Serum neuron-specific enolase and S-100ß levels as prognostic follow-up markers for oxygen administered carbon monoxide intoxication cases.

Serum neuron-specific enolase (NSE) and S-100ß levels are considered novel biochemical markers of neuronal cell injury. In this study, the initial and post-treatment levels of NSE and S-100ß were compared in carbon monoxide (CO) poisoning patients, who received normorbaric oxygen (NBO) or hyperbaric oxygen (HBO) therapy. Forty consecutive patients with acute CO poisoning were enrolled in this prospective, observational study. According to their clinical symptoms and observations, twenty patients were treated with NBO, and the other twenty with HBO. Serum S-100ß and NSE levels were measured both at time of admission and 6 h later (post-treatment). Serum NSE and S-100ß values decreased significantly in both of the therapeutic modalities. The initial and post-treatment values of NSE and S-100ß in NBO or HBO patients were comparable. A clear negative correlation was observed between the decrease of NSE and S-100ß levels and initial blood carboxyhemoglobin levels. In conclusion, the present results suggested the use of serum S-100ß and NSE levels as indicators for brain injury. Due to the significant increase of their values with oxygen therapy, they may also be useful as prognostic follow-up markers. However, the current findings reflected no difference between the efficacy of NBO or HBO therapy.

Soluble TWEAK plasma levels increase after renal transplantation and associate with the improvement of endothelial function.

BACKGROUND: Soluble TWEAK (sTWEAK) and asymmetric dimethyl arginine (ADMA) concentrations have been associated with endothelial function in patients with chronic kidney disease (CKD). We tested the hypothesis that the improvement in endothelial function observed after renal transplantation is directly linked to the normalization of both sTWEAK and ADMA. MATERIALS AND METHODS: One hundred and seventy-five kidney transplant recipients (71% men; 31·6 ± 9·4 years) were studied immediately before and on the 180th day post-transplantation. At each visit, blood samples were taken to assess circulating levels of sTWEAK and ADMA. Brachial artery endothelium-dependent vasodilatation (FMD) assessments were also performed. RESULTS: Renal transplantation was followed by an improvement in FMD. This improvement was paralleled by an increase in sTWEAK and a reduction in ADMA after transplantation (P < 0·001 for all). Cross-sectionally, both molecules associated with FMD before as well as after transplantation (P < 0·001 for all). Longitudinally, the changes observed in sTWEAK (ß = 0·26, P < 0·001) and ADMA (ß = -0·44, P < 0·001) levels were independently associated with the improvement of FMD (r(2)  = 0·30). CONCLUSIONS: Renal transplantation is followed by an improvement of FMD that is independently associated with the normalization of both sTWEAK and ADMA concentrations. We identify two surrogate biomarkers of endothelial function with potential as therapeutic targets.

Radiofrequency catheter ablation of ventricular tachycardia in a military parachuter.

BACKGROUND: Premature ventricular contractions (PVCs) presenting as isolated complexes are insignificant, but if they present as salvos they are considered indicators of high risk for potentially fatal arrhythmias. CASE REPORT: We present the case of a 39-yr-old male military parachuter with PVCs and ventricular tachycardia that were incidentally detected on ECG and treated with radiofrequency catheter ablation (RFCA). He had no significant past medical history. Physical examination and biochemical tests were normal. Transthoracic echocardiography showed no structural heart disease. Due to frequent ventricular extrasystoles (VES) detected on his ECG, 24-h Holter monitoring was conducted and revealed VES, including 13,351 isolated PVCs, 1427 episodes of bigeminy, 397 of trigeminy, 30 couplets, and 4 salvo periods. After beta-blocker and calcium channel blocker treatment for 1 mo, his repeat 24-h Holter monitoring showed 18,414 isolated PVCs, 819 episodes of bigeminy, 181 of trigeminy, and 6 couplet VES, but no episodes of salvos. Electrophysiological studies (EPS) were performed and the baseline measurements were: basic cycle length: 890 ms; atrium His interval: 78 ms; and ventricular His interval: 54 ms. VES were found to orginate from the right ventricular outflow tract and were terminated by RFCA. Medical treatment was stopped. Repeat Holter showed no VES. The parachuter was qualified for full duties. DISCUSSION: As the patient is an aircrew member and further usage of antiarrhythmic agents will interfere with his flying status, instead of initiating a drug therapy again, we performed EPS and RFCA as an effective and dependable method in order to treat and to determine his fitness.

