Effects of Losartan,HO‐1 Inducers or HO‐1 Inhibitors on Erectile Signaling in Diabetic Rats

IntroductionActivation of the renin‐angiotensin system which is common in diabetes mellitus might affect heme oxygenase (HO‐1) gene expression.AimAssessment of the effects of administration of angiotensin II (Ang II) receptor antagonist (losartan) with HO‐1 inducer or inhibitor on erectile signaling in diabetic rats.Materials and MethodsSeventy male rats were divided equally into seven groups; healthy controls, streptozotocin‐induced diabetic rats, rats on citrate buffer, diabetic rats on losartan, diabetic rats on HO‐1 inducer (cobalt protoporphyrin [CoPP]), diabetic rats on losartan and CoPP, and diabetic rats on losartan and HO‐1 inhibitor (stannus mesoporphyrin [SnMP]).Main Outcome MeasureHO enzyme activity, HO‐1 gene expression, cyclic guanosine monophosphate (cGMP) assay, intracavernosal pressure (ICP), and cavernous tissue sinusoids surface area.ResultsHO‐1 gene expression, HO enzymatic activity, and cGMP were significantly decreased in the cavernous tissue of diabetic rats. These parameters were significantly elevated with the use of CoPP that restored the normal control levels of HO enzyme activity. Administration of losartan exhibited a significant enhancing effect on these parameters compared with the diabetic group, but not restored to the control levels, whereas administration of CoPP combined with losartan led to the restoration of their normal levels. ICP demonstrated significant decline in diabetic rats. The use of CoPP and/or losartan led to its significant improvement compared with diabetic rats. Administration of either losartan and/or CoPP led to a significant increase in the cavernous sinusoids surface area of diabetic rats. Administration of losartan with SnMP significantly decreased the enhancing effect of losartan on the studied parameters.ConclusionThe decline in erectile function in diabetes mellitus could be attributed to the downregulation of HO‐1 gene expression. HO‐1 induction added to Ang II receptor antagonist could improve erectile function. Abdel Aziz MT, El Asmer MF, Mostafa T, Atta H, Mahfouz S, Fouad H, Rashed L, Sabry D, Hassouna A, Abdel Aziz AT, Senbel A, and Demery A. Effects of losartan, HO‐1 inducers or HO‐1 inhibitors on erectile signaling in diabetic rats.     

Estrogen and ghrelin decrease cytoplasmic expression of p27<Superscript>kip1</Superscript>, a cellular marker of ageing,in the striated anal sphincter and levator muscle of ovariectomized rats

A study was carried out to investigate the effect of estrogen and/or ghrelin on the cellular marker of ageing, p27^kip1, in pelvic floor muscles of ovariectomized rats. Virgin Wistar rats (13 months old) underwent ovariectomy followed (1 month) by 42 daily intraperitoneal 17-β estradiol (10 μg/kg), ghrelin (2 μg/kg), both hormones, or placebo vehicle (n=6×4 groups). Six more age-matched animals underwent sham surgery without ovariectomy. Cytoplasmic expression of p27^kip1 in the striated urethral and anal sphincters and levator muscle was measured by Western blot analysis in all animals (n=30). p27^kip1 signal intensity significantly increased postovariectomy in all muscles compared to sham animals. In the anal sphincter and levator, signal intensity decreased to sham levels with ghrelin or estrogen and decreased further after estrogen or ghrelin and estrogen/ghrelin administration. Urethral sphincter signal intensity decreased without reaching sham levels after drug administration. Estrogen and/or ghrelin replacement reverses the ovariectomy-induced exacerbation of biochemical cellular ageing in the anal sphincter and levator muscle of middle-aged rats.     

Effect of exercise training on heart rate recovery in patients post anterior myocardial infarction

Background

Regular exercise training has been shown to reduce mortality, improve functional capacity; and control the risk factors in myocardial infarction (MI) patients. Heart rate recovery (HRR) is a strong independent mortality predictor in patients with previous MI.

Ultrasound detection of heel enthesitis: a comparison with magnetic resonance imaging

