Major Risk Factor For Patients Research Articles

Outcomes of leadless pacemaker in chronic kidney disease patients: real-world data from the i-LEAPER registry

Abstract Background Chronic kidney disease (CKD) represents a major risk factor for patients requiring transvenous pacemaker (TV-PM), resulting in a high rate of operative complications and PM-related infection rate (21.9% and 12.5%, respectively), with both complications parallels to severity of CKD. Moreover, TV leads represent an important concern for end-stage CKD patients, often needing vascular access patency for renal replacement therapy. In this setting leadless pacemakers (LPMs) represent an attractive alternative to TV-PM for their lower device-related infection rate and the absence of TV leads. To date, limited data on LPM safety and efficacy profile in CKD patients are available. Purpose to assess operative and long-term safety and efficacy of LPMs implantation in patients with different stages of CKD in the real-world setting. Methods Consecutive patients who underwent LPM implantation in 12 European centers joining the i-LEAPER registry were retrospectively enrolled. CKD stage was assessed according to CKD-EPI equation for eGFR. Patients with CKD stage G3a/b (N=245) and stage G4/G5 (N=67) were compared with patients with normal kidney function (NKF) (N=867). Primary safety endpoint was LPM-related major complications rate at implant and during follow-up (FU). Additionally, the rate of patients showing sub-optimal electrical performance (pacing threshold [PT] >1V@0.24ms) was compared between groups. Results 1179 patients were enrolled and followed for a median of 33 [IQR 24-47] months. When compared with the NKF group, patients with CKD stage G3a/b and stage G4/G5 showed a higher burden of cardiovascular comorbidities (Table 1). The choice of a LPM was mainly due to vascular concern in the CKD stage G4/G5 group, while a perceived highest infective risk was reported in CKD stage G3a/b group (Table 1). Major complication rate at implant and during FU did not differ between groups, regardless of renal impairment stage (Table 2). All-cause mortality incidence resulted higher in CKD stage G4/G5 group when compared with NKF group (17.9% vs 6.8%; HR 4.24; 95%CI 4.25-7.94, p<0.001) (Figure A). The rate of patients with PT>V1@0.24ms during FU did not differ between groups, not exceeding 13.8%, and therefore remaining consistent with historical data for LPM (Figure B). Conclusion In the real-world setting, LPM showed a remarkable safety and efficacy profile in CKD patients regardless of renal impairment stage that was comparable to NKF population. LPM should be considered as first choice in CKD patients requiring a PM.

IMPACT OF POLYVASCULAR DISEASE ON LONG–TERM PROGNOSIS IN PATIENTS WITH ACUTE CORONARY SYNDROME. A PROSPECTIVE COHORT STUDY IN ITALY

Abstract Background Atherothrombosis should be considered a systemic disease that may involve one or more than one vascular beds. Data on the impact of polyvascular disease on long–term prognosis in patients with acute coronary syndrome (ACS) are still scarce. Aim To assess the prevalence of symptomatic polyvascular disease in a cohort of patients with ACS and to investigate the impact on long–term outcomes of single versus multiple vascular beds involvement. Methods We analyzed a nationwide, comprehensive, and universal administrative database of consecutive patients older than 40 years admitted for a new episode of ACS in 2013–14 in Italy. Patients with ACS were stratified according to the presence of Peripheral Arterial Disease (PAD) only, Cerebrovascular Disease (CeVD) only, PAD and CeVD (PAD+CeVD) or neither (noPAD/noCeVD). A Cox proportional hazard multivariate model was used to evaluate the impact of PAD only, CeVD only and PAD+CeVD on 5–year MACCE. Results 331320 new episode of ACS were identified. Among them, 24491 (7.4%) were patients with PAD only, 16269 (4.9%) with CeVD only and 4710 (1.4%) with PAD+CeVD. The 5 years MACCE was 42.6%, 64.7%, 66.1 and 72.2 (p<0.001) for noPAD/noCeVD, PAD only, CeVD only and PAD+CeVD, respectivelly. After adjustment for age, sex, and comorbidities, the hazard ratio (HR) for 5–year MACCE was 1.30 (p<0.0001), 1.39 (p<0.0001), and 1.46 (p<0.0001) in patients with PAD only, CeVD only, and PAD+CeVD, respectively, as compared with patients without PAD and CeVD. Conclusion Polyvascular disease represents a major risk factor in patients with ACS. The simultaneous involvement of three vascular beds further increases the risk of long–term outcomes. Greater effort should be directed toward identification of subclinical/clinical atherosclerosis of beds different from coronary for a better risk stratification.

