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Nigerian Medical Journal : Journal of... 2023Obesity and vascular ageing are two facets of type 2 diabetes (T2Ds) to study. The former can be studied by qualitative body fat analysis using bio-electrical impedance...
Correlation between Measures of Obesity and Vascular Ageing in Type 2 Diabetics of Rural Regions of West India with Low Prevailing Obesity: A Pulse Wave Analysis Based Cross-Sectional Study.
BACKGROUND
Obesity and vascular ageing are two facets of type 2 diabetes (T2Ds) to study. The former can be studied by qualitative body fat analysis using bio-electrical impedance (BIA) and later with blood pressure by pulse wave analysis (PWA). We studied the association between BIA and PWA parameters in T2Ds.
METHODOLOGY
One hundred and fifty-six T2Ds on treatment were evaluated for BIA (Omron Karada Scan, China) and PWA (IEM, Stolberg, Germany). BIA parameters (weight, BMI, total body fat, visceral fat, subcutaneous fat, skeletal muscle mass) and PWA parameters (arterial stiffness, brachial haemodynamics, aortic blood pressures, central haemodynamics) were studied. Comparison, correlation, risk association, and predictions were done with a p-value < 0.05 as statistically significant.
RESULTS
The mean age was 57.7 years, while the mean BMI was 22.8 kg/m2. The prevalence of hypertension was 50%, while the prevalence of glycaemic control was 10%. The correlation between BIA and PWA parameters in >75% instants was weak and insignificant (especially for aortic parameters and central haemodynamics). Female gender, BMI < 22.5 kg/m2, VF< 10, and low/normal TBF were associated with comparatively high PWA parameters, but inconsistently. High BMI or VF did not impose a significant Odds risk of high aortic pulse wave velocity or central pulse pressure. Visceral fat and aortic pulse wave velocities were not significantly predicted by blood pressure, BMI, and heart rate.
CONCLUSION
Among rural type 2 diabetics with a mean BMI of 22.8 kg/m2 and poor glycaemic control, there is largely a lack of association between obesity and vascular aging, suggesting differences in time course and pathology of the two entities in type 2 diabetics. Further studies are recommended.
PubMed: 38952885
DOI: 10.60787/NMJ-64-4-205 -
International Journal of Gynecological... Jul 2024To assess the diagnostic performance of ultrasonography in pre-operative assessment of lymph nodes in patients with cervical cancer, to compare the outcomes for pelvic...
OBJECTIVES
To assess the diagnostic performance of ultrasonography in pre-operative assessment of lymph nodes in patients with cervical cancer, to compare the outcomes for pelvic and para-aortic regions, and to detect macrometastases and micrometastases separately.
METHODS
Patients were retrospectively included if they met the following inclusion criteria: pathologically verified cervical cancer; ultrasonography performed by one of four experienced sonographers; surgical lymph node staging, at least in the pelvic region-sentinel lymph node biopsy or systematic pelvic lymphadenectomy or debulking. The final pathological examination was the reference standard.
RESULTS
390 patients met the inclusion criteria between 2009 and 2019. Pelvic node macrometastases (≥2 mm) were confirmed in 54 patients (13.8%), and micrometastases (≥0.2 mm and <2 mm) in another 21 patients (5.4%). Ultrasonography had sensitivity 72.2%, specificity 94.0%, and area under the curve (AUC) 0.831 to detect pelvic macrometastases, while sensitivity 53.3%, specificity 94.0%, and AUC 0.737 to detect both pelvic macrometastases and micrometastases (pN1). Ultrasonography failed to detect pelvic micrometastases, with sensitivity 19.2%, specificity 85.2%, and AUC 0.522. There was no significant impact of body mass index on diagnostic accuracy. Metastases in para-aortic nodes (macrometastases only) were confirmed in 16 of 71 patients who underwent para-aortic lymphadenectomy. Ultrasonography yielded sensitivity 56.3%, specificity 98.2%, and AUC 0.772 to identify para-aortic node macrometastases.
CONCLUSION
Ultrasonography performed by an experienced sonographer can be considered a sufficient diagnostic tool for pre-operative assessment of lymph nodes in patients with cervical cancer, showing similar diagnostic accuracy in detection of pelvic macrometastases as reported for other imaging methods (18F-fluorodeoxyglucose positron emission tomography/CT or diffusion-weighted imaging/MRI). It had low sensitivity for detection of small-volume macrometastases (largest diameter <5 mm) and micrometastases. The accuracy of para-aortic assessment was comparable to that for pelvic lymph nodes, and assessment of the para-aortic region should be an inseparable part of the examination protocol.
Topics: Humans; Female; Uterine Cervical Neoplasms; Middle Aged; Lymph Nodes; Retrospective Studies; Ultrasonography; Adult; Lymphatic Metastasis; Aged; Sensitivity and Specificity; Lymph Node Excision; Preoperative Care; Neoplasm Micrometastasis
PubMed: 38950926
DOI: 10.1136/ijgc-2024-005341 -
Sleep Advances : a Journal of the Sleep... 2024A high prevalence of sleep apnea has been reported among transcatheter aortic valve replacement (AVR) patients; however, the prevalence of sleep apnea in the younger and...
STUDY OBJECTIVES
A high prevalence of sleep apnea has been reported among transcatheter aortic valve replacement (AVR) patients; however, the prevalence of sleep apnea in the younger and relatively healthier population of surgical AVR (SAVR) patients is unknown.
METHODS
We assessed the prevalence of sleep apnea and overall sleep quality in patients having SAVR. Participants aged 50-89 were eligible for recruitment. All participants completed type II HST before SAVR. Sleep apnea was defined as an apnea-hypopnea index (AHI) ≥ 5 events/hour. The current use of positive airway pressure was exclusionary.
RESULTS
The 46 participants (32 males/14 females) had a mean age of 66.6 years, body mass index of 30, AHI of 23.5, and obstructive AHI of 22.0. Only four participants had a prior sleep apnea diagnosis, yet all but one had sleep apnea on type II sleep testing. Two-thirds of sleep apnea was moderate or severe (AHI ≥ 15). A quarter of respiratory events were defined by arousals without desaturations. Whereas most sleep parameters resembled those of similarly aged community cohorts, mean percentage of N3 was reduced, accounting for only 3.8% of total sleep time.
CONCLUSIONS
Type II home sleep testing (HST) revealed a 97.8% prevalence of sleep apnea in this sample, most of which was undiagnosed obstructive sleep apnea. Roughly two-thirds of sleep apnea was moderate or severe. Such a high impact of obstructive sleep apnea among patients with severe aortic valve disease deserves further investigation on potential underlying mechanisms and clinical implications.
PubMed: 38947231
DOI: 10.1093/sleepadvances/zpae034 -
Journal of the American Society of... Jun 2024
PubMed: 38945411
DOI: 10.1016/j.echo.2024.06.009 -
Cardiovascular Revascularization... Jun 2024Although the impact of predicted prosthesis-patient mismatch (PPM) on outcomes after surgical aortic valve replacement is well established, studies on PPM in...
BACKGROUND/PURPOSE
Although the impact of predicted prosthesis-patient mismatch (PPM) on outcomes after surgical aortic valve replacement is well established, studies on PPM in transcatheter aortic valve replacement (TAVR) are limited. This study investigated the effects of PPM on haemodynamic and 5-year clinical outcomes after TAVR.
METHODS/MATERIALS
We analysed 1733 patients who underwent TAVR. PPM was defined using two different methods: 1) normal reference values of the effective orifice area for each valve type and size indexed to body surface area (PPM; n = 1733) and 2) reference values for aortic annulus area or perimeter assessed with pre-procedural computed tomography indexed to body surface area (PPM; n = 1227). The primary endpoint was the composite of all-cause death and/or rehospitalisation for heart failure at 5 years.
RESULTS
The incidence of PPM was 11.7 % and 0.8 % in moderate and severe cases, respectively. PPM was classified as either moderate (3.8 %) or severe (0 %). Rates of residual mean aortic gradient ≥20 mmHg significantly increased depending on PPM severity (no PPM: 3.1 % vs. moderate PPM: 26.8 % vs. severe PPM: 53.9 %, p < 0.0001) and PPM (no PPM: 4.1 % vs. moderate PPM: 12.8 %, p = 0.0049). Neither of PPM methods were associated with the composite outcome in total cohort; however, PPM was significantly related to worse clinical outcomes at 5 years among patients with reduced left ventricular ejection fraction (LVEF) in multivariate analysis (HR: 1.87; 95 % CI: 1.02-3.43).
CONCLUSIONS
The impact of PPM on TAVR clinical outcomes may not be negligible in patients with low LVEF.
PubMed: 38944598
DOI: 10.1016/j.carrev.2024.06.011 -
Vascular Specialist International Jun 2024Endovascular treatment is an acceptable option for patients with aortoiliac occlusive disease. However, bilateral passage of guidewires through the aortoiliac occlusion...
