Glucagon-Like Peptide-1 and its Cardiovascular Effects

Recently, the crucial role of GLP-1 in cardiovascular disease has been suggested by both preclinical and clinical studies. In vivo and in vitro studies have demonstrated cardio-protective effects of GLP-1 by activating cell survival signal pathways, which have greatly reduced ischemia/reperfusion injury and also cardiac dysfunction in various congestive heart failure animal models. Clinically, beneficial effects of GLP-1 have been shown in patients with myocardial infarction, hypertension, and heart failure, and 2 classes of incretin enhancers, GLP-1 receptor agonists and DPP-4 inhibitors, are currently available for the treatment of type 2 diabetes mellitus. In this review, we will summarize the role of incretins in various cardiovascular events such as hypertension and heart failure and postprandial lipoprotein secretion, and discuss their molecular mechanisms and potentials as a new therapeutic as well as preventive drug type for reducing cardiovascular events in both diabetic and nondiabetic patients.     

Effect of nickel ion doping in MnO2/reduced graphene oxide nanocomposites for lithium adsorption and recovery from aqueous media

Novel and effective reduced graphene oxide–nickel (Ni) doped manganese oxide (RGO/Ni-MnO₂) adsorbents were fabricated via a hydrothermal approach. The reduction of graphite to graphene oxide (GO), formation of α-MnO₂, and decoration of Ni-MnO₂ onto the surface of reduced graphene oxide (RGO) were independently carried out by a hydrothermal technique. The physical and morphological properties of the as-synthesized adsorbents were analyzed. Batch adsorption experiments were performed to identify the lithium uptake capacities of adsorbents. The optimized parameters for Li⁺ adsorption investigated were pH = 12, dose loading = 0.1 g, Li⁺ initial concentration = 50 mg L⁻¹, in 10 h at 25 °C. It is noticeable that the highest adsorption of Li⁺ at optimized parameters are in the following order: RGO/Ni3-MnO₂ (63 mg g⁻¹) > RGO/Ni2-MnO₂ (56 mg g⁻¹) > RGO/Ni1-MnO₂ (52 mg g⁻¹). A Kinetic study revealed that the experimental data were best designated pseudo-second order for each adsorbent. Li⁺ desorption experiments were performed using HCl as an extracting agent. Furthermore, all adsorbents exhibit efficient regeneration ability and to some extent satisfying selectivity for Li⁺ recovery. Briefly, it can be concluded that among the fabricated adsorbents, the RGO/Ni3-MnO₂ exhibited the greatest potential for Li⁺ uptake from aqueous solutions as compared to others.

Novel and effective reduced graphene oxide–nickel (Ni) doped manganese oxide (RGO/Ni-MnO₂) adsorbents were fabricated via a hydrothermal approach for lithium adsorption and recovery from aqueous media.     

Robot-assisted Posterior Retroperitoneoscopic Adrenalectomy Using Single-port Access: Technical Feasibility and Preliminary Results

Background

Posterior retroperitoneoscopic adrenalectomy (PRA) has several benefits compared with transperitoneal adrenalectomy in that it is safe and has a short learning curve. In addition, it provides direct short access to the target organ, prevents irritation to the intraperitoneal space, and does not require retraction of adjacent organs.1 ^– 3 We have performed several cases of robot-assisted PRA using single-port access for small adrenal tumors. This multimedia article introduces the detailed methods and preliminary results of this procedure.

