Thoracic Artery Research Articles

The Interaction of Dietary Pectin, Inulin, and Psyllium with Copper Nanoparticle Induced Changes to the Cardiovascular System.

We aimed to analyze how supplementation with a standard (recommended, 6.5 mg/kg) or enhanced (two-times higher, 13 mg/kg) dose of copper (Cu), in the form of nanoparticles (NPs) along with dietary intervention via the implementation of diverse types of fiber, affects the cardiovascular system in rats. Nine-week-old male Wistar Han rats (n/group = 10) received, for an additional 6 weeks, a controlled diet with cellulose as dietary fiber and ionic Cu (in the form of carbonate salt). The experimental groups received cellulose, pectin, inulin, and psyllium as dietary fiber, together with CuNPs (6.5 or 13 mg/kg diet). After the experimental feeding, samples of blood, hearts, and thoracic arteries were collected for further analysis. Compared to pectin, and under a standard dose of CuNPs, inulin and psyllium beneficially increased the antioxidant capacity of lipid- and water-soluble compounds in the blood, and decreased heart malondialdehyde. Moreover, pectin decreased heart catalase (CAT) and cyclooxygenase (COX)-2 in the aortic rings compared to inulin and psyllium under standard and enhanced doses of copper. When the dose of CuNPs was enhanced, inulin and psyllium potentiated vasodilation to acetylcholine by up-regulation of COX-2-derived vasodilator prostanoids compared to both cellulose and pectin, and this was modulated with selective inducible nitric oxide synthase (iNOS) inhibitor for psyllium only. Moreover, inulin decreased heart CAT compared to psyllium. Our results suggest that supplementation with dietary fiber may protect the vascular system against potentially harmful metal NPs by modulating the antioxidant mechanisms.

Prevalence and distribution of vascular calcifications at CT scan in patients with and without large vessel vasculitis: a matched cross-sectional study

ObjectivesThe aim of this study was to compare the prevalence, entity and local distribution of arterial wall calcifications evaluated on CT scans in patients with large vessel vasculitis (LVV) and...

Abstract 13989: Glutaredoxin-1: A Redox Regulator of Metalloproteases in Vascular Endothelial Cells

Background: Endothelial dysfunction is a common mediator of aneurysmal remodeling regardless of etiology and the vascular bed that occur (e.g., genetic mutations, hypertension, aging, smoking, abdominal or thoracic artery or aortic root), but the underlying mechanisms remain unknown. This work aims to test the hypothesis that perturbing thiol redox signaling in endothelial cells triggers aberrant activation of matrix metalloproteinase-2 and -9, thereby precipitating aneurysmal remodeling. Methods and Results: In human aortic aneurysm (AA) samples from individuals with Marfan syndrome, levels of MMP-2/-9 were increased drastically that coincided with elevated oxidative stress markers: tyrosine nitrated proteins and lipid peroxidation product 4-hydroxynonenal . In mouse model of AA: fibrillin-1 mutant( Fbn1 mgR/mgR ) mice, reversible oxidation of cysteine residues—S-glutathionylation (PrS-SG) that mediate thiol redox signaling by modulating target proteins’ functions—were markedly elevated as an early redox event. Endothelial specific deletion of glutaredoxin-1(Grx1), a specific de-glutathionylation enzyme was found to massively increase gelatinase activity of MMP-2/-9 in whole aortas, and worsen vessel wall integrity. Using primary human aortic ECs, we showed that Grx1 can directly prevent pro-MMP-2/-9 from glutathionylation of their cysteine switch and consequent activation. Furthermore, the medium collected from HAECs that lack functional Grx1 stimulated MMP-2 activity in smooth muscle cells, thus setting up an amplifying mechanism of MMP activation. Conclusions: this study is the first to provide experiment evidence for a pathogenic role of dysregulated thiol redox signaling in vascular endothelial cells in aneurysmal remodeling.

Relationship of fibroblast growth factor 21 with the prevalence and progression of vascular and valvular calcification: Multi-ethnic study of atherosclerosis

BackgroundElevated circulating levels of fibroblast growth factor 21 (FGF21) are associated with cardiovascular disease (CVD). Therefore, we investigated the relationship of plasma FGF21 with calcification at different vascular and valvular sites. MethodsA total of 5786 participants, free of clinically apparent CVD at baseline and with valid data on plasma FGF21 and calcification (Agatston score, volume and density) at coronary arteries, thoracic arteries, mitral and aortic valves, and aortic valve ring, were included in the analysis. Vascular calcification was measured at 2–3 follow-up visits. ResultsAt baseline, higher FGF21 levels were associated with prevalent descending thoracic aortic calcification (DTAC) (prevalence ratio = 1.06 [95% CI 1.01–1.11] per SD increase in log-transformed unit, P = 0.016). Among participants without prevalent calcification, higher FGF21 levels were associated with incident DTAC (relative risk [RR] = 1.13 [95% CI 1.04–1.22], P = 0.002). Among all participants, higher FGF21 levels were also associated with the progression of DTAC score and volume (RR = 1.07 [95% CI 1.03–1.12] and 1.08 [95% CI 1.03–1.12] respectively, both P < 0.01). No significant association of FGF21 was found for prevalence (prevalence ratio = 0.89–1.05), incidence (RR = 0.97–1.16) and progression of calcification (RR = 0.94–1.14) at the other sites. ConclusionHigher FGF21 levels were associated with the presence, incidence and progression of DTAC. However, the magnitude of this association was similar to those of the non-significant associations of FGF21 levels with calcifications at other sites. Further research is needed to assess the potential of FGF21 as a biomarker for vascular calcification.

Associations of pulmonary and extrapulmonary computed tomographic manifestations with impaired physical activity in symptomatic patients with chronic obstructive pulmonary disease

In patients with chronic obstructive pulmonary disease (COPD), emphysema, airway disease, and extrapulmonary comorbidities may cause various symptoms and impair physical activity. To investigate the relative associations of pulmonary and extrapulmonary manifestations with physical activity in symptomatic patients, this study enrolled 193 patients with COPD who underwent chest inspiratory/expiratory CT and completed COPD assessment test (CAT) and the Life-Space Assessment (LSA) questionnaires to evaluate symptom and physical activity. In symptomatic patients (CAT ≥ 10, n = 100), emphysema on inspiratory CT and air-trapping on expiratory CT were more severe and height-adjusted cross-sectional areas of pectoralis muscles (PM index) and adjacent subcutaneous adipose tissue (SAT index) on inspiratory CT were smaller in those with impaired physical activity (LSA < 60) than those without. In contrast, these findings were not observed in less symptomatic patients (CAT < 10). In multivariable analyses of the symptomatic patients, severe air-trapping and lower PM index and SAT index, but not CT-measured thoracic vertebrae bone density and coronary artery calcification, were associated with impaired physical activity. These suggest that increased air-trapping and decreased skeletal muscle and subcutaneous adipose tissue quantity are independently associated with impaired physical activity in symptomatic patients with COPD.

Abstract 03: Ablation Of Endothelial Dysfunction Improves Blood Pressure And Fetal Growth Restriction In A Mouse Model Of Preeclampsia-like Hyperleptinemia

Placental ischemia, an initiating event of preeclampsia (PE), increases plasma leptin levels. We recently developed a model of midgestation (gestation day (GD)11-18) leptin infusion mimicking the midgestation rise in leptin levels of PE patients. Our previous work demonstrates that deletion of endothelial mineralocorticoid receptors (ECMR) improves markers of vascular dysfunction in leptin-infused female mice. We hypothesized vascular function improvement with ECMR deletion ablates hypertension and fetal growth restriction in pregnant leptin-infused mice. Pregnant ECMR +/+ (WT) and ECMR -/- (KO) mice were infused with vehicle or leptin by osmotic pump (lep, 0.9mg/kg/day, s.c.) on GD11-18 while implanted with radiotelemeters for conscious blood pressure (BP) measurement and wire myography of thoracic aorta and 2 nd order mesenteric arteries at GD18 (*=P&lt;0.05). Leptin infusion did not decrease maternal weight in any groups. Leptin decreased pup weight (0.86±0.04g WT vs 0.52±0.11 WT+lep*) and placental efficiency (pup/placenta ratio) (9.7±0.7 WT vs 7.9±0.6 WT+lep*) in WT pregnant mice. ECMR deletion prevented leptin-mediated decreases in pup weight (0.91±0.06g KO vs 1.0±0.07 KO+lep) and placental efficiency (9.6±0.5 KO vs 9.4±1.2 KO+lep). Mean arterial pressure (BP) increased in leptin-infused WT (102±3mmHg WT vs 120±12 WT+lep*), but not KO (107±2 KO vs 106±8 KO+lep), mice from GD11-18. Leptin infusion reduced acetylcholine-mediated relaxation in both aorta and mesenteric arteries of WT* and constriction to KCl in mesenteric arteries in WT*, but not KO, pregnant mice (2-way ANOVA, repeated measures). Leptin increased plasma endothelin-1 (ET-1, 1.1±0.3 pg/ml WT vs 4.4±1.8 WT+lep*), placental mRNA expression of prepro-ET-1 (1.9±0.3-fold change from WT*) and ET-1 converting enzyme-1 (1.6±0.3-fold change from WT*) in pregnant WT mice. Leptin infusion also increased adrenal aldosterone-synthase protein (1.4±0.4 WT ratio/β actin vs 3.2±0.3 WT+lep*) and angiotensin II type 1 receptor b (3.5±0.8-fold change from WT*) mRNA in pregnant mice. Collectively, these data indicate that leptin infusion induces hypertension and fetal growth restriction in pregnant mice due to vascular dysfunction and increased ECMR activation in pregnant mice.

Lysophosphatidylcholine in phospholipase A2-modified LDL triggers secretion of angiopoietin 2

Background and aimsSecretory phospholipase A2 (PLA2) hydrolyzes LDL phospholipids generating modified LDL particles (PLA2-LDL) with increased atherogenic properties. Exocytosis of Weibel–Palade bodies (WPB) releases angiopoietin 2 (Ang2) and externalizes P-selectin, which both play important roles in vascular inflammation.Here, we investigated the effects of PLA2-LDL on exocytosis of WPBs. MethodsHuman coronary artery endothelial cells (HCAECs) were stimulated with PLA2- LDL, and its uptake and effect on Ang2 release, leukocyte adhesion, and intracellular calcium levels were measured. The effects of PLA2-LDL on Ang2 release and WPB exocytosis were measured in and ex vivo in mice. ResultsExposure of HCAECs to PLA2-LDL triggered Ang2 secretion and promoted leukocyte-HCAEC interaction. Lysophosphatidylcholine was identified as a critical component of PLA2-LDL regulating the WPB exocytosis, which was mediated by cell-surface proteoglycans, phospholipase C, intracellular calcium, and cytoskeletal remodeling. PLA2-LDL also induced murine endothelial WPB exocytosis in blood vessels in and ex vivo, as evidenced by secretion of Ang2 in vivo, P-selectin translocation to plasma membrane in intact endothelial cells in thoracic artery and tracheal vessels, and reduced Ang2 staining in tracheal endothelial cells. Finally, in contrast to normal human coronary arteries, in which Ang2 was present only in the endothelial layer, at sites of advanced atherosclerotic lesions, Ang2 was detected also in the intima, media, and adventitia. ConclusionsOur studies reveal PLA2-LDL as a potent agonist of endothelial WPB exocytosis, resulting in increased secretion of Ang2 and translocation of P-selectin. The results provide mechanistic insight into PLA2-LDL-dependent promotion of vascular inflammation and atherosclerosis.

Novel hybrid treatment for extensive aortic arch aneurysms, a case report

BackgroundThe treatment for extensive aortic arch aneurysms involving the aortic arch and descending aorta is challenging for most cardiovascular surgeons. The surgical treatment is associated with a very high mortality rate. The optimal treatment has not been defined.Case presentationA 49-year-old male was hospitalized due to chest and upper back pain. Computed tomography angiography (CTA) demonstrated there was an extensive aortic arch aneurysm extending to the left common carotid artery and descending aorta. A novel single- stage hybrid surgery was performed on the patient through two steps: treatment of the aortic arch through median sternotomy and thoracic endovascular artery repair. The patient recovered uneventfully.ConclusionsOur single-stage hybrid repair approach is safe, simple and effective. It provides an alternative treatment for extensive aortic arch aneurysms.

MiR-155 acts as an inhibitory factor in atherosclerosis-associated arterial pathogenesis by down-regulating NoxA1 related signaling pathway in ApoE-/- mouse.

To investigate the protective efficacy of miR-155 on down regulating NADPH oxidase isoform subunit A1 (NoxA1) gene expression, resulting in inhibition of VSMC migration and over proliferation and thus ameliorating the progression of arterial atherosclerosis in AS mouse model. Therefore, to further explore the regulatory effect of miR-155 on neointima formation in AS and locate potential anti-atherosclerosis target. The mouse vascular aorta smooth muscle cell (MOVAS) was cultured and transfected with recombinant Pad2YFG adenovirus fluorescent vector with miR-155 fragment into 4 groups. Western blotting and RT-PCR were performed to identify the expression of NoxA1 under different circumstances. Fluorescence microscope was applied to observe the transfection rate of miR-155 into adenovirus. Twelve-week fatty food induced atherosclerotic ApoE-/- mouse model was established as host to accept miR-155 transfected adenovirus transplantation to observe its effect on VSMC in AS progression. Carotid and thoracic artery were extracted at 1 month after dosing. Distribution of miR-155 was quantified via expression levels of protein and RNA to detect NoxA1, Nox1, p47phox and NADPH expression. Immunohistochemistry, fluorescence imaging and other methods were performed in arteries section to compare the thickness of neointima and assess the severity of AS in each group. Luciferase reporter gene assay showed significant expression of miR-155 in mimic group indicating that miR-155 had target binding effect with NoxA1 gene. Western blotting and RT-PCR results both showed significantly decreased NoxA1 expression in miR-155 mimic group while increased with its inhibitor. The miR-155 distribution was observed varied at 1 month after in control, miR-155 mimic and inhibitor groups. The NoxA1, NADPH, Nox1 and pp47phox protein expression in VSMC was decreased in mimic group vs control and inhibitor groups (P<0.05); no significant difference of NADPH expression was observed in all groups. The NoxA1, Nox1 and p47phox gene expression in VSMC were both found reduced compared with those of control group at week 4 (P<0.05). Immunohistochemistry staining of artery frozen sections figured out that the thickness of neointima of carotid artery in miR-155 mimic group was significantly lower vs control and inhibitor groups (P<0.01) at week 4. miR-155 played an important role in NoxA1-related signaling pathway. miR-155 transfection into VSMC may have anti-inflammatory regulatory effect on NoxA1 expression in vivo and resulting in amelioration of atherosclerotic lesion in AS mouse model. In summary, miR-155 specifically plays in a negative feedback loop and demonstrates a protective role during atherosclerosis-associated VSMC proliferation and neointima formation through the miR-155-NoxA1-p47phox complex signaling pathway.

Ascending aorta: descending thoracic aorta ratio as an additional metric to early individually oriented diagnoses of abnormalities. A non-contrast enhanced cardiac CT study

Abstract Background Coronary artery calcium (CAC) detection is the established indication for a non-contrast enhanced cardiac computed tomography (NCE-CCT). Other information, beyond CAC, can be derived from the NCE-CCT. Amongst them, data regarding thoracic aorta and its abnormalities might be of interest. Aims We aimed at examination whether mutual proportion of ascending aorta and descending thoracic aorta diameters (AAD:DAD ratio) could be diagnostically relevant. Methods This retrospective study included 4372 patients out of 5905 subjects undergoing NC-CCT during the last decade, in whom the thoracic aorta and pulmonary artery trunk were within common limits (AAD≤40mm, DAD&amp;lt;30mm, PAD&amp;lt;30mm). 213 persons without CVD risk factors and CAC=0 were qualified into control group (1), and 4159 patients with CVD risk factor(s) ≥1 into examined group (2) of. The range of AAD/PAD ratio normality was referenced from the group 1. In addition body mass index and CAC score were accounted for. Results The AAD/PAD ratio in control group was 1.35±0.22 with the normal range between 1.12 and 1.57. The 90th percentile values for AAD have been established. In patients with CAC=0, amongst those with normal BMI the increased AAD:DAD ratio (&amp;gt;1.57), indicating high AAD, was found in 18 /43 cases with AAD&amp;gt;90 percentile (41.2%) and in 21/498 with normal AAD (4.2%). The respective proportions in overweight patients were 23/86 (26.7%) and 12/694 (1.7%), and in obese patients 13/67 (19.4%) and 5/397 (1.3%). In patients with CAC&amp;gt;0, and normal BMI the increased AAD:DAD ratio was found in 10/38 cases with AAD&amp;gt;90% (26.3%) and in 14/458 with normal ascending aorta size (3.1%). Proportions in overweight patients were 23/92 (25.0%) and 15/859 (1.75%), while in obese patients were 17/107 (15.9%) and 13/579 (2.2%), resp. Normal AAD:PAD ratio in patients with established AAD increase (&amp;gt;90 percentile), irrespective of BMI, might suggest accompanying increase in PAD. Lower AAD:PAD ratio indicated a relative increase of the DAD. Mean values of AAD and DAD in relation to BMI and CAC categories along with their ratio are presented in table 1. Conclusions Evaluation of thoracic aorta in NC-CCT enhanced diagnostic scope of NCE-CCT. The AAD/DAD ratio, being independent of age, gender and body constitution, does not require adjustment, should be considered as additional metric for early diagnoses of thoracic aorta abnormalities well before absolute values reach the arbitrary cut-off levels. Table 1 Funding Acknowledgement Type of funding source: None

Unusual internal injuries induced by fatal low-voltage electrocution: About two cases report

Summary Electrical injuries consist mainly in external burn marks. Internal injuries are rarely observed especially in low-voltage electrocution. In this context, we report two fatal cases due to electrocution by low voltage current (220 volts), with a special emphasis on pathological internal changes. Case no. 1 A 30-year-old male construction worker died after a low-voltage electrocution in the workplace. A medico-legal autopsy was required by judicial authorities. An external examination of the body showed marked facial cyanosis and electrical burn marks on the chest. The autopsy findings showed necrotic lesions of the heart, the thoracic aorta and pulmonary artery. The ischemic lesions were confirmed by histological tests. Case 2 A 20-year-old male was admitted to the Intensive Care Unit for pneumothorax after an accidental low-voltage electrocution. Despite cardiopulmonary reanimation, he died two hours later. An external examination of the corpse showed an electrical burn mark on the right hand. The autopsy findings revealed mainly a right pneumothorax as well as some necrotic lesions in the inferior lobe of the right lung and the anterior face of the liver, which were confirmed microscopically. Discussion-conclusion Death during electrocution by a low-voltage current is uncommon. Visceral necrosis is rarely described in this situation.

Blood supply of the esophagus in the early period of human ontogenesis

The article presents the results of the primary enlage of the esophagus in embryos 6.0-7.5 mm PCL, the formation of blood vessels in the cervical, thoracic and abdominal parts of esophagus. Purpose of the study. Find out the period of laying and forming the blood vessels of the esophagus in the early period of human ontogenesis. Material and methods. The research is based on the study of 18 embryos, 20 prefetuses and 12 fetuses by the methods of micro-micropreparation, making of topographic anatomical sections in three extraperpendicular planes, morphometry. Results. The organs and structures of the chest cavity were reconstructed, the blood supply to the cervical, thoracic, and abdominal esophagus was studied in the early period of ontogenesis. Conclusion. Blood supply of the esophagus is carried out by the arterial branches of the thyroidcervical, costal-cervical trunks, vertebral arteries and the thoracic artery, the arterial branches of the descending thoracic aorta and the left gastric artery, the left inferior diaphragm artery.

Congenital arteriovenous fistula between descending aorta and the left innominate vein

Thoracic aortocaval fistulae are rare entities where a direct shunt between thoracic arteries and systemic veins is seen. They can be traumatic or congenital in origin. Congenital thoracic aortocaval fistulae usually involve descending aorta and azygos, hemiazygos systems. Presenting symptoms range from continuous murmur to signs of congestive heart failure. In this case report, imaging findings of a 3-year-old girl referred for continuous murmur over the left sternal border are presented. Computed tomography angiography revealed multiple tortuous vessels along the descending aorta with a course toward the left brachiocephalic vein, and was suspicious for an aorta-venous fistula. Subsequent digital subtraction angiography for treatment planning showed a fistula originating at the level of the left 6th intercostal artery, with direct drainage into the left brachiocephalic vein without involvement of the azygos/hemiazygos system.

Type D personality is a predictor of prolonged acute brain dysfunction (delirium/coma) after cardiovascular surgery

BackgroundPrevious studies have shown a relationship between delirium and depressive symptoms after cardiac surgery with distress personalities linking to negative surgical outcomes. The aim of the present study is to further investigate the association between patients with Type D (distressed) personality with regards to delirium after cardiac surgery.MethodsWe conducted a consecutive-sample observational cohort pilot study with an estimated 142 patients needed. Enrollment criteria included patients aged ≥18 years who were undergoing planned cardiovascular, thoracic and abdominal artery surgery between October 2015 to August 2016 at the University of Tsukuba Hospital, Japan. All patients were screened by Type-D Personality Scale-14 (DS14) as well as the Hospital Anxiety and Depression Scale (HADS) the day before surgery. Following surgery, daily data was collected during recovery and included severity of organ dysfunction, sedative/analgesic exposure and other relevant information. We then evaluated the association between Type D personality and delirium/coma days (DCDs) during the 7-day study period. We applied regression and mediation modeling for this study.ResultsA total of 142 patients were enrolled in the present study and the total prevalence of delirium was found to be 34% and 26% of the patients were Type D. Non-Type D personality patients experienced an average of 1.3 DCDs during the week after surgery while Type D patients experienced 2.1 days over the week after surgery. Multivariate analysis showed that Type D personality was significantly associated with increased DCDs (OR:2.8, 95%CI:1.3–6.1) after adjustment for depressive symptoms and clinical variables. Additionally, there was a significant Type D x depression interaction effect (OR:1.7, 95% CI:1.2–2.2), and depressive symptoms were associated with DCDs in Type D patients, but not in non-Type D patients. Mediation modeling showed that depressive symptoms partially mediated the association of Type D personality with DCDs (Aroian test =0.04).ConclusionsType D personality is a prognostic predictor for prolonged acute brain dysfunction (delirium/coma) in cardiovascular patients independent from depressive symptoms and Type D personality-associated depressive symptoms increase the magnitude of acute brain dysfunction.

Ramos colaterais do arco aórtico e suas principais ramificações em nutria (Myocastor coypus)

Background: Nutria (Myocastor coypus), also known as Swamp Beaver, is a medium-sized semiaquatic rodent that belongs to the Capromyidae family. Originally from the southernmost part of South America, the species is distributed in several parts worldwide such as Europe and United States, where it has been used for commercial purposes due to the excellent quality of its fur and meat. Information about the nutria morphology is rare. Only a few articles about its abdominal aorta branches can be found, but nothing exists regarding its aortic arch. Consequently, other rodents such as chinchillas, agoutis, guinea pigs capybaras, pacas and rats will be used in the discussion. Therefore, this study aims to obtain morphological information that could justify such discussions in a functional point of view, and that could result in support for a better understanding of the physiology of this animal. Materials, Methods & Results: Thirty-two Myocastor coypus were used in the study, originated from a breeding facility in the town of Caxias do Sul, RS and authorized by IBAMA. The animals were put to sleep by means of an anesthetic overdose administrated intraperitoneally, and kept in formaldehyde for seven days to be subsequently dissected. After having their arterial system flushed with saline solution, the aorta of thirty specimens received an injection containing latex 603 through the left ventricle, for later observation of the arteries of the cranial mediastinal space and neck. Dental resin was injected in two specimens, for subsequent manufacture of molds by means of maceration. Schematic drawings of all parts were made with the help of a magnifying glass, for posterior composition of results. The brachiocephalic trunk and the subclavian artery arose in sequence from the aortic arch of the nutria in 60% of the samples, whereas the brachiocephalic trunk, left common carotid artery and left subclavian artery arose from the arch in 40% of the samples. The branching sequence of the collateral branches of the subclavian arteries showed a great variation, presenting isolated vessels and forming trunks among the arteries identified (according to the tables). The thoracic vertebral, vertebral, internal thoracic, dorsal scapular arteries and the superficial-deep cervical trunk aroused medially from the right subclavian artery towards a lateral direction, as main collateral branches of highest prevalence. On the other hand, the left subclavian artery also gave off the vertebral artery as its first vessel, followed by the internal thoracic and thoracic vertebral arteries, and its last collateral branch was a common trunk between the dorsal scapular artery and the superficial-deep cervical trunk. Discussion: Other rodents in the study presented the same aortic arch sequence as observed in nutrias i.e., the brachiocephalic trunk and the left subclavian artery. But the branches of these main vessels showed remarkable differences, with the formation of several common trunks among the arteries. Additionally, the origin sequence of these vessels was different in the rodents studied. Therefore, the aortic arch of nutrias has two model patterns for its branching. In 60% of the samples, the aortic arch gives off the brachiocephalic trunk and the left subclavian artery as collateral branches. In 40% of the samples, however, the branching sequence is composed of the brachiocephalic trunk, the common left carotid artery and the left subclavian artery.

Preoperative CT angiography to facilitate pedicle selection for high-risk breast reduction patients

Introduction: Large volume breasts, and also breasts with a long distance between the sternal notch and the nipple, have a higher risk of postoperative nipple necrosis after breast reduction surgery. This is due to vascular insufficiency. For these high-risk cases, free nipple grafts are sometimes performed. Free nipple grafts are not an ideal technique due to reduced sensation, duct disruption, variable take and common result of an under-projecting nipple and poor aesthetic outcome. In order to avoid both necrosis of the nipples and the use of free nipple grafts, we have investigated the use of angiographic computerized tomography (CTA) in the selection of the dominant blood supply in breast reduction pedicle selection. The first aim of this study was to investigate the dominant vascular supply to the nipple areolar complex (NAC) using CTA. The second aim was to investigate whether the preoperative CTA could change surgical planning and also reduce the incidence of nipple necrosis after breast reductions for patients considered to be at a high risk of nipple loss. Methods: Phase 1: All female CT thoraces performed at a single centre between January and May 2013 were reviewed by a single cardiothoracic radiologist to find arterial sources, which intercostal space that was perforated, glandular/subcutaneous course and vessel entry point into the NAC of each breast. Phase 2: Preoperative planning CTA’s performed for the 28 cases of high-risk breast reductions of the 392 breast reductions between 2008 and 2014. Results: Phase 1: The analysis was performed on CTAs of 69 patient cases, involving 132 breasts. The dominant blood supply was the internal mammary artery (IMA) in 96 breasts, with long thoracic artery (LTA) in 21 breasts. Phase 2: A dominant vascular supply was identified in all cases. In 27 of the 28 cases, preoperative planning was undertaken as guided by the CTA. Of the 28 cases, there was one case of unilateral infection, one hematoma, and a single case of partial thickness areolar necrosis. No free nipple grafts were required. Conclusion: Preoperative CTA for large-volume breast reduction may be a useful surgical planning tool for high-risk patients. With the insight gleaned from a CTA, pedicle design can be tailored to the specific patient’s blood supply in order to reduce the incidence of necrosis to the nipple areolar complex and to avoid the need for free nipple grafts.

Preoperative CT angiography to facilitate pedicle selection for high-risk breast reduction patients

Introduction: This study aimed to investigate the dominant vascular supply to the nipple areolar complex (NAC) using CTA and whether the preoperative CTA could change surgical planning and reduce the incidence of nipple necrosis after breast reductions for patients considered to be at a high risk of nipple loss.Methods: All female CT thoraces performed at a single centre between January and May 2013 were reviewed by a single cardiothoracic radiologist to find arterial sources, which intercostal space that was perforated, glandular/subcutaneous course and vessel entry point into the NAC of each breast. Preoperative planning CTA’s performed for the 28 cases of high-risk breast reductions of the 392 breast reductions between 2008 and 2014.Results: Analysis was performed on CTAs of 69 patient cases, involving 132 breasts. The dominant blood supply was the internal mammary artery (IMA) in 96 breasts, with long thoracic artery (LTA) in 21 breasts. A dominant vascular supply was identified in all cases. In 27 of the 28 cases, preoperative planning was undertaken as guided by the CTA. Of the 28 cases, there was one case of unilateral infection, one hematoma, and a single case of partial thickness areolar necrosis. No free nipple grafts were required.Conclusion: Preoperative CTA for large-volume breast reduction may be a useful surgical planning tool for high-risk patients. With CTA, pedicle design can be tailored to the specific patient’s blood supply in order to reduce the incidence of necrosis and avoid the need for free nipple grafts.

Case of laparoscopic right hemicolectomy for ascending colon cancer after aortic graft replacement and revascularization of the superior mesenteric artery

A 67-year-old man who presented with a bloody stool was diagnosed with ascending colon cancer. He had previously experienced thoracic and abdominal aortic dissections, which were treated with thoracic and abdominal aortic grafts and superior mesenteric artery revascularization. We performed a laparoscopic right hemicolectomy with a D3 lymph node dissection. During the laparotomy, we identified the superior mesenteric artery and an enlarged anterior superior pancreaticoduodenal artery. Injury to the latter artery could lead to severe ischemia in multiple organs; therefore, it was crucial to identify the primary feeding artery and vascular anatomy before and during surgery. We chose the laparoscopic right hemicolectomy to avoid injuring the anterior superior pancreaticoduodenal artery and the intra-abdominal abscess. This case study was the first to describe a laparoscopic hemicolectomy after thoracic and abdominal aortic grafts and superior mesenteric artery revascularization.

