Serum homocysteine level as a predictive marker in patients of coronary artery disease � A study of 150 cases

Background: Coronary Artery Disease (CAD) has a high prevalence in Asian Indians. The Acute Myocardial Infarction (AMI) or Ischemic Heart Disease is rapidly increasing in India and in the developing countries. India is on an epidemiological threshold of experiencing significant increase in cardiovascular diseases. This predilection to Coronary Heart Disease is attributable to a clustering of various risk factors. The factors implicated include: The lifestyle modifiable risk factors such as smoking, obesity, physical inactivity and those modifiable by lifestyle as well as pharmacotherapy such as lipid disorder, hypertension, and insulin resistance. The non-modifiable risk factors include age, sex and genetics. These are reasonably well established. The high rate of coronary heart disease however cannot be explained by the presence of these conventional risk factors alone. Of all the ethnic groups, people of Indian origin have one of the highest incidences of CAD. Aim and Objective: To study and establish correlation of Hyperhomocysteinemia with various coronary risk factors such as Age, Sex, socioeconomic status, and other lifestyle factors such as occupation, smoking, alcohol, tea/coffee, Dyslipidemia, hypertension, obesity and diabetes. Materials and Methods: The study was conducted in the department of Pathology at M.P. Shah Government medical college and Guru Gobind Singh hospital, Jamnagar- Gujarat; it was undertaken over a period of two years from August-2018 to August-2020. A total of 150 patients receiving In-patient care in the hospital were selected to enter the study. This was a cross-sectional study. Detailed clinical history and other important parameters as well as findings of all the concerned patients were collected. Estimation of serum homocysteine level done of all 150 patients. Results: This study was conducted in 150 patients admitted at a tertiary care center in Saurashtra region, for a duration of two years from August 2018-August 2020. The study was a cross-sectional study and included 150 patients who were diagnosed cases of coronary artery disease or Ischemic Heart Disease or previous history of Cardiac arrest. This study showed a male preponderance of coronary artery disease. Hyperhomocysteinemia is found to be an important risk factor in patients with younger age presenting with CAD. Conclusion: In this study, we showed that elevated level of homocysteine is significantly associated with CAD risk independent of other risk factors. Positive correlation was established between hyperhomocysteinemia and major traditional risk factors of Coronary artery disease mainly - Dyslipidemia, diabetes, hypertension and obesity and were proved statistically significant.

The predictive value of sFlt-1/PIGF ratio in high risk patients for the development of preeclampsia

Background: Hypertensive disorders of pregnancy constitute a major cause of maternal morbidity and mortality. Pre-eclampsia/eclampsia ranks second only to haemorrhage as a specific, direct cause of maternal mortality. A number of markers have been under study for the early detection of this disease. The study aims to evaluate the predictive value of sFlt-1/PlGF ratio for preeclampsia.Methods: This study was conducted in the Department of Gynaecology and Obstetrics of ASCOMS hospital, Jammu for a period of 6 months from Jan 2019 to June 2019. 50 antenatal patients attending the outpatient department with risk factors for developing preeclampsia were enrolled in the study. Their sFlT-1/PIGF ratio was determined at gestational age of 20 weeks to 37 weeks and its predictive value was evaluated.Results: In the present study, 8 patients developed preeclampsia subsequently. The mean sFlt-1/PIGF ratio values were significantly higher in the patients who developed preeclampsia (73.5) than who did not develop the disease (26.07). The positive predictive value at 1 week was 41.66% and negative predictive value was 100%. At 4 weeks, positive predictive value was 66.66% and negative predictive value was 100%.Conclusions: The present study suggests sFlt-1/PIGF ratio values are useful marker was a predictor of preeclampsia and values >38 were associated with preeclampsia. It is more useful in ruling out preeclampsia than ruling in the disease.

