Bicoronary-pulmonary fistulae with coexistent mitral valve prolapse: a case report and literature review of coronary-pulmonary fistula

Bicoronary-pulmonary artery fistulae are rare congenital coronaryartery fistulae. We report the case of a 57-year-old man whopresented with biventricular failure and angina pectoris. Atangiography the coronary arteries were normal, but bicoronary-pulmonaryfistulae were noted; severe mitral regurgitation secondary tomitral valve prolapse was also present. At right heart catheterizationthe calculated left to right shunt was 2.1. Fistula ligationand repair of both mitral and tricuspid valves was undertaken.The literature regarding coronary-pulmonary fistula is alsoreviewed.     

Menadione-Induced Oxidative Stress in Bovine Heart Microvascular Endothelial Cellsa

Objective: Oxidative stress from increased production of reactive oxygen species or decreased efficiency of inhibitory and scavenger systems may contribute to vascular injury. In this study, we developed an in vitro model of vascular injury by menadione-induced oxidative stress in bovine heart microvascular endothelial cells. Methods: Oxidative stress was induced by exposure to menadione. Superoxide, hydrogen peroxide and hydroxyl radical formation was measured by superoxide dismutase-inhibitable cytochrome c reduction, the dichlorofluorescin technique and the salicylate method, respectively. Electron paramagnetic-spin resonance spectroscopy employing 5–5′-dimethyl-1-pyrroline-N-oxide for superoxide trapping was used. Endothelial cell cytotoxicity was assessed by lactate dehydrogenase release. Results: Superoxide and hydroxyl radical were produced in a time- and concentration-dependent fashion. Fluorescence in the presence of dichlorofluorescin confirmed hydrogen peroxide formation. Endothelial cell cytotoxicity became evident after 5 h of menadione treatment at concentrations of 100 μM. 3-Aminobenzamide, a poly(ADP-ribose)polymerase inhibitor, and dimethylthiourea, a hydrogen peroxide and hydroxyl radical scavenger, decreased menadione cytotoxicity, whereas deferoxamine, an inhibitor of hydroxyl radical formation, did not. Conclusions: The results suggest that menadione toxicity is mediated by poly(ADP-ribose)polymerase activation via hydrogen peroxide formation and that menadione-treated bovine heart microvessel endothelial cells provide a suitable in vitro model to study oxidative stress in endothelial cells.     

Comparative Study Between Various Methods of Percutaneous Transvenous Mitral Commissurotomy Metallic Valvotome, Inoue Balloon, and Double-Balloon Techniques (VID) Study

The aim of this study was to compare the immediate results of percutaneous mitral commissurotomy using metallic valvotome, Inoue balloon, or double‐balloon techniques. We conducted a randomized trial comparing the immediate results of the three procedures in 150 patients (50 patients in each group) who were rheumatic mitral stenosis candidates for valvuloplasty. The procedures used per group were metallic valvotome (group I), Inoue balloon (group II), and double balloon (group III). The three groups were similar in age, sex, MVA, transmitral PG, LV function, predicted PAP, and presence of mitral re gurgitation. Patients in group I had a higher MV score (>9) than group II and III. The MVA was increased by a similar degree in groups I and III (2.1 ± 0.5 cm², 2.0 ± 1.2 cm²) but greater than group II (1.87 ± 0.4 cm²) (P = 0.01). Mean transmitral PG was lower in group III (4.3 ± 1.9 mmHg) than in groups I and II (6.3 ± 3.7 mmHg, 6.3 ± 5.3 mmHg), respectively (P = 0.01). Echocardiographic data showed a higher depth score of posterior commissural splitting in groups I and III (0.7 ± 0.3 cm, 0.8 ± 0.3 cm, respectively) than in group II (0.6 ± 0.3) (P = 0.006), while the depth score of anterior commissure splitting was comparable in all groups (0.6 ± 0.3, 0.6 ± 0.3, and 0.7 ± 0.3, respectively) (P = 0.4). Stepwise multivariate regression analysis revealed that the following variables significantly affect the success of valvuloplasty as evidenced by a MVA ≥ 1.5 cm². (1) techniques, the larger MVA was achieved by valvotome and double balloon (P = 0.0001); (2) MVA before valvuloplasty, the larger the MVA before, the larger the MVA after (P = 0.0008); (3) valve thickness, the more the thickness, the smaller the achieved MVA (P = 0.01); und (4) valve mobility, the more limited mobility, the smaller the MVA (P = 0.007). Small and restrictive ASD was present in 14 (28%) patients in group I, 2 (4%) patients in group II, and 3 (6%) patients in group III. Changes in grade of mitral regurgitation was comparable in all groups as the grade increased by I grade (40% in group I, 36% in group II, and 36% in group III). In contrast to the Inoue balloon technique, the metallic valvotome, and double‐balloon technique produced an excellent and comparable early improvement of MVA associated with minimal complications. However, the good results achieved with patients who had a higher MV score (≥9) by metallic valvotome and lower cost indicate that metallic valvotome should be the treatment of choice for tight mitral stenosis.     

