All Articles

Sanmuga Nathan*

Sultan Idris Education University, Malaysia

Teaching Games for Understanding (TGfU) offers tactical-technical instruction is gaining international recognition for its ability to produce intelligent players via a problem-solving approach in game play such as hockey. However the effect of TGfU pedagogical approach through small side game play (SSG) towards physiology components of Heart Rate (HR) still takes a backseat compared to research on tactical decision making and skill execution that has been studied widely. SSG proposed in TGfU approach dwells around duration of game play (load), how fast the SSG game manouvers (intensity) and players cardiovascular fitness can be detected by HR tool and therefore HR crucial to be investigated. This quasi-experimental study investigated the effect of TGfU compared to skill mastery instruction, termed as Skill Drill Technical (SDT), among Malaysian and Indian elite junior hockey players in terms of SSG game play intensity via heart rate (HR) measurement at different points of game play. A total of n = 60 players with an average age of 15 ± 1.03 were selected via simple random technique from both countries involved in this study and assigned equally into groups, with 15 players per group for TGfU and for SDT across Malaysia and India. Gathered data were analysed using the ANOVA and ANCOVA techniques. There was significant higher warm-up HR bpm among players via TGfU compated to SDT across the two countries. Whereas HR bpm immediately after the 5 vs. 5 game play intervention and HR bpm after three minutes’ recovery, Indian players with TGfU recorded a higher and significant difference compared to SDT. However, in contrast, findings indicated no significant difference between these two instruction models among Malaysian player. Therefore, overall findings reiterated that TGfU is a useful approach for game play to enhance intensity and cardiac output through HR bpm measurement. In conclusion, future research can employ together HR and RPM (Borg Scale) or electronic device for more accurate reading coupled 6 sec and 15 sec HR readings. Future study, should too address the effect of TGfU on different variation of small sided game play intensity along skill execution and tactical decision making.

Yoshiki Tsuchida^1#, Sigrid N.W. Vorrink^2,3*

¹Department of Physical Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan

²Utrecht University of Applied Sciences, Research Group Technology for Healthcare Innovations, Utrecht, Netherlands

³JointResearch, Department of Orthopaedic Surgery, OLVG Amsterdam, Netherlands

Physical activity (PA) is important for patients with chronic obstructive pulmonary disease (COPD). eHealth interventions may have the possibility to increase and maintain PA. The objective of this mini review is to provide an overview of research published from 2016 to 2018 about the effect of eHealth on PA in patients with COPD.

Recent studies used phone calls, websites combined with monitoring devices and smartphone applications as eHealth interventions. These studies showed both positive and no effects of eHealth interventions on PA in patients with COPD. The effects seem to depend on the type of eHealth intervention. A multicomponent eHealth intervention including reinforcement, self-management, monitoring and exercise with phone calls, websites and pedometers may be useful for stimulating PA for short-term periods.

Juan de Dios Arjona-Barrionuevo¹, Manuel Gonzales Vargas-Machuca², Francisco José Guerrero-Márquez³*, Luis Gil-Sacaluga⁴, Miguel Ángel Gentil-Govantes⁴

¹Department of Cardiology, Hospital University Virgen del Rocio, Seville, Spain

²Departament of Cardiology, Hospital San Juan de Dios del Aljarafe, Bormujos (Seville), Spain

³Department of Cardiology, Hospital de la Serrania Ronda, Spain

⁴Department of Nephrology, Hospital University Virgen del Rocio, Seville, Spain

Introduction and objectives: WHO recognizes chronic kidney disease as a serious health problem with increasing incidence and prevalence. In our midst, the first cause of death in renal replacement therapy is cardiovascular disease (CVD), especially ischemic. We studied and follow-up of candidates for renal transplantation and subsequently transplanted, With the objective of knowing the ischemic load and reducing the mortality of the transplant.

Methods: In November 2005, we began a cardiorenal monographic consultation for the study of all patients with chronic renal disease with a high cardiovascular risk who were candidates for renal transplantation who underwent coronary angiography, according to the protocol prior to transplantation, were studied.

