An altered balance of plasma arginine metabolites is associated with increased thickness of the coronary intima-media complex in the adjacent to the culprit segment of an infarct-related artery

Background

The biomarkers of atherosclerosis remain insufficiently understood.

Purpose

We sought to investigate whether an altered balance of arginine metabolites in patients following myocardial infarction (MI) is associated with remodeling of the adjacent to the culprit segments of an infarct-related artery (IRA) and with clinical outcomes.

Methods

Arginine and its metabolites including ornithine, citrulline, proline and asymmetric dimethylarginine were measured using liquid chromatography and tandem mass spectrometry in 85 consecutive ST-segment elevation MI patients upon admission and at 6-month follow-up and were compared with morphology of the adjacent to the culprit proximal and distal 10-mm segments of IRA assessed with optical coherence tomography. A composite ischemic event was defined as death, recurrent MI, stroke, or unplanned percutaneous coronary intervention.

Results

The ratios of citrulline/ornithine and citrulline/arginine decreased 5.22 and 2.20 times (both P<0.001) respectively, while the ornithine/arginine index (I_O/A) increased 2.96 times (P<0.001) following ischemia compared with stable follow-up, indicating the enhanced arginase activity over nitric oxide synthase (NOS) in acute phase of STEMI. Follow-up I_O/A correlated with the mean intima-media (R=0.34, P=0.003, Figure 1A) and intima (R=0.30, P=0.008) diameter of an adjacent to the culprit IRA segment. By multivariate analysis, apart from male gender (P<0.001) and diabetes mellitus (P=0.02), a higher follow-up I_O/A was associated with the larger mean intima-media diameter of an adjacent to the culprit IRA segments (coefficient 0.218, 95% confidence interval 0.040–0.397, P=0.017, per 0.01). Within the median follow-up of 25 (19–35) months, ischemic composite endpoint was found in 13 (15.3%) patients. The follow-up I_O/A reached the area under the ROC curve of 0.78 (95% confidence interval 0.66–0.91, P=0.005) for prediction of composite ischemic endpoint with a cut-off value of ≥0.57, and a sensitivity of 72.3% and specificity of 80.0% (Figure !B).

Conclusions

Our findings provide arguments that during the acute phase of MI, arginine metabolism is shifted from NOS towards arginase, as compared to 6-month stable conditions. Simultaneously, the enhanced residual arginase activity over NOS in chronic phase was correlated with a higher thickness of intima or intima-media in the adjacent to the culprit segment within the IRA, and was also associated with unfavorable clinical outcomes.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Grant of the National Science Center of Poland (Number 2016/21/B/NZ5/01378 to J.Z.)

Use of statins in cancer patients following acute myocardial infarction and its impact on long-term clinical outcomes

Background

Statin use and its impact on long-term clinical outcomes in cancer patients following acute myocardial infarction (MI) remains insufficiently elucidated.

Purpose

We sought to analyze the prevalence of statins use in MI patients with cancer hospitalized in a tertiary cardio-oncology center and its influence on long-term mortality.

Methods

Of the 1,011 consecutive acute MI patients hospitalized between 2012 and 2017, cancer was found in 134 (13.3%) subjects including newly diagnosed cancer in 24 of them. All patients underwent coronary angiography. Within a median follow-up of 69.2 (37.8–79.9) months, a mortality rate, and its determinants were analyzed.

Results

Compared with non-cancer population, MI patients with cancer were older (73 [66–79] versus 68 [60–78] years, P<0.001), had lower hemoglobin level (12.8 [11.2–14.0] vs 13.8 [12.8–15.0], P<0.001), lower total cholesterol (4.1 [3.4–4.8] vs 4.4 [3.6–5.3], P=0.006) and lower HDL cholesterol (1.1 [0.9–1.4] vs 1.2 [1.0–1.6], P<0.001), without significant differences in LDL cholesterol (2.5 [1.9–3.1] vs 2.6 [1.7–3.4], P=0.70). Statins were prescribed less frequently in MI patients with cancer as compared with non-cancer MI population (80.5% versus 92.1%, P<0.001). Atorvastatin was the most frequent statin in both cancer and non-cancer groups (68.4% versus 75.1%, P=0.13). In cancer group simvastatin was more frequently (16.7% versus 5.9%, P<0.001) while rosuvastatin was less frequently (8.8% versus 18.9%, P=0.007) prescribed than in non-cancer patients. The independent determinants of no use of statins were anemia (hazard ratio [HR] 2.3, 95% confidence interval [95% CI] 1.3–4.2, P=0.006), no coronary artery stenosis >50% (HR 5.0, 95% CI 2.5–10.1, P<0.001) and cancer (HR 1.9, 95% CI 1.01–3.7, P=0.049) but not LDL cholesterol. The mortality rates were significantly higher in MI patients not treated with statins, both in non-cancer population (29.5%/year versus 6.7%/year, P<0.001) as well as in cancer group (53.9%/year versus 24.9%/year, P<0.05) as compared to those treated with statins (Figure 1). No statin use (HR 2.3, 95% CI 1.8–3.0, P<0.001), an active cancer (HR 2.3, 95% CI 1.8–3.0, P<0.001), patient's age (HR 2.3, 95% CI 1.8–2.9, P<0.001, per year) and anemia (HR 1.7, 95% CI 1.4–2.1, P<0.001) independently increased long-term mortality while no coronary artery stenosis >50% (HR 0.65, 95% CI 0.44–0.96, P=0.03) and better left ventricular ejection fraction (HR 0.97, 95% CI 0.96–0.98, P<0.001, per 1%) improved long-term survival.

