Inflammation and Atherosclerosis

AbstractPurposeThe aim of this article is to discuss the role of inflammation in atherosclerosis.SummaryAn initial chemical, mechanical or immunological insult induces endothelial dysfunction. This triggers a cascade of inflammatory reactions, in which monocytes, macrophages, T lymphocytes and vascular smooth muscle cells participate. Leukocyte adhesion molecules, cytokines, growth factors and metalloproteinases participate in all stages of atherogenesis. Almost all of the traditional risk factors for atherosclerosis are associated with and participate in the inflammatory process. Many infectious agents, mainly Chlamydia pneumoniae, have been proposed as potential triggers of the cascade. The immune system has been implicated in plaque formation, through the activation of cellular and humoral immunity against innate or microbial heat shock protein 60. Methods of detection of systemic or local plaque inflammation have been developed and research is being conducted on the potential use of anti-inflammatory and antibiotic drugs in atherosclerosis

Bilateral lingual–facial trunk: anatomic and clinical implications

Common origin of lingual and facial artery is a relatively frequent anatomic varia­tion. Instead, bilateral lingual–facial trunk has been described only sparsely in the literature. In this report authors describe and analyse a case of bilateral common lingual–facial trunk in the context of its anatomical, clinical and embryological implications. We also describe possible consequences in performance of elective and emergent surgical operations and modification in surgical techniques that should be considered. We believe that surgeons should be suspicious for this variation’s existence and keep alternative solutions in their armentarium

Carotid ultrasound findings as a predictor of long-term survival after abdominal aortic aneurysm repair: a 14-year prospective study

AbstractPurposeSeveral factors have been related to long-term survival after open abdominal aortic aneurysm (AAA) repair. The effect of carotid stenosis on outcome has not yet been examined. We performed an open prospective study to evaluate the prognostic significance of carotid stenosis on long-term survival of patients who had undergone elective operative repair of AAA.MethodsTwo hundred eight patients who underwent elective open AAA repair in our department between March 1987 and December 2001 were included in the study. All patients were evaluated preoperatively with color duplex ultrasound (US) scanning of the carotid arteries, and were followed up with clinical examination and carotid duplex US scanning 1 month after the operation and every 6 months thereafter. Median duration of follow-up was 50 months (range, 5-181 months). Cardiovascular morbidity and mortality, as well as all causes of mortality, were recorded and analyzed with regard to traditional risk factors and carotid US findings.ResultsTwenty-seven fatal and 46 nonfatal cardiovascular events were recorded. Both univariate and multivariate analysis showed that carotid stenosis 50% or greater and echolucent plaque were significantly associated with cardiovascular mortality and morbidity. Carotid stenosis was a stronger predictor of cardiovascular death than was ankle/brachial index. Age, hypercholesterolemia, coronary artery disease, and diabetes mellitus were also associated with higher mortality and morbidity from cardiovascular causes.ConclusionPatients electively operated on for AAA repair and with stenosis 50% or greater and echolucent plaque at duplex US scanning are at significantly increased risk for cardiovascular mortality and morbidity. Carotid US can therefore be used to select a subgroup of patients with AAA who might benefit from medical intervention, including antiplatelet and lipid-lowering agents

