Onset Of Syndrome Research Articles

Analysis of Mortality in Patients with Acute Myocardial Infarction after Revascularization

Annotation. The objective of the study was to conduct a comparative analysis of the clinical and functional characteristics of the course of acute myocardial infarction (STEMI) after revascularization in patients who died and those who survived. The study included 286 patients with an average age of 62.8±9.8 years. Among the participants, 202 (70.6%) were men and 84 (29.4%) were women. All patients were hospitalized within 12 hours from the onset of pain syndrome, and all underwent urgent coronary angiography and stenting of the infarct-related artery. All patients underwent a general clinical examination, laboratory diagnostics including the determination of hemoglobin, glucose, creatinine, cystatin C, troponin I, C-reactive peptide; coronaroventriculography, 12-lead electrocardiography, and echocardiography according to the standard protocol. Statistical analysis of the obtained results was performed using the STATISTICA 6.1 software package, version No. ВХХR901E246022FA, and Microsoft Excel. It was found that 28 individuals (9.8%) died during the hospitalization stage. The average age of the deceased was 62.5 (55.5; 70.5) years, which does not significantly differ from that of the surviving patients. There was no statistical difference in gender characteristics either, with 21 (75.0%) men among the deceased and 181 (70.2%) men among the survivors, p=0.59. In the group of deceased patients, there was a significantly higher number of individuals with multivessel coronary artery disease, specifically 13 (46.4%) compared to 74 (28.7%), p=0.005. Among the surviving patients, there was a significantly higher number of individuals with single-vessel disease: 6 (21.4%) compared to 102 (39.5%), p=0.06. Among the deceased patients, acute heart failure Killip IV, p=0.009, and conduction disorders, p=0.01, were significantly more frequently diagnosed. In the group of deceased individuals, the levels of C-reactive peptide were significantly higher at 13.2 (5.5; 19.5) compared to 10.0 (6.0; 16.0), p=0.05; cystatin C levels were 1.61 (0.98; 1.51) compared to 1.23 (0.97; 1.38), p=0.05; and glucose levels were 8.8 (5.8; 12.1) compared to 7.1 (5.9; 10.0), p=0.05. So, among patients with STEMI, 28 individuals (9.8%) died during the hospital stage after urgent revascularization. Among the deceased patients, acute heart failure Killip IV and conduction disorders (sinoatrial and atrioventricular block) were significantly more frequently diagnosed, which became the cause of death. One of the most clinically and statistically significant factors distinguishing the comparison groups was the predominance of patients with multivessel disease. In the group of patients who died in the hospital, significantly higher levels of CRP, cystatin C, and glucose were noted. The level of cystatin C is a more sensitive diagnostic criterion in deceased patients compared to creatinine.

Pattern of Dyslipidemia in Patients with Acute Coronary Syndrome in a Cardiac hospital in Nepal

Background: Dyslipidemia is defined as an abnormal concentration of lipids in the blood and is a critical modifiable risk factor for the development of cardiovascular diseases, including acute coronary syndrome (ACS). The aim of the study was to determine the pattern of dyslipidemia among patients with Acute Coronary Syndrome admitted to a cardiac hospital. Methodology: This is a cross-sectional study including consequent 143 patients admitted to Chitwan Mutu Aspatal with a diagnosis of acute coronary syndrome. The study was conducted from July 2021 to Jan 2024 over a period of 2.5years. The patient’s lipid levels were taken within 24 hours from the onset of Acute Coronary Syndrome. Results: Out of total of 143 patients, dyslipidemia was found in majority of patients with low HDL in 92(64.30%) in our study. 53 (37.1%) were females and 90 (62.9%) were males. The mean age of the patients was 62.3013.03 SD (in years). Patients with STEMI had maximum elevation of LDL (52.9%) compared with those having NSTEMI in 44.4% and 31% in Unstable angina patients. Also, low HDL level was detected in the majority of the patients across all spectrum of ACS patients which was statistically significant (p<0.05). Conclusion: There is a higher prevalence of low HDL-C and high prevalence of LDL-C among the Nepalese population presenting with acute coronary syndrome (ACS) in the hospital

Favorable outcome in children with dense deposit disease with the use of long-term mycophenolate mofetil and high-dose alternate-day steroids.

