Hematological and biochemical reference intervals for <Emphasis Type="Italic">Bothrops asper</Emphasis> and <Emphasis Type="Italic">Crotalus simus</Emphasis> (Serpentes: Viperidae), maintained in captivity for venom extraction

This study presents hematological and biochemical reference intervals (RIs) for two species of viper snakes (Bothrops asper and Crotalus simus), which are the first of their type particularly for these two species maintained in captivity and for extraction of venom purposes. A total of 77 snakes were used in developing the study; specifically 39 B. asper and 38 C. simus snakes. Blood samples were obtained by puncturing the caudal vein, and hematological tests were performed manually by two independent technicians. Plasma biochemistry parameters were determined by an automatized analyzer. There are hematological differences between wild-caught and captive B. asper in the percentage of heterophils (P?<?0.001), while in captive and wild-caught C. simus, the differences are found in the percentage of eosinophils, lymphocytes, and monocytes (P?<?0.001). Differences in glucose (P?=?0.012), uric acid (P?<?0.001), and cholinesterase (P?=?0.004) are found in captive and wild-caught B. asper. Differences in albumin (P?=?0.002), calcium (P?<?0.001), CK (P?=?0.04), and LDH (P?=?0.037) are found between captive and wild-caught C. simus. This study constitutes the first set of hematological and biochemical RIs for B. asper and C. simus maintained in captivity with the purpose of producing antivenom in Costa Rica. The establishment of comprehensive RIs for hematology and plasma biochemistry for these two species of snakes is useful for interpretation of blood test results, moreover, to serving as a reference for viper snakes used for research purposes.     

Clinical chemistry profiles in injection heroin users from Coastal Region,Kenya

Background

Although the co-burden of injection drug use and HIV is increasing in Africa, little is known about the laboratory markers of injection drug use and anti-retroviral treatment (ART) in Kenyan injection drug users. This study, therefore, aimed at determining the clinical chemistry profiles and identifying the key laboratory markers of HIV infection during ART in injection heroin users (IHUs).

Methods

Clinical chemistry measurements were performed on serum samples collected from HIV-1 infected ART-experienced (n?=?22), naive (n?=?16) and HIV-1 negative (n?=?23) IHUs, and healthy controls (n?=?15) from Mombasa, coastal Kenya.

Results

HIV uninfected IHUs had lower alanine aminotransferase (ALT) levels (P?=?0.023) as ART-exposed IHUs exhibited lower albumin (P?=?0.014) and higher AST to platelet index (APRI) (P?<?0.0001). All IHUs presented with lower aspartate aminotransferase to ALT values (P?=?0.001) and higher C-reactive protein (CRP) levels (P?=?0.002). ART-naive IHUs had higher globulin levels (P?=?0.013) while ART-experienced and naive IHUs had higher albumin to total protein (P?<?0.0001) and albumin to globulin (P?<?0.0001) values. In addition, CD4+ T cells correlated with ALT (ρ = ?0.522, P = 0.011) and CRP (rho, ρ?=?0.529, P?=?0.011) in HIV negative and ART-experienced IHUs, respectively. HIV-1 viral load correlated with albumin to globulin index in ART-experienced (ρ?=??0.468, P?=?0.037) and naive (ρ?=??0.554, P?=?0.040) IHUs; and with albumin to total protein index (ρ?=??0.554, P?=?0.040) and globulin (ρ?=?0.570, P?=?0.033) in ART-naive IHUs.

Conclusion

Absolute ALT, albumin, globulin, and CRP measurements in combination with APRI, AST to ALT, albumin to total protein and albumin to globulin indices may be useful laboratory markers for screening IHUs for initiating and monitoring treatment.

