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Anna F. Delgado, Markus Fahlström, Markus Nilsson, Shala G. Berntsson, Maria Zetterling, Sylwia Libard, Irina Alafuzoff, Danielle van Westen, Jimmy Lätt, Anja Smits and Elna-Marie Larsson

Introduction Gliomas are neoplasms arising from neuroglial or precursor cells. Neuropathological classification is based on dominant cell type, malignancy grade atypia (I–IV), cell density, mitosis, endothelial proliferation, necrosis and genetic tumor properties. 1 , 2 Astrocytomas (ACs) and oligodendrogliomas (ODs) are the most prevalent histological glioma subtypes. Neuropathologically glioma grade II differs from grade III primarily based on cell density and proliferation and may present with similar imaging patterns on morphological Magnetic resonance

Open access

Adawan Permpanich, Vithaya Kulsomboon and Kamol Udol

Despite several new treatments having been developed for the treatment of acute myocardial infarction (MI), the survivors from acute MI still have higher risk to subsequent cardiovascular (CV) events and mortality. Data from the Thai Acute Coronary Syndrome (ACS) Registry showed that approximately 20% of post-MI patients died, 4% had recurrent MI and 10% experienced non-fatal stroke within 1 year after their first MI. In the Asia-Pacific region, cardiovascular death accounts for nearly one third of all deaths, whereas ischemic heart disease and stroke comprise

Open access

Jinqiu Lv, Xiaoming You and Sheng Liu

Abstract

This paper proposes an improved ant colony system with adaptive strategies, called α

-AACS and considers its performance. First of all, we introduce α-nearness based on the minimum 1-tree for the disadvantage of the Ant Colony System (ACS), which better reflects the chances of a given link, being a member of an optimal tour. Next, we utilize the adaptive operator to balance the population diversity and the convergence speed and propose other optimizations for ACS. Finally, we present an account of the experiments and the statistic-based analysis, which clearly shows that α-AACS has a better global searching ability in finding the best solutions and better performance in solution variation.

Open access

Tatjana Grdanoska, Planinka Zafirovska, Branko Jaglikovski, Jasmina Trojacanec, Dimce Zafirov, Dejan Neshov, Milena Petrovska, Zhaklina Cekovska and Nikola Panovski

Assessment of Three Inflammatory Markers of Cardiovascular Diseases with a Special Accent on C-Reactive Protein

Background: Elevated levels of CRP, myoglobin and creatine kinase are always associated with pathological changes and hence their values give useful information for exact diagnosis and therapy. They are helpful in monitoring the inflammatory processes and associated diseases.

Aim: The aim of this study was to determine the usefulness and practical value of application of CRP detection by comparing it with the results obtained for the classical enzymes - markers of myocardial damage, myoglobin and creatine kinase isoenzyme MB (CK-MB) in pts with acute coronary syndrome (ACS), pts with chronic coronary artery disease (CAD) and in healthy individuals.

Material and Methods: Sera were taken from a total of 152 individuals (78.9% males, 21.1% females, mean age 61.87 ± 10.32 years). The subjects were divided in three groups: 63 pts with ACS; 52 pts CAD and a group of 36 conditionally healthy individuals. Analysis of patients' sera for presence of markers for myocardial damage: myoglobin, CK-MB along with determination of CRP level was done on the Immulite system, DPC (Diagnostic Products Corporation), Los Angeles, USA.

Results: Comparison of examined biomarker's values in pts divided according to diagnosis showed statistically significant higher levels in patients with ACS vs. others. As for biomarker's cut-off values, out of all CK-MB ≥5.7 ng/mL was found in 34 (53.1%) pts with ACS with significant difference among the groups in favor of its higher values in pts with ACS (p=0.0001). Out of all, myoglobin ≥25 ng/mL was found in 54 (84.4%) pts with ACS without significant difference among the groups. As for CRP, value of ≥3 mg/L was found in 39 (60.9%) pts with ACS and there was significant difference among the groups in favor of higher values in pts with ACS (p=0.001). There was significant positive correlation among the levels of examined three biomarkers: CK-MB in correlation to myoglobin (r=0.460; p= 0.0001) and to CRP level (r=0.204; p= 0.009), as well as myoglobin to CRP level (r=0.218; p= 0.005).

Conclusion: We could conclude that determination of CRP levels is a valid test for detection of acute coronary artery disease in addition to the classical, standard markers for myocardial damage.

