Circulatory System In Patients Research Articles

PROGNOSTIC VALUE OF DIAGNOSTICLY VALUABLE LABORATORY MARKERS OF SYSTEMIC LUPUS ERYTHEMATOSUS FOR DETERMINING THE PROBABILITY OF COMORBID SYNTROPIC LESIONS OF THE CIRCULATORY SYSTEM ORGANS


 
 Abstract. Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that affects almost all internal organs, among which damage to the organs of the circulatory system (OSC) is not only one of the most common, but also ranks first in the structure of the causes of mortality.
 The aim of the study. To find out the prognostic value of diagnostically valuable laboratory markers of systemic lupus erythematosus to determine the probability of comorbid syntropic lesions of the circulatory system organs.
 Materials and methods. The study included 125 patients with SLE with OSC lesions, among whom the vast majority of women (88.00%) were young (average age of patients 42.48 ±1.12 years). Patients were stratified according to the presence of comorbid syntropic lesions of the OSC, i.e. those whose frequency reliably increased with an increase in the degree of activity of SLE – these are retinal angiopathy, capillaritis, Raynaud's syndrome, reticular livedo, atherosclerosis, mitral valve insufficiency, mitral valve sealing, pericardial effusion, pulmonary hypertension, myocarditis, endocarditis, symptomatic arterial hypertension, venous thrombosis. During the study, the prognostic value of diagnostically valuable individual laboratory markers and their constellations was determined. The difference was considered statistically significant if p < 0.050. The relationship was considered confirmed if the association coefficient ≥ 0.50 or the contingency coefficient ≥ 0.30.
 The results. It was found that for determining the probability of retinal angiopathy in patients with SLE, the constellation with ↑ LDL + ↑ IA + ↑ anti-ds DNA + ↑ ANA has the best prognostic value among diagnostically valuable individual laboratory markers and their constellations; for capillaritis – a separate marker of increased activity of AlT; for Raynaud's syndrome – a separate marker ↓ C3; for reticular livedo – ↑ ESR + ↑ small CIC + ↑ anti-ds DNA + ↑ anti-Sm; for atherosclerosis – ↓ hemoglobin + ↑ LDL + ↑ ANA + ↓ C4; for mitral valve insufficiency – ↑ ESR + ↑ anti-ds DNA + ↑ ANA + ↑ antiphospholipid antibodies Ig M; for mitral valve sealing – ↑ ESR + ↑ LDL + ↑ small CIC + ↑ ANA; for pericardial effusion – erythropenia + ↑ C-RP + ↑ lupus anticoagulant; for pulmonary hypertension – hypercholesterolemia + ↑ LDL + ↑ anti-ds DNA + ↑ ANA; for myocarditis – a separate marker ↓ C4; for endocarditis – not detected; for symptomatic hypertension – ↑ LDL + ↑ anti-ds DNA + ↑ ANA + ↑ anti-SSA (Ro); for venous thrombosis – erythropenia + ↓ hemoglobin + ↑ LDL + ↑ ANA.
 Conclusions. For each comorbid syntropic lesion of the organs of the circulatory system in patients with systemic lupus erythematosus, a diagnostically valuable separate laboratory marker or their constellation has been determined, which have the best prognostic value for determining the probability of occurrence of these lesions.

ВЛИЯНИЕ ГИПОТЕНЗИВНОЙ ТЕРАПИИ НА ПОКАЗАТЕЛИ ГЕМОДИНАМИКИ У БОЛЬНЫХ ГИПЕРТОНИЧЕСКОЙ БОЛЕЗНЬЮ В СОЧЕТАНИИ С РЕВМАТОИДНЫМ АРТРИТОМ