Evaluation of machine learning algorithms for renin-angiotensin-aldosterone system inhibitors associated renal adverse event prediction.

BACKGROUND: Renin-angiotensin-aldosterone system inhibitors (RAASi) are commonly used medications. Renal adverse events associated with RAASi are hyperkalemia and acute kidney injury. We aimed to evaluate the performance of machine learning (ML) algorithms in order to define event associated features and predict RAASi associated renal adverse events. MATERIALS AND METHODS: Data of patients recruited from five internal medicine and cardiology outpatient clinics were evaluated retrospectively. Clinical, laboratory, and medication data were acquired via electronic medical records. Dataset balancing and feature selection for machine learning algorithms were performed. Random forest (RF), k-nearest neighbor (kNN), naïve Bayes (NB), extreme gradient boosting (xGB), support vector machine (SVM), neural network (NN), and logistic regression (LR) were used to create a prediction model. RESULTS: 409 patients were included, and 50 renal adverse events occurred. The most important features predicting the renal adverse events were the index K and glucose levels, as well as having uncontrolled diabetes mellitus. Thiazides reduced RAASi associated hyperkalemia. kNN, RF, xGB and NN algorithms have the highest and similar AUC (≥ 98%), recall (≥ 94%), specifity (≥ 97%), precision (≥ 92%), accuracy (≥ 96%) and F1 statistics (≥ 94%) performance metrics for prediction. CONCLUSION: RAASi associated renal adverse events can be predicted prior to medication initiation by machine learning algorithms. Further prospective studies with large patient numbers are needed to create scoring systems as well as for their validation.

Hyperbaric oxygen therapy alleviates oxidative stress and tissue injury in renal ischemia/reperfusion injury in rats.

Hyperbaric oxygen (HBO) therapy has been shown to attenuate renal ischemia/reperfusion (I/R) injury in rats, when applied in the early reperfusion period. The aim of this study was to elucidate possible beneficial effects of HBO therapy on renal I/R injury, when applied 24 h after ischemia. Rats were randomized into three groups: (1) control group (n = 20), (2) I/R group (n = 20), and (3) I/R + HBO group (n = 20). Renal I/R injury was created by interrupting renal blood flow for 30 min with a non-traumatic vascular clamp. HBO therapy was administered 24 h after I/R injury and continued for 5 days. At the end of the study, rats were sacrificed under anesthesia, blood was drawn, and right kidneys were harvested for analysis. Renal I/R injury increased serum and tissue malondialdehyde (MDA) levels and reduced superoxide dismutase (SOD) and glutathione peroxidase (GPx) levels. HBO therapy attenuated MDA levels by increasing SOD and GPx activities. HBO therapy also prevented neutrophil infiltration and tissue injury in kidneys. Taken together, HBO therapy has been found to be effective in the delayed period of I/R injury.

Evaluation of the oxidative effect of long-term repetitive hyperbaric oxygen exposures on different brain regions of rats.

Hyperbaric oxygen (HBO(2)) exposure affects both oxidative and antioxidant systems. This effect is positively correlated with the exposure time and duration of the treatment. The present study aims enlightening the relation of HBO(2) with oxidative/antioxidant systems when administered in a prolonged and repetitive manner in brain tissues of rats. Sixty rats were divided into 6 study (n = 8 for each) and 1 control (n = 12) group. Rats in the study groups were daily exposed 90-min HBO(2) sessions at 2.8 ATA for 5, 10, 15, 20, 30 and 40 days. One day after the last session, animals were sacrificed; their whole brain tissue was harvested and dissected into three different regions as the outer grey matter (cortex), the inner white matter and cerebellum. Levels of lipid peroxidation and protein oxidation and activities of superoxide dismutase and glutathione peroxidase were measured in these tissues. Malondialdehyde, carbonylated protein and glutathione peroxidase levels were found to be insignificantly increased at different time-points in the cerebral cortex, inner white matter and cerebellum, respectively. These comparable results provide evidence for the safety of HBO treatments and/or successful adaptive mechanisms at least in the brain tissue of rats, even when administered for longer periods.

Differences in ischemia-modified albumin levels between end stage renal disease patients and the normal population.