Results: From November 2005 to December 2013, 313 patients were studied, 64% males, 56.7 ± 11 years old. The Prevalence of significant coronary lesions: 39.3%, 54.4, % of more than one vessel. Silent: 32.4%, 47.6% more than one glass. Total mortality of candidates: 10.2%. Cardiovascular: 4.8%. Total transplant mortality: 5.3%, cardiovascular: 2.1%. Cardiovascular mortality of the revascularized transplant patient: 0%.

Conclusions: Screening and intervention on CVD, leven preventive, reduce total and cardiovascular mortality of the transplant, extending this benefit to those remaining on dialysis. In our hospital, CVD is no longer the leading cause of death in renal replacement therapy.

Aidan (Jia Sheng) Yu¹*, Matthew Rowe², John Atherton¹, Arun Dahiya¹

¹Royal Brisbane and Women’s Hospital, Australia

²Princess Alexandra Hospital, Australia

A 54-year-old female presented with chest pain and was noted to have new T-wave inversion on her electrocardiograph (ECG) in leads V2-V6. The patient has a past history of recurrent DVT/PE and recently had a subtotal colectomy for ulcerative colitis. Serial troponin I measurements were normal (<0.040 µg/l). Transthoracic echocardiogram revealed an impaired left ventricular ejection fraction of 35-40% with hypokinesis within the lateral and apical segments. A coronary angiogram was performed and the left main coronary artery (LMCA) could not be located despite cuspal injections, ascending aortogram and left ventriculogram. A large, dominant right coronary artery (RCA) was visualised which passed around the left ventricular apex to the area normally supplied by the obtuse marginal (OM), diagonal and distal left anterior descending (LAD) arteries. Computed tomography coronary angiography (CTCA) revealed a superdominant RCA supplying the LV apex and lateral wall with no LMCA coming off the left coronary cusp. The left circumflex (LCx) was small and arose from a conus branch with a separate origin to the RCA. No significant stenosis was visualised on CTCA. The T-wave changes were deemed to be secondary to physiological stress/supply-demand ischaemia particularly at the distal end of the RCA, where it supplied the LAD. The patient was commenced on metoprolol 25mg b.d. and continued warfarin on discharge.

Single RCA with absent LMCA is extremely rare with only a few isolated cases reported in the literature. Use of CTCA in combination with coronary angiography was useful in defining this unusual anatomy and excluding a haemodynamically significant lesion. This anomaly is a variation to the typical Lipton subtypes and may represent a new subtype not previously described before.

Melissa Johnson*

College of Agriculture, Environment and Nutrition Sciences, Tuskegee University, USA

Cardiometabolic diseases and disorders continue to be the most significant and leading causes of morbidity and mortality in the United States, as well as globally. Among the cardiometabolic disorders, cardiovascular diseases (CVDs) have the greatest prevalence; other cardiometabolic disorders closely related to CVDs such as diabetes mellitus and Metabolic Syndrome (MetS) continue to contribute to the public health burden as well. Common risks for cardiometabolic disorders include biological (i.e. genetic predisposition, race, age, gender), demographic (socioeconomic status), dietary (dietary intake), behavioral (e.g., physical activity) and environmental (e.g., obesogenic, atherogenic, carcinogenic environments) characteristics. Paradoxically, dietary risk is both the most modifiable and least modifiable risk for certain diseases, as other modifiable and non-modifiable characteristics act in synergy to influence dietary intake. Although many inconclusive and conflicting research findings exist, the benefits of consuming a high quality diet are consistently valued and the role of diet in safeguarding cardiometabolic health cannot be underestimated. Diets rich in whole grains, non-starchy vegetables, and fruits, moderate in processed foods and refined grains, and consequently lower omega-6 to omega-3 fatty acid ratios appear to offer the greatest potential benefit. This mini review briefly summarizes the implications of diet and nutritional intake to cardiometabolic health.

