Hyperglycemia Suppresses Calcium Phosphate-Induced Aneurysm Formation Through Inhibition of Macrophage Activation

Background

The aim of this study was to elucidate aspects of diabetes mellitus–induced suppression of aneurysm. We hypothesized that high glucose suppresses aneurysm by inhibiting macrophage activation via activation of Nr1h2 (also known as liver X receptor β), recently characterized as a glucose‐sensing nuclear receptor.

Methods and Results

Calcium phosphate (CaPO₄)–induced aneurysm formation was significantly suppressed in the arterial wall in type 1 and 2 diabetic mice. A murine macrophage cell line, RAW264.7, was treated with tumor necrosis factor α (TNF‐α) plus CaPO₄ and showed a significant increase in matrix metalloproteinase 9 (Mmp9) mRNA and secreted protein expression compared with TNF‐α alone. Elevated Mmp9 expression was significantly suppressed by hyperglycemic conditions (15.5 mmol/L glucose) compared with normoglycemic conditions (5.5 mmol/L glucose) or normoglycemic conditions with high osmotic pressure (5.5 mmol/L glucose +10.0 mmol/L mannitol). Nr1h2 mRNA and protein expression were suppressed by treatment with TNF‐α plus CaPO₄ but were restored by hyperglycemic conditions. Activation of Nr1h2 by the antagonist GW3965 during stimulation with TNF‐α plus CaPO₄ mimicked hyperglycemic conditions and inhibited Mmp9 upregulation, whereas the deactivation of Nr1h2 by small interfering RNA (siRNA) under hyperglycemic conditions canceled the suppressive effect and restored Mmp9 expression induced by TNF‐α plus CaPO₄. Moreover, Nr1h2 activation with GW3965 significantly suppressed CaPO₄‐induced aneurysm in mice compared with vehicle‐injected control mice.

Conclusions

Our results show that hyperglycemia suppresses macrophage activation and aneurysmal degeneration through the activation of Nr1h2. Although further validation of the underlying pathway is necessary, targeting Nr1h2 is a potential therapeutic approach to treating aneurysm.

[Popliteal venous aneurysm]

Popliteal venous aneurysm is a rare disease. The diameter of the vein is at least twice as big as the normal proximal vein. The aneurysm is usually asymptomatic but it can suddenly cause pulmonary embolism even in young persons. Due to an unpredictable risk of thromboembolism even under anticoagulation treatment operation is often advisable if the diameter of the aneurysm is more than 20 mm. The operation can usually be done as tangential aneurysmectomy and lateral venorrhaphy which has a low complication rate and a good patency.

[INSULIN-LIKE GROWTH FACTOR 1 UNDER CONDITIONS OF THE BRAIN VASCULAR DISEASES.]

The system insulin-like growth factors (IGF) occupies an important place in the development and growth of the central nervous system (CNS). Gene expression of insulin-like growth factor I (IGF-1) and IGF-1 receptor are represented in all parts of the brain and are heavily concentrated in the cerebral vessels. IGF-1 is involved in neuro-, angiogenesis, in the stimulation of cell proliferation, and repair responses to damage for both the central and peripheral nervous system. IGF- 1 exerts antioxidant, anti-inflammatory and protective effects on the CNS. The review discusses the importance and the role of IGF-I in vascular diseases of the brain, in particular, aneurysms, the ischemic stroke, the aneurysmal subarachnoid hemorrhage, as well as neuroprotection.

[Surgical treatment of distal extracranial internal carotid artery aneurysms associated with pathological artery kinking]

Extracranial internal carotid artery (ICA) aneurysms located at the entrance of the skull are a rare pathology. Surgical treatment is indicated for this pathology because of the risk of arterio-arterial embolism and the development of cerebrovascular disease. The domestic and international literature reports single cases or small group cases of successful surgical treatment of patients with distal internal carotid artery aneurysms associated with pathological kinking of the artery. Open surgery for aneurysms of this localization is complicated because of a high injury risk associated with the approach. Endovascular interventions are not always possible due to the presence of degenerative changes in the vascular wall and pathological artery kinking. We propose a surgical option for creating a high-flow ec-ic bypass between the external carotid artery and the M2 segment of the middle cerebral artery. The article describes the results of successful application of this technique in three patients with distal extracranial internal carotid artery aneurysms associated with pathological kinking of the artery.

