Beta-trace protein and cystatin c as predictors of major bleeding in non-ST-segment elevation acute coronary syndrome.

BACKGROUND: Beta-trace protein (BTP) and cystatin C (CysC) are novel biomarkers of renal function. We assessed the ability of both to predict major bleeding (MB) in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS), compared to other renal function parameters and clinical risk scores. METHODS AND RESULTS: We included 273 patients. Blood samples were obtained within 24h of admission. The endpoint was MB. During a follow-up of 760 days (411-1,098 days), 25 patients (9.2%) had MB. Patients with MB had higher concentrations of BTP (0.98 mg/L; 0.71-1.16 mg/L vs. 0.72 mg/L, 0.60-0.91 mg/L, P=0.002), CysC (1.05 mg/L; 0.91-1.30 mg/L vs. 0.90 mg/L, 0.75-1.08 mg/L, P=0.003), higher CRUSADE score (39 ± 16 points vs. 29 ± 15 points, P=0.002) and lower estimated glomerular filtration rate (eGFR; 66 ± 27 vs. 80 ± 30 ml·min(-1)·1.73 m(-2), P=0.02) than patients without MB; there was no difference in creatinine level between the groups (P=0.14). After multivariable adjustment, both were predictors of MB, while eGFR and creatinine did not achieve statistical significance. Among subjects with eGFR >60 ml·min(-1)·1.73 m(-2), those with elevated concentrations of both biomarkers had a significantly higher risk for MB. Net reclassification indexes from the addition of BTP and CysC to CRUSADE risk score were 38% and 21% respectively, while the relative integrated discrimination indexes were 12.5% and 3.8%. CONCLUSIONS: Among NSTE-ACS patients, BTP and CysC were superior to conventional renal parameters for predicting MB, and improved clinical stratification for hemorrhagic risk.

Usefulness of ß-trace protein and cystatin C for the prediction of mortality in non ST segment elevation acute coronary syndromes.

Beta-trace protein (BTP) is a low-molecular mass protein belonging to the lipocalin protein family, which is more sensitive than serum creatinine for detecting impaired renal function. The aims of the present study were to evaluate whether plasma BTP improves the risk stratification of patients with non-ST-segment elevation acute coronary syndromes and to compare it to cystatin C (CysC), serum creatinine, and estimated glomerular filtration rate. Two hundred twenty-six consecutive patients with non-ST-segment elevation acute coronary syndromes were prospectively included. Blood samples were obtained within 24 hours of hospital admission to measure BTP, CysC, and creatinine. The study end point was all-cause death. Over a median follow-up period of 859 days (interquartile range [IQR] 524 to 1,164), 24 patients (10.6%) died. Decedents had higher concentrations of BTP (1.03 mg/L [IQR 0.89 to 1.43] vs 0.74 mg/L [IQR 0.61 to 0.92], p <0.001), CysC (1.16 mg/L [IQR 0.91 to 1.59] vs 0.90 mg/L [IQR 0.76 to 1.08], p = 0.001), and serum creatinine (1.10 mg/L [IQR 0.87 to 1.46] vs 0.94 mg/L [IQR 0.80 to 1.10], p = 0.004) and a lower mean estimated glomerular filtration rate (60 ± 20 vs 80 ± 24 ml/min/1.73 m(2), p <0.001). After multivariate adjustment, BTP and CysC were predictors of all-cause death, while estimated glomerular filtration rate and serum creatinine concentrations did not achieve statistical significance. In stratified analyses according to kidney function, elevated BTP and CysC were associated with a higher risk for all-cause death. Reclassification analyses showed that BTP and CysC added complementary information to Global Registry for Acute Coronary Events (GRACE) risk score. In conclusion, BTP and CysC levels were associated with all-cause death risk and modestly improved prognostic discrimination beyond the GRACE risk score in patients with non-ST segment elevation acute coronary syndromes.

Isoenzima de fosfatasa alcalina placental-like, importancia clínica como marcador en tumores de tipo germinal / Clinical relevance of placental-like alkaline phosphatase isoenzyme as a germ cell tumour marker

