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1.
Georgian Med News ; (298): 42-46, 2020 Jan.
Artículo en Ruso | MEDLINE | ID: mdl-32141846

RESUMEN

The main initiator of the development of PAH is the development of endothelial dysfunction of the pulmonary vessels. The cause of this dysfunction is associated with functional disorders of the serotonin system. This research is devoted to study the role of the serotonin system in the development mechanism of PAH in children with CHD. We examined 30 young children (from 1 month to 2 years) with congenital heart defects (CHD), which were divided into 3 groups: group I - 12 children with CHD complicated by pulmonary arterial hypertension (PAH); Group II - 9 children with CHD, not complicated by PAH; Group III - 9 relatively healthy children (control). The serotonin content of platelets, serum and serotonin transporter (SERT) in platelets was determined. To determine serotonin and its carrier, a quantitative enzyme-linked immunosorbent assay (Elisa kit) was used. The study was performed using the Serotonin ELISA diagnostic kit, IBL Hamburg at the automatic ELISA of the Evolis robotic station (BioRad). The results of our studies showed a pronounced (p <0.001) increase in SERT concentration in platelets in the group of children with CHD complicated by PAH compared with the group of children with CHD and the control group. The amount of serotonin in serum tended to increase in this group compared with the control groups and CHD, and the amount of serotonin in platelets tended to decrease. It is likely that an increase in the serotonin transporter in platelets against the background of an increase in serotonin in the blood plasma and a decrease in serotonin in the platelets indicates the inadequacy of SERT activity as a serotonin carrier. However, by activating the proliferation of smooth muscle cells in the pulmonary artery, SERT leads to the development of PAH in children with congenital heart defects. It is necessary to continue research in this direction, which will reveal the molecular mechanisms by which SERT regulates PASMC proliferation and clarify the role of serotonin and its transporter in the development of PAH in children with CHD.


Asunto(s)
Plaquetas/metabolismo , Cardiopatías Congénitas/complicaciones , Hipertensión Pulmonar/sangre , Hipertensión Pulmonar/etiología , Arteria Pulmonar/metabolismo , Proteínas de Transporte de Serotonina en la Membrana Plasmática/sangre , Serotonina/sangre , Biomarcadores/sangre , Niño , Preescolar , Ensayo de Inmunoadsorción Enzimática , Cardiopatías Congénitas/sangre , Cardiopatías Congénitas/fisiopatología , Humanos , Hipertensión Pulmonar/fisiopatología , Arteria Pulmonar/fisiopatología , Circulación Pulmonar
2.
Medicine (Baltimore) ; 99(9): e19239, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32118728

RESUMEN

Despite the availability of a series of tests, detection of chronic traumatic osteomyelitis is still exhausting in clinical practice. We hypothesized that machine learning based on computed-tomography (CT) images would provide better diagnostic performance for extremity traumatic chronic osteomyelitis than the serological biomarker alone. A retrospective study was carried out to collect medical data from patients with extremity traumatic osteomyelitis according to the criteria of musculoskeletal infection society. In each patient, serum levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and D-dimer were measured and CT scan of the extremity was conducted 7 days after admission preoperatively. A deep residual network (ResNet) machine learning model was established for recognition of bone lesion on the CT image. A total of 28,718 CT images from 163 adult patients were included. Then, we randomly extracted 80% of all CT images from each patient for training, 10% for validation, and 10% for testing. Our results showed that machine learning (83.4%) outperformed CRP (53.2%), ESR (68.8%), and D-dimer (68.1%) separately in accuracy. Meanwhile, machine learning (88.0%) demonstrated highest sensitivity when compared with CRP (50.6%), ESR (73.0%), and D-dimer (51.7%). Considering the specificity, machine learning (77.0%) is better than CRP (59.4%) and ESR (62.2%), but not D-dimer (83.8%). Our findings indicated that machine learning based on CT images is an effective and promising avenue for detection of chronic traumatic osteomyelitis in the extremity.


Asunto(s)
Extremidades/lesiones , Osteomielitis/diagnóstico por imagen , Biomarcadores/sangre , Proteína C-Reactiva/metabolismo , China , Enfermedad Crónica , Bases de Datos Factuales , Femenino , Productos de Degradación de Fibrina-Fibrinógeno , Humanos , Puntaje de Gravedad del Traumatismo , Aprendizaje Automático , Masculino , Persona de Mediana Edad , Osteomielitis/sangre , Osteomielitis/diagnóstico , Estudios Retrospectivos , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos X
3.
Medicine (Baltimore) ; 99(9): e19252, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32118731

RESUMEN

Stroke is a serious disease that can lead to disability and death in adults, and the prediction of functional outcome is important in the management of acute ischemic stroke (AIS). Blood biomarker is a promising technique, for the measurement is fast, cheap and convenient. Visinin-like protein-1 (VILIP-1) is a classic stroke biomarker, thus we tried to investigate the predictive value of VILIP-1 for early functional outcomes of AIS.A total of 70 AIS patients were enrolled in our study. Venous blood samples of all patients were taken at day 3 after admission to the stroke unit, and levels of serum VILIP-1 were analyzed by the use of the enzyme-linked immunosorbent assay. All subjects underwent diffusion weighted imaging (DWI) of the brain MRI scanning at 72 hours after stroke onset, and infarct volumes were calculated. Initial neurological status was evaluated by the National Institutes of Health Stroke Scale (NIHSS) on admission. The short-term functional outcome was graded by the modified Rankin Scale (mRS) at discharge from the hospital. Baseline data between the favorable outcome group and poor outcome group were compared, and univariate and multivariable logistic regression analysis were used to identify risk factors of early functional outcome of AIS.The multivariate logistic regression analysis showed age, initial NIHSS scores and levels of VILIP had a strong association with poor clinical outcomes.Levels of serum VILIP-1 are associated with short-term functional outcomes in patients with AIS.


