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Sef D, Kovacevic M, Jernej B, Novacic K, Slavica M, Petrak J, Medved I, Milosevic M. Immunohistochemical analysis of MMP-9 and COX-2 expression in carotid atherosclerotic plaques among patients undergoing carotid endarterectomy: A prospective study. J Stroke Cerebrovasc Dis 2022; 31:106731. [PMID: 36075131 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/27/2022] [Accepted: 08/14/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Matrix metalloproteinase-9 protein (MMP-9) and cyclooxygenase-2 (COX-2) proteins may have a role in remodelling of atherosclerotic plaques. We analysed and compared the radiological, histological and immunohistochemical characteristics of carotid atherosclerotic plaques between symptomatic and asymptomatic patients who underwent carotid endarterectomy (CEA). METHODS This prospective single-blinded study included 31 patients (70 [64-75] years, 58% males, 42% symptomatic) who underwent CEA and a total of 155 carotid plaque sections that were analysed. Preoperative assessment and multimodality diagnostic imaging with magnetic resonance imaging (MRI) or computed tomography angiography (CTA), histological and immunohistochemical analyses of carotid plaques including the expression of MMP-9 and COX-2 proteins were performed. RESULTS Symptomatic and asymptomatic patients did not significantly differ in respect to preoperative characteristics. Unstable plaques were detected in 12/13 (92.3%, p = 0.020) symptomatic patients using MRI or CTA. There was no perioperative mortality and perioperative outcomes were comparable in both groups. A significantly higher expression of MMP-9 in macrophages was observed among symptomatic patients (p = 0.020). ROC curve analysis showed statistically significant associations of both the higher intensity of COX-2 staining in CD68 PG-M1 positive macrophages (area under the curve [AUC]=0.701, p = 0.014) and higher MVD (AUC=0.821, p < 0.001) within the plaque with cerebrovascular symptoms. The expression of COX-2 and the intensity of COX-2 staining in macrophages within the unstable carotid plaques detected by preoperative MRI or CTA were significantly higher (76.1% vs. 40.0%, p = 0.038; 76.2% vs. 30.0%, p = 0.01, respectively). CONCLUSIONS Advanced non-invasive multimodality diagnostic imaging including MRI or CTA is reliable in differentiating unstable from stable carotid plaques. High expression of MMP-9 and COX-2 in macrophages within the symptomatic plaque is associated with increased risk of cerebrovascular complications. TRIAL REGISTRATION This study has been registered at the ISRCTN registry (ID ISRCTN46536832), isrctn.org Identifier: https://www.isrctn.com/ISRCTN46536832.
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Affiliation(s)
- Davorin Sef
- Department of Cardiac Surgery, Harefield Hospital, Royal Brompton and Harefield Hospitals, Part of Guy's and St. Thomas' NHS Foundation Trust, London, UK.
| | - Miljenko Kovacevic
- Department of Vascular Surgery, University Hospital Centre Rijeka, Rijeka, Croatia, EU
| | - Bojan Jernej
- Polyclinic for Radiology and Neurology "Dijagnostika 2000", Zagreb, Croatia, EU
| | - Karlo Novacic
- Department of Diagnostic and Interventional Radiology, University Hospital Centre Zagreb, Zagreb, Croatia, EU
| | - Marko Slavica
- Department of Diagnostic and Interventional Radiology, University Hospital Merkur, Zagreb, Croatia, EU
| | - Jelka Petrak
- University of Zagreb, School of Medicine, Zagreb, Croatia, EU
| | - Igor Medved
- Department of Cardiac Surgery, University Hospital Centre Rijeka, Rijeka, Croatia, EU
| | - Milan Milosevic
- University of Zagreb, School of Medicine, Zagreb, Croatia, EU; Andrija Stampar School of Public Health, Zagreb, Croatia, EU
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Kunišek L, Matušan Ilijaš K, Medved I, Ferenčić A, Erdeljac D, Arbanas S, Kunišek J. Cardiomyocytes calpain 2 expression: Diagnostic forensic marker for sudden cardiac death caused by early myocardial ischemia and an indicator of the duration of myocardial agonal period? Med Hypotheses 2021; 158:110738. [PMID: 34863067 DOI: 10.1016/j.mehy.2021.110738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/08/2021] [Accepted: 11/22/2021] [Indexed: 10/19/2022]
Abstract
Sudden cardiac death (SCD) is an unexpected natural death of cardiac etiology and occurs within one hour of the onset of cardiac symptoms in an apparently healthy subject or within 24 h if death is not witnessed. The diagnosis of early myocardial ischemia (EMI) or acute myocardial infarction (AMI) after death is a challenge for forensic pathologists especially when death occurs in a short period of time after the onset of myocardial ischemia. Disorder of cardiomyocytes Ca2+ homeostasis caused by myocardial ischemia during SCD can lead to the activation of calcium-activated non-lysosomal cysteine protease, including calpains. They serve as a proteolytic unit for cell balance and also participate in the processes of apoptosis and necrosis. Agony is a period that precedes somatic death that differs from cellular agony which may evolve for hours after somatic death lasting differently depending on the cell type and mechanism of death. We hypothesize that the expression of calpain 2 in cardiomyocytes could be a specific and sensitive diagnostic forensic marker for SCD caused by EMI and an indicator of the duration of myocardial agonal period. We will conduct a retrospective study that will prove this hypothesis on the respondents who died of SCD by EMI and AMI, instant death by head gunshot and hanging. There is no data on such an analysis in the available literature. The standard hematoxylin-eosin staining will be used to detect cardiac tissue damage. The expression of calpain 2 in cardiomyocytes will be analyzed immunohistochemically. In SCD caused by EMI we expect lower level of calpain 2 expressionin comparison to AMI due to shorter duration of dying. Similar, we predict in the remote region lower calpain 2 expression than in the region of ischemia for both EMI and AMI. In instant death caused by perforating traumatic brain injury we expect mild or no calpain 2 expression throughout the whole myocardium because of very short (immediate) duration of dying. In death caused by hanging calpain 2 expression throughout the whole myocardium should be strong because of longer cellular agonal period. We expect that our results would indicate the immediate activation of calpain 2 in different causes of cardiomyocytes death. From the degree of expression of calpain 2 we could conclude about the duration of cardiomyocytes agony so calpain 2 could be used as a marker for the assessment the duration of somatic and cellular agony.
