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Kamerman M, van Dijk JD, Timmer JR, Ottervanger JP, Knollema S, Jager PL, Mouden M. The incremental value of coronary artery calcium score in predicting long-term prognosis and defining the warranty period of normal adenosine stress-only myocardial perfusion imaging using CZT SPECT. J Nucl Cardiol 2023; 30:2692-2701. [PMID: 37592058 DOI: 10.1007/s12350-023-03349-6] [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: 04/13/2023] [Accepted: 07/12/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Normal stress-only (SO) myocardial perfusion imaging (MPI) using SPECT reduces imaging time and radiation dose with a good prognosis. However, the long-term prognostic value of combining coronary artery calcium score (CACS) with SO MPI to determine the warranty period remains unknown. Hence, we assessed the incremental prognostic value of CACS and its impact on the warranty period of normal SO MPI using SPECT. METHODS We retrospectively included 1375 symptomatic patients without a history of coronary artery disease (CAD) and a normal SO MPI using adenosine who underwent simultaneous CAC scoring. Annual major adverse cardiac events (MACE) rates were calculated for CACS categories: 0, 1-399, 400-999, and ≥1000. RESULTS The mean age was 60.0 ± 11.8 years (66.9% female) with a median follow-up of 10.3 [IQR 9.6-10.9] years. The warranty period for annual MACE rate for normal SO SPECT extended the total follow-up time in years. MACE rate categorized by CAC categories demonstrated an increase in MACE rates with increasing CACS; CACS 0 and CACS 1-399 were associated with a 10-year warranty period, CACS 400-999 had a warranty period of 4 years and no warranty period could be given for CACS≥1000 (5.9 % at 1 year). CONCLUSIONS CACS as an adjunct to normal pharmacological SO MPI provides additional prognostic information and aids in determining a warranty period.
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Affiliation(s)
- Mandy Kamerman
- Department of Cardiology, Isala Clinics, Zwolle, The Netherlands.
- Department of Nuclear Medicine, Isala Clinics, Zwolle, The Netherlands.
| | - Joris D van Dijk
- Department of Nuclear Medicine, Isala Clinics, Zwolle, The Netherlands
| | - Jorik R Timmer
- Department of Cardiology, Isala Clinics, Zwolle, The Netherlands
| | | | - Siert Knollema
- Department of Nuclear Medicine, Isala Clinics, Zwolle, The Netherlands
| | - Pieter L Jager
- Department of Nuclear Medicine, Isala Clinics, Zwolle, The Netherlands
| | - Mohamed Mouden
- Department of Cardiology, Isala Clinics, Zwolle, The Netherlands
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Makulo JR, Mandina MN, Mbala PK, Wumba RD, Akilimali PZ, Nlandu YM, Odio JO, Bepouka BI, Longokolo MM, Mukenge EK, Kamwiziku G, Muamba JM, Longo AL, Lufu CM, Keke HL, Mbula MM, Situakibanza HN, Sumaili EK, Kayembe JMN. SARS-CoV2 infection in symptomatic patients: interest of serological tests and predictors of mortality: experience of DR Congo. BMC Infect Dis 2022; 22:21. [PMID: 34983411 PMCID: PMC8724652 DOI: 10.1186/s12879-021-07003-9] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/22/2021] [Indexed: 01/08/2023] Open
Abstract
Background In symptomatic patients, the diagnostic approach of COVID-19 should be holistic. We aimed to evaluate the concordance between RT-PCR and serological tests (IgM/IgG), and identify the factors that best predict mortality (clinical stages or viral load).
Methods The study included 242 patients referred to the University hospital of Kinshasa for suspected COVID-19, dyspnea or ARDS between June 1st, 2020 and August 02, 2020. Both antibody-SARS-CoV2 IgM/IgG and RT-PCR method were performed on the day of admission to hospital. The clinical stages were established according to the COVID-19 WHO classification. The viral load was expressed by the CtN2 (cycle threshold value of the nucleoproteins) and the CtE (envelope) genes of SARS- CoV-2 detected using GeneXpert. Kappa test and Cox regression were used as appropriate.
Results The GeneXpert was positive in 74 patients (30.6%). Seventy two patients (29.8%) had positive IgM and 34 patients (14.0%) had positive IgG. The combination of RT-PCR and serological tests made it possible to treat 104 patients as having COVID-19, which represented an increase in cases of around 41% compared to the result based on GeneXpert alone. The comparison between the two tests has shown that 57 patients (23.5%) had discordant results. The Kappa coefficient was 0.451 (p < 0.001). We recorded 23 deaths (22.1%) among the COVID-19 patients vs 8 deaths (5.8%) among other patients. The severe-critical clinical stage increased the risk of mortality vs. mild-moderate stage (aHR: 26.8, p < 0.001). The values of CtE and CtN2 did not influence mortality significantly. Conclusion In symptomatic patients, serological tests are a support which makes it possible to refer patients to the dedicated COVID-19 units and treat a greater number of COVID-19 patients. WHO Clinical classification seems to predict mortality better than SARS-Cov2 viral load.
