The Prognostic Significance of Atrial Fibrillation and Left Atrium Size in Patients with Aortic Stenosis.

Aim    Aortic stenosis increases left atrial (LA) pressure and may lead to its remodeling. This can cause supraventricular arrhythmia. The aim of this study was to determine if the size of the LA and the presence of atrial fibrillation are related to the prognosis of patients with aortic stenosis.Material and methods    Clinical evaluation and standard transthoracic echocardiographic studies were performed in 397 patients with moderate to severe aortic stenosis.Results    In all patients, LA dimension above the median (≥43 mm) was associated with a significantly higher risk of death [HR 1.79 (CL 1.06-3.03)] and a LA volume above the median of 80 ml was associated with a significantly higher risk of death [HR 2.44 (CI 1.12-5.33)]. The presence of atrial fibrillation was significantly associated with a higher risk of death (p <0.0001). The presence of atrial fibrillation [HR 1.69 (CI 1.02-2.86)], lower left ventricular ejection fraction [HR 1.23 (CI 1.04-1.45)], higher NYHA heart failure class [HR 4.15 (CI 1.40-13.20)] and renal failure [HR 2.10 (CI 1.31-3.56)] were independent risk factors of death in patients in aortic stenosis.Conclusion    The size and volume of the LA and the occurrence of atrial fibrillation are important risk factors for death in patients with aortic stenosis. The presence of renal dysfunction, low left ventricular ejection fraction, high NYHA functional class and atrial fibrillation are independent risk factors of poor prognosis in patients with aortic stenosis.

Entosis: From Cell Biology to Clinical Cancer Pathology.

Entosis is a phenomenon, in which one cell enters a second one. New clinico-histopathological studies of entosis prompted us to summarize its significance in cancer. It appears that entosis might be a novel, independent prognostic predictor factor in cancer histopathology. We briefly discuss the biological basis of entosis, followed by a summary of published clinico-histopathological studies on entosis significance in cancer prognosis. The correlation of entosis with cancer prognosis in head and neck squamous cell carcinoma, anal carcinoma, lung adenocarcinoma, pancreatic ductal carcinoma and breast ductal carcinoma, is shown. Numerous entotic figures are associated with a more malignant cancer phenotype and poor prognosis in many cancers. We also showed that some anticancer drugs could induce entosis in cell culture, even as an escape mechanism. Thus, entosis is likely beneficial for survival of malignant cells, i.e., an entotic cell can hide from unfavourable factors in another cell and subsequently leave the host cell remaining intact, leading to failure in therapy or cancer recurrence. Finally, we highlight the potential relationship of cell adhesion with entosis in vitro, based on the model of the BxPc3 cells cultured in full adhesive conditions, comparing them to a commonly used MCF7 semiadhesive model of entosis.

[The effectiveness of cardiovascular education in the prevention of heart disease among the inhabitants of Lesser Poland].

OBJECTIVE: Introduction: Numerous risk factors for cardiovascular disease (CVD) are modifiable, therefore understanding their effects has a significant impact on lowering the incidence and mortality. The "Malopolska Cardiovascular Preventive Intervention Study (M-CARPI)" aims to educate the inhabitants of the voivodeship regarding preventative measures for developing CVD. The aim: To examine the effectiveness of the seminars regarding preventative measures for developing CVD according to the M-CAPRI among the inhabitants of Lesser Poland. PATIENTS AND METHODS: Material and methods: The seminars were carried out by a doctor with a specialization in cardiology, in the form of presentations, based on materials prepared by experts in accordance with European and Polish guidelines. Both initially and after the course, participants completed questionnaires regarding the subjects discussed. RESULTS: Results: The study covered 558 people (137 men, 411 women). The analysis was based on the sub-populations of retirees and non-retirees. The knowledge of risk factors was checked, the respondents most often indicated incorrect judgment of nutrition, physical activity and smoking (45.9%, 39%, 44.2% for non-retirees and 22.8%, 27.6%, 16.5% for retirees, respectively). A significant increase in the number of people who indicated individual risk factors after the training was found (p=0,047 for HDL level and for others). CONCLUSION: Conclusions: Educating and creating awareness towards the prevention of CVD according to the M-CAPRI survey protocol is an effective tool for prevention. Due to the limited knowledge of cardiovascular risk factors, it is necessary to carry out activities to raise awareness of the importance of cardiological disease prevention. Preventive interventions are equally effective regardless of age or profession.

