Thrombosis of the vasa vasorum of the large and medium size pulmonary artery and vein leads to pulmonary thromboembolism in COVID-19

ABSTRACT The vasa vasorum of the large pulmonary vessels is involved in the pathology of COVID-19. This specialized microvasculature plays a major role in the biology and pathology of the pulmonary vessel walls. We have evidence that thrombosis of the vasa vasorum of the large and medium-sized pulmonary vessels during severe COVID-19 causes ischemia and subsequent death of the pulmonary vasculature endothelium. Subsequent release of thrombi from the vasa interna into the pulmonary circulation and pulmonary embolism generated at the ischemic pulmonary vascular endothelium site, are the central pathophysiological mechanisms in COVID-19 responsible for pulmonary thromboembolism. The thrombosis of the vasa vasorum of the large and medium-sized pulmonary vessels is an internal event leading to pulmonary thromboembolism in COVID-19.

Manejo de embarazos únicos con diagnóstico antenatal de vasa previa / Management of singleton pregnancies with prenatal diagnosis of vasa previa

Introducción: vasa previa (VP) corresponde al paso de los vasos umbilicales por las membranas amnióticas, sin protección de gelatina de Wharton o placenta, antes de la presentación fetal, sobre el orificio cervical interno. Pese a su baja incidencia, el diagnóstico prenatal es relevante por las graves consecuencias que puede tener esta patología en caso de no ser diagnosticada. El objetivo de esta revisión es presentar la evidencia disponible para el manejo de embarazadas con diagnóstico antenatal de VP. Materiales y métodos: analizamos todos los estudios publicados (prospectivos, retrospectivos y reporte de casos) entre los años 1999 y 2023, con diagnóstico VP en embarazo único, reportando la edad gestacional de interrupción y el resultado neonatal. Resultados: incluimos 19 investigaciones (18 en la búsqueda primera y una adicional por relevancia). Las pacientes con manejo intrahospitalario desde las 34 semanas tuvieron mayor latencia al parto, mejores resultados neonatales y menor tasa de cesárea de urgencia que las pacientes con manejo ambulatorio. La edad gestacional de interrupción es variable entre los estudios, sin embargo, no se evidenció beneficio de interrupción a las 34 semanas comparado con manejo expectante hasta las 37 semanas de edad gestacional. Conclusión: existiría beneficio de hospitalización entre las 32-34 semanas en mujeres con diagnóstico de VP, siendo razonable la interrupción cercana a las 37 semanas por cesárea electiva.

Introduction: vasa previa (VP) corresponds to the passage of the umbilical vessels through the amniotic membranes, without the protection of Wharton's gelatin or placenta, in front of the fetal presentation, over the internal cervical os. Despite its low incidence, prenatal diagnosis is relevant due to the severe consequences of this pathology if the diagnosis is missed. This review presents the available evidence for pregnant women's management with an antenatal diagnosis of VP. Materials and methods: we analyzed all the studies published (prospective, retrospective, and case reports) between 1999 and 2023, with a diagnosis of VP in a single pregnancy, reporting gestational age at delivery and neonatal outcome. Results: We included 19 investigations (18 in the first search and another for relevance). Patients with in-hospital management from 34 weeks had a more extended latency period until delivery, better neonatal outcomes, and a lower rate of emergency cesarean section than patients with outpatient management. The gestational age at birth is variable between the studies; however, no benefit of delivery at 34 weeks was evidenced compared with expectant management until 37 weeks of gestational age. Conclusion: there would be a benefit of hospitalization between 32-34 weeks in women diagnosed with VP, being reasonable to schedule the delivery close to 37 weeks by elective cesarean section.

Diagnóstico prenatal de vasa previa tipo 3, comunicación de un caso

La vasa previa es una patología poco frecuente en la que los vasos umbilicales se encuentran transcurriendo en las cercanías del orificio cervical interno. Habitualmente está asociada a inserción velamentosa del cordón, placenta succenturiata, inserción baja placentaria y fertilización in vitro. Tiene importantes implicancias perinatales el lograr un diagnóstico precoz en el segundo trimestre, porque se logra disminuir la mortalidad neonatal. Presentamos el primer caso de diagnóstico prenatal de vasa previa tipo 3 (una variante poco conocida) comunicado en el Perú en una gestante con placenta previa y sin diagnóstico hasta el tercer trimestre.

