[Expert consensus on the usefulness of natriuretic peptides in heart failure.] / Stanowisko Grupy Ekspertów dotyczace oceny przydatnosci oznaczen peptydów natriuretycznych w niewydolnosci serca

Heart failure (HF) has becoming an increasing clinical and social problem worldwide and despite modern therapy the syndrome still imposes high burden on healthcare systems. In contrast to western countries, the diagnosis of HF in Poland is established later, at more advanced stage of the disease, thus leaving less time for modern therapy and more frequently requiring hospitalisation. As a result, the alarmingly high proportion of patients with HF is treated in hospitals in Poland. According to current guidelines clinical suspicion of HF should be verified based on early assessment of plasma levels of natriuretic peptides. Unfortunately, the key test for early diagnosis, especially in emergency departments and in general practice is not reimbursed and therefore hardly available. The paper provides a short review on the physiology and pathophysiology of natriuretic peptides. Important laboratory issues as well as limitations of their use in specific clinical situations are briefly discussed. Further, we focus on clinical use of natriuretic peptides as an important tool for HF diagnosis, guiding therapy and prognosis. Finally, we put spotlight on the use of natriuretic peptides in prevention of HF and also in ambulatory general practice.

A new generation of biomarkers tests of myocardial necrosis: the real quality a physician can get from the laboratory.

BACKGROUND: Recent guidelines recommended by ESC, ACC, AHA, and WHF concerning biomarkers of myocardial necrosis also apply to the work of clinical laboratories. Methodological modification for tests used in determining cardiac biomarkers reduced the time of the analytical procedure to 9 min (STAT version of the tests). We decided to determine and compare analytical quality of the tests in standard and STAT versions for determining serum level: troponin T, MB isoenzyme of creatine kinase, and myoglobin, as well as to verify whether the TnThs STAT test meets the following requirements: CV<10% at the level close to diagnostic, equal to the 99th percentile of reference population, and turnaround time<60 min. MATERIAL/METHODS: We evaluated real precision and accuracy for both standard and STAT versions of tests as well as the correlation of results of physiological and pathological levels. Additionally, observations of turnaround time were made. RESULTS: Calculated values of total errors did not exceed the recommended acceptable total error (<20%). Comparable precision of the 2 measurement methods (CV=3.07%) was obtained. A strong correlation (R>0.99) between both variants of tests for all the parameters was confirmed. Thanks to the application of new reagent kit, the percentage of results with turnaround time<60 min increased from 40% to 75% (n=115; p=0.000008). CONCLUSIONS: The new generation of STAT cardiac biomarkers has high analytical quality and meets international precision requirements. It guarantees high analytical and clinical reliability of results. Use of the STAT version of biomarkers contributes to a significant decrease in turnaround time and allows obtaining a good result of an analysis.

Assessment of the relationship between lipid parameters and obesity indices in non-diabetic obese patients: a preliminary report.

BACKGROUND: The aim of this cross-sectional study was to examine the relationship between obesity and lipid markers. MATERIAL AND METHODS: We divided 66 non-diabetic adult obese patients (mean age: 55.8±11.6 years) into 3 groups according to body mass index (BMI). All patients were measured for waist circumference (WC), hip circumference (HC), body mass index (BMI), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), body adiposity index (BAI), and visceral adiposity index (VAI). Serum levels of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG) were determined, and lipid indices TC/HDL, LDL/HDL, and TG/HDL were also estimated. RESULTS: TC and LDL-C in Group III were lower than in Group I (5.0±1.0 vs. 6.0±1.0 mmol/L, and 2.9±0.9 vs. 3.8±1.2 mmol/L; p<0.05 for both). Negative correlations were found between: BMI and TC, LDL, and HDL (r=-0.291; r=-0.310, r=-0.240, respectively); and WC, WHR, VAI, and HDL (r=-0.371, r=-0.296, r=-0.376, respectively). Positive correlations were found between WC, WHR, and TG/HDL (r=0.279, r=0.244, respectively) and between VAI and: TC (r=0.327), TG (r=0.885), TC/HDL (r=0.618), LDL/HDL (r=0.480), and TG/HDL (r=0.927). CONCLUSIONS: Obesity is associated with lipid disturbances, especially with HDL-C reduction, in obese non-diabetic patients. VAI is strongly related to lipid profile and thus may be the most valuable obesity index in obese patients with dyslipidemias.