O arco aórtico do sauim (Saguinus niger) e sua importância no processo de urbanização

Distribuído geograficamente em todos os estados da Federação do Brasil, o sauim está presente em grandes centros urbanos devido ao aumento quantitativo desta espécie, e, tendo em vista que a prática médica e cirúrgica de animais selvagens está mais presente na medicina veterinária, visamos colaborar com o conhecimento da anatomia do arco aórtico e seus ramos colaterais, contribuindo no contexto de emergências médicas. Foram estudados quatro animais, sendo que três indivíduos apresentaram arquitetura do arco aórtico similar ao descrito nos mamíferos domésticos, com presença da artéria subclávia esquerda e artéria braquiocefálica, e em um animal a disposição dos ramos colaterais do arco aórtico seguiu o padrão encontrado em humanos, com a presença da artéria braquiocefálica, artéria carótida comum esquerda e artéria subclávia esquerda. Independentemente da configuração inicial do arco aórtico do sauim, da artéria braquiocefálica surgiram sequencialmente as artérias subclávia direita, vertebral direita, torácica interna direita, costocervical direita e cervical superficial direita. A artéria subclávia esquerda originou os mesmos ramos correlatos com o antímero direito.

Abstract 062: Vascular Dysfunction and Hypertension are Prevented by a Novel PPARγ Target Gene, RhoBTB1

RhoBTB1 is a novel peroxisome proliferator-activated receptor gamma (PPARγ) target gene expressed in smooth muscle cells (SMC) which may mediate some of the vascular protective and antihypertensive benefits of PPARγ. Here, we tested the hypothesis that RhoBTB1 can prevent angiotensin II (ANG)-induced hypertension. RhoBTB1 expression in aorta from C57BL/6 mice was decreased by 54±9% (n=16) in response to ANG infusion (490 ng/min/kg, 2 weeks). To test if RhoBTB1 expression is protective, we generated double transgenic mice with tamoxifen-inducible, Cre-dependent overexpression of RhoBTB1 specifically in SMC (S-RhoBTB1). S-RhoBTB1 and non-transgenic (NT) mice were treated with tamoxifen (Tx; 75 mg/kg, ip, 5 days) or vehicle (corn oil) and then ANG was infused. Although RhoBTB1 expression was decreased in ANG-infused control mice (p&lt;0.01, n=8-10), RhoBTB1 expression in Tx-treated S-RhoBTB1 mice infused with ANG was restored to a level similar to NT treated with saline (n=11). Overexpression of RhoBTB1 did not alter baseline blood pressure (BP) in the absence of ANG (n=7-8). However, the increase in BP induced by ANG was significantly attenuated by RhoBTB1 restoration in S-RhoBTB1 mice with Tx compared to ANG-infused control mice (either NT with Tx, NT with corn oil, or S-RhoBTB1 with corn oil) in which RhoBTB1 was not restored (Systolic BP, 159±5 in control mice vs 132±6 mmHg in S-RhoBTB1 mice with Tx, p&lt;0.01, n=7-8). We also observed increased heart weight in ANG-infused control mice, which was prevented in S-RhoBTB1 mice treated with Tx (p&lt;0.05, n=8). Thoracic aorta and basilar artery from ANG-infused control mice exhibited impaired acetylcholine-induced endothelial-dependent relaxation (Aorta, 48±2%, p&lt;0.01, n=6-8), which was prevented by restoration of RhoBTB1 in SMC (Aorta, 76±5%, p&lt;0.01, n=6-8). Thoracic aorta from ANG-infused control mice also displayed decreased sodium nitroprusside-induced endothelial-independent relaxation with a right-shifted dose-response (76±9%, p&lt;0.01, n=8), which was also prevented in tamoxifen-treated S-RhoBTB1 mice (95±10%, p&lt;0.01, n=8). We conclude that the novel PPARγ target gene, RhoBTB1, functions in SMC to specifically facilitate vasodilation and mediates a protective anti-hypertensive effect.