Asunto(s)
Neurocalcina/sangre , Accidente Cerebrovascular/fisiopatología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Estudios de Cohortes , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Accidente Cerebrovascular/sangre , Accidente Cerebrovascular/mortalidad , Adulto Joven
4.
Orv Hetil ; 161(13): 483-490, 2020 Mar.
Artículo en Húngaro | MEDLINE | ID: mdl-32202149

RESUMEN

Inflammation contributes to the pathogenesis of low back pain and sciatica. Growing evidence suggests that elevated levels of some inflammatory biomarkers are associated with these conditions. Much of the research evaluating the association between pro- and anti-inflammatory cytokines, chemokines, other regulatory molecules, and low back pain and sciatica, focused on patients with chronic low back pain, while fewer studies addressed the issue of detectable biomarkers in the acute phase. Previous studies suggest that pro-inflammatory cytokines such as TNF-α, IL-6, and IL-8 and anti-inflammatory IL-4 and IL-10 play an important role in the inflammatory response following intervertebral disc herniation. According to the approach of personalized medicine it is important to identify subsets of patients within the acute patient group regarding etiology, prognosis and treatment. In addition, if we can identify subgroups based on levels of pro-inflammatory biomarkers, where inflammation may be the leading cause of pain, we assume that this subgroup would likely be effectively treated with anti-inflammatory medication. The efficacy of TNF-α inhibitors and IL-6 inhibitors in treating low back pain and sciatica has already been tested in clinical trials, but further studies are required. Overall, identification of circulating biomarkers of acute low back pain and sciatica may assist in refining personalized diagnosis and treatment. Further research is needed to evaluate the role of inflammation in acute low back pain and sciatica, to identify what methods are appropriate for evaluation in clinical practice, and whether there are biomarkers of prognostic value in these patients. Orv Hetil. 2020; 161(13): 483-490.


Asunto(s)
Citocinas/sangre , Desplazamiento del Disco Intervertebral/sangre , Dolor de la Región Lumbar/sangre , Ciática/sangre , Biomarcadores/sangre , Humanos , Degeneración del Disco Intervertebral/sangre , Desplazamiento del Disco Intervertebral/inmunología , Dolor de la Región Lumbar/etiología , Ciática/inmunología
5.
Medicine (Baltimore) ; 99(11): e19292, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32176054

RESUMEN

BACKGROUND: The aim of the study was to provide a theoretical basis for the early diagnosis and prediction of acute altitude sickness, to provide a better entry mode for healthy people from plain areas to plateau areas, and to preliminarily clarify the possible mechanism of this approach. METHODS: We measured endothelin-1 (ET-1), asymmetric dimethylarginine (ADMA), vascular endothelial growth factor (VEGF), nitric oxide (NO), and hypoxia-inducible factor 1 (HIF-1) levels in each sample and determined flow-mediated dilation (FMD) values using a portable OMRON color Doppler with a 7.0- to 12.0-MHz linear array probe. We used the Lewis Lake score to diagnose acute mountain sickness (AMS) and to stratify the disease severity. RESULTS: We found no cases of AMS at any of the studied elevation gradients. We found significant differences in FMD values between individuals when at 400 m above sea level and when at 2200, 3200, and 4200 m above sea level (P < .05) but found no significant differences among those at 2200, 3200, and 4200 m. Our variance analysis showed that serum ET-1, VEGF, ADMA, NO, and HIF-1 levels in individuals at ≥3000 m and those at subplateau and plain areas (<3000 m) significantly differed (P < .05). The level of these factors also significantly differed between individuals at elevation gradients of plateau areas (3260 m vs 4270 m) (P < .05). We found no significant differences in serum ET-1, VEGF, and ADMA levels between individuals at the plateau (2260 m) and plain (400 m) areas (P > .05). NO and HIF-1 levels were significantly different in serum samples from individuals between the plateau (2260 m) and plain (400 m) areas (P < .05). However, with increasing altitude, the NO level gradually increased, whereas ET-1, ADMA, VEGF, and HIF-1 levels showed a decreasing trend. With the increase of altitude, there is no correlation between the trend of FMD and hematologic-related factors such as VEGF, NO, and HIF-1. CONCLUSION: A healthy young male population ascending to a high-altitude area experiences a low incidence of AMS. Entering an acute plateau exposure environment from different altitude gradients may weaken the effect of acute highland exposure on vascular endothelial dysfunction in healthy individuals. Changes in serum ET-1, VEGF, ADMA, NO, and HIF-1 levels in healthy young men may be related to the body's self-regulation and protect healthy individuals from AMS. A short stay in a subplateau region may initiate an oxygen-free preconditioning process in healthy individuals, thereby protecting them from AMS. Noninvasive brachial artery endothelial function test instead of the detection of invasive hematologic-related factors for early diagnosis and prediction of the occurrence and severity of acute high-altitude disease is still lack of sufficient theoretical basis.