Progression in immunotherapy with immune checkpoint inhibitors for advanced gastric cancer / 中国肿瘤生物治疗杂志

@# Advanced gastric cancer is one of cancer types with poor prognosis in East Asia and China. Treatment strategies are especially limited in patients with advanced gastric cancer due to the lack of potent efficacy and serious toxicity. In 2017, immune checkpoint inhibitors targeting programmed cell death protein-1 (PD-1) or programmed death ligand-1 (PD-L1) have been approved by FDA for treating advanced gastric or gastroesophageal junction cancer (GC/GEJC) as a third-line option. However, immune checkpoint inhibitors have not been used in the first or second-line setting for advanced gastric cancer. Presently, many clinical trials are undergoing to determine the efficacy of combined therapy including checkpoint inhibitor plus chemotherapy, dual combinations with two immune checkpoint inhibitors, to enhance anticancer activity of immune checkpoint inhibitors and expand targeted patients. Furthermore, areas for further study include the development and validation of novel biomarkers to predict patients who are most likely to respond to treatment and characterization of outcomes with immune checkpoint inhibitors in different defined disease subgroups.

Structural Brain Alterations in Individuals at Ultra-high Risk for Psychosis: A Review of Magnetic Resonance Imaging Studies and Future Directions

Individuals at ultra-high-risk (UHR) for psychosis have become a major focus for research designed to explore markers for early detection of and clinical intervention in schizophrenia. In particular, structural magnetic resonance imaging studies in UHR individuals have provided important insight into the neurobiological basis of psychosis and have shown the brain changes associated with clinical risk factors. In this review, we describe the structural brain abnormalities in magnetic resonance images in UHR individuals. The current accumulated data demonstrate that abnormalities in the prefrontal and temporal cortex and anterior cingulate cortex occur before illness onset. These regions are compatible with the regions of structural deficits found in schizophrenia and first-episode patients. In addition, the burgeoning evidence suggests that such structural abnormalities are potential markers for the transition to psychosis. However, most findings to date are limited because they are from cross-sectional rather than longitudinal studies. Recently, researchers have emphasized neurodevelopmental considerations with respect to brain structural alterations in UHR individuals. Future studies should be conducted to characterize the differences in the brain developmental trajectory between UHR individuals and healthy controls using a longitudinal design. These new studies should contribute to early detection and management as well as provide more predictive markers of later psychosis.

Maternal serum highly sensitive C-reactive protein as a predictive marker of tocolytic success in preterm labor patient / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to evaluate whether maternal serum highly sensitive C-reactive protein (hsCRP) could be use as a marker of prediction of tocolytic success in preterm labor pregnancy, and was more useful in comparison with other inflammatory factors. METHODS: Maternal serum white blood cell (WBC) count, C-reactive protein (CRP), and hsCRP were determined in 87 patients in preterm labor and 68 controls. Preterm labor group was divided into tocolytic success group (n=44) and failure group (n=43). The levels of maternal serum WBC count, CRP, and hsCRP were evaluated using receiver operating characteristic (ROC) curve and area under the curve (AUC) to evaluate the relative value as prediction marker of tocolytic success in two preterm labor groups. The data were analyzed using student t-test. RESULTS: There was no significant difference for maternal age, body mass index (BMI), gestational age, and parity between normal group and preterm labor group. But, WBC count and hsCRP were significantly higher in preterm labor group in comparison to normal group (p<0.001). In preterm labor group, there was no significant difference in maternal age, BMI, gestational age, and parity between tocolytic success group and failure group. But, WBC count, CRP, and hsCRP were significantly lower in tocolytic success group. In the prediction of tocolytic success, the AUCs of WBC count, CRP, and hsCRP were 0.65, 0.77, and 0.82, respectively. CONCLUSION: This study showed that serum levels of hsCRP may be used as a marker of prediction of tocolytic success in preterm labor pregnancy.

Usefulness of B-type Natriuretic Peptide Assay in Predicting Symptomatic Patent Ductus Arteriosus in Preterm Infants

