Inflammatory reaction and angiogenesis intensity in aortic wall according to clinical manifestation of abdominal aortic aneurysm

Wstęp. Celem pracy jest ocena parametrów histologicznych w zależności od obrazu klinicznego tętniaka ze szczególnym uwzględnieniem obecności i jakości procesu zapalnego oraz nasilenia angiogenezy.   Materiały i metody. Materiał pobierano od chorych operowanych w Klinice Chirurgii Ogólnej i Naczyniowej AM w Łodzi w latach 1998&#8211;2000. Fragmenty ściany aorty utrwalano w 9-procentowym formaldehydzie. Do badań zakwalifikowano 98 przypadków. Wyróżniono 5 grup badawczych: 1. Chorzy z tętniakami operowanymi planowo (n = 50); 2. Osoby z tętniakami objawowymi i pękniętymi (n = 18); 3. Pacjenci z tętniakami aorty współistniejącymi z niedrożnością aortalno-biodrową (n = 9); 4. Chorzy z niedrożnością aortalno-biodrową bez tętniaka (n = 14); 5. Grupa kontrolna &#8211; osoby z prawidłową aortą pobraną od dawców narządów (n = 7). Preparaty barwione h + e oceniano pod względem obecności i/lub nasilenia procesu zapalnego, stosując skalę HISA, określano liczbę limfocytów T, limfocytów B, makrofagów oraz liczbę naczyń krwionośnych. W badaniach półilościowych oceniano liczbę naczyń w skali 1&#8211;3. Wyniki poddano analizie statystycznej z użyciem testu Manna-Whitneya. Wyniki. Nasilenie angiogenezy w grupie 2 było znamiennie statystycznie wyższe niż w pozostałych grupach. W grupie tej stwierdzono także największą liczbę makrofagów w błonie zewnętrznej (M = 47 vs. M = 34 w grupie 1; p < 0,01), limfocytów T w błonie środkowej (M = 447 vs. M = 292; p < 0,01), limfocytów B w błonie zewnętrznej (M = 633 vs. M = 431; p < 0,01), a także granulocytów (M = 26 vs. M = 7; p < 0,01). Grupę chorych z tętniakami objawowymi charakteryzowało także największe nasilenie procesu zapalnego w ścianie aorty oceniane w skali HISA. Wnioski. Wykazano korelację pomiędzy nasileniem procesu zapalnego i angiogenezy w ścianie aorty a klinicznymi objawami tętniaka.Background. The aim of the study was the estimation of histological parameters in association with the clinical manifestation of aortic aneurysm, mainly the intensity of angiogenesis and inflammatory infiltration. Material and metods. Material was obtained from patients operated on in the Department of General and Vascular Surgery at the Medical University of Łódź in 1998&#8211;2000. The samples of aortic wall were fixed in formalin. 98 cases were selected for the study and divided into 5 groups: 1. Patients with aneurysms undergoing elective surgery (n = 50); 2. Patients with aneurysms symptomatic and ruptured (n = 18); 3. Patients with aneurysms coexisting with aorto-iliac occlusion (n = 9); 4. Patients with aorto-iliac occlusion without aneurysm (n = 14); 5. Control group with normal aorta obtained from organ donors (n = 7). Slides were stained with h + e, the presence of inflammatory reaction was estimated according to conditions described in Histologic Inflammatory Scale Aneurysm. The numbers of T-cells, B-cells and macrophages were calculated after immunohistochemistry. The number of blood vessels was described semiquantitatively, using the 3-degree scale. Results. The intensity of angiogenesis in the second group was significantly higher than in the other groups. In this group we found the highest number of macrophages in adventitia (M = 47 vs. M = 37 in the first group; p < 0.01), T-cells in media (M = 447 vs. 292; p < 0.01), B-cells in adventitia (M = 633 vs. M = 431; p < 0.01) and neutrophiles (M = 26 vs. M = 7; p < 0.01). The symptomatic group also had the biggest intensity of inflammatory reaction estimated in HISA. Conclusions. We show the correlation between angiogenesis and inflammatory intensity and clinical manifestation of aneurysm

Usefulness of serum VEGF concentration measurement to estimate aortic aneurysm risk of rupture

