THE ROLE OF NT PRO-BNP IN THE EVALUATION OF DIABETIC PATIENTS WITH HEART FAILURE.

CONTEXT: The prevalence of patients with concomitant heart failure (HF) and diabetes mellitus (DM) is high. OBJECTIVE: To analyze the role of NT-pro-BNP levels in the evaluation of diabetic patients with heart failure. DESIGN: Retrospective comparative cohort study. SUBJECTS AND METHODS: A total of 174 patients admitted to our Cardiology Department, previously diagnosed with HF, were enrolled. Among these patients, 47.7% had DM. HF was defined according to the 2016 ESC criteria. The NT-pro BNP levels above 126 pg/mL indicate a high probability of heart failure. RESULTS: In diabetic patients there were significant correlations between NT-pro-BNP values and the following parameters: hemoglobin (rho=-0.28, p=0.01), hematocrit (rho= -0.27, p=0.014), total cholesterol (rho= -0.21, p=0.048), triglycerides (rho= -0.283, p=0.01), ejection fraction (rho= -0.465, p<0.0001), end-diastolic volume (rho= 0.253, p= 0.026), end-systolic volume (rho= 0.29 p=0.01). Only the following 3 parameters: ejection fraction (p= 0.0009), hemoglobin (p= 0.0092) and triglycerides (p= 0.0380) were independent predictive factors for elevated NT-pro-BNP values. CONCLUSION: In diabetic heart failure patients, the value of NT-pro-BNP holds a pivotal role in the evaluation of their overall status, facilitating the establishment of correct management and follow-up.

Nanostructure-based therapies for liver fibrosis.

Nanotechnology has led to the development of numerous new systems for drug delivery into the target tissue, as well as novel methods that may be useful in the treatment of liver fibrosis. Inorganic and organic nanoparticles (NPs) are currently used in medical investigations and in the treatment of liver diseases, with adverse reactions observed in some cases. A revised treatment procedure involving NPs is necessary to develop future drug delivery systems having minimal noxious effects on the hepatic cells that take up and metabolize these particles in a different manner, in order to find the medication that is capable of blocking and even reversing fibrosis in an inflamed liver. In addition, the administered medication should not induce systemic responses against the NPs used in the treatment.

LINKS BETWEEN RENIN-ANGIOTENSIN SYSTEM GENETIC POLYMORPHISMS AND LEPTIN SECRETION IN OBESE HEART FAILURE PATIENTS.

Chronic heart failure (CHF) and obesity are two conditions frequently associated and which, despite all the advances made in their management in the recent years, their prevalence continues to rise. Obese patients present unique challenges in the diagnosis of CHF and also therapeutic particularities. The genetic differences may be a possible explanation for the fact that some people, irrespective of their lifestyle and common classical cardiovascular risk factors, are more susceptible to develop heart failure. Moreover, the adipose tissue, a huge endocrine organ which secretes adipokines, is also a well-established source of all renin-angiotensin-aldosterone system components, being strongly involved in the pathogenesis of CHF. That is why this review will explore the possible links between the RAS genetic polymorphisms and leptin secretion in obese HF patients, trying to bring a more precise understanding of this relationship, which will undoubtedly facilitate a more appropriate treatment of HF in obese patients. We also try to explain the possible incriminated mechanisms, and plausible biological explanations for the relationship between RAS genetic polymorphisms and adipokines secretion in obese heart failure patients.

[Evolution of pain during respiratory rehabilitation after major lung resection]. / Évolution de la douleur en soins de suites et rééducation après résection pulmonaire majeure.