Endovascular treatment is an acceptable option for patients with aortoiliac occlusive disease. However, bilateral passage of guidewires through the aortoiliac occlusion can be a challenging step in achieving successful revascularization. The aim of this article is to present a novel strategy for successfully passing bilateral guidewires through long aortoiliac occlusive lesions. After one guidewire is passed through the aortic and iliac lesions via one side of the femoral artery, the other guidewire is passed using the up-and-over technique and pulled out from the ipsilateral side of the body. This contralateral guidewire is then inserted into the ipsilateral angiographic catheter along with the ipsilateral guidewire. Subsequently, the angiographic catheter is removed in a manner similar to a peel-away sheath. Eventually, bilateral guidewires can be passed through the lesion via a single aortic tract.
PubMed: 38937896
DOI: 10.5758/vsi.240033 -
European Journal of Vascular and... Jun 2024Numerous articles have reported an increased incidence of limb graft occlusion (LGO) with the Cook Zenith Alpha endograft compared with other endografts in endovascular...
OBJECTIVE
Numerous articles have reported an increased incidence of limb graft occlusion (LGO) with the Cook Zenith Alpha endograft compared with other endografts in endovascular aortic aneurysm repair (EVAR). The present study aimed to assess the rate of LGO after EVAR in particular with the Cook Zenith Alpha device when adhering to a standardised protocol designed to prevent limb related complications.
METHODS
This was a non-sponsored retrospective study performed in two university vascular surgery centres employing the same protocol for limb complication prevention during EVAR from 2016 to 2019. The protocol encompassed: (1) angioplasty of any common/external iliac artery with > 50% stenosis before endograft navigation; (2) proximal sealing zone of limbs at the same level of the flow divider with minimum overlap, which is more restrictive than the Cook Zenith Alpha instructions for use; (3) semicompliant kissing ballooning of limbs; (4) limb stenting in case of any residual tortuosity/kinking/stenosis; and (5) adjunctive common and external iliac stenting for residual stenosis/dissection after EVAR. Patients enrolled in this study were treated with standard aorto-bis-iliac EVAR. Follow up was performed by clinical visit and duplex ultrasonography at discharge, six months, and yearly thereafter. The primary endpoint was to evaluate the LGO rate with different EVAR devices (Cook Zenith Alpha, Gore C3, and Medtronic Endurant) and to determine potential risk factors for LGO associated with the Zenith Alpha.
RESULTS
In the study period, 547 EVARs were considered: 233 (42.6%) Cook Zenith Alpha, 196 (35.8%) Gore Excluder, and 118 (21.6%) Medtronic Endurant. The mean follow up was 44 ± 23 months, and the five year freedom from LGO was 97 ± 3%, without differences between groups (97 ± 2%, 95 ± 3%, and 100% with Cook Zenith Alpha, Medtronic Endurant, and Gore Excluder, respectively; p = .080). In the Zenith Alpha group, intra-operative adjunctive iliac artery angioplasty, iliac artery stenting, or iliac limb stenting was performed in 8%, 3.4%, and 9.7%, respectively. Analysis of potential risk factors for LGO identified external iliac artery distal landing and large main bodies (ZIMB 32 - 36) independently associated with LGO during follow up (hazard ratio [HR] 18, 95% confidence interval [CI] 3 - 130, p = .004; and HR 12, 95% CI 1.2 - 130, p = .030, respectively).
CONCLUSION
The present experience with a protocol for limb complication prevention allows one to obtain a low rate of LGO at five years with Zenith Alpha endografts similar to other endografts. Specific risk factors for the Cook Zenith Alpha endograft are the external iliac artery distal landing and the use of a large main body (ZIMB 32 - 36).
PubMed: 38936689
DOI: 10.1016/j.ejvs.2024.06.036 -
Prostaglandins & Other Lipid Mediators Jun 2024Atherosclerosis is a chronic inflammatory disease forming plaques in medium and large-sized arteries. ADAMTS-4 (a disintegrin and metalloproteinase with thrombospondin...
