Vascular healing after stenting: the role of 17-beta-estradiol in improving re-endothelialization and reducing restenosis

The predominant role of the endothelium in vascular healing after balloon injury and stent implantation is better recognized. The endothelium regulates vascular tone, thrombosis, inflammation and cell proliferation. It may be important to favour endothelial recovery after percutaneous coronary intervention (PCI) to reduce restenosis and improve clinical outcome. The present article reviews the scientific rationale, experimental data and early clinical results of 17-beta-estradiol and its role in the acceleration of endothelial recovery in vivo after PCI.     

Matrix metalloproteinase-9: A deleterious link between hepatic ischemia-reperfusion and colorectal cancer

Despite the advent of improved surgical techniques and the development of cytotoxic chemotherapeutic agents useful for the treatment of colorectal cancer, the primary clinical challenge remains that of preventing and combating metastatic spread. Surgical resection is the best treatment for colorectal metastases isolated to the liver. However, in rodent models, the hepatic ischemia-reperfusion (I/R) applied during the surgery accelerates the outgrowth of implanted tumors. Among the adverse effects of I/R on cellular function, several studies have demonstrated an over expression of the matrix metalloproteinase-9 (MMP-9) in the ischemic liver. Since several studies showed high local levels of expression and activity of this proteolytic enzyme in the primary colorectal adenocarcinoma, the role of MMP-9 might be considered as a potential common mediator, favoring both growth of local tumor and the dissemination of colorectal carcinoma metastases.     

Impact of CPAP interface and mandibular advancement device on upper airway mechanical properties assessed with phrenic nerve stimulation in sleep apnea patients

Oronasal mask (ONM) can be used when mouth leaks impair nasal-CPAP effectiveness. However, ONM's constraint on the chin and straps' traction may alter upper airway (UA) mechanical properties. In contrast, mandibular advancement device associated with nasal-CPAP (NM+MAD) may reduce UA resistance. The aim of this exploratory study was to compare the effects of ONM, NM, and NM+MAD on UA mechanical properties. The three interface modalities were assessed in 11 OSAS patients at 6, 8, 10cmH(2)O CPAP using a phrenic nerve magnetic stimulation (PNMS) protocol. PNMS-twitches' related flow, pharyngeal pressures (nasopharynx, velopharynx, oropharynx) and UA resistances were determined. Regardless of CPAP level, twitch-induced maximum flow was higher with NM+MAD than with ONM. Velopharyngeal resistance was higher with ONM than with NM+MAD. Oropharyngeal resistance was higher with ONM than with NM. In conclusion, NM+MAD reduced velopharyngeal resistance compared to those measured with ONM and NM alone. We hypothesize that this strategy may help reducing the effective pressure level and thus further limit the risk for mouth leaks.