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Kralova K, Vrtelka O, Fouskova M, Smirnova TA, Michalkova L, Hribek P, Urbanek P, Kuckova S, Setnicka V. Comprehensive spectroscopic, metabolomic, and proteomic liquid biopsy in the diagnostics of hepatocellular carcinoma. Talanta 2024; 270:125527. [PMID: 38134814 DOI: 10.1016/j.talanta.2023.125527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 11/30/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023]
Abstract
Liquid biopsy is a very topical issue in clinical diagnostics research nowadays. In this study, we explored and compared various analytical approaches to blood plasma analysis. Finally, we proposed a comprehensive procedure, which, thanks to the utilization of multiple analytical techniques, allowed the targeting of various biomolecules in blood plasma reflecting diverse biological processes underlying disease development. The potential of such an approach, combining proteomics, metabolomics, and vibrational spectroscopy along with preceding blood plasma fractionation, was demonstrated on blood plasma samples of patients suffering from hepatocellular carcinoma in cirrhotic terrain (n = 20) and control subjects with liver cirrhosis (n = 20) as well as healthy subjects (n = 20). Most of the applied methods allowed the classification of the samples with an accuracy exceeding 80.0 % and therefore have the potential to be used as a stand-alone method in clinical diagnostics. Moreover, a final panel of 48 variables obtained by a combination of the utilized analytical methods enabled the discrimination of the hepatocellular carcinoma samples from cirrhosis with 94.3 % cross-validated accuracy. Thus, this study, although limited by the cohort size, clearly demonstrated the benefit of the multimethod approach in clinical diagnosis.
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Affiliation(s)
- Katerina Kralova
- Department of Analytical Chemistry, Faculty of Chemical Engineering, University of Chemistry and Technology, Prague, Technicka 5, 166 28, Prague 6, Czech Republic
| | - Ondrej Vrtelka
- Department of Analytical Chemistry, Faculty of Chemical Engineering, University of Chemistry and Technology, Prague, Technicka 5, 166 28, Prague 6, Czech Republic
| | - Marketa Fouskova
- Department of Analytical Chemistry, Faculty of Chemical Engineering, University of Chemistry and Technology, Prague, Technicka 5, 166 28, Prague 6, Czech Republic
| | - Tatiana Anatolievna Smirnova
- Department of Biochemistry and Microbiology, Faculty of Food and Biochemical Technology, University of Chemistry and Technology, Prague, Technicka 5, 166 28, Prague 6, Czech Republic
| | - Lenka Michalkova
- Department of Analytical Chemistry, Faculty of Chemical Engineering, University of Chemistry and Technology, Prague, Technicka 5, 166 28, Prague 6, Czech Republic; Department of Analytical Chemistry, Institute of Chemical Process Fundamentals of the CAS, Rozvojova 135, 165 02, Prague 6, Czech Republic
| | - Petr Hribek
- Military University Hospital Prague, Department of Medicine 1st Faculty of Medicine Charles University and Military University Hospital Prague, U Vojenske Nemocnice 1200, 169 02, Prague 6, Czech Republic; Department of Internal Medicine, Faculty of Military Health Sciences in Hradec Kralove, University of Defense, Trebesska 1575, 500 01, Hradec Kralove, Czech Republic
| | - Petr Urbanek
- Military University Hospital Prague, Department of Medicine 1st Faculty of Medicine Charles University and Military University Hospital Prague, U Vojenske Nemocnice 1200, 169 02, Prague 6, Czech Republic
| | - Stepanka Kuckova
- Department of Biochemistry and Microbiology, Faculty of Food and Biochemical Technology, University of Chemistry and Technology, Prague, Technicka 5, 166 28, Prague 6, Czech Republic
| | - Vladimir Setnicka
- Department of Analytical Chemistry, Faculty of Chemical Engineering, University of Chemistry and Technology, Prague, Technicka 5, 166 28, Prague 6, Czech Republic.
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Kralova K, Vrtelka O, Fouskova M, Hribek P, Bunganic B, Miskovicova M, Urbanek P, Zavoral M, Petruzelka L, Habartova L, Setnicka V. Raman spectroscopy and Raman optical activity of blood plasma for differential diagnosis of gastrointestinal cancers. Spectrochim Acta A Mol Biomol Spectrosc 2024; 305:123430. [PMID: 37776835 DOI: 10.1016/j.saa.2023.123430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 08/26/2023] [Accepted: 09/18/2023] [Indexed: 10/02/2023]
Abstract
Improving the early diagnosis of gastrointestinal cancers is a crucial step in reducing their mortality. Given the non-specificity of the initial symptoms, the ability of any diagnostic method to differentiate between various types of gastrointestinal cancers also needs to be addressed. To detect disease-specific alterations in biomolecular structure and composition of the blood plasma, we have implemented an approach combining Raman spectroscopy and its conformation-sensitive polarized version, Raman optical activity, to analyze blood plasma samples of patients suffering from three different types of gastrointestinal cancer - hepatocellular, colorectal and pancreatic. First, we aimed to discriminate any type of gastrointestinal cancer from healthy control individuals; inthenext step, the focus was on differentiating among the three cancer types studied. The more straightforward of the two statistical approaches tested, the combination of linear discriminant analysis and principal component analysis applied to the entire spectral dataset, allowed the discrimination of cancer and control samples with 87% accuracy. The three gastrointestinal cancers were classified with an overall accuracy of 76%. The second method, the linear discriminant analysis applied to a selection of spectral bands, yielded even higher values. Cancer and control samples were distinguished with 89% accuracy and hepatocellular, colorectal and pancreatic cancer with an overall accuracy of 87%. The results obtained in our study suggest that the proposed approach may become a disease-specific diagnostic tool in daily clinical practice.
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Affiliation(s)
- Katerina Kralova
- Department of Analytical Chemistry, Faculty of Chemical Engineering, University of Chemistry and Technology Prague, Technicka 5, 166 28 Prague 6, Czech Republic.
| | - Ondrej Vrtelka
- Department of Analytical Chemistry, Faculty of Chemical Engineering, University of Chemistry and Technology Prague, Technicka 5, 166 28 Prague 6, Czech Republic
| | - Marketa Fouskova
- Department of Analytical Chemistry, Faculty of Chemical Engineering, University of Chemistry and Technology Prague, Technicka 5, 166 28 Prague 6, Czech Republic
| | - Petr Hribek
- Military University Hospital Prague, Department of Medicine 1st Faculty of Medicine Charles University and Military University Hospital Prague, U Vojenske nemocnice 1200, 169 02 Prague 6, Czech Republic; Department of Internal Medicine, Faculty of Military Health Sciences in Hradec Kralove, University of Defense, Trebesska 1575, 500 01 Hradec Kralove, Czech Republic
| | - Bohus Bunganic
- Military University Hospital Prague, Department of Medicine 1st Faculty of Medicine Charles University and Military University Hospital Prague, U Vojenske nemocnice 1200, 169 02 Prague 6, Czech Republic
| | - Michaela Miskovicova
- Department of Oncology, First Faculty of Medicine of Charles University and General University Hospital in Prague, U Nemocnice 2, 128 08 Prague 2, Czech Republic
| | - Petr Urbanek
- Military University Hospital Prague, Department of Medicine 1st Faculty of Medicine Charles University and Military University Hospital Prague, U Vojenske nemocnice 1200, 169 02 Prague 6, Czech Republic
| | - Miroslav Zavoral
- Military University Hospital Prague, Department of Medicine 1st Faculty of Medicine Charles University and Military University Hospital Prague, U Vojenske nemocnice 1200, 169 02 Prague 6, Czech Republic
| | - Lubos Petruzelka
- Department of Oncology, First Faculty of Medicine of Charles University and General University Hospital in Prague, U Nemocnice 2, 128 08 Prague 2, Czech Republic
| | - Lucie Habartova
- Department of Analytical Chemistry, Faculty of Chemical Engineering, University of Chemistry and Technology Prague, Technicka 5, 166 28 Prague 6, Czech Republic
| | - Vladimir Setnicka
- Department of Analytical Chemistry, Faculty of Chemical Engineering, University of Chemistry and Technology Prague, Technicka 5, 166 28 Prague 6, Czech Republic.
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Csomor J, Hribek P, Kupsa T, Bradac O, Urbanek P. Acute pancreatitis - predicting the severity of the disease. BRATISL MED J 2023; 124:802-809. [PMID: 37874801 DOI: 10.4149/bll_2023_123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
RATIONALE Acute pancreatitis (AP) is a serious acute abdominal disease. AP is often referred to as an unpredictable illness, which can take a mild to severe (fatal) course. AIMS OF THE STUDY 1) To identify clinical parameters that are significantly related to the clinical course of acute pancreatitis. 2) To compile a scoring system enabling the severity of AP to be predicted when the patient is first admitted to hospital. METHODS Analysis of available publications and clinical guidance, and retrospective analysis of data on patients hospitalised with AP at our clinic enable us to identify clinical details and laboratory results recorded at the time of patients' admission to hospital that are related to the subsequent severity of the disease. For the purposes of statistical analysis, the sample of patients was divided into two groups: group A (mild AP, without local or organ complications), group B (moderately severe and severe AP with local and/or organ complications). PATIENT GROUPS AND RESULTS In total, between 01.01.2013 and 30.06.2022, 312 patients with acute pancreatitis were allocated to the retrospective-prospective study sample. 74 % (231/312) of these patients were allocated to group A and 26 % (81/312) were allocated to group B. Univariate analysis of the data collected on the patient sample identified 5 parameters that are statistically significantly associated with the severity of the clinical course of the disease. Presence of SIRS on admission (A vs B, Odds ratio 10.787, 95% CI 5.09-22.85, p < 0.0001), diabetes mellitus type 2 in case history (A vs B, Odds ratio 7.703, 95% CI 3.04-19.51, p 2 mmol/l (A vs B, Odds ratio 3.293, 95% CI 1.59-6.82, p = 0.0013).In order to develop a scoring system, each of these parameters was allocated a points value based on its Odds ratio (OR): presence of SIRS 3 points, hypocalcaemia 3 points, diabetes mellitus type 2 in case history 2 points, urea concentration > 8 mmol/l 1 point and lactate concentration > 2 mmol/l 1 point. The authors refer to their scoring system as The Acute Pancreatitis Admission Score (APAS). The accuracy of APAS was modelled for various cut off values. Across the whole sample, we ascertained that an APAS ≥ 4 points predicts moderately severe or severe AP with a sensitivity of 81 % (95% CI: 71 - 89 %) and specificity of 87 % (95 CI: 81 - 91 %). The positive predictive value (PPV) of APAS ≥ 4 is 0.68, while its negative predictive value (NPV) is 0.93 and accuracy 0.85 (95% CI 0.81 - 0.89). CONCLUSION In this study we identify significant simple clinical and laboratory parameters that are commonly tested as part of an initial examination when admitting a patient with AP to hospital. Having identified these parameters we are able to establish a simple scoring system that is able to predict the severity of the course of AP at the moment of hospitalisation (Tab. 5, Fig. 2, Ref. 27).
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Warminski G, Kalinczuk L, Orczykowski M, Urbanek P, Bodalski R, Zielinski K, Gandor M, Palka F, Jaworski M, Mintz GS, Kowalik I, Hasiec A, Bilinska M, Plawiak P, Szumowski L. Artificial intelligence analysis of ECG signals to predict arrhythmia recurrence after cryoballoon ablation of atrial fibrillation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Cryoballoon-based pulmonary vein isolation (CB) is an effective option for rhythm control in atrial fibrillation (AF). There have been multiple attempts to predict arrhythmia recurrence, but with moderate success.
Purpose
To use artificial intelligence (AI) deep electrocardiogram (ECG) analysis to predict arrythmia recurrence after CB.
Methods
In a single-center study of 250 consecutive pts (58.2±12.6 years, 30% female) treated with CB for AF (05.2017–04.2019), 60% had paroxysmal AF (PAF), 66.5% had hypertension, and 27.2% had a redo CB. Analyses included left atrial volume (LA vol: indexed for BSA and assed by angio-MSCT in 76% and the rest with echo), left ventricle ejection fraction (LVEF) and hypertrophy (LVH: septal/posterior wall thickness ≥11mm in ♂ and ≥10mm in ♀) along with 30s arrhythmia recurrence at 2-yr follow-up. Baseline 500Hz raw 12-lead digital ECG signals were analyzed by means of convolutional neural network (CNN) architecture that was taught to process the 12-channel ECG signal (XML). The transfer learning method of CNN parameters learned on a very large number of coded consecutive training ECG samples (n=1,000) was adopted to analyze current sample of ECG signals.
Results
Arrhythmia recurrence at 2-yrs was 46.0% (n=115). There was gradual increase in predictive performance being the lowest if only baseline clinical data were analyzed and the highest combing all baseline clinical data plus anatomical and functional parameters (Table 1: #1–#3). AI baseline ECG analysis alone offered predictive performance similar to that made upon analysis of all baseline clinical data or joint analysis of LA vol, LVH, and LVEF (Table 1: #4). AI results added substantially to predictive performance of models using baseline clinical data alone (#1 vs #5, p<0.001) and joint analysis of baseline clinical plus LA vol, LVH and LVEF (#3 vs #6, p=0.0130) (Fig. 1).
