The Use of Lipoprotein-Associated Phospholipase A2 in a Chinese Population to Predict Cardiovascular Events / 生物医学与环境科学（英文）

Objective@#To explore associations between lipoprotein-associated phospholipase A2 (Lp-PLA2) and the risk of cardiovascular events in a Chinese population, with a long-term follow-up.@*Methods@#A random sample of 2,031 participants (73.6% males, mean age = 60.4 years) was derived from the Asymptomatic Polyvascular Abnormalities Community study (APAC) from 2010 to 2011. Serum Lp-PLA2 levels were determined by enzyme-linked immunosorbent assay (ELISA). The composite endpoint was a combination of first-ever stroke, myocardial infarction (MI) or all-cause death. Lp-PLA2 associations with outcomes were assessed using Cox models.@*Results@#The median Lp-PLA2 level was 141.0 ng/mL. Over a median follow-up of 9.1 years, we identified 389 events (19.2%), including 137 stroke incidents, 43 MIs, and 244 all-cause deaths. Using multivariate Cox regression, when compared with the lowest Lp-PLA2 quartile, the hazard ratios with 95% confidence intervals for developing composite endpoints, stroke, major adverse cardiovascular events, and all-cause death were 1.77 (1.24-2.54), 1.92 (1.03-3.60), 1.69 (1.003-2.84), and 1.94 (1.18-3.18) in the highest quartile, respectively. Composite endpoints in 145 (28.6%) patients occurred in the highest quartile where Lp-PLA2 (159.0 ng/mL) was much lower than the American Association of Clinical Endocrinologists recommended cut-off point, 200 ng/mL.@*Conclusion@#Higher Lp-PLA2 levels were associated with an increased risk of cardiovascular event/death in a middle-aged Chinese population. The Lp-PLA2 cut-off point may be lower in the Chinese population when predicting cardiovascular events.

The Correlation between Cardiac Enzymes and Cardiotrophin-1 Levels in Patients with Acute Coronary Syndrome

Abstract Background In the current era, there is always search for better cardiovascular biomarkers to early diagnose the disease. Objectives We aimed to investigate the association between a novel biomarker, cardiothropin-1 (CT-1), and standard markers of myocardial ischemia in patients with acute coronary syndrome (ACS) in Turkey. Patients and Methods In this prospective cohort study, patients who were admitted to our institution between July 2012 and July 2013 with the diagnosis of ACS were included. The standard markers of myocardial necrosis and CT-1 were evaluated at the time of admission and after 6 hours. Changes in laboratory parameters were statistically tested and correlated with routinely used markers of myocardial ischemia. The distribution of the data was analyzed by the Kolmogorov-Smirnov test. Proportional analysis and changes in laboratory parameters were evaluated with Chi-Square test and Fisher Exact test. Statistical significance was defined as p<0.05. Results The study enrolled 24 patients (14 male, 10 female) with ST-segment elevation myocardial infarction (STEMI) and 16 patients (9 male, 7 female) with non-ST-segment elevation myocardial infarction (NSTEMI) with elevated cardiac enzymes such as creatine kinase (CK), creatine kinase-MB (CK-MB) and Troponin-T (Tn-T). The average age of the patients was 61.45 ± 11.04 years. Increasing CT-1 levels were correlated with the increasing CK (p=0.035 and p=0.018, respectively), CK-MB (p=0.006 and p=0.096, respectively), and Tn-T (p=0.041 and p=0.000, respectively) at first and at the 6th hour measurements. The CT-1 values were found to be more increased in the STEMI group (p=0.0074). Conclusion CT-1 is one of the novel biomarkers for cardiac injury. It is correlated with standard markers of myocardial ischemia and the results suggest that CT-1 can be used as a new biomarker.

Relationship between Discordance of Low-Density Lipoprotein and Non-High-Density Lipoprotein Cholesterol and Risk Stratification in Acute Myocardial Infarction

Abstract Background: Sizeable proportion of patients have discordant low-density lipoprotein cholesterol (LDL-C) and non-high density lipoprotein cholesterol (NHDL-C). It has been shown that discordance of LDL-C and NHDL-C either underestimates or overestimates coronary risk. Objectıve: We assessed whether this discordance has an impact on GRACE and TIMI risk scores in patients with acute myocardial infarction (AMI). Methods: We retrospectively evaluated the data of 198 consecutive patients with AMI. Fasting serum lipid profiles were recorded, GRACE and TIMI scores were calculated. Patients were divided into 3 groups according to LDL-C and NHDL-C percentiles: Discordant group: LDL-C<NHDL-C (n=38), concordant group: LDL-C=NHDL-C (n=112) and discordant group LDL-C>NHDL-C (n=48). GRACE and TIMI scores, mortality and cardiovascular events (heart failure, non-fatal myocardial infarction and angina) at sixth month were compared between these three groups. Differences between these groups were analyzed with One-way ANOVA or Kruskal-Wallis rank test, and with chi-square for percentages. Also, post hoc LSD or Conover-Iman's non-parametric multiple comparison test were used. A p value <0.05 was accepted as statistically significant. Results: TIMI risk score didn't differ between discordant or concordant groups. Mean GRACE (death) and GRACE (death and MI) scores were higher in group with LDL-C<NHDL-C than with LDL-C=NHDL-C and LDL-C>NHDL-C (p=0.029 and 0.008, respectively). Cardiovascular events and mortality at sixth month were not different among groups (p=0.473 and p=0.176, respectively). Conclusion: GRACE score was higher in discordant group with LDL-C<NHDL-C, but there is no difference regarding TIMI scores between discordant and concordant groups in AMI patients.