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Affiliation(s)
- Leon Kunišek
- University Hospital Center Rijeka, Department of Cardiothoracic Surgery, Division of Cardiac Surgery, Rijeka, Krešimirova 42, Croatia.
| | - Koviljka Matušan Ilijaš
- University Hospital Center Rijeka, Department of Pathology and Cytology, Rijeka, Krešimirova 42, Croatia
| | - Igor Medved
- University Hospital Center Rijeka, Department of Cardiothoracic Surgery, Division of Cardiac Surgery, Rijeka, Krešimirova 42, Croatia
| | - Antun Ferenčić
- University of Rijeka, Faculty of Medicine, Department of Forensic Medicine and Criminalistics, Rijeka, Croatia
| | - Danijela Erdeljac
- University Hospital Center Rijeka, Department of Cardiothoracic Surgery, Division of Cardiac Surgery, Rijeka, Krešimirova 42, Croatia
| | - Silvia Arbanas
- University of Rijeka, Faculty of Medicine, Department of Forensic Medicine and Criminalistics, Rijeka, Croatia
| | - Juraj Kunišek
- Thalassotherapia Crikvenica, Special Hospital for Medical Rehabilitation Crikvenica, Gajevo šetalište 21, Croatia
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Saracevic A, Medved I, Hrabric Vlah S, Kozmar A, Bilic-Zulle L, Simundic AM. The association of systemic inflammatory markers with indicators of stress and cardiac necrosis in patients undergoing aortic valve replacement and revascularization surgeries. Physiol Res 2020; 69:261-274. [PMID: 32199011 DOI: 10.33549/physiolres.934243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim was to investigate: changes of inflammatory, stress and cardiac response in patients undergoing open heart surgeries up to five days after the procedure; the association between inflammatory, stress and cardiac response and whether changes in a certain marker can predict short-term patient outcome. Ninety patients were divided into three groups, 30 participants each (on-pump,off-pump revascularization and valve replacement group). The following markers were measured:complete blood count, CRP, IL-6, IL-10, leptin, resistin, monocyte chemoattractant protein-1 (MCP-1), cortisol, CK and hsTnT in 5 points. Resistin increased in all three groups. Lower IL-10 levels were found after the surgery and higher levels of leptin and MCP-1 in the off-pump than in the on-pump group. Off-pump group had higher values of IL-6, IL-10, leptin, resistin and MCP-1 and lower levels of CK and hsTnT 24 after surgery than the on-pump group. We found significant correlation between MCP-1 and resistin. The difference between resistin at time points 2 and 3 significantly predicted transfusion needs; while the difference between CRP and resistin before and at the end of the surgery together with the difference between leukocytes at the end and 24 hours after the surgery predicted the use of inotropic agents/vasopressors. Cardiac surgeries cause an increase of inflammatory, stress and cardiac markers. Only resistin correlated with MCP-1 which confirms the link between resistin secreted form infiltrated macrophages and enhanced release of MCP-1.
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Affiliation(s)
- A Saracevic
- Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia.
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Sokolic J, Knezevic D, Kuharic J, Medved I, Sustic A, Zupan Z, Laskarin G, Tadin T, Sotošek Tokmadžić V. Decrease of Perforin Expressing Lymphocytes after On-Pump Coronary Artery Bypass Grafting Surgery Irrespective of Carbohydrate Preoperative Oral Feeding. Heart Surg Forum 2019; 22:E218-E224. [PMID: 31237547 DOI: 10.1532/hsf.2003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 03/11/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Coronary artery bypass grafting (CABG) surgery continues to be the gold standard for treating the patients with coronary artery disease. CABG surgery can be performed on or off cardiopulmonary bypass, termed as on-pump or off-pump CABG, respectively. It has been shown that CABG surgery, preferably on-pump CABG surgery, leads to the changes of cell immunity during perioperative and early postoperative period. The mechanisms of regulation of the immune response in patients during and early after surgical revascularization are not fully understood. The aim of this study was to investigate the influence of carbohydrate preoperative oral feeding on frequency and perforin expression in peripheral blood lymphocytes in patients after on- or off-pump CABG surgery in early postoperative period. PATIENTS AND METHODS In this prospective clinical study, 80 patients scheduled for CABG surgery were included in the study. The patients were randomly allocated into four groups (20 in each group): patients in Group 1 underwent on-pump CABG and did not receive carbohydrate preoperative oral feeding; patients in Group 2 underwent on-pump CABG and were preoperatively fed; patients in Group 3 underwent off-pump CABG and did not receive carbohydrate preoperative oral feeding; while patients in Group 4 underwent off-pump CABG and received carbohydrate preoperative oral feeding. Blood samples were collected immediately before (T1), 24 (T2) and 72 (T3) hours after the surgery. Peripheral blood mononuclear cells were isolated by gradient centrifugation and simultaneously labelled by antigens using fluorochrome-conjugated monoclonal antibodies. Frequency of T lymphocytes, NK and NKT cells, their subsets as well as their perforin expression were detected, and analyzed by flow cytometry. RESULTS There was significant decrease in frequency of CD3+ and CD3+CD4+ cells, as well as perforin expressing CD3+CD8+ cells in patients who underwent on-pump CABG in comparison to patients who underwent off-pump CABG 24 hours after the surgery. Carbohydrate preoperative oral feeding did not effect changes in lymphocytes subpopulations and perforin expression at any time point. CONCLUSION Decreases of CD3+ cells on account of CD3+CD4+ subsets, and perforin expressing cells on account of CD3+CD8+ perforin+ cells were found in patients who had undergone on-pump CABG, but not in patients who had undergone off-pump CABG surgery, irrespectively of carbohydrate preoperative oral feeding.
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Affiliation(s)
- Jadranko Sokolic
- Department of Anesthesia, Resuscitation, Emergency and Intensive Care Medicine, Faculty of Medicine, University of Rijeka, Croatia
| | - Danijel Knezevic
- Department of Anesthesia, Resuscitation, Emergency and Intensive Care Medicine, Faculty of Medicine, University of Rijeka, Croatia
| | - Janja Kuharic
- Department of Anesthesia, Resuscitation, Emergency and Intensive Care Medicine, Faculty of Medicine, University of Rijeka, Croatia
| | - Igor Medved
- Department of Surgery, Faculty of Medicine, University of Rijeka, Croatia
| | - Alan Sustic
- Department of Anesthesia, Resuscitation, Emergency and Intensive Care Medicine, Faculty of Medicine, University of Rijeka, Croatia
| | - Zeljko Zupan
- Department of Anesthesia, Resuscitation, Emergency and Intensive Care Medicine, Faculty of Medicine, University of Rijeka, Croatia
| | - Gordana Laskarin
- Division of Cardiology, Hospital for Medical Rehabilitation of the Hearth and Lung Diseases and Rheumatism “Thalassotherapia-Opatija,” Opatija, Croatia.,Department of Physiology and Immunology, Faculty of Medicine, University of Rijeka, Croatia
| | - Tomislav Tadin
- Ultrasound Diagnostic Service, Health Centre Rijeka, Rijeka, Croatia
| | - Vlatka Sotošek Tokmadžić
- Department of Anesthesia, Resuscitation, Emergency and Intensive Care Medicine, Faculty of Medicine, University of Rijeka, Croatia
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Koulakov I, Gerya T, Rastogi BK, Jakovlev A, Medved I, Kayal JR, El Khrepy S, Al-Arifi N. Growth of mountain belts in central Asia triggers a new collision zone in central India. Sci Rep 2018; 8:10710. [PMID: 30013125 PMCID: PMC6048038 DOI: 10.1038/s41598-018-29105-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 06/22/2018] [Indexed: 11/17/2022] Open
Abstract
Several unusual strong earthquakes occurred in central India along the Narmada-Son Lineament (NSL) zone, far from active plate boundaries. To understand the role of collisional processes in the origin of this seismicity, we develop a numerical thermomechanical model of shortening between the Indian Plate and Asia. We show that at the final stage of collision, the shortening rate of the high mountain areas slows. The continuing convergence of India and Asia triggers the initiation of a new collision zone in continental part of India. Various geological and geophysical observations indicate that the NSL is a weakest zone with northward thrusting of the thinner central Indian lithosphere underneath the thicker northern part of the Indian Plate. We hypothesize that the NSL was reactivated during the final stage of the India Asia convergence and it will possibly form a new mountain belt within the Indian continent.
