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Open access

Razvan Peagu, Roxana Sararu, Ana Necula, Alexandru Moldoveanu, Ana Petrisor and Carmen Fierbinteanu-Braticevici

Abstract

Introduction: Current guidelines recommend that all patients with cirrhosis undergo upper gastrointestinal endoscopy (UGE) screening for esophageal varices (EV). Unfortunately, UGE has a lot of disadvantages, consequently various non-invasive methods of diagnosing EV have been proposed. We evaluated if spleen stiffness measured by Acoustic Radiation Force Impulse (ARFI) is a viable technique in diagnosing EV.

Methods: We recruited 178 patients with cirrhosis caused by Hepatitis B and C who underwent biochemical tests, abdominal ultrasound, UGE, LS and SS measurements using ARFI elastography. Based on the endoscopic results the patients were divided in 3 groups: without EV, with small EV (<5 mm) and with large EV (>5 mm).

Results: ARFI SS was the only non-invasive parameter associated with the presence of EV (2.7±0.30 vs. 3.4±0.52, p<0.001) and large EV (2.91±0.36 vs. 3.86±0.37, p=0.001) after multivariate logistic regression (p<0.001). ARFI SS for predicting EV showed an AUROC of 0.872 (CI 95%: 0.799-0.944), for a cut-off value of 2.89 m/s: Sensitivity (Se) 91.4% (CI 95%: 81-97%), Specificity (Sp) 67.7% (CI 95%: 51-85%). ARFI SS for diagnosing large EV (>5mm) had better results with an AUROC 0.969 (CI 95%:0.935-0.99), and for a cut-off of 3.30 m/s: Se 96.4% (CI 95%: 82-99.9%), Sp 88.5% (CI 95%: 78-95%).

Conclusions: SS measured using ARFI is a good method of detecting EV and is an excellent method of diagnosing large EV in patients with virus-related cirrhosis.

Open access

Caterina Delcea, Cătălin Adrian Buzea and Gheorghe Andrei Dan

Abstract

Introduction: Heart failure (HF) and systemic inflammation are interdependent processes that continuously potentiate each other. Distinct pathophysiological pathways are activated, resulting in increased neutrophil count and reduced lymphocyte numbers, making the neutrophil to lymphocyte ratio (NLR) a potential indirect marker of severity. We conducted this comprehensive review to characterize the role of NLR in HF.

Methods: We searched the PubMed (MEDLINE) database using the key words neutrophil”, “lymphocyte”, “heart failure”, “cardiomyopathy”, “implantable cardioverter defibrillator”, “cardiac resynchronization therapy” and “heart transplant”.

Results: We identified 241 publications. 31 were selected for this review, including 12107 patients. NLR was correlated to HF severity expressed by clinical, biological, and imaging parameters, as well as to short and long-term prognosis. Most studies reported its survival predictive value. Elevated NLR (>2.1-7.6) was an independent predictor of in-hospital mortality [adjusted HR 1.13(95%CI 1.01-1.27)-2.8(95%CI 1.43-5.53)] as well as long-term all-cause mortality [adjusted HR 1.43(95%CI 1.1-1.85) -2.403(95%CI 1.076-5.704)].

Higher NLR levels also predicted poor functional capacity [NLR>2.26/2.74, HR 3.93(95%CI 1.02-15.12)/3.085(95%CI 1.52-6.26)], hospital readmissions [NLR>2.9/7.6, HR 1.46(95%CI 1.10-1.93)/3.46(95%CI 2.11-5.68)] cardiac resynchronization therapy efficacy [NLR>3.45/unit increase, HR 12.22(95%CI 2.16-69.05)/1.51(95%CI 1.01-2.24)] and appropriate implantable cardioverter defibrillator shocks (NLR>2.93), as well as mortality after left ventricular assist device implantation [NLR>4.4/quartiles, HR 1.67 (95%CI 1.03-2.70)/1.22 (95%CI 1.01-1.47)] or heart transplant (NLR>2.41, HR 3.403(95%CI 1.04-11.14)].

Conclusion: Increased NLR in HF patients can be a valuable auxiliary biomarker of severity, and most of all, of poor prognosis.

Open access

Sebastien Redant, Francois Angoulvant, Patrick M. Honore, Rachid Attou, Dominique Biarent and David De Bels

Abstract

The authors describe two cases of metabolic acidosis, caused by diabetic ketoacidosis in the first case and by dehydration following gastroenteritis in the second one. Both patients were followed with noninvasive end-tidal CO2 (ETCO2) monitoring. A correlation between EtCO2 and PCO2 and HCO3− has been established in the literature. Noninvasive ETCO2 is used in only 5–6% of metabolic emergencies. In contrast, users described its use as easy and convenient.

Open access

Tianyun Shi, Xintong Feng and Zhijun Jie

Abstract

Influenza pandemics with different extent occur every year in the world. It can cause high morbidity and mortality, arouse fear panic in public, and attract extensive attention worldwide. This paper reviews the research progress in epidemiological characteristics, detection methods, pathogenesis, treatment and prophylactic measures of influenza in China. It will be helpful for us to understand the current situation of influenza.