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Affiliation(s)
- Jean-Robert Makulo
- Cliniques Universitaires de Kinshasa, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Madone Ndona Mandina
- Cliniques Universitaires de Kinshasa, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Placide Kingebeni Mbala
- Cliniques Universitaires de Kinshasa, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo.,Secrétariat Technique du Comité Multisectoriel de la Riposte Contre la Covid-19, Kinshasa, Democratic Republic of the Congo
| | - Roger Dimosi Wumba
- Cliniques Universitaires de Kinshasa, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Pierre Zalagile Akilimali
- Ecole de Santé Publique, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Yannick Mayamba Nlandu
- Cliniques Universitaires de Kinshasa, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo.
| | - Jerome Ossam Odio
- Cliniques Universitaires de Kinshasa, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Ben Izizag Bepouka
- Cliniques Universitaires de Kinshasa, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Murielle Mashi Longokolo
- Cliniques Universitaires de Kinshasa, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Eric Kasongo Mukenge
- Cliniques Universitaires de Kinshasa, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Guyguy Kamwiziku
- Cliniques Universitaires de Kinshasa, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jonathan Mutombo Muamba
- Cliniques Universitaires de Kinshasa, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Augustin Luzayadio Longo
- Cliniques Universitaires de Kinshasa, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Crispin Muanza Lufu
- Secrétariat Technique du Comité Multisectoriel de la Riposte Contre la Covid-19, Kinshasa, Democratic Republic of the Congo
| | - Hervé Letin Keke
- Secrétariat Technique du Comité Multisectoriel de la Riposte Contre la Covid-19, Kinshasa, Democratic Republic of the Congo
| | - Marcel Mambimbi Mbula
- Cliniques Universitaires de Kinshasa, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Hippolyte Nanituma Situakibanza
- Cliniques Universitaires de Kinshasa, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Ernest Kiswaya Sumaili
- Cliniques Universitaires de Kinshasa, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jean-Marie Ntuma Kayembe
- Cliniques Universitaires de Kinshasa, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo.,Secrétariat Technique du Comité Multisectoriel de la Riposte Contre la Covid-19, Kinshasa, Democratic Republic of the Congo
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Asghari A, Hassanipour S, Hatam G. Comparative molecular prevalence and subtypes distribution of Blastocystis sp. a potentially zoonotic infection isolated from symptomatic and a symptomatic patients in Iran: A systematic review and meta-analysis. Acta Parasitol 2021; 66:745-59. [PMID: 33686524 DOI: 10.1007/s11686-021-00360-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/24/2021] [Indexed: 01/09/2023]
Abstract
PURPOSE The present systematic review and meta-analysis was aimed to assess the weighted molecular prevalence of Blastocystis sp. in humans along with the comparative molecular prevalence and subtypes distribution of Blastocystis isolated from symptomatic and asymptomatic patients in Iran. METHODS International electronic databases including Medline/PubMed, ProQuest, Scopus, Embase, and Google Scholar were explored until 4th October 2020. Heterogeneity index was evaluated among studies using Cochran's Q test and I2 index. Finally, 23 eligible studies were qualified to be included in this review. RESULTS The pooled molecular prevalence of Blastocystis sp. in Iran was reported 15.2% (95% CI 11.5-19.7). In addition, the molecular prevalence based on PCR-sequencing and STS primers was reported 12.5% (95% CI 8.6-17.7) and 19.8% (95% CI 13.1-28.8), respectively. Interestingly, there was a considerably higher prevalence among asymptomatic patients [25.1% (95% CI 20.8-30.0)] in comparison to symptomatic ones [21.0% (95% CI 15.9-27.2)]. In addition, the frequency of Blastocystis ST1, ST2, and ST3 from positive samples in symptomatic patients was 19.7%, 35.1%, and 47.4%, respectively. In addition, the prevalence of Blastocystis ST1, ST2, and ST3 from positive samples in asymptomatic patients was 27.1%, 26.8%, and 37.8%, respectively. The results obtained in Iran showed that Blastocystis is more common in asymptomatic patients compared to patients having clinical symptoms. Of note, ST3, as the most common subtype causing clinical symptoms, was the most prevalent reported subtype among both symptomatic and asymptomatic patients in the country. CONCLUSIONS Hence, the pathogenicity of the Blastocystis parasite is not subtype-specific and appears to be related to a variety of risk factors. Still the Blastocystis epidemiology is open to question and more large-scale studies should be performed on this aspect.
