Can lipid mediators and free fatty acids guide acute coronary syndrome diagnosis and treatment?

OBJECTIVE

The aim of this study was to investigate fatty acids, lipid mediator levels, and the desaturase index rates on different acute coronary syndrome types and their possible relationship with routine lipid parameters.

METHODS

The study included 81 patients with myocardial infarction (MI), 20 patients with unstable angina pectoris, and 31 healthy people. Fatty acids, CD59, lipoxin A4, 8-isoprostane, serum lipids, albumin, C-reactive protein (CRP), and high sensitive troponin levels were measured in all participants.

RESULTS

When the fatty acid groups were evaluated as a ratio of albumin, MUFA/albumin and SFA/albumin ratios were significantly higher in the MI group compared to the control group. Although CD59 and lipoxin A4 levels were higher in the control group, there was no significant differences between the groups. When lipoxin A4/CRP and CD59/CRP ratios were evaluated, the results were significantly lower than those in the control group.

CONCLUSION

Lipid mediators may be useful in treating atherosclerosis by contributing to the resolution of inflammation.

Effects of prasugrel on membrane potential and contractile activity of rat ventricular myocytes

BACKGROUND

Though prasugrel is one of the important P2Y₁₂ inhibitors currently in use for antiplatelet therapy, its potential effects on contractility and electrical activity of ventricular myocytes have not yet been investigated. Hence this study was designed to study the impact of prasugrel on contractile function and membrane potential of isolated ventricular myocytes.

METHODS

Freshly isolated rat ventricular myocytes were used in this study. Myocyte contraction was measured during electrical stimulation of cardiomyocytes and the action potential (AP) recordings were obtained with current clamp mode of the patch-clamp amplifier.

RESULTS

AP duration and fractional shortening of ventricular myocytes did not show any change with the administration of 1μM of prasugrel. However, remarkable depolarization of resting membrane potential followed by apparent fibrillation episodes was detected in the cardiomyocytes. Similar events were observed in the contractile activity of myocytes during field stimulation. Also, a higher concentration of prasugrel (10μM) elicited repeated fibrillations, which disappeared after washout or nitric oxide synthase (NOS) inhibition with L-NAME. In contrast, the same concentration of ticagrelor, another P2Y₁₂ inhibitor did not induce fibrillation events though it decreased the contractility of ventricular myocytes significantly. The perfusion of ventricular myocytes with L-NAME did not alter the negative inotropic effect of ticagrelor.

CONCLUSIONS

Prasugrel, a widely used antithrombotic agent, may induce depolarization in the membrane potential of myocytes as well as fibrillation via NO mediated pathway.

Knowledge and attitude changes of pregnant women regarding prenatal screening and diagnostic tests after counselling

OBJECTIVES

This study aimed to reveal the knowledge level of pregnant women about prenatal diagnostic tests, Down syndrome (DS) and amniocentesis, their attitudes toward uptaking these tests, undergoing amniocentesis, and the termination of pregnancy. It also aimed to evaluate the effects of providing information, as well as a written information brochure about all the issues concerning women's knowledge and attitudes.

MATERIALS AND METHODS

The gynecologists provided verbal and written information on prenatal screening tests (PSTs) and invasive prenatal diagnostic tests. Data were collected using an anonymous questionnaire, which was designed by the researchers on the basis of the literature.

RESULTS

Knowledge of both DS and amniocentesis was found to be significantly higher after the education (p = 0.000 and p = 0.000, respectively). Attitudes toward amniocentesis changed significantly after the education.

CONCLUSIONS

This study has shown that women had an inadequate knowledge about PSTs, DS, and amniocentesis. It has also revealed that education provided by gynecologists along with a written brochure of information tended to increase women's knowledge about PSTs.

Predictive value of procalcitonin and IL-6 versus cervical length for the admission-to-delivery interval in preterm labour

OBJECTIVE

The authors aimed to determine whether concentrations of IL-6 and procalcitonin in maternal circulation can be used and compared with cervical length to predict the admission-to-delivery interval in preterm labour.

MATERIALS AND METHODS

Forty patients complicated with preterm labour between 24-34 weeks of gestation and having preterm birth were included in the study group. Fortyfour healthy pregnant women at similar gestational ages and having term labour ('> 37 weeks) were included in control group. Maternal concentrations of IL-6 was measured by an enzyme-linked immunosorbent assay (ELISA) and procalcitonin was measured by immunoturbidimetry with using human procalcitonin reagent kit. Transvaginal ultrasound to assess cervical length was perforned.

