Increased Pro Th1 And Th17 Transcriptional Activity In Patients With Severe COVID-19.

Background: COVID-19 is known to disrupt immune response and induce hyperinflammation that could potentially induce fatal outcome of the disease. Until now, it is known that interplay among cytokines is rather important for clinical presentation and outcome of COVID-19. The aim of this study was to determine transcriptional activity and functional phenotype of T cells and the relationship between pro- and anti-inflammatory cytokines and clinical parameters of COVID-19 severity. Methods: All recruited patients met criteria for COVID-19 are were divided in four groups according to disease severity. Serum levels of IL-12, IFN-γ, IL-17 and IL-23 were measured, and flow cytometry analysis of T cells from peripheral blood was performed. Results: Significant elevation of IL-12, IFN-γ, IL-17 and IL-23 in stage IV of the disease has been revealed. Further, strong intercorrelation between IL-12, IFN-γ, IL-17 and IL-23 was also found in stage IV of the disease, marking augmented Th1 and Th17 response. Analyses of T cells subsets indicate a noticeable phenotype change. CD4+, but not CD8+ T cells expressed increased transcriptional activity through increased expression of Tbet and RORγT, accompanied with increased percentage of IFN-γ and IL-17 producing T cells. Conclusion: Our results pose a novel hypothesis of the underlying mechanism behind deteriorating immune response in severe cases of COVID-19.

Risk factors for cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage.

INTRODUCTION: Aneurysmal subarachnoid hemorrhage is a type of spontaneous hemorrhagic stroke, which is caused by a ruptured cerebral aneurysm. Cerebral vasospasm (CVS) is the most grievous complication of subarachnoid hemorrhage (SAH). The aim of this study was to examine the risk factors that influence the onset of CVS that develops after endovascular coil embolization of a ruptured aneurysm. MATERIALS AND METHODS: The study was designed as a cross-sectional study. The patients included in the study were 18 or more years of age, admitted within a period of 24 h of symptom onset, diagnosed and treated at a university medical center in Serbia during a 5-year period. RESULTS: Our study showed that the maximum recorded international normalized ratio (INR) values in patients who were not receiving anticoagulant therapy and the maximum recorded white blood cells (WBCs) were strongly associated with cerebrovascular spasm, increasing its chances 4.4 and 8.4 times with an increase of each integer of the INR value and 1,000 WBCs, respectively. CONCLUSIONS: SAH after the rupture of cerebral aneurysms creates an endocranial inflammatory state whose intensity is probably directly related to the occurrence of vasospasm and its adverse consequences.

Analysis of risk factors for perifocal oedema after endovascular embolization of unruptured intracranial arterial aneurysms.

BACKGROUND: Endovascular embolization is a treatment of choice for the management of unruptured intracranial aneurysms, but sometimes is complicated with perianeurysmal oedema. The aim of our study was to establish incidence and outcomes of perianeurysmal oedema after endovascular coiling of unruptured intracranial aneurysms, and to reveal possible risk factors for development of this potentially serious complication. METHODS: In total 119 adult patients with endovascular embolization of unruptured intracranial aneurysm (performed at Department for Interventional Neuroradiology, Clinical Center, Kragujevac, Serbia) were included in our study. The embolizations were made by electrolite-detachable platinum coils: pure platinum, hydrophilic and combination of platinum and hydrophilic coils. Primary outcome variable was perianeurysmal oedema visualized by magnetic resonance imaging (MRI) 7, 30 and 90 days after the embolization. RESULTS: The perianurysmal oedema appeared in 47.6% of patients treated with hydrophilic coils, in 21.6% of patients treated with platinum coils, and in 53.8% of those treated with mixed type of the coils. The multivariate logistic regression showed that variables associated with occurrence of perianeurysmal oedema are volume of the aneurysm, hypertension, diabetes and smoking habit. Hypertension is the most important independent predictor of the perianeurysmal oedema, followed by smoking and diabetes. CONCLUSIONS: The results of our study suggest that older patients with larger unruptured intracranial aneurysms, who suffer from diabetes mellitus and hypertension, and have the smoking habit, are under much higher risk of having perianeurysmal oedema after endovascular coiling.

