Risk stratification using growth differentiation factor 15 in patients undergoing transcatheter aortic valve implantation

AIMS

Growth differentiation factor 15 (GDF15) shows potential predictive value in various cardiac conditions. We investigated relationships between GDF15 and clinical or procedural outcomes in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) in order to propose clinically useful predictive risk stratification model.

METHODS

This prospective single-center registry enrolled 88 consecutive patients with severe symptomatic aortic stenosis treated with TAVI. Clinical parameters were collected and biomarkers including GDF-15 were measured within 24 h before TAVI. All relevant clinical outcomes according to the Valve Academic Research Consortium-2 were collected over the follow-up period.

RESULTS

The cohort included 52.3% of females. The mean age of study participants was 81 years; the mean Society of Thoracic Surgeons (STS) score and logistic EuroSCORE were 3.6% and 15.4%, respectively. The mortality over the entire follow-up period was 10.2%; no death was observed within the first 30 days following TAVI. Univariate analysis showed significant associations between GDF15 and mortality (P=0.0006), bleeding (P=0.0416) and acute kidney injury (P=0.0399). A standard multivariate logistic regression model showed GDF-15 as the only significant predictor of mortality (P=0.003); the odds ratio corresponding to an increase in GDF15 of 1000 pg/mL was 1.22. However, incremental predictive value was not observed when the STS score was combined with GDF15 in this predictive model.

CONCLUSIONS

Based on our observations, preprocedural elevated GDF15 levels are associated with increased mortality and demonstrate their additional value in predicting adverse clinical outcomes in a TAVI population.

On the structures and luminescent properties of Eu3+ doped Li2 CaGeO4 , Ca2 GeO4 and Ca5 Ge3 O11 compounds

Powder samples of Li₂ CaGeO₄ , Ca₂ GeO₄ and Ca₅ Ge₃ O₁₁ doped by 0.5, 1, 2, 3, 4 and 5 at% Eu³⁺ relative to the Ca²⁺ , were prepared by conventional solid state synthesis technique. XRD analyses confirm obtaining of the pure phases at all dopant concentrations. In parallel, single crystals of the three compounds with the experimentally found optimal Eu³⁺ concentration were grown using the flux method. Structural investigation on the single crystals are done with a special attention on the form of Ca-O polyhedron, the mean Ca-O distance, the Ca-Ca distance in the structure, the distortion degree of the polyhedron as well as the of Eu-Ca substitution site. The main spectral characteristics are analyzed and several relations between the structural and spectra features were found. The optimal dopant concentration is 3 at% for Ca₂ GeO₄ and 4at% for Ca₅ Ge₃ O₁₁ and Li₂ CaGeO₄ . CIE coordinates of the samples show emission colors in the red region close to the standard red coordinates and slightly influenced by the active ion concentration. The obtained results show that europium doped Li₂ CaGeO₄ , Ca₂ GeO₄ and Ca₅ Ge₃ O₁₁ could be used as red phosphors.

Prospective study of signalling pathways in myeloma bone disease with regard to activity of the disease, extent of skeletal involvement and correlation to bone turnover markers

AIMS

The aim of our study was to address the utility of serum levels of selected parameters of myeloma bone disease (MBD) signalling with regard to the pathogenesis of multiple myeloma (MM), activity, markers of bone turnover and extent of skeletal changes.

PATIENTS AND METHODS

We assessed prospectively 77 individuals with monoclonal gammopathies - 46 patients with active MM (AMM), 12 patients with smouldering MM (SMM) and 19 individuals with monoclonal gammopathy of undetermined significance (MGUS) to determine the role of HGF, MIP-1α, Syndecan-1, osteoprotegerin, Activin A, DKK1, Annexin A2 and NF-κB.

RESULTS

We found significant differences of most of the parameters between MGUS and AMM, and with respect to the activity of MM assessed by International Staging System. Most of the parameters of MBD signalling correlated with traditional markers of bone turnover.