INTRODUCTION: Lung resection for cancer is the cause of significant postoperative pain. The aim of this study was to determine whether pulmonary rehabilitation could induce a resurgence of pain. METHODS: In 2014 and 2015, pulmonary rehabilitation was offered to all patients referred to our institution after lung resection for cancer. Patients were assessed at entry and departure for nociceptive pain, neuropathic pain (DN4), for quality of life using questionnaire EORTC QlQ-C30 and for anxiety and depression (HAD questionnaire). Pain was studied before and after the sessions of cycloergometer, gym and massages. RESULTS: During the period, 99 patients were admitted to our institution following lung resection for cancer. Medians changed during pulmonary rehabilitation from 3 to 1 for nociceptive pain (p<0.001), 3 to 3 for DN4 (NS), 50 to 67 for the quality of life score (p<0.001), 7 to 5 for the anxiety (p<0.001) and 5 to 3 for depression (p<0.0001). Pain remained stable during the sessions of cycloergometer and gym, and decreased during massage. Patients undergoing thoracotomy or video-assisted thoracic surgery evolved identically. CONCLUSION: Postoperative pulmonary rehabilitation after lung resection for cancer was not harmful. It was associated with a decrease in nociceptive pain and was without effect on neuropathic pain.

Xanthine oxidase inhibitors in ischaemic heart disease

Increased uric acid levels are correlated with cardiovascular disease, particularly with ischaemic heart disease. Xanthine oxidase inhibitors, especially allopurinol, lower the risk of ischaemic heart disease due to their effects on reactive oxygen species and endothelial function. In chronic stable angina pectoris, allopurinol increases the median time to ST depression, time to chest pain, and total exercise time. On the other hand, it has been reported that allopurinol has a beneficial effect on ischaemic patients referred for angioplasty, but there are insufficient data regarding its effect on acute myocardial infarction patients. Moreover, other important actions of allopurinol are regression of left ventricular hypertrophy and improvement in the results of cardiac rehabilitation. The efficacy of allopurinol has recently been acknowledged by the European Society of Cardiology guidelines for stable angina pectoris, but the particular role of allopurinol in ischaemic heart disease patients is not fully established.

Cardiovascular profiles of scleroderma patients with arrhythmias and conduction disorders.

Introduction Arrhythmias and conduction disorders are common among patients with scleroderma. Their early identification is important, since scleroderma patients with arrhythmias have a higher mortality risk compared with scleroderma patients without arrhythmias. The aim of this study was to characterize the cardiovascular profiles of scleroderma patients with different types of arrhythmias and conduction disorders. Methods One hundred and ten consecutive patients with a diagnosis of systemic sclerosis according to the ACR criteria were included in the study. Patients underwent a 12-lead ECG and a 24-hour Holter ECG monitoring for arrhythmias and conduction disorders identification. Blood sample testing, echocardiography, spirometry, chest X-ray and, when considered appropriate, high resolution chest CT were also performed. A subgroup of 21 patients underwent NT-pro BNP level measurements. Patients' clinical and para-clinical characteristics were compared according to the presence or absence of arrhythmias and conduction disorders. Results The prevalence of arrhythmia and conduction disturbances was 60.9%. Patients with such disorders were older (54.4 ± 13.3 vs. 49.7 ± 10.1 years, p=0.05), had a higher prevalence of pulmonary hypertension (p=0.008), valve disease (p < 0.001), especially mitral and tricuspid regurgitation, chamber enlargement on echocardiography (left atrial and right ventricular, p = 0.012 and 0.005, respectively) as well as higher NT-pro BNP levels: 265.5 ± 399.7 vs. 163 ± 264.3 pg/ml, p=0.04. Conclusion Arrhythmias and conduction disorders are common in patients with scleroderma. Patients with such disorders are older, have a higher prevalence of pulmonary hypertension, more severe mitral and tricuspid regurgitation, left atrial and right ventricular dilation on echocardiography.

Scientific investigation of the Imperial Gates belonging to the wooden church from Sacel, Turda County, Romania.