Continuous controllable balloon dilation: a novel approach for cervix dilation.

BACKGROUND: Cervical dilation using mechanical dilators is associated with various complications, such as uterine perforation, cervical laceration, infections and intraperitoneal hemorrhage. To achieve safe and painless cervical dilation, we constructed a new medical device to achieve confident mechanical cervical dilation: a continuous controllable balloon dilator (CCBD). METHODS: Controlled pumping of incompressible fluid into the CCBD increases the pressure and outer diameter of the CCBD, continuously dilating the cervical canal. The reliability of the CCBD was confirmed in vitro (testing for consistency and endurance, with no detected risk for breakage) and in vivo. A multi-center clinical study was conducted,with 120 pregnant women randomly assigned to one of three groups: Group I,control group, no dilation;Group II,mechanical dilation, Hegar dilator (HeD); and Group III,CCBD. The tissue material for histological evaluation was obtained from the endocervical mucosa before and after dilation using the HeD or CCBD. RESULTS: The CCBD dilations were successful and had no complications in all 40 patients of Group III. The cervical tissue was markedly less damaged after CCBD dilation compared with HeD dilation (epithelium damage: 95% (HeD) vs. 45% (CCBD), P <0.001; basal membrane damage: 82.5% (HeD) vs. 27.5% (CCBD), P <0.001; stromal damage: 62.5% (HeD) vs. 37.5% (CCBD), P <0.01). Cervical hemorrhagia was observed in 90% of the patients after HeD dilation versus in 32.5% of the patients after CCBD dilation. CONCLUSIONS: The CCBD should be used as a replacement for mechanical dilators to prevent uterine and cervical injury during cervical dilation. TRIAL REGISTRATION: ISRCTN54007498.

Embolization of ruptured intracranial aneurysms with detachable coils: case series.

PURPOSE: We present a series of patients with subarachnoid hemorrhage (SAH) from ruptured intracranial aneurysms who were treated with endovascular embolization by detachable coils. MATERIALS AND METHODS: There were 108 patients with SAH treated with endovascular coiling. The efficacy of the endovascular coiling was estimated by initial postembolization angiography and by digital subtraction angiography after 6 months, using the following categories: complete occlusion of an aneurysm (98%-100%), near-complete occlusion (90%-98%), and incomplete occlusion (<90%). RESULTS: In 42 (39%) patients the endovascular coiling was performed during the fi rst 72 h after SAH, and 48 (44%) patients had aneurysms <10 mm in diameter. The most frequent location of ruptured aneurysms was the internal carotid artery (39 patients, 36%). Initially, complete occlusion of the aneurysm was achieved in 87 patients (81%), near-complete in 12 patients (11%), and incomplete in 9 patients (8%). After 6 months, complete occlusion of the aneurysm remained in 84 patients, near-complete in 12 patients, and incomplete in 6 patients; 6 patients were lost to follow-up. CONCLUSION: Endovascular coiling of ruptured intracranial aneurysms is an efficient procedure that should be performed as soon as possible after detection of an SAH.

Balloon dilatation and insertion of temporary coated stents using a retrograde approach in patients with irreversible strictures of the distal ureter.

PURPOSE: Irreversible obstruction of urine flow due to stricture of the distal ureter is one of the most frequent reasons for uroradiological intervention. Using new technologies and with appropriate stents applied at the right time, it is possible to release the stricture and avoid external drainage of urine. MATERIALS AND METHODS: Our case series consists of six patients (four women, two men) initially treated by percutaneous nephrostomy due to ureteral stricture. The authors used a combined approach (both percutaneous and retrograde) because the balloon catheter could not be inserted using only one approach owing to the morphology of the stricture. The metal guidewire was inserted through a residual tract after previous nephrostomy, and the balloon catheter and a stent were introduced using a retrograde approach through the urinary bladder (four cases) or through an ileostomy positioned at the anterior abdominal wall. In five of the six cases, coated temporary ureteral stents were used. RESULTS: In all six cases the therapeutic aim was achieved. Urine flow through the strictures was established, and the need for percutaneous nephrostomy was obviated. Neither early nor late complications (11 months after the procedure and 6 months after stent removal) associated with the procedure were recorded. CONCLUSION: In patients with subtotal stricture of the distal ureter, which permits passage only of a hydrophyl guidewire, a combined percutaneous retrograde approach can achieve sustainable flow of urine through the stricture using a balloon catheter and coated stents.

