Objective: Compare the evolution regarding the complications concerning two types of incision (conventional x mini-incision), for saphenectomy in patients that go under myocardial revascularization or otherwise known as coronary artery bypass surgery. Methods: During the period from January 2012 to August 2013, 66 patients were prospectively selected for coronary artery bypass with cardiopulmonary bypass surgery. These were divided into two groups: Conventional and Mini-Incision, with 33 patients in each group chosen in a random fashion and with knowledge of which technique to be used being presented only at the start of the surgery. In the conventional group, the patients received an incision to the lower member of 7 to 10 centimeters. The patients in the Mini-Incision group received an incision to the lower member of 3 to 4 centimeters, both performed without the use of any special material for harvesting the saphenous vein. Results: The groups were similar in terms of clinical data and in the preoperative period. Males made up a greater part of the group with 63.7% and 81.9% in groups C and M, respectively. Among the complications of the analysed surgical areas, edema (p = 0.011), hematoma (p = 0.020), dehiscence (p = 0.012) and infection (p = 0.012), were significantly greater in group C when compared to group M. When the matter comes to the variable in relation to the risk of Surgical Site Infections (SSI), no significant difference was found between the groups. Conclusion: Coronary artery bypass surgery with mini-incision for saphenectomy, demonstrated a lower rate for preoperative complications, such as edema, hematoma, dehiscence and infection, when compared to saphenectomy under conventional incision procedures. / Objetivo: Comparar a evolução quanto às complicações de dois tipos de incisão (convencional X miniincisão) para safenectomia em pacientes que se submeteram à cirurgia de Revascularização do Miocárdio. Métodos: No período de janeiro de 2012 a agosto de 2013, 66 pacientes foram selecionados, prospectivamente, para cirurgia de revascularização do miocárdio com circulação extracorpórea. Estes foram distribuídos em dois grupos: Convencional e Miniincisão, com 33 pacientes em cada grupo de forma randomizada e conhecimento da técnica apenas no início da cirurgia. No grupo Convencional, os pacientes receberam uma incisão no membro inferior de 7 a 10 centímetros. Os pacientes do grupo Miniincisão receberam uma incisão no membro inferior de 3 a 4 centímetros, ambos sem o uso de material especial para a colheita da veia safena. Resultados: Os grupos eram semelhantes quanto aos dados clínicos de pré-operatório. Houve predominância do sexo masculino, 63,7% e 81,9% nos grupos C e M respectivamente. Dentre as complicações do sítio cirúrgico analisadas, o edema (p = 0,011), hematoma (p = 0,020), deiscência (p = 0,012) e infecção (p = 0,012), foram significativamente maiores no grupo C comparado com o grupo M. Quando tratamos a variável infecção em relação ao Índice de Risco para Infecção Cirúrgica (IRIC), não houve diferença significante entre os grupos. Conclusão: A cirurgia de revascularização do miocárdio com miniincisão para safenectomia demonstrou um menor índice de complicações pós-operatórias como edema, hematoma, deiscência e infecção quando comparado com a safenectomia com incisão convencional. / Mestre em Ciências da Saúde

A revascularização cardíaca utilizando a ponte de safena é um procedimento bastante utilizado para restabelecer o fluxo coronariano. Apesar do sucesso deste procedimento, a patência deste enxerto pode chegar a menos de 50% em 10 anos. Atribui-se parte deste insucesso a variações no processo adaptativo à nova condição hemodinâmica, onde o shear stress e o estiramento aumentados podem estar interferindo na função endotelial e vascular. Este processo envolve a participação de diversas proteínas e o estudo de como elas participam conjuntamente é uma importante abordagem para entender as alterações fisiológicas e patológicas que ocorrem no enxerto vascular. Neste trabalho, tecnologias proteômicas, gel 2-D e ICAT, foram utilizadas para identificar as proteínas que são modificadas nas fases precoces da arterialização do enxerto venoso. Foi utilizado um sistema ex vivo de perfusão controlada, desenvolvido em nosso laboratório, onde a veia safena humana foi cultivada tanto em regime hemodinâmico venoso (5 mL/min) e arterial (50 mL/min, 80 mmHg) por 24 horas. Dentre as proteínas identificadas, a maioria apresenta funções estruturais como, por exemplo, -actina de músculo liso, CRP1, colágeno VI, tropomiosina, miosina, desmina e vimentina. Para avaliação funcional foram selecionadas a -SMA e a CRP. A -SMA mostrou-se diminuída nas fases mais precoces da arterialização venosa, com quase desaparecimento após 3 dias da cirurgia, seguido de um aumento nos períodos subseqüentes. A CRP3 mostrou-se com expressão predominantemente arterial tanto em amostra humana como de rato. A arterialização de segmentos