Association of liver dysfunction with outcomes after percutaneous coronary intervention - a systematic review and meta-analysis

Abstract Background Liver dysfunction is currently receiving renewed attention as a major risk factor in patients undergoing cardiac surgery, including surgical treatment of coronary artery disease (CAD). Since percutaneous coronary intervention (PCI) for CAD treatment is much less invasive, the influence of liver dysfunction on outcomes after PCI may not be relevant. Purpose To assess the association of liver dysfunction with PCI outcomes. Methods We systematically searched three libraries (MEDLINE, Web of Science and The Cochrane Library) selecting all studies including patients with liver dysfunction who underwent PCI. A meta-analysis of studies comparing outcomes in patients with and without liver dysfunction who underwent PCI was performed. Primary outcome was short-term mortality. Secondary outcomes were major adverse cardiovascular events (MACE), bleeding and acute kidney injury. Random-effects model was performed. Results Five studies were selected and the data from 10,710,317 patients were included in the final analysis. Included studies were published between 2015 and 2021, all were observational risk-adjusted cohort studies, and two were national databases. In comparison with the absence of liver dysfunction, patients with liver dysfunction were associated with higher short-term mortality (OR, odds ratio: 2.97, 95% CI, confidence interval: 1.23-7.18, p=0.02), higher MACE (OR 1.42, 95%CI 1.08-1.87, p=0.01), and higher bleeding rates (OR 2.23, 95%CI 1.65-3.00, p<0.01). There was no significant difference regarding acute kidney injury (OR 1.20, 95%CI 0.50-2.87, p=0.69). Conclusions The analysis suggests that liver dysfunction is a major risk factor in patients undergoing PCI. It is independently associated with higher risk of short-term mortality and also with an increased occurrence of MACE and bleeding, without significantly affecting renal function.

Hemodynamic and Echocardiographic Characteristics and the Presence of Pulmonary Hypertension in Patent Ductus Arteriosus Patients who Underwent Transcatheter Closure.

We investigated the hemodynamic parameters of pediatric PDA patients and focused on the influence of PDA size on pulmonary arterial pressure and the prevalence of pulmonary hypertension. A total of 52 patients aged between 2months and 20years who received transcatheter closure of a PDA from January 2018 to June 2022 in our institution were retrospectively recruited. Their hemodynamic parameters collected both by echocardiography and by cardiac catheterization were analyzed to delineate the influence of PDA size on the pulmonary vascular system. The echocardiographic-based ductal size and indexed PDA size were 1.93mm (1.15-6mm) and 4.05mm/m2 (2.03-25.47mm/m2), respectively. The pulmonary artery pressure measured was 20.83mmHg (8-45mmHg). We found a positive correlation between indexed PDA size and mean pulmonary arterial pressure (mPAP) (Pearson correlation coefficient = 0.47, p < 0.001). A subgroup analysis showed that 28 patients (53.8%) developed pulmonary hypertension (PH) (defined as mPAP > 20mmHg). The median age of the PH group was 1.02years [range: 0.19-8.64], which was significantly younger than the non-PH group's median age of 3.43years [range: 0.42-19.96] (p = 0.001). The indexed PDA size for the PH group, 4.69mm/m2, was significantly higher than that of the non-PH group, 3.2mm/m2 (p = 0.004). The major risk factor for patients with PH was the PDA/BSA index, with an OR of 2.181 (95% CI, 1.224-3.887). Our demographic data showed younger patients with a higher PDA/BSA index are more likely to develop pulmonary hypertension.

