Intermediate monocytes are associated with the first major adverse cardiovascular event in patients with stable coronary artery disease

BACKGROUND

Traditional risk stratification modestly predicts adverse cardiovascular events in patients with coronary artery disease (CAD). Our aim was to investigate the association between monocyte subsets numbers and function, and the first major adverse cardiovascular event (MACE) in patients with symptomatic stable CAD and angiographically documented coronary atherosclerosis.

METHODS

Patients with stable CAD were screened for inclusion. Using flow cytometry, we identified classical, intermediate, and non-classical monocyte subsets and we assessed cytokine production capacity after ex-vivo stimulation of peripheral blood mononuclear cells. Clinical follow-up was performed after four years. The endpoint was the composite of cardiovascular death, acute myocardial infarction, and ischemic stroke.

RESULTS

A cohort of 229 patients was recruited. The percentage of intermediate monocytes was positively associated with adverse cardiovascular events at follow-up (HR 1.09; 95%CI 1.02-1.16; p = 0.006), while the percentage of classical monocytes was identified as a protective factor for adverse outcomes (HR 0.96; 95%CI 0.94-0.99; p = 0.02). The percentage of intermediate monocytes remained independently associated with outcomes after adjusting for age, systolic blood pressure, and left ventricular ejection fraction (HR 1.07; 95% CI 1.01-1.14; p = 0.04). Several correlations were identified between monocyte subsets and stimulated cytokine production, but cytokine production capacity was not associated with adverse outcomes.

CONCLUSIONS

In patients with stable CAD, intermediate monocytes were associated with MACE at follow-up. The association was not due to an increased cytokine production capacity. Novel biomarkers could improve risk stratification in patients with stable CAD and could represent new pharmacological targets against atherosclerosis progression.

Neutrophil Gelatinase-Associated Lipocalin for the Differentiation of Mucinous Pancreatic Cystic Lesions

Undetermined pancreatic cystic lesion (PCL) differentiation benefits from endoscopic ultrasound (EUS) based on morphology and cyst fluid analysis, but room for new biomarkers exists. Our aim was to assess the intracystic and serum diagnostic value of neutrophil gelatinase-associated lipocalin (Ngal) and interleukin 1 beta (IL-1β) for differentiation of PCLs. This prospective study included patients from one tertiary hospital, evaluated between April 2018 and May 2020. EUS fine-needle aspiration or pancreatic pseudocysts drainage was the source of PCL intracystic liquid. The final diagnosis was based on surgery or EUS results (morphology, cytology, glucose, and CEA-carcinoembryogenic antigen). The intracystic samples were tested for Ngal, IL-1β, glucose, and CEA, and serum for Ngal and IL-1β. We evaluated 63 cysts, 33 pseudocysts, and 30 non-inflammatory cysts. The diagnostic sensitivity and specificity for mucinous PCL was 70.8% and 92.3% for intracystic Ngal (cut-off: 500-800 ng/dL), without correlation with serum Ngal, no matter the inclusion of infected pseudocysts. After exclusion of infected pseudocysts, the sensitivity and specificity for glucose were 87% and 75%, respectively, and for CEA, they were 87.1%, and 96.8%, respectively. Intracystic Ngal shows promise in differentiating mucinous PCLs, but researchers need to conduct further studies to confirm its effectiveness. Intracystic IL-1β and serum Ngal made no diagnostic contribution.

The Effect of Rubus idaeus Polyphenols Extract in Induced Endometriosis in Rats

Endometriosis is a common gynecological condition with a complex physio-pathological background. This study aimed to assess the role of Rubus idaeus leaf extract (RiDE) as a potential therapeutic agent in reducing the size of the endometriotic lesions and modulate the plasma expression of MMP-2, MMP-9, and TGF-β1. The endometriotic lesions were induced in a rat model by the autologous transplant of endometrium. Thirty-six female rats, Wistar breed, with induced endometriosis, were divided into four groups and underwent treatment for 28 days. The CTRL group received 0.5 mL/day of the vehicle; the DG group received 1 mg/kg b.w./day dienogest; the RiDG group received 0.25 mL/kg b.w./day RiDE and the D+RiDG group received 1 mg/kg b.w./day dienogest and 0.25 mL/kg b.w./day RiDE, respectively. Rats' weight, endometriotic lesion diameter and grade, and plasma levels of MMP-2, MMP-9, and TGF-β1 were assessed before and after treatment. The administration of RiDE in association with dienogest vs. dienogest determined a lower weight gain and a reduction in diameter of the endometriotic lesions. RiDE administration restored MMP2 and MMP9 plasma levels to initial conditions. Rubus idaeus extract may help in reducing dienogest-associated weight gain, lower the size of endometriotic lesions, and have anti-inflammatory effects through MMP2 and MMP9 reduction.

Zingiber officinale Root Capsule Extract Synergistically Enhance the Anti-Inflammatory Effects of Diclofenac Sodium in Experimental Acute Inflammation

The present study aimed to evaluate the anti-inflammatory effects of ginger (Zingiber officinale) root capsule extract (GRCE) in doses of 100 mg/kg b.w. (body weight) and 200 mg/kg b.w. alone and in combination with a low dose (5 mg/kg b.w.) of diclofenac sodium (D) on carrageenan-induced acute inflammation (AI). The association of GRCE in a dose of 200 mg/kg b.w. with D offered the highest inhibition percentage for edema, reaching the maximum level of inhibition (95%) after 24 h. The association of GRCE in a dose of 200 mg/kg b.w. with D showed the ability to reduce tissue inflammatory changes when compared to D alone, while GRCE alone did not exhibit such properties. The association of both doses of GRCE with D showed significantly lower plasma and tissue levels of pro-inflammatory cytokines such as tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-1β (IL-1β) by up to 55% (p ≤ 0.0317), with the best results obtained by the group who received GRCE in the higher dose. These associations reduced the serum and tissue levels of prostaglandin-endoperoxide synthase 2 (COX-2) by up to 71% (p ≤ 0.0371). In conclusion, the association of GRCE with a low dose of D could be an appropriate combination to decrease the dose used to reduce serum and tissue levels of inflammatory molecules, edema, and histological changes in acute inflammation. Further research will be necessary to achieve clinical evaluation.

Efficacy of Handheld Ultrasound in Medical Education: A Comprehensive Systematic Review and Narrative Analysis

Miniaturization has made ultrasound (US) technology ultraportable and, in association with their relatively low cost, made handheld devices attractive for medical education training programs. However, performing an ultrasound requires complex skills, and it is unclear whether handheld devices are suitable for the training of novices. Our study aimed to identify to what extent handheld US devices can be employed in medical undergraduates' and residents' education. We selected studies that evaluate the results obtained by students and/or residents who have participated in ultrasound training programs using handheld devices. The studies were included if they reported post-test (pre-test optional) achievements or a comparison with a control group (a group of experts or novices who underwent a different intervention). Twenty-six studies were selected, and their characteristics were summarized. Handheld ultrasound devices were used in training programs to learn echocardiography, abdominal, and/or musculoskeletal ultrasound. Statistically significant progress was noted in the ability of naïve participants to capture and interpret ultrasound images, but training duration influenced the outcomes. While ultrasound training using handheld devices has proven to be feasible for various body regions and purposes (e.g., better understanding of anatomy, clinical applications, etc.), the long-term impacts of handheld education interventions must be considered in addition to the short-term results to outline guidelines for targeted educational needs.

Anti-inflammatory and antioxidant efficacy of lavender oil in experimentally induced thrombosis

BACKGROUND

Lavender oil (LO) possesses anti-inflammatory, antioxidant, antifungal, antibacterial, sedative, cardio-protective, and antinociceptive properties. Thrombosis and inflammation are interplayed processes that interact and influence one another. Our research compared three routes of administration to assess the efficacy of pretreatment with LO on carrageenan-induced thrombosis in rat tail.

MATERIALS AND METHODS

Wistar-Bratislava white rats were randomly divided into five groups of ten rats each and pretreated 3 consecutive days prior the inducement of thrombosis to with one dose of LO (150 mg/kg body weight (b.w.)): per os by gavage (TLOPO group), intraperitoneal (TIPLO group) and subcutaneous (TSCLO group). We also have a control (C, received saline solution 0.9% and DMSO (vehicle) 1 ml intraperitoneal (i.p.)) group and a group with thrombosis (T group, received saline solution 0.9% plus vehicle 1 ml i.p.). Histopathological examinations were conducted together with measurements of the circulating levels of three oxidative stress markers, antioxidant effect (TAC and THIOL), and three proinflammatory cytokines (TNF- α, RANTES, and MCP-1).

