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PMID = 28707760

The neural crest (NC) is a multipotent stem cell‐like population, unique to vertebrates, that is characterized by its migratory behavior and broad ability to differentiate into many diverse derivatives including elements of the cardiovascular system, bone and cartilage of the face, the peripheral nervous system, and melanocytes. After neurulation, neural crest cells (NCC) delaminate, undergo EMT from the neural tube, and migrate both individually and collectively as chains. Various developmental diseases, including craniofacial abnormalities and neural crest‐derived cancers such as melanoma arise due to improper development of NC. While there has been much focus on transcriptional mechanisms in regulation of neural crest specification, the process of cell migration involves rapid changes that likely require post‐transcriptional regulation. In order to uncover novel proteins that might influence NC development, we have performed transcriptional profiling of migrating neural crest cells and found >300 genes that are upregulated in the migrating crest including the sequence specific RNA binding protein Pumilio1 (PUM1). PUM proteins are evolutionarily conserved translational regulators that play essential roles during germline development in both invertebrates and vertebrates. Here, we showed that pum1 and pum2 mRNA is present in both premigratory and migratory NC. Pum loss of function resulted in depletion of NC cells migrating neural tube. Conversely, over expression led to an increase in numbers of migrating cells. This led us to think about the potential role of PUM proteins in modulating the specification of NC cells. To identify potential NC targets of PUM, we carried out a bioinformatics screen focusing on NC relevant genes across multiple species that possessed a Pumilio Response Element (PRE) in their 3'UTR region. The PRE element, 5’‐UGUANAUA‐3,’ is a highly conserved consensus that PUM proteins recognize in the 3’UTRs of their targets. Interestingly, several neural crest markers possess a PRE, thus representing potential targets regulated by Pumilio during NC development. Investigation of the specific mechanism whereby PUM proteins regulate NC development is currently in progress.

There are various echocardiographic parameters for diagnosis of pulmonary embolism. Among these paramaters, “McConnell sign” is defined as right ventricular free wall hypokinesis in the presence of normal right ventricular apical contractility. We presented a patient with acute pulmonary embolism which caused reversible akinesia of the apex and right ventricular midfree wall, a finding we would like to term “reverse McConnell sign.” Pulmoner embolinin tanısı için birçok ekokardiyografik parametre bulunmaktadır. Bu parametreler arasında, sağ ventrikül apikal kasılması normalken sağ ventrikül serbest duvar hareketinde hipokinezi olması “McConnell bulgusu” olarak tanımlanmaktadır. Biz sağ ventrikül apeksi ve serbest duvarının reversibl akinezisine yol açan akut pulmoner embolili bir olgu sunduk ve bu bulguyu “ters McConnell işareti” olarak yorumladık., Pulmoner embolinin tanısı için birçok ekokardiyografik parametre bulunmaktadır. Bu parametreler arasında, sağ ventrikül apikal kasılması normalken sağ ventrikül serbest duvar hareketinde hipokinezi olması “McConnell bulgusu” olarak tanımlanmaktadır. Biz sağ ventrikül apeksi ve serbest duvarının reversibl akinezisine yol açan akut pulmoner embolili bir olgu sunduk ve bu bulguyu “ters McConnell işareti” olarak yorumladık.

Koroner kollateraller koroner anjiyografide görülebilir ve yeterli kan akımını sağlamak için damar yetersiz kaldığında önemli bir alternatif kaynak olarak görev alırlar. Biz sol ön inen koroner arteri tam tıkanmış, anstabil anginalı ve normal elektrokardiyografi bulgularına sahip bir hasta rapor ediyoruz. Coronary collaterals can be visualized on coronary angiography and they potentially offer an important alternative source of blood supply when the original vessel fails to provide sufficient blood. We report a patient with unstable angina and normal electrocardiography and total occlusion of the left anterior descending coronary artery.