Abstract 14328: The Impact of Peripheral Arterial Disease in Major Bleeding and Major Cardiac and Cerebrovascular Events in Patient Undergoing Percutaneous Coronary Intervention: A Contemporary Assessment

Introduction: Peripheral arterial disease (PAD) has been associated with adverse outcomes in patients undergoing percutaneous coronary intervention (PCI). However, there are controversial reports regarding its impact in the current era of radial interventions. Hypothesis: We assessed the hypothesis that patients with PAD and patients without PAD undergoing PCI have similar major bleeding complications and major adverse cardiac and cerebrovascular events (MACCE). Methods: This was a retrospective analysis of data collected from 6 New York metropolitan area tertiary care hospitals and submitted to the NCDR between 2010 and 2018. Major bleeding events were classified using Bleeding Academic Research Consortium (BARC) classification. Severe bleeding was defined as a BARC ≥3. Hierarchical logistic regression was utilized to assess the association of PAD with post-PCI adverse outcomes, as appropriate. Results: A total of 2,933 PAD patients (9.4%) underwent PCI (without PAD, n = 28,172). Results are shown in the Table. PAD patients had a significantly higher odds of MACCE and major bleeding complications, including blood transfusions and in-hospital mortality. Access site bleeding and the need for post PCI dialysis did not reach statistical significance. A multivariable analysis will be presented. Conclusions: In conclusion, PAD continues to be a major risk factor for patients undergoing PCI. When compared with patients without PAD, these patients are at an increased risk of major adverse outcomes, including a 67% increase in mortality risk and a 44% in major bleeding complications risk.

Diabetes mellitus in coronary artery disease

Abstract Funding Acknowledgements Type of funding sources: None. Background Morbidity and mortality are increased in patients with myocardial infarction that also have co-existing diabetes mellitus (DM) making it an important risk factor for coronary artery disease (CAD). Overall, diabetes mellitus worsens the prognosis in CAD patients. Purpose This paper was done from a study, that enabled us to measure the prevalence of diabetes mellitus in patients with coronary artery disease, in relevance to other CAD risk factors (age, gender, systolic blood pressure, LDL-C and smoking). These results would give us the ability to compare it with the outcomes of the EUROSPIRE IV study published in 2015 (1). Methods Retrospective observational study of consecutive patients from the Registry of Cyprus Heart Survey, examined in the Cardiology Clinic of Nicosia General Hospital, between the years 2011-14. The total number of patients was 371 (11.5% females and 88.4% males). These patients had a history of myocardial infarction and underwent either a PCI or a CABG. Results From the total amount of patients, 36.9% had history of diabetes mellitus. The percentage adjusted to gender shows that 44% of females and 35.6% of males included in the study had diabetes. The mean age of people that had diabetes and coronary artery disease was 68.65 (CI: 67.18, 70.12). The prevalence of diabetics with hypertension and coronary artery disease was 75.91% while the average systolic blood pressure (SBP) was 138 mmHg (CI: 135.33, 140.67). The systolic blood pressure was ≥140 mmHg in half of the diabetic individuals. Smoking was also assessed as a risk factor in patients with diabetes and CAD. The prevalence of ex-smokers was 28.46%, of smokers 18.24% and of non-smokers 53.28%. Finally, values of low density lipoprotein cholesterol (LDL-C) were measured in 90.5% of diabetic patients, 88.7% of them had an LDL-C ≥1.8 mmol/L (≥70mg/dL) and 53.22% had an LDL-C ≥2.5 mmol/L (≥100mg/dL). The average LDL-C value was 109.19 mg/dL. Conclusions The outcome of the study revealed that a substantial number of patients with CAD suffer from diabetes. Therefore, diabetes was verified as a major risk factor in patients with CAD and the development of acute coronary syndrome. Regarding those patients, other risk factors proved to have a negative impact on their cardiovascular health. Moreover, the risk factors in patients with DM and CAD of this study were compared with the well known study, EUROASPIRE IV (1). The prevalence of diabetes in the present study was 36.9%, compared to 26.8% in EUROASPIRE IV, indicating a higher prevalence in our study. We concluded that marked reduction in the events of myocardial infarction can be seen if we reduce the prevalence of uncontrolled diabetes mellitus occurrences with medication or better control of the risk factors of CAD early in the diagnosis to reduce complications.

