Asymmetrical dimethylarginine and severity of erectile dysfunction and their impact on cardiovascular events in patients with acute coronary syndrome

Introduction

Coronary artery disease (CAD) and vascular erectile dysfunction (ED) are related to endothelial dysfunction. Elevated asymmetrical dimethylarginine (ADMA) levels and ED are common in patients with increased cardiovascular risk. Our aim was to investigate whether ADMA has a predictive role for major adverse cardiovascular events (MACE) in acute coronary syndrome (ACS). The secondary aim of this study was to investigate whether severity of ED predicts MACE in these patients.

Material and methods

Follow-up data were available for severity of ED in 71 patients with ACS. Plasma ADMA levels were determined by ELISA in 57 patients. Erectile dysfunction was assessed by the International Index of Erectile Function-6 (IIEF-6) score. Major adverse cardiovascular events (reinfarction, all-cause hospitalisation, stroke and all-cause death) was evaluated after a median of 10 months.

Results

Severe ED had no significantly increased hazard ratio for cardiovascular events compared with mild, mild to moderate, and moderate ED (0.259 [95% CI 0.041–1.6], p = 0.147; 0.605 [95% CI 0.095–3.8], p = 0.594; 0.980 [95% CI 0.233–4.1], p = 0.978; and 0.473 [95% CI 0.052–1.3], p = 0.508). The patients who had ADMA levels ≥ 0.32 µmol/l had no significantly increased hazard ratio for cardiovascular events compared with patients who had ADMA levels < 0.32 µmol/l (2.018 [95% CI 0.615–6.6], p = 0.247).

Conclusions

Severity of ED and ADMA did not increase the risk of cardiovascular events in follow-up patients with ACS in our study. Larger prospective studies are necessary to evaluate whether ADMA predicts cardiovascular events in patients with ACS.     

Effect of atorvastatin therapy on borderline vulnerable lesions in patients with acute coronary syndrome

Introduction

It is still controversial whether borderline lesions with a vulnerable plaque should be stented early or simply treated pharmacologically. No data exist concerning the potential effects of statin therapy on borderline vulnerable lesions in patients with acute coronary syndrome (ACS).

Material and methods

Fifty patients with ACS whose culprit lesions were classified as “borderline lesions” were enrolled. All patients were treated with atorvastatin (20 mg) for 12 months. Intravascular ultrasound (IVUS) was performed and matrix metalloproteinase-9 (MMP-9), tissue inhibitor of metalloproteinase-1 (TIMP-1), and high-sensitive C-reactive protein (hsCRP) levels were measured at baseline and 12-month follow-up.

Results

At 12-month follow-up, we found: 1) IVUS revealed that minimal lumen cross-sectional area (CSA) increased but plaque/media (P&M) area and plaque burden decreased. A total of 25 soft plaques (50%) were transformed into fibrous plaques. 2) ApoB, MMP-9 and hsCRP levels decreased, but TIMP-1 level increased. 3) Stepwise multivariate linear regression analysis showed that the independent predictors for changes in P&M area/year were the decrease in MMP-9 and hsCRP levels.

Conclusions

Atorvastatin therapy stabilized borderline vulnerable plaques and reversed atherosclerosis progression in patients with ACS. Reversal of this progression was accompanied by a decrease in the levels of plasma MMP-9 and hsCRP. Changes in MMP-9 and hsCRP could predict vulnerable plaque stabilization.     

Genetic variability and the risk of myocardial infarction in Poles under 45 years of age

Introduction

Myocardial infarction is caused by the obstruction of an artery in places of atherosclerosis plaque rupture. Endothelial cells during their activation express chemoattractant and adhesion molecules whereas infiltrating inflammatory cells produce enzymes, predisposing a lesion to rupture.

Material and methods

We investigated the correlation between polymorphisms in the human genes E-selectin (Ser128Arg), ICAM1 (K469E), OLR1 (K167N), MMP1 (1G/2G) and MMP3 (−1612 5A/6A) and the risk of MI in young Poles under 45 years. There was no significant difference in the frequency of single nucleotide polymorphism (SNP) of the studied genes E-selectin (Ser128Arg), ICAM1 (K469E), OLR1 (K167N) and MMP3 (−1612 5A/6A) between patients with MI and controls.

Results

The analysis of the association of the 1G2G polymorphism with the risk of myocardial infarction indicated an odds ratio (OR) of 5.68 (95% confidence interval [95% CI] 2.60 to 12.36). Other factors associated with myocardial infarction were: smoking (OR 4.12; 95% CI 1.63–10.44), male sex (OR 16.02; 95% CI 5.90–43.46), hypercholesterolaemia (OR 2.74; 95% CI 1.29–5.83) and arterial hypertension (OR 4.56; 95% CI 1.66–14.47).

Conclusions

We found that only MMP1 1G/2G polymorphism is associated with myocardial infarction in the Polish population of individuals younger than 45 years. Clinical factors seemed to play a greater role in the analysed group.     

Acute myocardial infarction due to left main coronary artery disease in men and women: does ST-segment elevation matter?

Introduction

Gender-specific issues regarding ST-segment elevation (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) due to unprotected left main coronary artery (ULMCA) disease were not sufficiently studied. We assessed the value of STEMI/NSTEMI initial classification on the management of men and women with acute MI due to critical stenosis or occlusion of the ULMCA.

Material and methods

The study group consisted of 643 consecutive patients with acute MI with the ULMCA as the infarct-related artery. Data derive from an ongoing, nationwide, multicenter, prospective, observational registry.

Results

Isolated ULMCA disease was more frequent in women and multivessel disease was more frequent in men in the NSTEMI group. The incidence of cardiogenic shock or pulmonary edema and cardiac arrest was higher in the STEMI group. Totally occluded ULMCA was more frequent in the STEMI group. Although the majority of patients underwent percutaneous coronary intervention (PCI), it was less frequently used in NSTEMI women and NSTEMI men. Although in-hospital and long-term mortality rates were higher in the STEMI group, there were no gender-related differences within groups. The initial ST-segment elevation was an independent predictor of in-hospital (OR = 2.37, 95% CI: 1.14–4.91, p = 0.02) and 12-month (OR = 1.52, 95% CI: 1.01–2.27, p = 0.045) mortality.

Conclusions

There were no gender-related differences in the management within the STEMI or NSTEMI group. Although acute myocardial infarction due to ULMCA disease is associated with high mortality in both genders, STEMI was a negative prognostic factor of in-hospital and 12-month mortality. Despite poor baseline characteristics and clinical presentation in women, female gender itself did not influence mortality.     

Correlation between central venous pressure and peripheral venous pressure with passive leg raise in patients on mechanical ventilation

Background:

Central venous pressure (CVP) assesses the volume status of patients. However, this technique is not without complications. We, therefore, measured peripheral venous pressure (PVP) to see whether it can replace CVP.

Aims:

To evaluate the correlation and agreement between CVP and PVP after passive leg raise (PLR) in critically ill patients on mechanical ventilation.

Setting and Design:

Prospective observational study in Intensive Care Unit.

Methods:

Fifty critically ill patients on mechanical ventilation were included in the study. CVP and PVP measurements were taken using a water column manometer. Measurements were taken in the supine position and subsequently after a PLR of 45°.

Statistical Analysis:

Pearson''s correlation and Bland–Altman''s analysis.

Results:

This study showed a fair correlation between CVP and PVP after a PLR of 45° (correlation coefficient, r = 0.479; P = 0.0004) when the CVP was <10 cmH₂O. However, the correlation was good when the CVP was >10 cmH₂O. Bland–Altman analysis showed 95% limits of agreement to be −2.912–9.472.

Conclusion:

PVP can replace CVP for guiding fluid therapy in critically ill patients.     

Influence of concomitant heparin administration on pregnancy-associated plasma protein-A levels in acute coronary syndrome with ST segment elevation

Introduction

The time course of pregnancy-associated plasma protein-A (PAPP-A) levels was studied at admission, immediately after percutaneous coronary intervention (PCI) and 1, 2, 4, 6, 12, 24 and 48 h after PCI in acute coronary syndrome with ST segment elevation (ACS-STE) to determine the impact of PCI, concomitant clinical complications and heparin administration.

Material and methods

Pregnancy-associated plasma protein-A serum levels, examined by the Kryptor^TM system, were studied in 30 heparinized PCI ACS-STE patients, in 10 elective PCIs and 12 coronary angiographies with heparin, and in 5 patients with normal coronary angiogram without heparin.

Results

Heparin caused a high PAPP-A increase in ACS-STE patients, in all patients with heparin without ACS and angiographic signs of significant atherosclerosis. This increase was directly associated with heparin dosage and activated clotting time (ACT) (r = 0.71, p = 0.0001) and inversely with the interval between heparin applications and time of serum sampling. It was followed by a rapid decrease within 1 to 2 h and return to normal levels in 10 to 12 h. In ACS-STE patients the decrease was significantly slower than in heparinized elective PCI and angiography patients. The PAPP-A increase was not significantly dependent on the length of PCI. Persistent increase after 24 h was associated in 4/7 patients with concomitant clinical complications.

Conclusions

The diagnostic validity of PAPP-A can be verified only within the 1^st h after clinical onset of ACS before heparin administration, the prognostic value in heparinized patients not earlier than 12 h after the last heparin application, if ACT is normal and serious clinical concomitant complications are eliminated.     

Ovarian reserve markers in unexplained infertility patients treated with clomiphene citrate during intrauterine insemination

Introduction

The aim of this retrospective case control study was to identify predictors of ovarian response and pregnancy outcomes in intrauterine insemination (IUI).

Material and methods

One hundred women undergoing IUI cycles with clomiphene citrate were enrolled. The number of antral follicles and the total ovarian volume by ultrasound, and the basal levels of follicle-stimulating hormone (FSH), estradiol, and inhibin B on cycle day 3 were measured in groups that were divided according to ovarian response. The tests were also evaluated according to ovarian response and pregnancy outcomes. All analyses were performed using the Statistical Package for the Social Sciences, version 15.0 (SPSS, Chicago, IL, USA).

Results

The antral follicle count (AFC) was the best single predictor for ovarian response and pregnancy outcomes. The sensitivity and specificity for prediction of ovarian response were 81% and 78% for AFC at an optimum cutoff value of ≤ 13.1. Age was negatively correlated with ovarian volume (r = –0.280, p = 0.021) and AFC (r = –0.358, p = 0.003). Increasing FSH was associated with a reduction in AFC (r = –0.273, p = 0.025). The AFC was significantly correlated with ovarian volume (r = 0.660, p < 0.0001) and FSH (r = –0.273, p = 0.03).

Conclusions

Our data demonstrate that the AFC provides better prognostic information on the occurrence of ovarian response during clomiphene citrate stimulation for IUI.     

Early clinical prediction of neurological outcome following out of hospital cardiac arrest managed with therapeutic hypothermia

Background:

Therapeutic hypothermia (TH) may improve neurological outcome in comatose patients following out of hospital cardiac arrest (OHCA). The reliability of clinical prediction of neurological outcome following TH remains unclear. In particular, there is very limited data on survival and predictors of neurological outcome following TH for OHCA from resource-constrained settings in general and South Asia in specific.

Objective:

The objective was to identify factors predicting unfavorable neurological outcome at hospital discharge in comatose survivors of OHCA treated with hypothermia.

Design:

Retrospective chart review.

Setting:

Urban 200-bed hospital in Chennai, India.

Methods:

Predictors of unfavorable neurological outcome (cerebral performance category score [3–5]) at hospital discharge were evaluated among patients admitted between January 2006 and December 2012 following OHCA treated with TH. Hypothermia was induced with cold intravenous saline bolus, ice packs and cold-water spray with bedside fan. Predictors of unfavorable neurological outcome were examined through multivariate exact logistic regression analysis.

Results:

A total of 121 patients were included with 106/121 (87%) experiencing the unfavorable neurological outcome. Independent predictors of unfavorable neurological outcome included: Status myoclonus <24 h (odds ratio [OR] 21.79, 95% confidence interval [CI] 2.89-Infinite), absent brainstem reflexes (OR 50.09, 6.55-Infinite), and motor response worse than flexion on day 3 (OR 99.41, 12.21-Infinite). All 3 variables had 100% specificity and positive predictive value.

Conclusion:

Status myoclonus within 24 h, absence of brainstem reflexes and motor response worse than flexion on day 3 reliably predict unfavorable neurological outcome in comatose patients with OHCA treated with TH.     

Lipoprotein-Associated Phospholipase A2 Is Related to Plaque Stability and Is a Potential Biomarker for Acute Coronary Syndrome

Purpose

Plasma lipoprotein-associated phospholipase A₂ (Lp-PLA₂) binds to low-density lipoprotein. The levels of Lp-PLA₂ reflect the plaque burden, and are upregulated in acute coronary syndrome (ACS). We investigated the diagnostic value of Lp-PLA₂ levels and found that it might be a potential biomarker for ACS.

Materials and Methods

We classified 226 study participants into three groups: patients without significant stenosis (control group), patients with significant stenosis with stable angina (SA group), and patients with ACS (ACS group).

Results

Lp-PLA₂ and high-sensitivity C-reactive protein (hs-CRP) levels were significantly greater in the ACS group than in the SA group (p=0.044 and p=0.029, respectively). Multivariate logistic regression analysis revealed that Lp-PLA₂ levels are significantly associated with ACS (odds ratio=1.047, p=0.013). The addition of Lp-PLA₂ to the ACS model significantly increased the global χ² value over traditional risk factors (28.14 to 35.602, p=0.006). The area under the receiver operating characteristic curve for Lp-PLA₂ was 0.624 (p=0.004). The addition of Lp-PLA₂ level to serum hs-CRP concentration yielded an integrated discrimination improvement of 0.0368 (p=0.0093, standard error: 0.0142) and improved the ability to diagnose ACS.

Conclusion

Lp-PLA₂ levels are related to plaque stability and might be a diagnostic biomarker for ACS.     

PON1 status evaluation in patients with chronic arterial occlusion of lower limbs due to atherosclerosis obliterans

Introduction

Human paraoxonase (PON1) is a calcium-dependent enzyme physically associated with HDL, and it is believed to contribute to the atheroprotective effect of HDL. The aim of the study was to evaluate PON1 status in patients with atherosclerosis obliterans as an effect of ischemia regarding its activity and phenotype distribution.

Material and methods

The study group consisted of patients with chronic arterial occlusion of the lower limbs due to atherosclerosis obliterans (AO). The patients were divided into two groups according to the degree of ischemia: moderate (MI), and critical (CI). The ratio of the hydrolysis of salt-stimulated PON1 activity to the hydrolysis of phenylacetate was used to assign individuals to one of three possible phenotypes (low activity – A, medium activity – AB, high activity – B). It was observed that PON1 arylesterase activity was affected by ischemia of the lower limbs depending on its degree.

Results

The odds ratio and the relative risk analysis showed that the patients with moderate ischemia are much more often characterized by phenotype A than by phenotype B. The low activity phenotype A occurs over twice as often in patients with chronic ischemia of the lower limbs as in individuals from the control group (OR = 2.125; 1.96 to 3.776, p = 0.0143).

Conclusions

This study presents the low activity phenotype A in relation to the risk of ischemia of the lower limbs due to atherosclerosis and shows the potentially important role of PON1 in conclusion of the process leading to intensification of ischemia degree.     

The role of matrix metalloproteinase 14 polymorphisms in susceptibility to intervertebral disc degeneration in the Chinese Han population

Introduction

Matrix metalloproteinase 14 (MMP14) plays an important role in the pathophysiology of intervertebral disc degeneration (IVDD). The present study aimed to determine whether two single nucleotide polymorphisms (–378 T/C and –364 G/T) of MMP14 were associated with the risk and severity of IVDD in the Chinese Han population.

Material and methods

A total of 908 patients with IVDD and 906 healthy controls were enrolled in this study. The grade of disc degeneration was determined according to Schneiderman''s classification for magnetic resonance imaging. The polymorphisms of MMP14 were genotyped using polymerase chain reaction and direct sequencing.

Results

The genotype distribution of –364G/T did not show a significant difference between IVDD patients and healthy controls. The frequencies of the –378T/C and CC genotypes were significantly lower among IVDD patients compared with healthy controls (p < 0.001); unconditional logistic regression analysis revealed that the CT and CC genotypes were significantly associated with a decreased risk of IVDD compared with the TT genotype (p < 0.001). Patients with IVDD showed significantly higher frequencies of the T allele at –378T/C than healthy controls (p < 0.001). In addition, the –375 CC genotype, as well as the C allele, was associated with lower degenerative grades of IVDD compared with the TT genotype and the T allele, respectively (both p < 0.001).

Conclusions

The –378T/C polymorphism of MMP14 may be associated with the risk and severity of IVDD in the Chinese Han population. It shows potential to become a biomarker to predict risk and severity of IVDD.     

Expression analysis of intercellular adhesion molecule-2 (ICAM-2) in the context of classical cardiovascular risk factors in acute coronary syndrome patients

Introduction

Cardiopulmonary diseases are the most common cause of hospitalization and death. Often the basic problem is endothelial dysfunction leading to elevated expression of adhesion proteins as well as increased adhesion and aggregation of blood cells. The goal of the study was to assess expression level of intercellular adhesive molecule-2 (ICAM-2) in patients with acute coronary syndrome (ACS).

Material and methods

The obtained data were analysed in the context of the occurrence of classical cardiovascular risk factors. The two studied groups consisted of 60 ACS patients and 20 healthy individuals who both were qualified based on electrocardiography (ECG), transthoracic echocardiography and biochemical tests. The ACS patients additionally had coronary angiography performed. The number of ICAM-2 gene mRNA molecules was evaluated on the basis of QRT-PCR reaction kinetics. To compare the results the Mann-Whitney U test was used. Results were judged statistically significant if p < 0.05.

Results

Analysis of the results showed a significantly higher number of ICAM-2 gene mRNA copies in ACS patients compared to healthy subjects (140920 ±105207 and 15023 ±14325, respectively). Furthermore, our results indicate a correlation between obesity (p = 0.012) and positive burdening family history (p = 0.041) and increased ICAM-2 levels in patients with ACS.

Conclusions

Increased ICAM-2 gene expression in ACS patients is probably symptomatic of endothelium dysfunction and may be responsible for intensified adhesion and aggregation processes as well as for appearance of acute coronary syndrome. These results indicate a correlation between obesity and burdening family history on the one hand, and increased ICAM-2 levels in patients with ACS, on the other.     

Usefulness of patient's history and non-invasive electrocardiographic parameters in prediction of ajmaline test results in patients with suspected Brugada syndrome

Introduction

The aim of the work was to assess the usefulness of patient''s history and non-invasive electrocardiographic parameters in the prediction of ajmaline test results in patients with suspected Brugada syndrome.

Material and methods

The study involved a group of 59 patients (37 men) at average age of 31.6 ±12.2 years with suspected concealed form of Brugada syndrome. Pharmacological provocation with intravenous ajmaline administration was performed. The patients were divided into two groups depending on ajmaline test results. Individual and total predictive value for ajmaline test was based on the analysis of medical anamnesis and non-invasive electrocardiographic examination.

Results

The analysis carried out within the work indicated a special predictive value of 2 parameters which constituted the study inclusion criteria – family history of Brugada syndrome (28.6% vs. 3.8%; p = 0.0477) and occurrence of saddleback electrocardiographic changes in ECG curve (42.9% vs. 0.0%; p = 0.0002). Non-invasive electrocardiographic parameters which showed significant predictive value for ajmaline test were as follows: dispersion of QTc interval (prior to the provocation test 54.43 ±24.77 ms vs. 32.70 ±12.98 ms; p = 0.0005 and during daytime activity 46.81 ±27.16 ms vs. 32.07 ±13.19 ms; p = 0.0198), corrected QT intervals, Tpeak-Tend intervals in particular leads, QTpeak intervals, dispersion of Tpeak-Tend interval assessed from precordial leads (V1–V6) (42.86 ±13.80 ms vs. 26.54 ±11.70 ms; p = 0.001) and J-point elevation in V2 and V3 leads.

Conclusions

Both interview and non-invasive electrocardiographic parameters which reflect cardiomyocyte repolarization disorders are of high predictive value in anticipating ajmaline pharmacological provocation results in patients with suspected Brugada syndrome.     

Quality of pregnant women's diet in Poland – macro-elements

Introduction

The objective was to assess the quality of pregnant women''s diet in Poland concerning macro-elements and to analyze reasons for low or high quality diets.

Material and methods

Five hundred and twelve pregnant women in their 20^th to 30^th week of pregnancy took part in the research conducted by means of a 7-day observation of diet. Consumed products were analyzed by means of DIETETYK software developed by the Polish National Food and Nutrition Institute. Obtained macro values were averaged. The results were compared with the recommendations from the World Health Organization, European Union and Polish National Food and Nutrition Institute and analyzed statistically (χ² test).

Results

The pregnant women consumed an average of 1898 ±380 kcal daily. Average value of macro components supplied with the diet did not deviate from EU and NFNI nutrition recommendations: protein – 72.1 g/person daily, fats overall – 72.8 g, polyunsaturated fatty acids – 10.93 g, cholesterol – 283 mg, carbohydrates – 257 g. The study proved a significant relation between a higher quality diet of pregnant women and tertiary or secondary education (p = 0.05) as well as urban residence (p = 0.01).

Conclusions

Pregnant women''s diet in Poland is not significantly different from diet quality of pregnant women from other countries. A lower quality diet was observed among women who smoked during pregnancy and lived in rural areas.     

Association study of COX-2 (PTGS2) –765 G/C promoter polymorphism by pyrosequencing in Sicilian patients with Alzheimer's disease

Introduction

Alzheimer''s disease (AD) is characterized by progression of memory problems to a slow global decline of cognitive function. Inflammation when left unregulated becomes a major cofactor in the pathogenesis of AD. PTGS2 is of crucial relevance in the inflammatory response, and it has been shown to play a considerable role in AD pathogenesis.

Material and methods

To assess the possible putative role of a PTGS2 polymorphism (–765 G/C) in AD patients, we examined, by pyrosequencing, its distribution in 84 Sicilian AD patients and in 80 controls.

Results

No significant statistical difference in PTGS2 –765 G/C genotype distribution was found comparing patients with AD and controls. In addition, no significant difference was observed in the distribution of the PTGS2 –765 alleles between AD patients and controls.

Conclusions

These findings suggest that the PTGS2 –765 G/C polymorphism may not be associated with AD in the Sicilian population.     

Gradual sucrose gastric loading test: A method for the prediction of nonsuccess gastric enteral feeding in critically ill surgical patients

Background and Aims:

Intolerance of gastric enteral feeding (GEN) commonly occurs in surgical Intensive Care Unit (SICU). A liquid containing sugar could prolong gastric emptying time. This study was to propose a method for prediction of nonsuccess GEN using gastric volume after loading (GVAL) following gradual sucrose gastric loading.

Materials and Methods:

Mechanical ventilator supported and hemodynamically stable patients in SICU were enrolled. About 180-240 min before the GEN starting, a sucrose solution (12.5%; 450 mosmole/kg, 800 mL) was administered via gastric feeding tube over 30 min with 45° head upright position. GVAL was measured at 30, 60, 90, and 120 min after loading. GEN success status using clinical criteria was assessed at 72 h after the starting GEN protocol. The receiving operating characteristic (ROC) and c statistic were used for discrimination at each time point of GVAL.

Results:

A total of 32 patients were enrolled and completed the protocol. 14 patients (43.7%) were nonsuccessful GEN. The nonsuccess group was found to have significantly more GVAL than the other group at all-time points during the test (P < 0.05). The most discriminating point of GVAL for the prediction of nonsuccess was 150 mL at 120 min after loading with a sensitivity of 92.3%, specificity of 88.9%, positive predictive value of 85.7%, negative predictive value of 94.1%, and ROC area 0.97 (95% confidence interval 0.91–1.00).

Conclusion:

A high GVAL following sucrose gastric loading test might be a method to predict nonsuccess GEN in critically ill surgical patients.     

Expression of angiogenesis-related genes in right atrial appendages from patients with advanced myocardial ischemia – preliminary results

Introduction

The most frequent cause of myocardial ischemia is atherosclerotic lesions which narrow coronary vessels leading to impaired blood flow or their total occlusion.

Material and methods

Using HG-U133A oligonucleotide microarrays (Affymetrix) we studied the expression levels of angiogenesis-related genes in patients with different types of heart failure. We analyzed the RNA from right atrial appendages from patients: 1) with advanced coronary disease and myocardial infarction history, 2) with advanced stable coronary disease and no infarction history, and 3) after surgery due to mitral stenosis, but with no coronary vessel lesions.

Results

Analysis of the data from oligonucleotide microarrays allowed identification of 2 genes (ENG and NPPB) differentiating the examination grups.

Conclusions

Analysis of the expression profile of genes involved in angiogenesis, carried out using data obtained from examined individuals’ samples, suggests that necrosis accompanying myocardial infarction is a significant factor leading to elevated expression levels of genes involved in neoangiogenesis.     

The effects of botulinum toxin type A on improvement and dynamic spastic equinus correction in children with cerebral palsy – preliminary results

Introduction

We evaluated the effects of botulinum toxin type A (BTA) with physical therapy on dynamic foot equinus correction and higher motor functional outcome in children with spastic type of cerebral palsy (CP).

Material and methods

Ankle joint active and passive movement, gastrocnemial muscle spasticity levels (Modified Ashworth Scale (MAS)), and higher motor functional status (Gross Motor Function Classification System (GMFCS) and Gross Motor Function Measure (GMFM) (GMFM-D – standing and GMFM-E – walking) were assessed before treatment and 3, 8, 16 weeks and 6 months after BTA administration in 12 children.

Results

There was a significant improvement of active (initial – (–)13.07 ±5.78; 6 months – (–)10.64 ±4.77; p < 0.001) and passive (initial – 4.21 ±2.29; 6 months – 4.71 ±2.16; p < 0.05) ankle joint foot dorsiflexion. GMFM-D and GMFM-E were significantly higher after 3, 8, 16 weeks (p < 0.001) and GMFM-D after 6 months (p < 0.001).

Conclusions

Botulinum toxin type A administration and physical therapy in patients with spastic CP improves the motion range of dynamic foot equinus after 3 weeks and higher motor functional outcome (standing and walking).     

Predicting reintubation,prolonged mechanical ventilation and death in post-coronary artery bypass graft surgery: a comparison between artificial neural networks and logistic regression models

Introduction

In coronary artery bypass (CABG) surgery, the common complications are the need for reintubation, prolonged mechanical ventilation (PMV) and death. Thus, a reliable model for the prognostic evaluation of those particular outcomes is a worthwhile pursuit. The existence of such a system would lead to better resource planning, cost reductions and an increased ability to guide preventive strategies. The aim of this study was to compare different methods – logistic regression (LR) and artificial neural networks (ANNs) – in accomplishing this goal.

Material and methods

Subjects undergoing CABG (n = 1315) were divided into training (n = 1053) and validation (n = 262) groups. The set of independent variables consisted of age, gender, weight, height, body mass index, diabetes, creatinine level, cardiopulmonary bypass, presence of preserved ventricular function, moderate and severe ventricular dysfunction and total number of grafts. The PMV was also an input for the prediction of death. The ability of ANN to discriminate outcomes was assessed using receiver-operating characteristic (ROC) analysis and the results were compared using a multivariate LR.

Results

The ROC curve areas for LR and ANN models, respectively, were: for reintubation 0.62 (CI: 0.50–0.75) and 0.65 (CI: 0.53–0.77); for PMV 0.67 (CI: 0.57–0.78) and 0.72 (CI: 0.64–0.81); and for death 0.86 (CI: 0.79–0.93) and 0.85 (CI: 0.80–0.91). No differences were observed between models.

Conclusions

The ANN has similar discriminating power in predicting reintubation, PMV and death outcomes. Thus, both models may be applicable as a predictor for these outcomes in subjects undergoing CABG.     

Left atrial and left atrial appendage systolic function in patients with post-myocardial distal blocks

Introduction

The study aimed to evaluate function of the left atrium (LA) and of the left atrial appendage (LAA) after myocardial infarction (MI) complicated by intracardiac conduction disturbances.

Material and methods

The study comprised 59 patients with persistent post-myocardial distal blocks, who were allocated to one of the three following subgroups: study group I – 20 patients with left bundle branch block (LBBB); study group II – 20 patients with right bundle branch block (RBBB), and study group III –19 pts with left anterior hemiblock (LAHB). The control groups included patients with MI in their history and no BBBs (19 pts – group IV) and clinically healthy people (16 patients – group V). The parameters of LA and LAA systolic function were determined by means of transthoracic (TTE) and transoesophageal echocardiography (TOE).

Results

We showed that patients who experienced myocardial infarction not complicated with conduction disturbances expressed compensatory LA systolic function enhancement. In patients with post-myocardial RBBB and LAHB significant enhancement of LA systolic function was observed as well but it was expressed to a lesser degree. There was also a tendency towards deterioration of LA systolic function in patients with post-myocardial LBBB. LBBB did not affect LAA systolic function negatively.

Conclusions

Parameters of LAA systolic function showed its enhancement in all patients after myocardial infarction irrespective of whether it was complicated by conduction disturbances.Key words: left atrium, left atrial appendage, echocardiography, distal blocks