The role of perivascular adipose tissue in vasoconstriction, arterial stiffness, and aneurysm

Since the "rediscovery" of brown adipose tissue in adult humans, significant scientific efforts are being pursued to identify the molecular mechanisms to promote a phenotypic change of white adipocytes into brown-like cells, a process called "browning". It is well documented that white adipose tissue (WAT) mass and factors released from WAT influence the vascular function and positively correlate with cardiac arrest, stroke, and other cardiovascular complications. Similar to other fat depots, perivascular adipose tissue (PVAT) is an active endocrine organ and anatomically surrounds vessels. Both brown-like and white-like PVAT secrete various adipokines, cytokines, and growth factors that either prevent or promote the development of cardiovascular diseases (CVDs) depending on the relative abundance of each type and their bioactivity in the neighboring vasculature. Notably, pathophysiological conditions, such as obesity, hypertension, or diabetes, induce the imbalance of PVAT-derived vasoactive products that promote the infiltration of inflammatory cells. This then triggers derangements in vascular smooth muscle cells and endothelial cell dysfunction, resulting in the development of vascular diseases. In this review, we discuss the recent advances on the contribution of PVAT in CVDs. Specifically, we summarize the current proposed roles of PVAT in relationship with vascular contractility, endothelial dysfunction, neointimal formation, arterial stiffness, and aneurysm.

Multimedia data mining for automatic diabetic retinopathy screening

This paper presents TeleOphta, an automatic system for screening diabetic retinopathy in teleophthalmology networks. Its goal is to reduce the burden on ophthalmologists by automatically detecting non referable examination records, i.e. examination records presenting no image quality problems and no pathological signs related to diabetic retinopathy or any other retinal pathology. TeleOphta is an attempt to put into practice years of algorithmic developments from our groups. It combines image quality metrics, specific lesion detectors and a generic pathological pattern miner to process the visual content of eye fundus photographs. This visual information is further combined with contextual data in order to compute an abnormality risk for each examination record. The TeleOphta system was trained and tested on a large dataset of 25,702 examination records from the OPHDIAT screening network in Paris. It was able to automatically detect 68% of the non referable examination records while achieving the same sensitivity as a second ophthalmologist. This suggests that it could safely reduce the burden on ophthalmologists by 56%.

Presentation of Anatomical Variations Using the Aurasma Mobile App

Knowledge of anatomical variations is critical to avoid clinical complications and it enables an understanding of morphogenetic mechanisms. Depictions are comprised of photographs or illustrations often limiting appreciation of three-dimensional (3D) spatial relationships. The purpose of this study is to describe an approach for presenting anatomical variations utilizing video clips emphasizing 3D anatomical relationships delivered on personal electronic devices. An aberrant right subclavian artery (ARSA) was an incidental finding in a routine dissection of an 89-year-old man cadaver during a medical student instructional laboratory. The specimen was photographed and physical measurements were recorded. Three-dimensional models were lofted and rendered with Maya software and converted as Quicktime animations. Photographs of the first frame of the animations were recorded and registered with Aurasma Mobile App software (www.aurasma.com). Resulting animations were viewed on mobile devices. The ARSA model can be manipulated on the mobile device enabling the student to view and appreciate spatial relationships. Model elements can be de-constructed to provide even greater spatial resolution of anatomical relationships. Animations provide a useful approach for visualizing anatomical variations. Future work will be directed at creating a library of variants and underlying mechanism of formation for presentation through the Aurasma application.

Spontaneous true aneurysm of the superficial temporal artery presenting as an asymptomatic forehead mass

Superficial temporal artery aneurysms are rare; when they do occur, they are usually associated with head trauma. Spontaneous true aneurysms of the superficial temporal artery are extremely rare. They are classified as true aneurysms when all three layers of the vessel are found to be involved on histologic examination. Therapeutic options include conservative management, image-guided embolization, and surgical excision. We report a case of an extracranial spontaneous aneurysm of the frontal branch of the superficial temporal artery. A 20-year-old man presented with an asymptomatic, pulsatile, 1-cm forehead mass that had gradually increased in size. The aneurysm was evaluated by clinical examination and three-dimensional computed tomographic angiography. Complete resection was performed with local anesthesia. Histologic examination revealed that the aneurysm involved all three layers of the blood vessel: the tunica intima, tunica media, and tunica adventitia. No atherosclerotic changes or inflammatory cells were found. To the best of our knowledge, this is only the third reported case of a histologically verified spontaneous aneurysm of the frontal branch of the superficial temporal artery. Awareness of this rare pathology in the differential diagnosis of a forehead mass may facilitate diagnosis and prevent complications.