Open access

Theodora Benedek, Ioana Rodean, Mihaela Ratiu, Nora Rat, Lia Yero Eremie, Carmen Biriș, Luminița Lazăr, Mariana Păcurar and Imre Benedek

Abstract

Recent studies have shown that systemic inflammation caused by periodontal disease (PD) can determine important changes in the coronary arteries, favoring atherosclerosis progression and the development of acute coronary syndromes (ACS). The aim of the ATHERODENT study (Protocol Record Number CM0117-ATD) is to assess the interrelation between PD, inflammation, and the progression of coronary atherosclerosis in patients with ACS.

Material and methods: This case-control observational study will enroll 100 patients (group 1 – ACS and associated PD, and group 2 – ACS and no PD), in whom the following data will be collected: (1) demographic and clinical data; (2) cardiovascular risk factors; (3) full characterization of PD markers; (4) systemic inflammatory biomarkers; (5) imaging biomarkers derived from transthoracic echocardiography, computed tomography, coronary angiography, optical coherence tomography, and intravascular ultrasound; and (6) assessment of the presence of specific oral bacteria in samples of coronary plaques collected by coronary atherectomy, which will be performed during percutaneous revascularization interventions, when indicated in selected cases, in the atherectomy sub-study. The follow-up will be performed at 1, 3, 6, 12, 15, 18, and 24 months. The primary endpoint of the study will be represented by the rate of major adverse cardiovascular events (MACE) in PD vs. non-PD patients and in correlation with: (1) the level of systemic inflammation triggered by PD and/or by ACS at baseline; (2) the vulnerability degree of atheromatous plaques in the coronary tree (culprit and non-culprit lesions); and (3) the presence and burden of oral bacteria in atheromatous plaques. Secondary endpoints will be represented by: (1) the rate of progression of vulnerability degree of non-culprit coronary plaques; (2) the rate of progression of atheromatous burden and calcium scoring of the coronary tree; and (3) the rate of occurrence of left ventricular remodeling and post-infarction heart failure. The ATHERODENT study has been registered in clinicaltrials.gov (ClinicalTrials.gov Identifier: NCT03395041).

Open access

David Gaze

Sensitive Cardiac Troponin Assays: Myth and Magic or a Practical Way Forward?

Cardiac troponins (cTn) are considered to be the ‘gold standard’ biomarkers for the diagnosis of acute coronary syndrome (ACS) a pathological spectrum which includes cardiac ischemia, angina, myocardial infarction and ultimately cardiac failure. The growing evidence base for the diagnostic and prognostic use of cTn in ACS has resulted in a universal redefinition of acute myocardial infarction (AMI). A diagnosis of AMI includes the detection of an elevated cTn (or CK-MB) with at least one measurement within 24 hours of the cardiac episode being >upper 99th percentile of a reference population, in conjunction with evidence of myocardial ischemia. A number of high sensitivity immunoassays with claims of superior imprecision and a definable 99th percentile have been produced. Clinically, these have two important impacts. First, there is a drive to change the values into whole numbers by the application of a unit change which carries the scope for confusion. Secondly, the near-normal Gaussian distribution of sensitive cTn in healthy subjects will increase the frequency of cTn positivity in the non-ACS population. The problem is to decipher if such minor elevations in cTn are of clinical concern. What is certain is that AMI remains a clinical not a biochemical diagnosis and the interpretation of cTn concentrations should be made according to the clinical context.

Open access

Daniel Ion, Dan Nicolae Păduraru, Florentina Mușat, Octavian Andronic and Alexandra Bolocan

Abstract

The clinical signs and symptoms of an acute in increase intraabdominal pressure (IAP) are subtle, especially in the conditions of the polytraumatized patient. Thus, abdominal compartment syndrome (ACS) can brutally occur and can have a major impact on the body’s main organs and systems. The purpose of our research was to identify the influence of intraabdominal pressure, intra-abdominal hypertension, and abdominal compartment syndrome, in the evolution of polytraumatized patients. Our study analyzed the patients admitted in the IIIrd Department of General Surgery of University Emergency Hospital in Bucharest between 1st of January 2010 and 31st of December 2018. The value of intraabdominal pressure, on admission, correlated with the risk of IAH/ ACS in patients with abdominal trauma - being major causes of morbidity and mortality. IAP monitoring should become a mandatory part of the management plan for patients with abdominal trauma.

