Atypical presentation of malignant hypertension

A woman in her 30s presented with complaints of sudden onset of defective vision in the right eye for 2 days, with history of headache for a month. On examination, best corrected visual acuity was 20/40 in the right eye and 20/20 in the left eye. Anterior segment examination was normal. Fundus examination of both the eyes showed generalised arteriolar attenuation with diffuse, hyperaemic disc oedema and serous retinal detachment at macula in the right eye. Her blood pressure (BP) was 230/140 mm Hg. Other systemic evaluation was unremarkable. In the review visit, patient's BP reduced to 140/100 mm Hg, and visual acuity in the right eye improved to 20/20. Fundus in the right eye showed resolving disc oedema with macular star formation, and the left eye had developed soft exudates. This seemed to confirm the diagnosis of the disc oedema being caused by hypertension and a highly asymmetrical presentation of hypertensive retinopathy.

Optical coherence tomography predictors of the outcomes of occlusion therapy in anisometropic amblyopia

AIM

(1) To compare optical coherence tomography (OCT) parameters between amblyopic eyes and fellow eyes in patients presenting with anisometropic amblyopia. (2) To find OCT factors predicting the outcomes of occlusion therapy.

MATERIALS AND METHODS

This prospective study was conducted in a tertiary eye care center for a period of 20 months. Fifty-four children diagnosed with anisometropic amblyopic were included in the study. After complete ophthalmic and OCT examination, patients were advised to undergo occlusion therapy with large spectacle patch. Patients were reviewed after 6 months to record improvement in visual acuity and analyze their OCT parameters. Statistical tests used were paired "t" test and independent "t" test.

RESULTS

The mean age of 54 study patients was 9.24 ± 2.82 years. For comparison of OCT parameters, they were classified as myopic (22 patients), hypermetropic (24 patients), and astigmatic (8 patients) groups. In the anisomyopic amblyopia group, the mean inner macular thickness was significantly increased in fellow eyes (304.09 ± 11.06 μm) compared to amblyopic eyes (297.59 ± 14.16 μm). In the anisohyperopic amblyopia group, the outer macular thickness significantly increased in amblyopic eyes (286.43 ± 18.63 μm) when compared to fellow eyes (272.62 ± 14.90 μm). In the follow-up visit, 28 patients showed improvement and 6 patients did not show improvement in final best-corrected visual acuity, and the OCT parameters in amblyopic eyes of these two groups did not differ significantly.

CONCLUSION

Abnormal experience in early life does not affect the maturation process of retinal layers as evident by OCT parameters, and these parameters cannot predict the outcomes of occlusion therapy.

Exploring macrophage mannose receptor expression after myocardial infarction by Al[18F]F-NOTA-DCM positron emission tomography

Introduction

Mannose receptor (CD206) is primarily expressed on the surface of alternatively activated macrophages that are involved in resolution of inflammation after myocardial injury [1]. The purpose of this study was to evaluate mannose receptor targeting positron emission tomography (PET) tracer Al[18F]F-NOTA-DCM consisting of dextran backbone with cysteine-mannose moieties for imaging of experimental acute myocardial infarction (MI) [2].

Methods

First, ALEXA-488 fluorophore-labelled DCM was used for specificity studies using flow cytometry of M1 and M2 polarized macrophages derived from human blood monocytes. Secondly, Sprague-Dawley rats were studied on day 3 and day 7 after permanent ligation of left coronary artery or after sham-operation. [18F]FDG PET (35 MBq, 10 min static scan) was performed to visualize myocardium and on the next day, 60 min dynamic PET was performed after injection of 50 MBq of Al[18F]F-NOTA-DCM. Then, rats were euthanized for biodistribution study by gamma counting followed by digital autoradiography and histology (H&E, CD206 staining) of left ventricle cryosections. In vitro Al[18F]F-NOTA-DCM blocking study was performed on left ventricle cryosection with molar excess of unlabelled DCM.