Methods

Five patients underwent single-port robot-assisted PRA between March 2010 and June 2011 at our institution. During the procedure, patients were placed in a prone jackknife position with their hip joints bent at a right angle (Fig. 1). A 3 cm transverse skin incision was made just below the lowest tip of the 12th rib (Fig. 2), and the Glove port (Nelis, Kyung-gi, Korea) was placed through the skin incision while maintaining pneumoretroperitoneum (Fig. 3). CO₂ was then insufflated to a pressure of 18 mm Hg to create an adequate working space. A 10 mm robotic camera with a 30-degree up view was placed at the center of the incision through the most cephalic portion of the Glove port. A Maryland dissector or Prograsp forceps (Intuitive Surgical, Inc., Sunnyvale, CA) was placed on the medial side of the incision, and Harmonic curved shears (Intuitive Surgical) were placed on the lateral side of the incision (Fig. 4). Using the Maryland dissector and the harmonic curved shears, the Gerota fascia is opened, perinephric fat is dissected, and the kidney upper pole is mobilized to expose the adrenal gland (Fig. 5). Gland dissection starts with lower margin detachment from the upper kidney pole in a lateral to medial direction (Fig. 6). After dissecting the adrenal gland from surrounding adipose tissue and medial isolation of the adrenal central vein, the vessel is ligated with a 5 mm hemolock clip (Fig. 7). Patient clinicopathologic data were analyzed retrospectively.

Results

The mean patient age was 56.6 ± 8.7 (range, 47–69) years. Right and left side approaches were used in two and three patients, respectively. All cases were adrenal cortical adenoma. The mean tumor size was 1.48 ± 0.28 (range, 1.0–1.7) cm. The mean surgery duration (skin to skin) was 159.4 ± 57.6 (range, 103–245) minutes, and the mean estimated blood loss was 46.0 ± 56.8 (range, 5–120) ml. The average time to oral intake and postoperative hospital stay were 0.65 ± 0.11 (range, 0.54–0.79) days and 4.0 ± 2.23 (range, 3–8) days, respectively. There were no conversions to open surgery or postoperative compli- cations.

Discussion

Some trials of minimally invasive single-access surgery of the adrenal gland have recently been performed.4 ^, 5 However, these new techniques have several limitations as a result of restrictions on instrumentation movement because of the small access ports used and relatively low-quality images produced. The recent introduction of the da Vinci S surgical robot system (Intuitive Surgical) to endoscopic surgery has improved instrumental dexterity and provided the surgeon with an ergonomically designed operating system. This system is also potentially safer and more meticulous in performing operations than endoscopic procedures as a result of a 3-D, magnified, stable operative view.6 ^, 7 The advantages of the da Vinci S surgical robot system and the numerous benefits of the posterior retroperitoneal approach motivated us to utilize single-port robot-assisted PRA. The primary selection criteria were small tumor size and a minimal amount of periadrenal fatty tissue because robot-assisted PRA using single-port access provides a small operative space, which causes manipulation problems when tumors are large. To ensure the safe application of these new techniques, we recommend that novice surgeons begin using single-port robot-assisted PRA for smaller tumors < 2 cm in patients with a body mass index of < 30 kg/m², gradually extending the size and body mass index as they accumulate experience. Although robot-assisted PRA using single-port access could not be compared with the other robotic adrenalectomy techniques in this study, the potential advantages of this approach compared to conventional robot-assisted transperitoneal adrenalectomy include a reduction in postoperative ileus, bacterial contamination, and intestinal complications because the peritoneal cavity is not opened, in addition to a reduction in postoperative pain because of its minimally invasive nature.

Conclusions

Our initial experiences with robot-assisted PRA using single-port access assured us of its safety and feasibility for the resection of small adrenal tumors. Although single-port robot-assisted PRA appears to be safe and feasible, further experience and research is required to optimize patient selection criteria and verify its advantages over the traditional three-incision PRA technique.     

The effect of screw length on fracture load and abutment strain in dental implants with external abutment connections

Purpose: One of the most common types of failure in dental implants is fracture of the abutment screw, after which the remnant is usually not easily removed. The purpose of this study was to investigate the effect of abutment screw length on the amount of screw resistance load and strain after loading. Materials and Methods: Twenty-one implants and straight abutments were prepared. The implants were placed in acrylic resin blocks at an angle of 30 degrees relative to the long axis. The abutment screws were prepared and classified into seven groups based on length (n = 3 abutments per group). The implants and abutments were joined with a torque of 30 Ncm. Strain gauges were attached to the abutments, and the implant-abutment assemblies were compressed. Curves of strain over time, peak load, and load at fracture were measured. Linear models of the variables over the abutment screw length were analyzed. Results: The break and peak loads were significantly associated with abutment screw length. However, all measured break and peak loads were greater than the maximal occlusal force. There were no significant changes in peak or break strain values associated with screw length (P > .05). Conclusions: Clinically, fractured abutment screws may be replaced by shorter abutment screws without removal of the broken screw remnant.     

