Exhaled Air Metabolome Analysis for Pulmonary Arterial Hypertension Fingerprints Identification-The Preliminary Study.

Pulmonary arterial hypertension (PAH) is a rare disease with a serious prognosis. The aim of this study was to identify biomarkers for PAH in the breath phase and to prepare an automatic classification method to determine the changing metabolome trends and molecular mapping. A group of 37 patients (F/M: 8/29 women, mean age 60.4 ± 10.9 years, BMI 27.6 ± 6.0 kg/m2) with diagnosed PAH were enrolled in the study. The breath phase of all the patients was collected on a highly porous septic material using a special patented holder PL230578, OHIM 002890789-0001. The collected air was then examined with gas chromatography coupled with mass spectrometry (GC/MS). The algorithms of Spectral Clustering, KMeans, DBSCAN, and hierarchical clustering methods were used to perform the cluster analysis. The identification of the changes in the ratio of the whole spectra of biomarkers allowed us to obtain a multidimensional pathway for PAH characteristics and showed the metabolome differences in the four subgroups divided by the cluster analysis. The use of GC/MS, supported with novel porous polymeric materials, for the breath phase analysis seems to be a useful tool in selecting bio-fingerprints in patients with PAH. The four metabolome classes which were obtained constitute novel data in the PAH population.

Coronary interventions via radial artery without pre-procedural routine use of spasmolytic agents.

INTRODUCTION: Radial access reduces the number of vascular complications. Radial artery spasm (RAS) can be prevented by the use of spasmolytic agents. However, use of these drugs can be possibly limited to certain groups of patients. AIM: To assess the feasibility and safety of coronary angiography and percutaneous coronary interventions through the radial artery without the routine use of spasmolytic agents. MATERIAL AND METHODS: A group of 293 patients (M/F 180/113, mean age: 67 ±10 years) who underwent coronary angiography and interventions through the radial artery approach was studied. Spasmolytic agents were applied in case of RAS. Every patient had ultrasound assessment of the radial artery on the next day to assess its diameter and detect occlusion. RESULTS: RAS was observed in 55 patients (18.8%, M/F 28/27) and radial artery occlusion (RAO) in 47 (16%, M/F: 24/23) cases. RAS was followed by RAO in 17 cases, which constituted 17/55 (30.9%) of all RAS. Two patients had symptomatic occlusion, which required prolonged anticoagulation with complete restoration of patency. The RAS was higher in prolonged procedures (angiography time 32.6 ±12.8 vs. 29 ±13.5 min, p = 0.03; intervention time 40 ±23.5 vs. 26.3 ±25 min, p = 0.0035) and was dependent on time of the local pressure (7.5 ±2.3 vs. 6.5 ±2.8 h, p = 0.03). The RAO increased proportionally to the number of catheters used (p = 0.01) and was dependent on time of the local pressure (8.6 ±3.5 vs. 6.4 ±2.7 h, p < 0.001). CONCLUSIONS: Our study showed that angiography and interventions without routine use of spasmolytic agents were feasible and safe. RAS and RAO are related to independent risk factors and comparable to data from the literature when spasmolytics were used.

Severe degenerative aortic stenosis with preserved ejection fraction does not change adipokines serum levels.

BACKGROUND: The role of the adipokines in the pathogenesis of aortic stenosis (AS) is not well established. The aim was to evaluate the relationship between adipokines and clinical characteristics as well as echocardiographic indices and noninvasive markers of vascular remodeling in patients with severe AS with preserved ejection fraction (EF). METHODS: Sixty-five patients (F/M: 38/27; age: 68.3 ± 9.0 years; body mass index [BMI]: 29.6 ± 4.3 kg/m2) with severe AS with preserved EF: 33 patients with paradoxical low-flow low-gradient AS (PLFLG AS) and 32 patients with normal flow high-gradient AS (NFHG AS) were prospectively enrolled into the study. Twenty-four subjects (F/M: 14/10; age: 65.4 ± 8.7 years; BMI: 29.6 ± 4.3 kg/m2) who matched as to age, sex, BMI and coronary artery disease (CAD) constituted the control group (CG). Clinical data and markers of vascular remodeling were related to the serum adipokines. RESULTS: There were no differences in the adipokines concentrations in the AS/CG. Patients with AS and coexisting CAD were characterized by decreased serum adiponectin (9.9 ± 5.5 vs. 12.7 ± 5.8 µg/mL, p = 0.040) and leptin (8.3 ± 7.8 vs. 21.6 ± 17.1 ng/mL, p < 0.001) levels compared to subjects without CAD. There were no differences in the serum adipokines concentrations between patients with PLFLG AS and NFHG AS. Systemic hypertension, diabetes, hyperlipidemia or markers of vascular remodeling did not discriminate adipokines concentrations. Multivariate regression analysis indicated that age (F = 3.02; p = 0.015) and E/E' index (F = 0.87, p = 0.032) were independent predictors of the adiponectin level in the AS group. CONCLUSIONS: The presence of AS with preserved EF did not change the adipokine serum profile. Adipokines levels were modified by coexisting atherosclerosis but not the typical cardiovascular risk factors or the hemodynamic type of AS.