Vasa previa is a rare condition in which the umbilical vessels are found to run in the vicinity of the internal cervical os. It is usually associated with velamentous insertion of the umbilical cord, placenta succenturiata, low placenta insertion and in vitro fertilization. Early diagnosis in the second trimester has important perinatal implications because it reduces neonatal mortality. We present the first case of prenatal diagnosis of vasa previa type 3 (a little known variant) reported in Peru in a pregnant woman with placenta previa and undiagnosed until the third trimester.

Vasa previa con inserción velamentosa de cordón: comunicación de un caso

La afección vasa previa es un hallazgo prenatal raro y poco frecuente de hemorragia en la segunda mitad del embarazo, en la que los vasos umbilicales desprovistos de la gelatina de Wharton se interponen entre la presentación fetal y el orificio cervical interno. Cuando no se la detecta y se produce la rotura de los vasos, se asocia a una alta tasa de mortalidad perinatal. Se describen 3 tipos; el caso presentado se trata de vasa previa de tipo 1 secundaria a inserción velamentosa de cordón. Fue diagnosticada prenatalmente mediante ecografía por vía transvaginal asociada a Doppler color. Se practicó una cesárea con evolución materno perinatal favorable.

Vasa previa is a rare and infrequent prenatal finding of hemorrhage in the second half of pregnancy, in which umbilical vessels devoid of Wharton's jelly interpose between the fetal presentation and the internal cervical os. When undetected and rupture of the vessels occurs, it is associated with a high perinatal mortality rate. Three types are described; the case presented is type 1 vasa previa secondary to velamentous insertion of the cord. It was diagnosed prenatally by transvaginal ultrasound associated with color Doppler. A cesarean section was performed with favorable maternal and perinatal evolution.

Construction and validation of sheep VASA gene knock-in vector based on CRISPR/Cas9 system / 生物工程学报

This study aimed to explore the expression changes of VASA gene in sheep testis development and to construct VASA gene knock-in vector to prepare for the study on the differentiation of sheep germ cells in vitro. The testicular tissues of 3-month-old (3M) and 9-month-old (9M) sheep which represent immature and mature stages, respectively, were collected. The differential expression of VASA gene was analyzed by quantitative real-time PCR (qPCR) and Western blotting, and the location of VASA gene was detected by immunohistochemistry. The sgRNA targeting the VASA gene was designed and homologous recombination vectors were constructed by PCR. Subsequently, plasmids were transferred into sheep ear fibroblasts. The VASA gene was activated in combination with CRISPR/dCas9 technology to further verify the efficiency of the vector. The results showed that the expression level of VASA gene increased significantly with the development of sheep testis (P < 0.01), and was mainly located in spermatocytes and round spermatids. The knock-in vector of VASA gene was constructed by CRISPR/Cas9 system, and the Cas9-gRNA vector and pEGFP-PGK puro-VASA vector were transfected into ear fibroblasts. After CRISPR/dCas9 system was activated, ear fibroblasts successfully expressed VASA gene. The results suggest that VASA gene plays a potential function in sheep testicular development and spermatogenesis, and the VASA gene knock-in vector can be constructed in vitro through the CRISPR/Cas9 system. Our results provided effective research tools for further research of germ cell development and differentiation.

Vasa Vasorum in Saphenous Vein for CABG: A Review of Morphological Characteristics