     

Reduced mitochondrial DNA content in lymphocytes is associated with insulin resistance and inflammation in patients with impaired fasting glucose

Altered mitochondrial DNA (mtDNA) is the most common denominator to numerous metabolic diseases. The present study sought to investigate the correlation between mtDNA content in lymphocytes and associated clinical risk factors for impaired fasting glucose (IFG). We included 23 healthy control and 42 IFG participants in this cross-sectional study. The measurements of mtDNA content in lymphocytes and pro-inflammatory markers derived from both normal and diseased individuals were quantified. Spearman partial correlation and multivariate statistical analyses were employed to evaluate the association between mtDNA content and other metabolic covariates in IFG. Reduced mtDNA content was observed in the IFG group with microvascular complications than those without complications. The IFG patients with lowest median of mtDNA content had considerably elevated hyperglycemia, insulin resistance and inflammation. The adjusted partial correlation analysis showed that mtDNA content was positively correlated with HDL-cholesterol and IL-10 (P?<?0.005 for all). Further, multiple linear regression analyses verified that reduced mtDNA content in lymphocytes was independently associated with HOMA-IR (β?=?0.027, P?=?0.003), HbA1c (β?=?0.652, P?=?0.002), HDL-cholesterol (β?=???1.056, P?=?0.021), IL-6 (β?=?0.423, P?=?0.002), IL-10 (β?=???1.234, P?=?0.043) and TNF-α (β?=?0.542, P?<?0.001) after adjustment for confounding factors. Our data show that reduced mtDNA content in lymphocytes was associated with insulin resistance and inflammation in individuals with IFG.     

The relationship between lymphovascular invasion and angiogenesis,hormone receptors,cell proliferation and survival in patients with primary operable invasive ductal breast cancer

Background

Several well-established tumour prognostic factors are used to guide the clinical management of patients with breast cancer. Lymphovascular invasion and angiogenesis have also been reported to have some promise as prognostic factors. The aim of the present study was to examine the prognostic value of tumour lymphovascular invasion and microvessel density compared with that of established prognostic factors in invasive ductal breast cancer.

Methods

In addition to hormone receptor status and Ki-67 proliferative activity, lymphovascular invasion and microvessel density and their relationship with survival were examined in patients with invasive ductal breast cancer. Full sections and tissue microarrays (n?=?384 patients) were utilised to assess these factors and were scored by appropriate methods.

Results

On univariate analysis tumour size (P?<?0.05), lymph node involvement (P?<?0.01), lymphovascular invasion (P?<?0.05), microvessel density (P?<?0.05) and local- regional treatment (P?<?0.01) were associated with poorer survival in ER negative tumours. On multivariate analysis in ER negative tumours lymph node involvement (P?<?0.01) and local- regional treatment (P?<?0.05) were independently associated with poorer cancer-specific survival. On univariate analysis tumour grade (P?<?0.05), lymph node involvement (P?<?0.001), HER-2 (P?<?0.05), Ki-67 (P?<?0.01) and lymphovascular invasion (P?<?0.001) were associated with poorer survival in ER positive tumours. On multivariate analysis lymph node involvement (P?<?0.001), Ki-67 (P?<?0.001) and lymphovascular invasion (P?<?0.05) were independently associated with poorer cancer-specific survival in ER positive tumours.

Conclusion

Lymphovascular invasion but not microvessel density was independently associated with poorer survival in patients with ER positive but not ER negative invasive ductal breast cancer.

     

The predictor of mortality outcome in adult patients with Ebola virus disease during the 2014–2015 outbreak in Guinea

The purpose of this study was to examine the association of any demographic and clinical factors with mortality outcome among adult patients with Ebola virus disease (EVD) in Guinea. This retrospective observational study analyzed medical records of laboratory confirmed EVD adult patients during the 2014–2015 EVD outbreak in Guinea. The associations between any demographic or clinical variables and mortality outcome of EVD were assessed using univariate and multivariate logistic regression analyses. Of 2,310 EVD adult patients included for analysis, the overall case fatality rate was 68.1%. Univariate analyses identified factors possibly associated with mortality outcome, including patient age (p?<?0.001), history of visiting or close contact with a suspected or confirmed EVD patient (p?=?0.035), and seven clinical symptoms on admission, i.e., fever (p?=?0.003), hiccups (p?<?0.001), vomiting (p?=?0.003), diarrhea (p?<?0.001), cough (p?=?0.001), sore throat (p?=?0.016), and unexplained bleeding (p?=?0.021). The multivariate analysis showed that patient age was independently associated with mortality outcome of EVD (OR?=?1.06; 95%CI?=?1.03–1.09; p?<?0.001), while none the of clinical symptoms on admission were significantly associated with the mortality outcome. Our analysis indicates that older age was the only independent factor associated with death among EVD adult patients in Guinea. This suggests that older EVD patients should receive intensive medical care and be carefully monitored.     

