Characterization of Carotid Smooth Muscle Cells during Phenotypic Transition.

Vascular smooth muscle cells (VSMCs) are central players in carotid atherosclerosis plaque development. Although the precise mechanisms involved in plaque destabilization are not completely understood, it is known that VSMC proliferation and migration participate in plaque stabilization. In this study, we analyzed expression patterns of genes involved in carotid atherosclerosis development (e.g., transcription factors of regulation of SMC genes) of VSMCs located inside or outside the plaque lesion that may give clues about changes in phenotypic plasticity during atherosclerosis. VSMCs were isolated from 39 carotid plaques extracted from symptomatic and asymptomatic patients by endarterectomy. Specific biomarker expression, related with VSMC phenotype, was analyzed by qPCR, western immunoblot, and confocal microscopy. MYH11, CNN1, SRF, MKL2, and CALD1 were significantly underexpressed in VSMCs from plaques compared with VSMCs from a macroscopically intact (MIT) region, while SPP1, KLF4, MAPLC3B, CD68, and LGALS3 were found significantly upregulated in plaque VSMCs versus MIT VSMCs. The gene expression pattern of arterial VSMCs from a healthy donor treated with 7-ketocholesterol showed high similarity with the expression pattern of carotid plaque VSMCs. Our results indicate that VSMCs isolated from plaque show a typical SMC dedifferentiated phenotype with macrophage-like features compared with VSMCs isolated from a MIT region of the carotid artery. Additionally, MYH11, KLF5, and SPP1 expression patterns were found to be associated with symptomatology of human carotid atherosclerosis.

RNAseq based transcriptomics study of SMCs from carotid atherosclerotic plaque: BMP2 and IDs proteins are crucial regulators of plaque stability.

Carotid artery atherosclerosis is a risk factor to develop cerebrovascular disease. Atheroma plaque can become instable and provoke a cerebrovascular event or else remain stable as asymptomatic type. The exact mechanism involved in plaque destabilization is not known but includes among other events smooth muscle cell (SMC) differentiation. The goal of this study was to perform thorough analysis of gene expression differences in SMCs isolated from carotid symptomatic versus asymptomatic plaques. Comparative transcriptomics analysis of SMCs based on RNAseq technology identified 67 significant differentially expressed genes and 143 significant differentially expressed isoforms in symptomatic SMCs compared with asymptomatic. 37 of top-scoring genes were further validated by digital PCR. Enrichment and network analysis shows that the gene expression pattern of SMCs from stable asymptomatic plaques is suggestive for an osteogenic phenotype, while that of SMCs from unstable symptomatic plaque correlates with a senescence-like phenotype. Osteogenic-like phenotype SMCs may positively affect carotid atheroma plaque through participation in plaque stabilization via bone formation processes. On the other hand, plaques containing senescence-like phenotype SMCs may be more prone to rupture. Our results substantiate an important role of SMCs in carotid atheroma plaque disruption.

Development of a Telemetric System for Postoperative Follow-up of Vascular Surgery Procedures: In Vitro Model.

BACKGROUND: Because of the unique electromagnetic characteristics of the magnetoelastic microwire, the changes in the pressure of a fluid will provoke a variation of the mechanical pressure on the sensor, which will cause a variation of its magnetization that will be detectable wirelessly. Thus, a wireless system can be developed for following up vascular surgery procedures. METHODS AND RESULTS: The sensor consists of a magnetoelastic microwire ring, which was integrated into an in vitro model with pulsatile flow. Different degrees of stenosis were simulated in different locations both in bovine artery as well as in a polytetrafluoroethylene anastomosis. A Fourier analysis of the registered signals and a statistical analysis using Pearson test and receiver operating characteristic (ROC) curves were made. A Pearson index of 0.945 (P<0.001) was obtained between the invasive pressure of the fluid and the power of the signal transmitted by the sensor in bovine artery. The sensor obtained very good ROC curves upon analyzing the signals registered, both in the case of preanastomotic stenosis (area under the curve [AUC], 0.98; 95% CI, 0.97-1.00), of anastomosis (AUC, 0.93; 95% CI, 0.86-0.99), as well as distal (AUC, 0.88; 95% CI, 0.79-0.98), compared to the control group. CONCLUSIONS: The magnetoelastic microwire has shown that it is capable of detecting, locating, and quantifying the degree of stenosis in bovine artery, as well as in a latero-terminal anastomosis, with a high statistical potency. For the first time, a wireless in vitro sensor has been developed for the postoperative follow-up of vascular surgery procedures.

Hipernefroma con trombosis tumoral de vena cava inferior / Hypernephroma with tumor thrombus of the inferior vena cava

No disponible

Aneurisma de aorta abdominal infrarrenal en asociación con riñón en herradura: aportación de un caso / New case of an infrarenal abdominal aortic aneurysm associated with horseshoe kidney

Se analiza la relación entre enfermedad aórtica quirúrgica y riñón en herradura, y se comentan los problemas diagnósticos y las diferentes posibilidades terapéuticas. Paciente de 81 años con riñones en herradura que, durante el seguimiento de su enfermedad prostática, se descubre de forma casual por ecografía un aneurisma de aorta abdominal. Se realizó mediante abordaje retroperitoneal una resección del aneurisma y bypass aorto aórtico, sin complicaciones. A los 2 años del diagnóstico, el paciente continúa asintomático en cuanto a la alteración vascular. La coexistencia de riñón en herradura y afección aórtica que precise corrección quirúrgica ocurre con poca frecuencia, pero incrementa de forma significativa la complejidad técnica de la reconstrucción aórtica. Se realiza una revisión de la literatura (AU)

We review the association between surgically resolvable aortic disease and horseshoe kidney with a discussion of diagnostic problems and therapeutic options. Male patient 81 years of age with horseshoe kidney and an abdominal aortic aneurysm that was discovered by chance in an abdominal ultrasound during a check-up for his prostate condition. A retroperitoneal approach was used in order to resect the aneurysm and perform an aorto-aortic bypass with no complications occurring. Two years after the diagnosis, the patient is still asymptomatic from a vascular point of view. The co-presence of horseshoe kidney and aortic disease needing surgical correction is infrequent, but it significantly increases the technical complexity of aortic reconstruction. A literature review is included (AU)

[Inflammatory aortic aneurysm and its relationship to urological disease: a case report and a literature review]. / Aneurismas de aorta inflamatorios y su relación con la patología urológica: caso clínico y revisión de la literatura científica.

OBJECTIVE: To report a successfully treated case of inflammatory aortic aneurysm. MATERIALS AND METHODS: A 57-year-old patient reported low back pain and urinary infections. An abdominal CT scan revealed a large inflammatory aneurysm in the abdominal aorta. An aortic bypass was performed with no complications. RESULTS: Patient course since surgery has been uneventful, and currently has no symptoms. CONCLUSIONS: Contribution of the radiographic team, mainly with the CT scan, is of great value both for differential diagnosis and adequate management and follow-up. Surgery is indicated to prevent aneurysm rupture, but an increased postoperative morbidity and mortality should be assumed.

Aneurismas de aorta inflamatorios y su relación con la patología urológica: caso clínico y revisión de la literatura científica / Inflammatory aortic aneurysm and its relationship to urological disease: a case report and a literature review

Objetivo: Presentamos un caso de aneurisma aórtico inflamatorio resuelto con éxito. Material y métodos: Paciente de 57 años que consulta por dolor lumbar e infecciones urinarias. Se realiza una angio-TC y se descubre un aneurisma de aorta abdominal inflamatorio de gran tamaño. Se interviene quirúrgicamente, realizando un bypass aorto aórtico, sin complicaciones intraoperatorias. Resultados: El paciente evoluciona favorablemente desde la cirugía; en la actualidad, se encuentra asintomático. Conclusiones: La participación del equipo de radiología, fundamentalmente con el angio-TC, es de gran valor, tanto para el establecimiento de un diagnóstico diferencial, como para un tratamiento y seguimiento correctos. La cirugía está indicada para prevenir la rotura de estos aneurismas, asumiendo un incremento en la morbimortalidad postoperatoria (AU)