Cultural heritage objects have a major contribution to the historical patrimony of every country. In Romania, wooden churches are famous, they are mostly dated in between the XVth and XXth century, but unfortunately many of them have been destroyed, by natural or anthropic means. Therefore, the necessity of conservation and restoration has appeared, to the ones that still exist, as legacy for the future generations. In the present article, an Imperial Gate from a wooden church in Cluj County, Romania, has been investigated, using scientific techniques (FTIR and XRF). A 3D reconstruction has been performed, using similar colors with the original artwork, as resulted from the scientific investigation of the painting materials. A limited number of constituent materials have been used for this artwork, and the wood species used was lime, due to the ease of carving.

[Impact of pulmonary rehabilitation after lung resection for cancer on patients' level of anxiety and depression]. / Impact de la réhabilitation respiratoire sur l'anxiété et la dépression après chirurgie thoracique pour cancer.

INTRODUCTION: Pulmonary rehabilitation (PR) for patients undergoing lung resection for cancer remains controversial. We studied the effects of PR, its impact on quality of life and the level of anxiety and depression. METHODS: In 2011 and 2012, PR was offered to all patients referred to our institution after lung resection for cancer. Patients were evaluated between admission and discharge by a 6 minutes walking test (6MWD), a Visual Analogue Pain Intensity Scale, a quality of life questionnaire (EORTC QLQ C30) and by the Hospital Anxiety and Depression Scale (HAD). The same questionnaires were mailed 6 months after completing PR. RESULTS: Between early 2011 and late 2012, 133 patients were admitted to our institution following lung resection for cancer. Of these, 59 (44%) patients completed PR and returned their questionnaires 6 months after discharge. During PR of these 59 patients, the mean quality of life score increased from 56.3 to 65.9 (P<0.05), the median anxiety score decreased from 5.5 to 4 (P<0.05) and that of depression from 3 to 2 (P<0.05). At 6 months post-discharge, the mean quality of life score remained stable at 66.3 (P=0.8), the median anxiety score reverted to 6 (P<0.05) and the median depression score reverted to 4.5 (P<0.05). CONCLUSION: This observational study during PR, showed that quality of life and the levels of anxiety and depression were improved at the end of the course. After returning home, the average quality of life score remained stable but the level of anxiety and depression increased.

[Pulmonary rehabilitation after lung resection for tumor - a feasibility study]. / Intérêt de la réhabilitation respiratoire après résection pulmonaire pour tumeur.

INTRODUCTION: To investigate the safety, feasibility and effectiveness of an inpatient pulmonary rehabilitation program (i-PR) after lung resection (LR) for cancer. METHODS: Between January 2007 and December 2009, we conducted a prospective observational study on patients admitted in our institution. An i-PR was offered to all patients. They completed respiratory function tests and a quality of life (QoL) questionnaire at the start and after completing the i-PR. RESULTS: During the study, 154 out of 175 patients who underwent LR and who were admitted in our center followed an i-PR. The remaining 21 patients were excluded because of emergency re-hospitalisation (10 patients), anticipated departure (six patients) or refusal to participate (five patients). Most functional parameters in the 154 treated patients improved between the beginning and the end of their stay: FVC (69.9% versus 79.6%; P<0.0001); FEV(1) (61.2% versus 69.9%; P<0.0001); timed walk-6MWT (356 m versus 444 m; P<0.0001) and constant work cycle ergometry test (281 s versus 683 s; P<0.0001). Also, the EORTC QLQ-C30 and the EORTC QLQ-LC13 improved during the stay, especially global health status (50.5 versus 64.5; P<0.0001). CONCLUSION: Postoperative PR is safe and could positively impact on functional status and QoL among this population.

Role of secretory phospholipase A2 in women with metabolic syndrome.