RESULTS

Receiver operator characteristic (ROC) analysis results of IL-6 and procalcitonin for prediction of preterm delivery (PTD)< 48 hours, < seven days, <32 weeks, < 34 weeks, and < 37 weeks were not statistically significant (p > 0.05). ). It was shown through ROC analysis, that only cervical length had area under curve (AUC) 0.692 (0.511-0.873,p = 0.044) at cut off value ≤ 3.64 cm, AUC 0.758 (0.574-0.943, p = 0.015) at cut off value ≤ 3.50 cm, AUC 0.716 (0.553-0.879,p = 0.032) at cut off value < 3.80 cm, in predicting PTD within seven days, <32 weeks and < 37 week, respectively.

CONCLUSION

This study suggests that in preterm labour, although IL-6 and procalcitonin have unsatisfactory predictive value for the admission-to-delivery interval, cervical length has better predictive values for the admission-to-delivery interval.

Swimming exercise reverses aging-related contractile abnormalities of female heart by improving structural alterations

BACKGROUND

The objective of this study was to examine the effect of swimming exercise on aging-related Ca2+ handling alterations and structural abnormalities of female rat heart.

METHODS

For this purpose, 4-month and 24-month old female rats were used and divided into three following groups: sedentary young (SY), sedentary old (SO), and exercised old (Ex-O). Swimming exercise was performed for 8 weeks (60 min/day, 5 days/week). Myocyte shortening, L-type Ca2+ currents and associated Ca2+ transients were measured from ventricular myocytes at 36 ± 1°C. NOX-4 levels, aconitase activity, glutathione measurements and ultrastructural examination by electron microscopy were conducted in heart tissue.

RESULTS

Swimming exercise reversed the reduced shortening and slowed kinetics of aged cardiomyocytes. Although the current density was similar for all groups, Ca2+ transients were higher in SO and Ex-O myocytes with respect to the SY group. Caffeine-induced Ca2+ transients and the integrated NCX current were lower in cardiomyocytes of SY rats compared with other groups, suggesting an increased sarcoplasmic reticulum Ca2+ content in an aged heart. Aging led to upregulated cardiac NOX-4 along with declined aconitase activity. Although it did not reverse these oxidative parameters, swimming exercise achieved a significant increase in glutathione levels and improved structural alterations of old rats' hearts.

CONCLUSIONS

We conclude that swimming exercise upregulates antioxidant defense capacity and improves structural abnormalities of senescent female rat heart, although it does not change Ca2+ handling alterations further. Thereby, it improves contractile function of aged myocardium by mitigating detrimental effects of oxidative stress.

Effects of Ticagrelor on Ionic Currents and Contractility in Rat Ventricular Myocytes

PURPOSE

Antiplatelet therapy has been widely used for management of patients with ischaemic heart diseases or thrombotic events. Experimental studies have shown that ticlopidine and clopidogrel decreased L-type Ca(2+) currents (ICaL), altered action potential (AP) duration and thence exerted negative inotropic effects. In this study we tested if ticagrelor, a non-thienopyridine agent, has any influence on contractile and electrical properties of isolated ventricular myocytes.

METHODS

Cardiomyocytes were isolated from male rat hearts with an enzymatic dissociation procedure and left ventricular myocytes were used for experiments. The effects of ticagrelor (1 μM) on sarcomere shortening, ionic currents and action potentials were measured at 36 ± 1 °C.

RESULTS

Ticagrelor significantly reduced ICaL density (~18%, p < 0.01) of ventricular myocytes and this effect was reversible. In consistence, it also decreased sarcomere shortening of electrically stimulated cardiomyocytes (13%, p < 0.05), while it did not change relaxation rates. Repolarizing K(+) currents and AP duration were unaffected by 1 μM ticagrelor application.

CONCLUSIONS

Ticagrelor exerts a significant influence on contractile properties and membrane currents of ventricular myocytes similarly to thienopyridine agents. The impact of ticagrelor on cardiac excitation-contraction coupling elements is important, since it is widely used for the treatment of patients with heart diseases.