ABSTRACT This short article discusses selected scanning electron microscope and transmission electron microscope features of vasa vasorum including pericytes and basement membrane of the human saphenous vein (SV) harvested with either conventional (CON) or no-touch (NT) technique for coronary artery bypass grafting. Scanning electron microscope data shows the general damage to vasa vasorum of CON-SV, while the transmission electron microscope data presents ultrastructural features of the vasa in more detail. Hence there are some features suggesting pericyte involvement in the contraction of vasa blood vessels, particularly in CON-SV. Other features associated with the vasa vasorum of both CON-SV and NT-SV preparations include thickened and/or multiplied layers of the basement membrane. In some cases, multiple layers of basement membrane embrace both pericyte and vasa microvessel making an impression of a "unit" made by basement membrane-pericyte-endothelium/microvessel. It can be speculated that this structural arrangement has an effect on the contractile and/or relaxing properties of the vessels involved. Endothelial colocalization of immunoreactive inducible nitric oxide synthase and endothelin-1 can be observed (with laser confocal microscope) in some of the vasa microvessels. It can be speculated that this phenomenon, particularly of the expression of inducible nitric oxide synthase, might be related to structurally changed vasa vessels, e.g., with expanded basement membrane. Fine physiological relationships between vasa vasorum endothelium, basement membrane, pericyte, and perivascular nerves have yet to be uncovered in the detail needed for better understanding of the cells'specific effects in SV preparations for coronary artery bypass grafting.

Video-dermoscopic Assessment of Capillaroscopic Pattern in Hansen's Disease

Leprosy is a chronic granulomatous infectious disease with a proven role of Mycobacterium leprae invasion into endothelial cells. Animal studies have shown evidence of involvement of vasa nervorum in the process of nerve invasion. Capillaries act as the mirror image of vascular involvement in any rheumatic disorder and holds good for leprosy also. Nailfold capillaroscopy (NFC) is a non-invasive, easily reproducible technique to study proximal nailfold capillaries. The aim of this study is to investigate morphological nailfold capillaroscopic alterations in patients with leprosy in its various forms and comparison with the normal individual. Total 20 Leprosy patients and 20 normal age and sex matched individuals recruited for nailfold capillaroscopic examination using video dermoscopye. Among 20 normal individuals, 3(15%) individuals showed tortuous capillaries and microhemorrhages each, 2(10%) showed meandering vessels, 1(5%) each showed megacapillaries, dilated/ectatic capillaries and bizarre vessels. Out of 20 leprosy patients, 11 (55%) patients showed bizarre and meandering capillaries, 10(50%) showed dilated vessels and avascular areas, 9(45%) showed capillary dropouts and neovascularisation, 8(40%) showed tortuous vessels, 6(30%) haemorrhages and 4 (20%) showed megacapillaries. Findings like avascular areas, capillary dropouts, haemorrhages were more noticed in lepromatous and borderline lepromatous leprosy, whereas early capillary abnormalities like dilated, meandering, bizarre vessels and neoangiogenesis were noticed more in borderline tuberculoid leprosy. However, statistical significant difference between clinical and dermoscopic observations was not seen in this study. Further studies with a large sample size are required to find out the same. Morphological changes may denote micro-vascular invasion by Mycobacterium leprae and may act as warning signs of fore- coming complications like loss of sensation and trophic ulcers. Follow-up studies are required to understand such correlation, if any.

