Cations In Patients Research Articles

The prognostic value of the biomarker complex in assessing the outcomes of acute coronary syndrome up to 12 months

Introduction. Highly sensitive tests to determine the level of cardiac troponin in the blood are currently recommended and have a number of advantages. For the purpose of timely diagnosis and identifi cation of patients with a high risk of adverse outcomes of acute coronary syndrome, attempts are made to take a comprehensive approach using several biological markers. The purpose of the study. To study the prognostic signifi cance of the determination of highly sensitive troponin (highly sensitive cardiac troponin — hs-cTn) in the complex with natriuretic peptide (NT-proBNP) in assessing the outcomes of acute coronary syndrome (ACS). Material and methods. The analysis of the possibility of using a complex of biological markers in patients with ACS (n = 120), urgently hospitalized in the State Budgetary Institution of Health Nizhny Novgorod region «Nizhny Novgorod Regional Clinical Hospital named after N.A. Semashko. Comparison Group for Existing Patients IHD (n = 37), hospitalized in the cardiology department of the State Budgetary Institution of Health Nizhny Novgorod region «Nizhny Novgorod Regional Clinical Hospital named after N.A. Semashko». Observation period showed 42–72 months (from February 2014 to August 2016). Patients underwent a general clinical examination, determination of the level of troponin I (cTnI), hs-cTnI, NT-proBNP, electrocardiogram (ECG), echocardiography, coronary angiography. Using statistical analysis, the prognostic value of the complex of biological markers in ACS was evaluated. The analysis of the obtained material was carried out using the application programs IBM SPSS Statistics for Mac, version 26.0 (IBM Corporation, www.ibm.com (2019), Microsoft Offi ce Excel for Mac (2016), Prism 8 for macOS, version 8.4.2 (464), April 7, 2020 (1994–2020 GraphPad Software, LLC). Results. A prognostic model of the immediate outcomes of ACS (hospital and up to 12 months) was constructed, which includes the concentration of hs-cTnI (quantitative), the value of NT-proBNP (qualitative), ST segment elevation, and multi-vessel lesion, hyperglycemia. It is shown that the value of the integral index «PROGNOSIS FOR ACS+5» ≥ 0.5926 is associated with a high risk of poor prognosis in ACS for 12 months, and the index value < 0.5926 indicates a low risk of an adverse forecast. Conclusion. The results of the study indicate the high importance of the prognostic model in assessing the outcomes of acute coronary syndrome (ACS) for 12 months.

Discordance between Clinical and Pathological TNM Classifi cations in Patients with Oropharyngeal Cancer – Infl uence on Treatment and Prognosis

The aim of this study was to determine the percentage of discordance between clinical (c) and pathological (p) TNM classifications in cases of oropharyngeal carcinoma and whether it influences recurrence rate and prognosis of primary disease. Fifty-one patients with oropharyngeal carcinoma who underwent primary surgical treatment were included in this retrospective study. Clinical TNM was determined on the basis of clinical examinations and imaging (US, CT, or MRI), and pathological TNM was determined by a histopathologist (analysis of the primary tumor and neck lymph nodes). Concordance and discordance were statistically evaluated. As potential prognostic factors, we statistically analyzed tumor recurrence, specific and nonspecific patient survival, patient age, extent of primary tumor, lymph node positivity, number of removed lymph nodes, and positive tumor margins. Discordance in the TNM classification was found in 27 cases. Disease-free survival was shorter in patients with discordance in T, and this was statistically significant (p = 0.034). Six patients died due to primary disease (11.8%). Disease-specific survival was at the limit of statistical significance (p = 0.069). Discordance between clinical and pathological TNM classifications was 52.9% patients with oropharyngeal carcinoma. Discordance in T is a potential prognostic factor. Improvement in cancer treatment to some extent relies on preoperative staging and should influence the decision about whether or not to administer adjuvant oncological treatment.

Baseline HV-interval predicts complete AV-block secondary to transcatheter aortic valve implantation

Purpose Development of AV-block is a frequent complication associated with transcatheter aortic valve implantation (TAVI). To date little is known about the predictive value of the HV-interval prior to TAVI with respect to the risk of AV- block development.Methods and results HV-interval was determined in 25 consecutive elderly patients with severe aortic valve stenosis (AS) before and immediately after TAVI. All patients subsequently underwent TAVI and 8 of these 25 patients (32%) developed complete AV-block during the TAVI procedure requiring permanent pacemaker implantation. Six of these 8 patients (75%) had marked HV prolongation (> 54 ms). Pre-procedural HV-interval was signifi cantly prolonged in the subgroup developing complete AV-block (62.1 ms ± 13.0 vs 49.2 ms ± 12.9; P = 0.029). Prolongation of the HV-interval above 54 ms was associated with a higher rate of complete AV-block (sensitivity 75.0%, specifi city 77.8%, P = 0.01).Conclusions HV-interval was prolonged in approximately one third of our elderly patients with aortic valve stenosis and associated with a high rate of complete AV-block following TAVI. HV-interval is easily obtained during TAVI screening procedures, thus facilitating identifi cation of patients at risk for complete AV-block due to TAVI and consequently enabling bespoke risk management.

