Vazoactive Effects of Oxidative Stress Elicited by Hydrogen Peroxide in the Human Umbilical Artery: An <i>in Vitro</i>Study

The vasoactive effects of oxidative stress induced by hydrogen peroxide (H2O2) on human umbilical artery strips as well as the possible mechanisms involved are studied. Contraction responses to cumulative H2O2 (10–7 M-3 × 10–2 M) in endothelium intact and denuded umbilical arteries and responses to cumulative H2O2 after incubation with L-NAME (10–4 M) (n = 8), indomethacin (10–5 M) (n = 8) and verapamil (10–6) (n = 8) were recorded. Responses elicited with cumulative H2O2 in Ca2+ free extracellular medium and the responses to cumulative Ca2+ (10–4 M-2 × 10–3 M) after H2O2 (10–3 M) induced contraction were also studied. The Emax for each experiment was calculated. p 2O2 elicited contraction was greater in endothelium denuded artery strips compared to endothelium intact strips (p 2O2 (p 2+ free extracellular medium caused decreases in cumulative H2O2 elicited contractions and cumulative Ca2+ caused concentration dependent increases in the contraction caused by a single bolus of H2O2 (p 2O2 causes concentration-dependent constriction in human umbilical arteries. The presence of the endothelium and NOS enzyme activation influences the H2O2 responses. Removal of the endothelium increases the H2O2 elicited contractions more than incubation with L-NAME suggesting beside NO, other endothelial vasodilators are also involved in vascular tonus of the umbilical arteries. Both intracellular and extracellular Ca2+ ions and constrictor cyclooxygenase metabolites play a role in the contractile responses elicited by H2O2 in human umbilical arteries.

Coronary artery disease in congenital single coronary artery in adults:A Dutch case series

AIM:To assess the current diagnostic and therapeutic management and the clinical implications of congenital single coronary artery(SCA) in adults.METHODS:We identified 15 patients with a SCA detected from four Dutch angiography centers in the period between 2010 and 2013.Symptomatic patients who underwent routine diagnostic coronary angiography(CAG) for suspected coronary artery disease and who incidentally were found to have isolated SCA were analyzed.RESULTS:Fifteen(7 females) with a mean age of 58.5 ± 13.78 years(range 43-86) had a SCA.ConventionalCAG demonstrated congenital isolated SCA originating as a single ostium from the right sinus of Valsalva in 6 patients and originating from the left in 9 patients.Minimal to moderate coronary atherosclerotic changes were found in 4,and severe stenotic lesions in another 4 patients.Seven patients were free of coronary atherosclerosis.Runs of non-sustained ventricular tachycardia were documented in 2 patients,one of whom demonstrated transmural ischemic changes on presentation.Myocardial perfusion scintigraphic evidence of transmural myocardial ischemia was found in 1 patient due to kinking and squeezing of the SCA with an interarterial course between the aorta and pulmonary artery.Multi-slice computed tomography(MSCT) was helpful to delineate the course of the anomalous artery relative to the aorta and pulmonary artery.Percutaneous coronary intervention was successfully performed in 3 patients.Eight patients were managed medically.Arterial bypass graft was performed in 4 patients with the squeezed SCA.CONCLUSION:SCA may be associated with transient transmural myocardial ischemia and aborted sudden death in the absence of coronary atherosclerosis.The availability and sophistication of MSCT facilitates the delineation of the course of a SCA.We present a Dutch case series and review of the literature.

