Littérature scientifique sur le sujet « Coronary bypa »

Aim. To determine the most significant predictors of an unfavorable progress of osteoporosis (OP) in men with coronary artery disease after coronary artery bypass grafting (CABG) according to long-term (5 years) follow-up data.Methods. The prospective study included 393 patients (men) hospitalized for CABG. All patients underwent multispiral computed tomography of the coronary and carotid arteries to assess the calcium score (CS) and determine the equivalent density of calcium deposits (EDCD), coronary angiography, and dual-energy X-ray absorptiometry. After 5 years (average 59 months) of follow-up, the prognosis (status alive/dead) was assessed in 335 patients. Mortality during follow-up in patients after CABG was 10.7% (36 patients died). 257 patients underwent repeated osteodensitometry, quantitative assessment of coronary and carotid calcification, assessment of the “end points” of bone status (osteoporotic fractures, osteoporosis).Results. During the five-year follow-up an increase in the prevalence of OP was noted from 76.1% to 90.7%, while in 43.6% of cases, the progression of OP was recorded. Fractures occurred in 39 patients (15.2%), and in 34 (13.2%) osteoporosis developed for the first time. OP progression is associated with smoking (OR 5.3, 95% CI 3.1–9.4), 30% or more carotid artery stenosis (OR 5.6, 95% CI 2.9–10.7), baseline severe (more than 400) calcification of the coronary arteries (OR 2.7 at 95% CI 1.3–9.8), low density of (EDCD less than 0.19 g/mm3 ) coronary (OR 1.7 at 95% CI 1.1–8.2) and carotid (OR 2.4, 95% CI 1.4–10.3) calcium deposits. Linear regression analysis made it possible to establish that the reliable predictors of an unfavorable course of OP are coronary CS, EDCD of the carotid arteries, and the absence of statin therapy.Conclusion. OP progression in patients in the long-term period (5 years) after CABG was noted in 43.6%. The predictors of OP progression and the complications are a high level of coronary artery calcification, a low EDCD in the carotid arteries, and 30% or more stenosis of the carotid arteries. Patients receiving statins were associated with a lower risk of osteoporosis.

Rdza koronowa, powodowana przez grzyb Puccinia coronata, jest jedną z najpowszechniej występujących chorób grzybowych owsa w Polsce. Do tej pory u owsa zidentyfikowano ponad 100 genów odporności na ten patogen, jednak są one szybko przełamywane przez nowe patotypy Puccinia coronata. Celem pracy była ocena efektywności genów warunkujących odporność na izolaty Puccinia coronata skolekcjonowane w centralnej i południowo-wschodniej Polsce w latach 2010-2011. W badaniach wykorzystano 31 linii referencyjnych owsa z pojedynczymi genami odporności na rdzę koronową. Analizy przeprowadzono z wykorzystaniem testów żywiciel-patogen w oparciu o 6 izolatów Puccinia coronata. Izolaty pochodzące z różnych rejonów uprawy owsa różniły się między sobą wirulencją w stosunku do 21 z 31 linii referencyjnych. Przeprowadzone badania wykazały, że najbardziej efektywne w stadium siewki są geny Pc14, Pc39, Pc51, Pc52, Pc53, Pc57, Pc60, Pc68, Pc71 i Pc91.

WstępW pracy omówiono techniki modyfikacji blaszki miażdżycowej w pniu lewej tętnicy wieńcowej wraz z przedstawieniem wyników własnych zabiegów z użyciem cewnika nacinającego (AngioSculpt) oraz cewnika niepodatnego (<i>non-compliant balloon</i><i></i> – NC balloon).Materiał i metodyDo badania włączono 23 pacjentów spełniających kryteria włączenia przy braku kryteriów wyłączających z badania. U 13 pacjentów przeprowadzono angioplastykę (<i>percutaneous coronary intervention</i> – PCI) z użyciem cewnika nacinającego, u 10 pacjentów z użyciem cewnika balonowego niepodatnego.WynikiGrupy nie różniły się pod względem danych demograficznych ani chorób współistniejących. W grupie badanej uzyskano większą średnicę pnia lewej tętnicy wieńcowej <i>(left main</i> – LM) w ocenie za pomocą ultrasonografii wewnątrznaczyniowej (<i>intravascular ultrasound</i> – IVUS). W grupie kontrolnej częściej stosowano technikę dwustentową; jednak ze względu na małą liczbę uczestników nie osiągnięto istotności statystycznej. W grupie kontrolnej użycie większej ilości kontrastu wiązało się z częstszym stosowaniem techniki dwustentowej. Pomimo jednego zawału mięśnia sercowego (<i>myocardial infarction</i> – MI), związanego z zabiegiem w grupie kontrolnej, śmiertelność 2-letnia między grupami była podobna. Regresja logistyczna nie wykazała istotnego związku żadnej z badanych zmiennych z 2-letnią śmiertelnością.WnioskiWstępne wyniki naszego badania sugerują, że nie ma różnicy we wczesnych wynikach 30-dniowych oraz 2-letniej śmiertelności w randomizowanej grupie pacjentów poddawanych angioplastyce wieńcowej pnia lewej tętnicy wieńcowej z użyciem cewnika balonowego nacinającego i cewnika balonowego niepodatnego. Wybór optymalnej strategii leczenia zwężenia LM jest nadal przedmiotem badań, a doświadczenie operatora ma fundamentalne znaczenie.

