Pulmonary vascular resistance in dogs and minipigs—effects of hypoxia and inhaled nitric oxide

The pig has been reported to present with a stronger hypoxic pulmonary vasoconstriction than many other species, including the dog, but it is not known whether this is associated with a different longitudinal partitioning of pulmonary vascular resistance (PVR). We investigated the relationships between cardiac output (Q̇) and mean pulmonary artery pressure (Ppa) minus occluded Ppa (Ppao), and effective pulmonary capillary pressure (Pc′) minus Ppao, in seven minipigs and in seven dogs in hyperoxia (FI_O2 0.4) and hypoxia (FI_O2 0.1), first without, then with the inhalation of 80 ppm nitric oxide (NO) to inhibit any reversible component of PVR. Pc′ was estimated from the Ppa decay curve following pulmonary artery balloon occlusion. In hyperoxia, minipigs compared to dogs had (Ppa−Ppao)/Q̇ and (Pc′−Ppao)/Q̇ plots shifted to higher pressures. Hypoxia at each level of Q̇ increased Ppa−Ppao in minipigs more than in dogs, and Pc′−Ppao in minipigs only. Inhaled NO reversed hypoxia-induced changes in (Ppa−Ppao)/Q̇ and (Pc′−Ppao)/Q̇ plots. We conclude that the minipig, compared to the dog, presents with higher PVR and reactivity including vessels downstream to the site of Pc′ as determined by the arterial occlusion technique.     

Arterial resections in pancreatic cancer – Systematic review and meta-analysis

BackgroundThe number of pancreatic resections due to cancers is increasing. While concomitant venous resections are routinely performed in specialized centers, arterial resections are still controversial. Nevertheless they are performed in patients presenting with locally advanced tumors. Our aim was to summarize currently available literature comparing peri-operative and long-term outcomes of arterial and non-arterial pancreatic resections.MethodsWe included studies comparing pancreatic operations with and without concomitant arterial resection. Inclusion criteria were morbidity or mortality. Studies additionally reporting venous resections with no possibility of excluding this data during the extraction were discarded.ResultsThe initial search yielded 1651 records. Finally, 19 studies were included in the analysis involving 2710 patients. Arterial resection was associated with a greater risk of death(RR: 4.09; p < 0.001) and complications (RR: 1.4; p = 0.01). There were no differences in the rate of pancreatic fistula, biliary fistula rate, cardiopulmonary complications, length of hospital stay and non-R0 rate. Oncologically, patients after arterial resection were at higher risk of worse 3-year survival.ConclusionArterial resection in pancreatic cancer is associated with an increased risk of mortality and complications in comparison to standard non-arterial resections. Nevertheless, arterial resection may become a viable treatment for selected patients in high volume centers.     

Is augmentation index a good measure of vascular stiffness in the elderly?

OBJECTIVES: we investigated the exact relationship between age and gender on augmentation pressure (AG) and augmentation index (AI) measured over the radial (muscular) and carotid (elastic) arteries. DESIGN AND METHODS: AG is the contribution that wave reflection makes to systolic arterial pressure. AI is an indirect measure of arterial stiffness and is calculated as AG divided by pulse pressure (PP) x100. AG and AI both increase with age. AG and AI were measured in 458 subjects using SphygmoCor. A total of 755 readings were obtained (302 carotid, 453 radial). The mean age was 57.5 +/- 13.7 years. Diabetic subjects were excluded. Among the subjects, 13.5% were hypertensive. RESULTS: statistically, women had mean values of AI significantly higher than men in both radial and carotid arteries. These differences were less marked with AG. Quadratic equations better described the relationship between AI and age but not AG and age. Thus, AI increased with age up to our median age of 55 years but plateaued thereafter, whereas the AG continued to increase steadily with age. A multiple regression analysis demonstrated that both AI and AG were negatively related to height and positively related to diastolic blood pressure (DBP). CONCLUSIONS: AG continues to increase in the elderly over the age of 55, but not AI. AI is higher in women and higher when measured over the carotid than the radial. AI is positively related to DBP and negatively to height. AG is proposed as a more suitable measure of arterial stiffness than AI.     