Automated lesion detectors in retinal fundus images

Diabetic retinopathy (DR) is a sight-threatening condition occurring in persons with diabetes, which causes progressive damage to the retina. The early detection and diagnosis of DR is vital for saving the vision of diabetic persons. The early signs of DR which appear on the surface of the retina are the dark lesions such as microaneurysms (MAs) and hemorrhages (HEMs), and bright lesions (BLs) such as exudates. In this paper, we propose a novel automated system for the detection and diagnosis of these retinal lesions by processing retinal fundus images. We devise appropriate binary classifiers for these three different types of lesions. Some novel contextual/numerical features are derived, for each lesion type, depending on its inherent properties. This is performed by analysing several wavelet bands (resulting from the isotropic undecimated wavelet transform decomposition of the retinal image green channel) and by using an appropriate combination of Hessian multiscale analysis, variational segmentation and cartoon+texture decomposition. The proposed methodology has been validated on several medical datasets, with a total of 45,770 images, using standard performance measures such as sensitivity and specificity. The individual performance, per frame, of the MA detector is 93% sensitivity and 89% specificity, of the HEM detector is 86% sensitivity and 90% specificity, and of the BL detector is 90% sensitivity and 97% specificity. Regarding the collective performance of these binary detectors, as an automated screening system for DR (meaning that a patient is considered to have DR if it is a positive patient for at least one of the detectors) it achieves an average 95-100% of sensitivity and 70% of specificity at a per patient basis. Furthermore, evaluation conducted on publicly available datasets, for comparison with other existing techniques, shows the promising potential of the proposed detectors.

MicroRNAs in vascular tissue engineering and post-ischemic neovascularization

Increasing numbers of paediatric patients with congenital heart defects are surviving to adulthood, albeit with continuing clinical needs. Hence, there is still scope for revolutionary new strategies to correct vascular anatomical defects. Adult patients are also surviving longer with the adverse consequences of ischemic vascular disease, especially after acute coronary syndromes brought on by plaque erosion and rupture. Vascular tissue engineering and therapeutic angiogenesis provide new hope for these patients. Both approaches have shown promise in laboratory studies, but have not yet been able to deliver clear evidence of clinical success. More research into biomaterials, molecular medicine and cell and molecular therapies is necessary. This review article focuses on the new opportunities offered by targeting microRNAs for the improved production and greater empowerment of vascular cells for use in vascular tissue engineering or for increasing blood perfusion of ischemic tissues by amplifying the resident microvascular network.

[Effects of urokinase type plasminogen activator and plasminogen activator inhibitor-1 expressions on the formation of aneurysm of perimembranous ventricular septal defect]

OBJECTIVE

The exact mechanisms of defect closure in patients with perimembranous ventricular septal defect (PMVSD) remain unknown. We hypothesized that the expression of urokinase type plasminogen activator (uPA) and plasminogen activator inhibitor-1 (PAI-1) may mediate extracellular matrix (ECM) remodeling in aneurysms.

METHOD

Seven normal heart tricuspid septal leaflet and 33 aneurysms were collected in Shanghai Renji Hospital and Shanghai Children's Medical Center from January 2008 to June 2010. Immunohistochemical expression of uPA and PAI-1 in 4 normal heart valvular tissues and 15 aneurysms was detected with immunohistochemical methods. The expression of uPA and PAI-1 mRNA in 3 normal heart valvular tissues and 7 aneurysms was studied by real time fluorescent PCR; the protein expression of uPA and PAI-1 in 4 normal heart valvular tissues and 11 aneurysms was tested with Western blotting.