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Affiliation(s)
- I Koulakov
- Trofimuk Institute of Petroleum Geology and Geophysics, SB RAS, Prospekt Koptyuga, 3, Novosibirsk, 630090, Russia. .,Novosibirsk State University, Novosibirsk, Russia, Pirogova 2, Novosibirsk, 630090, Russia.
| | - T Gerya
- ETH Zurich, Department Of Earth Sciences, Sonneggstrasse 5, Zurich, 8092, Switzerland
| | - B K Rastogi
- Institute of Seismological Research, Gandhinagar, 382009, India
| | - A Jakovlev
- Trofimuk Institute of Petroleum Geology and Geophysics, SB RAS, Prospekt Koptyuga, 3, Novosibirsk, 630090, Russia.,Novosibirsk State University, Novosibirsk, Russia, Pirogova 2, Novosibirsk, 630090, Russia
| | - I Medved
- Trofimuk Institute of Petroleum Geology and Geophysics, SB RAS, Prospekt Koptyuga, 3, Novosibirsk, 630090, Russia.,Novosibirsk State University, Novosibirsk, Russia, Pirogova 2, Novosibirsk, 630090, Russia
| | - J R Kayal
- Institute of Seismological Research, Gandhinagar, 382009, India
| | - S El Khrepy
- King Saud University, Riyadh, Saudi Arabia, P.O. Box 2455, Riyadh, 11451, Saudi Arabia.,National Research Institute of Astronomy and Geophysics, Seismology Department, NRIAG, Helwan, 11421, Egypt
| | - N Al-Arifi
- King Saud University, Riyadh, Saudi Arabia, P.O. Box 2455, Riyadh, 11451, Saudi Arabia
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Sokolic J, Sotosek Tokmadzic V, Knezevic D, Medved I, Vukelic Damjani N, Balen S, Rakic M, Lanca Bastiancic A, Laskarin G. Corrigendum to "Endothelial dysfunction mediated by interleukin-18 in patients with ischemic heart disease undergoing coronary artery bypass grafting surgery" [Med. Hypotheses 104 (2017) 20-24]. Med Hypotheses 2018; 111:40. [PMID: 29406994 DOI: 10.1016/j.mehy.2017.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- J Sokolic
- Clinic of Anesthesiology and Intensive Care Medicine, Clinical Hospital Center Rijeka, 51 000 Rijeka, Kresimirova 42, Croatia
| | - V Sotosek Tokmadzic
- Clinic of Anesthesiology and Intensive Care Medicine, Clinical Hospital Center Rijeka, 51 000 Rijeka, Kresimirova 42, Croatia; Department of Anesthesiology, Reanimatology and Intensive Care, Faculty of Medicine, University of Rijeka, 51000 Rijeka, B. Branchetta 20, Croatia.
| | - D Knezevic
- Department of Anesthesiology, Reanimatology and Intensive Care, Faculty of Medicine, University of Rijeka, 51000 Rijeka, B. Branchetta 20, Croatia
| | - I Medved
- Department of Surgery, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Tome Strizica 3, Croatia
| | - N Vukelic Damjani
- Department of Transfusion Medicine, Clinical Hospital Center Rijeka, 51 000 Rijeka, Kresimirova 42, Croatia
| | - S Balen
- Department of Transfusion Medicine, Clinical Hospital Center Rijeka, 51 000 Rijeka, Kresimirova 42, Croatia
| | - M Rakic
- Division of Cardiology, Hospital for Medical Rehabilitation of the Hearth and Lung Diseases and Rheumatism "Thalassotherapia" Opatija, 51410 Opatija, M. Tita 188, Croatia
| | - A Lanca Bastiancic
- Division of Cardiology, Hospital for Medical Rehabilitation of the Hearth and Lung Diseases and Rheumatism "Thalassotherapia" Opatija, 51410 Opatija, M. Tita 188, Croatia
| | - G Laskarin
- Division of Cardiology, Hospital for Medical Rehabilitation of the Hearth and Lung Diseases and Rheumatism "Thalassotherapia" Opatija, 51410 Opatija, M. Tita 188, Croatia; Department of Physiology and Immunology, Medical Faculty, University of Rijeka, 51000 Rijeka, B. Branchetta 20, Croatia
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Župan Ž, Mijatović D, Medved I, Kraljić S, Juranić J, Barbalić B, Oštrić M. Successful treatment of fulminant Lyme myocarditis with mechanical circulatory support in a young male adult: a case report. Croat Med J 2017; 58:185-193. [PMID: 28409501 PMCID: PMC5410731 DOI: 10.3325/cmj.2017.58.185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
We describe the case of fulminant myocarditis due to Lyme disease and use of mechanical circulatory support (MCS) for the treatment of the Lyme carditis associated with refractory cardiogenic shock. Fulminant Lyme myocarditis in young adult male patient led to a sudden onset of acute, severe biventricular heart failure with progressive cardiogenic shock, and multiorgan failure immediately after admission. The previously healthy 28-year-old man was admitted to hospital with dyspnea, atrial flutter with 160/min ventricles rate, normotension, cardiomegaly, and incipient cardiogenic pulmonary edema on chest x-ray. Within the next 24 hours, the acute heart failure (AHF) progressed to the refractory cardiogenic shock with severe systemic hypotension, respiratory distress, anuria, liver congestion, and laboratory evidence of extremely high level of the anaerobic metabolism in the arterial blood (pH 7.16; HCO3 12.3 mmol/L; BE -14.6; lactates level 17 mmol/L). The transesophageal echo imaging showed severe dilatation and global biventricular akinesis, with left ventricular ejection fraction of 5%. The diagnosis of acute fulminant myocarditis of unknown etiology was reached. Since the patient did not respond rapidly to vasoactive and supportive therapy, MCS was immediately inserted. Broad differential diagnosis of fulminant myocarditis was considered and disseminated Borrelia infection was serologically confirmed and appropriate antimicrobial therapy was started from the fifth day after admission. MCS used over the next 26 days was successfully integrated with pharmacologic support and artificial ventilation in therapy. The patient was discharged from hospital after 65 days with a complete restoration of bilateral heart ejection fraction. This case shows that the clinical course of the Lyme carditis can present uncommonly with profound cardiovascular collapse and the MSC implementation should be considered in the early stage of drug resistant hemodynamic instability. Rapid transfer to the cardiac center where the MCS is available for all patients with signs and symptoms of AHF due to confirmed or suspected Lyme carditis would be recommended, as this treatment could be the only life-saving method.