Wstęp. Celem niniejszej pracy jest ocena przydatności oznaczania wartości stężeń VEGF w surowicy u chorych z tętniakami aorty brzusznej w celu oceny ryzyka pęknięcia. Analizowano stężenia VEGF w surowicy pacjentów z tętniakami aorty w zależności od objawów klinicznych tętniaka oraz zbadano korelację wartości stężeń VEGF w surowicy z ekspresją tego czynnika w ścianie aorty.Materiał i metody. Materiał badawczy stanowiły próbki surowicy pobrane od chorych przed zabiegiem oraz fragmenty ściany aorty uzyskane od tych samych pacjentów podczas operacji rekonstrukcyjnej aorty. Wyodrębniono następujące grupy: I - tętniaki operowane planowo (n = 49), II - tętniaki objawowe i pęknięte (n = 19), III - niedrożności aortalno-biodrowe (n = 17), IV - grupa kontrolna, którą stanowiły fragmenty ściany aorty pobranej od dawców narządów (n = 9) oraz surowica pobrana u chorych operowanych planowo z powodu przepuklin i żylaków kończyn dolnych (n = 34). Stężenie VEGF w surowicy oznaczano metodą ELISA. Ekspresję VEGF w tkance oceniono morfometrycznie, zliczając komórki VEGF-dodatnie po wykonaniu odczynów immunohistochemicznych. Wyniki. Ekspresja VEGF w ścianie aorty była największa w grupie II. Stwierdzono istotną statystycznie różnicę tej wartości w porównaniu z grupą I (p < 0,003). Wykazano statystycznie znamienne różnice ekspresji VEGF między pozostałymi grupami (p < 0,001). Największą średnią wartość stężenia VEGF w surowicy odnotowano w grupie II, ale różnice między wartościami w poszczególnych grupach nie były istotne statystycznie, mimo że korelacja między wartościami VEGF w surowicy a ekspresją w tkance okazała się silna (p < 0,001). Wniosek. Wyniki badań wskazują na istotną rolę VEGF (i angiogenezy) w rozwoju tętniaka aorty, jednak brak specyficzności uniemożliwia zastosowanie pomiaru jego stężeń w ocenie dynamiki powiększania się tętniaka i ryzyka jego pęknięcia.Background. Risk of abdominal aortic aneurysm (AAA) rupture is difficult to estimate. Angiogenesis in aneurysm walls is an important morphologic finding. One of the most important factors stimulating angiogenesis is vascular endothelial growth factor (VEGF). The aim of our study was to evaluate if the two values: VEGF expression in aortic wall tissues, and VEGF serum concentration correlate with clinical manifestations of aneurysms, and if these two values correlate with each other. Material and methods. Aorta tissue samples were taken in the operating room from patients undergoing aorta reconstruction for aneurysms: electively (group I, n = 49), emergency (group II, n = 19) or because of aortoiliac occlusion (AIO) (n = 17). Control tissue was taken from healthy organ donors (n = 9). Blood samples were obtained from these patients before surgery. Control serum samples were taken from patients undergoing surgery because of hernias and varices. Expression of VEGF in tissue was measured with use of morphometric analysis in slides after immunohistochemistry with anti-VEGF antibodies. Vascular endothelial growth factor serum concentration was measured with the use of ELISA. Results. The highest level of serum VEGF was observed in the symptomatic AAA group (mean value: 404.3 pg/ml; sv = 331.7). Electively operated AAA showed lower serum VEGF concentration (mean value = 285.3; sv = 300.9), AIO and control: 366.4 and 277.3 respectively. These differences were not significant. Strong correlation was observed between VEGF serum level and VEGF tissue expression. Significant differences were shown in VEGF positive cell numbers between all examined groups (mean cell number in AAA symptomatic = 140.9, elective AAA = 108.5, AIO = 51.4, control = 21.0). Conclusions. There is strong correlation in VEGF tissue expression with clinical manifestation of AAA. Vascular endothelial growth factor serum concentration is not a good clinical marker to estimate the risk of rupture

Leczenie chorego z pękniętym tętniakiem aorty brzusznej i z nieoperacyjnym rakiem jelita grubego - opis przypadku i przegląd piśmiennictwa