Conclusions

An active cancer, anemia and lack of significant coronary lesions were associated with no use of statins in patients following MI. By multivariable approach both no statins use in MI patients independently on an active malignancy were associated with unfavorable long-term outcomes.

Funding Acknowledgement

Type of funding sources: None.

The determinants and significance of intraluminal stent protrusion in patients with acute myocardial infarction

Background

The mchanisms leading to intraluminal stent protrusion in patients following primary coronary angioplasty for ST-elevation myocardial infarction (STEMI) are not fully elucidated.

Purpose

We sought to investigate composition of stent protrusion, its systemic and local determinants as well as its consequences for epicardial blood flow restoration in STEMI patients.

Methods

We enrolled 85 STEMI patients with median age 61 (interquartile range 54–69) years. In all patients optical coherence tomography of an infarct-related artery was performed first following epicardial blood flow restoration after aspiration thrombectomy and second after final stent deployment. On admission, besides standard laboratory investigations we measured calibrated automated thrombogram parameters including time to start clotting, time to peak thrombin generation, peak thrombin generation and endogenous thrombin potential as well as ex vivo measured fibrin clot permeability reflecting fibrin pore size and fibrin clot lysis time.

Results

A median volume of stent protrusion was 13.4 (8.5–25.4) mm3 while atherothrombotic burden defined as a ratio of free intraluminal thrombus and tissue protrusion divided by stent volume was 6 (3.9–7.5)%. The main component of stent protrusion was lipid tissue in 32 (37.6%), fibrous tissue in 27 (31.8%) and thrombus in 26 (30.6%) patients. A volume of stent protrusion was correlated with total stent volume (R=0.79, P<0.001) and the length of lipid reach pool in the naïve coronary vessel intima (R=0.31, P=0.007) whereas atherothrombotic burden was correlated with residual thrombus volume before stent implantation (R=0.34, P=0.003), arcus of maximal lipid reach pool in the naïve coronary vessel intima (R=0.25, P=0.03) and stent area (R=0.26, P=0.02). The residual thrombus volume after aspiration thrombectomy was correlated with clot permeability (R=0.024, P=0.04) and inversely correlated with time to peak thrombin generation (R=−0.23, P=0.04). A temporary deterioration of epicardial blood flow of at least 1 point in Thrombolysis in Myocardial Infarction scale following stent implantation detected in 20 (23.5%) patients was associated with shorter lag time (3.0 [2.7–3.3] vs. 3.3 [3.0–4.0] min, P=0.015), shorter time to peak thrombin generation (5.7 [5.3–6.1] vs. 6.3 [5.7–7.1] min, P=0.026) and more frequent presence of lipid-rich stent protrusion (65 vs. 29%, P=0.007) as compared to the patients without slow-flow phenomenon after stent deployment.

Conclusions

The total volume of stent protrusion is correlated with local determinants including stent size and lipid content in the naïve coronary artery intima. After adjustment for stent volume, atherothrombotic burden is additionaly affected by residual thrombus volume after aspiration thrombectomy. However, patients with faster thrombin formation and lipid-rich stent protrusion are more prone to slow-flow phenomenon following stent implantation.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Science Center of Poland

Coronary slow-flow phenomenon in takotsubo syndrome: the prevalence, clinical determinants and long-term prognostic impact

Background

Previous studies demonstrated that patients with takotsubo syndrome (TTS) may present with coronary slow-flow (CSF) at coronary angiography performed in the acute phase [1]. However, the exact clinical relevance and its long-term prognostic impact have not been established yet. In the only recently published study Montone et al. proved that TTS patients with CSF were characterized by a worse clinical presentation with higher rate of intrahospital complications and poor long-term clinical outcome [2].

Purpose

We sought to investigate the prevalence of CSF in TTS patients, its determinants and long-term prognostic impact.

Methods

Among 7771 myocardial infarction patients hospitalized in our center in 2012–2019 years, we identified 82 (1.1%) TTS patients with performed coronary angiography (Figure 1A). The coronary flow was assessed quantitatively with TIMI Frame Count (TFC), whereas myocardial perfusion with TIMI myocardial perfusion grade (TMPG). The clinical and angiographic characterstics of 67 TTS patients complying with MINOCA definition were compared with representative 50 non-TTS MINOCA (Figure 1A).

Results

CSF (TIMI 2) was identified in 33 (40.2%) TTS patients. CSF-TTS patients were characterized with higher TFC and worse TMPG in each analyzed coronary vessel (Figure 1B). CSF was observed in LAD artery in each patient, in 78.8% in LCx and in 33.3% in RCA, respectively. In CSF-TTS lower values of LVEF on admission (33.5 (25–40) vs 40 (35–45)%, P=0.019) as well as more frequent midventricular TTS (27.3 vs 8.2%, P=0.020), nearly normal coronary arteries (<30% stenosis) (75.8 vs 49.0%, P=0.015) and coexistence of both physical and emotional triggers (9.1 vs 0%, P=0.032) were noted. Moreover, CSF was observed significantly more frequent than in non-TTS MINOCA (44.8 vs 10.0%, P<0.001) with different distribution in particular vessels (P<0.001). In median 55 months of long-term observation higher all-cause mortality was stated in CSF-TTS (30.3 vs 10.2%, P=0.024) (Figure 1C) without difference between TTS and non-TTS MINOCA (P=0.42) (Figure 1D). By Cox proportional hazards model the CSF was identified as an independent predictor of long-term mortality (P<0.001).