Conclusions
Prediction of recurrence after CB using raw ECG data with deep AI analysis is feasible. Joint analysis of results of AI of baseline ECG and basic clinical data offers predictive performance similar to that made upon analysis of clinical data including advanced information on LA volume and LVH and function. AI analysis of baseline ECG adds significantly to models aimed at recurrent AF prediction.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): National Institute of Cardiology, Warsaw, Poland
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Affiliation(s)
- G Warminski
- National Institute of Cardiology in Anin , Warsaw , Poland
| | - L Kalinczuk
- National Institute of Cardiology in Anin , Warsaw , Poland
| | - M Orczykowski
- National Institute of Cardiology in Anin , Warsaw , Poland
| | - P Urbanek
- National Institute of Cardiology in Anin , Warsaw , Poland
| | - R Bodalski
- National Institute of Cardiology in Anin , Warsaw , Poland
| | - K Zielinski
- National Institute of Cardiology in Anin , Warsaw , Poland
| | - M Gandor
- Cracow University of Technology, Poland , Cracow , Poland
| | - F Palka
- Cracow University of Technology, Poland , Cracow , Poland
| | - M Jaworski
- Cracow University of Technology, Poland , Cracow , Poland
| | - G S Mintz
- Cardiovascular Research Foundation , New York , United States of America
| | - I Kowalik
- National Institute of Cardiology in Anin , Warsaw , Poland
| | - A Hasiec
- National Institute of Cardiology in Anin , Warsaw , Poland
| | - M Bilinska
- National Institute of Cardiology in Anin , Warsaw , Poland
| | - P Plawiak
- Cracow University of Technology, Poland , Cracow , Poland
| | - L Szumowski
- National Institute of Cardiology in Anin , Warsaw , Poland
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Kmochova K, Grega T, Ngo O, Vojtechova G, Majek O, Urbanek P, Zavoral M, Suchanek S. Comparison of Four Bowel Cleansing Agents for Colonoscopy and the Factors Affecting their Efficacy. A Prospective, Randomized Study. J Gastrointestin Liver Dis 2021; 30:213-220. [PMID: 33951124 DOI: 10.15403/jgld-3401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND AND AIMS Adequate bowel preparation is essential for successful and effective colonoscopy. Several types of cleansing agents are currently available including low-volume solutions. The aim of this study was to compare the efficacy of four different bowel cleansing agents. METHODS A single-center, prospective, randomized, and single-blind study was performed. Consecutive patients referred for colonoscopy were enrolled and randomized into one of the following types of laxatives: polyethylenglycol 4L (PEG), oral sulfate solution (OSS), 2L polyethylenglycol + ascorbate (2L-PEG/Asc), or magnesium citrate + sodium picosulfate (MCSP). The primary outcome was quality of bowel cleansing evaluated according to the Boston Bowel Preparation Scale (BBPS). Secondary outcomes were polyp detection rate (PDR) and tolerability. RESULTS Final analysis was performed on 431 patients. The number of patients with adequate bowel preparation (BBPS total scores ≥6 and sub scores ≥2 in each segment) was not significantly different throughout all groups (95.4% PEG; 94.6% OSS; 96.3% 2L-PEG/Asc; 96.2% MCSP; p=0.955). Excellent bowel preparation (BBPS total scores ≥ 8) was associated with younger age (p=0.007). The groups did not have significantly different PDRs (49.5% PEG; 49.1% OSS; 38% 2L-PEG/Asc; 40.4% MCSP; p=0.201). The strongest predictors of pathology identification were age and male gender. The best-tolerated solution was MCSP (palatability: p<0.001; nausea: p=0.024).
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Affiliation(s)
- Klara Kmochova
- Department of Medicine, 1st Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic. .
| | - Tomas Grega
- Department of Medicine, 1st Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic.
| | - Ondrej Ngo
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Gabriela Vojtechova
- Department of Medicine, 1st Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic.
| | - Ondrej Majek
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Petr Urbanek
- Department of Medicine, 1st Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic.
| | - Miroslav Zavoral
- Department of Medicine, 1st Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic.
| | - Stepan Suchanek
- Department of Medicine, 1st Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic.
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Frankova S, Lunova M, Gottfriedova H, Senkerikova R, Neroldova M, Kovac J, Kieslichova E, Lanska V, Urbanek P, Spicak J, Jirsa M, Sperl J. Liver stiffness measured by two-dimensional shear-wave elastography predicts hepatic vein pressure gradient at high values in liver transplant candidates with advanced liver cirrhosis. PLoS One 2021; 16:e0244934. [PMID: 33411729 PMCID: PMC7790429 DOI: 10.1371/journal.pone.0244934] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 12/20/2020] [Indexed: 12/15/2022] Open
Abstract
Liver stiffness is a reliable non-invasive predictor of Hepatic Venous Pressure Gradient (HVPG) above 10 mm Hg. However, it failed to predict higher thresholds of HVPG. Our aim was to investigate whether liver stiffness and selected previously published non-invasive blood biomarkers could predict higher HVPG thresholds in liver transplant candidates without ongoing alcohol use. One hundred and nine liver transplant candidates with liver cirrhosis of various aetiologies underwent direct HVPG measurement, liver stiffness measurement by 2D shear-wave elastography (Aixplorer Multiwave, Supersonic Imagine, France) and assessment of blood HVPG biomarkers (osteopontin, VCAM-1, IL-6, TNF-α, IL-1ra/IL-1F3 and ELF score). The correlation between liver stiffness and HVPG was linear up to 30 mm Hg of HVPG (r = 0.765, p < 0.0001). The regression lines had similar slopes for HVPG values below and above 16 mm Hg (p > 0.05) and the correlation in patients with HVPG <16 mm Hg (r = 0.456, p = 0.01) was similar to patients with HVPG ≥ 16 mm Hg (r = 0.499, p < 0.0001). The correlation was similar in the subgroup patients with alcoholic (r = 0.718, p < 0.0001), NASH (r = 0.740, p = 0.008), cryptogenic (r = 0.648, p = 0,0377), cholestatic and autoimmune (r = 0.706, p < 0.0001) and viral cirrhosis (r = 0.756, p < 0.0001). Liver stiffness distinguished patients with HVPG above 16, and 20 mm Hg with AUROCs 0.90243, and 0.86824, sensitivity 0.7656, and 0.7027, and specificity 0.9333, and 0.8750. All studied blood biomarkers correlated better with liver stiffness than with HVPG and their AUROCs did not exceed 0.8 at both HVPG thresholds. Therefore, a composite predictor superior to liver stiffness could not be established. We conclude that liver stiffness is a clinically reliable predictor of higher HVPG thresholds in non-drinking subjects with advanced liver cirrhosis.
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Affiliation(s)
- Sona Frankova
- Department of Hepatogastroenterology, Transplant Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Mariia Lunova
- Laboratory of Experimental Hepatology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Halima Gottfriedova
- Department of Hepatogastroenterology, Transplant Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Renata Senkerikova
- Department of Hepatogastroenterology, Transplant Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
- Charles University, First Faculty of Medicine, Prague, Czech Republic
| | - Magdalena Neroldova
- Laboratory of Experimental Hepatology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jozef Kovac
- Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Eva Kieslichova
- Anaesthesiology, Resuscitation and Intensive Care Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Vera Lanska
- Department of Biostatistics, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Petr Urbanek
- Charles University, First Faculty of Medicine, Prague, Czech Republic
- Department of Internal Medicine, Central Military Hospital, Prague, Czech Republic
| | - Julius Spicak
- Department of Hepatogastroenterology, Transplant Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Milan Jirsa
- Laboratory of Experimental Hepatology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
- Charles University, First Faculty of Medicine, Prague, Czech Republic
| | - Jan Sperl
- Department of Hepatogastroenterology, Transplant Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
- Charles University, First Faculty of Medicine, Prague, Czech Republic
- * E-mail:
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Affiliation(s)
- Jan Csomor
- Department of Internal Medicine, 1st Medical Faculty Charles University, Central Military Hospital Prague, Prague, Czech Republic.,Department of Military Internal Medicine and Military Hygiene, Faculty of Military Health Sciences, University of Defense, Brno, Czech Republic
| | - Irena Murinova
- Department of Clinical Pharmacy, Military University Hospital Prague, Prague, Czech Republic.,Department of Applied Pharmacy, University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic
| | - Petr Hribek
- Department of Internal Medicine, 1st Medical Faculty Charles University, Central Military Hospital Prague, Prague, Czech Republic
| | - Petr Urbanek
- Department of Internal Medicine, 1st Medical Faculty Charles University, Central Military Hospital Prague, Prague, Czech Republic
| | - Miroslav Zavoral
- Department of Internal Medicine, 1st Medical Faculty Charles University, Central Military Hospital Prague, Prague, Czech Republic
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Csomor J, Jirkovska J, Vedralova L, Solar S, Grega T, Urbanek P, Zavoral M. DIABETIC KETOACIDOSIS WITH AN ACUTE ABDOMEN AS A FIRST MANIFESTATION OF TYPE 1 DIABETES MELLITUS. Acta Endocrinol (Buchar) 2017; 13:509-511. [PMID: 31149224 DOI: 10.4183/aeb.2017.509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Context Diabetic pseudoperitonitis is a very rare complication of the type 1 diabetes mellitus and it is associated with a severe ketoacidosis. The exact pathogenesis of the status is still unclear, the typical presentation is an acute abdomen by the patient. To confirm the diagnosis, it is necessary to make examinations, which exclude other possible reason of an acute abdomen by the patient (laboratory tests, abdominal ultrasound or a CT scan). Case presentation A 46-years old man was admitted to the hospital wih a history of a 10 days epigastric pain. Laboratory tests, abdominal ultrasound, CT scan and upper endoscopy were performed, the reason of the pain remained unclear. Because of the peritoneal signs at the first day of the hospitalisation an acute surgery was indicated, without any pathology at the laparoscopy. A severe metabolic acidosis was recognized only after the surgery, the initial hypoglycaemia rose up after giving a total parenteral nutrition to the patient. The increase of the glycaemia, the severe metabolic acidosis with glycosuria and ketonuria, and the elevation of the glycated haemoglobin brought us to the diagnosis of the new onset of the diabetes. Conclusion Diabetic pseudoperitonitis with the picture of an acute abdomen can occur as a first manifestation of the diabetes. Thinking of this rare complication and recognising it can avoid unnecessary acute surgery by the patient.
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Affiliation(s)
- J Csomor
- Charles University and Military University Hospital, 1 Faculty of Medicine, Department of Internal Medicine, Prague, Czech Republic
| | - J Jirkovska
- Charles University and Military University Hospital, 1 Faculty of Medicine, Department of Internal Medicine, Prague, Czech Republic
| | - L Vedralova
- Charles University and Military University Hospital, 1 Faculty of Medicine, Department of Internal Medicine, Prague, Czech Republic
| | - S Solar
- Charles University and Military University Hospital, 1 Faculty of Medicine, Department of Internal Medicine, Prague, Czech Republic
| | - T Grega
- Charles University and Military University Hospital, 1 Faculty of Medicine, Department of Internal Medicine, Prague, Czech Republic
| | - P Urbanek
- Charles University and Military University Hospital, 1 Faculty of Medicine, Department of Internal Medicine, Prague, Czech Republic
| | - M Zavoral
- Charles University and Military University Hospital, 1 Faculty of Medicine, Department of Internal Medicine, Prague, Czech Republic
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Sperl J, Horvath G, Halota W, Ruiz-Tapiador JA, Streinu-Cercel A, Jancoriene L, Werling K, Kileng H, Koklu S, Gerstoft J, Urbanek P, Flisiak R, Leiva R, Kazenaite E, Prinzing R, Patel S, Qiu J, Asante-Appiah E, Wahl J, Nguyen BY, Barr E, Platt HL. Efficacy and safety of elbasvir/grazoprevir and sofosbuvir/pegylated interferon/ribavirin: A phase III randomized controlled trial. J Hepatol 2016; 65:1112-1119. [PMID: 27542322 DOI: 10.1016/j.jhep.2016.07.050] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 07/27/2016] [Accepted: 07/30/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Direct-acting antiviral agents have improved treatment outcomes for patients with hepatitis C virus (HCV) infection; however, head-to-head comparisons are limited. The C-EDGE Head-2-Head Study compared the safety and efficacy of elbasvir/grazoprevir (EBR/GZR) with sofosbuvir plus pegylated interferon/ribavirin (SOF/PR) in patients with HCV infection. METHODS This was a randomized, open-label, phase III trial. Two hundred fifty-seven patients with HCV genotype (GT)1 or 4 infection and baseline viral load >10,000IU/ml were randomized to receive 12weeks of EBR/GZR 50mg/100mg once daily (n=129) or sofosbuvir (400mg once daily) plus PR (n=128). Primary efficacy objective was sustained virologic response 12weeks after the end of therapy (SVR12, HCV RNA <15IU/ml). The primary safety objective was the proportion of patients experiencing a tier 1 safety event. RESULTS The majority of patients were non-cirrhotic (83.1%), treatment-naïve (74.9%) and had HCV GT1b infection (82.0%). SVR12 rates were 99.2% (128/129) and 90.5% (114/126) in the EBR/GZR and SOF/PR groups, respectively. The estimated adjusted difference in SVR12 was 8.8% (95% confidence interval [CI], 3.6-15.3%). Because the lower bound of the 1-sided 1-sample exact test was greater than -10% and greater than zero, both non-inferiority and superiority of EBR/GZR vs. SOF/PR were established. The frequency of tier 1 safety events was lower among patients receiving EBR/GZR than SOF/PR (0.8% vs. 27.8%, between group difference, 27.0% [95% CI, -35.5% to -19.6%; p<0.001]). CONCLUSIONS EBR/GZR has a superior efficacy and safety profile in patients with HCV GT1 or 4 infection compared with SOF/PR. LAY SUMMARY The combination of elbasvir/grazoprevir for 12weeks was highly effective in treating patients with chronic hepatitis C, genotypes 1 or 4 infection. This regimen was more effective than sofosbuvir/pegylated interferon/ribavirin for 12weeks, and was notably superior in patients regarded as difficult to treat, including those with previous treatment failure, cirrhosis, or a high baseline viral load. The combination of elbasvir/grazoprevir also demonstrated a superior safety and tolerability profile based on fewer serious adverse events, no serious drug-related adverse events, and no treatment discontinuations. CLINICAL TRIAL REGISTRATION Clinical trials.gov Identifier: NCT02358044.
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Affiliation(s)
- Jan Sperl
- Institut Klinické a Experimentální Medicíny (IKEM), Prague, Czech Republic.
| | | | - Waldemar Halota
- Department of Infectious Diseases and Hepatology, Faculty of Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland
| | | | - Anca Streinu-Cercel
- Carol Davila University of Medicine and Pharmacy, National Institute for Infectious Diseases "Prof. Dr. Matei Balș", Bucharest, Romania
| | - Ligita Jancoriene
- Vilnius University, Department of Infectious and Chest Diseases, Dermatovenerology and Alergology, Vilnius University Hospital Santariškių Klinikos, Vilnius, Lithuania
| | | | - Hege Kileng
- UNN Universitetssykehuset Nord Norge, Tromsø, Norway
| | | | - Jan Gerstoft
- Klinik for Infektionsmedicin, Rigshospitalet, University of Copenhagen, Denmark
| | - Petr Urbanek
- Department of Internal Medicine, 1st Medical Faculty Charles University and Central Military Hospital, Prague, Czech Republic
| | - Robert Flisiak
- Department of Infectious Diseases and Hepatology, Medical University of Bialystok, Bialystok, Poland
| | | | - Edita Kazenaite
- Vilnius University, Faculty of Medicine, Vilnius University Hospital Santariškių Klinikos, Vilnius, Lithuania
| | | | - Sushma Patel
- Merck & Co., Inc., Kenilworth, NJ, United States
| | - Jingjun Qiu
- Merck & Co., Inc., Kenilworth, NJ, United States
| | | | - Janice Wahl
- Merck & Co., Inc., Kenilworth, NJ, United States
| | | | - Eliav Barr
- Merck & Co., Inc., Kenilworth, NJ, United States
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10
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Bruha R, Jachymova M, Petrtyl J, Dvorak K, Lenicek M, Urbanek P, Svestka T, Vitek L. Osteopontin: A non-invasive parameter of portal hypertension and prognostic marker of cirrhosis. World J Gastroenterol 2016; 22:3441-3450. [PMID: 27022226 PMCID: PMC4806202 DOI: 10.3748/wjg.v22.i12.3441] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 12/03/2015] [Accepted: 12/21/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the relationship between osteopontin plasma concentrations and the severity of portal hypertension and to assess osteopontin prognostic value.
