The Role Played by Novel Inflammatory Markers in Assessment of Peripheral Artery Disease.

Background and Objectives: Atherosclerosis is a multifactorial process in which inflammatory markers have both therapeutic and prognostic roles. Recent studies bring into question the importance of assessing new inflammatory markers in relation to the severity of peripheral artery disease (PAD), such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-C-reactive protein ratio (LCR). Materials and Methods: We conducted a retrospective and descriptive study including 652 patients with PAD, who were divided into two groups according to the severity of the ankle-brachial index value: mild and moderate obstruction (257 patients) and severe obstruction (395 patients). We evaluated demographics, anthropometric data and clinical and paraclinical parameters in relation to the novel inflammatory biomarkers mentioned above. Results: Weight (p = 0.048), smoking (p = 0.033), the number of cardiovascular risk factors (p = 0.041), NLR (p = 0.037), LCR (p = 0.041) and PLR (p = 0.019), the presence of gangrene (p = 0.001) and the number of lesions detected via peripheral angiography (p < 0.001) were statistically significant parameters in our study. For the group of patients with severe obstruction, all three inflammatory biomarkers were statistically significantly correlated with a serum low-density lipoprotein-cholesterol level, the number of cardiovascular risk factors, rest pain, gangrene and a risk of amputation. In addition, directly proportional relationships were found between NLR, PLR and the number of stenotic lesions (p = 0.018, p = 0.016). Also, NLR (area under the curve = 0.682, p = 0.010) and PLR (AUC = 0.692, p = 0.006) were predictors associated with a high risk of amputation in patients with an ABI < 0.5. Conclusions: in our study, we demonstrated the importance of assessing inflammatory markers in relation to the presence of cardiovascular risk factors through the therapeutic and prognostic value demonstrated in PAD.

The "Viral" Form of Polyarteritis Nodosa (PAN)-A Distinct Entity: A Case Based Review.

Classic polyarteritis nodosa (PAN) is a vasculitis with systemic manifestations that is characterized by inflammatory and necrotizing lesions affecting medium and small muscular arteries, most frequently at the bifurcation of the vessels. These lesions lead to the formation of microaneurysms, hemorrhaging ruptured aneurysms, thrombosis, and, consequently, ischemia or organ infarction. Background and Objectives: We present a complex clinical case of a patient with a late diagnosis of polyarteritis nodosa with multiorgan involvement. Materials and Methods: The 44-year-old patient, in an urban environment, presented on her own in the emergency room for acute ischemia phenomena and forearm and right-hand compartment syndrome, requiring surgical decompression in the Plastic Surgery Clinic. Results: Significant inflammatory syndrome is noted, alongside severe normocytic hypochromic iron deficiency anemia, nitrogen retention syndrome, hyperkalemia, hepatic syndrome, and immunological disturbances: absence of cANCA, pANCA, anti Scl 70 Ac, antinuclear Ac, and anti dDNA Ac, as well as a low C3 fraction of the plasmatic complement system. The morphological aspect described in the right-hand skin biopsy correlated with the clinical data supports the diagnosis of PAN. Conclusions: The viral form of PAN seems to be individualized as a distinct entity, requiring early, aggressive medication.

Role of Chemerin and Perivascular Adipose Tissue Characteristics on Cardiovascular Risk Assessment by Arterial Stiffness Markers in Patients with Morbid Obesity.