Fundamento y objetivo. Justificar la importancia clínica de la determinación del isoenzima de fosfatasa alcalina (PLAP-like) como marcador en tumores de células germinales (TCG). Pacientes y métodos. Se documentan dos casos clínicos observando el comportamiento de este isoenzima: 1) Niño con germinoma intracraneal en región pineal, 75% de actividad de PLAP-like al inicio (valor normal: 0%), resto de marcadores tumorales negativos, y 2) Niña con teratoma inmaduro de ovario estadio I, elevación de la alfafetoproteína (AFP), 197ng/mL; PLAP-like 5,1% al inicio y 0,7% en recidiva tumoral tras dos años. Se determina PLAP-like valorando la actividad remanente tras termodesnaturalización sérica. Discusión y conclusiones. PLAP-like se comporta como único marcador específico en el primer caso de tumor germinal pineal que justifica su utilidad junto a pruebas de imagen en el diagnóstico de tumores de localización craneal. En el seguimiento, también es crítico el análisis dado que constata la buena respuesta al tratamiento en el primer caso, y en el segundo caso clínico, es el único marcador que complemente la valoración de la recidiva. Concluimos en la relevancia del análisis de este isoenzima como marcador complementario en TCG (AU)

Background and purpose. To determine the clinical relevance of placental-like alkaline phosphatase isoenzyme (PLAP-like) as a marker for germ cell tumours (GCT). Patients and methods. We report the behaviour of this isoenzyme in two patients; 1) A Child with an intracranial germinoma in the pineal region who showed 75% of PLAP-like activity at onset (normal value: 0%), with the rest of the tumour markers being negative, and 2) A girl with a stage I ovarian immature teratoma who had an elevated alpha-fetoprotein (AFP), 197ng/mL, PLAP-like 5.1%, at onset and 0.7% at tumour recurrence two years later. PLAP-like was determined by assessing the remaining activity after heat denaturation of the serum. Discussion and conclusions. PLAP-like constituted the only specific marker in the case of the pineal cell germ tumour, which justifies its use in association with neuroimaging studies in the diagnosis of cranial tumours. At follow-up analysis, PLAP-like was also critical since it confirmed the good response to treatment in the first case, while in the second one, it was the only marker to complement the assessment of tumour recurrence. We believe that this isoenzyme analysis is of relevance as a complementary marker in GCT (AU)

Observational study of lipid profile and LDL particle size in patients with metabolic syndrome.

BACKGROUND: The atherogenic lipoprotein phenotype is characterized by an increase in plasma triglycerides, a decrease in high-density lipoprotein cholesterol (HDLc), and the prevalence of small, dense-low density lipoprotein cholesterol (LDLc) particles. The aim of this study was to establish the importance of LDL particle size measurement by gender in a group of patients with Metabolic Syndrome (MS) attending at a Cardiovascular Risk Unit in Primary Care and their classification into phenotypes. SUBJECTS AND METHODS: One hundred eighty-five patients (93 men and 92 women) from several areas in the South of Spain, for a period of one year in a health centre were studied. Laboratory parameters included plasma lipids, lipoproteins, low-density lipoprotein size and several atherogenic rates were determinated. RESULTS: We found differences by gender between anthropometric parameters, blood pressure and glucose measures by MS status. Lipid profile was different in our two study groups, and gender differences in these parameters within each group were also remarkable, in HDLc and Apo A-I values. According to LDL particle size, we found males had smaller size than females, and patients with MS had also smaller than those without MS. We observed inverse relationship between LDL particle size and triglycerides in patients with and without MS, and the same relationship between all atherogenic rates in non-MS patients. When we considered our population in two classes of phenotypes, lipid profile was worse in phenotype B. CONCLUSION: In conclusion, we consider worthy the measurement of LDL particle size due to its relationship with lipid profile and cardiovascular risk.

Kidney stones in a Mediterranean population from the south of Spain.

BACKGROUND: Kidney stones have become increasingly prevalent in the developed countries over the past 100 years. The incidence of urolithiasis in a population depends on the geographical area, racial distribution, socio-economic status and dietary habits. During the past decades, these factors have changed affecting the incidence and also the chemical composition of calculi; nowadays in our region, the most common stones composition is calcium oxalate. The identification of the calculi composition enables superior treatment, lower (decreased) cost and a better quality of life for the patients. METHODS: We analyzed the composition and the evolution of all of the cases concerning calculi received at Biochemical Clinical Analysis Laboratory from 2007 to 2010, using Interferometry with Fourier transformation (FTIR). The relationship between composition, gender and age was studied for an aleatory group in 2010 (n=657, 431 men and 226 women). RESULTS: The stone composition obtained was mixtures 24.7% and only one component 75.3%. Calcium oxalate monohydrate (COM) 41.5%, calcium oxalate dihydrate (COD) 7.6%, anhydrous uric acid (AUA) 12.4%, uric acid dehydrate (UAD) 6.7%, urates 1.4%, carbonate-apatite (CA) 2.9%, and others 2.8%. The male to female ratio was 1.9 and the largest number of stones was found in patients between the ages of 40 and 49, for both men and women. CONCLUSIONS: The most common composition (relative percentage) was COM, mixtures and AUA. Presence of calculi is more common in men than in women with the exception of carbonate apatite stones. Stones follow a Gaussian distribution throughout the lifetime of a patient, with particular incidence in those between 40 to 49 years old.