RESULT

The surface of the aneurysms were completely covered by endothelial cells. Two types of granulation tissue, myxoid and fibrous, were associated with the aneurismal formation. uPA were recognized predominantly in valvar interstitial cells (VICs) which located mainly in regions adjacent to the endothelium and smooth muscle cells of blood vessels. PAI-1 was found in both VICs which located mainly in granulation tissue and endothelial cells. Nine aneurysms expressed a higher uPA activity than 4 normal valvular tissues ((74.6±11.8)% vs. (49.5±7.4)%; t = 3.87, P = 0.003) and six aneurysms expressed a low uPA activity ((10.3±3.1)% vs. (49.5±7.4)%; t=11.78, P=0.000) and a high PAI-1 activity ((55.2±1.7)% vs. (50.8±3.8)%; t=2.55, P=0.034) using immunohistochemical methods. uPA / PAI-1 ratio of protein expression tested by Western blot was 0.88±0.22 in four normal heart vavular tissues; five aneurysms expressed high uPA activity and low PAI-1 activity and uPA/PAI-1 ratio was 4.26±2.04; while the other 6 cases expressed low uPA activity and high PAI-1 activity and uPA/PAI-1 ratio was 0.30±0.07; the difference among the three groups was statistically significant (P<0.05). The rate of uPA/PAI-1 in relative copy of mRNA expression among normal heart valvular tissue, high uPA expressed aneurysms and low uPA expressed aneurysms are also significantly different (2.14±0.17 vs. 0.45±0.04; 2.14±0.17 vs. 4.38±1.41, P<0.05) respectively.

CONCLUSION

The expression of uPA and PAI-1 in VICs suggests that interactions among these molecules contribute to the aneurysm formation and development. This provides a potential mechanism for defect closure in patients with PMVSD.

ENDOVASCULAR TREATMENT OF AN ANEURYSM OF THE SPLENIC ARTERY

Aneurysms of the splenic artery account for about 60% of all aneurysms of visceral arteries. Most of them are asymptomatic until rupture and are discovered accidentally, usually after an imaging study. The treatment is surgical or endovascular depending on the type, location and size. We present a case of a patient with an asymptomatic, accidentally found aneurysm of the splenic artery which we successfully treated with a covered stent. The control CT-angiography on 6th month showed patent stent and totally occluded aneurysm. It is very important in cases of acute abdomen and hemorrhagic shock to think of a ruptured aneurysm. In these cases the treatment of choice is endovascular as it is mini-invasive and organ-saving.

Fusiform aneurysm of a persistent primitive trigeminal artery associated with cerebrovascular anatomic variations: a report of two cases

There are four embryonic anastomoses that exist between the internal carotid artery (ICA) and the vertebrobasilar (VB) system, which may fail to regress postfetal life; one of which is the trigeminal artery. Other persistent anastomoses include those formed by the hypoglossal, otic and proatlantic intersegmental arteries. In addition, other cerebrovascular variations may accompany a persistent primitive trigeminal artery (PPTA); such as arteriovenous malformations, aneurysms, carotid-cavernous fistulas and stenotic cerebral vessels. We present two very rare cases of a left PPTA. In the first case, there was a past medical history significant for cervico-thoraco-lumbar spondylitis and in the second case of an operated occipital astrocytoma. In both cases, the PPTA was associated with a fusiform aneurysm located in the carotidian (lateral) aspect of the PPTA as well as other cerebrovascular anatomic variations. In the first case, the length of the PPTA was 26.0 mm and its endoluminal diameter, at its origin at the ICA, was 1.8 mm; the aneurysm has a length of 8.4 mm. In the second case, the length of the PPTA was 31.0 mm and its endoluminal diameter at its origin at the ICA was 3.0 mm; the aneurysm have a length of 7.6 mm. Identification of these variant vessels should not be ignored before planning and execution of neurosurgeries to prevent possible perioperative risks.