A directly GP130-targeting small molecule ameliorates collagen-induced arthritis (CIA) by inhibiting IL-6/GP130 signalling and Th17 differentiation

Rheumatoid arthritis is a chronic inflammatory disease associated with joint inflammation and destruction driven by T helper 17 (Th17) cells. Interleukin-6 (IL-6) is secreted by many cell types, including macrophages and synovial fibroblasts. It induces the differentiation and function of Th17 cells that can increase lymphocytic infiltration in the joint. LMT-28 can suppress IL-6 signalling through direct binding to glycoprotein-130 and alleviate inflammatory diseases such as rheumatoid arthritis and inflammatory bowel disease. The purpose of this study was to assess whether LMT-28 could potently inhibit Th17 differentiation and to determine the mechanism involved in the attenuating effect of LMT-28 on rheumatoid arthritis through the IL-6 signalling pathway. LMT-28 reduced the arthritis score and showed protective effects against bone and cartilage destruction in collagen-induced arthritis (CIA) mice. In mice with CIA, LMT-28 markedly decreased serum levels of IL-6, TNF and IL-1β compared to vehicle control. Moreover, LMT-28 attenuated Th17 cell activation in lymph nodes of CIA mice. We demonstrated that LMT-28 suppressed differentiation of Th17 in mouse splenocytes and human peripheral blood mononuclear cells (PBMCs). Additionally, LMT-28 inhibited phosphorylation of GP130, STAT3 and ERK induced by Hyper-IL-6 in human fibroblast-like synoviocytes (FLS). Collectively, these results suggest that LMT-28 can inhibit differentiated/activated-Th17 cells in rheumatoid arthritis by blocking activation of the STAT3 pathway. LMT-28 can attenuate rheumatoid arthritis by inhibiting differentiation/activation of Th17 cells and suppressing the proliferation and signalling activation of the IL-6/solubleIL-6 receptor complex stimulated FLS.     

Subclassification and Treatment Results of Ethanol Embolotherapy of Type II Arteriovenous Malformations of the Extremity and Body

PurposeTo evaluate the safety and efficacy of ethanol and coil embolization of type II arteriovenous malformation (AVM) according to a new subtype classification.Materials and MethodsEighty-four type II AVMs in the body or extremity of 79 patients who underwent AVM treatment from 1996 to 2017 were retrospectively subclassified according to the angiographic morphology of the draining vein as type IIa (arterioles shunt to focal segment of single draining vein), type IIb (arterioles shunt to venous sac with multiple draining veins), and type IIc (arterioles shunt along long segment of draining vein). Coil and ethanol embolization of the focal or long segment of the draining vein or the venous sac was performed with direct puncture or transvenous approach according to subtype. Treatment outcomes, number of treatment sessions, and complications were analyzed.ResultsAVM cure (ie, complete embolization) rates were 95%, 76%, and 65% in types IIa, IIb, and IIc AVMs, respectively. The cure rate of type IIa AVMs was significantly better than that of type IIc AVMs (P = .015). Median numbers of treatment sessions were 1 in types IIa and IIb AVMs and 2.5 in type IIc AVMs, with a significant difference between type IIc and the other 2 types (P < .05). Minor complications occurred in 20% of patents and major complications occurred in 7%.ConclusionsThe cure rate of type IIa AVMs was significantly better than that of type IIc AVMs, which also required significantly more treatment sessions than the other 2 types.