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Affiliation(s)
- Željko Župan
- Željko Župan, Clinic of Anesthesiology and Intensive Care Medicine, University Hospital Center Rijeka, Tome Strižića 3, 51000 Rijeka, Croatia,
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Sokolic J, Tokmadzic VS, Knezevic D, Medved I, Vukelic Damjani N, Balen S, Rakic M, Lanca Bastiancic A, Laskarin G. Endothelial dysfunction mediated by interleukin-18 in patients with ischemic heart disease undergoing coronary artery bypass grafting surgery. Med Hypotheses 2017; 104:20-24. [PMID: 28673582 DOI: 10.1016/j.mehy.2017.05.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 05/06/2017] [Indexed: 12/16/2022]
Abstract
When medication management or percutaneous coronary intervention is not successful in patients with advanced ischemic heart disease, surgical revascularisation-predominantly coronary artery bypass grafting (CABG)-is considered the gold standard. However, CABG surgery can lead to ischemia/reperfusion injury, which is characterized by a strong inflammatory response. Interleukin (IL)-18, is a strong inflammatory mediator, that is released from cardiomyocytes and can be found in the systemic circulation of patients during and immediately after CABG surgery. The existing damage of endothelial glycocalyx in patients with ischemic heart disease is further impaired concurrently during the surgery due to the anaesthesia-surgical technique used and intravascular fluid loading. This results in the increased incidence of adverse events, including myocardial infarction. IL-18 leads to the activation of lymphocyte cytotoxicity via cytotoxic mediators (Fas ligand, Tumour necrosis factor (TNF)-related apoptosis-inducing ligand, perforin, and granulysin). We hypothesize that IL-18 is released locally in the heart and the systemic circulation in patients undergoing CABG surgery and may be correlated with the level of activity of circulating lymphocytes. In turn, this may lead to lymphocyte-mediated cytotoxicity directed toward damaged and activated endothelial cells. Shear stress glycocalyx, as well as damaged and activated endothelial cells then become the main the source of pro-inflammatory cytokines, chemokines, and adhesion molecules. These attract activated lymphocytes to adhere to the endothelium or enter the subintimal layer, increasing existing or initiating the formation of new plaques, which leads to the development of myocardial infarction during or shortly after surgery. To evaluate our hypothesis, we will measure the local concentration of IL-18 in the sinus coronarius and systemic circulation. These values will then be correlated with immunological and biochemical parameters, predominantly with the concentration of degradation products of glycocalyx and cytotoxic mediators in activated lymphocytes. If our hypothesis is correct, measuring the IL-18 concentration that is responsible for glycocalyx deterioration, may become a useful tool for predicting myocardial infarction occurrence in patients undergoing CABG surgery.
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Affiliation(s)
- Jadranko Sokolic
- Clinic of Anesthesiology and Intensive Care Medicine, Clinical Hospital Center Rijeka, 51 000 Rijeka, Kresimirova 42, Croatia
| | - Vlatka Sotosek Tokmadzic
- Clinic of Anesthesiology and Intensive Care Medicine, Clinical Hospital Center Rijeka, 51 000 Rijeka, Kresimirova 42, Croatia; Department of Anesthesiology, Reanimatology and Intensive Care, Faculty of Medicine, University of Rijeka, 51000 Rijeka, B. Branchetta 20, Croatia.
| | - Danijel Knezevic
- Department of Anesthesiology, Reanimatology and Intensive Care, Faculty of Medicine, University of Rijeka, 51000 Rijeka, B. Branchetta 20, Croatia
| | - Igor Medved
- Department of Surgery, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Tome Strizica 3, Croatia
| | - Nada Vukelic Damjani
- Department of Transfusion Medicine, Clinical Hospital Center Rijeka, 51 000 Rijeka, Kresimirova 42, Croatia
| | - Sanja Balen
- Department of Transfusion Medicine, Clinical Hospital Center Rijeka, 51 000 Rijeka, Kresimirova 42, Croatia
| | - Marijana Rakic
- Division of Cardiology, Hospital for Medical Rehabilitation of the Hearth and Lung Diseases and Rheumatism "Thalassotherapia" Opatija, 51410 Opatija, M. Tita 188, Croatia
| | - Ana Lanca Bastiancic
- Division of Cardiology, Hospital for Medical Rehabilitation of the Hearth and Lung Diseases and Rheumatism "Thalassotherapia" Opatija, 51410 Opatija, M. Tita 188, Croatia
| | - Gordana Laskarin
- Division of Cardiology, Hospital for Medical Rehabilitation of the Hearth and Lung Diseases and Rheumatism "Thalassotherapia" Opatija, 51410 Opatija, M. Tita 188, Croatia; Department of Physiology and Immunology, Medical Faculty, University of Rijeka, 51000 Rijeka, B. Branchetta 20, Croatia
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Boban M, Barisic M, Persic V, Zekanovic D, Medved I, Zulj M, Vcev A. Muscle strength differ between patients with diabetes and controls following heart surgery. J Diabetes Complications 2016; 30:1287-92. [PMID: 27368124 DOI: 10.1016/j.jdiacomp.2016.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 05/20/2016] [Accepted: 06/04/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND The aim of our study was to analyze muscle strength in patients with recent surgical treatment for ischemic and combined ischemic-valvular heart disease, based on existence of diabetes mellitus. Connections existing between muscle strength and patient characteristics or conventional diagnostic tests were analyzed as well. METHODS Study prospectively included consecutive patients scheduled for cardiovascular rehabilitation 0-3months after heart surgery. Diagnostics covered drug utilization, anthropometrics, demographics, echocardiography, conventional laboratory, echocardiography, bioelectrical impedance analysis (BIA), and hand grip test (HGT). HGT was analyzed for dominant hand. RESULTS Patients with diabetes had significantly weaker muscle strength on HGT than controls; 29.4±12.2kg vs. 38.2±14.7kg (p=0.029), respectively. ROC analysis for HGT and existence of diabetes mellitus were significant; ≤40kg had sensitivity of 89.7% (95%CI: 72.6-97.8), specificity 43.7% (31.9-56.0); AUC 0.669 (0.568-0.760); p=0.002. HGT significantly correlated with hematocrit (Rho CC=0.247; p=0.013), whilst other laboratory or echocardiographic parameters were insignificant (all p>0.05). HGT also correlated with body weight (Rho CC=0.510; p<0.001); height (Rho CC=0.632; p<0.001); waist circumference (Rho CC=0.388; p<0.001); waist-to-hip ratio (Rho CC=0.274; p=0.006) and BIA (Rho CC=-0.412; p<0.001). CONCLUSIONS In postoperative recovery of patients with diabetes, muscle strength assessed by HGT is decreased and in relation with nutritional status. Clinically resourceful connections of HGT were also found to hematocrit and utilization of loop diuretics.