Obesity indices and inflammatory markers in obese non-diabetic normo- and hypertensive patients: a comparative pilot study.

BACKGROUND: The aim of this study was to estimate associations between inflammatory markers and obesity indices in normo- and hypertensive subjects. METHODS: 65 obese adult subjects were divided into two groups: (A) of hypertensives (n = 54) and (B) of normotensives (n = 11). Waist circumference (WC), body mass index (BMI), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), visceral adiposity index (VAI), body adiposity index (BAI) and tumor necrosis factor-α (TNF-α), interleukin (IL)-6 and high sensitivity C-reactive protein (hsCRP) serum concentrations were estimated. RESULTS: In group A WHtR was higher (0.69 ± 0.07 vs 0.63 ± 0.06; p < 0.01), hsCRP correlated with BMI and WHtR (r = 0.343; p = 0.011 and r = 0.363; p < 0.01, respectively). BAI correlated with hsCRP in group A and B (r = 0.329; p < 0.05 and r = 0.642; p < 0.05; respectively) and in females and males (r = 0.305; p = 0.05 and r = 0.44; p < 0.05, respectively). In females hsCRP was higher (3.2 ± 2.2 mg/l vs 2.1 ± 1.5 mg/l; p < 0.05). In patients without lipid lowering treatment hsCRP and IL-6 were higher (3.2 ± 1.7 mg/l vs 2.4 ±2.2 mg/l; p = 0.01 and 15.9 ± 7.2 pg/ml vs 13.6 ± 9.9 pg/ml; p < 0.01, respectively). CONCLUSIONS: WHtR is a sensitive index associated with chronic inflammation in obese hypertensive subjects. BAI correlates with hsCRP independently of hypertension and sex. hsCRP is more sensitive marker associated with obesity than IL-6 and TNF-α. Lipid lowering treatment influence chronic inflammation.

New obesity indices and adipokines in normotensive patients and patients with hypertension: comparative pilot analysis.

We compared the obesity parameters and selected adipokines-leptin, adiponectin, and resistin-in obese patients with hypertension and normotensive patients. A total of 67 nondiabetic obese outpatients were divided into 2 groups: A-hypertensive and B-normotensive. Serum levels of leptin, adiponectin, resistin, and insulin were measured. Weight, height, waist circumference, and hip circumference were measured to calculate waist-to-hip ratio (WHR), weight-to-height ratio, visceral adiposity index, and body adiposity index (BAI). Among patients with hypertension, significant positive correlations were observed between leptin and body mass index and BAI (r = .31 and r = .63, respectively). In normotensive patients, leptin positively correlated with BAI (r = .73, P < .01) and negatively with WHR (r = -.55, P < .0001); adiponectin negatively correlated with WHR (r = .38, P < .01) and BAI (r = .52; P < .0001), and resistin negatively correlated with WHR (r = -.36, P < .05). In conclusion, visceral obesity and leptin are associated with hypertension in obese patients.

Predictors of insulin resistance in patients with obesity: a pilot study.

We compared adipokines and inflammatory markers in obese insulin-sensitive (group A, n = 16) and insulin-resistant (group B, n = 48) patients divided according to homeostasis model assessment of insulin resistance (HOMA-IR). Serum levels of adiponectin, leptin, resistin, high-sensitivity C-reactive protein, interleukin 6, and tumor necrosis factor α were measured. Weight, height, waist (WC) and hip circumferences, waist to hip ratio , weight to height ratio, visceral adiposity index (VAI), and body adiposity index (BAI) were measured. The WC and VAI were significantly higher in group B (113.9 ± 11.1 vs 105.3 ± 9.8 cm; P < .01 and 2.3 ± 1.1 vs 1.6 ± 0.9; P < .05, respectively), while serum adiponectin levels were higher in group A (24.5 ± 14.6 vs 15.1 ± 9.6 ng/mL; P < .005). The BAI strongly correlated with adiponectin and leptin in group B (r = .479; P < .001 and r = .705; P < .001). Insulin resistance is associated with visceral adiposity described by VAI and WC. The BAI may be a useful index in obese patients, especially with insulin resistance.