INTRODUCTION: Conventional biomarkers suffer from the drawback of being elevated in chronic renal failure even in the absence of myocardial ischemia. Ischemia-modified albumin (IMA) is a new biomarker proposed for the diagnosis of myocardial ischemia. This study was performed with the primary aim of determining IMA levels in patients with end stage renal disease (ESRD). The secondary aim of the study was to determine the impact of hemodialysis (HD), HD speed, and hemoglobin (Hb) levels on IMA levels. METHODS: The study was conducted with 108 ESRD patients entering HD and 30 healthy volunteers. The serum IMA levels of ESRD patients were compared with the post-HD levels and also with healthy individuals. The interaction between Hb levels and HD treatment and the IMA levels were tested by using the Generalized Linear Model for repeated measurements. RESULTS: The IMA levels of ESRD patients, both pre- and post-HD, were significantly higher than those of the control group. The baseline IMA levels of "low" and "high Hb groups" were not significantly different. Hb level modifies the effect of HD treatment on IMA concentration in ESRD patients. Furthermore, post-HD levels of IMA were increased at a lower dialysis speed. CONCLUSIONS: Both pre- and post-dialysis IMA levels are higher in ESRD patients entering HD than in healthy individuals. Anemia is an effect-modifier for the effect of HD treatment on IMA levels in ESRD patients.

Comparison of warm fluid and cold fluid resuscitation during uncontrolled hemorrhagic shock model in rats.

BACKGROUND: This study was designed to compare the effects of resuscitation with cold and warm fluid on survival time, rate and volume of hemorrhage, hemodynamics, hypothermia, coagulopathy, acid-base balance, hematocrit, lactate, and base deficit during uncontrolled hemorrhagic shock (HS) model in rats. METHODS: HS model was created with splenic vascular and parenchymal injury in 29 rats under ketamine and xylazine anesthesia. Thirty minutes after the hemorrhage, the rats were randomized to receive 14.5 mL/kg 0.9% sodium chloride solution at either 24ºC (Group 1; n=9) or 4ºC (Group 2; n=10) for 20 minutes. Groups 1 and 2 were compared with group that did not receive fluid (Group 3; n=10). Statistical data were represented as mean±SD. SPSS for Windows, Version 15.0 (SPSS, Inc., Chicago, IL, USA) software, Bonferroni-adjusted Mann-Whitney U test and Kaplan-Meier procedure were used to perform statistical data analysis. P value of ≤0.05 was considered statistically significant. RESULTS: Cold fluid resuscitation decreased survival time due to increased rate and volume of hemorrhage, acidosis, hypothermia, lactate, and base deficit and decreased blood pressure and hematocrit. CONCLUSION: There is a great need for further experimental and clinical trials on fluid resuscitation in trauma in order to define which fluid should be administered, temperature of the fluid, quantity to be delivered, and duration.

The Relation Between No-Reflow Phenomenon and Complete Blood Count Parameters.

The no-reflow (NR) phenomenon represents an acute reduction in coronary blood flow without coronary vessel obstruction, coronary vessel dissection, spasm, or thrombosis. No reflow is an important complication among patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). The complete blood count (CBC) is one of the most frequently ordered laboratory tests in clinical practice. Various studies have evaluated the performance of CBC parameters to predict disease severity and mortality risk. Automated cell counters are routinely available in many clinical laboratories and can be used to determine red blood cell distrubiton width (RDW), platetecrit, platelet count, and and some ratios like the neutrophil-lymphocyte ratio and RDW-platelet ratio. These hematological markers have been reported to be independent predictors of impaired angiographic reperfusion and long-term mortality among patients with STEMI undergoing pPCI. In this context, we reviewed the role of admission CBC parameters for the prediction of NR in patients with STEMI undergoing pPCI.

Neopterin, homocysteine, and ADMA levels during and after urticaria attack.

BACKGROUND/AIM: Urticaria is a vascular skin reaction characterized with papules and plaques. Neopterin is accepted as an immunologic marker and an indicator of activation of the immune system. Homocysteine and asymmetric dimethylarginine (ADMA) are the markers of increased vascular resistance. Alteration in vascular resistance has a role in the pathogenesis of urticaria. We aimed to investigate whether there is a relationship between urticaria and neopterin, homocysteine, or ADMA. MATERIALS AND METHODS: The study is designed as a prospective descriptive study and patients with a diagnosis of urticaria in the emergency department were included in the study. Demographic data and characteristics of the disease were recorded. Neopterin, homocysteine, and ADMA levels were measured both during and after urticaria attacks. All data were statistically analyzed. RESULTS: The differences between neopterin levels measured during and after urticaria attacks were statistically significant (P < 0.001). The differences between homocysteine and ADMA levels measured during and after urticaria attacks were not statistically significant (P > 0.05). CONCLUSION: Our results indicate that neopterin levels in patients with urticaria attacks are increased and the level of neopterin is also a useful parameter in acute urticaria. Further studies should clarify whether homocysteine levels contribute to diagnosis of acute urticaria. However, no relation was found between ADMA and urticaria.