Viscoelastic evaluation of fetal umbilical vein for reconstruction of middle cerebral artery

The transplantation of artificial blood vessels with 〈 6 mm inner diameter as substitutes for human arterioles or veins has not achieved satisfactory results. Umbilical vein has been substituted for ar- tery in vascular transplantation, but it remains unclear whether the stress relaxation and creep be- tween these vessels are consistent. In this study, we used the fetal umbilical vein and middle cere- bral artery from adult male cadavers to make specimens 15 mm in length, 0.196-0.268 mm in tu- nica media thickness, and 2.82-2.96 mm in outer diameter. The results demonstrated that the stress decrease at 7 200 seconds was similar between the middle cerebral artery and fetal umbilical vein specimens, regardless of initial stress of 18.7 kPa or 22.5 kPa. However, the strain increase at 7 200 seconds of fetal umbilical veins was larger than that of middle cerebral arteries. Moreover, the stress relaxation experiment showed that the stress decrease at 7 200 seconds of the fetal umbilical vein and middle cerebral artery specimens under 22.5 kPa initial stress was less than the decrease in these specimens under 18.7 kPa initial stress. These results indicate that the fetal umbilical vein has appropriate stress relaxation and creep properties for transplantation. These properties are advantageous for vascular reconstruction, indicating that the fetal umbilical vein can be transplanted to repair middle cerebral artery injury.

Study of the mechanisms regulating human umbilical artery contractility

We studied the involvement of different types of Ca2+ channels, cyclic nucleotides and different kinases in the regulation of human umbilical artery (HUA) contractility. The elucidation of the precise mechanisms regulating the contractility of this artery could be very important to reveal potential therapeutic targets to treat HUA disorders such as preeclampsia. The relevancy of different types of Ca2+ channels on the regulation of HUA tonus was analyzed. Among the different Ca2+ channel inhibitors used, only the L-type calcium channels (LTCC) inhibition induced relaxation of HUA in Ca2+ containing medium. The inhibition of T-type calcium channels (TTCC) or TRP channels did not significantly affect HUA contractility. In presence of Ca2+, the intracellular increase of a cyclic nucleotide (cAMP or cGMP) induces relaxation of HUA, which was almost complete in histamine-con- tracted HUA, and lower effect was observed in arteries contracted by KCl and serotonin (5-HT). Inhibition of PKA and PKG weakly reduced the relaxations induced by the increase of cAMP and cGMP respectively, suggesting that the relaxation induced by these nucleotides is not totally mediated by the activation of their respective kinases and that other mechanisms are involved. In calcium containing solution, PP2A inhibition produces relaxation of contracted HUA. In KCl contracted arteries, the OA and nifedipine relaxant effects are similar and not additive, suggesting that PP2A could activate LTCC. Besides, the increase of cyclic nucleotides significantly increased the OA effect, suggesting that the effect of PP2A inhibition is independent of the cyclic nucleotide pathways. The contractions induced by KCl, histamine and 5-HT in presence of Ca2+ were not significantly affected by ROCK, ERK1/2 or p38MAPK inhibitors. In absence of extracellular Ca2+, histamine and 5-HT elicited contractions of HUA characterized by two components, a rapid phasic contractile component followed by a decrease of the contraction until a tonic component. However, KCl elicited sustained contractions of HUA in absence of extracellular Ca2+. As in presence of calcium, the ERK1/2 and p38MAPK inhibitors did not influence the contractions induced by KCl, histamine or 5-HT in absence of extracellular Ca2+. However, in these conditions, ROCK inhibition significantly relaxed the contractions induced by KCl and reduced the phasic and tonic components of the contraction elicited either by histamine or 5-HT. Our results show that calcium-dependent contractions of HUA depend on Ca2+ entry by LTCC, and these chan- nels seems to be positive regulated by PP2A. Cyclic nucleotides mediate HUA vasodilatation but their dependent kinases are not the unique responsible of this effect. HUA is able to contract independently of Ca2+ influx by activating the ROCK pathway and/or due to intracellular Ca2+ release.

