Microregulation of plaque neovascularization

Narrow-Band Imaging of Laryngeal Images and Endoscopically Proven Reflux Esophagitis

Objective

To compare the difference between white light (WL) and narrow-band imaging (NBI) endoscopy in evaluating patients who had reflux laryngitis and esophagitis.

Study Design

Retrospective review of medical records and endoscopic images.

Setting

Outpatient clinic.

Subjects and Methods

There were 102 consecutive patients with reflux esophagitis (mean age, 48 ± 11 years) who had office-based transnasal esophagoscopy (TNE) with WL and NBI views, including 60 men (59%) and 42 women (41%). We compared WL and NBI endoscopy in observing the laryngeal and esophageal epithelium. The nasopharynx, base of the tongue, epiglottis, hypopharynx, larynx, esophagus, gastroesophageal junction, and stomach were examined, and all procedures were digitally recorded. All patients were evaluated with WL and NBI views to determine the reflux finding score (RFS) in the larynx and Los Angeles (LA) classification grade in the esophagus.

Results

The NBI views were more sensitive than the WL views in the erythema/hyperemia, vocal cord edema, and global RFS scores. The NBI view facilitated the identification of the erythema/hyperemia change representing dilation or proliferation of microvessels caused by epithelial inflammation. The global RFS score was significantly associated with severity of LA grade only with the NBI view.

Conclusion

The endoscopic findings with the NBI view permit an easier identification of the RFS parameters of laryngeal erythema/vocal cord edema, which have a stronger correlation with the severity of reflux esophagitis, than the WL view. The importance of NBI in the evaluation of reflux laryngitis and gastroesophageal reflux disease deserves further study.

MicroRNAs and atherosclerosis

MicroRNAs (miRNAs) are small, ~22 nucleotide (nt) sequences of RNA that regulate gene expression at posttranscriptional level. These endogenous gene expression inhibitors were primarily described in cancer but recent exciting findings have also demonstrated a key role in cardiovascular diseases (CVDs), including atherosclerosis. MiRNAs control endothelial cell (EC), vascular smooth muscle cell (VSMC), and macrophage functions, and thereby regulate the progression of atherosclerosis. MiRNA expression is modulated by different stimuli involved in every stage of atherosclerosis, and conversely miRNAs modulates several pathways implicated in plaque development such as cholesterol metabolism. In the present review, we focus on the importance of miRNAs in atherosclerosis, and we further discuss their potential use as biomarkers and therapeutic targets in CVDs.

MicroRNA in ischemic stroke etiology and pathology

Small, noncoding, microRNAs (miRNAs) have emerged as key mediators of posttranscriptional gene silencing in both pathogenic and pathological aspects of ischemic stroke biology. In stroke etiology, miRNA have distinct expression patterns that modulate pathogenic processes including atherosclerosis (miR-21, miR-126), hyperlipidemia (miR-33, miR-125a-5p), hypertension (miR-155), and plaque rupture (miR-222, miR-210). Following focal cerebral ischemia, significant changes in the miRNA transcriptome, independent of an effect on expression of miRNA machinery, implicate miRNA in the pathological cascade of events that include blood brain barrier disruption (miR-15a) and caspase mediated cell death signaling (miR-497). Early activation of miR-200 family members improves neural cell survival via prolyl hydroxylase mRNA silencing and subsequent HIF-1α stabilization. Pro- (miR-125b) and anti-inflammatory (miR-26a, -34a, -145, and let-7b) miRNA may also be manipulated to positively influence stroke outcomes. Recent examples of successfully implemented miRNA-therapeutics direct the future of gene therapy and offer new therapeutic strategies by regulating large sets of genes in related pathways of the ischemic stroke cascade.