Current Issue : October - December Volume : 2016 Issue Number : 4 Articles : 7 Articles
Background: Novel pro-inflammatory and anti-inflammatory derivatives from adipose tissue, known as adipokines,\nact as metabolic factors. The aim of this study was to analyse the secreted expression of different adipo/cytokines\nin secretomes of unstable carotid atherosclerotic plaque versus non-atherosclerotic mammary artery.\nMethods: We evaluated the secretion levels of adiponectin, visfatin, lipocalin-2, resistin, IL-6 and TNFR2 by ELISA in\nhuman secretomes from cultured unstable carotid atherosclerotic plaque (n = 18) and non-atherosclerotic mammary\nartery (n = 13). We also measured visfatin serum levels in patients suffering from atherosclerosis and in a serum cohort\nof healthy subjects (n = 16).\nResults: We found that visfatin levels were significantly increased in unstable carotid atherosclerotic plaque\nsecretome than in non-atherosclerotic mammary artery secretome. No differences were found with regard the\nother adipo/cytokines studied. Regarding visfatin circulating levels, there were no differences between unstable\ncarotid atherosclerotic plaque and non-atherosclerotic mammary artery group. However, these visfatin levels were\nincreased in comparison to serum cohort of healthy subjects.\nConclusions: Of all the adipo/cytokines analysed, only visfatin showed increased levels in secretomes of unstable\ncarotid atherosclerotic plaque. Additional human studies are needed to clarify the possible role of visfatin as\nprognostic factor of unstable carotid atherosclerotic plaque....
Background: A low eicosapentaenoic acid (EPA) to arachidonic acid (AA) ratio is a known risk for acute coronary\nsyndrome (ACS). However, the association between the docosahexaenoic acid (DHA) to AA ratio and ACS remains\nunclear. This study aimed to assess the association between the DHA/AA ratio and ACS by patient characteristics.\nMethods: We enrolled 1733 patients and evaluated the serum levels of polyunsaturated fatty acids in 5 cardiology\ndepartments in a metropolitan area of Japan. We assessed the relationship between the DHA/AA ratio (median\ncut-off value: 0.903) and ACS according to the following 10 subgroups: sex, age, diabetes mellitus, hypertension,\ndyslipidemia, smoking history, family history of ischemic heart disease, chronic kidney disease, obesity, and history\nof coronary revascularization.\nResults: Interaction tests in the 10 subgroup analyses revealed a significant difference for adjusted log odds ratios\nbetween male and females (p = 0.01), and those with and without hypertension (p = 0.06). Especially in the\nsubgroup based on sex difference, a high DHA/AA ratio was significantly associated with a low risk of ACS among\nmen (adjusted odds ratio = 0.389; 95 % confidence interval: 0.211ââ?¬â??0.716). In contrast, a reverse association was\nfound among women, although this was not statistically significant (adjusted odds ratio = 3.820; 95 % confidence\ninterval: 0.718ââ?¬â??20.325).\nConclusions: The association between the DHA/AA ratio and ACS differed by clinical characteristic. Notably,\npatients with a low DHA/AA ratio had a higher risk of ACS than those with a high DHA/AA ratio, and this was\nsignificant for men in particular....
Background: Bone marrow examination may be required to discriminate causes of thrombocytopenia as\nhypoproductive or hyperdestructive. However, this procedure is invasive and time consuming. This study\nassessed the diagnostic value of Mean Platelet Volume (MPV), Platelet Distribution Width (PDW) and Platelet\nLarge Cell-Ratio (P-LCR) in discriminating causes of thrombocytopenia as hypoproductive or hyperdestructive\n(Immune thrombocytopenia purpura).\nMethod: A prospective cross-sectional study was conducted on 83 thrombocytopenic patients (Plt < 150 Ã?â?? 109/L).\nFrom these, 50 patients had hypoproductive and the rest 33 Immune Thrombocytopenia Purpura (ITP). Age and sex\nmatched 42 healthy controls were included as a comparative group. Hematological analysis was carried out using\nSysmex XT 2000i 5 part diff analyzer. SPSS Version16 was used for data analysis. A two by two table and receiver\noperating characteristic (ROC) curve was used to calculate sensitivity, specificity, positive and negative predictive values,\nfor a given platelet indices (MPV, PDW and P-LCR). Student t test and Mann Whitney U test were used to compare\nmeans and medians, respectively. Correlation test was used to determine associations between continuous variables.\nResults: All Platelet indices were significantly higher in ITP patients (n = 33) than in hypoproductive thrombocytopenic\npatients (n = 50) (p < 0.0001). In particular MPV and P-LCR have larger area under ROC curve (0.876 and 0.816,\nrespectively), indicating a better predictive capacity, sensitivity and specificity in discriminating the two causes of\nthrombocytopenia. The indices were still significantly higher in ITP patients compared to 42 healthy controls (p < 0.0001).\nA significant negative correlation was observed between platelet count and platelet indices in ITP patients, (p < 0.001).\nConclusion: MPV, PDW and P-LCR help in predicting thrombocytopenic patients as having ITP or hypoproductive\nthrombocytopenia. If these indices are used in line with other laboratory and clinical information, they may help\nin delaying/ avoiding unnecessary bone marrow aspiration in ITP patients or supplement a request for bone morrow\naspiration or biopsy in hypoproductive thrombocytopenic patients....