DNA extraction from FFPE tissue samples - a comparison of three procedures.

AIM OF THE STUDY: One of the critical steps in molecular oncology diagnostics is obtaining high quality genomic DNA. Therefore, it is important to evaluate and compare the techniques used to extract DNA from tissue samples. Since formalin-fixed, paraffin-embedded (FFPE) tissues are routinely used for both retrospective and prospective studies, we compared three commercially available methods of nucleic acid extraction in terms of quantity and quality of isolated DNA. MATERIAL AND METHODS: Slides prepared from 42 FFPE blocks were macro-dissected. Resulting material was divided and processed simultaneously using three extraction kits: QIAamp DNA FFPE Tissue Kit (QIAGEN), Cobas DNA Sample Preparation Kit (Roche Molecular Systems) and Maxwell 16 FFPE Plus LEV DNA Purification Kit (Promega). Subsequently, quantity and quality of obtained DNA samples were analysed spectrophotometrically (NanoDrop 2000, Thermo Scientific). Results of quantitative analysis were confirmed by a fluorometric procedure (Qubit 3.0 Fluorometer, Life Technologies). RESULTS: The results demonstrated that the yields of total DNA extracted using either Maxwell or Cobas methods were significantly higher compared to the QIAamp method (p < 0.001). The Maxwell Extraction Kit delivered DNA samples of the highest quality (p < 0.01). However, the highest total yield of extracted DNA was achieved with the Cobas technique, which may be due to a higher volume of eluate compared to the Maxwell method. CONCLUSIONS: To our knowledge, this is the first paper which directly compares three extraction methods: Cobas, Maxwell and QIAamp. The data herein provide information required for the selection of a protocol that best suits the needs of the overall study design in terms of the quantity and quality of the extracted DNA.

Correlation of TNF-α and TGF-ß polymorphisms with protein levels in pancreatic ductal adenocarcinoma and colorectal cancer.

AIM OF THE STUDY: To determine the correlation of protein serum levels of two cytokines and their polymorphisms, which have an influence on their expression. MATERIAL AND METHODS: The study group consisted of 65 patients (33 men, 31 women) who met the criteria for inclusion and exclusion of pancreatic cancer, and 41 patients (25 men, 16 women) with colorectal cancer. The control group consisted of 100 healthy volunteers (63 men, 37 women). Detection of polymorphisms was performed using TaqMan probes, and concentration of proteins by ELISA method. RESULTS: The mean TNF-α concentration in patients with colorectal cancer was significantly higher compared to the control group, p< 0.0001. A statistically significant difference was noted when comparing both study groups, p = 0.0009. The analyses show that the occurrence of the polymorphic genotype -308AA of the TNF-α gene was not correlated with the increased concentration of the examined protein in patients with both pancreatic and colorectal cancer. It was also noted that the concentration of TGF-ß protein was significantly higher in patients with colorectal cancer than in patients with pancreatic cancer. These results also proved to be statistically significant, p = 0.0353. CONCLUSIONS: The only statistically significant effects were the correlations between patients belonging to a specific group (pancreatic cancer/colorectal cancer/control) and average protein levels. There was no effect of sex or genotype on the occurrence of elevated levels of TNF-α and TGF-ß protein control, despite their variability in particular types of cancer.

Knowledge of cardiovascular disease (CVD) risk factors in population of Malopolska voivodeship in two independent cross-sectional studies

INTRODUCTION: Low level of knowledge of cardiovascular disease (CVD) risk factors is related to higher risk of death and health educational programs are of particular importance in CVD prevention. Monitoring the level of knowledge of CVD risk factors is necessary to verify the effectiveness of education and to facilitate the right choice of education methods. AIM: to compare the assessment of knowledge of CVD risk factors in the population of Malopolska Voivodeship from the two independent cross-sectional studies. MATERIAL AND METHODS: Data of 973 respondents of M-CAPRI Study and 333 respondents of WOBASZ II Study, at age 20-69, were included to analysis. M-CAPRI study was carried out in 2014 and WOBASZ II - in the years 2013-2014. Knowledge of CVD risk factors was assessed by the same standard questionnaire in both studies. Multivariate logistic regression was used to assess the differences in knowledge of CVD risk factors between participants of M-CAPRI and WOBASZ II studies. RESULTS: There were 80% of women and 71% of men, respondents of M-CAPRI Study who recognized theterm ,,risk factor" compared to 73% and 78% respectively in respondents of WOBASZ II Study. However, after adjustment for age and education the difference was statistically significant only in men. Respondents of M-CAPRI Study had knowledge of hypertension, high level of blood cholesterol, alcohol and unhealthy diet less frequently compared to respondents of WOBASZ II Study. Men from M-CAPRI Study had knowledge of diabetes and smoking less frequently but knowledge of low physical activity more frequently compared to men from WOBASZ II Study. CONCLUSIONS: The use of standard questionnaire in two independent cross-sectional studies appeared to be not sufficient to obtain reliable information on knowledge of CVD risk factors in Malopolska Voivodeship. In the studies that differed in the method of recruitment, participation and the technique of interview, the differences in the assessment of knowledge were substantial and it is impossible to assess which assessment was closer to the reality. However, the results of both M-CAPRI and WOBASZ II studies indicate that knowledge of CVD risk factors in Malopolska Voivodship is poor and there is a strong need to intensify health education.