Correlation between ductus venosus spectrum and right ventricular diastolic function in isolated single-umbilical-artery foetus and normal foetus in third trimester

BACKGROUND Single umbilical artery(SUA)is the most common umbilical cord malformation in prenatal diagnosis.The presence of an SUA can cause blood circulation disorder in the foetus and functional changes of the foetal heart,affecting foetal circulation.The right ventricular diastolic functions in foetuses with isolated SUA and in normal foetuses in the third trimester were evaluated using the spectral Doppler of blood flow in the foetal ductus venosus(DV).AIM To evaluate the right ventricular diastolic functions in foetuses with isolated SUA and in normal foetuses in the third trimester.METHODS Colour Doppler was used to measure the spectrum of foetal DV and tricuspid orifice in 34 foetuses with isolated SUA aged 28-39 wk and in age-matched healthy controls.The DV flow velocities and velocity ratios were measured.The early passive/late active(E/A)ratio at the tricuspid orifice and tissue Doppler Tei index of the foetal right ventricular in the two groups were also measured.RESULTS During the third trimester,the isolated SUA group showed a lower‘a’-wave peak velocity in the DV than the control group(P<0.05).The correlations between the velocity ratios and E/A ratio at the tricuspid orifice in the two groups were analysed,and the correlation between the ventricular late diastolic velocity/ventricular diastolic peak flow velocity and E/A ratios was the best(R^2of the isolated SUA group:0.520;R2 of the control group:0.358).The correlations between the velocity ratios and tissue Doppler Tei index of foetal right ventricular in the two groups were analysed,and the correlation between the pulsatility index for veins(PIV)and tissue Doppler Tei index ratios was the best(R2 of the isolated SUA group:0.865;R2 of the control group:0.627).CONCLUSION In the isolated SUA group,the atrial systolic peak velocity‘a’decreased,and this finding might be related to the changes in foetal cardiac functions.The ratio of ventricular late diastolic velocity to ventricular diastolic peak flow velocity was closely related to the E/A ratio at the tricuspid valve and can be used to identify changes in the right ventricular diastolic functions of isolated SUA and healthy foetuses.PIV was closely related to the tissue Doppler Tei index of the foetal right ventricular and can be used to identify the right ventricular overall functions of isolated SUA and healthy foetuses.

Percutaneous coronary intervention for ostial lesions of the left main stem in a patient with congenital single left coronary artery: A case report

BACKGROUND Single coronary artery(SCA)originating from a solitary ostium in the aorta and perfusing the entire myocardium is a very rare congenital anomaly of the coronary artery.Furthermore,a right coronary artery(RCA)arising from the mid segment of the left anterior descending artery(LAD)is an extremely uncommon variation of SCA.CASE SUMMARY A 76-year-old woman presented a 5-mo history of exertional angina.Selective coronary angiography revealed an SCA,with severe ostial stenosis that originated from the left sinus of Valsalva and bifurcated normally into the LAD and circumflex coronary artery.In addition,an anomalous RCA originated from the mid segment of the LAD as a separate branch.Successful balloon angioplasty and stenting for the SCA ostial stenosis were performed on the patient.CONCLUSION Percutaneous coronary intervention(PCI)of the main trunk for SCA is very similar to PCI of an unprotected left main coronary artery.Although technical difficulties and risks do exist,PCI for severe ostial stenosis of the main trunk is safe and efficacious in selected SCA patients.

Ultrasound blood flow characteristics changes in fetal umbilical artery thrombosis:A retrospective analysis

