Osteonecrosis of the jaw: surgical treatment results before and during the COVID-19 pandemic in one of the reference hospitals in Poland

OBJECTIVE

The COVID-19 pandemic has had a huge impact not only on everyday life but, above all, on the functioning of medical entities. During its duration, there were problems with access to health care, including maxillofacial surgery departments. The aim of the study is to analyze how the pandemic affected the surgical results of the treatment of osteonecrosis of the jaws at the Clinic of Maxillofacial Surgery in Poznań which delivers services in maxillofacial surgery for almost 4.5 million inhabitants in Poland.

PATIENTS AND METHODS

We conducted a retrospective analysis of patients' medical records before and during the pandemic restrictions. The data was obtained by entering the appropriate passwords and ICD-10 diagnoses (e.g., M87) in the hospital's IT system. The obtained information was subjected to statistical analysis.

RESULTS

The number of patients before and during the pandemic did not differ significantly. During the COVID-19 pandemic, the waiting time of patients after admission to the hospital for surgery and the total time of hospitalization were shortened. The number of complications was similar in both groups. However, the waiting time for a follow-up visit was longer during restriction time.

CONCLUSIONS

The COVID-19 pandemic had an impact on the course of surgical treatment in patients with osteonecrosis of the jaws. The outcomes of the medical procedure remained consistent with the ones observed before the implementation of restrictions. This is likely due to the urgency of the illness. Despite the pandemic, a critical condition called osteonecrosis of the jaw was treated promptly.

Tracheal airway pressure in tracheostomy tube capping trials: an experimental study

BACKGROUND

Tracheostomy tube capping is a commonly used test to determine if the tracheostomy tube can be removed. The success of the capping trial depends on the patient's ability to maintain sufficient spontaneous breathing with an occluded tracheostomy tube. The impact of an occluded tracheotomy tube on airway resistance is currently unknown. The aim of this study was to investigate tracheal pressure during capping or stoma button insertion and potential determinants concerning cuff.

METHODS

Eight cuffed and uncuffed tracheostomy tubes and three stoma buttons of various manufacturers and sizes were inserted into the trachea model. Cuffs were completely deflated or contained atmospheric pressure. The trachea was ventilated bidirectional with a respirator in volume-controlled mode and volume flows 15-60 L/min. Tracheal pressure drop during inspiration as a parameter of pressure required to move gas through the airway was measured.

RESULTS

Tracheal pressure drops occurred linearly or irregularly during capping trials to a maximum of 4.2 kPa at flow rates of 60 L/min for atmospheric pressure cuffs. In tracheostomy tubes with completely deflated cuffs, pressure drop in the trachea reaches a maximum of 3.4 kPa at a flow rate of 60 L/min. For tracheostomy tubes with cuff smaller inner or outer diameters do not regularly result in lower tracheal pressure drop. The pressure drop varies between different tracheostomy tubes depending on the manufacturer. In cuffed tracheostomy tubes, we observed three phenomena: sail-like positioning, folding over, and tightening of the cuff during flow. The maximum tracheal pressure drop during stoma button insertion reaches 0.014 kPa.

CONCLUSIONS

The cuff is a central element for the pressure drop in the airway and thus airway resistance during spontaneous translaryngeal breathing with a capped TT. Complete deflation reduces the pressure drop in the trachea. Due to deformation of the cuff, measured pressures are irregular as the volume flow is increased. Incomplete deflated cuffs and material characteristics of tracheostomy tubes and cuffs in addition to anatomical and clinical variables may cause unsuccessful capping trials due to increased airway resistance. All stoma buttons showed that pressure drop and thus airway resistance due to stoma buttons has no clinical relevance.

Thrombosis-related miR-16-5p predicts the disease severity in patients hospitalised for COVID-19

Introduction

SARS-CoV-2 tropism for the ACE2 receptor, along with the multifaceted inflammatory reaction, is likely to drive the generalized hypercoagulable state seen in patients with COVID-19.

Methodology

Using the original bioinformatic workflow and network medicine approaches we reanalyzed four coronavirus-related expression datasets and performed co-expression analysis focused on thrombosis and ACE2 related genes. We identified microRNAs (miRNAs) which play role in ACE2-related thrombosis in coronavirus infection and further, we validated the expressions of those miRNAs in 79 hospitalized COVID-19 patients and 32 healthy volunteers by PCR and monitored miRNAs patterns during the acute phase of COVID-19, as well as the prognostic potential of these miRNAs as biomarkers.

Results

We identified EGFR, HSP90AA1, APP, TP53, PTEN, UBC, FN1, ELAVL1 and CALM1 as regulatory genes which could play a pivotal role in COVID-19 related thrombosis. We also found miR-16-5p, miR-27a-3p, Let-7b-5p and miR-155-5p as regulators in coagulation and thrombosis process. We observed in separate cohort of COVID-19 patients and healthy controls that (i) expression of miR-16-5p, miR-27a-3p and miR-155-5p increased during observation, compared to the baseline measurement; (ii) a low baseline miR-16-5p expression presents predictive utility in assessment of the hospital length of stay or death in follow-up as a composite endpoint (AUC: 0.810, 95% CI, 0.71–0.91, p<0.0001); (iii) low baseline expression of miR-16-5p and diabetes mellitus are independent predictors of increased length of stay or death according to a multivariate analysis (OR: 9.417; 95% CI, 2.647–33.506; p=0.0005 and OR: 6.257; 95% CI, 1.049–37.316; p=0.044, respectively).

Conclusion

This study enabled us to better characterize changes in gene expression and signaling pathways related to COVID-19 thrombosis. In this study we identified, characterized and validated miRNAs which could serve as novel, thrombosis-related biomarkers of the COVID-19, can be used for early stratification of patients and prediction of severity of infection development in an individual.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Medical University of Warsaw

Diagnostic ability of miR-19a and Let-7f along with platelet and leukocyte extracellular vesicles in acute ischemic stroke patients

Background

Ischemic stroke (IS) is one of the most frequent causes of death. Since miRNAs have been illustrated to play an important role in various processes through regulation of multiple genes, and platelet function, their utility as novel biomarkers should be determined.

Purpose

We aimed to analyze the circulating platelet-derived miR-19a-3p, miR-186-5p, Let-7f, platelet-extracellular vesicles (EVs), leukocyte-EVs, and endothelial-EVs levels 24-h and 7-days after IS as novel diagnostic and prognostic/predictive biomarkers in 28 acute IS and 35 control patients.

Methods

Blood samples of 28 patients diagnosed with acute IS with hyper platelet reactivity were collected 24-h and 7-days after stroke and 35 age- and gender-matched individuals free of stroke with multiple risk factors for cardiovascular disease. Platelet reactivity was assessed by AA-, TRAP-, ADP-induced platelet aggregometry. PlasmaRNA was extracted; quality RNA was assessed: fluorometric assay; RT-PCR for miRNAs expression measurement and flow-cytometry for EVs determination p&lt;0.05.

Results

Patients with IS on day-1 had significantly higher platelet reactivity assessed by AA-induced platelet aggregometry compared to controls (p=0.001). Patients with normal platelet activation had significantly higher miR-186-5p expression levels compared to patients with HPR at day-1 acute-stroke (p=0.034). Seven days after acute stroke, expression levels of miR-186-5p significantly decreased in the same patients with normal platelet reactivity (p=0.036). Patients with HPR had significantly elevated platelet-EVs (CD62) concentration compared to patients with normal platelet reactivity at the day of 1 acute-stroke (p=0.012). Similarly, patients with HPR had significantly higher leukocyte-EVs (CD45) concentration compared to patients with normal platelet function at day-1 acute-stroke (p=0.002). Diagnostic values of baseline miRNAs and EVs were evaluated with receiver operating characteristic curve analysis. ROC curve showed that pooling the miR-19a-3p expressions, platelet-EVs, and leukocyte-EVs concentration yielded a higher AUC than the value of each individual biomarker as AUC was 0.893 (95% CI, 0.79–0.99). Patients with moderate stroke had significantly elevated miR-19a-3p expression levels compared with patients with minor stroke at the day of acute IS. AUC in ROC curve analysis was 0.867, (95% CI, 0.74–0.10) p=0.001.

Conclusions

Our analysis showed alteration of circulating miRNAs and EVs after IS. Combination of miR-19a-3p, Let-7f, platelet-EVs and leukocyte-EVs might have a diagnostic value for acute stroke and miR-19a-3p can predict the severity of stroke in IS patients.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Science Centre - Narodowe Centrum Nauki

Circulating miRNAs as independent predictors of cardiovascular mortality in patients with type 2 diabetes mellitus

Background

MicroRNAs (miRNAs, miR) are essential gene expression regulators involved in numerous biological processes and diseases including type 2 diabetes (DM).