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Al-Balas M, Al-Balas HI, Alqassieh R, Al-Balas H, Khamees A, Al-Balas R, Al-Balas S. Clinical Features of COVID-19 Patients in Jordan: A Study of 508 Patients. Open Respir Med J 2021; 15:28-34. [PMID: 34249180 PMCID: PMC8227432 DOI: 10.2174/1874306402115010028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Received: 11/21/2020] [Revised: 02/15/2021] [Accepted: 03/30/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The symptoms of COVID-19 have a wide range of severity ranging from no symptoms at all to mild symptoms, such as fever, cough, sore throat, general weakness. Moreover, in some situations, patients may develop severe complications as pneumonia, and sepsis, leading to death. This study aims to investigate the characteristic features of COVID-19 patients based on their medical condition prior to COVID-19 diagnosis. METHODS A retrospective cohort study took place between the 1st of April 2020 and the 31st of June 2020 in Prince Hamzah Hospital, Jordan. Patients were diagnosed by the Real-Time Reverse Transcriptase (RT)-PCR Diagnostic Panel, either through screening or for those who developed symptoms. During this period, patients who tested positive for COVID 19 were admitted to the hospital regardless of their symptoms according to the local government health policies. A total of 508 Patients were involved and divided into two groups based on the presence or absence of chronic illnesses prior to COVID-19 diagnosis. RESULTS A total of 371 patients were medically free (220 males and 151 females). Among them, 153 patients were symptomatic (41.2%), with an average hospitalization of 18 days. Generalized malaise, dry cough, and fever were the most common reported symptoms (51%, 45.8%, and 41.8%, respectively). On the other hand, the total number of COVID-19 patients with predefined comorbidities was 137 (93 males and 44 females). Among them, 86 patients (62.8%) were symptomatic, with an average duration of admission of 19.3 days. Similar to medically free patients, dry cough, generalized malaise, and fever were the most commonly reported symptoms (50%, 43%, and 38.4%, respectively). There was a statistically significant correlation between the presence of chronic illnesses and the development of symptoms among COVID-19 patients (P = 0.0001). CONCLUSION Dry cough, generalized malaise, and fever were the most commonly reported symptoms among our patients regardless of their medical condition. The average duration of hospitalization in medically free patients was less than patients with comorbidities, and it was less among asymptomatic compared to symptomatic patients. More than half of our COVID-19 patients were male and asymptomatic. A significant correlation between patients' medical condition and the possibility of developing symptoms in response to COVID-19 was identified.
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Affiliation(s)
- Mahmoud Al-Balas
- Department of General and Special Surgery, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | | | - Rami Alqassieh
- Department of General and Special Surgery, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Hamzeh Al-Balas
- Department of General and Special Surgery, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | | | | | - Samir Al-Balas
- Department of Basic Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan
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Stamos A, Drum M, Reader A, Nusstein J, Fowler S, Beck M. An Evaluation of Ibuprofen Versus Ibuprofen/Acetaminophen for Postoperative Endodontic Pain in Patients With Symptomatic Irreversible Pulpitis and Symptomatic Apical Periodontitis. Anesth Prog 2020; 66:192-201. [PMID: 31891295 DOI: 10.2344/anpr-66-03-06] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The purpose of this investigation was to compare ibuprofen versus an ibuprofen/acetaminophen combination for postoperative pain control in a patient model specific to teeth diagnosed with symptomatic irreversible pulpitis and symptomatic apical periodontitis. One hundred and two patients presenting with moderate to severe pain from a maxillary or mandibular posterior tooth diagnosed with symptomatic irreversible pulpitis and symptomatic apical periodontitis were included. Following local anesthetic administration, complete endodontic cleaning and shaping was performed. Patients were randomly assigned to receive identically appearing tablets of ibuprofen 200 mg or a combination of ibuprofen 200 mg/acetaminophen 216.7 mg with instructions to take 3 tablets every 6 hours as needed for pain. Patients were also given a prescription for an escape medication to take if the study medications did not adequately control their pain. A 4-day diary was used to record pain ratings and medication use. Moderate to severe pain was experienced by 59-61% of the patients on postoperative day 1 and 50-57% of the patients on day 2, with the pain ratings decreasing over the next 2 days. There were no statistically significant differences between the 2 groups in postoperative pain, percussion pain, or medication use. There was no difference between ibuprofen and the combination of ibuprofen/acetaminophen in the reduction of postoperative pain following endodontic debridement in patients with symptomatic irreversible pulpitis and symptomatic apical periodontitis.