Cancer Chemoprevention by Polyphenols and Their Potential Application as Nanomedicine

Today cancer is a leading cause of death among the developed countries. Its highly complex nature makes it difficult to understand as it entails multiple cellular physiological systems such as cell signaling and apoptosis. The biggest challenges faced by cancer chemoprevention/chemotherapy is maintaining drug circulation and avoiding multidrug resistance. Overall there is modest evidence regarding the protective effects of nutrients from supplements against a number of cancers. Numerous scientific literatures available advocate the use of polyphenols for chemoprevention. Some groups have also suggested use of combination of nutrients in cancer prevention. However, we have yet to obtain the desired results in the line of cancer chemotherapy research. Nanotechnology can play a pivotal role in cancer treatment and prevention. Moreover, nanoparticles can be modified in various ways to prolong circulation, enhance drug localization, increase drug efficacy, and potentially decrease the chances of multidrug resistance. In this communication, we will cover the use of various polyphenols and nutrients in cancer chemoprevention. The application of nanotechnology in this regard will also be included. In view of available reports on the potential of nanoparticles, we suggest their usage along with different combination of nutrients as cancer chemotherapeutic agents.     

Total Particulate Matter and Wound Healing: An in vivo Study with Histological Insights

Objectives Wound healing in the skin is a multifarious orchestration of cellular processes and cigarette smoking may be a cause for delayed wound healing. The aim of this study was to investigate the plausible association between exposures of cigarette total particulate matter （TPM） and wound healing. Methods An in vivo wound healing model of mice was established for determination of assorted events of wound healing, dermal matrix regeneration, re-epithelialization, and neovascularization. A total of 72 adult mice, separated in eight groups, were exposed to TPM for 12 days. Results A highly considerable diminution in wound closure （P〈0.001） was pragmatic among all TPM-treated mice from day 6 to day 8 post-wounding. Histological investigations unveiled a noteworthy impede in the outcome of re-epithelialization, dermal matrix regeneration and maturation of collagen bundles among all TPM-exposed wounds. Delayed commencement of neovascularization was pragmatic among all TPM-treated mice, on day 12 post wounding. Abbot curve, angular spectrum, and other different parameters of 3D surface behavior of wounds revealed a very highly significant reduction （P〈0.001） in angiogenesis on days 6 and 8 post-wounding, which points that application of TPM instigates extensive delay in trigging the progression of angiogenesis, resulting in delayed onset of wound healing. Conclusion Our annotations validate the damaging effects of TPM on wound healing and excessive use of TPM may lead to the production of chronic wounds and oral ulcers.     

A Twin Study of Metabolic Syndrome and Autonomic Tone

Introduction: One possible mechanism of higher cardiovascular mortality associated with the metabolic syndrome (MetS) may be through abnormal modulation in autonomic tone.
Methods and Results: We examined the association between the MetS and autonomic tone as measured by heart rate variability (HRV) among 288 twins from the Twins Heart Study (THS). Of the 288 participants, 151 (52%) had the MetS. The MetS was associated with decreased HRV across all frequency ranges, and each additional MetS risk factor was associated with lower HRV. After adjustment for several potential confounders, very-low frequency (P < 0.001), low frequency (P < 0.001), and total power (P = 0.02) spectra of HRV remained significantly lower in twins with a progressively higher number of MetS components (18–50% decrease comparing twins with 5 risk factors to those with no risk factors). Among 87 twin pairs who were discordant for the number of MetS components, a one-unit increment in MetS components was associated with an 8% smaller very-low frequency (p = 0.03) and a 15% smaller low frequency spectrum (P = 0.002) comparing each twin with his brother.
Conclusion: MetS was associated with lower HRV in a well-characterized sample of middle-aged male twins. This association persisted even after controlling for genetic and shared environmental factors accounted for by comparison within twin pairs. Abnormalities of autonomic tone, as evidenced by lower HRV, may be partly responsible for the higher rate of atrial fibrillation, coronary heart disease, cardiac death, and overall mortality seen in patients with the MetS.     

Comparative effects of intraduodenal psyllium and senna on canine small bowel motility

Background/aim: To define the possible contribution of altered small intestinal motor activity to side-effects of bulking fibres, we sought to compare the relative effects of intraduodenal and intracolonic administration of the bulking fibre psyllium and the anthraquinone laxative senna on canine small intestinal motor activity. Methods: Motor activity was recorded by serosal strain gauges implanted along the small intestine in 6 dogs. In random order, the motor responses to the instillation of psyllium (in doses of 5 or 10 g), senna (10 mg/kg) or appropriate vehicle (200 ml water infusion or saline 5 ml bolus) into either the proximal duodenum or proximal colon were assessed. Results: The intra-duodenal administration of psyllium in either dose consistently induced a prolonged burst of‘clustered’contractions; in contrast, clusters were infrequent and of short duration following instillation of either vehicle or senna (P < 0.05). Intraduodenal instillation of psyllium inhibited migrating motor complex (MMC) migration and consistently delayed the onset of the next MMC cycle; a similar inhibition occurred with vehicle, however. Neither senna nor its vehicle inhibited MMC migration. None of these agents had any effect on small intestinal motor activity when instilled directly into the colon. Conclusions: Psyllium administered directly into the duodenum inhibits MMC activity and consistently induces‘clustered’contractions. Whilst the MMC-inhibitory effect appears to be a non-specific volumerelated phenomenon, the induction of clusters is independent of volume or laxation. These motor effects of psyllium may contribute to the gastrointestinal symptomatology related to such agents and could be avoided by the preferential release of psyllium in the colon.