Associação entre o índice de massa corporal e a gravidade e complexidade das lesões coronarianas em pacientes pós-infarto / Association of body mass index and coronary lesions severity and complexity in post-myocardial infarction patients

Objetivo: Avaliar a associação entre o índice de massa corporal e a gravidade das lesões coronarianas em pacientes com infarto agudo do miocárdio. Métodos: Coorte aninhada ao Catarina Heart Study que avaliou 350 indivíduos durante o primeiro evento de infarto agudo do miocárdio e o 30º dia pós-infarto. As variáveis qualitativas foram analisadas pelo teste do qui-quadrado. Após o resultado da distribuição, a avaliação de variáveis quantitativas foi feita pelo teste de t de Student, pela correlação de Pearson, pelo teste de Mann-Whitney e pela correlação de Spearman. Resultados: Indivíduos com obesidade G2 (15,4%) tiveram maior probabilidade de trombose em 30 dias em comparação a indivíduos com índice de massa corporal normal (1,1%), com p=0,005. Indivíduos com obesidade grau 1 (6,0%) e obesidade grau 2 (7,7%) tiveram mais eventos de infarto agudo do miocárdio em 30 dias em comparação a indivíduos com índice de massa corporal normal (0,0%), com p=0,019 e p=0,009, respectivamente. Nenhuma associação significativa foi encontrada em termos de fração de ejeção do ventrículo esquerdo, mortalidade e complexidade das lesões coronarianas (escore SYNTAX e TIMI frame count). Conclusão: A obesidade em diversos graus está diretamente associada a fatores de risco para doença cardiovascular, como hipertensão arterial sistêmica, dislipidemia e tabagismo. Não houve associação entre o índice de massa corporal com a gravidade das lesões coronarianas ou a fração de ejeção do ventrículo esquerdo. Não houve diferença na mortalidade comparando-se indivíduos com índice de massa corporal elevado a pacientes com índice de massa corporal normal. Pacientes com obesidade tiveram mais desfechos cardiovasculares, como trombose e novo evento de infarto agudo do miocárdio em 30 dias, ao serem comparados a pacientes com índice de massa corporal normal. Outros desfechos de seguimento em 30 dias não estiveram associados ao índice de massa corporal.

Objective: To evaluate the association between body mass index and severity of coronary lesions in patients with acute myocardial infarction. Methods: A cohort nested to Catarina Heart Study, which evaluated 350 individuals during the first event of myocardial infarction and the 30th day post-infarction. Qualitative variables were analyzed using the Chi-square test. After the distribution result, the evaluation of quantitative variables was done through Student's t-test, Pearson's correlation, Mann Whitney's test, and Spearman's correlation. Results: Individuals with G2 obesity (15.4%) had a greater probability of having thrombosis in 30 days compared to individuals with normal body mass index (1.1%), p=0.005. Individuals with G1 obesity (6.0%) and G2 obesity (7.7%) had more events of myocardial infarction in 30 days compared to individuals with normal body mass index (0.0%), with p=0.019 and p=0.009, respectively. No significant association was found in terms of left ventricle ejection fraction, mortality, and complexity of coronary lesions (SYNTAX score and TIMI frame count). Conclusion: Obesity in several degrees is directly associated with risk factors for cardiovascular disease, such as hypertension, dyslipidemia, and smoking. There was no association between the body mass index and the severity of coronary lesions or left ventricle ejection fraction. There was no difference in mortality comparing individuals with high body mass index to patients with normal body mass index. Patients with obesity had more cardiovascular outcomes, such as thrombosis and a new event of myocardial infarction in 30 days when compared to patients with normal body mass index. Other follow-up outcomes in 30 days were not associated with body mass index

Associação entre a razão de monócitos por HDL e TIMI frame count e a trombose de stent em pacientes com primeiro infarto do miocárdio / Association of the monocyte to HDL ratio and TIMI frame count and stent thrombosis in patients with first myocardial infarction

Objetivo: Avaliar a associação entre marcadores de gravidade e complexidade, assim como de desfechos em 30 dias, com a razão de monócitos por HDL em pacientes com primeiro infarto agudo do miocárdio. Métodos: Foram selecionados 580 pacientes com primeiro infarto agudo do miocárdio submetidos a questionário durante a internação e seguimento em 30 dias. Os dados laboratoriais foram obtidos de 312 pacientes na entrada e de 237 em 72 horas. A gravidade e a complexidade foram avaliadas pelo TIMI frame count, pela fração de ejeção do ventrículo esquerdo e pelo escore Syntax. Resultados: O estudo evidenciou correlação positiva entre a razão de monócitos por HDL em 72 horas e o TIMI frame count, com r de 0,219 (p=0,018). Também evidenciou maior mediana de razão de monócitos por HDL nos pacientes que apresentaram trombose de stent em até 30 dias da internação ­ 35,8 (30,0-43,9) ­ comparados àqueles que não apresentaram, com 18,27 (12,98-26,74), p=0,038. Não houve correlação significativa entre a razão de monócitos por HDL da entrada com TIMI frame count, escore SYNTAX ou fração de ejeção do ventrículo esquerdo. Conclusão: Houve correlação positiva entre a razão de monócitos por HDL em 72 horas e o TIMI frame count em pacientes com primeiro infarto agudo do miocárdio submetidos à angioplastia primária. Verificou-se, também, associação entre maiores níveis de razão de monócitos por HDL na entrada com trombose de stent em 30 dias.