Purpose

We aimed to determine the predictive value of selected circulating miRNAs for cardiovascular and all-cause mortality and their potential usefulness as biomarkers in DM patients.

Method

Two hundred fifty-two patients with diabetes were enrolled in the study. Among the patients included, 26 (10.3%) patients died during a median follow-up of 71 months (5.9 years). Plasma miR-191 and miR-16 expressions were assessed by quantitative real-time PCR and compared between the patients who survived and those who died.

Results

Patients who died from cardiovascular-related death had significantly higher expression of miR-191 and miR-16 as compared with patients who survived (p=0.003, p=0.001, respectively). The study population was divided into two subgroups by using ROC curve analysis for each miRNA, i.e., low or high value of single miRNAs. Kaplan Meier and Cox regression were performed for survival analysis. High expression levels of miRNAs were associated with cardiovascular mortality, when the models included one single miRNA and other covariates: miR-191 (HR = 4.793, 95% CI: 1.48–15.579; p=0.009) and miR-16 (HR = 4.66, 95% CI: 1.48–14.75; p=0.009). Furthermore, miRNAs expression between clopidogrel and the whole acetylsalicylic acid groups (i.e., 75 mg +150 mg), miR-191 expressions was significantly higher in the clopidogrel subgroup (p=0.010), whereas miR-16 did not differ (p=0.127).

Conclusion

To conclude, miR-191 and miR-16 expression are strong and independent predictors of cardiovascular and all-cause mortality in patients with T2DM. Moreover, miR-191 and miR-16 present significant interactions with antiplatelet treatment regimens and clinical outcomes.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Medical University of Warsaw

Prevalence, patient characteristics and outcome of hyponatremia in acute heart failure

Background

Hyponatremia is the most common electrolyte disturbance found in hospitalized patients. Previous studies have shown that low serum sodium levels at presentation are associated with increased mortality and morbidity in patients hospitalized with acute heart failure (AHF). However, given the complicated multifactorial origin of hyponatremia, the role of serum sodium level in risk stratification in patients with AHF is still largely unknown.

Purpose

To evaluate the prevalence and prognostic value of hyponatremia in patients presenting with AHF to the emergency department (ED).

Methods

Basics in Acute Shortness of Breath EvaLuation (BASEL V) was a prospective, multicenter, diagnostic study recruiting dyspneic patients at the ED. The final diagnosis of AHF was adjudicated by 2 independent physicians. Hyponatremia was defined as a serum sodium level of &lt;135 mmol/l. The prognostic accuracy of hyponatremia in predicting all-cause mortality and a composite outcome of death and heart failure (HF) rehospitalization was quantified using multivariable adjusted Cox regression. Adjustments were made for the following variables: age, sex, history of ischemic heart disease, previous HF, infection as a trigger of AHF, systolic blood pressure, glomerular filtration rate and log-transformed N-terminal pro-B-type natriuretic peptide (NT-proBNP) at presentation. The incremental value of hyponatremia to the MEESSI-Score, a validated AHF risk score, was quantified using area under the curve (AUC) analyses.

Results

Among 1572 patients with AHF, 1499 patients were eligible for the main analysis, of whom 215 (14.3%) had hyponatremia, 1249 (83.3%) normonatremia and 35 (2.3%) hypernatremia at presentation. Of those with hyponatremia, 21 (9.8%) and 54 (25.1%) patients died, 27 (12.6%) and 79 (36.7%) patients experienced the composite outcome within 30 and 180 days, respectively. Multivariable adjusted hazard ratios (aHR) were 0.97 (95%-CI 0.94–1.01) and 0.97 (95%-CI 0.95–0.99) for mortality, 0.97 (95%-CI 0.94–1.00) and 0.98 (95%-CI 0.95–0.99) for the composite outcome within 30 and 180 days, respectively. The risk for mortality and a composite of all-cause mortality and HF rehospitalization within 180 days after presenting to the ED with AHF rose significantly with a lower sodium level at presentation. Each 1-unit decrease in sodium level [mmol/L] was associated with a 3% and 2.7% increase in the hazard rate of mortality (aHR 0.97, p=0.01) and the composite outcome (aHR 0.98, p=0.01), respectively. While in the 30-day analyses after multivariable adjustment sodium had no significant prognostic value. The already excellent predictive ability of the MEESSI-Score for 30-day mortality was not enhanced by sodium level (AUC 0.80 versus 0.80, p=0.834).

Conclusion

Hyponatremia at presentation is associated with a higher risk of 180-day mortality in patients with AHF. However, its role as an independent prognostic marker in risk stratification remains unclear.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swiss National Science FoundationSchweizerische Herzstiftung

Comorbidities Associated with Worse Outcomes Among Inpatients Admitted for Acute Gastrointestinal Bleeding

BACKGROUND

Multimorbidity increases healthcare resource utilization. Little is known on specific comorbidity combinations.

AIMS

To identify comorbidities associated with increased resource utilization among inpatients admitted for gastrointestinal bleeding (GIB).

METHODS

This retrospective cross-sectional study, 1/2010-5/2018 at the University Hospital Zurich, Switzerland, analyzed electronic health records of patients with upper (UGIB) and lower (LGIB) GIB, focusing on length of stay (LOS) and 30-day readmissions for resource use and clinical outcomes, investigated by multivariable regression adjusted for antithrombotics.

RESULTS

Of 1101 patients, 791 had UGIB and 310 LGIB, most often melena and bleeding diverticula, respectively. In UGIB, thromboembolic events showed a trend toward 27% increased LOS (1.27; 95% confidence interval [CI] 1.00-1.61), antithrombotics independently associated with 46% increased LOS (1.46; 95% CI 1.32-1.62). Cancer (odds ratio [OR] 2.86; 95% CI 1.68-4.88) independently associated with 30-day readmissions, anemia showed a trend (OR 1.68; 95% CI 1.00-2.84). In LGIB, none of the investigated comorbidities associated with increased LOS, but antithrombotics independently associated with 25% increased LOS (1.25; 95% CI 1.07-1.46). Atrial fibrillation/flutter (OR 2.69; 95% CI 1.06-6.82) and cancer (OR 4.76; 95% CI 1.40-16.20) associated strongly with 30-day readmissions.

CONCLUSIONS

In both groups, cancer associated with 30-day readmissions, antithrombotics with increased LOS. Thromboembolic events and anemia showed clinically important trends in UGIB. Atrial fibrillation/flutter associated with 30-day readmissions in LGIB. Prospective studies are needed to investigate these complex multimorbid populations and establish appropriate guidelines.

CA 125 in the diagnosis and risk stratification of acute heart failure

Background

Recent evidence confirms the elevation of CA 125 in non-tumor processes such as acute heart failure (AHF). However, the utility of this novel biomarker for diagnosis, prognosis, and therapy guidance in AHF remains unclear.

Purpose

To investigate the potential of CA 125 for diagnosis, prognosis and therapy guidance in unselected AHF patients presenting with acute dyspnea to the emergency department (ED).

Methods

We quantified CA 125 in a blinded fashion among patients presenting with acute dyspnea to the ED in a multicenter diagnostic study. Final diagnosis of AHF including AHF-phenotype was centrally adjudicated by two independent cardiologists. To further characterize CA 125's potential in AHF correlations with established biochemical and imaging markers were assessed. Diagnostic accuracy for AHF was quantified by the area under the receiver operating characteristic curve (AUC). All-cause mortality within 360 days was the prognostic endpoint.

Results

Among 470 patients eligible for this analysis, 268 (57.0%) had adjudicated AHF. CA 125 concentrations at presentation were significantly higher among AHF patients vs. patients with other final diagnoses (45.8 U/ml [interquartile range (IQR), 18.5–110.3] vs. 16.2 U/ml [IQR, 9.6–31.6], p&lt;.001). Patients with worsening heart failure had significant higher CA 125 levels compared to other heart failure phenotypes (p=.018). There was a significant positive correlation of CA 125 and high-sensitivity cardiac troponin T and NTproBNP and a significant negative correlation of CA 125 and left ventricular ejection fraction (correlation coefficients 0.204, 0.220, −0.331, respectively; all ps&lt;.001). CA 125's AUC for AHF was significantly lower compared to NTproBNP's in the overall population (0.72, 95% confidence interval (CI) 0.67–0.76 vs. 0.93, 95% CI 0.90–0.95, p&lt;.001, Figure 1) and in predefined subgroups according to age, gender and renal function. Among 268 AHF patients, 84 (31.3%) died within 360 days of follow-up. CA 125 plasma concentrations above the median indicated increased risk of all-cause mortality (hazard ratio 2.06, 95% CI 1.31–3.24; p=.002, Figure 2). CA 125's prognostic accuracy for 360-days mortality was comparable with NT-proBNP's and high-sensitivity cardiac troponin T's. CA 125 did not independently predict all-cause mortality at 360 days when used in validated multivariable regression models and had no interactions with medical therapies at discharge.