Asunto(s)
Mal de Altura/sangre , Altitud , Endotelina-1/sangre , Factor 1 Inducible por Hipoxia/sangre , Factor A de Crecimiento Endotelial Vascular/sangre , Enfermedad Aguda , Adulto , Mal de Altura/diagnóstico , Análisis de Varianza , Biomarcadores/sangre , China , Diagnóstico Precoz , Voluntarios Sanos , Humanos , Masculino , Personal Militar , Óxido Nítrico/sangre , Valores de Referencia , Sensibilidad y Especificidad , Adulto Joven
6.
Am Surg ; 86(2): 121-126, 2020 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-32167046

RESUMEN

We performed a retrospective study of our large patient cohort aiming to examine the ability to predict postthyroidectomy hypocalcemia. A retrospective review of patients who underwent total or near-total thyroidectomy at our institution between 2008 and 2018 was performed. Postoperative hypocalcemia was defined as Ca level <8.0 mg/dL (reference range: 8.9-10.1 mg/dL) within 30 days of operation. Logistic regression was used to develop models for prediction of the occurrence of postoperative hypocalcemia. Inclusion criteria were met by 1463 patients. Hypocalcemia was documented in 223 patients (15%). Models based on parathyroid hormone (PTH) levels alone had an associated receiver operator characteristic with an areas under the curve (AUC) of 0.79. There was an inverse relationship between time of measurement and PTH levels within the first two hours after thyroidectomy (P < 0.01). When measured two to six hours after closure, the predictive ability of PTH compared favorably (AUC = 0.82) with either earlier (within the first two hours after closure, AUC = 0.79) or later measurement (6-24 hours after closure, AUC = 0.77). When measured between two and six hours postoperatively, PTH < 19 pg/mL had a sensitivity of 90 per cent and negative predictive value of 96 per cent for postoperative hypocalcemia. The model that included the PTH level, concurrently measured total blood calcium level, and time of measurement had an improved predictive ability with an AUC of 0.87. PTH level of 19 pg/mL measured two to six hours after thyroidectomy had a sensitivity of 90 per cent and a negative predictive value of 96 per cent in our cohort. The model including postoperative PTH level, calcium level, and time of measurement may further improve the ability to predict postthyroidectomy hypocalcemia.


Asunto(s)
Hipocalcemia/etiología , Hormona Paratiroidea/sangre , Complicaciones Posoperatorias , Tiroidectomía/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Área Bajo la Curva , Biomarcadores/sangre , Calcio/sangre , Femenino , Humanos , Hipocalcemia/sangre , Modelos Logísticos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/sangre , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Sensibilidad y Especificidad , Factores de Tiempo , Adulto Joven
7.
Medicine (Baltimore) ; 99(9): e19326, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32118763

RESUMEN

Complete blood count (CBC)-derived parameters such as neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), eosinophil-to-lymphocyte (ELR) ratio, and platelet-to-lymphocyte ratio (PLR) are sensitive markers of occult inflammation and disease activity for systemic lupus erythematosus, rheumatoid arthritis, psoriasis, esophageal cancer, etc. We assessed NLR, PLR, MLR, and ELR as indicators of inflammation in achalasia patients.This cross-sectional study included 103 achalasia patients and 500 healthy blood donor volunteers (HD). Demographic, clinical and laboratory information was collected. NLR, MLR, ELR and PLR were calculated. Peripheral Th22, Th17, Th2 and Th1 subsets were determined by flow cytometry. Correlation between hematologic indices and clinical questionnaires scores, HRM parameters and CD4+ T-cells were assessed. Hematologic parameters associated with the different achalasia subtypes were evaluated by logistic regression analysis.Hemoglobin, leukocytes, lymphocytes, monocytes, and platelets counts were significantly lower in achalasia patients vs controls. NLR (P = .006) and ELR (P < .05) were higher in achalasia patients vs controls. NLR was significantly associated with achalasia in multivariate analysis (P < .001). Compared to HD, the achalasia group was 1.804 times more likely to have higher NLR (95% CI 1.287-2.59; P < .001). GERD-HRQL score had statistically significant correlations with PLR (Pearson's rho:0.318, P = .003), and ELR (Pearson's rho:0.216; P = .044). No correlation between CD4+ T-cells and hematologic indices were determined. NLR with a cut-off value of ≥2.20 and area under the curve of 0.581 yielded a specificity of 80% and sensitivity of 40%, for the diagnosis of achalasia.NLR is increased in achalasia patients vs HD. Sensitivity and specificity achieved by NLR may contribute to a clinical and manometric evaluation. We suggest these indices as potential indicators of silent inflammation and disease activity.


Asunto(s)
Biomarcadores/análisis , Recuento de Células Sanguíneas/métodos , Acalasia del Esófago/complicaciones , Inflamación/diagnóstico , Adulto , Biomarcadores/sangre , Recuento de Células Sanguíneas/tendencias , Estudios Transversales , Acalasia del Esófago/sangre , Femenino , Voluntarios Sanos , Humanos , Inflamación/sangre , Inflamación/fisiopatología , Masculino , México , Persona de Mediana Edad
8.
Medicine (Baltimore) ; 99(10): e19359, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32150077

RESUMEN

Monitoring anti-TNF agents in inflammatory bowel disease (IBD) patients may be helpful in optimizing outcomes. We aimed to evaluate potential correlations among demographic, clinical, laboratory, or imaging parameters, as well as serum levels of infliximab (IFX) and adalimumab (ADA) and their respective antibodies, in the clinical management of IBD patients.A cross-sectional study of 95 patients with Crohn's disease (CD) or ulcerative colitis (UC) in maintenance therapy with infliximab or adalimumab was performed. Drug trough levels and anti-drug levels were determined using ELISA-based assays.Regarding the serum IFX dosage, patients with higher relative C-reactive protein (CRP) levels had significantly lower relative serum IFX levels (<3 µg/mL) (P = .028). In contrast, higher concentrations of anti-IFX antibodies were found in patients who were not on concomitant immunomodulators (P = .022) and who had more biological-related adverse events (P = .001) and higher levels of CRP (P = .042). Serum CRP levels were also negatively correlated with IFX (CC = -0.315; P = .033) but positively correlated with the presence of IFX antibodies (CC = 0.327; P = .027). Serum albumin dosage showed a positive correlation with levels of both IFX (CC = 0.379; P = .004) and ADA (CC = 0.699; P = .003).Although anti-TNF-α trough levels and immunogenicity do not show a significant correlation with disease outcome, our results reinforce the use of combination therapy for patients treated with infliximab. Moreover, we confirmed the presence of significant associations between anti-TNF-α trough levels and immunogenicity with body mass index (BMI), the concomitant use of immunomodulators, the rates of side effects, and laboratory markers, including serum albumin and CRP.


