葦の髄から循環器の世界をのぞく

Remodelingという言葉を最初聞いた時は言葉の響きから生体にとっていい意味かと思ってしまいました。
しかし実際は良い意味で使われないことが多いようです。
以下の論文の中では”negative arterial remodeling”と表現されています。
また、生体にとって有利な場合には”positive（adaptive） arterial remodeling”と表現されています。

日本語では「再構築」というのでしょうか？
逆引きすればReconstructionになってしまいますが。

念のためにちょっと辞書をひも解いてみました。

modeling模倣

remodeling改造

construction構築

reconstruction復元

さらにGOOGLEでRemodelingを検索するとBathroom　Remodelingなどという家屋のリフォームの話が出てきたりします。

ちょっとRemodelingの適切な教材が見つからなかったのでAmerican Heart Journaｌの論文を教材にしてみました。

一時トピックスだったRemodelingｔという概念自体、ブーム（？）はちょっと過ぎたんでしょうね。


Subsequent Arterial Remodeling After Balloon Angioplasty
(from American Heart Journal)

Discussion
This IVUS investigation implies that vessel behavior after balloon angioplasty is affected by the presence or absence of deep vessel wall injury.
(POBA後の血管変化は血管損傷が深いかどうかによって決まる)

Deep vessel wall injury after balloon angioplasty may be related to the subsequent arterial remodeling process.
（このPOBA後の血管破綻がリモデりングを起こす原因と思われる）

In treated lesions with resultant deep vessel wall injury, either adaptive or inadequate arterial remodeling contributes to subsequent luminal changes, and these findings are consistent with previous IVUS studies.

In treated lesions without resultant deep vessel wall injury, however, neointimal increase rather than vessel shrinkage was found to contribute to late lumen loss.
（POBA成功例では血管内膜増生が再狭窄の原因となる）

Since the introduction of coronary stenting, restenosis after balloon angioplasty dropped by nearly half in selected lesion subsets.
This reduction of restenosis rate is thought to be achieved by the prevention of negative arterial remodeling, which is known to be a major determinant of late luminal narrowing after nonstent interventions.
（ステントの導入によりPOBAに比較して再狭窄率は半減したが、リモデリングの防止を介しての結果と考えられている。）

Although previous studies have suggested that increased neointimal proliferation may be responsible for late luminal narrowing after balloon angioplasty,recent clinical studies have clearly demonstrated that change in vessel size rather than the magnitude of neointimal proliferation contributes to the lumen change.
（最近の研究ではPOBAの際の再狭窄は、血管内膜増生より内径の変化率が関係しているといわれている。）

However, previous clinical studies with IVUS have not shown device- or vessel-related differences in the restenotic mechanism.
(今までのIVUSでの臨床研究では再狭窄の機序がバルーンやステントなどの器具に問題があるのか血管側の問題なのかは検討されていなかった。)

Although the results of our study suggest that the overall mechanism of restenosis after conventional balloon angioplasty is arterial remodeling rather than neointimal proliferation, the restenosis process may be more lesion specific (ie, an increase in plaque area was compensated for by an increase in vessel area in the lesions with deep vessel wall injury but  an increase in plaque area was not compensated for by an increased vessel area in the lesions without deep vessel wall injury and as a result, change in plaque area was a determinant of lumen loss).
（POBA後の再狭窄の原因は主としてリモデリングである。）

Although the overall mechanism of restenosis was similar to the previous IVUS reports, more late vessel expansion (as a result of deep vessel injury and vessel stretching) rather than vessel shrinkage was observed in this study population.

This may be, in part, related to the more aggressive balloon sizing and higher inflation pressure usage in the stent era. Our results are consistent with a previous necropsy study where 2 subgroups of histologic findings (presence or absence of intimal proliferation) were documented among the restenotic coronary arteries.

The authors suggested that restenotic lesion morphology is reflective of differing mechanisms of restenosis (neointimal increase vs vessel recoil).

Also, this restenotic lesion specific difference may in part explain the discrepancy in the reported mechanism of restenosis after intervention.

Previous IVUS studies have shown that positive arterial remodeling or compensatory enlargement of the coronary vessel was observed in up to 54% of lesions in de novo native atherosclerotic coronary lesions.
（良い方向での利モデリングも半数以上に見られる。）

A pathologic study suggests that coronary arteries enlarge in relation to plaque increase until the lesion occupies 40% of the vessel.

Although some authors have reported possible predictors of positive remodeling in de novo　atheroscleroticlesions,　mechanisms and predictors of positive (adaptive) remodeling after interventions have not been well understood.

Recently, several reports suggested that adventitial inflammation and subsequent fibrotic change may play a key role in vessel constriction and restenosis.
（外膜の炎症とその結果引き起こされる繊維化が血管収縮と再狭窄の原因となら。）

Additionally, IVUS studies have shown the possible relationship between deep vessel wall cutting and subsequent vessel dilatation after directional atherectomy.

Vessel wall injury deep in the adventitia may cause adventitial inflammation and thus result in aggravated remodeling after intervention.
（冠動脈の外膜に障害が及んだ場合には強い炎症が起こり、その分リモデリングが強く起こる。）


In conclusion, the results suggest that deep vessel wall injury may affect the subsequent arterial remodeling processes after balloon angioplasty.

The differences in the remodeling process may have implications regarding adjunctive therapies to prevent restenosis after balloon angioplasty.
（PTCA後再狭窄の予防にはリモデリングの様式によって治療法を構築することが望まれる）

Subsequent Arterial Remodeling After Balloon Angioplasty
http://www.medscape.com/viewarticle/440694_4
(GoogleやYAHOOで英文タイトル名をコピペして検索すればこの考察のみ出てきます。)

小田切訓「ハイデルベルクの春」P10号
http://page14.auctions.yahoo.co.jp/jp/auction/s68315764

血管リモデリングの細胞生物学
www.med.or.jp/jams/symposium/kiroku/120/pdf/120006.pdf
血管リモデリングの細胞生物学
www.kuba.co.jp/syoseki/PDF/3083.pdf
Relationship Between Coronary Artery Remodeling and Plaque Vulnerability
http://circ.ahajournals.org/cgi/content/full/105/8/939

お粗末な内容となってしまいました。
また新たな教材を見つけて修行して出直してきます。