Conclusion

CA 125 may aid physicians in the risk stratification and rapid triage of patients with suspected AHF.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Swiss National Science FoundationSwiss Heart Foundation Figure 1. ROC curve comparisonFigure 2. Kaplan-Meier curve 360 days mortality

Increased symmetric dimethyl-arginine is a predictor factor of decreased platelet reactivity and increased bleeding risk in patients with acute coronary syndrome

Background

One of the promising biomarkers in CVD are asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA), which are products of L-arginine methylation and are both involved in endothelial dysfunction. ADMA, SDMA and L-homoarginine, have emerged as biomarkers linked to cardiovascular outcomes [1].

Purpose

To investigate the association of SDMA with platelet reactivity and bleeding risk in patients with acute coronary syndrome (ACS) treated with potent P2Y12 inhibitors prasugrel and ticagrelor.

Methods

Our prospective observational study enrolled 292 patients with ACS undergoing percuteneus coronary intervention [2]. Plasma concentrations of SDMA were measured during the hospitalization for ACS. Impedance aggregometry was used. The primary study endpoint was the concentration of metabolites and platelet reactivity. The primary clinical outcome endpoint was the incidence of Thrombolysis in Myocardial Infarction (TIMI) bleeding events (major, minor and minimal). The efficacy endpoint was the composite of major adverse cardiac events (MACE: stent thrombosis, myocardial infarction, stroke and cardiac death).

Results

There was an inverse correlation between SDMA serum levels and platelet reactivity (r=−0.25; p&lt;0.000). The ADP+PGE1-induced platelet reactivity was 33% lower among patients with the highest SDMA quartile (4th) as compared to those with the 1–3rd SDMA quartile (8 [0–29] vs 12 [0–126] U; p&lt;0.001). The AA-induced platelet reactivity was 56% lower among patients with the highest SDMA quartile (4th) as compared to those with the 1–3rd SDMA quartile (4 [0–48] vs 9 [0–133]; p&lt;0.001). In a multivariate model, the highest SDMA (4th) quartile was found to be an independent predictor of the lowest ADP+PGE1 and AA induced platelet aggregation (OR: 2.666, 95% CI [1.184–5.999], p=0.018).

Conclusions

Our study shows that high plasma concentration of SDMA, but not ADMA, is independently associated with low platelet reactivity to ADP and AA and is associated with major and minor bleeding events in patients with ACS on potent antiplatelet therapies. Therefore, SDMA might have a potential to be further evaluated as a blood biomarker for individualization of duration and potency of antiplatelet therapies in an ACS population at high risk of bleeding complications.

Acknowledgment

I-COMET research team

Funding Acknowledgement

Type of funding sources: None. Figure 1Table 1

MicroRNAs as disease specific diagnostic biomarkers for neoplastic aetiology-related and inflammatory-related pericardial fluid effusion

Background and aim

Malignant involvement of the pericardium is seen in 1 to 20 percent of autopsies in patients with cancer. The most common metastatic tumor involving the pericardium is lung cancer [1]. We aimed to distinguish the origin of the pericardial fluid effusion (i.e. pericarditis vs cancer) based on miRNAs expression in peripheral blood plasma.

Method

8 patients hospitalized for collection of pericardial fluid with pericardial effusion of neoplastic aetiology (lung cancer). Control group includes 8 patients with effusion of inflammatory aetiology. Plasma RNA was extracted by mirVANAPARISKit and quality of RNA was assessed by fluorometric assay. GEP analysis was performed using the Clariom D pico chips, analysed on the Affymetrix platform. Statistical analysis by TAC software. Additional analyses were performed in and R using Signal information obtained from the TAC output. We performed the following tests using log2 transformed data and all comparison groups (A-F). Additional FDR correction, logistic regression, Mann-whitney t-test was used depending of the variables. We calculated Area under the curve using ROCp R package. Scores were ranging from 0 to 1. Co-expression analysis to identify genes authentically expressed was performed using Spearman correlation (cutoff = 0.9, Rpval = 0.05). In order to identify the targets of DE miRNAs we used our wizbionet R package and previously developed pipelines [2,3]. We performed target screening using multimiR package, selecting top 20% predictions from all available databases.

Results

We analyzed targets for all mature versions, and if DE miR was identified as pre-miR we generated -3p and -5p version for it. We also screened DisgeNet database for genes associated with cancer and pericarditis, we identified 2823 and 157 such genes. After identification of the targets of DE miRNAs we performed data aggregation, summarization and obtained information how many targets overall and targets associated with IS are regulated by each DE miRNA. Additionally we identified top targets regulated by the top miRNAs. MiR-5695, miR-4446-5p, miR-572, miR-3131 and miR-4784 were found the most significantly differentially expressed miRNAs in blood plasma for patients with malignancy compared to pericarditis. MiR-22-3p, miR-642a, miR-6771, miR-140-3p, and miR660-5p were found the most significantly differentially expressed miRNAs in pericardial fluid plasma for patients with malignancy compared to pericarditis. Importantly, miR-500b, miR-5188, miR-490, miR-24-3p, miR-383-3p were found the most promising differentially diagnostic biomarkers for malignancy and inflammatory-related pericardial fluid effusion.

Conclusions

For the first time our results indicate the differentially diagnostic power of miRNAs based on comparison of circulating in peripheral blood and pericardial fluid in patients having excessive pericardial fluid effusion due to different etiologies.

Funding Acknowledgement

Type of funding sources: None. Figure 1Figure 2

High concentrations of plasma trimethylamine-n-oxide is associated with long-term cardiovascular mortality in patients with acute coronary syndrome

Background

Acute coronary syndrome (ACS) remains a leading cause of mortality worldwide [1]. Patients who experienced ACS are at high risk of future cardiovascular events and death [2–4]. Identification of reliable predictive tools could potentially improve the risk stratification [5]. Numerous studies revealed that intestinal microbial organisms (microbiota) and its metabolites, as TMAO (trimethylamine-N-oxide) may play a pathogenic role in a cardiovascular disease (CVD) and ACS [6]. Elevated concentration of circulating TMAO has been associated with increased risk of CVD and major adverse cardiac events (MACE), including myocardial infarction (MI), stroke, major bleeding and all-cause mortality [7].

Purpose

To investigate the association of liver metabolite TMAO with cardiovascular disease (CV)-related and all-cause mortality in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention.

Methods

Our prospective observational study enrolled 292 patients with ACS. Plasma concentrations of TMAO were measured during the hospitalization for ACS. Observation period lasted 7 years in the median. Adjusted Cox-regression analysis was used for prediction of mortality.

Results

ROC curve analysis revealed that increasing concentrations of TMAO levels assessed at the time point of ACS significantly predicted the risk of CV mortality (c-index=0.78, p&lt;0.001). The cut-off value of &gt;4 μmol/L, labeled as high TMAO level (23% of study population), provided the greatest sum of sensitivity (85%) and specificity (80%) for the prediction of CV mortality and was associated with a positive predictive value of 16% and a negative predictive value of 99%. A multivariate Cox regression model revealed that high TMAO level was a strong and independent predictor of CV death (HR=11.62, 95% CI: 2.26–59.67; p=0.003). High TMAO levels as compared with low TMAO levels were associated with the highest risk of CV death in a subpopulation of patients with diabetes mellitus (27.3% vs 2.6%; p=0.004). Although increasing TMAO levels were also significantly associated with all-cause mortality, their estimates for diagnostic accuracy were low.

Conclusions

High TMAO level is a strong and independent predictor of long-term CV mortality among patients presenting with ACS. TMAO concentration of 4 μmol/L may be a cut-off value for prognosis of ACS patients.

Funding Acknowledgement

Type of funding sources: None. Figure 1. Kaplan-Meier curvesTable 1

Fingerprint of novel circulating microRNAs identify patients with stroke-embolic stroke of undetermined source

Background

Stroke is the second-most common cause of death worldwide. Circulating levels of selected microRNAs (miRNAs) were found to be modulated both in animal experimental models and in patients with stroke, opening up new avenues for the identification of more effective and specific biomarkers to identify and risk-stratify stroke patients. Aim of the present study is to identify all circulating miRNAs that are modulated in patients with stroke, to select specific miRNAs to be used as disease biomarkers to improve prognosis.