Jednoczasowe występowanie u pacjenta choroby nowotworowej i pękniętego tętniaka aorty brzusznej w praktyce klinicznej występuje rzadko. Ze względu na coraz większą liczbę zachorowań na nowotwory, coraz lepsze i bardziej wyrafinowane badania diagnostyczne, a także wzrost w populacji liczby osób powyżej 65. roku życia, lekarze coraz częściej w swojej praktyce będą spotykać się z pacjentami, u których jednoczasowo występuje tętniak aorty brzusznej i choroba nowotworowa. Leczenie takich chorych wciąż budzi duże kontrowersje. W niniejszej pracy przedstawiono przypadek leczenia chorego z pękniętym tętniakiem aorty brzusznej i nieoperacyjnym rakiem jelita grubego. Poruszono także problematykę etyczną i prawną związaną z postępowaniem lekarza w takich przypadkach.It is very unusual to encounter in clinical practice a simultaneous neoplasm and a ruptured abdominal aortic aneurysm in one patient. Because of the growing number of patients suffering from neoplasms, better and more precise diagnostic procedures, and a growing population of people over 65 years old, doctors will, more often than not, meet patients with simultaneous abdominal aortic aneurysm and neoplasm disease. The treatment of such cases gives rise to a great deal of controversy. In this paper, the treatment of a patient with a ruptured abdominal aortic aneurysm and with unoperative colon carcinoma is presented together with the ethical and legal problems related to medical procedures in such cases

The co-application of hypoxic preconditioning and postconditioning abolishes their own protective effect on systolic function in human myocardium

Background: Ischemic preconditioning (IPC) and postconditioning (POC) are well documented to trigger cardioprotection against ischemia/reperfusion (I/R) injury, but the effect oftheir both co-application remains unclear in human heart. The present study sought to assessthe co-application of IPC and POC on fragments of human myocardium in vitro.Methods: Muscular trabeculae of the human right atrial were electrically driven in the organbath and subjected to simulated I/R injury – hypoxia/re-oxygenation injury in vitro. To achieveIPC of trabeculae the single brief hypoxia period preceded the applied lethal hypoxia, and to achieve POC triple brief hypoxia periods followed the lethal hypoxia. Additional muscular trabeculae were exposed only to the hypoxic stimulation (Control) or were subjected to the non-hypoxic stimulation (Sham). 10 μM norepinephrine (NE) application ended every experiment to assess viability of trabeculae. The contraction force of the myocardium assessed as a maximal amplitude of systolic peak (%Amax) was obtained during the whole experiment’s period.Results: Co-application of IPC and POC resulted in decrease in %Amax during the re-oxygentaionperiod and after NE application, as compared to Control (30.35 ± 2.25 vs. 41.89 ± 2.25, 56.26 ± 7.73 vs. 65.98 ± 5.39, respectively). This was in contrary to the effects observed when IPC and POC were applied separately.Conclusions: The co-application of IPC and POC abolishes the cardioprotection of either intervention alone against simulated I/R injury in fragments of the human right heart atria

COVID-19 infection in patients on long-term home parenteral nutrition for chronic intestinal failure

To investigate the incidence and the severity of COVID-19 infection in patients enrolled in the database for home parenteral nutrition (HPN) for chronic intestinal failure (CIF) of the European Society for Clinical Nutrition and Metabolism (ESPEN).Period of observation: March 1st, 2020 March 1st, 2021.patients included in the database since 2015 and still receiving HPN on March 1st, 2020 as well as new patients included in the database during the period of observation. Data related to the previous 12 months and recorded on March 1st 2021: 1) occurrence of COVID-19 infection since the beginning of the pandemic (yes, no, unknown); 2) infection severity (asymptomatic; mild, no-hospitalization; moderate, hospitalization no-ICU; severe, hospitalization in ICU); 3) vaccinated against COVID-19 (yes, no, unknown); 4) patient outcome on March 1st 2021: still on HPN, weaned off HPN, deceased, lost to follow up.Sixty-eight centres from 23 countries included 4680 patients. Data on COVID-19 were available for 55.1% of patients. The cumulative incidence of infection was 9.6% in the total group and ranged from 0% to 21.9% in the cohorts of individual countries. Infection severity was reported as: asymptomatic 26.7%, mild 32.0%, moderate 36.0%, severe 5.3%. Vaccination status was unknown in 62.0% of patients, non-vaccinated 25.2%, vaccinated 12.8%. Patient outcome was reported as: still on HPN 78.6%, weaned off HPN 10.6%, deceased 9.7%, lost to follow up 1.1%. A higher incidence of infection (p = 0.04), greater severity of infection (p < 0.001) and a lower vaccination percentage (p = 0.01) were observed in deceased patients. In COVID-19 infected patients, deaths due to infection accounted for 42.8% of total deaths.In patients on HPN for CIF, the incidence of COVID-19 infection differed greatly among countries. Although the majority of cases were reported to be asymptomatic or have mild symptoms only, COVID-19 was reported to be fatal in a significant proportion of infected patients. Lack of vaccination was associated with a higher risk of death

