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Miao Y, Wang Y, Wang Y, Yan P, Chen Z, Wan Q. The Association Between Triglyceride-Glucose Index and Its Combination with Obesity Indicators and Lower Extremity Peripheral Artery Disease in Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study. Diabetes Metab Syndr Obes 2024; 17:2607-2617. [PMID: 38953012 PMCID: PMC11216433 DOI: 10.2147/dmso.s469692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 06/22/2024] [Indexed: 07/03/2024] Open
Abstract
Background Lower extremity peripheral artery disease (LEAD) is a significant chronic complication of type 2 diabetes mellitus (T2DM) that significantly contributes to disability and mortality. The subtle presentation of LEAD symptoms often leads to underrecognition and misdiagnosis. Therefore, identifying simple and effective evaluation indicators is essential for the early detection and management of LEAD. Insulin resistance is closely associated with diabetes and its complications. However, the specific relationship between insulin resistance-measured by the triglyceride-glucose (TyG) index-and obesity indicators in relation to LEAD remains unclear. Objective This study aims to investigate the association between the TyG index and its combination with obesity indicators in participants with T2DM and LEAD. Methods We performed a univariate analysis on 3176 T2DM patients to identify risk factors for LEAD. Patients were then divided into quartiles based on the TyG index combined with various obesity indicators. The chi-square test was used to compare the prevalence of LEAD across these groups. Logistic regression analysis was conducted to examine the association between the TyG index, in combination with different obesity indicators, and the occurrence of LEAD. Finally, we assessed the predictive ability of the TyG index combined with obesity indicators for LEAD by comparing the area under the ROC curve (AUC). Results The study included 3176 T2DM patients (1691 males and 1485 females) with a mean age of 56.16±10.60 years. Among them, 106 individuals had LEAD. The prevalence of LEAD varied significantly across quartiles of the TyG index, TyG-WC, and TyG-WHR (Q4 > Q3 > Q2 > Q1; P < 0.05). Multiple logistic regression analysis showed that the TyG index, TyG-WC, and TyG-WHR were positively associated with the risk of LEAD in T2DM patients. ROC curve analysis identified the best cutoff values for predicting LEAD: 9.8059 for the TyG index (sensitivity: 49.1%, specificity: 67.9%, AUC: 0.583), 808.8397 for TyG-WC (sensitivity: 70.8%, specificity: 47.8%, AUC: 0.603), and 8.8543 for TyG-WHR (sensitivity: 75.5%, specificity: 44.6%, AUC: 0.607). Conclusion In T2DM patients, the TyG index, TyG-WHR, and TyG-WC are positively associated with the occurrence of LEAD. TyG-WHR and TyG-WC exhibit a stronger correlation with LEAD compared to the TyG index alone, indicating their superior diagnostic value.
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Affiliation(s)
- Ying Miao
- Department of Endocrinology and Metabolism, Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Southwest Medical University, Luzhou, People’s Republic of China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, People’s Republic of China
- Sichuan Clinical Research Center for Diabetes and Metabolism, Luzhou, People’s Republic of China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, People’s Republic of China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, People’s Republic of China
| | - Yu Wang
- Department of Cardiology, Luzhou People’s Hospital, Luzhou, People’s Republic of China
| | - Yi Wang
- Department of Pharmacy, Luzhou People’s Hospital, Luzhou, People’s Republic of China
| | - Pijun Yan
- Department of Endocrinology and Metabolism, Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Southwest Medical University, Luzhou, People’s Republic of China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, People’s Republic of China
- Sichuan Clinical Research Center for Diabetes and Metabolism, Luzhou, People’s Republic of China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, People’s Republic of China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, People’s Republic of China
| | - Zhuang Chen
- Experimental Medicine Center, the Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
| | - Qin Wan
- Department of Endocrinology and Metabolism, Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Southwest Medical University, Luzhou, People’s Republic of China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, People’s Republic of China
- Sichuan Clinical Research Center for Diabetes and Metabolism, Luzhou, People’s Republic of China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, People’s Republic of China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, People’s Republic of China
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Jiang B, Wang X, Rivera-Bolanos N, Ameer GA. Generation of Autologous Vascular Endothelial Cells for Patients with Peripheral Artery Disease. J Cardiovasc Transl Res 2024; 17:558-569. [PMID: 37861912 DOI: 10.1007/s12265-023-10452-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/10/2023] [Indexed: 10/21/2023]
Abstract
Peripheral artery disease (PAD) is a prevalent cardiovascular disease with risks of limb loss. Our objective is to establish an autologous cell source for vascular regeneration to achieve limb salvage in PAD. Six PAD patients (age 50-80) were enrolled with their peripheral blood collected to derive vascular endothelial cells (ECs) with two different approaches: (1) endothelial progenitor cell (EPC) approach and (2) induced pluripotent stem cell (iPSC) approach. The iPSC approach successfully generated patient-specific ECs for all PAD patients, while the EPC approach did not yield any colony-forming ECs in any of the patients. The patient-derived iPSC-ECs expressed endothelial markers and exhibited endothelial functions. However, elevated inflammatory status with VCAM-1 expression was observed in the patient-derived cells. Pharmacological treatment with resveratrol resulted in patient-specific responses in cell viability and VCAM-1 expression. Our study demonstrates the potential of iPSC-ECs for autologous regenerative therapy in PAD, offering promise for personalized treatments for ischemic PAD.
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Affiliation(s)
- Bin Jiang
- Center for Advanced Regenerative Engineering, Northwestern University, Evanston, IL, 60208, USA.
- Department of Biomedical Engineering, Northwestern University, 2145 Sheridan Rd, Tech B382, Evanston, IL, 60208, USA.
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
| | - Xinlong Wang
- Center for Advanced Regenerative Engineering, Northwestern University, Evanston, IL, 60208, USA
- Department of Biomedical Engineering, Northwestern University, 2145 Sheridan Rd, Tech B382, Evanston, IL, 60208, USA
| | - Nancy Rivera-Bolanos
- Center for Advanced Regenerative Engineering, Northwestern University, Evanston, IL, 60208, USA
- Department of Biomedical Engineering, Northwestern University, 2145 Sheridan Rd, Tech B382, Evanston, IL, 60208, USA
| | - Guillermo A Ameer
- Center for Advanced Regenerative Engineering, Northwestern University, Evanston, IL, 60208, USA.
- Department of Biomedical Engineering, Northwestern University, 2145 Sheridan Rd, Tech B382, Evanston, IL, 60208, USA.
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
- Chemistry of Life Processes Institute, Northwestern University, Evanston, IL, 60208, USA.
- International Institute for Nanotechnology, Northwestern University, Evanston, IL, 60208, USA.
- Simpson Querrey Institute for BioNanotechnology, Northwestern University, Chicago, IL, 60611, USA.
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Todd M, Nair PK, Ohayon J, Pettigrew RI, Yazdani SK. Liquid Drug Delivery Approaches for the Treatment of Occlusive Arterial Disease: A Systematic Review. J Endovasc Ther 2024; 31:203-213. [PMID: 36052425 PMCID: PMC11149167 DOI: 10.1177/15266028221120755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Local Liquid drug (LLD) delivery devices have recently emerged as a novel approach to treat peripheral arterial disease. This systemic review aims to identify and evaluate the clinical utility of the most commonly used delivery devices. METHODS A systemic review was performed using the Medical Subjects Heading terms of "drug delivery," "liquid," "local," and "cardiovascular disease" in PubMed, Google Scholar, and Scopus. RESULTS Four commonly used delivery devices were identified, including (1) the Bullfrog Micro-Infusion Device, (2) the ClearWay RX Catheter, (3) the Occlusion Perfusion Catheter, and (4) the Targeted Adjustable Pharmaceutical Administration. All have shown to successfully deliver liquid therapeutic into the target lesion and have exhibited favorable safety and efficacy profiles in preclinical and clinical trials. The LLD devices have the ability to treat very long or multiple lesions with a single device, providing a more economical option. The safety profile in LLD clinical studies is also favorable in view of recent concerns regarding adverse events with crystalline-paclitaxel-coated devices. CONCLUSION There is clear clinical evidence to support the concept of local liquid delivery to treat occlusive arterial disease. CLINICAL IMPACT The 'leave nothing behind' strategy has been at the forefront of the most recent innovations in the field of interventional cardiology and vascular interventions. Although drug coated balloons have overcome limitations associated with plain old balloon angioplasty and peripheral stents, recent safety concerns and cost considerations have impacted their usage. In this review, various liquid drug delivery devices are presented, showcasing their capabilities and success in both preclinical and clinical settings. These innovative liquid delivery devices, capable of targeted delivery and their ability to be re-used for multiple treatment sites, may provide solutions for current unmet clinical needs.
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Affiliation(s)
- Meagan Todd
- Department of Engineering, Wake Forest University, Winston-Salem, NC, USA
| | | | - Jacques Ohayon
- Savoie Mont-Blanc University, Polytech Annecy-Chambéry, Le Bourget du Lac, France and Laboratory TIMC-IMAG, CNRS, UMR 5525, Grenoble-Alpes University, Grenoble, France
| | - Roderic I Pettigrew
- Texas A&M University and Houston Methodist Hospital, Engineering Medicine (EnMed), Houston, TX, USA
| | - Saami K Yazdani
- Department of Engineering, Wake Forest University, Winston-Salem, NC, USA
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Lukacs RA, Weisshaar LI, Tornyos D, Komocsi A. Comparing Endovascular Approaches in Lower Extremity Artery Disease: Insights from a Network Meta-Analysis. J Clin Med 2024; 13:1024. [PMID: 38398337 PMCID: PMC10889479 DOI: 10.3390/jcm13041024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Endovascular therapy offers an alternative for treating femoropopliteal (FP) and infrapopliteal (IP) lesions related to occlusive lower extremity artery disease. Despite numerous trials, the effectiveness of restenosis prevention using local drug delivery devices remains a topic of debate. OBJECTIVES An updated systematic review and network meta-analysis was conducted. Our overall aim was to summarize the most recent clinical evidence regarding endovascular approaches for FP and IP atherosclerotic lesions. METHODS We conducted a search for randomized trials in the MEDLINE database, and extracted data related to clinical endpoints. Our primary focus was on the rate of major adverse events (MAEs), including mortality, amputation, and target lesion revascularization (TLR). A multiple treatment network meta-analysis supplemented with component network analyses was performed to examine the impact of combined treatment. RESULTS Our search yielded 33 randomized controlled trials encompassing 5766 patients. This included 19 studies focused on femoropopliteal and 14 on IP lesions, accounting for 3565 and 2201 patients, respectively. Drug-coated balloons (DCBs) and drug-eluting stents (DESs) displayed a reduced MAE risk in comparison to plain old balloon angioplasty (POBA)-RR for DCB: 0.64 (95% CI: 0.52-0.77) and for DES: 0.71 (95% CI: 0.51-0.99). The bare-metal stent (BMS) group manifested the most substantial MAE risk, being 59% higher relative to the DCB cohort (BMS vs. DCB RR: 1.59; 95% CI: 1.03-2.47). For FP lesions, DES was the standout performer, curtailing MAE risk by 55% relative to POBA. Within IP lesions, DES mitigated the MAE risk by 25% versus POBA. DCB did not exhibit any notable MAE reduction when pitted against POBA. CONCLUSION In FP arteries, both DESs and DCBs yielded significantly diminished MAEs, thus outpacing other techniques. Regarding IP arteries, only DESs resulted in significantly fewer MAEs. In alignment with contemporary research, our findings revealed no signs of elevated mortality in patients undergoing treatment with drug-eluting apparatuses.
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Affiliation(s)
- Reka Aliz Lukacs
- Department of Interventional Cardiology, Heart Institute, Medical School, University of Pécs, 7624 Pécs, Hungary; (R.A.L.); (D.T.)
| | | | - Daniel Tornyos
- Department of Interventional Cardiology, Heart Institute, Medical School, University of Pécs, 7624 Pécs, Hungary; (R.A.L.); (D.T.)
| | - Andras Komocsi
- Department of Interventional Cardiology, Heart Institute, Medical School, University of Pécs, 7624 Pécs, Hungary; (R.A.L.); (D.T.)
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Wang Y, Li Y, Chen Y, Mao J, Ji J, Zhang S, Liu P, Pronyuk K, Fisher D, Dang Y, Zhao L. Corilagin relieves atherosclerosis via the toll-like receptor 4 signaling pathway in vascular smooth muscle cells. Int J Immunopathol Pharmacol 2024; 38:3946320241254083. [PMID: 38869980 PMCID: PMC11179462 DOI: 10.1177/03946320241254083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 04/24/2024] [Indexed: 06/15/2024] Open
Abstract
INTRODUCTION Corilagin possesses a diverse range of pharmacologic bioactivities. However, the specific protective effects and mechanisms of action of corilagin in the context of atherosclerosis remain unclear. In this study, we investigated the impact of corilagin on the toll-like receptor (TLR)4 signaling pathway in a mouse vascular smooth muscle cell line (MOVAS) stimulated by oxidized low-density lipoprotein (ox-LDL). Additionally, we examined the effects of corilagin in Sprague-Dawley rats experiencing atherosclerosis. METHODS The cytotoxicity of corilagin was assessed using the CCK8 assay. MOVAS cells, pre-incubated with ox-LDL, underwent treatment with varying concentrations of corilagin. TLR4 expression was modulated by either downregulation through small interfering (si)RNA or upregulation via lentivirus transfection. Molecular expression within the TLR4 signaling pathway was analyzed using real-time polymerase chain reaction (PCR) and Western blotting. The proliferation capacity of MOVAS cells was determined through cell counting. In a rat model, atherosclerosis was induced in femoral arteries using an improved guidewire injury method, and TLR4 expression in plaque areas was assessed using immunofluorescence. Pathological changes were examined through hematoxylin and eosin staining, as well as Oil-Red-O staining. RESULTS Corilagin demonstrated inhibitory effects on the TLR4 signaling pathway in MOVAS cells pre-stimulated with ox-LDL, consequently impeding the proliferative impact of ox-LDL. The modulation of TLR4 expression, either through downregulation or upregulation, similarly influenced the expression of downstream molecules. In an in vivo context, corilagin exhibited the ability to suppress TLR4 and MyD88 expression in the plaque lesion areas of rat femoral arteries, thereby alleviating the formation of atherosclerotic plaques. CONCLUSION Corilagin can inhibit the TLR4 signaling pathway in VSMCs, possibly by downregulating TLR4 expression and, consequently, relieving atherosclerosis.
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MESH Headings
- Animals
- Toll-Like Receptor 4/metabolism
- Hydrolyzable Tannins/pharmacology
- Rats, Sprague-Dawley
- Signal Transduction/drug effects
- Atherosclerosis/drug therapy
- Atherosclerosis/metabolism
- Atherosclerosis/pathology
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/metabolism
- Muscle, Smooth, Vascular/pathology
- Lipoproteins, LDL/metabolism
- Male
- Glucosides/pharmacology
- Glucosides/therapeutic use
- Mice
- Cell Line
- Rats
- Cell Proliferation/drug effects
- Myocytes, Smooth Muscle/drug effects
- Myocytes, Smooth Muscle/metabolism
- Myocytes, Smooth Muscle/pathology
- Disease Models, Animal
- Myeloid Differentiation Factor 88/metabolism
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Affiliation(s)
- Yujie Wang
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yiqing Li
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yunfei Chen
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinqian Mao
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jingyu Ji
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shaojun Zhang
- National & Local Joint Engineering Research Centre for High-Throughput Drug Screening Technology, State Key Laboratory of Biocatalysis and Enzyme Engineering, Hubei University, Wuhan, China
| | - Pan Liu
- Department of Pediatrics, Wuchang Hospital, Wuhan, China
| | - Khrystyna Pronyuk
- Department of Infectious Diseases, Bogomolets National Medical University, Kyiv, Ukraine
| | - David Fisher
- Department of Medical Biosciences, Faculty of Natural Sciences, University of the Western Cape, Cape Town, South Africa
- School of Health Professions, University of Missouri, Columbia, MO, USA
| | - Yiping Dang
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Zhao
- Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Hu J, Zeng Q, Chen X, Luo W, Tang Z, Mei M, Zhao W, Du Z, Liu Z, Li Q, Cheng Q, Yang S. Primary aldosteronism and lower-extremity arterial disease: a two-sample Mendelian randomization study. Cardiovasc Diabetol 2023; 22:352. [PMID: 38124109 PMCID: PMC10734059 DOI: 10.1186/s12933-023-02086-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND AND AIMS Primary aldosteronism (PA) is an adrenal disorder of autonomous aldosterone secretion which promotes arterial injury. We aimed to explore whether PA is causally associated with lower-extremity arterial disease (LEAD). METHODS We included 39,713 patients with diabetes and 419,312 participants without diabetes from UK Biobank. We derived a polygenic risk score (PRS) for PA based on previous genome-wide association studies (GWAS). Outcomes included LEAD and LEAD related gangrene or amputation. We conducted a two-sample Mendelian randomization analysis for PA and outcomes to explore their potential causal relationship. RESULTS In whole population, individuals with a higher PA PRS had an increased risk of LEAD. Among patients with diabetes, compared to the subjects in the first tertile of PA PRS, subjects in the third tertile showed a 1.24-fold higher risk of LEAD (OR 1.24, 95% CI 1.03-1.49) and a 2.09-fold higher risk of gangrene (OR 2.09, 95% CI 1.27-3.44), and 1.72-fold higher risk of amputation (OR 1.72, 95% CI 1.10-2.67). Among subjects without diabetes, there was no significant association between PA PRS and LEAD, gangrene or amputation. Two-sample Mendelian randomization analysis indicated that genetically predictors of PA was significantly associated with higher risks of LEAD and gangrene (inverse variance weighted OR 1.20 [95% CI 1.08-1.34]) for LEAD, 1.48 [95% CI 1.28-1.70] for gangrene), with no evidence of significant heterogeneity or directional pleiotropy. CONCLUSIONS Primary aldosteronism is genetically and causally associated with higher risks of LEAD and gangrene, especially among patients with diabetes. Targeting on the autonomous aldosterone secretion may prevent LEAD progression.