BACKGROUND Umbilical artery thrombosis(UAT)is extremely uncommon and leads to adverse perinatal outcomes.Hypercoagulation of blood in pregnant women is suspected to be an important risk for UAT.Ultrasound is an effective way to detect thrombosis.The mother can monitor her own fetal health using ultrasound,which enables her to take preventative action in case of emergency.AIM To investigate ultrasonic blood signal after UAT in the umbilical artery,and evaluate the relationship between hypercoagulability and UAT.METHODS We described a case of a newly formed UAT with markedly altered ultrasonic indices of umbilical artery blood flow,and retrospectively studied it with 18 UAT patients confirmed by histopathology from October 2019 and March 2023 in Xiamen Women and Children's Hospital.Patients’information was collected from medical archives,including maternal clinical data,neonatal outcomes,pathological findings and ultrasonic indices of umbilical artery blood flow,such as systolic-diastolic duration ratio(S/D),resistance index(RI),pulsatility index(PI)and peak systolic velocity(PSV).Ultrasound and coagulation indices were analyzed with matched samples t-test and Wilcoxon rank sum test using the statistical packages in R(version 4.2.1)including car(version 3.1-0)and stats(version 4.2.1),and visualized by ggplot2 package(version 3.3.6).RESULTS A patient with normal findings in second and third-trimester routine ultrasound scan developed UAT with severe changes in ultrasonic indices of umbilical artery blood flow(within 2.5th of reference ranges)in a short period of time.Statistical analysis of umbilical artery blood flow ultrasound indices for 19 patients with UAT showed that the decrease in S/D,RI,and PI and increase of PSV during the disease process was greater than that of non-UAT.All 18 patients delivered in our hospital showed characteristic manifestations of UAT on histological examination after delivery,most of which(16/18)showed umbilical cord abnormalities,with 15 umbilical cord torsion and 1 pseudoknot.Coagulation parameters were not significantly changed in UAT patients compared with normal pregnancy women.CONCLUSION Significant changes in ultrasound indicators after UAT were demonstrated.PSV can play important roles in the diagnosis of UAT.Hypercoagulability alone is not sufficient for the occurrence of UAT.

Fetal umbilical vein transplantation for the repair of middle cerebral artery injury

It is necessary to investigate the longitudinal tensile mechanical characteristics of the middle cere- bral artery and the fetal umbilical vein prior to applying fetal umbilical vein transplantation for repair of injured middle cerebral artery. Fifteen fresh fetal umbilical vein specimens and 15 normal human fresh cadaver middle cerebral artery specimens were collected for longitudinal tensile testing at the speed of 0.5 mm/min and at normal human temperature. The results showed that under 16.0 kPa physiological stress, the strain value of fetal umbilical vein specimens was larger, while the maximal stress and elastic modulus values were less than those of middle cerebral artery specimens. Our findings indicate that fetal umbilical vein has good elastic properties and the stress-strain curve of the fetal umbilical vein is similar to that of the middle cerebral artery. Fetal umbilical vein transplan- tation can, therefore, potentially repair the injured middle cerebral artery.

Correlation between the umbilical artery flow ultrasound parameters of intrauterine fetal distress and fetal ischemic hypoxic damage

Objective: To study the correlation between the umbilical artery flow ultrasound parameters of intrauterine fetal distress and fetal ischemic hypoxic damage. Methods: A total of 158 puerperae who gave birth in our hospital between July 2016 and June 2017 were selected and divided into the intrauterine distress group (Apgar<7 points) and normal pregnancy group (Apgar≥7 points) according to the neonatal Apgar score, the umbilical artery flow ultrasound parameters at 24-30 weeks, 31-36 weeks and 37-41 weeks of gestation were determined, and the umbilical arterial blood gas parameters and oxidative stress molecule levels were determined. Results: At 24-30 weeks, 31-36 weeks and 37-41 weeks of gestation, umbilical arterial RI, PI and S/D of intrauterine distress group were significantly higher than those of normal pregnancy group;umbilical arterial pH and PaO2 of intrauterine distress group were significantly lower than those of normal pregnancy group and negatively correlated with RI, PI and S/D while PaCO2 and lactic acid levels were significantly higher than those of normal pregnancy group and positively correlated with RI, PI and S/D;SOD, GSH-px and CAT levels in umbilical artery of intrauterine distress group were significantly lower than those of normal pregnancy group and negatively correlated with RI, PI and S/D while MDA and 8-OHdG levels were significantly higher than those of normal pregnancy group and positively correlated with RI, PI and S/D. Conclusion: Umbilical artery flow ultrasound characteristics of intrauterine fetal distress are characterized by the increased resistance and decreased blood flow and are correlated with the degree of fetal hypoxia and oxidative stress.