This study aimed to evaluate the response to therapy and outcome with long-term daily mycophenolate mofetil (MMF) and high-dose alternate-day steroids (HADS) in children with dense deposit disease (DDD). Children with DDD who received long-term MMF (1200mg/m2/day) and HADS (1.5-2mg/kg AD) with slow tapering were retrospectively evaluated for their clinico-pathological presentation, response to therapy (complete, partial, no remission) and outcome (patient and renal survival). Six out of eight children with DDD seen over 10years (3 boys, 3 girls) aged 6-13years received the above therapy. Clinical presentation was nephrotic syndrome (1/6), gross hematuria (2/6), and nephritic onset of nephrotic syndrome (3/6). Serum creatinine was elevated at presentation in 3/6; C3 levels were low in all. None had crescentic changes on biopsy. The duration of therapy was 2-3years. On therapy, haematuria resolved by 3months, and proteinuria decreased to non-nephrotic range by 12 to 18months in all six. Serum creatinine normalized, and all showed complete remission during treatment. Three had sustained remission. Two children relapsed while tapering steroids and attained partial remission on increasing the steroid dose. One patient relapsed, 1year after therapy completion and did not respond to restarting the same treatment. Over a mean follow-up period of 5years, patient and renal survival was 100%. Long-term treatment with MMF and HADS showed a beneficial effect in the resolution of proteinuria with preservation of renal function and survival in the medium term in children with DDD with nephritic/nephrotic presentation.

Extended versus standard corticosteroid treatment in primary nephrotic syndrome onset.

Introduction. The standard treatment for the onset of primary nephrotic syndrome (PNS) consists of 8 weeks of prednisone. Alternatively, it was postulated that extending treatment to 12 weeks is associated with fewer relapses. We aimed to evaluate whether relapses' cumulative incidence (CI) at 2 years was lower with extended treatment. Population and methods. This is a retrospective cohort study of patients with PNS who were followed for 2 years and grouped according to the initial treatment received. Results. Thirty-seven patients were included per regimen. The time to first relapse was similar (p = 0.63), and the CI of relapses at 2 years was 75.6% with standard treatment and 72.9% (p = 0.79) with extended treatment; relative risk was 0.96 (95%CI 0.73-1.26). Relapse-free survival in the 2 years of follow-up was also similar (log-rank test = 0.51). Conclusion. Relapse CI at 2 years was similar with both treatment regimens.

The Relationship Between Umbilical Cord Blood Interferon γ-Inducible Protein-10 (IP-10) Levels and Clinical and Laboratory Parameters in Preterm Infants

Interferon γ-inducible protein-10 (IP-10) is one of the potent inflammatory mediators. This research aims to compare cord blood IP-10 levels in preterm infants with or without antenatal preterm prelabor rupture of the membranes (PPROM), fetal inflammatory response syndrome (FIRS) and prematurity related morbidities. We enrolled 85 newborns with gestational age below 37 weeks. Umbilical cord blood samples were obtained at delivery and stored. Cord blood IP-10 and interleukin (IL)-6 levels measured with ELISA test. All enrolled preterm infants have been followed-up for prematurity related conditions including respiratory distress syndrome, early and late onset sepsis, necrotising enterocolitis, intraventricular haemorrhage, premature retinopathy, bronchopulmonary dysplasia and mortality. FIRS defined as IL-6 levels of umbilical cord above 11 pg/ml. Cord blood median IP-10 levels were significantly higher in PPROM group (n=27, 31.8%) than in the group without PPROM (IP-10=345.6 pg/ml vs. 28.3 pg/ml, p<0.001). Cord blood median IP-10 levels were significantly higher in preterm infants with FIRS (n=36, 42.4%) compared to infants without FIRS (p<0.001). Cord blood median IP-10 levels were also higher in preterm infants with early onset sepsis than those without early onset sepsis (p=0.019). We did not observe relationship between cord blood IP-10 levels and other prematurity-related complications. Increased cord blood IP-10 levels have been observed in preterm infants with fetal inflammation and who developed early onset sepsis. Cord blood IP-10 could be considered an early marker for intrauterine inflammation and its effect on fetal outcomes, such as the development of neonatal sepsis in preterm infants.

High Joule heat as a risk factor for post-endoscopic submucosal dissection electrocoagulation syndrome: A multicenter prospective study.

