The structural changes with atherosclerosis are currently considered degenerative phenomena, which primarily involve a sequence of reactions within the intima and include monocyte recruitment and macrophage formation, lipid deposition, smooth muscle cell migration, proliferation, and extracellular matrix synthesis. The molecular and cellular mechanisms underlying the disease cascade have been thoroughly investigated in experimental animals and cell culture, but the question of
how these models can correctly mimic the human course of the disease remains open to debate. In the present review the basic structure of healthy human arteries and the pathological events occurring during the atherosclerotic process have been examined by both transmission and scanning electron microscopy. Human atherosclerotic lesions are presented and described in the following order: initial GSK2126458 ic50 lesions, fatty dots and streaks, intermediate lesions, atheroma and fibrofatty plaques, and complicated lesions.”
“Many cardiac procedures using cardiopulmonary bypass (CPB) still require intraoperative transfusion. Retrograde autologous priming (RAP) has been selleck chemical introduced to decrease haemodilution and the blood transfusion rate. This study is designed to determine the influence or RAP on intraoperative haematocrit,
transfusion and its clinical consequences.
The RAP effect was retrospectively studied in 753 patients during contemporary cardiac surgery, targeting a haematocrit of 25%. Multivariate linear regression analysis was performed to identify the independent factors influencing intraoperative haematocrit, transfusion rate and transfusion quantity.
RAP was used in 498 patients and compared with 255 controls. RAP decreased the haemodilution level (nadir haematocrit 26.8 standard GSK2126458 manufacturer deviation [SD] 4.0% in RAP vs 25.8 SD 3.6% in controls; P = 0.001) and transfusion frequency (26.1 vs 33.3%, P = 0.04), despite smaller patients
(body surface area [BSA] 1.86 SD 0.20 m(2) vs 1.91 SD 0.21 m(2) in RAP vs controls; P = 0.002) with lower preoperative haematocrit (38.9 SD 4.4% vs 40.5 SD 4.6%; P < 0.001). Optimal RAP volume was overall 475 ml (ROC area 0.55; 95% confidence interval [CI] 0.50-0.60; P = 0.04) and 375 ml in patients with BSA < 1.7 m(2) (ROC area 0.63; 95% CI 0.54-0.73; P = 0.008) to decrease the transfusion incidence. Multivariate analysis revealed RAP volume as a significant determinant of nadir haematocrit (beta = 0.003, 95% CI 0.002-0.004, P < 0.001) and transfusion rate (odds ratio (OR) = 0.997, 95% CI 0.996-0.999, P < 0.001), independent of BSA, gender and preoperative haematocrit.
Retrograde autologous priming is an effective adjunct to decrease the blood transfusion rate, coping with the CPB-related haemodilution and its adverse clinical effects. A RAP volume individualized to each patient offers most benefit as part of a multidisciplinary blood conservation approach.