Deployment of stent grafts in curved aneurysmal arteries: toward a predictive numerical tool

The mechanical behavior of aortic stent grafts plays an important role in the success of endovascular surgery for aneurysms. In this study, finite element analysis was carried out to simulate the expansion of five marketed stent graft iliac limbs and to evaluate quantitatively their mechanical performances. The deployment was modeled in a simplified manner according to the following steps: (i) stent graft crimping and insertion in the delivery sheath, (ii) removal of the sheath and stent graft deployment in the aneurysm, and (iii) application of arterial pressure. In the most curved aneurysm and for some devices, a decrease of stent graft cross-sectional area up to 57% was found at the location of some kinks. Apposition defects onto the arterial wall were also clearly evidenced and quantified. Aneurysm inner curve presented significantly more apposition defects than outer curve. The feasibility of finite element analysis to simulate deployment of marketed stent grafts in curved aneurysm models was demonstrated. The study of the influence of aneurysm tortuosity on stent graft mechanical behavior shows that increasing vessel curvature leads to stent graft kinks and inadequate apposition against the arterial wall. Such simulation approach opens a very promising way toward surgical planning tools able to predict intra and/or post-operative short-term stent graft complications.

[The value of chest X-ray and cervical vascular ultrasound in predicting the presence of non-recurrent laryngeal nerves]

OBJECTIVE

To determine the value of chest X-ray and cervical vascular ultrasound in predicting the presence of non-recurrent laryngeal nerves (NRLN) in patients with thyroid disorders.

METHODS

Preoperative, intraoperative and postoperative documents of 2 251 patients with various thyroid disorders between January 2006 and December 2013 were reviewed. All of the patients underwent preoperative chest X-ray examinations. The patients who had confirmed NRLN during surgery were given a cervical vascular ultrasound examination postoperatively.

RESULTS

A total of 49 patients (2. 18%, A group) were identified having NRLN by preoperative chest X-ray as they showed aberrant right subclavian artery (ARSA). Of those suspected cases of NRLN, 23 (46.94%) were confirmed during subsequent surgeries and no NRLN injury was inflicted. In the 2 202 unsuspected cases (B group), 5 (0. 23%) were discovered having NRLN during surgeries, and one (20. 00%) NRLN injury occurred. ARSA were found in postoperative cervical vascular ultrasound examination in all of the 28 cases of NRLN confirmed during surgeries. The postoperative cervical vascular ultrasound suggested a normal right subclavian artery (RSA) for the 26 chest X-ray revealed but surgically dismissed cases of NRLN. The 23 X-ray predicted NRLN were revealed more quickly in surgeries than those that had been failed to show in X-ray (t= -18. 867 2, P=O. 000 0).

CONCLUSION

Chest X-ray of patients scheduled for thyroid surgery should be reviewed carefully and cervical vascular ultrasound should be allied for predicting ARSA before surgery. Detection of ARSA can accurately predict the existence of NRLN, preventing NRLN injury and shorten the duration of subsequent operations.

Splenic artery aneurysm presenting with abdominal discomfort and weight loss

Splenic artery aneurysm (SAA) is uncommon, but it is the most frequent visceral artery aneurysm. It is more common in women, especially during pregnancy. SAA is usually asymptomatic, but abdominal pain and rupture may develop. At present, computerized tomography (CT) angiogram is the best diagnostic test but not the only. Surgical or endovascular treatment may be considered both in symptomatic or asymptomatic aneurysms greater then 2 cm in diameter. We present the case of an elderly woman with an SAA and review the literature.

Vascular geometry of vertebrobasilar tree with and without aneurysm

AIM

To examine a possible relationship between the variable vascular geometry of vertebrobasilar joint angle and basilar bifurcation angle as well as the diameters of these blood vessels.

METHODS

The study included 60 adult patients, of both sexes, who were divided into two groups. One group (30) consisted of patients without aneurysm of vertebrobasilar tree, and another group (30) of patients with aneurysm. The patients were examined using Magnetic Resonance Imaging (MRI) and Computed Tomography Angiography (CTA) of head and neck.

RESULTS

In the group without aneurysm of vertebrobasilar tree, in 14 (46.6%) patients diameters of the right and the left vertebral artery were approximately the same. The average value of the angle of junctions of vertebral arteries was 65.43°, and the average angle of basilar bifurcation was around 94.53°. In the group with aneurysm of vertebrobasilar tree, in 12 (40%) patients diameters of the right and the left vertebral artery were also approximately the same. The average angle of junction of vertebral arteries was 68.46º, and the average angle of basilar bifurcation was 121.93º.

CONCLUSION

Anatomic variations of the vertebrobasilar joint angle and basilar bifurcation angle, as well as the diameters of these blood vessels, are some of the factors in the increase of the incidence of aneurysm in this anatomic area.