HEALTH-RELATED QUALITY OF LIFE IN PATIENTS BEFORE AND AFTER SURGERY FOR A HERNIATED LUMBAR DISC DURING THE ERA OF COVID 19 PANDEMIC

A herniated lumbar disc occurs when the nucleus pulposus or annulus brosis of the disc protrudes beyond the intervertebral disc space. The patient frequently complains of lower back pain, and radiological evaluation conrms the diagnosis. The most frequent spinal operation is lumbar disc herniation surgery. The study aims to compare patients' health-related quality of life before and after surgery for a herniated lumbar disc during the timeframe of the COVID 19 epidemic. Patients who had elective lumbar discectomy at SRN hospital in Prayagraj between September 2020 and September 2021 were selected for this cross-sectional research. Euroqol (EQ-5D) and VAS scores were used to measure health-related quality of life. Scores were taken before surgery and again after 6 months of follow-up. An analysis of variance (ANOVA) was used to undertake a multivariate analysis of the pre-operative ratings. Similarly, 6 months following surgery, an analysis was performed, and a comparison was made. The major risk factor in patients who did not improve or who had a lower quality of life was smoking. The ndings of our study can be used as part of a patient's pre-operative agreement to raise awareness and cooperation, as well as to aid rehabilitation during Pandemic times.

Clinical analysis for osmotic demyelination syndrome in patients with chronic hyponatremia

Background: Although osmotic demyelination syndrome (ODS) has been well known to be associated with a rapid correction of sodium (Na+) in patients with chronic hyponatremia, its risk factors and clinical outcomes have not been examined in Taiwan. Aim: The aim of the study was to analyze the underlying causes and overlooked risk factors in patients with ODS. Methods: We retrospectively collected chronic hyponatremic patients developing ODS and analyzed their clinical characteristics. Results: Fourteen patients (7 males and 7 females) with a mean age of 62.7 ± 17.9 years old were enrolled. Their underlying causes included gastrointestinal illness with poor intake (n = 7), chronic use of diuretics (n = 2), syndrome of inappropriate antidiuretic hormone (n = 2), pneumonia (n = 2), and hypopituitarism (n = 1). Their serum Na+ was 107.2 ± 1.2 mmol/L with mild hypokalemia (potassium 3.1 ± 7 mmol/L), hypoalbuminemia (albumin, 3.4 ± 0.6 g/dL), and hypophosphatemia (phosphorus, 2.3 ± 1.0 mg/dL). Their mean Na+ correction rate was 8.4 ± 9 mmol/L/day and most patients (60%) developed ODS in first 3 days. Their manifestations included delirium, seizures, unstable gait, aphasia, and drowsy consciousness. Brain magnetic resonance imaging demonstrated that 42.8% had isolated central pontine myelinolysis. Totally, 43% of ODS patients had unfavorable outcome with death and disability. In addition, patients with rapid Na+ correction rate (>12 mmol/L/day, n = 4) usually exhibited significant hypokalemia (2.5 ± 0.4 vs. 3.5 ± 0.7 mmol/L, P < 0.05) as compared with those without. Conclusion: Nutritional status and concurrent electrolyte deficiencies such as hypokalemia are major risk factors in patients with ODS. Clinicians should timely recognize these potential risks of ODS and reduce Na+ correction rate to avoid catastrophic outcomes.