Oxidized LDL and its correlation with lipid profile and oxidative stress biomarkers in young healthy Spanish subjects

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The biological effects of oxidized LDL (oxLDL) may contribute to initiation and progression of the atherosclerotic process, and the association between cardiovascular disease and oxidation of LDLhas been largely demonstrated. The objectives of this study were to establish the reference values of oxidative stress biomarkers in a young healthy Spanish population to determine the concentration of oxLDL and its relationship with lipid profile and with these biomarkers. oxLDL, F2-isoprostanes, protein carbonyls (PC), and (..) (AU)

Oxidized LDL and its correlation with lipid profile and oxidative stress biomarkers in young healthy Spanish subjects.

The biological effects of oxidized LDL (oxLDL) may contribute to initiation and progression of the atherosclerotic process, and the association between cardiovascular disease and oxidation of LDL has been largely demonstrated. The objectives of this study were to establish the reference values of oxidative stress biomarkers in a young healthy Spanish population to determine the concentration of oxLDL and its relationship with lipid profile and with these biomarkers. oxLDL, F(2)-isoprostanes, protein carbonyls (PC), and 8-hydroxy-2'-deoxyguanosine (8-OHdG) were determinate by ELISA in 72 healthy subjects. Antioxidant enzymes, superoxide dismutase (SOD), glutathione peroxidase (GPx), and glutathione reductase (GR) were carried out on a Hitachi 912 analyzer; lipid profile were assayed using automated systems (Cobas 711, Roche Diagnostics). All statistics were analyzed by using SPSS for Windows 15.0. SPSS Inc, Chicago, IL, USA. (Normal mean reference values): oxLDL (63.23 +/- 16.23 U/L), (Male/Female 68.06 +/- 17.69/58.39 +/- 13.6 U/L), F(2)-isoprostanes (2.26 +/- 0.9 microg/g creatinine), PC (0.34 +/- 0.15 nmol/mg), 8-OHdG (23.27 +/- 10.58 ng/ml), SOD (931.97 +/- 271.09 U/g Hb), GR (46.56 +/- 11.68 U/L), GPx (27.58 +/- 6.89 U/gHb (Male/Female 25.91 +/- 5.03/29.2 +/- 8.07 U/L)). OxLDL (63.23 U/L) was significantly (p < 0.05) positively correlated with BMI (22.53 Kg/m(2)), total cholesterol (175.79 mg/dl), triglycerides (87.58 mg/dl), LDL cholesterol (96.25 mg/dl), and uric acid (4.78 mg/dl), while negatively correlated with HDL-cholesterol (62.25 mg/dl). We have found different correlation between oxLDL and isoprostanes by gender with the rest of parameters. Normal reference values have been found significantly different for oxLDL and GPx by gender. Oxidized LDL is correlated with lipid profile but not with the oxidative stress biomarkers. Urinary isoprostanes are positively correlated with triglycerides and negatively with GR and GPx.

Evaluación de la gestión en el laboratorio de gastroenterología y significación clínica de la calprotectina fecal en el contexto de éste / Evaluation of management in a Gastroenterology laboratory and clinical significance of faecal calprotectin in this context

La gestión de una institución se define como la disposición y la organización de los recursos para obtener los resultados esperados. Para aplicar este concepto a un laboratorio clínico es necesario conocer la demanda de las pruebas y su evolución temporal, los resultados informados y el rendimiento. Nuestro objetivo es exponer la gestión del laboratorio de gastroenterología durante los años 2006/2007 y analizar la significación clínica de la calprotectina fecal. Material y métodos. La evaluación de la gestión se realiza considerando el número de determinaciones, los costes económicos y el rendimiento. Respecto a la calprotectina, se estudia la evolución de su demanda, se agrupan los resultados patológicos de 2007 según diagnóstico y se aplica un análisis estadístico ANOVA más un test de Tukey. Resultados y conclusiones. Los datos económicos revelan una buena gestión: aumento en la demanda de las técnicas, disminución del porcentaje de costes y mejora del rendimiento en las pruebas de cribado. Los resultados de calprotectina más elevados corresponden a pacientes con carcinoma colorrectal (significativamente mayores que en grupo misceláneo y sin diagnóstico conocido), seguidos de pacientes aquejados de enfermedad inflamatoria intestinal (AU)