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Affiliation(s)
- Jinbo Hu
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi St, Chongqing, 400016, China
| | - Qinglian Zeng
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi St, Chongqing, 400016, China
| | - Xiangjun Chen
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi St, Chongqing, 400016, China
| | - Wenjin Luo
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi St, Chongqing, 400016, China
| | - Ziwei Tang
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi St, Chongqing, 400016, China
| | - Mei Mei
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi St, Chongqing, 400016, China
| | - Wenrui Zhao
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi St, Chongqing, 400016, China
| | - Zhipeng Du
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi St, Chongqing, 400016, China
| | - Zhiping Liu
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi St, Chongqing, 400016, China
| | - Qifu Li
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi St, Chongqing, 400016, China.
| | - Qingfeng Cheng
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi St, Chongqing, 400016, China.
| | - Shumin Yang
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi St, Chongqing, 400016, China.
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Liu ZB, Fan XY, Wang CW, Ye X, Wu CJ. Potentially active compounds that improve PAD through angiogenesis: A review. Biomed Pharmacother 2023; 168:115634. [PMID: 37879211 DOI: 10.1016/j.biopha.2023.115634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/25/2023] [Accepted: 10/03/2023] [Indexed: 10/27/2023] Open
Abstract
Peripheral arterial disease (PAD) has been historically neglected, which has resulted in a lack of effective drugs in clinical practice. However, with the increasing prevalence of diseases like atherosclerosis and diabetes, the incidence of PAD is rising and cannot be ignored. Researchers are exploring the potential of promoting angiogenesis through exogenous compounds to improve PAD. This paper focuses on the therapeutic effect of natural products (Salidroside, Astragaloside IV, etc.) and synthetic compounds (Cilostazol, Dapagliflozin, etc.). Specifically, it examines how they can promote autocrine secretion of vascular endothelial cells, enhance cell paracrine interactions, and regulate endothelial progenitor cell function. The activation of these effects may be closely related to PI3K, AMPK, and other pathways. Overall, these exogenous compounds have promising therapeutic potential for PAD. This study aims to summarize the potential active compounds, provide a variety of options for the search for drugs for the treatment of PAD, and bring light to the treatment of patients.
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Affiliation(s)
- Zi-Bo Liu
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Xin-Yun Fan
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Chen-Wei Wang
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Xun Ye
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Chun-Jie Wu
- State Key Laboratory of Southwestern Chinese Medicine Resources, Innovative Institute of Chinese Medicine and Pharmacy/Academy for Interdiscipline, Chengdu Univesity of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China.
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Jeong JO, Ju YM, Kang HW, Atala A, Yoo JJ, Lee SJ. Biofunctionalized Electrospun Vascular Scaffolds for Enhanced Antithrombotic Properties and In Situ Endothelialization. ACS APPLIED MATERIALS & INTERFACES 2023. [PMID: 37923557 DOI: 10.1021/acsami.3c13738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
The development of innovative vascular substitutes has become increasingly significant due to the prevalence of vascular diseases. In this study, we designed a biofunctionalized electrospun vascular scaffold by chemically conjugating heparin molecules as an antithrombotic agent with an endothelial cell (EC)-specific antibody to promote in situ endothelialization. To optimize this biofunctionalized electrospun vascular scaffolding system, we examined various parameters, including material compositions, cross-linker concentrations, and cross-linking and conjugation processes. The findings revealed that a higher degree of heparin conjugation onto the vascular scaffold resulted in improved antithrombotic properties, as confirmed by the platelet adhesion test. Additionally, the flow chamber study demonstrated that the EC-specific antibody immobilization enhanced the scaffold's EC-capturing capability compared to a nonconjugated vascular scaffold. The optimized biofunctionalized vascular scaffolds also displayed exceptional mechanical properties, such as suture retention strength and tensile properties. Our research demonstrated that the biofunctionalized vascular scaffolds and the directed immobilization of bioactive molecules could provide the necessary elements for successful acellular vascular tissue engineering applications.
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Affiliation(s)
- Jin-Oh Jeong
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, United States
- Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan 44919, Republic of Korea
| | - Young Min Ju
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, United States
| | - Hyun-Wook Kang
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, United States
- Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan 44919, Republic of Korea
| | - Anthony Atala
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, United States
| | - James J Yoo
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, United States
| | - Sang Jin Lee
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, United States
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Jansen S, de Borst GJ, Hinchliffe R, Teraa M. Peripheral Artery Disease: Underappreciated Impact and Residual Cardiovascular Risk Despite Revascularization. Clin Ther 2023; 45:1019-1022. [PMID: 37940497 DOI: 10.1016/j.clinthera.2023.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/18/2023] [Accepted: 09/26/2023] [Indexed: 11/10/2023]
Abstract
This Commentary highlights the under-recognized prevalence and heavy burden of peripheral artery disease (PAD) and its important role as a harbinger of complications of atherosclerotic cardiovascular disease. Although increasing in prevalence globally, PAD is being further accelerated with diabetes, and patients with advanced PAD are at high risk for chronic limb-threatening ischemia. The need for (repeated) revascularization and amputation places a heavy social burden on patients and family, and a heavy financial burden on the health care system, exceeding the cost of coronary artery and cerebrovascular diseases. Clinical trial research in PAD will be enhanced by widely agreed-upon definitions of major adverse cardiovascular events and major adverse limb events. Antithrombotic and lipid-lowering therapies are recommended but underutilized, while the optimal peri-interventional antithrombotic regimen is still under debate. Additional antiinflammatory treatment is currently an unaddressed strategy in the management of patients with PAD, and there is a strong case for the evaluation of widely available antiinflammatory agents such as colchicine.
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Affiliation(s)
- Shirley Jansen
- Department of Vascular and Endovascular Surgery, Sir Charles Gairdner Hospital; Harry Perkins Institute of Medical Research; Curtin University Medical School; and the; Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia.
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Robert Hinchliffe
- Bristol Centre for Surgical Research, Bristol NIHR Biomedical Research Centre, University of Bristol, Bristol, United Kingdom
| | - Martin Teraa
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
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10
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Yu X, Wang B, Qiu C, He Y, Chen T, Zhu Q, Li Z, Wu Z. A systematic review and meta-analysis of primary bypass surgery compared with bypass surgery after endovascular treatment in peripheral artery disease patients. J Vasc Surg 2023; 78:1335-1345.e4. [PMID: 37453586 DOI: 10.1016/j.jvs.2023.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/23/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE Both bypass surgery and endovascular treatment are well-recognized interventions for the treatment of peripheral artery disease; however, the effect of failed endovascular treatment on subsequent surgeries remains controversial. A systematic review was conducted to compare the outcomes of primary bypass and bypass surgery after endovascular treatment. METHODS Three academic databases (Embase, PubMed, and Scopus) were searched from their inception to August 2022. Two independent investigators searched for studies that reported the outcomes of primary bypass surgery and bypass surgery after endovascular treatment in patients with peripheral artery disease. Abstracts and full-text studies were screened independently using duplicate data abstraction. Dichotomous outcome measures were reported using a random-effects model to generate a summary odds ratio (OR) and 95% confidence interval (CI). The risk of bias was assessed using the Newcastle-Ottawa Scale. RESULTS Seventeen retrospective observational studies were selected from 3911 articles and included 8064 patients, 6252 of whom underwent primary bypass surgery and 1812 underwent bypass surgery after endovascular treatment. The mean age was 69.0 years and 61.2% (n = 4938) were male. For perioperative outcomes, the 30-day results showed no difference in mortality (OR, 0.76; 95% CI, 0.53-1.10), or amputation (OR, 0.89; 95% CI, 0.67-1.20). For short- to mid-term outcomes, primary patency did not differ at 6 months (OR, 0.98; 95% CI, 0.81-1.19), 1 year (OR, 1.12; 95% CI, 0.97-1.30), or 2 years (OR, 1.17; 95% CI, 0.85-1.61) follow-up. Amputation-free survival did not differ at 6 months (OR, 1.03; 95% CI, 0.82-1.30), 1 year (OR, 1.09; 95% CI, 0.89-1.32), 2 years (OR, 1.18; 95% CI, 0.93-1.50), or 3 years (OR, 1.09; 95% CI, 0.84-1.40) of follow-up. No significant difference was found in overall survival or second patency. CONCLUSIONS This meta-analysis of retrospective, nonrandomized, observational studies suggests that prior endovascular treatment of lower extremity arterial disease does not result in worse perioperative, short-term, or mid-term clinical outcomes of subsequent infrainguinal bypass surgery compared with patients without prior endovascular treatment.
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Affiliation(s)
- Xinyu Yu
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Bing Wang
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chenyang Qiu
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yangyan He
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Tianchi Chen
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qianqian Zhu
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhenjiang Li
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ziheng Wu
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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11
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Nakamura N, Torii S, Aihara K, Noda S, Kato T, Nakazawa K, Ikari Y, Nakazawa G. Poor Below Knee Runoff Impacts Femoropopliteal Stent Failure and Fluoropolymer Antithrombotic Effect in Healthy Swine Model. Eur J Vasc Endovasc Surg 2023; 66:722-729. [PMID: 37516380 DOI: 10.1016/j.ejvs.2023.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 06/20/2023] [Accepted: 07/21/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVE Poor below knee (BTK) runoff is a predictor of stent failure after endovascular femoropopliteal artery treatment; however, lack of pathological evaluation has prevented characterisation of stent failure. The study aimed to investigate the impact of poor BTK runoff and the antithrombotic effect of the polymer of fluoropolymer coated paclitaxel eluting stents (FP-PESs) in a healthy swine femoropopliteal artery model. METHODS FP-PESs and bare metal stents (BMSs) and FP-PES and polymer free paclitaxel coated stents (PF-PCSs) were implanted in the bilateral femoral arteries of healthy swine (n = 6, respectively) following coil embolisation in both tibial arteries to induce poor BTK runoff. Histological assessment and intravascular imaging device evaluation were performed at one month. The Japanese Association for Laboratory Animal Science approved the study protocol (reference number: IVT22-90). RESULTS Optical coherence tomography showed significantly lower percent area stenosis in FP-PES compared with BMS (37.3%, [interquartile range (IQR), 25.6 - 54.3] % vs. 92.5% [IQR, 75.5 - 96.1] %, respectively, p = .031), and PF-PCS (8.3% [IQR, 4.5 - 27.0] % vs. 31.2% [IQR, 23.3 - 52.2] %, respectively, p = .031). Histopathological evaluation demonstrated that thin fibrin attachment without re-stenosis was the most dominant neointimal tissue characteristic in FP-PES. On the other hand, neointimal tissue characteristics with significant restenosis of BMS and PF-PCS were mainly organising or organised thrombus. CONCLUSION Organising and or organised thrombus attachment due to poor BTK runoff was the main cause of in stent restenosis of the swine femoral artery. FP-PES demonstrated the least percent area stenosis, suggesting the importance of the antithrombotic effect of polymer.
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Affiliation(s)
- Norihito Nakamura
- Tokai University School of Medicine, Department of Cardiology, Kanagawa, Japan
| | - Sho Torii
- Tokai University School of Medicine, Department of Cardiology, Kanagawa, Japan.
| | - Kazuki Aihara
- Tokai University School of Medicine, Department of Cardiology, Kanagawa, Japan
| | - Satoshi Noda
- Tokai University School of Medicine, Department of Cardiology, Kanagawa, Japan
| | - Tsukasa Kato
- Akita University, Department of Cardiology, Akita, Japan
| | - Keigo Nakazawa
- Tokai University Hachioji Hospital, Department of Clinical engineering, Tokyo, Japan
| | - Yuji Ikari
- Tokai University School of Medicine, Department of Cardiology, Kanagawa, Japan
| | - Gaku Nakazawa
- Kindai University, Department of Cardiology, Osaka, Japan
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12
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Ricco JB, Roiger RJ, Schneider F, Guetarni F, Thaveau F, Illuminati G, Pasqua R, Chaufour X, Porterie J, Hostalrich A. Editor's Choice - Infra-inguinal Endovascular Revascularisation and Bypass Surgery for Chronic Limb Threatening Ischaemia: a Retrospective European Multicentre Cohort Study with Propensity Score Matching. Eur J Vasc Endovasc Surg 2023; 66:531-540. [PMID: 37385368 DOI: 10.1016/j.ejvs.2023.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 05/31/2023] [Accepted: 06/17/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVE The aim of this study was to compare the long term efficacy of lower limb bypass with that of endovascular treatment (EVT) in patients with chronic limb threatening ischaemia (CLTI). METHODS This retrospective, multicentre study evaluated the outcomes of patients with CLTI who underwent first time infra-inguinal bypass or EVT. The primary outcome was to compare amputation free survival (AFS) rates between the two propensity score matched groups. The secondary outcome was to compare wound healing within the first six months. Major adverse events were compared according to the type of revascularisation. RESULTS Overall, 793 patients fulfilled the eligibility criteria, from whom 236 propensity score matched pairs were analysed. The mean follow up was 52 months. The 236 bypass procedures included 190 autogenous bypass grafts (80.5%), 151 (64.0%) of which were infrapopliteal. Among the 236 EVT procedures, the target lesion was the femoropopliteal segment in 81 patients (34.3%), the femoropopliteal and infrapopliteal segments in 101 patients (42.8%), and the infrapopliteal segment in 54 patients (22.9%). AFS was significantly better in the bypass group at five years (60.5 ± 3.6%) compared with the EVT group (35.3 ± 3.6%) (p < .001). Major amputation occurred in 61 patients (25.8%) in the bypass group and 85 patients (36.0%) in the EVT group (HR 0.66, 95% CI 0.47 - 0.92; p = .014). The probability of healing was significantly better in the bypass group at six months compared with the EVT group (p = .003). The median length of stay was shorter for the EVT group (4 days) than for the bypass group (8 days) (p = .001). Urgent re-intervention and re-admission rates were high and did not differ significantly between the groups. CONCLUSION This study has shown that lower limb bypass surgery offered a significantly higher probability of AFS and wound healing compared with EVT in patients with CLTI.