RESULTS

When administered intraperitoneally, lavender oil has the best efficacy on circulating levels of oxidative stress parameters (MDA, NOx, TOS), one oxidative stress marker (THIOL), and all studied proinflammatory cytokines (p-values < 0.02). Moreover, TIPLO displayed the closest values for bleeding and clotting time to the C group, as well as the lowest length of the thrombus than the T, TPOLO, and TSCLO groups (p-values < 0.001). The TIPLO group has histological appearance comparable to the C group, with the exception of the presence of oedema.

CONCLUSIONS

Lavender oil pretreatment with intraperitoneal administration as three days, one-dose per day, showed anti-inflammatory and antioxidant efficacy in experimentally induced thrombosis.

Identification of Histopathological Biomarkers in Fatal Cases of Coronavirus Disease: A Study on Lung Tissue

We aimed to evaluate the primary lung postmortem macro- and microscopic biomarkers and factors associated with diffuse alveolar damage in patients with fatal coronavirus (COVID-19). We retrospectively analyzed lung tissue collected from autopsies performed in Cluj-Napoca, Romania, between April 2020 and April 2021 on patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We examined 79 patients with confirmed SARS-CoV-2 infection, ages 34 to 96 years, split into two groups using the cut-off value of 70 years. Arterial hypertension (38%) and type 2 diabetes mellitus (19%) were the most common comorbidities with similar distribution between groups (p-values > 0.14). Macroscopically, bloody exudate was more frequently observed among patients < 70 years (33/36 vs. 29/43, p-value = 0.0091). Diffuse alveolar damage (53.1%) was similarly observed among the evaluated groups (p-value = 0.1354). Histopathological biomarkers of alveolar edema in 83.5% of patients, interstitial pneumonia in 74.7%, and microthrombi in 39.2% of cases were most frequently observed. Half of the evaluated lungs had an Ashcroft score of up to 2 and an alveolar air capacity of up to 12.5%. Bronchopneumonia (11/43 vs. 3/36, p-value = 0.0456) and interstitial edema (9/43 vs. 2/36, p-value = 0.0493) were significantly more frequent in older patients. Age (median: 67.5 vs. 77 years, p-value = 0.023) and infection with the beta variant of the virus (p-value = 0.0071) proved to be significant factors associated with diffuse alveolar damage.

Ginger (Zingiber officinale) Root Capsules Enhance Analgesic and Antioxidant Efficacy of Diclofenac Sodium in Experimental Acute Inflammation

Our study aimed to evaluate the analgesic and antioxidant effects of ginger (Zingiber officinale) root capsule extract (GRCE) in addition to diclofenac (D) sodium treatment in carrageenan-induced acute inflammation (AI). Seven groups of eight Wistar-Bratislava white rats were included in the study. One group was the control (C), and AI was induced in the other six groups. The following treatments were applied: saline solution for C and AI groups, D for the AID group, GRCE for two groups and GRCE and D for another two groups. The GRCE was administered by gavage in two doses (100 mg/Kg b.w. or 200 mg/kg b.w.), while D was administered intraperitoneally in a dose of 5 mg/kg b.w. The association of GRCE with this low dose of diclofenac reduced pain threshold and improved mobility with the best results for the dose of 200 mg/kg b.w. Moreover, this combination reduced, better than D alone, the serum levels of the evaluated pro-oxidant parameters (malondialdehyde, the indirect assessment of NO synthesis, total oxidative status and oxidative stress index) up to 78%, especially oxidative stress index (p < 0.0001). GRCE alone slightly improved the antioxidant parameters (total antioxidant capacity and total thiols), but when associated with, D the results were better, especially for total thiols as their plasma levels increased up to 50% (p < 0.0010), with the best results obtained for the 200 mg/kg b.w. dose of GRCE. In conclusion, ginger root capsules associated with diclofenac might offer additional antioxidant and analgesic effects in a dose-dependent manner in acute inflammation.

Exploratory Evaluation of Neopterin and Chitotriosidase as Potential Circulating Biomarkers for Colorectal Cancer

Chronic inflammation is demonstrated to play a direct role in carcinogenesis. Our exploratory study aimed to assess the potential added value of two inflammation biomarkers, chitotriosidase and neopterin, in follow-up evaluation of patients with colorectal cancer (CRC). An observational exploratory study was conducted. Patients with CRC and matched controls (1:1, age, sex, and living environment) were evaluated. The patients with CRC (CRC group) and controls were assessed at baseline (before surgical intervention for patients with CRC). Patients with CRC were also evaluated at 1-year follow-up. Significantly more patients with blood group A (54.5% vs. 25.0%) and smokers (50.0% vs. 22.7%) were in the CRC group. The serum values of chitotriosidase and neopterin were higher in CRC patients than in controls, but only neopterin reached the conventional level of statistical significance (p-value = 0.015). The circulating chitotriosidase and neopterin values decreased significantly at 1-year follow-up (p-value < 0.0001). Patients with higher N- and M-stage showed statistically significant higher levels of chitotriosidase and neopterin at baseline and 1-year follow-up (p-values < 0.03). Circulating chitotriosidase levels also showed statistically significant differences regarding baseline and 1-year follow-up on patients with CRC and different differentiation grades (p-values < 0.02). The circulating levels of neopterin significantly decreased at 1-year follow-up, indicating its potential as a prognostic marker. The circulating values of chitotriosidase and neopterin exhibit significant differences in patients with than without recurrences. Our results support further evaluation of chitotriosidase and neopterin as prognostic markers in patients with CRC.

Endoscopic Ultrasound-Guided Fine-Needle Biopsy versus Fine-Needle Aspiration in the Diagnosis of Focal Liver Lesions: Prospective Head-to-Head Comparison

Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) or fine-needle aspiration (EUS-FNA) from focal liver lesions are indicated in selected cases, but there has been no previous comparison of needle types of the same size. The aim of our study was to compare the histologic diagnostic accuracy and adequacy of cores obtained with EUS-FNB needles in contrast to those obtained with FNA needles in focal liver lesions. This prospective one-center study included patients with left lobe hepatic focal lesions with contraindications for percutaneous liver biopsy or need for EUS for concomitant lesions. Each patient had one pass of 22G EUS-FNB (Franseen) needle and one pass of 22G EUS-FNA in a crossover manner, without macroscopic on-site evaluation. Each sample was analyzed separately for histologic adequacy and diagnosis. The final diagnosis was based on histology results or on imaging follow-up in the case of negative biopsies. The EUS-FNB samples (n = 30) were found to be more adequate for histologic analysis, with more cellularity and longer tissue aggregates than the EUS-FNA samples (n = 30). The accuracy of EUS-FNB was 100%, whereas that of EUS-FNA was 86.7% (p = 0.039). No post-procedure complications were noted. The 22G EUS-FNB needle proved superior to 22G EUS-FNA in terms of tissue acquisition diagnostic accuracy and histologic adequacy in focal liver lesions.

Evaluation of Circulating Chitotriosidase Activity in Children with Obesity

Childhood obesity progresses to metabolic disturbances via low-grade inflammation. Identifying novel molecules that reflect the activity of the immune responses is critical in understanding its underlying pathogenesis. Our exploratory study aimed to evaluate the change of chitotriosidase (CHIT1) plasma activity according to Body Mass Index (BMI)-for-age z score in pediatric patients. The study evaluated 68 children consisting of 47.1% girls with a mean age of 12.47 ± 3.71 years and 52.9% boys with a mean age of 11.93 ± 3.18 years. The effect of the most frequent CHIT1 gene variants, the 24 base pair duplication (dup24) and G102S polymorphism, upon the association between circulating CHIT1 activity and the obesity level, was also investigated. A significantly higher logCHIT1 plasma activity was found in children with extreme obesity than in children with overweight (p = 0.048 for the uncorrected CHIT1 and 0.026 for the corrected CHIT1). The BMI-for-age z score significantly (p = 0.031) predicts increased CHIT1 activity in children with overweight, obesity, and extreme obesity after controlling for the two gene variants, age, gender, and time since weight gain. Dup24 and G102S polymorphism were significant independent predictors (p-values < 0.002) for the change of CHIT1 plasma activity. Circulating CHIT1 might be an accurate indicator of inflammation in children with obesity. Its role and the effect of the dup24 and G102S variants on the CHIT1 activity should be validated in a larger cohort.

Performances of Corneal Topography and Tomography in the Diagnosis of Subclinical and Clinical Keratoconus

Aim

The purpose of the study was to assess the efficacy of topographical and tomographical indices given by the Pentacam (pachymetric, tomopetric, and aberometric) in clinical and subclinical keratoconus (KCN) diagnosis.

Material and Methods

In this observational analytic retrospective study, patients with abnormal findings in topography and tomography maps but with no signs on clinical examination (subclinical KCN group, sKCN), patients with clinical keratoconus (KCN group), and healthy subjects (Control group) were evaluated.