Kleber Santiago Freitas e Silva*

Biological Sciences Institute, Federal University of Goiás, Brazil

Josef Neumüller^1,2, Thomas Wagner³*

¹Blood Donation Center of the Austrian Red Cross for Vienna, Lower Austria and Burgenland

²Center for Anatomy and Cell Biology, Department for Development Biology, Medical University of Vienna

³Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Austria

In this review, the technique of electron tomography is shortly summarized. Alignment procedures on the electron microscope are described. New techniques such as the focused ion beam tomography, the block face scanning tomography and the array tomography are mentioned. Application of these methods for vascular research, concerning endothelium-specific Weibel-Palade bodies in cell cultures from human umbilical vein endothelial cells and endothelial progenitor cells as well as about cellular communications between the endothelium and the subendothelium are referred. Platelets are important players in the interaction with the endothelium in thrombosis and hemostasis after transfusion, therefore electron tomographic investigations of platelet organelles as well as platelet microparticles are mentioned. Illustrations from our own investigations are added.

Abbreviations:

ART: Algebraic Reconstruction Technique; ADAMTS-13: A Disintegrin And Metalloproteinase with A Thrombospondin Type 1 Motif, Member 13; CCD Camera: Charge Coupled Device Camera; DAB: 3,3'-Diaminobenzidine; DART: Discrete Algebraic Reconstruction Technique; DTS: Dense Tubular System; EM: Electron Microscope; EPC: Endothelial Progenitor Cells; ET: Electron Tomography; FVIII: Factor VIII Blood Clotting Protein; FIB-SEM: Focused Ion Beam Scanning Electron Microscope; FITC: Fluorescein-Isothiocyanate; HUVEC: Human Umbilical Vein Endothelial Cells; LSM: Laser Confocal Scanning Microscope; MIT: Mitochondria; MTC: Microtubular Coil; OCS: Surface-Connected Open Canalicular System; PLT: Platelets; PLTC: Platelet Concentrates; PMP: Platelet Microparticles; ROI: Region Of Interest; SBEM: Serial Block Face Scanning Electron Microscopy; SIRT: Simultaneous Itinerative Reconstruction Technique; STEM: Scanning Transmission Electron Microscopical Device; TEM: Transmission Electron Microscope; TGN: Trans Golgi Network; TRITC: Tetramethylrhodamine-Isothiocyanate; vWF: von Willebrand Factor; WPB: Weibel Palade Bodies; WPB: Method: Weighted Back Projection Method.

Sebastián Videla¹*, Neus Gascón², Carlos Plata-Salamán²

¹Clinical Research Support Unit, Clinical Pharmacology Department, Bellvitge University Hospital/IDIBELL, Barcelona, Spain

²Medical Sciences Area, ESTEVE Pharmaceuticals S.A., Barcelona, Spain

Jessica A. Walsh¹, Xue Song²*, Gilwan Kim², Yujin Park³

¹University of Utah School of Medicine and Salt Lake City Veteran Affairs Medical Center, Division of Rheumatology, Salt Lake City, UT, USA

²IBM Watson Health, Cambridge, MA, USA

³Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA

Patients with chronic inflammatory rheumatic diseases, such as rheumatoid arthritis and spondyloarthritis, are at a higher risk of comorbidities, including cardiovascular disease. Although the prevalence of spondyloarthritis is estimated to be similar to that of rheumatoid arthritis, the risk of cardiovascular comorbidities in spondyloarthritis is not as well understood. Furthermore, the inflammatory rheumatic diseases differ in their pathogenic mechanisms, the populations affected, and treatment recommendations; therefore, it is important to examine these diseases separately. Ankylosing spondylitis (AS) is the prototype of spondyloarthritis; the onset of disease occurs at a relatively young age, and patients with AS are often undiagnosed for long periods of time. This increased duration of exposure to inflammation and use of nonsteroidal anti-inflammatory drugs may contribute to the higher risk of cardiovascular comorbidities in these patients.

Here we describe our recently published study (Walsh JA, et al. Clin Rheumatol. 2018;37[7]:1869-1878.), which used large national claims databases and showed that US patients with AS had significantly more comorbidities, including cardiovascular disease, than matched controls. We also review the current understanding of the risk of cardiovascular comorbidities in patients with AS. Knowledge of the frequency and risk of comorbidities can assist rheumatologists and primary care physicians with comorbidity screening and strategies for a holistic care approach for patients with AS, including the possibility of adapting the existing cardiovascular risk assessments for these patients. Counseling patients on additional lifestyle risk factors, early cardiovascular screening, and the necessity of further diagnostic testing will be important for optimizing patient care for AS.