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Affiliation(s)
- Jean-Baptiste Ricco
- Department of Clinical Research and Vascular Surgery Service, Poitiers University Hospital, Poitiers, France.
| | - Richard J Roiger
- Department of Computer Information Science, Minnesota State University, Mankato, MN, USA
| | - Fabrice Schneider
- Department of Vascular Surgery and CIC INSERM 1402, Poitiers University Hospital, Poitiers, France
| | - Farid Guetarni
- Department of Clinical Research and Data Management, Poitiers University Hospital, Poitiers, France; and CNAM, Paris, France
| | - Fabien Thaveau
- Department of Vascular Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Giulio Illuminati
- Department of Vascular Surgery, University of Rome, La Sapienza, Rome, Italy
| | - Rocco Pasqua
- Department of Vascular Surgery, University of Rome, La Sapienza, Rome, Italy
| | - Xavier Chaufour
- Department of Vascular Surgery, Toulouse University Hospital, Toulouse, France
| | - Jean Porterie
- Department of Cardiovascular Surgery, University Hospital Rangueil Toulouse, Toulouse, France
| | - Aurélien Hostalrich
- Department of Vascular Surgery, Toulouse University Hospital, Toulouse, France
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13
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Levy ES, Kim AS, Werlin E, Chen M, Sansbury BE, Spite M, Desai TA, Conte MS. Tissue factor targeting peptide enhances nanoparticle binding and delivery of a synthetic specialized pro-resolving lipid mediator to injured arteries. JVS Vasc Sci 2023; 4:100126. [PMID: 38045567 PMCID: PMC10692706 DOI: 10.1016/j.jvssci.2023.100126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 08/17/2023] [Indexed: 12/05/2023] Open
Abstract
Background Specialized pro-resolving lipid mediators (SPM) such as resolvin D1 (RvD1) attenuate inflammation and exhibit vasculo-protective properties. Methods We investigated poly-lactic-co-glycolic acid (PLGA)-based nanoparticles (NP), containing a peptide targeted to tissue factor (TF) for delivery of 17R-RvD1 and a synthetic analog 17-R/S-benzo-RvD1 (benzo-RvD1) using in vitro and in vivo models of acute vascular injury. NPs were characterized in vitro by size, drug loading, drug release, TF binding, and vascular smooth muscle cell migration assays. NPs were also characterized in a rat model of carotid angioplasty. Results PLGA NPs based on a 75/25 lactic to glycolic acid ratio demonstrated optimal loading (507.3 pg 17R-RvD1/mg NP; P = ns) and release of RvD1 (153.1 pg 17R-RvD1/mg NP; P < .05). NPs incorporating the targeting peptide adhered to immobilized TF with greater avidity than NPs with scrambled peptide (50 nM: 41.6 ± 0.52 vs 32.66 ± 0.34; 100 nM: 35.67 ± 0.95 vs 23.5 ± 0.39; P < .05). NPs loaded with 17R-RvD1 resulted in a trend toward blunted vascular smooth muscle cell migration in a scratch assay. In a rat model of carotid angioplasty, 16-fold more NPs were present after treatment with TF-targeted NPs compared with scrambled NPs (P < .01), with a corresponding trend toward higher tissue levels of 17R-RvD1 (P = .06). Benzo-RvD1 was also detectable in arteries treated with targeted NP delivery and accumulated at 10 times higher levels than NP loaded with 17R-RvD1. There was a trend toward decreased CD45 immunostaining in vessels treated with NP containing benzo-RvD1 (0.76 ± 0.38 cells/mm2 vs 122.1 ± 22.26 cells/mm2; P = .06). There were no significant differences in early arterial inflammatory and cytokine gene expression by reverse transcription-polymerase chain reaction. Conclusions TF-targeting peptides enhanced NP-mediated delivery of SPM to injured artery. TF-targeted delivery of SPMs may be a promising therapeutic approach to attenuate the vascular injury response.
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Affiliation(s)
- Elizabeth S. Levy
- Department of Bioengineering and Therapeutics, University of California San Francisco, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham, San Francisco, CA
- Small Molecules Pharmaceutics, Genentech, South San Francisco, CA
| | - Alexander S. Kim
- Department of Surgery and Cardiovascular Institute, University of California San Francisco, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham, San Francisco, CA
| | - Evan Werlin
- Department of Surgery and Cardiovascular Institute, University of California San Francisco, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham, San Francisco, CA
| | - Mian Chen
- Department of Surgery and Cardiovascular Institute, University of California San Francisco, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham, San Francisco, CA
| | | | - Matthew Spite
- Women's Hospital and Harvard Medical School, Boston, MA
| | - Tejal A. Desai
- Department of Bioengineering and Therapeutics, University of California San Francisco, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham, San Francisco, CA
- School of Engineering, Brown University, Providence, RI
| | - Michael S. Conte
- Department of Surgery and Cardiovascular Institute, University of California San Francisco, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham, San Francisco, CA
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Duong VT, Nguyen CT, Phan HL, Le VP, Dang TT, Choi C, Seo J, Cha C, Back SH, Koo KI. Double-layered blood vessels over 3 mm in diameter extruded by the inverse-gravity technique. Biofabrication 2023; 15:045022. [PMID: 37659401 DOI: 10.1088/1758-5090/acf61f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 09/01/2023] [Indexed: 09/04/2023]
Abstract
One of the most promising techniques for treating severe peripheral artery disease is the use of cellular tissue-engineered vascular grafts (TEVGs). This study proposes an inverse-gravity (IG) extrusion technique for creating long double-layered cellular TEVGs with diameters over 3 mm. A three-layered coaxial laminar hydrogel flow in an 8 mm-diameter pipe was realised simply by changing the extrusion direction of the hydrogel from being aligned with the direction of gravity to against it. This technique produced an extruded mixture of human aortic smooth muscle cells (HASMCs) and type-I collagen as a tubular structure with an inner diameter of 3.5 mm. After a 21 day maturation period, the maximal burst pressure, longitudinal breaking force, and circumferential breaking force of the HASMC TEVG were 416 mmHg, 0.69 N, and 0.89 N, respectively. The HASMC TEVG was endothelialised with human umbilical vein endothelial cells to form a tunica intima that simulated human vessels. Besides subcutaneous implantability on mice, the double-layered blood vessels showed a considerably lower adherence of platelets and red blood cells once exposed to heparinised mouse blood and were considered nonhaemolytic. The proposed IG extrusion technique can be applied in various fields requiring multilayered materials with large diameters.
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Affiliation(s)
- Van Thuy Duong
- Department of Electrical, Electronic and Computer Engineering, University of Ulsan, Ulsan 44610, Republic of Korea
| | - Chanh Trung Nguyen
- Department of Electrical, Electronic and Computer Engineering, University of Ulsan, Ulsan 44610, Republic of Korea
| | - Huu Lam Phan
- Department of Electrical, Electronic and Computer Engineering, University of Ulsan, Ulsan 44610, Republic of Korea
| | - Van Phu Le
- Department of Electrical, Electronic and Computer Engineering, University of Ulsan, Ulsan 44610, Republic of Korea
| | - Thao Thi Dang
- School of Biological Sciences, University of Ulsan, Ulsan 44610, Republic of Korea
| | - Cholong Choi
- Center for Multidimensional Programmable Matter, Department of Materials Science and Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan 44919, Republic of Korea
| | - Jongmo Seo
- Electrical and Computer Engineering, Seoul National University, Seoul 08826, Republic of Korea
| | - Chaenyung Cha
- Center for Multidimensional Programmable Matter, Department of Materials Science and Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan 44919, Republic of Korea
| | - Sung Hoon Back
- School of Biological Sciences, University of Ulsan, Ulsan 44610, Republic of Korea
| | - Kyo-In Koo
- Department of Electrical, Electronic and Computer Engineering, University of Ulsan, Ulsan 44610, Republic of Korea
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15
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Wang X, Yang Y, Yu L, Pang C, Sun W, Zang S, Li C. Association between fibrinogen level and length of stay in patients with lower extremity atherosclerotic disease: a retrospective cohort study. Sci Rep 2023; 13:11872. [PMID: 37481624 PMCID: PMC10363167 DOI: 10.1038/s41598-023-39219-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 07/21/2023] [Indexed: 07/24/2023] Open
Abstract
The level of fibrinogen in patients with lower extremity atherosclerosis (LEAD) has been widely identified as a risk factor contributing to adverse outcomes. However, some knowledge gaps remain regarding fibrinogen levels and downstream adverse outcomes, such as length of stay (LOS). We conducted this study to examine the association between fibrinogen level and LOS in LEAD patients. The retrospective cohort study included 1428 LEAD patients between January 2014 and November 2021 in China. Several generalized linear models with a negative binomial link function were used to evaluate the association between fibrinogen level and LOS. The area under the curve (AUC) was used to evaluate the predicting effect of fibrinogen level on a LOS greater than 10 days (median LOS). The median age of the patients was 70 years old, and 1153 (80.74%) were males. Fibrinogen level was positively associated with LOS (β = 1.14; 95% CI, 0.42-1.86; p = 0.002) in LEAD patients after controlling for age, gender, number of historical hospitalizations, surgical history, vascular disease history, drinking history, smoking history, insurance type, surgical approach, lesion site, weight loss, Fontaine classification, age-adjusted Charlson comorbidity index, urea, total protein, activated partial thromboplastin time, thrombin time, prothrombin time-international normalized ratio, calcium, triglyceride, albumin/globulin ratio, phosphorus, and D-dimer. The fibrinogen-added prediction model demonstrated good discrimination and calibration, with an AUC value of 0.807. Fibrinogen level was positively associated with LOS in LEAD patients. The fibrinogen level is a widely available and easy-to-measure biochemical indicator, and it could be used as a suitable indicator for the prognosis and prophylaxis of prolonged LOS in patients with LEAD during hospitalization.
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Affiliation(s)
- Xue Wang
- Department of Community Nursing, School of Nursing, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, China
| | - Yu Yang
- Department of Vascular Surgery, The First Hospital of China Medical University, No.155 Nanjing Bei Street, Heping District, Shenyang, 110001, Liaoning, China
| | - Ling Yu
- Phase I Clinical Trails Center, The First Hospital of China Medical University, No.155 Nanjing Bei Street, Heping District, Shenyang, 110001, Liaoning, China
| | - Chang Pang
- Department of General Practice, The Second Affiliated Hospital of Shenyang Medical College, No. 20 Bei Jiu Road, Heping District, Shenyang, 110002, Liaoning, China
| | - Wei Sun
- Department of Ultrasound, The Second Affiliated Hospital of Shenyang Medical College, No. 20 Bei Jiu Road, Heping District, Shenyang, 110002, Liaoning, China
| | - Shuang Zang
- Department of Community Nursing, School of Nursing, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, China.
| | - Cong Li
- Department of Vascular Surgery, The First Hospital of China Medical University, No.155 Nanjing Bei Street, Heping District, Shenyang, 110001, Liaoning, China.
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16
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Sligar AD, Howe G, Goldman J, Felli P, Gómez-Hernández A, Takematsu E, Veith A, Desai S, Riley WJ, Singeetham R, Mei L, Callahan G, Ashirov D, Smalling R, Baker AB. Syndecan-4 Proteoliposomes Enhance Revascularization in a Rabbit Hind Limb Ischemia Model of Peripheral Ischemia. Acta Biomater 2023:S1742-7061(23)00331-8. [PMID: 37321528 DOI: 10.1016/j.actbio.2023.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 06/17/2023]
Abstract
Regenerative therapeutics for treating peripheral arterial disease are an appealing strategy for creating more durable solutions for limb ischemia. In this work, we performed preclinical testing of an injectable formulation of syndecan-4 proteoliposomes combined with growth factors as treatment for peripheral ischemia delivered in an alginate hydrogel. We tested this therapy in an advanced model of hindlimb ischemia in rabbits with diabetes and hyperlipidemia. Our studies demonstrate enhancement in vascularity and new blood vessel growth with treatment with syndecan-4 proteoliposomes in combination with FGF-2 or FGF-2/PDGF-BB. The effects of the treatments were particularly effective in enhancing vascularity in the lower limb with a 2-4 increase in blood vessels in the treatment group in comparison to the control group. In addition, we demonstrate that the syndecan-4 proteoliposomes have stability for at least 28 days when stored at 4°C to allow transport and use in the hospital environment. In addition, we performed toxicity studies in the mice and found no toxic effects even when injected at high concentration. Overall, our studies support that syndecan-4 proteoliposomes markedly enhance the therapeutic potential of growth factors in the context of disease and may be promising therapeutics for inducing vascular regeneration in peripheral ischemia. STATEMENT OF SIGNIFICANCE: Peripheral ischemia is a common condition in which there is a lack of blood flow to the lower limbs. This condition can lead to pain while walking and, in severe cases, critical limb ischemia and limb loss. In this study, we demonstrate the safety and efficacy of a novel injectable therapy for enhancing revascularization in peripheral ischemia using an advanced large animal model of peripheral vascular disease using rabbits with hyperlipidemia and diabetes.
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Affiliation(s)
- Andrew D Sligar
- University of Texas at Austin, Department of Biomedical Engineering, Austin, TX
| | - Gretchen Howe
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Texas Medical School at Houston, TX
| | - Julia Goldman
- Center for Laboratory Animal Medicine and Care, UT Health Science Center at Houston
| | - Patricia Felli
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Texas Medical School at Houston, TX
| | - Almudena Gómez-Hernández
- Department of Biochemistry and Molecular Biology, School of Pharmacy, Complutense University of Madrid, Madrid, Spain
| | - Eri Takematsu
- University of Texas at Austin, Department of Biomedical Engineering, Austin, TX
| | - Austin Veith
- University of Texas at Austin, Department of Biomedical Engineering, Austin, TX
| | - Shubh Desai
- University of Texas at Austin, Department of Biomedical Engineering, Austin, TX
| | - William J Riley
- University of Texas at Austin, Department of Biomedical Engineering, Austin, TX
| | - Rohan Singeetham
- University of Texas at Austin, Department of Biomedical Engineering, Austin, TX
| | - Lei Mei
- University of Texas at Austin, Department of Biomedical Engineering, Austin, TX
| | - Gregory Callahan
- University of Texas at Austin, Department of Biomedical Engineering, Austin, TX
| | - David Ashirov
- University of Texas at Austin, Department of Biomedical Engineering, Austin, TX
| | - Richard Smalling
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Texas Medical School at Houston, TX; Memorial Hermann Heart and Vascular Institute, Houston, TX
| | - Aaron B Baker
- University of Texas at Austin, Department of Biomedical Engineering, Austin, TX; Institute for Cellular and Molecular Biology, University of Texas at Austin, Austin, TX; The Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin, TX; Institute for Biomaterials, Drug Delivery and Regenerative Medicine, University of Texas at Austin, Austin, TX.
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17
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Gao Y, Xiao J, Chen Z, Ma Y, Liu X, Yang D, Leo HL, Yu H, Kong J, Guo Q. Engineering orthotopic tumor spheroids with organ-specific vasculatures for local chemoembolization evaluation. Biomater Sci 2023; 11:2115-2128. [PMID: 36723179 DOI: 10.1039/d2bm01632j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Developing a three-dimensional (3D) in vitro tumor model with vasculature systems suitable for testing endovascular interventional therapies remains a challenge. Here we develop an orthotopic liver tumor spheroid model that captures the organ-level complexity of vasculature systems and the extracellular matrix to evaluate transcatheter arterial chemoembolization (TACE) treatment. The orthotopic tumor spheroids are derived by seeding HepG2 cell colonies with controlled size and location surrounding the portal triads in a decellularized rat liver matrix and are treated by clinically relevant drug-eluting beads embolized in a portal vein vasculature while maintaining dynamic physiological conditions with nutrient and oxygen supplies through the hepatic vein vasculature. The orthotopic tumor model exhibits strong drug retention inside the spheroids and embolization location-dependent cellular apoptosis responses in an analogous manner to in vivo conditions. Such a tumor spheroid model built in a decellularized scaffold containing organ-specific vasculatures, which closely resembles the unique tumor microenvironment, holds the promise to efficiently assess various diagnostic and therapeutic strategies for endovascular therapies.
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Affiliation(s)
- Yanan Gao
- Shenzhen Key Laboratory of Smart Healthcare Engineering, Guangdong Provincial Key Laboratory of Advanced Biomaterials, Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, Guangdong 518055, China.
| | - Jingyu Xiao
- Shenzhen Key Laboratory of Smart Healthcare Engineering, Guangdong Provincial Key Laboratory of Advanced Biomaterials, Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, Guangdong 518055, China.
| | - Zijian Chen
- Shenzhen Key Laboratory of Smart Healthcare Engineering, Guangdong Provincial Key Laboratory of Advanced Biomaterials, Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, Guangdong 518055, China. .,Department of Biomedical Engineering, National University of Singapore, Singapore, 117583, Singapore
| | - Yutao Ma
- Shenzhen Key Laboratory of Smart Healthcare Engineering, Guangdong Provincial Key Laboratory of Advanced Biomaterials, Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, Guangdong 518055, China.
| | - Xiaoya Liu
- Shenzhen Key Laboratory of Smart Healthcare Engineering, Guangdong Provincial Key Laboratory of Advanced Biomaterials, Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, Guangdong 518055, China.
| | - Dishuang Yang
- Shenzhen Key Laboratory of Smart Healthcare Engineering, Guangdong Provincial Key Laboratory of Advanced Biomaterials, Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, Guangdong 518055, China.
| | - Hwa Liang Leo
- Department of Biomedical Engineering, National University of Singapore, Singapore, 117583, Singapore
| | - Hanry Yu
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117593, Singapore.,Mechanobiology Institute, National University of Singapore, Singapore 117411, Singapore.,Institute of Bioengineering and Nanotechnology, Agency for Science, Technology and Research, Singapore 138669, Singapore.,Singapore-MIT Alliance for Research and Technology, Singapore 138602, Singapore
| | - Jian Kong
- Department of Interventional Radiology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, 518020, China.
| | - Qiongyu Guo
- Shenzhen Key Laboratory of Smart Healthcare Engineering, Guangdong Provincial Key Laboratory of Advanced Biomaterials, Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, Guangdong 518055, China.