Objective: To investigate the association between complexity and severity markers, as well as 30-day outcomes with the monocytes to HDL-cholesterol ratio in patients with first myocardial infarction. Methods: A total of 580 patients with first myocardial infarction was selected and answered a questionnaire during hospitalization and 30-day follow up. Laboratory data were obtained at admission for 312 patients and for 237 in 72 hours. Severity and complexity were assessed by TIMI frame count, left ventricular ejection fraction, and Syntax score. Results: The study showed that the monocyte to HDL ratio in 72 hours was significantly positively correlated with TIMI frame count, with r of 0.219 (p=0.018). It also showed higher monocyte to HDL ratio median in patients presenting stent thrombosis within 30 days of hospitalization ­ 35,8 (30,0-43,9) ­ compared to those who did not develop it 18,27 (12,98-26,74), p=0.038. No correlation was found between admission monocytes to HDL ratio and TIMI frame count, Syntax score, or left ventricular ejection fraction. Conclusion: There was a positive correlation between Monocytes to HDL ratio in 72 hours and TIMI frame count in patients with first myocardial infarction undergoing primary percutaneous coronary intervention. An association between higher levels of admission monocyte to HDL ratio and stent thrombosis in 30 days was also observed.

Associação de índices hematológicos com fatores de risco, gravidade e complexidade da lesão no infarto agudo do miocárdio / Association of hematological índices with risk factors, severity and complexity of lesion in the acute myocardium infarction

Objetivo: Avaliar a associação entre os índices hematológicos e os fatores de risco, a complexidade e a gravidade do infarto em relação aos desfechos cardiovasculares. Métodos: Trata-se de uma coorte prospectiva, aninhada ao Catarina Heart Study e realizada em um hospital público da Grande Florianópolis. Resultados: Entre 2016 e 2019, foram analisados 580 participantes. Os indivíduos diabéticos apresentaram valores de hemoglobina de 13,0g/dL (12,0 a 14,1g/dL), inferior aos não diabéticos, com valores de 14,0g/dL (12,7 a 15,0g/dL; p<0,001). Indivíduos dislipidêmicos apresentavam valores de hemoglobina e segmentados, respectivamente, de 13,3g/dL (12,1 a 14,4g/dL) e 6.910mm³ (5.990 a 7.807mm³), inferiores aos sem dislipidemia, que possuíam, respectivamente, 14,0g/dL (12,8 a 15,0g/dL; p<0,001) e 7.205mm³ (6.300 a 8.030mm³; p=0,038). A contagem de plaquetas foi maior nos que possuíam dislipidemia, 224.000mm³ (178.000 a 273.500mm³), quando comparados aos que não possuíam, 210.000mm³ (173.000 a 255.000mm³; p=0,029). Houve correlação entre o SYNTAX e a contagem de leucócitos (r=0,143; p=0,001) e segmentados (r=0,222; p<0,001). Houve correlação negativa entre a fração de ejeção ventricular e a contagem de leucócitos (r=-0,173; p<0,001) e dos segmentados (r=-0,255; p<0,001). Indivíduos reinternados em 30 dias apresentaram valores de segmentados de 7.440mm³ (6.590 a 8.360mm³), maior em relação aos não reinternados, com 7.100mm³ (6.100 a 8.022mm³), sendo p=0,05. Os participantes que morreram por qualquer causa possuíam hemoglobina de 12,0g/dL (11,4 a 13,7g/dL), inferior aos indivíduos que permaneceram vivos em 30 dias, cujos valores foram de 13,7g/dL (12,5 a 14,9g/dL), sendo p=0,021. Conclusão: A contagem maior de plaquetas está associada à dislipidemia. Valores de hemoglobina baixas estão associados a um pior prognóstico em 30 dias e aos fatores de risco cardiovasculares, como diabetes mellitus e dislipidemia. A contagem maior de leucócitos está associada à reinternação em 30 dias e correlacionada à gravidade e à complexidade da lesão do infarto.

Objective: To evaluate the association of hematological indices with risk factors, complexity, and severity of the acute myocardial infarction regarding cardiovascular outcomes. Methods: This is a prospective cohort, nested to Catarina Heart Study, performed in a public hospital of Florianópolis. Results: Between 2016 and 2019, 580 participants were analyzed. Diabetic individuals had hemoglobin levels of 13.0g/dL (12.0 to 14.1g/dL), lower than those in non-diabetic individuals, with values of 14.0g/dL (12.7 to 15.0g/dL; p<0.001). Individuals with dyslipidemia had hemoglobin and segmented leukocytes of, respectively, 13.3g/dL (12.1 to 14.4g/dL) and 6,910mm³ (5,990 to 7,807mm³), lower than in non-dyslipidemic individuals, who had, respectively, 14.0g/dL (12.8 to 15.0g/dL; p<0.001) and 7,205mm³ (6,300 to 8,030mm³; p=0.038). Platelet count was higher in those who had dyslipidemia, 224,000mm³ (178,000 to 273,500mm³), when compared to non-dyslipidemic, 210,000mm³ (173,000 to 255,000mm³; p=0.029). There was a correlation between Syntax and leukocyte count (r=0.143, p=0.001) and segmented (r=0.222; p<0.001). There was a negative correlation between ventricular ejection fraction and leukocytes count (r=-0.173; p<0.001) and segmented (r=-0.255; p<0.001). Individuals readmitted in 30 days had segmented values of 7,440mm³ (6,590 to 8,360mm³), higher compared to non-readmitted, with 7,100mm³ (6,100 to 8,022mm³), p=0,05. Individuals who died of any cause had hemoglobin of 12.0g/dL (11.4 to 13.7g/dL), lower than those that remained alive in 30 days, with values of 13.7g/dL (12.5 to 14.9g/dL), p=0.021. Conclusion: Higher platelet count is associated with dyslipidemia. Low hemoglobin values are associated with worse outcomes in 30 days and with cardiovascular risk factors, such as diabetes mellitus and dyslipidemia. Higher leukocyte count is associated with readmission in 30 days and is also correlated to the severity and complexity of acute myorcardial infarction.