BACKGROUND & OBJECTIVES: Secretory phospholipase A2 (sPLA2), a member of the phospholipase A2 superfamily of enzymes that hydrolyses phospholipids, is a potentially useful plasma biomarker for atherosclerotic cardiovascular disease. Cardiovascular diseases are the leading cause of mortality in women. The purpose of this study was to investigate the correlation between cardiovascular risk factors and the sPLA2 levels in women with metabolic syndrome as compared to women without metabolic syndrome and men with metabolic syndrome. METHODS: Patients (n=100) with various cardiovascular risk factors consecutively evaluated at the Rehabilitation Hospital-Cardiology Department, Cluj-Napoca, Romania were enrolled during 2011, of whom 10 were excluded. The patients were divided in three groups: group 1 (37 women with metabolic syndrome), group 2 (27 men with metabolic syndrome), and group 3 (26 women without metabolic syndrome). Body weight, smoking habits, glycaemia, hypertension, and serum lipids fractions were analysed as cardiovascular factors. Serum sPLA2 activity was measured using the chromogenic method. RESULTS: There were no statistically significant correlations between sPLA2 levels and the investigated risk factors, irrespective of patient groups. However, there were significant positive correlations between sPLA2 and hsCRP in all three groups (P<0.05). In women with no metabolic syndrome an negative correlation was found between sPLA2 levels and HDL-C- r=-0.419, P=0.03. In men with metabolic syndrome there was a direct correlation between sPLA 2 levels and HOMA, r=0.43, P<0.05, 95% CI (-0.098; 1.15). INTERPRETATION & CONCLUSIONS: Women with metabolic syndrome did not display different sPLA2 levels as compared to men with metabolic syndrome and women without metabolic syndrome. However, women with metabolic syndrome demonstrated a low but positive correlation between sPLA2 and hsCRP levels.

Cisplatin-docetaxel induction plus concurrent 3-D conformal radiotherapy and weekly chemotherapy for locally advanced non-small cell lung cancer patients: a phase II trial.

Concurrent chemoradiotherapy (CHRT) is the standard of care for unresectable locally advanced stage III non-small cell lung cancer. However, the optimal combination remains unclear. The aim of this study was to evaluate the efficacy of 2 induction chemotherapy cycles (days 1 and 22) with docetaxel 75 mg/m(2) and cisplatin 75 mg/m(2) followed by concurrent chemotherapy (weekly docetaxel-cisplatin, 20 mg/m(2)) and 3-D conformal radiotherapy for 6 weeks (66 Gy/5 fractions per week/2 Gy per fraction). The primary endpoint was the response rate. Secondary objectives were toxicity, time to progression, and overall survival. Forty-four patients were included and 40 were eligible. The mean age was 60.5 years (range 40.7-72.1), and 75% had stage IIIB disease. Six patients underwent complete R0 resection including 2 pathologic complete responses after a planned intermediate evaluation. Thirty-three patients completed CHRT. The objective response rate was 65% (95% CI 50.2-79.8). Grade 3-4 hematologic and digestive toxicities were observed mainly during the induction phase. Grade 3 esophagitis (5%) was experienced during CHRT. With a median follow-up of 38.7 months, the median progression-free survival was 28.3 months (95% CI 11.0-35.0) and the median survival rate was 31.4 months. Cisplatin-docetaxel induction followed by concurrent 3-D conformal radiotherapy and weekly chemotherapy is a feasible protocol associated with a promising response rate and acceptable toxicity.

[18-FDG PET-scan of intrathoracic gossypiboma during the monitoring of lung cancer]. / Fixation au TEP-FDG d'un gossypiboma intrathoracique au cours de la surveillance d'un cancer du poumon.

The 18-FDG PET-scan is today used to monitor patients operated for non small-cell lung cancer. The presence of an intrathoracic gossypiboma (or textiloma) can be responsible for intense enhancement in a PET-scan because of inflammatory phenomenon. The authors report the case of a patient who underwent surgery for lung cancer nine years ago, where a newly discovered intrathoracic mass with intensive enhancement on PET-scan, led to concern about a local recurrence in spite of the fine-needle transthoracic biopsy identifying textile fibers in the histological examination.

Assessment of the correlation between two defining criteria for bidirectional isthmic block in the ablation of typical atrial flutter.

