Circulating Angiogenic Factors and Ischemic Diabetic Foot Syndrome Advancement-A Pilot Study.

Despite clear evidence of inadequate angiogenesis in ischemic diabetic foot syndrome (DFS) pathogenesis, angiogenic factor level changes in patients with ischemic DFS remain inconsistent. This study aimed to assess circulating angiogenic factors concerning ischemic DFS advancement and describe their relationships with patients' clinical characteristics, microvascular parameters, and diabetic control. The study included 41 patients with ischemic DFS (67.3 (8.84) years; 82.9% males). Angiogenic processes were assessed by identifying circulating concentrations of five pro- and two anti-angiogenic factors. We found that penetrating ulcers were related to a significantly higher FGF-2 level (8.86 (5.29) vs. 5.23 (4.17) pg/mL, p = 0.02). Moreover, plasma FGF-2 showed a significant correlation with the SINBAD score (r = 0.32, p = 0.04), platelet count (r = 0.43, p < 0.01), white cell count (r = 0.42, p < 0.01), and age (r = -0.35, p = 0.03). We did not observe any significant linear relationship between the studied biomarkers and microcirculatory parameters, nor for glycemic control. In a univariate analysis using logistic regression, an increase in plasma FGF-2 was tied to greater odds of high-grade ulcers (OR 1.16; 95% CI 1.02-1.38, p = 0.043). This suggests that circulating FGF-2 may serve as a potential biomarker for predicting DFU advancement and progression. It is necessary to conduct further studies with follow-up observations to confirm this hypothesis.

Biomarkers of Cardiovascular Diseases in Saliva and Gingival Crevicular Fluid: A Review.

Due to the fact that cardiovascular diseases (CVDs) have become the most serious problem in public health, there is a need for new and efficient methods for screening and early detection. In the recent literature, saliva and gingival crevicular fluid (GCF) have been gaining recognition as sources of many potential biomarkers of various systemic diseases, mainly because of correlation between the level of some compounds in the blood and saliva and association between the composition of saliva and health status. In this review, we summarize published findings of patients with atherosclerosis, arterial hypertension, coronary artery disease (CAD), acute coronary syndrome (ACS), and stroke in the context of clinical utility of saliva and GCF in diagnosing and assessing CVD severity. We hypothesize that substances in saliva including inflammatory markers, enzymes, or hormones might become novel contributors to the diagnosis and screening of CVDs. In particular, C-reactive protein (CRP), tumor necrosis alpha (TNFα), and cortisol seem to be the most promising. However, further investigation is warranted to determine the most effective markers and methods for their analysis.

Pro- and Anti-Angiogenic Factors: Their Relevance in Diabetic Foot Syndrome-A Review.

Peripheral arterial disease can involve tissue loss in up to 50% of patients with diabetic foot syndrome (DFS). Consequently, revascularization of narrowed or occluded arteries is one of the most common forms of comprehensive treatment. However, technically successful angioplasty does not always result in the healing of ulcers. The pathomechanism of this phenomenon is still not fully understood, but inadequate angiogenesis in tissue repair may play an essential role. Changes in pro- and anti-angiogenic factors among patients with DFS are not always clear and conclusive. In particular, some studies underline the role of decreased concentration of pro-angiogenic factors and higher levels of anti-angiogenic mediators. Nevertheless, there are still controversial issues, including the paradox of impaired wound healing despite high concentrations of some pro-angiogenic factors, dynamics of their expression during the healing process, and their mutual relationships. Exploring this process among diabetic patients may provide new insight into well-known methods of treatment and show their real benefits and chances for improving outcomes.

Assessment of the implementation level of the guidelines for secondary prevention of cardiovascular disease in everyday clinical practice.

BACKGROUND: The goal of secondary prevention is to hinder the recurrence of cardiovascular events in patients already diagnosed with cardiovascular diseases. AIMS: We aimed to assess the level of adherence to guidelines for secondary prevention of cardiovascular disease in everyday clinical practice. METHODS: This was a single­center retrospective analysis of 460 consecutive rehospitalized patients previously diagnosed with coronary artery disease. The presence of main risk factors for cardiovascular disease was analyzed in this cohort. RESULTS: Overall, 80.7% of patients did not comply with the body mass index recommendations. Among nondiabetic patients, 43.5% exceeded the recommended blood glucose level and 55.5% of diabetic patients exceeded the recommended level of glycated hemoglobin. Total cholesterol level was higher than recommended in 13.5% of patients, the level of low­density lipoprotein (LDL) cholesterol was exceeded in 78.7% individuals, and the level of triglycerides was over the limit in 30.2% of patients. Systolic and / or diastolic blood pressure higher than or equal to 140/90 mm Hg was recorded in 41.3% of patients. Low level of physical activity was declared by 56.7% of the studied patients and 14.6% of them admitted to being current tobacco smokers. No patient fulfilled all of the main prevention goals (body weight, no smoking, LDL cholesterol level, glucose level, systolic and / or diastolic blood pressure) and in 10.2% of cases none of the above­mentioned criteria were achieved. Significant difference in the implementation level of the guidelines was found between the sexes, with men showing lower adherence than women. CONCLUSIONS: The level of adherence to the guidelines for secondary prevention of coronary artery disease was extremely low, with men being worse responders than women.

Comparison of clinical and echocardiographic outcomes and quality of life in patients with severe mitral regurgitation treated by MitraClip implantation or treated conservatively.

INTRODUCTION: The most common alternative method of treatment for patients with severe mitral regurgitation (MR) is the implantation of a MitraClip device. AIM: To evaluate clinical and echocardiographic outcomes and quality of life (QoL) in patients with severe secondary MR, disqualified from surgical intervention, treated by implantation of a MitraClip in comparison to conservative therapy. MATERIAL AND METHODS: A total of 33 patients were included. Patients were stratified by treatment method: group A, MitraClip implantation (n = 10); group B, conservative treatment (n = 23). Clinical, echocardiographic, and QoL (EQ-5D-3L, SF-12v2 Health Survey) characteristics were compared at baseline and at follow-up of 8.0 ±2.3 months. RESULTS: In group A, 2 deaths were observed: one patient died 7 days after MitraClip implantation, and the second patient died 4 months after the procedure. No cases of rehospitalization were reported. In group B, 4 (17.4%) deaths and 6 (26.1%) hospitalizations were reported. After MitraClip implantation a significant reduction of the NYHA class (p = 0.02), decrease in grade of MR (p = 0.01), vena contracta width (p = 0.006), effective regurgitant orifice area (EROA) (p = 0.003), regurgitant volume (p = 0.03) and end-diastolic left ventricle diameter (p = 0.02) as well as an improvement in QoL were reported. There were no significant changes in the NYHA class and QoL in the group treated conservatively. In those patients, we observed increased intercommissural mitral annulus diameter (p = 0.03), left atrium diameter (p = 0.002), and right ventricle dimension (p = 0.008), more severe tricuspid regurgitation (p = 0.02) and lower mitral annular plane systolic excursion (p = 0.01). CONCLUSIONS: Patients with severe secondary MR treated with the MitraClip achieved a significant reduction in symptoms and MR grade, as well as an improvement in QoL, as compared to patients treated conservatively.