Experimental intrahepatic portacaval anastomosis: use of expandable Gianturco stents

Original Gianturco expandable stents and their modifications were used to create an experimental intrahepatic portacaval anastomosis (EIPCA) in 30 young domestic swine without portal hypertension. The study focused on the design of a suitable stent, the technique of its application, and the evaluation of short-term patency of the EIPCA. A stent with a 2.5-cm-long body and wire skirts on both ends was most suitable for EIPCA creation. Well-positioned stents shunted most of the portal blood in the inferior vena cava circulation and remained patent for 4-6 weeks. Ingrowth of liver parenchyma and abundant proliferation of the intima and connective tissue inside the stent lumen in these rapidly growing animals gradually decreased EIPCA patency, and thrombus formation with diminished blood flow closed them completely.     

Spontaneous Remission in Localized Diffuse Large B-cell Lymphoma

Diffuse large B-cell lymphoma (DLBCL) is an aggressive neoplastic disease of the lymphatic system, the activated B-cell type of this disease is likely to have a substantially worse prognosis. In this study, we report the favorable outcome of the activated B-cell type of DLBCL, though untreated, 7 years after diagnosis. In 2003, DLBCL localized to the root of tongue was found in the patient complaining of dysphonia and a pharyngeal globus perception but the patient did not agree to get any active hematological treatment. During the following years, the patient did not have any complaints. At the otorhinolaryngological control examination, in 2010, she was complaint-free, had normal laboratory parameters. Moreover a PET-CT scan did not reveal metabolic activity relating to malignancy. The extraordinary disease process can be explained by the spontaneous regression of the activated B-cell type DLBCL. Spontaneous regression of oral lymphoma has been published only exceptionally. To our knowledge, no report of spontaneous regression of activated B-cell type DLBLC has been reported.     

Renal transplantation in the United Kingdom for patients from ethnic minorities

BACKGROUND: To investigate any differences in access to transplant and post-transplant outcomes for ethnic minority patients in the United Kingdom, national data on ethnicity of patients on the waiting list, those receiving a transplant, and deceased donors were analyzed. METHODS: Adult patients and donors were included. Ethnic origin was classified as white, Asian, black, or "other." National data were analyzed, and 2001 U.K. National census data were used for comparative purposes. Median waiting times to transplant were obtained from Kaplan-Meier estimates for patients registered 1998-2000. Transplant survival was estimated for patients transplanted from 1998 to 2003. RESULTS: A total of 92% of the U.K. population was white, compared with 77% of waiting list patients, 88% of transplant recipients, and 97% of deceased donors. Median waiting time to transplantation for white patients was 719 days (95% confidence interval 680-758) compared with 1368 (1131-1605) days for Asian patients and 1419 (1165-1673) days for black patients. The degree of human leukocyte antigen matching achieved was inferior for Asian and black patients. There is some evidence of inferior 3-year transplant survival for black patients compared with white and Asian patients (P=0.03). CONCLUSIONS: There are imbalances in the ethnic make up of the waiting list, the donor pool, and renal transplant recipients. There are significant differences in both post-transplant outcomes and time to transplantation between patients of different ethnic origin. Waiting times are influenced by allocation schemes, and the 2006 U.K. National Kidney Allocation Scheme is designed to achieve greater equity of access to transplant for all patients, regardless of geography, blood group, or ethnicity.     

Telmisartan increases fatty acid oxidation in skeletal muscle through a peroxisome proliferator-activated receptor-gamma dependent pathway

OBJECTIVES: Telmisartan is an angiotensin II receptor blocker and selective modulator of peroxisome proliferator-activated receptor-gamma reported to increase energy expenditure and improve glucose and lipid metabolism compared with other angiotensin II receptor blockers. As muscle fatty acid oxidation is a major determinant of energy expenditure, we investigated the effects of telmisartan on skeletal muscle fatty acid oxidation in a rat model of the metabolic syndrome. METHODS: We measured fatty acid oxidation in soleus muscles obtained from polydactylous (PD)/Cub rats fed a high sucrose, high fat diet and treated with either telmisartan or losartan. In addition, we measured fatty acid oxidation in soleus muscle tissue isolated from Sprague-Dawley rats, incubated for 3 h with either telmisartan or valsartan. RESULTS: Compared with treatment with losartan, treatment with telmisartan was associated with significantly greater palmitate oxidation in skeletal muscle (44.4 +/- 2.9 versus 28.9 +/- 3.2 nmol palmitate/g/2 h, P = 0.004) as well as significantly greater glucose tolerance and significantly lower body weight and visceral adiposity. In addition, in-vitro incubation of skeletal muscle with telmisartan induced significantly greater increase in palmitate oxidation than in-vitro incubation with valsartan (9.4 +/- 1.6 versus 0.2 +/- 4.3 nmol palmitate/g/h, P < 0.05). The increased fatty acid oxidation induced by telmisartan in vitro was blocked by addition of the peroxisome proliferator-activated receptor-gamma antagonist GW9662 (-0.4 +/- 1.8 nmol palmitate/g/h, P < 0.05). CONCLUSION: The current results are consistent with the possibility that telmisartan may increase energy expenditure and protect against dietary induced obesity and features of the metabolic syndrome at least in part by increasing muscle fatty acid oxidation through activation of peroxisome proliferator-activated receptor-gamma.     

Gene therapy and CVD: how near are we?

Critical for success of any gene therapy approach is the efficient packaging, effective cell specific delivery and nuclear translocation of the nucleic acid with minimal toxicity. Delivery systems utilizing a wide variety of viral vectors have traditionally been used to modify genomic DNA. However, drawbacks to the viral vectors include difficulties in large-scale production, potential contamination by wild-type viral particles and immunogenicity. Thus, efficient non-viral delivery of both plasmids for transgene expression and short oligonucleotides for modulating cellular functions has been developed. Gene therapy is now a consideration in the treatment of certain inherited and acquired genetic disorders associated with cardiovascular disease (CVD). Furthermore, many other cardiovascular conditions are potential targets for gene therapy, and advances in knowledge will increase the ability to link specific genes to a disease, resulting in the identification of further targets. With improvements in delivery and targeting, gene therapy is likely to substantially augment established and emerging therapies in reducing the global burden of cardiovascular disease.