Cardiovascular Complications Related to Lower Limb Revascularization and Drug-Delivering Technology in Peripheral Arterial Disease

The cardiovascular complication related to lower limb revascularization is the common cause of mortality in patients with peripheral arterial disease (PAD). The coexisting multisite atherosclerotic vascular disease is increasing risk of major adverse cardiovascular events (MACE). The minimally invasive approach for revascularization, namely, endovascular-first strategy for decreasing risk of intervention is the modern approach. The novel technology of the drug delivering device by paclitaxel, sirolimus, and other antiproliferative drug coated balloon (DCB) and drug eluting stent (DES) to increase the patency of the target artery are trending to use in patients with CLTI. However, the long-term result and safety of a drug delivering device are still controversial. The paclitaxel related to MACE and major adverse limb events (MALE) need to be investigated. The new drug coating balloon, sirolimus demonstrated the excellent short-term result. However, there are some limitations of previous randomized studies and meta-analyses to conclude the best strategy and device to perform the best result for revascularization without increasing risk of MACE and MALE in CLTI patients who candidate for revascularization. This article is summarized the pathophysiology of MACE and MALE in the patients with PAD during revascularization, paclitaxel related cardiovascular complications and sirolimus coated balloon

Endovascular Aneurysm Repair in HIV Patients with Ruptured Abdominal Aneurysm and Low CD4

We report two HIV infected patients with ruptured abdominal aneurysm by using endovascular aneurysm repair (EVAR) technique. A 59-year-old Thai man had a ruptured abdominal aortic aneurysm and a 57-year-old man had a ruptured iliac artery aneurysm. Both patients had a CD4 level below 200 μ/L indicating a low immune status at admission. They were treated by EVAR. Neither patient had any complications in 3 months postoperatively. EVAR may have a role in HIV patients with ruptured abdominal aneurysm together with very low immunity

The Predictive Factors Associated with Longer Operative Time in Single-Incision Laparoscopic Cholecystectomy

Objective: The difficult laparoscopic cholecystectomy (LC) is defined as the presence of one of the following conditions including prolonged operative time, conversion to open cholecystectomy or significant blood loss. At present, there is no evidence of predictive factors related to longer operative time in single-incision laparoscopic cholecystectomy (SILC). The aim of this study is to determine predictive factors associated with longer operative time in SILC procedure. Materials and Methods: A retrospective study was conducted of patients with benign gallbladder disease who underwent SILC in Thammasat University Hospital between October 2014 and December 2020. Patients’ records were reviewed. Primary outcomes were preoperative predictive factors associated with DSLC. Secondary outcomes were perioperative and 3-month postoperative adverse outcomes. Results: 592 SILC procedures were categorized as 80 DSLC and 512 non-difficult SILC (NDSLC). The median (interquartile range) of operative time in all SILC procedure is 48 (38, 62) minutes. The threshold of operative time of difficult SILC was 72 minutes. The multivariate analysis indicated 5 significant predictive factors. Obesity (body mass index > 25 kg/m2)) and abdominal pain reflected the difficulty of SILC procedures (p = 0.041 and p = 0.009). Calcified gallbladder showed the highest RR of 14.08 (p = 0.011). Contracted gallbladder and chronic cholecystitis were also predictive factors with RR of 13.79 and 3.64, respectively (p < 0.001 and p = 0.007). Conclusion: Obesity, abdominal pain, chronic cholecystitis, contracted gallbladder and calcified gallbladder were preoperative predictive factors. Surgeons should perform the SILC procedure carefully when predictive factors are identified

Fungicidal activity of recombinant javanicin against Cryptococcus neoformans is associated with intracellular target(s) involved in carbohydrate and energy metabolic processes

The occurrence of Cryptococcus neoformans, the human fungal pathogen that primarily infects immunocompromised individuals, has been progressing at an alarming rate. The increased incidence of infection of C. neoformans with antifungal drugs resistance has become a global concern. Potential antifungal agents with extremely low toxicity are urgently needed. Herein, the biological activities of recombinant javanicin (r-javanicin) against C. neoformans were evaluated. A time-killing assay was performed and both concentration- and time-dependent antifungal activity of r-javanicin were indicated. The inhibitory effect of the peptide was initially observed at 4 h post-treatment and ultimately eradicated within 36 to 48 h. Fungal outer surface alteration was characterized by the scanning electron microscope (SEM) whereas a negligible change with slight shrinkage of external morphology was observed in r-javanicin treated cells. Confocal laser scanning microscopic analysis implied that the target(s) of r-javanicin is conceivably resided in the cell thereby allowing the peptide to penetrate across the membrane and accumulate throughout the fungal body. Finally, cryptococcal cells coped with r-javanicin were preliminarily investigated using label-free mass spectrometry-based proteomics. Combined with microscopic and proteomics analysis, it was clearly elucidated the peptide localized in the intracellular compartment where carbohydrate metabolism and energy production associated with glycolysis pathway and mitochondrial respiration, respectively, were principally interfered. Overall, r-javanicin would be an alternative candidate for further development of antifungal agents

Unlocking the tumor-immune microenvironment in osteosarcoma: insights into the immune landscape and mechanisms

Osteosarcoma has a unique tumor microenvironment (TME), which is characterized as a complex microenvironment comprising of bone cells, immune cells, stromal cells, and heterogeneous vascular structures. These elements are intricately embedded in a mineralized extracellular matrix, setting it apart from other primary TMEs. In a state of normal physiological function, these cell types collaborate in a coordinated manner to maintain the homeostasis of the bone and hematopoietic systems. However, in the pathological condition, i.e., neoplastic malignancies, the tumor-immune microenvironment (TIME) has been shown to promote cancer cells proliferation, migration, apoptosis and drug resistance, as well as immune escape. The intricate and dynamic system of the TIME in osteosarcoma involves crucial roles played by various infiltrating cells, the complement system, and exosomes. This complexity is closely associated with tumor cells evading immune surveillance, experiencing uncontrolled proliferation, and facilitating metastasis. In this review, we elucidate the intricate interplay between diverse cell populations in the osteosarcoma TIME, each contributing uniquely to tumor progression. From chondroblastic and osteoblastic osteosarcoma cells to osteoclasts, stromal cells, and various myeloid and lymphoid cell subsets, the comprehensive single-cell analysis provides a detailed roadmap of the complex osteosarcoma ecosystem. Furthermore, we summarize the mutations, epigenetic mechanisms, and extracellular vesicles that dictate the immunologic landscape and modulate the TIME of osteosarcoma. The perspectives of the clinical implementation of immunotherapy and therapeutic approaches for targeting immune cells are also intensively discussed

Reliability, validity, and minimal clinically important differences for the Thai-version of the Aberdeen Varicose Vein Questionnaire (AVVQ-Thai) in patients with chronic venous disease [version 2; peer review: 1 approved, 2 approved with reservations]

Background Patient-reported outcome measures (PROMs) are essential for assessing the health of patients with chronic venous disease (CVD). Therefore, we aimed to translate the Aberdeen Varicose Vein Questionnaire into Thai language (AVVQ-Thai) and evaluate its reliability and validity. Minimal clinically important differences (MCID) of the AVVQ-Thai also be estimated. Methods International standards for PROM translation were followed including the forward-backwards translation of the AVVQ. Patients with Clinical-Etiology-Anatomy-Pathophysiology (CEAP) C2-C6 with truncal reflux were prospectively included. Venous interventions were used to treat reflux and varicosities. Patients’ characteristics, venous clinical severity scores (VCSS), EuroQol EQ-5D, and AVVQ-Thai were collected pre- and one-month post-intervention. AVVQ-Thai was also collected one to two weeks after the initial visit by reply-paid postal questionnaire. Results The study included 119 patients (30% C2, 29% C3, 28% C4, 11% C5, and 2% C6). The AVVQ-Thai had good internal consistency with Cronbach’s alpha of 0.783 and moderate reliability with the intraclass correlation coefficient of 0.67 (95%CI: 0.50, 0.79). The AVVQ-Thai was significantly correlated with VCSS and was able to discriminate patients with different levels of health problems as assessed by EQ-5D at both pre-and post-intervention, demonstrating good construct and discriminative validity. The median AVVQ scores improved significantly after intervention from 15.4 (IQR 8.3, 24.2) to 4.2 (IQR 1.3, 8.4) in C2-C3, and 18.9 (IQR 14.1, 25.5) to 7.3 (IQR 4.6, 16.3) in C4-C6. The MCID of the AVVQ was 6.21 on the 0-100 scale, which equates to the level of difference necessary to be clinically meaningful. Conclusions AVVQ-Thai has satisfactory evidence for internal consistency, reliability, validity, and responsiveness to change and is recommended for application in Thailand

