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CARDIOLOGY

Academician Ge Junbo: Pan-vascular Medicine——From Idea to Practice

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The 14th Oriental Cardiology Conference (OCC2020) kicked off on May 28, 2020.Due to the impact of the epidemic, this year’s OCC meeting uses a brand new online form, which connects experts located in Tiannan and Haibei through live broadcast, bringing a rich academic feast to everyone.With the theme of “openness, innovation and cooperation”, OCC2020 showcases new technologies, new concepts and new progress in the field of international cardiovascular disease.The theme of the opening ceremony of the Oriental Society is “Pan Vascular Medicine”. The organizer of the conference is Professor Liu Jianmin of the Neurosurgery Branch of the Shanghai Medical Association, Professor Chen Nan of the Nephrology Doctor Branch of the Shanghai Medical Association and Professor Fu Weiguo of the Vascular Surgery Branch of the Shanghai Medical Association.The experts from the three brother disciplines, together with Academician Ge Junbo, “rafted on the cloud” and discussed the latest progress of panvascular medicine!Academician Ge Junbo mentioned at the opening ceremony that pan-vascular medicine re-understands the rules and characteristics of the occurrence and development of vascular diseases from the perspective of system biology and requires a multidisciplinary cross-disciplinary integrated research model and development concept.The idea of ​​treating headaches and pains from the head needs to be reformed. It is necessary to prevent the occurrence of vascular diseases from the source from the perspective of the whole body.Therefore, the development of panvascular medicine requires multi-disciplinary cooperation and common progress.Afterwards, Academician Ge Junbo recounted the theory and practice of panvascular medicine to the topic of “Panvascular Medicine-From Idea to Practice” at the Metabolism and Cardiovascular Disease Forum on May 30.The origin of the concept of pan-vascular medicine The current vascular diseases are studied and treated separately according to the target organs for blood supply, but scholars at home and abroad gradually recognize the limitations of single sites and propose to understand such diseases from a holistic perspective.In the early 1990s, domestic scholars put forward the concept of “vascular tree” and tried to use system biology methods to carry out research on vascular diseases.By the end of the last century, foreign scholars further proposed the concept of “vascular network” based on this.With the further development of the doctrine, by 2002, Peter Lanzer and Eric J. Topol formally proposed the concept of “pan-vascular” disease and laid the foundation for the discipline of pan-vascular medicine.The scientific basis of pan-vascular medicine Pan-vascular refers to the vascular system of the human body, which is a complex network of arteries, veins, lymphatic vessels and so on.Pan-vascular disease is a group of diseases of the vascular system, with atherosclerosis as the common pathological feature, harming important organs such as heart, brain, kidney, limbs and so on.A wide range of pan-vascular diseases also include small and microvessels, veins as well as tumors, diabetes and immunity.There are common risk factors for pan-vascular disease including hypertension, diabetes, hyperlipidemia, smoking and obesity. The main pathological change is, as mentioned above, atherosclerosis.Therefore, regardless of the origin of blood vessels or prevention and control strategies, pan-vascular disease has similar characteristics in general.So how should we control the occurrence and development of atherosclerosis?Academician Ge believes that we must start with the evaluation.Pan-vascular disease assessment practice 1. The clinical study of pan-vascular evaluation of plaque characteristics and/or components is inseparable from the rapid development of imaging.Traditional non-invasive and interventional imaging helps assess plaque characteristics and composition.The age of a blood vessel represents the biological age of a person, the thickness of the blood vessel wall represents the age of the blood vessel, and the thickness of the carotid intima is a sign of early atherosclerosis.Ultrasound assessment of plaques can visualize the age of pan vessels, while CT can not only assess the stenosis caused by plaques, but also the composition and nature of plaques, while MR can further observe microvascular perfusion.In addition, noninvasive and invasive imaging assessment methods can also effectively assess the stability of plaque.2. Assessment of plaque inflammation Sometimes the degree of plaque stenosis and the patient’s prognosis are not necessarily linear, which makes people think about the nature of plaque.In the case of low stenosis, the infiltration of inflammatory cells will affect the prognosis of patients. Therefore, imaging techniques for detecting inflammation also play an increasingly important role in the diagnosis, risk prediction, and guidance of pan-vascular disease.18F-NaF uptake in coronary plaques has a significant correlation with high-risk features such as plaque microcalcification, positive remodeling, and necrotic core.The interaction between the perivascular adipose tissue (PVAT) and the vessel wall plays a very important role in regulating the occurrence, progression and inflammation of atherosclerotic plaques.Increased PVAT Decay Index (FAI) (≥ -70.1 HU) can predict the risk of cardiac death and all-cause death, and is expected to become a new risk stratification marker and guide individualized secondary prevention measures.In addition, myeloperoxidase (MPO-Gd) magnetic resonance molecular imaging, SERS imaging, etc. can evaluate atherosclerotic plaque inflammation.3. The evaluation of the neovascularization in the plaque of the nourishing blood vessel is related to the stability of the plaque, so the plaque stability can be judged by evaluating the condition of the nourishing blood vessel.4. Assess that biomechanics, fluid mechanics and solid mechanics are related to the decline of plate progress.In the plaque progression area, the lower the shear force, the greater the plaque load.The shear force has nothing to do with the change of the necrotic core, but the higher plaque structure stress is related to the increase of the necrotic core.In the plaque regression area, low shear force can cause a slight reduction in plaque load, a slight decrease in fibrous adipose tissue, and a significant reduction in necrotic core area; high plaque structural stress can cause a slight reduction in necrotic core area, and fiber fatThe organization is significantly reduced..
In general, to treat the whole blood vessel as a system, the evaluation practice of pan-vascular disease needs to be based on the “pan-vascular index” of comprehensive evaluation. This index is based on the concept of “pan-omics” and includes demographic characteristics and clinical manifestations., Biomarker omics, imaging omics, functional omics, mechanics and genomics, etc., assisted by artificial intelligence, together constitute the pan-vascular health index.From concept to model to practice, the pan-vascular discipline will continue to implement the “patient-centered” all-round management concept, continue to build a multi-disciplinary cross-platform with multiple efforts, and build a pan-vascular disease prevention, research and industrial platform, from differentExplore the pathogenic mechanism of pan-vascular disease and effective prevention and control strategies at a level to further promote the cardiovascular health of Chinese residents.The above content is only authorized for exclusive use by 39Health.com, please do not reprint without the authorization of the copyright party.

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