The synergistic effect of ω3 and Vit D3 on glycemia and TNF-α in islet transplantation

The current treatment of type 1 diabetes consists of insulin administration. Transplantation of islets of Langerhans is considered very favorable because the full effect of insulin treatment cannot be obtained in severe cases. Although agents such as omega-3 (ω3) and vitamin D3 (Vit D3) are known to contribute to the success of islet allo-transplantation (ITX), in this study we aimed to experimentally determine their effects on glycemia and TNF-α production. Wistar albino rats, which were used as recipients, were given ω3, Vit D3, and islets by gavage, and intraperitoneal- and intraportal injections, respectively. Daclizumab (DAC) was used for immunosuppression. Glycemia levels decreased in rats treated with ω3 and vit D3. TNF-α increased in all groups due to application of STZ. After ITX (day +1), the weakest increase was observed in the ω3 + Vit D3 group. In the ITX+DAC group, compared with that of ITX only, DAC was shown to decrease levels of TNF- α following ITX, only in control group, however, similar levels of TNF-α were observed in other groups. The values in the treated groups were already lower than those of the controls in the ITX group and also remained almost equal in the ITX+DAC group. We suggest that the use of ω3 and Vit D3 together will improve the pro-inflammatory aspect encountered during and after ITXs, and contribute to the reduction of the dose of immunosuppressants in these procedures.

Evaluation of the left ventricular regional function using two-dimensional speckle tracking echocardiography in patients with end-stage renal disease with preserved left ventricular ejection fraction

OBJECTIVE

It is known that patients with end-stage renal disease (ESRD) more frequently develop a wide range of left ventricular (LV) structural and functional abnormalities. The aim of our study is to evaluate the left ventricular regional function using two-dimensional speckle tracking echocardiography (2D-STE) in ESRD patients with preserved left ventricular ejection fraction (PLVEF) undergoing haemodialysis treatment.

METHODS AND RESULTS

In total 61 healthy individuals and 87 ESRD patients were enrolled. Using the 2D-STE method, the strain (S) and strain rate (SR(S): systolic, SR(E): early diastolic, SR(A): late diastolic) values belonging to the radial (R), circumferential (C), and longitudinal (L) functions of the LV have been measured and the SR(E/A) values were calculated. While the LVEF values in the ESRD group were found to be lower than in the healthy control group (64.39 +/- 5.7 vs. 65.49 +/- 3.95, P = 0.033; R(S) = 45.17 +/- 17.28 vs. 53.97 +/- 14.29, P = 0.001; L(S) = -19.71 +/- 3.1 vs. -30.13 +/- 2.1, P < 0.001; RSRE(E/A) = 1.55 +/- 0.85 vs. 2.04 +/- 0.96, P = 0.001; LSR(E/A) = 1.42 +/- 0.51 vs. 1.88 +/- 0.7, P < 0.001), no difference was observed in terms of the C(S) (19.42 +/- 7.14 vs. 18.57 +/- 4.12, P = 0.155) and CSR(E/A) (2.5 +/- 1.34 vs. 2.56 +/- 1.35, P = 0.869) values. The C(S) was observed as an independent predictor related to the LVEF (beta = 0.2, 95% CI: 0.126-0.207, P = 0.015).

CONCLUSION

In patients with ESRD, although the longitudinal and radial systolic functions are reduced, the LVEF may remain within normal limits due to the preservation of the circumferential functions. 2D-STE has the potential to detect the severity of uraemic cardiomyopathy in the early stages of the disease and might provide useful information for the risk stratification in ESRD patients with PLVEF.

Assessment of left atrial dysfunction in obstructive sleep apnea patients with the two dimensional speckle-tracking echocardiography

BACKGROUND

The aim of this study was to compare left atrial (LA) longutidinal myocardial function in obstructive sleep apnea (OSA) patients with healthy individuals using two-dimensional speckle-tracking echocardiography method (2D-STE).

METHOD

Twenty one healthy individuals and 58 OSA patients were included. According to the AHI (apnea hypopnea index) patients were examined in mild, moderate and severe OSA groups. Images of the LA were acquired from the apical two- and four-chamber views. LA strain(LA(S)) and strain rate(LA(SR)) parameters [systolic (S), early diastolic (E), late diastolic (A) during atrial contraction] were assessed.

RESULTS

LA(S-S), LA(SR-S), LA(S-E) and LA(SR-E) values decreased with severity of OSA. Severe OSA patients have lower LA(S-S) and LA(SR-S) values (p < 0.03). While a difference in the LA(SR-E) value between groups was significant beginning with the moderate OSA group (p < 0.03), no LA(S-E) value differences were observed between moderate and mild OSA groups (p > 0.03). LA(S-A) and LA(SR-A) values were increasing with the disease severity up to moderate OSA. LA(S-A) and LA(SR-A) values of moderate OSA were greater than the mild OSA patients and healthy individuals (p < 0.03). These were lower in severe OSA than the moderate OSA (p < 0.03), however, they were greater than the healthy individuals (p < 0.03). The AHI was found to be negatively correlated with the LA(S-S), LA(SR-S) LA(S-E), LA(SR-E), whereas AHI was not correlated with the LA(S-A), LA(SR-A) values.