Objective: To report a successfully treated case of inflammatory aortic aneurysm. Materials and methods: A 57-year-old patient reported low back pain and urinary infections. An abdominal CT scan revealed a large inflammatory aneurysm in the abdominal aorta. An aortic bypass was performed with no complications. Results: Patient course since surgery has been uneventful, and currently has no symptoms. Conclusions: Contribution of the radiographic team, mainly with the CT scan, is of great value both for differential diagnosis and adequate management and follow-up. Surgery is indicated to prevent aneurysm rupture, but an increased postoperative morbidity and mortality should be assumed (AU)

New case of an infrarenal abdominal aortic aneurysm associated with horseshoe kidney.

We review the association between surgically resolvable aortic disease and horseshoe kidney with a discussion of diagnostic problems and therapeutic options. Male patient 81 years of age with horseshoe kidney and an abdominal aortic aneurysm that was discovered by chance in an abdominal ultrasound during a check-up for his prostate condition. A retroperitoneal approach was used in order to resect the aneurysm and perform an aorto-aortic bypass with no complications occurring. Two years after the diagnosis, the patient is still asymptomatic from a vascular point of view. The co-presence of horseshoe kidney and aortic disease needing surgical correction is infrequent, but it significantly increases the technical complexity of aortic reconstruction. A literature review is included.

¿Es útil el empleo del autotransfusor en la cirugía aortoilíaca por enfermedad oclusiva? / Use of autotransfusion device in aortoiliac reconstruction because occlusive disease. Is it worthwile?

Objetivo: El objetivo del presente estudio es determinar si el empleo de dispositivos de autotransfusión es útil en las reconstrucciones del sector aortoilíaeo por patología oclusiva. Material y métodos: Se analizó de forma retrospectiva el empleo del autotransfusor en 227 procedimientos electivos primarios realizados sobre la aorta por patología oclusiva del sector aortoilíaeo. Se valoraron los factores de riesgo, valores hematológicos preoperatorios, volumen reinfundido por el autotransfusor y administración de sangre homóloga. Se realizó, además, una valoración del coste económico derivado del uso de AT.Resultados: De los 227 procedimientos, 201 fueron bypasses aortobifemorales y 26 aortofemorales. El uso del autotransfusor se asoció a una disminución en la cantidad de unidades de sangre homóloga administrada en los pacientes intervenidos de bypass aortobifemoral (1,7 frente a 3 unidades, p<0,01). Sin embargo, esto no ocurrió en las revascularizaciones unilaterales (1 frente a 1,2 unidades -N.S.). Asimismo, el mímero de pacientes en los que la cirugía se realizó sin necesidad de transfusión homóloga durante todo el ingreso fue mayor cuando se empleó el autotransfusor, (41 por ciento frente a 24 por ciento, p<0,05). Esta diferencia fue significativa en los pacientes intervenidos de un bypass aortobifemoral (41 por cientofrente a 17 por ciento, p<0,05) pero no para la cirugía aortofemoral (40 por ciento frente a 47 por ciento, p NS).El coste del dispositivo de autotransfusión se justificó con recuperaciones superiores a 440 ml de sangre. Siguiendo este criterio, el autotransfusor resultó rentable desde un punto de vista de costes en el 36 por ciento de los pacientes (37 por ciento en los aortobifemorales y 20 por ciento en los aortofemorales). El uso de autotransfusor supone en nuestro medio un coste aproximado adicional de unas 3.000 ptas. por paciente en el caso de un bypass aortobifemoral y de 19.000 ptas. en un bypass aortofemoral. Conclusiones El empleo rutinario del autotransfusor está justificado en el bypass aortobifemoral por patología oclusiva. Reduce cl consumo de sangre, con un discreto aumento de costes. En la cirugía unilateral, cl empleo rutinario del autotransfusor no está justificado, no reduce el consumo de sangre de banco y no es coste-efectivo. (AU)