Serum ferritin levels is associated with acute myocardial infarction: a meta-analysis

SUMMARY BACKGROUND An association between increased serum ferritin levels and acute myocardial infarction (AMI) remains controversial. The purpose of this meta-analysis is to confirm the association between increased serum ferritin levels and AMI. METHODS We searched PubMed and China National Knowledge Infrastructure (CNKI) for relevant articles that assessed the association between serum ferritin and acute myocardial infarction using terms that included serum ferritin and acute myocardial infarction up to February 13, 2019. RESULTS A total of 11 studies were identified for analysis. All pooled analysis was based on a random-effects models. The variance was exhibited using a forest plot, and the heterogeneity among studies was examined using the I2 index, the publication bias was evaluated using a funnel plot. The pooled standard mean difference of ferritin levels between AMI and controls was 0.78 (95%CI,0.68-0.88). CONCLUSION The results of this meta-analysis demonstrate that serum ferritin in acute myocardial infarction patients is higher than that of healthy controls.

RESUMO ANTECEDENTES a correlação entre o aumento do nível de proteínas de ferro no soro e o infarto agudo do miocárdio (AMI) continua controversa. O objetivo desta análise é confirmar a relação entre o aumento dos níveis de proteínas de ferro no soro y o AMI. METODOLOGIA busca de artigos sobre Pubmed e a infraestrutura nacional de conhecimentos da China (cnki) para avaliar a relação entre a proteína de ferro no soro e o infarto agudo do miocárdio, incluída a proteína de ferro no soro e o infarto agudo de miocárdio, até 13 de fevereiro de 2019. RESULTADO foram identificados 11 estudos para sua analise e todas as análises resumidas tiveram base em modelos de efeitos aleatórios. Foram utilizados mapas florestais para mostrar as margens, foi utilizado o índice 12 para examinar a heterogeneidade dos estudos e foram utilizados mapas de funil para avaliar os desvios publicados.A diferença entre a norma de fusão dos níveis de proteína de ferro do Grupo ami e o Grupo de controle é de 0,78 (intervalo de confiança de 95% 0,68-0,88). CONCLUSÃO nos resultados das análises da meta indicam que os pacientes com infarto agudo do miocárdio têm proteínas de ferro superiores às do Grupo de controle de saúde.

Serum Sirtuin 1, 3 and 6 Levels in Acute Myocardial Infarction Patients / Níveis de Sirtuína 1, 3 e 6 em Pacientes com Infarto Agudo do Miocárdio

Abstract Background: Sirtuins may act in many cellular processes like apoptosis, DNA repair and lipid/glucose metabolism. Experimental studies suggested some sirtuin types may have protective effects against endothelial dysfunction, atherosclerosis, cardiac hypertrophy and reperfusion injury. Data about sirtuins in acute myocardial infarction (AMI) patients are scarce. Objectives: To investigate temporal changes of serum sirtuin 1,3 and 6 levels in AMI patients; to compare the serum sirtuin 1,3 and 6 levels between AMI patients and control subjects; and to investigate the association of serum sirtuin 1,3 and 6 levels with prognostic markers of AMI. Methods: Forty patients with AMI and 40 patients with normal coronary arteries were included. Left ventricular ejection fraction (LVEF), serum proBNP, CRP, sirtuin1, sirtuin 3 and sirtuin 6 levels were processed. Peak troponin T levels, GRACE score, first day / second day sirtuin levels were recorded of AMI patients. A p value < 0.05 was considered statistically significant. Results: Serum sirtuin 1,3 and 6 levels in AMI patients were similar to those in normal coronary patients. No temporal change in serum sirtuin 1,3 and 6 levels were found in AMI course. No correlation was evident between the sirtuin levels and the following parameters: proBNP, CRP, peak troponin and LVEF. Baseline sirtuin 1 and 6 levels were positively correlated with reperfusion duration. Baseline sirtuin 3 levels were negatively correlated with GRACE score. Conclusion: Serum sirtuin 1,3 and 6 levels in AMI patients were similar to those in normal coronary patients. This study does not represent evidence of the possible protective effects of sirtuin1, 3 and 6 in AMI patients.

Resumo Fundamento: As sirtuínas podem atuar em muitos processos celulares, como a apoptose, reparo de DNA e metabolismo de lipídios e de glicose. Estudos experimentais sugeriram que alguns tipos de sirtuínas possam ter efeitos protetores contra disfunção endotelial, aterosclerose, hipertrofia cardíaca e lesão decorrente de reperfusão. Dados sobre as sirtuínas em pacientes com infarto agudo do miocárdio (IAM) são escassos. Objetivos: Avaliar as mudanças temporais dos níveis de sirtuína 1, 3 e 6 entre pacientes com IAM e indivíduos controles; investigar a associação entre os níveis de sirtuína 1, 3 e 6 e marcadores prognósticos de IAM. Métodos: Quarenta pacientes com IAM e 40 pacientes com artérias coronárias normais foram incluídos. Foram avaliados fração de ejeção do ventrículo esquerdo (FEVE), concentrações séricas de pró-BNP, proteína C-reativa, sirtuína 1, sirtuína 3 e de sirtuína 6. Pico de troponina T, escore GRACE, concentrações de sirtuínas no primeiro e no segundo dia foram registrados dos pacientes com IAM. Um valor de p<0,05 foi considerado estatisticamente significativo. Resultados: Os níveis de sirtuína 1, 3 e 6 em pacientes com IAM foram similares aos de pacientes com coronária normal. Não foram observadas mudanças temporais nos níveis de sirtuína 1, 3 e 6 no curso do IAM. Nenhuma correlação evidente foi observada dos níveis de sirtuína com os seguintes parâmetros: pró-BNP, proteína C-reativa, pico de troponina e FEVE. Níveis basais de sirtuína 1 e 6 apresentaram correlação positiva com a duração da reperfusão. Os níveis basais de sirtuína 3 correlacionaram-se negativamente com o escore GRACE. Conclusão: Os níveis de sirtuína 1, 3 e 6 em pacientes com IAM foram similares aos de pacientes com artérias coronárias normais. Este estudo não apresenta evidência de possíveis efeitos protetores da sirtuína 1, 3 e 6 em pacientes com IAM.