METHODS: A cohort of 154 patients with confirmed liver cirrhosis (112 ethylic, 108 men, age 34-72 years) were enrolled in the study. Hepatic venous pressure gradient (HVPG) measurement and laboratory and ultrasound examinations were carried out for all patients. HVPG was measured using a standard catheterization method with the balloon wedge technique. Osteopontin was measured using the enzyme-linked immunosorbent assay (ELISA) method in plasma. Patients were followed up with a specific focus on mortality. The control group consisted of 137 healthy age- and sex- matched individuals.
RESULTS: The mean value of HVPG was 16.18 ± 5.6 mmHg. Compared to controls, the plasma levels of osteopontin in cirrhotic patients were significantly higher (P < 0.001). The plasma levels of osteopontin were positively related to HVPG (P = 0.0022, r = 0.25) and differed among the individual Child-Pugh groups of patients. The cut-off value of 80 ng/mL osteopontin distinguished patients with significant portal hypertension (HVPG above 10 mmHg) at 75% sensitivity and 63% specificity. The mean follow-up of patients was 3.7 ± 2.6 years. The probability of cumulative survival was 39% for patients with HVPG > 10 mmHg and 65% for those with HVPG ≤ 10 mmHg (P = 0.0086, odds ratio (OR), 2.92, 95% confidence interval (CI): 1.09-7.76). Osteopontin showed a similar prognostic value to HVPG. Patients with osteopontin values above 80 ng/mL had significantly lower cumulative survival compared to those with osteopontin ≤ 80 ng/mL (37% vs 56%, P = 0.00035; OR = 2.23, 95%CI: 1.06-4.68).
CONCLUSION: Osteopontin is a non-invasive parameter of portal hypertension that distinguishes patients with clinically significant portal hypertension. It is a strong prognostic factor for survival.
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Frankova S, Jirsa M, Merta D, Neroldova M, Urbanek P, Senkerikova R, Spicak J, Sperl J. USP18 downregulation in peripheral blood mononuclear cells predicts nonresponse to interferon-based triple therapy in patients with chronic hepatitis C, genotype 1: a pilot study. Ther Clin Risk Manag 2015; 11:1853-61. [PMID: 26719699 PMCID: PMC4687952 DOI: 10.2147/tcrm.s94010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background and aims Patients with advanced liver fibrosis owing to chronic hepatitis C virus genotype 1 represent a difficult-to-treat group even if a protease inhibitor is added to pegylated interferon alpha and ribavirin. Therefore, only patients with a high chance of cure should be treated with interferon-based treatment. Patients and methods Expression of IFNG, IFNLR1, and interferon-sensitive genes CXCL9, IFI16, IFI27, ISG15, and USP18 in peripheral blood mononuclear cells was assessed before and during the initial 12 weeks of treatment. The studied group consisted of 26 treatment-experienced patients of average age of 50 years with advanced liver fibrosis compared to seven healthy volunteers. Fourteen patients were treated with pegylated interferon alpha 2b, ribavirin, and boceprevir and 12 patients with telaprevir. The overall sustained virological response (SVR) rate was 69% (18/26). Results A significant difference in the initial expression (median, interquartile range [IQR]) of CXCL9 2.9×, IQR: 1.7–12.4 vs 1.2×, IQR: 0.5–1.8; (P=0.01) IFNG 7.3×, IQR: 1.7–32.6 vs 0.7×, IQR: 0.4–1.3; P=0.002 and USP18 3.7×, IQR: 2.1–7.7 vs 1.4×, IQR: 0.9–1.6; (P=0.03) was found between the SVR and non-SVR groups. Expression of all analyzed genes was progressively increasing during the first 12 weeks of therapy, but a significant difference between SVR and non-SVR group was found only in USP18 expression at week 12 (P=0.001). Initial expression of four genes predicted SVR in univariate analysis (CXCL9 [OR: 12.00, 95% CI: 1.21–118.89], IFI27 [OR: 12.00, 95% CI: 1.21–118.89], IFNG [OR: 10.50, 95% CI: 1.50–73.67], USP18 [OR: 21.00, 95% CI: 2.05–215.18]). In multivariate analysis, only the initial expression of USP18 was identified as a predictor of SVR (P=0.047). Conclusion Initial expression of USP18 and the course of its activation could be a reliable predictor of SVR achievement.
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Affiliation(s)
- Sona Frankova
- Department of Hepatogastroenterology, Resuscitation and Intensive Care, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Milan Jirsa
- Laboratory of Experimental Hepatology, Resuscitation and Intensive Care, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Dusan Merta
- Department of Anesthesiology, Resuscitation and Intensive Care, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Magdalena Neroldova
- Laboratory of Experimental Hepatology, Resuscitation and Intensive Care, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Petr Urbanek
- Department of Internal Medicine, Central Military Hospital, First Medical School, Prague, Czech Republic
| | - Renata Senkerikova
- Department of Hepatogastroenterology, Resuscitation and Intensive Care, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Julius Spicak
- Department of Hepatogastroenterology, Resuscitation and Intensive Care, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jan Sperl
- Department of Hepatogastroenterology, Resuscitation and Intensive Care, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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Lepida A, Colombo M, Fernandez I, Abdurakhmanov D, Abrao Ferreira P, Strasser SI, Urbanek P, Mangia A, Calleja JL, Iraqi W, DeMasi R, Lonjon-Domanec I, Moreno C, Wedemeyer H. Final Results of the Telaprevir Access Program: FibroScan Values Predict Safety and Efficacy in Hepatitis C Patients with Advanced Fibrosis or Cirrhosis. PLoS One 2015; 10:e0138503. [PMID: 26398503 PMCID: PMC4580464 DOI: 10.1371/journal.pone.0138503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 08/29/2015] [Indexed: 12/12/2022] Open
Abstract
Background Liver stiffness determined by transient elastography is correlated with hepatic fibrosis stage and has high accuracy for detecting severe fibrosis and cirrhosis in chronic hepatitis C patients. We evaluated the clinical value of baseline FibroScan values for the prediction of safety and efficacy of telaprevir-based therapy in patients with advanced fibrosis and cirrhosis in the telaprevir Early Access Program HEP3002. Methods 1,772 patients with HCV-1 and bridging fibrosis or cirrhosis were treated with telaprevir plus pegylated interferon-α and ribavirin (PR) for 12 weeks followed by PR alone, the total treatment duration depending on virological response and previous response type. Liver fibrosis stage was determined either by liver biopsy or by non-invasive markers. 1,282 patients (72%) had disease stage assessed by FibroScan; among those 46% were classified as Metavir F3 at baseline and 54% as F4. Results Overall, 1,139 patients (64%) achieved a sustained virological response (SVR) by intention-to-treat analysis. Baseline FibroScan values were tested for association with SVR and the occurrence of adverse events. By univariate analysis, higher baseline FibroScan values were predictive of lower sustained virological response rates and treatment-related anemia. By multivariate analysis, FibroScan was no longer statistically significant as an independent predictor, but higher FibroScan values were correlated with the occurrence of infections and serious adverse events. Conclusions FibroScan has a limited utility as a predictor of safety and efficacy in patients treated with telaprevir-based triple therapy. Nevertheless it can be used in association with other clinical and biological parameters to help determine patients who will benefit from the triple regiments. Trial Registration ClinicalTrials.gov NCT01508286
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Affiliation(s)
- Antonia Lepida
- Liver Unit, Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Massimo Colombo
- Department of Medicine, Division of Gastroenterology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Universita’ degli Studi di Milano, Milan, Italy
| | - Inmaculada Fernandez
- Hospital Universitario 12 de Octubre, Sección de Aparato Digestivo, Madrid, Spain
| | - Djamal Abdurakhmanov
- I.M. Sechenov First Moscow State Medical University, E.M. Tareev Clinic for Nephrology, Internal and Occupational Medicine, Moscow, Russia
| | - Paulo Abrao Ferreira
- Outpatient Clinic to HIV and Viral Hepatitis Division of Infectious Disease, Federal University of São Paulo, São Paulo, Brazil
| | - Simone I. Strasser
- AW Morrow Gastroenterology and Liver Center, Royal Prince Alfred hospital and University of Sydney, Sydney, Australia
| | - Petr Urbanek
- Department of Internal Medicine, First Medical Faculty, Charles University, and Central Military Hospital Prague, Prague, Czech Republic
| | - Alessandra Mangia
- Liver Unit, IRCCS Hospital 'Casa Sollievo della Sofferenza', San Giovanni Rotondo, Italy
| | - José L. Calleja
- Gastroenterology, Hospital Universitario Puerta de Hierro, Universidad Autonoma de Madrid, CIBERehd, Madrid, Spain
| | | | - Ralph DeMasi
- Janssen Research and development, Titusville, New Jersey, United States of America
| | | | - Christophe Moreno
- Liver Unit, Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
- * E-mail:
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Zakharov S, Csomor J, Urbanek P, Pelclova D. Toxic Epidermal Necrolysis After Exposure to Dithiocarbamate Fungicide Mancozeb. Basic Clin Pharmacol Toxicol 2015; 118:87-91. [PMID: 26073440 DOI: 10.1111/bcpt.12430] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 06/10/2015] [Indexed: 11/30/2022]
Abstract
Toxic epidermal necrolysis (TEN) is a life-threatening mucocutaneous disease with high mortality. Dithiocarbamates (DTC) are organosulphur compounds widely used in agriculture, industry and households. We report a case of TEN after exposure to mancozeb in fungicide. A 48-year-old 75 kg b.w. man was admitted with fever and generalized skin/mucous lesions after application of fungicide in a home garden. The patient had necrotic desquamation of gastrointestinal/respiratory tract mucosa, ocular lesion and skin epidermolysis of 90% of body surface. The laboratory findings included elevation of inflammatory parameters, hyperglycaemia, increased urea, creatinine, liver enzymes, hypoalbuminemia and electrolyte disturbances. The treatment included supportive care, management of fluid/electrolyte requirements, analgesics and enteral nutrition. Skin lesions were treated with occlusive non-adhesive biological wound dressings. Due to the proof of Acinetobacter, Escherichia coli and Escherichia faecalis from skin swabs, a combination of meropenem with amikacin was administered. During the next 2 weeks, complete re-epithelialization of skin lesions occurred, mucosal lesions healed and the laboratory parameters returned to normal. The patient was discharged on day 42. TEN is a rare condition that is generally caused by medications. Nevertheless, high attention should be paid to the cases of occupational or household exposure to DTC fungicides widely used in agriculture and home gardens because of their ability to cause TEN after skin and inhalation exposure. Greater emphasis on the hazardous properties of these products is necessary to ensure non-professional users are aware of the necessity of protective clothing during mixing, loading, application and early re-entry into treated fields.
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Affiliation(s)
- Sergey Zakharov
- Toxicological Information Centre, Department of Occupational Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jan Csomor
- Department of Internal Medicine, First Faculty of Medicine, Charles University and Central Military Hospital, Prague, Czech Republic
| | - Petr Urbanek
- Department of Internal Medicine, First Faculty of Medicine, Charles University and Central Military Hospital, Prague, Czech Republic
| | - Daniela Pelclova
- Toxicological Information Centre, Department of Occupational Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
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14
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Colombo M, Strasser S, Moreno C, Abrao Ferreira P, Urbanek P, Fernández I, Abdurakmonov D, Streinu-Cercel A, Verheyen A, Iraqi W, DeMasi R, Hill A, Lonjon-Domanec I, Wedemeyer H. Sustained virological response with telaprevir in 1,078 patients with advanced hepatitis C: the international telaprevir access program. J Hepatol 2014; 61:976-83. [PMID: 24946280 DOI: 10.1016/j.jhep.2014.06.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 05/15/2014] [Accepted: 06/08/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS There is little information regarding the extent to which difficult to cure patients with advanced liver fibrosis, due to hepatitis C virus genotype-1 (HCV-1) can successfully and safely be treated with triple therapy with telaprevir (TVR), pegylated interferon alpha (P) and ribavirin (R). In the TVR early access program HEP3002 we aimed to explore treatment safety and efficacy, and identify predictors of sustained virological response at week 24 (SVR24). METHODS 1078 patients with bridging fibrosis (n=552) or cirrhosis (n=526) diagnosed by either liver biopsy or non-invasive markers, with compensated bone marrow (neutrophils >1500/mm(3), Hb >12/13 g/dl) and liver function (Albumin >3.3g/dl, Platelets >90,000/ml) received TVR PR for 12 weeks, followed by a PR tail according to label. RESULTS Overall, 614 (57%) achieved SVR24 by intention-to-treat analysis. The SVR24 rate was 68% in 221 treatment naïve patients (62.8% F4), 72% in 356 prior relapsers (64.4% F4), 55% in 139 partial responders (53.2% F4), and 34% in 294 null responders (28.6% F4). The SVR24 rate to response-guided therapy (24 weeks treatment duration if undetectable viremia at weeks 4 and 12) was 84% in 222 naïve/relapser F3 patients. Independent predictors of response were: (A) F3 (odds ratio (OR)=1.51, 95% CI 1.31-2.00, p=0.005), (B) subtype 1b (OR=1.63, 95% CI 1.18-2.24, p=0.0029), (C) alpha-fetoprotein <10 ng/ml (OR=2.50, 95% CI 1.87-3.36, p<0.0001) and (D) any prior response other than null (OR=3.29, 95% CI 2.40-4.52, p<0.0001). SVR24 rose for patients who had more of these predictive factors: 6/32 (19%) for none, 38/139 (27%) for 1, 129/260 (50%) for 2, 202/329 (61%) for 3, and 194/235 (83%) for 4 factors. Grade 2-4 treatment-related adverse events (AE) were experienced by 719 (67%) patients; 169 (16%) discontinued therapy for AE and 7 (0.6%) died during the PR tail. CONCLUSIONS Naïve and experienced patients with advanced fibrosis or cirrhosis due to HCV-1 who have compensated bone marrow and liver function, can effectively and safely be treated by TVR triple therapy. Baseline predictors of outcome have been identified to optimize pre-treatment counselling.