Conclusions

As has been shown high proportion of TTS patients were characterized with remarkably marked myocardial perfusion abnormalities, especially in the left coronary vessels, which were associated with unfavorable long-term prognosis. Our study is the first presenting the direct angiographic, clinical and prognostic comparison of TTS MINOCA and non-TTS MINOCA patients.

Funding Acknowledgement

Type of funding sources: None. Figure 1

Dementia screening in elderly high-risk patients following heart failure decompensation may predict unfavorable long-term clinical outcomes

Background

Recently heart failure (HF) has been found to be a new dementia risk factor, nevertheless their relations in patients following HF decompensation remain unknown.

Purpose

We sought to investigate whether a screening diagnosis for dementia (SDD) in this high-risk population may predict unfavorable long-term clinical outcomes.

Methods

142 patients following HF decompensation requiring hospitalization were enrolled. Within a median time of 55 months all patients were screened for dementia with ALFI-MMSE scale whereas their compliance was assessed with the Morisky Medication Adherence Scale. Any incidents of myocardial infarction, coronary revascularization, stroke or transient ischemic attack (TIA), revascularization, HF hospitalization and bleedings during follow-up were collected.

Results

SDD was established in 37 patients (26%) based on the result of an ALFI-MMSE score of <17 points. By multivariate analysis the lower results of the ALFI-MMSE score were associated with a history of stroke/TIA (β=−0.29, P<0.001), peripheral arterial disease (PAD) (β=−0.20, P=0.011) and lower glomerular filtration rate (β=0.24, P=0.009). During the follow-up, patients with SDD were more often rehospitalized following HF decompensation (48.7% vs 28.6%, P=0.014) than patients without SDD, despite a similar level of compliance (P=0.25). Irrespective of stroke/TIA history, SDD independently increased the risk of rehospitalization due to HF decompensation (HR 2.22, 95% CI 1.23–4.01, P=0.007).

Conclusions

As shown for the first time in literature patients following decompensated HF, a history of stroke/TIA, PAD and impaired renal function independently influenced SDD. In this high-risk population, SDD was not associated with patients' compliance but irrespective of the stroke/TIA history it increased the risk of recurrent HF hospitalization.

The survival free of rehospitalization

Funding Acknowledgement

Type of funding source: None

The artificial intelligence system in prediction of the prevalence of acute coronary syndromes based on weather conditions

Background

It was shown that different individual weather conditions are associated with the incidence of acute coronary syndromes (ACS). Despite this, the prediction of the number of ACS depending on the weather conditions in the given place and time is not effective to date.

Purpose

We sought to investigate whether the artificial intelligence system might be useful in prediction of the prevalence of ACS based on weather conditions.

Methods

In this study, data of 159307 consecutive patients obtained from National Health Service registry, hospitalized due to ACS in Lesser Poland Province (province area of 15008 km2, population of 3.4 M in 2014) between 2008 and 2018 have been compared with meteorological conditions collected in the Institute of Meteorology and Water Management from five weather stations scattered across Lesser Poland Province. Because of small sample size in three of them, only data from two stations (Krakow-Balice, n=75565, Tarnow, n=30079) were used for further analysis. In four separate seasons, the number of ACS events in each day was compared with meteorological conditions on a given day and six days before. We analysed weather conditions such as: wind 10 metres above ground (W_10), temperature (T), dew point temperature (T_dp), relative humidity 2 metres above the ground (Hum_2), atmospheric pressure reduced to mean sea level (Pres), atmospheric precipitation (Prec), and 3 hours atmospheric pressure changes (Pres_3h). For all parameters extreme (maximum – max, minimum – min) values and ranges of these parameters in each day were analysed. All data were used in a system based on machine learning (Random Forest), which allowed to create a model that predicted the incidence of ACS and to determine importance of each inputted weather parameter in this prediction.

Results

All weather parameters were divided into machine learning data (70%) and test data (30%) to verify functioning of the model. The correlation between real number of ACS and predicted number of ACS for two meteorological stations for spring ranges from 0.69 to 0.71 with confidence intervals (CI) of 0.63–0.77, for summer the correlation was 0.66–0.75 with CI of 0.59–79, for autumn 0.69–0.74 with CI of 0.63–0.79 and for winter 0.69–0.72 with CI 0.63–0.77 (P<0.0001 for each prediction, example of prediction in the Figure 1A). Among all analysed meteorological parameters the most important in the machine learning were range of relative humidity, range of dew point temperature and maximal relative humidity (Figure 1B).

Conclusions

Artificial intelligence system seems to be useful in predicting the prevalence of ACS with model based on weather conditions.

Figure 1. ACS prediction for summer in Krakow

Funding Acknowledgement

Type of funding source: None

Over-representation of myocardial infarction with nonobstructive coronary arteries in oncological patients. The prevalence, clinical characteristics and long-term mortality

Introduction

According to the current guidelines, myocardial infarction with nonobstructive coronary arteries (MINOCA) is defined by general criteria of myocardial infarction (MI) with no hemodynamically significant lesions in coronary arteries (<50%). As shown in large MI registers, MINOCA is diagnosed in 1–13% of patients. The potential etiology of MINOCA is an intensively studied issue. To date, a number of potential mechanisms have been proposed. In our opinion, hypercoagulable states may be indicated as a direct trigger for such a sequence of events. Based on our previously published study, we found the presence of inherited thrombophilia in over 23.8% of MINOCA patients

Purpose

We suspect that oncological patients, the group with well-known prothrombotic state, are predisposed to MINOCA and have different clinical characteristics and long-term prognosis.