Abstract 10463: Angiotensin-Converting Enzyme 2 (ACE2) is Rate-limiting for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Viral Infection in Beating Stem Cell-Derived Cardiomyocytes

Introduction: Cardiovascular comorbidities are a major risk factor in patients infected with SARS-CoV-2. SARS-CoV-2 Spike protein binds to host cell surface ACE2 to gain entry. ACE2 is subsequently downregulated by internalisation. We hypothesise that an ACE2 knockdown system in beating human embryonic stem cell-derived cardiomyocytes (hESC-CMs) will recapitulate the downregulation of ACE2, and reduce the ability of a SARS-CoV-2 Spike protein pseudotyped virus to infect these clinically relevant cells. Method: ACE2 was knocked down (KD) with CRISPR/Cas9 in hESCs, before differentiating to hESC-CMs and sub-culturing in 96 well plates. Sanger sequencing confirmed amino acid changes. Catalytic ACE2 activity was measured by mass spectrometry in wild-type versus KD by conversion of apelin-13 to apelin-12 in hESC-CMs supernatant. ACE2 activity was also measured by fluorescent substrate assay. Pseudotyped virus infection was visualised by high content screening in ACE2 KD versus wild-type (n=4). All data are mean±SEM. Results: Sequencing revealed two substitutions at ACE2 222-223 , and three deletions at ACE2 224-226 . This reduced ACE2 catalytic activity by ~60-70% by apelin-12 accumulation using mass spectrometry (Fig 1a), and fluorescent assay. Furthermore, KD reduced infection of hESC-CMs by pseudotyped virus to 27.3±9.6% of the cell population versus 74.8±4.7% for wild-type (Fig 1b,c). This is consistent with our previous data, showing DX600 (peptidic inhibitor of ACE2 catalytic site) significantly reduced infection of wild-type hESC-CMs to 20.5±6.5%. Conclusions: In conclusion, we generated a functional ACE2 knockdown in a beating cardiomyocyte cell model. Both the catalytic activity and the ability to bind SARS-CoV-2 Spike protein of ACE2 reduced, importantly indicating ACE2 is rate limiting for infection. We aim to use this system to further explore the cardiovascular consequences of SARS-CoV-2 infection and subsequent downregulation of ACE2.

A case-control study on factor V Leiden: an independent, gender-dependent risk factor for venous thromboembolism

BackgroundActivated protein C resistance (APCR) due to factor V Leiden (FVL) mutation (R506Q) is a major risk factor in patients with venous thromboembolism (VTE). The present study investigated the clinical manifestations and the risk of venous thromboembolism regarding multiple clinical, laboratory, and demographic properties in FVL patients.Material and methodsA retrospective cross-sectional analysis was conducted on a total of 288 FVL patients with VTE according to APCR. In addition, 288 VET control samples, without FVL mutation, were also randomly selected. Demographic information, clinical manifestations, family and treatment history were recorded, and specific tests including t-test, chi-square and uni- and multi-variable regression tests applied.ResultsAPCR was found to be 2.3 times significantly more likely in men (OR: 2.1, p < 0.05) than women. The risk of deep vein thrombosis (DVT) and pulmonary embolism (PE) in APCR patients was 4.5 and 3.2 times more than the control group, respectively (p < 0.05). However, APCR could not be an independent risk factor for arterial thrombosis (AT) and pregnancy complications. Moreover, patients were evaluated for thrombophilia panel tests and showed significantly lower protein C and S than the control group and patients without DVT (p < 0.0001).ConclusionFVL mutation and APCR abnormality are noticeable risk factors for VTE. Screening strategies for FVL mutation in patients undergoing surgery, oral contraceptive medication, and pregnancy cannot be recommended, but a phenotypic test for activated protein C resistance should be endorsed in patients with VTE.

