Thymidine kinase (TK1) is an enzyme involved in DNA synthesis that leaks into the blood as a result of high cell turnover, particularly in the case of cancer. Serum TK1 activity has been used for ...prognosis and monitoring of leukemia and lymphoma patients for many years. Here, we describe the first clinical results with the newly developed TK 210 ELISA from AroCell AB. Sera from 124 breast cancer patients with known TNM classification along with sera from 53 healthy females were analyzed by TK 210 ELISA for TK1 protein and TK1 activity levels by the
3
H-deoxythymidine (dThd) phosphorylation assay. The limit of detection for the TK 210 ELISA was 0.17 ng/ml, and 60 % of the sera from female blood donors were below this value. The median TK1 levels found in sera from breast cancer patients with T1 to T4 stage disease were 0.31, 0.46, 0.47, and 0.55 ng/ml, and these levels significantly differed from healthy controls. The median values of the biomarker CA 15-3 were also increased in patient sera from T1 to T4 patients (16, 34, 36, 40 U/ml, respectively). TK 210 ELISA showed significantly higher sensitivity for the T1 and T2 breast cancer patients compared to the TK activity assay. The combination of the TK1 ELISA and CA 15-3 biomarkers demonstrated a significant increase in sensitivity up to 15 % compared to each marker alone. This evaluation of the TK 210 ELISA strongly suggests that it can provide independent and complementary information for patients with breast cancer.
Renal dysfunction predicts mortality in patients with myocardial infarction but less is known about the impact of renal dysfunction on in‐hospital mortality after ischaemic stroke. All 361 patients ...(185 men, 176 women; mean age 72.1 years) with ischaemic stroke and glomerular filtration rate (GFR) <90 ml/min/1.73 m2 were followed‐up. GFR was calculated according to abbreviated modification of diet in renal disease (MDRD) formula. Stroke severity was determined by National Institutes of Health Stroke Scale (NIHSS).
The mean GFR was 61.5 ± 16.6 ml/min/1.73 m2. There were 49 (13.6%) in‐hospital deaths. Patients who died had higher NIHSS (P = 0.0001), were older (P = 0.024), had lower GFR (P = 0.028), higher hs‐C‐reactive protein (P = 0.001) and lower albumin (P = 0.048). No differences in presence of diabetes and hypertension, cholesterol (total, HDL and LDL), triglycerides and BMI between patients who died or survived were found. With univariate analysis association between in‐hospital mortality and NIHSS (P = 0.0001), GFR (P = 0.041), total cholesterol (P = 0.021) and LDL cholesterol (P = 0.034) was found. With Cox multivariable regression analysis of risk factors, NIHSS (P = 0.0001), GFR (P = 0.018), total cholesterol (P = 0.008) and LDL cholesterol (P = 0.011) were only predictors of in‐hospital mortality. In patients with ischaemic stroke, decreased GFR was associated with higher in‐hospital mortality.
: Atherosclerosis is accelerated in hemodialysis patients. Intima media thickness (IMT) is a strong predictor for cardiovascular events in the general population. Using B‐mode ultrasonography, IMT ...in the common carotid arteries was measured in 99 nondiabetic hemodialysis patients (44 women and 55 men, mean age 53.1 years and mean dialysis duration 45.8 months). During a follow‐up of 42.4 ± 19.5 months, 33 patients died, 19 (57.6%) of them of cardiovascular causes. In these 19 patients IMT was significantly higher (0.89 vs. 0.69 mm) than in those who survived. Correlation between cardiovascular mortality and IMT was found. Patients were divided in relationship to the tertiles of IMT and the risk for cardiovascular death was progressively higher from the first tertile of IMT onward (P < 0.0006). IMT turned out to be an independent predictor of cardiovascular death (P < 0.025). According to our results IMT may be usefully applied for cardiovascular mortality risk stratification in nondiabetic hemodialysis patients.