The association between galectin-3 and clinical parameters in patients with first acute myocardial infarction treated with primary percutaneous coronary angioplasty.

BACKGROUND: Galectin-3, a biomarker associated with fibrosis and inflammation, has been implicated in development and progression of heart failure (HF) and predicts increased mortality and morbidity in this condition. HF frequently develops after myocardial infarction (MI), contributing to worse outcome. The aim of this study is to assess the association between galectin-3 levels and various clinical parameters in acute phase of first MI treated with primary percutaneous coronary intervention (pPCI) in patients without prior HF. METHODS: We included 145 consecutive patients with first acute MI treated with pPCI with stent implantation. Exclusion criteria were: prior HF, severe valvular diseases, coexisting cancers, connective tissue diseases and cirrhosis. Serum galectin-3 concentration was measured within 3-5 days after onset of acute MI. RESULTS: Thirty-six patients with the highest galectin-3 levels (4th quartile, > 16 ng/mL) were compared to 109 subjects with a biomarker concentration ≤ 16 ng/mL. Elevated galectin-3 levels were more often observed in females, the elderly, subjects with coexisting diabetes, renaldysfunction and permanent atrial fi brillation (AF). Galectin-3 correlated with N-terminal pro-B-type natriuretic peptide (r = 0.27, p < 0.001) and high-sensitivity C-reactive protein (r = 0.20, p < 0.05). Multivariate analysis revealed that only new-onset AF and diuretics treatment during hospitalization were independently associated with galectin-3 levels > 16 ng/mL. CONCLUSIONS: Elevated galectin-3 levels were associated with a higher rate of new-onset AF and diuretics treatment during hospitalization in patients with first MI treated with pPCI without prior HF.

Obesity indices and adipokines in non-diabetic obese patients with early stages of chronic kidney disease.

BACKGROUND: The aim of this study was to estimate obesity parameters: waist circumference (WC), waist-to-hip ratio (WHR), weight-to-height ratio (WHtR), visceral adiposity index (VAI), body adiposity index (BAI), and serum adipokines (leptin, adiponectin, resistin) and their associations with estimated glomerular filtration rate (eGFR), serum creatinine, and microalbuminuria (MA) in patients with early stages of CKD and in non-CKD obese patients. MATERIAL AND METHODS: 67 non-diabetic obese (BMI ≥ 30 mg/kg(2) out-clinic patients (25 males, 42 females), aged from 36.5 to 64 years were divided into 2 groups: Group A (n=15)--patients with early stages of CKD (eGFR between 30 and 60 ml/min/1.73 m(2) or with MA >20 mg/l in morning urine sample independently from GFR) and Group B--patients without chronic CKD (n=52). RESULTS: In Group A compared to Group B, BAI and leptin were higher (42.2 ± 7.1 vs. 37.5 ± 7.0; p<0.05 and 51.8 ± 26.7 ng/mL vs. 35.3 ± 24.9 ng/mL; p<0.05; respectively) and negative correlations occurred between eGFR and BAI (r=-0.709; p=0.003), leptin (r=-0.68; p=0.005), and resistin (r=-0.528; p<0.05). In Group B, negative correlations occurred between creatinine and VAI (r=-0.332; p<0.05), BAI (r=-0.619; p<0.0001), leptin (r=-0.676; p<0.0001), and adiponectin (r=-0.423; p=0.002), and between eGFR and resistin (r=-0.276; p<0.05). CONCLUSIONS: BAI may be a valuable obesity parameter as a predictor of early stages of CKD in patients with obesity. Leptin may be an important pathogenic factor in obese patients with early stages of CKD. Resistin is associated with eGFR in obese patients, independently of CKD.

The association between galectin-3 and occurrence of reinfarction early after first myocardial infarction treated invasively.