Clinical characteristics of vasa previa with low-lying placenta / 中华围产医学杂志

Objective:To investigate the clinical characteristics of vasa previa (VP) with low-lying placenta (LP).Methods:A retrospective case-control study was conducted on pregnant women with VP who delivered at Guangzhou Women and Children's Medical Center from January 2015 to August 2021. According to the status of LP, these cases were classified into VP with LP (VP+LP) and VP without LP (VP-LP) group. The cases diagnosed with placenta previa (PP, n=128) during the same period were collected as control. Maternal-fetal clinical characteristics and outcomes were compared among the three groups using t-test, Mann-Whitney U test, and Chi-square test (or Fisher's exact test). Results:During the study period, 116 VP cases were diagnosed, accounting for 0.085% (116/136 450) of all deliveries. Apart from one case of intrauterine death caused by non-VP reasons in the third trimester, there were 64 in the VP+LP group and 51 in the VP-LP group. VP+LP cases accounted for about 2.9% (64/2 219) of all the cases with PP or LP. The proportions of multiparae and women with a history of cesarean section were significantly higher in the VP+LP group than in the VP-LP group [62.5% (40/64) vs 39.2% (20/51), χ 2= 6.17, P=0.013; 31.3% (20/64) vs 13.7% (7/51), χ 2= 4.85, P=0.028]. Besides, a rare type of VP (type Ⅲ) was only found in the VP+LP group (9.4%, 6/64). The median gestational age at first diagnosis by prenatal ultrasound was significantly larger in the VP+LP group than in the VP-LP group [28.3 (23.6-31.7) vs 23.9 (23.3-25.9) weeks, Z=2.61, P=0.007]. There was no significant difference in the incidence of antepartum hemorrhage between the two groups. In contrast, the amount of postpartum hemorrhage was significantly increased in the VP+LP group [550 (436-732) vs 420 (300-540) ml, Z=3.37, P=0.001]. Compared with the VP-LP group, the VP+LP group showed a lower incidence of lower neonatal Apgar score (<7 at 5 min) and hypoxic-ischemic encephalopathy [0.0%(0/64) vs 6.9%(4/58), 0.0%(0/64) vs 8.6% (5/58), Fisher's exact test, both P<0.05]. No neonatal death was reported in the VP+LP and VP-LP groups. No significant difference in the incidence of antepartum hemorrhage was found between the VP+LP group and the PP group. Still, the median time at delivery was earlier [36.0 (34.3-36.9) vs 37.0 (35.7-37.3) weeks, Z=3.79, P<0.001], and the incidence of abnormal fetal heart rate was higher [10.9% (7/64) vs 3.1% (4/128), Fisher's exact test , P=0.044] in the VP+LP group. Furthermore, the neonatal NICU admission rate and the incidence of respiratory distress syndrome were significantly higher in the VP+LP group than in the PP group [36.4% (24/66) vs 12.1% (16/132), χ 2= 16.04, P<0.001; 25.8% (17/66) vs 12.1% (16/132), χ 2= 5.89, P=0.015]. Conclusions:For VP+LP cases, there might be an additional type (type Ⅲ VP). Patients with VP+LP would have more blood loss within 24 h after delivery and a higher risk of adverse neonatal outcomes. Intensive attention should be paid to those diagnosed with LP during the third trimester to identify any VP.

A brief comment on vasa vasorum of human saphenous vein: relevance for coronary artery bypass surgery

Abstract The importance of the vasa vasorum and blood supply to the wall of human saphenous vein (hSV) used for coronary artery bypass grafting (CABG) is briefly discussed. This is in the context of the possible physical link of the vasa vasorum connecting with the lumen of hSV and the anti-ischaemic impact of this microvessel network in the hSV used for CABG.

Saphenous vein vasa vasorum as a potential target for perivascular fat-derived factors

Abstract Perivascular adipose tissue (PVAT) is a source of factors affecting vasomotor tone with the potential to play a role in the performance of saphenous vein (SV) bypass grafts. As these factors have been described as having constrictor or relaxant effects, they may be considered either beneficial or detrimental. The close proximity of PVAT to the adventitia provides an environment whereby adipose tissue-derived factors may affect the vasa vasorum, a microvascular network providing the vessel wall with oxygen and nutrients. Since medial ischaemia promotes aspects of graft occlusion the involvement of the PVAT/vasa vasorum axis in vein graft patency should be considered.

Vasa previa: a case report

Vasa previa is defined as a condition where fetal vessels traverse the membranes in the lower segment below the presenting part unsupported by placental tissue or umbilical cord. Rupture of the membranes leads to fetal exsanguinations and even neonatal death. The etiology is uncertain, but risk factors include bilobed or succenturiate lobed placenta, velamentous insertion of cord, placenta previa, pregnancies resulting from In vitro fertilization (IVF) and multiple pregnancies. We report here a case of 24 year old woman, G3A2 at 34 weeks of gestation and history of 2 previous spontaneous abortions with vasa previa which was successfully managed. Prenatal sonographic diagnosis has the potential to improve or prevent the poor obstetric and neonatal outcome associated with it.