<Emphasis Type="Italic">Mycoplasma hominis</Emphasis> and <Emphasis Type="Italic">Gardnerella vaginalis</Emphasis> display a significant synergistic relationship in bacterial vaginosis

Gardnerella vaginalis plays an important role in bacterial vaginosis (BV,) while the role of genital Mollicutes is less obvious. The diagnosis of BV by use of the current Gram stain Nugent score is also suboptimal for defining the role of Mollicutes that lack a cell wall. Since bacterial load and diversity is an important prerequisite for BV, real-time quantitative polymerase chain reaction (qPCR) assays enable these to be assessed. The purpose of this study was to define the role of genital Mollicutes and potential patterns of synergy with G. vaginalis in women with BV. Vaginal swabs from 130 women categorised by Nugent score as BV (n?=?28), intermediate (n?=?22) and non-BV (n?=?80) were tested against four qPCR TaqMan assays targeting G. vaginalis, Mycoplasma hominis, M. genitalium, Ureaplasma urealyticum and U. parvum. Statistical analyses were used to compare bacterial prevalence and load between the three groups of women. Mycoplasma hominis and G. vaginalis co-infection was significantly more common in BV (60.7 %) compared to intermediate (36.4 %) and non-BV (8.8 %) Nugent scores (p?<?0.001). Significantly higher loads of M. hominis (p?=?0.001) and G. vaginalis (p?<?0.001) were detected in women with BV and the respective loads in M. hominis and G. vaginalis co-infections displayed a significant positive correlation (p?<?0.001; r?=?0.60). No significant associations were seen with the other Mollicutes. The findings strengthen the evidence of a role for M. hominis in BV and a potential synergy with G. vaginalis. This synergy could be an important trigger of the condition and sexual contact the conduit for the transmission of an otherwise commensal bacterium that could initiate it.     

The correlation between <Emphasis Type="Italic">Toxoplasma gondii</Emphasis> infection and prenatal depression in pregnant women

Previous studies have demonstrated that latent toxoplasmosis is associated with neuropsychiatric disorders. We evaluated the correlation between Toxoplasma gondii infection and prenatal depression. In this case–control study, we enrolled 116 depressed pregnant women and 244 healthy controls. The Edinburgh Postpartum Depression Scale (EPDS) was used to evaluate the depression symptom severity in study participants. All participants were screened for the anti-Toxoplasma IgG by enzyme-linked immunosorbent assay. Seroprevalence of T. gondii did not significantly differ between the depressed pregnant women and healthy controls (OR?=?1.4; 95 % CI?=?0.9–2.19; P?=?0.142). T. gondii IgG titer was significantly higher in depressed women (18.6?±?10.9 IUs) than those in the control group (13.6?±?8.1 IUs) (z?= ?5.36, P?<?0.001). The T. gondii–positive depressed women showed a positive correlation of T. gondii IgG titer with the EPDS scores (r?=?0.52; P?<?0.01). The mean EPDS score was also significantly higher in the T. gondii–positive depressed women (20.7?±?2.7) compared with the controls (18.36?±?2.7) (P?<?0.001). The results obtained from the current study revealed that T. gondii infection might affect susceptibility to depression and severity of depressive symptoms in pregnant women, particularly in those patients who have high antibody titers. Further study is required to fully elucidate the characteristics and mechanisms of this association.     