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Affiliation(s)
- Marko Boban
- Department of Cardiology, University Hospital "Thalassotherapia Opatija", Medical Faculty University of Rijeka, Croatia; Department of Internal Medicine, Medical Faculty "J.J. Strossmayer" University of Osijek, Croatia.
| | - Mijana Barisic
- Department of Cardiology, University Hospital "Thalassotherapia Opatija", Medical Faculty University of Rijeka, Croatia
| | - Viktor Persic
- Department of Cardiology, University Hospital "Thalassotherapia Opatija", Medical Faculty University of Rijeka, Croatia; Department of Internal Medicine, Medical Faculty "J.J. Strossmayer" University of Osijek, Croatia
| | | | - Igor Medved
- Department of Cardiac Surgery, Medical Faculty University of Rijeka, University Hospital Centre "Rijeka", Croatia
| | - Marinko Zulj
- Department of Internal Medicine, Medical Faculty "J.J. Strossmayer" University of Osijek, Croatia
| | - Aleskandar Vcev
- Department of Internal Medicine, Medical Faculty "J.J. Strossmayer" University of Osijek, Croatia
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Boban M, Zulj M, Persic V, Medved I, Zekanovic D, Vcev A. Prolonged utilization of proton pump inhibitors in patients with ischemic and valvular heart disease is associated with surgical treatments, weight loss and aggravates anemia. Int J Cardiol 2016; 219:277-81. [PMID: 27343420 DOI: 10.1016/j.ijcard.2016.06.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 06/18/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Proton pump inhibitors (PPIs) are among the commonest drugs used nowadays. The aim of our study was to analyze prolonged utilization of proton pump inhibitors in medical therapy of patients with ischemic and valvular heart disease. Secondly, profile of utilization was scrutinized to patient characteristics and type of cardiovascular treatments. METHODS The study included consecutive patients scheduled for cardiovascular rehabilitation 2-6months after index cardiovascular treatment. RESULTS Two hundred ninety-four patients (n=294/604; 48.7%) have been using proton pump inhibitor in their therapy after index cardiovascular treatment. Cardiovascular treatments were powerfully connected with utilization of PPIs; surgery 5.77 (95%-confidence intervals [CI]: 4.05-8.22; p<0.001) and PCI 0.15 (CI: 0.10-0.22; p<0.001). The odds for having proton pump inhibitor in their chronic therapy were increased for atrial fibrillation 1.87 (CI: 1.08-3.23; p=0.025) and decreased for obesity 0.65 (CI: 0.45-0.96; p=0.035); surviving myocardial infarction 0.49 (CI: 0.29-0.83; p=0.035). Multinomial logistic regression controlled for existence of chronic renal disease found no significant association of renal dysfunction and PPI therapy. The existence of anemia was significantly increased in patients taking PPIs than controls; 6.00 (CI: 3.85-9.33; p<0.001). The use of PPI was also associated with worsening of metabolic profile, in part due to decreased utilization of ACE-inhibitors and statins. PPI consumption correlated with age of patients (Rho=0.216; p<0.001). CONCLUSIONS High proportion of cardiovascular, particularly surgical patients with ischemic and valvular heart disease utilized proton pump inhibitor in prolonged courses. Prolonged courses of PPIs were connected with existence and worsening of red blood count indexes, older age, lesser weight of patients and underutilization of cardioprotective drugs.
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Affiliation(s)
- Marko Boban
- Department of Cardiology, University hospital "Thalassotherapia Opatija", Medical Faculty, University of Rijeka, Croatia; Department of Internal Medicine, Medical Faculty "J.J. Strossmayer", University of Osijek, Croatia.
| | - Marinko Zulj
- Department of Internal Medicine, Medical Faculty "J.J. Strossmayer", University of Osijek, Croatia
| | - Viktor Persic
- Department of Cardiology, University hospital "Thalassotherapia Opatija", Medical Faculty, University of Rijeka, Croatia; Department of Internal Medicine, Medical Faculty "J.J. Strossmayer", University of Osijek, Croatia
| | - Igor Medved
- Department of Cardiac Surgery, Medical Faculty, University of Zagreb, University hospital centre "Zagreb", Croatia
| | - Drazen Zekanovic
- Department of Cardiology, University hospital "Thalassotherapia Opatija", Medical Faculty, University of Rijeka, Croatia; Department of Internal Medicine, Medical Faculty "J.J. Strossmayer", University of Osijek, Croatia
| | - Aleksandar Vcev
- Department of Internal Medicine, Medical Faculty "J.J. Strossmayer", University of Osijek, Croatia
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11
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Kovacević M, Boroe M, Medved I, Kovacić S, Primc D, Sokolić J. Successful Treatment of Acute Aortic Dissection Type Stanford A Presenting as Limb Ischemia, Successfully Treated with Operative and Endovascular Procedures. Coll Antropol 2015; 39:953-956. [PMID: 26987166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We report a successful treatment of unusual case of a 48 year old male patient with acute aortic dissection type Stanford A that expanded into left common and external iliac artery diagnosed by MSCT angiography, presenting as a single leg paresis, without symptoms of a chest or back pain. Patient was operated with conventional ascending aortic replacement. Patient had no known prior medical condition. He has been treated for acute thrombosis of the left popliteal artery developing one day after ascending aortic replacement surgery, embolectomy was performed. Critical limb ischemia developed due to preocclusive stenosis of the left common and left external iliac artery and was treated by endovascular procedure of iliac artery stenting performed on the fifth postoperative day. After 17 days patient was discharged form hospital, showing no neurological or vascular deficit. For successful treatment of acute aortic dissection type Stanford A complicated with limb ischemia, rapid and accurate diagnosis is essential, together with close cooperation of cardio surgeons, vascular surgeons and invasive radiologists and individual approach to these demanding patients.
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12
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Medved I, Oštrić M, Osman S, Ljubačev A, Božić A. Case report of undiagnosed retrosternal goitre – an unpleasant finding during complex cardiac surgery procedure. J Cardiothorac Surg 2013. [PMCID: PMC3845064 DOI: 10.1186/1749-8090-8-s1-p31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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13
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Ljubacev A, Medved I, Ostric M, Zuvic-Butorac M, Sokolici J. Mitral regurgitation and coronary artery bypass surgery: comparison of mitral valve repair and replacement. Acta Chir Belg 2013; 113:187-91. [PMID: 24941714 DOI: 10.1080/00015458.2013.11680909] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The aim of this retrospective study was to determine if there is a statistically significant difference (p < or = 0.05) between mitral valve repair (MVRp) with concomitant surgical revascularization of the myocardium (CABG) and mitral valve replacement (MVR) with concomitant CABG, considering the duration of surgery, early postoperative morbidity, in-hospital mortality, length of stay in the Intensive Care Unit (ICU) and overall in-hospital stay. METHODS Between January 1st 2006 and December 31st 2008, 75 patients underwent surgery for mitral regurgitation and ischemic heart disease. Patients were divided in two groups determined by the procedure that was performed on the mitral valve (MVRp + CABG group had 34 patients, MVR + CABG group had 41 patients). All the patients were operated by the same surgical team and received the usual anaesthesia protocol. RESULTS Patients in the MVR + CABG group had statistically significant higher EuroSCORE risk levels, higher NYHA status and higher incidence of postoperative low cardiac output syndrome (LCOS). Neurological complications showed statistically significant higher incidence in the MVRp + CABG group. There was no statistically significant difference in regard to in-hospital mortality between these two groups. Patients in the MVR + CABG group had statistically significant longer in-hospital stay. CONCLUSIONS Mitral valve repair and mitral valve replacement are complementary methods considering early postoperative morbidity and mortality. Higher incidence of LCOS and in-hospital stay in the MVR + CABG group was to be expected on behalf of poorer preoperative status.