Introduction. The appointment of antihypertensive therapy in patients with comorbidity of primary hypertension and rheumatoid arthritis, considering the activity of rheumatoid arthritis is not always specified, and therefore is an urgent issue that may cause a discrepancy between the hemodynamic influence of the prescribed therapy and the nature of existing hemodynamic shifts in this category of patients. Aim. Impact evaluation of the 6-month antihypertensive therapy with drugs of various classes on the hemodynamic parameters of the circulatory system in patients with hypertension stage II combined with rheumatoid arthritis, including its activity. Material and methods. Patients complying the inclusion criteria by age (58.6±6.4 years), hypertension duration (11.2±1.6 years), debut (aged 45-64 years) and rheumatoid arthritis experience (7.2±2.1 years) were formed into three groups: Group I included 277 patients with hypertension stage II (136 men, 141 women); Group II consists of 142 patients (28 men, 114 women) with hypertension stage II and rheumatoid arthritis (in the stage of clinical and laboratory remission); and in Group III there were 112 patients (20 men, 92 women) with hypertension stage II and rheumatoid arthritis (in the stage of clinical and laboratory exacerbation). Antihypertensive therapy was administered by polyclinic physicians. Lisinopril, nebivolol, losartan, amlodipine, indapamide and an unfixed combination of lisinopril and indapamide were prescribed as monotherapy drugs. The follow up period has lasted for 6 months. Results and discussion. Effectiveness control of the prescribed therapy in 6 months was presented in patients in Groups I and II with positive dynamics of morphometric and velocity parameters, in patients in Group III, the indicators were less significant and more delayed. Conclusion. Rheumatoid arthritis presence adds additional changes in the dynamics of the hemodynamic influence of the prescribed antihypertensive therapy, and is determined by the activity degree of the disease and the adequacy of basic anti- inflammatory therapy.

Treacher Collins Syndrome Associated with Disproportionate Nervous System, Cardiovascular, Otologic Complications Among 1,114 Patients.

To compare the rates of selected nervous system, cardiovascular, and otologic abnormalities in patients with and without Treacher Collins Syndrome (TCS). Retrospective TriNetX platform cohort study. Aggregated and deidentified electronic health record (EHR) data from across the United States. Patients with TCS (n = 1,114) and a propensity matched control cohort without TCS (n = 1,114 matched from n = 110,368,585). Prevalence and relative risk (RR) of selected diagnoses in a propensity-matched cohort. The RR of congenital malformations of the circulatory system in patients with TCS was 8.5 (95% CI 4.44-16.28). Patients with TCS also had higher rates of otologic abnormalities including conductive hearing loss (RR 44, 95% CI 24-83) and nervous system disorders including movement disorders (RR 2.60, 95% CI 1.27-5.50) and recurrent seizures (RR 4.2, 95% CI 2.12-8.33). We found a significantly elevated risk in TCS patients within all three systems. We postulate that the nervous system effects may be the result of one of the TCS-linked genes, for which a mutation has also been associated with progressive ataxia, cerebellar atrophy, hypomyelination, and seizures. As the previously-identified causal genes influence neural crest cells that form the head and face, these cells may also populate cardiac structures, resulting in cardiovascular abnormalities. Finally, the characteristic craniofacial abnormalities identified in TCS impair hearing and are associated with increased risk of otitis media. Our findings may help researchers to hypothesize the function of the genes underlying TCS, as well as to inform the care of affected individuals.