Results

The KCN group proved significantly different (p < 0.001) values of the investigated parameters than the Control group. Eleven out of 28 investigated parameters proved significantly different in the sKCN group compared to controls (p < 0.001). Two topographic measurements, namely I-S (cut-off = 1.435, a large value indicates the presence of KCN) and CCT (cut-off = 537, a small value indicates the presence of KCN), showed AUCs equal to 1 [0.999 to 1]. Six other Pentacam measurements, including Back maximum keratometry (Back Kmax) proved to be excellent parameters for case-finding and screening. In distinguishing sKCN from normal eyes, Pentacam index of vertical asymmetry (IVA), inferior-superior difference (I-S) value, thinnest point (TP), Belin Ambrosio Enhanced Ectasia Display (BAD_D) and root mean square total (RMS total) performed best.

Conclusions

In distinguishing sKCN from normal eyes, Back Kmax, IVA, I-S, and RMS total values demonstrated higher accuracy and utility. Six indices, namely ISV, IVA, KISA, PRC, RMS-HOA, and Back Kmax demonstrate excellent utility in case-finding and screening for clinical KCN.

Association of Parental Factors and Insulin-like Growth Factor 2 Polymorphism with Intrauterine Growth Restriction

Polymorphism of insulin-like growth factor 2 (IGF2) is known to play a role in cell development. Only the paternal IGF2 copy is active, while the copy inherited from the mother is inactive. This study aimed to explore whether maternal and paternal factors influence IGF2 polymorphism in newborns with intrauterine growth restriction (IUGR) compared to appropriate for gestational age (AGA). A cross-sectional exploratory study was conducted from June 2014 to November 2015 at the Neonatology, Gynecology 1 Clinic, Cluj-Napoca, Romania. The ApaI IGF2 genotypes and allele frequencies were similar in the IUGR and AGA groups (p-value > 0.10). The IUGR babies with a protective IGF2 genetic profile had significantly younger parents (a difference in the median age of 8 years for mothers and 9 years for fathers; p-value < 0.009). The IUGR babies had parents with lower birth weights than AGA babies (mothers’ medians: 2800 g vs. 3100 g; fathers’ medians: 3000 g vs. 3400 g; p-value < 0.02). In univariable regression analysis, the mother’s and father’s birth weight proved to be associated with IUGR. The father’s birth weight proved to be the only factor significantly associated with IUGR, independent of the mother’s birth weight or the presence of a protective IGF2 genetic profile (odd ratio = 0.998 [0.996 to 1.000], p-value = 0.032).

Effectiveness of Ultrasound Cardiovascular Images in Teaching Anatomy: A Pilot Study of an Eight-Hour Training Exposure

The present study aimed to evaluate the students’ progress in evaluating ultrasound (US) and cadaveric cardiac images and long-time retention of information. First-year medical students were invited to participate in four two-hour online lectures during one week voluntarily. The students were trained to recognize cardiovascular anatomical structures on US and cadaveric images during the intervention. The participants’ abilities to identify specific anatomical structures were tested before, immediately after and six months after the training. A group of second-year students without US training participated as a control group and filled the same test once. Ninety-one first-year students agreed to participate, and forty-nine completed all three tests. The performances in the correct identification of cardiovascular structures on the US images significantly improved after the training but significantly decreased after six months. In the intervention group, the accurate identification of cardiovascular structures was significantly higher on cadaveric images (80% vs. 53%, p-value < 0.0001, n = 91 at post-training; 70% vs. 33%, p-value < 0.0001, n = 49 at 6 months after training). The correct answers percentage score in the control group varied from 6.7% to 66.7% for US cardiovascular anatomical without a significant difference than the intervention group (p-value = 0.7651). First-year students’ knowledge of heart US anatomy proved less effective than cadaveric images, significantly improved after training and decreased over time, indicating the need for repetition reinforcement.

Protective Effect of Liposomal Epigallocatechin-Gallate in Experimental Gentamicin-Induced Hepatotoxicity

Our study aimed to assess the effect of liposomal epigallocatechin-gallate (LEGCG) compared with epigallocatechin-gallate (EGCG) solution on hepatic toxicity induced by gentamicin (G) administration in rats. Five groups were evaluated, a control group (no G administration) and four groups that received G (1 mL, i.p, 80 mg/kg b.w. (body weight/day), for 7 days) to which we associated daily administration 30 min before G of EGCG (G-EGCG, 2.5 mg/0.1 kg b.w.), LEGCG (G-LEGCG, 2.5 mg/0.1 kg b.w.) or silymarin (100 mg/kg b.w./day). The nitro-oxidative stress (NOx), catalase (CAT), TNF-α, transaminases, creatinine, urea, metalloproteinase (MMP) 2 and 9, and liver histopathological changes were evaluated. LEGCG exhibited better efficacy than EGCG, improving the oxidant/antioxidant balance (p = 0.0125 for NOx and 0.0032 for CAT), TNF-α (p < 0.0001), MMP-2 (p < 0.0001), aminotransferases (p = 0.0001 for AST and 0.0136 for ALT), creatinine (p < 0.0001), urea (p = 0.0006) and histopathologic liver changes induced by gentamicin. Our study demonstrated the beneficial effect of EGCG with superior results of the liposomal formulation for hepatoprotection in experimental hepatic toxicity induced by gentamicin.

Direct Comparison of Elastography Endoscopic Ultrasound Fine-Needle Aspiration and B-Mode Endoscopic Ultrasound Fine-Needle Aspiration in Diagnosing Solid Pancreatic Lesions

Elastography endoscopic ultrasound (E-EUS) has been proved to be a valuable supplement to endoscopic ultrasound fine-needle aspiration (EUS-FNA) in differentiating solid pancreatic lesions, but the improvement of EUS-FNA guided during E-EUS has not been proven. Our study aimed to evaluate whether E-EUS fine-needle aspiration (E-EUS-FNA) was superior to B-mode EUS-FNA for the diagnosis of solid pancreatic masses and whether the diagnostic rate was affected by specific factors. Our prospective study was conducted between 2019-2020 by recruiting patients with solid pancreatic masses. E-EUS examination was followed by one pass of E-EUS-FNA towards the blue part of the lesion and a second pass of EUS-FNA. The final diagnosis was based on surgery, E-EUS-FNA or EUS-FNA results, or a 12-month follow-up. Sixty patients with solid pancreatic lesions were evaluated. The sensitivity, specificity, and accuracy for diagnosing malignancy using E-EUS-FNA and EUS-FNA were 89.5%, 100%, 90%, 93%, 100%, and 93.3%, respectively, but the differences were not significant. Neither mass location nor the lesion size influenced the results. The lengths of the core obtained during E-EUS-FNA and EUS-FNA were similar. E-EUS-FNA in solid pancreatic lesions was not superior to B-mode EUS-FNA.

The effect of the learning curve on paravalvular aortic regurgitation and mid-term mortality in transfemoral transcatheter aortic valve implantation

OBJECTIVE

Paravalvular aortic regurgitation is an important independent mortality predictor in transcatheter aortic valve implantation (TAVI). Our study evaluated the association between paravalvular aortic regurgitation and mid-term mortality in relation with the learning curve, in patients with severe aortic stenosis who underwent transfemoral TAVI in the first 3 years since the establishment of the program.

METHODS

Patients with severe aortic stenosis who underwent transfemoral TAVI between 2017 and 2020 were included in the analysis. Paravalvular aortic regurgitation was assessed by transthoracic echocardiography at 48 hours after the procedure. All-cause mortality was evaluated after 30 days and at mid-term follow-up.

RESULTS

Paravalvular aortic regurgitation ≥grade II was associated with mid-term all-cause mortality (OR 4.4; 95%CI 1.82-11.55; p < 0.001), their prevalence declining after the first 60 cases. Baseline characteristics did not significantly differ in the first 60 patients from the rest of the cohort. Male sex (p = 0.006), advanced age (p = 0.04), coronary artery disease (p = 0.003), or elevated STS Score (p = 0.02) influenced mid-term survival. When adjusting for the presence of these factors, only age (OR 1.1; 95%CI 1.0-1.2), paravalvular aortic regurgitation ≥grade II (OR 3.9; 95%CI 1.3-12.9), and the number of days spent in the intensive care unit (OR 1.4; 95%CI 1.1-1.8) were independent predictors of mid-term all-cause mortality.

CONCLUSIONS

In a group of patients with severe aortic stenosis who underwent transfemoral TAVI in the first 3 years since the establishment of the program, paravalvular aortic regurgitation ≥grade II was associated with mid-term mortality, both declining after the first 60 cases.