venosos induziu a expressão da CRP3, sendo dependente do aumento do estiramento (stretch) nas células musculares lisas e não do aumento do shear stress na superfície endotelial. Coletivamente, neste trabalho caracterizamos duas proteínas que foram modificadas durante o processo de arterialização e/ou adaptação da veia à condição hemodinâmica arterial. As proteínas identificadas contribuirão para o melhor entendimento do processo de arterialização venosa e poderão ser testadas como novos alvos terapêuticos para melhorar a patência destes enxertos / Coronary artery bypass surgery by saphenous vein graft is still widely used to revascularization of ischemic heart. Despite the success of this procedure, about 50% occlude after 5-10 years. The vein graft is subjected to increased tensile stress and the adaptive vein response to the arterial hemodynamic condition may predispose to bypass occlusion. Several proteins are modulated during arterialization, the understanding of the molecular changes of this process may be useful to new therapeutics approaches development attempting to increase vein graft patency. In this work, proteomics plataform, gel 2-D and ICAT, were used to identify the proteins that are modified in the early stages of vein graft rterialization. Human saphenous vein were cultured in an ex vivo flow through system in both venous (5 ml / min) and arterial (50 ml / min, 80 mm Hg) hemodymanic conditions for 24 hours. The identified proteins were related to cell structural function, such as -SMA, CRP1, collagen VI, tropomyosin, myosin, desmin and vimentin. To functional characterization, -SMA and CRP were selected. In rat vein arterialization model, - SMA showed to be decreased during the early stages of arterialization and almost disappeared after 3 days of surgery. Later on, -SMA-positive cells increase reaching similar expression levels of normal jugular vein. The expressiom of CRP3 showed to be predominantly to arterial beds both in human and rat. When vein segment were submitted to arterial hemodynamic condition, it was observed a significant induction of CRP3 expression. Interestingly, the increase of CRP3 is dependent of stretch stimulus in smooth muscle cells while shear stress did not modify its expression in endothelial cells. Collectively, we successfully identified proteins differentially expressed during the vein arterialization by using proteomic technique. -SMA and CRP3 were modified in vein segments exposed to arterial hemodynamic condition and efficiently discriminate smooth muscle cell phenotype. The identified proteins will contribute to the better understanding of the venous arterialization process and may be tested as new therapeutic targets for improving the patency these grafts

A revascularização cardíaca utilizando a ponte de safena é um procedimento bastante comum usado para restabelecer o fluxo coronariano. O sucesso do implante depende da adaptação do vaso que estava em um regime hemodinâmico venoso, e passa subitamente para um regime arterial. Durante este processo adaptativo, ocorrem diversas alterações moleculares cujo conhecimento pode fornecer alternativas de melhoramento da patência dos enxertos venosos em leito arterial. Neste trabalho está sendo investigada a regulação da IL-1beta tanto em veia safena humana como em modelo animal de arterialização venosa. A IL-1beta mostrou-se aumentada em veia safena humana arterializada tanto in vivo como ex vivo. Interessantemente, este aumento observado nos dias iniciais (1-5 dias) parece diminuir em tempos mais tardios (1-4 anos). Em modelo de arterialização de rato foi observado aumento de 12 vezes na expressão da IL-1beta após o primeiro dia de arterialização com diminuição posterior, mantendo-se em torno de 2 vezes maior em comparação a veia jugular normal. Além da regulação temporal da IL-1beta, foram também acompanhadas as alterações morfológicas que ocorrem durante o processo de arterialização venosa. Observou-se uma redução gradual de células musculares lisas (SMC) que quase desaparecem 3 dias após a cirurgia. Esta perda celular pode estar relacionada ao pico de apoptose observado já no primeiro dia de arterialização. Após 7 dias as SMC reaparecem, porém, de maneira ainda desorganizada. Concomitante com o reaparecimento das SMC observou-se progressivo espessamento da camada média, assim como surgimento de uma camada neoíntima. A IL-1beta, devido ao seu padrão de regulação assim como sua localização durante o processo de arterialização, pode estar relacionada com as alterações estruturais verificadas na arterialização do enxerto. Estratégias de intervenção modulando a atividade da IL-1beta poderão fornecer indicativos da sua participação no remodelamento do enxerto venoso. Em conjunto, demonstramos que o modelo de arterialização de segmento venoso em rato reproduz várias das alterações morfológicas descritas na doença do enxerto venoso em humanos e por isso será útil na caracterização de genes candidatos que participam deste