Surgical repair for abdominal aortic aneurysm concomitant with iliac arterial disease using InterGard? Quadrifurcated

InterGard? Quadrifurcated [InterVascular S.A. (MAQUET Cardiovascular), La Ciotat, France], a knitted quadrifurcated prosthetic graft, is useful to simplify the procedures for patients with abdominal aortic aneurysm concomitant with iliac arterial disease. From March 2008 to April 2010, 59 patients underwent abdominal aortic aneurysm repair in our department. InterGard? Quadrifurcated was used in 22 patients (37.3%). All patients were male with a mean age of 72.1 ± 12.1 years (range from 45 to 90 years). Four were emergency cases. Nineteen patients had common iliac arterial lesions, and 19 patients had internal iliac arterial lesions. In addition to abdominal aortic aneurysm repair, reconstruction of bilateral internal iliac arteries was performed in 4 patients, reconstruction of unilateral internal iliac artery in 15 (right 6, left 9), and internal mesenteric artery in 13. There was one hospital death due to nonocclusive mesenteric infarction. There were two complications, which were intestinal perforation and intestinal obstruction. All of these three cases were emergency cases. Computed tomography scan 1 week after operation showed that all reconstructed grafts were patent. Although patients with abdominal aortic aneurysm concomitant with iliac arterial disease had many preoperative comorbidities, surgical results with InterGard? Quadrifurcated were satisfactory. It is useful to simplify the procedures for these patients.     

Elastin-laminin receptor and abdominal aortic aneurysms. New subject to study? A review.

Abdominal aortic aneurysms and their management remain a significant health problem that is likely to assume greater importance with the expansion of the elderly population. Elastin fibres degradation and extracellular matrix remodelling seems to be the basic process in aneurysm formation. Recent investigations revealed the principal role of elastin-laminin receptor in extracellular matrix remodelling in aging and atherosclerosis. The correlation between events observed in animal aneurysm models, human aneurysms and in experiments on elastin-laminin receptor properties was discussed to propose the hypothesis about the role of elastin peptides and elastin-laminin receptor in aortic aneurysm formation.     

CA-125 concentration in serum and peritoneal fluid in patients with endometriosis – preliminary results

Introduction

Cancer antigen 125 (CA-125), known as a biomarker for women genital tract malignancies, could be also useful in detecting and monitoring endometriosis. The aim of this study was to evaluate CA-125 in serum and peritoneal fluid (PF) as an indicator of endometriosis.

Material and methods

Fifty-six patients admitted to the First Department of Obstetrics and Gynaecology for diagnostic or therapeutic laparoscopy conducted for infertility, pelvic pain, suspected endometriosis or ovarian cysts entered the study. Those with laparoscopically confirmed endometriosis were assigned to group A, those without this condition to group B. Blood for CA-125 was taken prior to surgery, centrifuged and assayed in accordance with the manufacturer''s instructions (VIDAS CA-125 II). Peritoneal fluid and an endometrial biopsy were taken during laparoscopy. Statistical comparisons were performed using Statistica 7.1.

Results

Group A consisted of 44 women with laparoscopically confirmed diagnosis; 15 patients served as a control group. The mean value of CA-125 concentration in the endometriosis group was 33.98 U/ml, vs. 9.3 U/ml in the control group. The mean value of CA-125 in peritoneal fluid was 1241.88 U/ml in the non-endometriosis group versus 2640.23 U/ml in the study group; both results were statistically significant (p < 0.05). There was a significant correlation between the stage of endometriosis and CA-125 plasma concentration (R = 0.5993, p < 0.001). Cancer antigen 125 concentration in serum was a moderate predictor to distinguish between patients with and without endometriosis (AUC 0.794; 95% CI 0.668-0.921; p = 0.001).

Conclusions

Cancer antigen 125 is a well-known biomarker for endometriosis and helpful in daily clinical practice when endometriosis is suspected. The cut-off value in serum suggesting endometriosis with 68% sensitivity is 11 U/ml. This value is normal range for Ca-125 concentration.     

Prognostic value of GRIM-19, NF-κB and IKK2 in patients with high-grade serous ovarian cancer

Aims

High grade serous carcinoma (HGSC) is an aggressive tumour, and most patients relapse after treatment, acquiring resistance to platinum-based chemotherapy. One of the resistance mechanisms proposed is apoptosis evasion triggered by drug-related cytotoxic effect in the cell. In this context, this study aims to evaluate the protein expression of GRIM-19, NF-κB and IKK2, their association with chemotherapy response and to determine their prognostic values in HGSC.