Clinical Significance of Platelet Volume and Other Platelet Parameters in Acute Myocardial Infarction and Stable Coronary Artery Disease / Significado Clínico do Volume Plaquetário e Outros Parâmetros Plaquetários no Infarto Agudo do Miocárdio e Doença Arterial Coronariana Estável

Abstract Background: Platelets are important in the initiation of thrombosis, and their morphological and functional changes are closely related with the occurrence and development of coronary artery thrombosis. Platelet parameters might be valuable in distinguishing between acute myocardial infarction (AMI) and stable coronary artery disease (SCAD). Objective: This study was designed to detect and compare changes in platelet parameters, such as mean platelet volume (MPV) in patients with acute myocardial infarction (AMI) and stable coronary artery disease (SCAD) and to investigate their roles in these diseases. Methods: Specimen collection: Between January 2011 and December 2013, 2 mL of elbow vein blood was drawn from each of 31 patients primarily diagnosed with AMI, 34 SCAD patients and 50 healthy subjects; and placed in EDTA-K2 anticoagulant tubes. Platelet count (PLT), MPV, plateletcrit (PCT), platelet distribution width (PDW), white blood cell (WBC) and neutrophil (NEU) counts were determined using an STKS automated hematology analyzer (Beckman Courter). Results: Compared with the control group, MPV levels were significantly higher in the AMI and SCAD groups (p < 0.05), while PLT was significantly lower (p < 0.05). Conclusion: These results suggest that MPV and other related parameters have a certain value in the diagnosis of SCAD and AMI.

Resumo Fundamento: As plaquetas são importantes no início da trombose e suas alterações morfológicas e funcionais estão intimamente relacionadas com a ocorrência e o desenvolvimento de trombose da artéria coronária. Os parâmetros plaquetários podem ser valiosos na distinção entre infarto agudo do miocárdio (IAM) e doença arterial coronariana estável (DACE). Objetivo: O objetivo desse estudo foi detectar e comparar alterações nos parâmetros plaquetários, como o volume plaquetário médio (VPM) em pacientes com infarto agudo do miocárdio (IAM) e doença arterial coronariana estável (DACE) e investigar seu papel nessas doenças. Métodos: Coleta de amostras: Entre janeiro de 2011 e dezembro de 2013, foram retirados 2 mL de sangue da veia do antebraço de cada um dos 31 pacientes diagnosticados principalmente com IAM, 34 pacientes com DACE e 50 indivíduos saudáveis; e colocado em tubos com anticoagulante EDTA-K2. As contagens de plaquetas (PQT), VPM, massa total de plaquetas (MTP), Amplitude de Distribuição de Plaquetas (PDW, do inglês platelet distribution width), contagem de glóbulos brancos (WBC, do inglês white blood cells) e neutrófilos (NEU) foram determinadas utilizando-se um analisador de hematologia automatizado STKS (Beckman Courter). Resultados: Comparado com o grupo controle, os níveis de VPM foram significativamente maiores nos grupos IAM e DACE (p < 0,05), enquanto os níveis de PQT foram significativamente menores (p < 0,05). Conclusão: Esses resultados sugerem que o VPM e outros parâmetros associados têm um certo valor no diagnóstico de DACE e IAM.

Desafios na interpretação dos ensaios de troponina ultrassensível em terapia intensiva / Challenges in high-sensitive troponin assay interpretation for intensive therapy

RESUMO As troponinas cardíacas T e I são marcadores considerados altamente sensíveis e específicos para o diagnóstico de infarto agudo do miocárdio. Atualmente, com o advento dos ensaios ultrassensíveis, uma série de anormalidades não primariamente cardíacas pode se manifestar por meio da elevação destes ensaios. A redução de seu limiar de detecção promoveu maior precocidade no diagnóstico e na utilização de medidas terapêuticas baseadas em evidência, no entanto, esta característica aumentou o espectro de doenças cardíacas não coronarianas detectáveis, trazendo desafios para a caracterização das síndromes coronarianas agudas e um novo papel para estes testes nas desordens conhecidas no ambiente das unidades de tratamento intensivo, em especial na sepse. A abordagem de pacientes por meio de um maior entendimento do comportamento destes marcadores deve ser redimensionada para sua correta interpretação.

ABSTRACT Cardiac troponins T and I are considered highly sensitive and specific markers for the diagnosis of acute myocardial infarction. Currently, a series of nonprimary cardiac abnormalities may manifest as an elevation in high-sensitive assays. The reduction in their detection limits has allowed earlier diagnosis and the use of evidence-based therapeutic measures; however, this characteristic has increased the spectrum of detectable noncoronary heart diseases, which poses challenges for characterizing acute coronary syndromes and creates a new role for these tests in known disorders in intensive care units, especially sepsis. Management of patients through a greater understanding of how these markers behave should be re-evaluated to ensure their correct interpretation.