Introduction. The management of an institution is defined as the arrangement and organisation of resources to obtain the expected results. To apply this concept to a clinical laboratory it is necessary to know the test demand and its development over time, the reported results and the performance. Our goal is to explain the management of Gastroenterology Laboratory for the years 2006/2007 and analyse the clinical significance of faecal calprotectin. Material and methods. Management takes into account: the number of determinations, cost and performance. With calprotectin, we examined the evolution of its demand, grouped the results of 2007 according to pathological diagnosis and applied ANOVA statistics and the Tukey test. Results and conclusions. The economic data show a good management: increase in demand for techniques, decrease in percentage of costs and increase in performance of the screening techniques. The results of calprotectin are higher in patients with colorectal carcinoma (significantly higher than in a group with no known diagnosis and a miscellaneous group), followed by patients with inflammatory bowel disease (AU)

Evaluación de un método electroforético para el subfraccionamiento de las partículas plasmáticas de lipoproteínas de baja densidad / Evaluation of an electrophoresis method to obtain plasma low density lipoproteins subfractions

Desde que el NCEP ATP III (National Cholesterol Education Program. Adult Treatment Panel III) aceptó el predominio de partículas LDL (low density lipoproteins "lipoproteínas de baja densidad") pequeñas y densas como factor de riesgo emergente de desarrollo de enfermedad cardiovascular, el interés por los métodos para fraccionar las LDL ha aumentado. Por eso, el presente trabajo pretende valorar la utilidad de un sistema de electroforesis en gel de poliacrilamida (Lipoprint(R)) para separar LDL en nuestra población. Se recogieron 194 muestras de sangre de personas de entre 15 y 94 años (el 49%, hombres) y se calculó la imprecisión del ensayo, así como los valores de referencia por sexo. Además, se realizaron correlaciones entre los distintos parámetros lipídicos. Se obtuvieron resultados aceptables para el estudio de imprecisión mediante el sistema Lipoprint®. Al correlacionar el diámetro medio de las partículas LDL con otros marcadores del metabolismo lipídico, destacamos una asociación inversamente proporcional con la concentración de triglicéridos y apolipoproteína (apo) B100 y directamente proporcional con la de colesterol ligado a lipoproteínas de alta densidad (cHDL). Encontramos diferencias entre sexos en los niveles de triglicéridos y colesterol ligado a LDL (mayores en hombres), y cHDL y diámetro medio de las partículas LDL (mayores en mujeres). Al comparar el diámetro medio de las partículas LDL con los parámetros lipídicos encontramos que está asociado inversamente con la concentración de triglicéridos y apo B100, y directamente con la de cHDL, lo que se asocia a un mayor riesgo cardiovascular. El sistema Lipoprint® es útil para la medida de la concentración y diámetro medio de las partículas LDL debido a su sencillez y rapidez de resultados. Aún así faltan estudios que relacionen los resultados obtenidos con los parámetros clínicos que se emplean en la valoración del riesgo cardiovascular (AU)

Since NCEP ATP III accepted the small and dense LDL particle as an emergent risk factor of cardiovascular disease, the methods to calculate LDL subfractions have increased. The present report attempts to evaluate the usefulness of a polyacrylamide gel electrophoresis system (LipoprintTM) to separate LDL in our population. 194 blood samples were collected from subjects between 15–94 years old (49% men). Imprecision and lipid parameter study population ranges by sex, and the correlations between them were calculated. Imprecision study results were acceptable. When correlating the average diameter of particle LDL with other lipid markers, we observed an inverse association with triglyceride concentration and Apo B100, and a direct association with HDL-cholesterol. We found differences between sex in triglyceride and LDL-cholesterol levels (greater in men) and HDL-cholesterol and average diameter of LDL particles (greater in women). When comparing the average LDL particle diameter with the lipid parameters, we found that it is inversely associated with the triglyceride and Apo B100 concentration, and directly with HDL-cholesterol, which is associated with a greater cardiovascular risk. We believe that LipoprintTM system is useful for the measurement of the concentration and average diameter of LDL particles, due to its simplicity and speed of results. Nevertheless, studies are needed that can associate the results obtained to the clinical parameters that are used in the evaluation of cardiovascular risk (AU)

[LDL concentration and particle size after treatment with rosiglitazone in patients with diabetes mellitus type 2]. / Concentración y tamaño de las partículas de LDL tras el tratamiento con rosiglitazona en pacientes con diabetes mellitus tipo 2.