Background: Socioeconomicstatus (SES) is an influential determinant of prognosis in coronary artery disease (CAD). Patient neighbourhood SES may contribute to CAD outcomes, beyond effects of personal SES. Methods: Following 485 CAD patients for > 10 years, we examine the effect of neighbourhood income, education, and unemployment on survival, and investigate relationships between SES and markers of inflammation and oxidative stress. Results: SES was associated significantly with risk of mortality, however this relationship was not observed for cardiovascular death. Each one quintile decrease in income, education, and employment was associated with a 32%, 40% and 45% greater risk of non-cardiovascular mortality, respectively. Inflammatory and oxidative stress markers correlate with income, but do not diminish associations between neighbourhood SES and mortality. Conclusions: Significant disparities in non-cardiovascular mortality related to neighbourhood SES were observed in this study, which argues for greater attention to socioeconomic factors in chronic disease prevention and health care delivery. C.L.H. is supported bya Providence Health Research Institute & Canadian Institutes of HealthResearch MD/PhD Studentship Award, and a Michael Smith Foundation for HealthResearch Trainee Award. (colour figure available in PDF version)

ABSTRACTA relationship between periodontitis and coronary heart disease has been investigated intensively. A pathogenic role for the oral bacteriumPorphyromonas gingivalishas been suggested for both diseases. We examined whether complement activation byP. gingivalisstrain ATCC 33277 allows the bacterium to adhere to human red blood cells (RBCs) and thereby evade attack by circulating phagocytes. On incubation with normal human serum, theP. gingivalisstrain efficiently fixed complement component 3 (C3). Incubation of bacteria with washed whole blood cells suspended in autologous serum resulted in a dose- and time-dependent adherence to RBCs. The adherence required functionally intact complement receptor 1 (CR1; also called CD35) on the RBCs and significantly inhibited the uptake ofP. gingivalisby neutrophils and B cells within 1 min of incubation (by 64% and 51%, respectively) and that by monocytes after between 15 min and 30 min of incubation (by 66% and 53%, respectively). The attachment of C3b/iC3b to bacterium-bearing RBCs decreased progressively after 15 min, indicating that conversion of C3 fragments into C3dg occurred, decreasing the affinity for CR1 on RBCs. We propose thatP. gingivalisexploits RBCs as a transport vehicle, rendering it inaccessible to attack by phagocytes, and by doing so plays a role in the development of systemic diseases.

This study was conducted to survey the facilities, bed strength, functional characteristics, manpower,operational practices and distribution of intensive care units in Bangladesh. Direct interview ofconsultants in charge of different Intensive Care Units (ICUs) in the city of Dhaka was conducted bya structured questionnaire. All Adult Intensive Care Units (ICUs) and Coronary Care Units (CCUs)with ventilator support in the city of Dhaka belonging to government and private sectors wereincluded. Our survey showed that 90% of all Intensive Care Units in Bangladesh were located in thecity of Dhaka. There were 40 Intensive Care Units in the city of Dhaka, of which 33 were ICUs and7 CCUs with ventilator support (also considered as ICU). Only 4 (10%) ICUs were located ingovernment hospitals. Rest of the ICUs was in private hospitals / clinics. Total number of ICU bedswas 424 and total numbers of beds in these hospitals were 8824. So 4.8% of total hospital beds wereprovisioned for critical care. Among these only 240 beds (60%) had ventilator support. 27(68%) ofthe 40 ICUs were multidisciplinary, 7(18%) CCUs, 5(12%) cardiac surgery and 1(2%) neurology.64% ICUs were run by anesthesiologists. 85% facilities were open units as opposed to 15% closedunits. Nurse: bed ratio of 1:1 was seen in 15(42%) facilities. On duty doctor: patient ratio wasvariable and highest was 1:4 in 9 ICUs (27 %). ICUs in Bangladesh are mainly situated in the cityof Dhaka and mostly in the private sector. The standards and management strategies vary greatly.Ibrahim Med. Coll. J. 2010; 4(1): 13-16Key words: Intensive Care Unit; Bangladesh; audit.DOI: 10.3329/imcj.v4i1.5929