CONTEXT: Galectin-3, as a biomarker of inflammation and fibrosis, has been reported to be associated with coronary artery disease. OBJECTIVE: The study aimed to assess the relationship between galectin-3 levels and the occurrence of reinfarction early after myocardial infarction (MI). METHODS: The study included 145 consecutive patients with first MI treated invasively. Serum galectin-3 was measured using VIDAS (bioMérieux, Marcy-l'Etoile, France). RESULTS: The independent predictors of reinfarction in our group were as follows: female gender, elevated hs-C-reactive protein and galectin-3 levels (measured both at discharge). CONCLUSIONS: Galectin-3 might be an additional useful biomarker in prediction for reinfarction early after first MI.

[Comparative analyses of reference values used in Polish medical diagnostic laboratories for selected biochemical investigations]. / Analiza porównawcza wartosci referencyjnych stosowanych w polskich medycznych laboratoriach diagnostycznych dla wybranych parametrów biochemicznych.

UNLABELLED: The establishment of reference values comparative ranges for each laboratory test result does not meet expectations. THE AIM OF THE STUDY was to make a comparative analysis of the reference values (RV) used in medical diagnostic laboratories (MLD) in Poland for concentrations in serum or plasma biochemical parameters (potassium, calcium, creatinine, and glucose) in adults. MATERIAL AND METHODS: The data source was the information sent to the Centre for Quality Assessment in Laboratory Medicine by MLD participating in programs interlaboratory surveys. RESULTS: Studies have shown that there is a great diversity of reference values for the analyzed biochemical parameters used in MLD. The study also demonstrated the use by MLD various units of measurement systems (SI and weight-volume). CONCLUSION: A large variation of the reference values in the parameters significantly hinders the interpretation of laboratory results by physician.

[The alternative method for albuminuria determination: second morning urine sample instead of 24-hour urine collection]. / Alteratywna metoda oznaczania albuminuril: druga ranna porcja moczu zamiast dobowej zbiórki.

UNLABELLED: Urinary albumin excretion is an established risk factor for renal and cardiovascular events. Measurement of albumin in the urine daily collection is the gold standard in assessing albuminuria. The 24-hour urine collection is cumbersome procedure that generates a lot of mistakes, therefore other methods have been proposed. The aim of the study was to compare the assessment of albuminuria in the 24-hour urine collection and in the second morning urine sample as well as to determine UACR. MATERIAL AND METHODS: The study included 32 patients, from whom the daily and the second morning urine samples were collected. In both samples, the albumin and creatinine concentrations were determined and the urinary albumin: creatinine ratio (UACR) was calculated. RESULTS: An excellent correlation between the UACR determined from the 24-hour urine collection and the other portion of the second morning sample was obtained within a wide range of albuminuria values (r = 0.9825). Furthermore, a better correlation between the same characteristics was obtained in urine of patients with normoalbuminuria when UACR did not exceed 30 mg/g creatinine (r = 0.9771). Above this value, the correlation was slightly lower for micro- and macroalbuminuria and equalled 0.9249 and 0.9332, respectively. CONCLUSIONS: On the basis of the obtained results it can be concluded that the second morning urine sample with the determination of UACR is a good alternative to the 24-hour urine collection and the first morning urine sample which are burdened with a preanalytical error.

Examination of serum pregnancy-associated plasma protein A clinical value in acute coronary syndrome prediction and monitoring.