Methods

48 patients with stroke- ESUS were involved in the study. We have divided the patient groups based on patients who had a second stroke or TIA and did not have (safety vs safety control). Total RNA was extracted from plasma samples quality of extracted material was assessed using a fluorometric electrophoretic assay. MiRNA profiling was performed using the Affymetrix platform using. Statistical analysis was performed in TAC software. Additional analyses were performed in and R using Signal information obtained from the TAC output. We performed the following tests using log2 transformed data and all comparison groups (A-F). We performed additional FDR correction, logistic regression, Mann-whitney test t-test depending if variances were equal or differing. We calculated Area under the curve using ROCp R package. Scores were ranging from 0–1. Co-expression analysis to identify genes authentically expressed was performed using Spearman correlation (cutoff=0.9, Rpval=0.05). In order to identify the targets of DE miRNAs we used our wizbionet R package and previously developed pipelines [1,2]. We performed target screening using multimiR package, selecting top 20% predictions from all available databases.

Results

MiR-4786, miR-1205, miR-548ar-3p and miR-518e-3p were found the most differentially expressed miRNAs between the groups. So far, miR-4786 was studied only in patients with acute leukemia [3]. Several studies showed the importance of miR-1205 in cell carcinoma and ovarian cancer progression [4]. Moreover, so far only one study showed the regulation of miR-548ar-3p in breast cancer [5]. Finally only one study showed the alteration of miR-518e-3p in Parkinsons disease patients [6]. Besides, our enrichment analysis showed Interleukin-2 signaling pathway, Lipid and lipoprotein metabolism, BDNF signaling pathway, MAPK signaling pathway, Intellectual Disability, Alzheimer's Disease are significantly related to ESUS- patients.

Conclusions

Any of those miRNAs were never studied in stroke before, our results identified several novel circulating prognostic biomarkers miRNAs that are down- of up-regulated in ESUS-stroke patients (who had only one vs multiple stroke). Among those several miRNAs were identified that are known to play a role in the pathophysiology of neurovascular diseases, paving the way to a new class of smart pathophysiology-based biomarkers in stroke.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Polish National Science Center OPUS Figure 1Figure 2

Increased Let-7e expression is associated with long-term all-cause mortality and antiplatelet treatment in patients with type 2 diabetes mellitus

Background

In the light of growing prevalence of type 2 diabetes mellitus (T2DM), efforts are made to discover novel biomarkers. MicroRNAs (miRNAs-miR) are non-coding RNAs used in various processes involved in regulating gene expression which play a role in platelet function.

Purpose

To analyze the ability of platelet-derived miRNAs in prediction of mortality and response to antiplatelet treatment among T2DM-patients.

Methods

252 diabetic subjects were enrolled and were receiving either acetylsalicylic acid (ASA) 75mg (65%) or 150 mg (15%) or clopidogrel (19%). Plasma miR-126, miR-223, miR-125a-3p and Let-7e expressions were assessed by qRT-PCR and compared between the patients who survived and those who died. Median observation time was 5.9 years. Adjusted Cox-regression analysis was used for prediction of mortality. Differential miRNAs expression due to different antiplatelet treatment was analyzed.

Results

ROC curve analysis revealed increasing concentrations of miR-126, Let-7e and miR-125a-3p levels had a diagnostic ability for prediction of long-term all-cause mortality (c-index=0.75, p&lt;0.001; 0.72, p&lt;0.001; 0.72, p=0.001, respectively). Multivariate Cox regression model revealed high miR-126 and Let-7e expressions which were strong and independent predictors of all-cause long-term mortality (HR=5.08, 95% CI: 1.92–13.43; p=0.001; HR=5.94, 95% CI: 1.98–17.79; p=0.001,respectively). After including all miRNAs into one multivariate Cox regression model, only Let-7e was predictive of future occurrence of long-term all-cause death (HR=7.83, 95% CI: 1.2–51.1; p=0.032). MiR-126, Let-7e and miR-223 expressions in the clopidogrel group were significantly higher than in the ASA group (p=0.014; p=0.013; p=0.028, respectively).

Conclusions

Let-7e expression is a strong and independent predictor of long-term all-cause mortality among patients with T2DM. MiR-223, miR-126 and Let-7e present significant interactions with antiplatelet treatment and clinical outcomes.

Funding Acknowledgement

Type of funding sources: None. Figure 1Table 1

Prognostic value of self-reported subjective exercise capacity in patients with acute dyspnea

Background

Quantitative assessment of self-reported exercise capacity as provided by the Duke Activity Status Index (DASI) is a validated measure of exercise capacity in stable ambulatory patients.

Objectives

This study aimedto test whether the quantification of self-reported exercise capacityusing the DASI may aid physicians in the risk stratification of patients presenting with acute dyspnea to the emergency department (ED).

Methods

Basics in Acute Shortness of Breath EvaLuation (BASEL V) was a prospective cohort study recruiting dyspneic patients at the ED. The prognostic value and accuracy of theDASI assessed shortly after presentation were quantified using Cox regression analyses and the Area under the curve (AUC).

Results

Among 1019 patients eligible for this analysis 529 (51.9%) had an adjudicated final diagnosis of acute heart failure, 75 (7.4%) and 297 (29.1%) patients died within 90 and 720 days after presentation. Unadjusted hazard ratios (HR) and multivariable adjusted hazard ratios (aHR) for 90-day and 720-day mortality increased continuously from the fourth (best self-reported exercise capacity) to the first DASI-quartile (worst self-reported exercise capacity). For 720-day mortality in the first quartile theHR was 9.1 (95%-CI 5.5–14.9) (aHR 6.1 [95%-CI 3.7–10.1]), in the second quartile 6.4 (95%-CI 3.9–10.6) (aHR 4.4 [95%-CI 2.6–7.3]), while in the third quartile the HR was 3.2 (95%-CI 1.9–5.5) (aHR 2.4 [95%-CI 1.4–4.0]). The prognostic accuracy of the DASI was moderate-to-high and higher than that of B-type natriuretic peptide (BNP) and NT-proBNP (N-terminal pro-BNP) concentrations, e.g. for 720-day mortality prediction AUC 0.70 versus 0.64, p=0.020; 0.72 versus 0.68, p=0.074.

Conclusions

Quantification of self-reported subjective exercise capacityusing the DASI provides moderate-to-high prognostic accuracy in patients presenting with acute dyspnea to the ED and may aid physicians in further risk stratification.

Funding Acknowledgement

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Union, the Swiss National Science Foundation. Duke Activity Status Index

MicroRNA-223 might be a predictive biomarker for major adverse cardiovascular events prognosis in patients undergoing transcatheter aortic valve implantation procedure

Background

Transcatheter aortic valve implantation (TAVI) is an emerging invasive therapeutic strategy for patients with severe aortic stenosis (AS) significantly enhancing not only quality-of-life measures but also improving short-and long-term survival rates.

Purpose

For these purposes we aimed to analyze correlation between expression levels of platelet-derived microRNAs in patients with heart failure (HF) due to AS who underwent TAVI procedure and assess their association with primary major adverse cardiac events (MACE) defined by all cause mortality and secondary MACE defined as cardiovascular mortality, ischemic stroke, and non-fatal myocardial infarction.

Methods

61 patients before and after the TAVI procedure were included. PlasmaRNA was extracted by mirVANA PARIS Kit and quality of RNA was assessed by fluorometric assay. GEP analysis was performed using the Clariom D pico chips, analyzed on the Affymetrix platform. RT-PCR was performed in order to validate the miRNAs in 61 patients by using the Taqman advanced protocol. MiRNA related to platelet function/antiplatelet treatment were chosen among those with the most relevant modulation between the groups. Wilcoxon test was performed for miRNAs comparison before and after TAVI. Calculations were performed using SPSS version 22.0, p&lt;0.05 (IBM Corporation, Chicago, USA).

Results

We have found that miR-223, miR-125b and miR-125a were significantly increased in patients after the TAVI procedure. ROC analysis showed that increased miR-223 expression after the TAVI procedure might slightly have protective value against MACE outcome.

Conclusions

Our analysis showed alteration of circulating miRNAs after the TAVI procedure and miR-223 might have a predictive value for MACE prognosis in patients with HF due to AS who underwent TAVI procedure.

Acknowledgment

I-COMET research team

Funding Acknowledgement

Type of funding sources: None. Figure 1Figure 2

Does maternal age or related factors influence the appearance of psychopathology in children?

Introduction

Maternal age and related factors, such as social vulnerability, are associated with neurodevelopmental and behavioral disorders in offspring.