PO-01-208 A COMPUTATIONAL MODEL TO TRACK CHANGES IN LEFT VENTRICULAR END-DIASTOLIC PRESSURE DURING ATRIAL FIBRILLATION

Heart failure and Atrial Fibrillation (AF) commonly occur concomitantly, resulting in significant morbidity and mortality. Thus, monitoring of heart failure status is essential in directing medical therapy in these patients. Left ventricular (LV) filling pressures are one of the most important parameters in assessing worsened or acutely decompensated left heart failure, however current LV pressure monitoring strategies include invasive devices and catheterization. Our study aims to develop a computational model of heart failure in AF and demonstrate that beat-to-beat variations in RR intervals during AF can be exploited to predict changes in LV filling pressure. We used a modified Research CardioVascular SIMulator (RCVSIM) human cardiovascular model to simulate an intact circulatory system in patients with AF over 300 seconds. To simulate beat-by-beat variation of rhythm in AF, the length of each RR-interval was drawn randomly from a Mixed Gaussian Distribution. We modelled worsening HF by changing LV end-systolic compliance in the simulator, using compliances ranging from 1 to 3.5 mL/mmHg, with interval increases in compliance of 0.1 mL/mmHg. Stroke volumes, RR-intervals, and LV end-diastolic pressures are recorded for each simulation. This was repeated for mean heart rates from 60 to 110 beats per minute. Stroke volumes were found to have a strong linear correlation with the previous beat’s RR-interval for all mean heart rates tested (Spearman rho = 0.9-0.97). In Figure 1 below, we show the slope of the RR-interval versus stroke volume (SV/RR-interval) plotted against average LV end-diastolic pressure for all LV systolic compliances noted above and a mean heart rate of 84 beats per minute. A cubic function fit to this plot shows excellent goodness-of-fit with the simulated data with a coefficient of determination (R2) of 0.99. This relationship remained consistent for all mean heart rates tested, and all cubic fits had R2 greater than 0.98. Our study provides a highly accurate model for estimating LV end-diastolic pressures over a broad range of LV systolic heart failure in simulated AF patients using only stroke volume and RR-intervals. Further work using photoplethysmography or continuous non-invasive arterial pressure (CNAP) monitoring could potentially be used to obtain these measures non-invasively, thus leading to a non-invasive method for tracking heart failure in patients with AF.

Methylglyoxal Induces Inflammation, Metabolic Modulation and Oxidative Stress in Myoblast Cells.

Uremic sarcopenia is a serious clinical problem associated with physical disability and increased morbidity and mortality. Methylglyoxal (MG) is a highly reactive, dicarbonyl uremic toxin that accumulates in the circulatory system in patients with chronic kidney disease (CKD) and is related to the pathology of uremic sarcopenia. The pathophysiology of uremic sarcopenia is multifactorial; however, the details remain unknown. We investigated the mechanisms of MG-induced muscle atrophy using mouse myoblast C2C12 cells, focusing on intracellular metabolism and mitochondrial injury. We found that one of the causative pathological mechanisms of uremic sarcopenia is metabolic flow change to fatty acid synthesis with MG-induced ATP shortage in myoblasts. Evaluation of cell viability revealed that MG showed toxic effects only in myoblast cells, but not in myotube cells. Expression of mRNA or protein analysis revealed that MG induces muscle atrophy, inflammation, fibrosis, and oxidative stress in myoblast cells. Target metabolomics revealed that MG induces metabolic alterations, such as a reduction in tricarboxylic acid cycle metabolites. In addition, MG induces mitochondrial morphological abnormalities in myoblasts. These changes resulted in the reduction of ATP derived from the mitochondria of myoblast cells. Our results indicate that MG is a pathogenic factor in sarcopenia in CKD.

The Role of Uremic Intoxication in the Development of Cardiovascular Remodeling in Patients with Chronic Kidney Disease Stages 3a-5d

In recent decades, the prevalence of chronic kidney disease (CKD) in the population has a clear upward trend. This is due, first of all, to an increase in the frequency of occurrence of the main factors leading to its development: diabetes mellitus and arterial hypertension. The progression of CKD against the background of the action of these factors leads to a steady loss of the kidneys of their filtration capacity and the development of complications associated with this process. These include, first of all, metabolic and acid-base disorders, electrolyte abnormalities, uremic intoxication, overhydration, protein-energy wasting, sarcopenia and others. Most of them are involved in the development of endothelial dysfunction and the formation of cardiovascular remodeling (CVR), as a key component of the cardiorenal continuum. At the same time, there is a mutual negative influence of pathology of the cardiovascular system on renal function and manifestations of CKD on cardiovascular hemodynamics. This “vicious circle” leads to the development of end-stage renal disease and an increase in cardiovascular risk and mortality from diseases of the circulatory system in patients with advanced stages of CKD. In this connection, this work is devoted to the study of the role of uremic intoxication and, in particular, indoxyl sulfate, in the development of CVR in patients with CKD at different stages of the disease.

Effects of different drugs on the curative effect, stress responses, and the circulatory system of patients with hypertensive trigeminal neuralgia.