OBJECTIVE: Seronegative arthropathies are associated with inflammatory enthesopathy. The involvement of Achilles tendon and plantar aponeurosis is common, with strong tendency toward fibrosis and calcification. This study tests the diagnostic efficacy of ultrasound (US) in depicting enthesitis, and compares sonographic images with magnetic resonance images (MRI). METHODS: We studied 32 patients with a diagnosis of seronegative arthropathies, 22 men, 10 women, mean age 29 years. They had heel enthesopathy without typical conventional radiographic evidence. T1 and T2 weighted and short-tau inversion recovery (STIR) MRI sequences were obtained in axial and sagittal planes. An HDI 3000 ATL US device equipped with 12 MHz linear transducer was used to examine the enthesis. Three independent observers assessed the reliability of sonographic images by using video recording of the US examinations. RESULTS: US images of enthesitis showed loss of normal fibrillar echotexture of tendon (100%), lacking the homogeneous pattern, with blurring of tendon margins (56.2%) and irregular fusiform thickening (84.3%). The affected tendons showed intratendinous lesions with ill defined focal tendon defects filled with a mixture of fluid, fat, and/or granulation tissue, with loss of their tightly packed echogenic dots. MRI showed tendon enlargement (62.5%) with loss of the normal flattened hypointense appearance, focal thickening and rounded configuration at the insertion site (31.2%), intermediate T1 and high T2 signals, and diminished signals within the pre-Achilles fat pad due to inflammatory edema. Among all patients, 40.6% developed osteitis. CONCLUSION: MRI was not sensitive compared to US in detecting early changes of enthesopathy. Fatty degeneration appeared late in MRI, while it was detected earlier using US. MRI was not able to detect any calcification process at the insertion site, while US images clearly showed the very early signs of the calcification process. We recommend use of US for early diagnosis and in treatment and followup of patients with tendon enthesopathy, to accurately identify and diagnose different pathologic and biomechanical changes.     

Serum endostatin level as a marker for coronary artery calcification in type 2 diabetic patients

Objective

To assess the relationship between serum endostatin (ES) and coronary artery calcification (CAC) in type 2 diabetic (T2DM) patients.

A Survey of Expert Practice and Attitudes Regarding Advanced Imaging Modalities in Surveillance of Barrett’s Esophagus

Background

Published guidelines do not address what the minimum incremental diagnostic yield (IDY) for detection of dysplasia/cancer is required over the standard Seattle protocol for an advanced imaging modality (AIM) to be implemented in routine surveillance of Barrett’s esophagus (BE) patients. We aimed to report expert practice patterns and attitudes, specifically addressing the minimum IDY in the use of AIMs in BE surveillance.

Methods

An international group of BE experts completed an anonymous electronic survey of domains relevant to surveillance practice patterns and use of AIMs. The evaluated AIMs were conventional chromoendoscopy (CC), virtual chromoendoscopy (VC), volumetric laser endomicroscopy (VLE), confocal laser endomicroscopy (CLE), and wide-area transepithelial sampling (WATS^3D). Responses were recorded using five-point balanced Likert items and analyzed as continuous variables.

Results

The survey response rate was 84% (61/73)—41 US and 20 non-US. Experts were most comfortable with and routinely use VC and CC, and least comfortable with and rarely use VLE, CLE, and WATS^3D. Experts rated data from randomized controlled trials (1.4?±?0.9) and guidelines (2.6?±?1.2) as the two most influential factors for implementing AIMs in clinical practice. The minimum IDY of AIMs over standard biopsies to be considered of clinical benefit was lowest for VC (15%, IQR 10–29%) and highest for VLE (30%, IQR 20–50%). Compared to US experts, non-US experts reported higher use of CC for BE surveillance (p?<?0.001).

Conclusion

These results should inform benchmarks that need to be met for guidelines to recommend the routine use of AIMs in the surveillance of BE patients.

     

Periprocedural Anticoagulation Management of Patients receiving Warfarin in Qatar: A Prospective Cohort Study

Background: The use of anticoagulant bridging remains controversial. This study was conducted to evaluate our warfarin periprocedural management in Qatar and investigate the associated clinical outcomes with such management. Methods: A prospective cohort study was designed to describe the periprocedural clinical practice in warfarin patients in Qatar and to compare clinical safety and efficacy outcomes between anticoagulant bridging and nonbridging. Results: 103 patients were recruited. Bridging occurred in 82% of the participants. No thromboembolic events were observed, while 39.1% of patients experienced bleeding events during the study period. The incidence of overall bleeding and major bleeding were numerically higher for bridging group compared to nonbridging but did not reach statistical significance ([30.6% vs 22.2%, P = 0.478] and [12.9% vs 5.6%, P = 0.375], respectively). Conclusion: Warfarin interruption and bridging are overwhelmingly used in warfarin-treated patients in Qatar. While bridging was numerically associated with increased bleeding events, there is no statistical difference in reported clinical events between bridging and nonbridging strategies.     

A systematic review of vaccine-induced thrombotic thrombocytopenia in individuals who received COVID-19 adenoviral-vector-based vaccines

Journal of Thrombosis and Thrombolysis - Reports of thrombotic response after receiving COVID-19 Adenoviral-Vector Based Vaccines raise concerns about vaccine-induced thrombotic thrombocytopenia...