Amaç: Karvedilol tedavisi, sol ventrikül ejeksiyon fraksiyonunu artırır, ventriküler disfonksiyonun şiddetini, morbidite ve mortaliteyi azaltır. Ancak sistolik kalp yetmezlikli hastalarda karvedilolün P dalga dispersiyonu ve süresi üzerine etkileri bilinmemektedir. Bu çalışmada kalp yetmezliği olan hastalarda karvedilolün P dalga süresi ve dispersiyonu üzerine olan etkilerini araştırdık. Hastalar ve Yöntemler: Sol ventrikül ejeksiyon fraksiyonu %40'ın altında olan kalp yetmezlikli 56 hasta ileriye dönük olarak çalışmaya alındı. Karvedilol kalp yetmezliğinin standart tedavisine ek olarak verildi. Başlangıçta ve karvedilol tedavisinin dördüncü ayında fizik muayene, radyonüklid çalışma ve başlangıç maksimum ve minimum P-dalga süresi ve P-dalga dispersiyonu ölçümleri yapıldı. Bulgular: Karvedilol tedavisi ile maksimum P dalga süresi ve P-dalga dispersiyonu belirgin olarak azaldı. Sol ventrikül ejeksiyon fraksiyonu ve NYHA fonksiyonel sınıfı karvedilol tedavisi sonrası düzeldi. (Maksimum P-dalga süresi; 126±9 ms'den 120±7ms'ye; p=0.001, P- dalga dispersiyonu; 51±7 ms'den 46±5 ms'ye geriledi; p=0.001). Sonuç: Karvedilol tedavisi maksimum P-dalga süresi ve P-dalga dispersiyonunu direkt (doğrudan) ve indirekt (dolaylı) olarak azaltır. Bu kalp yetmezliği olan hastalarda atriyal fibrilasyon görülme sıklığını azaltabilir. Objectives: Carvedilol therapy reduces the severity of the ventricular dysfunction, increases left ventricular ejection fraction and reduces the mortality and morbidity. However, the effect of carvedilol on P-wave dispersion and P-wave duration in patients with systolic heart failure is unknown. In the present study, we aimed to evaluate the effect of carvedilol therapy on P-wave duration and P-wave dispersion in patients with heart failure. Patients and Methods: Fifty-six patients with heart failure and a left ventricular ejection fraction less than 40% were prospectively included in the study. Carvedilol was administered in addition to standard therapy for heart failure. Clinical examination and radionuclide study and baseline maximum and minimum P-wave duration and P-wave dispersion measurements were performed for each patient at the beginning and at the end of the fourth month of carvedilol therapy. Results: Maximum P-wave duration and P-wave dispersion significantly decreased, left ventricular ejection fraction and NYHA functional class improved by carvedilol therapy (Maximum P-wave duration; from 126±9 ms to 120±7ms; p=0.001, P-wave dispersion; from 51±7 ms to 46±5 ms; p=0.001). Conclusion: Carvedilol therapy directly or indirectly reduces maximum P-wave duration and P-wave dispersion. This may lead to a reduction in the occurrence of atrial fibrillation in patients with heart failure.

Kocayigit, Ibrahim/0000-0001-8295-9837; WOS:000473278000005 PubMed ID: 31264653 Objective: It is still debatable whether diagnostic coronary angiography (CA) or percutaneous coronary interventions (PCIs) increase radiation exposure when performed via radial approach as compared to femoral approach. This question was investigated in this study by comparison of dose-area product (DAP), reference air kerma (RAK), and fluoroscopy time (FT) among radial and femoral approaches. Methods: All coronary procedures between November 2015 and November 2017 were assessed; and 4215 coronary procedures were enrolled in the study. Patients with bifurcation, chronic total occlusion, cardiogenic shock, or prior coronary artery bypass surgery were excluded. These 4215 procedures were evaluated for three different categories: diagnostic CA (Group I), PCI in patients with stable angina (Group II), and PCI in patients with ACS (Group III). Results: Age was significantly higher in the femoral arm of all groups. Among patients in the radial arm of Groups I and II, males were over-represented. Therefore, a multiple linear regression analysis with stepwise method was performed. After adjusting these clinical confounders, there was no significant difference with regard to DAP, RAK, and FT between femoral and radial access in Group I. In contrast, PCI via radial access was significantly associated with increased DAP, RAK, and FT in Groups II and III. Conclusion: In spite of an increased experience with trans-radial approach, PCI of coronary lesions via radial route was associated with a relatively small but significant radiation exposure in our study. Compared to femoral access, diagnostic CA via radial access was not related to an increased radiation exposure.

