Nox4 promotes endothelial differentiation through chromatin remodeling

RATIONALE

Nox4 is a constitutively active NADPH oxidase that constantly produces low levels of H2O2. Thereby, Nox4 contributes to cell homeostasis and long-term processes, such as differentiation. The high expression of Nox4 seen in endothelial cells contrasts with the low abundance of Nox4 in stem cells, which are accordingly characterized by low levels of H2O2. We hypothesize that Nox4 is a major contributor to endothelial differentiation, is induced during the process of differentiation, and facilitates homeostasis of the resulting endothelial cells.

OBJECTIVE

To determine the role of No×4 in differentiation of murine inducible pluripotent stem cells (miPSC) into endothelial cells (ECs).

METHODS AND RESULTS

miPSC, generated from mouse embryonic wildtype (WT) and Nox4-/- fibroblasts, were differentiated into endothelial cells (miPSC-EC) by stimulation with BMP4 and VEGF. During this process, Nox4 expression increased and knockout of Nox4 prolonged the abundance of pluripotency markers, while expression of endothelial markers was delayed in differentiating Nox4-depleted iPSCs. Eventually, angiogenic capacity of iPSC-ECs is reduced in Nox4 deficient cells, indicating that an absence of Nox4 diminishes stability of the reached phenotype. As an underlying mechanism, we identified JmjD3 as a redox target of Nox4. iPSC-ECs lacking Nox4 display a lower nuclear abundance of the histone demethylase JmjD3, resulting in an increased triple methylation of histone 3 (H3K27me3), which serves as a repressive mark for several genes involved in differentiation.

CONCLUSIONS

Nox4 promotes differentiation of miPSCs into ECs by oxidation of JmjD3 and subsequent demethylation of H3K27me3, which forced endothelial differentiation and stability.

Analysis of metastases rates during follow-up after endoscopic resection of early "high-risk" esophageal adenocarcinoma

BACKGROUND AND AIMS

After endoscopic resection (ER) of early esophageal adenocarcinoma (EAC), the optimal management of patients with high-risk histologic features for lymph node metastases (ie, submucosal invasion, poor differentiation grade, or lymphovascular invasion) remains unclear. We aimed to evaluate outcomes of endoscopic follow-up after ER for high-risk EAC.

METHODS

For this retrospective cohort study, data were collected from all Dutch patients managed with endoscopic follow-up (endoscopy, EUS) after ER for high-risk EAC between 2008 and 2019. We distinguished 3 groups: intramucosal cancers with high-risk features, submucosal cancers with low-risk features, and submucosal cancers with high-risk features. The primary outcome was the annual risk for metastases during follow-up, stratified for baseline histology.

RESULTS

One hundred twenty patients met the selection criteria. Median follow-up was 29 months (interquartile range, 15-48). Metastases were observed in 5 of 25 (annual risk, 6.9%; 95% confidence interval [CI], 3.0-15) high-risk intramucosal cancers, 1 of 55 (annual risk, .7%; 95% CI, 0-4.0) low-risk submucosal cancers, and 3 of 40 (annual risk, 3.0%; 95% CI, 0-7.0) high-risk submucosal cancers.

CONCLUSIONS

Whereas the annual metastasis rate for high-risk submucosal EAC (3.0%) was somewhat lower than expected in comparison with previous reported percentages, the annual metastasis rate of 6.9% for high-risk intramucosal EAC is new and worrisome. This calls for further prospective studies and suggests that strict follow-up of this small subgroup is warranted until prospective data are available.

Face masks: benefits and risks during the COVID-19 crisis

Background

The German government has made it mandatory to wear respiratory masks covering mouth and nose (MNC) as an effective strategy to fight SARS-CoV-2 infections. In many countries, this directive has been extended on shopping malls or public transportation. The aim of this paper is to critically analyze the statutory regulation to wear protective masks during the COVID-19 crisis from a medical standpoint.

Methods

We performed an extensive query of the most recent publications addressing the prevention of viral infections including the use of face masks in the community as a method to prevent the spread of the infection. We addressed the issues of practicability, professional use, and acceptability based on the community and the environment where the user resided.

Results

Upon our critical review of the available literature, we found only weak evidence for wearing a face mask as an efficient hygienic tool to prevent the spread of a viral infection. However, the use of MNC seems to be linked to relevant protection during close contact scenarios by limiting pathogen-containing aerosol and liquid droplet dissemination. Importantly, we found evidence for significant respiratory compromise in patients with severe obstructive pulmonary disease, secondary to the development of hypercapnia. This could also happen in patients with lung infections, with or without SARS-CoV-2.