Objectives

To examine the influence of maternal age and its related factors on the appearance of autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), alterations in executive functions and behavioral syndromes of the offspring.

Methods

A prospective study was conducted, consisting of 131 healthy pregnant women aged 20 to 41 years, recruited at 38 weeks’ gestation. Their offspring were followed up to 2 years after birth, when psychopatology was assessed. Maternal age and possible related factors were considered predictors. Bayesian ordinal regression models were performed for each outcome variable.

Results

Symptoms of ASD in children were associated with an older maternal age (OR = 0.188; 95% CI[1.062, 1.401]) and a lower educational level of the parents (OR = -0.879; 95% CI[0.202, 0.832]), meanwhile poor social support predicted most ADHD symptoms OR = -0.086; 95% CI[0.838, 1]) and executive dysfunctions OR = -0.661; 95% CI[0.313, 0.845]. Lower parental education predicted both externalizing and internalizing behavior.

Conclusions

Maternal age-related factors were the main predictors of neurodevelopmental disorders in offspring, rather than maternal age. The performance of prenatal interventions in pregnant women with advanced age and anxious depressive symptoms or adverse social situation, is crucial to reduce the risk of neurodevelopmental disorders in the offspring. Likewise, being able to carry out an early detection of childhood psychopathology would allow the implementation of resources that improve their long-term prognosis.

Disclosure

No significant relationships.

Standardising clinical outcomes measures for adult clinical trials in Fabry disease: A global Delphi consensus

BACKGROUND

Recent years have witnessed a considerable increase in clinical trials of new investigational agents for Fabry disease (FD). Several trials investigating different agents are currently in progress; however, lack of standardisation results in challenges to interpretation and comparison. To facilitate the standardisation of investigational programs, we have developed a common framework for future clinical trials in FD.

METHODS AND FINDINGS

A broad consensus regarding clinical outcomes and ways to measure them was obtained via the Delphi methodology. 35 FD clinical experts from 4 continents, representing 3389 FD patients, participated in 3 rounds of Delphi procedure. The aim was to reach a consensus regarding clinical trial design, best treatment comparator, clinical outcomes, measurement of those clinical outcomes and inclusion and exclusion criteria. Consensus results of this initiative included: the selection of the adaptative clinical trial as the ideal study design and agalsidase beta as ideal comparator treatment due to its longstanding use in FD. Renal and cardiac outcomes, such as glomerular filtration rate, proteinuria and left ventricular mass index, were prioritised, whereas neurological outcomes including cerebrovascular and white matter lesions were dismissed as a primary or secondary outcome measure. Besides, there was a consensus regarding the importance of patient-related outcomes such as general quality of life, pain, and gastrointestinal symptoms. Also, unity about lysoGb3 and Gb3 tissue deposits as useful surrogate markers of the disease was obtained. The group recognised that cardiac T1 mapping still has potential but requires further development before its widespread introduction in clinical trials. Finally, patients with end-stage renal disease or renal transplant should be excluded unless a particular group for them is created inside the clinical trial.

CONCLUSION

This consensus will help to shape the future of clinical trials in FD. We note that the FDA has, coincidentally, recently published draft guidelines on clinical trials in FD and welcome this contribution.

Sexual function in women with androgen excess disorders: classic forms of congenital adrenal hyperplasia and polycystic ovary syndrome

PURPOSE

We compared the sexual function in women with classic forms of congenital adrenal hyperplasia (CAH) and polycystic ovary syndrome (PCOS) to find if the cause of androgen excess determines sexual functioning.

METHODS

Hundred and four women (21 with CAH, 63 with PCOS and 20 healthy controls) aged 18-40 years were included into the study. All participants completed a questionnaire regarding their sociodemographic background and underwent anthropometric and basic biochemical measurements. Plasma levels of total testosterone, androstenedione, and 17-hydroxyprogesterone were measured with immunoassay. To assess the sexual functions, the Female Sexual Function Index (FSFI) questionnaire was applied.

RESULTS

Apart from the higher physical activity in PCOS patients (P = 0.017), we found no significant sociodemographic differences between the studied groups. In clinical assessment, women with CAH had a lower incidence of acne (P = 0.006). Their plasma levels of 17OHP (P = 0.005) and insulin resistance index (P = 0.0248) were higher, while total testosterone (P = 0.0495) and glucose (P = 0.0061) was lower compared to the PCOS group. Significantly more women with CAH were homosexual (P = 0.003) and bisexual (P = 0.006). CAH group showed a lower total FSFI score (P = 0.0043) and lower scores in three domains: lubrication (P = 0.0131), sexual satisfaction (P = 0.0006), and dyspareunia (P < 0.0001). Higher physical activity was associated in all women with higher total FSFI score (P = 0.009) and scores in the domain of desire (P = 0.034) and sexual satisfaction (P = 0.01), while in CAH women apart from the total score (P = 0.03) and sexual satisfaction (P = 0.002) also in the domains of orgasm (P = 0.005), and pain (P = 0.03).

CONCLUSIONS

CAH women present more often homosexual and bisexual orientation, while their sexual functions are impaired compared to PCOS patients.

Safety of percutaneous dilatational tracheotomy (PDT) with the rigid tracheotomy endoscope (TED): a 6-month follow-up multicenter investigation

Background

The rigid tracheotomy endoscope (TED) was recently introduced to improve the fiberoptic technique during percutaneous dilatational tracheotomy (PDT) in critically ill patients. The aim was to evaluate the long-term complications of PDT using TED equipment in a prospective multicenter investigation.

Methods

One hundred eighty adult patients underwent PDT using TED in four German hospitals. Patients who were alive or their guardians were contacted via telephone and interviewed using a structured questionnaire 6 months following the tracheostomy procedure. Patients with airway complaints were invited for outpatient clinical ENT examination. The incidence of adverse events related to PDT was registered.

Results

Of 180 patients who received tracheostomy, 137 (76.1%) were alive at the time of follow-up. None of the 43 lethal events was related to the PDT. Fifty-three (38.7%) patients were available for follow-up examination, whereas 14 (10.2%) were able to visit ENT physicians. Two (3.8%) out of 53 patients developed tracheocutaneous fistula with required surgical closure of tracheostoma. Dyspnea (7.5%), hoarseness (5.7%), stridor and swallowing difficulties (both with 3.8%) were the most common complaints. Tracheal stenosis was confirmed in 1 patient (1.88% [95% CI: 0.33; 9.93]).

Conclusion

The use of TED for PDT in the clinical setting is safe regarding adverse events at 6-month follow-up. The incidence of tracheal stenosis after PDT with TED is comparable with that of flexible bronchoscopy; however, its role for PDT at the intensive care unit should be clarified in further investigations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12871-021-01264-2.

46 Use of time-lapse imaging technology to assess relationships of morphological and phototextural attributes of presumptive ovine zygotes and early embryos with their developmental competence invitro

The assessment of morphology and digital image opacity may provide valuable information on embryo viability because such traits are linked to embryonic gene expression, metabolism and ultrastructure. Time-lapse imaging has been used in research to monitor the dynamic nature of the developing pre-implantation embryo, which includes capturing alterations in various morphological parameters over time. The present study examined the effectiveness of time-lapse technology in assessing several morphometric and phototextural parameters for predicting the developmental potential of ovine embryos. The development of 37 long wool sheep embryos from IVF to the blastocyst stage was monitored and evaluated using Primo Vision time-lapse imaging technology. Image-Pro Plus software was then used to measure zona pellucida thickness, embryo diameter, cellular grey-scale pixel intensity and heterogeneity, and total area of the perivitelline space. A one-way analysis of variance (ANOVA) was done using SigmaPlot® 11.0 for all attributes at various time points during embryo development [i.e. presumptive zygote stage, t(0); first cleavage, t(2) or t(3); second cleavage, t(4) or t(6); and third cleavage, t(7) or t(8)]. Our results indicate that most parameters analysed did not differ among embryos varying in their developmental fate, with the exception of the perivitelline space area, which was greater (P&lt;0.05) for non-dividing embryos than for future blastocysts at the presumptive zygote stage (4040±4137 vs. 857±642µm2, respectively; mean±s.d.). Consequently, the measurement of perivitelline space at t(0) could be used to predict developmental potential of invitro-produced ovine embryos, but further investigation is required.

Not chronic exercise but acute exercise is related with increased cell survival, enhanced cell proliferation and decreased cell apoptosis

Background

Endurance training can be described as long-time activity characterized by high dynamic and low to high power and was proven beneficial in CVD prevention. Nevertheless, studies reported that excessive endurance training can act as double-edged sword inducing the inflammatory response and cell apoptosis. This negative effect can be the reason of exercise duration.