Thermal damage may lead to inflammation of the peeled mucosal surface during endoscopic submucosal dissection (ESD). To determine the effect of Joule heat on the onset of post-ESD electrocoagulation syndrome (PECS). In this prospective study, PECS was characterized by in-hospital fever (white blood cell count: ≥ 10000 μ/L or body temperature ≥ 37.5 °C) and abdominal pain (visual analog scale score ≥ 30 mm during hospitalization or increased by ≥ 20 mm from baseline at admission). High Joule heat was defined as 15390 J. Between April 2020 and April 2024, 209 patients underwent colorectal ESD; those with intraoperative perforation or penetration were excluded. The remaining 202 patients were divided into the PECS and non-PECS groups. PECS occurred in 30 (14.9%) patients. Multivariate analysis revealed high Joule heat as an independent factor associated with PECS (odds ratio = 7.96; 95% confidence interval: 2.91-21.8, P < 0.01). The procedure time and presence of lesions in the right colon were not associated with PECS. Accumulated thermal damage on the peeled mucosal surface should be considered during PECS onset. This thermal damage is likely a major component of the mechanism underlying PECS.

Associations of Ultra-Processed Food Intake with the Incidence of Cardiometabolic and Mental Health Outcomes Go Beyond Specific Subgroups-The Brazilian Longitudinal Study of Adult Health.

Background/Objectives: Avoidance of ultra-processed foods (UPFs) has been recommended to achieve a healthy diet, but whether it applies equally to all UPFs is uncertain. We evaluated individual UPF subgroups in the prediction of cardiometabolic and mental health outcomes. Methods: The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is an occupational cohort study of 15,105 adults (35-74 years) recruited in 2008-2010. We followed participants up to 2018 to ascertain elevated weight and waist gains and the onset of metabolic syndrome, hypertension, metabolic dysfunction-associated steatotic liver disease, diabetes, common mental disorders, depressive episodes, and anxiety disorders. Results: In adjusted robust Poisson regression, greater overall UPF intake at the baseline predicted all studied outcomes. Various subgroups of UPF, most frequently processed meat and sweetened beverages, individually conferred a greater risk, and nearly all predicted at least one studied outcome. Considering all subgroups and outcomes, a broad pattern of overall risk was present. When subgroups not individually predictive of these outcomes were aggregated, increased risk (for a one-standard deviation change) was observed for elevated weight (RR = 1.05; 95% CI 1.01-1.11) and waist (RR = 1.05; 95% CI 1.00-1.10) gains, and for the incidence of common mental (RR = 1.06; 95% CI 1.01-1.12), and anxiety (RR = 1.09; 95% CI 1.02-1.16) disorders. Conclusions: UPFs overall and their subgroups predicted future cardiometabolic and mental health outcomes. The pattern of individual UPF subgroup associations varied across outcomes, and the aggregate of subgroups not individually predicting risk also predicted large gains in overall and central adiposity and the incidence of mental health disorders. While additional studies investigating other outcomes are needed, these findings justify avoidance of overall UPF intake in health promotion and disease prevention.

Investigating the Impact of Different Diets on Metabolism and Related Diseases Based on Gut Microbiota

The gut microbiota, as a critical regulator of host metabolism, is significantly influenced by dietary patterns. This study explores the effects of different diets on gut microbiota and their relationship with metabolism and related diseases. First, the composition of gut microbiota and its role in metabolism are reviewed. Next, the impacts of high-fat diets, low-carbohydrate diets, and high-fiber diets on the structure and function of gut microbiota are analyzed, and how these changes affect the onset and progression of metabolic syndrome, diabetes, and obesity is discussed. Finally, theoretical models based on existing research are proposed to explain the interactions between gut microbiota, diet, and metabolic diseases, with a discussion on future research directions. This study aims to provide theoretical foundations and practical guidance for dietary interventions and the prevention of metabolic diseases.