CONCLUSION

LA remodeling and dysfunction that accompany OSA can be detected in the subclinical stage with a detailed evaluation of active and passive functions of the LA using the 2D-STE method.

Labial fusion first diagnosed during pregnancy with voiding difficulty and its management: a case report

INTRODUCTION

Labial fusion is described as partial or complete adherence of the labia minora. Adhesions of the labia are extremely rare in the reproductive population with only a few cases described in the literature and none reported with pregnancy.

CASE PRESENTATION

A 24-year-old woman who had extensively fused labia with a pinhole opening at the upper midline with menstrual delay was diagnosed at six weeks of pregnancy. The case and its management are presented.

CONCLUSION

The condition was treated surgically with complete resolution of the urinary symptoms.

Recurrent ventricular arrhythmias and myocardial infarctions associated with cocaine induced reversible coronary vasospasm

Cocaine has become the most frequently used illicit drug among patients presenting to emergency departments worldwide. Although acute myocardial infarction is the most common reported cardiovascular manifestation in this setting, there are many other potential cardiotoxic effects of cocaine use including coronary artery spasm, arrhythmia, and sudden death. We report the case of a 54 year-old male with angiographically documented reversible coronary arterial spasm leading to severe life-threatening recurrent ventricular arrhythmias and electrocardiographic changes suggesting acute myocardial infarction secondary to cocaine use. Recurrent ventricular arrhythmias of this patient required implantation of a cardioverter-defibrillator which successfully treated following arrhythmia episodes.

Effect of hypothermia on blood-brain barrier permeability following traumatic brain injury in chronically ethanol-treated rats

The objective of this study was to investigate the effect of hypothermia on the blood-brain barrier (BBB) disruption caused by traumatic brain injury (TBI) in chronically ethanol-treated rats. BBB permeability was measured using Evans blue (EB) dye. Arterial blood pressure levels of animals in hypothermic groups decreased significantly. The EB dye extravasation into the brain significantly increased in hypothermia and at 6 and 24 h after TBI. In ethanol-treated rats that were subjected to TBI, hypothermia led to a significant decrease in EB dye content in the brain at 24 h but not at 6 h after TBI when compared with TBI alone.

Demographic analysis and outcome features in a transplant outpatient clinic

AIM

This retrospective report analyzed the demographic features of kidney transplant outpatients grafted in Turkey and in different regions of the world.

METHODS

The patients were divided into 4 groups: Every cohort was subgrouped as either receiving a cadaveric (CT) or a live donor transplant (LT) performed in our institute (ICT, n = 147, ILT, n = 304), other institutions in Turkey (TCT, n = 16, TLT, n = 86), or in a foreign country (FCT, n = 66, FLT, n = 154).

RESULTS

Among the patients with functional grafts, FLT transplantations, of which the vast majority were paid transplantations, constituted the second largest group (n = 105) following ILT (n = 214). In the ILT group, 5- and 10-year graft survival rates were 76% and 50%, respectively, and patient survival rates were 88% and 78%, respectively. Considering the FLT group, 5- and 10-year graft survival figures were 70% and 42%, respectively, while patient survival rates in these periods were 81% and 69%, respectively. Patients with paid donor transplantations were characterized by a high risk of unconventional infectious complications in the early period, while midterm patient and graft survival was somewhat better than expected considering the high rate of complications in the early period.

CONCLUSIONS

Paid organ transplantation should be discouraged. Organ donation should be stimulated by every means to avoid potentially fatal unconventional infections after transplantation from paid donors. If patients receive a paid transplant, however, they should be closely followed for these complications, since, if they survive the early period the midterm and long-term outcomes are quite reasonable.