Purpose

In order to investigate the effect of the training duration we compared and analysed acute vs chronic exercise by using in silico technique and we performed two different bioinformatics analysis: tissue-specific and cardiovascular process specific.

Materials

Bioinformatics analysis miRNA targets predictions, data filtering and visualization as interaction networks were performed. We used multiMiR 1.4 R package, hemopoiesis, angiogenesis, cardiac muscle functions, muscle hypertrophy process was performed a screening of the GO terms for the presence of the key words using the biomaRt package in R, Gene-gene interaction data were retrieved from String App, Cytoscape. Enrichment analysis of Reactome and KEGG pathways using String App. p&lt;0.05.

Results

Enrichment analysis of Reactome and Kegg pathways revealed strong regulation of senescence-related pathways, RUNX1 expression and activity, Ca2+ signaling involving AGO genes. For the first time our in silico analysis showed that AGO, HMGA2 genes may be associated with adaptive changes in response to exercise. Importantly, we found, that PI3K/AKT signalling (pathway incusing cell survival, growth, and proliferation) was present only in acute but not in chronic exercise.

Conclusions

In our analysis long-term training miRNA-gene target interaction was different than the short-term training. As PI3K/AKT signaling was present only in acute exercise, we suggest that not long-term but short-term training can be related with increased cell survival, enhanced cell proliferation, and decreased cell apoptosis.

Genes associated cardiac muscle function

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): “Preludium” from the National Science Center, Poland

Prognostic value of health-related quality of life in patients with acute dyspnea

Background

Previous studies have shown the prognostic value of health-related quality of life (HRQL) in stable and ambulatory chronic heart failure patients. However, it is unknown whether HRQL can predict all-cause mortality in patients presenting to the emergency department (ED) after acute onset of symptoms. In order to address this unmet need, the aim of this study was to assess the prognostic value of HRQL in patients with acute dyspnea caused by acute heart failure (AHF) and other dyspnea aetiologies for 360-day mortality.

Purpose

To assess prognostic value of HRQL using the generic EQ-5D and visual analogue scale (EQ VAS) in patients with acute dyspnea.

Methods

Basics in Acute Shortness of Breath EvaLuation (BASEL V) is a prospective, multicenter, diagnostic study enrolling adult patients presenting with acute dyspnea to the ED. For this analysis, only patients with a complete set of variables necessary for calculation of EQ-5D (range 0–10; with higher score indicating worse HRQL) and EQ VAS (range 0–100; with 100 being the best imaginable health state) at baseline were included. The endpoint was the prognostic value of EQ-5D and EQ VAS at 360 days of follow-up regarding all-cause death. Prognostic accuracy was calculated using c-statistics. In a cox regression analysis EQ-5D was treated as both, a continuous and categorical variable. Adjustments were made for clinically relevant covariates (age, sex, orthopnoea, edema, level of N-terminal pro-B-type natriuretic peptide (NT-proBNP) at presentation, history of coronary artery disease and chronic obstructive pulmonary disease, diuretics, β-blockers and ACE-inhibitors at discharge).

Results

Among 2605 patients enrolled, 1141 (43,8%) had a complete set of variables allowing the calculation of EQ-5D and EQ VAS. Of these patients 594 (52.1%) had an adjudicated final diagnosis of AHF. 211 (18.5%) patients died within 360 days of follow-up. Median EQ-5D was 3 (interquartile range (IQR) 1.5–5) and median EQ VAS was 50 (IQR 40–70). The prognostic accuracy for 360-day mortality was 0.65 (95% confidence interval ((CI) 0.61–0.69) and 0.58 (95% CI 0.54–0.62) for EQ-5D and EQ VAS, respectively (p=0.002). After combining EQ-5D and EQ VAS in a logistic regression model c-statistics regarding all-cause mortality within 360 days did not improve. The prognostic accuracy of EQ-5D was comparable to that of NT-proBNP (c-statistics 0.69, p=0.385). In an adjusted cox regression analysis the hazard ratio for patients with EQ-5D &gt;4 was 2.2 (95% CI 1.7–2.9; p&lt;0.001).

Conclusions

In patients presenting with acute dyspnea HRQL is a strong prognostic instrument. Independently of the aetiology of the dyspnea the prognostic value of the generic EQ-5D for 360-day mortality is comparable to NT-proBNP. Patients with an EQ-5D &gt;4 are at significantly higher risk for mortality within 360 days.

Figure 1. Prognostic value of HRQL

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Swiss National Science Foundation, Swiss Heart Foundation

The impact of chemotheraphy and supervised high-intensity interval physical activity on left ventricle strain and myocardial work parameters – SPORT NATHY TRIAL pilot study results

Introduction

Cardiotoxic effect of chemotheraphy represents known and challenging problem, thus search for potentially cardioprotective factors plays a key role in the contemporary cardio-oncology. Physical activity may allievate side effects of chemotheraphy and improve quality of live. Myocardial Work is a novel echocardiographic technique and promising tool for cancer patients assesement.

Purpose

The aim of this randomised pilot study was to assess left ventricle function using speckle tracking myocardial strain (2D STE) with Myocardial Work (MW) module in young women undergoing neoadjuvant chemotheraphy due to breast cancer and the impact of supervised high-intensity interval physical activity on these echocardiographic parameters.

Material and methods

We evaluated 24 women aged 27–41 (mean 34±4 yrs) with invasive breast cancer undergoing standard neoadjuvant chemotheraphy and randomized them into two groups: control - (CG, 15 pts) and experimental - with 6 months of supervised high-intensity interval exercise (SHIIEG, 9 pts). Every patient underwent echocardiographic examination 2D STE and MW before chemotheraphy and at 6 months follow-up. The following parameters were evaluated: Global Longitudinal Strain (GLS), Global Work Index (GWI), Global Constructive Work (GCW), Global Work Efficiency (GWE), Global Waste Work (GWW).

Results

Following parameters significantly decreased after chemotherapy: EF (65.4±5.7 vs 60.5±7.0%; p=0.003), GLS (20.4±2.5 vs 18.4±2.0%; p=0.001), GWI (1835.4±206.9 vs 1594.1±228.3 mmHg%; p=0.0004), GCW (2240.5±270.8 vs 1884.9±241.3 mmHg%; p=0.0001), GWE (95.9±1.5 vs 94.9±1.7%; p=0.02). No signifficant changes in GWW (78.6±36.4 vs 80.5±32.2 mmHg%; p=0.7) were found.

The comparison of control (CG) and experimental group (SHIIEG) at 6 months follow-up revealed no signifficant differences in the following parameters: GLS (p=0.9), GWI (p=0.3), GCW (p=0.2), GWE (p=0.3) and GWW (p=0.5). However analysis of relative percentage change from baseline in GLS and GWW (Δ%GLS, Δ%GWW) almost reached statistical significance [for CG and SHIIEG respectively: Δ%GLS (−15.6 vs −4.4; p=0.07), Δ%GWW (+39.4 vs −7.3; p=0.06)].

Conclusions

Neoadjuvant chemotherapy administered in young women with invasive breast cancer impaires the function of left ventricle after 6 month of theraphy, resulting in decrease of GLS, GWI, GCW and GWE. The supervised high-intensity interval physical activity impacts the relative change of GLS (Δ%GLS) and GWW (Δ%GWW), therefore may have cardioprotective effect on left ventricle function.

Funding Acknowledgement

Type of funding source: Public hospital(s). Main funding source(s): Greater Poland Cancer Centre, Poznan, Poland

Direct comparison of BNP and NT-proBNP for mortality prediction in patients with acute dyspnea

Background

It is unclear whether BNP or NT-proBNP, their admission or discharge measurement or percentage change during hospitalization are preferable for mortality prediction in patients with acute dyspnea.

Purpose

To directly compare BNP and NT-proBNP regarding their potential in mortality prediction in patients with acute dyspnea and in patients with dyspnea due to AHF.

Methods

In a prospective multicenter diagnostic study the presence of AHF was centrally adjudicated by two independent cardiologists among patients presenting with acute dyspnea. The levels of BNP and NT-proBNP were measured at presentation and discharge. Patients were stratified according to their natriuretic peptide response (responders vs. non-responders: natriuretic peptide decrease ≥25% vs. &lt;25% before discharge). Prognostic accuracy for 720-day mortality was quantified using the area under the receiver-operating-characteristic curve (AUC). Cox proportional hazard models were constructed to identify significant predictors for 720-day mortality.

Results

Among 1156 patients presenting with acute dyspnea, 353 (30.5%) died within 720 days of follow-up. Prognostic accuracy for death at 720 days was significantly higher for discharge compared to admission measurements for BNP (AUC 0.750 vs. 0.711, p&lt;0.001) and NT-proBNP (AUC 0.769 vs. 0.720, p&lt;0.001). When directly comparing discharge measurements, NT-proBNP levels exhibited a significantly higher accuracy (p=0.013). 632 (54.6%) and 600 (51.9%) patients were BNP and NT-proBNP non-responders, respectively. Among BNP and NT-proBNP non-responders 202 (32%) and 207 (34.5%) patients died within 720 days of follow-up. After adjusting for common covariates NTproBNP response was the strongest predictor for 720-day mortality in a Cox regression model (Hazard ratio for NT-proBNP non-responders: 2.096 (95% CI 1.550–2.835), p&lt;0.001). Results were confirmed in a sensitivity analysis of 687 (59.4%) patients with adjudicated AHF.

Conclusion

Percentage change of NT-proBNP during hospitalization seems to be the strongest predictor for long-term mortality in patients with acute dyspnea in general and in those with dyspnea due to AHF in particular.

ROC curve for direct comparison

Funding Acknowledgement

Type of funding source: None

Quantifying inflammation using interleukin-6 for improved phenotyping and risk stratification in acute heart failure

Background

Acute heart failure (AHF) is the most common cause of hospital admission and continues to have unacceptable high rates of mortality and morbidity. In contrast to acute myocardial infarction, the pathophysiology of AHF is incompletely understood and risk-prediction is poorly defined.

Aim

We aimed to quantify systemic inflammation to assess its possible role in the pathophysiology and risk stratification of patients with AHF.

Methods

Using a novel Interleukin-6 immunoassay with unprecedented sensitivity (limit of detection 0.01ng/l) we quantified systemic inflammation in unselected patients presenting with acute dyspnea to the emergency department in a multicenter study. Plasma concentrations of NT-proBNP (open label) and Interleukin-6 (blinded) were measured at presentation and at discharge. The final diagnosis of AHF and the AHF phenotype were adjudicated by two independent cardiologists. 1-year mortality was the prognostic endpoint.

Results

Among 2042 patients, 1026 (50.2%) had an adjudicated diagnosis of AHF. Interleukin-6 concentrations were significantly higher in AHF patients compared to patients with other causes of dyspnoea (11.2 [6.1–26.5] ng/l vs 9.0 [3.2–32.3] ng/l, p&lt;0.0005). Among patients with AHF Interleukin-6 concentrations were elevated (&gt;4.45ng/l) in 83.7% of them. Among the different AHF phenotypes, Interleukin-6 concentrations were highest in patients with cardiogenic shock (25.7 [14.0–164.2] ng/l) and lowest in patients with hypertensive HF (9.3 [4.8–21.6] ng/l, p=0.001). Inflammation as quantified by Interleukin-6 was a strong predictor of 1-year mortality both in AHF as well as in other causes of acute dyspnea (Figure). During in-hospital treatment Interleukin-6 concentrations significantly decreased in AHF patients. However, changes in the extend of systemic inflammation (delta Interleukin-6) were poorly correlated with changes in hemodynamic stress as quantified by NT-proBNP (delta NT-proBNP, Φc=0.11, p=0.004).

Conclusions

An unexpectedly high percentage of patients with AHF have subclinical systemic inflammation that can be quantified by Interleukin-6, which seems to contribute to the AHF phenotype and to the risk of death.

Kaplan Meier curves for mortality

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): Swiss National Science Foundation, Swiss Heart Foundation, European Union, Stiftung für kardiovaskuläre Forschung Basel, University of Basel, University Hospital Basel

Tracheotomy When and Where?

The time for elective tracheotomies has been discussed for years in what has become very comprehensive literature by now. In this chapter, studies with high levels of evidence are taken into account and recommendations are given for the timing of tracheotomies in long-term ventilated patients, with the individual decision being at the center of consideration.

Tracheotomies can be performed both in the operating room and in an intensive care unit. The criteria for such choice are presented under interdisciplinary medical and organizational aspects.

Impact of temperature on the physicochemical, structural and biological features of copper-silica nanocomposites

Classical wet chemical synthesis was used to fabricate a hybrid composite that contained copper nanoparticles (average size ∼1 nm), which were embedded into a silicon oxide carrier. The structural and chemical alternations in the copper-functionalized silica were investigated in systems that were sintered at 573 K, 873 K, 1173 K, and 1473 K. A general trend, which was associated with the transformation of metallic copper with a cubic structure into copper(II) oxide with a monoclinic structure in the heat-treated systems, was found. XPS and FTIR spectroscopies also revealed the presence of copper(I) oxide, which formed a shell around the CuO. SEM and TEM showed gradual densification of the hybrid system at ever higher sintering temperatures, which corresponded with the gradual copper agglomeration. A temperature of 873 K was determined to be the temperature at which amorphous silica was transformed into cristoballite and tridymite, as well as the formation of a bulk-like copper structure. In relation to the physicochemical and structural data, high antimicrobial features that had a relatively low toxicity effect on the normal human fibroblasts (NHDF) below 250 mg/L was found for the initial copper-silica composite and the samples that were sintered at 573 K. In turn, a significant decrease in the biological impact was observed in the samples that were sintered at temperatures above 573 K. As a result, the paper discusses the model of structural modifications in copper-silica nanocomposite concerning their biological impact that was developed.

Clinical experience and results with a Rhombic Plate for transoral endoscopically-assisted osteosynthesis of fractures of the condylar neck

The intraoral approach is favoured by many patients and surgeons for the treatment of fractures of the condylar neck, but the limited space offered by this approach can make positioning and fixation of the osteosynthesis plate difficult. A rhombic-shaped plate was designed specifically for use with the intraoral approach, and introduced into our clinical practice in 2012. We present the clinical and functional results in 81 patients with 98 fractures of the condylar neck who we have treated with this technique. Of these six required surgical revision, and ultimately all but two had satisfactory occlusion and mandibular function. Our complication rate of 6/81 (7.4%) compares favourably with those reported elsewhere, and confirms that open reduction and internal fixation of condylar fractures using the Rhombic plate through an intra-oral approach provides good outcomes.

P1656Incremental value of interleukin-6 and C-reactive protein to the MEESSI acute heart failure risk score

Background

The MEESSI-acute heart failure (AHF) risk score has high accuracy in the prediction of 30-day mortality in patients presenting with AHF and may be considered the current gold standard for this indication.

Purpose

As the original MEESSI model does not include measurements of inflammatory biomarkers, the impact of interleukin-6 or C-reactive protein (CRP) on the model's goodness of fit is unknown.

Methods

In a prospective multicenter diagnostic study the presence of AHF was centrally adjudicated by two independent cardiologists among patients presenting with acute dyspnea to the ED. The MEESSI-AHF risk score was calculated using a recalibrated model containing 12 independent risk factors. The incremental value of interleukin-6 and CRP was examined by the use of logistic regression analysis and enter method variable selection with an entry criterion of p<0.05. Goodness of fit tests were performed to measure the updated model's discrimination and calibration.

Results

In 1247 patients with adjudicated AHF, the MEESSI-AHF risk score was calculated. Of these, 1113 patients (89.3%) had available measurements of interleukin-6 and CRP. In the logistic regression analysis both biomarkers had a highly significant impact on the MEESSI model (p<0.001, respectively). Compared to the original MEESSI-Model (c-statistic, 0.79 (95% CI, 0.75–0.83)) the addition of interleukin-6 (c-statistic, 0.81 (95% CI, 0.77–0.85)) or CRP (c-statistic, 0.83 (95% CI, 0.79–0.86)) significantly improved the model's discrimination (p=0.022 and p=0.011, respectively). When assessing the cumulative mortality, the gradient in 30-day mortality over six predefined risk groups was increased by addition of interleukin-6 or CRP. 30-day mortality rates in the lowest and highest risk groups of the original model were 0.4% and 32.5% compared to 0% and 34.9% in the model updated with interleukin-6 and 0.6% and 37.6% in the model updated with CRP. All compared models showed good overall calibration (Hosmer-Lemeshow p=0.302 (original model), p=0.136 (model updated by interleukin-6) and p=0.902 (model updated by CRP)).

Discrimination original_updated

Conclusion

There is significant incremental value of interleukin-6 and CRP to the MEESSI score as indicated by the improved goodness of fit compared to the original model.