Open access

Katya S. Kovacheva, Petya A. Nikolova, Valentin V. Hristov, Diana I. Pendicheva, Sotir T. Marchev, Tihomir R. Rashev, Georgi M. Golemanov, Zornica B. Kamburova, Maria N. Simeonova and Rusi G. Marev

Summary

Administration of antiplatelet therapy Aspirin and Clopidogrel (CLP) is a corner stone inpatients with Acute Coronary Syndrome (ACS) undergoing Percutaneous Coronary Intervention (PCI) with/without stent implantation. The CYP2C19*2 allele is the most important genetic variant determining response to CLP. We aim to investigate frequency of CYP2C19*2 polymorphism in patients with ACS and significance for the individual response to CLP therapy. The preliminary data of a study including a total of 120 patients with ACS undergoing PCI with stent placement and treated with dual antiplatelet therapy (CLP and Aspirin) are presented. So far 18 patients (41-81 year age) are tested for CYP2C19*l/*2 polymorphisms. The genotype CYP2C19*1/*1; CYP2C19*l/*2 and CYP2C19*2/*2 is demonstrated in 50%, 33%, 17% respectively, of the patients. The established frequency of CYP2C 19*2 allele (33%) is significantly higher (x2=5.220; p=0.022) than in healthy Bulgarian individuals (16%). In-stent thrombosis have developed 3 (17%) of patients: 2 are C YP2C19* l/*2 carriers, and 1 - homozygous CYP2C19*2/*2. The preliminary data demonstrate high prevalence of CYP2C19*2 polymorphism in patients with ACS and point to significance of the variant for CLP therapy. Further extension of the study with larger samples and monitoring of the patients are required to determine the effects of the polymorphism on the prognosis for major adverse cardiovascular events.

Open access

Raina G. Ardasheva, Mariana D. Argirova, Valentin I. Turiiski and Athanas D. Krustev

Abstract

Background: Increased intra-abdominal pressure (IAP) causes tissue ischemia, subsequent hypoxia, and impairment of normal tissue metabolism. Elevation of IAP above 20 mmHg leads to progression of abdominal compartment syndrome (ACS) that is associated with organ dysfunction or failure not previously manifested. Aim: To evaluate the eff ects of diff erent grades and time of exposure to IAP on biochemical parameters and oxidative stress in organs aff ected by ischemia using previously developed rat model. Results: Three experimental groups exposed to diff erent IAP and time frames were tested for liver, kidney, and pancreas injury by measuring the activities of tissue specifi c enzymes in blood serum. Elevated activities of aspartate aminotransferase, pancreatic amylase, lipase, and higher concentrations of D-lactate, urea, and creatinine were found in some of the experimental groups compared to a control group of animals not subjected to increased IAP. Increased levels of biomarkers of oxidative stress as well as decrease in concentration of the major cellular antioxidant glutathione indicated the presence of oxidative injury as a result of elevated IAP. Conclusions: The developed rat model is appropriate to study the mechanism and manifestation of tissue injury during diff erent grades of elevated IAP but also to test approaches aimed to attenuate the detrimental eff ects of ACS. This study also underlines the necessity of using not a single but a set of biochemical parameters in order to assess the severity of tissue injury during elevated IAP and progression to ACS.

Open access

Hektor Sula, Rudin Domi, Arben Beqiri and Andi Koraqi

Abdominal Compartment Syndrome as an Independent Mortality Predictor Factor During Acute Pancreatitis

Aim: The aim was to study the role of abdominal compartment syndrome and intra-abdominal hypertension (IAH) as indipendent predictor factors on outcome and mortality in patients during early phase of acute pancreatitis (AP).

Material and Methods: According the IAP 102 patients with medically treated AP were divided: in the first group (N = 32 patients) the IAP was over 12 mmHg, in second group (N = 27 patients) the IAP was over 20 mmHg (ACS), and the third group (N = 43 patients) with normal pressure. There were recorded APACHE 2 score in admission, the incidence of multiorganic dysfunction syndrome and mortality.

Results: No statistical significance is observed between three groups regarding age, gender, APACHE II score, Ranson score, CTSI. Kruskal-Wallis test resulted positive for all variables suggesting a statistically significant difference between groups. The pairwise test for comparison of subgroups according to Conover, yielded a statistically significant difference of ACS (p<0.05). ACS group resulted with more early deaths (13 patients) and total deaths (15 patients).

Conlusion: The abdominal compartment syndrome and increased intrabdominal pressure occurred during the early fase of AP may be predictors of increased MODS and mortality.