Questionnaire survey on cardiologists' view and management of coronary microvascular disease in clinical practice

Methyltransferase-like 14 silencing relieves the development of atherosclerosis via m6A modification of p65 mRNA

To explore the METTL14-dependent m⁶A modification mechanism involved in the development of atherosclerosis. Oxidized low-density lipoprotein (ox-LDL) and the HUVEC cell line were used to establish an atherosclerosis cell model in vitro, and APOE^−/− mice fed a high-fat diet were used as the animal model. Cell viability and apoptosis were assessed using MTT assays and flow cytometry. The status of m⁶A in HUVECs was examined using MeRIP-qPCR. Oil Red O staining was used to evaluate the lesions or plaques on aortas separated from the target mice. METTL14 and METTL3 were upregulated in HUVECs after ox-LDL treatment. After transfection with si-METTL14, the bcl-2 expression level and the viability of ox-LDL-incubated cells increased, whereas the apoptosis rate and the expressions of Bax and cleaved caspase-3 decreased. However, the effect of METTL14 knockdown was reversed by p65 overexpression. After METTL14 knockdown, there was a decrease in the total m⁶A content in HUVECs, m⁶A modification, and p65 expression. The plaques and lesion areas on the high-fat diet APOE^−/− mouse aortas were smaller after METTL14 silencing. METTL14 reduced cell viability and promoted apoptosis of HUVECs, which were both induced by ox-LDL via m⁶A modification of p65. Knocking down METTL14 could inhibit the development of atherosclerosis in high-fat diet-treated APOE^−/− mice.

Prevalence of microvascular angina among patients with stable symptoms in the absence of obstructive coronary artery disease: a systematic review

Our purpose was to perform a systematic review to assess the prevalence of microvascular angina (MVA) among patients with stable symptoms in the absence of obstructive coronary artery disease (CAD). We performed a systematic review of the literature to group the prevalence of MVA, based on diagnostic pathways and modalities. We defined MVA using three definitions: (i) suspected MVA using non-invasive ischaemia tests; proportion of patients with non-obstructive CAD among patients with symptoms and a positive non-invasive ischaemia test result, (ii) suspected MVA using specific modalities for MVA; proportion of patients with evidence of impaired microvascular function among patients with symptoms and non-obstructive CAD, and (iii) definitive MVA; proportion of patients with positive ischaemia test results among patients with an objectified impaired microvascular dysfunction. We further examined the ratio of women-to-men for the different groups. Of the 4547 abstracts, 20 studies reported data on MVA prevalence. The median prevalence was 43% for suspected MVA using non-invasive ischaemia test, 28% for suspected MVA using specific modalities for MVA, and 30% for definitive MVA. Overall, more women were included in the studies reporting sex-specific data. The women-to-men ratio for included participants was 1.29. However, the average women-to-men ratio for the MVA cases was 2.50. In patients with stable symptoms of ischaemia in the absence of CAD, the prevalences of suspected and definitive MVA are substantial. The results of this study should warrant cardiologists to support, promote and facilitate the comprehensive evaluation of the coronary microcirculation for all patients with symptoms and non-obstructive CAD.

European Attitudes and Outcomes Regarding Breast Implant-Associated Anaplastic Large Cell Lymphoma: A Multinational Survey

BACKGROUND

Breast implants have been related to breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). While some research has been conducted to study BIA-ALCL incidence, little is known regarding surgeon concern about the disease.

OBJECTIVES

This study aims to determine surgeon concern about BIA-ALCL within the European plastic surgeon community as related to their practice of breast plastic surgery.

METHODS

A 27-question online survey was sent to 2353 members of the European Plastic Surgery Society and EURAPS. 240 surgeons responded (10.2%) from 18 different societies. Questions were related to demographics, exposure to BIA-ALCL cases, clinical practices, awareness, and concern. Univariate and multivariable analyses were used.

RESULTS

Of surveyed surgeons, 8% had encountered a case of BIA-ALCL, while 73% were concerned about the disease. The rate of concern seemed to be influenced by seven of the variables studied. However, multivariate analysis demonstrated that none of the combined variables analyzed predicted concern or disclosure of the risks of BIA-ALCL to patients. Textured silicone-filled implants were implicated in the disease (56.5% of cases, P = 0.005). Mentor® and Polytech® were the two brands involved in most of the reported cases (20% each).

CONCLUSIONS

Consistent with epidemiological reports worldwide, this study confirms that BIA-ALCL is more prevalent in patients undergoing placement of textured silicone implants, the use of which was greater among surgeons not concerned about the risks of BIA-ALCL. Surgeons appear to approach their patients with similar risk disclosures regardless of practice pattern and type of breast implant used, but not regardless of their concern about the disease.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .