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James D Cameron,1 Roland Asmar,2 Harry Struijker-Boudier,3 Kohji Shirai,4 Yuriy Sirenko,5 Yulia Kotovskaya,6 Jirar Topouchian71Monash Cardiovascular Research Centre, Clayton, Melbourne, Victoria, Australia; 2Roland Asmar, Foundation Medical Research Institutes, Paris, France; 3Department of Pharmacology, Maastricht University, Maastricht, The Netherlands; 4Department of Vascular Function, Sakura Hospital, Toho University, Tokyo, Japan; 5Institute of Cardiology, Kiev, Ukraine; 6ESH Hypertension Excellence Center of Peoples Friendship University of Russia, Moscow, Russia; 7Department of Diagnosis and Therapeutics, Hôtel-Dieu University Hospital, Paris, FranceAbstract: Central arterial structure and function comprise a primary determinant of vascular health, and are integral to the important concept of ventriculo-vascular coupling or interaction. Central aortic stiffening is a major influence on central blood pressure, and directly relates to coronary perfusion. The joint session of the International Society of Vascular Health (Eastern Region) and the Ukrainian Congress of Cardiology was held in Kiev, Ukraine, on September 23, 2011; it provided an expert forum to discuss arterial evaluations, clinical applications, and progress toward translating arterial protection into cardiovascular benefits. The conclusions of the expert panel were:1. Aortic stiffness is not presently a treatment target but may be useful for substratifying cardiovascular risk in individuals in order to better target the intensity of conventional therapy, and it may be useful in assessing response to treatment.2. Crosstalk between macro- and microcirculation in hypertension has important implications for pharmacological treatment. An antihypertensive regimen should abolish the vicious cycle between the increased resistance in the microcirculation and the increased stiffness of the larger arteries. Such treatment should be based on drugs with multiple actions on the vascular tree, or on drug combinations that target the various segments of the arterial system.3. Several blood pressure-independent mechanisms of large artery stiffness exist. Future considerations for clinical understanding of large artery stiffness should involve new drugs and new evaluation methods – with a focus on vascular health, for the initiation of cardiovascular prevention, for newly designed studies for treatment evaluation, and for new studies of drug combinations.4. Arterial stiffening is a sign of cardiovascular aging and is a major factor affecting the biomechanics of large arteries. Arterial stiffness is an attractive therapeutic target in terms of vascular aging. Healthy lifestyle, physical exercise, and smoking cessation are the most effective ways of preventing and treating early vascular aging. Long-term effects of cardiovascular drugs on arterial stiffness need to be further investigated.5. The emerging clinical data on the cardio ankle vascular index (CAVI) technique of arterial health assessment is presented, showing that the CAVI is elevated in aging, coronary artery diseases, chronic kidney disease, hypertension, diabetes mellitus, smoking, and stress. The CAVI decreased with the administration of statins, angiotensin II receptor blocking agents, and calcium channel blockers. The CAVI is suggested as an important predictor of cardiovascular diseases.Future development of a clinical understanding of large artery stiffness is important and should include consideration of new drugs and new evaluation methods, with a focus on vascular health aimed at cardiovascular prevention.Keywords: arterial stiffness, cardiovascular protection, hypertension, arterial hemodynamic evaluation