Echocardiographic evaluation of myocardial strain in patients after transcatheter aortic valve implantation.

INTRODUCTION: Echocardiographic evaluation of regional myocardial function helps to assess the efficacy of therapeutic interventions and to predict the prognosis and clinical outcomes. AIM: To assess whether myocardial strain can be useful in estimation of left ventricle (LV) function in patients who have undergone transcatheter aortic valve implantation (TAVI). MATERIAL AND METHODS: Twenty-six patients with severe aortic stenosis, who successfully underwent TAVI, were enrolled in the study. Left ventricular peak systolic longitudinal strain (LV PSLS) was obtained before and 1 year after the procedure. Analysis included the potent influence of factors such as sex, LV ejection fraction (LVEF), type of prosthesis implanted or the type of the approach on LV PSLS values. RESULTS: We observed a significant improvement in LV PSLS values after TAVI (-10.9 ±5.7 vs. -13.4 ±4.7, p < 0.05). Men had better improvement in LV PSLS after TAVI, but their starting values were considerably lower (M: -10.7 ±4.5 before vs. -13.3 ±4.9 after, p < 0.05; W: -11.8 ±6.8 before vs. -11.9 ±5.6 after, p = NS). Patients with starting LVEF ≤ 40% benefited from the procedure (LV PSLS: -10.3 ±6.4 before vs. -13.7 ±2.9 after, p < 0.05), but in the group of patients with the higher starting LVEF no significant changes in LV PSLS were observed. We also did not note any differences in LV PSLS depending on type of the prosthesis implemented (Edwards Sapiens/CoreValve). Patients in whom the prostheses were implemented via the femoral approach only presented significant increase in LV PSLS values (before: -10.4 ±6.7 vs. after: -13.6 ±3.7, p < 0.05). CONCLUSIONS: The TAVI results in improvement of LV systolic function according to LV PSLS values. Some factors, especially lower baseline LVEF, are related to increased benefit in LV PSLS after TAVI.

Subjective assessment of rehabilitation protocol by patients after ACL reconstruction - preliminary report.

BACKGROUND: Subjective evaluation by patients has recently become an important adjunct to postoperative clinical assessment. Apart from standard physical examination, scales demonstrating patients' subjective outcome measures are used for assessing the efficacy of the treatment and rehabilitation of knee ligamentous injuries. The present work presents patients' subjective assessment of rehabilitation protocols after ACL reconstruction. MATERIAL AND METHODS: Forty individuals who had undergone ACL reconstruction were randomised into two groups (G1, G2) and followed one of two rehabilitation protocols (A or B). The subjects assessed their knee function at baseline and after physical therapy using the Lysholm score and the IKDC form. The results were analysed with the Mann-Whitney U test. The subjects also completed a questionnaire at discharge. RESULTS: Analysis of Lysholm and IKDC scores revealed significant differences between the mean pre- and postrehabilitation results in the groups (p<0.05). The greatest improvement was seen in G2 patients rehabilitated with protocol B, with significant mean improvements of 56.3% and 46.7% for the Lysholm and IKDC scores, respectively. Group G1 registered only half of this magnitude of change. Protocol B was also highly rated in the questionnaires. CONCLUSION: According the patients opinion a rehabilitation protocol involving a larger number of open kinetic chain exercises may prove more effective in the rehabilitation of patients after ACL reconstruction compared to a programme basing mainly on closed kinetic chains.

The effects of treatment the avascular necrosis of the femoral head with extracorporeal focused shockwave therapy.

