Expression pattern of the bone morphogenetic protein-4 and its relationship with inflammation, vascular injury in patients suffered the arterial occlusive diseases. / åŠ¨è„‰é˜»å¡žæ€§ç–¾ç— æ‚£è€ è¡€æµ†éª¨å½¢æ€å‘ç”Ÿè›‹ç™½-4çš„è¡¨è¾¾å˜åŒ–åŠå ¶ä¸Žç‚Žç—‡å’Œè¡€ç®¡æŸä¼¤çš„ç›¸å ³æ€§.

OBJECTIVES: Bone morphogenetic protein-4 (BMP4) has been proved to be an important regulatory factor for the pathological process of atherosclerosis (AS). However, there are few related clinical studies. This study aims to investigate the levels of plasma BMP4 in patients suffering from the arterial occlusive diseases (ACD) characterized by AS, and further to test the relationship between BMP4 and inflammation and vascular injury. METHODS: A total of 38 ACD patients (the ACD group) and 38 healthy people for the physical examination (the control group) were enrolled. The plasma in each subject from both groups was obtained to test the levels of BMP4, tumor necrosis factor-α (TNF-α), interleukin-1ß (IL-1ß), IL-10, and vascular endothelial cadherin (VE-cadherin), and the relationship between BMP4 and the detected indicators above were further analyzed. RESULTS: Compared with the control group, the patients in the ACD group displayed significant elevations in the neutrophil to lymphocyte ratio [NLR, 1.63 (1.26, 1.91) vs 3.43 (2.16, 6.61)] and platelet to lymphocyte ratio [PLR, 6.37 (5.26, 7.74) vs 15.79 (7.97, 20.53)], while decrease in the lymphocyte to monocyte ratio [LMR, 5.67 (4.41, 7.14) vs 3.43 (2.07, 3.74)] (all P<0.05). Besides, the ACD patients displayed significant elevations in plasma BMP4 [581.26 (389.85, 735.64) pg/mL vs 653.97(510.95, 890.43) pg/mL], TNF-α [254.16 (182.96, 340.70) pg/mL vs 293.29(238.90, 383.44) pg/mL], and VE-cadherin [1.54 (1.08, 2.13) ng/mL vs 1.85 (1.30, 2.54) ng/mL], and decrease in IL-10 [175.89 (118.39, 219.25) pg/mL vs 135.92 (95.80, 178.04) pg/mL] (all P<0.05). While the levels of IL-1ß remained statistically comparable between the 2 groups (P=0.09). Furthermore, the plasma BMP4 levels were further revealed to be positively correlated with the levels of IL-1ß (r=0.35), TNF-α (r=0.31) and VE-cadherin (r=0.47), while they were negatively correlated with the levels of IL-10 (r=-0.37; all P<0.01). CONCLUSIONS: After ACD occurrence, the patients' plasma concentrations of BMP4 would be upregulated, which may serve as a candidate to indicate the levels of inflammation and vascular injury.

Predictors of bleeding complications during catHeter-dirEcted thrombolysis for peripheral arterial occlusions (POCHET).

INTRODUCTION: The risk of major bleeding complications in catheter directed thrombolysis (CDT) for acute limb ischemia (ALI) remains high, with reported major bleeding complication rates in up to 1 in every 10 treated patients. Fibrinogen was the only predictive marker used for bleeding complications in CDT, despite the lack of high quality evidence to support this. Therefore, recent international guidelines recommend against the use of fibrinogen during CDT. However, no alternative biomarkers exist to effectively predict CDT-related bleeding complications. The aim of the POCHET biobank is to prospectively assess the rate and etiology of bleeding complications during CDT and to provide a biobank of blood samples to investigate potential novel biomarkers to predict bleeding complications during CDT. METHODS: The POCHET biobank is a multicentre prospective biobank. After informed consent, all consecutive patients with lower extremity ALI eligible for CDT are included. All patients are treated according to a predefined standard operating procedure which is aligned in all participating centres. Baseline and follow-up data are collected. Prior to CDT and subsequently every six hours, venous blood samples are obtained and stored in the biobank for future analyses. The primary outcome is the occurrence of non-access related major bleeding complications, which is assessed by an independent adjudication committee. Secondary outcomes are non-major bleeding complications and other CDT related complications. Proposed biomarkers to be investigated include fibrinogen, to end the debate on its usefulness, anti-plasmin and D-Dimer. DISCUSSION AND CONCLUSION: The POCHET biobank provides contemporary data and outcomes of patients during CDT for ALI, coupled with their blood samples taken prior and during CDT. Thereby, the POCHET biobank is a real world monitor on biomarkers during CDT, supporting a broad spectrum of future research for the identification of patients at high risk for bleeding complications during CDT and to identify new biomarkers to enhance safety in CDT treatment.

