Effects of pentoxifylline on the vascular response to injury after angioplasty in rabbit iliac arteries

Pentoxifylline (PTX) inhibits the effects of several cytokines and reduces injury-related collagen accumulation. The aim of the present study was to investigate the effect of PTX on the vascular response to injury. We treated rabbits with PTX (100 mg/kg/day) or placebo (saline) subcutaneously from 2 days before angioplasty of an iliac artery until euthanasia 7 or 28 days later. At 7 days after injury, PTX treatment was associated with a more differentiated (less proliferation, more smoothelin-positive) intimal smooth muscle cell phenotype. Furthermore, PTX reduced myofibroblast accumulation in adventitia. At 28 days after injury, PTX-treated rabbits had a 48.5% larger lumen area (P = 0.03) and a 28.1% larger area within the external elastic lamina (P = 0.04). There were no significant differences between PTX-treated rabbits and the placebo group with regard to neointima and media area. Angioplasty induced marked neoadventitial hyperplasia, which was reduced by 20.5% (P = 0.01) in the PTX-treated group. Finally, PTX reduced collagen density in all three arterial layers. We conclude that PTX treatment induces less proliferation within the vessel wall early after angioplasty and increases late lumen size after angioplasty by a positive effect on vascular remodeling. Martin Busk and Michael Maeng contributed equally to this paper. Returned for 1. Revision: 6 September 2007 1. Revision received: 4 October 2007 Returned for 2. Revision: 24 October 2007 2. Revision received: 31 October 2007     

A Misinterpreted Case of Aorta Prosthesis Endocarditis: Remember The Phenomenon of Microbubbles

A 17‐year‐old male with a history of newly implanted mechanical valve at the aortic position, presented with fever, rigors, and painful cutaneous abscesses on his lower extremities and was suspected for infective endocarditis. Transthoracic echocardiography (TTE) showed a vegetation‐like structure following the movement of the mechanical heart valve (MHV), which eventually proved to be a product of degassing microbubbles (MB).     

Effects of liraglutide on cardiovascular risk factors in patients with type 1 diabetes

We investigated the short‐term effect of adding liraglutide 1.8 mg once daily to insulin treatment on cardiovascular risk factors in patients with type 1 diabetes. In total, 100 overweight (BMI ≥25 kg/m²) adult patients (age ≥18 years) with type 1 diabetes and HbA1c ≥ 8% (64 mmol/mol) were randomized to liraglutide 1.8 mg or placebo added to insulin treatment in a 24‐week double‐blinded, placebo‐controlled trial. At baseline and after 24 weeks of treatment, 24‐hour blood pressure and heart rate, pulse pressure, pulse wave velocity and carotid intima‐media thickness were evaluated. Compared with placebo, liraglutide increased 24‐hour heart rate by 4.6 beats per minute (BPM); P = .0015, daytime heart rate by 3.7; P = .0240 and night‐time heart rate by 7.5 BPM; P < .001 after 24 weeks. Diastolic nocturnal blood pressure increased by 4 mm Hg; P = .0362 in the liraglutide group compared with placebo. In conclusion, in patients with long‐standing type 1 diabetes, liraglutide as add‐on to insulin increased heart rate and did not improve other cardiovascular risk factors after 24 weeks of treatment.     

Comparison of peri‐implant clinical and radiographic status around short (6 mm in length) dental implants placed in cigarette‐smokers and never‐smokers: Six‐year follow‐up results

Background

It is hypothesized that peri‐implant clinical and radiographic inflammatory parameters (probing depth [PD], bleeding on probing [BOP] and plaque index [PI]; and radiographic (crestal bone loss [CBL]) are worse among cigarette‐smokers (CS) compared with never‐smokers (NS) with short implants.

Purpose

The present 6‐year follow‐up retrospective study compared the peri‐implant clinical and radiographic parameters in CS and NS with short dental implants (6 mm in length).

Materials and methods

Fifty‐six male individuals were included. These individuals divided into 2 groups as follows: (a) Group‐1: 29 self‐reported systemically healthy CS with 48 short‐implants; and (b) Group‐2: 27 self‐reported systemically healthy NS with 43 short implants. Peri‐implant PD, PI, BOP, and CBL were measured. Group comparisons were done using the Kruskal‐Wallis test and sample size was estimated. Level of significance was set at P values < .05.

Results

In groups 1 and 2, the follow‐up durations were 6.2 ± 0.1 years and 6.1 ± 0.3 years, respectively. A cigarette smoking history of 8.9 ± 3.6 pack years was reported by individuals in Group‐1. At follow‐up, scores of peri‐implant PD, BOP, PI, and mesial and distal CBL were comparable around short implants in both groups.

Conclusion

Under strict oral hygiene maintenance protocols, short dental implants can remain functionally stable in CS in a manner similar to NS.     

Metformin‐associated risk of acute dialysis in patients with type 2 diabetes: A nationwide cohort study

Recent guidelines governing anti‐diabetic medications increasingly advocate metformin as first‐line therapy in all patients with type 2 diabetes. However, metformin could be associated with increased risk of acute kidney injury (AKI), acute dialysis and lactate acidosis in marginal patients. In a retrospective nationwide cohort study, a total of 168 443 drug‐naïve patients with type 2 diabetes ≥50 years, initiating treatment with either metformin or sulphonyl in Denmark between 2000 and 2012 were included in this study (70.7% initiated treatment with metformin); calculation of 1‐year risk of acute dialysis was based on g‐standardization of cause‐specific Cox regression models for acute dialysis, end‐stage renal disease and death. One‐year risks of acute dialysis were 92.4 per 100 000 (95% CI, 67.1‐121.3) and 142.7 per 100 000 (95% CI, 118.3‐168.0) for sulphonylurea and metformin, respectively. The metformin‐associated 1‐year risk of acute dialysis was increased by 50.3 per 100 000 (95% CI, 7.9‐88.6), corresponding to a risk ratio of 1.53 (95% CI, 1.06‐2.23), and a number needed to harm of 1988, thus providing evidence of potential concerns pertaining to the increasing use of metformin.     

Several Conventional Risk Markers Suggesting Presence of Albuminuria Are Weak Among Rural Africans With Hypertension

The objective of this cross‐sectional study was to investigate risk markers indicating the presence of albuminuria in patients with hypertension in rural sub‐Saharan Africa (SSA). Urine albumin‐creatinine ratio, glycated hemoglobin (HbA_1c), blood pressure, anthropometry, and other patient characteristics including medications were assessed. We identified 160 patients with hypertension, of whom 68 (42.5%) were co‐diagnosed with diabetes mellitus (DM). Among the included participants, 57 (35.6%) had albuminuria (microalbuminuria [n=43] and macroalbuminuria [n=14]). A backward multivariate logistic regression model identified age (per 10‐year increment) (odds ratio [OR], 1.42; 95% confidence interval [CI], 1.03–1.95), HbA_1c >53 compared with <48 mmol/mol (OR, 3.81; 95% CI, 1.74–8.35), and treatment with dihydropyridine calcium channel blockers (OR, 2.59; 95% CI, 1.09–6.16) as the variables significantly associated with albuminuria. Only dysregulated DM and age were the conventional risk markers that seemed to suggest albuminuria among patients with hypertension in rural SSA.