Objective: Pulmonary hypertension and right heart failure are poorprognostic factors in systemic sclerosis (SSc). The effect of coldstress on pulmonary vasospasm was evaluated in some trials butthe results were conflicting. The aim of our study was to determinethe effect of cold stress on right ventricular (RV) functions.Materials and Methods: Twenty-four patients with SSc and24 age and sex-matched healthy controls were enrolled in thestudy. Transthoracic echocardiography (TTE) was performed to allpatients at rest and after peripheral cold exposure. Baseline andafter cold stress test TTE were compared between the groups.Results: Cold exposure induced changes in particularly rightventicular functions. Pulmonary acceleration time was significantlyshortened in the SSc group (118.8±11.7ms vs 111.3±13.7ms,P, Amaç: Skleroderma (SSc)’da, pulmoner hipertansiyon ve sağkalp yetersizliği kötü prognoz göstergesidir. SSc’da soğuk stresinpulmoner vazospazm üzerine etkisi ile ilgili çeşitli çalışmalaryapılmış ancak sonuçlar çelişkili çıkmıştır. Bu çalışma ile SSchastalarında periferik soğuk stresin sağ ventrikül fonksiyonlarınaetkisini araştırmayı amaçladık.Gereç ve Yöntem: Yirmi dördü sklerodermalı, 24’ü sağlıklıtoplam 48 kişi çalışmaya alındı. Her iki gruba istirahat ve periferiksoğuk stres uygulama sonrasında transtorasik ekokardiyografiyapıldı. İstirahat ve soğuk stres sonrası sol ve sağ ventrikülfonksiyonları karşılaştırıldı.Bulgular: Soğuk stresin özellikle sağ ventrikül fonksiyonlarındadeğişikliğe yol açtığı görüldü. Pulmoner akselerasyon zamanıskleroderma grubunda anlamlı olarak kısaldı (118.8±11.7ms vs111.3±13.7ms, P

Introduction Percutaneous endovascular therapy is an accepted and preferred procedure for symptomatic subclavian artery disease. However, the technical feasibility and effectiveness of treating chronic total occlusion of the subclavian artery with this approach is uncertain. We aimed to evaluate the initial and mid-term results of endovascular therapy for patients with symptomatic chronic total occlusion of the left subclavian artery. Methods Consecutive patients who underwent balloon angioplasty and stenting for chronic total occlusion of the left subclavian artery between January 2010 and February 2014 were included. Results Overall, 16 patients (10 male, 6 female; mean age 56 ± 13 years) underwent balloon angioplasty and stenting for chronic total occlusion of the left subclavian artery. 6 (37.5%) had arm claudication, 8 (50.0%) had vertebrobasilar insufficiency and 2 (12.5%) had coronary steal. 18 balloon-expandable stents were implanted in 15 patients. Central luminal passage was not achieved in one patient because of the subintimal position of the guidewire (procedural success rate 93.8%). There were no procedure-related complications. Mean preprocedural and postprocedural systolic blood pressure differences between the upper extremities were 37 ± 13 (range 25-60) mmHg and 11 ± 9 (range 5-38) mmHg, respectively; the improvement was statistically significant. Outpatient follow-up revealed one asymptomatic restenosis at two years. The patency rate at two years was 93.3%. Conclusion Balloon angioplasty and stenting for chronic total occlusion of the left subclavian artery is safe and effective, with good acute success rate and mid-term patency. Prospective randomised studies on larger patient populations would provide more precise results.