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Affiliation(s)
- Massimo Colombo
- Department of Medicine, Division of Gastroenterology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
| | - Simone Strasser
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia
| | - Christophe Moreno
- Liver Unit, Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Paulo Abrao Ferreira
- Outpatient Clinic to HIV and Viral Hepatitis Division of Infectious Disease, Federal University of São Paulo, São Paulo, Brazil
| | - Petr Urbanek
- Department of Internal Medicine, First Medical Faculty, Charles University, and Central Military Hospital Prague, Prague, Czech Republic
| | - Inmaculada Fernández
- Hospital Universitario 12 de Octubre, Sección de Aparato Digestivo, Madrid, Spain
| | - Djamal Abdurakmonov
- I.M. Sechenov First Moscow State Medical University, E.M. Tareev Clinic for Nephrology, Internal and Occupational Medicine, Moscow, Russia
| | - Adrian Streinu-Cercel
- Carol Davila University of Medicine and Pharmacy, National Institute for Infectious Diseases "Prof. Dr. Matei Bals", Bucharest, Romania
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15
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Colombo M, Fernández I, Abdurakhmanov D, Ferreira PA, Strasser SI, Urbanek P, Moreno C, Streinu-Cercel A, Verheyen A, Iraqi W, DeMasi R, Hill A, Läuffer JM, Lonjon-Domanec I, Wedemeyer H. Safety and on-treatment efficacy of telaprevir: the early access programme for patients with advanced hepatitis C. Gut 2014; 63:1150-8. [PMID: 24201995 PMCID: PMC4078754 DOI: 10.1136/gutjnl-2013-305667] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Severe adverse events (AEs) compromise the outcome of direct antiviral agent-based treatment in patients with advanced liver fibrosis due to HCV infection. HEP3002 is an ongoing multinational programme to evaluate safety and efficacy of telaprevir (TVR) plus pegylated-interferon-α (PEG-IFNα) and ribavirin (RBV) in patients with advanced liver fibrosis caused by HCV genotype 1 (HCV-1). METHODS 1782 patients with HCV-1 and bridging fibrosis or compensated cirrhosis were prospectively recruited from 16 countries worldwide, and treated with 12 weeks of TVR plus PEG-IFN/RBV, followed by 12 or 36 weeks of PEG-IFN and RBV (PR) alone dependent on virological response to treatment and previous response type. RESULTS 1587 patients completed 12 weeks of triple therapy and 4 weeks of PR tail (53% cirrhosis, 22% HCV-1a). By week 12, HCV RNA was undetectable in 85% of naives, 88% of relapsers, 80% of partial responders and 72% of null responders. Overall, 931 patients (59%) developed grade 1-4 anaemia (grade 3/4 in 31%), 630 (40%) dose reduced RBV, 332 (21%) received erythropoietin and 157 (10%) were transfused. Age and female gender were the strongest predictors of anaemia. 64 patients (4%) developed a grade 3/4 rash. Discontinuation of TVR due to AEs was necessary in 193 patients (12%). Seven patients died (0.4%, six had cirrhosis). CONCLUSIONS In compensated patients with advanced fibrosis due to HCV-1, triple therapy with TVR led to satisfactory rates of safety, tolerability and on-treatment virological response with adequate managements of AEs.
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Affiliation(s)
- M Colombo
- Department of Medicine, Division of Gastroenterology, Fondazione IRCCS Ca` Granda Ospedale Maggiore Policlinico, Universita` degli Studi di Milano, Milan, Italy
| | - I Fernández
- Hospital Universitario 12 de Octubre, Sección de Aparato Digestivo, Madrid, Spain
| | - D Abdurakhmanov
- I.M. Sechenov First Moscow State Medical University, E. M. Tareev Clinic for Nephrology, Internal and Occupational Medicine, Moscow, Russia
| | - P A Ferreira
- Viral Hepatitis Division of Infectious Disease, Outpatient Clinic to HIV, Federal University of São Paulo, São Paulo, Brazil
| | - S I Strasser
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
| | - P Urbanek
- Department of Internal Medicine, First Medical Faculty, Charles University, and Central Military Hospital Prague, Prague, Czech Republic
| | - C Moreno
- Liver Unit, Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - A Streinu-Cercel
- Carol Davila University of Medicine and Pharmacy, National Institute for Infectious Diseases, "Prof. Dr. Matei Bals", Bucharest, Romania
| | | | - W Iraqi
- Janssen Pharmaceuticals, Paris, France
| | - R DeMasi
- Janssen Research and Development, Titusville, New Jersey, USA
| | - A Hill
- Janssen Research and Development, High Wycombe, UK
| | | | | | - H Wedemeyer
- Medizinische Hochschule Hannover, Hannover, Germany
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16
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Bruggmann P, Berg T, Øvrehus ALH, Moreno C, Brandão Mello CE, Roudot-Thoraval F, Marinho RT, Sherman M, Ryder SD, Sperl J, Akarca U, Balık I, Bihl F, Bilodeau M, Blasco AJ, Buti M, Calinas F, Calleja JL, Cheinquer H, Christensen PB, Clausen M, Coelho HSM, Cornberg M, Cramp ME, Dore GJ, Doss W, Duberg AS, El-Sayed MH, Ergör G, Esmat G, Estes C, Falconer K, Félix J, Ferraz MLG, Ferreira PR, Frankova S, García-Samaniego J, Gerstoft J, Giria JA, Gonçales FL, Gower E, Gschwantler M, Guimarães Pessôa M, Hézode C, Hofer H, Husa P, Idilman R, Kåberg M, Kaita KDE, Kautz A, Kaymakoglu S, Krajden M, Krarup H, Laleman W, Lavanchy D, Lázaro P, Marotta P, Mauss S, Mendes Correa MC, Müllhaupt B, Myers RP, Negro F, Nemecek V, Örmeci N, Parkes J, Peltekian KM, Ramji A, Razavi H, Reis N, Roberts SK, Rosenberg WM, Sarmento-Castro R, Sarrazin C, Semela D, Shiha GE, Sievert W, Stärkel P, Stauber RE, Thompson AJ, Urbanek P, van Thiel I, Van Vlierberghe H, Vandijck D, Vogel W, Waked I, Wedemeyer H, Weis N, Wiegand J, Yosry A, Zekry A, Van Damme P, Aleman S, Hindman SJ. Historical epidemiology of hepatitis C virus (HCV) in selected countries. J Viral Hepat 2014; 21 Suppl 1:5-33. [PMID: 24713004 DOI: 10.1111/jvh.12247] [Citation(s) in RCA: 179] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Chronic infection with hepatitis C virus (HCV) is a leading indicator for liver disease. New treatment options are becoming available, and there is a need to characterize the epidemiology and disease burden of HCV. Data for prevalence, viremia, genotype, diagnosis and treatment were obtained through literature searches and expert consensus for 16 countries. For some countries, data from centralized registries were used to estimate diagnosis and treatment rates. Data for the number of liver transplants and the proportion attributable to HCV were obtained from centralized databases. Viremic prevalence estimates varied widely between countries, ranging from 0.3% in Austria, England and Germany to 8.5% in Egypt. The largest viremic populations were in Egypt, with 6,358,000 cases in 2008 and Brazil with 2,106,000 cases in 2007. The age distribution of cases differed between countries. In most countries, prevalence rates were higher among males, reflecting higher rates of injection drug use. Diagnosis, treatment and transplant levels also differed considerably between countries. Reliable estimates characterizing HCV-infected populations are critical for addressing HCV-related morbidity and mortality. There is a need to quantify the burden of chronic HCV infection at the national level.
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Affiliation(s)
- P Bruggmann
- Arud Centres for Addiction Medicine, Zurich, Switzerland
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Razavi H, Waked I, Sarrazin C, Myers RP, Idilman R, Calinas F, Vogel W, Mendes Correa MC, Hézode C, Lázaro P, Akarca U, Aleman S, Balık I, Berg T, Bihl F, Bilodeau M, Blasco AJ, Brandão Mello CE, Bruggmann P, Buti M, Calleja JL, Cheinquer H, Christensen PB, Clausen M, Coelho HSM, Cramp ME, Dore GJ, Doss W, Duberg AS, El-Sayed MH, Ergör G, Esmat G, Falconer K, Félix J, Ferraz MLG, Ferreira PR, Frankova S, García-Samaniego J, Gerstoft J, Giria JA, Gonçales FL, Gower E, Gschwantler M, Guimarães Pessôa M, Hindman SJ, Hofer H, Husa P, Kåberg M, Kaita KDE, Kautz A, Kaymakoglu S, Krajden M, Krarup H, Laleman W, Lavanchy D, Marinho RT, Marotta P, Mauss S, Moreno C, Murphy K, Negro F, Nemecek V, Örmeci N, Øvrehus ALH, Parkes J, Pasini K, Peltekian KM, Ramji A, Reis N, Roberts SK, Rosenberg WM, Roudot-Thoraval F, Ryder SD, Sarmento-Castro R, Semela D, Sherman M, Shiha GE, Sievert W, Sperl J, Stärkel P, Stauber RE, Thompson AJ, Urbanek P, Van Damme P, van Thiel I, Van Vlierberghe H, Vandijck D, Wedemeyer H, Weis N, Wiegand J, Yosry A, Zekry A, Cornberg M, Müllhaupt B, Estes C. The present and future disease burden of hepatitis C virus (HCV) infection with today's treatment paradigm. J Viral Hepat 2014; 21 Suppl 1:34-59. [PMID: 24713005 DOI: 10.1111/jvh.12248] [Citation(s) in RCA: 275] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The disease burden of hepatitis C virus (HCV) is expected to increase as the infected population ages. A modelling approach was used to estimate the total number of viremic infections, diagnosed, treated and new infections in 2013. In addition, the model was used to estimate the change in the total number of HCV infections, the disease progression and mortality in 2013-2030. Finally, expert panel consensus was used to capture current treatment practices in each country. Using today's treatment paradigm, the total number of HCV infections is projected to decline or remain flat in all countries studied. However, in the same time period, the number of individuals with late-stage liver disease is projected to increase. This study concluded that the current treatment rate and efficacy are not sufficient to manage the disease burden of HCV. Thus, alternative strategies are required to keep the number of HCV individuals with advanced liver disease and liver-related deaths from increasing.
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Affiliation(s)
- H Razavi
- Center for Disease Analysis, Louisville, Colorado, USA
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Wedemeyer H, Duberg AS, Buti M, Rosenberg WM, Frankova S, Esmat G, Örmeci N, Van Vlierberghe H, Gschwantler M, Akarca U, Aleman S, Balık I, Berg T, Bihl F, Bilodeau M, Blasco AJ, Brandão Mello CE, Bruggmann P, Calinas F, Calleja JL, Cheinquer H, Christensen PB, Clausen M, Coelho HSM, Cornberg M, Cramp ME, Dore GJ, Doss W, El-Sayed MH, Ergör G, Estes C, Falconer K, Félix J, Ferraz MLG, Ferreira PR, García-Samaniego J, Gerstoft J, Giria JA, Gonçales FL, Guimarães Pessôa M, Hézode C, Hindman SJ, Hofer H, Husa P, Idilman R, Kåberg M, Kaita KDE, Kautz A, Kaymakoglu S, Krajden M, Krarup H, Laleman W, Lavanchy D, Lázaro P, Marinho RT, Marotta P, Mauss S, Mendes Correa MC, Moreno C, Müllhaupt B, Myers RP, Nemecek V, Øvrehus ALH, Parkes J, Peltekian KM, Ramji A, Razavi H, Reis N, Roberts SK, Roudot-Thoraval F, Ryder SD, Sarmento-Castro R, Sarrazin C, Semela D, Sherman M, Shiha GE, Sperl J, Stärkel P, Stauber RE, Thompson AJ, Urbanek P, Van Damme P, van Thiel I, Vandijck D, Vogel W, Waked I, Weis N, Wiegand J, Yosry A, Zekry A, Negro F, Sievert W, Gower E. Strategies to manage hepatitis C virus (HCV) disease burden. J Viral Hepat 2014; 21 Suppl 1:60-89. [PMID: 24713006 DOI: 10.1111/jvh.12249] [Citation(s) in RCA: 136] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The number of hepatitis C virus (HCV) infections is projected to decline while those with advanced liver disease will increase. A modeling approach was used to forecast two treatment scenarios: (i) the impact of increased treatment efficacy while keeping the number of treated patients constant and (ii) increasing efficacy and treatment rate. This analysis suggests that successful diagnosis and treatment of a small proportion of patients can contribute significantly to the reduction of disease burden in the countries studied. The largest reduction in HCV-related morbidity and mortality occurs when increased treatment is combined with higher efficacy therapies, generally in combination with increased diagnosis. With a treatment rate of approximately 10%, this analysis suggests it is possible to achieve elimination of HCV (defined as a >90% decline in total infections by 2030). However, for most countries presented, this will require a 3-5 fold increase in diagnosis and/or treatment. Thus, building the public health and clinical provider capacity for improved diagnosis and treatment will be critical.
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Affiliation(s)
- H Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
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Nelson D, Yoshida EM, Paulson MS, Hengen PN, Ge D, Kanwar B, McNally J, Pang PS, Subramanian GM, McHutchison JG, Urbanek P, Lawitz E, Urban TJ. Genome-wide association study to characterize serum bilirubin elevations in patients with HCV treated with GS-9256, an HCV NS3 serine protease inhibitor. Antivir Ther 2014; 19:679-86. [PMID: 24503447 DOI: 10.3851/imp2747] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Protease inhibitors for the treatment of HCV can cause mild and reversible elevations of unconjugated bilirubin. We sought to characterize genetic determinants of bilirubin elevations using a genome-wide approach among patients with genotype 1 HCV who received combination therapy that included GS-9256, a novel potent inhibitor of HCV NS3 serine protease, as part of a Phase IIb trial. METHODS Of the 200 patients sampled, 176 had confirmed European ancestry and were included in the analysis. Infinium HumanOmni5BeadChip (Illumina, Inc., San Diego, CA, USA) was used for genotyping. A categorical analysis of low (grade 0-1) versus high (grade 2-4) bilirubin toxicity grade and a quantitative trait locus mapping of peak bilirubin concentrations was performed. RESULTS A total of 4,466,809 genetic markers were analysed. No single variant showed a statistically significant association with observed bilirubin elevations in this patient population. In a targeted analysis of single nucleotide polymorphisms in genes known to be involved in bilirubin transport, no significant differences in allele frequency between high and low bilirubin toxicity grade were observed. CONCLUSIONS These results indicate that risk for bilirubin elevation in patients receiving GS-9256 is unlikely to be strongly influenced by common genetic variants with large effects. The current study cannot rule out a role for common variants of weak effect, or a more complex model, including multiple contributing factors, such as rare variants and as yet unidentified environmental influences.