The effect of angulation in abdominal aortic aneurysms: fluid–structure interaction simulations of idealized geometries

Abdominal aortic aneurysm (AAA) represents a degenerative disease process of the abdominal aorta that results in dilation and permanent remodeling of the arterial wall. A fluid structure interaction (FSI) parametric study was conducted to evaluate the progression of aneurysmal disease and its possible implications on risk of rupture. Two parametric studies were conducted using (i) the iliac bifurcation angle and (ii) the AAA neck angulation. Idealized streamlined AAA geometries were employed. The simulations were carried out using both isotropic and anisotropic wall material models. The parameters were based on CT scans measurements obtained from a population of patients. The results indicate that the peak wall stresses increased with increasing iliac and neck inlet angles. Wall shear stress (WSS) and fluid pressure were analyzed and correlated with the wall stresses for both sets of studies. An adaptation response of a temporary reduction of the peak wall stresses seem to correlate to a certain extent with increasing iliac angles. For the neck angulation studies it appears that a breakdown from symmetric vortices at the AAA inlet into a single larger vortex significantly increases the wall stress. Our parametric FSI study demonstrates the adaptation response during aneurysmal disease progression and its possible effects on the AAA risk of rupture. This dependence on geometric parameters of the AAA can be used as an additional diagnostic tool to help clinicians reach informed decisions in establishing whether a risky surgical intervention is warranted.     

Higher rate of aortic stenosis progression in patients with bicuspid versus tricuspid aortic valve – A single center experience

PurposeWe sought to investigate aortic stenosis (AS) progression rate (pr) with the comparison between bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) morphology.Materials and methodsWe compared ASpr in patients with BAV and TAV examined by transthoracic echocardiography (TTE) in the years 2004–2019.ResultsData from 363 TTEs in 161 AS patients (median age 70 [61–77] years; 63% men; 25% with BAV; 20% with severe AS) performed at different time points (median time interval 10 months) was analyzed. We assessed changes of AS severity with peak velocity through aortic valve (Vmax), mean/peak pressure gradients (MG/PG), aortic valve area by planimetry and continuity equation (AVAce). We compared pr (defined as parameter change per year) between the BAV and the TAV groups. BAV patients showed faster ASpr with odds ratio 3.467 and 95% confidence intervals 1.36 to 8.86, moreover, expressed as a quicker AVAce decrease 0 (−0.4-0.0) in the BAV vs. 0 (−0.15 – 0.0) cm²/year in the TAV group, p ​= ​0.02. Furthermore, in BAV, female sex was associated with lower ASpr (p ​= ​0.01), and in the whole group a larger aortic diameter was a predictor of faster progression (p ​< ​0.001).ConclusionThe ASpr, expressed as a decrease in the AVAce, was faster in BAV. Moreover, ASpr depends on both: valve morphology being faster in BAV and Vmax increase. Furthermore, the female sex was related to slower pace of AVA reduction in BAV subgroup whereas the larger baseline aortic diameter associated to faster AS progression in the whole studied group.     

The favourable effect of Helicobacter pylori eradication therapy in patients with recurrent angina-like chest pain and non-responsive to proton pump inhibitors – a preliminary study

Introduction

The outcome of Helicobacter pylori (Hp) eradication therapy from the aspect of prevention of chest pain recurrence is still uncertain. The aim of this study was to assess the influence of Hp eradication therapy on the risk of hospitalization due to acute coronary syndrome.

Material and methods

The analysis was carried out in 63 consecutive patients with recurrent retrosternal symptoms: 28 (44%) with significant coronary artery narrowing in coronarography not qualified for revascularization by an invasive cardiologist, and 35 (56%) with no obstructive coronary artery lesions. In 33 (52%) of the patients, Hp infection was found and standard eradication therapy with omeprazole (2 × 20 mg), amoxicillin (2 × 1 g) and metronidazole (2 × 500 mg) was recommended. The mean follow-up period was 977 ±249 days.

Results

Chest pain requiring hospitalization because of unstable angina within the follow-up period was observed in 9 (27%) of the Hp-infected individuals and in 15 (50%) subjects in whom a urease test and histology did not confirm this infection (p = 0.055). The recommendation of Hp-eradication treatment was a significant factor prolonging the hospitalization-free period, both in the two Kaplan-Meier curve analyses (Cox’s F test = 1.96; p = 0.049) and the Cox proportional hazard model (beta = –1.18; p = 0.045), but was weaker than the effect of the non-obstructive coronary angiogram (beta = –1.45; p = 0.03).

