Aberrant Insertion of the Right Subclavian Artery: an Unusual Cause of Dysphagia in an Adult

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Minimally Invasive Vein Harvesting in Femoropopliteal Bypass Surgery:Does Using an Old Technique Give New Perspectives? Short Report of Five Patients

<p>Background: Femoropopliteal bypass surgery is the most commonly performed type of peripheral bypass in vascular surgery. The great saphenous vein (GSV) is the preferred bypass conduit. Commonly used methods of GVS harvesting are related to morbidity, such as wound infection, skin necrosis, hematoma, and edema.</p><p>Methods: In this feasibility study we present an "old-new" way of harvesting of the GSV by inversion stripping, which is significantly less invasive than conventional GSV harvesting, resulting in less morbidity.</p><p>Results: All patients recovered uneventfully and all lower limb wounds healed with conventional wound management. No excessive bruising was seen in the VSM trail nor were there any surgical wound infections.</p><p>Conclusions: The inversion stripping of the GSV is an easy, safe, and minimally invasive harvesting technique for bypass surgery.</p>

Loss of Kidney Function after Endovascular Treatment of Peripheral Arterial Disease

Background: Administration of radiocontrast during endovascular procedures for peripheral arterial disease (PAD) may cause acute kidney injury, which generally recovers with supportive treatment. Long-term effects of endovascular procedures on renal function remain to be investigated. Method: This retrospective observational cohort study includes all patients who newly presented to the vascular surgery outpatient clinic with Rutherford class II or III PAD and who were treated with either supervised exercise therapy or endovascular interventions. Changes in estimated glomerular filtration rates (eGFR) after 1 year were compared between the 2 treatment groups. Multivariate regression analysis and propensity score matched paired analysis were done to correct for potential confounders. Results: One year after treatment, eGFR was reduced by 8.6 mL/min (95% confidence interval [CI], 7.3-9.9, P <0.001) after endovascular intervention (n = 284) and by 1.7 mL/min (95% CI, 0.9-25, P <0.001) after supervised exercise therapy (n = 299). After correction for potential confounders, endovascular interventions were associated with 9.2 mL/min (95% CI, 5.9-12.4, P <0.001) more renal decline compared to exercise therapy. Similar results were found in the propensity score matched paired analysis. Conclusions: Endovascular procedures for PAD are associated with clinically relevant and long-term loss of kidney function

The Strong <i>In Vivo</i> Anti-Tumor Effect of the UIC2 Monoclonal Antibody Is the Combined Result of Pgp Inhibition and Antibody Dependent Cell-Mediated Cytotoxicity

<div><p>P-glycoprotein (Pgp) extrudes a large variety of chemotherapeutic drugs from the cells, causing multidrug resistance (MDR). The UIC2 monoclonal antibody recognizes human Pgp and inhibits its drug transport activity. However, this inhibition is partial, since UIC2 binds only to 10–40% of cell surface Pgps, while the rest becomes accessible to this antibody only in the presence of certain substrates or modulators (e.g. cyclosporine A (CsA)). The combined addition of UIC2 and 10 times lower concentrations of CsA than what is necessary for Pgp inhibition when the modulator is applied alone, decreased the EC₅₀ of doxorubicin (DOX) in KB-V1 (Pgp⁺) cells <i>in vitro</i> almost to the level of KB-3-1 (Pgp^-) cells. At the same time, UIC2 alone did not affect the EC₅₀ value of DOX significantly. In xenotransplanted severe combined immunodeficient (SCID) mice co-treated with DOX, UIC2 and CsA, the average weight of Pgp⁺ tumors was only ∼10% of the untreated control and in 52% of these animals we could not detect tumors at all, while DOX treatment alone did not decrease the weight of Pgp⁺ tumors. These data were confirmed by visualizing the tumors <i>in vivo</i> by positron emission tomography (PET) based on their increased ¹⁸FDG accumulation. Unexpectedly, UIC2+DOX treatment also decreased the size of tumors compared to the DOX only treated animals, as opposed to the results of our <i>in vitro</i> cytotoxicity assays, suggesting that immunological factors are also involved in the antitumor effect of <i>in vivo</i> UIC2 treatment. Since UIC2 binding itself did not affect the viability of Pgp expressing cells, but it triggered <i>in vitro</i> cell killing by peripheral blood mononuclear cells (PBMCs), it is concluded that the impressive <i>in vivo</i> anti-tumor effect of the DOX-UIC2-CsA treatment is the combined result of Pgp inhibition and antibody dependent cell-mediated cytotoxicity (ADCC).</p></div

Antibody-dependent cell-mediated cytotoxicity (ADCC, <i>panels A</i> and <i>B</i>) and complement mediated lysis (CDC, <i>panels C</i> and <i>D</i>) induced by UIC2 mAb treatment <i>in vitro</i>.

<p>In the ADCC assay KB-V1 (<i>A</i>) and KB-3-1 (<i>B</i>) tumor cells were labeled with CFDA-SE then mixed with PBMCs freshly isolated from peripheral blood at different target to effector cell ratios. Samples were treated with 10 µM CsA (○), 20 µg/ml UIC2 mAb (▪), 10 µM CsA and 20 µg/ml UIC2 mAb (□) or buffer (•). After 8 h incubation at 37°C, samples were stained with PI and analyzed by flow cytometry. In the CDC assay, cells were incubated with human serum at different dilutions for 4 h. <i>Inset of panel C</i>: Hemolytic effect of the serum (▴) and of heat inactivated serum (▵) on sensitized sheep red blood cells served as positive and negative control, respectively. The percentages of killed cells were calculated as described in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0107875#s2" target="_blank">Materials and Methods</a>. Values are means (± SD) of four independent experiments, ***P<0,001.</p