One year outcomes after small incision lenticule extraction ReLEX in the correction of myopia and myopic astigmatism

Purpose

To report the visual and refractive outcomes of small incision lenticule extraction ReLEX (SMILE) technique using VisuMax femtosecond laser in myopia and myopic astigmatism patients.

Material and methods

A non-randomized clinical study has been conducted on patients with myopia and myopic astigmatism who underwent ReLEX SMILE technique, using the Zeiss VisuMax Laser system (Carl Zeiss Meditec AG, Jena, Germany) at Oculens Clinic, Cluj-Napoca, Romania. Patients older than 18 years, with ocular astigmatism up to -5 diopters (D), spherical equivalent up to -10.00 D, corrected distance visual acuity (CDVA) of 0.3 or better before the surgery, stable refraction for one year, and with a minimum calculated post operator residual stromal bed of 250μ were included in the study.

Results

The study involved a total of 25 myopic eyes (median of sphere diopters equal with -4D) and 67 myopic astigmatic eyes (median of cylinder diopters equal with -1.5 D). The mean refractive spherical equivalent (MRSE) on patients with myopic eyes reduced from -4.25D (median) to -0.5D at one month follow-up, -0.25 D at 6 and 12 months. The mean refractive spherical equivalent (MRSE) on patients with astigmatic myopic eyes reduced from-6.25 D to -0.67 D at one month, -0.62 D at six and twelve months. The value of sphere decreased postoperatively on myopic eyes with a median of -0.25D at one, six and twelve months. The value of cylinder decreased postoperatively on myopic astigmatic eyes with a median of -0.50 D at one month, -0.25 D at six months and -0.50 D at 12 months. At 6 and 12 months, 20 (80.0%) of myopic eyes were maintained within ±0.5 D and 22 (88.0%) with ±1D. On both groups (myopic eyes and myopic astigmatic eyes), statistically significant differences were observed when the keratometric baseline values were compared to each follow-up (P-values < 0.0001), without any significant differences between follow-ups (P-values>0.15). At 1-month follow-up, uncorrected distance visual acuity (UDVA) was better than or equal to 0.5 in 88.0% of myopic eyes and 82.1% of myopic astigmatic eyes. UDVA remained stable in all cases of myopic eyes at six months and the percentage increased at 92.0% in myopic eyes. UDVA slightly increased at 6-months (85.1%) and remained at the same value at 12-months in myopic astigmatism eyes.

Conclusions

SMILE proved an effective and safe refractive corneal procedure and provided a predictable and stable correction of myopia and myopic astigmatism. SMILE technique demonstrated very good outcomes in terms of keratometric, cylinder, spherical measurements.

Evaluation of several serum interleukins as markers for treatment effectiveness in naïve HIV infected patients: A pilot study

In this observational pilot study, we investigated the impact of Dolutegravir, Raltegravir, Elvitegravir (Integrase Strand Transfer Inhibitors, INSTIs), or boosted Darunavir (a Protease Inhibitor, PI) in combination with two nucleoside reverstranscriptase inhibitors (Emtricitabine/Tenofovir disoproxil or Lamivudine/Tenofovir disoproxil, NRTI) on four interleukins (IL-4, IL-10, IL-13, and IL-21) as immune activation markers in naïve HIV(Human Immunodeficiency Virus)-infected patients during the first six months of combined standard-of-care antiretroviral therapy (cART). Newly diagnosed with HIV-infected subjects and without any disease that could affect the immune activation markers were evaluated. The patients’ physicians recommended the cART as standard-of-care and the ILs were measured before cART and six months of cART. The levels of CD4⁺ T-cells count and CD4⁺/CD8⁺ ratio significantly increased at six months (P-value<0.02) regardless of the drugs, INSTIs or PI. However, a CD4⁺/CD8⁺ >1 was observed in 25% of patients treated with Raltegravir and half of those treated with Dolutegravir. At six months of cART, viral load was detectable in only 6/31 individuals. IL-21 had an undetectable level in 30/31 patients after six months of cART. Our results suggest the potency in restoring immune markers in HIV-infected patients with all investigated drugs. Dolutegravir showed a tendency to statistically significant changes in IL-4 and IL-10. A clinical trial with random allocation of medication and an extensive follow-up is needed to replicate this research and validate the usefulness of evaluated ILs as markers of cART effectiveness.

Continuum of Care UNAIDS Fast-Track Targets Evaluation of Patients Living with Human Immunodeficiency Virus Infection

The current study evaluated the progress of continuum healthcare for patients living with human immunodeficiency virus (HIV) infection from Cluj County in two moments, 2016 and 2020, and compared the results to the Fast-Track targets (FTTs) proposed by the Joint United Nations Programme (UNAIDS) on HIV/AIDS. By the end of 2020, 368 out of 385 confirmed HIV-positive patients from Cluj County were under surveillance in our center, representing almost 95% of the patients living with HIV and knowing their diagnosis, compared to 87.9% in 2016. Nearly 97% of those in active follow-up from Cluj County were under antiretroviral therapy (ART) in 2020, compared to 89% in 2016. The number of virally suppressed patients from those under ART was almost 94% in 2020, compared to 82.7% in 2016, and the increase is observed regardless of the ART regime. A shift towards integrase strand transfer inhibitors, with a higher efficacy, fewer adverse effects, and fewer drug interactions, is observed, which could contribute to the decrease in HIV transmission.

Feasibility of a pilot study on point-of-care biomarkers in spontaneous intracerebral hemorrhage in an emergency setting

Background and aims

Stroke is a worldwide leading cause of death and disability and spontaneous intracerebral hemorrhage (sICH) has significant economic and social impact, regardless of recent efforts towards outcome-bettering acute interventions. The aim of the study was to assess the feasibility of a prospective observational research regarding point-of-care (POC) biomarkers in sICH, conducted in a level one emergency department (ED).

Methods

Patients with acute (<8 hours) sICH were enrolled in this study. Patients presenting a Glasgow Coma Scale score <8, secondary causes of intracerebral hemorrhage, seizures, recent ischemic events, known thromboembolic disease, anticoagulant treatment, severe pre-stroke disability, terminal disease, scheduled neurosurgery/hemostatic treatment were excluded. Feasibility was defined as ED inclusion and follow-up rates, time-to-inclusion, and frequency of missing data. Baseline demographic, imaging and POC biochemical status of the study group were documented, including inflammatory (complete blood count, C-reactive protein), metabolic (glucose, hepatic, and renal function) and cardiovascular markers (cardiac troponin I, D-dimer).

Results

The inclusion rate was 2.16 patients/month with a final sample of 35 patients out of 239 potentially eligible patients. The median time from symptom onset to ED presentation was 128 minutes (IQR 96-239), with 21/35 patients having presented within the first 3 hours from ictus. Median times between symptoms' onset to Computer Tomography (CT) scan and ED presentation to CT scan were 170 minutes (IQR 126-317) and 25 minutes (IQR 17-62), respectively. The median time from patient's presentation to CBC result was 12 minutes (IQR 6.5-20), with 21/35 study participants having the results available within 15 minutes from ED arrival. The median cohort age was 72-years, with a 19/16 male/female ratio. Hypertension was the most frequent risk factor (77%), along with ischemic heart disease (31%) and diabetes (29%). One-third of the hypertensive patients did not undergo blood pressure lowering treatment. Median values of POC biomarkers on ED admission were within normal range.

Conclusions

It was feasible to determine point-of-care biomarkers in spontaneous intracerebral hemorrhage on admission in ED, despite the urgency of the medical condition.

Hand-Held Ultrasound of the Lung: A Systematic Review

BACKGROUND

The ultrasound examination is a surface technique with an accurate diagnosis of pathological processes adjacent to the pleural line. The purpose of the study was to evaluate the role of hand-held ultrasound devices (visual stethoscopes) in the diagnosis of peripheral lung disease.

METHODS

We conducted a systematic search of literature comparing the diagnostic accuracy of truly hand-held ultrasound devices compared to conventional high-end ultrasound devices, chest X-rays, thoracic CT (computer tomography), or physical examinations to diagnose peripheral lung lesions. ScienceDirect, PubMed, and PubMed Central bibliographic databases were searched within a time limit of 15 years.

RESULTS

The applied search strategy retrieved 439 studies after removing duplicates; 34 were selected for full-text review, and 15 articles met all inclusion criteria and were included in the analysis. When comparing hand-held ultrasound devices to chest X-rays, negative predictive values were above 90%, while positive predictive values tended to be lower (from 35% to 75.8%). Hand-held ultrasound reached a correlation of 0.99 as associated with conventional ultrasound with a Bland-Altman bias close to zero.

CONCLUSIONS

Being accessible, radiation-free, and comparatively easy to decontaminate, hand-held ultrasound devices could represent a reliable tool for evaluating peripheral lung diseases. This method can be successfully employed as an alternative to repeated X-ray examinations for peripheral lung disease monitoring.