BACKGROUND: A complete, bidirectional conduction block in the cavotricuspid isthmus (CTI) represents the end-point of the typical atrial flutter ablation. We investigated the correlation between two criteria for successful ablation, one based on the atrial bipolar electrogram morphology before and after complete CTI conduction block, compared to the standard criteria of differential pacing and reversal in the right atrial depolarization sequence during coronary sinus (CS) pacing. METHOD: We conducted a retrospective study in 111 patients (81 males, average age 62±10 years) who underwent an atrial flutter ablation during September 2007 - July 2009 in the Cardiology - Rehabilitation Hospital, UMF Cluj-Napoca. We assessed the presence of a bidirectional block at the end of the procedure using the standard criteria. We then analyzed the morphology of the bipolar atrial electrograms adjacent to the ablation line, before and after CTI conduction block. RESULTS: A change from a qRs morphology to a rSr' morphology when pacing from the coronary sinus and from a rsr' morphology to a QRS morphology when pacing from the low-lateral right atrium was associated with a CTI conduction block. Sensitivity (Se), specificity(Sp), positive predictive value (PPV), negative predictive value (NPV) were 96%, 89%, 99% and 67% respectively. CONCLUSION: Our study suggests that the analysis of the atrial bipolar electrogram next to the ablation line before and after CTI ablation may be used as a reliable criterion to validate CTI conduction block due to its high sensitivity, specificity and positive predictive value.

[Thoracic surgery: the major surgical procedures]. / Chirurgie thoracique: les grandes opérations.

The most frequent thoracic surgeries are performed for the treatment of primary lung cancer and pleural mesothelioma. For lung cancer, the standard procedures are pneumonectomy and lobectomy with associated mediastinal lymphadenectomy. In order to avoid pneumonectomy, extended lobectomy with sleeve bronchoplasty and/or angioplasty can be done. When adjacent organs are involved, extended resections are accepted (chest wall, vena cava...). For small lesions (<2 cm) without lymph nodes involvement and for patients with limited respiratory function, segmentectomy is an option (results under evaluation). For the treatment of pleural mesothelioma, the accepted oncologic resection is extra-pleural pneumonectomy extended to the diaphragm and pericardium. This surgical indication requires careful evaluation of tumour staging and patient's capacities. The morbidity and mortality of these resections require comprehensive follow-up (clinical, biological (including blood gases) and radiological).

Can intrapleural C-reactive protein predict VATS pleurodesis failure?

BACKGROUND: Intrapleural inflammatory reaction after surgery for spontaneous pneumothorax is a key indicator whether an effective pleurodesis has been achieved. In this study, we tested the hypothesis that intrapleural C-reactive protein (CRP) might precisely quantify the postoperative pleural inflammation, offering potentially useful information for patient management. METHODS: The study population consisted of 75 consecutive patients who underwent video-assisted thoracoscopic pleurectomy or pleural abrasion for spontaneous pneumothorax between April 2003 and August 2004. We assessed CRP levels in pleural and blood samples taken daily in the first 4 postoperative days. RESULTS: Intrapleural CRP profile was significantly lower in patients who underwent pleural abrasion, in younger patients (< 25 years) and in patients who were not drained before surgery. Patients with pleurodesis failure had a lower CRP peak with a delayed peak. Receiving operating characteristics (ROC) analysis showed that the cutoff value of intrapleural CRP for pleurodesis failure was 25 mg/l on the second postoperative day (sensitivity 87.5 %, specificity 66.6 %, positive predictive value 24.1, negative predictive value 97.7 %). CONCLUSIONS: Pleural CRP levels of less than 25 mg/l on the second postoperative day indicate only a moderate pleural inflammation.

Mediastinal cystic lymphangioma: is resection always necessary?

Mediastinal cystic lymphangiomas are rare tumours. Usually asymptomatic, they can be complicated by a chylopericardium or/and chylothorax. We report a case of a left lesion infiltrating through the supra-aortic vessels complicated with a iatrogenic left chylothorax managed by bilateral video-assisted thoracoscopy at the same time. First, on the right, the chylous inflow was stopped by suturing the thoracic duct; then, on the left, a fenestration was done to confirm the diagnosis and treat the lesion while preserving the adjacent structures.