Estigma social e estigma internalizado: a voz das pessoas com transtorno mental e os enfrentamentos necessários / Social stigma and internalized stigma: the voice of persons with mental disorders and the confrontations required

Resumo O estigma internalizado ocorre quando o indivíduo tem consciência do estigma a ele atribuído, concordando e aplicando a si próprio os estereótipos negativos sobre sua doença. A internalização do estigma agrava os sintomas do transtorno mental, levando a isolamento, sentimentos de baixa autoestima, culpa e autorreprovação. Buscou-se produzir mais conhecimentos acerca dessa temática, a partir da visão das pessoas com transtorno mental que participam de ações visando construir coletivamente soluções no cuidado em saúde mental. Com o objetivo de analisar o processo de estigma e estigma internalizado, realizou-se pesquisa qualitativa, com entrevistas semiestruturadas. Os resultados revelaram que o estigma internalizado tem efeitos negativos no indivíduo, e que a família tem forte influência nesse processo.

Abstract Internalized stigma occurs when individuals become aware of the stigma assigned to them, agree, and apply these negative stereotypes about their illness to themselves. The internalization of stigma aggravates the symptoms of mental disorders, leading to isolation, feelings of low self-esteem, guilt, and self-condemnation. Our goal was to produce more knowledge on this topic from the point of view of people with mental disorders who participate in activities aimed at collectively building mental health care solutions. With the objective of analyzing the process of stigma and internalized stigma, we carried out qualitative research using semi-structured interviews. The results showed that internalized stigma has negative effects on individuals, and that the family has a strong influence on this process.

Interleukin-6 and adhesion molecules VCAM-1 and ICAM-1 as biomarkers of post-acute myocardial infarction heart failure

Acute coronary syndromes are associated with a high prevalence of complications including heart failure (HF). The aim of this study was to investigate the association of novel biomarkers with the occurrence of post-acute myocardial infarction (AMI) HF. A prospective study was conducted with patients admitted to the emergency department with ST-segment elevation myocardial infarction (STEMI). Blood and urine samples were collected for analysis of traditional and novel biomarkers, including interleukin-6, vascular cell adhesion molecule 1 (VCAM-1), and intercellular adhesion molecule-1 (ICAM-1). We compared the levels of these biomarkers between patients with and without post-STEMI HF. A total of 48 patients were assessed, with a prevalence of males. Fifteen patients (31.2%) had post-STEMI HF. Patients with HF had higher mean values of IL-6, VCAM-1, and ICAM-1 compared to those who did not develop HF (57.06 vs 14.03 pg/mL, P=0.001; 1719.58 vs 1304.34 ng/mL, P=0.001; and 1594.20 vs 1158.74 ng/mL, P<0.001, respectively). The three biomarkers were shown to be good predictors of post-STEMI HF (IL-6: AUC 0.786, P=0.002; VCAM-1: AUC 0.797, P=0.001; and ICAM-1: AUC 0.825, P<0.0001), with the respective cutoff points being calculated based on the best sensitivity and specificity indexes (IL-6: 8.67 pg/mL; VCAM-1: 1501.42 ng/mL; and ICAM-1: 1262.38 ng/mL). Of the three biomarkers, only VCAM-1 and ICAM-1 had a direct linear association between them (r=0.470, P<0.0001). IL-6, VCAM-1, and ICAM-1 were associated with the development of new post-AMI HF symptoms, but only VCAM-1 and ICAM-1 correlated with each other, possibly because they have the same pathophysiological mechanism of action.

Clinical significance and correlation of microRNA-21 expression and the neutrophil-lymphocyte ratio in patients with acute myocardial infarction

OBJECTIVES: To explore the clinical significance and correlation of microRNA-21 (miR-21) and the neutrophil-lymphocyte ratio (NLR) in patients with acute myocardial infarction (AMI). METHODS: The observation group contained 184 patients, while the control group contained 150 patients. The expression of miR-21 in the serum of each group was detected by qRT-PCR. RESULTS: A total of 184 patients and their family members were followed-up for 30 days, among which 35 patients died and 149 patients survived, resulting in a survival rate of 80.97%. According to univariate analysis, there were significant differences in age, cardiac troponin (cTn), heart rate, Killip grade, percutaneous coronary intervention (PCI) operation rate, miR-21 and NLR. In the receiver operating characteristic (ROC) analysis, the area under the curve (AUC) values of miR-21 and NLR for the diagnosis of AMI were 0.909 and 0.868, respectively, and the area under the combined detection curve was 0.960. In the Kaplan-Meier survival analysis, the survival of patients with high miR-21 expression and NLR was significantly higher than that of patients with low miR-21 expression and NLR (p=0.027; p=0.001). The correlation showed that miR-21 expression in serum was positively correlated with the NLR in the observation group (r=0.528, p<0.05). cTn, heart rate, Killip classification, PCI operation rate, miR-21, NLR are independent risk factors for AMI. CONCLUSION: miR-21 and NLR play a role in the diagnosis of AMI and can be used as predictors for the survival of AMI.

