Inhibitory effect of Labisia pumila leaf extract on angiogenesis via down-regulation of vascular endothelial growth factor

Purpose: To investigate the anti-angiogenic activity of a methanol leaf extract of Labisia pumila (ME), and its bioactive water fraction (WF), using in vitro models.Methods: The antioxidant activity and total phenolic contents of ME and WF were assessed using DPPH and Folin–Ciocalteu reagents. Antiproliferative effects of extracts towards human umbilical vein endothelial cells (HUVECs) were evaluated using MTT assay. Isolated rat aortic ring and matrigel tube formation assays were performed to assess the antiangiogenic potential of Me and its WF. Levels of VEGF protein in the cell lysates were measured using ELISA kit.Results: Among all the extracts prepared, ME and its WF showed higher total phenolic contents and exhibited moderate antioxidant effects. Significant (p < 0.001) suppression of microvessels outgrowth with half-maximal concentration (IC50) values of 20 and 26 μg/mL for ME and WF, was observed in rat aortic ring assay. ME and its WF halted proliferation and tube formation capacity of HUVECs in in vitro assays. Marked reduction in VEGF levels was observed in lysates of HUVECs treated with ME and its WF.Conclusion: Labisia pumila leaf extract and its water fraction halted angiogenesis by blocking VEGF secretion leading to inhibition of endothelial cells proliferation and differentiation which is suggested to be due to its phenolic antioxidant contents.Keywords: Labisia pumila, Anti-angiogenesis, Antioxidant, Tube formation, Rat aort

In vitro anti-angiogenic properties of ethanolic crude extract of Vernonia amygdalina

Angiogenesis is the process of generating new blood vessels that deliver tumor cells with oxygen and essential nutrients for growth and metastasis. This study examined the in vitro antiangiogenic properties of the ethanolic crude extract from Vernonia amygdalina (VA) grown in Malaysia. The direct antiangiogenic activity of VA was evaluated on EA.hy926 cells using in vitro assessments: Cell proliferation, colony formation, migration, and cell invasion assays. VA ethanolic crude extract cytotoxic activity was evident in the antiproliferative and colony formation assays. The growth inhibition (IC50) of 50% against EA.hy926 endothelial cells was achieved after 72 h treatment at a concentration of 85.43±3.57 μg/mL. Upon 48 h treatment, colony formation was inhibited completely at 100 μg/mL while 51.94% inhibition was achieved at 50 μg/mL. Moreover, the extract showed 54.72% and 31.99% inhibitory effects against migration of cells when treated for 24 h treatment at two different concentrations, 25 μg/mL and 12.5 μg/mL, respectively. The use of 100 μg/mL VA ethanolic extract inhibited cell invasion by 35.43%, which was lower than that of 57.81% inhibition achieved by the vinblastine as a positive control. All in all, the present work clearly demonstrated the antiangiogenic properties of VA ethanolic extract that may reflect a chemotherapeutic and/or chemoprevention potential for biomedical applications

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

The influence of selected sulphur containing compounds on retinal cell death: neuroprotective effects of hydrogen sulphide in a glaucoma model