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Affiliation(s)
- A. Ljubacev
- Department of Cardiac Surgery,University Hospital Rijeka, Rijeka, Croatia, Rijeka, Croatia
| | - I. Medved
- Department of Cardiac Surgery,University Hospital Rijeka, Rijeka, Croatia, Rijeka, Croatia
| | - M. Ostric
- Department of Cardiac Surgery,University Hospital Rijeka, Rijeka, Croatia, Rijeka, Croatia
| | - M. Zuvic-Butorac
- Faculty of Engineering, University of Rijeka, Rijeka, Croatia, Rijeka, Croatia
| | - J. Sokolici
- Department of Anaesthesiology and ICU,University Hospital Rijeka, Rijeka, Croatia
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14
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Vlah SH, Sokolic J, Medved I, Dvornik S. Unexpectedly elevated cardiac troponin I level in the patient without acute coronary syndrome. Clin Lab 2013; 59:661-665. [PMID: 23865367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Since cTnI assay is leading test in diagnostic of myocardial infarctions, and it is used for risk assessment in patients with ACS as well as unstable angina pectoris, it is very important to measure its concentration accurately and precisely. METHODS Here we report a case in which there was a significant difference in the cTnI concentrations measured by three different methods, which was detected in one patient's sera during preoperative evaluation for cardiac surgery. RESULTS Due to variations in the results for the cTnI concentrations (0.62; 0.13; 0.89 microg/L), the question was raised about the possibility of an interference known to occur in especially rare situations. A 76-year-old male was operated, temporal elevation and subsequent decrease in the concentrations of cTnI were monitored. CONCLUSIONS It was observed that results obtain with different assays are not comparable.
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Affiliation(s)
- Snjezana Hrabric Vlah
- Clinical Department of Laboratory Diagnostics, Clinical Hospital Center Rijeka, Rijeka, Croatia.
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15
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Vlah S, Sokolic J, Medved I, Dvornik S.
Unexpectedly Elevated Cardiac Troponin I Level in the Patient without Acute Coronary Syndrome. Clin Lab 2013. [DOI: 10.7754/clin.lab.2012.120919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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16
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Petersen AC, McKenna MJ, Medved I, Murphy KT, Brown MJ, Della Gatta P, Cameron-Smith D. Infusion with the antioxidant N-acetylcysteine attenuates early adaptive responses to exercise in human skeletal muscle. Acta Physiol (Oxf) 2012; 204:382-92. [PMID: 21827635 DOI: 10.1111/j.1748-1716.2011.02344.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Production of reactive oxygen species (ROS) in skeletal muscle is markedly increased during exercise and may be essential for exercise adaptation. We, therefore, investigated the effects of infusion with the antioxidant N-acetylcysteine (NAC) on exercise-induced activation of signalling pathways and genes involved in exercise adaptation in human skeletal muscle. METHODS Subjects completed two exercise tests, 7 days apart, with saline (control, CON) or NAC infusion before and during exercise. Exercise tests comprised of cycling at 71% VO(2peak) for 45 min, and then 92% VO(2peak) to fatigue, with vastus lateralis biopsies at pre-infusion, after 45-min cycling and at fatigue. RESULTS Analysis was conducted on the mitogen-activated protein kinase signalling pathways, demonstrating that NAC infusion blocked the exercise-induced increase in JNK phosphorylation, but not ERK1/2, or p38 MAPK. Nuclear factor-κB p65 phosphorylation was unaffected by exercise; however, it was reduced in NAC at fatigue by 14% (P < 0.05) compared with pre-infusion. Analysis of exercise and/or ROS-sensitive genes demonstrated that exercise-induced mRNA expression is ROS dependent of MnSOD, but not PGC-1α, interleukin-6, monocyte chemotactic protein-1, or heat-shock protein 70. CONCLUSION These results suggest that inhibition of ROS attenuates some skeletal muscle cell signalling pathways and gene expression involved in adaptations to exercise.
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Affiliation(s)
- A C Petersen
- School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Vic., Australia.
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Pavlík Z, Žumár J, Medved I, Černý R. Water Vapor Adsorption in Porous Building Materials: Experimental Measurement and Theoretical Analysis. Transp Porous Media 2011. [DOI: 10.1007/s11242-011-9884-9] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Medved I, Anić D, Ostrić M, Zrnić B, Ivancić A, Tomulić V. Is mitral valve repair safe procedure in elderly patients? Coll Antropol 2010; 34 Suppl 2:213-215. [PMID: 21302724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The aim of this randomized, prospective, study was to evaluate postoperative hospital mortality and morbidity after mitral valve repair by comparing two surgical techniques for resolving mitral valve insufficiency in elderly patients. In comparison were: mitral valve repair vs. mitral valve replacement in patients older than 70 years. In period from January 1st 2006 until August 30th 2009. Eighty patients with mitral valve disease, isolated or associated with other comorbidities, were scheduled for mitral valve repair or mitral valve replacement in our institution. Patients were randomized in two groups, one scheduled for mitral valve repair and another one for mitral valve replacement using the envelope method with random numbers. Results show no difference in hospital mortality and morbidity postoperatively in both groups. In group undergoing valve replacement we had one significant complication of ventricle rupture in emphatically calcified posterior part of mitral valve annulus. In conclusion we found no distinction in postoperative hospital mortality and morbidity after using one of two surgical techniques.
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Affiliation(s)
- Igor Medved
- Department of Cardiac Surgery, University Hospital Rijeka, Rijeka, Croatia.
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Marinović M, Cicvarić T, Juretić I, Grzalja N, Medved I, Ahel J. Application of wound closure Molndal technique after laparoscopic cholecystectomy--initial comparative study. Coll Antropol 2010; 34 Suppl 2:243-245. [PMID: 21305739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Because of a possible delayed wound healing, critical colonization and infection of wounds present a problem for surgeons. Colonized and infected wounds are a potential source for cross-infection. Molndal technique of wound dressing has proven to be effective in prevention of infection. Also the wound heal better and faster. In our study we wanted to describe the benefits of the Molndal technique wound dressing after laparoscopic cholecistectomy compared to traditional wound dressing technique. Molndal technique consisted of wound dressing with Aquacel Ag--Hydrofiber (ConvaTec, Dublin, Ireland). Traditional technique was performed using gauze compresses and hypoallergic adhesives. We analyzed the results of 100 patients after laparoscopic cholecystectomy. 50 patients were treated by Molndal technique and 50 patients by the traditional technique of wound dressing. In the group treated by Molndal technique only 1 (2%) patient has revealed a wound infection, proven by positive microbiological examination and suppuration, mostly in the subumbilical incision. In the traditional technique group 7 (14%) patients developed wound infection also predominantly in the subumbilical incision. The difference was statistically significant (p < 0.01). Our results are clearly showing that Molndal technique is effective in preventing the infection of subumbilical incision wound and is to by recommend for regular use at designated site after laparoscopic cholecistectomy.