INTRODUCTION: Chronic vascular inflammatory process promotes and intensifies all atherogenic events. The aim of this research was to estimate the clinical value of pregnancy-associated plasma protein A (PAPP-A) measurement associated with plaque destabilization and rupture in prediction and monitoring of acute coronary syndromes (ACS) as well as to assess the predictive value of this biomarker in comparison to traditional myocardial infarction (MI) risk markers. MATERIAL AND METHODS: The study included 119 patients in 2 investigated groups and one control group. PAPP-A assay was performed using manual ELISA kit, DRG. All other parameters were determined using automatic analyzers: Olympus and Dade Behring. RESULTS: A statistically significant difference between PAPP-A concentration median value was found in the investigated group MI individuals' serum and control group individuals' serum (11.42 ng/ml and 7.22 ng/ml respectively, p = 0.003). PAPP-A assay had the highest specificity (83.3%) and sensitivity (53.8%), and therefore the highest clinical value. In patients with clinically and laboratory confirmed MI we proved that PAPP-A serum level is a clinically useful biomarker in ACS prediction, better than C-reactive protein (hsCRP) and fibrinogen (FBG) level. CONCLUSIONS: The highest diagnostic efficiency for ACS prediction was proved for simultaneous panel assays consisting of 2-3 parameters (PAPP-A - hsCRP, PAPP-A - FBG, PAPP-A - hsCRP - FBG), while PAPP-A itself does not show characteristics necessary for it to be used as a biomarker for MI dynamic monitoring. It is possible that prothrombotic component is mainly responsible for repeated major adverse cardiac events, more than inflammatory process.

Serum concentrations of adiponectin, leptin, resistin, ghrelin and insulin and their association with obesity indices in obese normo- and hypertensive patients - pilot study.

INTRODUCTION: Hypertension often coexists with obesity. Adipokines, ghrelin and insulin play important roles in the pathogenesis of both diseases. The aim of this study was to compare adiponectin, leptin, resistin, insulin and ghrelin mean serum concentrations and insulin resistance (HOMA-IR) in normo- and hypertensive patients with obesity. MATERIAL AND METHODS: ALL INCLUDED PATIENTS WERE DIVIDED ON THE FOLLOWING GROUPS: non-diabetic hypertensive patients with class I obesity (group A, n = 21) and class II/III obesity (group B, n = 10), and normotensive obese (class I)patients (group C, n = 7). Correlations between obesity indices (body mass index [BMI], waist-to-hip ratio [WHR], waist circumference [WC]), HOMA-IR, and hormone and adipokine serum levels were also analyzed. RESULTS: Leptin level and HOMA-IR were significantly higher in group B compared to group C (9.74 ±3.88 ng/ml vs. 4.53 ±3.00 ng/ml; p < 0.02 and 3.30 ±1.59 vs. 1.65 ±0.41; p < 0.02, respectively). A negative correlation between WC and adiponectin level (R = -0.6275; p < 0.01) and a positive correlation between WC and insulin concentration (R = 0.5122; p< 0.05) as well as with HOMA-IR (R = 0.5228; p < 0.02) were found in group A. Negative correlations between BMI and ghrelin level (R = -0.7052; p < 0.05), WHR and adiponectin level (R = -0.6912; p < 0.05) and WHR and leptin level (R = -0.6728; p < 0.05) were observed in group B. CONCLUSIONS: Insulin resistance and leptin may be important pathogenic factors in hypertensive patients with severe obesity. Indices of abdominal obesity (WC, WHR) correlate better than BMI with HOMA-IR, insulin, adiponectin and leptin serum levels in hypertensive obese patients.

Waist circumference, ghrelin and selected adipose tissue-derived adipokines as predictors of insulin resistance in obese patients: preliminary results.

BACKGROUND: The aim of the study was to estimate the association between anthropometric obesity parameters, serum concentrations of ghrelin, resistin, leptin, adiponectin and homeostasis model assessment (HOMA-IR) in obese non-diabetic insulin-sensitive and insulin-resistant patients. MATERIAL/METHODS: Study subjects included 37 obese (body mass index [BMI] ≥ 30 kg/m2) out-clinic patients aged 25 to 66 years. Insulin resistance was evaluated by HOMA-IR. Serum fasting concentrations of glucose, insulin, ghrelin, adiponectin, resistin and leptin were measured by using the ELISA method. Body weight, waist and hip circumferences were measured to calculate BMI and waist-to-hip ratio (WHR) values for all the patients. According to HOMA-IR, patients were divided into two groups: A, insulin sensitive (n=19); and B, insulin resistant (n=18). RESULTS: Patients with insulin resistance have greater mean waist circumference (WC) higher mean serum insulin level and leptin concentration, but lower concentrations of adiponectin and ghrelin. In the insulin-sensitive patient group we observed positive correlations between BMI and HOMA-IR, WC and HOMA-IR, and adiponectin and leptin, and negative correlations between ghrelin and HOMA-IR, WC and adiponectin, and WHR and adiponectin. In the insulin-resistant group, there was a positive correlation between resistin and ghrelin and a negative correlation between WHR and leptin. CONCLUSIONS: Waist circumference, adiponectin, leptin and ghrelin are associated with insulin resistance and may be predictors of this pathology.