Methods

We analyzed a group of 1011 consecutive patients with MI who underwent coronary angiography in the years 2012–2017. A group of 134 patients with active cancer (13.3%) was separated. Working diagnosis of MINOCA was performed in accordance with current guidelines.

Results

MINOCA diagnosis was stated in 21 oncological patients (15.7%) and 51 others (5.8%) (P<0.001). Cancer patients were characterized by a higher incidence of anemia (47.6 vs 21.6%, P=0.027), lower hemoglobin levels (12.9 vs 14.1 g/dl, P=0.048) and higher troponin values (0.306 vs 0.076 ng/ml, P=0.003). Based on echocardiographic measurements, more frequent occurrence of takotsubo cardiomyopathy (19.1 vs 2.0%, P=0.010), higher values of right ventricular systolic pressure (44.5 vs 31.5 mmHg, P=0.016) and lower left atrial dimensions (36 vs 41.5 mm, P=0.020) were observed in the group of cancer patients. As expected, patients with active cancer had significantly higher all-cause mortality during long-term follow-up (66.7 vs 29.4%, P=0.003). In a multivariable analysis of oncological MINOCA was independently associated with a long-term mortality (P<0.001).

Conclusions

To our knowledge, our study is the first report concerning a high prevalence of MINOCA in oncological patients with MI. We observed a significant proportion of cancer-associated anemia in this group of patients. The high incidence of takotsubo cardiomyopathy and significant differences in individual echocardiographic parameters underline the important role of cardiac imaging in this group of patients with unfavorable long-term prognosis.

Figure 1

Funding Acknowledgement

Type of funding source: None

The effectiveness of chemotherapy and electrochemotherapy on ovarian cell lines in vitro

The presented study aimed to evaluate in vitro the effectiveness of improvement standard chemotherapy with bleomycin by electroporation in two various ovarian cancer cell lines. Two human ovarian cell lines OvBH-1 and SKOV-3 were used. The lines were selected because of their resistance to several therapeutic methods. As anticancer drug we use range of concentrations of bleomycin. In EP and ECT experiments different voltage values: from 0 to 1200 V/cm, 8 pulses with duration of 100μs and intervals between pulses 1s long were used. The cells viability after applied treatments was evaluated by MTT assay. The expression of heat shock proteins - HSP27 was examined by immunocytochemical ABC method.The cytotoxicity with different concentrations of bleomycin alone was not significantly decrease in both cell lines. It confirms resistance of these cells to conventional chemotherapy. The highest decrease of cell proliferation was observed after EP with bleomycin after 48h of incubation for 1000 V/cm. The intensity of expression of small heat shock proteins HSP27 slightly increased after ECT in both treated cell lines, in particular in OvBH-1. The presented study indicated that application of electroporation may effectively enhance chemotherapy with bleomycin, particularly in the case of treating ovarian cancer resistant to standard therapy.

[Estimation of HPV infection presence in cytological smears in a group of asymptomatic women]

Papanicolau (Pap) smear is the most important screening method in gynaecological oncology. According to EUROGIN and WHO statements it is suggested to perform additionally molecular detection of human papillomavirus (HPV), which is the most important risk factor of cervical cancer. The aim of this study was to estimate the HPV infection prevalence in healthy, asymptomatic women. Pap smears from 255 women were investigated according to The Bethesda Terminology. HPV DNA was detected by PCR method. We were able to detect high "oncogenic risk" HPV types: 16, 18, 31, 33, 35, 39, 45, 52b, 58 and "low oncogenic risk"--HPV6 and 11. We found only 15 cases (5.9%) of HPV DNA presence. Most of them were HPV16--in 5 patients (33.3%) and HPV58--in 3 (20%). HPV detection could be very useful supplement to Pap smears. It allows selecting the patients with high risk of cervical cancer many years before clinical manifestation of the disease.

Effects of exposure to tobacco smoke in pregnancies complicted by oligohydramnios and premature rupture of the membranes. II. Activity of brush border enzymes in human amniotic fluid

The aim of the present study was to assess the activity of membrane enzymes: alanine aminopeptidase (AAP), gamma-glutamyltransferase (GGT) and trehalase in amniotic fluid of women who smoke cigarettes during pregnancy complicated by idiopathic oligohydramnios or premature rupture of the membranes (PROM). The enzyme activity was measured between 22 and 31 (group A) and between 32 and 39 (group B) weeks of gestation. In the women of group A with idiopathic oligohydramnios, AAP activity was five times higher than in PROM women. AAP activity was declining with the progression of gestation, and in the B group women with oligohydramnios, it was over eight times lower than in group A. A threefold increase in GGT activity was found in women of group A with oligohydramnios as compared to women of group A with PROM. No statistically significant differences in trehalase activity were found in amniotic fluid of women with oligohydramnios and PROM, AAP, GGT and trehalase activity in women with idiopathic oligohydramnios correlated with the cadmium ion concentration, and AAP and GGT activity with the lead ion concentration in amniotic fluid which confirms toxical properties of these heavy metals present in cigarette smoke. It has already been confirmed that measurements of the brush border enzyme activity in amniotic fluid are very useful in prenatal diagnosis and detection of the placenta disorders.