Open access

Xue Peng, Can Wei, Hong-Zhu Li, Hong-Xia Li, Shu-Zhi Bai, Li-Na Wang, Yu-Hui Xi, Jin Yan and Chang-Qing Xu

Abstract

Background and Objectives

Calcium-sensing receptor (CaSR) is known to regulate hypoxia-induced pulmonary hypertension (HPH) and vascular remodeling via the phenotypic modulation of pulmonary arterial smooth muscle cells (PASMCs) in small pulmonary arteries. Moreover, autophagy is an essential modulator of VSMC phenotype. But it is not clear whether CaSR can regulate autophagy involving the phenotypic modulation under hypoxia.

Methods

The viability of human PASMCs was detected by cell cycle and BrdU. The expressions of proliferation protein, phenotypic marker protein, and autophagy protein in human PASMCs were determined by western blot.

Results

Our results showed that hypoxia-induced autophagy was considerable at 24 h. The addition of NPS2390 decreased the expression of autophagy protein and synthetic phenotype marker protein osteopontin and increased the expression of contractile phenotype marker protein SMA-ɑ and calponin via suppressing downstream PI3K/Akt/mTOR signal pathways.

Conclusions

Our study demonstrates that treatment of NPS2390 was conducive to inhibit the proliferation and reverse phenotypic modulation of PASMCs by regulating autophagy levels.

Open access

Chuan Li, Lili Qu, Cullen Farragher, Anthony Vella and Beiyan Zhou

Open access

Gianluca Rigatelli, Marco Zuin, Tra T. Ngo, Hung T. Nguyen, Aravinda Nanjundappa, Ernest Talarico, Le Cao Phuong Duy and Thach Nguyen

Abstract

Background and Objectives

Significant rather than moderate coronary artery stenosis has been postulated to be the main substrate of plaque rupture in acute myocardial infarction (AMI). We evaluate if cavitation could influence the coronary artery plaque rupture contributing to the progression of thrombotic process.

Methods

We reconstructed a 3D model of the left anterior descending coronary artery (LAD) after reviewing the intravascular ultrasound (IVUS) data of 30 consecutive patients with mild to severe coronary artery disease.

Results

Turbulent flow or cavitation occurs in both concentric and eccentric coronary artery stenosis (≥ 75% for the former and ≥ 50% for the latter). The analysis of vapor phase demonstrated that cavitation propagated downstream, creating microbubbles, which exploded when the fluid pressure was lower than the vapor pressure at a local thermodynamic state. The relative higher vorticity magnitude (as turbulent flow in vivo angiogram) observed on the distal cap of the atherosclerotic plaque created a higher turbulence, probably able to destabilize the plaque through a micro-erosion process.

Conclusions

Cavitation seems to be able to promote the thrombotic occlusion within the coronary vessels due the ‘constant injuries’ created by the micro-explosion of bubbles.

Open access

Sebastien Redant, Hamda Hussein, Aude Mugisha, Rachid Attou, David De Bels, Patrick M. Honore and Corinne C. De Laet

Open access

Afshin Shafaghi, Faeze Gharibpoor, Zahra Mahdipour and Ali Akbar Samadani

Abstract

Introduction: Management of Upper gastrointestinal bleeding (UGIB) is of great importance. In this way, we aimed to evaluate the performance of three well known scoring systems of AIMS65, Glasgow Blatchford Score (GBS) and Full Rockall Score (FRS) in predicting adverse outcomes in patients with UGIB as well as their ability in identifying low risk patients for outpatient management. We also aimed to assess whether changing Albumin cutoff in AIMS65 and addition of Albumin to GBS, add predictive value to these scores.

Methods: This was a retrospective study on adult patients who were admitted to Razi hospital (Rasht, Iran) with diagnosis of upper gastrointestinal bleeding between March 21, 2013 and March 21, 2017. Patients who didn’t undergo endoscopy nor had incomplete medical data were excluded. Initially, we calculated three score systems of AIMS65, GBS and FRS for each patient by using initial Vital signs and lab data. Secondary, we modified AIMS65 and GBS by changing Albumin threshold from <3.5 to <3.0 in AIMS65 and addition of Albumin to GBS, respectively. Primary outcomes were defined as in hospital mortality, 30-day rebleeding, need for blood transfusion and endoscopic therapy. Secondary outcome was defined as composition of primary outcomes excluding need for blood transfusion. We used AUROC to assess predictive accuracy of risk scores in primary and secondary outcomes. For Albumin-GBS model, the AUROC was only calculated for predicting mortality and secondary outcome. The negative predictive value for AIMS65, GBS and modified AIMS65 was then calculated.

Result: Of 563 patients, 3% died in hospital, 69.4% needed blood transfusion, 13.1% needed endoscopic therapy and 3% had 30-day rebleeding. The leading cause of UGIB was Erosive Disease. In predicting composite of adverse outcomes all scores had statistically significant accuracy with highest AUROC for Albumin-GBS. However, in predicting in hospital mortality, only albumin-GBS, modified AIMS65 and AIMS65 had acceptable accuracy. Interestingly, Albumin, alone, had higher predictive accuracy than other original risk scores. None of the four scores could predict 30-day rebleeding accurately; on the contrary, their accuracy in predicting need for blood transfusion was high enough. The negative predictive value for GBS was 96.6% in score of≤2 and 85.7% and 90.2% in score of zero in AIMS65 and modified AIMS65, respectively.

Conclusion: Neither of risk scores was highly accurate as a prognostic factor in our population; however, modified AIMS65 and Albumin-GBS may be optimal choice in evaluating risk of mortality and general assessment. In identifying patient for safe discharge, GBS≤2 seemed to be advisable choice.