CONCLUSIONS

All the signalling pathways were activated in MM with more pronounced osteoclastogenesis in comparison with bone formation but not in MGUS regardless of its risk category, suggesting that MBD is not activated in MGUS until the process of transformation into MM. The parameters of MBD signalling might precede the increase of conventional parameters of bone turnover suggesting their possible role in early indication of anti-resorption therapy.

[PRENATAL DIAGNOSIS OF FOETAL TRISOMY 3Q WITH PATERNAL ORIGIN]

Balanced chromosomal translocations do not generally have phenotypic manifestation, but lead to increased risk of miscarriage and live-birth of chromosomally unbalanced offspring in carriers. Frequently prenatal diagnosis of an unbalanced translocation may incidentally detect a balanced translocation in the family. Here, we report a unique case of trisomy 3q (karyotype 46,XYder(3)t(3;21)(q11;p11)), detected prenatally due to abnormal findings of the fetus ascertained through ultrasound assessment like growth retardation, vermal agenesis, micrognathia, cystic hygroma of the neck, dextra position of arcus aortae, shorter for the gestational week long bones In order to determine the paternity of this chromosomal aberration, the cytogenetic analyses of the parents was performed. A balanced paternal translocation 46,XY,t(3;21)(q11;p11) wase identified. During the next pregnancy the same balanced translocation of paternal origin wase also identified. This case demonstrate the significance of prenatal ultrasound screening of the fetus; the necessity of cytogenetic analysis of a fetus with prenatal ultrasound abnormalities; genetic counseling of such families with aim of prenatal care and prevention during next pregnancies.

Analysis of thymidine kinase serum levels by novel method DiviTum in multiple myeloma and monoclonal gammopathy of undetermined significance - comparison with imaging methods 99mTc-MIBI scintigraphy and 18F-FDG PET/CT

AIMS

The study aimed at comparing two methods for evaluating thymidinekinase TK in serum - an older RIA method and novel DiviTum - in patients with MM and MGUS, and also comparing them with biochemical markers and degree of activity evaluated by imaging methods 99mTc-MIBI scintigraphy and 18F-FDG PET/CT.

METHODS

Serum thymidinekinase TK levels were evaluated by DiviTum and an RIA method (TK REA kit by Immunotech);The study analyzed correlation of TK activity in serum with biochemical markers reflecting activity of MM: β2-m, LDH, the ratio of kappa to lambda (κ/λ) free light chains and percentage of bone marrow plasma cells (BMPC). 99mTc-MIBI scintigraphy and 18F-FDG PET/CT were performed at the time of diagnosis. The degree of activity was expressed semiquantitatively. Scans were classified as 0 (normal activity), 1 (diffuse positivity) or 2 (focal positivity).

RESULTS

We found a strong positive correlation between TK in serum evaluated by DiviTum and by TK REA.. The DiviTum analytic method extended the detection range and was able to detect higher levels of TK than the RIA method. DiviTum technique found positive correlation with β2-m (r = 0.497) and LDH (r = 0.502) and moderate positive correlation with BMPC (r = 0.368). Significantly higher TK values measured by TK REA and DiviTum in the group of patients with MM (stages I, II or III) than in those with MGUS. Increased TK levels were observed in MIBI- or PET/CT-positive patients. Analysis of repeated measurements of TK in serum during treatment of MM patients found a correlation between change in TK measured by DiviTum and LDH during treatment.

CONCLUSIONS

Analysis revealed a significant correlation between TK in serum and LDH, β2-m and BMPC. Increased levels of TK in serum were observed in MIBI- or PET/CT-positive patients. Combination of positivity of imaging methods which can localize active tumor lesions and increased levels of TK in serum can have an impact on decision-making and optimization of the therapeutic approach.