Aim:Transradial access (TRA) for coronary intervention is increasingly used in current clinical practice. The aim of the present study was to evaluate the hypothesis that cutaneous analgesia before TRA for coronary intervention at a puncture site 30 minutes before puncture can reduce patient discomfort and the incidence of radial artery spasm (RAS).Methods:Patients (n=104) undergoing planned coronary interventions using TRA were prospectively randomized to receive either 1 mL of 1% lidocaine subcutaneously (n=52) (control group) or subcutaneous lidocaine plus 5% lidocaine cream (n=52) cutaneously 30 minutes before puncture (treatment group). The primary endpoint was angiographically or clinically confirmed RAS. Secondary endpoints were the occurrence of patient discomfort in the forearm during the procedure and access-site crossover to the femoral artery. Patient discomfort was quantified with a visual analogue scale (VAS) score.Results:Fifty-two patients in the treatment group (60.5±9.4 years of age and 16 female) and 52 patients in the control group (60.4±9.7 years of age and 16 female) were included in the final analysis. Radial artery spasm occurrence decreased in the treatment group compared to the control group (26.9% vs 9.6%; p=0.04) accompanied by a VAS score of 3.7±1.8 in the treatment group and 4.9±2.0 in the control group; p=0.02. The access site crossover rate did not differ between the groups (7.6% vs 21.1%; p=0.09).Conclusion:Cutaneous analgesia before TRA for coronary interventions is associated with a substantial reduction in the RAS and the procedure-related level of patient discomfort.

Sawhney et al reported that nurse-led, physician-directed moderate sedation during cardiac electrophysiology procedures is safe.1 All of the patients undergoing cardiac electrophysiological (EP) procedures and cardiac implantable electronic device (CIED) implantation during the last 12 years were moderately sedated. Since this study is a retrospective study, we could not …

Introduction: Carotid artery stenting (CAS) is a promising alternative to surgery in high-risk patients. However, the impact of stent cell design on outcomes in CAS is a matter of continued debate. Aim : To compare the periprocedural and clinical outcomes of different stent designs for CAS with distal protection devices. Material and methods : All CAS procedures with both closed- and hybrid-cell stents performed at our institution between February 2010 and December 2015 were analyzed retrospectively. Adverse events were defined as death, major stroke, minor stroke, transient ischemic attack and myocardial infarction. Periprocedural and 30-day adverse events and internal carotid artery (ICA) vasospasm rates were compared between the closed-cell and hybrid-cell stent groups. Results : The study included 234 patients comprising 146 patients with a closed-cell stent (Xact stent, Abbott Vascular) (mean age: 68.5 ±8.6; 67.1% male) and 88 patients with a hybrid-cell stent (Cristallo Ideale, Medtronic) (mean age: 67.2 ±12.8; 68.2% male). There was no significant difference between the groups with respect to periprocedural or 30-day adverse event rates. While there was no difference in terms of tortuosity index between the groups, there was a higher procedural ICA vasospasm rate in the closed-cell stent group (35 patients, 23%) compared with the hybrid-cell stent group (10 patients, 11%) (p = 0.017). Conclusions : The results of this study showed no significant difference in the clinical adverse event rates after CAS between the closed-cell stent group and the hybrid-cell stent group. However, procedural ICA vasospasm was more common in the closed-cell stent group.

Abstract. Background: Carotid artery stenting (CAS) is currently used as an alternative treatment to carotid endarterectomy (CEA). The objective of this study was to analyse our 5-year experience performing CAS. Secondarily, we sought to determine independent risk factors which predict periprocedural complications. Patients and Methods: A total of 146 patients who underwent 153 CAS procedures were analysed. The majority of patients (123, 84.2%) had symptomatic carotid stenosis. Demographic and interventional data, angiographic lesion characteristics, and periprocedural complications were recorded. Using univariate and multivariate logistic regression analyses, risk factors associated with adverse clinical outcomes were determined. Results: Periprocedural neurological complications, including four (2.7 %) major strokes, three (2 %) transient ischaemic attacks, one (0.7%) amaurosis fugax, and two (1.3 %) cases of hyperperfusion syndrome occurred in ten (6.8%) patients. The incidence of periprocedural complications significantly increased in female patients (r = 0.214, p = 0.009) and patients with longer lesions (r = 0.183, p = 0.027), contralateral stenosis ≥50 % (r = 0.222, p = 0.007), the presence of complicated plaques (r = 0.478, p < 0.001) and inadequate glycaemic control (r = 0.259, p = 0.002). Multivariate regression analysis also determined four variables to be potential independent risk factors for 30-day adverse events: higher age (Odds ratio [OR] = 1.283; 95 % CI, 1.051 to 1.566, p = 0.014); longer lesions (OR = 1.459, 95 % CI, 1.124 to 1.893, p = 0.004); higher tortuosity index (OR = 1.015, 95 % CI, 1.001 to 1.030, p = 0.034), and the presence of complicated plaque morphology (OR = 4.321, 95 % CI, 1.621 to 10.23, p = 0.001). Conclusions: Patient and lesion characteristics including age, lesion length, complicated plaque morphology and tortuosity index, may be associated with periprocedural complications.