Nivel de conocimientos de estudiantes de medicina sobre diagnóstico y manejo del infarto agudo del miocardio

Introduction: acute myocardial infarction is a disease with high morbidity and mortality.Objective: to determine the knowledge level of medical students about the diagnosis and management of acute myocardial infarction.Method: an observational, descriptive and cross-sectional study was carried out between January and February 2022 in medical students from the University of Medical Sciences of Pinar del Río who participated in the provincial update workshop on acute myocardial infarction. Through intentional sampling, a sample of 92 students was selected. To collect the information, a survey was used using Google Forms.Results: the female sex (65,21%), the age group from 21 to 22 years (65,21%) and the fourth-year students (50%) prevailed. Hypertension was the most identified risk factor (97,98%). 97,82% of the students identified precordial pain as the main clinical manifestation. 100% identified the presentation with complications, where sudden death was the most identified (81,52%). 100% point to the electrocardiogram as the main complementary, where ST alterations were the most identified (84,78%). 95,65% of the students indicated constant monitoring of vital parameters and cardiovascular function as the management measure.Conclusions: Medicine students belonging to the clinical area at the University of Medical Sciences of Pinar del Río have an adequate level of knowledge about the diagnosis and management of acute myocardial infarction.Introducción: el infarto agudo del miocardio constituye una enfermedad con elevada morbilidad y mortalidad.Objetivo: determinar el nivel de conocimientos de estudiantes de medicina sobre el diagnóstico y manejo del infarto agudo del miocardioMétodo: se realizó un estudio observacional, descriptivo y transversal entre enero y febrero de 2022 en estudiantes de Medicina de la Universidad de Ciencias Médicas de Pinar del Río del ciclo clínico que participaron en el Taller provincial de actualización sobre infarto agudo de miocardio. Mediante un muestreo intencional se seleccionó una muestra de 92 estudiantes. Para la recolección de la información se empleó una encuesta mediante Google Forms.Resultados: predominó el sexo femenino (65,21 %), el grupo etario de 21 a 22 años (65,21 %) y los estudiantes de cuarto año (50 %). La hipertensión fue el factor de riesgo más identificado (97,98 %). El 97,82 % de los estudiantes identificó el dolor precordial como principal manifestación clínica. El 100 % identificó la presentación con complicaciones, donde la muerte súbita fue la más identificada (81,52 %). El 100 % señala al electrocardiograma como principal complementario, donde las alteraciones del ST fueron las más identificada (84,78 %). El 95,65 % de los estudiantes indicaron la monitorización constante de los parámetros vitales y función cardiovascular como la medida de manejo.Conclusiones: los estudiantes de Medicina pertenecientes al área clínica en la Universidad de Ciencias Médicas de Pinar del Río poseen un adecuado nivel de conocimientos sobre el diagnóstico y manejo del infarto agudo del miocardio.  

Endovascular Aneurysm Repair in HIV Patients with Ruptured Abdominal Aneurysm and Low CD4

We report two HIV infected patients with ruptured abdominal aneurysm by using endovascular aneurysm repair (EVAR) technique. A 59-year-old Thai man had a ruptured abdominal aortic aneurysm and a 57-year-old man had a ruptured iliac artery aneurysm. Both patients had a CD4 level below 200 μ/L indicating a low immune status at admission. They were treated by EVAR. Neither patient had any complications in 3 months postoperatively. EVAR may have a role in HIV patients with ruptured abdominal aneurysm together with very low immunity