Serum protein gamma-glutamyl hydrolase,Ig gamma-3 chain C region,and haptoglobin are associated with the syndromes of pulmonary tuberculosis in traditional Chinese medicine

Background

Traditional Chinese Medicine (TCM) has been applied in treating tuberculosis (TB) based on the TCM syndromes with the effects of inhibiting Mycobacterium, strengthening the body immune system, and reducing the pulmonary toxicity. We used bioinformatic methods to study the clinical and pathological characteristics of pulmonary TB patients with TCM syndromes. Isobaric tags for relative and absolute quantification - coupled two dimensional liquid chromatography-tandem mass spectrometry (iTRAQ-2DLC-MS/MS) methods were applied to screen differentially expressed serum proteins.

Methods

Pulmonary TB cases were divided into four distinctive TCM syndromes: pulmonary Yin deficiency (PYD) syndrome, hyperactivity of fire due to Yin deficiency (HFYD) syndrome, deficiency of Qi and Yin (DQY) syndrome, and deficiency of Yin and Yang (DYY) syndrome. The serum samples from 214 pulmonary TB patients were collected, and the clinical and pathological data was analyzed by using iTRAQ-2DLC-MS/MS. Finally, the differentially expressed proteins were screened and tested by ELISA. Only 5 patients with DYY syndrome were recruited in 3 years, which were not enough for further research.

Results

The DQY cases had higher erythrocyte sedimentation rate (ESR) compared to the PYD and HFYD cases (P?=?0.0178). 94.44 % (12 PYD, 18 HFYD, and 4 DQY before anti-TB treatment) of 36 treated TB cases were transformed to PYD accompanied with the reduction of ESR and absorption of pulmonary lesions. A total of 39 differentially expressed proteins (ratios of >1.3 or <0.75) were found among the three TCM syndromes. Proteomic studies revealed that gamma-glutamyl hydrolase (GGH), Ig gamma-3 chain C region (IGHG3), and haptoglobin (HPT) were specifically over-expressed in PYD (P?<?0.01), HFYD (P?<?0.001), and DQY cases (P?<?0.01), respectively. Furthermore, GGH was significantly higher in PYD cases compared to the HFYD and DQY cases (P?<?0.01, P?<?0.001, respectively), whereas IGHG3 was significantly higher in HFYD cases than PYD and DQY cases (P?<?0.001, P?<?0.01, respectively).

Conclusions

The results suggest that TCM syndromes are significantly correlated with the pulmonary lesions and ESR. GGH was associated with folate metabolism in PYD cases, IGHG3 was linked to the control of Mycobacterium infection in HFYD patients, and HPT was involved in hypoxia in DQY patients. The present study provides new biological basis to understand the pathological changes and proteomic differences of TB syndromes.

     

Comparing Clinicopathologic and Radiographic Findings Between TT-UMP,Classical, and Non-Encapsulated Follicular Variants of Papillary Thyroid Carcinomas

Thyroid tumors of uncertain malignant potential (TT-UMP) comprise an accepted subgroup of follicular-patterned thyroid tumors for which benignancy or malignancy cannot be precisely assessed. We aimed to evaluate the demographic characteristics, ultrasound (US) findings, and cytological results of patients with TT-UMP and compare these findings to a classical variant of papillary thyroid carcinoma (CV-PTC) and non-encapsulated follicular variant of PTC (NEFV-PTC) patients; we also evaluated the immunohistochemical characteristics of patients with TT-UMP. Twenty-four patients with TT-UMP, 672 with CV-PTC, and 132 with NEFV-PTC were included in the study. Mean longitudinal nodule size and median nodule volume were higher in the TT-UMP group than in the CV-PTC and NEFV-PTC groups (p?<?0.001 and p?<?0.001 for CV-PTC; p?<?0.001 and p?=?0.008 for NEFV-PTC). The presence of halo and peripheral vascularization was observed more frequently in the TT-UMP group than in the CV-PTC group (p?=?0.002 and p?=?0.024). Benign and follicular neoplasm/suspicious for follicular neoplasm cytological results were higher in the TT-UMP group than in the CV-PTC group (p?=?0.030 and p?=?0.001). US findings were similar between TT-UMP and NEFV-PTC groups (all, p?>?0.05). However, none of the patients with TT-UMP were called malignant; 105 patients (31.2 %) of CV-PTC and 11 patients (9.5 %) of NEFV-PTC (infiltrative FV) were classified as malignant cytologically. Tumor size was higher in the TT-UMP group than in the CV-PTC and NEFV-PTC groups (p?<?0.001 and p?=?0.006). In the TT-UMP group, positive expression of HBME-1, CK-19, and Gal-3 was found in 50, 33.3, and 25 % of patients, respectively. This study demonstrated that none of the TT-UMP patients were evaluated as malignant in preoperative cytology. However, patients with TT-UMP had higher nodule and tumor sizes than CV-PTC and NEFV-PTC patients; US features were similar between NEFV-PTC and TT-UMP patients.     