Assessment of knowledge on cardiovascular disease risk factors by postal survey in residents of Malopolska Voivodeship. Malopolska CArdiovascular PReventive Intervention Study (M-CAPRI).

[b]Introduction.[/b] Education is a key tool in the prevention of cardiovascular disease (CVD). Education programmes require monitoring of their effectiveness. [b]Objectives. [/b]1) to introduce postal screening for the assessment of knowledge on CVD risk factors (RFs) for the Polish population, 2) to assess this knowledge in adult residents of Malopolska Voivodeship, and 3) to assess whether knowledge on RFs is related to age, gender, place of residence, level of education and family history of CVD. [b]Materials and method.[/b] Anonymous questionnaires were posted to a random sample of 5,000 residents of Malopolska Voivodeship in Poland. Results were presented as proportions of participants who listed RFs correctly. A series of multiple logistic regression models was used to assess the associations of knowledge on RFs with the potential determinants. [b]Results.[/b] 1,126 completed questionnaires were returned. Over 35% of respondents could not list a single RF and 14 % listed only 1-2 RFs. About 40% named 3-5 and only 12% listed 6 or more RFs. About a half of the respondents listed incorrectly from 1-8 characteristics as being associated with higher risk of CVD. In the multivariate analysis, knowledge on RFs was not significantly associated with age. Level of education was the strongest determinant of knowledge. Male rural and small town residents had less knowledge, whereas women with a family history of CVD had more knowledge on some CVD RFs. [b]Conclusions.[/b] Using a postal questionnaire for the assessment of knowledge of CVD RFs in the population of Malopolska Voivodeship appeared to have serious limitations due to low participation in the study. Despite this, the results of the study indicate that knowledge on CVD RFs is insufficient. Female gender and higher education were related to more prevalent knowledge on RFs. Family history of CVD was related to better knowledge in women only. Male residents of rural areas and small towns had slightly less knowledge on CVD RFs.

Relationship between knowledge of cardiovascular disease risk factors and watching educational television materials. Malopolska CArdiovascular PReventive Intervention Study (M-­CAPRI).

INTRODUCTION The current guidelines on cardiovascular disease (CVD) prevention in clinical practice emphasizes the importance of education in the media for population-­based approaches. OBJECTIVES The aim of the study was to assess the relationship between knowledge of CVD risk factors and watching educational television materials in the adult population. PATIENTS AND METHODS After 22 months of repeated broadcasting of educational television materials, which addressed problems related to CVD, a postal survey was conducted on a random sample of 5000 persons aged 18 years or older. The questionnaire included information on demographics, personal and family history of CVD, educational materials, and knowledge of the risk factors. A multivariate logistic regression was used to assess the relationship between the knowledge of each risk factor and watching educational materials. RESULTS A total of 1129 questionnaires were sent back and used for the analysis. There were 208 participants (18%) who watched the educational materials. The median number of the risk factors listed was 4 (interquartile range, 2-5) for persons who watched the materials and 2 (interquartile range, 0-4) for those who did not watch them. After adjustment for age, sex, education, place of residence, and personal and family history of CVD, the participants who watched the educational materials were 2 to 5 times more likely to have knowledge on particular risk factors, with the exception of hypercholesterolemia for which the relationship was not significant. CONCLUSIONS A strong, plausible relationship revealed by our study supports the idea that in the adult population, better knowledge of CVD risk factors was the effect of watching educational materials.

Mechanism and prognostic role of qR in V1 in patients with pulmonary arterial hypertension.

