Soluble urokinase plasminogen activator receptor in one-year prediction of major adverse cardiac events in patients after first myocardial infarction treated with primary percutaneous coronary intervention.

INTRODUCTION: Soluble urokinase plasminogen activator receptor (suPAR) level reflects the general condition of the organism and was proved to give independent information in risk stratification of patients. The aim of this study was to assess the usefulness of suPAR in the prediction of adverse cardiac events in patients with first myocardial infarction (MI) undergoing primary percutaneous coronary intervention. Additionally, the diagnostic power of suPAR was assessed. MATERIAL AND METHODS: One hundred and thirty-nine of 150 consecutive patients were included in the study. Serum suPAR level (ELISA, Virogates) as well as C-reactive protein (on admission and at discharge) and maximum troponin T (assessed from successive 6-hour periods of blood collection) were measured. In the 1-year follow-up study the following major adverse cardiac events were observed: myocardial infarction, revascularization, stroke and death. RESULTS: Multi-variable analysis revealed prognostic usefulness only for suPAR and glomerular filtration rate: p < 0.0001 and p = 0.018; OR = 2.59 and OR = 0.98 respectively, with area under the curve in receiver operating characteristic analysis for both parameters simultaneously 0.89 (p < 0.0001). There was no correlation between suPAR level and the left ventricular dysfunction parameters or the MI type. CONCLUSIONS: Soluble urokinase plasminogen activator receptor level appears to be an independent useful biomarker for the prediction of major adverse cardiac events early after first myocardial infarction. The biomarker's level seems to have more prognostic than diagnostic power.

Clinical and prognostic usefulness of soluble urokinase plasminogen activator receptor in hemodialysis patients.

PURPOSE: Considering its prognostic usefulness and the relationship with chronic kidney disease, we analyzed the clinical utility of soluble urokinase plasminogen activator receptor (suPAR) in end-stage renal disease patients undergoing hemodialysis treatment. We focused on the association between suPAR levels and clinical outcomes, especially those related to cardiovascular events and mortality as well as the effect of hemodialysis on the protein levels. METHODS: We enrolled 64 patients. Blood samples for laboratory tests were collected before and after the midweek hemodialysis. The concentration of suPAR was assessed using suPARNostic ELISA, ViroGates. RESULTS: Spearman rank analyses showed a positive association between suPAR and creatinine, cystatin C, galectin 3, N-terminal prohormone of brain natriuretic peptide and troponin T (p < 0.05). In ROC analysis, the suPAR concentration equal to 11.5 ng/mL was established to be the cutoff value for the prediction of mortality in the analyzed patients. Simultaneous analysis of creatinine and suPAR increased the predictive value of the latter-the area under curve increased to 0.84 (95% CI 0.70-0.94, p < 0.0001). Logistic regression analysis revealed that increase in the suPAR level was associated with the increase in odds ratio for death by 1.3 (95% CI 1.1-1.6, χ2 = 8.2, p = 0.004). In multivariable analysis, the prediction power of suPAR appeared to be stronger after including creatinine (p = 0.0005). CONCLUSIONS: Elevated suPAR levels provide independent information on mortality risk in patients undergoing hemodialysis. The protein appears not to cross the dialysis membrane; thus, blood collection before the second hemodialysis session seems to give reliable information on the suPAR level for clinical interpretation.

[Accidental severe poisoning with methemoglobinogenic substance: A case report]. / Zatrucie substancja methemoglobinotwórcza o ciezkim przebiegu ­ opis przypadku.

A 45-year-old male patient was admitted to the Regional Poison Center because of poisoning with dimethyloaniline contained in a toxic resin-curing dimethyl aniline-based formulation ingested inadvertently. Intoxication happened at workplace. The patient was then transferred to the Toxicology Clinic, where he stayed for 3 weeks. During the hospitalization, the primary method of treatment involved administration of methylene blue, which is the antidote of choice in such cases. During the intensive care and treatment of the patient massive intravascular hemolysis was seen. In that case treatment with blood products was required. He also showed signs of liver dysfunction due to cholestatic liver damage and jaundice. The reported case shows that severe organ damage may result from poisoning with even a small amount of the toxicant. Med Pr 2017;68(6):795-801.

Analysis of Separation of White Blood Cells in Peripheral Blood as an Indicator of MPO Deficiency.