This research aimed to analyze the effects of stellate nerve block with different drugs on the curative effect, stress responses, and the circulatory system of patients with hypertensive trigeminal neuralgia (TN). A retrospective analysis of 82 patients with hypertensive TN admitted to our hospital from January 2019 to January 2021 was conducted, and the patients were divided into a control group and an observation group according to different drugs. The pain visual analogue scale (VAS) scores were determined between the 2 groups before treatment and at 1, 2, 3, 7, and 30 d after treatment. The mean arterial pressure (MAP) and heart rate (HR) were measured in the 2 groups of patients before treatment and immediately after treatment (T0), half an hour after treatment (T1), 1 h after treatment (T2), and 6 h after treatment (T3). The left ventricular wall thickness (LVWT), left ventricular end systolic volume (LVESV), left ventricular ejection fraction (LVEF), and fraction shortening (FS) were detected in the 2 groups before treatment and at T0-T2. Patient satisfaction was also scored, and the incidence of adverse reactions was assessed. The VAS scores of the 2 groups of patients decreased significantly after treatment at 1, 2, 3, 7, and 30 d. The MAP and HR indicators of the 2 groups decreased gradually at T0-T2, and gradually recovered to levels before treatment at the T3 time point. The MAP and HR indicators of the observation group were significantly lower than those of the control group at T0-T2. After treatment, the levels of LVWT, LVESV, LVEF, and FS in the observation group at the T0-T2 time points were significantly lower than those of the control group. Additionally, after treatment, the satisfaction of the observation group was significantly higher than that of the control group. The total incidence of adverse reactions in the observation group was significantly lower than that in the control group. For patients with hypertensive TN, a single ropivacaine stellate nerve block can significantly relieve pain, and has little effect on heart function.

Cerebral arteriovenous malformations: features of the functioning of the blood circulation system after endovascular treatment with long-term monitoring

Objective ‒ to determine the features of the functioning of the circulatory system in patients with arteriovenous malformations (AVM) of the brain after endovascular operations with long-term observation.Materials and methods. 479 patients with cerebral AVM were examined and treated, of which 377 (78.7 %) were men and 102 (21.3 %) were women. The average age of patients was (27.5±3.5) years. Patients aged 18‒30 years predominated (75.4 %). A dynamic observation of 347 patients after endovascular treatment after 3, 6, 12 and 24 months and more was carried out. Patients underwent cerebral angiography, computed tomography, magnetic resonance imaging, single-photon emission computed tomography, echocardiography, Doppler cardiography, electrocardiography, duplex scanning of cerebral vessels.Results. The study shows the effect of arteriovenous shunting on cerebral and systemic hemodynamics in general. Switching off AVM from the cerebral blood flow improved cerebral hemodynamics already in the early postoperative period, the changes were more significant after 3‒6 months of observation and in some cases reached values ​​in healthy individuals 2 years after the operation. In 52.8 % of patients with AVM, systemic circulation disorders occurred due to an increase in heart rate, minute and stroke blood volumes, left ventricular ejection fraction with an increase in mechanical load on the heart, which led to changes in systolic contraction and diastolic relaxation of the left ventricle of the heart with the development of heart failure. Switching off the AVM from the cerebral blood flow did not cause significant changes in heart functions in the early postoperative period; positive changes occurred over a long period. Dynamic observation showed a positive restructuring of the functioning of the circulatory system in patients after endovascular exclusion of the malformation.Conclusions. Arteriovenous malformations are hemodynamically active systems that lead to hemodynamic-perfusion changes, both at the local and at the general hemodynamic level. The exclusion of the malformation from the bloodstream contributes to the regression of disorders of cerebral and intracardiac blood flow caused by the anatomical and functional characteristics of the malformation itself and its clinical course.

Синтропічні ураження серцево-судинної системи у хворих на цироз печінки: виелімінування; деякі патогенетичні механізми; характеристика й особливості; клінічні маркери, їх прогностична цінність; обґрунтування та ефективність модифікованого лікування (повідомлення друге)