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18
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Zhang M, Lotfollahzadeh S, Elzinad N, Yang X, Elsadawi M, Gower A, Belghasem M, Shazly T, Kolachalama VB, Chitalia V. Alleviating iatrogenic effects of paclitaxel via anti-inflammatory treatment. RESEARCH SQUARE 2023:rs.3.rs-2487922. [PMID: 36778300 PMCID: PMC9915804 DOI: 10.21203/rs.3.rs-2487922/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background Paclitaxel is touted as an essential medicine due to its extensive use as a chemotherapeutic for various cancers and an antiproliferative agent for restenosis. Due to recent concerns related to long-term mortality, paclitaxel (PTX)-based endovascular therapy is now surrounded by controversies. Objective Examine the inflammatory mediators driven by the systemic administration of PTX and explore the means to suppress these effects. Methods RNAseq analysis, cell and mouse models. Results RNAseq analysis of primary human endothelial cells (ECs) treated with PTX demonstrated transcriptional perturbations of a set of pro-inflammatory mediators, including monocyte chemoattractant protein-1 (MCP-1) and CD137, which were validated in EC lysates. These perturbations were abrogated with dexamethasone, a prototypic anti-inflammatory compound. The media of ECs pre-treated with PTX showed a significant increase in MCP-1 levels, which were reverted to baseline levels with DEX treatment. A group of mice harvested at different time points after PTX injection were analyzed for immediate and delayed effects of PTX. A 3-fold increase in MCP-1 was noted in blood and aortic ECs after 12 hours of PTX treatment. Similar changes in CD137 and downstream mediators such as tissue factor, VCAM-1 and E-selectin were noted in aortic ECs. Conclusions Our study shows that systemic PTX exposure upregulates atherothrombotic markers, and co-delivery of DEX can subdue the untoward toxic effects. Long-term studies are needed to probe the mechanisms driving systemic complications of PTX-based therapies and evaluate the clinical potential of DEX to mitigate risk.
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Song X, Qiu H, Yang S, Liu Y, Cao Y, Wang S, Zhao J. Peri-therapeutic multi-modal hemodynamic assessment and detection of predictors for symptomatic in-stent restenosis after percutaneous transluminal angioplasty and stenting. Front Neurol 2023; 14:1136847. [PMID: 37144006 PMCID: PMC10151536 DOI: 10.3389/fneur.2023.1136847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/16/2023] [Indexed: 05/06/2023] Open
Abstract
Backgrounds This study performed multi-modal hemodynamic analysis including quantitative color-coded digital subtraction angiography (QDSA) and computational fluid dynamics (CFD) to delineate peri-therapeutic hemodynamic changes and explore the risk factors for in-stent restenosis (ISR) and symptomatic ISR (sISR). Methods Forty patients were retrospectively reviewed. Time to peak (TTP), full width at half maximum (FWHM), cerebral circulation time (CCT), angiographic mean transit time (aMTT), arterial stenosis index (ASI), wash-in gradient (WI), wash-out gradient (WO) and stasis index were calculated with QDSA and translesional pressure ratio (PR) and wall shear stress ratio (WSSR) were quantified from CFD analysis. These hemodynamic parameters were compared between before and after stent deployment and multivariate logistic regression model was established to detect predictors for ISR and sISR at follow-up. Results It was found that stenting generally reduced TTP, stasis index, CCT, aMTT and translesional WSSR while significantly increased translesional PR. ASI decreased after stenting, and during the mean follow-up time of 6.48 ± 2.86 months, lower ASI (<0.636) as well as larger stasis index were corroborated to be independently associated with sISR. aMTT showed a linear correlation with CCT before and after stenting. Conclusion PTAS not only improved cerebral circulation and blood flow perfusion but also changed local hemodynamics significantly. ASI and stasis index derived from QDSA were proved to play a prominent role in risk stratification for sISR. Multi-modal hemodynamic analysis could facilitate intraoperative real-time hemodynamic monitoring and help the determination of the end point of intervention.
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Affiliation(s)
- Xiaowen Song
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hancheng Qiu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Shuo Yang
- Department of Vascular Neurosurgery, New Era Stroke Care and Research Institute, The PLA Rocket Force General Hospital, Beijing, China
| | - Yuqi Liu
- Escope Innovation Academy, Beijing, China
| | - Yong Cao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- *Correspondence: Jizong Zhao,
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20
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Golledge J. Surgical Revascularization - Best for Limb Ischemia? N Engl J Med 2022; 387:2377-2378. [PMID: 36546631 DOI: 10.1056/nejme2214046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Jonathan Golledge
- From the Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, and the Australian Institute of Tropical Health and Medicine, James Cook University, and the Department of Vascular and Endovascular Surgery, Townsville University Hospital - all in Townsville, QLD, Australia
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21
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Bioadhesive Perivascular Microparticle-Gel Drug Delivery System for Intimal Hyperplasia Prevention: In Vitro Evaluation and Preliminary Biocompatibility Assessment. Gels 2022; 8:gels8120776. [PMID: 36547300 PMCID: PMC9778534 DOI: 10.3390/gels8120776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022] Open
Abstract
Intimal hyperplasia (IH) is an undesirable pathology occurring after peripheral or coronary bypass surgery. It involves the proliferation and migration of vascular smooth muscle cells, leading to a reduction in the diameter of the vascular lumen, which can lead to stenosis and graft failure. Topically applied atorvastatin (ATV) has been shown to slow down this process. To be effective, the drug delivery system should remain at the perivascular site for 5-8 weeks, corresponding to the progression of IH, and be capable of releasing an initial dose of the drug followed by a sustained release. Ideally, bioadhesion would anchor the gel to the application site. To meet these needs, we encapsulated ATV in a 2-component system: a hyaluronic acid-dopamine bioadhesive gel for rapid release and biodegradable microparticles for sustained release. The system was characterized by scanning electron microscopy, rheology, bioadhesion on porcine arteries, and a release profile. The rheological properties were adequate for perivascular application, and we demonstrated superior bioadhesion and cohesion compared to the control HA formulations. The release profile showed a burst, generated by free ATV, followed by sustained release over 8 weeks. A preliminary evaluation of subcutaneous biocompatibility in rats showed good tolerance of the gel. These results offer new perspectives on the perivascular application towards an effective solution for the prevention of IH.
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22
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Zhang Q, Li F, Ritchie RH, Woodman OL, Zhou X, Qin CX. Novel strategies to promote resolution of inflammation to treat lower extremity artery disease. Curr Opin Pharmacol 2022; 65:102263. [DOI: 10.1016/j.coph.2022.102263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/24/2022] [Accepted: 05/31/2022] [Indexed: 12/24/2022]
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23
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Wu J, Zhu D, Currie S. Editorial: Arteriogenesis and Collateral Remodelling in Ischaemic Disease. Front Cardiovasc Med 2022; 9:916218. [PMID: 35783846 PMCID: PMC9242630 DOI: 10.3389/fcvm.2022.916218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 05/18/2022] [Indexed: 12/02/2022] Open
Affiliation(s)
- Junxi Wu
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, United Kingdom
- *Correspondence: Junxi Wu
| | - Dongxing Zhu
- Guangdong Key Laboratory of Vascular Diseases, State Key Laboratory of Respiratory Disease, School of Basic Medical Sciences, The Second Affiliated Hospital, Guangzhou Institute of Cardiovascular Disease, Guangzhou Medical University, Guangzhou, China
| | - Susan Currie
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
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Szyszkowska A, Barańska S, Sawicki R, Tarasiuk E, Dubatówka M, Kondraciuk M, Sawicka-Śmiarowska E, Knapp M, Głowiński J, Kamiński K, Lisowska A. Insulin-Like Growth Factor-Binding Protein 7 (IGFBP-7)-New Diagnostic and Prognostic Marker in Symptomatic Peripheral Arterial Disease?-Pilot Study. Biomolecules 2022; 12:712. [PMID: 35625639 PMCID: PMC9138972 DOI: 10.3390/biom12050712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/05/2022] [Accepted: 05/12/2022] [Indexed: 11/18/2022] Open
Abstract
The aim of our study was to evaluate the importance of insulin-like growth-factor-binding protein 7 (IGFBP-7) as a potential marker of symptomatic peripheral artery disease (PAD) occurrence. The study group consisted of 145 patients with diagnosed PAD, who qualified for the invasive treatment. The control group consisted of 67 individuals representing the local population and an ischemic heart disease (IHD) group of 88 patients after myocardial infarction or percutaneous coronary intervention. Patients with PAD had significantly higher IGFBP-7 concentrations than control group (1.80 ± 1.62 vs. 1.41 ± 0.45 ng/mL, p = 0.04). No significant differences between PAD patients and IHD patients were found (1.80 ± 1.62 vs. 1.76 ± 1.04 ng/mL, p = 0.783). Patients with multilevel PAD presented significantly higher IGFBP-7 concentrations than patients with aortoiliac PAD-median 1.18 (IQR 0.48-2.23) vs. 1.42 ng/mL (0.71-2.63), p = 0.035. In the group of patients who died or had a major adverse cardiovascular event (MACE) during six months of follow-up, a statistically significant higher IGFBP-7 concentration was found (median 2.66 (IQR 1.80-4.93) vs. 1.36 ng/mL (IQR 0.65-2.34), p = 0.004). It seems that IGFBP-7 is elevated in patients with atherosclerotic lesions-regardless of their locations. Further research should be conducted to verify IGFBP-7 usefulness as a predictor of MACE or death.
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Affiliation(s)
- Anna Szyszkowska
- Department of Cardiology, Medical University of Bialystok, 15-276 Bialystok, Poland; (A.S.); (R.S.); (E.T.); (E.S.-Ś.); (M.K.); (K.K.)
| | - Sylwia Barańska
- Department of Vascular Surgery and Transplantation, Medical University of Bialystok, 15-276 Bialystok, Poland; (S.B.); (J.G.)
| | - Robert Sawicki
- Department of Cardiology, Medical University of Bialystok, 15-276 Bialystok, Poland; (A.S.); (R.S.); (E.T.); (E.S.-Ś.); (M.K.); (K.K.)
| | - Ewa Tarasiuk
- Department of Cardiology, Medical University of Bialystok, 15-276 Bialystok, Poland; (A.S.); (R.S.); (E.T.); (E.S.-Ś.); (M.K.); (K.K.)
| | - Marlena Dubatówka
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, 15-276 Bialystok, Poland; (M.D.); (M.K.)
| | - Marcin Kondraciuk
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, 15-276 Bialystok, Poland; (M.D.); (M.K.)
| | - Emilia Sawicka-Śmiarowska
- Department of Cardiology, Medical University of Bialystok, 15-276 Bialystok, Poland; (A.S.); (R.S.); (E.T.); (E.S.-Ś.); (M.K.); (K.K.)
| | - Małgorzata Knapp
- Department of Cardiology, Medical University of Bialystok, 15-276 Bialystok, Poland; (A.S.); (R.S.); (E.T.); (E.S.-Ś.); (M.K.); (K.K.)
| | - Jerzy Głowiński
- Department of Vascular Surgery and Transplantation, Medical University of Bialystok, 15-276 Bialystok, Poland; (S.B.); (J.G.)
| | - Karol Kamiński
- Department of Cardiology, Medical University of Bialystok, 15-276 Bialystok, Poland; (A.S.); (R.S.); (E.T.); (E.S.-Ś.); (M.K.); (K.K.)
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, 15-276 Bialystok, Poland; (M.D.); (M.K.)
| | - Anna Lisowska
- Department of Cardiology, Medical University of Bialystok, 15-276 Bialystok, Poland; (A.S.); (R.S.); (E.T.); (E.S.-Ś.); (M.K.); (K.K.)
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Al-Damluji MS, Smolderen KG, Meng C, Dai F, Nanna MG, Sumpio B, Henke P, Mena-Hurtado C. Frailty and outcomes following revascularization of lower-extremity peripheral artery disease: Insights from the Vascular Quality Initiative (VQI). Vasc Med 2022; 27:251-257. [PMID: 35485400 DOI: 10.1177/1358863x221083701] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Multiple frailty screening tools are implemented; however, it is unclear whether they perform in a comparable way for both frailty detection and prediction of perioperative outcomes in patients undergoing lower-extremity revascularization. METHODS Patients undergoing lower-extremity revascularization were identified from the Vascular Quality Initiative (VQI) national database. Two cohorts were established based on the revascularization type (percutaneous vascular interventions (PVI) or lower-extremity bypass). Frailty was assessed by the 5-item modified frailty index (mFI-5) and the VQI-derived risk analysis index (RAI). RESULTS Out of 134,081 patients undergoing PVI, frailty was identified in 67% by mFI-5 and 28% by RAI. Similarly, out of 41,316 patients in the bypass cohort, frailty was identified in 69% by mFI-5 and 16% by RAI. There was little agreement between the two frailty tools for both vascular cohorts (PVI: kappa: 0.17; bypass: kappa: 0.13). In an adjusted analysis, frailty as assessed by mFI-5 and RAI was associated with higher odds of mortality in both cohorts (p < 0.001). A significant association between frailty and unplanned amputations was only noted in the bypass cohort when RAI was applied (OR: 1.50, p < 0.01). The addition of frailty to traditional PAD risk factors marginally improved model performance to predict mortality and unplanned major amputations. CONCLUSION There was significant variation in frailty detection by mFI-5 and RAI. Although frailty was associated with mortality, the predictive value of these tools in predicting outcomes in PAD was limited. Future research should focus on designing new frailty screening tools specific to the PAD population.
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Affiliation(s)
| | - Kim G Smolderen
- Department of Cardiology, Yale University, New Haven, CT, USA.,Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Can Meng
- Yale Center for Analytical Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Feng Dai
- Yale Center for Analytical Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Michael G Nanna
- Department of Cardiology, Yale University, New Haven, CT, USA
| | - Bauer Sumpio
- Department of Vascular Surgery, Yale University, New Haven, CT, USA
| | - Peter Henke
- Department of Vascular Surgery, University of Michigan, Ann Arbor, MI, USA
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Niu H, Gao N, Dang Y, Guan Y, Guan J. Delivery of VEGF and delta-like 4 to synergistically regenerate capillaries and arterioles in ischemic limbs. Acta Biomater 2022; 143:295-309. [PMID: 35301145 PMCID: PMC9926495 DOI: 10.1016/j.actbio.2022.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 03/06/2022] [Accepted: 03/09/2022] [Indexed: 12/11/2022]
Abstract
Vascularization of the poorly vascularized limbs affected by critical limb ischemia (CLI) is necessary to salvage the limbs and avoid amputation. Effective vascularization requires forming not only capillaries, but also arterioles and vessel branching. These processes rely on the survival, migration and morphogenesis of endothelial cells in the ischemic limbs. Yet endothelial cell functions are impaired by the upregulated TGFβ. Herein, we developed an injectable hydrogel-based drug release system capable of delivering both VEGF and Dll4 to synergistically restore endothelial cellular functions, leading to accelerated formation of capillaries, arterioles and vessel branching. In vitro, the Dll4 and VEGF synergistically promoted the human arterial endothelial cell (HAEC) survival, migration, and formation of filopodial structure, lumens, and branches under the elevated TGFβ1 condition mimicking that of the ischemic limbs. The synergistic effect was resulted from activating VEGFR2, Notch-1 and Erk1/2 signaling pathways. After delivering the Dll4 and VEGF via an injectable and thermosensitive hydrogel to the ischemic mouse hindlimbs, 95% of blood perfusion was restored at day 14, significantly higher than delivery of Dll4 or VEGF only. The released Dll4 and VEGF significantly increased density of capillaries and arterioles, vessel branching point density, and proliferating cell density. Besides, the delivery of Dll4 and VEGF stimulated skeletal muscle regeneration and improved muscle function. Overall, the developed hydrogel-based Dll4 and VEGF delivery system promoted ischemic limb vascularization and muscle regeneration. STATEMENT OF SIGNIFICANCE: Effective vascularization of the poorly vascularized limbs affected by critical limb ischemia (CLI) requires forming not only capillaries, but also arterioles and vessel branching. These processes rely on the survival, migration and morphogenesis of endothelial cells. Yet endothelial cell functions are impaired by the upregulated TGFβ in the ischemic limbs. Herein, we developed an injectable hydrogel-based drug release system capable of delivering both VEGF and Dll4 to synergistically restore endothelial cell functions, leading to accelerated formation of capillaries, arterioles and vessel branching.