Predicting obstetric outcomes of advanced maternal age through determination of hemodynamics of uterine artery, umbilical artery and fetal cerebral middle artery

Objective: The purpose of this study was to investigate the relationship between pregnancy outcome in older pregnant women and the uterine artery and fetal hemodynamic parameters in the third trimester. Methods: Randomized selection of 100 patients in our hospital delivery and late pregnancy monitoring of uterine artery and fetal hemodynamics in patients. (1) There were compared and analyzed the hemodynamic parameters (PSV, EDV, RI, PI, S/D) of the uterine artery, umbilical artery and fetal middle cerebral artery in the third trimester between 36 elderly patients with normal pregnancy outcome (≥35 years old, observation group) and 32 patients with normal age of normal pregnancy (<35 years old, control group). (2) There were compared and analyzed the hemodynamic parameters of the uterine artery, umbilical artery and fetal middle cerebral artery in the third trimester between 32 elderly patients with abnormal pregnancy outcome and 36 elderly patients with normal pregnancy outcome. Results: (1) Normal pregnancy outcomes in different age groups, the hemodynamic parameters of uterine artery, umbilical artery and fetal middle cerebral artery were not significantly different. (2) The high age group had different pregnancy outcomes,Fetal middle cerebral artery PI was statistically significant, there was no significant difference in Uterine artery and umbilical artery of the hemodynamic parameters. Conclusion: Color Doppler ultrasonography to evaluate the PI value of fetal middle cerebral artery in older pregnant women has a certain reference value to judge whether there is hypoxia and distress and neonatal prognosis in the fetus, and to provide some reference information for clinicians to predict the pregnancy outcome of the older pregnant women.

Pulsed Umbilical Artery Doppler Ultrasound Findings in Management of High-Risk Term Pregnant Women during Labour

Purpose: Intrapartum Doppler velocimetry is a non-invasive investigation method. This method is useful for evaluating the pathophysiological mechanisms underlying changes in fetal heart rate. This study aimed to determine the usefulness of Doppler ultrasound findings during labor in high-risk women on determining the mode of delivery and outcome of the newborn. Methods: A cross-sectional study was conducted from January 1, 2015 to December 31, 2015 on 100 high-risk pregnant women during labor. The study was performed in the Maternity Teaching Hospital in Erbil City, Kurdistan Region, Iraq. Results: The majority of women (77%) had a normal end-diastolic blood flow pattern through the umbilical artery. A total of 76.9% of those with abnormal Doppler results had a Cesarean delivery compared with only 9.5% of those with normal Doppler results (p p p = 0.07) and fifth minutes (p = 0.01). Conclusions: Abnormal umbilical artery Doppler ultrasound findings in high-risk pregnancies for women in labor are associated with increased rates of emergency cesarean sections and a poor outcome of the newborn.

Evaluation of revascularization after total arch replacement in common carotid artery occlusion

Occlusion of the common carotid artery(CCA) is rare. CCA occlusion(CCAO) can present as drowsiness and right hemiplegia related to emboli after total arch replacement. Although we selected a follow-up at first because color duplex sonography showed retrograde flow from the left external carotid artery to the internal carotid artery, this patient had epilepsy and single-photon emission computed tomography(SPECT) acquired quantitative results of actual brain perfusion and showed insufficient collateral blood flow. To improve brain perfusion, we performed a bypass of the left subclavian artery to left CCA bypass. Postoperatively, the patient did not have epilepsy and drowsiness. Also, right hemiplegia improved enough for him to walk with support. SPECT showed increased left cerebral flow(the asymmetry ratio was 71% to 81%). Evaluation of the carotid artery with color duplex sonography alone was insufficient when CCAO showed retrograde or collateral flow. We should have performed quantitative evaluation with SPECT at the same time.