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Affiliation(s)
- Marin Marinović
- Department of Traumatology, University Hospital of Rijeka, Rijeka, Croatia.
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20
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Ivancić A, Medved I, Cicvarić T, Protić A, Marinović M, Pavlović N. Perioperative and early postoperative neurological deficit in older patients during carotid artery thrombendarterectomy. Coll Antropol 2010; 34 Suppl 2:205-208. [PMID: 21305736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Cerebrovascular accidents, strokes in particular, are among the most frequent causes of death today in developed countries. In the last two decades, stroke was the second most frequent cause of death in Primorsko-Goranska Region in Croatia. In older patients, individuals older than 65 years of age have an increased risk of stroke, mainly because the degree of carotid artery stenosis increases with age. The most frequent complication of the high percent stenosis of the carotid arteries is thrombosis in the area of atherosclerotic changes of blood vessels. With the increase in the age of the population, there is also an increase in the number of risk factors of cerebrovascular accident. Doppler ultrasound sonography and Multi Slice CT scans have the most prominent role in the early detection of atherosclerotic changes and in the assessment of the degree of carotid artery narrowing. Today, in Croatia as well as worldwide, thrombendarterectomy holds the most important place in stroke prevention. Between 2006 and 2009, 209 patients underwent surgical intervention at the Clinical Hospital Center in Rijeka for high degree of carotid artery narrowing. In the group younger than 65 years of age, which consisted of 53 patients, a neurological deficit was noted in 4 patients (7.54%) in the perioperative and early postoperative course. In the group of individuals older than 65 years of age, which consisted of 156 patients, a neurological deficit was noted in 9 patients (5.76%). There was no significant statistical difference in the incidence of neurological deficit, nor in the mortality in individuals older than 65 years of age during carotid arteries thrombendarterectomy.
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Affiliation(s)
- Aldo Ivancić
- Department of Surgery, University Hospital of Rijeka, Rijeka, Croatia.
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Zrnic B, Anic D, Medved I, Matana A. Rare case of a large aneurysm of Valsalva's sinus rupturing into the right ventricle. Ultraschall Med 2008; 29 Suppl 5:273-274. [PMID: 18484064 DOI: 10.1055/s-2008-1027326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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22
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Murphy KT, Medved I, Brown MJ, Cameron-Smith D, McKenna MJ. Antioxidant treatment withN-acetylcysteine regulates mammalian skeletal muscle Na+-K+-ATPase α gene expression during repeated contractions. Exp Physiol 2008; 93:1239-48. [DOI: 10.1113/expphysiol.2008.042796] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Medved I, Anić D, Zrnić B, Ostrić M, Saftić I. Off-pump versus on-pump--intermittent aortic cross clamping--myocardial revascularisation: single center expirience. Coll Antropol 2008; 32:381-384. [PMID: 18756885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The aim of this randomised, prospective study was to evaluate hospital mortality and morbidity after myocardial revascularisation, comparing on-pump coronary artery bypass graft (CABG) myocardial revascularisation versus off-pump coronary artery bypass graft (OPCAB) myocardial revascularisation in population with multivessels coronary artery disease. Sixty patients with multivessels coronary artery diseases were scheduled to undergo coronary artery bypass grafting from January 15, 2006 to June 30, 2007 in our institution. Patients were randomized to off-pump or on-pump surgery with intermittent cross-clamping of aorta and ventricular fibrillation, using the envelope method with random numbers. In the results only difference we did find postoperatively was in Creatine Kinase-MB (CK-MB) release, the amount of bleeding and intensive care unit (ICU) stay (p<0.05). There was no diference between the two groups of patients regarding incidence of main morbidity and hospital moratlity. In summary, we didn't find no superiority in any of the two techniques regarding on hospital mortality and morbidity.
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Affiliation(s)
- Igor Medved
- Department of Cardiac Surgery, University Hospital Rijeka, Rijeka, Croatia.
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Kovacevic M, Simic O, Medved I, Lucin K, Padovan M. Ochronosis of the aortic valve and aorta. J Heart Valve Dis 2006; 15:730-2. [PMID: 17044384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
A 64-year-old male patient with unknown alkaptonuria and severe aortic stenosis and ischemic heart disease was admitted to the authors' institution for elective surgery. The patient underwent aortic valve replacement with a 25-mm aortic valve (ATS Medical, Inc.) and single venous aortocoronary artery bypass grafting for a right coronary artery. Aortotomy revealed typical ochronotic pigmentation of a severely calcified aortic valve and aortic intima. A diagnosis of alkaptonuria was confirmed by evidence of homogentisic acid in the patient's urine, together with histopathological analysis.
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Medved I, Simic O, Bralic M, Stemberga V, Kovacevic M, Matana A, Bosnar A. Chronic Heart Perforation With 13.5 cm Long Kirschner Wire Without Pericardial Tamponade: An Unusual Sequelae After Shoulder Fracture. Ann Thorac Surg 2006; 81:1895-7. [PMID: 16631702 DOI: 10.1016/j.athoracsur.2005.06.061] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2005] [Revised: 06/03/2005] [Accepted: 06/20/2005] [Indexed: 11/18/2022]
Abstract
We report a unique case of cardiac embolization with the Kirschner wire that has been used for osteosynthesis for 24 months previously. According to the complete analysis of medical records and autopsy report, the wire had migrated from the right humeroscapular joint to the heart. Although migration of a Kirschner wire has been reported in the literature, migration of the wire with a total length of 13.5 cm with no pericardial tamponade, despite myocardial perforation, has not been previously described.
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Affiliation(s)
- Igor Medved
- Department of Cardiac Surgery, University Hospital Rijeka, Rijeka, Croatia.
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26
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Stemberga V, Bosnar A, Bralic M, Medved I, Simic O, Pocekaj L. Heart embolization with the Kirschner wire without cardiac tamponade. Forensic Sci Int 2005; 163:138-40. [PMID: 16288843 DOI: 10.1016/j.forsciint.2005.09.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2005] [Revised: 07/29/2005] [Accepted: 09/29/2005] [Indexed: 11/22/2022]
Abstract
The case of the heart embolization with the Kirschner wire that was used for shoulder trauma fixation, 2 years previously in a 67-year-old female, is reported. This case is unique; although embolization of foreign bodies to the heart is not a novel occurrence, heart embolization with non-broken Kirschner wire with a total length of 13.5 cm without cardiac tamponade was not described in medical literature so far.
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Affiliation(s)
- Valter Stemberga
- Institute of Forensic Medicine, School of Medicine Rijeka, University of Rijeka, Vukovarska 11, 51000 Rijeka, Croatia.