The Importance of the Skin Syndrome in the Primary Diagnosis of Connective Tissue Diseases in Children: Case Report

Background. Timely verification of the clinical diagnosis of connective tissue diseases in children based on the onset of the earliest symptoms, including skin manifestations, and timely initiation of treatment can prevent the development of irreversible complications, increase the life expectancy of patients and its quality.The aim of the study. To analyze the nature of skin manifestations as a marker of the onset connective tissue disorders, such as systemic lupus erythematosus (SLE), localized scleroderma (morphea), juvenile dermatomyositis (JDM), juvenile polyarteritis nodosa (PAN), systemic juvenile idiopathic arthritis (SJIA), and the timing of the main clinical diagnosis from the moment of manifestation of connective tissue disorders. To clearly demonstrate the importance of skin syndrome in the timeliness of clinical diagnosis, a clinical case is presented.Methods. Analysis of medical records and prospective observation of 47 patients aged up to 17 years 11 months with an established diagnosis of connective tissue diseases and the presence of skin syndrome at the onset of the disease.Results. Among patients with SLE, only 20.0% of children had skin syndrome only in the form of butterfly rash, and other skin manifestations were noted in 80.0% of patients. The period from the onset of skin syndrome to diagnosis was 8.0 ± 2.1 months. In 57.2% of patients with morphea, skin syndrome was detected exclusively in the form of single or multiple elements, and in 42.8% there was a combination of a pathognomonic morphological element with alopecia and scleroderma. The average time to make a clinical diagnosis of morphea from the onset of the skin syndrome was 11.0 ± 1.9 months. In all patients with JDM, skin manifestations were characterized by polymorphism (papules and Gottron’s sign, heliotrope rash, palmar capillaritis, livedo reticularis, cheilitis). The diagnosis was made 14.0 ± 3.2 months from the onset of skin syndrome. In patients with documented PAN, skin manifestations debuted in the form of erythema, areas of necrosis, palmar capillaritis, livedo reticularis, and cheilitis. The period from the onset of skin syndrome to clinical diagnosis was 6.0 ± 2.4 months. Among patients with SJIA, skin syndrome was represented by a maculopapular rash associated with fever and its regression when body temperature normalized. The period until clinical diagnosis was made from the onset of the skin syndrome was 2.0 ± 1.1 months.Conclusion. In most cases, the skin syndrome in patients at the onset of the disease was characterized by polymorphism and diversity of elements with the involvement of the vascular component. At the same time, the time from the debut of connective tissue disease in the form of the appearance of skin syndrome to the clinical diagnosis varied in the range from 2 to 14 months.

PsicoCare: a pilot randomized controlled trial testing a psychological intervention combining cognitive-behavioral treatment and positive psychology therapy in acute coronary syndrome patients.

Although psychological factors play a significant role in the onset and prognosis of acute coronary syndrome (ACS), psychological interventions (PIs) are rarely included in cardiac rehabilitation (CR) programs due to inconclusive evidence regarding specific intervention components and effect sizes. This study aimed to assess the efficacy of a PI based on cognitive-behavioral treatment (CBT) and positive psychology therapy (PPT) in improving psychological and clinical outcomes in patients with ACS. This PsicoCare trial was an open-label randomized controlled trial that compared a combined CBT and PPT-based PI (the PsicoCare program) with a standard CR program (control group). We recruited 87 ACS patients, and psychological outcomes, functional capacity, biochemical and anthropometric measures, and clinical outcomes were assessed at baseline, 2 months, and 9 months after the ACS event. The PsicoCare group showed significant improvements in depression, anger traits, anger-in, and anger control-out compared to the control group. Additionally, the PsicoCare intervention was associated with the improved maintenance of cognitive function, social support, and spiritual coping styles, while the control group showed deterioration in these areas. Patients experiencing severe ACS showed significant improvement in personal strength and meaning as a result of the PsicoCare intervention. However, no significant effects were observed on anxiety, anger-out, emotion regulation skills, dispositional optimism, other personal strengths, or quality of life. Both groups demonstrated similar improvements in functional capacity and clinical outcomes. The study suggests that CBT and PPT-based PIs may offer additional benefits for ACS patients, particularly regarding their psychological health. Further larger trials are required to confirm these findings. identifier, NCT05287061.

An acute bleeding metastatic spinal tumor from HCC causes an acute onset of cauda equina syndrome

An acute bleeding metastatic spinal tumor from HCC causes an acute onset of cauda equina syndrome

Plasma proteomic signature of risk and prognosis of frailty in the UK Biobank.