[The importance of fibronectin in amniotic fluid in anticipation of premature labor]

We analysed 86 pregnant women where we estimated the fibronectin level in specimens of amniotic fluid. During carrying out the experiment we noted that fibronectin is present in amniotic fluid and can be identified in a quantity mode. We have proved dependence between fibronectin level in amniotic fluid and the period of time from collecting the sample, up to the delivery. Fibronectin level in amniotic fluid doesn't depend on pregnancy duration, preterm rupture of amniotic membranes.

[Ultrasonographic assessment of cervical length and measurement of fetal fibronectin level in cervical secretion of pregnant women in prophylaxis of premature deliveries]

OBJECTIVE

The aim of this study was to assess the usefulness of the assessment of cervical length and and measurement of fetal fibronectin level in cervical secretion of pregnant women in prophylaxis of premature deliveries.

MATERIAL AND METHODS

78 pregnant women hospitalized in Department of Fertility and Obstetrics, University School of Medicine Wrocław. They were divided into III groups: Group I-13 pregnant women who had premature delivery and the time between examination and delivery was no longer than 24 hours. Group II-20 women who had premature delivery, and the time between examination and delivery was longer than 24 hours. Group III-pregnant who delivered at term (control group). Between the 25th and the 34th week of pregnancy presence of fetal fibronectin in cervical secretion and ultrasonographic assessment of cervical length were done.

RESULTS

Significantly higher percentage of women with presence of fibronectin in cervical secretion and significantly shorter length of cervical length was stated in 13 pregnant women who delivered prematurely, between the 28th and 35th week of pregnancy comparing with other groups. In group II pregnant women delivered between the 28th and 35th week of pregnancy, and the time between examination and delivery was from 3 days to 4 weeks. In this group in 75% examined women fibronectin was present in cervical secretion. Significant was that cervical length in 14 of this group of women (70%) was no longer than 20 mm and in the rest was between 20-30 mm, moreover in no cases was longer than 30 mm. In group III only in 7% women presence of fibronectin in cervical secretion was stated and only in two cases (4%) cervical length was shorter than 20 mm, both of them delivered in 38th week of pregnancy.

CONCLUSIONS

1. Examination of fetal fibronectin in cervical secretion allows precisely estimate the risk of premature delivery. 2. Cervical length shorter then 20 mm collerates with the presence of fetal fibronectin in cervical secretion and with increased risk of premature delivery.

[The course of pregnancy, delivery and puerperium in women with varices and thrombophlebitis of lower extremities, after application of low molecular weight heparins]

OBJECTIVES

Estimation of the long term prophylactic or therapeutic application of low molecular weight heparin (LMWH) on the platelets count, and incidence bleedings during pregnancy, delivery and puerperium in the women with varices of lower extremities and past thrombophlebitis of lower extremities.

MATERIAL AND METHODS

5212 pregnant, women in labour and in puerperium divided into 4 groups.; 142 women with varices and thrombophlebitis of lower extremities (group I); 10 with past thrombophlebitis of lower extremities (group II); 15 with thrombophlebitis in current pregnancy; 5045 without vascular complications (group IV--control). In group I during pregnancy compression therapy was applied (stockings) and low molecular weight heparins (LMWH) in course of puerperium. In group II during the 1st trimester of pregnancy and in labour the same heparin doses were administered, while the doses were increased in the 2nd and 3rd trimester. In group III, when thrombophlebitis was stated non-steroid anti-inflammatory drugs and LMWH were administered. In all cases treated with heparin both number of platelets and incidents of bleedings from genitourinary tract were observed. Presence of embolic complications was also noted.

RESULTS

No cases of decrease platelets number or bleedings from genitourinary tract were observed in group I-III during administering of LMWH. In women in group II where prophylactic with LMWH was applied no incidences of recurrent thrombophlebitis during pregnancy and puerperium were observed. In group I-III all newborns were born in good condition and no complications were observed. Average blood loss during both labour and cesarean section, among women in group I-III was not significantly different comparing with control group. No incidences of pulmonary artery embolism or decrease number of platelets were observed.

CONCLUSIONS

1. The long term prophylactic or therapeutical administration of LMWH in the women with varices of lower extremities or thrombophlebitis has no influence on the platelets count and incidence of bleedings from genitourinary tract during pregnancy or increase of blood loss during labour and puerperium. 2. In the women with past thrombophlebitis of the lower extremities after application of LMWH during pregnancy there were no recurrence observed.

[Sialic acid of glycoconjugates in amniotic fluid]

OBJECTIVES

Sialic acid is a negatively charged monosaccharide attached to non-reducing end of N- and O-linked carbohydrate chains of glycoconjugates. The claimed biological functions of sialic acid include its participation in cell to cell recognition and interaction as well as affecting the function of receptors by providing binding sites for ligand. Increased sialic acid concentration have been observed in several diseases e.g. malignancies, diabetes, inflammatory disorders, rheumatoid arthritis and alcoholism.

DESIGN

The aim of the present work was to determine if the amount of sialic acid attached to glycoconjugates of amniotic fluid changes during pregnancy.

MATERIALS AND METHODS

The sialic acid content in 47 samples of amniotic fluid derived from pregnant women with gestational age between 13 and 42 was studied by sialic acid specific lectins immunosorbent assay. The patient samples were divided into seven groups.

RESULTS

Time dependent changes in the degree of sialylation of glycoconjugates in amniotic fluid during pregnancy, particularly in advanced pregnancy were observed. Moreover, the highest sialic acid content on glycoconjugates in pregnancies complicated by premature rupture of membranes and is prolonged pregnancy were also detected.

CONCLUSIONS

Sialic acid content determination in amniotic fluid could be a potentially useful marker of inflammation process of amniochorion during pregnancy.

[Comparison of vaginal misoprostol and oxytocin for labor induction in post-term pregnancy]

OBJECTIVES

To compare labour induction intervals between vaginal misoprostol and intravenous oxytocin as well as side effects of induction in post term pregnancies with intact membranes.

METHODS

One hundred women were retrospectively selected to two groups treated with vaginal misoprostol 50 micrograms every 12 hours as needed to maximum 150 micrograms and treated with intravenous oxytocin. The primary outcome measure was time from induction to vaginal delivery. Statistical analysis was performed by t-Student test.

RESULTS

Maternal age, parity, gestation were similar. There was a statistically important difference in labour induction intervals between the two groups. The mean time +/- SD to vaginal delivery in misoprostol group was 20.6 +/- 15.2 hours compared with 11.23 +/- 7.4 hours with oxytocin (p = 0.0396). Induction of labour failed in 12% and 32% in misoprostol and oxytocin treated group. Pethidine consumption in oxytocin treated group was higher (41 mg vs 89 mg, p = 0.04). Episodes of vomiting were more frequent in misoprostol treated group (22% vs 6%). There were no episodes of uterine hyperstimulation in both groups.

CONCLUSIONS

Oxytocin stimulation resulted in a shorter induction to delivery interval. In misoprostol group induction failed in only 12% whereas in oxytocin group in 32%. There were no serious side effects in both groups. In misoprostol treated group patients required less analgetics then in oxytocin treated group.

Ischemic and reperfusive release of the endogenous purines and its influence on the myocardial viability during beta-adrenergic blockade

The aim of this study was to estimate ischemic and reperfusive release of myocardial adenosine degradation products (MADP) during beta-adrenergic blockade and its relation to infarct size (IS) and viable myocardium size (VM). In a group of 24 shepherd-mongrel dogs, randomly assigned to a metoprolol (M-) and placebo-group (P-group), occlusion of the left anterior descending coronary artery (LAD) followed by reperfusion with recombinant tissue plasminogen activator was performed. Regional myocardial blood flow (MBF) was measured by the radiolabelled microsphere technique. Blood samples from aorta and great cardiac vein were collected to evaluate the concentrations of MADP. The triphenyltetrazolium chloride perfusion and fixation technique was used for infarct size measurement. MBF in the area at risk decreased in both groups during ischemia, but it was significantly higher (p = 0.013) in M-group. Recanalization of LAD was associated with an increase in flow in postischemic vascular bed. MBF was significantly higher (p = 0.024) in P-group during late reperfusion. In M-group IS was smaller (p = 0.007) and VM was bigger (p = 0.007). The correlation between arterial adenosine concentration during early reperfusion and IS (p = 0.044, r = -0.588) or VM (p = 0.036, r = 0.607) in M-group was noted. Values of net MADP balances significantly increased during early reperfusion. The correlation between reperfusive net MADP balance and IS (p = 0.00005, r = 0.906) or VM (p = 0.016, r = -0.675) in M-group was observed. The amount of MADP released during reperfusion correlates with the IS and is inversely proportional to the area of VM. The endogenously released adenosine may have additional cardioprotective effect during beta-adrenergic blockade.

Effects of exposure to tobacco smoke in pregnancies complicated by oligohydramnios and premature rupture of the membranes. I. Concentration of Cd and Pb in blood and Zn, Cu, Cd and Pb in amniotic fluid

To assess the exposure to tobacco smoke in pregnant women with oligohydramnios, idiopathic or caused by premature rupture of the membranes (PROM), cotinine concentrations were measured, using enzyme-like immunosorbent assay (ELISA). In women with idiopathic oligohydramnios (22-31 weeks of gestation), serum cotinine concentration was 1010 +/- 445 micrograms/L which provides evidence that women of this group were heavy smokers. In these women, significantly higher Cd concentrations in blood and amniotic fluid were found as compared to other pregnant women. A positive correlation between Cd concentrations in blood and amniotic fluid was observed (PROM r = 0.784; p < 0.001; idiopathic oligohydramnios r = 0.7118; p < 0.02). In oligohydramnios cases of both types, Cd concentration in amniotic fluid was over two times and Pb concentration ten times lower than blood concentrations of these metals, whereas amniotic fluid Zn concentration was two times lower than that found earlier in women with normal pregnancy. In the group of women with idiopathic oligohydramnios who were mostly exposed to tobacco smoke, a considerably larger number of still births and new-borns with CNS disorders than in PROM cases, were observed. Zn deficiency at increased exposure to Cd and Pb could play a significant role in etiology of these abnormalities. A positive correlation was found between Zn and Cu concentrations (r = 0.862; p < 0.05) in PROM cases which indicates regular transport of trace metals to the fetal ovum. The condition of infants born to this group of women was much better, and prematurity was the only complication of pregnancy.