Erland Erdmann*

University in Cologne, Germany

Iron deficiency is a common comorbidity in chronic heart failure (CHF) with a negative impact on the outcome of the patient. Even without anaemia iron deficiency can cause decreased physical performance, poor quality of life, and increased mortality. Therefore it is important to diagnose and treat iron deficiency, especially in patients with CHF.

Despite the great relevance for the outcome of CHF-patients little attention is being payed to iron deficiency in these patients, even though a specific diagnosis and therapy is available and is recommended by the current ESC guidelines.

A simple, practical and evidence based algorithm is available and can now help to improve diagnosis and treatment of iron deficiency in everyday practice. This article reviews a discussion of a group of German cardiologists who aimed to give practical advice on how to diagnose and treat iron deficiency in CHF patients.

Thomas J. Humphries*

44 Pinewood Drive, Neptune, NJ 07753, USA

Giulia Masiero¹, Luca Nai Fovino¹, Alessandro Schiavo¹, Daisuke Ueshima¹, Mostafa Rabea Abdelhaleem Badawy^{1, 2}, Giuseppe Tarantini¹*

¹Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy

²Cardiology Department, Faculty of Medicine, Minia University, Egypt

The optimal percutaneous treatment of diffuse coronary artery disease (CAD) remains an unsolved issue. Bioresorbable scaffold (BRS) technology has been developed to overcome the disadvantages of metallic drug-eluting stents (DES) due to their permanent struts. Through the resorption process, BRS may provide complete vascular restoration, which appears very attractive in the treatment of diffuse CAD. However, robust evidence on the use of BRS in this setting is lacking and recent data have raised concerns about the safety of this novel technology, especially when BRS are used in complex CAD or without adequate protocol implantation. This review aims at summarizing current evidence and future perspectives on Absorb BRS implantation in complex CAD, such as in distal coronary segments involvement and diffused disease.

Marek Jankowski^1,2*, Tom L. Broderick³, Jolanta Gutkowska^1,2#

¹Cardiovascular Biochemistry Laboratory, CRCHUM (7-134), Tour Viger, 900 St-Denis St, Montreal, Canada H2X 0A9, USA

²Department of Medicine, University of Montreal, Quebec, Canada, USA

³Department of Physiology, Laboratory of Diabetes and Exercise Metabolism, Midwestern University, Glendale, AZ, USA

Jan Jacques Michiels^1,3*, Petr Dulicek², Zwi Berneman¹, Alain Gadisseur¹, Wilfried Schroyens¹

¹Departments of Hematology and Coagulation Research, University Hospital Antwerp, Belgium

²Fourth Department of Internal Medicine–Hematology, University Hospital in Hradec Kralove and Charles University Prague, Faculty of Medicine in Hradec Kralove and Prague, Czech Republic on behave of the Central European Vascular Forum: CEVF

³Blood, Coagulation and Cardiovascular Medicine Research Center and International Collaboration and Academic Research on Myeloproliferative Neoplasms: ICAR.MPN, Goodheart Institute & Foundation in Nature Medicine & Health, Rotterdam, The Netherlands

Congenital venous thrombophilia is associated with increased risk of venous thrombosis at adolescent and adult age, with recurrent abortions and fetal loss in females, and less frequently with splanchnic vein thrombosis, but not with arteriolar microvascular circulation disturbances. Based on original observations in view of the literature on thrombocythemia in patients with essential thrombocythemia (ET) and polycythemia vera (PV), both ET and PV are associated with increased risk of platelet-von Willebrand factor (VWF) mediated arteriolar microvascular circulation disturbances at adult age, with recurrent abortions and fetal loss in females, and less frequently with splanchnic vein thrombosis, but not with venous thromboembolism.