Clinicopathological value of programmed cell death 1 (PD-1) and programmed cell death ligand 1 (PD-L1) expression in synovium of patients with rheumatoid arthritis

The etiology of rheumatoid arthritis (RA) is thought to involve dysfunction of the programmed cell death 1/programmed cell death ligand 1 (PD-1/PD-L1) pathway; PD-1 negatively regulates autoimmunity by interacting with its ligand, PD-L1. We therefore investigated PD-1/PD-L1 expression in synovial tissue of patients with RA. We immunohistochemically stained synovial specimens from 51 patients with RA and assessed the association between PD-1/PD-L1 expression and rheumatoid factor (RF), the total count of infiltrating T cells, C-reactive protein (CRP), and Krenn’s synovitis score. PD-1 expression on infiltrating lymphocytes was detected in 34/51 RA cases (66.7%), while PD-1 expression was very mildly correlated only with the number of total infiltrating T cells (R²?=?0.1011, P?=?0.0230). On the other hand, PD-L1 expression on synovial lining cells was observed in 37/51 RA cases (72.5%). Furthermore, a higher PD-L1 expression was significantly associated with RF positive state (P?=?0.0454), and the correlations between PD-L1 expression and the number of infiltrating T cells (R²?=?0.5571, P?<?0.0001), CRP (R²?=?0.4060, P?<?0.0001), and Krenn’s synovitis score (R²?=?0.7785, P?<?0.0001) were confirmed. PD-1 was expressed on infiltrating lymphocytes, while PD-L1 was expressed on synovial lining cells; the expression of PD-L1 on synovial lining cells was significantly correlated with the active state of the disease. These data suggest that PD-1/PD-L1 pathway may have an important role in the pathogenesis of RA.     

Comparison of Reconstruction Algorithms for Decreasing the Exposure Dose During Digital Tomosynthesis for Arthroplasty: a Phantom Study

To explore the possibility of decreasing the radiation dose during digital tomosynthesis (DT) for arthroplasty, we compared the image qualities of several reconstruction algorithms, such as filtered back projection (FBP) and two iterative reconstruction (IR), methods maximum likelihood expectation maximization (MLEM) and the simultaneous iterative reconstruction technique (SIRT) under different radiation doses. The three algorithms were implemented using a DT system and experimentally evaluated by contrast-to-noise ratio (CNR), artifact spread function (ASF), and power spectrum measurements on a prosthesis phantom. The CNR and ASF data were statistically analyzed by a one-way analysis of variance. The effectiveness of each technique for enhancing the visibility of the prosthesis phantom was quantified by the CNR (reference dose vs. 20 % reduced dose in FBP, P?=?0.62; reference vs. 37 % reduced dose in FBP, P?=?0.16; reference vs. 55 % reduced dose in FBP, P?<?0.05; reference vs. 20 % reduced dose in IR, P?=?0.92; reference vs. 37 % reduced dose in IR, P?=?0.40; reference vs. 55 % reduced dose in IR, P?<?0.05) and ASF (reference dose vs. 20 % reduced dose in FBP, P?=?0.25; reference vs. 37 and 55 % reduced dose in FBP, P?<?0.05; reference vs. 20 % reduced dose in IR, P?=?0.16; reference vs. 37 and 55 % reduced dose in IR, P?<?0.05). The power spectra under the reference and reduced doses are equivalent. In this phantom study, the radiation dose of the reference dose could be decreased by 20 % with FBP and IR for consideration of common factors.     