The Pattern of Calculated Inflammation Ratios as Prognostic Values in Patients with Colorectal Cancer

AIM

In this study, we evaluated the prognostic value of four calculated inflammatory ratios in patients with colorectal cancer.

MATERIALS AND METHODS

A six-year retrospective study was conducted on subjects admitted for colorectal cancer at "Prof. Dr. Octavian Fodor" Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Romania, from January 2014 until September 2019. The medical charts of patients diagnosed with colorectal cancer were used as the source of raw data and for the calculation of four ratios (neutrophil-to-lymphocyte ratio-NLR, derived neutrophil-to-lymphocyte ratio-dNLR, platelet-to-lymphocyte ratio-PLR, and systemic immune-inflammation index-SII), considered as prognostic markers related to mortality in colorectal cancer.

RESULTS

One thousand six hundred and eighty-eight patients, with ages ranging from 17 to 98 years, were evaluated. NLR and dNLR displayed significantly higher values among patients who died (NLR: 4.2 for deceased vs. 3.4 for alive, P-value=0.0224; dNLR: 2.7 for deceased vs. 2.3 for alive, P-value=0.0566). Ischemic cardiomyopathy (odds ratio (OR)=2.70), liver cirrhosis (OR=7.84), post-operative complications (OR=2.39), and neutrophil-to-lymphocyte ratio (OR=1.08) proved to be significant prognostic factors for the primary outcome, independent of age and gender.

CONCLUSION

Patients with high NLR, post-operative complications, ischemic cardiomyopathy, and/or liver cirrhosis are the candidates to a less favorable outcome among subjects with colorectal cancer regardless the age and gender.

Comparing the First and Second Wave of COVID-19 in Kidney Transplant Recipients: An East-European Perspective

Background

The present study examined whether patient characteristics, management, and outcome of kidney transplant recipients (KTx) with COVID-19 changed in the second versus the first pandemic wave.

Methods

We reviewed all available data (demographics, medical history, comorbidities, therapeutic interventions, and outcome) on our KTx with COVID-19 during the first wave (March–September 2020, n = 33) and the second wave (October 2020–February 2021, n = 149) of the COVID-19 pandemic.

Results

One hundred eighty-two out of our 1,503 KTx in active follow-up got COVID-19 during 12-month period, corresponding to a prevalence of 12.1%. No difference was found in age, gender distribution, comorbidities, body mass index, or baseline immunosuppression between the 2 COVID-19 waves. Bilateral COVID pneumonia was more frequent during the first wave. More KTx were managed as outpatients during the second wave (15 vs. 39%, p < 0.01). Calcineurin inhibitors were more sparingly reduced during the second wave, whereas antimetabolites were similarly reduced (91 vs. 86, p = ns). Admission to intensive care units was comparable between the first (27%) and second waves (23%). During the first wave, 8 out of 9 patients (89%) requiring intensive care died, whereas the mortality of the ICU patients in the second wave was 68% (23 deaths) (p = 0.2). The overall mortality was 24% during the first wave and 16% during the second wave (p = 0.21), while in-hospital mortality was identical between the CO­VID-19 waves (27%). Increasing age and poor allograft function were significant predictors of mortality.

Conclusions

Most patient characteristics and outcome were comparable between the first 2 COVID-19 waves. More KTx were managed as outpatients without an overall negative impact on outcome.

Risk factors for positive sentinel lymph node, lymphatic or hematogenous dissemination over time in patients with cutaneous melanoma

The aim of the present study was to assess the influence of localization, age or sex and histopathological characteristics upon the chance of developing lymphatic or hematogenous metastatic spread over time, or a positive sentinel lymph node in cutaneous melanoma patients. Patients from the Department of Dermatology, County Emergency Hospital Cluj-Napoca (Cluj-Napoca, Romania), presenting with cutaneous melanoma confirmed histopathologically and a SPECT/CT or lymphoscintigraphic examination to detect the sentinel lymph node, were included in the present study. Our results revealed that Breslow index >2 mm [odds ratio (OR)=4.22, 95% confidence interval (CI) (1.12; 15.93)], presence of ulceration [OR=6.01, 95% CI (1.87; 19.35)], and positive sentinel lymph node [for at least one sentinel lymph node OR=3.58, 95% CI (1.06; 12.04)] were risk factors for hematogenous metastases. All these, except for the Breslow index >2 mm, were demonstrated to be a risk factor for lymphatic spread metastases over time. Ulceration and male sex also represented risk factors for a positive sentinel lymph node, men having a higher risk of developing sentinel lymph nodes than women [adjusted OR=2.27, 95% CI (1.00; 5.13)]. In conclusion, the predictors that influence the occurrence of lymphatic or hematogenous metastases may differ, ulceration and positive sentinel lymph node being common for both types of metastatic spread, while Breslow index being a significant predictor only for hematogenous metastases. Male sex and the presence of ulceration were demonstrated to be significant risk factors for positive sentinel lymph nodes.

Lockdown, Social Media exposure regarding COVID-19 and the relation with self-assessment depression and anxiety. Is the medical staff different?

INTRODUCTION

Locking the humanity in their homes, COVID-19 forced people to use the technology at hand to keep informed about the outbreak and to keep close to their loved ones. During this time, even if physical health is theoretically unaffected, keeping calm and sane can be challenging. The aim of this research was to evaluate whether exposure to COVID-19 information available in the digital space has a different impact on the mental condition of Romanian medical staff, compared with the general population, particularly searching for depression and anxiety symptoms.

MATERIALS AND METHODS

An online survey was conducted from April 6 to 16, 2020 within the Romanian users of Social Media platforms. The questionnaire assessed depression with the WHO-Five Well-Being Index, anxiety with the Generalised Anxiety Disorder Scale and Social Media exposure by asking how often the respondents saw COVID-19 related information on the most popular Social Media channels in Romania. Information about: gender, age, educational level, occupation, area of living and risk category was also collected. The risk categories were defined as no risk, medium risk and medical staff.

RESULTS

Almost 90% of the 402 participants received daily through at least one Social Media channel information related to the COVID-19 outbreak. Social Media Exposure significantly associated with the risk group only for Facebook and LinkedIn. However, exposure to information regarding COVID-19 was neither associated with anxiety nor depression. No significant association was identified neither between age class and self-assessed anxiety nor self-assessed depression. The self-assessment of depression was significantly more frequent as compared with the self-assessment of anxiety.

CONCLUSION

The results of this research are opposite to most of the already published literature. Depression and anxiety could not be correlated with the context of lockdown and excessive COVID-19-related information.

Abilities of Pre-Treatment Inflammation Ratios as Classification or Prediction Models for Patients with Colorectal Cancer

Background: Systemic inflammatory status is known as an important factor of colorectal cancer prognosis. Our study aimed to evaluate the performances of inflammation biomarker ratios as classification models of seven outcomes in patients with colorectal cancer. Methods: A retrospective cohort study was conducted on subjects with colorectal cancer over five years at a single center in Transylvania, Romania. Seven derived ratios were calculated based on laboratory data: neutrophil-to-lymphocyte (NLR), derived neutrophil-to-lymphocyte (dNLR), platelet-to-lymphocyte (PLR), lymphocyte-to-monocyte (LMR) and albumin-to-globulin (AGR) ratios, Systemic Immune Inflammation Index (SII) and Prognostic Nutritional Index (PNI). The utility of these ratios as predictors for seven outcomes was further evaluated in multivariable regression models. Results: Our study shows that the evaluated ratios exhibit specific performances for individual outcomes, proving a fair ability as screening tools (NLR and dNLR for survival, T stage and M stage; NLR and SII for T stage; and PLR for M stage). A dNLR over 3.1 (OR = 2.48, 95% CI (1.421 to 4.331)) shows predictive value for survival. A value of NLR over 3.10 (OR = 1.389, 95% CI (1.061 to 1.817)) is positively associated with an advanced T stage, while LMR is negatively related to the T stage (OR = 0.919, 95% CI (0.867 to 0.975)). NLR over 4.25 (OR = 2.647, 95% CI (2.128 to 3.360)) is positively associated with, while PNI is negatively related (OR = 0.970, 95% CI (0.947 to 0.993)) to, the M stage. Conclusion: Each of the evaluated ratios possesses prognostic value for certain outcomes considered, but the reported models need external validation to recommend their clinical practice utilization.

Interplay between metabolic and thyroid parameters in obese pubertal children. Does visceral adipose tissue make the first move?