The high incidences of congenital venous thrombophilic factors including antithrombin III, protein C and S, factor V Leiden and the prothrombin G20210A mutation, acquired lupus anticoagulant as well as the presence of the JAK2^V617F mutation indicative for thrombocythemia in trilinear myeloproliferative disease (MPD) are described as the underlying hypercoagulable states in patients with Budd-Chiari syndrome (BCS) and splanchnic vein thrombosis (SVT). In this editorial we propose the novel concept of coagulation and/or platelet mediated microvascular liver pathology is the primary event for the development of BCS, splanchnic vein thrombosis, and portal hypertension with portal and oesophageal varicosal veins as a serious complication in patients with congenital thrombophilia and/or JAK2^V617F mutated sticky platelets in clonal ET and PV. Clinical and liver pathology observations are in line with a two hit hypothesis of coagulation- and/or platelet-mediated thrombosis in the liver microcirculation as the underlying etiology of BCS and splanchnic vein thrombosis in patients with congenital venous thrombophilia and/or an acquired JAK2^V617F mutated thrombocythemia in ET and PV patients. Severe ADAMTS13 deficiency in advanced liver cirrhosis is related to the severity of liver cell insufficiency due to the combined ADAMTS13 synthesis defect and autoantibodies against ADAMTS13 thereby explaining the more pronounced ADAMTS13 deficiency as compared to the degree of AT III synthesis deficiency in advanced liver cirrhosis. An imbalance between the severely decreased ADAMTS13:AC level and its substrate may indeed reflect the predisposing state for platelet thrombi in the liver microcirculation in patients with advanced liver cirrhosis similar on op of congenital venous thrombophilia and platelet-VWF mediated arteriolar microvascular thrombosis in JAK2^V617F mutated thrombocythemia as etiological risk factors of intrahepatic microvascular obstructive diseases in BCS followed by splanchnic vein thrombosis.

Robert C Bahler*, Neal V Dawson

Case Western Reserve University School of Medicine at MetroHealth Medical Center, Cleveland, Ohio, United States of America

Outcomes in patients with moderate to severe aortic stenosis (AS) from a community hospital cohort are similar those reported from tertiary institutions. Echocardiographic measures of the severity of obstruction are key variables in predicting outcomes. Additional variables that are not direct measures of AS severity are associated with adverse events. A reduced left ventricular (LV) ejection fraction forecasts a less favorable outcome yet most asymptomatic patients have preserved LV ejection fractions. Consequently, other measures of LV systolic function associated with adverse outcomes are important; namely, reduced LV longitudinal shortening and increased LV mass. Diastolic function can be compromised in AS indicated by either elevated E/e´ or left atrial enlargement; both are associated with unfavorable outcomes. Electrocardiographic evidence of LV strain reflects LV mid-wall fibrosis and identifies patients with adverse outcomes. Biomarkers including elevated values of high sensitivity troponin I and BNP contribute to models predicting outcomes. Prediction models help identify asymptomatic patients with quite unfavorable prognoses who may benefit from early aortic valve replacement.

Lindsay A Sobotka*, Khalid Mumtaz^#

Department of Gastroenterology, Hepatology and Nutrition, The Ohio State Wexner Medical Center, USA

Decompensated cirrhosis with ascites results in high health care expenditures, 30 day readmission, morbidity, and mortality. Paracentesis is indicated in patients with cirrhosis and ascites to rule out spontaneous bacterial peritonitis and for symptomatic control. Performing at least a diagnostic paracentesis has been proved to reduce inpatient mortality; however, the procedure was also associated with longer length of stay, higher costs during hospitalization and increased risk of 30-day readmission. In summary, diagnostic paracentesis is crucial to rule out infection, but other interventions should be utilized to control ascites, as worse hospital outcomes as likely associated with a large volume paracentesis.

Jason Salsamendi, Yi Shuen Chang*

Department of Vascular and Interventional Radiology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, 1611 NW 12th Ave. WW-279, Miami, FL, 33136, USA

Monica Sacco^1*, Stefano Lancellotti^1*, Maria Basso¹, Raimondo De Cristofaro^1,2*

¹Servizio Malattie Emorragiche e Trombotiche, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, Italy

²Istituto di Medicina Interna e Geriatria, Università Cattolica S. Cuore, Roma, Italy

