Volume Articles

The Dilemma of Complete Coronary Revascularization

Cristina Aurigemma^1*, Francesco Burzotta², Carlo Trani²

¹Institute of Cardiology, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy

²Institute of Cardiology, Fondazione Policlinico Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy

Despite 20 years of investigation the Completeness of Revascularization in patients with multivessel coronary artery disease (CAD) remains an unanswered question. The lack of universal definition and the multiplicity of confounding variables that in general favor patients who receive a complete revascularization (CR) are the reason of studies’ conflicting results.

The CR is achieved more commonly with coronary artery by-pass (CABG) than with percutaneous coronary intervention (PCI). In this regard, the possibility of achieving CR is one of variable that should be factored when deciding the optimal strategy of revascularization between PCI and CABG in patients with multivessel coronary artery disease. However clinical features, such as patient’s age, life expectancy, symptoms at presentation, comorbidities and left ventricular function may increase the morbidity or mortality risk of CABG intervention and a “reasonable” incomplete revascularization (IR) achieved with PCI may be a better choice in particular clinical subset.

Commentary: A New Model for Chronic Care to Improve Patient's Skill

Patrick Dunn^1,2*, Scott Conard³

¹Walden University, Minneapolis, MN, USA

²American Heart Association, Dallas, TX, USA

³Converging Health, Dallas, TX, USA

Anthracycline and Trastuzumab-Based Therapy in Early Stage Breast Cancer: Do the Data Justify Cardiac Surveillance?

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

Protective Effects of Nitric Oxide and Phycocyanin Against Oxidative Stress Induced by Hepatic Ischemia/Reperfusion Injuries

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.

Commentary: Early Versus Delayed Use of Ultrasound-Assisted Catheter-Directed Thrombolysis in Patients with Acute Submassive Pulmonary Embolism

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.

The Dichotomous Role of N-methyl-D-Aspartate Receptors in Ischemic Stroke

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.