Conclusions

The recommendation of Hp-eradication therapy may prolong the hospitalization-free period for patients with recurrent chest pain.     

Heart rate variability in children with aortic valve stenosis – a pilot study

Introduction

The aim of our prospective study was to evaluate heart rate variability (HRV) in children with aortic valve stenosis (AS) and its relationship with left ventricular mass and peak transaortic valve pressure gradient (PG).

Material and methods

Sixty children with AS divided into 3 groups according to their PG and 60 healthy controls were studied. Holter ECG monitoring with time domain HRV analysis was performed. Left ventricular mass was calculated by echocardiography.

Results

Mean values of all HRV parameters were statistically significantly lower (p < 0.001) in children with AS than in controls (respectively: SDNN 127.8 ±28.2 ms; 162.6 ±38.0 ms, SDNN day 99.7 ±26.6 ms; 134.1 ±36.1 ms, SDNN night 99.9 ±32.8 ms; 123.4 ±45.7 ms, SDANN 112.2 ±27.7 ms; 142.4 ±34.6, SDNNi 62.2 ±16.2 ms; 75.9 ±21.6, RMSSD 39.6 ±12.1 ms; 50.3 ±16.7 ms, rMSSD day 33.6 ±10.9 ms; 43.1 ±14.7 ms, rMSSD night 49.8 ±18.1 ms; 64.4 ±24.9 ms, pNN50 16.4 ±9.5%; 23.5 ±11.7%, pNN50 day 12.0 ±8.5%; 18.4 ±10.7%, pNN50 night; 26.5 ±14.8%; 36.4 ±17.4%. No significant differences between the mean values of HRV parameters in children with different PG and with and without myocardial hypertrophy were found. In children with AS and ventricular arrhythmia SDNN day was significantly lower (p < 0.05) compared to patients without arrhythmia (94.9 ±22.1 ms vs. 109.3 ±22.5 ms).

Conclusions

In children with AS the balance of the autonomic nervous systemic disturbed which manifests in an increase in sympathetic and decrease in parasympathetic activity. Transaortic valve pressure gradient and myocardial hypertrophy do not influence the HRV. The SDNN reduction during the day period may indicate the risk of ventricular arrhythmia in children with AS.     

Alterations in the erythrocyte plasma membranes in patients with alcohol-induced liver cirrhosis – preliminary results

Introduction

Conformations of membrane proteins, membrane fluidity of erythrocytes in patients with AILC were studied with the use of electron paramagnetic resonance and spectrophotometric methods. The concentration of substances reacting with thiobarbituric acid was also determined. The aim of the study was to recognize the nature, level and causes of changes in the structure of erythrocytary membrane observed in erythrocytes of patients compared to erythrocytes from healthy controls.

Material and methods

Spin labels: MSL and ISL binding covalently to thiol groups of membrane cytoskeleton proteins were used to analyse modifications occurring in erythrocytary membrane proteins. Doxyl derivatives of fatty acids: 5-DS, 12-DS and 16-DS binding hydrophobically to erythrocytary membrane were used as spin labels for the analysis of erythrocyte membrane lipid fluidity.

Results

Modification of membrane cytoskeleton proteins and increase of membrane lipids fluidity were observed in erythrocytes of the investigated patients. An increase of the concentration of substances reacting with thiobarbituric acid was also confirmed in the erythrocytes of AILC patients.

Conclusions

Observed disorders in the structure of erythrocyte cytoskeleton proteins in patients, which might developed as a consequence of oxidative stress may be conformation changes in the structure of proteins which affect membrane cytoskeleton. The differences in the structure of membrane proteins could be associated with an increase in membrane lipids fluidity. Increased fluidity of erythrocyte membrane may be a result of disorders in protein-lipid interaction or membrane lipid peroxidation activity.     

Significance of BRCA1 expression in breast and ovarian cancer patients with brain metastasis – A multicentre study