Increasing evidence shows a potential role of ADAMTS13 deficiency as a risk factor for the high prevalence of portal vein thrombosis (PVT) in cirrhotic patients. This deficiency, due to myofibroblastic transformation of hepatic stellate cells (HSCs), the source of ADAMTS13, is responsible for the prevalence of ultra large molecular weight multimers of von Willebrand factor (UL-VWF) in the hepatic microcirculation. This phenomenon would favor the pro-haemostatic function of VWF, which, together with an elevation of coagulation FVIII, which is associated to VWF, could sustain microcirculatory thrombosis in the liver. These phenomena, triggering an increase of the intra-hepatic pressure, would cause a slowdown of the portal flow, favoring the occurrence of PVT. Although this scenario is justified by retrospective observational clinical studies, it will be mandatory to clarify the ADAMTS13 expression in HSCs associated with the activity of plasma ADAMTS13 in different stage of liver diseases. Hence, a prospective clinical trial (ClinicalTrials.gov Identifier: NCT03322696) is ongoing to unravel the linkage between all the actors involved in the complex phenomenon of PVT occurring in cirrhosis.

Yanina Post, Achim Paululat*

University of Osnabrueck, Faculty of Biology & Chemistry, Zoology and Developmental Biology, Barbarastraße 11, 49076 Osnabrueck, Germany

It is well known that cardiovascular diseases are becoming the number one cause of mortality in developed countries¹. Minimal differences in a wide range of biological pathways can lead to organ malfunction or failure. In addition to the heart itself, its surroundings are also crucial for proper organ integrity and functionality. Changes in extracellular matrix (ECM) composition, such as a higher amount of incorporated collagens, can result in cardiac hypertrophy² or hypertension-related diastolic dysfunction³ by stiffening the surrounding matrix and constricting the embedded organ. Similar observations have been made while studying the heart of the fruit fly, Drosophila melanogaster. In this model organism, altered amounts of ECM components, including Laminin or Collagen IV (Viking), cause impaired cardiac function⁴. This demonstrates the notable relevance of an organ-specific ECM composition that provides the correct balance of stiffness and elasticity, both in vertebrates and invertebrates. In our recent study we were able to unravel the function of several protein domains belonging to the ADAMTS-like protein Lonely heart⁵. Furthermore, we analysed its interaction with the Collagen IV-like protein Pericardin and described new interactions within the extracellular matrix that led to a more detailed model of the whole network. In addition, we investigated the impact of altered Pericardin levels on physiological aspects, including locomotion and heart beating parameters, and strengthened the hypothesis that ECM composition is crucial for proper organ functionality. Here we summarize our approaches and comment on additional observations, possible follow-up analyses and restrictions as well as advantages. Moreover, we discuss possible additional roles of ADAMTS-like proteins within an extracellular matrix.

Ashlee L Culver¹, Annika S Silfvast-Kaiser², Alan Menter^1,2*

¹Texas A&M Health Science Center College of Medicine, TX

²Division of Dermatology, Baylor University Medical Center, Dallas, TX

Psoriasis is a systemic inflammatory disease which contributes to an increased risk for cardiovascular disease, specifically coronary artery disease. Patients with psoriasis tend to have greater total coronary plaque burden and more high risk plaque than healthy controls. This likely contributes to the higher rate of myocardial infarction and 4-5 year reduction in lifespan observed in our psoriasis population. With biologic therapy and improvement in PASI scores, total plaque burden and noncalcified coronary plaque decreases as well. Specifically, ustekinumab decreases intima-media thickness and reduces vascular inflammation. Likewise, TNF-α inhibitors decrease vascular inflammation and reduce cardiovascular events in both sexes, and reduce coronary plaque formation in men with psoriasis. This may be due to elevation in glycoprotein acetylation, which is associated with cardiovascular events and elevated in psoriasis. This elevation has also been shown to decrease with adalimumab usage. Despite all of the knowledge gained on this topic, the incidence of myocardial infarction in psoriasis patients currently remains unchanged when compared to prior years. Consequently, we emphasize the need for further research on the unique pathogenesis of psoriatic coronary plaque formation as well as the effect biologic agents have on this coronary plaque in order to improve the wellbeing of this patient population.