BACKGROUND AND OBJECTIVE: The development of arterial stiffness (AS) in obesity is a multifactorial and complex process. The pleomorphic actions of adipokines and their local activity in perivascular adipose tissue (PVAT) are potential modulators of AS appearance and progression. We aimed to assess the correlations between two adipokines (chemerin, adiponectin), PVAT morphological changes (adipocyte size, blood vessel wall thickness) and AS parameters in the special subgroup of patients with morbid obesity. MATERIAL AND METHODS: We enrolled 25 patients with morbid obesity and 25 non-obese patients, who were age- and gender-matched, untreated for cardiovascular risk factors, and admitted to hospital for laparoscopic surgical procedures (bariatric surgery for morbid obesity and non-inflammatory benign pathology surgery for non-obese patients). Before the surgical procedures, we evaluated demographic and anthropometric data and biochemical parameters including the studied adipokines. Arterial stiffness was evaluated using a Medexpert ArteriographTM TL2 device. In both groups, adipocyte size and vascular wall thickness as well as local adiponectin activity were analyzed in PVAT from intraoperative biopsies. RESULTS: In our study, adiponectin (p = 0.0003), chemerin (p = 0.0001) and their ratio (p = 0.005) had statistically significant higher mean values in patients with morbid obesity compared to normal-weight patients. In patients with morbid obesity there were significant correlations between chemerin and AS parameters such as aortic pulse wave velocity (p = 0.006) and subendocardial viability index (p = 0.009). In the same group adipocyte size was significantly correlated with another AS parameter, namely, aortic systolic blood pressure (p = 0.030). In normal-weight patients, blood vessel wall thickness positively correlated with AS parameters such as brachial (p = 0.023) and aortic augmentation index (p = 0.023). An important finding was the negative adipoR1 and adipoR2 immunoexpression in PVAT adipocytes of patients with morbid obesity. Additionally, we found significant correlations between blood vessel wall thickness and blood fasting glucose (p < 0.05) in both groups. CONCLUSIONS: Chemerin and adipocyte size could be predictive biomarkers for AS in patients with morbid obesity. Given the small number of patients included, our results need further validation.

Determinants of Arterial Stiffness in Patients with Morbid Obesity. The Role of Echocardiography and Carotid Ultrasound Imaging.

Background and objective: Morbid obesity is accompanied by an increased cardiovascular (CV) risk, which justifies a multidisciplinary, integrative approach. Arterial stiffness has a well-defined additional role in refining individual CV risk. Given that echocardiography and carotid ultrasound are usual methods for CV risk characterization, we aimed to identify the imaging parameters with a predictive value for early-onset arterial stiffness. Material and methods: We conducted a study in which 50 patients (divided into two equal groups with morbid obesity and without obesity), age and gender matched, untreated for cardiovascular risk factors, were addressed to bariatric surgery or non-inflammatory benign pathology surgery. Before the surgical procedures, we evaluated demographics, anthropometric data and biochemical parameters including adipokines (chemerin, adiponectin). Arterial stiffness was evaluated using the Medexpert ArteriographTM TL2 device. Transthoracic echocardiography and carotid ultrasound were also performed. We also analyzed adipocyte size and vascular wall thickness in intraoperative biopsies. Results: Left ventricle (LV) mass index (p = 0.2851), LV ejection fraction (LVEF) (p = 0.0073), epicardial adipose tissue thickness (p = 0.0001) as echocardiographic parameters and carotid intima-media thickness (p = 0.0033), relative wall thickness (p = 0.0295), wall to lumen thickness ratio (p = 0.0930) and carotid cross-sectional area (p = 0.0042) as ultrasound parameters were significant measures in our groups and were assessed in relation to adipocyte size, blood vessel wall thickness and adipokines serum levels. Statistical analysis revealed directly proportional relationships between LV mass index (p = 0.008), carotid systolic thickness of the media (p = 0.009), diastolic thickness of the media (p = 0.007), cross-sectional area (p = 0.001) and blood vessel wall thickness. Carotid relative wall thickness positively correlates with adipocyte size (p = 0.023). In patients with morbid obesity, chemerin and adiponectin/chemerin ratio positively correlates with carotid intima-media thickness (p = 0.050), systolic thickness of the media (p = 0.015) and diastolic thickness of the media (p = 0.001). The multiple linear regression models revealed the role of epicardial adipose tissue thickness and carotid cross-sectional area in predicting adipocyte size which in turn is an independent factor for arterial stiffness parameters such as pulse wave velocity, subendocardial viability ratio and aortic augmentation index. Conclusions: Our results suggest that epicardial adipose tissue thickness, carotid intima-media thickness, relative wall thickness and carotid cross-sectional area might be useful imaging parameters for early prediction of arterial stiffness in patients with morbid obesity.