Results

Flow cytometry confirmed that ALEXA-488-DCM bound specifically to M2 macrophages. In rats, the infarcted area was clearly detected in vivo with Al[18F]F-NOTA-DCM PET and its SUV was significantly higher than that of remote area or myocardium of sham-operated rats both on day 3 (SUV 0.78±0.18 vs. 0.47±0.13 vs. 0.43±0.07, p<0.005) and day 7 post-MI (SUV 0.64±0.10 vs. 0.47±0.12 vs. 0.51±0.07, p<0.05). Autoradiography confirmed increased uptake in the infarcted area compared to the remote area or to the myocardium of sham-operated rats on day 3 (PSL/mm2 141.21±46.06 vs. 49.76±20.37 vs. 57.97±6.77, p<0.005) and day 7 (PSL/mm2 139.22±19.44 vs. 55.38±28.83 vs. 60.83±7.63, p<0.0001). In vitro blocking study indicated that the tracer binding in infarcted area was specific. The area-% of CD206-positive staining in the infarcted area was significantly higher on day 3 post-MI than on day 7 (p<0.05), and higher at both time points than in remote area or myocardium of sham-operated rats (p<0.0001). Area-% of CD206 staining in the MI area positively correlated with Al[18F]F-NOTA-DCM uptake and MI size (p<0.05 and p<0.01, respectively).

Conclusions

Al[18F]F-NOTA-DCM PET detects overexpression of mannose receptor after ischemic myocardial injury and may be a suitable biomarker for early detection of the inflammation resolution process after MI.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Jane and Aatos Erkko FoundationSigrid Juselius FoundationFInnish Foundation for Cardiovascular Research

Single cell profiling of adipose tissue in atherosclerosis

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Academy of Finland

Sigrid Jusélius Foundation

Adipose tissue influences the physiological and pathological processes in our body by regulating lipid storage and metabolic homeostasis. Extracellular matrix (ECM) is a dynamic and complex assemblage consisting of polysaccharides, proteogylcans and signalling proteins. Though both adipocytes and non- adipose cells of the stromal fraction contribute to ECM maintenance, role of adipose tissue ECM in the disease remains poorly characterised. High fat diet (HFD) and obesity represent major risk factors for atherosclerosis. Our overall aim in this study was to understand HFD induced changes in the adipose tissue during atherosclerosis progression using single cell RNA sequencing (scRNA-seq), to identify the ligands responsible for changes in the expression of ECM components and to characterise the role of ECM protein fibrillin in disease associated tissue changes.

We performed scRNA-seq in the adipose tissue of control mice and atherosclerotic LDLR-/- / ApoB100/100 subjected to 1 (early disease) or 3 months (advanced disease) of HFD. This allowed us to identify 13 different cell types in the adipose tissue of the diseased mice. Among them, we identified mesenchymal cells (MSC) undergoing changes from putatively adipogenic to fibrogenic cells. The differentially expressed genes in the MSC population exhibited functions related to ECM development, maintenance and signalling. We identified Fibrillin-1 (Fbn1) as one of the most prominent up regulated genes and studied the effect of Fbn1 knockout in ApoE-/- Fbn1C1039G+/- mice. The Fbn1 knockout mice model suited our experimental design to study the adipose tissue during atherosclerosis as the mice developed significantly large and unstable plaques characterised by large necrotic core. Our results demonstrated that adipose tissue expresses a new subtype with HFD in Fbn1 knockout mice, which could be associated with insulin resistance and fat accumulation. Fbn1 knockout led to an altered phenotype of MSCs (or adipocytes) in adipose tissue.

Altogether, our analysis provides the first steps toward understanding the role of MSCs in ECM-related changes during atherosclerosis and HFD stimulation.

Nephroprotective and antioxidant activities of Salacia oblonga on acetaminophen-induced toxicity in rats

Salacia oblonga, a woody climbing plant belonging to the family Celastaceae, is widely distributed in India and other southeast Asian countries. The genus Salacia have been used particularly for the treatment of diabetes, obesity, gonorrhoea, rheumatism, pruritus and asthma. Acetaminophen (APAP), used as an analgesic drug, produces liver and kidney necrosis in mammals at high doses. The aim of this study was to investigate the nephroprotective and antioxidant activities of the ethanol extract of Salacia oblonga (EESO) at the two dose levels of 250 and 500 mg/kg bw on APAP-induced toxicity in rats. The results showed that APAP significantly increases the levels of serum urea, creatinine, and reduces levels of uric acid concentration. The EESO reduces these by increasing anti-oxidative responses as assessed by biochemical and histopathological parameters. In conclusion, our results suggest that the EESO possesses nephroprotective and antioxidant effects against APAP-induced nephrotoxicity in rats.