Rotura de vasa previa en una inserción velamentosa del cordón umbilical / Ruptured vasa previa in a velamentous umbilical cord insertion

RESUMEN La rotura de vasa previa es una afección infrecuente que aparece cuando el cordón umbilical tiene una inserción velamentosa y los vasos fetales desprotegidos, que al carecer de la gelatina de Wharton, discurren a través de las membranas, lo que los hace especialmente vulnerables a la rotura o desgarros. Los factores de riesgo más relevantes son: la gestación gemelar monocorial, las gestaciones conseguidas mediante técnicas de reproducción asistida y las anomalías de inserción placentaria. La rotura de la vasa previa puede llevar a: una hemorragia fetal aguda, un choque hipovolémico, una asfixia fetal y a la muerte perinatal. El estudio ecográfico de la placenta y el empleo del Doppler color tienen gran importancia para lograr el diagnóstico precoz de las pacientes en riesgo, el cual constituye la premisa fundamental para lograr disminuir la morbilidad y mortalidad fetal y neonatal.

ABSTRACT Ruptured vasa previa is an uncommon condition that appears when the umbilical cord has a velamentous insertion and the unprotected fetal vessels, which, in the absence of Wharton's jelly, run through membranes making them especially vulnerable to rupture or tears. The most relevant risk factors are: monochorionic twin pregnancy, pregnancies achieved through assisted reproductive techniques and abnormal placental cord insertion. Ruptured vasa previa can lead to: acute fetal hemorrhage, hypovolemic shock, fetal asphyxia and perinatal death. The ultrasound study of the placenta and the use of color Doppler ultrasound are of great importance to achieve early diagnosis of patients at risk, which is the fundamental premise to achieve lower fetal and neonatal morbidity and mortality.

In vitro fertilization and vasa previa: A report of two cases / Fertilização in vitro e vasa previa: relato de dois casos

Abstract Vasa previa (VP) is a dangerous obstetric condition associated with perinatal mortality and morbidity. In vitro fertilization (IVF) is a risk factor for VP due to the high incidence of abnormal placentation. The diagnosis should be made prenatally, because fetal mortality can be extremely high. We report two cases to demonstrate the accuracy of transvaginal ultrasound in the prenatal diagnosis of VP. A 40-year-old primiparous Caucasian woman with IVF pregnancy was diagnosed with VP at 29 weeks of gestation and was hospitalized for observation at 31 weeks of gestation. She delivered a male newborn weighing 2,380 g, with an Apgar score of 10 at 5 minutes, by elective cesarean section at 34 weeks + 4 days of gestation, without complications. A 36-yearold primiparous Caucasian woman with IVF pregnancy was diagnosed with placenta previa, bilobed placenta increta and VP. The cord insertion was velamentous. She was hospitalized for observation at 26 weeks of gestation. She delivered a female newborn weighing 2,140 g, with an Apgar score of 9 at 5 minutes, by emergency cesarean section at 33 weeks + 4 days of gestation due to vaginal bleeding. The prenatal diagnosis of VP was associated with a favorable outcome in the two cases, supporting previous observations that IVF is a risk factor for VP and that all IVF pregnancies should be screened by transvaginal ultrasound.

Resumo Vasa previa (VP) é uma condição obstétrica perigosa associada a mortalidade e morbidade perinatais. Fertilização in vitro (FIV) é um fator de risco para VP devido à alta incidência de placentação anormal. O diagnóstico deve ser realizado no período pré-natal, pois a possibilidade de mortalidade fetal é extremamente elevada. Relatamos dois casos para demonstrar a acurácia da ultrassonografia transvaginal no diagnóstico pré-natal de VP. Mulher caucasiana, primigesta, de 40 anos, submetida a FIV, foi diagnosticada com VP na 29ª semana de gestação e hospitalizada para observação na 31ª semana de gestação. A paciente foi submetida à cesariana eletiva com 34 semanas e 4 dias, sem complicações, com recém-nascido do sexo masculino, pesando 2.380 g, e com Apgar de 10 no 5° minuto. Mulher caucasiana, primigesta, de 36 anos, subetida a FIV, foi diagnosticada com placenta prévia, placenta bilobada, acretismo placentário e VP. Cordão umbilical com inserção velamentosa. A paciente foi hospitalizada para observação na 26ª semana de gestação. Foi submetida à cesariana de emergência com33 semanas e 4 dias por sangramento vaginal. O recém nascido do sexo feminino pesou 2.140 g, com Apgar de 9 no 5°minuto. O diagnóstico de VP no período pré-natal associou-se a um desfecho favorável nos dois casos, corroborando observações anteriores de que a FIV é um fator de risco para VP e de que todas as gestações por FIV deveriam ser avaliadas por ultrassonografia transvaginal.