To determine the significance of the relationship between some traditional risk factors (age, arterial hypertension, smoking, total cholesterol, high-density lipoprotein cholesterol, low-density ...lipoprotein cholesterol, triglycerides) and some nontraditional risk factors (lipoproteina, apolipoprotein A, apolipoprotein B, homocysteine, calcium, phosphorus, parathyroid hormone) and asymptomatic atherosclerosis in hemodialysis patients.
Ninety-one hemodialysis patients were included in the study. Using B-mode ultrasonography, we measured intima-media thickness and plaque occurrence in the carotid arteries in these patients. Biochemical parameters were determined in all participants according to standard laboratory procedure, systolic and diastolic blood pressure was measured, and information on smoking habits was obtained by questionnaire.
A correlation between intima-media thickness and age of the hemodialysis patients was found. Intima-media thickness values also correlated with total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B. Compared to those without plaques, patients with plaques were statistically significantly older; had higher concentrations of total cholesterol, low-density lipoprotein cholesterol, triglycerides, and apolipoprotein B; and had lower concentrations of high-density lipoprotein cholesterol. The number of plaques correlated with age, total cholesterol, low-density lipoprotein cholesterol, triglycerides, and apolipoprotein B. Using multivariate models (linear or logistic regression) of traditional and nontraditional risk factors, a relationship was found between intima-media thickness, plaque occurrence, number of plaques, and age of the hemodialysis patients. With the same multivariate statistical analysis of nontraditional risk factors, a relationship was found only between intima-media thickness, plaque occurrence, number of plaques and apolipoprotein B.
The results indicate that hemodialysis patients showed advanced atherosclerosis that is associated with traditional as well as nontraditional risk factors such as apolipoprotein B.
Background. In dialysis patients cardiovascular mortality is 10 to 20 times higher than in general population. It remains uncertain whether atherosclerosis of dialysis patients is effectively ...accelerated because many of dialysis patients have more or less marked vascular lesions already at the start of dialysis treatment. Subjects and methods. Using B-mode ultrasonography (ATL HDI 3000), we compared intima-media thickness (IMT) and plaque occurrence (indicators of atherosclerosis) in the common carotid arteries (CC), in the area of bifurcation (CB) and in the proximal part of internal carotid arteries (CI) in 28 hemodialysis patients (14 men and 14 women; mean age 49.4 years; mean duration of HD treatment 66.6 months) with that in 28 age-sex matched patients prior to initiation of hemodialysis. We also investigated possible differences in atherosclerotic risk factors in both groups. Results. The IMT values of CC (0.71 vs. 0.70 mm; p = 0.937), CB (0.81 vs. 0.77 mm; p = 0,423) and CI (0.72 vs. 0.71 mm; p = 0.935) were not significantly different in dialysis patients and patients starting dialysis treatment. We also found no difference in plaque occurrence (61% vs. 54%; p = 0.787) and in atherosclerotic risk factors (hypertension, smoking, lipids) between both groups. Conclusions. In our study we found no difference in atherosclerotic lesions in carotid arteries between dialysis patients and patients with end-stage renal failure starting dialysis treatment. Patients with chronic renal failure are at high risk for cardiovascular diseases so we should intervene earlier and more actively long before dialysis treatment in order to reduce the atherosclerotic risk factors.
Rhabdomyolysis is common clinical and laboratory syndrome resulting from skeletal muscle injury and acute renal failure is the most important complication. Acute renal failure is common in critically ...ill medical patients. The aim of our study was to determine the prevalence of rhabdomyolysis induced acute renal failure in these patients and to established the prognosis of critically ill patients with acute renal failure and rhabdomyolysis
In the study were included 1557 patients treated in our medical intensive care unit. Seventy-three patients had criteria for acute renal failure. Twelve of them (16.4%) had rhabdomyolysis, eight were women and four were men (average age was 71 years). Sixty-one patients (83.6%) had acute renal failure without rhabdomyolysis, 33 were women and 28 were men (average age was 69 vears).