Association Between Increased Levels of Cystatin C and the Development of Cardiovascular Events or Mortality: A Systematic Review and Meta-Analysis / Associação entre Níveis Elevados de Cistatina C e o Desenvolvimento de Eventos Cardiovasculares ou Mortalidade: Uma Revisão Sistemática e Meta-Análise

Abstract Background: Cystatin C seems promising for evaluating the risk of cardiovascular events and mortality. Objective: To evaluate the association between high levels of cystatin C and the development of cardiovascular events or mortality. Methods: The articles were selected in the Medline/PubMed, Web of Science, and Scielo databases. The eligibility criteria were prospective cohort observational trials that assessed the association of high serum levels of cystatin C with the development of cardiovascular events or mortality in individuals with normal renal function. Only studies that evaluated the mortality outcome compared the fourth with the first quartile of cystatin C and performed multivariate Cox's proportional hazard regression analysis were included in the meta-analysis. A p value < 0,05 was considered significant. Results: Among the 647 articles found, 12 were included in the systematic review and two in the meta-analysis. The risk of development of adverse outcomes was assessed by eight studies using the hazard ratio. Among them, six studies found an increased risk of cardiovascular events or mortality. The multivariate regression analysis was performed by six studies, and the risk of developing adverse outcomes remained significant after the analysis in four of these studies. The result of the meta-analysis [HR = 2.28 (1.70-3.05), p < 0.001] indicated that there is a significant association between high levels of cystatin C and the risk of mortality in individuals with normal renal function. Conclusion: There is a significant association between high levels of cystatin C and the development of cardiovascular events or mortality in individuals with normal renal function.

Resumo Fundamento: A cistatina C tem-se mostrado promissora para avaliação do risco de eventos cardiovasculares e mortalidade. Objetivo: Avaliar a associação entre níveis elevados de cistatina C e o desenvolvimento de eventos cardiovasculares ou mortalidade. Métodos: A seleção dos artigos foi realizada por meio das bases de dados Medline/PubMed, Web of Science e Scielo. Os critérios de elegibilidade foram estudos observacionais de coorte prospectivos que avaliaram a associação entre níveis séricos elevados de cistatina C e o desenvolvimento de eventos cardiovasculares ou mortalidade em indivíduos com função renal normal. Apenas os estudos que avaliaram o desfecho mortalidade, que compararam o quarto com o primeiro quartil de cistatina C e que realizaram análise de regressão multivariada de riscos proporcionais de Cox foram incluídos na meta-análise. Foi considerado significativo o valor p < 0,05. Resultados: Dentre os 647 artigos encontrados, 12 foram incluídos na revisão sistemática e dois na meta-análise. O risco de desenvolvimento dos desfechos adversos foi avaliado por oito estudos por meio do cálculo do hazard ratio. Dentre estes, seis estudos encontraram um maior risco de eventos cardiovasculares ou mortalidade. A análise de regressão multivariada foi realizada por seis destes estudos, e o risco de desenvolvimento dos desfechos adversos permaneceu significativo após realização desta análise em quatro destes estudos. O resultado da meta-análise [HR = 2,28 (1,70-3,05), p < 0,001] indicou que há uma associação significativa entre níveis elevados de cistatina C e o risco de mortalidade nos indivíduos com função renal normal. Conclusão: Há uma associação significativa entre níveis elevados de cistatina C e o desenvolvimento de eventos cardiovasculares ou mortalidade em indivíduos com função renal normal.

Behavior of ultrasensitive c-reactive protein in myocardial revascularization with and without cardiopulmonary bypass

Abstract Objective: To analyze the inflammation resulting from myocardial revascularization techniques with and without cardiopulmonary bypass, based on ultrasensitive C-reactive protein (US-CRP) behavior. Methods: A prospective non-randomized clinical study with 136 patients was performed. Sixty-nine patients were enrolled for Group 1 (on-pump coronary artery bypass - ONCAB) and 67 patients were assigned to Group 2 (off-pump coronary artery bypass - OPCAB). All study participants had blood samples collected for analysis of glucose, triglycerides, creatinine, total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL) and creatinephosphokinase (CPK) in the preoperative period. The samples of creatinephosphokinase MB (CKMB), troponin I (TnI) and US-CRP were collected in the preoperative period and at 6, 12, 24, 36, 48 and 72 hours after surgery. We also analyzed the preoperative biological variables of each patient (age, smoking, diabetes mellitus, left coronary trunk lesion, body mass index, previous myocardial infarction, myocardial fibrosis). All angiographically documented patients with >70% proximal multiarterial stenosis and ischemia, documented by stress test or classification of stable angina (class II or III), according to the Canadian Cardiovascular Society, were included. Reoperations, combined surgeries, recent acute myocardial infarction, recent inflammatory disease, deep venous thrombosis or recent pulmonary thromboembolism, acute kidney injury or chronic kidney injury were not included. Results: Correlation values between the US-CRP curve and the ONCAB group, the treatment effect and the analyzed biological variables did not present expressive results. Laboratory variables were evaluated and did not correlate with the applied treatment (P>0.05). Conclusion: The changes in the US-CRP at each moment evaluated from the postoperative period did not show any significance in relation to the surgical technique applied.

Cardioprotective effect of lipstatin derivative orlistat on normotensive rats submitted to cardiac ischemia and reperfusion

Abstract Purpose: To evaluate in vivo animal model of cardiac ischemia/reperfusion the cardioprotective activity of pancreatic lipase inhibitor of the orlistat. Methods: Adult male Wistar rats were anesthetized, placed on mechanical ventilation and underwent surgery to induce cardiac I/R by obstructing left descending coronary artery followed by reperfusion to evaluation of ventricular arrhythmias (VA), atrioventricular block (AVB) and lethality (LET) with pancreatic lipase inhibitor orlistat (ORL). At the end of reperfusion, blood samples were collected for determination of triglycerides (TG), very low-density lipoprotein (VLDL), low-density lipoprotein (LDL), high-density lipoprotein (HDL), lactate dehydrogenase (LDH), creatine kinase (CK), and creatine kinase-MB (CK-MB). Results: Treatment with ORL has been able to decrease the incidence of VA, AVB and LET. Besides that, treatment with ORL reduced serum concentrations of CK and LDL, but did not alter the levels of serum concentration of TG, VLDL and HDL. Conclusion: The reduction of ventricular arrhythmias, atrioventricular block, and lethality and serum levels of creatine kinase produced by treatment with orlistat in animal model of cardiac isquemia/reperfusion injury suggest that ORL could be used as an efficient cardioprotective therapeutic strategy to attenuate myocardial damage related to acute myocardial infarction.