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Affiliation(s)
- Hong Niu
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis. St. Louis, MO, 63130, United States; Center of Regenerative Medicine, Washington University in St. Louis. St. Louis, MO, 63130, United States; Department of Materials Science and Engineering, Ohio State University. Columbus, OH, 43210, United States
| | - Ning Gao
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis. St. Louis, MO, 63130, United States; Institute of Materials Science and Engineering, Washington University in St. Louis. St. Louis, MO, 63130, United States
| | - Yu Dang
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis. St. Louis, MO, 63130, United States; Institute of Materials Science and Engineering, Washington University in St. Louis. St. Louis, MO, 63130, United States
| | - Ya Guan
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis. St. Louis, MO, 63130, United States; Institute of Materials Science and Engineering, Washington University in St. Louis. St. Louis, MO, 63130, United States
| | - Jianjun Guan
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis. St. Louis, MO, 63130, United States; Center of Regenerative Medicine, Washington University in St. Louis. St. Louis, MO, 63130, United States; Department of Materials Science and Engineering, Ohio State University. Columbus, OH, 43210, United States; Institute of Materials Science and Engineering, Washington University in St. Louis. St. Louis, MO, 63130, United States.
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Collins GC, Brumfiel TA, Bercu ZL, Desai JP, Lindsey BD. Dual-Resonance (16/32 MHz) Piezoelectric Transducer With a Single Electrical Connection for Forward-Viewing Robotic Guidewire. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2022; 69:1428-1441. [PMID: 35143395 PMCID: PMC9013008 DOI: 10.1109/tuffc.2022.3150746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Peripheral artery disease (PAD) affects more than 200 million people globally. Minimally invasive endovascular procedures can provide relief and salvage limbs while reducing injury rates and recovery times. Unfortunately, when a calcified chronic total occlusion is encountered, ~25% of endovascular procedures fail due to the inability to advance a guidewire using the view provided by fluoroscopy. To enable a sub-millimeter, robotically steerable guidewire to cross these occlusions, a novel single-element, dual-band transducer is developed that provides simultaneous multifrequency, forward-viewing imaging with high penetration depth and high spatial resolution while requiring only a single electrical connection. The design, fabrication, and acoustic characterization of this device are described, and proof-of-concept imaging is demonstrated in an ex vivo porcine artery after integration with a robotically steered guidewire. Measured center frequencies of the developed transducer were 16 and 32 MHz, with -6 dB fractional bandwidths of 73% and 23%, respectively. When imaging a 0.2-mm wire target at a depth of 5 mm, measured -6 dB target widths were 0.498 ± 0.02 and 0.268 ± 0.01 mm for images formed at 16 and 32 MHz, respectively. Measured SNR values were 33.3 and 21.3 dB, respectively. The 3-D images of the ex vivo artery demonstrate high penetration for visualizing vessel morphology at 16 MHz and ability to resolve small features close to the transducer at 32 MHz. Using images acquired simultaneously at both frequencies as part of an integrated forward-viewing, guidewire-based imaging system, an interventionalist could visualize the best path for advancing the guidewire to improve outcomes for patients with PAD.
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Gao B, Wang X, Wang M, You K, Ahmed Suleiman GS, Ren XK, Guo J, Xia S, Zhang W, Feng Y. Superlow Dosage of Intrinsically Bioactive Zinc Metal-Organic Frameworks to Modulate Endothelial Cell Morphogenesis and Significantly Rescue Ischemic Disease. ACS NANO 2022; 16:1395-1408. [PMID: 35006685 DOI: 10.1021/acsnano.1c09427] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Despite long-term efforts for ischemia therapy, proangiogenic drugs hardly satisfy therapy/safety/cost/mass production multiple evaluations and meanwhile with a desire to minimize dosages, thereby clinical applications have been severely hampered. Recently, metal ion-based therapy has emerged as an effective strategy. Herein, intrinsically bioactive Zn metal-organic frameworks (MOFs) were explored by bridging the dual superiorities of proangiogenic Zn2+ and facile/cost-effective/scalable MOFs. Zn-MOFs could enhance the morphogenesis of vascular endothelial cells (ECs) via the PI3K/Akt/eNOS pathway. However, high dosage is inevitable and Zn-MOFs suffer from insolubility and low stability, which lead to the bioaccumulation of Zn-MOFs and seriously potential toxicity risks. To alleviate this, it is required to decrease the dosage, but this can be entrapped into the dosage/therapy/safety contradiction and disappointing therapy effect. To address these challenges, the bioavailability of Zn-MOFs is urgent to improve for the minimization of dosage and significant therapy/safety. The mitochondrial respiratory chain is Zn2+ active, which inspired us to codecorate EC-targeted and mitochondria-localizing-sequence peptides onto Zn-MOF surfaces. Interestingly, after codecoration, a 100-fold reduced dosage acquired equally powerful vascularization, and the superlow dosage significantly rescued ischemia (4.4 μg kg-1, about one order of magnitude lower than the published minimal value). Additionally, no obvious muscle injury was found after treatment. Potential toxicity risks were alleviated, benefiting from the superlow dosage. This advanced drug simultaneously satisfied comprehensive evaluations and dosage minimization. This work utilizes engineering thought to rationally design "all-around" bioactive MOFs and is expected to be applied for ischemia treatment.
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Affiliation(s)
- Bin Gao
- School of Chemical Engineering and Technology, Tianjin University, Yaguan Road 135, Tianjin 300350, China
| | - Xiaoyu Wang
- School of Chemical Engineering and Technology, Tianjin University, Yaguan Road 135, Tianjin 300350, China
| | - Meiyu Wang
- School of Chemical Engineering and Technology, Tianjin University, Yaguan Road 135, Tianjin 300350, China
| | - Kexin You
- School of Chemical Engineering and Technology, Tianjin University, Yaguan Road 135, Tianjin 300350, China
| | - Gasim Sebit Ahmed Suleiman
- School of Chemical Engineering and Technology, Tianjin University, Yaguan Road 135, Tianjin 300350, China
| | - Xiang-Kui Ren
- School of Chemical Engineering and Technology, Tianjin University, Yaguan Road 135, Tianjin 300350, China
- Collaborative Innovation Center of Chemical Science and Chemical Engineering (Tianjin), Weijin Road 92, Tianjin 300072, China
| | - Jintang Guo
- School of Chemical Engineering and Technology, Tianjin University, Yaguan Road 135, Tianjin 300350, China
- Collaborative Innovation Center of Chemical Science and Chemical Engineering (Tianjin), Weijin Road 92, Tianjin 300072, China
| | - Shihai Xia
- Department of Hepatopancreatobiliary and Splenic Medicine, Affiliated Hospital, Logistics University of People's Armed Police Force, 220 Chenglin Road, Tianjin 300162, China
| | - Wencheng Zhang
- Department of Physiology and Pathophysiology, Logistics University of Chinese People's Armed Police Force, Tianjin 300309, China
| | - Yakai Feng
- School of Chemical Engineering and Technology, Tianjin University, Yaguan Road 135, Tianjin 300350, China
- Collaborative Innovation Center of Chemical Science and Chemical Engineering (Tianjin), Weijin Road 92, Tianjin 300072, China
- Key Laboratory of Systems Bioengineering (Ministry of Education), Tianjin University, Tianjin 300072, China
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Alushi K, Hinterseher I, Peters F, Rother U, Bischoff MS, Mylonas S, Grambow E, Gombert A, Busch A, Gray D, Konstantinou N, Stavroulakis K, Horn M, Görtz H, Uhl C, Federrath H, Trute HH, Kreutzburg T, Behrendt CA. Distribution of Mobile Health Applications amongst Patients with Symptomatic Peripheral Arterial Disease in Germany: A Cross-Sectional Survey Study. J Clin Med 2022; 11:jcm11030498. [PMID: 35159950 PMCID: PMC8836389 DOI: 10.3390/jcm11030498] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 12/22/2021] [Accepted: 01/18/2022] [Indexed: 12/16/2022] Open
Abstract
Background: Broadly available digital and mobile health applications (also known as mHealth) have recently gained increasing attention by the vascular community, but very little is known about the dissemination and acceptance of such technologies in certain target populations. The current study aimed to determine the user behaviour and acceptance of such digital technologies amongst patients with peripheral arterial disease (PAD). Methods: A cross-sectional survey of consecutively treated inpatients at 12 university institutions, as well as one non-university institution, was conducted. All admitted patients with symptomatic PAD were surveyed for 30 consecutive days within a flexible timeframe between 1 July and 30 September 2021. The factors associated with smartphone use were estimated via backward selection within a logistic regression model with clustered standard errors. Results: A total of 326 patients participated (response rate 96.3%), thereof 102 (34.0%) were treated for intermittent claudication (IC, 29.2% women, 70 years in median) and 198 were treated for chronic limb-threatening ischaemia (CLTI, 29.5% women, 70 years in median). Amongst all of the patients, 46.6% stated that they had not changed their lifestyle and health behaviour since the index diagnosis (four years in median), and 33.1% responded that they were not aware of the reasons for all of their medication orders. Amongst all those surveyed, 66.8% owned a smartphone (IC: 70.6%, CLTI: 64.1%), thereof 27.9% needed regular user support. While 42.5% used smartphone apps, only 15.0% used mobile health applications, and 19.0% owned wearables. One out of five patients agreed that such technologies could help to improve their healthy lifestyle. Only higher age was inversely associated with smartphone possession. Conclusions: The current survey showed that smartphones are prevalent amongst patients with peripheral arterial disease, but only a small proportion used mobile health applications and a considerable number of patients needed regular user support. Almost half of the patients did not change their lifestyle and one third were not aware of the reasons for their medication orders, emphasising room for improvement. These findings can further help to guide future projects using such applications to identify those target populations that are reachable with digital interventions.
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Affiliation(s)
- Kastriot Alushi
- Research Group GermanVasc, Department of Vascular Medicine, University Heart and Vascular Centre UKE Hamburg, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany; (K.A.); (F.P.); (T.K.)
| | - Irene Hinterseher
- Berlin Institute of Health, Vascular Surgery Clinic, Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany;
- Brandenburg Medical School Theodor Fontane, 16816 Neuruppin, Germany
| | - Frederik Peters
- Research Group GermanVasc, Department of Vascular Medicine, University Heart and Vascular Centre UKE Hamburg, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany; (K.A.); (F.P.); (T.K.)
| | - Ulrich Rother
- Department of Vascular Surgery, University Medical Center Erlangen, 91054 Erlangen, Germany;
| | - Moritz S. Bischoff
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (M.S.B.); (C.U.)
| | - Spyridon Mylonas
- Department of Vascular and Endovascular Surgery, Medical Faculty, University of Cologne, 50937 Cologne, Germany;
| | - Eberhard Grambow
- Department of General, Visceral, Thoracic, Vascular and Transplantation Surgery, Rostock University Medical Center, 18057 Rostock, Germany;
| | - Alexander Gombert
- European Vascular Center Aachen Maastricht, Department of Vascular Surgery University Hospital RWTH Aachen, 52074 Aachen, Germany;
| | - Albert Busch
- Division of Vascular and Endovascular Surgery, Department of Visceral, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, 01307 Dresden, Germany;
| | - Daphne Gray
- Department of Vascular and Endovascular Surgery, Goethe University Hospital, 60590 Frankfurt, Germany;
| | - Nikolaos Konstantinou
- Department of Vascular Surgery, Ludwig Maximilians University Hospital, 80539 Munich, Germany; (N.K.); (K.S.)
| | - Konstantinos Stavroulakis
- Department of Vascular Surgery, Ludwig Maximilians University Hospital, 80539 Munich, Germany; (N.K.); (K.S.)
| | - Marco Horn
- Division of Vascular and Endovascular Surgery, Department of Surgery, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany;
| | - Hartmut Görtz
- Department of Vascular and Endovascular Surgery, Bonifatius Hospital Lingen, 49808 Lingen, Germany;
| | - Christian Uhl
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (M.S.B.); (C.U.)
| | - Hannes Federrath
- Working Group Security in Distributed Systems at University of Hamburg, Department of Computer Science, University of Hamburg, 22527 Hamburg, Germany;
| | | | - Thea Kreutzburg
- Research Group GermanVasc, Department of Vascular Medicine, University Heart and Vascular Centre UKE Hamburg, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany; (K.A.); (F.P.); (T.K.)
| | - Christian-Alexander Behrendt
- Research Group GermanVasc, Department of Vascular Medicine, University Heart and Vascular Centre UKE Hamburg, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany; (K.A.); (F.P.); (T.K.)
- Correspondence:
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Golledge J. Update on the pathophysiology and medical treatment of peripheral artery disease. Nat Rev Cardiol 2022; 19:456-474. [PMID: 34997200 DOI: 10.1038/s41569-021-00663-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 12/15/2022]
Abstract
Approximately 6% of adults worldwide have atherosclerosis and thrombosis of the lower limb arteries (peripheral artery disease (PAD)) and the prevalence is rising. PAD causes leg pain, impaired health-related quality of life, immobility, tissue loss and a high risk of major adverse events, including myocardial infarction, stroke, revascularization, amputation and death. In this Review, I describe the pathophysiology, presentation, outcome, preclinical research and medical management of PAD. Established treatments for PAD include antithrombotic drugs, such as aspirin and clopidogrel, and medications to treat dyslipidaemia, hypertension and diabetes mellitus. Randomized controlled trials have demonstrated that these treatments reduce the risk of major adverse events. The drug cilostazol, exercise therapy and revascularization are the current treatment options for the limb symptoms of PAD, but each has limitations. Novel therapies to promote collateral and new capillary growth and treat PAD-related myopathy are under investigation. Methods to improve the implementation of evidence-based medical management, novel drug therapies and rehabilitation programmes for PAD-related pain, functional impairment and ischaemic foot disease are important areas for future research.
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Affiliation(s)
- Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia. .,The Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia. .,The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia.
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Buyang Huanwu Decoction Enhances Revascularization via Akt/GSK3 β/NRF2 Pathway in Diabetic Hindlimb Ischemia. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:1470829. [PMID: 34900083 PMCID: PMC8664534 DOI: 10.1155/2021/1470829] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/16/2021] [Accepted: 10/28/2021] [Indexed: 11/18/2022]
Abstract
Background Peripheral arterial disease (PAD) is a typical disease of atherosclerosis, most commonly influencing the lower extremities. In patients with PAD, revascularization remains a preferred treatment strategy. Buyang Huanwu decoction (BHD) is a popular Chinese herbal prescription which has showed effects of cardiovascular protection through conducting antioxidant, antiapoptotic, and anti-inflammatory effects. Here, we intend to study the effect of BHD on promoting revascularization via the Akt/GSK3β/NRF2 pathway in diabetic hindlimb ischemia (HLI) model of mice. Materials and Methods All db/db mice (n = 60) were randomly divided into 6 groups by table of random number. (1) Sham group (N = 10): 7-0 suture thread passed through the underneath of the femoral artery and vein without occlusion. The remaining 5 groups were treated differently on the basis of the HLI (the femoral artery and vein from the inguinal ligament to the knee joint were transected and the vascular stump was ligated with 7-0 silk sutures) model: (2) HLI+NS group (N = 15): 0.2 ml NS was gavaged daily for 3 days before modeling and 14 days after occlusion; (3) HLI+BHD group (N = 15): 0.2 ml BHD (20 g/kg/day) was gavaged daily for 3 days before modeling and 14 days after occlusion; (4) HLI+BHD+sh-NC group (N = 8): local injection of adenovirus vector carrying the nonsense shRNA (Ad-GFP) in the hindlimbs of mice before treatment; (5) HLI+BHD+sh-NRF2 group (N = 8): knockdown of NRF2 in the hindlimbs of mice by local intramuscular injection of adenovirus vector carrying NRF2 shRNA (Ad-NRF2-shRNA) before treatment; and (6) HLI+BHD+LY294002 group (N = 4): intravenous injection of LY294002 (1.5 mg/kg) once a day for 14 days on the basis of the HLI+BHD group. Laser Doppler examination, vascular cast, and immunofluorescence staining were applied to detect the revascularization of lower limbs in mice. Western blot analysis was used to detect the expression of vascular endothelial growth factor (VEGF), interleukin-1beta (IL-1β), interleukin-6 (IL-6), tumor necrosis factor- (TNF-) α, heme oxygenase-1 (HO-1), NAD(P)H dehydrogenase quinone-1 (NQO-1), catalase (CAT), glyceraldehyde-3-phosphate dehydrogenase (GAPDH), phosphorylated protein kinase B (p-AKT), and phosphorylated glycogen synthase kinase-3 beta (p-GSK3β). HE staining was used to assess the level of muscle tissue damage and inflammation in the lower extremities. Local multipoint injection of Ad-NRF2-shRNA was used to knock down NRF2, and qPCR was applied to detect the mRNA level of NRF2. The blood glucose, triglyceride, cholesterol, MDA, and SOD levels of mice were tested using corresponding kits. The SPSS 20.0 software and GraphPad Prism 6.05 were used to do all statistics. Values of P < 0.05 were considered as statistically significant. Results and Conclusions. BHD could enhance the revascularization of lower limbs in HLI mice, while BHD has no effect on blood glucose and lipid level in db/db mice (P > 0.05). BHD could elevate the protein expression of VEGF, HO-1, NQO-1, and CAT (P < 0.05) and decrease the expression of IL-1β, IL-6, and TNF-α (P < 0.05) in HLI mice. Meanwhile, BHD could activate NRF2 and promote the phosphorylation of AKT/GSK3β during revascularization (P < 0.05). In contrast, knockdown of NRF2 impaired the protective effects of BHD on HLI (P < 0.05). LY294002 inhibited the upregulation of NRF2 activated by BHD through inhibiting the phosphorylation of the AKT/GSK3β pathway (P < 0.05). The present study demonstrated that BHD could promote revascularization on db/db mice with HLI through targeting antioxidation, anti-inflammation, and angiogenesis via the AKT/GSK3β/NRF2 pathway.
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Yang Y, Xu Q, Li T, Shao S. Trimetazidine ameliorates hindlimb ischaemic damage in type 2 diabetic mice. Ann Med 2021; 53:1099-1107. [PMID: 34259103 PMCID: PMC8281072 DOI: 10.1080/07853890.2021.1925147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/27/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Ischaemia caused by lower extremity artery stenosis is the main cause of peripheral artery disease (PAD) in patients with diabetes. Trimetazidine (TMZ) has traditionally been used as an anti-ischaemic drug for coronary artery disease. The effect of TMZ on PAD in a diabetic animal model and the underlying molecular mechanisms remain unclear. METHODS The db/db mice were challenged with femoral artery ligation (FAL), followed by TMZ treatment for 2 weeks. Scores on hindlimb ischaemia and function were evaluated. Histological and capillary density analyses of gastrocnemius were performed. The expression of vascular endothelial growth factor (VEGF) and myogenic regulators was also confirmed by Western blotting. We also detected serum intercellular adhesion molecule 1 (ICAM-1) level through ELISA. RESULTS Diabetic mice exhibited limb ulceration and motor dysfunction after FAL while TMZ-treated db/db mice exhibited milder ischaemic impairment. Furthermore, decreased capillary density in the gastrocnemius muscles of ischaemic hindlimb and reduced expressions of VEGF, myogenic markers, and serum ICAM-1 could be partially reversed by TMZ treatment. CONCLUSION TMZ may alleviate hindlimb ischaemic damage in db/db mice, at least partly, through enhancing angiogenesis and promoting myogenesis in ischaemia region.Key messagesTMZ intervention could alleviate hindlimb ischaemic damage in db/db mice.TMZ intervention could enhance angiogenesis and stimulate myogenesis in ischaemia region.
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Affiliation(s)
- Yan Yang
- Division of Endocrinology, Tongji Hospital, Huazhong University of Science & Technology, Wuhan, PR China
- Branch of national clinical research center for metabolic diseases, Hubei, PR China
| | - Qinqin Xu
- Division of Endocrinology, Tongji Hospital, Huazhong University of Science & Technology, Wuhan, PR China
- Branch of national clinical research center for metabolic diseases, Hubei, PR China
| | - Tao Li
- Division of Ophthalmology, Tongji Hospital, Huazhong University of Science & Technology, Wuhan, PR China
| | - Shiying Shao
- Division of Endocrinology, Tongji Hospital, Huazhong University of Science & Technology, Wuhan, PR China
- Branch of national clinical research center for metabolic diseases, Hubei, PR China
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Decker JA, Varga-Szemes A, Schoepf UJ, Emrich T, Schwarz F, Kroencke TJ, Scheurig-Muenkler C. In-patient care trends in peripheral artery disease in the German healthcare system over the past decade. Eur Radiol 2021; 32:1697-1708. [PMID: 34647176 DOI: 10.1007/s00330-021-08285-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/04/2021] [Accepted: 08/19/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To analyze trends of in-hospital treatment of patients admitted due to peripheral artery disease (PAD) from 2009 to 2018 with special focus on comorbidities, revascularization procedures, resulting costs, and outcome. METHODS Using data from the research data center of the German Federal Statistical Office, we included all hospitalizations due to PAD Fontaine stage IIb or higher from 2009 to 2018. To analyze comorbidities, Elixhauser diagnostic groups and linear van Walraven score (vWS) were assessed. RESULTS A total of 1.8 million hospitalizations resulting in €10.3 billion in reimbursement costs were included. From 2009 to 2018, the absolute number of hospitalizations due to PAD increased by 13.3% (163,547 to 185,352). The average cost per hospitalization increased by 20.8% from €5,261 to €6,356. The overall in-hospital mortality decreased from 3.1 to 2.6%. Median vWS of all PAD cases increased by 3 points (2 to 5). The number of percutaneous transluminal angioplasties (PTA) increased by 43.9% while some surgical procedures such as bypasses and embolectomies decreased by 30.8% and 6.8%, respectively. Many revascularization procedures showed a disproportionate increase of those performed in vessels below the knee for example in PTA (+ 68.5%) or in endarterectomies (+ 38.8%). CONCLUSIONS This decade-long nationwide analysis shows a rising number of hospitalizations due to PAD with more comorbid patients resulting in increasing reimbursement costs. Interventions are shifting from surgical to endovascular approaches with a notable trend towards interventions in smaller vessels below the knee. KEY POINTS • The number of hospitalizations due to peripheral artery disease is rising and it is associated with increasing reimbursement costs. • Admitted patients are older and show an increasing number of comorbidities while overall in-hospital mortality is decreasing. • Revascularization procedures are shifting from surgical to endovascular approaches and show a trend towards intervention in smaller vessels below the knee. • Major amputations are decreasing while the number of minor amputations is increasing.
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Affiliation(s)
- Josua A Decker
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany.,Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA.
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA.,Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Florian Schwarz
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
| | - Thomas J Kroencke
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
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Lu YH, Cai Y, Zhang Y, Wang R, Li ZY. Digital Subtraction Angiography Contrast Material Transport as a Direct Assessment for Blood Perfusion of Middle Cerebral Artery Stenosis. Front Physiol 2021; 12:716173. [PMID: 34421658 PMCID: PMC8375590 DOI: 10.3389/fphys.2021.716173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/05/2021] [Indexed: 11/13/2022] Open
Abstract
Digital subtraction angiography (DSA) is a fluoroscopic technique used extensively in interventional radiology for visualizing blood vessels. It has also been used to evaluate blood perfusion. However, the perfusion obtained in previous techniques was extracted from signal intensity rather than by the transport of contrast material (CM) through blood flow. The main aim of this study is to evaluate the morphological effects on the hemodynamics and the CM concentration in the middle cerebral artery (MCA) stenosis. We proposed a quantitative parameter, i.e., contrast material remaining time (CMRT), to describe the variation in the transport of CM over time. Computational fluid dynamics simulations were performed on both reconstructive synthetic and patient-derived models. In the synthetic models, we evaluated the variation of flow patterns and the transport of CM with different degrees of stenosis and the location of the lesion. It was found that an increase in the degree of stenosis (from 30 to 80%) resulted in a significant increase in CMRT at the anterior cerebral artery (ACA) outlet (p = 0.0238) and a significant decrease in CMRT at the MCA outlet (p = 0.012). The patient-derived models were reconstructed from the pre- and post-interventional DSA images of a patient with MCA stenosis. Both blood flow velocity and CMRT increased at the ACA outlet but decreased at the MCA outlet. The perfusion analysis demonstrated that the perfusion function was improved after interventional surgery. In conclusion, changes in stenotic degree at MCA may lead to apparent differences in the hemodynamic distribution and the transport of CM. CMRT could be a quantitative indicator to evaluate the changes in blood perfusion after the intervention for MCA stenosis.
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Affiliation(s)
- Yun-Hao Lu
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, China
| | - Yan Cai
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, China
| | - Yi Zhang
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Rui Wang
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Zhi-Yong Li
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, China.,School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia
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Peripheral Vascular Disease and Kidney Transplant Outcomes: Rethinking an Important Ongoing Complication. Transplantation 2021; 105:1188-1202. [PMID: 33148978 DOI: 10.1097/tp.0000000000003518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Peripheral vascular disease (PVD) is highly prevalent in patients on the waiting list for kidney transplantation (KT) and after transplantation and is associated with impaired transplant outcomes. Multiple traditional and nontraditional risk factors, as well as uremia- and transplant-related factors, affect 2 processes that can coexist, atherosclerosis and arteriosclerosis, leading to PVD. Some pathogenic mechanisms, such as inflammation-related endothelial dysfunction, mineral metabolism disorders, lipid alterations, or diabetic status, may contribute to the development and progression of PVD. Early detection of PVD before and after KT, better understanding of the mechanisms of vascular damage, and application of suitable therapeutic approaches could all minimize the impact of PVD on transplant outcomes. This review focuses on the following issues: (1) definition, epidemiological data, diagnosis, risk factors, and pathogenic mechanisms in KT candidates and recipients; (2) adverse clinical consequences and outcomes; and (3) classical and new therapeutic approaches.
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Abstract
Effective revascularization of the patient with peripheral artery disease is about more than the procedure. The approach to the patient with symptom-limiting intermittent claudication or limb-threatening ischemia begins with understanding the population at risk and variation in clinical presentation. The urgency of revascularization varies significantly by presentation; from patients with intermittent claudication who should undergo structured exercise rehabilitation before revascularization (if needed) to those with acute limb ischemia, a medical emergency, who require revascularization within hours. Recent years have seen the rapid development of new tools including wires, catheters, drug-eluting technology, specialized balloons, and biomimetic stents. Open surgical bypass remains an important option for those with advanced disease. The strategy and techniques employed vary by clinical presentation, lesion location, and lesion severity. There is limited level 1 evidence to guide practice, but factors that determine technical success and anatomic durability are largely understood and incorporated into decision-making. Following revascularization, medical therapy to reduce adverse limb outcomes and a surveillance plan should be put in place. There are many hurdles to overcome to improve the efficacy of lower extremity revascularization, such as restenosis, calcification, microvascular disease, silent embolization, and tools for perfusion assessment. This review highlights the current state of revascularization in peripheral artery disease with an eye toward technologies at the cusp, which may significantly impact current practice.
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Affiliation(s)
- Joshua A Beckman
- Cardiovascular Division, Vanderbilt University Medical Center, Nashville, TN (J.A.B.)
| | - Peter A Schneider
- Division of Vascular and Endovascular Surgery, University of California, San Francisco (P.A.S., M.S.C.)
| | - Michael S Conte
- Division of Vascular and Endovascular Surgery, University of California, San Francisco (P.A.S., M.S.C.)
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Ma Y, Jia L, Wang Y, Ji Y, Chen J, Ma H, Lin X, Zhang Y, Li W, Ni H, Xie L, Xie Y, Xiang M. Heme Oxygenase-1 in Macrophages Impairs the Perfusion Recovery After Hindlimb Ischemia by Suppressing Autolysosome-Dependent Degradation of NLRP3. Arterioscler Thromb Vasc Biol 2021; 41:1710-1723. [PMID: 33761761 DOI: 10.1161/atvbaha.121.315805] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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MESH Headings
- Animals
- Cells, Cultured
- Databases, Genetic
- Disease Models, Animal
- Heme Oxygenase-1/genetics
- Heme Oxygenase-1/metabolism
- Hindlimb
- Humans
- Inflammasomes/genetics
- Inflammasomes/metabolism
- Inflammation Mediators/metabolism
- Ischemia/enzymology
- Ischemia/genetics
- Ischemia/physiopathology
- Lysosomes/enzymology
- Macrophages/enzymology
- Male
- Membrane Proteins/genetics
- Membrane Proteins/metabolism
- Mice, Inbred C57BL
- Mice, Knockout
- Muscle, Skeletal/blood supply
- Muscle, Skeletal/enzymology
- Muscle, Skeletal/physiopathology
- NLR Family, Pyrin Domain-Containing 3 Protein/genetics
- NLR Family, Pyrin Domain-Containing 3 Protein/metabolism
- Neovascularization, Physiologic
- Proteolysis
- Recovery of Function
- Regional Blood Flow
- Mice
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Affiliation(s)
- Yuankun Ma
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Liangliang Jia
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yidong Wang
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yongli Ji
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jian Chen
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hong Ma
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoping Lin
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuhao Zhang
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wudi Li
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hui Ni
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lan Xie
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yao Xie
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Meixiang Xiang
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Won JH. [General Treatment Strategy for Intervention in Lower Extremity Arterial Disease]. TAEHAN YONGSANG UIHAKHOE CHI 2021; 82:500-511. [PMID: 36238791 PMCID: PMC9432442 DOI: 10.3348/jksr.2021.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/09/2021] [Accepted: 04/17/2021] [Indexed: 11/19/2022]
Abstract
The prevalence of lower extremity disease is increasing with age. With recent technological advancements, endovascular treatment is being performed more frequently. The treatment goal of intermittent claudication is to improve walking and reduce claudication. To achieve these goals, anatomical durability and patency are important. In patients with critical limb ischemia, the lesions are diffuse and particularly severe in below-the-knee arteries. The treatment goal of critical limb ischemia is to promote wound healing and to prevent major amputation, which is evaluated by the limb salvage rate. Primary stenting using covered or bare metal stents is a widely accepted endovascular treatment. While drug-eluting technologies with or without atherectomy are widely used in the treatment of femoropopliteal disease, balloon angioplasty is the mainstay treatment for below-the-knee intervention. CT angiography provides a road map for planning endovascular treatment in patients without absolute contraindications.
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Parvar SL, Ngo L, Dawson J, Nicholls SJ, Fitridge R, Psaltis PJ, Ranasinghe I. Long-term outcomes following endovascular and surgical revascularization for peripheral artery disease: a propensity score-matched analysis. Eur Heart J 2021; 43:32-40. [PMID: 33624819 DOI: 10.1093/eurheartj/ehab116] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/26/2021] [Accepted: 02/14/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS Peripheral artery disease (PAD) revascularization can be performed by either endovascular or open surgical approach. Despite increasing use of endovascular revascularization, it is still uncertain which strategy yields better long-term outcomes. METHODS AND RESULTS This retrospective cohort study evaluated patients hospitalized with PAD in Australia and New Zealand who underwent either endovascular or surgical revascularization between 2008 and 2015, and compared procedures using a propensity score-matched analysis. Hybrid interventions were excluded. The primary endpoint was mortality or major adverse limb events (MALE), defined as a composite endpoint of acute limb ischaemia, urgent surgical or endovascular reintervention, or major amputation, up to 8 years post-hospitalization using time-to-event analyses 75 189 patients fulfilled eligibility (15 239 surgery and 59 950 endovascular), from whom 14 339 matched pairs (mean ± SD age 71 ± 12 years, 73% male) with good covariate balance were identified. Endovascular revascularization was associated with an increase in combined MALE or mortality [hazard ratio (HR) 1.13, 95% confidence interval (CI): 1.09-1.17, P < 0.001]. There was a similar risk of MALE (HR 1.04, 95% CI: 0.99-1.10, P = 0.15), and all-cause urgent rehospitalizations (HR 1.01, 95% CI: 0.98-1.04, P = 0.57), but higher mortality (HR 1.16, 95% CI: 1.11-1.21, P < 0.001) when endovascular repair was compared to surgery. In subgroup analysis, these findings were consistent for both claudication and chronic limb-threatening ischaemia presentations. CONCLUSION Although the long-term risk of MALE was comparable for both approaches, enduring advantages of surgical revascularization included lower long-term mortality. This is at odds with some prior PAD studies and highlights contention in this space.