Compositional analysis of tubers from insect and virus resistant potato plants

Genetically modified potato plants that are resistant to the Colorado potato beetle, plus either the potato leaf roll virus or potato virus Y, have recently been commercialized. As part of the safety assessment for plants produced by modern biotechnology, the composition of the food/feed must be compared to that of the food/feed produced by an equivalent plant variety from a conventional source. The composition of important nutritional and antinutritional factors in tubers produced by virus- and insect-resistant potato plants were compared to tubers produced by conventional potato plants. Key nutritional, quality, and antinutritional components measured were total solids, vitamin C, dextrose, sucrose, soluble protein, and glycoalkaloids. Proximate analyses included fat, ash, calories, total protein, and crude fiber. Minor nutrients measured were vitamin B6, niacin, copper, magnesium, potassium, and amino acids. The results from these analyses confirm that tubers produced by insect- and virus-protected varieties are substantially equivalent to tubers produced by conventional potato varieties.

[Activity of N-b-D-acetylglucosaminidase molecular forms in amniotic fluid of tobacco smoking pregnant women with oligohydramnios or premature rupture of the membrane complications]

OBJECTIVES

Morphological lesions in placenta and changed metal distribution through placenta, which were observed in pregnancy exposed to tobacco smoke, could cause alternations in lysosomal enzymes secretion to amniotic fluid.

DESIGN

Assessment of total activity and molecular forms of N-beta-D-acetylglucosaminidase in amniotic fluid in pregnancy with oligohydramnios or PROM.

MATERIALS AND METHODS

The materials for studies were amniotic fluids collected from pregnancy with oligohydramnios and from pregnancy with PROM. Determination of N-beta-D-acetylglucosaminidase activity was performed with use of sodium salt of 3-crezolosulfthaleinyl-N-beta-D-acetylglucosamide as a substrate (test Boehringer, Niemcy). Creatinine was determined by kinetic method (test of Analco-GBG firm). Protein was determine by Bredford method. NAG-B was assessed after previous thermal NAG-A inactivation in 56 degrees C, for 2 hours and the difference between activity of total form and termostabile form of NAG were assessed. The microsomal and cytosol fractions were separated by ultracentrifugation.

RESULTS AND CONCLUSIONS

The statistically significant growth of NAG activity in amniotic fluid in pregnant with oligohydramnios was observed. The cytosol form took over 90% of whole activity. The activity of NAG microsomal fraction was lower in amniotic fluid in women with PROM diagnosis. The positive coleration between NAG-A activity and the Pb level was observed in this group of women as well. In the second group of women with oligohydramnios, the positive coleration between NAG and Cd level, NAG-A and level, NAG-B and Pb level were demonstrated. Obtained results show on damage of placental and foetal membranes cell structure. It could be caused by metal ions cumulation and releasing of molecular N-beta-D-acetylglucosaminase form to amniotic fluid.

[Levels of Cd, Pb in blood and Zn, Cu, Cd, Pb in amniotic fluid of tobacco smoking women during pregnancy complicated oligohydramnios or premature rupture of membranes]

OBJECTIVES

The ingredients of tobacco smoke have the impact on uterine blood vessels. They caused vascular insufficiency of placenta during development of gestation and changes in placental tissue and fetal membranes. It manifest changeable metal permeability and others symptoms.

DESIGN

Assessment of metal contents in blood and amniotic fluid in pregnancies with oligohydramnios and PROM.

MATERIALS AND METHODS

The materials for studies were blood and amniotic fluid of 30 pregnancies. All of them had made amino-punction between 20 and 38 week of pregnancy before procedure of amniotic fluid supplementation. 15 patients had diagnosed oligohydramnios and the next 15 women had diagnosed premature rupture of membranes. Metals were determined by method of electrothermal atomical absorbic spectrophotometry (ET-ASA).

RESULTS AND CONCLUSIONS

Twice lower concentration of Zn and Cd and ten times lower concentration of Pb in amniotic fluids in examined women than women in normal pregnancy were observed. The women, with oligohydramnios in earlier period of gestation, smoked many more cigarettes and cotinine++ and Cd. were much higher. Both these facts had relevance with each other certainly. The stillborns were many more in this group. The different distribution of Cd, Pb, Zn in pregnant women with PROM and oligohydramnios, comparing with women in normal pregnancy was demonstrated. It is probable to be effect of placental tissue and fetal membranes disfunction.

[Useful of cerebral placental ratio in pregnancies complicated by intrauterine growth retardation and it correlation with perinatal outcome]

OBJECTIVE

The aim of this study was to asses usefulness of cerebro-placental ratio in the estimation of the intrauterine fetal well being in pregnancies complicated by intrauterine growth retardation and prediction of perinatal outcome.

MATERIAL AND METHODS

We investigated 22 pregnant women between 28th and 40th week of pregnancy with IUGR detected by ultrasound examination. 19 pregnant women between 28th and 41st week of pregnancy was control group. We measured parameters blood flow in umbilical arteries and in middle cerebral arteries in both groups. We calculated cerebro placental ratios(CPR, CPP). We divided pregnant women with IUGR int 2 groups depending on correct (CPR, CPP > 1.08) or incorrect (CPR, CPP < 1.08). In both groups we analyzed perinatal outcome.

RESULTS

In group pregnancies complicated with IUGR cerebro-placental ratios (CPR and CPP) were statistically significant lower than in control group. (for CPR p < 0.015 and for CPP p < 0.033). Sensitivity of cerebro placental ratio in screening small gestational age fetuses was 59% and specificity 89%. Sensitivity of cerebro placental ratio in predicting adverse perinatal outcome was 85% and specificity was 82%.