Women with familial risk for breast cancer have an increased frequency of aldehyde dehydrogenase expressing cells in breast ductules

Background

Knowledge is limited regarding the association between stem cells in histologically benign breast tissue and risk factors for breast cancer, and hence we addressed this issue in the present study. Recently, we assessed the histology of benign breast tissue from cancer and non-cancer patients for cells positive for the putative stem cell marker aldehyde dehydrogenase 1 A1 (ALDH), and the findings indicated an association between expression of ALDH and the hormonal factors menopause and hormone therapy. The current investigation examined possible associations between various known clinical and genetic risk factors for breast cancer and cellular expression of ALDH in ductules in benign human breast tissue.

Methods

The study included breast surgery patients that were BRCA1/2 mutation carriers without breast cancer (n?=?23), had BRCA1/2 (n?=?28) or sporadic (n?=?21) breast cancer, or required non-cancer-related mammoplasty (n?=?34). The distribution and frequency of ALDH-immunolabelled cells were correlated to patient subgroups with different risk factors, using mammoplasty patients as a control group. Statistical analyses comprised linear and logistic regression, Spearman’s rank test, Pearson’s test, and Fisher’s exact test. In two-tailed tests, p?<?0.05 was considered significant.

Results

A strong association was found between family history of breast cancer and a high frequency of ALDH+ cells (p?=?0.001) at all ductular levels in all groups, regardless of BRCA status, age, parity, or occurrence of cancer. In pre-menopausal non-BRCA cancer patients, the frequency of ALDH+ cells increased with age (p?<?0.01) but decreased with increasing parity (p?<?0.03). High frequencies of ALDH+ cells were found in the non-basal ductular levels in BRCA1 mutation carriers (p?=?0.03), but in the basal ductular level in BRCA2 cancer patients (p?=?0.02). Among post-menopausal patients, only on-going hormone replacement therapy was correlated with a high number of ALDH+ cells (p?<?0.03).

Conclusion

In histologically normal breast tissue, we found a positive association between the frequency of ductular ALDH+ cells and several breast cancer risk factors, particularly family history of this disease, which supports previous evidence that ALDH plays a role in breast cancer.

     

Risk prediction in infective endocarditis by modified MELD-XI score

The suitability of the model for end-stage liver disease excluding international normalized ratio (MELD-XI) score to predict adverse outcomes in infective endocarditis (IE) patients remains uncertain. This study was performed to explore the prognostic value of the MELD-XI score and modified MELD-XI score for patients with IE. A total of 858 patients with IE were consecutively enrolled and classified into two groups: MELD-XI ≤?10 (n?=?588) and MELD-XI >?10 (n?=?270). Multivariate analysis was performed to determine risk factors independent of MELD-XI score. Higher MELD-XI score was associated with higher in-hospital mortality (15.6 vs. 4.8%, p?<?0.001) and major adverse clinical events (33.3 vs. 18.4%, p?<?0.001). MELD-XI score was an independent predictor of in-hospital death (odds ratio [OR]?=?1.06, 95% CI, 1.02–1.10, p?=?0.005). Based on a multivariate analysis, NYHA class III or IV (3 points), C-reactive protein >?9.5 mg/L (4 points), and non-surgical treatment (6 points) were added to MELD-XI score. Modified MELD-XI score produced higher predictive power than previous (AUC 0.823 vs. 0.701, p?<?0.001). The cumulative incidence of long-term mortality (median 29 months) was significantly higher in patients with modified MELD-XI score >?13 than those without (log-rank?=?25.30, p?<?0.001). Modified MELD-XI score was independently associated with long-term mortality (hazard ratio?=?1.08, 95% CI, 1.04–1.12, p?<?0.001). MELD-XI score could be used as a risk assessment tool in IE. Furthermore, modified MELD-XI score remained simple and more effective in predicting poor prognosis.     