Asunto(s)
Enfermedades Inflamatorias del Intestino/sangre , Factor de Necrosis Tumoral alfa/análisis , Adalimumab/análisis , Adalimumab/sangre , Adalimumab/uso terapéutico , Adulto , Biomarcadores/análisis , Biomarcadores/sangre , Índice de Masa Corporal , Proteína C-Reactiva/análisis , Estudios Transversales , Femenino , Humanos , Infliximab/análisis , Infliximab/sangre , Infliximab/uso terapéutico , Masculino , Persona de Mediana Edad , Factor de Necrosis Tumoral alfa/sangre
9.
Chirurgia (Bucur) ; 115(1): 39-49, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32155398

RESUMEN

Introduction: The inflammatory response plays a critical role in carcinogenesis. There are recent scores based on the systemic inflammatory response, such as neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), lymphocyte/monocyte ratio (LMR), which have been shown to have prognostic value in cancer patients. These scores allow the identification of patients who will have poor response to treatment and poor survival. The aim of this study is to evaluate the prognostic role of NLR, PLR, LMR and PNI in terms of long-term survival in patients with colorectal cancer, operated in emergency. Material and Methods: We included 391 patients admitted and operated for complicated colorectal cancer in the Surgery II clinic of the Clinical Emergency County Hospital Sf. Ap. Andrei - from Galati, between 2008-2017. We analyzed the paraclinical factors of systemic inflammation NLR, PLR, MRL and PNI. As prognostic factors, survival curves were analyzed. Results: The high values of NLR and PLR increased the risk of death (HR = 7.581, 95% CI = (6.358,9.039), p value = 0.000000, respectively HR = 1.043, 95% CI = (1.039, 1.047), p value = 0.000000), and the increased values of LMR and PNI led to the decrease of this risk (HR = 0.069, 95% CI = (0.054.0.090), p value = 0.000000, respectively HR = 0.758, 95 % CI = (0.730.0.788), p value = 0.000000). In the multivariate regression analysis, the increase of PLR resulted in an increase in the risk of death (HR = 1.024, 95% CI = (1.019.1.029), p value = 0.000000), and for the LMR and PNI, a reduction of the risk of death (HR = 0.353, 95% CI = (0.248.0.504), p value = 0.000000, respectively HR = 0.852, 95% CI = (0.822.0.883), p value = 0.000000). Conclusions: The univariate analysis showed that NLR and PLR are risk factors, and LMR and PNI are protective factors in terms of survival. The multivariate analysis revealed that PLR is an independent risk factor, and LMR and PNI were independent protection factors.


Asunto(s)
Neoplasias Colorrectales/sangre , Neoplasias Colorrectales/mortalidad , Inflamación/sangre , Recuento de Leucocitos , Recuento de Plaquetas , Biomarcadores/sangre , Neoplasias Colorrectales/patología , Neoplasias Colorrectales/cirugía , Urgencias Médicas , Humanos , Pronóstico
10.
J Korean Med Sci ; 35(10): e65, 2020 Mar 16.
Artículo en Inglés | MEDLINE | ID: mdl-32174064

RESUMEN

BACKGROUND: Neutrophil gelatinase-associated lipocalin (NGAL), a bacteriostatic agent, is known to inhibit erythropoiesis leading to anemia. We aimed to investigate the associations of NGAL, anemia, and renal scarring in children with febrile urinary tract infections (UTIs). METHODS: We retrospectively reviewed the medical records of 261 children with febrile UTIs. The relationship between the presence of anemia and plasma NGAL levels was investigated. NGAL performance in comparison with serum C-reactive protein (CRP) at admission and after 72 hours of treatment was also evaluated for the prediction of renal scarring as well as acute pyelonephritis (APN) and vesicoureteral reflux (VUR). RESULTS: Plasma NGAL levels were elevated in patients with anemia compared with those without anemia. Multiple linear regression analysis showed an inverse relationship between NGAL levels and erythrocyte counts (standard ß = -0.397, P < 0.001). Increased NGAL, but not CRP, was independently associated with the presence of anemia (odds ratio [OR], 2.37; 95% confidence interval [CI], 1.07-5.27; P < 0.05). Receiver operating curve analyses showed good diagnostic profiles of pre- and post-treatment NGAL for identifying APN, VUR, and renal scarring (all P < 0.05). For detecting renal scars, the area under the curve of post-treatment NGAL (0.730; 95% CI, 0.591-0.843) was higher than that of post-treatment CRP (0.520; 95% CI, 0.395-0.643; P < 0.05). The presence of anemia and elevated NGAL at admission (> 150 ng/mL) were independent risk factors for renal scarring in children with febrile UTIs. With anemia, NGAL levels increased consecutively in children with febrile UTI without renal involvement, with APN without scar, and with APN with renal scarring. CONCLUSION: Increased plasma NGAL levels may be associated with the presence of anemia and renal scarring in children with febrile UTIs.