[Evaluation of clinical usefulness of selected laboratory markers in the prediction of myocardial infarction in patients under secondary prevention]. / Ocena uzytecznosci klinicznej wybranych wskazników laboratoryjnych w predykcji zawalu miesnia sercowego u chorych objetych prewencja wtórna.

UNLABELLED: The aim of the study was to evaluate the range of chronic inflammation in patients after second or subsequent myocardial infarction, and to compare it with its range in patients after first MI. MATERIAL AND METHODS: C-reactive protein measurement clinical value was examined by high sensitivity CRP method (hsCRP) and compared to clinical value of other heart attack risk factors: total cholesterol (TC) and cholesterol in HDL fraction (HDL-C), triglycerides (TG) and fibrinogen (FBG). The research included 120 patients in two investigated groups: Z2--30 patients undergoing secondary prevention after second (subsequent) heart attack, and Z1--30 patients with first myocardial infarction. There were two reference groups: KOR--30 people undergoing planned coronarography and K--30 healthy individuals. Groups Z2, Z1 and KOR patients were treated with PCI (percutaneous coronary intervention). RESULTS: HsCRP medians for group Z2 (2.65 mg/I) and groups Z, (2.25 mg/) and KOR (2.35 mg/l) were significantly higher than in group K (1.10 mg/dl). CONCLUSIONS: Highest clinical value of hsCRP in coronary attack prediction was confirmed. Relative area under ROC curve (AUC) was highest in group 2, higher than in group Z1 (0.778 and 0.711, respectively). In patients undergoing secondary prevention, group Z2, hsCRP measurement showed higher clinical value in subsequ ent myocardial infarction prediction than in first one. In groups Z2 and Z1, HDL-C measurement also shows high diagnostic value for coronary risk assessment. AUC are 0.875 and 0.782, respectively. However, in treatment with statins, high AUC values do not necessarily reflect myocardial infarction risk.

Coordinated increase of miRNA-155 and miRNA-196b expression correlates with the detection of the antigenomic strand of hepatitis C virus in peripheral blood mononuclear cells.

A tight relationship has been revealed between cellular microRNAs (miRNAs) and the course of hepatitis C virus (HCV) replication in human hepatoma cells. Although the detection of the antigenomic HCV RNA strand in peripheral blood mononuclear cells (PBMCs) has provided evidence for viral replication in PBMCs, no reports have shown how miRNAs are affected upon HCV RNA synthesis in PBMCs. The aim of the present study was to assess if and how the expression levels of miRNA-155 and miRNA-196b in PBMCs are related to HCV replication in PBMCs of chronic hepatitis C (CHC) patients. Supporting analyses were performed to evaluate the expression of precursor pri-miR-155 (BIC) and Dicer protein. The genomic and antigenomic HCV RNA strands in PBMCs were detected by strand-specific qRT-PCR. The expression levels of miRNAs, BIC RNA and Dicer protein were assayed on PBMCs by qRT-PCR and Western blotting, respectively. miRNA-155 and miRNA-196b were detected in all studied PBMC samples, but their levels varied according to the presence of the antigenomic HCV RNA strand in PBMCs. Increased expression levels of miRNA-155 and miRNA-196b were associated with the presence of the antigenomic HCV RNA strand in PBMCs. In this group of patients higher frequency of BIC RNA and Dicer protein detection was also found. This study demonstrates that HCV RNA replication in PBMCs of CHC patients is connected with the increased and coordinated expression of miRNA-155 and miRNA-196b.

[Evaluation of dynamic cardiac troponin I concentrations and C-reactive protein in the monitoring of myocardial infarction in patients with repeated myocardial infarction]. / Ocena dynamiki stezen sercowej troponiny I oraz bialka C-reaktywnego w monitorowaniu zawalu miesnia sercowego u chorych z powtórnym zawalem.