Increased expression of osteoprotegerin in vascular smooth muscle cells from spontaneously hypertensive rats

Osteoprotegerin (OPG) is a secreted protein of the tumor necrosis factor receptor family,whichregulates bone mass by inhibiting osteoclast differentiation and activation.Although OPG is expressed ubiquitouslyand abundantly in many tissues and cell types including vascular cells,the role of OPG in other tissues is unknown.Our previous studies demonstrated that OPG was highly expressed in vascular smooth muscle cells (VSMC) andupregulated during vascular lesion formation.Methods and Results We documented,by Northern blot analysis,that the expression of OPG was more prevalent in the aorta and cultured VSMC from spontaneously hypertensive rats(SHR) compared to Wistar-Kyoto rats (WKY).In addition,we found that the expression of Angiotensin Ⅱ (Ang Ⅱ)type Ⅰ receptor (AT1R) in SHR VSMC was at significantly increased levels than in WKY VSMC.Furthermore,AngⅡ potently induced the expression of OPG in VSMC in a time- and dose-dependent manner through the AT1Rsignaling pathway.Conclusions OPG expression was substantially greater in SHR VSMC,suggesting that OPGmay be an important determinant of vascular remodeling in SHR.(J Ceriatr Cardiol 2004;1:49-54.)     

Arterial stiffness and ventricular stiffness: a couple of diseases or a coupling disease? A review from the cardiologist's point of view

The assessment of arterial stiffness, a common feature of ageing,exacerbated by many common disorders such as hypertension, diabetesmellitus, or renal diseases, has become an attractive tool foridentifying structural and functional abnormalities of the arteriesin the preclinical stages of the atherosclerotic disease. Arterialstiffness has been recognized as an important pathophysiologicaldeterminant of systolic blood pressure and pulse pressure increasesand therefore the cause of cardiovascular complications, demonstratingalso an independent predictive value for cardiovascular events.Although there are many techniques and indices currently available,their large clinical application is limited by a lack of standardization,with important difficulties when one try effectively to measure,quantify, and compare. Moreover, information on the ‘heart-vesselcoupling disease’, in which combined stiffness of bothheart and arteries interact to limit cardiovascular performanceand its possible implications in different clinical conditions,is still not well known. We overviewed main methods and indicesused to estimate arterial stiffness and aimed to provide aninsight into the knowledge of the ventricular–arterialcoupling from the cardiologist's point of view.     

Does the presence of diabetic nephropathy in parents influence the metabolic response in the offspring?

Non-insulin dependent (Type 2) diabetes mellitus (NIDDM) and long-term complications such as nephropathy have a strong genetic predisposition. Insulin resistance is thought to be a pathogenetic factor, predisposing genetically prone individuals to develop the microvascular complications of diabetes. To test these hypotheses, two groups of young individuals were studied: 28 offspring of parents having NIDDM and diabetic nephropathy (group 1) aged 29.5 ± 6.1 years, BMI 25.2 ± 4.7 kg m⁻² and 31 offspring of diabetic parents with no history of nephropathy, aged 31.6 ± 4.1 years and BMI 26.3 ± 4.9 kg m⁻² (group 2). All underwent a standard oral glucose tolerance test with measurement of serum insulin levels and serum lipid profile. Urine albumin:creatinine ratio (A/C ratio) and blood pressure were also recorded. Diabetes was detected in 2/28 (7.1 %) and 3/31 (9.7 %) and IGT was detected in 5/28 (25 %) and 8/31 (25 %) of groups 1 and 2, respectively. These differences were not statistically significant, but were higher than in a group of non-diabetic controls with healthy parents. Comparison of the normoglycaemic subjects (19 and 20 in group 1 and 2, respectively) showed no significant differences between blood pressure readings, fasting and 2 h plasma glucose, and lipid profiles. Plasma insulin values, fasting and 2 h, and the area under the graph were also similar in both groups, indicating an absence of higher insulin response in group 1 in comparison with group 2. These values were also not different from those in the non-diabetic controls. A delay in insulin response to glucose was noted in many of the offspring as indicated by a low ΔI/ΔG at 30′. We conclude that offspring of diabetic parents with nephropathy do not show higher risk of glucose intolerance or insulin resistance compared to those with diabetic parents without nephropathy. The relatively high plasma glucose values in the presence of normal insulin secretion in both groups of offspring of diabetic parents suggest the presence of insulin resistance. © 1997 John Wiley & Sons, Ltd.     