CONCLUSIONS

Statistically significant decrease of cerebro-placental ratios is observed in pregnancies complicated wit IUGR. Cerebro placental ratio is very useful tool for prediction of adverse perinatal outcome.

[Amniocentesis and amniotic infusion: benefits and risks]

The introduction of the amnioinfusion technic in the treatment of chosen complications of pregnancy, requires an easy access to the amniotic cavity. Catheterisation of the amniotic cavity requires the skilled technic, and is not associated with the rise of the obstetrics complications.

[Usefulness of amniotic fluid index determination in monitoring the effectiveness of amniotic infusion in pregnancy complicated by oligohydramnios]

In our research we intended to evaluate the usefulness of AFI measurements in the monitoring of the effectiveness of the amnioinfusions in the cases of pregnancy complicated by premature rupture of membranes (PROM), or in the selected cases idiopathic oligohydramnios, in pregnancies between 26-36 weeks of gestation.

[Evaluation of the usefulness and reference values for the amniotic fluid index in normal pregnancy between 30 and 42 weeks of gestation]

The four-quadrant sum of amniotic fluid pockets (amniotic fluid index) was studied prospectively in 130 normal pregnancies from 30 to 42 weeks. Statistical investigation were used to establish the mean, 95% confidence intervals and standard deviations for the AFI at each week of gestation. The AFI value decreased since 30 week, especially between 33 and 34 week and after 41 week. The AFI value < or = 5 represents oligohydramnios, the AFI value > or = 20 constitutes polyhydramnios.

[Ultrasonographic evaluation of fetal weight in normal, single fetus pregnancies in the population of Wrocław]

The aim of this paper was the analysis of the clinical usefulness of the nomogram presented by Hansmann for the fetal weight prediction in normal, single fetus pregnancies of Wrocław population. The authors proved, that in the group of 36 pregnant women the least difference between fetal weight evaluated before birth and the birth weight of newborn was noted in the group of babies with birth weight 2000-4000 g. In the group with birth weight below 2000 g and over 4000 g respectively, the twice to octuple evaluation error is expected.

[Ultrasonographic evaluation of growth in twin pregnancies in the population of Wrocław. I]

Authors have ultrasonographically evaluated and analysed appropriate parameters determining fetal growth in bigeminal pregnancies in the population of Wrocław. The following parameters were taking in consideration: biparietal head dimension (BPD), transversal chest dimension (THD) and thigh bone length (FL). After the comparative analysis of the average BPD, THD, and FL values in fetuses from 28-40th single fetus and bigeminal pregnancies authors revealed, that BPD and TDH values were significantly smaller in twins that single fetuses. No correlation was found in FL values in both groups. In the aim to obtain more accurate evaluation of intrauterine growth in twins. Authors proposed an application of special ultrasonographic BPD and THD parameters net-works, different from those applicable for primiparous pregnancies.

[Ultrasonic evaluation of fetal growth of twins in the Wrocław population. II. Proposed percentile curves of ultrasonographic parameters]

Authors analyzed and evaluated biparietal head dimension (BPD), transversal chest dimension (THD) and femur length (FL) measured in the fetuses from 28 to 40th week in bigeminal pregnancies on the material of Wrocław population. Obtained results were presented as percentile curves of each parameter in succeeding weeks of pregnancy. In the face of findings in the 1st part of work (statistically lower parameters BPD and THD in twins in confrontation with fetuses in single fetus pregnancies and lack of correlations between FL dimensions), authors are of opinion that, for accurate evaluation of twins growth in examined population, in the period from 28 to 40 weeks of pregnancy, the application of ultrasonographical parameters net-work of BPD and THD parameters in necessary. Moreover, the authors are considering that the presented percentile BPD and THD curves may make a graphic image of twins intrauterine growth in the evaluated population.

[Pregnancy and labor in the patient with arteriovenous congenital fistula]

The paper presents a case of uncomplicated pregnancy in 26-years old primipara suffering from congenital arteriovenous fistula. The clinical picture of disease was manifested by presence of vaso-dilatations in lower and upper limbs and in the vulva, because of which the pregnancy was terminated by cesarean section. Puerperal and postoperative outcome was uncomplicated. In the puerperal period heparin and large-spectrum antibiotic therapy was administered. No cardiovascular or thromboembolic complications were observed. Authors are of opinion, that in face of menace, the pregnancy and labour in the women presenting arterio-vascular fistula have to be considered as situation of high obstetrical risk.

[Latent retrograde atrioventricular conduction in healthy persons]

45 patients (13 females and 32 males; mean age-37 years) without an organic heart disease underwent the study, on condition that effective transesophageal, ventricular stimulation was achieved. The transesophageal pacemaker SP-5 made by OBR TEMED ZABRZE was used. Ventricular stimulation threshold and a lock of evident retrograde conduction was estimated during ventricular stimulation with a constant cycle length of 500 ms. To assess concealed retrograde atrioventricular conduction, programmed ventricular stimulation of a 50 ms cycle length was applied between late diastole and left ventricular refraction. Concealed retrograde atrioventricular conduction was diagnosed of a sinus impulse reached later ventricles than that during sinus rhythm preceding an examination. There was no evident atrioventricular retrograde conduction in 15 patients (33%). In 9 of them (60%) programmed stimulation revealed concealed retrograde atrioventricular conduction reaching atrioventricular node. Obtained results indicate, that the transesophageal programmed ventricular stimulation enables to examine concealed a-v conduction phenomenon and can be helpful in approximate localization of retrograde atrioventricular block.