UNLABELLED: Significant progress in diagnosis and treatment of heart attack led European Society of Cardiology (ESC) and American College of Cardiology (ACC) to develop in 2007 a document on contemporary criteria for diagnosis of fresh myocardial infarction. In the case of percutaneous coronary intervention (PCI) in patients with initially normal serum concentrations of biomarkers troponin increase above the 99th percentile upper limit of the reference points to the occurrence of myocardial necrosis dislodgement. Conventionally assumed that the increased levels of biomarkers of value in excess of 3 x 99th percentile upper reference requires identification of MI in conjunction with PCI. THE AIM OF THE STUDY: To evaluate the dynamic of troponin concentrations and C-reactive protein in patients with the second or subsequent myocardial infarction undergoing percutaneous coronary intervention (PCI) and comparing the results obtained with the results obtained in patients with first myocardial infarction, in patients undergoing elective coronary angiography and the healthy control group. MATERIAL AND METHODS: The study involved a total of 120 patients who entered in four groups: study group Z2 and three comparative groups: Z1, the NRA and C. Z2 study group consisted of patients admitted to hospital because of second or subsequent myocardial infarction. Z1 group consisted of patients with first myocardial infarction. Patients groups Z2 and Z1 underwent PCI. The group included people the NRA people with a history of previous myocardial infarction, who underwent elective coronary angiography and after noting the time of surgery of coronary arteries was performed in one PCI slot. Control group C consisted of healthy, free from recognized risk factors for heart attack, in which there were no previous episodes of acute heart. Patients groups Z2 and NRA received statins and ASA before hospitalization. The material in patients with suspected myocardial infarction (study group Z2 and Z1 and in the group NRA represented the blood clot, taken on at the time of notification to the patient to the hospital, between 6 and 9 h, in 16 h, 24 and 48 h hospitalization. In the control group C blood samples were taken at one time. In plasma the concentrations of cardiac troponin I (cTnl), and serum CRP. RESULTS: The dynamics of median concentrations of cTnl for the test group Z2 and control group Z1 are comparable. Median concentrations are very close to each other (with the exception of point 1) in any of the measuring points, there was no statistically significant differences. Between 6 and 9 time of infarction in group Z1 median concentrations were significantly higher than in Z2. Significant differences were found between the Z1 and Z2 group and the NRA in all. measuring points, at the time of admission, between 6 and 9 time, the 16th, 24th and 48 time of onset of stroke (point 0, p = 0.027, points 1, 2, 3, and 4 p = 0.0000). The reference group of people from the NRA who previously underwent selective coronary heart attack and surgery PCI, 7 patients were observed a slight increase in troponin I concentrations (usually between the 9th and 24th h hospitalisation), not exceeding three times the value of the decision, which permits the exclusion of myocardial. Median concentrations of CRP in 16 h, 24 and 48 h MI showed significant differences between the group and the NRA Z2 (section 2, p = 0.001, section 3 and 4--p < 0.001) and between the group and the NRA Z1 (section 2, p = 0.028, section 3 and 4--p < 0.001). Median values in the group Z2 versus Z1 showed similar dynamics in the time points 0, 1, 2 and 3. Higher median values in the fourth time point were observed in the group Z2. Median CRP at the time of admission to hospital was the highest in the group Z2 (2.65 mg/l), and reference groups Z1 and NRA was 2.25 mg/l and 2.35 mg/l. Median CRP in the groups Z2, Z1 and CRV were significantly higher against the group C (1.20 mg/l). In group C the lowest percentage observed in the results of CRP >3 mg/l (indicating the risk of ACS) of 16.7%. In the other groups this proportion was 30-40% and was highest in the group Z2. CONCLUSIONS: The concentration of cardiac troponin I in the first hours of the course of myocardial infarction (between 6 and 9 h) in patients who have made a second heart attack tends to lower its growth levels compared to people with first MI. It can be assumed that the myocardial inflammatory response to repeated defense system reduces the area of necrosis and less ejection from the troponin myocardial cells. In patients who underwent myocardial infarction in the past and were subjected to selective coronary angiography, and its treatment by PCI, troponin I, did not exceed three times the 99th percentile of the healthy population, suggesting that the proper emergency procedures cardiac surgeons performing PCI.