En el Infarto agudo al miocardio los niveles plasmáticos de microvesículas extracelulares se elevan más precozmente que el aumento de la Troponina-I / Plasma levels of extracellular macrovesicles are elevated earlier than troponin-I in patients with myocardial infarction

Introducción: La Troponina I (TnI) plasmática es el biomarcador "Gold" estándar utilizado en diagnóstico de Infarto Agudo al Miocardio (IAM), indicando necrosis cardíaca. Las microvesículas extracelulares (MVEC), participan en comunicación celular, por lo que estudiar su distribución entregaría información respecto del evento isquémico, antesala del infarto. Objetivo: Estudiar las MVECs plasmáticas en pacientes con Síndrome Coronario Agudo (SCA) y compararlas con los niveles de TnI. Métodos: Plasma de 22 pacientes controles se recolectó 0-2hrs post-ingreso a urgencia. Plasma de 45 pacientes SCA se recolectó 0-2, 6-8 y 10-14hrs post ingreso, junto con la toma de muestra para estudio de TnI. Las MVECs plasmáticas fueron enriquecidas mediante kit comercial. La determinación de la concentración y tamaño MVECs se realizó por NTA (Nanoparticles Tracking Assay) usando el equipo Nanosight. Resultados: La concentración promedio de MVECs 0-2 hrs post ingreso fue 7,2 veces superior en plasma de pacientes con SCA vs controles y la moda del tamaño disminuyó en pacientes con SCA. La TnI no mostró diferencias significativas en 0-2 hrs post ingreso en el grupo estudiado. La concentración de las MVEC disminuyó significativamente después de 10-14 hrs post ingreso, mientras que la concentración promedio TnI se mantuvo invariable demostrando el aumento de MVECs previo al incremento de TnI. Conclusión. El aumento de MVECs previo al incremento de la TnI en pacientes infartados, sugiere que las MVECs aumentan en la fase previa del IAM, como respuesta al daño tisular. Actualmente, estudiamos el contenido molecular de las MVECs, para establecer un método diagnóstico del Síndrome Coronario Agudo basado en MVECs.

Background: Troponin I (TnI) is the gold standard used to establish the diagnosis of myocardial infarction (AMI), indicating the presence of myocardial necrosis. Extracellular micro vesicles are involved in cellular communication. Their distribution may provide information relating to the development of AMI in patients with acute coronary syndromes (ACS) Aim: to study plasma levels of ECMV compared to those of TnI in patients with ACS. Methods: The plasma levels of TnI and ECMV from 22 control patients coming to the emergency units was compared to plasma from 45 patients with ACS. Levels of both parameters were determined 0-2, 6-8 and 10-14 hours post admission. ECMVs were enriched by means of a commercial kit. Concentration and size of ECMV was determined by NTA (Nanoparticles tracking assay) using the Nanosight equipment. Results: Plasma concentration of ECMV was 7.2 times higher than that of TnI 0-2 hrs post admission. The mode of ECMV size was lower in patients with ACS. Concentration of ECMV had decreased significantly 10-14 hrs post admission, whereas the TnI levees remained stable. Conclusion: The increase in ECMV earlier than TnI in AMI suggests that ECMV are elevated in the pre-AMI phase, as a response to early tissue damage. A study of cellular content of ECMV, being carried out, may lead to develop a method for the early diagnosis of AMI in patients with ACS.

Serum Klotho (but not haplotypes) associate with the post-myocardial infarction status of older adults

OBJECTIVES: The number of deaths from vascular diseases is incredibly high worldwide, and reliable markers for major events are still needed. The current cross-sectional study investigated the association of Klotho haplotypes and Klotho serum levels with classic risk factors and a clinical history of vascular events. METHODS: Clinical, anthropometric, biochemical and nutritional assessments were conducted with 168 older adults, complemented by genotyping (rs9536314 and rs9527025) and the detection of serum Klotho (ELISA). RESULTS: Klotho levels and haplotypes did not associate with most classic risk factors for vascular events, including markers such as C-reactive protein and homocysteine. A positive association was only found between Klotho levels and the previous occurrence of a myocardial infarction by both correlational (p=0.006) and variance analyses (p<0.001), and these associations were independent of the context. CONCLUSION: Our results suggest that serum Klotho is higher in individuals with a clinical history of myocardial infarction but not with a history of coronary artery disease or stroke. None of the Klotho haplotypes were associated with the variables investigated herein.

Onychomatricoma: a tumor unknown to dermatologists

A sixty-one year old white female was referred to the Dermatology Department to treat an ingrown nail in the inner corner of the left hallux. Examination of the entire nail unit showed the presence of xanthonychia in the outer corner besides thickening and increase in the transverse curvature of the nail plate. Dermoscopy and nuclear magnetic resonance of the free edge of the nail plate detected characteristic signs of onychomatricoma, a diagnosis that was later confirmed by anatomopathological exam.