The availability of proteomics data in large, population-based cohort studies offers an unprecedented opportunity to understand the onset and progression of aging-related diseases and syndromes. We examined the proteomic signature of the onset of frailty and the progression to death among the prefrail and frail. A total of 2920 proteins were assayed using Olink among 43,895 participants (aged 39-70years) in the UK Biobank. Using multinomial logistic models, we identified 102 and 90 proteins cross-sectionally associated with baseline prefrailty and frailty (Bonferroni-corrected p-value < 0.05), respectively. Additionally, cox regression identified 87 and 48 proteins associated with death among initially prefrail (n = 16,661) and frail (n = 1647) individuals, respectively. Eight overlapping proteins were cross-sectionally associated with prefrailty and frailty at baseline and prospectively associated with death among prefrail and frail individuals. CD300E, GDF15, and PLAUR were the most significant proteins among these eight proteins. LASSO regression selected 73 and 23 proteins predicting death in prefrail and frail participants, respectively. Protein-based prediction models based on LASSO regression and the light gradient boosting machine classifier demonstrated satisfactory discrimination, calibration, and reclassification among the prefrail and frail. GDF15, WFDC2, and NEFL were the most important proteins predicting death among prefrail and frail individuals. Proteins associated with the onset and progression of prefrailty and frailty were enriched in pathways involving protein metabolism, cellular signaling in disease, apoptosis, and inflammation. Our research could uncover novel therapeutic targets for addressing the onset and progression of frailty, potentially informing the design of patient-centered treatment strategies and management plans.

Asymmetry of the Frontal Aslant Tract and Development of Supplementary Motor Area Syndrome.

Background/Objectives: The purpose of this study was to investigate preoperative interhemispheric differences of the FAT in relation to the onset of postoperative SMA syndrome. Methods: This was a single-center retrospective analysis of patients who underwent surgical resection of diffuse gliomas involving the SMA between 2018 and 2022. Inclusion criteria were availability of preoperative and postoperative Magnetic Resonance Imaging, no previous surgery, and no neurological deficits at presentation. Diffusion-weighted data were processed by spherical deconvolution (SD) and diffusion tensor imaging tractography algorithms, and TrackVis was used to dissect the FAT of both hemispheres. The FAT data were analyzed for correlation with postoperative SMA syndrome onset. Results:N = 25 cases were included in the study, among which n = 23 had preoperative bilaterally identifiable FAT by SD. N = 12 developed an SMA syndrome, 6 demonstrated a motor-only syndrome, 4 had a verbal-only syndrome, and 2 had mixed verbal and motor features. The SMA syndrome incidence was significantly more frequent in lower-grade gliomas (p = 0.005). On the tumor side, the FAT identified by SD was smaller than the contralateral (mean volume 6.53 cm3 and 13.33 cm3, respectively, p < 0.001). In the 6 cases that developed a verbal SMA syndrome, a normalized FAT volume asymmetry (FAT-VA) demonstrated an asymmetry shifted towards the non-dominant side (mean FAT-VA = -0.68), while the cases with no postoperative verbal impairment had opposite asymmetry towards the dominant side (mean FAT-VA = 0.42, p = 0.010). Conclusions: Preoperative interhemispheric FAT volume asymmetry estimated according to functional dominance can predict postoperative onset of verbal SMA syndrome, with proportionally smaller FAT on the affected dominant hemisphere.

Systemic immune-inflammation mediates the association between Klotho protein and metabolic syndrome: findings from a large-scale population-based study.