Fat,fire and muscle – The role of adiponectin in pulmonary vascular inflammation and remodeling

Pulmonary hypertension is a life-threatening condition that results from a heterogeneous group of diseases, many of which demonstrate characteristic pathologic changes of pulmonary vascular inflammation and remodeling. Recent clinical studies indicate obesity to be a risk factor for the development of pulmonary hypertension; however, the mechanisms leading to this association are unknown. Adipocytes secrete multiple bioactive mediators that can influence inflammation and tissue remodeling, suggesting that adipose tissue may directly influence the pathogenesis of pulmonary hypertension. One of these mediators is adiponectin, a protein with a wide range of metabolic, anti-inflammatory, and anti-proliferative activities. Paradoxically, adiponectin is present in high concentration in the serum of lean healthy individuals, but decreases in obesity. Studies suggest that relative adiponectin-deficiency may contribute to the development of inflammatory diseases in obesity, and recent animal studies implicate adiponectin in the pathogenesis of pulmonary hypertension. Most notably, experimental studies show that adiponectin can reduce lung vascular remodeling in response to inflammation and hypoxia. Moreover, mice deficient in adiponectin develop a spontaneous lung vascular phenotype characterized by age-dependent increases in peri-vascular inflammatory cells and elevated pulmonary artery pressures. Emerging evidence indicates adiponectin's effects are mediated through anti-inflammatory and anti-proliferative actions on cells in the lung. This review aims to synthesize the existing data related to adiponectin's effects on the pulmonary vasculature and to discuss how changes in adiponectin levels might contribute to the development of pulmonary hypertension.     

An analysis of gender differences in treatment and outcome of periampullary tumours in Sweden – A national cohort study

BackgroundLittle is known of possible gender differences in treatment of periampullary tumours and outcome after pancreatoduodenectomy (PD), and the aim of this study was therefore to investigate any variances from national multicentre perspective.MethodsData from the Swedish National Registry for Pancreatic and Periampullary Cancer for all patients diagnosed with a periampullary tumour from 2012 throughout 2017 was collected. The material was analysed in two groups, men and women, for palliative treatment and curative intended resection.ResultsA total of 5677 patients were included, 2906 (51%) men and 2771 (49%) women. Women were older than men, 72 (65–78) years vs. 70 (64–76), p < 0.001. A lesser proportion of women were planned for resection (1131 (41%) vs. 1288 (44%), p = 0.008), but after adjusting for age and tumour location no difference was seen. Postoperative morbidity was equal, but women had significantly better long-term survival than men. The survival was equal for palliative men and women.ConclusionNo gender bias could be established when analysing treatment for periampullary tumours in Sweden, even though less women were offered surgery. Data suggest that even though women were older they tolerate surgery well and hence offering PD at a higher age for women could be suggested.     

Are parents able to rate the symptoms and quality of life of their offspring with IBD?

The aim of this study was to investigate the degree of agreement between parents and their offspring with inflammatory bowel disease for the presence of symptoms and the assessment of health-related quality of life (HRQOL). Factors influencing parent-child agreement were studied. Eighty-three Children and 81 parents separately filled out a five-item symptom card and a validated generic HRQOL instrument, which assesses seven domains of HRQOL, using the child and parent form. The parent also filled out the GHQ-30, an instrument assessing nonpsychotic psychiatric disorder in the parent, and an item on marital status. Intraclass correlation coefficients and paired student t-test were used to assess the level of agreement between raters. On one domain, parents reported their children as having a worse QOL than did the children themselves (social functioning). The parents were adequate raters of objective components of their child's HRQOL (overall correlation coefficient: 0.88). However, on more subjective components, the coefficient dropped to 0.62. In 82% of the cases did parents correctly classify their child into the disease activity category the child classified him- or herself. In conclusion, agreement between parents and offspring is good for the child's symptoms, but for HRQOL assessment only when it concerns objective states.     

Influence of stress on the expression of bcl-2/bax protein in spontaneously hypertensive rats

Cardiachypertrophyinhypertensionwasanadaptivereactiontoover－load．Althoughthishyper－trophicreactionmayeffectivelymaintainhemodynamicbalanceinitially，itcanresultinimpairedcardiaccontractility．Themechanismsunderlyingthetransitionfromcardiachypertrophyto     

Association between diet and measures of arterial stiffness in type 1 diabetes – Focus on dietary patterns and macronutrient substitutions

Background and aims

Increased arterial stiffness contributes to diabetic vascular complications. We identified dietary factors related to arterial stiffness in individuals with type 1 diabetes, a population with high risk of cardiovascular disease.