Atherosclerosis is a chronic inflammatory disease forming plaques in medium and large-sized arteries. ADAMTS-4 (a disintegrin and metalloproteinase with thrombospondin motifs-4) is an extracellular-matrix remodelling enzyme involved in the degradation of versican in the arterial wall. Recent reports indicated that increased expression of ADAMTS-4 is associated with plaque progression and vulnerability. Bioactive components of dietary oil, like sesame oil, are reported to have anti-inflammatory and antioxidant properties. Here, we studied the effect of sesame oil on regulating ADAMTS-4 in high-fat diet-induced atherosclerosis rat model. Our results indicated that sesame oil supplementation improved the anti-inflammatory and anti-oxidative status of the body. It also reduced atherosclerotic plaque formation in high-fat diet-fed rats. Our results showed that the sesame oil supplementation significantly down-regulated the expression of ADAMTS-4 in serum and aortic samples. The versican, the large proteoglycan substrate of ADAMTS-4 in the aorta, was downregulated to normal control level on sesame oil supplementation. This study, for the first time, reveals that sesame oil could down-regulate the expression of ADAMTS-4 in high-fat diet-induced atherosclerosis, imparting a new therapeutic potential for sesame oil in the management of atherosclerosis.
PubMed: 38936541
DOI: 10.1016/j.prostaglandins.2024.106862 -
International Journal of Molecular... Jun 2024Takayasu's arteritis (TAK) manifests as an insidiously progressive and debilitating form of granulomatous inflammation including the aorta and its major branches. The... (Review)
Review
Takayasu's arteritis (TAK) manifests as an insidiously progressive and debilitating form of granulomatous inflammation including the aorta and its major branches. The precise etiology of TAK remains elusive, with current understanding suggesting an autoimmune origin primarily driven by T cells. Notably, a growing body of evidence bears testimony to the widespread effects of B cells on disease pathogenesis and progression. Distinct alterations in peripheral B cell subsets have been described in individuals with TAK. Advancements in technology have facilitated the identification of novel autoantibodies in TAK. Moreover, emerging data suggest that dysregulated signaling cascades downstream of B cell receptor families, including interactions with innate pattern recognition receptors such as toll-like receptors, as well as co-stimulatory molecules like CD40, CD80 and CD86, may result in the selection and proliferation of autoreactive B cell clones in TAK. Additionally, ectopic lymphoid neogenesis within the aortic wall of TAK patients exhibits functional characteristics. In recent decades, therapeutic interventions targeting B cells, notably utilizing the anti-CD20 monoclonal antibody rituximab, have demonstrated efficacy in TAK. Despite the importance of the humoral immune response, a systematic understanding of how autoreactive B cells contribute to the pathogenic process is still lacking. This review provides a comprehensive overview of the biological significance of B cell-mediated autoimmunity in TAK pathogenesis, as well as insights into therapeutic strategies targeting the humoral response. Furthermore, it examines the roles of T-helper and T follicular helper cells in humoral immunity and their potential contributions to disease mechanisms. We believe that further identification of the pathogenic role of autoimmune B cells and the underlying regulation system will lead to deeper personalized management of TAK patients. We believe that further elucidation of the pathogenic role of autoimmune B cells and the underlying regulatory mechanisms holds promise for the development of personalized approaches to managing TAK patients.
Topics: Takayasu Arteritis; Humans; B-Lymphocytes; Immunity, Humoral; Rituximab; Autoimmunity; Animals; Autoantibodies
PubMed: 38928233
DOI: 10.3390/ijms25126528 -
Bioengineering (Basel, Switzerland) Jun 2024Autologous-engineered artificial tissues constitute an ideal alternative for radical surgery in terms of natural anticoagulation, self-repair, tissue regeneration, and... (Review)
Review
Autologous-engineered artificial tissues constitute an ideal alternative for radical surgery in terms of natural anticoagulation, self-repair, tissue regeneration, and the possibility of growth. Previously, we focused on the development and practical application of artificial tissues using "in-body tissue architecture (iBTA)", a technique that uses living bodies as bioreactors. This study aimed to further develop iBTA by fabricating tissues with diverse shapes and evaluating their physical properties. Although the breaking strength increased with tissue thickness, the nominal breaking stress increased with thinner tissues. By carving narrow grooves on the outer periphery of an inner core with narrow grooves, we fabricated approximately 2.2 m long cord-shaped tissues and net-shaped tissues with various designs. By assembling the two inner cores inside the branched stainless-steel pipes, a large graft with branching was successfully fabricated, and its aortic arch replacement was conducted in a donor goat without causing damage. In conclusion, by applying iBTA technology, we have made it possible, for the first time, to create tissues of various shapes and designs that are difficult using existing tissue-engineering techniques. Thicker iBTA-induced tissues exhibited higher rupture strength; however, rupture stress was inversely proportional to thickness. These findings broaden the range of iBTA-induced tissue applications.
PubMed: 38927834
DOI: 10.3390/bioengineering11060598