Patients with Gastric Antral Vascular Ectasia (GAVE) Are at a Higher Risk of Gastrointestinal Bleeding in the Absence of Cirrhosis

Background and Aims: Gastric antral vascular ectasia (GAVE) is commonly found in patients with cirrhosis, but it is also associated with other diseases in the absence of cirrhosis. Whether GAVE confers a different severity of gastrointestinal (GI) bleeding between patients with and without cirrhosis remains unknown. We aim to examine whether there is a difference in clinically significant GI bleeding due to GAVE in patients with or without cirrhosis. Methods: This is a retrospective case-control study of patients who were diagnosed with GAVE between January 2000 and June 2014. Patients were categorized into cirrhosis and noncirrhosis groups, and those with an additional GI bleeding source were excluded. Univariate comparisons and multivariable models were constructed using logistic regression. Results: In total, 110 patients diagnosed with GAVE on esophagogastroduodenoscopy (EGD) were included in our analysis; 84 patients had cirrhosis (76.4%) and 26 (23.6%) did not. Active GI bleeding was more prevalent in patients without cirrhosis (63.4% vs. 32.1%, p=0.003) despite similar indications for EGD, and endoscopic treatment with argon plasma coagulation (APC) was required more often in this group, approaching statistical significance (27% vs. 10.7%, p=0.056). There was no difference in bleeding severity, as evidenced by similar re-bleeding rates, surgery, or death attributed to uncontrolled bleeding. The strongest independent risk factor for GI bleeding was the absence of cirrhosis (odds ratio (OR): 5.151 (95% confidence interval (CI): 1.08-24.48, p=0.039). Conclusions: Patients with GAVE in the absence of cirrhosis are at higher risk for active GI bleeding and require more frequent endoscopic treatment than similar patients with cirrhosis. It may be worthwhile to treat GAVE in this population even in the absence of active bleeding.     

Atypical Abnormal Pulmonary Vein Drainage with Atrial Septal Defect: Surgical Treatment

Sinus venosus atrial septal defect (SV‐ASD) usually coexists with partial anomalous pulmonary vein connection (PAPVC). It is a difficult diagnosis in transthoracic echocardiography (TTE) due to eccentric position of defects. We present a rare case of atypical anatomical variation in PAPVC, which was never described before. Two right pulmonary veins drained into superior vena cava, which overrode SV‐ASD and interatrial septum, a third pulmonary vein into the right atrium. Complete diagnosis could not be set after TTE, nor transesophageal echocardiography, whereas angio‐CT was finally conclusive. This diagnostic approach allowed the surgical planning.     

Melatonin reduces oxidative stress and improves vascular function in pulmonary hypertensive newborn sheep

Pulmonary hypertension of the newborn (PHN) constitutes a critical condition with severe cardiovascular and neurological consequences. One of its main causes is hypoxia during gestation, and thus, it is a public health concern in populations living above 2500 m. Although some mechanisms are recognized, the pathophysiological facts that lead to PHN are not fully understood, which explains the lack of an effective treatment. Oxidative stress is one of the proposed mechanisms inducing pulmonary vascular dysfunction and PHN. Therefore, we assessed whether melatonin, a potent antioxidant, improves pulmonary vascular function. Twelve newborn sheep were gestated, born, and raised at 3600 meters. At 3 days old, lambs were catheterized and daily cardiovascular measurements were recorded. Lambs were divided into two groups, one received daily vehicle as control and another received daily melatonin (1 mg/kg/d), for 8 days. At 11 days old, lung tissue and small pulmonary arteries (SPA) were collected. Melatonin decreased pulmonary pressure and resistance for the first 3 days of treatment. Further, melatonin significantly improved the vasodilator function of SPA, enhancing the endothelial‐ and muscular‐dependent pathways. This was associated with an enhanced nitric oxide‐dependent and nitric oxide independent vasodilator components and with increased nitric oxide bioavailability in lung tissue. Further, melatonin reduced the pulmonary oxidative stress markers and increased enzymatic and nonenzymatic antioxidant capacity. Finally, these effects were associated with an increase of lumen diameter and a mild decrease in the wall of the pulmonary arteries. These outcomes support the use of melatonin as an adjuvant in the treatment for PHN.     

全反式维甲酸联合5-氟尿嘧啶对Eca109细胞增殖、迁移和VEGF表达的影响

目的:探讨全反式维甲酸(ATRA)、5-氟尿嘧啶(5-FU)单独或联合作用对Eca109细胞增殖、迁移和血管内皮生长因子(VEGF)表达的影响。方法:将常规传代的Eca109细胞分为4组:ATRA组、5-FU组、ATRA+5-FU组和对照组,采用MTT法检测各组细胞的增殖情况,通过划痕实验测定各组细胞的迁移能力,采用RT-PCR和免疫细胞化学法分别检测各组细胞VEGF mRNA和蛋白的表达情况。结果:作用24、48和72 h后,ATRA+5-FU组的细胞生长抑制率均高于其他2组(F=23.432、13.605、73.369,P均<0.05);作用24 h后,ATRA+5-FU组的迁移率均低于其他3组(P均<0.001);作用48 h后,ATRA+5-FU组细胞VEGF mRNA和蛋白的相对表达量均低于其他3组(P均<0.05)。结论:ATRA、5-FU均能抑制食管癌细胞的增殖,且联合用药效果更为显著,可能与其抑制肿瘤血管生成有关。     