The role of inflammation markers in occurrence of radial artery occlusion.

Aim: Radial artery occlusion (RAO) is a major complication of catheterization via transradial access (TRA). Our aim is to reveal the ability of high-sensitive C-reactive protein (hs-CRP) and complete blood count (CBC) components, which are inflammation markers, to predict RAO. Methods: Patients were divided into two groups: 103 with RAO and 300 without RAO. The relationship between CRP, CBC components and RAO was evaluated. Results: A significant increase in hs-CRP, monocyte, platelet (PLT), platelet distribution width (PDW) and plateletcrit values was observed after TRA, and only the increase in PDW, PLT and hs-CRP was found to be independent determinants in regression analysis. Conclusion: High PDW and PLT and increased hs-CRP levels are new independent determinants of the development of RAO.

The role of inflammation markers in occurrence of radial artery occlusion that restricts the transradial cardiac catheterization.

Impact of hepatitis virus infection on arterial calcification among incident hemodialysis patients / Impacto de la infección por el virus de la hepatitis en la calcificación arterial en nuevos pacientes en hemodiálisis

BACKGROUND: The impact of hepatitis virus infection on arterial calcification (AC) was not studied. OBJECTIVE: To study the prevalence, severity and distribution of AC in incident hemodialysis patients with hepatitis B and C viral infection. Cases and methods: 172 stage 5 CKD adults (98 male and 74 female) were included; 58 of them were seronegative for both hepatitis B and C (SN group), 48 were positive for hepatitis B virus infection (HBV group) and 66 were hepatitis C virus positive (HCV group). Beside histopathology of the obtained arterial samples, all these cases were examined for body mass index (BMI), serum calcium (Ca), phosphorus (P), alkaline phosphatase (AP), serum albumin, uric acid (UA), alanine transaminase (ALT), parathormone (PTH), fibroblast growth factor 23(FGF23), interleukin 6 (IL6), and 25 hydroxy vitamin D (25 (OH) vit D), hemoglobin concentration, and serum ferritin. RESULTS: 86 (50%) of the cases had AC; 11 of them were in SN group (19%), 9 in HBV group (18.8%) and all the 66 CV group (100%). In SN group, 4 had intimal calcification, 5 had medial calcification, and 2 had both intimal and medial calcification. In HBV group, 9 had intimal calcification, while no cases were encountered with either medial or both site calcifications. In HCV group, 16 had intimal calcification, 31 had medial calcification, and 19 had both intimal and medial calcification. Calcification was in the form of spots in one case in SN group, and 6 cases in HBV group, a single plaque of calcification in 5 cases of SN group, 3 cases of HBV group, and 16 cases of HCV group, multiple plaques were detected in 4 cases in SN group, and 31 cases in HCV group, and diffuse calcification in one case in SN group, and 19 cases in HCV group. In HBV group, calcification was only detected in patients with high viremia, while all patients with low or moderate viremia were devoid of calcification. In HCV group, all patients with low viremia had intimal solitary plaque of calcification, all patients with moderate viremia had multiple plaques of medial calcification, while all patients with high viremia had diffuse intimal and medial calcification. Both groups of viral hepatitis were significantly different in comparison to SN group in either distribution or calcification score (P < 0.001 in all). HBV group had significantly lower serum P, CaxP and PTH in comparison to SN group (4.6±0.66 vs. 5.45±0.77mg/dL, 36.4±7.2 vs. 44.1±8.69, and 348±65.4 vs. 405.9±83.2pg/mL, P<0.001, <0.001, and 0.035 respectively). On the other hand, HCV group did not show any significant difference in any of the studied parameters compared to SN group. CONCLUSION: HCV positive patients are more prone to develop AC that is more extensive. HBV positive patients were less likely to have arterial medial calcification, probably related to lower serum phosphorus, CaxP product and PTH. HCV infection should be added as risk factor for AC among CKD patients. Further studies are needed to confirm these findings