Gary S Goldfield,1–5 Lauren Marie Dowler,5 Mark Walker,6,7 Jameason D Cameron,3 Zachary M Ferraro,1 Eric Doucet,3 Kristi B Adamo1–31Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, 2Department of Paediatrics, 3School of Human Kinetics, 4School of Psychology, University of Ottawa, 5Department of Psychology, Carleton University, 6Ottawa Hospital Research Institute, 7Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, CanadaBackground: Excessive gestational weight gain is associated with postpartum weight retention and downstream child obesity. Dopamine plays a critical role in the regulation of energy intake and body weight. The purpose of this study was to examine the relationship between excessive gestational weight gain and dopamine pathway-related polymorphisms, namely the variable nucleotide tandem repeat in the 3´untranslated region (UTR) region of the SLC6A3 (DAT-1) dopamine transporter gene and the 30-base pair variable nucleotide tandem repeat polymorphism of the 5´UTR of the monoamine oxidase-A (MAO-A) gene.Methods: Ninety-three women of mean age 31.7 ± 4.2 years were recruited from the Ottawa and Kingston birth cohort and assessed at 12–20 weeks’ gestation. Mean body mass index was 22.7 ± 2.5 kg/m2. Excessive gestational weight gain was defined according to the 2009 Institute of Medicine guidelines based on body mass index. Genotype analyses were performed using polymerase chain reaction and agarose gel electrophoresis.Results: There was no relationship between the prevalence or magnitude of excessive gestational weight gain among women with the 3´ UTR single nucleotide polymorphism of the DAT-1 gene. However, 70% (19 of 27) of women carrying the MAO-A 4/4 (high activity) allele exceeded recommendations for gestational weight gain compared with 48% (32 of 60) of those with the pooled 3/3, 3/4, and 3/3.5 (low activity) alleles (P < 0.05). Similarly, those with the MAO-A 4/4 allele had significantly greater gestational weight gain than those with the 3/3, 3/4, or 3/3.5 pooled genotypes (19.3 ± 4.1 versus 17.0 ± 5.0 kg, P = 0.03).Conclusion: Carriers of the 4/4 variants of the MAO-A gene may be at increased risk for excessive gestational weight gain.Keywords: gestational weight gain, dopamine genes, monoamine oxidase-A

Sohei Nakamura1, Naofumi Hikita2, Ryoji Yamakawa1, Fukuko Moriya3, Hirohisa Yano3, Emiko Furusato4, J Douglas Cameron5, Elisabeth J Rushing41Department of Ophthalmology, Kurume University School of Medicine, Kurume, 2Fukubiru Hikita Eye Clinic, 3Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka, Japan; 4Department of Neuropathology and Ophthalmic Pathology, Armed Forces Institute of Pathology, Washington, DC, 5Departments of Ophthalmology and Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, USABackground: Adenoma of the retinal pigment epithelium (RPE) is a rare intraocular tumor that can simulate other pigmented tumors such as choroidal melanoma. We report a case of non-pigmented adenoma of the RPE initially diagnosed as choroidal hemangioma.Case report: A 42-year-old woman presented to Kurume University Hospital in November 1992 with an orange-yellow tumor nasal to the optic disc in the left fundus. The tumor was 9.0 × 9.0 mm in diameter, 6.0 mm thick, and was characterized by high intensity on T1-weighted magnetic resonance imaging (MRI), low intensity on T2-weighted MRI, and enhancement on gadolinium MRI. Fluorescein angiography revealed early hypofluorescence and late hyperfluorescence of the tumor and retinal feeder vessels. By April 1996, exudate had developed around the tumor margins. The patient was treated with external beam radiation therapy (20 Gy) in July 1996, but the tumor did not diminish in size. Subsequently, she developed extensive loss of vision due to total retinal detachment. Accordingly, her left eye was enucleated in June 2005 because of severe ocular pain due to absolute glaucoma. Histopathological examination indicated that the tumor was contiguous with the normal surrounding RPE and was composed of cords and tubules of mostly non-pigmented spindle-shaped cells with round to oval nuclei and a small amount of cytoplasm containing melanin granules. The tumor cells were immunoreactive for vimentin, S-100 protein, and cytokeratin 18. The final diagnosis was adenoma of the RPE.Conclusion: Adenoma of the retinal pigment epithelium may be associated with incompetent vessels leading to serous retinal detachment and extensive visual loss, and may exhibit clinical characteristics similar to choroidal hemangioma.Keywords: adenoma, choroidal hemangioma, histopathology, retinal pigment epithelium