Ganglion cell death in glaucoma is caused by a variety of insults that include ischemia, insufficient neurotrophic support and oxidative stress. Experimental studies were therefore conducted on cell cultures to determine how serum deprivation (to mimic insufficient neurotrophic support) or oxidative glutamate toxicity (GB), cause oxidative stress and induce retinal cell death. Moreover, studies were carried out to deduce whether selected sulphur containing compounds can blunt any negative influences to cells in culture and/or a defined ischaemic insult to the rat retina in situ, as this might suggest their use for the treatment of glaucoma. Serum deprivation and GB caused generation of reactive oxygen species (ROS) and apoptosis-like death to transformed retinal ganglion cells (RGC-5 cells). RGC-5 cells were more susceptible to the detrimental effects of GB than serum deprivation. RGC-5 cells subjected to serum deprivation appear to die by mechanisms that resemble classical apoptosis more closely than that caused by GB and the phase between the maximal generation of ROS and cell death were different. Cell death caused by serum deprivation was caspase-dependent but this was not the case for GB. Moreover, of the two sulphur compounds sulbutiamine and N-acetyl cysteine (NAC), sulbutiamine blunts the effect of serum deprivation more effectively. In addition, the pan caspase inhibitor z-VAD-fmk attenuated the negative effect of serum deprivation to RGC-5 cells while the necroptosis inhibitor (necrostsatin-1) counteracted solely the insult of GB. The sulphur containing compounds, ACS1 and ACS 67 which release hydrogen sulphide (H2S) slowly and NAC (a pro-cysteine GSH precursor) attenuated GB-induced cell death of RGC-5 cells. In contrast, sulbutiamine (a lipophilic thiolic thiamine derivative) was particularly effective in protecting RGC-5 cells from an insult of serum deprivation. Moreover, all of the sulphur compounds directly sequestered different types of ROS but with varying efficiency. Common features by which all tested sulphur containing agents seem to elicit a mode of action include the stimulation of GSH and the antioxidant enzyme glutathione-S-transferase (GST) as well as to scavenge excess free radicals. Moreover, the slow release of H2S from the ACS compounds appears to protect cells from oxidative stress through increasing the level of GSH, modulation of the cystine uptake transporter xCT, stimulation of the oxidative stress related transcription factor Nrf2 and the stimulation of pro-survival signalling pathways. The slow releasing H2S sulphur compound ACS67 also counteracts a number of detrimental influences to the rat retina in situ because of ischemia/reperfusion that includes damage to their ganglion cells. This suggests that such sulphur compounds might find a use in the treatment of glaucoma where ischemia probably plays a part in the disease process

The influence of selected sulphur containing compounds on retinal cell death

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

The influence of selected sulphur containing compounds on retinal cell death: neuroprotective effects of hydrogen sulphide in a glaucoma model

Ganglion cell death in glaucoma is caused by a variety of insults that include ischemia, insufficient neurotrophic support and oxidative stress. Experimental studies were therefore conducted on cell cultures to determine how serum deprivation (to mimic insufficient neurotrophic support) or oxidative glutamate toxicity (GB), cause oxidative stress and induce retinal cell death. Moreover, studies were carried out to deduce whether selected sulphur containing compounds can blunt any negative influences to cells in culture and/or a defined ischaemic insult to the rat retina in situ, as this might suggest their use for the treatment of glaucoma. Serum deprivation and GB caused generation of reactive oxygen species (ROS) and apoptosis-like death to transformed retinal ganglion cells (RGC-5 cells). RGC-5 cells were more susceptible to the detrimental effects of GB than serum deprivation. RGC-5 cells subjected to serum deprivation appear to die by mechanisms that resemble classical apoptosis more closely than that caused by GB and the phase between the maximal generation of ROS and cell death were different. Cell death caused by serum deprivation was caspase-dependent but this was not the case for GB. Moreover, of the two sulphur compounds sulbutiamine and N-acetyl cysteine (NAC), sulbutiamine blunts the effect of serum deprivation more effectively. In addition, the pan caspase inhibitor z-VAD-fmk attenuated the negative effect of serum deprivation to RGC-5 cells while the necroptosis inhibitor (necrostsatin-1) counteracted solely the insult of GB. The sulphur containing compounds, ACS1 and ACS 67 which release hydrogen sulphide (H2S) slowly and NAC (a pro-cysteine GSH precursor) attenuated GB-induced cell death of RGC-5 cells. In contrast, sulbutiamine (a lipophilic thiolic thiamine derivative) was particularly effective in protecting RGC-5 cells from an insult of serum deprivation. Moreover, all of the sulphur compounds directly sequestered different types of ROS but with varying efficiency. Common features by which all tested sulphur containing agents seem to elicit a mode of action include the stimulation of GSH and the antioxidant enzyme glutathione-S-transferase (GST) as well as to scavenge excess free radicals. Moreover, the slow release of H2S from the ACS compounds appears to protect cells from oxidative stress through increasing the level of GSH, modulation of the cystine uptake transporter xCT, stimulation of the oxidative stress related transcription factor Nrf2 and the stimulation of pro-survival signalling pathways. The slow releasing H2S sulphur compound ACS67 also counteracts a number of detrimental influences to the rat retina in situ because of ischemia/reperfusion that includes damage to their ganglion cells. This suggests that such sulphur compounds might find a use in the treatment of glaucoma where ischemia probably plays a part in the disease process.</p