Clinical value of prenatal ultrasound in diagnosis of vasa previa / 中国医学影像技术

Objective: To explore the clinical value of prenatal ultrasound in diagnosis of vasa previa. Methods: The images of 65 230 pregnant women who underwent prenatal ultrasound examination were analyzed retrospectively. The accuracy of prenatal ultrasound in diagnosis of vasa previa was calculated. The delivery modes of all pregnant women and outcomes of all perinatal infants with vasa previa diagnosis were followed up. Results: Fifty-three vasa previa cases were diagnosed during the first examination using prenatal ultrasound and 10 cases were eliminated during reexamination in late pregnancy, so 43 cases were diagnosed. Finally 41 cases (41/65 230, 0.06%) were clinically confirmed. The accuracy of middle pregnancy screening (15-28 weeks) and late pregnancy (28-40 weeks) reexamination was 100%(28/28), and the accuracy of late pregnancy was 86.67%(13/15). Cesarean section surgery was performed in all 41 pregnant women, and all fetuses survived. Conclusion: Prenatal ultrasound has a high value of prenatal ultrasound in diagnosis of vasa previa.

Prenatal ultrasound diagnosis and prognosis analysis of vasa previa / 中华超声影像学杂志

Objective To investigate the prenatal ultrasonographic features and prognosis of vasa previa,to explore the application value of sector scanning in the intracervical mouth by antenatal ultrasound,then to increase vasa previa detection rate.Methods Prenatal ultrasound images,clinical characteristics and pregnancy outcome of 35 pregnant women with vasa previa confirmed by surgery and pathology were analyzed retrospectively,the diagnostic effectiveness of sector scanning in the intracervical mouth was evaluated.Results Thirty-three of the 35 vasa previa cases were detected by sector scanning in the intracervical mouth,with a detection rate of 94.3 ％ (33/35).Of the 35 cases,20 cases (60.6 ％) were first contacted in second trimester and 13 cases (39.4％) were first contacted in third trimester.Two cases were missed or misdiagnosed,which were all first contact in third trimester.Among the 35 cases,25 were velamentous placenta and 4 were battledore placenta.Twenty cases were low-lying placenta or marginal placenta previa.All 35 women underwent cesarean section.No neonatal mortality,11 term infants,20 premature infants of more than 34 weeks and 4 premature infants of less than 34 weeks.All placentas underwent pathological examination after delivery,4 cases placentas underwent vascular casting,and it was found that 2 cases were vasa previa of umbilical artery branch and 2 cases were vasa previa of allantoic veins branch.Conclusions Vasa previa can be effectively detected by prenatal ultrasonography through sector scanning in the intracervical mouth.Second trimester is the best period to detect vasa previa.Pathomorphological examination on placenta after delivery and vascular casting are helpful to the understanding of vasa previa.

Prenatal ultrasound diagnosis and prognosis analysis of vasa previa / 中华超声影像学杂志

Objective@#To investigate the prenatal ultrasonographic features and prognosis of vasa previa, to explore the application value of sector scanning in the intracervical mouth by antenatal ultrasound, then to increase vasa previa detection rate.@*Methods@#Prenatal ultrasound images, clinical characteristics and pregnancy outcome of 35 pregnant women with vasa previa confirmed by surgery and pathology were analyzed retrospectively, the diagnostic effectiveness of sector scanning in the intracervical mouth was evaluated.@*Results@#Thirty-three of the 35 vasa previa cases were detected by sector scanning in the intracervical mouth, with a detection rate of 94.3% (33/35). Of the 35 cases, 20 cases (60.6%) were first contacted in second trimester and 13 cases (39.4%) were first contacted in third trimester. Two cases were missed or misdiagnosed, which were all first contact in third trimester. Among the 35 cases, 25 were velamentous placenta and 4 were battledore placenta. Twenty cases were low-lying placenta or marginal placenta previa. All 35 women underwent cesarean section. No neonatal mortality, 11 term infants, 20 premature infants of more than 34 weeks and 4 premature infants of less than 34 weeks. All placentas underwent pathological examination after delivery, 4 cases placentas underwent vascular casting, and it was found that 2 cases were vasa previa of umbilical artery branch and 2 cases were vasa previa of allantoic veins branch.@*Conclusions@#Vasa previa can be effectively detected by prenatal ultrasonography through sector scanning in the intracervical mouth. Second trimester is the best period to detect vasa previa. Pathomorphological examination on placenta after delivery and vascular casting are helpful to the understanding of vasa previa.