Study on the uterine artery and fetal umbilical artery hemodynamics in patients with HDP

Objective:To explore the uterine artery and fetal umbilical artery hemodynamic change in patients with HDP.Methods:A total of 80 patients with HDP who came to our hospital from July, 2015 to July, 2016 for pregnancy examination were included in the study and served as the observation group, while 80 healthy pregnant women who came for pregnancy examination in the same period were served as the control group. The pregnant women in the two groups were performed with sequential color Doppler ultrasound at gestation 30-40 weeks. The two-dimensional ultrasound apparatus was used to detect the uterine artery and umbilical artery. PI, RI, and S/D were recorded. The fetal BPD, head girth, femur length, and abdominal girth were measured. ELISA was used to detect 8-iso-PGF2α. The immunoturbidimetry was used to detect Cys-C and CRP.Results:The uterine artery PI, RI, and S/D in the observation group were significantly higher than those in the control group. The umbilical artery PI, RI, and S/D in the observation group were significantly higher than those in the control group. The fetal BPD, head girth, femur length, and abdominal girth in the observation group were significantly less than those in the control group. 8-iso-PGF2α, Cys C, and CRP levels in the observation group were significantly higher than those in the control group.Conclusions:The uterine artery and umbilical artery blood flow resistance in patients with HDP are significantly elevated, which can severely affect the placental blood perfusion and fetal growth and development, while the color Doppler ultrasound can provide a non-invasive diagnosis for fetal distress in uterus.

Challenging situation of coronary artery anomaly associated with ischemia and/or risk of sudden death

Coronary artery anomaly is known as one of the causes of angina pectoris and sudden death and is an important clinical entity that cannot be overlooked.The incidence of coronary artery anomalies is as low as 1%-2%of the general population,even when the various types are combined.Coronary anomalies are practically challenging when the left and right coronary ostium are not found around their normal positions during coronary angiography with a catheter.If there is atherosclerotic stenosis of the coronary artery with an anomaly and percutaneous coronary intervention(PCI)is required,the suitability of the guiding catheter at the entrance and the adequate back up force of the guiding catheter are issues.The level of PCI risk itself should also be considered on a caseby-case basis.In this case,emission computed tomography in the R-1 subtype single coronary artery proved that ischemia occurred in an area where the coronary artery was not visible to the naked eye.Meticulous follow-up would be crucial,because sudden death may occur in single coronary arteries.To prevent atherosclerosis with full efforts is also important,as the authors indicated admirably.

Association of G-protein coupled purinergic receptor P2Y2 with ischemic stroke in a Han Chinese population of North China

The G-protein-coupled purinergic receptor P2Y2(P2RY2) plays an important role in the mechanism of atherosclerosis, which is relevant to ischemic stroke. This retrospective case-control study aimed to assess the relationship between P2RY2 gene polymorphisms and ischemic stroke risk in the northern Han Chinese population. In this study, clinical data and peripheral blood specimens were collected from 378 ischemic stroke patients and 344 controls. The ischemic stroke participants were recruited from the First Affiliated Hospital of China Medical University and the First Affiliated Hospital of Liaoning Medical University. The controls were recruited from the Health Check Center at the First Affiliated Hospital of China Medical University. Ischemic stroke patients were divided into two subgroups according to the Trial of ORG 10172 in Acute Stroke Treatment(TOAST) classification: large-artery atherosclerosis(n = 178) and small-artery occlusion(n = 200) strokes. All subjects were genotyped for three single nucleotide polymorphisms(rs4944831, rs1783596, and rs4944832) in the P2RY2 gene using peripheral venous blood samples. The distribution of the dominant rs4944832 phenotype(GG vs. GA+AA) differed significantly between small-artery occlusion patients and control subjects(odds ratio(OR) = 1.720, 95% confidence interval(CI): 1.203–2.458, P < 0.01). Multivariable logistic regression analysis revealed that the GG genotype of rs4944832 was significantly more prevalent in small-artery occlusion patients than in control subjects(OR = 1.807, 95% CI: 1.215–2.687, P < 0.01). The overall distribution of the haplotype established by rs4944831-rs1783596-rs4944832 was significantly different between ischemic stroke patients and controls(P < 0.01). In ischemic stroke patients, the frequency of the G-C-G haplotype was significantly higher than in control subjects(P = 0.028), whereas the frequency of the T-C-A haplotype was lower than in control subjects(P = 0.047). These results indicate that the G-C-G haplotype of P2RY2 is a susceptibility haplotype for ischemic stroke. In addition, the GG genotype of rs4944832 may be associated with the development of small-artery occlusion in the northern Han Chinese population. The study protocol was approved by the Ethics Committee of the First Affiliated Hospital of China Medical University on February 20, 2012(No. 2012-38-1) and the First Affiliated Hospital of Liaoning Medical University, China, on March 1, 2013(No. 2013-03-1). All participants gave their informed consent. This trial was registered with the ISRCTN Registry(ISRCTN11439124) on October 24, 2018. Protocol version(1.0).