Aorto femoral bypass is usually the recommended therapy for diffuse disease involving the aorta and iliac arteries. In this case report, a case involving a chronic endovascular abdominal aortic stent graft occlusion in which percutaneous angioplasty was performed via a transbrachial and transfemoral approach is presented. This case emphasized that occlusion of an endovascular abdominal aortic stent graft can also be treated, primarily, with an endovascular technique.

ConclusionsHemorrhagic and vascular complications are rarely seen during TRC. However, majority of these complications could be managed conservatively without a requirement for surgical reconstruction. (J Interven Cardiol 2015;28:305-312)

WOS: 000351491700017 PubMed: 24846517 Background: This study was conducted to evaluate the initial and mid-term patency rates of chronic total femoropopliteal artery (FPA) occlusions treated by subintimal angioplasty (SIA) and stenting. Methods: From March 2010 to February 2013, 74 patients were included in the study. Seventy two patients with total occlusion of the FPA and good distal runoff (2 or 3 patent vessels) were treated with percutaneous SIA and stenting. All patients had severe claudication or critical limb ischemia. In all cases, the procedure was performed with a contralateral approach. Follow-up was done at 6 months with clinical evaluation and color-Doppler. If it was necessary, peripheric angiography was performed. Results: Immediate technical success was achieved in 72 (97%) patients. Two (3%) distal embolizations, 2 (3%) groin hematomas, 1 (1%) femoral pseudoaneurysm and 1 (1%) rupture of the junction-external iliac-superficial femoral artery occurred. All of the complications were treated successfully. Total occlusion in 1 patient and critical occlusion in 3 patients were showed at the 6th month. Patency rate at the sixth month was 94% with a stent length of 13.4 +/- 8.2 cm. Conclusions: Percutaneous SIA and stenting for chronic total of the FPA occlusion showed good initial and mid-term patency rates, with few periprocedural complications.

Aim: The objective of this study was to compare the periprocedural and clinical outcomes after carotid artery stenting (CAS) with proximal protection devices versus with distal protection devices. Material and methods: Patients with internal carotid artery (ICA) stenosis undergoing CAS with cerebral embolic protection were randomly assigned to proximal balloon occlusion or distal filter protection. Adverse events were defined as death, major stroke, minor stroke, transient ischemic attack (TIA) and myocardial infarction (MI). Periprocedural and 30-day adverse events and ICA vasospasm rates were compared between the two embolic protection groups. Results: Eighty-eight consecutive patients were randomized: 48 patients with proximal protection (mean age 68.8 ±13.6, 66% male) and 40 patients with a distal protection device (mean age 65.4 ±12.3; 70% male). There was no significant difference in periprocedur - al or 30-day adverse event rates between the two groups ( p > 0.05). However, there was a higher periprocedural ICA vasospasm rate in the distal filter protection group (9 patients, 23%) compared with the proximal balloon occlusion group (1 patient, 2%) ( p = 0.019). Conclusions: There was no difference between the clinical periprocedural and 30-day adverse event rates of distal filter and prox - imal balloon protection systems. However, distal filter protection systems showed higher rates of periprocedural ICA vasospasm.