50 caries-free adults(CF) and 50 caries-active adults(CA). Standard procedures of culture and identification of aerobic and anaerobic bacteria were used. Data were analyzed using Chi-square test.Results: A total of 117 bacterial strains were isolated from supragingival plaques in CF group subjects, 76(64.96%) of them belonged to 9 aerobic genera, and 41(35.04%) to 9anaerobic genera(P < 0.05). While in the second group, 199 strains were isolated, 119(59.80%) of the strains belonged to 10 aerobic genera and 80(40.20%) to 10 anaerobic bacteria(P < 0.05). Streptococcus mutans, Enterococcus faecium, Aerococcus viridans,Actinomyces meyeri, Lactobacillus acidophilus and Eubacterium limosum showed a significantly higher prevalence in the CA group(P < 0.05). The findings revealed that CA group had a high sugar intake(80%). A significantly higher frequency of tooth brushing(P < 0.000) and a significantly less self-reported oral malodor(P < 0.000) and tooth pain(P < 0.000) were found in CF group, while there was no association of socioeconomic levels and intake of meal snacks with dental caries.Conclusions: This study confirms the association of some aciduric bacteria with caries formation, and a direct association of sugar intake and cultural level with dental caries.Furthermore, oral hygiene practices minimize the prevalence of tooth decay.
基金supported by the grants from National Key R&D Program of China [2017YFC1310700,2016YFC1305600]the National Natural Science Foundation of China [81622011,81561128019]+2 种基金the Shanghai Municipal Commission of Health and Family Planning [15GWZK0802]the'Gaofeng Gaoyuan Program for Clinical Scientists'from Shanghai Jiao-Tong University School of Medicine [20161301,20161307]Dr.Yu Xu was supported by the'Outstanding Young Talent Program'from Shanghai Municipal Government
文摘Objective The objective of this study is to determine whether coronary atherosclerotic plaque composition is associated with cardiovascular disease(CVD) risk in Chinese adults. Methods We performed a cross-sectional analysis in 549 subjects without previous diagnosis or clinical symptoms of CVD in a community cohort of middle-aged Chinese adults. The participants underwent coronary computed tomography(CT) angiography for the evaluation of the presence and composition of coronary plaques. CVD risk was evaluated by the Framingham risk score(FRS) and the 10-year atherosclerotic cardiovascular disease(ASCVD) risk score. Results Among the 549 participants, 267(48.6%) had no coronary plaques, 201(36.6%) had noncalcified coronary plaques, and 81(14.8%) had calcified or mixed coronary plaques. The measures of CVD risk including FRS and ASCVD risk score and the likelihood of having elevated FRS significantly increased across the groups of participants without coronary plaques, with noncalcified coronary plaques, and with calcified or mixed coronary plaques. However, only calcified or mixed coronary plaques were significantly associated with an elevated ASCVD risk score [odds ratio(OR) 2.41; 95% confidence interval(CI) 1.09-5.32] compared with no coronary plaques, whereas no significant association was found for noncalcified coronary plaques and elevated ASCVD risk score(OR 1.25; 95% CI 0.71-2.21) after multivariable adjustment. Conclusion Calcified or mixed coronary plaques might be more associated with an elevated likelihood of having CVD than noncalcified coronary plaques.
基金supported by Major Project of Science and Technology of Beijing Municipal Education Commission and Type B Project of Beijing Natural Science Foundation(KZ201710005007).
文摘Clinical application of bare metal stents is constrained by the occurrence of instent restenosis,mainly due to the complex biomechanical environment in the body.Numerical simulation method was used to evaluate the effect of plaque composition on stent performance in a carotid artery.CT angiography(CTA)data were used as a reference,and zero-load state of the carotid artery was used to establish a 3D stenotic artery model.Different plaque compositions,calcified and hypo-cellular were defined in Model 1 and Model 2,respectively.Interactions between the stents and arterial tissues within the stent crimping-expansion process were analyzed to explore the effects of plaque composition on the mechanical parameters of carotid stents.Goodman diagram and fatigue safety factor(FSF)were analyzed to explore the effects of plaque composition on fatigue performance of a carotid stent in the stent service process.In the stent crimping-expansion process,the von Mises stress in the stent and the dog-boning ratio in Model 1 were higher than that in Model 2.The calcified plaque prevented the stent from expanding the stenotic vessel to a pre-set diameter.Thus,the risk of rupture in the calcified plaque was higher than that in the hypo-cellular plaque.Plaque also affected the stress/strain in the vessel wall,which was observed to be lower in Model 1 than in Model 2.This indicated that calcified plaque could decrease the stress-induced injury of arterial tissues.Within the stent service process,the stents used in these two models were predicted to not fail under fatigue rupture as calculated by the Goodman diagram.Additionally,the points closer to the fatigue limit were generally observed at the inner bend of the stent crowns.The FSF of the stent in Model 1 was lower than that in Model 2.The stent operating in the presence of calcified plaques suffered high risk of fractures.Reliability and fatigue performance of the stent were found to be associated with plaque composition.Hence,this study may provide stent designers an approach toward enhancing the mechanical reliability of a stent.