Asunto(s)
Anemia/complicaciones , Lipocalina 2/sangre , Infecciones Urinarias/complicaciones , Biomarcadores/sangre , Proteína C-Reactiva/análisis , Estudios de Casos y Controles , Niño , Femenino , Fiebre , Humanos , Riñón/patología , Masculino , Oportunidad Relativa , Pielonefritis/complicaciones , Reflujo Vesicoureteral/complicaciones
11.
Medicine (Baltimore) ; 99(11): e18963, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32176028

RESUMEN

High levels of serum alanine aminotransferase (ALT) and gamma-glutamyltransferase (GGT) are associated with increased diabetes risk. In the present study, we investigated the combined effects of ALT and GGT on the development of diabetes in a Korean population. A total of 9405 individuals (4020 women and 5385 men) without diabetes were enrolled in this study. From the baseline health screening to the follow-up examination, the development of diabetes, based on changes in ALT and GGT quartile levels, was analyzed. In addition, we analyzed the quartiles of ALT and GGT together to determine any synergistic effect from the fourth quartile of ALT and GGT on the development of diabetes. The development of diabetes gradually increased with an increase in the circulating levels of ALT and GGT. For the fourth quartile ALT and GGT, the hazard ratios of diabetes compared with the first quartile were 1.892 (95% confidence interval [CI]: 1.26-2.83, P = .002) and 3.526 (95% CI: 2.12-5.85, P < .001) after adjusting for confounders, respectively. Hazard ratios of diabetes after combining both fourth quartiles of ALT and GGT were 3.663 (95% CI: 2.42-5.52, P < .001), as compared with the first and second quartiles. Serum ALT and GGT levels are well associated with diabetes in Koreans after adjusting for confounders, and a combination of ALT and GGT levels can have a synergy in predicting the development of diabetes.


Asunto(s)
Alanina Transaminasa/sangre , Diabetes Mellitus/enzimología , gamma-Glutamiltransferasa/sangre , Biomarcadores/sangre , Diabetes Mellitus/sangre , Diabetes Mellitus/epidemiología , Femenino , Humanos , Incidencia , Estudios Longitudinales , Masculino , Persona de Mediana Edad , República de Corea/epidemiología , Factores de Riesgo
12.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(3): 289-293, 2020 Mar 06.
Artículo en Chino | MEDLINE | ID: mdl-32187934

RESUMEN

Objective: To understand the levels of Pb, Cd, As, Hg, Mn, and Se in maternal and umbilical cord blood, and to explore the transplacental transfer efficiency (TTE). Methods: From September 2010 to December 2013, a total of 773 pregnant women and their newborns (Laizhou Bay Birth Cohort) were recruited from a second grade hospital in the south bank of Laizhou Bay, Bohai, Shandong Province. According to different detection methods, the six measured elements are classified into three groups including the Hg measurement group (595 mother-newborn pairs), the Pb measurement group (534 mother-newborn pairs), and the Cd, As, Mn and Se measurement group (244 mother-newborn pairs). The demographic characteristics of pregnant women and their newborns were obtained by the questionnaire. The concentrations of elements in maternal and umbilical cord blood were detected and the TTE of each element (elemental concentration in cord blood/elemental concentration in maternal blood) was calculated. The correlation of elements between maternal and cord blood was analyzed using Spearman's rank correlation coefficient. Results: The mean±SD of maternal age, gestational week and newborn birth weight of 773 mother-infant pairs were (28.34±4.50) years, (39.47±1.39) weeks and (3 419.47±497.39) g respectively. The median concentrations of Pb, Cd, As, Hg, Mn and As in maternal and cord blood were 31.12 and 30.02, 1.19 and 0.47, 8.05 and 6.03, 0.69 and 1.26, 100.70 and 105.55, 127.25 and 115.00 µg/L, respectively. The TTE of Pb, Cd, As, Hg, Mn, and Se was 0.98, 0.41, 0.73, 1.73, 0.96 and 0.91, respectively. Pb, Cd, Hg, Mn, and Se showed a significant positive correlation between maternal blood and cord blood, with Spearman correlation coefficients of 0.397, 0.298, 0.698, 0.555, and 0.285 (all P values<0.001). Conclusion: Each element was commonly detected in maternal blood and cord blood. The TTE of Hg was the highest.


Asunto(s)
Cadmio/sangre , Sangre Fetal/química , Sangre Fetal/metabolismo , Plomo/sangre , Manganeso/sangre , Intercambio Materno-Fetal , Mercurio/sangre , Selenio/sangre , Cordón Umbilical/química , Biomarcadores/análisis , Biomarcadores/sangre , Femenino , Humanos , Recién Nacido , Embarazo , Oligoelementos/análisis , Oligoelementos/sangre , Cordón Umbilical/irrigación sanguínea
13.
Medicine (Baltimore) ; 99(11): e19477, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32176079

RESUMEN

We assessed the predictive value of serum ammonia level on admission for the 28-day mortality of patients with sepsis.We retrospectively included septic patients admitted to the emergency department of West China Hospital, Sichuan University and The Fourth People's Hospital of Zigong city from June 2017 to May 2018. Patients were divided into 2 groups according to 28-day survival. Comparisons of serum ammonia level and sequential organ failure assessment (SOFA) score were made between 2 groups. Multivariate logistic regression models were employed to determine independent risk factors affecting 28-day mortality rate, and receiver operating characteristic (ROC) curve was also used to evaluate the efficacy of risk factors.Total of 316 patients were included into the study, 221 survived to 28 days and 95 were died before 28 days. The 28-day mortality rate was 30.06%. Multivariate logistic regression analyses revealed that the ammonia level, C reactive protein, SOFA score, and the leukocyte were independent risk factors for the 28-day mortality rate. In predicting the 28-day mortality rate, the SOFA score presented an area under the ROC curve (AUC) of 0.815, and the ammonia levels presented the AUC of 0.813.The ammonia level, C reactive protein, SOFA score, and the leukocyte are independent risk factors for 28-day mortality rate in septic patients. Moreover, the serum ammonia and SOFA score have similar predictive values. The serum ammonia level is also a suitable early indicator for prognostic evaluation of patients with sepsis as well.