Evaluation of changes of intracranial blood flow after carotid artery stenting using digital subtraction angiography flow assessment

AIM: To evaluate the changes of intracranial blood flow after carotid artery stenting(CAS), using the flow assessment application "Flow-Insight", which was developed in our department.METHODS: Twenty patients treated by CAS participated in this study. We analyzed the change in concentration of the contrast media at the anterior-posterior and profile view image with the flow assessment application "Flow-Insight". And we compared the results with N-isopropyl-p-[123I] iodoamphetamine-single-photon emission computed tomography(IMP SPECT) performed before and after the treatment. RESULTS: From this study, 200% of the parameter "blood flow" change in the post/pre-treatment is suggested as the critical line of the hyperperfusion syndrome arise. Although the observed blood flow increase in the digital subtraction angiography system did not strongly correlate with the rate of increase of SPECT, the "Flow-Insight" reflected the rate of change of the vessels well. However, for patients with reduced reserve blood flow before CAS, a highly elevated site was in agreement with the site analysis results. CONCLUSION: We concluded that the cerebral angiography flow assessment application was able to more finely reveal hyperperfusion regions in the brain after CAS compared to SPECT.

R-I subtype single right coronary artery with congenital absence of left coronary system: A case report

BACKGROUND Isolated single coronary artery is a rare congenital anomaly.R-I subtype single coronary artery is even rarer.In this subtype,a very large right coronary artery extends in the coronary sulcus to the anterior base of the heart where it produces the left anterior descending coronary artery.Currently,only a few case reports are available in the literature for this anomaly.CASE SUMMARY Here,we report the case of a 62-year-old woman who presented to the cardiology clinic with decreased exercise tolerance and poor blood pressure control.The patient underwent coronary angiography(CAG)and emission computed tomography(ECT).CAG images revealed a single gigantic right coronary artery(R-I type)arising from the right coronary sinus with branches supplying the left coronary territory.The ECT results confirmed myocardial ischemia at the location of the absent left coronary artery.The ECT findings confirmed that ischemia was consistent with the vascular loss location in CAG images.In such anomalies,there is a compensatory widening of the coronary artery lumen.Medical treatment was administered,and the patient was discharged.CONCLUSION Isolated single coronary arteries are associated with ischemia and potentially fatal acute coronary events.Hence,controlling risk factors is critical.

Single organ hepatic artery vasculitis as an unusual cause of epigastric pain:A case report