PurposeCerebral metastases develop in 10–30% of patients with breast cancer (BC) and in around 3.3 to 4% of patients with ovarian cancer (OC). The aim of the multicenter study is to investigate the correlation between the expression of estrogen alpha receptors (ERα), progesterone receptors (PR), human epidermal growth factor receptor 2 (HER2), stromal cell-derived factor 1 (SDF1) and its receptor C-X-C chemokine receptor type 4 (CXCR4), breast cancer metastasis suppressor 1 (BRMS1), astrocyte elevated gene 1 (AEG1), depending on the status of BRCA1 protein, in patients suffering from OC and BC with brain metastases.Patients and methodsThe analysis included 51 patients: 29 with BC and 22 with OC, in whom brain metastases were disclosed.ResultsIn most patients (65.5% of BC patients and 68.2% of patients with OC tumors) BRCA1 protein loss was found. No correlation was disclosed between the levels of ERα, PR receptors, HER2, SDF1, CXCR4, AEG1, BRMS1 and BRCA1 status, patient age, stage of disease advancement, grade of histological maturity of the cells, presence of metastases to lymph nodes. A statistically significant correlation was disclosed between the negative expression of PR receptors and a high expression of CXCR4 in patients with BC. High values of the AEG1 protein (linked to metastases) were detected alongside a high expression of BRMS1 (a suppressor of metastases).ConclusionsPatients with BC and OC and brain metastases have a frequent loss of BRCA1 expression. The role of ERα, PR, HER2, SDF1, CXCR4, AEG1, BRMS1 in metastatic process needs further studies.     

Morphology and immuno-distribution of the histamine H4 receptor and histamine – releasing factor in choroid plexus of patients with paraneoplastic cerebellar degeneration

Objective and Design:  The study was aimed at screening out the mimetic peptides from the binding site of lipopolysaccharide binding protein and CD 14, and then observing if the mimetic peptide will inhibit in vitro LPS-induced inflammatory reaction and function as an anti-endotoxin in the model of LPS-induced acute lung injury. Material and Methods:  Human monocytic cell line (U937) was used in vitro. Thirty three-month-old SD rats were used. Phage display peptide library was adapted to screen mimetic peptide sequences. Treatment:  U937 cells were exposed to treatment with LPS and rhLBP and then were incubated with MP12 at three different concentrations after they were induced and differentiated by PMA. LPS intravenous injection was used to establish a model of rat acute lung injury which was later treated with intravenous injection of MP12. Results:  We successfully obtained the mimetic peptide of lipopolysaccharide-binding protein and CD 14 binding site, the gene sequence of which is FHRWPTWPLPSP (MP12). MP12 can markedly inhibit LPS induced TNF-α expression. MP12 can evidently increase PaO₂ of rats with acute lung injury and also increase the survival rate of these rats. Conclusions:  MP12 (FHRWPTWPLPSP) has the same function as mimetic of lipopolysaccharide-binding protein and CD 14 binding site. The application of MP12, both in vitro and in vivo, confers the biological activity required to antagonise LBP/CD14 and block LPS inflammatory signals, and it can markedly enhance PaO₂ of rats suffering from acute lung injury and also enhance their survival rate. Received 28 April 2008; returned for revision 2 June 2008; received from final revision 4 October 2008; accepted by A. Falus 7 October 2008     

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.     

Lack of change in serum sCD36 concentration in children with non-alcoholic fatty liver disease – A preliminary study

PurposeNon-alcoholic fatty liver disease (NAFLD) is increasingly being recognized in the pediatric population, therefore, the search for non-invasive parameters to predict progression of NAFLD is of great interest. The aim of this study was to assess serum concentration of sCD36 in children with obesity and to determine its diagnostic value in pediatric NAFLD.Patients and methodsThe study group consisted of 50 children with obesity aged 8–17.5 years, admitted to our Department because of suspected liver pathology. Selected liver diseases were excluded in the examined group. Anthropometry, laboratory tests (including the concentration of sCD36) and liver ultrasound, were performed in all subjects.ResultsNAFLD was confirmed in 16 out of 50 patients with obesity. There was significantly higher activity of ALT, AST, GGT, and increased waist-hip ratio WHR in individuals with NAFLD in comparison to non-hepatopathic children with obesity. We did not find a significant difference between sCD36 concentration in patients with obesity and NAFLD and non-hepathopathic patients with obesity. We also did not find a significant difference between sCD36 concentration in children with obesity in comparison to the control group and between mild (grade 1) vs. advanced (grade ≥2) steatosis. Correlation of sCD36 concentration with anthropometric, biochemical, and bioimpedance parameters in children with obesity was confirmed only with body fat percentage.ConclusionssCD36 is not a suitable parameter to differentiate children with NAFLD from non-hepatopathic children with obesity and controls without obesity. Further studies on a larger pediatric population are needed to confirm these findings.     

Transapical aortic valve implantation – a rescue procedure for patients with aortic stenosis and “porcelain aorta”

Surgical aortic valve replacement (AVR) still remains the treatment of choice in symptomatic significant aortic stenosis (AS). Due to technical problems, extensive calcification of the ascending aorta (“porcelain aorta”) is an additional risk factor for surgery and transapical aortic valve implantation (TAAVI) is likely to be the only rescue procedure for this group of patients. We describe the case of an 81-year-old woman with severe AS and “porcelain aorta”, in whom the only available life-saving intervention was TAAVI.     