Asunto(s)
Amoníaco/sangre , Servicio de Urgencia en Hospital , Sepsis/sangre , Sepsis/mortalidad , Biomarcadores/sangre , Proteína C-Reactiva/metabolismo , China/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Puntuaciones en la Disfunción de Órganos , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia
14.
Zhonghua Jie He He Hu Xi Za Zhi ; 43(3): 203-208, 2020 Mar 12.
Artículo en Chino | MEDLINE | ID: mdl-32164089

RESUMEN

Objective: To analyze the clinical characteristics of 2019 novel coronavirus (2019-nCoV) pneumonia and to investigate the correlation between serum inflammatory cytokines and severity of the disease. Methods: 29 patients with 2019-ncov admitted to the isolation ward of Tongji hospital affiliated to Tongji medical college of Huazhong University of Science and Technology in January 2020 were selected as the study subjects. Clinical data were collected and the general information, clinical symptoms, blood test and CT imaging characteristics were analyzed. According to the relevant diagnostic criteria, the patients were divided into three groups: mild (15 cases), severe (9 cases) and critical (5 cases). The expression levels of inflammatory cytokines and other markers in the serum of each group were detected, and the changes of these indicators of the three groups were compared and analyzed, as well as their relationship with the clinical classification of the disease. Results: (1) The main symptoms of 2019-nCoV pneumonia was fever (28/29) with or without respiratory and other systemic symptoms. Two patients died with underlying disease and co-bacterial infection, respectively. (2) The blood test of the patients showed normal or decreased white blood cell count (23/29), decreased lymphocyte count (20/29), increased hypersensitive C reactive protein (hs-CRP) (27/29), and normal procalcitonin. In most patients, serum lactate dehydrogenase (LDH) was significantly increased (20/29), while albumin was decreased (15/29). Alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (Tbil), serum creatinine (Scr) and other items showed no significant changes. (3) CT findings of typical cases were single or multiple patchy ground glass shadows accompanied by septal thickening. When the disease progresses, the lesion increases and the scope expands, and the ground glass shadow coexists with the solid shadow or the stripe shadow. (4) There were statistically significant differences in the expression levels of interleukin-2 receptor (IL-2R) and IL-6 in the serum of the three groups (P<0.05), among which the critical group was higher than the severe group and the severe group was higher than the mild group. However, there were no statistically significant differences in serum levels of tumor necrosis factor-alpha (TNF-α), IL-1, IL-8, IL-10, hs-CRP, lymphocyte count and LDH among the three groups (P>0.05). Conclusion: The clinical characteristics of 2019-nCoV pneumonia are similar to those of common viral pneumonia. High resolution CT is of great value in the differential diagnosis of this disease. The increased expression of IL-2R and IL-6 in serum is expected to predict the severity of the 2019-nCoV pneumonia and the prognosis of patients.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Biomarcadores , Infecciones por Coronavirus/diagnóstico , Interleucina-6/metabolismo , Neumonía Viral/diagnóstico , Receptores de Interleucina-2/metabolismo , Biomarcadores/sangre , Infecciones por Coronavirus/metabolismo , Citocinas/sangre , Humanos , Pulmón/diagnóstico por imagen , Neumonía Viral/metabolismo , Pronóstico , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X
15.
Med. clín (Ed. impr.) ; 154(5): 171-174, mar. 2020. graf, tab
Artículo en Español | IBECS | ID: ibc-186629

RESUMEN

Introducción y objetivos: Los antidiabéticos orales inhibidores del cotransportador sodio-glucosa (iSGLT2) reducen la morbimortalidad cardiovascular en la DM2. El aumento de la rigidez arterial puede participar en esta morbimortalidad. El objetivo de este trabajo fue analizar el efecto de la administración de dapagliflozina en la rigidez arterial. Pacientes y métodos: Estudio observacional, prospectivo que incluyó a 32 pacientes con DM2. Antes del inicio de dapagliflozina y a los 6 y 12 meses, se analizaron parámetros bioquímicos en sangre y orina. Basalmente y a los 12 meses se determinó la velocidad de pulso carótida-femoral (VPc-f) mediante tonometría. El análisis de los cambios en las variables y su interrelación se hizo mediante ANOVA de datos repetidos, test de Wilcoxon y regresión múltiple. Resultados: Se objetivó un descenso significativo de la VPc-f. No se evidenció asociación entre descenso de VPc-f y cambios de la glucemia, la uricemia, la presión arterial ni del peso. Conclusiones: Dapagliflozina, en sujetos con DM2, produce, a medio-largo plazo, una disminución de la rigidez arterial


Introduction: Oral antidiabetic inhibitors of the sodium-glucose cotransporter (SGLT2i) reduce cardiovascular morbidity and mortality in DM2. The increase in arterial stiffness can participate in this morbidity and mortality. The aim of this study was to analyse the effect of the administration of dapagliflozin on arterial stiffness. Patients and methods: Prospective observational study that included 32 patients with DM2. Before starting dapagliflozin, and at 6 and 12 months, biochemical parameters in blood and urine were analysed. Before starting dapagliflozin and at 12 months the velocity of the carotid-femoral pulse (VPc-f) was determined by tonometry. Changes in the variables and their interrelation was analysed by repeated data ANOVA, Wilcoxon's test and multiple regression. Results: A significant decrease in the VPc-f was observed. There was no association between decreased VPc-f and changes in blood glucose, uric acid, blood pressure or weight. Conclusions: Dapagliflozin, in subjects with DM2, produces a medium to long-term decrease in arterial stiffness