Objectives: The mechanisms of obesity-associated thyroid dysfunction in children are incompletely deciphered. We aimed to evaluate whether visceral adipose tissue (VAT), insulin resistance (IR), inflammation, oxidative stress (OS) are involved in thyroid morpho-functional changes in pubertal obese children. Methods: We recruited 43 obese pubertal children without history of thyroid pathology. Metabolic and thyroid parameters (visceral fat thickness [VFT], waist/hip ratio [WHR], waist/height ratio [WHtR], insulin, glucose, liver parameters, thyroid stimulation hormone [TSH], free thyroxine [FT4], free triiodothyronine [FT3], thyroid and abdominal ultrasonography) were evaluated. Serum monocyte chemoattractant protein-1 (MCP-1) and malondialdehyde (MDA) levels were quantified as markers of inflammation and OS. Results: VFT correlated positively both with WHR (p= 0.034) and the presence of thyroid nodules (p= 0.036). WHR associated with TSH (p= 0.005), FT3/FT4 (p= 0.033) and was independently associated with FT3/FT4 increase (p< 0.001). HOMA-IR increased with visceral obesity (waist circumference, p= 0.001; WHR, p= 0.018; WHtR: p< 0.001), hepatic impairment (alanine aminotransferase, p= 0.019) and hepatic steatosis (HS; p= 0.013) and correlated positively with FT3/FT4 (p= 0.036). TSH was significantly higher in subjects with HS versus those without HS (p= 0.007) and logistic regression analysis identified TSH as a risk factor for HS (p= 0.014). MDA correlated positively with MCP-1 (p= 0.021). Conclusion: VAT and IR may be responsible for changes in thyroid parameters associated with obesity: elevated TSH, FT3/FT4 levels and increased prevalence of thyroid nodules. WHR was predictive of increased FT3/FT4. In obese children, there is an interdependent relationship between HS and thyroid function.

Correction: Self-reported and clinical periodontal conditions in a group of Eastern European postpartum women

[This corrects the article DOI: 10.1371/journal.pone.0237510.].

Evaluation of neutrophil-to-lymphocyte, platelet-to-lymphocyte, and lymphocyte-to-monocyte ratios in patients with Klatskin tumors

AIM

Our study aimed to evaluate the baseline and early follow-up evolution of three inflammatory ratios, namely neutrophil- to-lymphocyte (NLR), platelet-to-lymphocyte (PLR), and lymphocyte-to-monocyte (LMR) in patients with Klatskin tumors.

MATERIAL AND METHODS

A cohort retrospective study was conducted on consecutive patients with Klatskin tumor who presented in a regional surgical department for seven years (1 January 2012 to 31 December 2018). Raw data regarding the patients' characteristics and inflammatory biomarkers were collected from the hospital database. The cohort was divided according to the received treatment as surgical resection or palliative treatment (such as surgical drainage, percutaneous biliary drainage, or endoscopic stenting), and the patterns between groups were compared.

RESULTS

Fifty-seven patients, age from 39 to 79 years were evaluated. Neutrophil to lymphocyte ratio (NLR) increased significantly after both procedures (P<0.001). Lymphocytes-to-monocytes ratio (LMR) decreased significantly in the follow- up for patients with surgical resection, for Bismuth class III or IV (P=0.0037), and invasion (P<0.001). The baseline NLR (odd ratio OR=1.23, 95% CI: 1.00 to 1.52, P-value = 0.05) and PLR (OR=1.01, 95%CI: 1.00 to 1.01, P-value = 0.06) ratios could be markers for severity of the disease.

CONCLUSIONS

Changes in inflammatory ratios as increases in NLR and decreases of LMR (for patients with resection, higher Bismuth class and invasion) were observed in early follow-up in patients with Klatskin tumors. Baseline NLR and PLR values are potential markers in the identification of advanced hilar cholangiocarcinoma but need further investigation.

KEY WORDS

Invasive procedures, Lymphocyte-to-monocyte ratio (LMR), Neutrophil-to-lymphocyte ratio (NLR), Platelet-to-lymphocyte ratio (PLR), Klatskin tumor.

Follow-up Evaluation of Association between Weight Changes, Metabolic, and Hormonal Outcomes in Children - a Single-center Pilot Study

INTRODUCTION

Fasting blood glucose, insulin level, and lipid profile are the minimal tests according to the Romanian guidelines to evaluate obese children. Cross-sectional studies for pediatric obesity in Romania focused only on epidemiology and management.

AIM

Our study aimed to evaluate the metabolic and hormonal changes in association with follow-up bodyweight modifications.

MATERIALS AND METHODS

Medical charts of overweight or obese children presenting at the First Paediatric Hospital, Cluj-Napoca from January 2017 to March 2019 were retrospectively evaluated. Anthropometric measures [e.g., body mass index (BMI), and waist circumference] and blood tests such as inflammatory markers (e.g., white blood cell and neutrophil absolute/relative counts, C-reactive protein), metabolic parameters (e.g., liver enzymes, uric acid, fasting blood glucose, triglycerides, high-density lipoprotein-cholesterol), fasting blood insulin, and cortisol levels were evaluated.

RESULTS

Twenty-two overweight or obese children (17 girls, median age of 13 years) monitored on median for 7.5 months were in-cluded in the study. Blood glucose level significantly decreased (p=0.010) and fasting insulin levels increased (p=0.051) at follow-up evaluation, independently of BMI-for-age z-score. Fasting insulin levels were associated with waist circumference (Spearman's rank cor-relation coefficient) ρ=0.58, p=0.030). BMI-for-age z-score proved to be associated with the C-reactive protein level at baseline (ρ=0.70, p=0.036, n=9) and high-density lipoprotein cholesterol at follow-up (ρ=-0.52, p=0.033, n=17).

CONCLUSIONS

Present analysis found changes in fasting insulin levels in relation to the abdominal circumference and high-density lipoprotein cholesterol and C-reactive protein levels in relation to BMI-for-age z-score in obese children.

Contrast-enhanced harmonic versus standard endoscopic ultrasound-guided fine-needle aspiration in solid pancreatic lesions: a single-center prospective randomized trial

BACKGROUND

Contrast-enhanced harmonic endoscopic ultrasound (CH-EUS) can visualize necrotic areas and vessels inside lesions. CH-EUS findings combined with EUS-guided fine-needle aspiration (EUS-FNA) improves diagnosis in pancreatic solid masses. CH-EUS can also guide EUS-FNA (CH-EUS-FNA), potentially improving the diagnostic rate of EUS-FNA, but such superiority has not been proved in prospective studies. We aimed to assess whether CH-EUS-FNA is superior to standard EUS-FNA for specific diagnosis of solid pancreatic masses and what factors affect the diagnostic rate.

METHODS

This randomized controlled study in one tertiary medical academic center included patients with suspected pancreatic solid masses on transabdominal ultrasound or computed tomography (CT) scan. Two passes with a 22-G standard FNA needle were done using EUS-FNA and CH-EUS-FNA in random order, and the visible core obtained was sent for histological analysis. Final diagnosis was based on EUS-FNA or surgical specimen results and on 12-month follow-up by imaging.

RESULTS

148 patients were evaluated. EUS-FNA and CH-EUS-FNA showed diagnostic sensitivities of 85.5 % and 87.6 %, respectively (not significantly different) and the combined sensitivity of the two passes was 93.8 %. The false-negative rate was not significantly different when hypoenhanced or hyperenhanced lesions were compared with the EUS-FNA results. No differences were seen for the results related to location, size, tumor stage, chronic pancreatitis features, or presence of biliary plastic stent.

CONCLUSIONS

The diagnostic rates for samples obtained using 22-G needles with standard EUS-FNA and CH-EUS-FNA were not statistically significantly different.

Endoscopic ultrasonography-fine needle aspiration of solid pancreatic masses: Do we need the fourth pass? A prospective study

BACKGROUND

Endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) is important for the differential diagnosis of solid pancreatic lesions. Sample adequacy is related to the number of needle passes, and European guidelines recommend three to four needle passes with a standard EUS-FNA needle. We aimed to evaluate the optimal number of passes with standard EUS-FNA needles in solid pancreatic lesions.

METHODS

Patients with solid pancreatic masses without cystic component >20% on computed tomography scan, and without biliary metallic stents, or coagulation problems were included prospectively. Standard 22G needles were used (maximum four passes); each sample was paraffin-embedded and analyzed separately. Final diagnosis was established by EUS-FNA, repeat EUS-FNA, surgery, or follow-up.

RESULTS

Sixty-one of 65 patients were included. The final diagnoses were adenocarcinoma (n = 44, 72%), neuroendocrine tumor (NET) (n = 10, 16%), metastasis (n = 1, 4%) and nonmalignant lesion (n = 6, 10%). Immunohistochemical staining was possible in 17 cases. The diagnosis was established by the first pass in 62% of cases (n = 38), by the second in 15% (n = 9), by the third in 15% (n = 9), and by the fourth in 3% (n = 2). The diagnostic accuracy for all four passes compared to the first three passes was 95% vs 92% (P = .5). The contribution of the fourth pass was not different between adenocarcinoma and NET (2% vs 10%, respectively; P = .667).