Introduction. Comorbid syntropic lesions of the circulatory system in patients with liver cirrhosis (LC), although often fatal, are poorly studied. The aim of the study. To distinguish syntropic lesions of the cardiovascular system in patients with LC, to determine some of their pathogenetic mechanisms, nature, and characteristics, to determine clinical markers with prognostic value, to justify and evaluate the effectiveness of their modified treatment. Materials and methods. We processed medical records of 603 patients with LC and detected circulatory system lesions in 490 patients. Some of them had only one type of lesions (study groups): 103 patients were diagnosed with cirrhotic cardiomyopathy (CCMP), and 89 patients were diagnosed with arterial hypotension. Patients without the circulatory system lesions (113 patients) formed a comparison group. The purpose of the first step of the study was to determine syntropic comorbid lesions of the circulatory system. The purpose of the second step was to study some pathogenetic mechanisms of their formation. The purpose of the third step was to characterize these lesions, classify them, and determine their specific characteristics related to the severity of LC. The purpose of the fourth step was to determine their clinical markers. The purpose of the fifth step was to justify a modified course of treatment for patients with LC and syntropic cardiovascular lesions as well as to assess its effectiveness. Results. The presence of the combination of such complaints as nausea, jaundice of the skin and sclera in patients with LC and the absence of the “jellyfish head” symptom lets us think with 97.09 % sensitivity, 98.02 % specificity and 97.70 % accuracy about syntropic secondary CCMP. In the presence of the combination of such complaints as pain and heaviness in the right side of the abdomen, ascites, hepato-, splenomegaly and telangiectasia lets us think with 85.39 % sensitivity, 98.61 % specificity and 94.75 % accuracy about syntropic persistent hypotension. Improvement of the comprehensive treatment of patients with LC, syntropic secondary CCMP and persistent hypotension, taking into account the peculiarities of their pathogenesis and clinical course, can improve the quality of life of patients by 44.95 % and 40.39 %, respectively, and significantly increase the effectiveness of treatment. Conclusions. Clinical symptom complexes that indicate the presence of syntropic lesions of the circulatory system – a combination of complaints of nausea, jaundice and sclera in the absence of symptoms of “jellyfish head” indicates CCMP, and a combination of complaints of pain and heaviness in the right hypochondrium, ascites, hepato- and splenomegaly and telangiectasia indicate persistent hypotension. Improvement of the comprehensive treatment of patients with LC and CCMP by adding a β-blocker with α-blocking properties of carvedilol (1 tablet (3.125 mg) twice a day), cardio- and hepatoprotector thiotriazoline (in patients with LC and CCMP of the 1st degree of severity (100.0 mg) three times a day, patients with LC and CCMP II and III degrees of severity – intramuscularly 2.0 ml of 2.5 % solution (50.0 mg) three times a day for five days, then 1 tablet (100.0 mg) three times a day), and improvement of the comprehensive treatment of patients with LC and persistent hypotension of I and II degrees of severity by adding ivabradine (1 tablet (5.0 mg) in the morning after meals), patients for hypotension of III degree of severity – intravenous albumin solution (at the rate of 1.5 g/kg for at least 10 days), as well as α-lipoic acid (1 capsule (600.0 mg) in the morning after meals), in the presence of ascites and edema syndrome – spironolactone (in the dosage, which is provided by the severity of the complication, of us a blunt transition to a maintenance dose of 1 tablet (50.0 mg) in the morning after a meal) enhanced the quality of life by 44.95 % and 40.39 %, respectively, and significantly increased the effectiveness of treatment.

Syntropic Lesions of the Cardiovascular System in Patients With Liver Cirrhosis: Their Determination; Selected Pathogenetic Mechanisms; Characteristics and Specifics; Clinical Markers, Their Prognostic Value; Justification and Effectiveness of Modified Treatment (First Notice)