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Affiliation(s)
- Saman L Parvar
- Vascular Research Centre, Lifelong Health Theme, South Australian Health & Medical Research Institute, North Terrace, Adelaide, SA 5000, Australia.,Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.,Department of Cardiology, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Linh Ngo
- School of Clinical Medicine, The University of Queensland, Brisbane, QLD, Australia.,Department of Cardiology, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Joseph Dawson
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.,Department of Vascular & Endovascular Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University, Melbourne, VIC, Australia
| | - Robert Fitridge
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.,Department of Vascular & Endovascular Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Peter J Psaltis
- Vascular Research Centre, Lifelong Health Theme, South Australian Health & Medical Research Institute, North Terrace, Adelaide, SA 5000, Australia.,Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.,Department of Cardiology, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Isuru Ranasinghe
- School of Clinical Medicine, The University of Queensland, Brisbane, QLD, Australia.,Department of Cardiology, The Prince Charles Hospital, Brisbane, QLD, Australia
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Ilonzo N, Goldberger C, Hwang S, Rao A, Faries P, Marin M, Tadros R. The Effect of Patient and Hospital Characteristics on Total Costs of Peripheral Bypass in New York State. Vasc Endovascular Surg 2021; 55:434-440. [PMID: 33590811 DOI: 10.1177/1538574421993317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION With the aging U.S. population, peripheral vascular procedures will become increasingly common. The objective of this study is to characterize the factors associated with increased total costs after peripheral bypass surgery. METHODS Data for 34,819 patients undergoing peripheral bypass surgery in NY State were extracted using the Statewide Planning and Research Cooperative System (SPARCS) database for years 2009-2017. Patient demographics, All Patient Refined Diagnostic Related Groups (APR) severity score, mortality risk, hospital volume, and length of stay data were collected. Primary outcomes were total costs and length of stay. Data were analyzed using univariate and multivariate analysis. RESULTS 28.1% of peripheral bypass surgeries were performed in New York City. 7.9% of patients had extreme APR severity of illness whereas 32.0% had major APR severity of illness. 6.3% of patients had extreme risk of mortality and 1 in every 5 patients (20%) had major risk of mortality. 24.9% of patients were discharged to a facility. The mean length of stay (LOS) was 9.9 days. Patient LOS of 6-11 days was associated with +$2,791.76 total costs. Mean LOS of ≥ 12 days was associated with + $27,194.88 total costs. Multivariate analysis revealed risk factors associated with an admission listed in the fourth quartile of total costs (≥$36,694.44) for peripheral bypass surgery included NYC location (2.82, CI 2.62-3.04), emergency surgery (1.12, CI 1.03-1.22), extreme APR 2.08, 1.78-2.43, extreme risk of mortality (2.73, 2.34-3.19), emergency room visit (1.68, 1.57-1.81), discharge to a facility (1.27, CI 1.15-1.41), and LOS in the third or fourth quartile (11.09, 9.87-12.46). CONCLUSION The cost of peripheral bypass surgery in New York State is influenced by a variety of factors including LOS, patient comorbidity and disease severity, an ER admission, and discharge to a facility.
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Affiliation(s)
- Nicole Ilonzo
- Division of Vascular Surgery, Department of Surgery, 5925The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Cody Goldberger
- Division of Vascular Surgery, Department of Surgery, 5925The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Songhon Hwang
- Division of Vascular Surgery, Department of Surgery, 5925The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ajit Rao
- Division of Vascular Surgery, Department of Surgery, 5925The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Peter Faries
- Division of Vascular Surgery, Department of Surgery, 5925The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael Marin
- Division of Vascular Surgery, Department of Surgery, 5925The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rami Tadros
- Division of Vascular Surgery, Department of Surgery, 5925The Icahn School of Medicine at Mount Sinai, New York, NY, USA
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41
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Jadidi M, Razian SA, Anttila E, Doan T, Adamson J, Pipinos M, Kamenskiy A. Comparison of morphometric, structural, mechanical, and physiologic characteristics of human superficial femoral and popliteal arteries. Acta Biomater 2021; 121:431-443. [PMID: 33227490 PMCID: PMC7855696 DOI: 10.1016/j.actbio.2020.11.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/12/2020] [Accepted: 11/17/2020] [Indexed: 01/03/2023]
Abstract
Peripheral arterial disease differentially affects the superficial femoral (SFA) and the popliteal (PA) arteries, but their morphometric, structural, mechanical, and physiologic differences are poorly understood. SFAs and PAs from 125 human subjects (age 13-92, average 52±17 years) were compared in terms of radii, wall thickness, and opening angles. Structure and vascular disease were quantified using histology, mechanical properties were determined with planar biaxial extension, and constitutive modeling was used to calculate the physiologic stress-stretch state, elastic energy, and the circumferential physiologic stiffness. SFAs had larger radii than PAs, and both segments widened with age. Young SFAs were 5% thicker, but in old subjects the PAs were thicker. Circumferential (SFA: 96→193°, PA: 105→139°) and longitudinal (SFA: 139→306°, PA: 133→320°) opening angles increased with age in both segments. PAs were more diseased than SFAs and had 11% thicker intima. With age, intimal thickness increased 8.5-fold, but medial thickness remained unchanged (620μm) in both arteries. SFAs had 30% more elastin than the PAs, and its density decreased ~50% with age. SFAs were more compliant than PAs circumferentially, but there was no difference longitudinally. Physiologic circumferential stress and stiffness were 21% and 11% higher in the SFA than in the PA across all ages. The stored elastic energy decreased with age (SFA: 1.4→0.4kPa, PA: 2.5→0.3kPa). While the SFA and PA demonstrate appreciable differences, most of them are due to vascular disease. When pathology is the same, so are the mechanical properties, but not the physiologic characteristics that remain distinct due to geometrical differences.
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Affiliation(s)
- Majid Jadidi
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Sayed Ahmadreza Razian
- Department of Biomechanics, Biomechanics Research Building, University of Nebraska Omaha, Omaha, NE, USA
| | - Eric Anttila
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Tyler Doan
- Department of Biomechanics, Biomechanics Research Building, University of Nebraska Omaha, Omaha, NE, USA
| | - Josiah Adamson
- Department of Biomechanics, Biomechanics Research Building, University of Nebraska Omaha, Omaha, NE, USA
| | - Margarita Pipinos
- Department of Biomechanics, Biomechanics Research Building, University of Nebraska Omaha, Omaha, NE, USA
| | - Alexey Kamenskiy
- Department of Biomechanics, Biomechanics Research Building, University of Nebraska Omaha, Omaha, NE, USA.
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Stojkovic S, Demyanets S, Kopp CW, Hengstenberg C, Wojta J, Eichelberger B, Panzer S, Gremmel T. Association of Soluble Suppression of Tumorigenesis 2 (sST2) With Platelet Activation, Monocyte Tissue Factor and Ischemic Outcomes Following Angioplasty and Stenting. Front Cardiovasc Med 2021; 7:605669. [PMID: 33415128 PMCID: PMC7782352 DOI: 10.3389/fcvm.2020.605669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 11/26/2020] [Indexed: 01/22/2023] Open
Abstract
Background: Peripheral artery disease (PAD) patients undergoing infrainguinal angioplasty with stenting suffer high rates of target lesion restenosis and ischemic events. Blood-based prognostic markers in these patients are currently limited. The IL-33/ST2-system is involved in atherothrombosis. Soluble ST2 has been proposed as a biomarker in patients with cardiovascular disease. Aim: To investigate the association of sST2 with platelet activation and monocyte tissue factor (TF) in 316 patients undergoing elective angioplasty and stenting for cardiovascular disease, and its predictive value for ischemic outcomes following infrainguinal angioplasty with stent implantation in 104 PAD patients within this cohort. Methods and Results: Circulating levels of sST2, platelet surface P-selectin, monocyte TF expression as well as soluble P-selectin were determined in 316 consecutive patients on dual antiplatelet therapy following angioplasty and stenting. sST2 was independently associated with soluble P-selectin (B = 6.4, 95% CI 2.0-10.7, p = 0.004) and TF expression (B = 0.56, 95% CI 0.02-1.1, p = 0.041) but not with platelet surface P-selectin (B = 0.1, 95% CI -0.1-0.3, p = 0.307) after adjustment for age, sex, clinical risk factors and inflammatory parameters. During the follow-up of 24 months, the primary endpoint occurred in 41 of 104 PAD patients (39.4%). However, circulating levels of sST2 did not predict the primary endpoint in PAD patients (HR 1.1, 95% CI 0.76-1.71, p = 0.527). Conclusion: sST2 is associated with soluble P-selectin and monocyte TF expression in atherosclerosis but not with ischemic outcomes following infrainguinal angioplasty with stent implantation for PAD.
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Affiliation(s)
- Stefan Stojkovic
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Svitlana Demyanets
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Christoph W Kopp
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | | | - Johann Wojta
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.,Core Facilities, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria
| | - Beate Eichelberger
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
| | - Simon Panzer
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
| | - Thomas Gremmel
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.,Department of Internal Medicine I, Cardiology and Intensive Care Medicine, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
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43
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Fang EF, Xie C, Schenkel JA, Wu C, Long Q, Cui H, Aman Y, Frank J, Liao J, Zou H, Wang NY, Wu J, Liu X, Li T, Fang Y, Niu Z, Yang G, Hong J, Wang Q, Chen G, Li J, Chen HZ, Kang L, Su H, Gilmour BC, Zhu X, Jiang H, He N, Tao J, Leng SX, Tong T, Woo J. A research agenda for ageing in China in the 21st century (2nd edition): Focusing on basic and translational research, long-term care, policy and social networks. Ageing Res Rev 2020; 64:101174. [PMID: 32971255 PMCID: PMC7505078 DOI: 10.1016/j.arr.2020.101174] [Citation(s) in RCA: 219] [Impact Index Per Article: 54.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 08/13/2020] [Accepted: 09/03/2020] [Indexed: 12/18/2022]
Abstract
One of the key issues facing public healthcare is the global trend of an increasingly ageing society which continues to present policy makers and caregivers with formidable healthcare and socio-economic challenges. Ageing is the primary contributor to a broad spectrum of chronic disorders all associated with a lower quality of life in the elderly. In 2019, the Chinese population constituted 18 % of the world population, with 164.5 million Chinese citizens aged 65 and above (65+), and 26 million aged 80 or above (80+). China has become an ageing society, and as it continues to age it will continue to exacerbate the burden borne by current family and public healthcare systems. Major healthcare challenges involved with caring for the elderly in China include the management of chronic non-communicable diseases (CNCDs), physical frailty, neurodegenerative diseases, cardiovascular diseases, with emerging challenges such as providing sufficient dental care, combating the rising prevalence of sexually transmitted diseases among nursing home communities, providing support for increased incidences of immune diseases, and the growing necessity to provide palliative care for the elderly. At the governmental level, it is necessary to make long-term strategic plans to respond to the pressures of an ageing society, especially to establish a nationwide, affordable, annual health check system to facilitate early diagnosis and provide access to affordable treatments. China has begun work on several activities to address these issues including the recent completion of the of the Ten-year Health-Care Reform project, the implementation of the Healthy China 2030 Action Plan, and the opening of the National Clinical Research Center for Geriatric Disorders. There are also societal challenges, namely the shift from an extended family system in which the younger provide home care for their elderly family members, to the current trend in which young people are increasingly migrating towards major cities for work, increasing reliance on nursing homes to compensate, especially following the outcomes of the 'one child policy' and the 'empty-nest elderly' phenomenon. At the individual level, it is important to provide avenues for people to seek and improve their own knowledge of health and disease, to encourage them to seek medical check-ups to prevent/manage illness, and to find ways to promote modifiable health-related behaviors (social activity, exercise, healthy diets, reasonable diet supplements) to enable healthier, happier, longer, and more productive lives in the elderly. Finally, at the technological or treatment level, there is a focus on modern technologies to counteract the negative effects of ageing. Researchers are striving to produce drugs that can mimic the effects of 'exercising more, eating less', while other anti-ageing molecules from molecular gerontologists could help to improve 'healthspan' in the elderly. Machine learning, 'Big Data', and other novel technologies can also be used to monitor disease patterns at the population level and may be used to inform policy design in the future. Collectively, synergies across disciplines on policies, geriatric care, drug development, personal awareness, the use of big data, machine learning and personalized medicine will transform China into a country that enables the most for its elderly, maximizing and celebrating their longevity in the coming decades. This is the 2nd edition of the review paper (Fang EF et al., Ageing Re. Rev. 2015).
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Affiliation(s)
- Evandro F Fang
- Department of Clinical Molecular Biology, University of Oslo and Akershus University Hospital, 1478 Lørenskog, Norway; The Norwegian Centre on Healthy Ageing (NO-Age), Oslo, Norway; Department of Hypertension and Vascular Disease, The First Affiliated Hospital, Sun Yat-Sen University, 510080, Guangzhou, China; Institute of Geriatric Immunology, School of Medicine, Jinan University, 510632, Guangzhou, China; Department of Geriatrics, The First Affiliated Hospital, Zhengzhou University, 450052, Zhengzhou, China.
| | - Chenglong Xie
- Department of Clinical Molecular Biology, University of Oslo and Akershus University Hospital, 1478 Lørenskog, Norway; Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
| | - Joseph A Schenkel
- Durham University Department of Sports and Exercise Sciences, Durham, United Kingdom.
| | - Chenkai Wu
- Global Health Research Center, Duke Kunshan University, 215316, Kunshan, China; Duke Global Health Institute, Duke University, Durham, 27710, North Carolina, USA.
| | - Qian Long
- Global Health Research Center, Duke Kunshan University, 215316, Kunshan, China.
| | - Honghua Cui
- Department of Endodontics, Shanghai Stomatological Hospital, Fudan University, China; Oral Biomedical Engineering Laboratory, Shanghai Stomatological Hospital, Fudan University, China.
| | - Yahyah Aman
- Department of Clinical Molecular Biology, University of Oslo and Akershus University Hospital, 1478 Lørenskog, Norway.
| | - Johannes Frank
- Department of Clinical Molecular Biology, University of Oslo and Akershus University Hospital, 1478 Lørenskog, Norway.
| | - Jing Liao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 510275, Guangzhou, China; Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, 510275, Guangzhou, China.