Effect of Simiao Yongan Tang on Permeability of Vasa Vasorum of Atherosclerotic Plaque / 中国实验方剂学杂志

Objective:To observe the effect of Simiao Yongan Tang on the pathologic morphology of atherosclerosis (AS) vulnerable plaque and the permeability of vasa vasorum (VV), and to explore its intervention mechanism with VV as the target. Method:Healthy male ApoE-/- mice were randomly divided into model group, Simiao Yongan Tang group(11.7 mg·kg-1·d-1)and simvastatin group(2.6 mg·kg-1·d-1). High-fat diet supplemented with 1.1% L-methionine was given to induce the animal model, while C57BL/6 mice were used as the control group. The model was evaluated after 8 weeks of feeding. After successful modeling, continued drug intervention was given for 8 weeks, and the pathological changes of the mouse aorta were observed by oil red O staining. The expression levels of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) proteins in the outer membrane of aortic root plaques were observed by immunohistochemical staining. Result:The results of oil red O staining showed that as compared with the control group, the plaque area of the aortic wall was significantly increased in the model group (PPPPPPConclusion:Simiao Yongan Tang can reduce the area of mouse aortic plaque, reduce the VV permeability of the outer plaque by regulating the expression of MMP-9 and TIMP-1, and stabilize the vulnerable plaque.

Histological changes secondary to use of anti-angiogenic therapy after interruption of vasa vasorum flow in the descending aorta: results in a porcine model / Alterações histológicas secundárias à interrupção dos vasa vasorum na aorta descendente com o uso de terapia antiangiogênica: resultados em modelo suíno

Background Anti-angiogenic regulators may have therapeutic implications for onset and progression of atherosclerosis. Objectives To demonstrate histological changes secondary to the use of bevacizumab in the aorta of pigs after interruption of flow in the vasa vasorum. Methods Twelve pigs were divided into two groups. The intercostal arteries of the descending aorta were dissected and ligated and wrapped with a polyvinyl chloride membrane. The treatment group received an intravenous dose of bevacizumab. After 15 days, the animals were euthanized and the aorta removed. Histological slides were prepared for control and treatment groups and for non-manipulated areas and analyzed for degree of angiogenesis, injury, inflammation, and intimal thickening. Data were expressed as mean (SD) of scores and groups were compared using the Mann-Whitney test. The Poisson distribution was used to calculate 95% confidence intervals for mean scores, in order to determine effect statistics. Results Bevacizumab had adverse effects on all treated pigs. The analysis using a Scale of Magnitudes for Effect Statistics showed a trend toward a decrease in angiogenesis [0.58 (1.79/-0.63)] and injury [0.55 (1.76/-0.66)] and an increase in inflammation [0.67 (1.89/-0.55)] with threshold moderate effects. There was no difference in intimal thickening [0 (1.19/-1.19)]. Conclusions The medication exhibited a trend toward reduced angiogenesis and injury, but no reduction in the inflammatory process or intimal thickening of the aortic wall. These findings are in disagreement with studies that correlate neovascularization with increased migration of inflammatory cells. Bevacizumab exhibited toxicity in the porcine model