Mo Chen , Hongqian Wang , Erliang Kong , Jinmin Zhang , Weifeng Yu , Feixiang Wu*

Department of Anesthesiology & Intensive Care, Shanghai Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, P.R. China

Acute renal failure occurring in patients with obstructive jaundice after surgery is still a serious clinical complication. Renin-angiotensin-aldosterone system (RAAS) plays a key role in the progression of kidney disease. Previous studies have demonstrated that angiotensin-converting-enzyme-2 (ACE2), a component of the RAAS system, acts as a local regulator for renal protection, and has a beneficial effect on renal fibrosis. This review will summarize the role of ACE2 and the protective effects on renal dysfunction in obstructive jaundice.

Karim Saleb*

Department of Internal Medicine, Ascension St. John Hospital, USA

Pulmonary embolism remains one of the major causes of morbidity and mortality in the United States. For patients with an intermediate-risk pulmonary embolism, Ultrasound-Assisted Catheter-Directed Thrombolysis (USAT) is a contemporary treatment modality that has emerged as a potential alternative to systemic thrombolysis and surgical embolectomy. Multiple studies have demonstrated the efficacy of USAT in reducing the thrombus burden and reversing right ventricular dysfunction in patients with an intermediate-risk pulmonary embolism. However, literature addressing the potential impact of an early catheter directed revascularization is lacking. A recent retrospective study carried out by Edla et al suggests that, compared to a delayed intervention, early USAT can improve recovery of pulmonary hemodynamics in patients with submassive pulmonary embolism and also reduce the overall in-hospital length of stay. This commentary provides a thorough analysis of the results of this study and revisits the existing information on ultrasound-assisted thrombolysis for acute pulmonary embolism.

Adam R. Holmes1, Francis J. Castellino^1,2, Rashna D. Balsara^1,2*

¹W. M. Keck Center for Transgene Research, University of Notre Dame, Indiana 46556, USA

²Department of Chemistry and Biochemistry, University of Notre Dame, Indiana 46556, USA

Ischemia-mediated glutamate elevation causes activation of the N-methyl-D-aspartate receptor (NMDAR) and consequent excitotoxicity. This triggers a cascade of pathological events, including aberrant NMDAR ion channel kinetics, large neuronal Ca²⁺ influx, and activation of pro-death signaling pathways. Previous studies have shown that functional outcomes of post-ischemia are influenced by the type of GluN2 subunit assembled in the NMDAR (GluN2A, GluN2B, GluN2C, or GluN2D), as well as its cellular location. GluN2A-containing synaptic NMDAR’s activate pro-survival pathways, whereas, activation of GluN2B-containing extrasynaptic NMDARs results in cell death. However, there is no consensus omnium on the individual role of the GluN2 subunits in ischemia. Published studies suggest that the GluN2A, GluN2B, and GluN2C subunits can promote either neuronal death or survival, depending on the experimental model employed and the CNS region investigated. In this mini-review, we aim to succinctly outline the mechanisms that underlie the dichotomous role of the NMDAR in ischemic stroke and possible NMDAR--directed therapeutic approaches.

Neyla Ben Gdara*, Ikram Khemiri, Amel Belgacem, Safa Mannai, Lotfi Bitri

Department of Biology, University of Tunis El Manar, Faculty of Sciences of Tunis, University campus 2092, El Manar, Tunis, Tunisia

Liver ischemia-reperfusion induced hepatocellular damage that contributes to the morbidity and mortality^1,2 associated with shock, thermal injury, re-sectional surgery and liver transplantation. One of the earliest events associated with reperfusion of ischemic liver is the release of Reactive Oxygen Species (ROS) causing oxidative stress. The following review focuses on the antioxidant effects of nitric oxide (NO) and Phycocyanin (Pc) after cold ischemia/reperfusion injury (IRI). In this regard, this review investigates in the first part the effect of the addition of NO to the preservation solution at different concentrations (1000, 500 and 50 nM) and in the second part the effect of the addition of phycocyanin to the conservation solution at two doses (0.2 mg / ml / g of liver and 0.1 mg / ml / g of liver) on liver graft quality. In conclusion, phycocyanin and nitric oxide (at a low dose) are effective in preserving the hepatic graft and protecting it against IRI by acting as a potent antioxidant against the products of oxidative stress.

Natalie Berger¹, Charles L. Shapiro^2*

¹Hematology/Oncology Fellowship Program, Icahn School of Medicine at Mount Sinai, New York, NY

²Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY