Serum level of interleukin-6 (IL-6) and N-terminal propeptide of procollagen type I (PINP) in patients with liver diseases

Introduction: The aim of this study was to evaluate the concentration of interleukin-6 and N-terminal propeptide of procollagen type I and their relationship in liver diseases of different etiologies.

Material and methods: Serum samples were obtained from 30 healthy volunteers and patients suffering from alcoholic cirrhosis (AC) – 31, non-alcoholic cirrhosis (NAC) – 28 and toxic hepatitis (HT) – 23 patients. Cirrhotic patients were classified according to Child–Pugh score. IL-6 and PINP concentrations were determined according to the electrochemiluminescence immunoassay.

Results: The mean serum IL-6 concentration was significantly higher in AC (mean?±?SD:21.52?± 15.01?pg/mL), NAC (20.07?±?32.12?pg/mL) and HT (15.14?±?17.18?pg/mL) when compared to the control group (C) (1.67?±?0.42?pg/mL) (Mann–Whitney U test: p?p?p?=?.020 and p?p?p?=?.022, respectively). IL-6 and PINP concentrations appeared to vary depending on the severity of liver damage (p?p?p?Conclusions: We conclude that serum concentrations of IL-6 and PINP change in liver diseases, and those changes reflect the severity of liver disease.     

Influence of patient related factors on number of mesenchymal stromal cells reached after in vitro culture expansion for clinical treatment

Background: Number of stromal cells injected in patients with ischaemic heart disease (IHD) may be of importance for the treatment efficacy, which in turn may be influenced by various patient-related factors. In this study, we investigate whether patient-related factors influence the number of autologous stromal cells reached after in vitro culture expansion for clinical therapy.

Methods: Culture expansion data from 111 patients with IHD treated with autologous stromal cells in three clinical trials were used. We correlated the final cell count after two passages of cultivation with different patient factors.

Results: There was a significant relation between body mass index (BMI) and the number of adipose derived stromal cells (ASCs) reached after culture expansion and for all patients included into the three studies (r?=?0.375, p?=?.019 and r?=?0.200, p?=?.036, respectively). Moreover, there was a significantly higher number of ASCs reached in patients with hypertension compared to those without hypertension and for all patients overall (68.8?±?39.6?×?10⁶ vs. 39.1?±?23.6?×?10⁶, p?=?.020 and 62.0?±?55.0?×?10⁶ vs. 29.0?±?19.3?×?10⁶, p?<?.001, respectively). The same tendency was seen with bone marrow derived mesenchymal stromal cells (MSCs) in patients with hypertension compared to those without hypertension (58.4?±?61.8?×?10⁶ vs. 22.6?±?13.3?×?10⁶, p?<?.001) and in males compared to females (56.4?±?61.5?×?10⁶ vs. 30.9?±?27.9?×?10⁶, p?=?.041). Moreover, a significant negative correlation between left ventricular ejection fraction and number of MSCs was found (r?=??0.287, p?=?.017).

Conclusions: Patient related factors such as BMI, hypertension and gender may influence the number of MSCs reached after in vitro culture expansion.     

The usage of fasting glucose and glycated hemoglobin for the identification of unknown type 2 diabetes in high risk patients with morbid obesity

Background: In spite of increased vigilance of undiagnosed type 2 diabetes (DM2), the prevalence of unknown DM2 in subjects with morbid obesity is not known.

Aim: To assess the prevalence of undiagnosed DM2 and compare the performance of glycated A1c (HbA1c) and fasting glucose (FG) for the diagnosis of DM2 and prediabetes (preDM) in patients with morbid obesity.

Patients and methods: We measured fasting glucose and HbA1c in 537 consecutive patients with morbid obesity without previously known DM2.

Results: A total of 49 (9%) patients with morbid obesity had unknown DM2 out of which 16 (33%) fulfilled both the criteria for HbA1c and FG. Out of 284 (53%) subjects with preDM, 133 (47%) fulfilled both the criteria for HbA1c and FG. Measurements of agreement for FG and HbA1c were moderate for DM2 (κ?=?0.461, p?<?.001) and fair for preDM (κ?=?0.317, p?<?.001). Areas under the curve for FG and HbA1c in predicting unknown DM2 were 0.970 (95% CI 0.942, 0.998) and 0.894 (95% CI 0.837, 0.951) respectively. The optimal thresholds to identify unknown DM2 were FG ≥6.6?mmol/L and HbA1c ≥ 6.1% (43?mmol/mol).

Conclusions: The prevalence of DM2 remains high and both FG and HbA1c identify patients with unknown DM2. FG was slightly superior to HbA1c in predicting and separating patients with unknown DM2 from patients without DM2. We suggest that an FG ≥6.6?mmol/L or an HbA1c ≥6.1% (43?mmol/mol) may be used as primary cut points for the identification of unknown DM2 among patients with morbid obesity.     

Influence of videogames and musical instruments on performances at a simulator for robotic surgery

Objective: To assess if exposure to videogames, musical instrument playing, or both influence the psychomotor skills level, assessed by a virtual reality simulator for robot-assisted surgery (RAS).

Materials and methods: A cohort of 57 medical students were recruited: playing musical instruments (group 1), videogames (group 2), both (group 3), and no activity (group 4); all students executed four exercises on a virtual simulator for RAS.

Results: Subjects from group 3 achieved the best performances on overall score: 527.09?±?130.54 vs. 493.73?±?108.88 (group 2), 472.72?±?85.31 (group 1), and 403.13?±?99.83 (group 4). Statistically significant differences (p?p?=?.009) and for time of completion (p?=?.044). As regards experience with the piano, subjects from group 3 outperformed those from group 1 on overall score (496.98?±?122.71 vs. 470.25?±?92.31), but without statistically significant difference (p?=?.646).

Conclusions: The present study suggests that the level of psychomotor skills in subjects exposed to both musical instrument playing and videogames is higher than that in those practicing either one alone. The effect of videogames appears negligible in individuals playing the piano.     

Changes in peripheral blood T-cell balance after percutaneous tumor ablation

Purpose: To evaluate the changes in T-cell balance in peripheral blood following percutaneous tumor ablation.

Material and methods: Patients underwent thermal ablation including radiofrequency (n?=?9) and microwave ablation (n?=?5), or cryoablation (n?=?5). Target tumors were located in the lung (n?=?7), soft tissue (n?=?5), liver (n?=?4), and bone (n?=?3). Patient peripheral blood samples were collected before and within 14?days after ablation. Peripheral blood populations of cytotoxic T-cells (CTL), type-1 (T_h1) and type-2 helper T-cells (T_h2), and regulatory T-cells (T_reg) were measured using flow cytometry. Changes in CTL/T_reg and T_h1/T_h2 ratios before and after ablation therapy were compared using paired t-tests.

Results: Peripheral blood CTL population (27.5?±?2.1% to 30.2?±?2.5%, p?reg ratios (18.8?±?3.7% to 21.6?±?3.6%, p?reg ratios was found after heat-based ablation (18.0?±?4.4% to 21.6?±?4.7%, p?p?=?.92). T_h1/T_h2 ratio (13.7?±?3.0% to 17.2?±?3.5%, p?=?.12) remained unchanged after ablation.

Conclusion: Ablation therapy alters the T-cell balance by increasing the systemic CTL/T_reg, ratio. Heat-based ablation might be a more effective approach than cryoablation to enhance systemic anti-tumor immunity.     

Glycated albumin as a glycaemic marker in patients with advanced chronic kidney disease and anaemia: a preliminary report

Abstract

Background: The association between glycated albumin (GA) and glycaemic status has not been fully described in patients with advanced chronic kidney disease (CKD) in relation to anaemia. The aim of this study was to evaluate the relationship between GA and fasting plasma glucose (FPG) and HbA1c in patients with advanced CKD and to evaluate the influence of anaemia in such relationship.

Materials and methods: Patients with CKD stage 4 or 5 were included in the study. eGFR was calculated by the CKD-EPI creatinine equation. Plasma GA was measured by an enzymatic method.

Results: Eighty-one patients were included in the study, 46 (57%) were males; the mean age was 67?±?14?years. HbA1c was correlated with Hb (r?=?0.39; p?=?.0003), and no significant correlation was detected between plasma GA and serum albumin (p?=?.82). A significant association between FPG and GA (r²?=?0.41; p?r²?=?0.42; p?r²?=?0.55; p?Conclusions: GA, alone or in combination with other biomarkers, can be considered for the evaluation of glycaemic status in patients with advanced CKD and severe anaemia.     

Clinical and genetic determinants of chronic visual pathway changes after methanol - induced optic neuropathy: four-year follow-up study

Context: Methanol poisoning induces acute optic neuropathy with possible long-term visual damage.

Objective: To study the dynamics and key determinants of visual pathway functional changes during 4 years after acute methanol poisoning.

Methods: A total of 42 patients with confirmed methanol poisoning (mean age 45.7?±?4.4 years) were examined 4.9?±?0.6, 25.0?±?0.6, and 49.9?±?0.5 months after discharge. The following tests were performed: visual evoked potential (VEP), retinal nerve fiber layer (RNFL) measurement, brain magnetic resonance imaging (MRI), complete ocular examination, biochemical tests, and apolipoprotein E (ApoE) genotyping.

Results: Abnormal VEP P1 latency was registered in 18/42 right eyes (OD) and 21/42 left eyes (OS), abnormal N1P1 amplitude in 10/42 OD and OS. Mean P1 latency shortening during the follow-up was 15.0?±?2.0?ms for 36/42 (86%) OD and 14.9?±?2.4?ms for 35/42 (83%) OS, with maximum shortening up to 35.0?ms. No significant change of mean N1P1 amplitude was registered during follow-up.

A further decrease in N1P1 amplitude ≥1.0 mcV in at least one eye was observed in 17 of 36 patients (47%) with measurable amplitude (mean decrease ?1.11?±?0.83 (OD)/?2.37?±?0.66 (OS) mcV versus ?0.06?±?0.56 (OD)/?0.83?±?0.64 (OS) mcV in the study population; both p?ApoE4 allele carriers had lower global and temporal RNFL thickness and longer initial P1 latency compared to the non-carriers (all p?p?r?=?0.384; p?=?.013) and brain hemorrhages (r?=?0.395; p?=?.011).

Conclusions: Improvement of optic nerve conductivity occurred in more than 80% of patients, but evoked potential amplitude tended to decrease during the 4 years of observation. ApoE4 allele carriers demonstrated lower RNFL thickness, longer P1 latency, and more frequent methanol-induced brain damage compared to non-carriers.     

Chronic psychological stress seems associated with elements of the metabolic syndrome in patients with ischaemic heart disease

Background and objectives: Chronic psychological stress, the metabolic syndrome (MS) and ischaemic heart disease (IHD) seem closely connected. In this study, we evaluate the association between chronic stress and elements of MS in patients with stable IHD.

Design: Cross-sectional cohort study.

Methods: Three hundred and fifty patients with stable IHD were included. Chronic stress was evaluated by the two questionnaires, Major Depression Inventory (MDI) and the psychological wellbeing index WHO-5, as well as by Pressure Pain Sensitivity (PPS), a physiological measure of hyperalgesia at the sternum known to be associated to elements of the chronic stress syndrome. Elements of MS were evaluated by dual-energy X-ray absorptiometry, body weight, HOMA-IR and blood lipids.

Results: Depressive symptoms were associated with a high percentage of body fat (β?=?0.179, p?=?.001), and high level of triglycerides (β?=?0.150, p?=?.007). Low psychological wellbeing was associated with a high percentage of body fat (β?=?–0.165, p?=?.002) and low level of HDL cholesterol (β?=?0.128, p?=?.024). Chronic stress measured by PPS was associated with a high percentage body fat (β?=?0.327, p?<?.001), low body weight (β?=?–0.218, p?<?.001) and low HDL-cholesterol (β?=?–0.137, p?=?.013). Adjusting for several life style factors did not change these results.

Conclusions: In patients with stable IHD, different measures of chronic psychological stress seem associated with a high percentage of body fat and adverse blood lipids independent of several lifestyle factors.     

Arterial stiffness in fertile women with metabolic syndrome

Introduction: Although metabolic syndrome (MetS) is evidently associated with the risk of cardiovascular disease (CVD), recently its use has been questioned. We studied the utility of MetS diagnosis when estimating individual CVD risk.

Methods: We compared 27 fertile women with MetS and 27 counterparts without the syndrome, matched pairwise according to well-known risk factors of CVD. Pulse wave velocity (PWV) and central blood pressure (cBP) were determined noninvasively via a SphygmoCor device. Arterial compliance was measured noninvasively with an HDI/PulseWave^TMCR-2000 arterial tonometer.

Results: PWV (7.1?±?2.5 versus 6.5?±?1.1 m/s, p?=?.037), and both systolic (120.9?±?12.2 versus 111.5?±?16.0?mmHg, p?=?.031) and diastolic cBP (81.3?±?8.5 versus 74.1?±?11.2?mmHg, p?=?.035) were higher in the MetS group. Systemic arterial compliance values were lower in both large (15.1?±?8.0 versus 16.1?±?4.4?mL/mmHg?×?10, p?=?.034) and small arteries (7.1?±?2.5 versus 9.3?±?3.2?mL/mmHg?×100, p?=?.010) in women with MetS.

Conclusions: Fertile women with MetS had increased arterial stiffness, as measured by three different methods. Our results highlight the utility of MetS when revealing increased individual CVD risks in fertile-aged women.

• Key messages

• Women with MetS have increased arterial stiffness when measured by different methods.

• MetS is a useful clinical tool to assess increased cardiovascular risk, particularly among fertile-aged women.

     

A nine year follow-up study of patients with lymphoedema cholestasis syndrome 1 (LCS1/Aagenaes syndrome)

Abstract

The risks of developing energy or nutrient deficits are of great concern in infants and children with the rare lymphoedema cholestasis syndrome 1 (LCS1)/Aagenaes syndrome. In adolescents and adults, it is not known whether LCS1 patients need specific dietary advice outside periods of cholestasis. The primary objective of the present study was to evaluate the progression of the liver disease and nutritional status in patients with LCS1 over a period of nine years. Dietary and biochemical data were obtained for patients and healthy controls in two cross-sectional studies, a baseline (2000) and a follow-up study (2009). Thirteen patients above 18?years of age with LCS1 (65%) were included (six females). Dietary intake and biochemical measures were stable in the patients from baseline until follow-up. Compared to healthy controls, the patients had significantly higher serum levels of alkaline phosphatase (p?=?.015 and p?=?.002), gamma-glutamyltransferase (p?=?.001 and p?p?=?.037 and p?=?.016), and fibrinogen (p?=?.046 and p?p?=?.033 and p?p?=?.011 and p?=?.003) at baseline and follow-up. Despite stable liver function, the presence of a low grade of hepatobiliary dysfunction in these patients was suggested. Patients with LCS1 had a nutritional status similar to healthy controls, with no clinical deterioration of liver function during the nine-year period. The findings presented in this paper support that more than 50% of patients with LCS1 can expect a normal lifespan.     

Are general practitioners characteristics associated with the quality of type 2 diabetes care in general practice? Results from the Norwegian ROSA4 study from 2014

Objective: To explore the associations between general practitioners (GPs) characteristics such as gender, specialist status, country of birth and country of graduation and the quality of care for patients with type 2 diabetes (T2DM).

Design: Cross-sectional survey.

Setting and subjects: The 277 GPs provided care for 10082 patients with T2DM in Norway in 2014. The GPs characteristics were self-reported: 55% were male, 68% were specialists in General Practice, 82% born in Norway and 87% had graduated in Western Europe. Of patients, 81% were born in Norway and 8% in South Asia. Data regarding diabetes care were obtained from electronic medical records and manually verified.

Main outcome measures: Performance of recommended screening procedures, prescribed medication and level of HbA1c, blood pressure and LDL-cholesterol stratified according to GPs characteristics, adjusted for patient and GP characteristics.

Result: Female GPs, specialists, GPs born in Norway and GPs who graduated in Western Europe performed recommended procedures more frequently than their counterparts. Specialists achieved lower mean HbA1c (7.14% vs. 7.25%, p?p?=?0.018) and lower mean systolic blood pressure (133.0?mmHg vs. 134.7?mmHg, p?p?Conclusion: Several quality indicators for type 2 diabetes care were better if the GPs were specialists in General Practice.

• Key Points

• Research on associations between General Practitioners (GPs) characteristics and quality of care for patients with type 2 diabetes is limited.

• Specialists in General Practice performed recommended procedures more frequently, achieved better HbA1c and blood pressure levels than non-specialists.

• GPs who graduated in Western Europe performed screening procedures more frequently and achieved lower diastolic blood pressure compared with their counterparts.

• There were few significant differences in the quality of care between GP groups according to their gender and country of birth.

     

Improved assessment of arterial stiffness using corrected cardio-ankle vascular index (CAVI0) in overweight adolescents with white-coat and essential hypertension

Arterial stiffness is a marker of vascular damage. Although adiposity increases cardiovascular risk, the relationship between paediatric overweight and arterial stiffness is unclear. The study aimed to evaluate the simultaneous effect of hypertension and overweight on arterial stiffness using cardio-ankle vascular index (CAVI) and related novel, theoretically blood pressure (BP)-independent, index CAVI₀. CAVI and CAVI₀ were measured in 140 adolescent boys (16.0?±?1.9?years) divided into age-matched groups: normal-weight normotensives, overweight normotensives, overweight white-coat hypertensives, and overweight essential hypertensives. Overweight normotensives had significantly lower CAVI and CAVI₀ compared to normal-weight normotensives (4.81?±?0.64 vs. 5.33?±?0.66, p?<?.01; 7.10?±?0.99 vs. 7.81?±?1.00, p?<?.01, respectively). CAVI and CAVI₀ in overweight essential hypertensives showed no significant difference compared to normal-weight normotensives and were significantly higher compared to overweight normotensives (5.32?±?0.77 vs. 4.81?±?0.64, p?<?.01; 7.77?±?1.19 vs. 7.10?±?0.99, p?<?.01, respectively). CAVI, but not CAVI₀, was associated positively with diastolic pressure (0.022?mmHg^?1, p?=?.002) and negatively with pulse pressure (?0.022?mmHg^?1, p?=?.001), and it was significantly higher in overweight white-coat hypertensives compared to overweight normotensives (5.20?±?0.63 vs. 4.81?±?0.64, p?<?.05). The lowering effect of overweight on arterial stiffness indexed by CAVI and CAVI₀ in hypertensive adolescents seems to counterbalance the early arteriosclerotic effect of essential hypertension. The increase in CAVI, but not CAVI₀, in overweight white-coat hypertensives could be attributable to residual BP dependence of CAVI, which is not present in CAVI₀. Under certain conditions, CAVI₀ may offer a clinically relevant improved assessment of arterial stiffness superior to CAVI.     

Barium exposure increases the risk of congenital heart defects occurrence in offspring

Context: Several studies have investigated the association between heavy metal exposure and congenital heart defects (CHDs). However, there are limited data regarding the relationship between barium exposure and the occurrence of CHDs. The objective of this study was to analyze the association between barium exposure in mothers and the risk of CHD in offspring.

Materials and methods: We developed a case-control study with 399 cases and 490 controls with normal live births in China. The concentrations of barium in hair of pregnant woman and fetal placenta were measured. We used a logistic regression analysis to explore the association between barium exposure and the risk of CHD.

Results: Logistic regression analysis indicated that the median concentration of barium in maternal hair in the CHD group was 4.180?ng/mg (adjusted odds ratio [aOR], 1.230; 95% confidence interval [CI], 1.146–1.321; p?p?=?.003). Significant differences in the concentration of barium in hair were also found between the different CHD subtypes and the controls. These differences were found in cases with septal defects (p?p?p?p?p?=?.010). Significantly different barium concentrations in fetal tissue were only found in cases with septal defects (p?=?.010).

Conclusions: Maternal barium exposure was dose-dependently related to the risk of CHD in the offspring. Our findings suggest that the occurrence of some subtypes of CHD is associated with barium exposure.     

Change in the new psychoactive substances associated with Emergency Department acute toxicity presentations associated with the introduction of the UK 2016 Psychoactive Substances Act

Objectives: In May 2016, the Psychoactive Substances Act (PSA) came into effect in UK making it an offence to produce or supply new psychoactive substances (NPS). The aim of this study was to determine whether this was associated with a change in Emergency Department (ED) presentations with acute NPS toxicity.

Method: ED presentations to our inner-city hospital in London, UK, with acute NPS toxicity in the 12 months before and after the PSA introduction [June 2015–May 2016 (2015/2016) and June 2016–May 2017 (2016/2017)] were obtained from our database. The following data were extracted: (i) demographics; (ii) NPS(s) self-reported [categorized as synthetic cannabinoids (SC), cathinones, and “other NPS”)]; and (iii) month of presentation.

Results: There were 1884 presentations with recreational drug toxicity, 447 (23.7%) involved NPS. There was no difference in the overall proportion of presentations involving an NPS in 2015/2016 [n?=?196 (22.3%)] and 2016/2017 [251 (24.9%); (p?=?.48)]. There were a mean?±?SD of 16.3?±?3.7 NPS-related presentations per month in 2015/2016 and 20.9?±?9.2 in 2016/2017; there was no significant change in overall monthly NPS-related presentations between these periods (p?=?.15). However, mean?±?SD monthly SC-related presentations increased from 2015/2016 (5.9?±?2.5) to 2016/2017 (17?±?9.8); p?=?.004. Mean monthly cathinone-related presentations decreased from 2015/2016 (8.8?±?4.2) to 2016/2017 (3.8?±?2.7); p?=?.001. There was no significant change in monthly mean “other NPS” presentations from 2015/2016 (1.8?±?2.2) to 2016/2017 (0.5?±?0.8); p?=?.062. Between 2015/2016 and 2016/2017, SCs as a proportion of NPS-related presentations increased (r?=?.90) whilst cathinones decreased (r?=??0.82).

Conclusion: NPS present front-line health services with unique challenges, and the PSA 2016 represents a major legislative effort in UK to limit their availability and supply. The burden of NPS use on this inner-city ED remains large 12 months after this legislation has come into force, with evolving patterns of NPS use.     

Inflammatory biomarkers in saliva and serum of patients with rheumatoid arthritis with respect to periodontal status

Objective: To study prospectively the association of salivary and serum matrix metalloproteinase (MMP)-8, tissue inhibitor of MMPs (TIMP)-1 and interleukin (IL)-6 with periodontal and systemic inflammation in rheumatoid arthritis (RA). We hypothesized that biomarker concentrations reflect inflammation.

Methods: Fifty three early untreated RA (ERA) and 28 chronic RA (CRA) patients, underwent rheumatological and dental examinations at baseline and one year later after starting first conventional or biological disease modifying antirheumatic drug. We included 43 control subjects. Saliva and serum samples were analyzed for MMP-8, TIMP-1 and IL-6. Periodontal health was assessed by bleeding on probing (BOP), pocket depth (PD) and periodontal inflammatory burden index (PIBI); RA disease activity was assessed by disease activity score DAS28. Joint destruction was analyzed by the modified Sharp-van der Heijde (SHS) method.

Results: Serum MMP-8 (p?p?p?p?=?.002) were significantly higher in CRA vs. other study groups during the study. Salivary MMP-8 (p?=?.010) and IL-6 (p?=?.010) were significantly higher in ERA vs. other study groups at baseline. Salivary MMP-8 was associated with periodontal parameters.

Conclusion: Elevated serum concentrations of MMP-8 and IL-6 in CRA patients reflected chronic RA, while elevated salivary concentrations of MMP-8 levels in ERA patients reflected increased periodontal inflammation.

• Key messages

• Concentrations of inflammatory biomarkers in serum and saliva were different between patients with RA and healthy controls.

• Concentrations of MMP-8 and of IL-6 in serum were elevated in patients with chronic RA reflecting joint inflammation and the burden of established RA.

• Concentrations of MMP-8 in saliva was elevated already at the early stage of RA and the level of salivary MMP-8 was associated with poor periodontal health both in patients with early and in those with chronic RA.

     

Metabolic factors and oxidative stress in osteoarthritis: a case–control study

Previous studies suggest that metabolic disturbances might be involved in the development of osteoarthritis (OA). Associations have been found between the individual components of metabolic syndrome (MetS) and OA. MetS has been associated with increased oxidative stress (OxS). The study aimed to clarify the role of MetS components in OA and to evaluate the levels of OxS in OA patients and in age-matched controls. Fifty-five patients with end-stage OA (age 63?±?7 years) prior to hip or knee joint replacement surgery and 55 age-, gender- and body mass index matched controls (61?±?8 years) were enrolled in the study. Serum levels of glucose, insulin, c-peptide, cholesterols and OxS markers were recorded. Homeostasis model assessment for insulin resistance was used as the proxy measure of insulin resistance. Radiographic severity was assessed using the Kellgren–Lawrence score. The OA patients had higher total peroxide concentration and oxidative stress index [488 (250–612) μmol/L vs. 326 (168–442) μmol/L, p?=?.011 and 34 (17–51) vs. 20 (11–28), p?=?.002, respectively] and decreased total antioxidant capacity (1.49?±?0.27 vs. 1.66?±?0.27?mmol trolox equivalent/L, p=?.008) compared with the controls. In addition, OA group had significantly higher level of C-peptide compared with the controls [1.8 (0.94–2.47) vs. 1.3 (0.46–1.42) ng/mL, p?<?.001, respectively]. Furthermore, OA radiographic severity was independently associated with LDL-cholesterol (p?=?.007) and oxidized LDL (p?=?.022). This study demonstrates that end-stage OA patients have increased levels of OxS and decreased antioxidant capacity. OA is associated with impaired lipid metabolism and dysglycemia. Our results underline the importance OxS and metabolic disturbances in the pathogenesis of OA.     

Ten-year experience with transcatheter and surgical aortic valve replacement in Finland

Aim: We investigated the outcomes of transcatheter (TAVR) and surgical aortic valve replacement (SAVR) in Finland during the last decade.

Methods: The nationwide FinnValve registry included data from 6463 patients who underwent TAVR or SAVR with a bioprosthesis for aortic stenosis from 2008 to 2017.

Results: The annual number of treated patients increased three-fold during the study period. Thirty-day mortality declined from 4.8% to 1.2% for TAVR (p?=?.011) and from 4.1% to 1.8% for SAVR (p?=?.048). Two-year survival improved from 71.4% to 83.9% for TAVR (p?<?.001) and from 87.2% to 91.6% for SAVR (p?=?.006). During the study period, a significant reduction in moderate-to-severe paravalvular regurgitation was observed among TAVR patients and a reduction of the rate of acute kidney injury was observed among both SAVR and TAVR patients. Similarly, the rate of red blood cell transfusion and severe bleeding decreased significantly among SAVR and TAVR patients. Hospital stay declined from 10.4?±?8.4 to 3.7?±?3.4 days after TAVR (p?<?.001) and from 9.0?±?5.9 to 7.8?±?5.1 days after SAVR (p?<?.001).

Conclusions: In Finland, the introduction of TAVR has led to an increase in the invasive treatment of severe aortic stenosis, which was accompanied by improved early outcomes after both SAVR and TAVR.

Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT03385915

• Key Messages

• This study demonstrated that the introduction of transcatheter aortic valve replacement has led to its widespread use as an invasive treatment for severe aortic stenosis.

• Early and 2-year survival after transcatheter and surgical aortic valve replacement has improved during past decade.

• Transcatheter aortic valve replacement has fulfilled its previously unmet clinical needs and has surpassed surgical aortic valve replacement as the most common invasive treatment for aortic stenosis.

     

Association of sleep-disordered breathing with diabetes-associated kidney disease

Introduction: Diabetes-associated kidney disease is characterized by impairment of renal function and albuminuria. The aim of the present study was to assess whether sleep-disordered breathing is associated with decreased estimated glomerular filtration rate or increased urine-albumin-to-creatinine-ratio independently from known modulators of diabetes-associated kidney disease.

Material and methods: Estimated glomerular filtration rate and urine-albumin-to-creatinine-ratio were determined in the baseline survey of the DIACORE-SDB substudy, a prospectively planned study of Diabetes mellitus 2 patients. As a measure of the severity of sleep-disordered breathing, the apnea-hypopnea-index was assessed using a 2-channel ambulatory SDB-monitoring device.

Results: A total of 679 patients (mean age 66 years, men 61%, mean body-mass-index 31.2?kg/m²) were analyzed. In multivariable linear regression models adjusting for known modulators of diabetes-associated kidney disease, such as sex, age, body-mass-index, systolic blood pressure, duration of diabetes and HbA1c, apnea-hypopnea-index [beta-estimate –0.2?ml/min/1.73 m², 95% CI (–0.3; –0.1), p?=?.004], duration of diabetes and age were associated with estimated glomerular filtration rate. Apnea-hypopnea-index [beta-estimate 0.01?mg/g, 95% CI (0.00; 0.02), p?=?.009], duration of diabetes, HbA1c and systolic blood pressure were associated with ln(urine-albumin-to-creatinine-ratio).

Conclusion: In patients with diabetes mellitus type 2, more severe sleep-disordered breathing is significantly associated with lower estimated glomerular filtration rate and increased albuminuria, independent of known modulators of diabetes-associated kidney disease.     

Efficacy of sufficient operation view by ring-shaped thread counter traction for safer duodenal ESD

Abstract

Background: Duodenal ESD is considered especially difficult with perforation and bleeding. This study assessed safer duodenal ESD procedures, especially with regard to obtaining a good operation view using a ring-thread method and closure of a post-ESD artificial ulcer.

Methods: From 2013 to 2015, 17 patients who were diagnosed with duodenal adenoma or early duodenal cancer >20?mm in diameter underwent conventional ESD (C group). From 2016 to 2017, 12 patients underwent ring-shaped thread counter traction ESD with hemoclips and/or Over-The-Scope Clip (OTSC) (Ovesco Endoscopy GmbH, Tuebingen, Germany) closure of post ESD artificial ulcer (ring group). An observational study between the C group and Ring group was conducted. The primary outcome was perforation events during ESD (UMIN000026184).

Results: There was a significant difference in perforation during ESD with five cases vs. 0 case in C and ring groups (p?=?.038). For bleeding that needed to be coagulated by forceps during ESD, there was a significant difference with four cases in the C group (p?=?.07). The total procedure time was 96.6?±?28.2 and 72.8?±?24.2 (min) with a significant difference (p?=?.027).

Conclusions: Ring-shaped thread counter traction makes the most difficult duodenal ESD safer and easier without complications.