Conclusion

Epidemiologists currently emphasize that wearing MNC will effectively interrupt airborne infections in the community. The government and the politicians have followed these recommendations and used them to both advise and, in some cases, mandate the general population to wear MNC in public locations. Overall, the results seem to suggest that there are some clinically relevant scenarios where the use of MNC necessitates more defined recommendations. Our critical evaluation of the literature both highlights the protective effects of certain types of face masks in defined risk groups, and emphasizes their potential risks.

The history and value of face masks

In the human population, social contacts are a key for transmission of bacteria and viruses. The use of face masks seems to be critical to prevent the transmission of SARS-CoV-2 for the period, in which therapeutic interventions are lacking. In this review, we describe the history of masks from the middle age to modern times.

Scientific language trends among Swedish urologists and surgeons 1900-1955

PURPOSE

Before English took the lead as the prime scientific language among northern European urologists and surgeons, German was widely regarded as the "lingua franca". This shift has to date not been systematically reconstructed. This article provides insights into the question how political and social factors influence how physicians communicate with each other, what they read, and how the constellations of international scientific communities in medicine change over time.

METHODS

Through a language analysis of more than 2000 articles, including their references, in major Swedish medical journals as well as surgical doctoral dissertations defended at Swedish universities, this paper explores scientific language trends during the first half of the twentieth century among Swedish physicians for the first time on a large scale.

RESULTS AND CONCLUSIONS

The study shows that Swedish urologists and surgeons generally did not switch to English during the years immediately after the First World War, as has been documented in other countries. After a decrease during the first 10 years after the First World War, the German language dominated among Swedish urologists and surgeons from the 1930s until the early 1940s, when English first dominated at large. The rapidity of this process shows that almost all surgical researchers had changed from German to English within just a few years.

Nobel Prize nominees and the rise of urology in Europe around 1900

PURPOSE

Recent historical research has reconstructed the roads leading to the Nobel Prize for the trained urologists Werner Forssmann (1904-1979) in 1956 and Charles Huggins (1901-1997) in 1966. However, the story of urology and the Nobel Prize does not start and end with the laureates. Taking James Israel (1848-1926), Félix Guyon (1831-1920), and Peter J Freyer (1852-1921) as examples, this paper shows that pioneers in urology were in fact runners-up for the award much earlier.

METHODS

The study is based on an analysis of original files in the Nobel Prize archive in Stockholm, scientific publications of the early twentieth century, and secondary literature.

RESULT AND CONCLUSION

We argue that Israel's, Guyon's, and Freyer's candidacies reflect not only scientific trends and controversies in urology at the turn of twentieth century, but that the development of the specialty itself was reflected in nominations of physicians working on problems of the genito-urinary system.

Remembering Charles B. Huggins' Nobel Prize for Hormonal Treatment of Prostatic Cancer at its 50th Anniversary

Charles B. Huggins received the Nobel Prize in 1966. Based on archival sources from the Nobel archive we have found that nominators emphasised the practical therapeutic applications of his discoveries that were showing 25 yr after his key publications.

Prophylactic intraoperative antithrombotics in open infrainguinal arterial bypass surgery: a systematic review

Unfractionated heparin (UFH) is used intraoperatively as antithrombotic by most vascular surgeons worldwide during infrainguinal bypass surgery (IABS) to reduce the risk of peroperative and early graft thrombosis. To reduce the harmful side effects of UFH (bleeding complications, HIT) and to reduce peroperative and early graft failure, other pharmaceuticals have been suggested for IABS. A systematic review was performed using MEDLINE, EMBASE and Cochrane databases. Only 9 studies on IABS and intraoperative antithrombotic use were eligible for review. Between studies heterogeneity was high and investigated study populations were often of small size. No study was retrieved comparing UFH to no-UFH. Dextran, human antithrombin and iloprost showed no beneficial effect compared to UFH alone for patency, mortality and morbidity. Low molecular weight heparin (LMWH) has potential benefits compared to UFH, but a statistically significant effect could not be demonstrated from the current review. The use of UFH during IABS to prevent intraoperative graft thrombosis has not been proven in randomized clinical trials. Dextran, human antithrombin and iloprost showed to be of no added beneficial effect for the patient compared to UFH alone. Data on the use of LMWH instead of UFH are promising, but no statistically significant benefit could be reproduced from literature. Results from a recent Cochrane review were favourable for LMWH, but it appeared that included data were not complete in that review. Randomized controlled trials are required for intra-operative use of antithrombotics and to improve peroperative and early patency after IABS.

