Lipocalin-2-induced proliferative endoplasmic reticulum stress participates in Kawasaki disease-related pulmonary arterial abnormalities

Clinical cases have reported pulmonary arterial structural and functional abnormalities in patients with Kawasaki disease(KD);however,the underlying mechanisms are unclear.In this study,a KD rat model was established via the intraperitoneal injection of Lactobacillus casei cell wall extract(LCWE).The results showed that pulmonary arterial functional and structural abnormalities were observed in KD rats.Furthermore,proliferative endoplasmic reticulum stress(ER stress)was observed in the pulmonary arteries of KD rats.Notably,the level of lipocalin-2(Lcn 2),a trigger factor of inflammation,was remarkably elevated in the plasma and lung tissues of KD rats;increased Lcn 2 levels following LCWE stimulation may result from polymorphonuclear neutrophils(PMNs).Correspondingly,in cultured pulmonary artery smooth muscle cells(PASMCs),Lcn 2 markedly augmented the cleavage and nuclear localization of activating transcription factor-6(ATF6),upregulated the transcription of glucose regulated protein 78(GRP78)and neurite outgrowth inhibitor(NOGO),and promoted PASMCs proliferation.However,proapoptotic C/EBP homologous protein(CHOP)and caspase 12 levels were not elevated.Treatment with 4-phenyl butyric acid(4-PBA,a specific inhibitor of ER stress)inhibited PASMCs proliferation induced by Lcn 2 and attenuated pulmonary arterial abnormalities and right ventricular hypertrophy and reduced right ventricular systolic pressure in KD rats.In conclusion,Lcn 2 remarkably facilitates proliferative ER stress in PASMCs,which probably accounts for KD-related pulmonary arterial abnormalities.

Emerging role of computed tomography coronary angiography in evaluation of children with Kawasaki disease

Coronary artery abnormalities are the most important complications in children with Kawasaki disease(KD).Two-dimensional transthoracic echocardiography currently is the standard of care for initial evaluation and follow-up of children with KD.However,it has inherent limitations with regard to evaluation of mid and distal coronary arteries and,left circumflex artery and the poor acoustic window in older children often makes evaluation difficult in this age group.Catheter angiography(CA)is invasive,has high radiation exposure and fails to demonstrate abnormalities beyond lumen.The limitations of echocardiography and CA necessitate the use of an imaging modality that overcomes these problems.In recent years advances in computed tomography technology have enabled explicit evaluation of coronary arteries along their entire course including major branches with optimal and acceptable radiation exposure in children.Computed tomography coronary angiography(CTCA)can be performed during acute as well as convalescent phases of KD.It is likely that CTCA may soon be considered the reference standard imaging modality for evaluation of coronary arteries in children with KD.

Radiation dose analysis of computed tomography coronary angiography in Children with Kawasaki disease

BACKGROUND There is evolving role of computed tomography coronary angiography(CTCA)in non-invasive evaluation of coronary artery abnormalities in children with Kawasaki disease(KD).Despite this,there is lack of data on radiation dose in this group of children undergoing CTCA.AIM To audit the radiation dose of CTCA in children with KD.METHODS Study(December 2013-February 2018)was performed on dual source CT scanner using adaptive prospective electrocardiography-triggering.The dose length product(DLP in milligray-centimeters-mGy.cm)was recorded.Effective radiation dose(millisieverts-mSv)was calculated by applying appropriate age adjusted conversion factors as per recommendations of International Commission on Radiological Protection.Radiation dose was compared across the groups(0-1,1-5,5-10,and>10 years).RESULTS Eighty-five children(71 boys,14 girls)with KD underwent CTCA.The median age was 5 years(range,2 mo-11 years).Median DLP and effective dose was 21 mGy.cm,interquartile ranges(IQR)=15(13,28)and 0.83 mSv,IQR=0.33(0.68,1.01)respectively.Mean DLP increased significantly across the age groups.Mean effective dose in infants(0.63 mSv)was significantly lower than the other age groups(1-5 years 0.85 mSv,5-10 years 1.04 mSv,and>10 years 1.38 mSv)(P<0.05).There was no significant difference in the effective dose between the other groups of children.All the CTCA studies were of diagnostic quality.No child required a repeat examination.CONCLUSION CTCA is feasible with submillisievert radiation dose in most children with KD.Thus,CTCA has the potential to be an important adjunctive imaging modality in children with KD.