Acknowledgement/Funding

European Union, the Swiss National Science Foundation, the Swiss Heart Foundation, the Cardiovascular Research Foundation Basel,

P899Long-term evolution of Fabry cardiomyopathy under enzyme replacement therapy in the Swiss Fabry cohort. An echocardiographic study

Introduction

Fabry cardiomyopathy may present with left ventricular hypertrophy (LVH) and enzyme replacement therapy (ERT) aims to slow its progression in affected patients. LVH progression may be observed despite ERT and the aim of this study was to identify predictors of adverse LV remodeling under treatment.

Methods

This multicentric study included consecutive Fabry patients receiving ERT and for whom a clinical follow-up (FU) with echocardiography (TTE) of at least 5 years was available. The first TTE was performed at the time of ERT start and disease progression was defined as an increase in LV mass index between the first and the last available FU TTE.

Results

Sixty-one patients (median age 35 years [23–48] and 40 (66%) men) were included with a median FU of 10.5 years [7.2–12.2]. Progression was seen in 33 (54%) patients with an annual increase in LV mass index of 1.8 g/m2/year [0.7–3.2] (vs −0.8 g/m2/year [−1.6 to 0.4] in the non-progression group). Presence of LVH (>95 g/m2 in women or >115 g/m2 in men) at the start of ERT was the only morphological baseline parameter significantly associated with progression after adjustment for age, gender and baseline arterial hypertension (OR 22.5, 95% CI 2.7–188.3, p=0.004). Over the FU duration, patients with baseline LVH (n=22) had higher increase in LV diastolic diameter (2.3±4.9 mm vs 0.9±4.1, p=0.009), a lower increase in relative wall thickness (−1.7±14.1% vs 4.6±9.8%, p=0.04), and a higher increase in LV mass index (22±22 g/m2 vs 0±17 g/m2, p=0.001), as compared with patients with no baseline LVH. While no difference was seen in the evolution of the LV ejection fraction, a faster decline in diastolic function was observed in patients with baseline LVH, with a higher increase in E/e' ratio (5.9±7.4 vs 1.1±2.8, p=0.001) and in left atrial diameter (4.7±5.4 mm vs 1.8±5.2 mm).

Baseline characteristics All (n=61) No LVH (n=39) LVH (n=22) p Age (years) 35 [23–48] 17 [21–36] 50 [44–54] <0.001 Male gender 40 (66%) 22 (56%) 18 (82%) 0.79 Arterial hypertension 10 (17%) 3 (8%) 7 (31%) 0.03 LV mass index (g/m2) 105±43 79±18 150±38 <0.001 Mitral E/e' ratio 7.8±5.0 6.7±2.0 9.9±7.8 0.02

Conclusion

Over a median FU of over 10 years, LV wall thickness, LV mass and LV diastolic function remained stable under ERT, providing the treatment was started, early, i.e. before development of LVH. If LVH is already present at baseline, ERT appears to be less effective, with significant progression in LV mass and significantly faster decrease in diastolic function.

Nonmelanoma Skin Cancer with Skull Infiltration and Cranial Involvement

BACKGROUND

Skin cancer is an uncommon cause of skull invasion, dural infiltration and brain parenchyma involvement.

CASE REPORT

We report on a series of three elderly patients who presented with squamous cell carcinoma of the scalp with skull bone and cerebral invasion and discuss the diagnostic and therapeutic challenges.

CONCLUSION

A major factor of delayed diagnosis of this potentially life-threatening skin cancer feature is patients' neglecting.

Dermatoporosis - The Chronic Cutaneous Fragility Syndrome

Dermatoporosis is an important clinical condition leading to chronic skin fragility. It can be separated into primary and secondary subtypes, with the latter induced by medical drugs and environmental factors. Dermatoporosis can be classified into 4 major stages with increasing morbidity and mortality with the advanced stages. Its aetiology has been related to the epidermal hyalusome. Dermatoporosis is a cause of mortality in the intensive care unit and should be known not only by a dermatologist but another medical speciality as well. Prevention is of major importance. Therapeutic options are limited but available.

Computerized 4-choice reaction time test for the measurement of psychomotor recovery after general anesthesia

The recovery of patients after general anesthesia is usually estimated by using clinical scores. Since there is a lack of objective methods for assessing psychomotor recovery, the aim of this study was to evaluate three psychological tests for this purpose. Patients, scheduled for ambulatory gynecological surgery, underwent 3 standard psychological tests before (T1), 15 min after the surgery (T2) and on discharge from the recovery room (T3). The tests used were Wechsler memory scale (test 1, working memory capacity), d2-test (test 2, concentration endurance) and computer-based 4-choice-reaction time (4CRT, test 3, reaction time) as well as Postanesthesia Discharge Scoring System (PADSS). The same test battery was used in healthy female volunteers, all test results were compared at the different time points. In 109 patients, working memory capacity and concentration (tests 1 and 2) decreased, the reaction time (test 3) was prolonged at T2 in comparison with T1 and T3 (P < 0.01). PADSS increased from 8 (T2) to 10 (T3) (medians, P < 0.001). Fifty-seven healthy volunteers demonstrated a practice effect in all 3 tests through the course of the study (P <0.01). 4CRT test had shortest duration and enabled computerized data processing. All three tests objectively assess the recovery of psychomotor function in patients after general anesthesia, the computer-based 4CRT seems to be the most convenient for the clinical routine.

Physicochemical and structural features of heat treated silver-silica nanocomposite and their impact on biological properties

In the last few decades, many nanostructures with varying properties and possible applications have been developed. These materials have been intended to work in various environmental temperature conditions. In this context, the main challenge has been to comprehend the impact of synergic interaction between individual elements included in non-annealed materials in relation to systems subjected to temperature impact. Another problem has corresponded to the impact of thermal modification on organisms such as bacteria and human cells. Such problems can be solved by the fabrication of a nanocomposite with mono-dispersed 8 nm silver (Ag⁰ or Ag⁺) embedded into a silica carrier, followed by the analysis of the impact of heat treatment under various temperature conditions on its physicochemical features. Therefore, methodical studies reported in this text have shown an increase of silver particle size up to 170 nm, a decrease of its concentration, as well as the formation of sub-nanometer Ag⁺ and/or Ag²⁺ clusters as the temperature rises to 1173 K. In turn, the structurally disordered silica carrier had been entirely transformed to cristobalite and tridymite only at 1473 K as well as partial reduction of Ag²⁺ to Ag⁺. Simultaneously, inhibition of growth of Gram-positive and Gram-negative bacteria, as well as an increase in cytotoxicity towards human cells was observed as the temperature rose. As a final point, for the first time, a "pseudo" phase diagram of the structural alterations in the Ag/SiO₂ nanocomposite has been created, as well as a model of silver-silica transformation to biological systems has been developed.

The Viability of Serval (Leptailurus serval) and Pallas Cat (Felis manul) Oocytes after Cryopreservation Using the Rapid-I Method

BACKGROUND

Vitrification by Rapid-I method could be essential for felid rescue programs to protect wild felid in the future.

OBJECTIVE

This study was aimed at adapting the Rapid I method and evaluating the viability of serval and Pallas cat oocytes compared to oocytes of the domestic cat.

MATERIALS AND METHODS

Oocytes after collection and in vitro maturation were vitrified using Cryotech medium (Cryotech, Japan) and a Rapid-I device (Vitrolife, Sweden). To evaluate viability, oocytes after warming were stained with fluorescein diacetate and ethidium bromide.

RESULTS

Survival rate in the control group (domestic cat) was 75 %. In the experimental group, 70% (serval) and 60% (pallas cat) viable oocytes were found.

CONCLUSION

The Rapid-I method can be applied successfully for the vitrification of wild felid oocytes.

Using Rapid I Method for Vitrification of Bovine Oocytes

BACKGROUND

Vitrification is commonly used for cryopreservation of gametes.

OBJECTIVE

The study aimed at evaluating viability and developmental competence of bovine oocytes vitrified by Rapid-I method.

MATERIALS AND METHODS

Oocytes after collection (group 1) and IVM (group 2) were vitrified using medium containing 18% Ficoll, 40% ethylene glycol, 0.3 M sucrose. To evaluate viability, oocytes after warming were stained with fluorescein diacetate and ethidium bromide. In experiment 2, oocytes after IVM and vitrification were activated by 0.5 µM ionomycin in TCM 199 combined with 2 mM 6-DMAP in TCM 199 with 10% fetal bovine serum.

RESULTS

Survival rate in group 1 was 58%, and 88% in the control. In group 2, 63% viable oocytes were found, compared to 82% in the control group. After parthenogenetic activation 27.2% morulas were observed. This percentage was lower than in the non-vitrified group (31%).

CONCLUSION

Maturity stage of bovine oocytes has no effect on their survival after vitrification.