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Affiliation(s)
- Alex Stamos
- Former Graduate Student in Endodontics, The Ohio State University
| | - Melissa Drum
- Professor and Graduate Program Director, Division of Endodontics, The Ohio State University
| | - Al Reader
- Emeritus Professor, Division of Endodontics, The Ohio State University
| | - John Nusstein
- Professor and Chair, Division of Endodontics, The Ohio State University
| | - Sara Fowler
- Assistant Professor and Predoctoral Director, Division of Endodontics, The Ohio State University
| | - Mike Beck
- Emeritus Associate Professor, Division of Biosciences, The Ohio State University
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Netz FRS, Pickhardt PJ, Janssen Heijnen MLG, Simons PCG. Detection of potentially relevant extracolonic and colorectal findings at CT colonography in a low-risk symptomatic patient population. Abdom Radiol (NY) 2017; 42:2799-806. [PMID: 28647771 DOI: 10.1007/s00261-017-1221-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE CT colonography (CTC) is a widely accepted examination tool for detection of colorectal lesions but evidence of the proportions of relevant extracolonic findings (ECF) in a large symptomatic but still relatively low-risk cohort is lacking, as well as their relationship to symptoms, age, and sex. METHODS All patients (n = 3208) with colorectal symptoms, imaged between January 2007 and September 2016 with first-time CTC, were retrospectively selected. The majority (96.7%) was examined with low-dose unenhanced protocol. The most relevant ECF and colorectal lesions (≥6 mm) were prospectively assessed according to C-RADS classifications. Follow-up was elaborated based on the electronic record review. Chi-square test was utilized for evaluating the associations between relevant findings and symptoms, age, and sex. RESULTS A total of 270 (8.4%) patients were classified as C-RADS E3, 63 (2.0%) patients as C-RADS E4, and 437 (13.6%) patients were assessed with colorectal lesions (C-RADS C2-4). At follow-up, two thirds of ECF turned out to be a malignancy or relevant disease that required further medical attention. The proportion of ECF was not related to specific colorectal symptoms. Patients aged ≥65 years and men had significantly higher proportions of ECF than younger patients (C-RADS E3 p = 0.005; C-RADS E4 p < 0.001) and women (C-RADS E3 p = 0.013; C-RADS E4 p = 0.009), respectively. CONCLUSION Proportions of relevant ECF and colorectal findings are relatively low in symptomatic low-risk patients. By use of CTC as a singular examination, especially in elderly patients, most colonoscopies can be avoided with the benefit of diagnosing relevant ECF without introducing substantial over-diagnosis.
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de Lucio A, Merino FJ, Martínez-Ruiz R, Bailo B, Aguilera M, Fuentes I, Carmena D. Molecular genotyping and sub-genotyping of Cryptosporidium spp. isolates from symptomatic individuals attending two major public hospitals in Madrid, Spain. Infect Genet Evol 2015; 37:49-56. [PMID: 26518912 DOI: 10.1016/j.meegid.2015.10.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 10/09/2015] [Accepted: 10/26/2015] [Indexed: 02/04/2023]
Abstract
Infections by members of the protozoan genus Cryptosporidium are among the most common causes of human gastrointestinal illness worldwide. In Spain cryptosporidiosis is not a compulsory notifiable disease, so the actual burden of the infection in both clinical and general populations remains largely unknown. We present here data on the diversity and frequency of the Cryptosporidium species and sub-genotypes identified in symptomatic individuals seeking medical care in two major hospitals in Madrid, Spain, between December 2013 and January 2015. Initial detection of the parasite was conducted on a total of 122 stool samples collected from 120 patients by microscopy with modified Ziehl-Neelsen and/or immunochromatographic tests. We used immunofluorescence, PCR-based methods and sequence analyses of the 60-kDa (GP60) glycoprotein and the small subunit ribosomal RNA (SSU rRNA) genes for confirmatory purposes and to characterize Cryptosporidium isolates. A total of 110 patients were confirmed with cryptosporidiosis. Overall, 101 isolates were successfully sub-genotyped at the GP60 locus, and an additional seven at the SSU rRNA locus. The analyses of all amplicons defined 10 distinct sequence types representing the GP60 family sub-genotypes IbA10G2 (78.7%), IeA11G3T3 (3.7%) of C. hominis, and the GP60 family sub-types IIaA15G2R1 (5.6%), IIaA18G6R1 (0.9%), IIcA5G3a (0.9%), IIdA18G1 (0.9%), IIdA19G1 (0.9%), IIdA21G1 (0.9%), and IIdA22G1 (0.9%) of C. parvum. A single isolate was assigned to C. felis (0.9%), two C. parvum isolates (1.9%) could not be characterized at the sub-genotype level and an additional four isolates (3.7%) were not typable. These results strongly suggest that transmission of cryptosporidiosis is mostly anthroponotic in origin in the clinical sample under study. We expect that our molecular epidemiological data will make a significant contribution to unravel the actual epidemiological situation of cryptosporidiosis in Spain, providing health care and policy makers with solid baseline information to unavoidably improve the national surveillance system and allocate additional resources to research, diagnosis, and treatment of cryptosporidiosis.