Effects of valsartan compared with telmisartan in reducing insulin resistance on type 2 diabetes mellitus (T2DM) patients with hypertension

Insulin resistance is a major risk factor for patients with type 2 diabetes mellitus (T2DM). Telmisartan and valsartan are angiotensin II type I receptor blockers (ARBs) that are often used in patients with metabolic syndrome and T2DM. This study aimed to compare the effect of valsartan and telmisartan in reducing insulin resistance on T2DM with hypertension. Patients of T2DM were open-label screened at the Endocrinology Policlinic, Department of Internal Medicine, Dr. Sardjito General Hospital, Yogyakarta, and then randomized into two groups. The first group received valsartan 80 mg per day up to 160 mg per day, the second group received telmisartan 40 mg per day up to 80 mg per day in addition with life-style modifying and diabetes therapy. Homeostasis model assessment of insulin resistance (HOMA-IR), triglyceride and HDL cholesterol levels of patients were measured before and after receiving telmisartan and valsartan for 12 weeks. A total of forty-nine outpatients were involved in this study comprised of 25 female patients (51%) and 24 male patients (49%) with 27 patients (55.1%) received telmisartan and 22 patients (44.9%) received valsartan as the hypertension therapy. No significantl difference were observed between telmisartan group compared with valsartan group in HOMA-IR (14.01 ± 16.39 vs. 5.31 ± 3.51; p=0.053), triglyceride levels (165.71 ± 94.70 vs 144.41 ± 48.33 mg/dL; p=0.620), HDL-C level (48.57 ± 9.78 vs 49.24 vs 49.24 ± 12.56 mg/dL; p=0.999). In conclusion, telmisartan demonstrated no difference compared to valsartan in reducing insulin resistance on T2DM patients with hypertension.

POS-273 Antihypertensive treatment with a hydrochlorothiazide-based regimen enhances medial vascular calcification in CKD rats with mineral bone disorders

Increased arterial stiffness and medial vascular calcification are a major risk factors in patients with chronic kidney disease (CKD) due to mineral bone disorders (MBD). The impact of antihypertensive therapy on MBD-induced vascular calcification remains uncertain. The aim of the present study was to investigate whether the reduction in mean blood pressure reduces arterial stiffness and medial vascular calcification in CKD rats with MBD.

Venous Resections in Pancreatic Head Carcinoma - 15 Years Experience with Survival and Prognostic Factor Analysis.

Background: We present a comparative analysis of survival, complications and major risk factors in patients who underwent surgery for pancreatic head carcinoma. Methods: This is a single-centre retrospective study aimed to evaluate clinical, surgical and pathoanatomical features of 467 patients who underwent radical surgery for pancreatic head carcinoma between September 2004 and October 2019. The series includes 88 patients (18.8%) with venous resections for borderline resectable pancreatic adenocarcinoma. Results: The estimated median survival rates were statistically significant with 19.3 months in pancreatoduodenal venous resections (VR) and 26.9 months in pancreatoduodenal resections (PDR), respectively (p=0.047). On the other hand, one, three, and five-year survival rates of 46.6%, 17.6% and 8.3% in VR, and 53.6%, 20.8%, 14.9% in PDR were not statistically significant (p=0.13, 0.5 and 0.11 respectively). Survival rates comparison in PDR, VR, and palliative procedures (PP) between the three groups showed statistical significance (p 0.05). The clinically relevant postoperative complications in venous resections (13.6%) vs. 14.8% in PDR were not statistically significant (p=0.77). Postoperative bleeding and reoperation (p 0.05) are independent prognostic factors for worse outcomes. There was no statistically significant relationship between survival and presence of vascular invasion (p=0.581). Conclusions: When performed by experienced surgeons at specialized high-volume centres, pancreatoduodenal resections combined with venous resection and reconstruction are reliable and safe surgical procedures.

Inhaled corticosteroids in virus pandemics: a treatment for COVID-19?

Inhaled corticosteroids in virus pandemics: a treatment for COVID-19?

Practice patterns in the management of congestive heart failure and post-discharge quality of life: A hospital-based cross-sectional study.