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Rigidez Vascular/efectos de los fármacos , Cardiotónicos/efectos adversos , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Inhibidores del Cotransportador de Sodio-Glucosa 2/administración & dosificación , Cardiotónicos/uso terapéutico , Estudios Prospectivos , Análisis de Varianza , Biomarcadores/sangre , Biomarcadores/orina
16.
Zhonghua Fu Chan Ke Za Zhi ; 55(1): 29-35, 2020 Jan 25.
Artículo en Chino | MEDLINE | ID: mdl-32074770

RESUMEN

Objective: To observe the dynamic changes of human serum albumin (HSA) level during pregnancy and study the early warning significance of HSA level on the onset of preeclampsia (PE) . Methods: Totally 369 PE pregnant women (PE group) and 309 normal pregnant women (control group) without PE who admitted in Haidian Maternal and Child Health Hospital from January 2013 to December 2017 were selected. HSA levels were tested before meeting the criterion of PE in the first trimester, the early-third trimester and the late-third trimester, the difference between the two groups were compared. The relationship between the HSA level and the incidence of complications in PE patients was analyzed. Results: (1)The mean values of HSA level in PE group and control group were (41.9±3.1) versus (40.0±2.2) g/L, (34.2±2.7) versus (35.4±2.7) g/L and (33.7±2.9) versus (36.7±3.3) g/L in the first trimester,the early-third trimester and the late-third trimester respectively,the difference in the first trimester was no significance (P>0.05), while the differences in the early-third trimester and the late-third trimester were both significant (all P<0.05). (2) The HSA level during pregnancy of PE group showed a continuous downward trend, while the control group was V-shaped trend. The receiver operating characteristic (ROC) curve analysis showed that PE could be early warned by the decrease of HSA level in PE group [area under curve (AUC)=0.742, cut-off value=5.97 g/L, sensitivity 70.8%, specificity 62.8%], the same result was in severe PE (AUC=0.756, cut-off value=6.85 g/L, sensitivity 70.8%, specificity 72.0%). The level of HSA was negatively correlated with the incidence of complications (r=-0.19, P<0.01). Conclusions: Excessive decrease of HSA level is an early warning factor for PE onset. The higher the baseline of HSA level and the greater the extent of pregnancy decline, the risk of PE in pregnant women is higher. The lower of HSA level in PE, the incidence of complications is higher. The excessive decrease of HSA level may be the first clinical manifestation before the onset of clinical symptoms of PE, so it may be the warning factor and one of the laboratory indicators in the PE sub-clinical stage.


Asunto(s)
Preeclampsia/diagnóstico , Albúmina Sérica Humana/análisis , Biomarcadores/sangre , Estudios de Casos y Controles , Femenino , Humanos , Preeclampsia/sangre , Embarazo , Primer Trimestre del Embarazo , Tercer Trimestre del Embarazo , Curva ROC
17.
Adv Clin Exp Med ; 29(1): 147-155, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32011830

RESUMEN

BACKGROUND: Chest pain is one of the most frequent symptoms in patients seeking treatment at emergency departments (ED). These patients differ according to the cause of their reported symptoms and resultant mortality. OBJECTIVES: Evaluation of the influence of hospitalization and biochemical parameters on mortality rates in patients admitted to the ED with chest pain, in whom no cardiovascular emergencies were established. MATERIAL AND METHODS: The study group consisted of 243 patients with chest pain admitted to the ED in the Wroclaw Medical University Clinical Hospital, Poland, between January 1 and March 31, 2015, in whom no specific diagnosis was made at discharge. A retrospective analysis was carried out based on medical documentation, and 60-day and 1-year survival was assessed. RESULTS: In the study group, the 60-day mortality rate was 0.8% (2 persons) while the 1-year mortality rate was 6.6% (16 persons). The stepwise multivariable logistic regression analysis revealed that 1-year mortality was related to increased level of D-dimer (odds ratio (OR) = 8.5, 95% confidence interval (95% CI) = 21.9-37.5, p < 0.005), age (OR (per year) = 1.10, 95% CI = 1.03-1.18, p < 0.03) and lower than 12 g/dL hemoglobin concentration (OR = 18.5, 95% CI = 4.2-80.4, p < 0.001). Troponin I (TNI) levels and hospitalization were not related independently to mortality when other clinical factors were considered. CONCLUSIONS: Hospitalization of patients with chest pain who were not diagnosed with cardiac emergencies is not related with better survival than of those discharged home from the ED. The 60-day mortality is very low and occurs in older patients with numerous comorbidities. In multivariate analysis, survival of the 1-year period depends on the patient's age, hemoglobin levels and D-dimer levels. Risk of death in patients admitted to the ED due to chest pain in whom the cause of the chest pain was not due to cardiovascular emergencies depends on the presence of old age and comorbidities.


Asunto(s)
Dolor en el Pecho/diagnóstico , Dolor en el Pecho/terapia , Urgencias Médicas , Servicio de Urgencia en Hospital/estadística & datos numéricos , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Mortalidad Hospitalaria , Troponina I/sangre , Anciano , Biomarcadores/sangre , Dolor en el Pecho/sangre , Dolor en el Pecho/mortalidad , Hospitalización/estadística & datos numéricos , Humanos , Persona de Mediana Edad , Polonia/epidemiología , Estudios Retrospectivos
18.
West Afr J Med ; 37(1): 246-252, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32030711