Nonostante generalmente si preferisca utilizzare i condotti arteriosi, la grande vena safena (SV) rimane indispensabile per il bypass aortocoronarico, specialmente nella malattia coronarica multi-vasale. È stato scoperto che il rimodellamento precoce causato da alterazioni meccaniche a carico della parete del vaso gioca un ruolo chiave nella malattia da trapianto di vena safena. Il meccanismo rimane, tuttavia, sconosciuto. Lo scopo di questo lavoro è quello di dimostrare l'esistenza di un effetto meccanico nel fallimento dell'innesto venoso, dovuto ai cambiamenti nelle condizioni emodinamiche che si verificano a seguito del trapianto in posizione coronarica. I segmenti di vena safena di pazienti sottoposti a bypass coronarico sono stati stimolati all’interno di un bioreattore in grado di mimare le condizioni emodinamiche venose o coronariche. Cellule muscolari lisce e cellule progenitrici avventiziali derivate dalla vena safena umana sono state stimolate meccanicamente in vitro utilizzando lo strumento Flexcell. La differenziazione pro-patologica delle cellule residenti nella vena, derivante dall'esposizione al flusso coronarico, è causata da un fenomeno meccano-percettivo. In particolare, le cellule avventiziali vengono attivate a seguito del rilascio di Trombospondina-1 da parte delle cellule muscolari lisce nelle vene esposte al flusso coronarico, suggerendo così una connessione tra lo stress meccanico sperimentato dalla parete vascolare e il rimodellamento del bypass. Inoltre, un'analisi dell'arricchimento genico dei trascritti differenzialmente modulati dallo stress meccanico, ha rivelato il coinvolgimento di un circuito trascrizionale meccano-sensitivo (HIPPO/YAP/TEAD pathway) nelle cellule stimolate meccanicamente. Questi risultati suggeriscono l'esistenza di un effetto "meccano-paracrino" dovuto al stress di parete negli innesti di vena safena. Sia il reclutamento delle cellule progenitrici avventiziali, sia il loro differenziamento verso il fenotipo fibrotico, sono eventi potenzialmente coinvolti nell’insorgenza della malattia da trapianto di vena safena.
Despite the preferred application of arterial conduits, the greater saphenous vein (SV) remains indispensable for coronary artery bypass grafting (CABG), especially in multi-vessel coronary artery disease. Early remodeling induced by altered wall mechanics has been recognized to play a key role in SV graft disease. The mechanism remains, however, unknown. The aim of this work was to unveil the existence of a mechanical effect in SV graft failure, due to changes in the hemodynamic conditions occurring in SV grafts after transplantation into coronary position. SV segments from patients receiving coronary artery bypass grafts were stimulated in a coronary ‘pulse-duplicator’ bioreactor with either CABG or venous hemodynamic conditions. Human saphenous vein derived-smooth muscle cells (SMCs) and adventitial progenitors (SVPs) were mechanically stretched in vitro using Flexcell Tension System. The pro-pathological differentiation of resident cells in the vein, resulting from exposure to coronary flow, derives from a mechano-perception phenomenon. In particular, adventitial cells are activated by the release of Thrombospondin-1 by stretched smooth muscle cells in the veins exposed to coronary flow, thus suggesting a connection between the mechanical stress experienced by the vascular wall and the remodeling of the bypass. In addition, a gene enrichment analysis of transcripts up/downmodulated by mechanical stress revealed the involvement of a mechanosensing transcriptional circuitry (HIPPO/YAP/TEAD pathway) in cells stimulated with the cyclic strain. These findings suggest the existence of a ‘mechano-paracrine’ effect due to CABG-specific wall strain in SV grafts. This process has consequences for recruitment of adventitial progenitor cells, and a fibrotic-like process possibly involved in pathologic programming of SV graft failure.