Evaluation of serum total protein concentration and protein fractions in sheep naturally infected with <Emphasis Type="Italic">Babesia ovis</Emphasis>

Serum electrophoresis in cellulose acetate strip is a technique commonly used to separate the protein fractions. This technique allows detecting quantitative and qualitative changes in the serum proteins associated with different diseases. The aim of this study was to characterize the changes of the serum protein fractions produced in sheep suffering from babesiosis. Blood samples were collected from 52 healthy and naturally infected sheep with Babesia ovis. Serum total proteins were calculated, and serum electrophoresis was performed. The parasitological diagnosis was confirmed using polymerase chain reaction assay by amplifying a partial small subunit ribosomal RNA gene sequence of B. ovis. Mean values from total proteins and globulin fractions were significantly higher (P?<?0.05) than that observed for the healthy group. Compared to the healthy group, significant decrease (P?<?0.05) in the mean percentage of albumin in the infected group was determined. Results obtained in this study showed that B. ovis infection has caused albumin reduction and increased serum total protein and globulin level.     

Anti-SIRT1 autoantibody is elevated in ankylosing spondylitis: a potential disease biomarker

Background

Little is known about the presence of specific autoantibodies in ankylosing spondylitis (AS), an immune-mediated inflammatory disease. The object of this study was to explore potential autoantibody profiles in AS patients.

Results

Levels of anti-SIRT1 autoantibodies were significantly higher in AS (P?< 0.001) and psoriatic arthritis (PsA) (P?<?0.01) patients but not rheumatoid arthritis (RA) patients compared with healthy controls. Additionally, titers of anti-NAD-dependent protein deacetylase sirtuin-1(SIRT1) antibodies were significantly higher in AS patients than in RA (P?<?0.05) and PsA (P?<?0.05) patients. Moreover, levels of anti-SIRT1 (P?<?0.001) antibodies were significantly higher during the first year in patients with hip joint involvement. The anti-SIRT1 antibody positivity rate was 18.9% in AS patients.

Conclusions

Our findings indicate that anti-SIRT1 autoantibodies may serve as a marker for diagnosing AS and predicting hip joint involvement at an early stage.

     

Implementing a practice change: early initiation of continuous renal replacement therapy during neonatal extracorporeal life support standardizes care and improves short-term outcomes

Purpose

We hypothesized that a standardized approach to early continuous renal replacement therapy (CRRT) during neonatal extracorporeal life support (ECLS) results in greater homogeneity of CRRT initiation times with improvements in fluid balance and outcomes.

Methods

Retrospective analysis of data (2007–2015) obtained from neonates treated prior to (E1; n?=?32) and after (E2; n?=?31) a 2011 practice change: CRRT initiation within 48 h of ECLS.

Results

Birthweight, gestational age, ECLS mode, and age at ECLS initiation were similar to each epoch. Survival [E1: median 75%, E2: 71%] and length of ECLS [E1: median 221 h, E2: 180 h] were comparable. During E2, 100% of infants received CRRT (vs. E1: 37%; p?<?0.001) and 97% of infants initiated CRRT within 48 h of ECLS (vs. E1: 13%; p?<?0.001). Control charts demonstrate reduced practice variation. Elapsed time from ECLS to CRRT differed between Epochs [E1: median 105 h, E2: 9 h; p?<?0.001] as did weight at CRRT initiation [E1: 4.13 kg (29% above baseline), E2: 3.19 kg (0%); p?<?0.001]. Significant differences in weight change were noted on days 6 and 7 (E1: 14%, E2: 2%; raw data comparison yielded p?<?0.05) and curves were different (p?<?0.05).

Conclusions

We successfully implemented a practice change, initiating CRRT within 48 h of ECLS cannulation, leading to decreased practice variation and improved short-term outcomes including decreased weight gain at CRRT initiation and faster return to baseline weight during the first 7 days of ECLS. We did not demonstrate changes in duration of ECLS, invasive ventilation, or survival.