[Thoracic angio-Behçet--total regression on immunosuppressive treatment (about a case)]

La maladie de Behçet est une Vascularite multisystémique d’étiologie obscure. L'angio-Behçet thoracique est en rapport avec le tropisme vasculaire bien connu de la maladie, et les anévrysmes des artères pulmonaires constituent une des complications majeures de cette maladie. Nous rapportons le cas d'un patient qui s'est présenté en consultation pour douleur thoracique avec toux et crachats hémoptoïques. Le diagnostic d'une maladie de Behçet est retenu sur des arguments cliniques et confirmé par un angioscanner thoracique qui a objectivé des dilatations anévrysmales des bronches lobaires et segmentaires des deux artères pulmonaires. Devant l'urgence thérapeutique, un bolus de solumédrol sur trois jours est réalisé relayé par un bolus de cyclophosphamide. Après 12 mois de suivi, le patient rapporte une nette amélioration clinique. L'angio-scanner de contrôle note une disparition totale des anévrysmes des artères pulmonaires. L'atteinte thoracique de l'angio-Behçet est grave et met en jeu le pronostic vital, le traitement médical de ces anévrysmes à base d'immunosuppresseur permet une évolution favorable.

In vivo response to an implanted shape memory polyurethane foam in a porcine aneurysm model

Cerebral aneurysms treated by traditional endovascular methods using platinum coils have a tendency to be unstable, either due to chronic inflammation, compaction of coils, or growth of the aneurysm. We propose to use alternate filling methods for the treatment of intracranial aneurysms using polyurethane-based shape memory polymer (SMP) foams. SMP polyurethane foams were surgically implanted in a porcine aneurysm model to determine biocompatibility, localized thrombogenicity, and their ability to serve as a stable filler material within an aneurysm. The degree of healing was evaluated via gross observation, histopathology, and low vacuum scanning electron microscopy imaging after 0, 30, and 90 days. Clotting was initiated within the SMP foam at time 0 (<1 h exposure to blood before euthanization), partial healing was observed at 30 days, and almost complete healing had occurred at 90 days in vivo, with minimal inflammatory response.

[3D hemodynamic numerical simulation of carotid artery aneurysm before and after surgery based on CT date]

Hemodynamic situation is an important factor of recurrence of postoperative carotid artery aneurysm. In order to investigate the hemodynamic factors of postoperative carotid artery aneurysm affect carotid artery aneurysm recurrence, we established a 3D finite element carotid artery aneurysm for the preoperative and postoperative periods using the three-dimensional reconstruction techniques. And then we measured the hemodynamic factors of carotid artery aneurysm of preoperative and postoperative by the finite element method. The carotid artery aneurysm model has an accurate and realistic shape; the pressure of the recurrence of aneurysm was reduced significantly after surgery,wall shear stress increased significantly at residual neck, and blood flow velocity increased significantly, which will increase the risk of recurrence. The hemodynamic analysis provides a reference for development of aneurysm clinical treatment programs and prevention of recurrence.

Aneurysmal dermatofibroma mimicking both clinical and dermoscopic malignant melanoma and Kaposi's sarcoma

Aneurysmal dermatofibroma (AD) or aneurysmal fibrous histiocytoma (AFH) is a relatively rare form of histiocytoma representing less than 2% of total cases. It shares many clinical and dermoscopic similarities with skin tumors, especially malignant melanoma and Kaposi's sarcoma, which can make differentiation problematic. We report the case of a 53-year-old man, who presents with a black nodular tumor with increased consistency, edges infiltrated from the surface to depth, spontaneous and sensitive to touch that shows rapid growth in the last three months. Dermoscopically, the central region consists of intricate areas colored in red, violet, blue-white and black. On the periphery stand two rings, centrally white and peripherally pigmented, with an abundance of polymorphic capillaries. To clarify the diagnosis, the lesion was widely excised and histopathological examination was performed, which revealed immunophenotypical tumor cells negative for HMB-45 and S100, and numerous CD68 macrophages between tumor cells. This aneurysmal fibrous histiocytoma shows both clinical and dermoscopically discrete differential criteria, which are not specific and that make it difficult to distinguish from malignant melanoma and Kaposi's sarcoma, and required performing histopathology and immunohistochemistry.