Procalcitonin, neopterin and C-reactive protein in diagnostics of intrauterine infection and preterm delivery.

OBJECTIVE: The purpose of this study was to find out whether Procalcitoni, Neopterin and C-reactive protein are sensitive and specific markers of intrauterine infection. METHODS: We evaluated 155 patients from 26. to 41. week of pregnancy at the time of delivery. We measured serum concentrations of procalcitonin (PCT), neopterin and C-reactive protein (CRP) from mother's blood sample at the beginning of delivery and from umbilical cord blood after delivery. RESULTS: In first group occurred in higher percentage (27.41%) preterm delivery (26.-37. week of pregnancy), chorioamnionitis confirmed by histological examination (16.12%) and preterm premature rupture of membranes (24.19%). In this group occured perinatal infection of newborn in 61.29%. In the second group preterm delivery (6.31%) and perinatal infection of newborn (7.36%) occured in lower percentage. CONCLUSION: The results suggest that the simultaneous measurement of CRP, PCT and NPT in mother's blood sample before delivery and umbilical cord blood may provide an accurate early diagnosis of infection and then preterm delivery (Tab. 1, Fig. 3, Ref. 18). Full Text (Free, PDF) www.bmj.sk.

On the use of biochemical markers in diagnostics of sudden cardiac death.

INTRODUCTION: Medical examiners frequently examine victims of sudden death. Most often sudden deaths have a cardiovascular cause. determine the diagnosis of sudden cardiac death based only on morphological findings may be often very difficult. Measurement of blood concentrations of cardiac troponin I (cTnl) and atrial natriuretic peptide (pro-ANP) is now in clinical use in adult patients with heart failure caused by myocardial damage. AIM: The aim of the study was the estimation wheather cTnl and/or pro-ANP could be markers of sudden cardiac death. PATIENTS AND METHODS: The study was carried out on 89 necroptic cases, of which 53 were concluded as cardiac-related sudden death, and 36 cases were used as a control group being other than cardiac death cases. Concentrations of markers were determined in blood taken from the left cardiac ventricle and from the right femoral vein. The dependence between the results of biochemical studies and death causes, results of histopathological examination of myocardium, time interval between the death and taking of samples, and resuscitation data was investigated. RESULTS: Concentrations of cTnl as determined in blood samples from the left ventricle were in most cases very high, largely exceeding the cut-off level, and so were concentrations of pro-ANP. The values of both parameters were significantly lower in peripheral blood. No statistically significant dependences were found between the levels of the studied markers and the cause of death, myocardial histopathological findings, time interval between the death and taking of samples, and resuscitation data. CONCLUSION: Based on the results obtained, the study can be concluded that blood is not a suitable medium for determination of biochemical markers of cardial troponin I and atrial natriuretic peptide for post-mortem diagnostics of myocardial damage and for determining the diagnosis of sudden cardiac death in a manner similar to diagnostics of myocardium damage in living patients.

The correlation of procalcitonin serum levels with the presence of biliary obstruction.

INTRODUCTION: There is still no general agreement as to which patients suffering from attacks of acute biliary pancreatitis should undergo emergent endoscopic retrograde cholangiopancreatography (ERCP) with subsequent endoscopic intervention (endoscopic papilotomy, stent placement etc.). Many authors have described large differences in Procalcitonin (PTC) serum levels in patients suffering from biliary pancreatitis as opposed to patients whose acute pancreatitis is based on toxic etiology. Therefore, we have investigated the correlation of Procalcitonin serum levels with the presence of biliary obstruction in patients undergoing ERCP examination. MATERIAL AND METHODS: From 1.8.2004 to 31.3.2005, 97 patients undergoing ERCP were enrolled into the study. Blood samples were taken from each patient just before their ERCP examinations, and PCT serum levels were subsequently correlated to ERCP findings. RESULTS: ERCP examinations were completed in 90 out of 97 patients. Bile ducts obstructions were confirmed in 61 out of 90 patients and the mean serum level of PTC was 0.078 ng/ml. In the remaining 29 patients ERCP revealed normal findings and the mean PCT value was 0.069 ng/ml. There was no statistical correlation between PCT serum levels and the presence of biliary obstruction on ERCP findings. CONCLUSION: The measurement of PCT serum levels is of no help in the identification of patients, who should undergo emergent ERCP due to acute biliary pancreatitis (Tab. 1, Fig. 1, Ref. 6).

The clinical value of the procalcitonin in prediction of severity and outcome in acute pancreatitis.

BACKGROUND/AIMS: Early identification of patients with severe forms of acute pancreatitis (AP) and subsequent management of these high risk patients are the most important aims in order to decrease mortality from AP. Procalcitonin (PCT) as a marker for systemic inflammation appears to be a useful marker for early identification of severe forms. METHODOLOGY: 101 patients with confirmed AP have been admitted to department of general surgery. PCT values were measured in each patient on admission and after 12 hours. PCT levels were correlated to the disease's course and prognosis. Results are given through PPV and NPV. Immunoluminometric assay (BRAHMS Diagnostica) was used for measurement. RESULTS: PPV and NPV for prediction of disease's course were better for PCT than for CRP PPV 64.7% versus 36% and NPV 82,6% versus 79.6% and for prediction of fatal outcome PCT reached 75% and 100% for cut off value 5 ng/ml. CONCLUSIONS: PCT seems to be a useful screening parameter for detecting severe AP and for identifying the patients who need ICU treatment, ATB covering and who can benefit from the novel therapies.

Cytokine levels in patients with a very low left ventricular ejection fraction after open heart surgery.