Introduction. Comorbid syntropic lesions of the circulatory system in patients with liver cirrhosis, although often fatal, are poorly studied. The aim of the study. To distinguish syntropic lesions of the cardiovascular system in patients with liver cirrhosis, to determine some of their pathogenetic mechanisms, nature, and characteristics, to determine clinical markers with prognostic value, to justify and evaluate the effectiveness of their modified treatment. Materials and methods. We processed medical records of 603 patients with liver cirrhosis and detected circulatory system lesions in 490 patients. Some of them had only one type of lesions (study groups): 103 patients were diagnosed with cirrhotic cardiomyopathy, and 89 patients were diagnosed with arterial hypotension. Patients without the circulatory system lesions (113 patients) formed a comparison group. The purpose of the first step of the study was to determine syntropic comorbid lesions of the circulatory system. The purpose of the second step was to study some pathogenetic mechanisms of their formation. The purpose of the third step was to characterize these lesions, classify them, and determine their specific characteristics related to the severity of liver cirrhosis. The purpose of the fourth step was to determine their clinical markers. The purpose of the fifth step was to justify a modified course of treatment for patients with liver cirrhosis and syntropic cardiovascular lesions as well as to assess its effectiveness. Results. At the first step of the study, we found that 81.26 % of patients with liver cirrhosis had circulatory system lesions, in particular, secondary cirrhotic cardiomyopathy (57.50 % of patients with the circulatory system lesions) and persistent arterial hypotension (35.31 % of patients with the circulatory system lesions) as syntropic lesions. At the second step, we found that patients with liver cirrhosis and syntropic lesions of the circulatory system had also autonomic dysfunction and endothelial dysfunction. At the third step, we detected left ventricular remodeling in patients with liver cirrhosis and syntropic secondary cirrhotic cardiomyopathy, along with diastolic dysfunction and elevated S. Tei-index scores; these indicators worsened in parallel with the increase in the severity of cirrhosis; S. Tei-index scores should be used to classify secondary cirrhotic cardiomyopathy by severity. Patients with liver cirrhosis and syntropic persistent arterial hypotension had reduced ratio between blood pressures during the day and at night, low variability in blood pressure; in parallel with the increase in the severity of cirrhosis, arterial hypotension progressed with a disturbed circadian rhythm and pressure variability at all stages of the disease; the indicator of average daily arterial pressure should be used to classify arterial hypotension by severity. Conclusions. 81.26 % of patients with liver cirrhosis had comorbid lesions of the circulatory system, including secondary cirrhotic cardiomyopathy (57.50 %) and persistent arterial hypotension (35.31 %) as syntropic lesions; the activation of humoral and metabolic factors with disorders of the autonomic nervous system is one of the links in the pathogenesis of these syntropic lesions; syntropic secondary cirrhotic cardiomyopathy and persistent arterial hypotension have their specific characteristics, their manifestations worsen in parallel with the decompensation of liver cirrhosis, it is proposed to classify both diseases by severity.

Adaptive potential of the circulatory system in patients with vibration disease and sensorineural hearing loss

The study presents the results of the study of adaptive reactions and adaptive potential of the circulatory system of patients with vibration disease and chronic bilateral sensorineural hearing loss.

Assessment of selected parameters of the circulatory system in patients undergoing oral aspirin challenge.

IntroductionIt is known that the administration of the drug during the oral aspirin challenge (OAC) can cause hypersensitivity symptoms not only from the respiratory system or skin, but also from the cardiovascular system.AimTo assess the occurrence and nature of cardiovascular adverse events during the OAC in patients suspected of hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs).Material and methodsThe study included 52 patients with symptoms of hypersensitivity to aspirin (ASA) or other NSAIDs in the form of skin reactions or respiratory response in anamnesis. Patients were treated with OAC and simultaneously were subject to monitoring of clinical manifestations of hypersensitivity to ASA/NSAIDs, ventilation disorders and cardiovascular functions.ResultsThe most common reaction of the cardiovascular system during OAC was tachycardia or supraventricular and ventricular extrasystoles, regardless of the day of the study and the result of OAC. Supraventricular and ventricular tachycardia was recorded incidentally. Atrial or ventricular fibrillation or flutter was not observed. There was no evidence of any ischemic heart disease. In 2 patients, hypotension was registered, but only 1 of them required typical treatment of anaphylaxis.ConclusionsNo clinically significant cardiac arrhythmias were recorded during OAC. The changes observed in the records of blood pressure and ECG monitoring show that OAC performed in accordance with the current guidelines does not pose a high risk to the patient’s health and life as a result of cardiovascular reactions.