Background: Galectin-3 is a marker of myocardial inflammation and fibrosis shown to correlate with morbidity and\nmortality in heart failure (HF). We examined the utility of galectin-3 as a marker of the severity of HF, the response\nof galectin-3 levels to ventricular assist device (LVAD) implantation or heart transplantation (HTx), and its use as a\nprognostic indicator.\nMethods: Plasma galectin-3 was measured using a commercially available ELISA assay in patients with stable HF\n(n = 55), severe HF (n = 63), at 3 (n = 17) and 6 (n = 14) months post-LVAD and at LVAD explantation (n = 23),\npatients following HTx (n = 85) and healthy controls (n = 30).\nResults: Galectin-3 levels increase with the severity of HF (severe HF: 28.2 �± 14, stable HF: 19.7 �± 13, p = 0.001;\ncontrols: 13.2 �± 9 ng/ml, p = 0.02 versus stable HF). Following LVAD implantation, galectin-3 levels are initially lower\n(3 months: 23.7 �± 9, 6 months: 21.7 �± 9 versus 29.2 �± 14 ng/ml implantation; p = NS) but are higher at explantation\n(40.4 �± 19 ng/ml; p = 0.005 versus pre-LVAD). Galectin-3 levels >30 ng/ml are associated with lower survival post-LVAD\nplacement (76.5 % versus 95.0 % at 2 years, p = 0.009). After HTx, galectin-3 levels are lower (17.8 �± 7.1 ng/ml post-HTx\nversus 28.2 �± 14 pre-HTx; p < 0.0001). Patients with coronary allograft vasculopathy (CAV) post-HTx showed higher\ngalectin-3 levels (20.5 �± 8.8 ng/ml versus 16.8 �± 6.3, p = 0.1) and the degree of CAV correlated with levels of galectin-3\n(r2 = 0.17, p < 0.0001).\nConclusions: Galectin-3 is associated with the severity of HF, exhibits dynamic changes during mechanical unloading\nand predicts survival post-LVAD. Further, galectin-3 is associated with the development on CAV post-HTx. Galectin-3\nmight serve as a novel biomarker in patients with HF, during LVAD support and following HTx....
Background: Left Ventricular Assist Device (LVAD) is a promising therapy for patients with advanced heart failure\n(HF), but bleeding complications remain an important issue. Previous series show that acquired von Willebrand\nsyndrome was present in up to 100 % of first generation LVAD recipients. We report the effects of new generation\nLVADs on vW factor (vWF) metabolism and activity in our center.\nMethods: Fifteen LVAD recipients (HeartWare�®, Framingham, MA, USA) were compared to 12 HF patients, matched\nfor age and body mass index. vWF antigen and activity, as well as D-dimers, were measured on hemostasis\nanalyzers. A vWF LVAD-induced alteration was evocated when the [vWF activity]/[vWF antigen] ratio was <0.6.\nADAMTS13 and high molecular weight multimers of vWF were also assessed.\nResults: LVAD recipients had similar levels of endothelial vWF production than the HF subjects (137 �± 14.5 vs. 147 �±\n11.7 %; respectively, p = 0.611) but a decreased vWF activity (90 �± 11 vs. 132.6 �± 13 %; respectively, p = 0.017). [vWF\nactivity]/[vWF antigen] ratio was 0.65 �± 0.02 in the LVAD recipients and 0.92 �± 0.06 in the subjects with HF (p = 0.001).\nADAMTS13 activity was 80.3 �± 4.7 % in LVAD recipients and 96.2 �± 3.5 % in the HF patients (p = 0.016). LVAD patients\ndisclosed markedly elevated D-dimers (3217.7 �± 735 vs. 680.6 �± 223.2 ng/mL FEU in the HF patients, p = 0.006). The\nLVAD patients experienced one major hemorrhagic event and one systemic thrombotic event during the median\nfollow-up of 345 days.\nConclusions: LVAD recipients achieved a new hemostatic equilibrium characterized by infrequent major hemorrhagic\nand thrombotic events, despite a mildly impaired vWF function and a markedly enhanced thrombin formation....