CIRUGÍA TRANSANAL POR PUERTO ÚNICO PARA LA RESECCIÓN LOCAL DE LESIONES DE RECTO

Single port transanal excision for local treatment of rectal lesions Background: Since 2009, transanal minimally invasive surgery (TAMIS) is increasingly used as an alternative to local excision and transanal microscopic excision (TEM) for rectal lesions located in the mid and superior third. The clinical benefits of the technique are being evaluated. Aim: To establish the feasibility, quality of excision and short term results of single port transanal excision for rectal lesions. Patients and Methods: Analysis of a prospective series of patients subjected to single port transanal excision. Patients had benign or malignant lesions located in the mid or superior third of the rectum. Those with a diagnosis of adenocarcinoma were excluded. Results: The transanal resection using the SILS Port ® was completed in 11 patients aged 21 to 86 years (eight women). The American Society of Anesthesiologists (ASA) classifi cation of patients was two and their body mass index was 24 ± 3.1 kg/m 2 . The lesion distance from the anal margin ranged from 5 to 10 cm. The surgical time was 47 min and hospital stay was 2.8 days. One patient was converted to conventional transanal surgery and two patients had self-limited episode of hematochezia. Conclusions: TAMIS is a feasible technique and with promising results in selected patients.

Time-resolved magnetic resonance imaging of contrast kinetics to identify severe tricuspid valve regurgitation

Introduction The gold standard for identifying and grading tricuspid valve regurgitation is transthoracic echocardiography. However, the acoustic window using transthoracic echocardiography is not always suffi cient to quantify the amount of regurgitation. Time-resolved imaging of contrast kinetics (TRICKS) is a 4-dimensional magnetic resonance angiography option with high spatial and temporal resolution. The aim of the present study is to fi nd out whether identifi cation of patients with severe tricuspid valve regurgitation by using TRICKS angiography is feasible.Methods TRICKS angiography was performed in a 3T-CMR-scanner after antecubital injection of gadolinium dimeglumine during breath hold. Retrograde appearance of contrast agent in the hepatic veins was classifi ed as severe tricuspid regurgitation (TR). Additional semi quantifi cation of retrograde perfusion was performed by temporal signal intensity curve (SIC) analysis in the hepatic veins close to their drainage into the inferior vena cava. Transthoracic echocardiography (TTE) using the actual European guidelines on the management of valvular heart disease served as gold standard for TR grading.Results 185 patients (57 ± 17 years) with TR ranging from no to severe TR were analysed prospectively. 14 (7.6%) patients had severe TR, 27 (14.6%) showed moderate, 137 (74.1%) mild and 7 (3.8%) no TR. TRICKSangiography identifi ed 13 patients with retrograde contrast appearance in the hepatic veins, of whom all had severe TR in TTE. No patient with echocardiographic mild or moderate TR was graded as severe TR using TRICKSangiography. One patient with echocardiographic severe TR showed neither in the visual analysis nor in SIC analysis retrograde appearance of contrast agent in the hepatic veins. Overall, the sensitivity for detecting severe TR using TRICKSangiography was 93% with a specifi city of 100%. The positive predictive value was 100%, the negative predictive value 99%. For severe TR there was no intra- and interobserver variability.Conclusion MR TRICKSangiography is a very reliable tool to identify patients with severe TR by the imaging of retrograde appearance of contrast agent in the hepatic veins. Sensitivity and specifi city of this approach is very high with no intra- and interobserver variability.

Influence of Therapy with Metformin on the Concentration of Certain Divalent Cations in Patients with Non-insulin-Dependent Diabetes Mellitus

Research was performed on a group of 30 patients with non-insulin-dependent diabetes mellitus (NIDDM), who never received antidiabetic medication before, and on a group of 17 healthy adults. The patients were administered treatment with metformin, 1,000 mg/day. Plasmatic and urinary concentration of magnesium have been measured, copper and zinc along with the concentrations of glucose, HDL, LDL, cholesterol, tryglicerides, HbA1c, and total erythrocyte magnesium, in advance and after 3 months of treatment. Data showed significant differences in the NIDDM group vs the control group: for plasma magnesium-1.95 ± 0.19 vs 2.20 ± 0.18 mg/dl, p < 0.001; urine magnesium-237.28 ± 34.51 vs 126.25 ± 38.22 mg/24 h, p < 0.001; erythrocyte magnesium-5.09 ± 0.63 vs 6.38 ± 0.75 mg/dl, p < 0.001; plasma zinc-67.56 ± 6.21 vs 98.41 ± 20.47 μg/dl, p < 0.001; urine zinc-1,347.54 ± 158.24 vs 851.65 ± 209.75 μg/24 h, p < 0.001; plasma copper-111.91 ± 20.98 vs 96.33 ± 8.56 μg/dl, p < 0.001; and urine copper-51.70 ± 23.79 vs 36.00 ± 11.70 μg/24 h, p < 0.05. Treatment with metformin for 3 months modified significant erythrocyte magnesium-5.75 ± 0.61 vs 5.09 ± 0.63 mg/dl, p < 0.001 and urine magnesium-198.27 ± 27.07 vs 237.28 ± 34.51 mg/24 h, p < 0.001, whereas it did not modify significant the plasmatic and urinary concentration of the other cations. The erythrocyte magnesium concentration was inversely correlated with HbA1c (r = -0.438, p = 0.015). The plasma level of copper was positively correlated with HbA1c (r = 0.517, p < 0.003), tryglicerides (r = 0.534, p < 0.003), and cholesterol (r = 0.440, p < 0.05), and the plasma level of zinc was inversely correlated with glycemia (r = -0.399, p = 0.029). Our data show a significant action of metformin therapy, by increasing the total intraerythrocyte magnesium concentration and decreasing the urinary magnesium elimination, positively correlated with the decrease of glycemia and HbA1c in NIDDM patients.