The purpose of this study was to analyze the white blood cell (WBC) percentage pattern of patients with myeloperoxidase disorder. During the 18 months of routine work, 36 blood samples were found with disorders of myeloperoxidase activity: 12 cases of total myeloperoxidase (MPOt) deficiency and 24 cases of partial myeloperoxidase (MPOp) deficiency. In the group with MPOp, according to the results, monocytes (MONO) were the dominant population 33.2%±21.3; however, the microscopic evaluation of leucocytes showed the dominance of neutrophil (NEUT). The average NEUT value was 66.63%±12.31; LYMPH 23.33%±10.08; MONO 6.00%±3.20; EOS 2.04%±2.20; BASO 0.29%±0.62; ATYP 0.83%±1.09. In the group with MPOt, the results of automated leukocyte analysis showed that the dominant group consisted of large unstained cells (LUC) 72.6%±8.64. LUC category reflects large immature cells such as blusts. In the microscopic evaluation: NEUT 67% ±11.40; LYMPH 23%±8.94; MONO 6.17%±3.47; EOS 1.25%±1.06; BASO 0.08%±0.29; ATYP 0.92%±1.38. During microscopic verification, no LUC cells were found. Results of the evaluation of automatic WBC separation according to morphology and functionality of cells led to the conclusion that monocyte dominance in the differential WBC count is associated with a high likelihood of MPOp, and the domination of large unstained cells with MPOt.

[The problem of re-confirming the driving licence in the practice of the clinical department]. / Problem weryfikacji uprawnien do prowadzenia pojazdów mechanicznych w praktyce oddzialu klinicznego.

BACKGROUND: The standpoint published by the National Consultant in the Field of Occupational Medicine obliges physicians to send, to institutions responsible for traffic safety, the information on individuals who, for medical reasons, should not be permitted to drive motor vehicles. This situation is a source of a conflict: on the one hand the medical profession is a profession of public trust; on the other the doctor, when performing his/her official duties, is obliged to safeguard the wellbeing of the general population and, therefore, is expected to take suitable measures (including administrative) if he/she is in the possession of an information that something or someone may offer a threat to traffic safety. MATERIAL AND METHODS: On the basis of the existing legal regulations as well as author's own experiences, it has been attempted to standardize clinical and certifying procedures to be used in cases when an individual (a driver candidate or a current driver) is reasonably suspected to be encumbered with a characteristic that precludes him/her from being granted permission to drive motor vehicles. RESULTS: The authors of this publication developed and then implemented a standard clinical test procedure to be applied in circumstances as those described above. A statistical analysis of the implemented algorithm based on clinical cases hospitalized in 2008-2010 at the Nofer Institute of Occupational Medicine, Department of Occupational Diseases and Toxicology, Toxicology Unit (DODTTU) has been also performed. CONCLUSIONS: This paper reports the first attempt to implement, in a hospital ward, the algorithm intended to ensure comprehensive and honest procedure to be applied when institution responsible for issue and/ or re-confirming of driving licenses must be notified by a hospital ward worker to the concerned institution that the examined patient should not, for medical reasons, be permitted to

Waist circumference, ghrelin and selected adipose tissue-derived adipokines as predictors of insulin resistance in obese patients: preliminary results.

BACKGROUND: The aim of the study was to estimate the association between anthropometric obesity parameters, serum concentrations of ghrelin, resistin, leptin, adiponectin and homeostasis model assessment (HOMA-IR) in obese non-diabetic insulin-sensitive and insulin-resistant patients. MATERIAL/METHODS: Study subjects included 37 obese (body mass index [BMI] ≥ 30 kg/m2) out-clinic patients aged 25 to 66 years. Insulin resistance was evaluated by HOMA-IR. Serum fasting concentrations of glucose, insulin, ghrelin, adiponectin, resistin and leptin were measured by using the ELISA method. Body weight, waist and hip circumferences were measured to calculate BMI and waist-to-hip ratio (WHR) values for all the patients. According to HOMA-IR, patients were divided into two groups: A, insulin sensitive (n=19); and B, insulin resistant (n=18). RESULTS: Patients with insulin resistance have greater mean waist circumference (WC) higher mean serum insulin level and leptin concentration, but lower concentrations of adiponectin and ghrelin. In the insulin-sensitive patient group we observed positive correlations between BMI and HOMA-IR, WC and HOMA-IR, and adiponectin and leptin, and negative correlations between ghrelin and HOMA-IR, WC and adiponectin, and WHR and adiponectin. In the insulin-resistant group, there was a positive correlation between resistin and ghrelin and a negative correlation between WHR and leptin. CONCLUSIONS: Waist circumference, adiponectin, leptin and ghrelin are associated with insulin resistance and may be predictors of this pathology.

Comparison of microscopic methods for evaluating platelet adhesion to biomaterial surfaces.

Microscopic methods usable for sample surface imaging and subsequent qualitative and quantitative evaluation of platelet adhesion to the surface of the biomaterial studied were compared. It was shown, making use of the samples of medical steel (AISI 316L), that such tools as surface imaging with scanning electron microscopy (SEM), glutaraldehyde induced fluorescence technique (GIFT) and metallurgical microscopy (MM) are equivalent in evaluating surface platelet adhesion. The importance of biological variability of blood samples for a proper result assessment and the necessity of using internal standards were also considered.