基金supported in part by the National Natural Science Foundation of China ( NSFC ) ( 11772093)ARC ( FT140101152)
文摘Background Coronary artery calcification is a well-known marker of atherosclerotic plaque burden.High-resolution intravascular optical coherence tomography(OCT)imaging has shown the potential to characterize the details of coronary calcification in vivo.In routine clinical practice,it is a time-consuming and laborious task for clinicians to review the over 250 images in a single pullback.Besides,the imbalance label distribution within the entire pullbacks is another problem,which could lead to the failure of the classifier model.Given the success of deep learning methods with other imaging modalities,a thorough understanding of calcified plaque detection using Convolutional Neural Networks(CNNs)within pullbacks for future clinical decision was required.Methods All 33 IVOCT clinical pullbacks of 33 patients were taken from Affiliated Drum Tower Hospital,Nanjing University between December 2017 and December 2018.For ground-truth annotation,three trained experts determined the type of plaque that was present in a B-Scan.The experts assigned the labels'no calcified plaque','calcified plaque'for each OCT image.All experts were provided the all images for labeling.The final label was determined based on consensus between the experts,different opinions on the plaque type were resolved by asking the experts for a repetition of their evaluation.Before the implement of algorithm,all OCT images was resized to a resolution of 300×300,which matched the range used with standard architectures in the natural image domain.In the study,we randomly selected 26 pullbacks for training,the remaining data were testing.While,imbalance label distribution within entire pullbacks was great challenge for various CNNs architecture.In order to resolve the problem,we designed the following experiment.First,we fine-tuned twenty different CNNs architecture,including customize CNN architectures and pretrained CNN architectures.Considering the nature of OCT images,customize CNN architectures were designed that the layers were fewer than 25 layers.Then,three with good performance were selected and further deep fine-tuned to train three different models.The difference of CNNs was mainly in the model architecture,such as depth-based residual networks,width-based inception networks.Finally,the three CNN models were used to majority voting,the predicted labels were from the most voting.Areas under the receiver operating characteristic curve(ROC AUC)were used as the evaluation metric for the imbalance label distribution.Results The imbalance label distribution within pullbacks affected both convergence during the training phase and generalization of a CNN model.Different labels of OCT images could be classified with excellent performance by fine tuning parameters of CNN architectures.Overall,we find that our final result performed best with an accuracy of 90%of'calcified plaque'class,which the numbers were less than'no calcified plaque'class in one pullback.Conclusions The obtained results showed that the method is fast and effective to classify calcific plaques with imbalance label distribution in each pullback.The results suggest that the proposed method could be facilitating our understanding of coronary artery calcification in the process of atherosclerosis andhelping guide complex interventional strategies in coronary arteries with superficial calcification.
基金supported by the Natural Science Foundation of Zhejiang Province,China(No.LY13H180007)
文摘This study was undertaken to investigate the correlation of the enhancement degree on contrast-enhanced ultrasound(CEUS) with the histopathology of carotid plaques and the serum high sensitive C-reactive protein(hs-CRP) levels in patients undergoing carotid endarterectomy(CEA). Carotid CEUS was performed preoperatively in 115 patients who would undergo CEA, and the enhancement degree of the carotid plaques was evaluated by both the visual semiquantitative analysis and the quantitative time-intensity curve analysis. Serum hs-CRP levels were detected using the particle-enhanced immunoturbidimetric assay also before the operation. Additionally, the carotid plaque samples were subjected to histopathological examination postoperatively. The density of neovessels and the number of macrophages in the plaques were assessed by immunohistochemistry. The results showed that among the 115 patients, grade 0 plaque contrast enhancement was noted in 35 patients, grade 1 in 48 patients and grade 2 in 32 patients. The degree of plaque enhancement, the density of neovessels, the number of macrophages, and the hs-CRP levels were highest in the grade 2 patients. Correlation analysis showed that the enhancement degree of the carotid plaques was closely related to the immunohistochemical parameters of the plaques and the serum hs-CRP levels. It was suggested that the carotid plaque enhancement on CEUS can be used to evaluate the vulnerability of carotid plaques.
文摘Background Subintimal plaque modification(SPM) is often performed to restore antegrade flow and facilitate subsequent lesion recanalization. This study aimed to compare the safety and efficacy of modified SPM with traditional SPM. Methods A total of 1454 consecutive patients who failed a chronic total occlusion percutaneous coronary intervention(CTO PCI) attempt and underwent SPM from January 2015 to December 2019 at our hospital were reviewed retrospectively. Fifty-four patients who underwent SPM finally were included in this study. We analyzed the outcomes of all the patients, and the primary endpoint was recanalization rate, which was defined as Thrombolysis in Myocardial Infarction(TIMI) grades 2-3 flow on angiography 30 to 90 days post-procedure. Results The baseline characteristics were similar between the two groups. In the follow-up, the recanalization rate was noticeably higher in the modified SPM group compared with the traditional SPM group(90.9% vs. 62.5%, P < 0.05). The proposed strategy in the modified group was more aggressive, including a larger balloon size(1.83 ± 0.30 vs. 2.48 ± 0.26 mm, P < 0.05) and longer subintimal angioplasty(0.59 ± 0.16 vs. 0.92 ± 0.12 mm, P < 0.05). Also, the common use of a Stingray balloon and guide catheter extension resulted in improvement of patients in the modified SMP group(12.5% vs. 100%, P < 0.05). Conclusion Modified SPM, which is associated with a high likelihood of successful recanalization, is an effective and safe CTO PCI bail out strategy.