Chronic monitoring of vascular progression after ischemic stroke using multiexposure speckle imaging and two-photon fluorescence microscopy

Monitoring the progression of the vascular structure and cerebral blood flow (CBF) after brain injury is vital to understand the neurovascular recovery process. Multiexposure speckle imaging (MESI) provides a quantitatively accurate technique for chronically measuring the postocclusion CBF perfusion of the infarct and peri-infarct regions in rodent stroke models, while multiphoton microscopy offers direct visualization of the microvascular structure. In this paper, we present imaging outcomes extending 35 days after photo-thrombotic occlusion, tracking the progression of the vasculature throughout this period. We compare MESI flow estimates within the unresolvable parenchyma with subsurface microvascular volume fractions taken with two-photon microscopy in the same regions to assess how the vascular density influences the surface-integrated MESI flow values. The MESI flow measurements and volume fractions are shown to have high correlations (r=0.90) within areas of recovering vasculature in the peri-infarct region. We also observe vascular reorientation occurring within the microvascular structure throughout the 35-day postocclusion period. With the combination of a chronic mouse model and relatively noninvasive optical imaging techniques, we present an imaging protocol for monitoring long-term vascular progression after photo-thrombotic occlusion with the potential to test the efficacy of rehabilitation and pharmacological therapies.     

Utilization and Complications of Central Venous Access Devices in Oncology Patients

Purpose: To describe how central venous access devices (CVADs) are utilized for ambulatory oncology patients and to evaluate the rate of complications. Method: Single institution retrospective study of oncology patients with CVADs who received systemic treatment at the Walker Family Cancer Centre (WFCC) between 1 January and 31 December 2018. Results: A total of 480 CVADS were placed in 305 patients, of which 408 (85%) were peripherally inserted central catheters (PICCs) and 72 (15%) were implanted vascular access devices (PORTs). The incidence of early and late complications was 9% and 24%, respectively. For the entire cohort, the rate of venous thromboembolism (VTE) was 16%, of which 9% were CVAD-related thrombosis (CRTs) and 7% were distant VTE. The CRT rates were similar for PICCs and PORTs (9% vs. 7%). A total of 6% of CVADs were complicated by infection (i.e., localized infections and bacteremia), with a total infection rate of 0.43 and 0.26 per 1000 indwelling days for PICCs and PORTs, respectively. The incidence of central line associated bloodstream infections (CLABSI) was greater for PICCs than PORTs, at a rate of 0.22 compared with 0.08 per 1000 indwelling days, respectively. The premature catheter removal rate was 26% for PICCs and 18% for PORTs. PORTs required more additional hospital visits. Conclusions: PICCs were utilized more frequently than PORTs and had a higher rate of premature removal. The rates of VTE and CRT were similar for both CVAD types. PORTs had a lower rate of infection per 1000 indwelling days. However, the management of PORT related complications required more visits to the hospital and oncology clinic.     

白藜芦醇通过激活PI3K/AKT通路抑制内皮细胞凋亡的研究

目的观察白藜芦醇对脂多糖作用下人脐静脉血管内皮细胞凋亡的影响,并探讨其作用机制。方法体外培养人脐静脉血管内皮细胞,实验分为5组:空白组给予单纯培养基培养;模型组培养基中加入1000 ng/mL脂多糖孵育24 h;5μmol/L白藜芦醇组和10μmol/L白藜芦醇组培养基中分别先加入5μmol/L、10μmol/L白藜芦醇孵育12 h,再加入1000 ng/mL脂多糖孵育24 h;PI3K抑制剂组培养基中先加入10μmol/L白藜芦醇和10μmol/L PI3K抑制剂LY294002共处理12 h,再加入1000 ng/mL脂多糖孵育24 h。使用CCK-8试剂盒检测各组细胞的增殖能力;流式细胞术检测各组细胞凋亡率;DHE荧光探针检测各组细胞中活性氧(ROS)含量;ELISA检测各组细胞培养液中一氧化氮(NO)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)水平;Western blot法检测各组AKT的磷酸化情况。结果与空白组相比,模型组细胞增殖能力明显降低,细胞凋亡率和细胞中ROS含量及TNF-α、IL-6水平均明显升高,NO水平及P-AKT/AKT表达水平明显降低,差异均有统计学意义(P均<0.05)。与模型组和PI3K抑制剂组相比,10μmol/L白藜芦醇组细胞增殖能力明显升高,细胞凋亡率和细胞中ROS含量及TNF-α、IL-6水平明显下降,NO水平及P-AKT/AKT表达水平明显升高,差异均有统计学意义(P均<0.05)。结论白藜芦醇能够提升脂多糖作用下人脐静脉血管内皮细胞的增殖能力,抑制细胞凋亡,减轻细胞的氧化应激和炎性反应,恢复细胞的分泌功能,可能与其激活PI3K/AKT通路而发挥保护作用有关。