Klinichni markery` sy`ntropichny`x komorbidny`x urazhen` sy`stemy` krovoobigu u xvory`x na cy`roz pechinky`

Klinichni markery` sy`ntropichny`x komorbidny`x urazhen` sy`stemy` krovoobigu u xvory`x na cy`roz pechinky`

The impact of dapagliflozin on cardiovascular system in the course of type 2 diabetes mellitus

The following paper is an attempt to revise current data and the results of clinical trials concerning the impact of dapagliflozin on long-term cardiovascular complications of type 2 diabetes mellitus. Short-term clinical trials, including relatively small groups of patients, suggest positive influence of dapagliflozin on the cardiovascular system. Currently ongoing long-term trials are likely to confirm these data, but so far we can assume that dapagliflozin not only acts as an efficient antihyperglycaemic drug, but also protects the circulatory system in patients with type 2 diabetes mellitus.

Highly Sensitive Enzymatic MWCNTs-Based Biosensors for Detection of Abiraterone in Human Serum

A highly sensitive enzymatic biosensor is successfully experimented for detection of abiraterone in human serum with significance in personalized medicine and point-of-care chemotherapy of patients with metastatic prostate cancer. The dynamic range and limit of the detection of the proposed biosensor coincide with the therapeutic range of abiraterone in circulatory system of patients (below 1 μM). An optimized label-free electrochemical biosensor was exploited in order to improve the performance of biosensor to detect low concentrations of abiraterone in human serum. Electroactive surface area has been increased by 4314 mm2 by multiwalled carbon nanotubes (MWCNTs) nanostructuring with respect to bare electrode to enhance the sensitivity. CYP3A4 protein was immobilized on MWCNTs as probe biomolecule. Electrochemical cyclic voltammetries demonstrated an inhibition effect on the CYP3A4, clearly observed as a diminished electrocatalytic activity of the enzyme. Dose-response behavior of biosensor in interaction with abiraterone in human serum samples is demonstrated that shows a dynamic range between zero and 1 μM and a detection limit of 230 nM.

The Strange Case of Smoking and Schizophrenia—The Epidemiology Detectives Are on the Trail

The Strange Case of Smoking and Schizophrenia—The Epidemiology Detectives Are on the Trail

Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries

ObjectiveExcess mortality from diseases and medical conditions (natural death) in persons with psychiatric disorders has been extensively reported. Even in the Nordic countries with well-developed welfare systems, register based studies find evidence of an excess mortality. In recent years, cardiac mortality and death by diseases of the circulatory system has seen a decline in all the Nordic countries, but a recent paper indicates that women and men in Denmark, Finland, and Sweden, who had been hospitalised for a psychotic disorder, had a two to three-fold increased risk of dying from a cardiovascular disease. The aim of this study was to compare the mortality by diseases of the circulatory system among patients with bipolar disorder or schizophrenia in the three Nordic countries Denmark, Sweden, and Finland. Furthermore, the aim was to examine and compare life expectancy among these patients. Cause specific Standardized Mortality Rates (SMRs) were calculated for each specific subgroup of mortality. Life expectancy was calculated using Wiesler’s method.ResultsThe SMR for bipolar disorder for diseases of the circulatory system was approximately 2 in all countries and both sexes. SMR was slightly higher for people with schizophrenia for both genders and in all countries, except for men in Denmark. Overall life expectancy was much lower among persons with bipolar disorder or schizophrenia, with life expectancy being from 11 to 20 years shorter.ConclusionOur data show that persons in the Nordic countries with schizophrenia or bipolar disorder have a substantially reduced life expectancy. An evaluation of the reasons for these increased mortality rates should be prioritized when planning healthcare in the coming years.

Case 1–2003 The use of intraoperative echocardiography during insertion of ventricular assist devices

Transesophageal echocardiography (TEE) assists in the intraoperative decision-making process during cardiac anesthesia and cardiac surgery. Mechanical ventricular support may be necessary to support the circulatory system temporarily or serve as a bridge to heart transplantation. A left ventricular assist device (LVAD) is most commonly used.1 Biventricular failure necessitates the use of an LVAD along with a right ventricular assist device (RVAD) to form a biventricular assist device (BIVAD) (Fig 1). TEE plays a vital role in evaluating effective mechanical assistance of the circulation.1-3 This case describes a BIVAD placement in a patient and shows the roles and limitations of TEE in this scenario.