This study utilized large-scale population data from the National Health and Nutrition Examination Survey (NHANES) to elucidate the relationship between the Klotho protein and metabolic syndrome along with its components. We further investigated the possible mediating effect of inflammation on these relationships. Our objective was to identify biomarkers for risk stratification and potential therapeutic targets for metabolic syndrome. This study enrolled 13,119 participants aged 40-79 years, spanning five NHANES cycles from 2007 to 2016, with complete information on metabolic syndrome and the Klotho protein. The definition of metabolic syndrome followed the criteria of the National Cholesterol Education Program-Adult Treatment Panel III. Survey-weighted logistic regression and subgroup analysis were used to explore the associations between serum Klotho protein levels and metabolic syndrome, along with its components. Mediation analysis was performed to investigate the mediating effects of inflammation-related markers, including white blood cells, neutrophils, lymphocytes, monocytes, the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), the systemic immune-inflammation index (SII) and the monocyte-to-HDL ratio (MHR), with the aim of elucidating how the Klotho protein influences the onset and progression of metabolic syndrome. The study participants had an average age of 56.06 years (95% CI: 55.76-56.37), with a Klotho protein concentration of 798.10 pg/ml (95% CI: 656.50-980.50) and a 43.77% prevalence of metabolic syndrome (n = 5742). In the crude model, Klotho was negatively correlated with metabolic syndrome and its components, including central obesity, hypertension, and hypertriglyceridemia. After adjusting for all confounding factors, Klotho was demonstrated to be negatively associated only with metabolic syndrome (OR: 0.82, 95% CI: 0.70-0.97), hypertension (OR: 0.83, 95% CI: 0.70-0.98), and hypertriglyceridemia (OR: 0.78, 95% CI: 0.67-0.91). Subgroup and interaction analyses revealed significant interactions between age, sex, race/ethnicity, body mass index, and Klotho. Additionally, mediation analysis demonstrated that leukocytes, neutrophils and monocytes accounted for 34.78%, 31.91% and 7.13%, respectively, of the associations between Klotho and metabolic syndrome. The serum concentration of Klotho protein was negatively associated with metabolic syndrome, with the relationship being partly mediated by systemic immune inflammation. The findings of this research revealed that the Klotho protein may be a valuable biomarker for risk stratification and a potential therapeutic target for metabolic syndrome.

Knowledge And Prevalence Of Burnout Syndrome In Military Police

Burnout syndrome, or professional burnout syndrome, is an emotional disorder primarily caused by excessive work, with key symptoms including extreme exhaustion, physical and emotional depletion, deep depression, negative feelings, insomnia, loss of appetite, and prolonged stress. Objective: This study aimed to analyze the knowledge and prevalence of the dimensions of burnout syndrome among military personnel. Methodology: The methodology was based on a quantitative, exploratory, and descriptive approach, utilizing questionnaires and the Maslach Burnout Inventory to identify factors contributing to the onset of burnout syndrome, including all inclusion and exclusion criteria for the research. Data were collected at the end of April and the beginning of May 2020, with the study sample consisting of 42 military police officers assigned to the 9th Battalion of Araguatins-TO. Results: The study revealed that the majority of the participating military personnel (71.4%) were unaware of burnout syndrome. Among the evaluated dimensions, depersonalization showed a high prevalence (57.1%), while professional achievement was found to be low in frequency (47.6%), indicating a lack of satisfaction and motivation at work. These data demonstrate a profile of emotional exhaustion and distancing, consistent with other studies involving professional groups with high exposure to stress. The results suggest an urgent need for educational actions to raise awareness about burnout among military personnel and to implement preventive strategies within institutions. Conclusion: The high prevalence of depersonalization and low professional achievement indicates a negative impact on both personal well-being and professional performance, highlighting the importance of early interventions to mitigate the effects of burnout in this group

Impact of measured or calculated small dense LDL cholesterol compared with apolipoprotein B or non-HDL cholesterol for long-term secondary prevention in patients with stable coronary artery disease

Abstract Background This study was aimed to investigate whether directly measured small dense low-density lipoprotein cholesterol (D-sdLDL-C) can predict long-term coronary artery disease (CAD) events compared with LDL-C, non–high-density lipoprotein cholesterol (non-HDL-C), apolipoprotein B (apoB), and estimated sdLDL-C (E-sdLDL-C) determined by Sampson’s equation in patients with stable CAD. Methods D-sdLDL-C measured at Showa University, and E-sdLDL-C were evaluated in 790 male and 244 female patients with stable CAD. CAD events defined as sudden cardiac death, onset of acute coronary syndrome, and/or need for coronary revascularization were monitored for 12 years. Cut-points of D-sdLDL-C, E-sdLDL-C, LDL-C, non-HDL-C, and apoB were determined by receiver operating characteristic curves. Results CAD events were observed in 238 male and 67 female patients. The Kaplan–Meier event-free survival curves showed that patients with D-sdLDL-C ≥32.1 mg/dL had an increased risk for CAD events (chi-square from log-rank test = 7.23), whereas risk in patients with E-sdLDL-C ≥36.2 mg/dL was not. In the group with high D-sdLDL-C, the multivariable-adjusted hazard ratio (HR) was 1.47, 95% confidence interval (CI) 1.15-1.89, and it remained significant after adjustment for LDL-C, non-HDL-C, or apoB. These results remained significant in the patients treated with statin. HRs for high LDL-C, non-HDL-C, or apoB were not statistically significant after adjustment for high D-sdLDL-C. The high D-sdLDL-C enhanced risk of high LDL-C, non-HDL-C, and apoB (HR 1.73, 95%CI 1.27-2.37). Conclusions: High D-sdLDL-C can predict long-term recurrence of CAD in stable CAD patients independently of apoB and non-HDL-C by distinguishing the patients at high risk. D-sdLDL-C is an independent risk-enhancer for secondary CAD prevention whereas E-sdLDL-C is not.Figure