We found no difference in age and sex between patients with acute renal failure with or without rhabdomyolysis. Ten patients (83.3%) with rhabdomyolysis and 39 patients (63.9%) without rhabdomyolysis had multiorgan failure syndrome. In patients with rhabdomyolysis, the number of failing organs were statistically significantly higher (p < 0.027). Nine patients (75%) with rhabdomyolysis and 27 patients (44.3%) without rhabdomyolysis died. Mortality was statistically significantly higher (p < 0.05) in patients with rhabdomyolysis.
Rhabdomyolysis with acute renal failure was frequently observed in patients treated in our medical intensive care unit. Multiorgan failure syndrome was common in these patients and mortality was higher compared to patients without rhabdomyolysis.
Cardiovascular mortality is higher in hemodialysis (HD) patients than in the general population. Cardiac troponin T (cTnT) is established as a sensitive marker of myocardial injury in the general ...population. Less is known about the association between cTnT and intima-media thickness (IMT) and presence of plaques in carotid arteries (asymptomatic atherosclerosis) and prognostic value of cTnT for cardiovascular mortality (symptomatic atherosclerosis) in HD patients.
In our study 90 HD patients (mean age 56.2 ± 13.3 years) were followed after determination of cTnT level. Outcome after 21 months was chosen as the end point. In 52 randomly selected HD patients, IMT was measured with B-mode ultrasonography. Plaque occurrence and their numbers were also determined.
In 24 (26.6%) patients, cTnT values were >0.1 μg/L (positive test for myocardial injury). During follow-up, 13 patients died from cardiovascular causes and their cTnT values were significantly higher (0.12 vs. 0.06 μg/L;
p <0.001) than in those who survived. Correlation between cardiovascular mortality and cTnT was found (
p <0.001). The cut-off level of 0.1 μg/L resulted in survival rates of 92% and 64% (
p
=
0.0006). The IMT values of carotid artery were significantly higher (0.85 vs. 0.70 mm;
p <0.011) in patients with elevated cTnT. All patients with elevated cTnT had plaques and the number of plaques was significantly higher in these patients (
p <0.0001).
cTnT was frequently elevated in our HD patients and was associated with higher cardiovascular mortality and a predictor of cardiovascular outcome. Patients with elevated cTnT showed advanced asymptomatic atherosclerosis in carotid arteries.
A 39-year-old male suffered a myocardial infarction at work and cardiopulmonary resuscitation was initiated immediately. After 15 cardioversions, ventricular fibrillation converted to sinus rhythm. ...Rhabdomyolysis with a 100-fold increase of serum creatine kinase level and myoglobinuria with acute renal failure ensued, requiring hemodialysis treatment. The patient died and autopsy revealed acute posterior myocardial infarction. Prolonged cardiopulmonary resuscitation involving repeated cardioversion may predispose to myoglobinuric renal failure.
Zika Virus Associated with Microcephaly Mlakar, Jernej; Korva, Misa; Tul, Nataša ...
The New England journal of medicine,
2016-Mar-10, Letnik:
374, Številka:
10
Journal Article
Recenzirano
Odprti dostop
A widespread epidemic of Zika virus (ZIKV) infection was reported in 2015 in South and Central America and the Caribbean. A major concern associated with this infection is the apparent increased ...incidence of microcephaly in fetuses born to mothers infected with ZIKV. In this report, we describe the case of an expectant mother who had a febrile illness with rash at the end of the first trimester of pregnancy while she was living in Brazil. Ultrasonography performed at 29 weeks of gestation revealed microcephaly with calcifications in the fetal brain and placenta. After the mother requested termination of the pregnancy, a fetal autopsy was performed. Micrencephaly (an abnormally small brain) was observed, with almost complete agyria, hydrocephalus, and multifocal dystrophic calcifications in the cortex and subcortical white matter, with associated cortical displacement and mild focal inflammation. ZIKV was found in the fetal brain tissue on reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay, with consistent findings on electron microscopy. The complete genome of ZIKV was recovered from the fetal brain.
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