Markers of activation of coagulation in cancer patients.

BACKGROUND: Prothrombotic tendency is characteristic of tumors. The aim of the study is to investigate the changes in the laboratory parameters for coagulation and fibrinolysis, namely in fibrinogen, thrombin-antithrombin complex (ТАТ), tissue factor (ТF), prothrombin fragment (F1+2), antithrombin III (AT III), D-dimer and screening coagulation tests in cancer patients before initiation of chemotherapy. MATERIALS AND METHODS: Levels of F1+2, fibrinogen, ТАТ, AT III, TF, D-dimer, PT, aPTT and TT were measured baseline in 80 patients with breast and lung cancer before systemic treatment. The same parameters were investigated in 65 healthy volunteers. TF, ТАТ, F1+2 were measured by ELISA; AT III, D-dimer, fibrinogen and screening coagulation tests were measured by automated coagulation system Sysmex CS 2000i.  RESULTS: Levels of F1+2, fibrinogen, ТАТ, TF, and D-dimer in cancer patients were significantly higher than those in the control group, while the levels of ATIII activity were significantly lower (p < 0.001). The highest area under the ROC curve was for D-dimer, which made it a good marker for the risk of thrombosis. CONCLUSION: Higher levels of TF, ТАТ, F1+2, fibrinogen and D-dimer and lower activity of АТ III in cancer patients support our hypothesis of an association between malignant disease and coagulation disorders. Cancer patients are at an increased risk of thrombosis wherefore antithrombotic prophylaxis may be considered (Tab. 6, Fig. 2, Ref. 34). Text in PDF www.elis.sk Keywords: coagulation, fibrinolysis, cancer.

Longitudinal Dynamics of Coagulation and Angiogenesis Markers in Cancer Patients During and After Chemotherapy.

Hemostatic parameters have been investigated as molecular determinants of tumor progression. To analyze the dynamics of microparticle-associated tissue factor activity (MPTF), tissue factor antigen (TF-Ag), and angiopоietin-2 (ANG-2) in cancer patients before, during, and after active treatment and to explore their potential as biomarkers for metastatic occurrence and death. Blood for the analysis of MPTF, TF-Ag, ANG-2, and conventional hemostatic tests was sampled in 111 patients with various cancers at 4 consecutive visits: before first chemotherapy cycle, after 3 courses, at the sixth course, and 3 months after chemotherapy cessation. Patients were followed up until metastatic progression/death or the end of the study. MPTF did not change during chemotherapy, but increased significantly after treatment cessation. Total TF-Ag and ANG-2 decreased throughout active treatment. Significant drop of their levels was observed 3 months post therapy cessation. Progressive disease was significantly associated with higher pre-chemotherapy TF-Ag and fibrinogen. Elevated baseline levels of fibrinogen were associated with increased risk of shortened progression free survival. Cessation of chemotherapy is associated with significant change of hemostatic parameters. Pre-chemotherapy levels of TF-Ag and fibrinogen may be informative of disease state and prognosis.

Evaluation of Anxiety, Depression, and Biological Markers in Health Professionals with Burnout.

INTRODUCTION: Medical profession is a stress factor for the development of burnout, symptoms of anxiety and depression as a result of 24-hour work, delayed work-life balance gratification and challenges associated with patient care. AIM: This study aimed to verify the rates of burnout, anxiety, and depression presented by health professionals working 24-hour shifts under emergency conditions. Saliva cortisol and glycated hemoglobin were also studied as stress-related biomarkers. MATERIALS AND METHODS: Ninety-five medical professionals - physicians, biologists, chemists, and laboratory technicians were compared to a control group working outside medicine. Burnout was measured by the Maslach Burnout Inventory. Anxiety and depression were measured by the State-Trait Anxiety Inventory and the Zung Depression Scale. Salivary cortisol and glycated hemoglobin were analyzed by the immunoassay methods. RESULTS: The level of burnout in the subscale of emotional exhaustion was high in 95.6% of medical professionals. In the subscale of personal accomplishment, 100% had high scores. Regarding the State-Trait Anxiety Inventory, 22.2% and 68.9% of the medical specialists showed a positive score (≥40) for S-anxiety and T-anxiety scale, respectively. 11.1% indicated greater anxiety (score ≥ 55) for T-anxiety. In relation to the depression scale, 31.1% had mildly depressive states and 8.9% had moderately depressive states. Participants with a high level of emotional exhaustion presented higher results for saliva cortisol and glycated hemoglobin compared to the control group. A significant positive correlation existed between the two dimensions - emotional exhaustion and depression (r=0.683, p<0.01). CONCLUSIONS: Our study may be relevant for further research in order to decrease the negative aspects of professional stress.

Pathophysiological Role of Adiponectin, Leptin and Asymmetric Dimethylarginine in the Process of Atherosclerosis.

Adipose tissue is recognized as a rich source of proinflammatory mediators that may directly contribute to vascular injury, insulin resistance, and atherogenesis. Many studies have shown that adiponectin has antiatherogenic and anti-inflammatory properties. Adiponectin acts not only as a factor increasing insulin sensitivity, and the protective effect may result from its ability to suppress production of proinflammatory cytokines. It negatively regulates the expression of TNF-alpha and C-reactive protein (CRP) in adipose tissue; reduces expression of vascular and intracellular adhesion molecules (VCAM-1, ICAM-1), E-selectin, interleukin-8 (IL-8). Hyperleptinemia has been linked with the development of hypertension and endothelial dysfunction/atherosclerosis, two main pathophysiological conditions associated with cardiovascular disease development. Leptin-mediated increases in sympathetic nervous system activity may be among the principal mechanisms evoking obesity related hypertension. Leptin stimulates the secretion of proinflammatory cytokines, and increases the release of endothelin-1 (ET-1), which may promote hypertension. Increased serum levels of asymmetric dimethylarginine (ADMA), a physiological regulator of the biosynthesis of nitric oxide (NO), promote the process of atherosclerosis, leading to the occurrence of endothelial dysfunction and cardiovascular disease.