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Affiliation(s)
- David Nelson
- Department of Medicine, University of Florida, Gainesville, FL, USA
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20
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Juenemann M, Yeniguen M, Schleicher N, Blumenstein J, Nedelmann M, Tschernatsch M, Bachmann G, Kaps M, Urbanek P, Schoenburg M, Gerriets T. Impact of bubble size in a rat model of cerebral air microembolization. J Cardiothorac Surg 2013; 8:198. [PMID: 24139539 PMCID: PMC4016598 DOI: 10.1186/1749-8090-8-198] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Accepted: 09/24/2013] [Indexed: 11/16/2022] Open
Abstract
Background Cerebral air microembolization (CAM) is a frequent side effect of diagnostic or therapeutic interventions. Besides reduction of the amount of bubbles, filter systems in the clinical setting may also lead to a dispersion of large gas bubbles and therefore to an increase of the gas–liquid-endothelium interface. We evaluated the production and application of different strictly defined bubble diameters in a rat model of CAM and assessed functional outcome and infarct volumes in relation to the bubble diameter. Methods Gas emboli of defined number and diameter were injected into the carotid artery of rats. Group I (n = 7) received 1800 air bubbles with a diameter of 45 μm, group II (n = 7) 40 bubbles of 160 μm, controls (n = 6) saline without gas bubbles; group I and II yielded the same total injection volume of air with 86 nl. Functional outcome was assessed at baseline, after 4 h and 24 h following cerebral MR imaging and infarct size calculation. Results Computer-aided evaluation of bubble diameters showed high constancy (group I: 45.83 μm ± 2.79; group II: 159 μm ± 1.26). Animals in group I and II suffered cerebral ischemia and clinical deterioration without significant difference. Infarct sizes did not differ significantly between the two groups (p = 0.931 u-test). Conclusions We present further development of a new method, which allows reliable and controlled CAM with different bubble diameters, producing neurological deficits due to unilateral cerebral damage. Our findings could not display a strong dependency of stroke frequency and severity on bubble diameter.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Tibo Gerriets
- Department of Neurology, Justus-Liebig-University Giessen, Giessen, Germany.
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21
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Nedelmann M, Schleicher N, Doenges S, Reuter P, Kaps M, Urbanek S, Schwarz N, Madlener K, Schoenburg M, Urbanek P, Gerriets T. Ultrasound destruction of air microemboli as a novel approach to brain protection in cardiac surgery. J Cardiothorac Vasc Anesth 2013; 27:876-83. [PMID: 23791496 DOI: 10.1053/j.jvca.2013.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Evaluation of a novel approach to eliminate air microemboli from extracorporeal circulation via ultrasonic destruction. DESIGN In vitro proof-of-concept study. SETTING Research laboratory. PARTICIPANTS None. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS An extracorporeal circulation device was filled with human blood circulating at 3 L/min. Air bubbles were injected into the system. For bubble destruction, the blood in the tubing system was repeatedly insonated for 3 minutes using a therapeutic 60-kHz device, with variation of intensity and duty cycle settings, ranging from 0.2 W/cm² to 1.0 W/cm² and from duty cycle 60% to continuous wave (CW). Number and diameter of air microemboli were counted upstream and downstream of the ultrasound device by a 2-channel microemboli Doppler detector. For safety assessment, circulating blood was insonated continuously for 2 hours at 0.8 W/cm² CW and compared with circulation without insonation; and standard blood parameters were analyzed. Without treatment, 1,313 to 1,580 emboli were detected upstream, diameter ranging between 10 and 130 μm. Ultrasound treatment eliminated up to 87% of all detected bubbles in cw application (p<0.01) and showed comparable effects at intensities from 0.4 W/cm² to 1.0 W/cm² cw. Bubbles sized>15 μm almost were eliminated completely (p<0.001). Pulsed wave application rendered inferior results (p>0.05). No relevant changes of blood parameters were observed compared with control circulation. CONCLUSIONS Ultrasound destruction of air emboli is a very efficient method to reduce number and size of emboli. Within the limits of safety assessment, the authors could not detect relevant side effects on standard blood parameters.
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Affiliation(s)
- Max Nedelmann
- Department of Neurology, Justus-Liebig-University, Giessen, Germany; Heart and Brain Research Group, Justus-Liebig-University, Giessen and Kerckhoff Clinic, Bad Nauheim, Germany.
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Petrtyl J, Dvorak K, Jachymova M, Vitek L, Lenicek M, Urbanek P, Linhart A, Jansa P, Bruha R. Functional variants of eNOS and iNOS genes have no relationship to the portal hypertension in patients with liver cirrhosis. Scand J Gastroenterol 2013; 48:592-601. [PMID: 23452051 DOI: 10.3109/00365521.2013.773459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Nitric oxide is an important vasoactive mediator. Changes in NO production, caused by functional variants of both endothelial and inducible NO synthase (eNOS, iNOS), might play a role in portal hypertension. The aim was to study the significance of functional eNOS and iNOS gene variants in cirrhotic patients and their interrelationship to both inflammatory and endothelial activation parameters. MATERIAL AND METHODS One hundred and thirty-two patients with liver cirrhosis (age 36-72 years) and 101 controls were examined for functional variants of eNOS (E298D, 27bpintr4, 786T/C) and iNOS (R221W, S608L) genes. Inflammatory (IL6, IL8, IL10) and vasoactive (sVCAM-1, E-selectin) cytokines were measured using ELISA kits. RESULTS The frequency of E298D (GG 12%, GT 41%, TT 47%), 28bpintr4 (AA 6%, AB 28%, BB 66%), 786T/C genotypes (CC 17%, CT 45%, TT 38%), as well as R221W (CC 93%, CT 7%, TT 0%), and S608L (CC 65%, CT 32%, TT 3%) genotypes in cirrhotic patients did not differ from the controls (p > 0.05 for all comparisons). No relationship was found between the frequency of these genotypes and the severity of portal hypertension, or either inflammatory or vasoactive cytokines. A positive correlation was found between hepatic venous pressure gradient and cytokine concentration: sVCAM-1, IL6, IL8, IL10. CONCLUSIONS Examined eNOS and iNOS variants have no relationship to pathogenesis of liver cirrhosis. Severity of portal hypertension was associated with the changes in endothelial activation.
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Affiliation(s)
- Jaromir Petrtyl
- Charles University in Prague, 1st Faculty of Medicine, 4th Department of Internal Medicine, U Nemocnice 2, Prague 2, Czech Republic
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Urbanek P, Kreidlova M, Dusek L, Bruha R, Marecek Z, Petrtyl J. Anemia as a predictor of response to antiviral therapy in chronic hepatitis C. ACTA ACUST UNITED AC 2013; 114:213-7. [PMID: 23514554 DOI: 10.4149/bll_2013_044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The standard therapy for chronic HCV infection is the administration of pegylated interferons in combination with ribavirin. Anemia is a dose-dependent side-effect of ribavirin administration. The degree of anemia could be indicative of the individual exposure to ribavirin. AIMS 1) To evaluate the correlation of HGB level decreases at specified time-points with a sustained virological response during the antiviral treatment. 2) To compare these parameters with the virological predictors for responses. METHODS A retrospective analysis of cohort, which comprised 164 patients treated with standard therapy at a tertiary center in Prague, Czech Republic. RESULTS We identified several predictive factors for a sustained virological response in females: baseline HGB level ≤140 g/l (p=0.025), maximum drop from baseline >40 g (p=0.039), and a HGB drop in week 4 >30 g (p=0.044). There was only one predictor identified for males: reaching the lowest HGB level after week 19 (p=0.021). The strongest positive predictor of response was a rapid virological response. A low viral load (<600 000 IU/ml) at baseline was not associated with a sustained response in either gender. CONCLUSIONS The parameters of HGB decrease during antiviral treatment are better correlated with a sustained response in females. None of these response predicting parameters was as significant as that of rapid virological response as that of rapid virological response (Tab. 4, Fig. 1, Ref. 15).
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Affiliation(s)
- P Urbanek
- Department of Internal Medicine 1st Medical Faculty Charles University and Centrla Military Hospital Prague, Czech Republic.
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24
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Subhanova I, Muchova L, Lenicek M, Vreman HJ, Luksan O, Kubickova K, Kreidlova M, Zima T, Vitek L, Urbanek P. Expression of Biliverdin Reductase A in peripheral blood leukocytes is associated with treatment response in HCV-infected patients. PLoS One 2013; 8:e57555. [PMID: 23536765 PMCID: PMC3594226 DOI: 10.1371/journal.pone.0057555] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 01/26/2013] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND AIMS Hepatitis C virus (HCV) infection is associated with systemic oxidative stress. Since the heme catabolic pathway plays an important role in antioxidant protection, we attempted to assess the gene expression of key enzymes of heme catabolism, heme oxygenase 1 (HMOX1), heme oxygenase 2 (HMOX2), and biliverdin reductase A (BLVRA) in the liver and peripheral blood leukocytes (PBL) of patients chronically infected with HCV. METHODS Gene expressions (HMOX1, HMOX2, BLVRA) and HCV RNA were analyzed in PBL of HCV treatment naïve patients (n = 58) and controls (n = 55), with a subset of HCV patients having data on hepatic gene expression (n = 35). Based upon the therapeutic outcome, HCV patients were classified as either responders (n = 38) or treatment-failure patients (n = 20). Blood samples in HCV patients were collected at day 0, and week 12, 24, 36, and 48 after the initiation of standard antiviral therapy. RESULTS Compared to the controls, substantially increased BLVRA expression was detected in PBL (p<0.001) of therapeutically naïve HCV patients. mRNA levels of BLVRA in PBL closely correlated with those in liver tissue (r2 = 0.347,p = 0.03). A marked difference in BLVRA expression in PBL between the sustained responders and patients with treatment failure was detected at week 0 and during the follow-up (p<0.001). Multivariate analysis revealed that BLVRA basal expression in PBL was an independent predictor for sustained virological response (OR 15; 95% CI 1.05-214.2; P = 0.046). HMOX1/2 expression did not have any effect on the treatment outcome. CONCLUSION Our results suggest that patients with chronic HCV infection significantly upregulate BLVRA expression in PBL. The lack of BLVRA overexpression is associated with non-responsiveness to standard antiviral therapy; whereas, HMOX1/2 does not seem to have any predictive potential.
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Affiliation(s)
- Iva Subhanova
- Institute of Medical Biochemistry and Laboratory Diagnostics, General University Hospital and 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
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25
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Bruha R, Vitek L, Marecek Z, Pospisilova L, Nevsimalova S, Martasek P, Petrtyl J, Urbanek P, Jiraskova A, Malikova I, Haluzik M, Ferenci P. Decreased serum antioxidant capacity in patients with Wilson disease is associated with neurological symptoms. J Inherit Metab Dis 2012; 35:541-8. [PMID: 22139496 DOI: 10.1007/s10545-011-9422-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 11/03/2011] [Accepted: 11/08/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Wilson disease (WD) is an inherited disorder of copper disposition caused by an ATP7B transporter gene mutation, leading to copper accumulation in predisposed tissues. In addition to a genetic predisposition, other factors are likely to contribute to its clinical manifestation. The aim of the study was to assess whether oxidative stress affects the phenotypic manifestation of WD. METHODS In 56 patients with WD (29 men; 26 with the hepatic form, 22 with the neurologic form, and eight asymptomatic; mean age 38.5 ± 12 years), total serum antioxidant capacity (TAC) and inflammatory parameters (hs-CRP, IL-1β, IL-2, IL-6, IL-10, and TNF-α) were analyzed and related to the clinical manifestation, and mutations of the ATP7B gene. The control group for the TAC and inflammatory parameters consisted of 50 age- and gender-matched healthy individuals. RESULTS WD patients had a significantly lower TAC (p < 0.00001), lower IL-10 levels (p = 0.039), as well as both higher IL-1β (p = 0.019) and IL-6 (p = 0.005) levels compared to the control subjects. TNF-α, hs-CRP, and IL-2 did not differ from the controls. Patients with the neurological form of WD had a significantly lower TAC than those with the hepatic form (p < 0.001). In addition, the lower TAC was associated with the severity of the neurological symptoms (p = 0.02). No relationship between the inflammatory parameters and clinical symptoms was found. CONCLUSIONS Data from our study suggest that the increased oxidative stress contributes significantly to the clinical manifestation of WD; as a lower TAC is associated with the neurological symptoms in WD patients.
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Affiliation(s)
- Radan Bruha
- First Faculty of Medicine, 4th Department of Internal Medicine, Charles University in Prague, Prague, Czech Republic.