Effects of lipopolysaccharide on the blood-brain barrier permeability in prolonged nitric oxide blockade-induced hypertensive rats

The authors investigated the effects of lipopolysaccharide (LPS) on the blood-brain barrier (BBB) integrity and the activity of astrocytes during the Nw-nitro-L-arginine methyl ester (L-NAME) hypertension followed by angiotensin (ANG) II in rats. They measured the changes in the BBB permeability using the Evans blue (EB) dye and concomitantly in the levels of TNF-a, IL-1b, and IL-6 in serum and nitric oxide in plasma. The authors performed two tight junction-specific proteins, zonula occludens-1 and occludin, and glial fibrillary acidic protein, by using immunohisto-chemical method. The serum levels of TNF-a, IL-1 IL-6, and the plasma level of nitric oxide significantly increased in LPS-treated rats (p<.01). The EB dye extravasation increased in cerebellum (p<.001) and diencephalon (p<.05) of L-NAME plus ANG II-treated animals. However, LPS reduced the increased EB dye extravasation in the brain regions of L-NAME-induced hypertensive rats treated with ANG II (p<.001). In L-NAME, there was a considerable loss of staining in both zonula occludens-1 and occludin. Staining for zonula occludens-1 and occludin was highly intensive in animals treated with LPS. Glial fibrillary acidic protein staining was seen in a few astrocytes in brains of L-NAME-treated animals. However, this staining showed an increased intensity in the brain sections of animals treated with LPS. This study indicates that, in L-NAME hypertensive rats, ANG II leads to an increase in the extravasation of EB dye to brain as a result of decreased activity of tight junction proteins and astrocytes, and LPS could significantly attenuate the EB dye transport to the brain through the increased activity of tight junction proteins and astrocytes.

Does the endothelial function change in renal transplant patients with longer duration of exposure and with higher cumulative doses of cyclosporine?

OBJECTIVE

Administration of cyclosporine (CsA) is one potential cause of endothelial dysfunction in renal transplant patients. We sought to investigate endothelial functional changes with respect to the cumulative dose and duration of exposure to CsA.

METHODS

Sixty-six renal recipients and 25 healthy controls were included in the study. The recipients were classified according to their time of CsA exposure: group 1 (0 to 36 months); group 2 (36 to 72 months); and group 3 (over 72 months). Endothelial function of the brachial artery was evaluated using high-resolution vascular ultrasound. Endothelium-dependent and -independent vasodilatation (EDD and EID, respectively) were assessed by assessing the responses to reactive hyperemia and using sublingual isosorbide dinitrate (ISDN), respectively.

RESULTS

There were no statistically significant differences between the groups with regard to their demographic, clinical, and most biochemical characteristics. Baseline measurements of the diameter of the brachial artery were similar in all groups. The values of mean brachial artery EDD and EID responses in groups 1, 2, and 3 were less than those in the control group (P < .05, P < .05, and P < .05, respectively). Mean brachial artery EDD and EID in group 1 were significantly impaired compared to groups 2 and 3 (for EDD: P < .05 and P < .05, respectively; for EID: P < .05 and P < .05, respectively). In contrast there was no difference between groups 2 and 3 with respect to these parameters. There were mild to moderate positive correlations between the cumulative doses of CsA and EDD and EID (r = .26 and r = .52, P < .05, respectively).

CONCLUSION

Endothelial dysfunction was more prominent in the first 36-month period than later despite the longer exposure to and higher cumulative doses of CsA. This finding may reflect an extended effect of the uremic state on endothelial function or more intense doses of CsA in early posttransplant period.

Non-closure of visceral peritoneum at abdominal hysterectomy

Our purpose was to determine whether non-closure of the visceral peritoneum alters post-operative outcome at abdominal hysterectomy. A prospective, randomized trial was performed. Of the 100 evaluable subjects, 50 had the visceral peritoneum left open whereas 50 were closed. Patients were observed for evidence of morbidity after the operation. Analysis of data was performed with use of the unpaired t-test for continuous variables. The visceral peritonization process at abdominal hysterectomy does not provide immediate post-operative benefits while unnecessarily lengthening surgical time and anesthesia exposure. We suggest that visceral peritonization process can be abolished at abdominal hysterectomy.

Tap test, shake test and phosphatidylglycerol in the assessment of fetal pulmonary maturity

OBJECTIVE

No single test of amniotic fluid has yet been found completely reliable, easily performed and universally applicable in the prediction of fetal pulmonary maturity.

SETTING

Department of obstetrics and gynecology of a university hospital.

METHOD

The tap test and shake test were compared to the phosphatidylglycerol (PG) on amniotic fluid samples in 180 fetuses.

RESULTS

We found that the tap test results were correlated to the absence or presence of the respiratory distress syndrome in the newborn. When the tap test was evaluated at 5 min, the sensitivity (80.00%), specificity (91.03%) and predictive value for maturity (94.96%) and immaturity (68.29%) were comparable to those of the PG, which has a sensitivity of 82.85%, specificity of 92.41% and predictive value for maturity of 95.71% and immaturity of 72.50%.

CONCLUSION

Our findings suggest that the tap test can be a valuable clinical procedure.