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China; Kirby Institute, University of New South Wales, Sydney, Australia.
| | - Ninie Y Wang
- Pinetree Care Group, 515 Tower A, Guomen Plaza, Chaoyang District, 100028, Beijing, China.
| | - Jing Wu
- Department of Sociology and Work Science, University of Gothenburg, SE-405 30, Gothenburg, Sweden.
| | - Xiaoting Liu
- School of Public Affairs, Zhejiang University, Hangzhou, 310058, Zhejiang, China.
| | - Tao Li
- BGI-Shenzhen, Beishan Industrial Zone, 518083, Shenzhen, China; China National GeneBank, BGI-Shenzhen, 518120, Shenzhen, China.
| | - Yuan Fang
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands.
| | - Zhangming Niu
- Aladdin Healthcare Technologies Ltd., 25 City Rd, Shoreditch, London EC1Y 1AA, UK.
| | - Guang Yang
- Cardiovascular Research Centre, Royal Brompton Hospital, London, SW3 6NP, UK; and National Heart and Lung Institute, Imperial College London, London, SW7 2AZ, United Kingdom.
| | | | - Qian Wang
- Department of Geriatrics, The First Affiliated Hospital, Zhengzhou University, 450052, Zhengzhou, China.
| | - Guobing Chen
- Institute of Geriatric Immunology, School of Medicine, Jinan University, 510632, Guangzhou, China.
| | - Jun Li
- Department of Biochemistry and Molecular Biology, The Institute of Basic Medical Sciences, The Chinese Academy of Medical Sciences (CAMS)& Peking Union Medical University (PUMC), 5 Dondan Santiao Road, Beijing, 100730, China.
| | - Hou-Zao Chen
- Department of Biochemistry and Molecular Biology, The Institute of Basic Medical Sciences, The Chinese Academy of Medical Sciences (CAMS)& Peking Union Medical University (PUMC), 5 Dondan Santiao Road, Beijing, 100730, China.
| | - Lin Kang
- Department of Geriatrics, Peking Union Medical College Hospital, Beijing, 100730, China.
| | - Huanxing Su
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao.
| | - Brian C Gilmour
- The Norwegian Centre on Healthy Ageing (NO-Age), Oslo, Norway.
| | - Xinqiang Zhu
- Department of Toxicology, Zhejiang University School of Public Health, Hangzhou, 310058, Zhejiang, China; The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, 322000, Zhejiang, China.
| | - Hong Jiang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China; Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China.
| | - Na He
- School of Public Health, Fudan University, 200032, Shanghai, China; Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, 200032, Shanghai, China; Key Laboratory of Health Technology Assessment of Ministry of Health, Fudan University, 200032, Shanghai, China.
| | - Jun Tao
- Department of Hypertension and Vascular Disease, The First Affiliated Hospital, Sun Yat-Sen University, 510080, Guangzhou, China.
| | - Sean Xiao Leng
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, 5505 Hopkins Bayview Circle, Baltimore, MD 21224, USA.
| | - Tanjun Tong
- Research Center on Ageing, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Peking University Health Science Center, Beijing Key Laboratory of Protein Posttranslational Modifications and Cell Function, Beijing, China.
| | - Jean Woo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
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Tan J, Lv H, Ma Y, Liu C, Li Q, Wang C. Analysis of angiographic characteristics and intervention of vitamin D in type 2 diabetes mellitus complicated with lower extremity arterial disease. Diabetes Res Clin Pract 2020; 169:108439. [PMID: 32926956 DOI: 10.1016/j.diabres.2020.108439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/14/2020] [Accepted: 09/08/2020] [Indexed: 12/26/2022]
Abstract
AIMS Previous studies have suggested that type 2 diabetes mellitus with lower extremity arterial disease is related to 25-hydroxyvitamin D deficiency. The purpose of this study is to explore the relation between vitamin D supplementation and the characteristics of type 2 diabetes mellitus complicated with lower extremity arterial disease. METHODS The clinical data of 514 patients and 148 healthy subjects treated in the First Hospital of Lanzhou University from January 2012 to June 2019 were collected, including the clinical data, ankle-brachial index, and medical records of lower limb artery angiography. We divided the patients into control group (NC group), type 2 diabetes mellitus group (DM group), lower extremity artery disease in type 2 diabetes mellitus without vitamin D supplement group (DM1 group) and lower extremity artery disease in type 2 diabetes mellitus with vitamin D supplement group (DM2 group). The level of serum 25(OH)D was analyzed and the characteristics of arterial lesions of lower extremities were compared by DSA arteriography in DM1 and DM2 group, respectively. RESULTS Compared with the NC group, serum 25(OH)D level decreased in DM group (25.39 ± 4.94 ng/mL vs 19.43 ± 5.98 ng/mL) and significantly decreased in DM1 and DM2 group (14.22 ± 5.64 ng/mL vs 17.36 ± 6.25 ng/mL). However, the level of serum 25(OH)D in the DM2 group was higher than that in the DM1 group. Compared with the DM1 group, the disease rate of the inferior knee artery (65% vs 39.3%) and occlusion rate (11.5% vs 3.7%)were decreased in the DM2 group (P < 0.05). Logistic stepwise regression analysis showed that serum 25(OH)D level was a risk factor for lower extremity arterial disease in patients with type 2 diabetes mellitus (OR = 0.898,95%CI = 0.856-0.942). CONCLUSIONS The serum level of 25(OH)D in patients with type 2 diabetes mellitus complicated with lower extremity arterial disease is decreased, and level of 25 (OH) D is related to stenosis and occlusion rate, especially in inferior genicular artery in T2DM complicated with LEAD. A high level of 25(OH)D may be a protective factor in type 2 diabetes with lower extremity arterial disease.
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Affiliation(s)
- Jiaojiao Tan
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou 730000, China
| | - Haihong Lv
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou 730000, China.
| | - Yuping Ma
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou 730000, China
| | - Chunhua Liu
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou 730000, China
| | - Qian Li
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou 730000, China
| | - Chenyi Wang
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou 730000, China
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Weissler EH, Lippmann SJ, Smerek MM, Ward RA, Kansal A, Brock A, Sullivan RC, Long C, Patel MR, Greiner MA, Hardy NC, Curtis LH, Jones WS. Model-Based Algorithms for Detecting Peripheral Artery Disease Using Administrative Data From an Electronic Health Record Data System: Algorithm Development Study. JMIR Med Inform 2020; 8:e18542. [PMID: 32663152 PMCID: PMC7468640 DOI: 10.2196/18542] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/21/2020] [Accepted: 06/28/2020] [Indexed: 12/18/2022] Open
Abstract
Background Peripheral artery disease (PAD) affects 8 to 10 million Americans, who face significantly elevated risks of both mortality and major limb events such as amputation. Unfortunately, PAD is relatively underdiagnosed, undertreated, and underresearched, leading to wide variations in treatment patterns and outcomes. Efforts to improve PAD care and outcomes have been hampered by persistent difficulties identifying patients with PAD for clinical and investigatory purposes. Objective The aim of this study is to develop and validate a model-based algorithm to detect patients with peripheral artery disease (PAD) using data from an electronic health record (EHR) system. Methods An initial query of the EHR in a large health system identified all patients with PAD-related diagnosis codes for any encounter during the study period. Clinical adjudication of PAD diagnosis was performed by chart review on a random subgroup. A binary logistic regression to predict PAD was built and validated using a least absolute shrinkage and selection operator (LASSO) approach in the adjudicated patients. The algorithm was then applied to the nonsampled records to further evaluate its performance. Results The initial EHR data query using 406 diagnostic codes yielded 15,406 patients. Overall, 2500 patients were randomly selected for ground truth PAD status adjudication. In the end, 108 code flags remained after removing rarely- and never-used codes. We entered these code flags plus administrative encounter, imaging, procedure, and specialist flags into a LASSO model. The area under the curve for this model was 0.862. Conclusions The algorithm we constructed has two main advantages over other approaches to the identification of patients with PAD. First, it was derived from a broad population of patients with many different PAD manifestations and treatment pathways across a large health system. Second, our model does not rely on clinical notes and can be applied in situations in which only administrative billing data (eg, large administrative data sets) are available. A combination of diagnosis codes and administrative flags can accurately identify patients with PAD in large cohorts.
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Affiliation(s)
- Elizabeth Hope Weissler
- Division of Vascular and Endovascular Surgery, Duke University School of Medicine, Durham, NC, United States
| | - Steven J Lippmann
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Michelle M Smerek
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Rachael A Ward
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Aman Kansal
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Adam Brock
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Robert C Sullivan
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Chandler Long
- Division of Vascular and Endovascular Surgery, Duke University School of Medicine, Durham, NC, United States
| | - Manesh R Patel
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States.,Department of Medicine, Duke University School of Medicine, Durham, NC, United States.,Duke Clinical Research Institute, Durham, NC, United States
| | - Melissa A Greiner
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
| | - N Chantelle Hardy
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Lesley H Curtis
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States.,Duke Clinical Research Institute, Durham, NC, United States
| | - W Schuyler Jones
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States.,Department of Medicine, Duke University School of Medicine, Durham, NC, United States.,Duke Clinical Research Institute, Durham, NC, United States
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Ran P, Chen W, Wei J, Qiu B, Chen M, Xie S, Li X. Macrophage Spheroids with Chronological Phenotype Shifting To Promote Therapeutic Angiogenesis in Critical Limb Ischemia. ACS APPLIED BIO MATERIALS 2020; 3:3707-3717. [DOI: 10.1021/acsabm.0c00333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Pan Ran
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu 610031, P. R. China
| | - Weijia Chen
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu 610031, P. R. China
| | - Jiaojun Wei
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu 610031, P. R. China
| | - Bo Qiu
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu 610031, P. R. China
| | - Maohua Chen
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu 610031, P. R. China
| | - Songzhi Xie
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu 610031, P. R. China
| | - Xiaohong Li
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu 610031, P. R. China
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Zhao S, Zou J, Wang H, Qin J, Lu X, Zhang A, Xu LX. A new radiofrequency balloon angioplasty device for atherosclerosis treatment. Biomed Eng Online 2020; 19:44. [PMID: 32522205 PMCID: PMC7288419 DOI: 10.1186/s12938-020-00790-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 06/04/2020] [Indexed: 11/10/2022] Open
Abstract
Background Restenosis remains a challenge in the treatment of atherosclerosis due to damage to the endothelial layer and induced proliferation of smooth muscle cells. A novel radiofrequency (RF) heating strategy was proposed to selectively ablate atherosclerosis plaque and to thermally inhibit the proliferation of smooth muscle cells while keeping the endothelial cells intact. Methods To realize the proposed strategy, a new radiofrequency balloon catheter, consisting of three ports, a three-channel tube, a balloon and an electrode patch, was designed. To evaluate the feasibility of this new design, a phantom experiment with thermocouples measuring temperatures with different voltages applied to the electrodes was conducted. A numerical model was established to obtain the 3D temperature distribution. The heating ability was also evaluated in ex vivo diseased artery samples. Results The experimental results showed that the highest temperature could be achieved in a distance from the surface of the balloon as designed. The temperature differences between the highest temperature at 0.78 mm and those of the surface reached 9.87 °C, 12.55 °C and 16.00 °C under applied 15 V, 17.5 V and 20 V heating, respectively. In the circumferential direction, the heating region (above 50 °C) spread from the middle of the two electrodes. The numerical results showed that the cooling effect counteracted the electrical energy deposition in the region close to the electrodes. The thermal lesion could be directed to cover the diseased media away from the catheter surface. The ex vivo heating experiment also confirmed the selective heating ability of the device. The temperature at the targeted site quickly reached the set value. The temperature of the external surface was higher than the inner wall surface temperature of the diseased artery lumen. Conclusion Both the experimental and numerical results demonstrated the feasibility of the newly designed RF balloon catheter. The proposed RF microelectrodes heating together with the cooling water convection can realize the desired heating in the deeper site of the blood vessel wall while sparing the thin layer of the endothelium.
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Affiliation(s)
- Shiqing Zhao
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jincheng Zou
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Hongying Wang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jinbao Qin
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinwu Lu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Aili Zhang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.
| | - Lisa X Xu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.
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He Y, DeSart K, Kubilis PS, Irwin A, Tran-Son-Tay R, Nelson PR, Berceli SA. Heterogeneous and dynamic lumen remodeling of the entire infrainguinal vein bypass grafts in patients. J Vasc Surg 2020; 71:1620-1628.e3. [DOI: 10.1016/j.jvs.2019.05.069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 05/18/2019] [Indexed: 11/30/2022]
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Demyanets S, Stojkovic S, Mauracher LM, Kopp CW, Wojta J, Thaler J, Panzer S, Gremmel T. Surrogate Markers of Neutrophil Extracellular Trap Formation are Associated with Ischemic Outcomes and Platelet Activation after Peripheral Angioplasty and Stenting. J Clin Med 2020; 9:jcm9020304. [PMID: 31979010 PMCID: PMC7073960 DOI: 10.3390/jcm9020304] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/14/2020] [Accepted: 01/16/2020] [Indexed: 12/12/2022] Open
Abstract
Neutrophil extracellular traps (NETs) are supposed to play a central role in atherothrombosis. We measured circulating citrullinated histone H3 (H3Cit) and cell-free DNA (cfDNA), which serve as surrogate markers of NET formation, in 79 patients with peripheral artery disease (PAD) following infrainguinal angioplasty with stent implantation. Analysis of cfDNA and H3Cit was performed using Quant-iT™ PicoGreen® dsDNA Assay Kit or an ELISA, respectively. Within two years of follow-up, the primary endpoint defined as nonfatal myocardial infarction, stroke or transient ischemic attack, cardiovascular death, and >80% target vessel restenosis occurred in 34 patients (43%). Both H3Cit (HR per 1-SD: 2.72; 95% CI: 1.2–6.3; p = 0.019) and cfDNA (HR per 1-SD: 2.15; 95% CI: 1.1–4.2; p = 0.028) were associated with the primary endpoint in a univariate Cox regression analysis. Multivariate linear regression analyses showed associations between cfDNA and platelet surface expression of P-selectin (p = 0.006) and activated glycoprotein IIb/IIIa (p < 0.001) in response to arachidonic acid (AA) after adjustment for age, sex, clinical risk factors, and inflammatory markers. H3Cit was also associated with P-selectin expression in response to thrombin-receptor activating peptide (p = 0.048) and AA (p = 0.032). Circulating H3Cit and cfDNA predict ischemic outcomes after peripheral angioplasty with stent implantation, and are associated with on-treatment platelet activation in stable PAD.
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Affiliation(s)
- Svitlana Demyanets
- Department of Laboratory Medicine, Medical University of Vienna, Waehringer-Guertel 18-20, 1090 Vienna, Austria;
| | - Stefan Stojkovic
- Department of Internal Medicine II, Medical University of Vienna, Waehringer-Guertel 18-20, 1090 Vienna, Austria; (S.S.); (C.W.K.); (J.W.)
| | - Lisa-Marie Mauracher
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Waehringer-Guertel 18-20, 1090 Vienna, Austria; (L.-M.M.); (J.T.)
| | - Christoph W. Kopp
- Department of Internal Medicine II, Medical University of Vienna, Waehringer-Guertel 18-20, 1090 Vienna, Austria; (S.S.); (C.W.K.); (J.W.)
| | - Johann Wojta
- Department of Internal Medicine II, Medical University of Vienna, Waehringer-Guertel 18-20, 1090 Vienna, Austria; (S.S.); (C.W.K.); (J.W.)
- Core Facilities, Medical University of Vienna, Waehringer-Guertel 18-20, 1090 Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, Waehringer-Guertel 18-20, 1090 Vienna, Austria
| | - Johannes Thaler
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Waehringer-Guertel 18-20, 1090 Vienna, Austria; (L.-M.M.); (J.T.)
| | - Simon Panzer
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Waehringer-Guertel 18-20, 1090 Vienna, Austria;
| | - Thomas Gremmel
- Department of Internal Medicine II, Medical University of Vienna, Waehringer-Guertel 18-20, 1090 Vienna, Austria; (S.S.); (C.W.K.); (J.W.)
- Department of Internal Medicine, Cardiology and Nephrology, Landesklinikum Wiener Neustadt, Corvinusring 3-5, 2700 Wiener Neustadt, Austria
- Correspondence: ; Tel.:+43-1-40400-46700; Fax: +43-1-40400-46650
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Ababneh M, Al Ayed MY, Robert AA, Al Dawish MA. Clinical Utility of the Ankle-Brachial Index and Toe Brachial Index in Patients with Diabetic Foot Ulcers. Curr Diabetes Rev 2020; 16:270-277. [PMID: 31146664 DOI: 10.2174/1573399815666190531093238] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/01/2019] [Accepted: 05/03/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND This cross sectional study investigated the clinical use of the ankle-brachial index (ABI) and toe brachial index (TBI) in 91 type 2 diabetic foot ulcer patients who visited the diabetic foot clinic, Prince Sultan Military Medical City, Saudi Arabia during July 2017 and January 2018. MATERIALS AND METHODS The ABI and TBI facilitated the detection of peripheral arterial disease (PAD) and the patients' medical records were used to collect the clinical and demographic variables. The variables of duration (p = 0.047) and treatment (p = 0.046) of the ABI showed significant differences. Age (p = 0.034) and duration (p = 0.001) were the factors related to the diagnosis of TBI by the "χ2" test. RESULTS From the TBI, 26.4% of the patients were found to have PAD, while the ABI showed that 21.8% of patients had the condition. However, no statistical significance was noted. From the regression analysis, the variable duration of diabetes (≥ 20 years of age) was recognized as an independent risk factor for TBI. CONCLUSION In conclusion, it is recommended both the ABI and TBI to be used as screening tests for PAD in diabetic foot ulcer patients.
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Affiliation(s)
- Mutasem Ababneh
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mousab Y Al Ayed
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Asirvatham A Robert
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohamed A Al Dawish
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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