CONCLUSION

Three passes with standard EUS-FNA was optimal for a specific diagnosis of solid pancreatic masses, regardless of the histological type of the lesion.

Receiver Operating Characteristic Prediction for Classification: Performances in Cross-Validation by Example

The stability of receiver operating characteristic in context of random split used in development and validation sets, as compared to the full models for three inflammatory ratios (neutrophil-to-lymphocyte (NLR), derived neutrophil-to-lymphocyte (dNLR) and platelet-to-lymphocyte (PLR) ratio) evaluated as predictors for metastasis in patients with colorectal cancer, was investigated. Data belonging to patients admitted with the diagnosis of colorectal cancer from January 2014 until September 2019 in a single hospital were used. There were 1688 patients eligible for the study, 418 in the metastatic stage. All investigated inflammatory ratios proved to be significant classification models on both the full models and on cross-validations (AUCs > 0.05). High variability of the cut-off values was observed in the unrestricted and restricted split (full models: 4.255 for NLR, 2.745 for dNLR and 255.56 for PLR; random splits: cut-off from 3.215 to 5.905 for NLR, from 2.625 to 3.575 for dNLR and from 134.67 to 335.9 for PLR), but with no effect on the models characteristics or performances. The investigated biomarkes proved limited value as predictors for metastasis (AUCs < 0.8), with largely sensitivity and specificity (from 33.3% to 79.2% for the full model and 29.1% to 82.7% in the restricted splits). Our results showed that a simple random split of observations, weighting or not the patients with and whithout metastasis, in a ROC analysis assures the performances similar to the full model, if at least 70% of the available population is included in the study.

Diagnostic Criteria of Oral Lichen Planus: A Narrative Review

Oral lichen planus (OLP) is a disease with unclear etiology or pathogenesis, categorized by the World Health Organization as oral lichenoid lesions (OLL; interface mucositis or lichenoid mucositis) into a group of potentially malignant disorders. The diagnosis of OLP is challenging because the clinical and histopathologic features are frequently seen in OLP, OLL and/or other mucosal diseases with lichenoid characteristics. Furthermore, OLP has a dynamic nature. Finally, an early and precise diagnosis can play a decisive role, allowing timely treatment and thus improving the patient quality of life. This article summarizes the state-of-the-art regarding OLP and OLL and discusses the challenges faced on making an accurate diagnosis, aiming to provide a practical guideline for the postgraduates and oral physicians in reaching the diagnosis of these lesions.

Self-reported and clinical periodontal conditions in a group of Eastern European postpartum women

Periodontitis is a highly prevalent condition leading to a continuous destruction of tooth-supporting tissues. It increases the risk for various systemic diseases and adverse pregnancy outcomes. Therefore, screening for periodontitis is important. Screening measures can range from self-reported symptoms to clinical full-mouth periodontal examination. The hypothesis of our study was that self-reported parameters and clinical definition perform equally well in identifying periodontitis patients. The aim of this study was to develop, validate its internal consistency, and evaluate a self-reported instrument against periodontal clinical evaluation for diagnosis of periodontitis in a group of postpartum women, as well as to describe their periodontal status and the risk factors associated with periodontal disease. A cross-sectional study on postpartum women was conducted in a tertiary university hospital, from April 2018 to March 2019. Sociodemographic and behavioral data, periodontal clinical parameters, and self-reported periodontal perception were collected. A 16-item questionnaire was developed to obtain information about perceived periodontal alterations and oral hygiene habits. The utility of the questionnaire was tested against a periodontal diagnosis based on a full-mouth periodontal examination. The questionnaire was applied in 215 postpartum women aged 29.16±5.54 years (mean age (y) ± standard deviation) having the following periodontal status: 16 individuals without periodontal disease (7.44%), 32 individuals with gingivitis (14.88%), 19 individuals with mild periodontitis (8.84%), 132 individuals with moderate periodontitis (61.39%), and 16 individuals with severe periodontitis (7.44%). A significant association was observed between oral hygiene score, smoking status, and periodontal conditions (p<0.05). A significant association between the self-reported items related to “gum swelling”, “halitosis”, “previous periodontal diagnosis” and “previous periodontal treatment” with clinical periodontitis have been identified (p<0.05). Using self-reported questionnaires for detection of periodontal disease was ineffective in our studied population, since self-reported parameters and clinical definition do not appear to perform equally in identifying periodontitis cases. Clinical periodontal examination remains the gold standard for screening. Periodontitis was frequent in our group and the severity was significantly associated with the oral hygiene score and smoking. These results underline the necessity for periodontal clinical examination during pregnancy.

Renal Tumors in Young Adults: Is Preoperative Computer Tomography Imaging Suggestive for the Nature of the Tumors?

Renal cell carcinoma (RCC) accounts for 2–3% of all adult malignant neoplasms and is even rarer in patients under 45 years old. Clear-cell carcinoma represents most of the pathological subtypes. Our study aimed to investigate the association between preoperative computer tomography imagistic evaluation and histopathological diagnosis of renal tumors in young adults. Patients younger than 45 years old with renal tumors who were referred for medical treatment at the Clinical Institute of Urology and Renal Transplantation Cluj-Napoca from 2012 to 2019 were considered eligible for the study. Medical charts were retrospectively reviewed, and patients with complete data regarding preoperative diagnostic, histopathological evaluation, and follow-up data, regardless of gender, were included in the study. Sixteen patients younger than 45 years fulfilled all the inclusion criteria and were evaluated. With two exceptions, the evaluated patients were in a T1 and T2 stage, with no vascular invasion or of the adjacent organs. Two-thirds of our patients had a clear-cell renal cell carcinoma. None of our patients fitted in the low complexity surgery category of the R.E.N.A.L. Nephrometry Score and 37.5% of them benefited from partial nephrectomy. Half of the suppositions made based on imaging were concordant with the histopathology report. Fifteen of the patients showed no recurrence during the respective follow-up interval. Computer tomography imaging reports showed on our sample a higher concordance with the histopathological report in the more common subtypes (namely Renal Clear Cell RCC), with typical appearances.

Retinal Nerve Fiber Layer Thickness and Oxidative Stress Parameters in Migraine Patients without Aura: A Pilot Study

BACKGROUND

Migraine is one of the most common disorders and its pathophysiological mechanisms are still under research, oxidative stress being emphasized as an important contributor. This study aimed to analyze the retinal nerve fiber layer (RNFL) thickness and oxidative/anti-oxidant balance in migraine patients.

METHODS

Two groups of subjects were evaluated: a group of patients with migraine and a control group of healthy volunteers. RNFL thickness was assessed for all subjects by the ocular coherence tomography spectral domain (OCT-SD). The oxidative stress parameter, namely nitric oxide (NOx), malondialdehyde (MDA), and total oxidative stress (TOS) were assessed. The antioxidant capacity of plasma was evaluated by assessing the level of catalase, and total anti-oxidative (TOS) capacity. Migraine severity was graded using the Migraine Disability Assessment Score (MIDAS) questionnaire.

RESULTS

All the oxidative stress parameters (NOx, MDA, and TOS) were significantly increased, and both parameters for anti-oxidative status were significantly decreased in the migraine group compared with the control group (p < 0.0001). Significant correlations with all the quadrants and different oxidative stress parameters were found, most involved being temporal quadrant. A significant positive correlation between catalase and macular RNFL thickness (inner ring, temporal quadrant) in migraine patients, for both eyes, was observed (p = 0.014 for the right eye and p = 0.12 for the left eye).

CONCLUSION

The assessment of the oxidative stress/anti-oxidative balance together with RFLN thickness can constitute a promising method to evaluate the progression of the diseases. It can also contribute to the estimation of the efficiency of various therapies targeting oxidative stress and associated inflammation.

Gender Differences in the Levels of Periodontal Destruction, Behavioral Risk Factors and Systemic Oxidative Stress in Ischemic Stroke Patients: A Cohort Pilot Study

Background: Due to the higher frequency of ischemic stroke in men compared to women, we aimed to determine if gender differences exist regarding periodontal status and several plasma biomarkers in patients with a recent large artery atherosclerosis ischemic stroke (IS). Material and methods: Patients with their first IS within less than six weeks who were able to undergo periodontal examinations were evaluated. Demographic data, periodontal status, oxidative stress parameters/plasma antioxidant capacity, and C-reactive protein in patients who suffered a recent large artery atherosclerosis ischemic stroke were reccorded. Results: 93 patients were included in the study. More men were smokers (12/57 vs. 3/36) and consumed alcohol (17/57 vs. 3/36), and more women had higher glycemic values (p = 0.023), total cholesterol (p < 0.001), LDL (low-density lipoprotein)-cholesterol (p = 0.010), and HDL (high-density lipoprotein)-cholesterol (p = 0.005) levels. Significantly more men than women had moderate plus severe periodontal disease (p = 0.018), significantly higher levels of nitric oxide (p = 0.034), and significantly lower levels of total antioxidant capacity (p = 0.028). Conclusions: In this pilot study, men seem to be more prone to oxidative stress and to develop more severe forms of periodontitis among patients with stroke, but the results need validation on a larger sample.