Fatal venous air embolism in swine during surgical procedure

Η εμβολή με αέρα της φλεβικής κυκλοφορίας είναι ένα σχετικά σπάνιο γεγονός που μπορεί να συμβεί τόσο κατάτην εκτέλεση απλών χειρουργικών χειρισμών όσο και κατά τη διάρκεια μεγάλων χειρουργικών επεμβάσεων. Αν και υπάρχειπληθώρα βιβλιογραφικών αναφορών για τον άνθρωπο, η αναφορά περιστατικών σε ζώα είναι περιορισμένη. Περιγράφεται περιστατικόφλεβικής εμβολής με αέρα, που παρατηρήθηκε κατά τη διάρκεια χειρουργικής επέμβασης, για την τοποθέτηση μοσχεύματοςαπό πολυτετραφλουοροαιθυλένιο μεταξύ κοινής καρωτίδας και έξω σφαγιτιδας φλέβας σε χοίρο. Πριν και μετά τηντοποθέτηση του μοσχεύματος πραγματοποιήθηκε λήψη μετρήσεων της ενδοαγγειακής πίεσης και των μεταβολών της διαμέτρουτης έξω σφαγιτιδας φλέβας, κεντρικά και περιφερικά της αναστόμωσης του μοσχεύματος, καθώς και μετρήσεις των μεταβολώντης ροής τόσο στην κοινή καρωτίδα όσο και στην έξω σφαγιτιδα φλέβα, κεντρικά και περιφερικά των αντίστοιχων αναστομώσεων.Το ζώο παρέμενε σταθερό αιμοδυναμικά για δυο ώρες και σαράντα λεπτά, οπότε αιφνιδίως παρατηρήθηκε ραγδαία πτώσητου κορεσμού του αίματος σε οξυγόνομε ταυτόχρονη μείωση της καρδιακής συχνότητας. Παρά τους χειρισμούς που έγιναν από τη χειρουργική ομάδα, μετά από δέκα λεπτά το ζώο κατέληξε. Κατά τη νεκροτομική εξέταση παρατηρήθηκε συγκέντρωση μεγάλης ποσότητας αέρα στη δεξιά καρδιά, στην πρόσθια και την οπίσθια κοίλη φλέβα, στην πνευμονική αρτηρία, καθώς και στις στεφανιαίες αρτηρίες. Παρόλο που πιθανολογείται ότι η είσοδος του αέρα έγινε από την αναισθητική μηχανή ή το σημείο της αναστόμωσης, ο τρόπος εισόδου παραμένει άγνωστος.Air embolism can occur after minor invasive procedures, as well as during major surgical operations. Reports of air embolism cases in veterinary literature are not very often, although it is considered that it happens more often than it is recognized. During a surgical procedure in swine, for the creation of a fistula of PTFE graft between the right common carotid artery and the right jugular vein under general anaesthesia, the animal died due to massive venous air embolism. Although it is supposed that the air was possibly inserted through the anaesthetic machine or through the anastomosis, the exact mechanism of the air insertion remains unknown

A Dynamic Stochastic Model of Frequency-Dependent Stress Fiber Alignment Induced by Cyclic Stretch

BACKGROUND: Actin stress fibers (SFs) are mechanosensitive structural elements that respond to forces to affect cell morphology, migration, signal transduction and cell function. Cells are internally stressed so that SFs are extended beyond their unloaded lengths, and SFs tend to self-adjust to an equilibrium level of extension. While there is much evidence that cells reorganize their SFs in response to matrix deformations, it is unclear how cells and their SFs determine their specific response to particular spatiotemporal changes in the matrix. METHODOLOGY/PRINCIPAL FINDINGS: Bovine aortic endothelial cells were subjected to cyclic uniaxial stretch over a range of frequencies to quantify the rate and extent of stress fiber alignment. At a frequency of 1 Hz, SFs predominantly oriented perpendicular to stretch, while at 0.1 Hz the extent of SF alignment was markedly reduced and at 0.01 Hz there was no alignment at all. The results were interpreted using a simple kinematic model of SF networks in which the dynamic response depended on the rates of matrix stretching, SF turnover, and SF self-adjustment of extension. For these cells, the model predicted a threshold frequency of 0.01 Hz below which SFs no longer respond to matrix stretch, and a saturation frequency of 1 Hz above which no additional SF alignment would occur. The model also accurately described the dependence of SF alignment on matrix stretch magnitude. CONCLUSIONS: The dynamic stochastic model was capable of describing SF reorganization in response to diverse temporal and spatial patterns of stretch. The model predicted that at high frequencies, SFs preferentially disassembled in the direction of stretch and achieved a new equilibrium by accumulating in the direction of lowest stretch. At low stretch frequencies, SFs self-adjusted to dissipate the effects of matrix stretch. Thus, SF turnover and self-adjustment are each important mechanisms that cells use to maintain mechanical homeostasis

Editor's Choice \u2013 Management of Atherosclerotic Carotid and Vertebral Artery Disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS)

2017 Clinical Practice Guidelines of the European Society for Vascular Surgery

European training requirements in vascular surgery

The Union Europénne des Médecins Spécialistes (UEMS) is a non-governmental organization representing national associations of medical specialists (over 1.6 million) at the European level. It has strong links and relations with European institutions (Commission and Parliament), the other independent European medical or-ganizations and the European medical/scientific societies. With a current membership of 40 national associations and 43 specialist sections and European boards, the UEMS promotes the free movement of medical specialists across Europe while ensuring the highest level of training which will pave the way to the improvement of quality of care for the benefit of all European citizens. The UEMS areas of expertise notably encompass Continuing Medical Education, Post-Graduate Training and Quality Assurance. It is the UEMS conviction that the quality of medical care and expertise is directly linked to the quality of train-ing provided to the medical professionals. Therefore, the UEMS committed itself to contribute to the improvement of medical training at the European level through the de-velopment of European standards in the different medical disciplines. One of the added values of the UEMS is the development of new harmonized models for the training of the next generation of medical specialists, and of high standards of clinical practice, hence improved care for pa-tients throughout Europe. It is not important where doc-tors are trained, they should have at least the same core competencies.peer-reviewe