Exercise-induced inflammatory and thrombotic acute phase response in hypertensive patients

Abstract Background/Introduction Vigorous physical activity may acutely trigger the onset of an acute coronary syndrome especially in sedentary persons with established cardiovascular risk factors such as arterial hypertension. The rupture of an inflamed coronary plaque and the activation of the coagulation cascade are the main underlying mechanisms. Purpose The present study aimed to determine the effect of acute exercise on the inflammatory and thrombotic response in patients with arterial hypertension as compared to normotensive peers. Methods After excluding patients with any inflammatory or/and coronary artery disease, a total of 60 non-treated hypertensive patients and 65 normotensive individuals underwent a maximal treadmill exercise testing. Βlood samples were drawn at rest and immediately after peak exercise. High-sensitivity C-reactive protein (hsCRP), serum amyloid A (SAA), white blood cell (WBC), interleukin-6 (IL-6), and total fibrinogen (TF) levels, as well as plasminogen activator inhibitor-1 (PAI-1) activity were measured. Results All biomarkers increased with exercise, except PAI-1, which decreased (P&amp;lt;0.05 for the change between resting and peak exercise for all biomarkers). The normotensive group had less marked (P&amp;lt;0.05) exercise-induced changes than the hypertensive group in hsCRP (7.7 vs. 8.6%), SAA (5.6 vs. 11.9%), WBC (45.0 vs. 51.7%), and PAI-1 (-17.3 vs. -20.1%) and a similar (P=NS) change in IL-6 (23.8 vs. 23.0%) and TF (8.5 vs. 8.5%) (see also Figure). Conclusion(s) In conclusion, the exercise-induced inflammatory and thrombotic acute phase response seems to be more pronounced in non-treated hypertensive patients than in normotensive controls. The effect of blood-pressure lowering treatment on the exercise-induced acute phase response remains to be elucidated.Figure

Ankle brachial index,a non invasive tool predicts cardiovascular events after acute myocardial infarction:a 3 year follow -up study

Abstract Background / Introduction The ankle-brachial index (ABI) is a non-invasive tool that was initially used for the diagnosis of lower-extremity peripheral artery disease (PAD). It has been proven that ABI is a marker of atherosclerosis in other vascular sites and can therefore be used to predict cardiovascular events regardless the presence or not of PAD symptoms. Purpose This study aims to examine the prognostic value of ABI in the setting of acute myocardial infarction (MI), as up till now there is not enough relevant evidence. Method We followed up 441 patients [79% male;mean age 62 years;67% hypertnesive; 30% with diabetes mellitus (DM); 52% current smokers] who were hospitalized because of MI for a period of three years. All patients underwent baseline estimation of clinical and laboratory parameters during theri hospitalization.The ABI was measured according to established methodology using a certified automated device and abnormal ABI defined as a value ≤ 0.9. The primary endpoint was a composite of all-cause and cardiovascular death, as well as major cardiovascular events including decompensated heart failure, new acute coronary syndrome, cerebrovascular event, malignant arrhythmia, PAD event and new onset renal dysfunction. All events were assessed both in-hospital and within 3 years of follow-up. Results Our study population had a mean ABI of 1.1 (IQR: 1.00 to 1.18). With the use of reduced multivariate regression models ABI was proven to be a prognostic indicator for the in-hospital composite endpoint. Patients with an abnormal ABI had a threefold risk of in-hospital events [HR 2.93, 95% CI: 1.48-5.81, p=0.002]. After conducting multivariate analysis ABI maintained its predictive power of all-cause mortality [HR 2.88, 95% CI: 1.53 – 5.42, p=0.001], regardless of hypertension DM, LDL levels and smoking status of the study population in 3 years follow-up. Conclusion An impaired ABI is associated with greater risk of in-hospital events in patients with acute MI. Moreover, ABI emerges as an independent predictor of long-term all-cause mortality in those patients.The findings of this study suggest that subclinical and clinical PAD are associated with poor outcomes among patients with acute MI; thus, routine ABI tests enhance risk stratification and might carry important prognostic significance in these patients regardless of PAD symptoms.