Objective:The objective of the study is to identify the etiology, risk factors, frequency of major and minor components of the Framingham criteria for heart failure, discharge medications, mortality, and quality of life after discharge from the hospital, for patients who were admitted to the in-patient unit of a tertiary care hospital in central India, with a diagnosis of congestive heart failure (CHF).Methods:This hospital-based cross-sectional study involved retrospective chart review of patients who were admitted to the in-patient unit with a diagnosis of CHF. These patients were then attempted to reach via their telephone numbers listed in the medical records and their current quality of life was assessed using Euro-QoL 5D questionnaire.Results:In the 69 patients who were admitted to the hospital with congestive cardiac failure during the pre-defined period, ischemic heart disease was the most common etiology and smoking was the most common risk factor for the development of CHF. The most common findings based on Framingham criteria were dyspnea on mild exertion, rales and bilateral ankle edema. It was determined that one-fourth of the individuals were non-compliant to the medical treatment and more than half of the patients had a poor health score.Conclusion:Smoking remains to be a major risk factor for patients to develop ischemic heart disease and subsequent CHF. Patients with congestive cardiac failure also had severe deterioration in their quality of life after discharge from the hospital, implying the need for improving efforts toward prevention and better management.

Association between blood transfusion and serum creatinine as a major risk factor in patients undergoing cardiac surgeries: An observational study

Background: Blood transfusion is associated with altered serum creatinine levels. However, there are not many studies available to substantiate the cause of acute kidney injury (AKI) in patients undergoing cardiac surgeries. Aims and Objectives: The present study was aimed to assess and analyze serum creatinine levels, after blood transfusion (post-operative) in patients undergoing cardiac surgery and to assess its significance as a potential diagnostic and prognostic serum biomarker in predicting renal dysfunction. Materials and Methods: An observational study was performed after obtaining the Institution’s Ethical Committee approval. Patients (n = 162) who underwent cardiac surgeries were considered for the study and were evaluated for alterations in serum creatinine levels and creatinine clearance rate, before (pre-operative) and after blood transfusion (post-operative). Analysis of variance, paired t-test, Chi-square test, and logistic regression test were used. Results: Statistically significant difference (P < 0.0001) in mean creatinine levels as well as creatinine clearance rate was observed in 70 patients who were at a greater risk of developing AKI (post-operative). Post-operative median creatinine level as well as creatinine clearance rate were also significantly different (P < 0.001) in AKI group, compared to non-AKI group. Mean difference between pre- and post-operative serum creatinine, for congenital procedure, was statistically significant (P < 0.001). Conclusion: Blood transfusion is often associated with altered serum creatinine levels, leading to unfortunate adverse effects of potentially renal dysfunction. Therefore, better blood conservation and anesthetic techniques should be studied upon to prevent excessive bleeding and avoid unnecessary blood transfusion.

Risk factors for partial and total loss of limbal stem cells

Introduction: In certain pathological conditions limbal stem cells are unable to function adequately - to proliferate and differentiate through their inferior capabilities to maintain corneal integrity. They are either reduced in number or have abnormal cell function. This condition is known as limbal stem cell deficiency. Depending on its severity, limb stem cell deficiency is divided into partial (sectoral) and total diffuse. Aim: The purpose of this study is to investigate the risk factors for limbal stem cell deficiency. Material and M ethods: The study included 64 patients with LSC deficiency and the risk factors for setting in and progression of the disease were evaluated using a questionnaire and clinical trials. The results were processed with SPSS v. 20 for Windows, using variation, comparative and correlation analyses, and risk assessment analysis (RR). Results and D iscussion: As a primary risk factor wearing contact lenses that have a moderate dependence (r = 0.455; p <0.001) and carry a high risk of developing mild LSC (limbal stem cell) deficiency (RR = 13.85 (2.65 - 72.46)) stands out. A major risk factor for patients with moderate LSC deficiency are penetrating injuries that have a moderate dependence (r = 0.475; p <0.001) and significantly higher risk (RR = 15.37 (2.92 - 81.01)). In the severe form of LSC deficiency the major risk factors are chemical and thermal burns that have a significant correlation (r = 0.525; p <0.001) with severe LSC deficiency and carry an extremely high risk (RR = 12.35 (3.43 - 44.53) ) of occurring. Conclusion: The major risk factors for total limbal stem cell loss are chemical burns and injuries, and risk factors for partial loss are iatrogenic factors and the dry eye syndrome.