Perioperative prophylactic antithrombotic strategies in vascular surgery: current practice in the Netherlands

AIM

The aim of this study was to evaluate the current practice of the use of perioperative antithrombotic drugs to prevent arterial thrombo-embolic complications during arterial vascular surgery by Dutch vascular surgeons. Aim was also to compare the results with the literature and to evaluate the effect of guidelines.

METHODS

A comprehensive questionnaire was sent to all Dutch vascular surgeons performing arterial reconstructive surgery.

RESULTS

The response rate was 84%. Acetylsalicylic acid (ASA) was continued perioperatively by most surgeons (91%). Clopidogrel was discontinued by the majority of respondents (65%). During operation 97% of surgeons administered unfractionated heparin (UFH) before arterial clamping. A minority (11%) measures peroperatively anticoagulant activity in patients' blood. After infrainguinal venous bypass most surgeons (81%) preferred monotherapy with vitamin K antagonists (VKA), in agreement with the Dutch guideline in this respect. Before the introduction of the guideline in 2005, a survey was performed in 2004. Results of our 2011 survey showed more respondents (6% to 11%) prescribed ASA or VKA according to these guidelines.

CONCLUSION

This survey showed a recognizable pattern of variation for perioperative arterial thrombosis prophylaxis amongst Dutch vascular surgeons, in agreement with reports from other countries over the past 20 years. Although a higher percentage of surgeons complied in 2011 with existing guidelines than in 2004, guidelines were not completely met. Possibly because current guidelines are not fully supported by evidence and do not cover all aspects of perioperative arterial thrombosis prophylaxis. Clearly there is need for (more) convincing data based on RCT's concerning the various aspects of perioperative arterial thrombosis prophylaxis.

Castrati singers--all for fame

INTRODUCTION

The phenomenon of castration is very closely associated with the baroque era. In a period that placed emphasis on pure sensual pleasure, castrati singers, with their angelic voices, were a perverted outcome of this ambition. It was the intention that these castrato voices with their supernatural sound would mesmerize audiences. At that time, it could be said that within certain society circles, an addiction to these voices existed. Equally, they were oblivious to the spiritual side of the lives of the castrati. Farinelli, Caffarelli, and Senesino, three of the most famous castrati, were the first musical superstars of the 18th century. Their voices moved decadent audiences to tears and standing ovations. The price for this fame was, however, high.

AIM

The aim of this review is to provide an overview of castrati singers, especially in the baroque era, their sexuality and the effects of castration on their physical development.

METHODS

A literature search of relevant databases, books, and articles in journals was performed and compared with current data concerning androgen suppression and endocrine aspects of male sexual dysfunction.

RESULTS

The effects of castration on physical development were notoriously erratic. Much depended on the timing of the operation: boys pruned before the age of 10 or so very often grew up with feminine features; smooth, hairless bodies, incipient breasts, infantile penis, and often a complete lack of sex drive.

CONCLUSION

The peak success of the castrati ended with the end of the 18th century. The last castrato was Alessandro Moreschi, a solo singer in the choir of the Sistine Chapel of the Vatican. Following the ban on castration, Pope Pius X sent him into retirement in 1912, thus putting an end to a very impressive part of the history of music.

[The history of prostate cancer from the beginning to DaVinci]

For hardly any other organ can the development of medicine and technical advances in the last 150 years be so clearly illustrated as for the prostate. The history of radical prostatectomy was initially characterised by the problems in approaching this relatively difficulty accessible organ. In 1867, Theodor Billroth in Vienna performed the first partial prostatectomy via a perineal access. In 1904, Hugh Hampton Young and William Stewart Halsted at the Johns Hopkins Hospital in Baltimore / USA carried out the first successful extracapsular perineal prostatectomy and opened up a new era. In Germany, Prof. Friedrich Voelcker in Halle in 1924 developed the so-called ischiorectal prostatectomy. But it was left to Terence Millin to publish in 1945 the first series of retropubic prostatectomies. In 1952, the sacroperineal approach according to Thiermann and the sacral prostatectomy according to were introduced. Finally, in 1991 another new era in prostate surgery started with the first laparoscopic prostatectomy. This development peaked in 2011 with the presentation of the laparoscopic DaVinci prostatectomy by Binder. Originally a stepchild of urological surgery that was to be avoided whenever possible due to the fear of serious complications, the prostate has progressed in the course of time to an obscure object of lust. The stepchild has become the favorite child.

Biology and treatment of recurrent carotid stenosis

The benefit of carotid revascularization in long term stroke prevention is hampered by the occurrence of restenosis at the site of surgery, which is associated with a modestly increased risk of stroke. Preventing restenosis is an important part in the overall treatment and prevention of stroke in patients with carotid artery disease. The site of recurrent stenosis is primarily situated at the ends of, or within the confines of the original endarterectomy site and the suture lines. Several etiological factors but also surgical technique play a key role in the development of carotid recurrent stenosis. However, the exact pathophysiology of recurrent disease is not fully understood. The morphogenesis of recurrent lesions is a process of ongoing thrombogenesis beginning immediately after blood flow is restored across the endarterectomized surface. The early lesion is subsequently formed as the thrombus organizes and smooth muscle cell ingrow occurs, creating a supposed morphologic distinction between early (within 2 years of CEA) and late (over 2 years) recurrent carotid disease. Further, plaque composition at primary CEA is an independent predictor of restenosis after CEA and dissection of a lipid-rich and macrophage infiltrated plaque is associated with a reduced risk of stenosis. CEA of stable atherosclerotic plaques has been associated with an increased risk for restenosis. In addition, stable atherosclerotic plaque characteristics with low macrophage content and small lipid core size are associated with an increased incidence of restenosis compared with unstable inflammatory lesions. The implication of these findings is that macrophage infiltration and lipid core size are the plaque characteristics that should be targeted with noninvasive plaque imaging to assess the risk of patients with recurrent carotid stenosis to become symptomatic. Furthermore, the longer the delay from stroke until revascularization, the more the lesion stabilizes and the higher the risk for restenosis. Thus, operating on symptomatic patients within a few weeks after the index event could potentially reduce the risk of restenosis. The optimal treatment strategy for restenosis has yet to be defined. Optimally, one would strive to a "tailor-made" treatment comprising of best medical therapy, surgery or CAS including regular follow-up. With the ongoing developments and insights in histological plaque characterization this tailor-made treatment might be available in the near future, thereby reducing the risk of, or maybe even avoiding the development of restenosis.

[Research perspectives on the history of urology in Germany, 1933-1945]

Between 1933 and 1945, German medical practitioners were easily persuaded to align themselves with Nazi ideology. Jewish urologists were forced out of academia, editorial boards of medical journals and medical practice. Like most German physicians, urologists quickly accepted their new role as caretakers of public health instead of individual patients' wellbeing. The specialty of urology profited from this collaboration with Nazi policies as it gained further independence.

[The 100th anniversary of the German Society for Urology]

Medical thought followed the general acceptance of scientific method in the mid-19th century with the foundation of specialist areas. In Vienna, urology was established very early as such a specialist area along with surgery. At the beginning of the 20th century, however, urology was still taught under the specialist areas of dermatology or surgery in universities in Berlin and other German cities. With the foundation of "modern urology" the battle for recognition as an independent specialist area began. Urology's origins are to be found in the two classical disciplines surgery and internal medicine as well their two older daughter specializations of gynecology and dermatovenerology. In September 1906, the German Society for Urology was founded, exactly 10 years after a first attempt had been made. In 1907 the "Zeitschrift für Urologie" (Journal for Urology) was founded.

Remote superficial femoral artery endarterectomy and distal aSpire stenting: results of a multinational study at three-year follow-up

AIM

The aim of this study was to examine the results of remote superficial femoral artery endarterectomy (RSFAE) in conjunction with distal aSpire stenting in a multinational study.

METHODS

RSFAE is a minimally invasive procedure performed through a limited groin incision. A total of 210 patients were included in this study. The indications for the procedure were claudication in 158 (75%) patients and limb salvage in 52 (25%). After RSFAE the outflow tract atheromatous plaque was ''tacked'' with the aSpire stent, which is an expanded polytetrafluoroethylene (ePTFE) covered nitinol stent with high radial strength, yet it is flexible enough to withstand the compressive forces at the knee joint. Prior to stent deployment, if the stent position is not in optimal position, it can be ''wrapped down'', repositioned and re-expanded. Therefore, not only is the plaque end point tacked, but the collaterals are preserved as well. All patients underwent follow-up examination with serial color-flow duplex ultrasound scanning.

RESULTS

The mean length of endarterectomized superficial femoral arteries (SFAs) was 28.2+/-6.2 cm (range 15-43 cm). The primary cumulative patency rate by means of life-table analysis was 60.6+/-4.8% (SE) at 33 months, (mean 17.1 months; range 1-33 months). During follow-up percutaneous transluminal balloon and/or stent angioplasty was necessary in 50 patients for a primary assisted patency of 70.2+/-4.8% at 33 months. The locations of the restenosis after RSFAE were evenly distributed along the endarterectomized artery. There were 2 deaths (myocardial infarctions), 12 (5.7%) wound complications (7 hematomas, 5 skin edge sloughs) and the mean hospital length of stay was only 1.3+/-0.5 days.

CONCLUSION

RSFAE with distal aSpire stenting is a minimally invasive, safe durable procedure for the treatment of long-segment SFA occlusive disease.

Chordin is underexpressed in ovarian tumors and reduces tumor cell motility

Ovarian cancers mostly derive from the monolayer epithelium that covers the ovary. There are currently very few molecular clues to the etiology of this cancer. Bone morphogenetic proteins (BMPs) are required for follicular development and female fertility and are expressed in the ovarian surface epithelium (OSE). We previously reported the expression of human chordin (CHRD), a BMP extracellular regulator, in the ovary. Here we show that CHRD is underexpressed in epithelium ovary cancer and epithelial cancer cell lines as compared with normal tissues and OSE, respectively. Besides, we detected BMP expression in all ovarian cell lines analyzed. To determine the functional relevance of the absence of CHRD mRNA in tumors and cancer cell lines, we studied the effects of CHRD on two cancer cell lines, BG1 and PEO14. Migratory and invasive properties were greatly reduced, whereas cell adhesion to the support was enhanced. In addition, we detected chordin (Chrd) expression in OSE of rat ovaries in a pattern similar to that of BMP4. Altogether, these results suggest that CHRD could participate in regulating BMP activity in normal OSE physiology, and that its mis-expression in OSE may facilitate cancer incidence and/or progression.

Towards a VR trainer for EVAR treatment

Endovascular repair of aortic abdominal aneurysms (AAA) is more and more becoming part of clinical practice. Up to approximately 30 clinical procedures however are necessary to obtain the surgical skills to make the procedure reliable and safe. The current study aims to generate a VR trainer to speed up the training process of experienced vascular surgeons to become experienced EVAR (endovascular AAA repair) surgeons by introducing a VR environment. This manuscript describes the contents and validation of the first step in the VREST - EVAR trainer, i.e. the proper definition of the knowledge and skills that need to be transferred.

THE CATHETER AND ITS USE FROM HIPPOCRATES TO GALEN

PURPOSE

We comprehensively reviewed the history and use of the bladder catheter in Western medicine from 500 BC to 200 AD.

MATERIALS AND METHODS

Greek and Latin texts were key word searched to identify descriptions of contemporary instruments and their uses.

RESULTS

The catheter and its use were mentioned by about 10 ancient authors in more than a total of 20 texts dating to the end of the second century AD. The authors include Hippocrates, Celsus, Soranus, Rufus, Aretaeus and Galen. They described the use of the instrument in reference to contemporary anatomy and physiology, and indications and contraindications in regard to certain conditions, such as urinary retention, bladder stones and intravesical blood clots. Technical details and particularities of use were also reviewed, as were pharmacological considerations and underlying physical principles.

CONCLUSIONS

Knowledge of the urinary catheter, and its usefulness and risks in ancient medicine can be dated from the 5th century BC. Our study of European texts documents its broad use. Because catheterization was perceived as a practical measure, it generated little scientific controversy.

The catheter and its use in late antiquity and the early middle ages

PURPOSE

Based on Greek and Latin sources the use of the urinary catheter in Western medicine between 200 and 1000 CE was reviewed.

MATERIALS AND METHODS

Computerized databank searches permitted the identification and analysis of ancient and early medieval texts that include material on the catheter.

RESULTS

Ten medical authors mentioned the catheter and its use. In the Byzantine world they include the encyclopedists Oribasius, Aetius and Paul of Aegina. The best known Latin author is Caelius Aurelianus. These writers often put together summaries of earlier works. Innovation or independent research was not easily found at a time during which neither anatomical autopsy nor experimentation was widely practiced.

CONCLUSIONS

Old texts contain numerous instructions on how to skillfully use the catheter. As a technical achievement, it was independent of philosophical trends. Its primary indications, namely urinary retention, bladder stones and the administration of cures, changed little with time. As one of the oldest and most important instruments at the disposal of physicians, the history of the catheter should be known to every urologist.

[Possible treatments for patients with symptomatic carotid artery stenosis]

The classical treatment for severe and symptomatic stenosis of the internal carotid is carotid endarterectomy. An endarterectomy within two weeks after the initial symptoms of a TIA or CVA decreases the chances of new ischaemic symptoms. However, there is now an alternative for this operation, namely the placement of an endovascular stent. Although this method offers some advantages, there are still insufficient prospective randomised trials to prove that this technique is just as suitable as the classical method. Various studies are now in progress to evaluate the short- and longterm results of endovascular treatment in comparison with endarterectomy. For the time being, therefore, stent placement should only be done in the context of clinical trials.