Statin therapy protects against abdominal aortic aneurysms by inducing the accumulation of regulatory T cells in ApoE−/− mice

Journal of Molecular Medicine - CD4+CD25+ regulatory T cells (Tregs) have been shown to protect against abdominal aortic aneurysm (AAA) progression. Statins have immunomodulatory properties, and...     

Intima-media thickness and arterial stiffness of carotid artery in Korean patients with Behçet's disease

Behçet''s disease (BD) is a systemic vasculitis involving diverse sizes of arteries and veins. We performed this study to evaluate the vascular changes by assessment of the arterial stiffness and intima-media thickness (IMT) of carotid artery in Korean patients with BD. Forty-one patients with BD and age-, and sex-matched 53 healthy subjects were recruited in this study. Carotid arterial stiffness and IMT were assessed by using high-resolution B-mode ultrasonography. Arterial stiffness parameters such as carotid arterial distensibility coefficient, stiffness index, and incremental elastic modulus (E_inc) were significantly increased in BD patients compared with those in healthy subjects, but not in IMT. Positive relationship was noted between age and IMT, whereas age of onset was significantly associated with arterial stiffness in BD. This finding suggests impaired endothelial function before visible structural changes of arterial wall in BD. Age and age of onset may be an independent risk factor for carotid IMT and arterial stiffness, respectively. Further studies in more large populations are required to confirm our results.     

PvuII and XbaI polymorphisms of estrogen receptor-α and the results of estroprogestagen therapy in girls with functional hypothalamic amenorrhea – preliminary study

Introduction

The aim of this study was the long-term prospective evaluation of the effects of estroprogestagen (EP) therapy on the bone mineral density (BMD) of girls with functional hypothalamic amenorrhea (FHA) carrying various PvuII and XbaI polymorphisms of ER-α.

Material and methods

Prospective observation included 84 FHA girls and 50 controls. The FHA patients were subjected to 4-year sequential therapy with 17β estradiol (2 mg from the 2^nd to 25^th day of the menstrual cycle) and dydrogesterone (10 mg from the 16^th to the 25^th day). Hormonal parameters, serum concentration of the bone fraction of alkaline phosphatase (BALP), urine concentration of cross-linked n-telopeptide of type I collagen (Ntx) and BMD were determined before and after the treatment.

Results

Six-month treatment resulted in a marked increase in estradiol (p = 0.001), testosterone and prolactin levels (p = 0.01 both) and a significant decrease in BALP and Ntx (p = 0.001 both). Patients with the PP polymorphism had significantly lower baseline BMD compared to carriers of other polymorphic variants of PvuII (p = 0.003). A significant increase in BMD was observed throughout the entire therapy period, with no significant differences in the yearly dynamics of BMD changes observed amongst various polymorphic variants and haplotypes of ER-α.

Conclusions

The EP therapy is effective in the treatment of BMD disorders associated with FHA, and treatment results do not depend on PvuII and XbaI polymorphisms of ER-α.     

Is gender a factor in psychiatrists' evaluation and treatment of patients with major depression?

BACKGROUND: Gender differences in clinical assessment and treatment have been reported in several areas of medicine. We examine whether differences exist in the routine outpatient psychiatric management of men and women with major depression. METHODS: Psychiatrists practicing in the community completed case forms on a systematic sample of their adult outpatients with major depression. Comparisons are presented between male (n=261) and female (n=472) patients focusing on their background characteristics, clinical presentation, assessment, and treatment. Significant gender disparities in assessment and treatment are also examined with respect to the gender of the treating psychiatrist. RESULTS: Although male and female patients had generally similar clinical profiles, a significantly greater proportion of males than females had psychomotor retardation and substance use disorders. No significant gender differences were observed in the assessment of depressive symptoms, psychiatric comorbidities, and treatment with antidepressant medications or psychotherapy. However, a significantly smaller percentage of depressed women than men received assessments of sexual function and medication-related sexual side effects. Female patients were also less likely to have discussed their treatment preferences with their psychiatrists. LIMITATIONS: Only a minority (33.2%) of psychiatrists invited to participate contributed patients to this study. The results are based on structured assessments completed by practicing psychiatrists rather than patient self-assessments or independent research assessments. CONCLUSIONS: Although we find overall little evidence of gender bias in the clinical management of major depression, both male and female psychiatrists need to further explore sexual function and treatment preferences in female patients.