     

Abdominal pain in patient with antiphospholipid syndrome—the role of MDCT angiography on visceral blood vessels

Antiphospholipid syndrome (APS) is an autoimmune disease defined by accelerated atherosclerosis, arterial and venous thrombosis, fetal loss, and the presence of antiphospholipid antibodies (aPL) in the serum and which leads to the occurrence of various vascular events. Nonspecific abdominal pain can be one of the symptoms due to changes on visceral blood vessels. The goal of our work is to show the results we obtained in multidetector computed tomography (MDCT) angiography examination of visceral arteries, comparing patients with primary antiphospholipid syndrome (PAPS) and secondary antiphospholipid syndrome (SAPS) with control group. In this study, we analyzed 50 patients with primary PAPS and 50 patients, with secondary SAPS. The results were compared to 50 patients in the control group. The groups were compared in terms of age, gender, and the most common risk factors except for the lipid status, since controls had significantly higher levels of cholesterol and triglycerides. The study was conducted on 64-MDCT, on which we analyzed quantitative and morphological characteristics of the blood vessel lesions. Patients from the control group had statistically significant elevation of cholesterol and triglyceride levels compared to the patients with SAPS and PAPS (p?<?0.001 and p?<?0.05). The results showed that the frequency of changes is statistically (p?<?0.05 and p?<?0.001) more common in patients with PAPS and SAPS than in the control group. Statistically significant difference between the groups was found in superior and inferior mesentery arteries. Analyzing the number of lesions, there was statistically high difference between the patients with one and two lesions than in patients with four or more lesions (p?<?0.001), lower difference compared to the patients with three lesions (p?<?0.01), while there was low, but yet statistically important difference between the patients with three lesions and those with five or more blood vessel lesions (p?<?0.05). Analyzing percentage of diameter stenosis, we established that the lesions in the groups of 0–30% diameter stenosis (DS) and 30–50% DS in patients with PAPS (n?=?42) and SAPS (n?=?44) are more common than in the control group (n?=?18, p?<?0.05). Analyzing the qualitative characteristics of plaques, we established significantly higher frequency of soft tissue and mixed lesions than calcified ones in patients with PAPS and SAPS (p?<?0.001; p?<?0.05). Our study showed that the subclinical manifestation of the changes on visceral arteries is more common in patients with APS. Patients with abdominal pain were those with two or more lesions, and according to our results, majority had PAPS. Because of its safety and accuracy, the method of choice is MDCT angiography in monitoring the progression of disease.     

Left ventricle assist devices and driveline’s infection incidence: a single-centre experience

Different left ventricular assist devices (LVADs) are provided of different driveline exit sites: HeartWare HVAD presents abdominal power-cable-supply, while the Jarvik 2000 LVAD is powered by a retroauricular driveline. We analyzed 93 LVAD-implanted patients from January-2009 to October-2016 (41 HeartWare and 52 Jarvik 2000), hypothesizing a different incidence of infection, according to driveline exit site. The two populations were propensity matched for the demographic data and preoperative variables, and the outcomes were further analyzed. Nine driveline infections (DLIs) were in each LVAD group recorded (22% for HVAD and 17% for Jarvik 2000). The incidence of the complication was similar between groups (p?=?0.97), even during time (p?=?0.27 within 6 months and p?=?0.16 over 6 months of support). Age at implant (p?=?0.01), revision for bleeding (p?=?0.05), days of postoperative intubation (p?=?0.002), and ICU stay (p?<?0.001), as well as days on device (p?<?0.001) were identified as risk factors for DLIs. The type of device and the driveline exit site were not statistically co-related to infections. Similar infection-freedom survival was identified (p?=?0.87). Younger age at implant, revision for bleeding, prolonged mechanical ventilation, delayed rehabilitation, as well as long time LVAD support were identified as risk factors for exit site DLIs. Despite similar incidence of DLIs, the different management and care of the retroauricular exit site makes it more appropriate and comfortable in long-term support.