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Apo B/Apo A-I ratio in central and peripheral arterial diseases

BACKGROUND: The apo B/apo A-I ratio represents the balance between atherogenic particles, rich in apo B, and the antiatherogenic ones, apo A-I rich. This study investigated the association between atherosclerotic diseases in different anatomical sites and apo B/apo A-I ratio. METHODS: Lipids, lipoproteins, and apolipoproteins A-I and B were assessed in 30 subjects with coronary artery disease (CAD), 26 with ischemic stroke (IS), 30 with peripheral arterial obstructive disease (PAOD), and 38 healthy subjects (controls). RESULTS: HDLc and Apo A-I were significantly lower in PAOD and CAD groups, respectively, than in other groups. Significantly higher levels of triglycerides were observed for CAD and PAOD groups than for controls. Apo B was significantly higher in IS group than in control and PAOD groups. The apo B/apo A-I ratio showed significantly higher in CAD and IS groups when compared to control and PAOD groups (p < 0.001). CONCLUSION: The apo B/apo A-I ratio was important for identifying an increased trend for coronary and cerebral atherosclerosis. In spite of the increased trend for apo B/apo A-I ratio in IS and CAD groups, the studied variables cannot be considered in an isolated way, given as those parameters were analyzed together by a binary logistic regression, no association has been demonstrated.

INTRODUÇÃO: O índice apo B/apo A-I representa o balanço entre partículas de colesterol potencialmente aterogênicas ricas em apo B e partículas anti-aterogênicas ricas em apo A-I. O objetivo deste estudo foi investigar a associação entre doenças ateroscleróticas em diferentes sítios anatômicos e o índice apo B/apo A-I. MÉTODOS: Lípides, lipoproteínas e apolipoproteínas A-I e B foram quantificados em 30 indivíduos apresentando doença arterial coronariana (DAC), 26 com acidente vascular cerebral (AVC), 34 apresentando doença arterial obstrutiva periférica (DAOP) e 38 indivíduos hígidos (grupo controle). RESULTADOS: HDLc e apo A-I apresentaram-se significativamente mais baixos nos grupos DAOP e DAC, respectivamente, quando comparados com os demais grupos. Níveis de triglicérides foram significativamente mais elevados nos grupos DAC e PAOD quando comparados com o grupo controle. Apo B foi significativamente mais elevada no grupo AVC quando comparado com os grupos controle e DAOP. O índice apo B/apo A-I se mostrou significativamente elevado nos grupos DAC e AVC quando comparados com os demais (p < 0,001). CONCLUSÃO: O índice apo B/apo A-I foi importante para identificar uma tendência aumentada para aterosclerose coronariana e cerebral. No entanto, os parâmetros avaliados não podem ser considerados de forma isolada, considerando que nenhuma associação foi demonstrada quando os dados foram analisados pelo modelo de regressão logística binária.

Estudo dos níveis da creatino-fosfoquinase nos quadros de obstruçäo arterial aguda embólica de membros / Serum levels of creatinophosphokinase in patients with peripheral acute arterial embolism

Foram estudados 33 episódios de oclusäo arterial aguda dos membros em 32 pacientes, atendidos no Pronto Socorro do Hospital das Clínicas da Faculdade de Medicina da Universidade de Säo Paulo e no Hospital Israelita Albert Einstein, no período de 1979 a 1984. Täo logo reconhecido o episódio isquêmico, os pacientes foram submetidos a coleta de sangue para a media da atividade sérica da creatino-fosfoquinase com o objetivo de compará-la com parâmetros clínicos obtidos no pré-operatório e com o resultado do tratamento (cirúrgico em todos). Estes foram: 1) localizaçäo da isquemia, 2) tempo de evoluçäo da isquemia, 3) capacidade motora da extremidade comprometida, 4) presença de empastamento muscular, 5) recuperaçäo funcional da exttremidade, 6) preservaçäo da extremidade e 7) sobrevida. Através da aplicaçäo de testes estatísticos para se comparar os níveis séricos da creatino-fosfoquinase com os parâmetros acima, concluímos que: 1) os níveis séricos da CPK näo guardam relaçäo com a localizaçäo da isquemia, 2) näo houve diferença estatisticamente significativa entre os níveis séricos da CPK e o tempo de evoluçäo da isquemia, 3) houve elevaçäo dos níveis da CPK em pacientes com comprometimento motor, 4) os pacientes portadores de empastamento muscular apresentaram valores mais elevados da CPK, 5) houve diferença significativa nos níveis da enzima entre pacientes que recuperaram a funçäo da extremidade, 6) näo pudemos relacionar os níveis da enzima com a probabilidade de amputaçäo ou preservaçäo da extremidade e 7) os pacientes que faleceram tinham níveis de CPK mais elevados que aqueles que sobreviveram