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Affiliation(s)
- Aida de Lucio
- Parasitology Service, National Centre for Microbiology, Carlos III Health Institute, Majadahonda, Madrid, Spain
| | - Francisco J Merino
- Microbiology Service, University Hospital Severo Ochoa, Leganés, Madrid, Spain
| | - Rocío Martínez-Ruiz
- Microbiology and Clinical Parasitology Service, University Hospital Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Begoña Bailo
- Parasitology Service, National Centre for Microbiology, Carlos III Health Institute, Majadahonda, Madrid, Spain
| | - María Aguilera
- Parasitology Service, National Centre for Microbiology, Carlos III Health Institute, Majadahonda, Madrid, Spain
| | - Isabel Fuentes
- Parasitology Service, National Centre for Microbiology, Carlos III Health Institute, Majadahonda, Madrid, Spain
| | - David Carmena
- Parasitology Service, National Centre for Microbiology, Carlos III Health Institute, Majadahonda, Madrid, Spain.
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Degraba TJ, Hoehn GT, Nyquist PA, Wang H, Kenney R, Gonzales DA, Kern SJ, Ying SX, Munson PJ, Suffredini AF. Biomarker discovery in serum from patients with carotid atherosclerosis. Cerebrovasc Dis Extra 2011; 1:115-29. [PMID: 22566989 PMCID: PMC3343755 DOI: 10.1159/000334477] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [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: 01/01/2023] Open
Abstract
BACKGROUND Blood-based biomarkers of atherosclerosis have been used to identify patients at high risk for developing stroke. We hypothesized that patients with carotid artery disease would have a distinctive proteomic signature in blood as compared to a healthy control population without carotid artery disease. In order to discover protein biomarkers associated with increased atherosclerotic risk, we used two different strategies to identify biomarkers from patients with clinically defined atherosclerosis who were undergoing endarterectomy for atherosclerotic carotid artery disease. These patients were compared with healthy matched controls. METHODS Serum was obtained from patients undergoing endarterectomy (EA; n = 38) and compared to a group of age-matched healthy controls (n = 40). Serum was fractionated using anion exchange chromatography and three different surface-enhanced laser desorption/ionization (SELDI) chip surfaces and then evaluated with mass spectrometry (MS) and two-dimensional difference gel electrophoresis (2D-DIGE). RESULTS A random forest (RF) analysis of the SELDI-MS protein peak data distinguished these two groups with 69.2% sensitivity and 73.2% specificity. Four unique SELDI peaks (4.2, 4.4, 16.7 and 28 kDa, all p< 0.01) showed the greatest influence in the RF model. The EA patients with a history of prior clinical atherosclerotic plaque rupture manifested as either stroke or transient ischemic attack (symptomatic; n = 16) were compared to patients with carotid atherosclerosis but no clinical evidence of plaque rupture (asymptomatic; n = 22). Analysis of the SELDI spectra did not separate these two patient subgroups. A subgroup analysis using 2D-DIGE images obtained from albumin-depleted serum comparing symptomatic (n = 10) to asymptomatic EA patients (n = 10) found 4 proteins that were differentially expressed (p < 0.01) in the symptomatic patients. These proteins were identified as α(1)-antitrypsin, haptoglobin and vitamin D binding protein that were downregulated and α(2)-glycoprotein precursor that was upregulated in the symptomatic EA group. CONCLUSIONS SELDI-MS data analysis of fractionated serum suggests that a distinct protein signature exists in patients with carotid atherosclerosis compared to age-matched healthy controls. Identification of 4 proteins in a subset of patients with symptomatic and asymptomatic carotid atherosclerosis suggests that these and other protein biomarkers may assist in identifying high-risk patients with carotid atherosclerosis.
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Affiliation(s)
- Thomas J Degraba
- Neurology Department, National Naval Medical Center, Bethesda, Md., USA
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