BACKGROUND: The presence of qR pattern in lead V1 of the 12-lead surface ECG has been proposed as a risk marker of death in patients with pulmonary arterial hypertension (PAH). We aimed to validate these findings in the modern era of PAH treatment and additionally to assess the relation of qR in V1 to PAH severity. We also investigated the possible mechanisms underlying this ECG sign. METHODS: Consecutive patients with PAH excluding patients with congenital heart defect were recruited between February 2008 and January 2016. A 12-lead standard ECG was acquired and analyzed for the presence of qR in V1 and other potential prognostic patterns. Cardiac magnetic resonance and echocardiography were used for structural (masses and volumes) and functional (ejection fraction, eccentricity index) characterization of left (LV) and right (RV) ventricles. Standard markers of PAH severity were also assessed. RESULTS: We enrolled 66 patients (19 males), aged 50.0±15.7years with idiopathic PAH (n=52) and PAH associated with connective tissue disease (n=14). qR in V1 was present in 26(39.4%) patients and was associated with worse functional capacity, hemodynamics and RV function. The main structural determinants of qR in V1 were RV to LV volume ratio (OR: 3.99; 95% CI: 1.47-10.8, p=0.007) and diastolic eccentricity index (OR: 15.0; 95% CI: 1.29-175.5, p=0.03). During observation time of 30.5±19.4months, 20 (30.3%) patient died, 13 (50%) patients with qR and 7 (17.5%) patients without qR pattern. Electrocardiographic determinants of survival were qR (HR: 3.06, 95% CI: 1.21-7.4; p=0.02) and QRS duration (HR: 1.02, 95% CI: 1.01-1.04; p=0.01). CONCLUSIONS: Presence of qR in V1 reflects RV dilation and diastolic interventricular septum flattening. It is a sign of advanced PAH and predicts the risk of death in this population.

An Overview of Genetic Changes and Risk of Pancreatic Ductal Adenocarcinoma.

The pancreatic carcinoma is a leading cause of death in cancer carriers worldwide. The early diagnostic is difficult due to late stage during diagnosis, lack of characteristic symptoms and also multifactor basis. In cancer development take part both, environmental and genetic factors, alone or in conjunction with each other. The nonspecific biomarkers of cancers are a reason for the search for more accurate factors which allow for fast and personalized diagnostics. Some of cancers have identified molecular (metabolic, biochemical or genetic) markers but in most cases the only clue is patient`s interview and abnormal levels of organ functions markers. Possible genetic basis of cancer suggests to widen studies on connection between environmental factors with both, nuclear and mitochondrial, genes changes.

[Prevalence and knowledge of modifiable cardiovascular risk factors among patients of primary health care. Malopolska CArdiovascular Preventive Intervention Study (M-CAPRI)].

Introduction: Cardiovascular diseases (CVD) are the main cause of death in Poland. The prevalence of CVD risk factors is regionally differentiated. Awareness of their presence in the population is crucial for identification of high-risk patients and implementation of appropriate preventive intervention. Therefore, the aim of our study was to assess the prevalence and knowledge of modifiable CVD risk factors among patients of primary health care in Malopolska. Material and Methods: The study was conducted among participants of Malopolska CArdiovascular Preventive Intervention Study (M-CAPRI). Standardized questionnaire and clinical evaluation was conducted in a total of 978 consecutive patients (aged 45.7±13.0) without known CVD in randomly selected primary care units in Malopolska. Results: The most common major modifiable CVD risk factor was hypercholesterolemia (648; 66.3%) while predisposing was incorrect nutrition (890; 91.0%). The prevalence of hypertension, hypercholesterolemia, diabetes and obesity was increased with age but cigarette smoking, low physical activity and poor nutrition remain unchanged. CVD risk assessed using Pol-SCORE charts was high or very high in 104 (16.9%) and moderate in 369 (59.5%) patients. Each of the modifiable CVD risk factors was often identified by people with higher education and educated beforehand by a doctor or nurse. The presence of a particular CVD risk factor was not associated with better knowledge of it except for diabetes (OR 3.44, 95% CI 0.996-11.863). Conclusions: Educated patients have better knowledge on CVD risk factors. Identification of CVD risk factors and education about them should be implemented during visits in primary health care.

Innate immunity gene expression changes in critically ill patients with sepsis and disease-related malnutrition.