BACKGROUND AND OBJECTIVE: The effects of rosiglitazone on the lipid profile are controversial, with related increases in the concentration of total and LDL cholesterol. Our objective is to evaluate the evolution of the concentration and size of LDL particles in a group of patients with type 2 diabetes mellitus taking rosiglitazone. PATIENTS AND METHODS: We studied 30 patients under treatment with oral antidiabetics to whom rosiglitazone was added to their initial therapy. The following tests were determined before and after 6 months of treatment: glucose, total cholesterol, HDL, LDL, triglycerides, C reactive protein, lipoprotein (a) and glycosylated haemoglobin. The average diameter of the particles LDL was also estimated, as well as the probability of cardiovascular events up to ten years, according to the Framingham and SCORE model. RESULTS: Statistically significant reductions of glucose, HbA(1C) and CRP levels, and an increase of total cholesterol, cholesterol LDL and triglycerides concentrations were observed, with statistical significance for total cholesterol. A significant increase in the estimation of cardiovascular risk up to ten years was found. No modifications either in the concentrations of HDL-c and Lp (a) or in the average size of LDL particles were detected. CONCLUSIONS: After treatment with rosiglitazone, there is an increase of total cholesterol concentrations without variation in the mean size of LDL particles. Nevertheless, the reduction of CRP, and thus of inflammation is clear, with prevention of the progression of atherosclerosis.

Concentración y tamaño de las partículas de LDL tras el tratamiento con rosiglitazona en pacientes con diabetes mellitus tipo 2 / LDL concentration and particle size after treatment with rosiglitazone in patients with diabetes mellitus type 2

Fundamento y objetivo: los efectos de la rosiglitazona en el perfil lipídico son controvertidos, y se han descrito aumentos en la concentración de colesterol total y del colesterol unido a lipoproteínas de baja densidad (LDL). Nuestro objetivo es evaluar la concentración y el tamaño de las partículas de LDL en un grupo de pacientes con diabetes mellitus tipo 2, a los que se les añadió rosiglitazona a su tratamiento inicial. Pacientes y método: se estudió a 30 pacientes diagnosticados de diabetes mellitus tipo 2 en tratamiento con antidiabéticos orales. Se determinaron las pruebas siguientes, antes y tras 6 meses de tratamiento con rosiglitazona añadida a su tratamiento inicial: glucosa, colesterol total, colesterol unido a lipoproteínas de alta densidad (HDL), colesterol LDL (cLDL), triglicéridos, proteína C reactiva (PCR), lipoproteína (a) y hemoglobina glucosilada (HbA1C). Además, se estimó el diámetro medio de las partículas LDL y se calculó la probabilidad de episodios cardiovasculares a 10 años según el modelo Framingham y SCORE. Resultados: encontramos una reducción estadísticamente significativa de los valores de glucosa, HbA1C y PCR, y un aumento de las concentraciones de colesterol total, cLDL y triglicéridos, con significación estadística para el colesterol total. Observamos un incremento significativo en la estimación del riesgo cardiovascular a 10 años. No encontramos variaciones en las concentraciones de colesterol HDL, lipoproteína (a) ni tampoco en el diámetro medio de las partículas LDL. Conclusiones: tras el tratamiento con rosiglitazona hay un aumento de la concentración de colesterol total, sin variación en el tamaño medio de la partícula LDL. Sin embargo, es clara la reducción de la PCR y, con ella, de la inflamación, que previene la progresión de la aterosclerosis (AU)

Background and objective: The effects of rosiglitazone on the lipid profile are controversial, with related increases in the concentration of total and LDL cholesterol. Our objective is to evaluate the evolution of the concentration and size of LDL particles in a group of patients with type 2 diabetes mellitus taking rosiglitazone. Patients and methods: We studied 30 patients under treatment with oral antidiabetics to whom rosiglitazone was added to their initial therapy. The following tests were determined before and after 6 months of treatment: glucose, total cholesterol, HDL, LDL, triglycerides, C reactive protein, lipoprotein (a) and glycosylated haemoglobin. The average diameter of the particles LDL was also estimated, as well as the probability of cardiovascular events up to ten years, according to the Framingham and SCORE model. Results: Statistically significant reductions of glucose, HbA1C and CRP levels, and an increase of total cholesterol, cholesterol LDL and triglycerides concentrations were observed, with statistical significance for total cholesterol. A significant increase in the estimation of cardiovascular risk up to ten years was found. No modifications either in the concentrations of HDL-c and Lp (a) or in the average size of LDL particles were detected. Conclusions: After treatment with rosiglitazone, there is an increase of total cholesterol concentrations without variation in the mean size of LDL particles. Nevertheless, the reduction of CRP, and thus of inflammation is clear, with prevention of the progression of atherosclerosis (AU)