Prognostic value of hepatocyte growth factor, syndecan-1, and osteopontin in multiple myeloma and monoclonal gammopathy of undetermined significance

Our aim was to compare serum levels of selected biological parameters in different phases of multiple myeloma (MM) and monoclonal gammopathy of undetermined significance (MGUS) to determine their diagnostic and prognostic potential. A cohort of 234 individuals was assessed for serum levels of hepatocyte growth factor (HGF), syndecan-1/CD₁₃₈ (SYN), and osteopontin (OPN). The patients with MM (N = 156) were divided into 3 groups: at the time of diagnosis (N = 45), in relapse/progression (N = 56), and in remission (N = 50). The analysis revealed significant differences of all three parameters in comparison of active and remission phase MM. Moreover, the parameters in active myeloma were significantly higher than in MGUS. Within the comparison of active disease (newly diagnosed and relapsing), there was no significant difference. Similar results were in remission phase MM and MGUS. There was no relationship of pretreatment levels of the parameters to therapeutic response. We conclude that serum levels of HGF, OPN, and SYN correspond to the activity of MM and might become useful in differentiation of MGUS, asymptomatic MM, and overt/symptomatic form of MM. The levels of all three parameters behave accordingly with MM activity. Pretreatment measurement without the assessment of their kinetics, however, has no relationship to therapeutic response.

Analysis of the serum levels of selected biological parameters in monoclonal gammopathy of undetermined significance and different stages of multiple myeloma

The aim of the study was to analyze differences in the serum levels of 8 selected biological parameters between monoclonal gammopathy of undetermined significance (MGUS) and different stages of multiple myeloma (MM), potentially beneficial for distinguishing between the two conditions. The analyzed group of 131 subjects comprised 62 individuals with MGUS and 69 MM patients examined at the time of diagnosis. The serum levels were determined by a quantitative immunoradiometric assay (insulin-like growth factor 1, IGF-1) and quantitative sandwich enzyme immunoassay (osteopontin, OPN; endostatin, ES; macrophage inflammatory proteins 1α/β, MIP-1α/β; angiogenin, ANG; and interleukin 17, IL-17). The analysis showed a statistically significant difference in serum concentrations between MGUS and the symptomatic form of MM using the Durie-Salmon (D-S) staging system only in the cases of OPN and stages II and III (0.001 and MM. More benefit may be expected from analyses using multiparametric immunophenotyping of plasma cells and molecular biology methods including gene expression analysis and proteomics.

The relationship between some soluble osteogenic markers, angiogenic cytokines/other biological parameters and the stages of multiple myeloma evaluated according to the Durie-Salmon and International Prognostic Index stratification systems

BACKGROUND

The aim of the present paper was to examine the correlation between serum concentrations of 12 soluble biological markers and stages of myeloma evaluated according to the Durie-Salmon (D-S) and International Prognostic Index (IPI) stratification systems.

METHODS

We analyzed a non-pretreated group of 179 patients with MM stratified according to D-S and IPI. Serum levels of soluble biological markers were evaluated using ELISA, REA and quantitative sandwich enzymatic immunoassays. The data were analyzed using the Kruskal-Wallis and Mann-Whitney U tests.

RESULTS

The staging system according to D-S revealed a highly significant relationship between all stages (I-III) in case of beta(2)-m (p<0.0001) and sTK (p<0.001), in sICTP a significant difference was found only in stages II vs III (p<0.001) and I vs III (p<0.001), in case of sCD(138) (syndecan-1) in stages I vs II (p = 0.006) and I vs III (p<0.001), in sVEGF only in stages I vs III (p = 0.006). In substages A vs B we found a significant difference in case of beta2-m (p<0.0001), sTK (p = 0.041), sICTP (p 0.0001), sOSP (p = 0.008), sHGF (p<0.001), sCD138 (p = 0.001) and sFas (p= 0.001). The relationship between other factors and stages and substages according to D-S appeared nonsignificant. The IPI system showed a highly significant relationship between all 3 categories (1-3) in case of beta(2)-m (p<0.001), sTK (p<0.0001) and sICTP (p<0.0001), while in sHGF only in stages 2 vs 3 (p<0.0001) and 1 vs 3 (p<0.0001). In 4 parameters there were only discrete differences in 1 vs 3: sPINP (p= 0.036), sOSP (p= 0.002), sCD(138) (p = 0.03) and sFas (p=0.012), in the remaining markers the analysis was negative.