processo. A IL-1beta tem sua expressão aumentada em segmento venoso arterializado in vivo e ex vivo, podendo representar um interessante alvo para aplicação de metodologias de intervenção visando influenciar a adaptação de enxertos venosos com finalidade terapêutica / The vein graft is subjected to increased tensile stress and the complex adaptive vein response to the arterial hemodynamic condition may predispose to bypass failure in some individuals. The understanding of molecular changes underlying this process may be useful for the development of novel therapeutical interventions to increase the vein graft patency. In this work, we investigated the early effect of arterialization on the expression of IL-1beta gene in human saphenous vein and the time-course regulation in rat arterialization model. IL-1beta is upregulated in early stage of human saphenous vein arterialization in vivo and ex vivo. This increase is also observed in arterialized rat jugular vein which showed IL-1beta expression 12 times higher on day 1 compared to normal jugular vein. Later, the IL-1beta levels decreases and maintain the level about twice above normal jugular vein. Moreover, it is observed gradual reduction of smooth muscle cells (SMC), which almost disappeared on the 3rd day after surgery. Apoptosis, which is markedly increased on the 1st day, appears to be an important event during this process. At the 7th day, cellular density and SMC proliferation gradually increased till the 90th day. There was a gradual thickening of the medial layer and formation of neointima with deposition of SMC in the subendotelial layer from day 7 on. Initially the medial layer appeared disorganized, day 7 to 14, then by day 28 it became more organized and the presence of an intimal layer with SMCs was evident. The neointimal layer increased gradually from day 7 on. These results provide evidence that the modulation of IL-1beta activity may be an interesting target to be explored I the future to increase the vein graft patency. Altogether, we demonstrate that the model of arterialization of venous segment in rat reproduces several of the morphological changes described in the venous graft disease in humans and thus will be useful in characterization of candidate genes involved in this process and testing them as a potential therapeutic targets. The IL-1beta expression is increased after 1 day of arterialization of vein segment in vivo and ex vivo and shall be an interesting target to be tested to influence the adaptation of venous grafts for therapeutic purpose

No / Human saphenous vein endothelial cells (HSVECs) derived from primary cultures of adult human veins constitute an excellent in vitro model for studying human endothelial metabolism. In this study we report the14C-labelled prostanoid profile of HSVECs under resting and stimulated conditions and the effect of the n-3 polyunsaturated fatty acids eicosapentaenoic acid and docosahexaenoic acid on them. Results indicate that HSVECs while under resting conditions produce mainly prostaglandin F2 ¿(PGF2 ¿). After stimulation with calcium ionophore A23187, the cells were found to synthesise PGI2, PGE2and PGF2¿as major products and thromboxane B2and PGD2as minor products. Production of14C-labelled hydroxyeicosatetraenoic acids was not detected. Eicosapentaenoic acid was found to inhibit basal and stimulated prostanoid production whereas docosahexaenoic acid inhibited basal but strongly increased stimulated prostanoid production. These results may offer the basis for further studies aiming to investigate targets for pharmacological intervention in inflammatory conditions.

Neointimal hyperplasia (NIH) is a cardiovascular disease characterised by increased smooth muscle cell (SMC) inflammation and proliferation. Suppressor of cytokine signalling 3 (SOCS3) limits Janus kinase (JAK)/signal transducer and activator of transcription (STAT) pathways involved in vascular remodelling but is limited by its short biological half-life. Therefore, mutation of all 9 Lys residues that are potential sites of ubiquitylation to Arg should produce a mutated SOCS3 resistant to ubiquitin-mediated proteasomal degradation (“Lys-less” SOCS3). This study hypothesise that enhancing SOCS3 stability and limiting JAK/STAT signalling may provide sustained inhibition of the vascular remodelling in NIH. Lentiviral transduction of WT and Lys-less SOCS3 in human saphenous vein (HSVSMCs) was highly efficient after 48 hours (>97%) and was sustained over 2 weeks. Lys-less SOCS3 was resistant to ubiquitylation contrary to WT-transduced HSVECs, and Lys-less SOCS3 was more stable (t1/2=4h) than WT (t1/2<4h) (n=6, P<0.001) in HSVSMCs. In HSVSMCs, both Lys-less SOCS3 and WT inhibited sIL-6Rα/IL-6 mediated STAT3 activation but not extracellular signal regulated protein kinase 1/2 (ERK1/2) by 80±7% (Lys-lessSOCS3/pSTAT3) and 74±6% (WT/pSTAT3) (n=3, P<0.05) and similarly inhibited PDGF-mediated STAT3 activation but not ERK1/2 by 67±17% (Lys-less SOCS3/pSTAT3) and 72±18% (WT/pSTAT3) (n=3, P<0.05). Functionally, Lys-less SOCS3 and WT were equivalent in inhibiting sIL-6Rα/IL-6 and PDGF-induced proliferation, whilst having no effects on PDGF-induced migration in HSVSMCs. Lys-less SOCS3 can be successfully transduced into primary HSVSMCs. It is more stable than WT yet retains its functional ability to ameliorate pro-inflammatory signalling and SMC proliferation, making it an attractive option for developing treatment of NIH. / University of Botswana