PURPOSE: Earlier and accurate identification of preterm infants who are likely to develop hemodynamically significant patent ductus arteriosus (hsPDA) would allow for early prophylaxis and thus minimize the risk of neurologic and respiratory morbidity. The purpose of this study is to clarify the usefulness of plasma B-type natriuretic peptide (BNP) as an early biochemical predictive marker of subsequent symptomatic PDA (sPDA) in preterm infants. METHODS: Clinical and echocardiographic findings of PDA were evaluated at 24 and 48 hours of age in 69 infants ranging from 25 to 34 gestational weeks of age. Plasma BNP concentrations were simultaneously measured with a Triage(R) BNP test kit (Biosite Diagnositics, San Diego, California, U.S.A.). When two or more clinical symptoms of PDA and large ductal shunt from echocardiographic findings were found, sPDA was diagnosed and treated with indomethacin. RESULTS: The mean BNP level in sPDA group (N=22) was significantly higher than that of control group (N=47) at 24 and 48 hours. BNP levels were significantly correlated with the magnitudes of the ductal shunt, such as the ratio of left atrial to aortic root diameter and the diastolic flow velocity of the left pulmonary artery. At 24 hours of age, a cutoff BNP value of 468.5 pg/mL had a sensitivity of 90.9%, a specificity of 74.5% and a positive predictive value of 95.2% for prediction of sPDA (area under ROC curve: 0.908, P<0.001, 95% CI: 0.840 to 0.977). CONCLUSION: Rapid BNP assay allows early prediction of subsequent sPDA that may require treatment in preterm infants.

Expression of Tubular Intercellular Adhesion Molecule-1 (ICAM-1) as a Marker of Renal Injury in Children with IgA Nephropathy

PURPOSE: In order to evaluate the value of the renal expression of ICAM-1 as a marker of renal injury, we analyzed the relationship between abnormal tubular expression of ICAM-1 and histopathological features and clinical manifestations in children with IgA nephropathy (IgAN). METHODS: The clinical data from 43 patients with IgAN were analyzed retrospectively and compared to the histopathologic subclassification proposed by Haas. ICAM-1 in tubular epithelium was assessed using the LSAB(Labeled streptavidine biotin) kit on the renal biopsy specimens. RESULTS: In 43 patients with primary IgAN, 28 males and 15 females aged 12.2+/-2.2 years were studied. There were no differences of renal tubular expression of ICAM-1 between patients with gross hematuria and without gross hematuria. But renal tubular expression of ICAM-1 in patients with proteinuria was significantly higher than that of in patients without proteinuria(78.72+/-14.19% vs. 55.80+/-32.20%, P0.05; F=0.31, P>0.05; F=0.21, P>0.05). CONCLUSION: Renal tubular expression of ICAM-1 can be a useful marker of renal injury in children with IgAN.

Efficacy of midtrimester amniotic fluid 8-isoprostane measurement in the prediction of severe preeclampsia / 대한산부인과학회잡지

OBJECTIVE: The objective of this study is to investigate whether the amniotic fluid 8-isoprostane levels at the time of genetic amniocentesis is a marker for severe preeclampsia. METHODS: A case-control study was conducted to compare mid-trimester concentrations of amniotic fluid 8-isoprostane in women with normal pregnancies (n=22) and in those who subsequently developed severe preeclampsia (n=22). Amniotic fluid was also obtained by amniocentesis from another women who already developed severe preeclampsia (n=22) after 20 weeks of gestation. The 8-isoprostane levels were measured by enzyme-linked immunoassay. For statistical analysis, nonparametric tests and receiver-operating characteristic curves were used where appropriate. Statistical significance was considered when probability was <0.05. RESULTS: The levels of midtrimester amniotic fluid 8-isoprostane were found to be significantly decreased in the women who subsequently developed severe preeclampsia in comparison with those who underwent normal pregnancies (P<0.05). The levels of 8-isoprostane in preeclamptic amniotic fluid were found to be significantly decreased with respect to that in midtrimester amniotic fluid (P<0.05). No relationship was found between the midtrimester amniotic fluid 8-isoprostane levels and preeclampsia with small-for- gestational-age. After the onset of severe preeclampsia, however, the amniotic fluid 8-isoprostane levels were significantly decreased in women with small-for-gestational-age. The midtrimester amniotic fluid 8-isoprostane level of 170 pg/ml had a sensitivity of 72.7% and a specificity of 63.6% in the prediction of severe preeclampsia. CONCLUSION: The midtrimester amniotic fluid 8-isoprostane levels may predict the later occurrence of severe preeclampsia. This study not only presents a new information that 8-isoprostane is detected in human amniotic fluid, but also provides a convincing evidence that a subclinical process from faulty placentation in early gestation is important for the occurrence of preeclampsia. Further studies are warranted to determine which mechanism causes such decrease in amniotic fluid 8-isoprostane in preeclampsia.