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26
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Yeniguen M, Schleicher N, Nedelmann M, Bachmann G, Urbanek P, Schoenburg M, Walther T, Gerriets T. Cerebral air microembolisation: Does size matter? Thorac Cardiovasc Surg 2012. [DOI: 10.1055/s-0031-1297729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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27
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Andersson T, Magnusson A, Bryngelsson IL, Frobert O, Henriksson KM, Edvardsson N, Poci D, Polovina M, Potpara T, Licina M, Mujovic N, Kocijancic A, Simic D, Ostojic MC, Providencia RA, Botelho A, Trigo J, Nascimento J, Quintal N, Mota P, Leitao-Marques AM, Bosch RF, Kirch W, Rosin L, Willich SN, Pittrow D, Bonnemeier H, Valenza MC, Martin L, Munoz Casaubon T, Valenza G, Botella M, Serrano M, Valenza B, Cabrera I, Anderson K, Benzaquen BS, Koziolova N, Nikonova J, Shilova Y, Scherr D, Narayan S, Wright M, Krummen D, Jadidi A, Jais P, Haissaguerre M, Hocini M, Hunter R, Liu Y, Lu Y, Wang W, Schilling RJ, Bernstein S, Wong B, Rooke R, Vasquez C, Shah R, Rosenberg S, Chinitz L, Morley G, Bashir Choudhary M, Holmqvist F, Carlson J, Nilsson HJ, Platonov PG, Jadidi AS, Cochet H, Miyazaki S, Shah AJ, Scherr D, Marrouche N, Haissaguerre M, Jais P, Calvo N, Nadal M, Andreu D, Tamborero D, Diaz FE, Berruezo A, Brugada J, Mont L, Fichtner S, Hessling G, Estner HL, Jilek C, Reents T, Ammar S, Wu J, Deisenhofer I, Nakanishi H, Kashiwase K, Hirata A, Wada M, Ueda Y, Skoda J, Neuzil P, Popelova J, Petru J, Sediva L, Lavergne T, Le Heuzey JY, Mousseaux E, Hersi A, Alhabib K, Alfaleh H, Sulaiman K, Almahmeed W, Alsuwidi J, Amin H, Reddy VY, Almotarreb A, Pang HWK, Redfearn DP, Simpson CS, Michael K, Pereira EJ, Munt PW, Fitzpatrick MF, Baranchuk A, Revishvili AS, Uldry L, Simonyan G, Dzhordzhikiya T, Sopov O, Kalinin V, Locati ET, Vecchi AM, Cattafi G, Sachero A, Lunati M, Sayah S, Forclaz A, Alizadeh A, Nazari N, Hekmat M, Moradi M, Zeighami M, Ghanji H, Suzuki K, Takagi M, Maeda K, Tatsumi H, Virag N, Gomes C, Meireles A, Anjo D, Roque C, Vieira P, Lagarto V, Reis H, Torres S, Toth A, Vago H, Hocini M, Takacs P, Edes E, Marki A, Balazs GY, Huttl K, Merkely B, Lainis F, Buckley MM, Johns EJ, Seifer CM, Vesin JM, Daba L, Liebrecht K, Pietrucha AZ, Borowiec A, Mroczek-Czernecka D, Bzukala I, Wnuk M, Piwowarska W, Nessler J, Toquero Ramos J, Jais P, Perez Pereira E, Mitroi C, Castro Urda V, Fernandez Villanueva JM, Corona Figueroa A, Hernandez Reina L, Fernandez Lozano I, Bartoletti A, Bocconcelli P, Giuli S, Kappenberger L, Massa R, Svetlich C, Tarsi G, Tronconi F, Vitale E, Pietrucha AZ, Bzukala I, Wnuk M, Stryjewski P, Konduracka E, Haissaguerre M, Wegrzynowska M, Kruszelnicka O, Nessler J, Lousinha A, Labandeiro J, Antunes E, Silva S, Alves S, Timoteo A, Oliveira M, Sehra R, Cruz Ferreira R, Pietrucha AZ, Wnuk M, Jedrzejczyk-Spaho J, Bzukala I, Kruszelnicka O, Wegrzynowska M, Piwowarska W, Nessler J, Krummen D, Briggs C, Rappel WJ, Narayan S, Sediva L, Neuzil P, Petru J, Skoda J, Janotka M, Chovanec M, Yamashiro K, Takami K, Sakamoto Y, Satoh K, Suzuki T, Nakagawa H, Romanov A, Pokushalov E, Artemenko S, Shabanov V, Stenin I, Elesin D, Turov A, Yakubov A, Hioki M, Matsuo S, Ito K, Narui R, Yamashita S, Sugimoto K, Yoshimura M, Yamane T, Pokushalov E, Romanov A, Artemenko S, Shabanov V, Elesin D, Stenin I, Turov A, Yakubov A, Miyazaki S, Shah AJ, Hocini M, Jais P, Haissaguerre M, Di Biase L, Gallinghouse JD, Rajappan K, Kautzner J, Dello Russo A, Tondo C, Lorgat F, Natale A, Balta O, Buenz K, Paessler M, Anders H, Horlitz M, Deneke T, Lickfett L, Liberman I, Linhart M, Andrie R, Mittmann-Braun E, Stockigt F, Nickenig G, Schrickel J, Tilz R, Rillig A, Feige B, Metzner A, Fuernkranz A, Burchard A, Wissner E, Ouyang F, Betts TR, Jones MA, Wong KCK, Qureshi N, Bashir Y, Rajappan K, Romanov A, Pokushalov E, Corbucci G, Artemenko S, Shabanov V, Turov A, Losik D, Selina V, Crandall MA, Daniels C, Daoud E, Kalbfleisch S, Yamaji H, Murakami T, Kawamura H, Murakami M, Hina K, Kusachi S, Dakos G, Vassilikos V, Paraskevaidis S, Mantziari A, Theophylogiannakos S, Chouvarda I, Chatzizisis I, Styliadis I, Kimura T, Fukumoto K, Nishiyama N, Aizawa Y, Fukuda Y, Sato T, Miyoshi S, Takatsuki S, Navarrete Casas AJ, Ali I, Conte FC, Moran M, Graham BG, Kalejs O, Lacis R, Stradins P, Koris A, Putnins I, Vikmane M, Lejnieks A, Erglis A, Estrada A, Perez Silva A, Castrejon S, Doiny D, Merino JL, Baranchuk A, Greiss I, Simpson CS, Abdollah H, Redfearn DP, Buys-Topart M, Nitzsche R, Thibault B, Deisenhofer I, Reents T, Ammar S, Fichtner S, Kathan S, Kolb C, Hessling G, Reif S, Schade S, Taggeselle J, Frey A, Birkenhagen A, Kohler S, Schmidt M, Cano Perez O, Buendia F, Igual B, Osca JM, Sanchez JM, Sancho-Tello MJ, Olague JM, Salvador A, Calvo N, Tolosana JM, Fernandez-Armenta J, Matas M, Barbarin MC, Berruezo A, Brugada J, Mont L, Habibovic M, Van Den Broek KC, Theuns DAMJ, Jordaens L, Alings M, Van Der Voort PH, Pedersen SS, Pupita G, Molini S, Brambatti M, Capucci A, Molodykh S, Idov EM, Belyaev OV, Segreti L, Soldati E, Zucchelli G, Di Cori A, Viani S, Paperini L, De Lucia R, Bongiorni MG, Binner L, Taborsky M, Bello D, Heuer H, Ramza B, Jenniskens I, Johnson WB, Silvetti MS, Rava' L, Russo MS, Di Mambro C, Ammirati A, Gimigliano G, Prosperi M, Drago F, Santos AR, Picarra B, Semedo P, Dionisio P, Matos R, Leitao M, Jacinto A, Trinca M, Mazzone P, Ciconte G, Marzi A, Paglino G, Vergara P, Sora N, Gulletta S, Della Bella P, Koppitz P, Fach A, Hobbiesiefken S, Fiehn E, Hambrecht R, Sperzel J, Jung M, Schmitt J, Pajitnev D, Burger H, Burger H, Goebel G, Ehrlich W, Walther T, Ziegelhoeffer T, Vancura V, Wichterle D, Melenovsky V, Kautzner J, Glikson M, Goldenberg G, Segev A, Dvir D, Kuzniec J, Finkelstein A, Hay I, Guetta V, Choo WK, Gupta S, Kirkfeldt R, Johansen J, Nohr E, Moller M, Arnsbo P, Nielsen J, Santos AR, Picarra B, Semedo P, Dionisio P, Matos R, Leitao M, Banha M, Trinca M, Stojanov P, Raspopovic S, Vasic D, Savic D, Nikcevic G, Jovanovic V, Defaye P, Mondesert B, Mbaye A, Cassagneau R, Gagniere V, Jacon J, Sanfins V, Reis HR, Nobre JN, Martins VM, Duarte LD, Morais CM, Conceicao JC, Hero M, Rey JL, Thibault B, Ducharme A, Simpson C, Stuglin C, Blier L, Senaratne M, Khaykin Y, Pinter A, Mlynarska A, Mlynarski R, Sosnowski M, Wilczek J, Iorgulescu C, Bogdan S, Constantinescu D, Caldararu C, Dorobantu M, Radu A, Vatasescu RG, Yusu S, Ikeda T, Mera H, Miwa Y, Abe A, Miyakoshi M, Tsukada T, Yoshino H, Nayar V, Cantelon P, Rawling A, Belham MRD, Pugh PJ, Osca Asensi J, Sanchez JM, Cano O, Tejada D, Munoz B, Rodriguez M, Sancho-Tello MJ, Olague J, Wecke L, Van Hunnik A, Thompson T, Di Carlo L, Zdeblick M, Auricchio A, Prinzen F, Doltra Magarolas A, Bijnens B, Silva E, Penela D, Mont L, Tolosana JM, Brugada J, Sitges M, Ofman P, Navaravong L, Leng J, Peralta A, Hoffmeister P, Levine R, Cook J, Stoenescu M, Tettamanti ME, Revilla Orodea A, Lopez Diaz J, De La Fuente Galan L, Arnold R, Garcia Moran E, San Roman Calvar JA, Gomez Salvador I, Nakamura K, Takami M, Keida T, Mesato A, Higa S, Shimabukuro M, Masuzaki H, Proietti R, Sagone A, Domenichini G, Burri H, Valzania C, Biffi M, Sunthorn H, Gavaruzzi G, Foulkes H, Boriani G, Koh S, Hou W, Rosenberg S, Snell J, Poore J, Dalal N, Bornzin G, Kloppe A, Mijic D, Bogossian H, Ninios I, Zarse M, Lemke B, Guedon-Moreau L, Kouakam C, Klug D, Marquie C, Ziglio F, Kacet S, Mohamed Fereig Hamed H, Hamdy AMAL, Abd El Aziz AHMED, Nabih MRVAT, Hamdy REHAB, Yaminisaharif A, Davoudi GH, Kasemisaeid A, Sadeghian S, Vasheghani Farahani A, Yazdanifard P, Shafiee A, Alonso C, Grimard C, Jauvert G, Lazarus A, Fernandez-Armenta J, Berruezo A, Mont LL, Sitges M, Andreu D, Ortiz-Perez J, Caralt T, Brugada J, Escudero J, Perez F, Griffith KM, Ferreyra R, Urena P, Demas M, Muratore C, Mazzetti H, Guardado J, Sanfins V, Fernandes M, Pereira VH, Canario-Almeida F, Ferreira F, Rodrigues B, Almeida J, Sokal A, Jedrzejczyk E, Lenarczyk R, Pluta S, Kowalski O, Pruszkowska P, Swiatkowski A, Kalarus Z, Heinke M, Ismer B, Kuehnert H, Heinke T, Surber R, Osypka N, Prochnau D, Figulla HR, Iacopino S, Landolina M, Proclemer A, Padeletti L, Calvi V, Pierantozzi A, Di Stefano P, Boriani G, Bauer A, Bode F, Le Gal F, Deharo JC, Delay M, Nitzsche R, Clementy J, Kawamura M, Munetsugu Y, Tanno K, Kobayashi Y, Cannom D, Hosoda J, Ishikawa T, Andoh K, Nobuyoshi M, Fujii S, Shizuta S, Kimura T, Isshiki T, Castel MA, Tolosana JM, Perez-Villa F, Mont L, Sitges M, Vidal B, Brugada J, Pluta S, Lenarczyk R, Kowalski O, Pruszkowska-Skrzep P, Sokal A, Szulik M, Kukulski T, Kalarus Z, Gianfranchi L, Bettiol K, Pacchioni F, Alboni P, Abu Sham'a R, Buber J, Nof E, Kuperstein R, Feinberg M, Luria D, Eldar M, Glikson M, Parks K, Stone JR, Singh JP, Hatzinikolaou-Kotsakou E, Kotsakou M, Beleveslis TH, Moschos G, Reppas E, Latsios P, Tsakiridis K, Kazemisaeid A, Davoodi G, Yamini Sharif A, Sadeghian S, Sheikhvatan M, Toniolo M, Zanotto G, Rossi A, Tomasi L, Vassanelli C, Versteeg H, Van Den Broek KC, Theuns DAMJ, Mommersteeg PMC, Alings M, Van Der Voort PH, Jordaens L, Pedersen SS, Vergara G, Blauer J, Ranjan R, Vijayakumar S, Kholmovski E, Volland N, Macleod R, Marrouche N, Aguinaga Arrascue LE, Bravo A, Garcia Freire P, Gallardo P, Hasbani E, Dantur J, Quintana R, Adragao PP, Cavaco D, Parreira L, Reis Santos K, Carmo P, Miranda R, Marcelino S, Cabrita D, Sommer P, Gaspar T, Rolf S, Arya A, Piorkowski C, Hindricks G, Valles Gras E, Bazan V, Portillo L, Suarez F, Bruguera J, Marti J, Huo Y, Arya A, Richter S, Schoenbauer R, Sommer P, Hindricks G, Piorkowski C, Rivas N, Casaldaliga J, Roca I, Dos L, Perez-Rodon J, Pijuan A, Garcia-Dorado D, Moya A, Carter HB, Garg A, Hegrenes J, Sih HJ, Teplitsky LR, Kuroki K, Tada H, Seo Y, Ishizu T, Igawa M, Sekiguchi Y, Kuga K, Aonuma K, Rodriguez A C, Mejias J, Hidalgo P, Hidalgo L JA, Orczykowski M, Derejko P, Walczak F, Szufladowicz E, Urbanek P, Bodalski R, Bieganowska K, Szumowski L, Peichl P, Wichterle D, Cihak R, Skalsky I, Kautzner J, Kubus P, Vit P, Zaoral L, Peichl P, Gebauer RA, Fiala M, Janousek J, Hiroshima K, Goya M, Ohe M, Hayashi K, Makihara Y, Nagashima M, An Y, Nobuyoshi M, Schloesser M, Lawrenz T, Meyer Zu Vilsendorf D, Strunk-Mueller C, Stellbrink C, Papagiannis J, Avramidis D, Kokkinakis C, Kirvassilis G, Eidelman G, Arenal A, Datino T, Atienza F, Gonzalez Torrecilla E, Miracle A, Hernandez J, Fernandez Aviles F, Ene E, Caldararu C, Iorgulescu C, Dorobantu M, Vatasescu RG, Insulander P, Bastani H, Braunschweig F, Drca N, Kenneback G, Schwieler J, Tapanainen J, Jensen-Urstad M, Andrea B, Andrea EMA, Maciel WM, Siqueira LS, Cosenza RC, Mittidieri FM, Farah SF, Atie JA, Kanoupakis E, Kallergis E, Mavrakis H, Goudis C, Saloustros I, Malliaraki N, Chlouverakis G, Vardas P, Bonnes JL, Jaspers Focks J, Westra SW, Brouwer MA, Smeets JLRM, Inama G, Pedrinazzi C, Landolina M, Oliva F, Senni M, Proclemer A, Zoni Berisso M, Mostov S, Haim M, Nevzorov R, Hasadi D, Starsberg B, Porter A, Kuschyk J, Schoene A, Streitner F, Veltmann CG, Schimpf R, Borggrefe M, Luesebrink U, Gardiwal A, Oswald H, Koenig T, Duncker D, Klein G, Bastiaenen R, Batchvarov V, Atty O, Cheng JH, Behr ER, Gallagher MM, Starrenburg AH, Kraaier K, Pedersen SS, Scholten MF, Van Der Palen J, Adhya S, Smith LA, Zhao T, Bannister C, Kamdar RH, Martinelli M, Siqueira S, Greco R, Nishioka SAD, Pedrosa AAA, Alkmim-Teixeira R, Peixoto GL, Costa R, Pedersen SS, Versteeg H, Nielsen JC, Mortensen PT, Johansen JB, Kwasniewski W, Filipecki A, Urbanczyk-Swic D, Orszulak W, Trusz - Gluza M, Jimenez-Candil J, Hernandez J, Morinigo J, Ledesma C, Martin-Luengo C, Vogtmann T, Gomer M, Stiller S, Kuehlkamp V, Zach G, Loescher S, Kespohl S, Baumann G, Snell JD, Korsun N, Rooke R, Snell JR, Morley B, Bharmi R, Nabutovsky Y, Mollerus M, Naslund L, Meyer A, Lipinski M, Libey B, Dornfeld K, Jimenez-Candil J, Hernandez J, Martin A, Gallego M, Morinigo J, Ledesma C, Martin-Luengo C, De Bie MK, Van Rees JB, Borleffs CJ, Thijssen J, Jukema JW, Schalij MJ, Van Erven L, Van Der Velde ET, Witteman TA, Foeken H, Van Erven L, Schalij MJ, Szili-Torok T, Akca F, Caliskan K, Ten Cate F, Jordaens L, Michels M, Cozma DC, Petrescu L, Mornos C, Dragulescu SI, Groeneweg JA, Velthuis BK, Cox MGPJ, Loh P, Dooijes D, Cramer MJ, De Bakker JMT, Hauer RNW, Park SD, Shin SH, Woo SI, Kwan J, Park KS, Kim DH, Kwan J, Iorio A, Vitali Serdoz L, Brun F, Daleffe E, Zecchin M, Dal Ferro M, Santangelo S, Sinagra GF, Ouali S, Hammemi R, Hammas S, Kacem S, Gribaa R, Neffeti E, Remedi F, Boughzela E, Korantzopoulos P, Letsas K, Christogiannis Z, Kalantzi K, Ntorkos A, Goudevenos J, Foley PWX, Yung L, Barnes E, Munetsugu Y, Tanno K, Kikuchi M, Ito H, Miyoshi F, Kawamura M, Kobayashi Y, Pecini R, Marott JM, Jensen GB, Theilade J, Mine T, Kodani T, Masuyama T, Mozos IM, Serban C, Costea C, Susan L, Barthel P, Mueller A, Malik M, Schmidt G, Schmidt G, Barthel P, Mueller A, Malik M, Karakurt O, Kilic H, Munevver Sari DR, Mroczek-Czernecka D, Pietrucha AZ, Borowiec A, Wnuk M, Bzukala I, Kruszelnicka O, Konduracka E, Nessler J, Kikuchi Y, Meireles A, Gomes C, Anjo D, Roque C, Pinheiro Vieira A, Lagarto V, Hipolito Reis A, Torres S, Nof E, Miller L, Kuperstein R, Eldar M, Glikson M, Luria D, Vedrenne G, Bruguiere E, Redheuil A. Poster Session 2. Europace 2011. [DOI: 10.1093/europace/eur222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Doenges S, Schoenburg M, Reuter P, Madlener K, Urbanek P, Gerriets T, Walther T, Nedelmann M. Elimination of gaseous microbubbles from the extracorporeal circulation with a novel ultrasound technique - In-vitro data. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1269229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bruha R, Marecek Z, Pospisilova L, Nevsimalova S, Vitek L, Martasek P, Nevoral J, Petrtyl J, Urbanek P, Jiraskova A, Ferenci P. Long-term follow-up of Wilson disease: natural history, treatment, mutations analysis and phenotypic correlation. Liver Int 2011; 31:83-91. [PMID: 20958917 DOI: 10.1111/j.1478-3231.2010.02354.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Wilson disease (WD) is an inherited disorder of copper metabolism. When treated, the outcome can be excellent, although the long-term survival has yet to be well documented. The aim of this study was to describe the long-term outcome of a cohort of patients with WD and to assess those factors affecting the phenotypic manifestation of WD. METHODS The presence of mutations to the ATP7B gene, the clinical manifestations, treatments and the long-term outcomes were analysed retrospectively in 117 patients with WD (59 men and 58 women, aged at evaluation 38.5 ± 11, range 16-63 years). RESULTS Fifty-five patients with a neurological presentation, 51 patients with a hepatic presentation and 11 asymptomatic patients were followed up for an average of 15.1 ± 10 years (median 12 years, range 1-41 years). The H1069Q ATP7B gene mutation was the most frequent genetic variant (54.3%); the frequency of this mutation did not differ between patients with either the hepatic or the neurological presentation (P = 0.099). d-penicillamine or zinc salts (81 and 17% respectively) were used for treatment, and three patients underwent liver transplantation. The majority of symptomatic patients became asymptomatic, or improved, during the follow-up (82% patients with hepatic presentation, 69% with neurological presentation). The long-term survival of patients with WD did not differ from that of the general Czech population (P = 0.95). CONCLUSIONS Long-term follow-up shows a satisfactory response in the great majority of adequately treated patients with WD and survival coincides with that of the general population.
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Affiliation(s)
- Radan Bruha
- 4th Department of Internal Medicine, 1st Faculty of Medicine, Charles University in Prague, General Teaching Hospital, Prague, Czech Republic.
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Schönburg M, Nedelmann M, Walberer M, Dönges S, Ritschel N, Bachmann G, Stolz E, Urbanek S, Ziegelhöffer B, Szalay Z, Urbanek P, Gerriets T. A rat model for cerebral air microembolisation. Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1247013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Platonov PG, Bollmann A, Tveit A, Platonov PG, Olesen M, Tveit A, Enger S, Carlson J, Holmqvist F, Svendsen JH, Dakos G, Vassilikos V, Chouvarda I, Karvounis H, Maglaveras N, Mochlas S, Styliadis I, Parcharidis G, Elvan A, Linnenbank AC, Van Bemmel MW, Beukema WP, Delnoy PPHM, Ramdat Misier AR, De Bakker JT, Urbanek P, Szumowski LJ, Derejko P, Kuklik P, Bodalski R, Orczykowski M, Szufladowicz E, Walczak F, Radinovic A, Ciconte G, Gulletta S, Paglino G, Mazzone P, Pappone C, Santinelli V. Abstracts: Electrical properties of the atrium in atrial fibrillation. Europace 2009. [DOI: 10.1093/europace/euq244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bruha R, Marecek Z, Prochazka V, Lata J, Spicak J, Ehrmann J, Kroupa R, Petrtyl J, Dolina J, Taimr P, Drastich P, Urbanek P, Vrzalova D. Double-blind randomized multicenter study comparing the efficacy and safety of 10-day to 5-day terlipressin treatment of bleeding esophageal varices. Hepatogastroenterology 2009; 56:390-394. [PMID: 19579605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND/AIMS The aim of the study was to compare the efficacy and safety of 5-day terlipressin treatment of bleeding esophageal varices to 10-day treatment period. METHODOLOGY Of 25 patients with variceal bleeding, 15 were randomized to receive terlipressin for day 1-5 and placebo for day 6-10 (Group A), and 10 to receive terlipressin for day 1-10 (Group B). RESULTS The bleeding was stopped in 24 patients (96%). Rebleeding till day 42 was observed in 9 (36%) patients (5 in group A, 4 in group B, ns). 2 patients died in group B (due to rebleeding till day 5) and one in group A (rebleeding between day 5-10). Transfusion needs were lower in group B (2.7 +/- 2.6TU compared to 4.13 +/- 5.8 TU in group A, ns). Serious AE leading to treatment discontinuation were observed in 1 patient in group A (peripheral ischemia) and none in B, non-significant AE in 3 patients in group A (hypertension), and in 3 in group B (hypertension, hyponatremia, epiparoxysm). CONCLUSIONS Prolonged treatment with terlipressin did not prove significant decrease of mortality or bleeding recurrence; lower rebleeding rate after day 5 and tendency towards lower transfusion requirements were observed. Prolonged treatment had no influence on AE rate.
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Affiliation(s)
- Radan Bruha
- Charles University in Prague, First Faculty of Medicine, 4th Department of Internal Medicine Prague, Czech Republic.
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Bruha R, Vitek L, Petrtyl J, Lenicek M, Urbanek P, Zelenka J, Jachymova M, Svestka T, Kalab M, Dousa M, Marecek Z. Effect of carvedilol on portal hypertension depends on the degree of endothelial activation and inflammatory changes. Scand J Gastroenterol 2006; 41:1454-63. [PMID: 17101577 DOI: 10.1080/00365520600780403] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Bleeding from esophageal varices is a major complication of liver cirrhosis. Non-selective beta-blockers exert an influence on the functional part of portal hypertension, thereby reducing the risk of bleeding. Direct measurement of this functional part is not possible; nevertheless, pro-inflammatory markers as well as parameters of endothelial dysfunction might serve as surrogate markers. The aim of study was to assess the correlation between the therapeutic efficacy of carvedilol and markers of endothelial dysfunction and systemic inflammation in patients with liver cirrhosis and portal hypertension. MATERIAL AND METHODS Thirty-six patients with cirrhosis and portal hypertension were given carvedilol, 25 mg q.i.d. for 30 days. Hepatic venous pressure gradient (HVPG) and biochemical determinations were performed prior to and after the treatment. Eight healthy individuals served as controls for comparison of biochemical markers. RESULTS In the whole group of cirrhotic patients, HVPG decreased from 17.7+/-3.8 to 14.9+/-4.8 mmHg (p<0.001). Complete response was seen in 15 patients (42%). Baseline serum levels of E-selectin were significantly higher in responders than in non-responders (119.8+/-70.6 versus 52.6+/-25.7 ng/ml; p=0.023) and in controls (28.8+/-22.2 ng/ml; p=0.004). Furthermore, baseline TNF-alpha levels were significantly higher in responders than in non-responders (22.8+/-15.7 versus 7+/-8.9; p=0.047) and in controls (5.5+/-5.9 pg/ml; p=0.005). Serum levels of ICAM-1 showed the same trend (4360+/-2870 versus 2861+/-1577 versus 651+/-196 ng/ml), although differences did not reach statistical significance. CONCLUSIONS Markers of systemic inflammation and endothelial dysfunction seem to predict the hypotensive effect of carvedilol on portal hypertension in patients with liver cirrhosis and may be useful in the assessment of the efficacy of the therapy.
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Affiliation(s)
- Radan Bruha
- 4th Medical Department, General Teaching Hospital, 1st Faculty of Medicine, Charles University, Prague, Czech Republic.
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Bruha R, Petrtyl J, Urbanek P, Svestka T, Maskova J, Marecek Z. Hepatic vein stenosis and inferior vena cava stenosis in a patient with chronic obstructive pulmonary disease. Hepatogastroenterology 2005; 52:1867-8. [PMID: 16334795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The case is presented of a patient with stenosis of the intrahepatic portion of the inferior vena cava and the terminal part of hepatic veins, a state manifesting itself in ascites resistant to treatment. The case was originally seen as decompensated cirrhosis of the liver. Once properly diagnosed, it was successfully treated with angioplasty and subsequent anticoagulation. After all the relevant hypercoagulation states potentially leading to IVC and hepatic vein stenosis were ruled out, the cause of the patient's stenosis could be traced to: 1. secondary polycythemia concomitant to severe pulmonary obstruction disease and 2. simultaneous corticosteroid therapy. This cause has not been described in literature before.
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Affiliation(s)
- Radan Bruha
- 4th Internal Department, General Teaching Hospital, Charles University Prague, Czech Republic.
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Szumowski L, Szufladowicz E, Jedynak Z, Kozluk E, Kepski R, Bujnowska E, Derejko P, Urbanek P, Gajek J, Walczak F. P-313 Sudden cardiac death due to ventricular fibrillation in overt and concealed Wolff- Parkinson-White syndrome. Europace 2003. [DOI: 10.1016/eupace/4.supplement_2.b140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Affiliation(s)
| | | | - Z. Jedynak
- Institute of Cardiology
,
Warsaw, Poland
| | - E. Kozluk
- Institute of Cardiology
,
Warsaw, Poland
| | - R. Kepski
- Institute of Cardiology
,
Warsaw, Poland
| | | | - P. Derejko
- Institute of Cardiology
,
Warsaw, Poland
| | - P. Urbanek
- Institute of Cardiology
,
Warsaw, Poland
| | - J. Gajek
- Institute of Cardiology
,
Warsaw, Poland
| | - F. Walczak
- Institute of Cardiology
,
Warsaw, Poland
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36
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Walczak F, Szumowski L, Szufladowicz E, Bodalski R, Kepski R, Biederman A, Bujnowska E, Stepinska J, Urbanek P. A05-3 Efficacy of nonpharmacological treatment in patients with pseudo mahaim fibers. Europace 2003. [DOI: 10.1016/eupace/4.supplement_2.b7-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
| | | | | | | | - R. Kepski
- Institute of Cardiology, Warsaw, Poland
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37
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Szumowski L, Walczak F, Witkowski A, Chmielak Z, Ruzyllo W, Kepski R, Urbanek P, Szufladowicz E, Bodalski R, Apel T, Kuklik P, Zebrowski J. A37-1 Patchwork-like viability leads to arrhythmia. Border-zone characteristics in patients with and without ventricular tachycardia and ischeamic heart disease. Europace 2003. [DOI: 10.1016/eupace/4.supplement_2.b57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - F. Walczak
- National Institute of Cardiology Warsaw Poland
| | | | - Z. Chmielak
- National Institute of Cardiology Warsaw Poland
| | - W. Ruzyllo
- National Institute of Cardiology Warsaw Poland
| | - R. Kepski
- National Institute of Cardiology Warsaw Poland
| | - P. Urbanek
- National Institute of Cardiology Warsaw Poland
| | | | - R. Bodalski
- National Institute of Cardiology Warsaw Poland
| | - T. Apel
- National Institute of Cardiology Warsaw Poland
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38
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Szumowski L, Walczak F, Szufladowicz E, Urbanek P, Bodalski R, Bujnowska E, Kepski R. P-328 Follow up of patients with ischaemic heart disease, after ablation of ventricular tachycardia. Europace 2003. [DOI: 10.1016/eupace/4.supplement_2.b143-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Affiliation(s)
| | - F. Walczak
- Institute of Cardiology
,
Warsaw, Poland
| | | | - P. Urbanek
- Institute of Cardiology
,
Warsaw, Poland
| | | | | | - R. Kepski
- Institute of Cardiology
,
Warsaw, Poland
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39
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Amaraa R, Mareckova H, Urbanek P, Fucikova T. Immunological predictors of different responses to combination therapy with interferon alpha and ribavirin in patients with chronic hepatitis C. J Gastroenterol 2003; 38:254-9. [PMID: 12673448 DOI: 10.1007/s005350300044] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study aimed to investigate peripheral blood CD4+ T-helper (Th) and CD8+ cytotoxic T-lymphocyte (CTL) responses to combination treatment with interferon (IFN) alpha and ribavirin in 59 patients with chronic hepatitis C, and to correlate the results with the therapy outcome. METHODS The expression of activation molecules on the surface of CD8+ T cells and cytokine production by in-vitro activated CTLs and Th lymphocytes were examined before and at the end of the therapy, using flow cytometry. RESULTS There were 36 complete responders to the treatment and 23 transient responders who relapsed after withdrawal of the therapy. A significant increase in the production of Th1-type cytokines [IFNgamma, interleukin 2 (IL2), and tumor necrosis factor-alpha (TNFalpha)] was found at the end of the treatment in complete responders compared with baseline values (P < 0.001). In contrast, transient responders had a marked decrease in the percentage of activated CD8+ T cells expressing CD28 or HLA-DR costimulatory molecules in peripheral blood, and a lower production of TNFalpha by CTLs and Th cells at the end of the therapy with respect to pretreatment values (P < 0.001). CONCLUSIONS The efficacy of IFNalpha and ribavirin combination therapy for chronic hepatitis C is associated with a vigorous response of peripheral blood Th1 cells, whereas weak CTL responses at the end of the therapy might predict a further relapse of the disease.