CONCLUSIONS

A highly convincing relationship between myeloma stages and serum levels was found only in beta(2)-m, sTK, sICTP and partly also in sCD(138) (syndecan-1) and sHGF. More favourable was the IPI stratification system.

[Effect of intravenous gamma-globulin therapy on lymphocyte population in pregnant women with antiphospholipid antibodies]

The aim of the study was to establish the distribution of the lymphocyte populations in peripheral blood in pregnant women with antiphospholipid antibodies (aPL) and a history of recurrent pregnancy loss as well as to make a study on the influence of the intravenous IgG-treatment (IVIg) on the levels of antibodies and peripheral lymphocytes.

MATERIALS AND METHODS

14 pregnant women were investigated. The latter had two or more recurrent abortions and positive aPL--anticardiolipin (aCL) and/or anti-beta 2-Glycoprotein I (anti-beta 2-GPI). The lymphocyte populations were examined, using a flowcytometric method in peripheral blood before 6-7th gestational week and on the 10-14 day after the second IVIg infusion. 10 pregnant women wer used as controls who had no aPL antibodies and no pregnancy loss.

RESULTS

13 out of 14 pregnancies were successful Lymphocyte populations of the examined patients before the first infusion compared to the controls showed statistically significant differences for: T-lymphocyted Th(reduced) and CD3-CD56 + NK (increased) Significant increase after therapy was noticed for the levels of T-lymphocytes, and Th while the NK-cell populations were significantly reduced.

CONCLUSIONS

aPL-positive pregnancies most probably were associated with elevated and activated peripheral NK-cell subpopulations. The low doses of IVIg successfully reduce the levels of aPL, as well as peripheral CD3-CD56 + NK cells.

[Role of antiphospholipid antibodies in 147 patients with spontaneous abortions and stillbirths: a retrospective and prospective analysis]

Antiphospholipid antibodies (aPL) are a family of autoantibodies including lupus anticoagulant (LA), anticardiolipin antibodies (aCL), and ect. That appear to react with negatively charged phospholipids. These antibodies induce thrombosis and pregnancy complications including recurrent spontaneous abortions (RSA), recurrent stillbirth (SB), preeclampsia and intra-uterine growth retardation, although their exact pathogenic mechanisms remain poorly defined. The aim of this study was to investigate the frequency and the role of a aPL women with a history of RSA and SB due to positive aPL. The study included 147 women with a history of RSA and 48 women with a history of SB and to investigate the histological changes in the heams and stillborn fetuses in aCL positive women. We established that: 1, aCL were significantly increased in 62.2% (n = 92) in women with history of RSA and in 71% (n = 34) in women with history of SB; 2. aTr antibodies were positive in 22.7% (n = 5) in women with history of SB; 3. Tr activation status was increased in 77.3% (n = 17) in women with history of SB.

CONCLUSION

The investigation of aPL in women with history of RSA and SB provides new insights into the disease and offers promise for prophylaxis and treatment in subsequent pregnancies.

[Disturbances in humoral immunity and immunomodulation in patients with peritonitis]

Violations in immunity humoral in patients with peritonitis are fact, which have discovered in the beginning on past century. Authors investigate the changes in humoral immunity at 112 patients with peritonitis in the day of hospitalization. In 26 patients the examination is recur after 7 days. To be under consideration the determined disturbance in humoral immunity and theirs meaning for the final exit. It's necessitate immunomodulation in 10 per cent of the patients who have determined considerable disturbance in immunity. Authors share yours experience of application at Imunovenin and Isoprenazone.