[Contributions to the implementation of screening tests for assessing the neuropsychic development in children]. / Contributii la implementarea unui test screening de apreciere a dezvoltarii neuropsihice la copil.

UNLABELLED: Currently, in Romania the general practitioner does not use screening tests to detect the developmental problems in children. That might be the reason why many cases are diagnosed too late. AIM: To evaluate the impact and the usefulness of a screening tool for neurodevelopmental disorders in primary care. MATERIAL AND METHODS: This trans-sequential study was carried out a on a series of 324 children under the age of 5 in the interval January 2007-December 2010. The neurodevelopmental status of the children was assessed by two methods: routine clinical assessment, and ASQ screening tools. RESULTS: Compared to routine assessment, by which 33 children (10,2%) with development delays have been detected, the use of parent-addressed questionnaires raised the detection percentage to 12% (6 more children). The use of parent-addressed questionnaires also improved the doctor-patient communication, increased the degree of parental involvement in their child's development stimulation, especially with regard to the malfunctions in verbal and cognitive behavior. CONCLUSIONS: The use of validated screening tests is a goal for improving the primary care practice.

[Clinical aspects of hypertension in children with aortic coarctation]. / Aspecte ale hipertensiunii arteriale în coarctatia de aorta la vârsta copilariei.

UNLABELLED: Our study is focused on blood pressure before and after repair of aortic coarctation in childhood. METHODS: A group of 26 children (13 boys, 13 girls, range 1-18 years, of which 12 operated: 9 boys and 3 girls) was studied, blood pressure being followed before and after operation. The recorded blood pressure was compared to normal values for age and height. RESULTS: Before the surgical treatment blood pressure being above normal in all cases, the figures were: "high normal"--6 cases, significant--8 cases and severe hypertension--12 cases. After surgery: 75% normal blood pressure, 25% hypertension (variable degrees). CONCLUSION: Hypertension in aortic coarctation varies from "high normal" to severe. Hypertension got worse during pregnancy in an unoperated girl. In most of children, blood pressure decreased after surgical treatment, being normal in 75% of all cases, in one year after surgery. Persistence of a severe hypertension after surgery signifies presence of an underlying lesion unrecognised yet.

[Atrio-ventricular canal: possibilities of recovery]. / Canal atrio-ventricular comun. Posibilitati de recuperare.

UNLABELLED: The evolution and prognosis of the atrioventricular canal (AVC) depend very much on the clinical type of the disease and its recovery is sometimes an extremely difficult problem. METHODS: The evolution of the 24 cases with atrioventricular canal (10 boys and 14 girls), registered in the files of pediatric cardiology consulting room from the Outpatient Department of the "Sf. Spiridon" Hospital from Iasi, has been studied. According to the state of the patients and, especially, with the parents' permission, these children were sent to Cardiovascular Surgery, for corrective surgical treatment. Before that, they had received a medical treatment for the cardiac failure (digitals, diuretics) and for the pulmonary hypertension (beta-adrenergic blockers, renin angiotensin inhibitors) and they continued this treatment for 1-2 years after the surgical correction. RESULTS AND DISCUSSIONS: This sample included: 9 cases with AVC-complete type; 1 case with AVC-intermediate type; 14 cases with AVC-partial type (13 cases with atrial septal defect-ostium primum + mitral valve cleft and 1 case with left ventricle to right atrium type IIa communication). Only 7 of the 10 children with AVC partial type were surgically corrected, and in all cases the evolution was positive. Three of the nine cases with AVC complete type were investigated in Cardiovascular Surgery in our country, all of them considered without surgical solution. For one of the cases with AVC--complete type and pulmonary stenosis, considered also without surgical solution, a palliative systemic-to-pulmonary artery shunt was made, for the improvement of the pulmonary circulation. CONCLUSIONS: 1. AVC partial type could be recovered in the best conditions in the clinics of cardiovascular surgery in our country. 2. AVC--complete type didn't have, in our cases, surgical solution, either in our country or abroad. 3. For the special situation of the AVC complete type with pulmonary stenosis, the only treatment possible was palliative, performed to increase the pulmonary artery blood flow.