Serum neutrophil gelatinase-associated lipocalin is associated with cardiovascular events in patients with chronic kidney disease.

BACKGROUND: Neutrophil gelatinase-associated lipocalin (NGAL) is a member of the lipocalin family best known as a novel and early marker of acute kidney injury (AKI). Recent data suggest that NGQueryAL is not only a marker of AKI, but also an important player in the vascular remodeling, atherosclerotic plaque stability and thrombus formation. We conducted this study to investigate the association of serum NGAL levels with fatal and composite (fatal and non-fatal) cardiovascular events (CVE) in a cohort of patients with stage 1-5 CKD. METHODS: This was an observational cohort study in which serum NGAL was obtained from 298 CKD (stages 1-5) patients. Fatal and composite CVE were recorded for a median 41 months. We examined alteration of serum NGAL through CKD groups as well as association with inflammatory markers. We also performed a Cox regression analysis to determine the association of NGAL with predefined clinical outcomes. RESULTS: The median value of NGAL was 50.5 ng/mL (IR 47.6-54.9 ng/mL), and higher NGAL values were recorded in diabetic patients. In a multiple linear regression model, including all univariate associates of NGAL, only log eGFR, log hs-CRP and log HDL cholesterol maintained an independent association with log NGAL. During the observational period, 30 patients died due to cardiovascular causes and 69 non-fatal CVE were registered. In the fully adjusted model, we observed a 2.08-fold increase in the risk of fatal CVE and a 1.50-fold increase in the risk of fatal and non-fatal CVE for each increment of 1 SD in log NGAL values. CONCLUSIONS: This is the first study that shows that serum NGAL is associated with cardiovascular events (fatal and non-fatal) in patients with CKD, independently of traditional risk factors, renal function and inflammation.

Carbon monoxide poisoning increases Tpeak-Tend dispersion and QTc dispersion.

OBJECTIVES: Carbon monoxide (CO) poisoning leads to cardiac dysrhythmia. Increased heterogeneity in ventricular repolarisation on electrocardiogram (ECG) shows an increased risk of arrhythmia. A number of parameters are used to evaluate ventricular repolarisation heterogeneity on ECG. The aim of our study is to investigate the effect of acute CO poisoning on indirect parameters of ventricular repolarisation on ECG. METHODS: Sixty-seven patients were included in this case-control study. Thirty patients with acute CO poisoning were assigned to group 1 (19 females, mean age: 30.8 ± 11.3 years). A control group was formed with patients without known cardiac disease (group 2, n = 37; 25 females, mean age: 26.0 ± 5.2 years). Twelve-lead ECG and serum electrolyte levels were recorded in all patients. Also, carboxyhaemoglobin (COHb) levels were recorded in group 1. Tpeak-Tend (TpTe) interval, TpTe dispersion, TpTe/QT ratio, QT interval and QTd durations were measured as parameters of ventricular repolarisation. Corrected QT (QTc ) and QTc dispersion (QTcd) intervals were determined with the Bazett's formula. RESULTS: The mean COHb level in group 1 was 27.6 ± 7.4% and mean duration of CO exposure was 163.5 ± 110.9 min. No statistically significant difference was found in age, gender, serum electrolytes or blood pressure levels between the groups. QRS, QT, QTc, TpTe interval and TpTe/QT ratio were similar between the groups (p > 0.05). QTcd (65.7 ± 64.4 vs 42.1 ± 14.2 ms, p = 0.003) and TpTe dispersion (40.5 ± 14.8 vs 33.2 ± 4.9 ms, p = 0.006) were significantly longer in group 1 than group 2. COHb level was moderately correlated with TpTe dispersion (r = 0.29; p = 0.01). CONCLUSION: To our knowledge, this is the first study to investigate TpTe interval and dispersion in CO poisoning. Our results showed that TpTe dispersion and QTc dispersion increased after CO poisoning.