Advances in Diagnostic Imaging of Hepatopulmonary Syndrome

Hepatopulmonary syndrome (HPS) is a serious pulmonary complication of progressive liver disease that leads to a poor clinical prognosis. Patients with HPS may develop acute respiratory failure, which requires intensive care and therapy. At present, the only effective treatment is liver transplantation; therefore, early diagnosis and timely treatment are of considerable significance. The three main features of HPS are liver disease, oxygenation disorder, and intrapulmonary vascular dilatation (IPVD). Diagnosing HPS is challenging due to the difficulty in detecting the presence or absence of IPVD. As such, imaging examination is very important for detecting IPVD. This paper reviews the imaging methods for diagnosing HPS such as ultrasound, dynamic pulmonary perfusion imaging, pulmonary angiography, and computed tomography.

The effect of phacoemulsification performed with vitrectomy on choroidal vascularity index in eyes with vitreomacular diseases

This study evaluated the effects of cataract surgery combined with pars plana vitrectomy (ppV) on choroidal vascularity index (CVI) in eyes with epiretinal membrane (ERM) and full thickness macular hole (FTMH). Medical records of 132 eyes with ERM or FTMH were retrospectively reviewed and classified into a ppV group and a ppV combined with cataract surgery group (phaco + ppV group). The CVI were measured at baseline, 1, 3 and 6 months after the surgery, using the selected swept-source (SS) optical coherence tomography (OCT) scan passing through the central fovea, which was then segmented into luminal and stromal area by image binarization. The mean CVI of phaco + ppV group were 61.25 ± 1.97%, 61.66 ± 1.81%, and 62.30 ± 1.92% at baseline, 1 and 3 months, respectively (p < 0.001). The mean CVI of ppV group were 62.69 ± 1.92%, 62.03 ± 1.51%, and 61.45 ± 1.71% at baseline, 1 and 3 months, respectively (p < 0.001). The final CVI were measured at 6 months and compared with the baseline CVI. The mean CVI of phaco + ppV group were 61.21 ± 1.99% at baseline and 60.68 ± 2.02% at 6 months (p < 0.001). The mean CVI of ppV group were 62.93 ± 1.70% at baseline and 61.77 ± 1.74% at 6 months (p < 0.001). Vitrectomy significantly decreases CVI in vitreomacular diseases possibly due to the removal of vitreomacular traction or postoperative oxygenation change in the eye. On the contrary, combined surgery of vitrectomy and cataract surgery significantly increases CVI in the early stage of postoperative period, which suggests choroidal vascular dilatation or congestion due to postoperative inflammation. Although the CVI were measured lower than the baseline in the end, more thorough inflammation control may be essential after combined surgery.

Hepatopulmonary syndrome as the first and only manifestation of cirrhosis in a patient with hypopituitarism

Hepatopulmonary syndrome (HPS) is characterised by the development of intrapulmonary arteriovenous blood shunts and vascular dilatation with consequent hypoxaemia, usually in the context of end-stage liver disease (ESLD). The estimated incidence of HPS in ESLD has been reported to be 13%–47%. Chronic liver disease has been described in patients with hypothalamic–pituitary dysfunction, mainly in the form of non-alcoholic fatty liver disease due to metabolic syndrome, with occasional progression to cirrhosis. We report a challenging case of a 27-year-old man with a background of hypopituitarism with no known liver disease who presented with progressive dyspnoea and hypoxaemia and was eventually diagnosed with severe HPS.

First presentation of portal hypertension complicated by hepatopulmonary syndrome

Hepatopulmonary syndrome (HPS) is a serious complication of chronic liver disease, characterised by portal hypertension and arterial hypoxaemia due to intrapulmonary vascular dilatation. We report an unusual case in which a 27-year-old man had a first presentation of portal hypertension and cirrhosis complicated by HPS. This patient presented with progressive dyspnoea on exertion and deterioration in mobility, with a type 1 respiratory failure and increased oxygen demand. A bubble echocardiogram showed a possible right-to-left shunt, CT aortogram displayed evidence of portal hypertension and cirrhosis, and liver biopsy findings were consistent with alpha-1 antitrypsin deficiency. The patient’s increased oxygen demand was subsequently treated with continuous positive airway pressure before he was discharged with 8 L home oxygen. With no current established medical therapy for HPS, the patient was assessed for liver transplantation and a decision was made in favour of this.

Abstract P277: β-arrestin-2-mediated Vasodilatation In Mouse Mesenteric Arteries

As part of GPCRs-dependent signaling, β -arrestin-2 has been shown to stimulate eNOS activity and thus has the potential to modulate vascular function. We hypothesized that the absence of β -arrestin-2 would alter vascular dilatation and contraction in resistance arteries. We tested acetylcholine (ACh)-dependent relaxation and phenylephrine (PE)-dependent contraction in mouse mesenteric arteries isolated from 3-mo old male C57Bl6 (WT, n=5) and β -arrestin-2 KO ( βarr2 -/- , n=5) mice. Segments were mounted in a Wire Myograph (DMT) for determination of isometric force; vessels studied included intact, without endothelium, or pre-incubated with L-NAME (10 -4 M). Dose-response curves were performed for ACh (10 -10 -10 -4.5 M) and PE (10 -10 -10 -4.5 M). Data were acquired using a PowerLab (ADInstruments) system. Maximal response to ACh (ACh MAX ) was expressed as maximal relaxation after pre-constriction, maximal response to PE (PE MAX ) as % of contraction to 75mM KCl (%K MAX ), and sensitivity as pD 2 (-Log[EC 50 ]). Data were analyzed using Prism (GraphPad). After pre-constriction (PE, 3x10 -6 M), arteries from βarr2 -/- mice presented similar ACh MAX (79±6 vs. 82±6, p>0.05) and lower sensitivity to ACh compared to WT (6.66±0.2 vs. 7.12±0.1, p<0.05). The sensitivity of the contraction to PE was increased in βarr2 -/- arteries (6.4±0.2 vs. 6.04±0.1, p<0.05), with no changes in PE MAX . Differences in vasodilation and contraction were abolished in arteries without endothelium and in arteries pre-incubated with L-NAME. We conclude that the absence of β -arrestin-2 induces a pro-contractile phenotype in an endothelium- and nitric oxide-dependent manner in mouse resistance arteries.

AYURVEDIC MANAGEMENT OF SHITPITTA W.S.R. TO URTICARIA- A CASE REPORT

Urticaria is an allergic reaction of the skin to a variety of exogenous and endogenous antigens. It is a common disease nowadays, characterized by pale red rashes and severe itching caused by an allergic reaction. Vascular dilatation, the resultant dermal oedema and pruritis are due to the releases of histamine and other mediators from mast cells. Ayurvedic classics mentioned this similar condition as shitpitta, among twakroga which is vaatpradhan tridosha in nature. Symptoms mentioned by aacharyas are shotha, toda, kandu and daha. Even after the availability of newer medicine, there is a lack of promising results against this ailment. Moreover, the use of drugs like antihistamines and corticosteroids lead to various side effects. The study aims to evaluate the effect of ayurvedic treatment in the management of shitpitta with special reference to urticaria. This study deals with a case of chronic urticaria, where a male patient was given an ayurvedic therapy which included shodhan-shamanaushadi and sthanik treatment on an OPD basis for 3 months. Criteria’s like shotha, toda, kandu and daha were assessed before and after the treatment & significant result was found. The conclusion was drawn that given ayurvedic therapy was found to be significantly effective in the management of urticaria. Keywords: Shitpitta, Twakroga, Urticaria, Shodhan, Shamana

The GPR18 Agonist PSB-KD-107 Exerts Endothelium-Dependent Vasorelaxant Effects

GPR18 is an orphan GPCR that is activated by the cannabinoid tetrahydrocannabinol (THC). Emerging evidence indicates its involvement in the control of cardiovascular functions, including heart rate, contractility, vascular tone, as well as blood pressure. Therefore, we investigated the effects of selective GPR18 receptor ligands, namely PSB-KD-107 (agonist) and PSB-CB-92 (antagonist), on blood pressure, electrocardiogram (ECG), and vascular dilatation in vitro and in vivo, as well as their anti-oxidative potential in in vitro ferric reducing antioxidant power (FRAP) and 2,2-diphenyl-1-picryl-hydrazyl-hydrate free radical (DPPH) assays. Our results clearly show that PSB-KD-107 dilates blood vessels. This effect is related to its activation of GPR18 as it can be blocked by the GPR18 antagonist PSB-CB-92. Moreover, our finding confirms the presence of GPR18 in blood vessels. The mechanism of the vasorelaxant activity of PSB-KD-107 is mainly related to endothelial nitric oxide generation; however, we cannot exclude additional nitric oxide-independent mechanisms or a direct influence on K+ channels. PSB-KD-107 may affect blood pressure and heart function after a single administration; however, this effect was no longer observed after repeated administrations once daily for eight days. PSB-KD-107 does not affect platelet aggregation—an important feature considering the safety of its administration. PSB-KD-107 also shows a significant anti-oxidant effect and further studies of its antioxidant activity in vivo are justified.

ENDOTHELIAL FUNCTION IN CHILDREN WITH PERIODONTITIS

The presence of oral inflammation has recently been linked with the pathogenesis of cardiovascular diseases. Endothelial dysfunction is considered one of the pathogenetic mechanisms of a whole range of cardiovascular diseases. In the study describes links between periodontitis and endothelial dysfunction. 32 patients (16 boys and 16 girls) with periodontitis and 60 healthy children were examined. Flow-mediated vascular dilatation data were measured in all patients. Flow-mediated dilatation was 9,78±3,16% in children with periodontitis, and 12,85±3,48% in healthy children (p<0,05). Area under the dilation curve was larger in healthy children, then in children with periodontitis, 710±121%·с in comparison with 519±175%·с (p<0,05). An inverse correlation was found between flow-mediated dilatation, area under the dilation curve and periodontitis duration (r = -0,71, -0,77). A negative correlation was found between flow-mediated dilatation, area under the dilation curve and worsening of periodontitis (r = -0,70, -0,71). This study did not demonstrate association between periodontal disease in children and arterial hypertension, coronary heart disease, heart failure. However, the identified endothelial dysfunction requires protective therapeutic and preventive measures. Given the insignificant symptoms of chronic periodontitis in the examined children, it is important to activate efforts aimed at early detection and treatment of this disease. Further research is needed to clarify the prognostic role of endothelial dysfunction in chronic periodontitis.