Agentes antiangiogênicos podem ter implicações terapêuticas na progressão e manifestação da aterosclerose. Objetivos Demonstrar a alteração histológica secundária ao uso de bevacizumabe na aorta descendente de suínos submetida à interrupção dos vasa vasorum. Métodos Em doze suínos, divididos em dois grupos, foi realizada dissecção da aorta torácica, além de ligadura das artérias intercostais e proteção com polivinil. O grupo tratamento recebeu dose endovenosa de bevacizumabe. Após 15 dias, os animais foram sacrificados para retirada da artéria e preparo das lâminas histológicas dos grupos tratamento, controle e áreas não manipuladas para análise quanto aos graus de angiogênese, injúria, inflamação e espessamento intimal. A análise estatística foi conduzida através da média e do desvio padrão dos escores. As comparações entre os grupos foram realizadas pelo teste de Mann-Whitney. A distribuição de Poisson calculou os intervalos de confiança de 95% para as médias, a fim de determinar o efeito estatístico. Resultados O bevacizumabe causou efeitos adversos em todos os suínos tratados. As variáveis analisadas através da Escala de Magnitude para Efeito Estatístico demonstraram tendência de redução da angiogênese [0,58 (1,79/-0,63)] e da injúria [0,55 (1,76/-0,66)] e aumento da inflamação [0,67 (1,89/-0,55)] no limite do moderado. Não ocorreu diferença no espessamento intimal [0 (1,19/-1,19)]. Conclusões A medicação utilizada mostrou tendência de redução da angiogênese e da injúria, mas não reduziu o processo inflamatório ou o espessamento intimal da parede arterial. Esses achados contrariam estudos que correlacionam a neovascularização com o aumento da migração de células inflamatórias. O bevacizumabe mostrou toxicidade no modelo suíno

Placenta succenturiata. Reporte de un caso / Succenturiate placenta. Case report

Resumen La placenta succenturiata es una anomalía morfológica de la placenta donde se presentan uno o más lóbulos accesorios por fuera del cuerpo placentario, pueden ser de diferentes tamaños y estar conectados mediante vasos sanguíneos a la placenta principal. El lóbulo accesorio se desarrolla a partir de las vellosidades coriónicas no asociadas al corion leve. La incidencia estimada a nivel mundial es de 1.04% y los principales factores de riesgo asociado a esta entidad son edad materna avanzada y el antecedente de haberse sometido a fertilización in vitro. Presentamos el caso de una paciente de 18 años con diagnóstico de placenta succenturiata con inserción marginal y velamentosa del cordón umbilical, la cual tuvo la finalización de la gestación por parto eutócico en el que se obtuvo recién un nacido eutrófico y sano, con tercer período de trabajo de parto prolongado y retención placentaria, por lo que se realizó alumbramiento manual, y se obtuvo la placenta completa con la presencia de un lóbulo accesorio con conexiones vasculares con el cuerpo placentario. En conclusión, la placenta succenturiata es una anormalidad morfológica relativamente rara, de diagnóstico clínico y morfológico en el puerperio inmediato, sin embargo, debe buscarse de manera intencionada mediante ultrasonido Doppler color en el período prenatal debido a que esta variedad de placenta conlleva a riesgos que pueden comprometer la salud y la vida tanto del feto como de la madre.

Abstract Placenta succenturiate is a morphological anomaly of the placenta where one or more of the lobes are present at a distance, which can be of different sizes and are connected by blood vessels to the main placenta. The accessory lobe develops from the chorionic villi that did not involute from the mild chorion. The estimated incidence worldwide is 1.04%. This entity has been associated with two main risk factors, advanced maternal age and women who have undergone in vitro fertilization. We report the case of a finding of placenta succenturiate in the postpartum period, in an 18-year-old woman in her first pregnancy, with vaginal delivery, eutrophic and apparently healthy newborn was obtained. During the third period of labor the patient presented placental retention, for which manual delivery was performed, obtaining a complete placenta that upon inspection was observed the presence of an accessory lobe in the membranes, which had vascular connections with the main placenta. In conclusion, placenta succenturiata is a relatively rare morphological abnormality, diagnosed in the postpartum period, but it can be diagnosed intentionally by color Doppler ultrasound in the prenatal period. This variety of placenta carries many risks that can compromise the health and life of both the fetus and the mother.