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Affiliation(s)
- Ravdan Amaraa
- Institute of Microbiology and Clinical Immunology, First Medical Faculty, Charles University, Karlovo nam 32, Prague 2 Cz-12111, Czech Republic
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40
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Taborski U, Urbanek P, Erhardt G, Schönburg M, Basser S, Wohlgemuth L, Heidinger K, Klövekorn WP. In vitro biocompatibility evaluation of the dynamic bubble trap. Artif Organs 2003; 27:736-43. [PMID: 12911349 DOI: 10.1046/j.1525-1594.2003.07143.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The goal of this study was to evaluate the biocompatibility of the dynamic bubble trap (DBT) prior to the clinical trial. It was set up as an in vitro model, which simulates physiological conditions. Twenty runs were performed (ten with the DBT, ten without the DBT) at a blood flow of 3 l/min, each lasting 180 min. Fifteen blood parameters (hemogram, hemostasis, complement system, and cytokines) were measured at five time intervals. None of the tested parameters showed a statistically significant difference between the DBT and control group. The data assessed in this in vitro model show that the DBT has no adverse influence on hemocompatibility. It may be concluded that the DBT is a safe tool to be used in vivo.
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Affiliation(s)
- Uwe Taborski
- Kerckhoff-Klinik, Bad Nauheim, Augsburg, Germany.
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41
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Amaraa R, Mareckova H, Urbanek P, Fucikova T. Production of interleukins 10 and 12 by activated peripheral blood monocytes/macrophages in patients suffering from chronic hepatitis C virus infection with respect to the response to interferon and ribavirin treatment. Immunol Lett 2002; 83:209-14. [PMID: 12095711 DOI: 10.1016/s0165-2478(02)00102-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Circulating monocytes/macrophages are important for the initiation of immune responses to hepatitis C virus (HCV). Their presentation capacities and production of immunoregulatory cytokines enable them to activate cellular immune responses which is critical in determining the outcome of infection. We used flow cytometry to examine the expression of a CD80 costimulatory molecule on the surface of peripheral blood CD14+ monocytes/macrophages and to analyse the production of IL10 and IL12 by these cells. Forty-three individuals (6 asymptomatic HCV carriers, 37 patients with chronic hepatitis C (CHC)) were enrolled in this study. Thirty-seven patients with CHC (23 responders and 14 non-responders, NR) received combination (interferon+ribavirin) treatment for 52 weeks. The baseline percentage of CD14+CD80+ peripheral blood monocytes/macrophages was high in patients with CHC (P<0.001) and returned to normal after the treatment. All patients with CHC showed significantly high production of IL10 (P<0.001). In asymptomatic HCV carriers production level of this cytokine tended to be higher than in patients with CHC (P<0.001). A baseline production of IL12 was higher in asymptomatic HCV carriers and patients with CHC compared to healthy controls (P<0.001). The level of IL12 production was increased in treatment responders whereas in NR returned to normal value. Our data argue against functional impairment of circulating monocytes/macrophages during HCV infection. Furthermore, the positive therapeutic outcome following combination treatment might associate with increased production of IL12 by these cells.
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Affiliation(s)
- Ravdan Amaraa
- Institute of Microbiology and Clinical Immunology, 1st Medical Faculty, Charles University, Karlovo nam 32, Prague 2 Cz 12111, Czech Republic.
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42
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Bruha R, Marecek Z, Spicak J, Hulek P, Lata J, Petrtyl J, Urbanek P, Taimr P, Volfova M, Dite P. Double-blind randomized, comparative multicenter study of the effect of terlipressin in the treatment of acute esophageal variceal and/or hypertensive gastropathy bleeding. Hepatogastroenterology 2002; 49:1161-6. [PMID: 12143227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
BACKGROUND/AIMS 1) To compare the effect of 2-day application of 0.2 mg terlipressin i.v. every 4 hours (group I) with that of 5-day application of 1 mg i.v. every 4 hours (group II) in the treatment of bleeding esophageal varices and portal gastropathy. 2) To assess the incidence of adverse events. METHODOLOGY Eighty-six patients with liver cirrhosis (54 men and 32 women, average age 51 years) were randomized over a period of 2 years into 2 groups. Acute bleeding was diagnosed endoscopically within 24 hours of its onset. The two groups fully comparable; treatment failure rated according to "Baveno II". RESULTS Success rate in group I was 78% at day 2 and 75% at day 5; in group II 89% and 79%, respectively (no statistical significance). Rebleeding had occurred by day 5 in 15% in group I, and in 16.3% in group II. Transfusion needs by day 2 were significantly lower in group II (2.4 units compare to 3.4 units in I). The 30-day mortality was 17.1% in group I and 20% in group II. No statistical difference between I and II in the occurrence of adverse events. CONCLUSIONS At a dosage of 1 mg i.v. every 4 hours, the success rate at day 2 was as much as 90% while blood consumption was significantly lower compared with the lower dosage. Rebleeding during first 48 hours occurred almost exclusively at lower dosage. There was no increase in the rate of adverse events relative to the higher dosage.
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Affiliation(s)
- R Bruha
- First Medical Department, Teaching Hospital Prague 2, Czech Republic.
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43
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Bruha R, Petrtyl J, Kubecova M, Marecek Z, Dufek V, Urbanek P, Kodadova J, Chodounsky Z. Intraluminal brachytherapy and selfexpandable stents in nonresectable biliary malignancies--the question of long-term palliation. Hepatogastroenterology 2001; 48:631-7. [PMID: 11462891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
BACKGROUND/AIMS To evaluate the effect of a combination of intraluminal brachytherapy and metallic stent implantation in the treatment of patients with nonresectable biliary tumors. METHODOLOGY Thirty-two patients aged 41-80 years with nonresectable biliary malignancies--Klatskin's tumor (n = 17), gallbladder carcinoma (n = 11) and carcinoma of papilla Vateri (n = 4)--were treated with a combination of intraluminal brachytherapy (source Ir192, high-dose radiation regimen, total dose 30 Gy) and metallic stent implantation. Intraluminal brachytherapy and stent insertion (metallic, spiral-Z stent) were performed percutaneously in all patients. RESULTS The mean survival in patients with Klatskin's tumor was 457 days (range: 64-1186; median: 358 days), in patients with gallbladder carcinoma 237 days (range: 92-609; median: 210 days) and in patients with carcinoma of papilla Vateri 850 days (range: 48-1518; median: 1277 days). The rate of 2-year survival in these groups as 27, 0 and 50%, respectively. The survival time differed significantly at the 5% level. The mean time of stent patency was 418, 220 and 850 days, respectively. No complications related directly to intraluminal brachytherapy were observed. CONCLUSIONS Intraluminal brachytherapy combined with stent implantation is a safe method and appears to prolong survival in inoperable patients with Klatskin's tumor and carcinoma of papilla Vateri compared with nontreated patients in previous studies. In contrast no similar effect should be expected in patients with gallbladder carcinoma.
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Affiliation(s)
- R Bruha
- 1st Medical Department and Department of Radiology, Charles University Teaching Hospital, Prague 2, Czech Republic.
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Schönburg M, Urbanek P, Erhardt G, Kraus B, Taborski U, Mühling A, Hein S, Roth M, Tiedtke HJ, Klövekorn WP. Significant reduction of air microbubbles with the dynamic bubble trap during cardiopulmonary bypass. Perfusion 2001; 16:19-25. [PMID: 11192303 DOI: 10.1177/026765910101600104] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Air microbubbles mostly occur unnoticed during cardiopulmonary bypass and are predominantly responsible for serious postoperative psychoneurological dysfunction. A dynamic bubble trap (DBT), which removes air microbubbles from the arterial blood, was tested in a clinical study. The aim was to evaluate the efficiency of microbubble removal under clinical conditions. As blood passes through the DBT, which is placed in the arterial line between the arterial filter and arterial cannula, it is converted into a rotating stream. The bubbles are directed to the centre of the blood flow and are collected in the distal end of the DBT, from where they are returned to the cardiotomy reservoir. Doppler ultrasonography was used to detect the microbubbles before and after the DBT, and also the number of high-intensity transient signals (HITS) in the right and left middle cerebral artery during extracorporeal circulation. A significant reduction of microbubbles in the arterial line (3,990 before DBT, 537 after, p < 0.001) and HITS in the brain (51 in the DBT group, 77 in the placebo group, p = 0.04) was measured.
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Affiliation(s)
- M Schönburg
- Kerckhoff-Klinik, Thoracic and Cardiovascular Surgery, Bad Nauheim, Germany
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Schönburg M, Urbanek P, Erhardt G, Taborski U, Plechinger H, Hein S, Roth M, Klövekorn WP. A dynamic bubble trap reduces microbubbles during cardiopulmonary bypass: a case study. J Extra Corpor Technol 2000; 32:165-9. [PMID: 11146963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Microemboli passing to the cerebral circulation during cardiopulmonary bypass can contribute to postoperative neurologic dysfunction. Many studies conclude that air microbubbles predominantly are responsible for this problem. A dynamic bubble trap (DBT) was developed to diminish the number of microbubbles in the arterial line of extracorporeal circulation. The DBT is able to substantially reduce the number of air microbubbles, as shown in two patients undergoing coronary artery bypass grafting, where a high number of microbubbles was assessed. Although a 40-micron arterial filter was used, many bubbles larger than 40 microns occurred in the arterial line. The DBT reduced the number of large microbubbles from 2,267 to 67 in patient 1 and from 897 to 61 in patient 2.
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Affiliation(s)
- M Schönburg
- Kerckhoff-Klinik GmbH Benekestr, 2-8 61231 Bad Nauhelm Germany
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Abstract
The cardiopulmonary support system allows to maintain the patient's cardiac and pulmonary functions when the patient's cardiac or pulmonary status is failing. This system consists of a centrifugal pump with its control system, membrane oxygenator, measure devices for blood flow and pressure and a heating system for temperature conditioning of blood. The percutaneous application is easy and fast. Rapid priming, rapid insertion and high flow rates are characteristic for this method. The material costs for cardiac support of one patient are high, the price for one patient amounts to approximately DM 3,500. For the application the presence of an operating cardiologist, an anesthetist and a perfusionist is necessary.
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Windberger U, Urbanek P, Vierhapper H, Wieselthaler G, Dolezel S, Nowotny P, Trubel W, Dostal M, Vasku J, Losert U. Diminished release of atrial natriuretic factor in calves with a total artificial heart. Artif Organs 1992; 16:392-7. [PMID: 10078281 DOI: 10.1111/j.1525-1594.1992.tb00538.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Venous hypertension after total artificial heart (TAH) replacement, a common problem in humans as well as experimental animals, is thought to be related to reduced release of atrial natriuretic factor (ANF) due to atrial damage. To verify this hypothesis, we stimulated the release of ANF in 6 calves before (-7 days) and after TAH replacement (+25, +50, +80, and +100 days) by the rapid (+ = 10 min) infusion of 2 L of Ringer's solution. In normal calves (-7 days) this procedure induced a rise in plasma concentration of ANF from 18.5 +/- 12 to 31.6 +/- 12 pmol/L (p < 0.05). After TAH the ANF release continuously decreased (analysis of variance, p < 0.02). Thus, ANF increased by 9.8 +/- 9.3, 6.8 +/- 17.5, 0.4 +/- 5.2, and 0.5 +/- 3.2 pmol/L at days 25, 50, 80, and 100, respectively. The central venous pressure increased by 3.4 +/- 1.5 mm Hg (before TAH) and by 6 +/- 2.9 mm Hg (after TAH) during this procedure. A decrease in plasma concentrations of aldosterone, most likely due to extracellular volume expansion and a decrease in total protein plasma concentrations and in hematocrit due to the dilution of blood, was seen in each experiment. Necropsy demonstrated massive atrial dilatation and myocardial dystrophy with atrial fibrosis. ANF granules were present to a small extent in every calf. We conclude that rapid intravenous infusion is an adequate stimulus to release ANF in normal calves. After TAH implantation the release of ANF by high venous pressure declines although ANF granules are still present in the damaged atrial stumps. Therefore, the loss of stimulated ANF could contribute to the observed increase in venous pressure in TAH calves although other pathophysiologic mechanisms cannot be excluded.
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Affiliation(s)
- U Windberger
- Center for Biomedical Research, University of Vienna, Austria
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