INTRODUCTION: Cardiopulmonary bypass and cardiac operations are obligatorily connected with systemic inflammatory reaction. Production of proinflammatory cytokines is responsible also for negative effects on the myocardial function. OBJECTIVE OF STUDY: Follow-up of the dynamic changes of proinflammatory and antiinflammatory cytokine levels in patients with left ventricular dysfunction during the first week after cardiac surgery. PATIENTS AND METHODS: A total of nine patients with a very low left ventricular ejection fraction (22.75 +/- 0.65%) who had undergone cardiac surgery (for coronary artery bypass grafting or aortic valve reconstruction) were investigated during the first after week operation. The preoperative and postoperative plasma levels of tumor necrosis factor (TNF), interleukin-8 (IL-8) and interleukin-10 (IL-10) were estimated by means of ELISA technique. RESULTS: With respect to the preoperative levels, on the first postoperative day the levels IL-8 (from 9.36 to 16.65 pg/ml) (p < 0.05) and of IL-10 (from 6.93 to 28.09 pg/ml) (p < 0.02) significantly rose with a stepwise decrease down to the seventh day after surgery. From the third to seventh day an insignificant increase in TNF level was also noted. CONCLUSIONS: The results have shown that open heart surgery in patients with a severe left ventricular dysfunction evoked a systemic inflammatory response demonstrated by early increase in proinflammatory cytokine IL-8 and was accompanied by increased level of antiinflammatory cytokine IL-10. Despite stepwise decrease in IL-8 levels, they did not reach the preoperative levels, not even on the seventh postoperative day. (Tab. 1, Fig. 3, Ref. 21.)

[Serum cystatin C in haemodialysed patients]. / Cystatín C v sére u hemodialyzovaných pacientov.

BACKGROUND: Cystatin C (CyC) is protein (m. w. 13 300), which is produced by nucleated cells, filtered through glomeruli and subsequently reabsorbed and degraded in tubuli. OBJECTIVE: To investigate changes in serum CyC concentration during two low-flux membrane haemodialyses (HD-I, HD-II) and relationship between serum CyC a creatinine concentrations. PATIENTS AND METHODS: Serum CyC was determined in 17 patients on chronic haemodialysis during HD-I and HD-II by immunonephelometric method (Dade Behring, Austria). RESULTS: Significant correlation between serum CyC and creatinine before HD-I and before/after HD-II was found (p < 0.001). Serum CyC before HD-I (median 6.3 mg/I, 95 % CI 5.5 - 6.7) increased after HD-I (7.1 mg/l, 6.1 - 8.9) (p < 0.001). Serum CyC before HD-II (6.4 mg/l, 5.8 - 7.2) increased after HD-II (8.0 mg/l, 7.3 - 9) (p < 0.001), while serum creatinine decreased after HD-I and HD-II (p < 0.001). There was correlation between the increase in serum CyC and albumin during HD-I (p < 0.001) and HD-II (p < 0.01). CONCLUSION: There was close correlation between serum CyC and creatinine before haemodialyses. Serum CyC increased after haemodialyses, due to CyC non-dialysability through low-flux membrane and haemoconcentration. Unlike creatininaemia, serum CyC reflects the residual renal function even after haemodialyses.

Muscular adaptation and strength during the early phase of eccentric training: influence of the training frequency.

We investigated the effects of different training frequencies on maximum isometric voluntary contraction (MVC) force and plasma concentrations of muscle proteins during the early phase of eccentric training. MVC and plasma concentrations of creatine kinase (CK) and slow-twitch skeletal (cardiac beta-type) myosin heavy chain (MHC) fragments were measured before and 4 and 7 d after performing the first and last training task. Training tasks, which comprised 70 high-force eccentric contractions involving the thigh muscles (single leg), were performed under supervision in three groups (A, B, C) at the beginning and at the end of the study period (7 wk). In addition, groups A (N = 10) and B (N = 10) trained during the study period starting 1 wk after the first training task. Group A performed one training task once a week for 5 wk and group B (N = 10) twice a week for 2 wk and three times a week during the subsequent 3 wk. In all three groups the first training task resulted in delayed CK and MHC peaks and decrements in MVC, which were comparable (P > 0.05). Only training regimen B resulted in a significant increase in the MVC. Compared with the first training task training regimens, A and B significantly (P < 0.01) reduced the increase in serum muscle protein and muscle function impairment. The responses to the last training task did not differ significantly between groups A and B. In group C the responses after the second training task did not differ significantly from those observed after the first task. Our results suggest that, compared with group A, additional eccentric exercise in group B is the essential basis for the increase in muscle strength during the early phase of eccentric training without further benefits for muscular adaptation. In group C we found no muscular adaptation.

Carnitine level and several lipid parameters in venous blood of newborns, cord blood and maternal blood and milk.

To obtain a rather complex picture on fat metabolism in newborns, fundamental characteristics of this metabolism as well as the carnitine level in their blood was correlated with corresponding values from cord blood, maternal blood and milk. The concentrations of cholesterol (CHOL), triglycerides (TGL) and apolipoprotein B (Apo-B) in 4 days old infants were higher than in cord blood (P < 0.01 and P < 0.001, resp.), but were only 50% of those in blood of the respective mothers. No differences in HDL-CHOL were observed, whereas the level of apolipoprotein A (Apo-A) in cord blood exceeded that in newborn blood (P < 0.05). The level of carnitine in milk was about twice as high as in maternal blood (P < 0.001) which was the consequence of the high acylcarnitine content in milk. Our results represent a basis for comparison of normal and pathologically altered metabolic situation, e.g. in hypotrophic newborns and potentially in newborns in need of parenteral nutrition.