Limb salvage procedure in occlusion of the infrapopliteal arteries.

BACKGROUND/AIM: Limb salvage is a procedure for treatment of the causes of ischemia in the peripheral arteries of the lower limbs. This procedure consists of percutaneous transluminal angioplasty (PTA) of arteries of the infrapopliteal segment in the lower limbs, endovascular stents implantation and selective intraarterial thrombolytic therapy. The main PTA principle is balloon dilatation of a blood vessel and increasing blood flow in this zone. The aim of this study was to show the validity and benefits of applying this procedure in pathologically corrupted arteries of the infrapopliteal segment. METHODS: A prospective study included 30 patients: 15 with PTA dilatations, 13 with stents implantations and five with thrombolytic therapy. The follow-up pertiod was: immediately after the procedure, a month later, and six months later. RESULTS: Of the 15 patients with balloon dilatation, three still suffered from artery stenosis, and they additionally underwent stents implantation. These three patients were in the group of 13 patients who had underwent stent implantation. The last group consisted of five patients with thrombolytic therapy (urokinase, streptokinase, rt-PA--recombinant tissue plasminogen activator). Restenosis appeared only in the three patients from the first group (PTA) immediately after the intervention. A month later, there was no restenosis or ischemia of the limbs. After six months, restenosis appeared in three patients from the first group (PTA), in one patient from the second group (stent), and in two patients from the third group (thrombolytic therapy). The best results were shown by the stent implantation method (successful in 92.3% of the cases), PTA (75%), and thrombolytic therapy (60%). CONCLUSION: On the basis of the obtained results it can be concluded that the limb salvage method in case of occluded arteries of infrapopliteal segment is fully justified, especially the stent implantation method being successful in 92.3% of the patients within a six month-period of time, which is a relevant proof of its efficiency.

[Effects of a one-year weight reduction program and physical activity on obesity and comorbid conditions]. / Uticaj jednogodisnjeg programa redukcione ishrane i dozirane fizcke aktivnosti na pratece bolesti gojaznosri.

INTRODUCTION: Obesity prevalence is increasing all over the world. Obese patients are at increased risk for developing many medical problems, including insulin resistance and type 2 diabetes mellitus, hypertension, dyslipidemia, cardiovascular diseases and stroke. Excess body weight is associated with substantial increase in mortality from all causes, cardiovascular diseases in particular. Weight control is part of the major health priorities identified for the future. The aim of the study was to evaluate effects of a one-year weight reduction program on obesity and its comorbid conditions and to make a model for long term weight reducing program. MATERIAL AND METHODS: Two hundred obese (ITM > 30 kg/m2) subjects, who attended a 15-day weight reduction ("Cigota") program, three times during a year, were followed up. Participants from group A strictly adhered to the prescribed regimen, while participants from group B followed their own routine of diet and physical activity. Two groups were comparable in terms of gender, age, duration of obesity, previous and concomitant diseases. RESULTS: A year later, a statistically significant mean weight loss was established in both groups, but it was greater in group A (p<0.05). In both groups, all serum lipid parameters, parameters of glycemic control, as well as values of systolic and diastolic blood pressures improved. There was a further decrease in serum levels of total cholesterol, LDL-cholesterol, and LDL/HDL ratio in group A. As compared to group B, group A experienced better glycemic control in diabetic and non-diabetic obese patients, and enhanced reversion from diabetes to impaired glucose tolerance or normal glucose tolerance. This study has demonstrated a well-known fact that body mass reduction is associated with a decrease in blood pressure. CONCLUSION: Treatment of obesity can make a substantial contribution to reducing hyperlipidemia, improving glycemic control, and treating hypertension. Prevention and treatment of obesity may reduce overall morbidity and mortality in the years to come. We suggest starting with weight reducing program "Cigota" and combining it with balanced program of diet and physical activity until normalizing body weight.