Estudio de la agregación plaquetaria, la fibrinólisis y los lípidos sanguíneos en pacientes con arteriopátia diabética de los miembros inferiores / Platelet aggregation, fibrinolysis and blood lipids in patients with diabetic arterial disease of lower extreities

En la diabetes melitus se ha observado que la agregación plaquetaria se encuentra exacerbada y la fibrinólisis alterada, planteándose que esta última puede ser índice de un defecto en la defensa contra los depósitos vasculares de fibrína, que resultaria de gran importancia para la angiopatía diabética. Se propuso también una asociación entre hiperlipidemia y actividad fibrinolítica deprimida. El presente trabajo analiza el comportamiento de estos tres conjuntos o parámetros que parecen actuar de forma conjunta en la aterogénesis del diabético. Para la comparación estadística entre los grupos, se realizó un análisis de varianza de una dosificación y en los casos en que se encontraron diferencias significativas entre los grupos, se realizó una prueba de comparación múltiple. Se obtuvieron resultados que indican que tanto la agregación plaqueatria inducida por ADP, colágeno y epinefrina, como la actividad fibrinolítica media por el tiempo de lisis de euglobulinas y los PDF, sufren variaciones significativas en varios de los grupos comparados. Además de algunos parámetros lipídicos que se encuentran también significativ amente alterados. Estos resultados implican un mejor conocimiento de las características de los diferentes tipos de pacientes diabéticos que presentan complicaciones vasculares en los miembros inferiores (AU)

Estudio de la agregación plaquetaria, la fibrinólisis y los lípidos sanguíneos en pacientes con arteriopátia diabética de los miembros inferiores / Platelet aggregation, fibrinolysis and blood lipids in patients with diabetic arterial disease of lower extremities

En la diabetes melitus se ha observado que la agregación plaquetaria se encuentra exacerbada y la fibrinólisis alterada, planteándose que esta última puede ser índice de un defecto en la defensa contra los depósitos vasculares de fibrína, que resultaria de gran importancia para la angiopatía diabética. Se propuso también una asociación entre hiperlipidemia y actividad fibrinolítica deprimida. El presente trabajo analiza el comportamiento de estos tres conjuntos o parámetros que parecen actuar de forma conjunta en la aterogénesis del diabético. Para la comparación estadística entre los grupos, se realizó un análisis de varianza de una dosificación y en los casos en que se encontraron diferencias significativas entre los grupos, se realizó una prueba de comparación múltiple. Se obtuvieron resultados que indican que tanto la agregación plaqueatria inducida por ADP, colágeno y epinefrina, como la actividad fibrinolítica media por el tiempo de lisis de euglobulinas y los PDF, sufren variaciones significativas en varios de los grupos comparados. Además de algunos parámetros lipídicos que se encuentran también significativ amente alterados. Estos resultados implican un mejor conocimiento de las características de los diferentes tipos de pacientes diabéticos que presentan complicaciones vasculares en los miembros inferiores

Consideraçöes sobre lipoproteínas, risco cardiovascular e conotaçäo com o ciclo gravídico-puerperal / Lipoproteins, cardiovascular risk and connotation with the gravidic puerperal cycle

Neste estudo atualiza-se aspectos relevantes sobre a elevaçäo do colesterol total plasmático e particularmente enfatiza a sua distribuiçäo nas classes de lipoproteínas LDL (lipoproteína de baixa densidade) e HDL (lipoproteína de alta densidade), como preditores de risco para a coronariopatia, acidente vascular cerebral e/ou obstruçäo arterial periférica. O trabalho correlaciona esses aspectos com a chamada "hiperlipemia da gravidez"