BackgroundUltrasound-guided foam sclerotherapy (UGFS) is a minimally invasive procedure recommended for the management of chronic venous disease, particularly for varicose veins and saphenous trunk insufficiency, although rare, systemic effects may occur. The study aims to evaluate the impact of UGFS on pulmonary artery pressure and right ventricular function through indirect echocardiographic measurements.Material and MethodsA total of 50 patients with incompetent great saphenous veins underwent UGFS. Preoperative assessments and echocardiographic monitoring of right heart function were conducted at baseline (T0), 5 min (T5), 10 min (T10), and 15 min (T15) after FS injection. Primary endpoint included changes in systolic pulmonary artery pressure (PAPs), while secondary endpoints focused on tricuspid annular plane systolic excursion (TAPSE) and right ventricular diameter (RVD1). Statistical analyses were performed using paired t-tests and linear mixed models.ResultsThe results indicated a significant increase in PAPs from T0 to T10 (mean increase of 8.13 mmHg, p < .01) and T5, with a reduction at T15 that remained above baseline (mean difference of 3.01 mmHg, p < .01). TAPSE showed a significant increase at T15 compared to T0 (mean increase of 1.6 mm, p = .04). No significant changes were observed in RVD1. Importantly, no local or systemic complications occurred, and all patients remained asymptomatic.ConclusionUGFS is a safe and effective treatment for chronic venous disease, with transient and benign alterations in right heart hemodynamic likely attributable to foam degradation products. Further studies with larger cohorts and longer follow-up are warranted to enhance understanding of the long-term effects of UGFS on pulmonary hemodynamic and right ventricular function.

The purpose of this review is to synthesize literature investigating the relationship between type 2 diabetes (T2D) and obstructive airway diseases and to identify implications for clinical care.

Tetralogy of Fallot (TOF) patients are at risk for long-term adverse events. Electrocardiogram (ECG) abnormalities may reflect ventricular maladaptation and predict complications. We investigated whether ECG changes correlated with cardiac magnetic resonance imaging (CMR) measures of right ventricular (RV) function and their prevalence in less mature myocardium (prematurity or early repair). This retrospective study included 219 TOF patients operated between 2000-01-01 and 2018-12-31. Parameters analyzed included PQ interval, QRS duration, dispersion, fragmentation, QTc, JTc, and right bundle branch block (RBBB) at predefined time points. In patients undergoing pulmonary valve replacement (PVR) with available CMR, measures of RV size and function were compared with ECG variables. Early repair was defined as < 3 months and prematurity < 37 weeks' gestation. Median age at follow-up was 12.3 years (IQR, 8.4;17), and 4.9 months (IQR, 3.4;6.9) at primary repair. PQ interval correlated with RV end-diastolic, stroke and regurgitant volume, whereas RBBB correlated with larger RV. Forty-five patients (21%) underwent early repair (median 2.3 months [IQR 1.3;2.7]) with no significant ECG differences. Forty-one patients (20%) were premature. Premature patients were older at repair versus term (5.8 months [IQR 4.1;7.3] vs. 4.5 months [IQR 3.0;6.3], p = 0.001) but weighed less (5.6 kg [SD 1.2] vs. 6.5 kg [SD 1.7], p = 0.001). PQ interval was shorter in premature patients at multiple time points. Neither prematurity nor early repair were associated with increased reintervention or PVR. These findings support an association between PQ interval and RV volume load. Shorter PQ intervals with prematurity may reflect stiff myocardium, with unknown long-term implications.

Osteosarcoma (OS) is a highly aggressive primary bone malignancy with a strong predilection for lung metastasis, and the formation of a lung pre-metastatic niche represents a key early event driving OS distant dissemination. Elucidating the molecular mechanisms of pre-metastatic niche establishment is therefore critical for developing novel anti-metastatic therapies for OS. However, the mechanisms by which OS cells initiate the formation of a lung pre-metastatic niche remain poorly understood. Exosomes, as key mediators of intercellular communication, play a pivotal role in promoting tumor metastasis by shuttling functional biomolecules to remodel the microenvironment of distant target organs. In this study, we found that MG63 OS cells secreted exosomal miR-27a-3p, which targeted TNFAIP3 in lung fibroblasts, resulting in decreased TNFAIP3 protein expression. This downregulation enhanced the metastatic potential of OS cells toward lung fibroblasts. TNFAIP3 was identified as a direct target of miR-27a-3p, and TNFAIP3-Mut abrogated the regulatory effect of miR-27a-3p on TNFAIP3 expression, confirming the specific targeting relationship. Mechanistically, miR-27a-3p-mediated suppression of TNFAIP3 abrogated its negative regulation of the NF-κB pathway, leading to increased transcription of downstream inflammatory cytokines IL-1β, IL-6, and IL-8. The resulting pro-inflammatory microenvironment contributed to the establishment of a lung pre-metastatic niche, thereby promoting OS lung metastasis. These findings underscore the critical role of OS-derived exosomes in lung metastasis and suggest that exosomal miR-27a-3p may serve as a promising therapeutic target in OS lung metastasis.

IntroductionSarcopenia is recognized as a predictor of adverse outcomes in colorectal cancer, but evidence regarding its impact specifically in right-sided colon cancer remains limited. This study aimed to evaluate the prognostic significance of sarcopenia in patients undergoing colectomy for right-sided colon cancer.MethodsWe retrospectively analyzed 228 patients with right-sided colon adenocarcinoma who underwent curative-intent colectomy between 2016 and 2021 in a single institution. Sarcopenia was diagnosed using the psoas muscle index (PMI) on preoperative CT scans. Clinicopathologic variables, postoperative complications, overall survival (OS), and disease-free survival (DFS) were compared between sarcopenic and non-sarcopenic groups.ResultsAmong sarcopenic patients (34.2%), postoperative complications occurred in 46.2% compared with 23.3% of non-sarcopenic patients (P < .001). Sarcopenia was significantly associated with intra-abdominal infection (P = 0.040), pulmonary infection (P = .011), cardiac complications (P = .013), urinary tract infection (P = .013), and postoperative hypoalbuminemia (P < .022). Logistic regression identified postoperative hypoalbuminemia (P = .026) and prolonged hospital stay (P = .002) as independent predictors of complications. The 5-year OS was 19.7% in sarcopenic patients vs 43.0% in non-sarcopenic patients (P = .597), and 5-year DFS was 43.1% vs 51.7% (P = .154). Multivariate Cox analysis identified age ≥65 years (P = .015), male sex (P = .007), stage IV disease (P = .016), and elevated CEA (P = .021) as independent predictors of OS, and age ≥65 years (P = .046) and stage IV disease (P = .001) as independent predictors of DFS, while sarcopenia was not an independent predictor of either outcome.ConclusionSarcopenia was strongly associated with postoperative complications but not with OS or DFS. These findings suggest sarcopenia reflects perioperative risk rather than long-term prognosis in this subgroup.

Pulmonary hypertension (PH) is a major complication of interstitial lung disease (ILD) and is associated with increased morbidity and mortality. Early recognition of PH in ILD is crucial for guiding diagnostic evaluation, initiating treatment, and considering lung transplantation. The previously developed PH-ILD Detection Tool by Parikh et al. incorporated eight variables to stratify patients into low-, intermediate-, and high-risk groups, and was subsequently validated in an independent cohort. While effective, the multi-component score may be difficult to implement in routine practice. The aim of this study was to develop a simplified assessment tool for PH in ILD that relies on easily obtainable clinical data. We retrospectively evaluated 154 ILD patients who underwent right heart catheterization. The abbreviated PH-ILD score assigned one point each for: (1) physical examination findings suggestive of PH, (2) diffusion capacity for carbon monoxide < 40% predicted, and (3) supplemental oxygen use (range 0-3). Diagnostic performance was assessed using sensitivity, specificity, predictive values, and an ROC curve. The mean age was 70.0 ± 12.1 years, and the overall prevalence of PH was 48.1%. PH prevalence increased with higher scores: 14.3% (score 0), 58.1% (score 1), 79.0% (score 2), and 87.2% (score 3). The abbreviated tool demonstrated good discriminatory ability (AUC 0.74; 95% CI 0.65-0.82; p < 0.001). A threshold of ≥ 2 yielded a sensitivity of 90%, specificity of 58%, PPV of 78%, and NPV of 79%, while a score of 3 produced higher specificity (88%) with lower sensitivity (54%). This simplified 3-point PH-ILD assessment tool effectively stratifies PH risk in ILD using readily accessible clinical variables. A threshold of ≥ 2 provides high sensitivity for screening, whereas a score of 3 offers improved specificity. This tool may support early identification of PH in ILD and prompt timely referral for specialized evaluation and advanced therapies.

An 8-month-old intact male Labrador retriever dog from New Brunswick was referred to the Atlantic Veterinary College Small Animal Internal Medicine service (Prince Edward Island) for evaluation of marked hypercalcemia, polyuria-polydipsia, and urinary incontinence. Thoracic radiographs revealed a nonspecific, patchy-to-diffuse, interstitial-to-alveolar lung pattern, despite the absence of respiratory signs or abnormal lung auscultation. Fecal examination by Baermann analysis identified 1st-stage larvae of Angiostrongylus vasorum. Although A. vasorum has been documented in wild canid populations in parts of eastern Canada, this was the first confirmed case of an autochthonous infection in a companion animal in mainland Canada. The findings provide further evidence for the geographic expansion of A. vasorum within the Canadian Maritimes and contribute to a growing body of reports describing its emergence in North America. The dog's clinical presentation was atypical for angiostrongylosis, with no respiratory signs despite radiographic abnormalities, and hypercalcemia as a prominent clinical feature. These findings highlighted the variable and sometimes nonspecific nature of A. vasorum infection in dogs. Veterinarians practicing in eastern Canada should consider A. vasorum as a differential diagnosis in dogs with compatible clinical or imaging findings, even in the absence of respiratory signs or known endemicity. Routine Baermann fecal screening and prophylaxis with effective anthelmintics are recommended for dogs with increased risk of exposure to gastropod intermediate hosts. Key clinical message: Angiostrongylus vasorum is an emerging parasite in North America and can induce a variety of clinical signs in dogs. Veterinarians, specifically in the Canadian Maritimes, need to consider A. vasorum as a potential cause of respiratory signs, neurological signs, bleeding, and other clinical signs, and should recommend appropriate parasite prophylaxis in newly endemic areas.