RESUMEN

BACKGROUND: Clinical evidence had suggested that hyperhomocysteinaemia features in hypertensive disorders of pregnancy. However, there is still conflicting evidence on the extent to which elevated maternal homocysteine contributes to this deadly complication of pregnancy. OBJECTIVES: This study investigated the impact of elevated maternal homocysteine levels in early pregnancy on preeclampsia and its severity among Nigerian women in Lagos. METHODS: This was a prospective cohort study conducted at the Lagos University Teaching Hospital. Participants were enrolled in the first trimester of pregnancy following which their sociodemographic data were obtained by interview. Venous blood samples were collected for measurement of homocysteine concentration using the ELISA method. Data on the occurrence of preeclampsia was obtained from the delivery records. Binary logistic regression model was used to study the effects of the major baseline characteristics on the development of preeclampsia. RESULTS: The final analysis included 167 patients; hyperhomocysteinaemia was recorded in 24 (24.6%) patients. Women with hyperhomocysteinaemia had no statistically significant risk of developing preeclampsia or severe preeclampsia, compared with women with a normal homocysteine concentration. CONCLUSION: The prevalence of hyperhomocysteinaemia in the study was relatively low. The absence of a significant association between maternal hyperhomocysteinaemia and preeclampsia reported in this study could create room for the conduct of a more robust, adequately powered longitudinal research needed to answer some of the major reservations that remain from the present study.


Asunto(s)
Homocisteína/sangre , Hiperhomocisteinemia/complicaciones , Preeclampsia/diagnóstico , Adulto , Biomarcadores/sangre , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Hiperhomocisteinemia/epidemiología , Nigeria/epidemiología , Preeclampsia/sangre , Preeclampsia/epidemiología , Embarazo , Prevalencia , Estudios Prospectivos , Índice de Severidad de la Enfermedad
19.
Medicine (Baltimore) ; 99(7): e19096, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32049816

RESUMEN

INTRODUCTION: The assessment of bone marrow thrombopoietic activity in patients with thrombocytopenia is necessary to achieve an accurate diagnosis and administer effective treatment. We evaluated the discriminatory power of the immature platelet fraction (IPF) in differentiating hyperdestructive/consumptive thrombocytopenia from hypoproductive thrombocytopenia and its potential use as a predictive marker for platelet recovery. METHODS: In this observational study, platelet indices, including IPF, were measured in 105 healthy individuals, 27 patients with hyperdestructive/consumptive thrombocytopenia (all with immune thrombocytopenic purpura [ITP]), and 35 patients with hypoproductive thrombocytopenia (5 with aplastic anemia and 30 with cancer who were undergoing chemotherapy) using a Sysmex XN-3000 hematology analyzer. RESULTS: The platelet distribution width, mean platelet volume, platelet large cell ratio, IPF, and absolute immature platelet count (AIPC) were significantly higher in the hyperdestructive/consumptive thrombocytopenia group than in the hypoproductive thrombocytopenia group (P < .001). The IPF showed the highest difference between the two patient groups (200%). Receiver operating characteristics analysis that showed the IPF had the largest area under the curve among all the platelet indices analyzed; its cut-off value was 2.3%. The IPF decreased 3 to 4 days in advance of platelet count elevation in patients with ITP, whereas the delta AIPC increased 3 days in advance. Furthermore, the IPF and delta AIPC increased 5.5 days and 8.5 days, respectively, before platelet counts increased up to 130.0 × 10/L in cancer patients receiving chemotherapy. CONCLUSION: These data demonstrated that the IPF and delta AIPC are both excellent indicators of the etiology of thrombocytopenia and predictive markers for platelet recovery.


Asunto(s)
Anemia Aplásica/diagnóstico , Volúmen Plaquetario Medio , Recuento de Plaquetas , Púrpura Trombocitopénica Idiopática/diagnóstico , Adulto , Anciano , Anemia Aplásica/sangre , Anemia Aplásica/complicaciones , Biomarcadores/sangre , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/complicaciones , Valor Predictivo de las Pruebas , Púrpura Trombocitopénica Idiopática/sangre , Curva ROC
20.
Diab Vasc Dis Res ; 17(1): 1479164119896978, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32000522

RESUMEN

OBJECTIVE: To investigate the relationship of 1-h postload plasma glucose during the oral glucose tolerance test with the severity of coronary artery lesions and risk of 1-year re-admission in coronary heart disease patients with normal glucose tolerance. METHODS: A total of 266 consecutive coronary heart disease patients who underwent coronary angiography and had normal glucose tolerance confirmed by oral glucose tolerance test during hospitalization were prospectively enrolled and followed in two groups according to the 1-h postload plasma glucose cut-off point (1-h postload plasma glucose <155 mg/dL, n = 149 and 1-h postload plasma glucose ⩾155 mg/dL, n = 117). Angiographic severity was assessed by number of diseased vessels, lesion morphology and Gensini score. The risk of 1-year re-admission with adverse cardiovascular events after discharge was analysed. RESULTS: Subjects with a 1-h postload plasma glucose ⩾155 mg/dL had higher incidence of multivessel disease and complex lesions, Gensini score and risk of 1-year re-admission than subjects with a 1-h postload plasma glucose <155 mg/dL (all p < 0.05). In the stepwise multivariate regression analysis, 1-h postload plasma glucose was the major determinant of the Gensini score. Subgroup analyses by sex showed that men with a 1-h postload plasma glucose ⩾155 mg/dL had higher incidence of complex lesions and risk of 1-year re-admission than men with a 1-h postload plasma glucose <155 mg/dL (all p < 0.05). CONCLUSION: Coronary heart disease patients with normal glucose tolerance and elevated 1-h postload plasma glucose levels had a greater severity of coronary artery lesions and an increased risk of re-admission with adverse cardiovascular events, particularly in men.


Asunto(s)
Glucemia/metabolismo , Enfermedad de la Arteria Coronaria/sangre , Readmisión del Paciente , Anciano , Biomarcadores/sangre , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/terapia , Femenino , Prueba de Tolerancia a la Glucosa , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales , Factores de Tiempo , Regulación hacia Arriba
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