[Oxidative stress in nephrology]. / Stres oksydacyjny w nefrologii.

The effect of reactive oxygen species (ROS) on pathophysiology of many diseases is widely documented in numerous scientific publications. Nephropathies belong to pathologies in which ROS undoubtedly play a role. Imbalance between ROS and antioxidants results in destructive effect on mesangial cells by altering lipid metabolism. This phenomenon is frequently observed in patients with glomerulonephritis and nephritic syndrome. Accumulation of hypoxanthine and oxygen in the mechanism of reperfusion damages renal cells by the produced ROS in patients with acute renal failure. Inactivation of nitric oxide by superoxide anion radical increases vascular resistance in renal arteries and contributes to the development of hypertensive nephropathy. Diabetic nephropathy, in which a significant role is ascribed to glycation end products, oxidative stress and decrease of antioxidant mechanisms, is another nephropathy associated with oxidant/antioxidant imbalance. Pro-inflammatory processes with activation of nonspecific system cells and destruction of kidney structure by free radical processes play an important role in urinary system infections. Similar phenomena are observed in patients with urinary system neoplastic diseases. Each of the above pathological conditions may in consequence lead to chronic renal failure (CRF) requiring nephro-substitute therapy. The therapy substituting for normal kidney function but not devoid of disadvantages. Despite of the application of numerous techniques of detoxification in patients with CRF, none of them has become the "gold standard" yet, because according to the so far carried out research they all induce free radical reactions in the course of dialysis and decrease total antioxidant potential of plasma. It is a very crucial problem of nephro-substitute therapy which will be developed in our next review paper.

[Vitamins E, A and C as antioxidatives]. / Witaminy E, A i C jako antyoksydanty.

It has been found during last years that vitamins A, C, E and carotenoids, besides previously recognized functions of preventing particular lipido- and avitaminosis, significantly participate in the protection of the human body against oxidation stress that is characterized by balance disturbance between speed of free radical creation and reactive oxygen forms with pace of their neutralization by enzymes and antioxidants. The antioxidative system creates special protective barrier which includes numerous chemical form with antiperoxidative proprieties and vitamins are the most important part of it. The aim of this work was the profile of occurrence and antioxidative action of the vitamins A, C and E.

[Selected laboratory risk factors for cardiovascular diseases in a group of healthy professionally active policemen in the Lodz region]. / Badania wybranych laboratoryjnych czynników ryzyka chorób sercowo-naczyniowych u zdrowych czynnych zawodowo policjantów województwa lódzkiego.

The aim of the study was to estimate cardiovascular diseases risk based on the concentration of total blood cholesterol, HDL-cholesterol, triglycerides, glucose, C-reactive protein determined by high sensitivity assay and platelet count. The study was carried out in a group of healthy professionally active policemen in the Lodz region. The significant factors of atherosclerosis are: life style including diet and physical activity. Policeman profession requires a greater physical activity and good physical condition. The study group consisted of 836 policemen aged 31-63 years, mean 43,5 +/- 4,9 years. The mean value of total cholesterol was 217,7 mg/dl (69% > 200 mg/dl), cholesterol HDL--53,6 mg/dl (8% < 40 mg/dl), TG--168,8 mg/dl (47% > 150 mg/dl), CRP--1,95 mg/l (median 1,30 mg/l), 19,3% > 3 mg/l, a 7,4% > 5 mg/l, glucose--92,6 mg/dl (median 91 mg/dl), 7,2% > or = 110 mg/dl, a 20% > or = 100 mg/dl. The platelet count was 245,8 (median 244 x 103/microl), 99% < 350 x 103/microl. The concentration of lipids parameters is similar both for population of Lodz region and another population. In respect to proper values of the total cholesterol and HDL-cholesterol observed for Polish population including Lodz, the number of people with abnormal values is lower. The contrary tendency concerns to triglycerides.