Co-extraction for Metabolomics and Proteomics from a Single CSF Sample.

In the field of neurodegeneration, it is important to identify biomarkers that enable early disease prediction, since these disorders start decades before clinical symptoms manifest. Cerebrospinal fluid (CSF) is considered an excellent source for biomarker discovery since it is in direct contact with the extracellular space of the brain and directly reflects disease-specific changes.While the liquor drainage is no major risk factor for patients, it is still not as easy and popular as simple blood sampling and less liquid can be collected. Especially when a variety of experiments for one cohort is planned, the volume of CSF can be a limiting factor. Therefore, it is essential that extraction and analytical methods are adapted to low amounts of liquor. If in follow-up studies, additional replicates to increase statistical significance or different extraction approaches are planned, the required amounts have to be minimized.With this extraction method, a combined proteomics and metabolomics approach is possible. This opportunity implies a variety of advantages. First, a classification matrix based on the comprehensive data set has a potentially higher accuracy even without a deeper understanding of the biological meaning of the different omics changes. If the proteome and metabolome differences can be linked to each other, this approach can conceivably open so far unknown doors regarding the cause or progression of different diseases like Alzheimer's or Parkinson's disease.

Chronic Kidney Disease and Major Risk Factors in Patients from Two Large Healthcare Systems: The CURE-CKD Registry

Author(s): Tuttle, Katherine; Alicic, Radica Z; Duru, O Kenrik; Jones, Cami R; Daratha, Kenn B; Nicholas, Susanne B; McPherson, Sterling M; Neumiller, Joshua J; Bell, Douglas S; Mangione, Carol M; Norris, Keith C

Differences in the Incidence of Major Risk Factors in Patients with Ischemic or Hemorrhagic Stroke in the Siberian Population

Background. The study of the incidence of risk factors (RF) of stroke for primary and secondary prevention of this disease remains relevant. There are modifiable and non-modifiable RF.Aim. To study the frequency of the main RF in patients with ischemic and hemorrhagic stroke in the urban population of Krasnoyarsk (Eastern Siberia).Material and methods. Examination of 124 patients with an ischemic stroke and 28 with hemorrhagic was performed. Patients received treatment in neurologic center of Krasnoyarsk in 2014 year. The main criterion of inclusion was the confirmed diagnosis of an ischemic or hemorrhagic stroke. All patient had the clinic-tool and neurovisualizing examination and collecting the individual and family anamnesis with examination of modifiable and non-modifiable RF. The research of the neurologic status at patients both with ischemic, and with a hemorrhagic stroke was conducted by the standard technique. Based on results of computer or magnetic resonance imaging of a brain the diagnosis of an ischemic or hemorrhagic stroke was established.Results. A distinctive feature of patients with hemorrhagic stroke was the occurrence of a vascular accident in younger age (6 years earlier) in comparison with ischemic stroke. Among patients with ischemic stroke elevated body mass index (BMI) was in 87 (70.2%) patients, burdened heredity was in 8.1% of cases, and 43.5% of patients were smokers. Among patients with hemorrhagic stroke 16 (57.1%) patients had elevated BMI. People with burdened heredity were not identified among them. Smoking was found in 22 (78.6%) patients in this group.Conclusion. Improvement of treatment and prevention of an ischemic stroke are in many respects connected with clarification of RF and pathogenic mechanisms of its development. The rational pharmacotherapy directed to pointed impact on individual RF can reduce the risk of development of stroke not only at individual, but also at the population level.