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Medved I, Brown MJ, Bjorksten AR, Murphy KT, Petersen AC, Sostaric S, Gong X, McKenna MJ. N-acetylcysteine enhances muscle cysteine and glutathione availability and attenuates fatigue during prolonged exercise in endurance-trained individuals. J Appl Physiol (1985) 2004; 97:1477-85. [PMID: 15194675 DOI: 10.1152/japplphysiol.00371.2004] [Citation(s) in RCA: 159] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The production of reactive oxygen species in skeletal muscle is linked with muscle fatigue. This study investigated the effects of the antioxidant compound N-acetylcysteine (NAC) on muscle cysteine, cystine, and glutathione and on time to fatigue during prolonged, submaximal exercise in endurance athletes. Eight men completed a double-blind, crossover study, receiving NAC or placebo before and during cycling for 45 min at 71% peak oxygen consumption (VO2 peak) and then to fatigue at 92% VO2 peak. NAC was intravenously infused at 125 mg.kg(-1).h(-1) for 15 min and then at 25 mg.kg(-1).h(-1) for 20 min before and throughout exercise. Arterialized venous blood was analyzed for NAC, glutathione status, and cysteine concentration. A vastus lateralis biopsy was taken preinfusion, at 45 min of exercise, and at fatigue and was analyzed for NAC, total glutathione (TGSH), reduced glutathione (GSH), cysteine, and cystine. Time to fatigue at 92% VO2 peak was reproducible in preliminary trials (coefficient of variation 5.6 +/- 0.6%) and with NAC was enhanced by 26.3 +/- 9.1% (NAC 6.4 +/- 0.6 min vs. Con 5.3 +/- 0.7 min; P <0.05). NAC increased muscle total and reduced NAC at both 45 min and fatigue (P <0.005). Muscle cysteine and cystine were unchanged during Con, but were elevated above preinfusion levels with NAC (P <0.001). Muscle TGSH (P <0.05) declined and muscle GSH tended to decline (P=0.06) during exercise. Both were greater with NAC (P <0.05). Neither exercise nor NAC affected whole blood TGSH. Whereas blood GSH was decreased and calculated oxidized glutathione increased with exercise (P <0.05), both were unaffected by NAC. In conclusion, NAC improved performance in well-trained individuals, with enhanced muscle cysteine and GSH availability a likely mechanism.
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Affiliation(s)
- I Medved
- Muscle, Ions and Exercise Group, School of Human Movement, Recreation and Performance (FO22 Victoria University of Technology, PO Box 14428, MCMC, Melbourne, Victoria 8001, Australia
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Murphy KT, Snow RJ, Petersen AC, Murphy RM, Mollica J, Lee JS, Garnham AP, Aughey RJ, Leppik JA, Medved I, Cameron-Smith D, McKenna MJ. Intense exercise up-regulates Na+,K+-ATPase isoform mRNA, but not protein expression in human skeletal muscle. J Physiol 2004; 556:507-19. [PMID: 14754991 PMCID: PMC1664937 DOI: 10.1113/jphysiol.2003.054981] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Characterization of expression of, and consequently also the acute exercise effects on, Na(+),K(+)-ATPase isoforms in human skeletal muscle remains incomplete and was therefore investigated. Fifteen healthy subjects (eight males, seven females) performed fatiguing, knee extensor exercise at approximately 40% of their maximal work output per contraction. A vastus lateralis muscle biopsy was taken at rest, fatigue and 3 and 24 h postexercise, and analysed for Na(+),K(+)-ATPase alpha(1), alpha(2), alpha(3), beta(1), beta(2) and beta(3) mRNA and crude homogenate protein expression, using Real-Time RT-PCR and immunoblotting, respectively. Each individual expressed gene transcripts and protein bands for each Na(+),K(+)-ATPase isoform. Each isoform was also expressed in a primary human skeletal muscle cell culture. Intense exercise (352 +/- 69 s; mean +/-s.e.m.) immediately increased alpha(3) and beta(2) mRNA by 2.4- and 1.7-fold, respectively (P < 0.05), whilst alpha(1) and alpha(2) mRNA were increased by 2.5- and 3.5-fold at 24 h and 3 h postexercise, respectively (P < 0.05). No significant change occurred for beta(1) and beta(3) mRNA, reflecting variable time-dependent responses. When the average postexercise value was contrasted to rest, mRNA increased for alpha(1), alpha(2), alpha(3), beta(1), beta(2) and beta(3) isoforms, by 1.4-, 2.2-, 1.4-, 1.1-, 1.0- and 1.0-fold, respectively (P < 0.05). However, exercise did not alter the protein abundance of the alpha(1)-alpha(3) and beta(1)-beta(3) isoforms. Thus, human skeletal muscle expresses each of the Na(+),K(+)-ATPase alpha(1), alpha(2), alpha(3), beta(1), beta(2) and beta(3) isoforms, evidenced at both transcription and protein levels. Whilst brief exercise increased Na(+),K(+)-ATPase isoform mRNA expression, there was no effect on isoform protein expression, suggesting that the exercise challenge was insufficient for muscle Na(+),K(+)-ATPase up-regulation.
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Affiliation(s)
- K T Murphy
- School of Human Movement, Recreation and Performance (FO22), Victoria University of Technology, PO Box 14428, MCMC, Melbourne, Victoria, Australia
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Medved I, Brown MJ, Bjorksten AR, Leppik JA, Sostaric S, McKenna MJ. N-acetylcysteine infusion alters blood redox status but not time to fatigue during intense exercise in humans. J Appl Physiol (1985) 2003; 94:1572-82. [PMID: 12496140 DOI: 10.1152/japplphysiol.00884.2002] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Infusion of the antioxidant N-acetylcysteine (NAC) reduces fatigability in electrically evoked human muscle contraction, but due to reported adverse reactions, no studies have investigated NAC infusion effects during voluntary exercise in humans. We investigated whether a modified NAC-infusion protocol (125 mg. kg(-1). h(-1) for 15 min, then 25 mg. kg(-1). h(-1)) altered blood redox status and enhanced performance during intense, intermittent exercise. Eight untrained men participated in a counterbalanced, double-blind, crossover study in which they received NAC or saline (control) before and during cycling exercise, which comprised three 45-s bouts and a fourth bout that continued to fatigue, at 130% peak oxygen consumption. Arterialized venous blood was analyzed for glutathione status, hematology, and plasma electrolytes. NAC infusion induced no severe adverse reactions. Exercise decreased the reduced glutathione (P < 0.005) and increased oxidized glutathione concentrations (P < 0.005); NAC attenuated both effects (P < 0.05). NAC increased the rise in plasma K(+) concentration-to-work ratio (P < 0.05), indicating impaired K(+) regulation, although time to fatigue was unchanged (NAC 102 +/- 45 s; saline 107 +/- 53 s). Thus NAC infusion altered blood redox status during intense, intermittent exercise but did not attenuate fatigue.
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Affiliation(s)
- I Medved
- Muscle, Ions, and Exercise Group, Centre for Rehabilitation, Exercise, and Sport Science, School of Human Movement, Recreation, & Performance, Victoria University of Technology, Victoria, Australia 8001
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