Background.Avascular necrosis of the femoral head continues to represent a major challenge for the orthopaedist and trauma surgeon. A fully effective method of treatment is yet to be introduced. After femoral head collapse, only total hip replacement can help the patient. Our study aims to assess the effects of treatment of avascular necrosis of the femoral head with extra corporeal focused shockwave therapy.Material and methods. A prospective study was carried out in patients with avascular necrosis of the femoral head, ARCO stage I-III, diagnosed by MRI imaging. Shock waves are applied under x-ray guidance. Four points are marked on the skin above the lesion. Each spot receives a dose of 1500 pulses at an energy flux density of 0.4 mJ/mm2 and a frequency of 4 Hz. Each patient undergoes 5 therapy sessions. A posturometric and stabilometric assessment is carried out before and after the therapy. Other examinations include a tensometric evaluation of the strength of the treated limb, and an assessment of pain intensity (VAS scale)and hip function (Harris hip score). Follow-up visits are scheduled at 6 weeks and 3, 6 and 12 months post-treatment.Results. Nine patients were treated with shockwave therapy at the Department of Orthopaedics and Musculoskeletal Traumatology, Medical Faculty, Medical University of Silesia, between 5 May 2011 and 1 June 2012. The patients demonstrated pain reduction and improved mobility of the treated joint (VAS score decreasing from 6.75 +/- 0.71 to 2.5 +/- 1.7; Harris hip score increasing from 55.21 +/- 15.45 to 89.21 +/- 8.26). Tensometric platform testing carried out after the treatment revealed a statistically significant difference between mean velocity of the centre of pressure (CoP) movement when walking with eyes open and closed (p<0.05) and mean CoP movement along the x (walking with eyes closed) and y (free standing with eyes closed) axes.Conclusions. 1. Extracorporeal focused shockwave therapy resulted in considerable improvement in the patients' quality of life at 6 weeks' follow-up. 2. At 6 months some patients reported intensified pain and worse hip function.

Laceration of abdominal aorta by a fragment of fractured L2 vertebral body after a low-energy injury: a case report and review of literature.

STUDY DESIGN: A rare case of direct injury to the wall of abdominal aorta caused by a displaced fracture of the L2 vertebral body resulting from a low-energy injury. Potential injury mechanism and predisposing factors are discussed along with a review of literature pertaining to the subject. OBJECTIVE: To describe a unique case of direct aortic wall injury caused by a displaced vertebral body fracture. SUMMARY OF BACKGROUND DATA: The literature on aortic wall injuries after vertebral fractures is reviewed. So far, only the injuries of the thoracic aorta were extensively described. Injuries of the abdominal aorta are much less frequent and usually associated with high-energy trauma. However, coexisting disorders, predisposing the patient to thoracolumbar vertebral body fractures (e.g., osteoporosis, chronic alcoholism) and aortic wall injuries (atherosclerosis) make aforementioned complication possible, despite the low-energy mechanism of injury. METHODS: A clinical and radiographical interpretation of the reported case is presented. RESULTS: Laceration of abdominal aorta was caused by a sharp, anteriorly displaced bone fragment of the fractured L2 vertebral body. CONCLUSION: The reported case adds to the literature on vertebral fractures by describing another mechanism leading to aortic wall disruption. Similar vascular complications may be identified more frequently in the future given the high prevalence of osteoporosis and atherosclerosis in the general population.

Retransfusion of shed blood collected in drains after Total Knee Replacement.

BACKGROUND: Total knee arthroplasty is associated with a perioperative blood loss, which is usually addressed with transfusion of allogenic blood. The possible risks of such treatment include viral infection, immunologic complications and occasional lack of blood products. Recently, retransfusion of blood recovered from the operative field or drains has become an effective treatment for blood loss. The purpose of this study was to evaluate the clinical usefulness of autologous transfusion of blood recovered from drains and to determine if the retransfusion alone is sufficient for treatment of the perioperative blood loss. MATERIALS AND METHODS: A retrospective evaluation of 214 patients (240 knees) was performed. Standard suction drains were used in 127 cases, whereas in 113 cases we used the HandyVac retransfusion system. The comparative analysis included the preoperative haemoglobin level, surgery time, length of hospitalisation, incidence of fever and demand for allogenic blood transfusion. RESULTS: Retransfusion of blood from drains decreased the incidence of allogenic transfusion from 69.3% to 43.4%. The global demand for blood products was reduced by 42%. The use of retransfusion kits did not increase surgery time. In the retransfusion group, the incidence of elevated body temperature and number of days with fever per one patient were higher than in the allogenic transfusion group. CONCLUSIONS: Retransfusion of shed blood from drains decreases the demand for allogenic blood. However, it does not eliminate the need for transfusion. The method is simple and relatively safe. It does not increase surgery time. No serious adverse effects were noted apart from elevated body temperature. A low preoperative haemoglobin level was a risk factor for additional allogenic transfusions in patients who have received retransfusion.