The aim of this study was an attempt to determine whether the expression of genes involved in innate antibacterial response (TL R2, NOD 1, TRAF6, HMGB 1 and Hsp70) in peripheral blood leukocytes in critically ill patients, may undergo significant changes depending on the severity of the infection and the degree of malnutrition. The study was performed in a group of 128 patients with infections treated in the intensive care and surgical ward. In 103/80.5% of patients, infections had a severe course (sepsis, severe sepsis, septic shock, mechanical ventilation of the lungs). Clinical monitoring included diagnosis of severe infection (according to the criteria of the ACC P/SCC M), assessment of severity of the patient condition and risk of death (APACHE II and SAPS II), nutritional assessment (NRS 2002 and SGA scales) and the observation of the early results of treatment. Gene expression at the mRNA level was analyzed by real-time PCR. The results of the present study indicate that in critically ill patients treated in the IC U there are significant disturbances in the expression of genes associated with innate antimicrobial immunity, which may have a significant impact on the clinical outcome. The expression of these genes varies depending on the severity of the patient condition, severity of infection and nutritional status. Expression disorders of genes belonging to innate antimicrobial immunity should be diagnosed as early as possible, monitored during the treatment and taken into account during early therapeutic treatment (including early nutrition to support the functions of immune cells).

Effectiveness of single medical advice on emergency phone number knowledge in urban adult population--"Health, Alcohol and Psychosocial Factors in Eastern Europe" substudy.

INTRODUCTION: Early access to Emergency Medical Services determines survival in out-of-hospital cardiac arrest. However, a significant proportion of adults do not know the emergency phone number (EN) and no intervention has been proposed to improve it. Therefore, we aimed to assess prospectively the effectiveness of single advice from a physician on knowledge of the EN in adult population. MATERIALS AND METHODS: The study was conducted among participants of "Health, Alcohol and Psychosocial Factors in Eastern Europe" study. A total of 942 persons (aged 48-82 years) randomly selected from an urban population registry were interviewed and then instructed about the correct EN (the intervention group). After 12 months knowledge of the EN was assessed in the intervention group (n=716) and in matched control group (n=435). RESULTS: The correct EN was given by 498 (69.6%) participants at baseline and in 550 (76.8%) participants 12 months afterwards (p<0.001). At follow-up the knowledge of EN was higher by in intervention group than in controls (76.8% vs 70.6%, p=0.02). Factors associated with better educational effect were male sex (OR 1.49; 95% CI 1.04-2.1) and secondary or higher level of education (OR 1.44; 95% CI 1.08-1.91). CONCLUSIONS: We concluded that a single instruction about the EN from a physician increases its long-term knowledge and should be offered during medical visits.

Genetic Polymorphism and Messenger Ribonucleic Acid Concentrations of TNFα and TGFß Genes in Patients with Chronic Lower Limb Infections.

BACKGROUND: The number of chronic lower limb infections and their complications as venous and diabetic ulcers and chronic calf dermatitis is increasing worldwide. The clinical course and outcome in the immune responses to infection have been shown to be associated with genetic polymorphisms. The aim of study was to investigate frequencies of chosen single nucleotide polymorphisms (SNPs) in TNFα and TGFß genes in patients with chronic lower limb infections and evaluate expression of messenger ribonucleic acid (mRNA) concentrations in chronic leg ulcers. METHODS: Patients were divided into three groups: (group A) chronic venous leg ulcers, (group B) chronic post-traumatic non-healing wounds, and (group C) infected ischemic necrosis of the foot. Blood donors comprised the control group. Detection of polymorphisms was performed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and gene expression by real-time PCR methods. RESULTS: Patients in all groups showed higher frequency of TNFα gene polymorphism -308GG and lower frequency of -308GA genotypes than controls. The mutated homozygote AA was higher in groups A and B than in controls. The TGFß74GG genotype was represented at highest values in group B. The GC genotype was found in all groups at a similar concentration lower than in controls. Genotypes TGFß29TT and TC were represented at similar concentrations as controls. Analyses showed that the presence of the polymorphic allele -308A of TNFα gene was correlated with an increased concentration of gene expression in patients with chronic leg ulcers (group A). In the case of both TGFß gene polymorphisms the presence of polymorphic allele C resulted in increased TGFß gene expression. CONCLUSIONS: Comparison of genotypes in polymorphic sites in TNFα and TGFß genes with their expression concentrations showed that the presence of polymorphic alleles could predispose to increased production of their proteins. Patients with prolonged non-healing wounds should have their genotypes studied, and in cases of mutation, long-term antibiotic and immune protein supply should be considered.