BACKGROUND Single-organ vasculitis(SOV)is characterized by inflammation of a blood vessel,affecting one organ,such as the skin,genitourinary system,or the aorta without systemic features.Gastrointestinal SOV is rare,with hepatic artery involvement reported only in two prior published cases.Herein,we presented a case of isolated hepatic artery vasculitis presenting after Pfizer-BioNTech mRNA corona virus disease 2019(COVID-19)vaccination.CASE SUMMARY A 50-year-old woman with hypertension presented to our Emergency Department with recurrent diffuse abdominal pain that localized to the epigastrium and emesis without diarrhea that began eight days after the second dose of the PfizerBioNTech COVID-19 vaccine.Blood work revealed an elevated C-reactive protein(CRP)of 19 mg/L(normal<4.8 mg/L),alkaline phosphatase 150 U/L(normal 25-105 U/L),gamma-glutamyl transferase(GGT)45 U/L(normal<43 U/L)and elevated immunoglobulins(Ig)G 18.4 g/L(normal 7-16 g/L)and IgA 4.4 g/L(normal 0.7-4 g/L).An abdominal computed tomography revealed findings in keeping with hepatic artery vasculitis.A detailed review of her history and examination did not reveal infectious or systemic autoimmune causes of her presentation.An extensive autoimmune panel was unremarkable.COVID-19polymerase chain reaction nasopharyngeal swab,human immunodeficiency virus,viral hepatitis and Heliobacter pylori serology were negative.At six months,the patient’s symptoms,and blood work spontaneously normalized.CONCLUSION High clinical suspicion of SOV is required for diagnosis in patients with acute abdominal pain and dyspepsia.

Postnatal development of fetuses with a single umbilical artery:differences between malformed and non-malformed infants

Background:The presence of a single umbilical artery(SUA)is a fetal soft marker of congenital abnormalities.Among the most common related malformations,there are cardiological,nephrourological and digestive anomalies,most of which are considered to have a vascular etiology.There is an association between increased incidence of intrauterine growth retardation and adverse perinatal indicators,but whether this association is due to related anomalies or isolated SUA(SUA)is controvisal.Methods:We reviewed 96 cases of iSUA and non-isolated SUA(niSUA),diagnosed in a period of two years in a referral hospital for high-risk pregnancies.Data on prenatal explorations,including fetal ultrasonography and karyotyping,were obtained.niSUA was diagnosed when no malformations were found prenatally or in postnatal evaluation.Results:Sixty-six newborns(68.8%)had no other anomalies and 30(31.3%)presented with a variety of malformations including heart diseases,urophaties,digestive,nervous and musculoskeletal disorders,genetic abnormalities and complex malformations.Cardiological and nephrourological abnormalities were found to be the most frequent association with a SUA(both in 23.8%of malformed SUA newborns).Intrauterine growth restriction was not higher in iSUA newborns than in a normal population.Utrasound allowed optimal prenatal diagnosis in most cases.Conclusions:The prognosis of the fetus with a SUA is determined by the presence of other malformations observed by an expert sonographer.If no other findings are made,only a routine physical examination should be performed in newborns,but no other complementary examinations are required.

Shengmai Suppressed Vascular Tension in Umbilical Arteries and Veins of Human and Sheep

Objective—The umbilical cord is a critical pathway between mothers and fetuses, and regulations of umbilical vessel tension are important for fetal growth. Shengmai is an herbal medicine being used in treatments of cardiovascular diseases. However, effects of Shengmai on human blood vessels and related pharmacological mechanisms are unclear. Methods—This study investigated the effects of related mechanisms of Shengmai and its key compounds on human and sheep umbilical arteries and veins using organ bath systems. Key Findings—Shengmai significantly suppressed phenylephrine-stimulated vasoconstriction in umbilical arteries and veins. NG-Nitro-L-arginine Methyl Estercould not change the Shengmai-suppressed vasoconstriction in human and sheep umbilical vessels. Among four key compounds of Shengmai, Ginsenoside Re, Ginsenoside Rb1, Ginsenoside Rg1, and Schisandrin, only Ginsenoside Re showed the significant effect similar to Shengmai’s in the umbilical vessels. In Ca2+-free solution, Ginsenoside Re did not affect vasoconstriction. In addition, caffeine- or phenylephrine-stimulated vasoconstriction were not changed by Ginsenoside Re. Either charybdotoxin or glibenclamide could inhibit Ginsenoside Re-caused inhibition of the stimulated vasoconstriction in both human and sheep umbilical vessels, where 4-aminopyridine did not show the similar inhibitory effect. Conclusion—The results provide new information on Shengmai’s effects and underlying mechanisms in umbilical vessels. Importantly, the information gained offers interesting potential for developing new drugs acting on umbilical cords for fetal medicine.