Donor hepatic artery reconstruction based on human embryology:A case report

BACKGROUND Embryonic hepatic artery anatomy simplifies its identification during liver transplantation.Injuries to the donor hepatic artery can cause complications in this process.The hepatic artery's complex anatomy in adults makes this step challenging;however,during embryonic development,the artery and its branches have a simpler relationship.By restoring the embryonic hepatic artery anatomy,surgeons can reduce the risk of damage and increase the procedure's success rate.This approach can lead to improved patient outcomes and lower complication rates.CASE SUMMARY In this study,we report a case of donor liver preparation using a donor hepatic artery preparation based on human embryology.During the preparation of the hepatic artery,we restored the anatomy of the celiac trunk,superior mesenteric artery,and their branches to the state of the embryo at 5 wk.This allowed us to dissect the variant hepatic artery from the superior mesenteric artery and left gastric artery during the operation.After implanting the donor liver into the recipient,we observed normal blood flow in the donor hepatic artery,main hepatic artery,and variant hepatic artery,without any leakage.CONCLUSION Donor hepatic artery preparation based on human embryology can help reduce the incidence of donor hepatic artery injuries during liver transplantation.

Surgical treatment of abnormal systemic artery to the left lower lobe: A case report

BACKGROUND Abnormal systemic artery to the left lower lobe is a rare congenital abnormality characterized by anomalous communication between the systemic and pulmonary circulation.Owing to its rarity,there is limited clinical experience with respect to the diagnosis and treatment of this disease.CASE SUMMARY We report a 60-year-old man who presented with a history of hemoptysis for 20 d.Contrast-enhanced computed tomography of the chest confirmed the diagnosis of abnormal systemic artery to the left lower lobe,and surgical treatment was performed.The aberrant artery arising from the descending thoracic aorta was ligated,followed by removal of the left lower lobe.The patient showed good recovery and was discharged 6 d after the surgery.At the 1-year follow-up,the patient had recovered completely,and lung CT showed no abnormal findings.CONCLUSION We present a case of abnormal systemic artery to the left lower lobe that was successfully managed by surgical resection of the aberrant artery and the left lower lobe.This case report adds to the clinical experience of diagnosing and treating this rare entity.

Evaluation of renal artery stenosis using color Doppler sonography in young patients with multiple renal arteries

Background Some individuals have multiple renal arteries. Severe stenosis in one of the arteries may cause refractory hypertension. The detection of stenosis within one of the multiple renal arteries usually required invasive procedures, such as computed tomographic angiography （CTA） and magnetic resonance angiography （MRA）. This study reported the application of color Doppler sonography （CDS） in the detection of severe stenosis in one of the multiple arteries. Methods Patients with multiple renal arteries and one of the arteries with severe stenosis were retrospectively studied. Peak systolic velocities （PSV） of renal arteries and the intrarenal CDS patterns were collected and compared. The diagnosis was confirmed by digital subtraction angiography （DSA）. Results Four children with multiple renal arteries and one of the arteries with stenosis were investigated. They were admitted due to refractory hypertension. CDS screening identified two renal arteries in one kidney of each patient with one of the two renal arteries having stenosis 〉70%. The PSV of the stenosed arteries were much higher, and the intrarenal CDS patterns supplied by the stenosed arteries changed into T-P patterns. Conclusion Non-invasive CDS technology may be a useful method to identify severe stenosis in one of multiple renal arteries in younq patients.