Photoelectron spectroscopy on thin films of extended zinc porphyrazines.

Photoemission measurements were performed on a series of stepwise benzoannelated zinc porphyrazine molecules in thin films. The electronic structure of tert-butyl-substituted zinc tetraazaporphyrin, phthalocyanine, and naphthalocyanine is investigated using mainly EUV synchrotron radiation. A detailed analysis of the zinc satellites in the spectra of the valence region is performed in an attempt to infer the effect of ligand size extension on the metal-ligand interactions. No differences in the character of the bond between zinc and ligand were detected as a function of ligand size. The results are compared with those for the respective metal-free and copper-containing molecules.

Spinal muscle forces, internal loads and stability in standing under various postures and loads--application of kinematics-based algorithm.

This work aimed to evaluate trunk muscle forces, internal loads and stability margin under some simulated standing postures, with and without external loads, using a nonlinear finite element model of the T1-S1 spine with realistic nonlinear load-displacement properties. A novel kinematics-based algorithm was applied that exploited a set of spinal sagittal rotations, initially calculated to minimize balancing moments, to solve the redundant active-passive system. The loads consisted of upper body gravity distributed along the spine with or without 200 N held in the hands, either in the front of the body or on the sides. Nonlinear and linear stability/perturbation analyses at deformed, stressed configurations with a linear stiffness-force relationship for muscles identified the system stability and critical muscle stiffness coefficient. Predictions were in good agreement with reported measurements of posture, muscle EMG and intradiscal pressure. Minimal changes in posture (posterior pelvic tilt and lumbar flattening) substantially influenced muscle forces, internal loads and stability margin. Addition of 200 N load in front of the body markedly increased the system stability, global muscle forces, and internal loads, which reached anterior shear and compression forces of approximately 500 N and approximately 1,200 N, respectively, at lower lumbar levels. Co-activation in abdominal muscles (up to 3% maximum force) substantially increased extensor muscle forces, internal loads and stability margin, allowing a smaller critical muscle coefficient. A tradeoff existed between lower internal loads in passive tissues and higher stability margins, as both increased with greater muscle activation. The strength of the proposed model is in accounting for the synergy by simultaneous consideration of passive structure and muscle forces under applied postures and loads.

[Surgical treatment of pulmonary metastases of colorectal cancer. Do the indications evolved?]. / Le traitement chirurgical des métastases pulmonaires des cancers colorectaux. Les indications ont-elles évoluées?

AIM OF THE STUDY: The aim of this study was to evaluate a single-institution experience in the surgical treatment of lung metastases from colorectal cancer. PATIENTS AND METHODS: During a 16 years period, 42 patients underwent lung metastasectomy at the University Hospital of Nice for a total of 57 surgical interventions. Data were retrospectively collected and analysed in term of prognostic factors and long-term survival. RESULTS: The mean age was 64.5 years and there were 26 males and 16 females. In 36 cases lung metastasis were metachronous and the disease-free mean interval was 28.7 months. Eighteen patients had bilateral disease. In ten patients hepatic metastasectomy was done before lung resection. Forty-seven operations were performed for the 1(st) episode of lung metastasis (1 bilobectomy, 21 lobectomy, 4 segmentectomy and 38 wedge resections). Mediastinal metastatic disease was present in six patients. No patient died and the postoperative morbidity was 6.25%. Six patients needed operation for recurrent disease. Two patients died after completion pneumonectomy. Overall five and ten-year survival were 29.5 respectively 26.2%. The log-rank test identified two significant prognostic factors: radicality of metastasectomy (P =0.0066) and a disease-free interval longer than two years (P= 0.0021). CONCLUSION: Our study suggests that local control of lung metastasis can improve survival only when a radical resection can be achieved. Selection criteria need to be improved in order to avoid unnecessary lung resection in patients with high risk of recurrences. The Pet-scan should probably have a certain interest in selecting these patients.