Background: Iron deficiency anemia is highly prevalent in patients with chronic kidney disease and is often treated\nwith intravenous iron. There are few trials directly comparing the safety and efficacy of different intravenous iron\nproducts.\nMethods: This post-hoc analysis pooled data from 767 patients enrolled in two randomized, controlled, open-label\ntrials of similar design comparing the treatment of iron deficiency anemia with ferumoxytol and iron sucrose across\npatients with all stages of renal function. One trial was conducted in adults with CKD either on or not on dialysis\nand the second in adults with IDA of any underlying cause and a history of unsatisfactory oral iron therapy or in\nwhom oral iron could not be used who had normal to no worse than moderately impaired renal function. Patients\nwere categorized by chronic kidney disease stage (i.e., estimated glomerular filtration rate), and the primary efficacy\nendpoint was the mean change in hemoglobin from Baseline to Week 5.\nResults: The overall incidence of adverse events was numerically lower in ferumoxytol-treated patients compared\nto those treated with iron sucrose (42.4 vs. 50.2 %, respectively); the incidence of treatment-related adverse events\nwas generally similar between the two treatment groups (13.6 vs. 16.0 %, respectively). Adverse events of Special\nInterest (i.e., hypotension, hypersensitivity) occurred at lower rates in those treated with ferumoxytol compared to\nthose treated with iron sucrose (2.5 vs. 5.3 %, respectively). Overall, mean hemoglobin increased in both treatment\ngroups, regardless of degree of renal insufficiency, although greater increases were seen among those with less\nsevere kidney damage. Mean increases in hemoglobin from Baseline to Week 5 were significantly greater with\nferumoxytol than with iron sucrose treatment in the subgroup with an estimated glomerular filtration rate �90 mL/min\n(Least Squares mean difference = 0.53 g/dL; p < 0.001). There were no other consistent, significant differences in\nhemoglobin levels between treatment groups for the other chronic kidney disease categories except for isolated\ninstances favoring ferumoxytol.\nConclusions: The efficacy and safety of ferumoxytol is at least comparable to iron sucrose in patients with varying\ndegrees of renal function....
Objective: To assess the relationship between SCT, hemoglobin levels and anemia in CKD black patients.\nMethod: A post-hoc analysis of data from 188 patients, enrolled in a cross-sectional study of\nsickle cell trait (SCT) and chronic kidney disease (CKD), was performed to assess the relationship\nbetween SCT, hemoglobin (Hb) levels and anemia defined as Hb < 12 g/dl in men and <11 g/dl in\nwomen. Student t test, Mann Whitney and Chi square test were used as appropriate for different\ncomparisons. P < 0.05 defined the level of statistical significance. Results: SCT (HbAS) and normal\nhemoglobin (HbAA) were present in 39 (21%) and 149 (79%) CKD patients, respectively. Despite\nsimilar estimated GFR (eGFR) and age, HbAS patients had significantly lower Hb levels (8.8 �± 1.8 vs\n10 �± 2.2 g/dl; p = 0.001) and a higher proportion of anemia (95% vs 72%, p = 0.001). In multiple\nlinear regression analysis, eGFR, BMI, SBP and SCT emerged as independent determinants of Hb\nlevels. The presence of SCT was associated with 1.185 g/dl decrease in Hb levels. Conclusion: In\nthe present case series, SCT was associated with lower Hb levels suggesting its potential contribution\nto the pathogenesis of CKD-associated anemia....
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