Home parenteral nutrition with an omega-3-fatty-acid-enriched MCT/LCT lipid emulsion in patients with chronic intestinal failure (the HOME study):study protocol for a randomized, controlled, multicenter, international clinical trial

BACKGROUND: Home parenteral nutrition (HPN) is a life-preserving therapy for patients with chronic intestinal failure (CIF) indicated for patients who cannot achieve their nutritional requirements by enteral intake. Intravenously administered lipid emulsions (ILEs) are an essential component of HPN, providing energy and essential fatty acids, but can become a risk factor for intestinal-failure-associated liver disease (IFALD). In HPN patients, major effort is taken in the prevention of IFALD. Novel ILEs containing a proportion of omega-3 polyunsaturated fatty acids (n-3 PUFA) could be of benefit, but the data on the use of n-3 PUFA in HPN patients are still limited. METHODS/DESIGN: The HOME study is a prospective, randomized, controlled, double-blind, multicenter, international clinical trial conducted in European hospitals that treat HPN patients. A total of 160 patients (80 per group) will be randomly assigned to receive the n-3 PUFA-enriched medium/long-chain triglyceride (MCT/LCT) ILE (Lipidem/Lipoplus® 200 mg/ml, B. Braun Melsungen AG) or the MCT/LCT ILE (Lipofundin® MCT/LCT/Medialipide® 20%, B. Braun Melsungen AG) for a projected period of 8 weeks. The primary endpoint is the combined change of liver function parameters (total bilirubin, aspartate transaminase and alanine transaminase) from baseline to final visit. Secondary objectives are the further evaluation of the safety and tolerability as well as the efficacy of the ILEs. DISCUSSION: Currently, there are only very few randomized controlled trials (RCTs) investigating the use of ILEs in HPN, and there are very few data at all on the use of n-3 PUFAs. The working hypothesis is that n-3 PUFA-enriched ILE is safe and well-tolerated especially with regard to liver function in patients requiring HPN. The expected outcome is to provide reliable data to support this thesis thanks to a considerable number of CIF patients, consequently to broaden the present evidence on the use of ILEs in HPN. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT03282955. Registered on 14 September 2017

Home parenteral nutrition provision modalities for chronic intestinal failure in adult patients:An international survey

Background & aims: The safety and effectiveness of a home parenteral nutrition (HPN) program depends both on the expertise and the management approach of the HPN center. We aimed to evaluate both the approaches of different international HPN-centers in their provision of HPN and the types of intravenous supplementation (IVS)-admixtures prescribed to patients with chronic intestinal failure (CIF). Methods: In March 2015, 65 centers from 22 countries enrolled 3239 patients (benign disease 90.1%, malignant disease 9.9%), recording the patient, CIF and HPN characteristics in a structured database. The HPN-provider was categorized as health care system local pharmacy (LP) or independent home care company (HCC). The IVS-admixture was categorized as fluids and electrolytes alone (FE) or parenteral nutrition, either commercially premixed (PA) or customized to the individual patient (CA), alone or plus extra FE (PAFE or CAFE). Doctors of HPN centers were responsible for the IVS prescriptions. Results: HCC (66%) was the most common HPN provider, with no difference noted between benign-CIF and malignant-CIF. LP was the main modality in 11 countries; HCC prevailed in 4 European countries: Israel, USA, South America and Oceania (p < 0.001). IVS-admixture comprised: FE 10%, PA 17%, PAFE 17%, CA 38%, CAFE 18%. PA and PAFE prevailed in malignant-CIF while CA and CAFE use was greater in benign-CIF (p < 0.001). PA + PAFE prevailed in those countries where LP was the main HPN-provider and CA + CAFE prevailed where the main HPN-provider was HCC (p < 0.001). Conclusions: This is the first study to demonstrate that HPN provision and the IVS-admixture differ greatly among countries, among HPN centers and between benign-CIF and cancer-CIF. As both HPN provider and IVS-admixture types may play a role in the safety and effectiveness of HPN therapy, criteria to homogenize HPN programs are needed so that patients can have equal access to optimal CIF care