INTRODUCTION : Les greffons de veine saphène interne (GVS) sont encore régulièrement utilisés comme conduits en chirurgie de pontage aorto-coronarien (PAC). Les dommages subis par les segments de veine saphène pendant le prélèvement et le stockage favorisent une dysfonction endothéliale qui se manifeste par une diminution de la production d'oxyde nitrique et/ou par une augmentation du niveau de stress oxydant pouvant entraîner une défaillance du greffon veineux se traduisant par une occlusion. La solution saline héparinée est la solution de préservation de référence malgré plusieurs études démontrant ses effets néfastes sur les GVS. GALA est une solution de préservation de greffons autologues vasculaires spécialement développée pour préserver l'intégrité structurale et fonctionnelle de la couche endothéliale des greffons utilisés en chirurgie de pontages aorto-coronariens. OBJECTIF : Comparer la préservation de l'intégrité des fonctions endothéliales des greffons de veine saphène après le stockage dans la solution GALA versus dans la solution saline héparinée dans le cadre d’une étude contrôlée et randomisée en étudiant la réactivité vasculaire en chambres d’organes. RÉSULTATS : Les segments de GVS d'un total de quinze patients ont été obtenus et divisés en anneaux de 3 mm de largeur. Il n'y avait pas de différences significatives dans les niveaux de contraction en réponse au chlorure de potassium, à la phényléphrine, ni dans les concentrations de phényléphrine nécessaires pour atteindre le niveau de contraction cible entre les anneaux du groupe GALA versus le groupe de saline héparinée. Les courbes dose-réponse du groupe solution GALA ont démontré une amélioration significative des relaxations dépendantes de l'endothélium par rapport au groupe solution saline héparinée. Les contractions et relaxations indépendantes de l'endothélium induites respectivement par la phényléphrine et le nitroprussiate de sodium étaient similaires dans les anneaux de GVS des deux groupes. CONCLUSION : L’utilisation intra-opératoire d'une solution développée spécifiquement pour la préservation de l’intégrité endothéliales présente un potentiel d’avantages cliniques chez les patients qui subissent une chirurgie de PAC. Les observations précédentes suggèrent que la solution GALA pourrait réduire la dysfonction endothéliale associée à la défaillance des greffons veineux et incite des évaluations à long terme plus approfondies dans le cadre d’essais cliniques. / INTRODUCTION: Saphenous vein grafts (SVGs) are still commonly used as conduits for coronary artery bypass grafting (CABG). Injury to SVGs during harvesting and storage promotes endothelial dysfunction, which is attributed to a decrease in production of nitric oxide and/or increased level of oxidative stress that can lead to vein graft failure (VGF). Heparinized saline is still the standard of care intraoperative preservation solution despite several studies demonstrating its detrimental effects on SVGs. GALA is an innovative one-time intraoperative graft storage solution developed to preserve endothelial integrity. OBJECTIVE: To investigate, in a randomized controlled study, endothelial functional integrity of saphenous vein grafts following storage in GALA vs heparinized saline using ex vivo vascular reactivity studies in organ chamber experiments. RESULTS: Segments of saphenous vein grafts from a total of fifteen patients were obtained and divided into 3 mm wide rings for evaluation. There were no significant differences in the levels of contraction in response to potassium chloride and to phenylephrine between groups, nor in the concentrations of phenylephrine needed to achieve the target level of contraction in saphenous vein graft rings. Concentration-response curves of the GALA group demonstrated a significant improvement in endothelium-dependent relaxations compared to the heparinized saline group. Endothelium-independent contractions and relaxations induced by phenylephrine and sodium nitroprusside, respectively, were not altered in saphenous vein graft rings from both groups. CONCLUSIONS: Intraoperative application of a solution developed for graft preservation demonstrated a potential benefit to protect endothelial and vascular functional integrity in saphenous vein grafts of patients undergoing CABG. These data suggest that the GALA solution may reduce endothelial dysfunction associated with vein graft failure and warrant further long-term evaluation in clinical trials.

Einführung - Periphere Blutmonozyten spielen eine Rolle in der Pathogenese der Arteriosklerose. Bei spontan hypertensiven Ratten wurden im Vergleich zu normotonen Wistar-Kyoto-Ratten signifikant erhöhte Zahlen aktivierter Monozyten beobachtet [Liu 1996]. Wir untersuchten Monozyten von Patienten mit essentieller Hypertonie und von gesunden Probanden hinsichtlich möglicher Unterschiede in der Aktivierung anhand ihrer Adhäsion an von uns kultivierte (HAEC) und isolierte (HSVEC, HUVEC, HUAEC) humane Endothelzellen. Wir bestimmten die Adhäsionsmoleküle ICAM-1, VCAM-1 sowie E-Selektin und analysierten die Superoxidfreisetzung von humanem Endothel und Monozyten. Methoden - Humane periphere Blutmonozyten wurden mittels Dichtegradienten-zentrifugation und Plastikadhärenz isoliert und mit LPS, Angiotensin II (Ang II), und Ang II nach Vorinkubation mit dem AT1-Antagonisten Eprosartan stimuliert. Die Monozyten wurden auf einschichtigem Endothel ausgesät und die Adhäsion als Prozentsatz der initial gesäten Zellen erfasst. Die durch PMA induzierte Superoxidfreisetzung des Endothels oder der Monozyten wurde mittels Chemilumineszenz bestimmt. Ergebnisse - Monozyten von Patienten mit essentieller Hypertonie hefteten sich im Vergleich zu gesunden Probanden spontan und nach Stimulation mit Ang II signifikant verstärkt an HAEC und HUVEC-Monolayer an. Die Spiegel von ICAM-1 und VCAM-1 waren bei Patienten mit arterieller Hypertonie im Vergleich zu den gesunden Kontrollpersonen signifikant erhöht. Die Chemilumineszenzaktivität postkonfluenter Endothelzellen erhöhte sich nach Stimulation mit Ang II im Vergleich zur Messung ohne vorherige Stimulierung. Nach Stimulation mit PMA oder mit Ang II wurden bei Hypertonikern signifikant höhere Werte für die Chemilumineszenzaktivität der Monozyten gemessen als bei gesunden Kontrollpersonen. Schluss - Mit diesen Versuchen an humanen Monozyten und Endothelzellen wurde ein weiterer Beweis für die Aktivierung der Monozyten von Patienten mit essentieller Hypertonie erbracht. Meine Ergebnisse unterstützen die Sicht einer Monozytenbeteiligung an der Pathogenese atherosklerotischer Läsionen, die mit arterieller Hypertonie in Zusammenhang stehen. / Introduction - Peripheral blood monocytes are involved in the pathogenesis of atherosclerosis. Significantly elevated numbers of activated monocytes were observed in spontaneously hypertensive rats compared to those in normotensive Wistar-Kyoto rats [Liu 1996]. We isolated and cultivated human endothelial cells and examined monocytes from patients with arterial hypertension and healthy volunteers to identify possible differences in their adhesion behavior to human endothelial cells (HAEC, HSVEC, HUVEC, HUAEC). We determined the levels of ICAM-1, VCAM-1 and E-selectin, and we analyzed superoxide release by human endothelium and human monocytes. Methods - Peripheral blood monocytes were isolated by density gradient centrifugation and plastic adherence. Subsets of the samples were stimulated with LPS, Angiotensin II, Angiotensin II following preincubation with the AT1-antagonist eprosartan or left without a stimulant. After incubation, monocytes were seeded onto confluent monolayers of human aortic endothelial cells and the adhesion was determined as the percentage of the initially seeded cells. Oxygen species release induced by PMA was analyzed for endothelium and monocytes in suspension by chemiluminescence. Results - Peripheral blood monocytes of patients with essential hypertension performed a significantly increased spontaneous adhesion and adhesion following stimulation with Angiotensin II to HAEC- and HUVEC-monolayers. Levels of human soluble adhesion molecules ICAM-1 and VCAM-1 were significantly raised in hypertensive patients. Chemiluminescence activity of post confluent endothelial cells was increased after stimulation with Angiotensin II compared to the measurement before stimulation. Following stimulation with PMA or Angiotensin II, significantly higher chem-iluminescence levels were measured in hypertensive patients compared to healthy volunteers. Conclusion - These data indicate that monocytes of patients with essential hypertension may be preactivated. My results support the view of a monocyte involvement in the pathogenesis of atherosclerotic lesions that are related to arterial hypertension.