Comparison οf Immune Responses Through Multiparametric T-Cell Cytokine Expression Profile Between Children with Convalescent COVID-19 or Multisystem Inflammatory Syndrome.

The immunological pathways that cause Multisystem Inflammatory Syndrome after SARS-CoV-2 infection in children (MIS-C) remain under investigation. The aim of this study was to prospectively compare the T-cell cytokine expression profile in unvaccinated children with acute MIS-C (MISC_A) before immunosuppression, convalescent MIS-C (one month after syndrome onset, MISC_C), convalescent COVID-19 (one month after hospitalization), and in healthy, unvaccinated controls. The intracellular expression of IL-4, IL-2, IL-17, IFNγ, TNF-α and Granzyme B, and the post SARS-CoV-2-Spike antigenic mix stimulation of T-cell subsets was analyzed by 13-color flow cytometry. Twenty children with a median age (IQR) of 11.5 (7.25-14) years were included in the study. From the comparison of the flow cytometry analysis of the 14 markers of MISC_A with the other three groups (MISC_C, post-COVID-19 and controls), significant differences were identified as follows: 1. CD4+IL-17+/million CD3+: 293.0(256.4-870.9) vs. 50.7(8.4-140.5); p-value: 0.03, vs. 96.7(89.2-135.4); p-value: 0.03 and vs. 8.7(0.0-82.4); p-value: 0.03, respectively; 2. CD8+IL-17+/million CD3+: 335.2(225.8-429.9) vs. 78.0(31.9-128.9) vs. 84.1(0.0-204.6) vs. 33.2(0.0-114.6); p-value: 0.05, respectively; 3. CD8+IFNγ+/million CD3+: 162.2(91.6-273.4) vs. 41.5(0.0-77.4); p-value: 0.03 vs. 30.3(0.0-92.8); p-value: 0.08, respectively. In children presenting with MIS-C one month after COVID-19 infection, T cells were found to be polarized towards IL-17 and IFNγ production compared to those with uncomplicated convalescent COVID-19, a finding that could provide possible immunological biomarkers for MIS-C detection.

Novel Compound Heterozygous Variants in the FAS Gene Lead to Fetal Onset of Autoimmune Lymphoproliferative Syndrome (ALPS).

FAS gene defects lead to autoimmune lymphoproliferative syndrome (ALPS), which is often inherited in an autosomal dominant and rarely in an autosomal recessive manner. We report a case of a newborn girl with novel compound heterozygous variants in FAS and reveal the underlying mechanism. Whole-exome sequencing (WES) was used to identify pathogenic variants. Multiparametric flow cytometry analysis, phosflow analysis, and FAS-induced apoptosis assays were used to explore the effects of the variants on FAS expression, apoptosis, and immunophenotype. The HEK293T cells were used to assess the impact of the variants on protein expression and FAS-induced apoptosis. The patient was born with hepatosplenomegaly, anemia, and thrombocytopenia. She also experienced COVID-19, rotavirus infection, herpes simplex virus infection, and severe pneumonia. The proportion of double-negative T cells (DNTs) was significantly elevated. Novel FAS compound heterozygous variants c.310T > A (p.C104S) and c.702_704del (p.T235del) were identified. The apoptotic ability of T cells was defective, and FAS expression on the surface of T cells was deficient. The T235del variant decreased FAS expression, and the C104S protein remained in the endoplasmic reticulum (ER) and could not translocate to the cell surface. Both mutations resulted in loss-of-function in terms of FAS-induced apoptosis in HEK293T cells. The DNTs were mainly terminally differentiated T (TEMRA) and CD45RA+HLA-DR+, with high expression of CD85j, PD-1, and CD57. The percentage of Th1, Tfh, and autoreactive B cells were significantly increased in the patient. The abnormal immunophenotyping was partially attenuated by sirolimus treatment. We identified two variants that significantly affect FAS expression or localization, leading to early disease onset of in the fetus. Abnormalities in the mTOR pathway are associated with a favorable response to sirolimus.