Relation between serum cotinine levels and trophic lesions in patients with critical limb ischemia: a pilot study

Aim: To evaluate if smoking, quantified by the serum cotinine levels, is related to the evolution of patients with critical limb ischemia (CLI).Method: A pilot study was conducted on CLI patients who addressed at the Second Surgery Clinic of the Emergency County Hospital, Cluj-Napoca, Romania between November 2015 and December 2016. The sample of patients was split into two groups using the threshold of 15 ng/mL for the serum level of cotinine (low cotinine level - LCL vs. high cotinine level - HCL). Furthermore, the ROC analysis was conducted to identify the threshold of cotinine level able to discriminate between CLI patients with and without trophic lesions.Results: The mean age of patients was 60.7 ± 10.5 years with a significantly higher percentage of male patients (84%). A significant association was identified between urban origin and serum cotinine level, which is related to the increased number of cigarettes smoked per day among urban participants. Excepting necrectomy and toe disarticulation, no differences were found between LCL and HCL group regarding symptoms, signs or comorbidities. In smokers with CLI (38/43), a serum cotinine cut-off of 9.765 ng/mL was observed on eight out of 10 CLI patients with necrectomy and five out of 28 patients without necrectomy.Conclusion: Our study showed higher serum cotinine levels associated with a higher number of smoked cigarettes and necrectomy in patients with CLI. The serum cotinine could be a fair screening test for necrectomy in smokers CLI patients.

Sugars and Sweeteners: Structure, Properties and In Silico Modeling

Several studies report the effects of excessive use of sugars and sweeteners in the diet. These include obesity, cardiac diseases, diabetes, and even lymphomas, leukemias, cancers of the bladder and brain, chronic fatigue syndrome, Parkinson's disease, Alzheimer's disease, multiple sclerosis, autism, and systemic lupus. On the other hand, each sugar and sweetener has a distinct metabolic assimilation process, and its chemical structure plays an important role in this process. Several scientific papers present the biological effects of the sugars and sweeteners in relation to their chemical structure. One important issue dealing with the sugars is the degree of similarity in their structures, focusing mostly on optical isomerism. Finding and developing new sugars and sweeteners with desired properties is an emerging research area, in which in silico approaches play an important role.

Evidence-based medicine self-assessment, knowledge, and integration into daily practice: a survey among Romanian physicians and comparison between trainees and specialists

BACKGROUND

A gap between the attitude towards evidence-based medicine (EBM), knowledge and awareness has been reported among physicians from different parts of the world. However, no investigation on Romanian physicians is available in the scientific literature. Our study aimed, firstly, to assess EBM awareness and the knowledge used by Romanian physicians, and, secondly, to compare resident trainees with specialists.

METHODS

Romanian trainee and specialist physicians were invited to participate in this cross-sectional study. The study tool was an online questionnaire designed to explore their awareness, knowledge, usefulness, the attitude in medical documentation, and the use of professional EBM resources. Data were collected by Google Form from January 1st to April 30th, 2017, respecting the responders' anonymity. Two groups of physicians were investigated as trainees and specialists, respectively. Descriptive statistics (number, percentage, median and interquartile range) was used to describe the survey-related variables. Statistical significance on qualitative data was calculated with the Chi-square test, Fisher's exact test, or the Z-test for proportions.

RESULTS

Two hundred and 50 physicians participated in this study (68% trainees vs. 32% specialists). In both groups, a significantly high percentage was represented by women as compared to men (trainees 72.4%, specialists 70%). The correct definition of EBM was identified by most respondents (75.6%). Affirmatively, both trainees and specialists always looked at levels of evidence when reading scientific literature, but a small percentage (6.5% trainees and 3% specialists) adequately identified the uppermost types of evidence in the hierarchy. Almost a quarter of the respondents shared the name of mobile EBM resources that they used to support the daily practice. Only six out of the 49 listed mobile resources met the EBM criteria.

CONCLUSIONS

The participants proved to have limited knowledge of EBM and a positive attitude towards the concept. They made use of mobile medical resources without understanding which of these were evidence-based.

Shear-Wave Elastography Variability Analysis and Relation with Kidney Allograft Dysfunction: A Single-Center Study

Shear-wave elastography (SWE) showed the absence or presence of significant differences among stable kidney allograft function and allograft dysfunction. We evaluated the variability of kidney allograft stiffness in relation to allograft dysfunction, respectively, in terms of a correlation of stiffness with patients' characteristics. A single-center prospective study on patients who had undergone renal transplantation was conducted between October 2017 and November 2018. Patients were clinically classified as having a stable allograft function or allograft dysfunction. SWE examinations performed by the same radiologist with a LOGIQ E9 were evaluated. Ten measurements were done for Young's modulus (kPa) at the level of allograft cortex and another ten at the level of medulla. Eighty-three SWE examinations from 63 patients, 69 stable allografts, and 14 allografts with dysfunction were included in the analysis. The intra-examinations stiffness showed high variability, with the quantile covariation coefficient ranging from 2.21% to 45.04%. The inter-examinations stiffness showed heterogeneity (from 28.66% to 42.38%). The kidney allograft cortex stiffness showed significantly higher values in cases with dysfunction (median = 28.70 kPa, interquartile range (IQR) = (25.68-31.98) kPa) as compared to those with stable function (median = 20.99 kPa, interquartile range = (16.08-27.68) kPa; p-value = 0.0142). Allograft tissue stiffness (both cortex and medulla) was significantly negatively correlated with body mass index (-0.44, p-value < 0.0001 for allograft cortex and -0.42, p-value = 0.0001 for allograft medulla), and positively correlated with Proteinuria/Creatinuria ratio (0.33, p-value = 0.0021 for allograft cortex and 0.28, p-value = 0.0105 for allograft medulla) but remained statistically significant only in cases with stable function. The cortical tissue stiffness proved significantly higher values for patients with allograft dysfunction as compared to patients with stable function, but to evolve as an additional tool for the evaluation of patients with a kidney transplant and to change the clinical practice, more extensive studies are needed.

The accuracy of elastographic strain ratio and ultrasound thickness in the differentiation of thin and thick cutaneous melanoma

Background

Cutaneous melanoma is the most deadly of skin neoplasms. Few studies have investigated the role of elastography characteristics so the ability of elastography in the differentiation of thin and thick cutaneous melanoma is still narrow.

Purpose

To investigate the accuracy of elastography in differentiating thin and thick melanoma, by measuring strain ratio (SR) between the lesion and adjacent dermis and hypodermis.

Material and Methods

We investigated by ultrasound and elastography 52 melanoma lesions in 49 patients. The receiver operating characteristic (ROC) curve method was used to investigate the accuracy of ultrasound and elastographic measurement of SR to surrounding tissue, in the differentiation of thin and thick melanomas. The histopathological measurement of lesions depth called Breslow index was the golden standard test.

Results

Areas under the curve (AUC) showed low accuracy for SR to hypodermis in distinguishing between thin melanomas and others (AUC = 0.739, 95% confidence interval [CI] = 0.508–0.970]) with a cut-off value of 0.950, being the only statistically significant result in matter of elastographic measurements. Highly statistically significant results were obtained for B-mode ultrasound depth measurements of the lesion, with an AUC = 0.970 (95% CI = 0.927–1.0) in discriminating thin melanomas of others and 0.951 (95% CI = 0.869–1.0) in discriminating thick melanomas of other types.

Conclusion

Despite the appearance that SR may correlate with the depth of the lesion, elastography, by measuring the SRs to dermis and hypodermis, does not have enough accuracy in distinguishing thin and thick melanoma.

A View of Human Immunodeficiency Virus Infections in the North-West Region of Romania

Background and objectives: In Romania, the human immunodeficiency virus (HIV) epidemic is almost the same as it is in Central Europe, with some differences; particularity the following one: people with nosocomial HIV infection, also known as Romanian cohort. Aim: The study aimed to present a local view of HIV infection in the North-West part of Romania, and to identify the particularities of patients under medical care in the Cluj AIDS Center. Materials and Methods: The demographic characteristics (age and gender), and medical and epidemiological data (stage of HIV infection and mode of transmission) of patients in a medical care in the Cluj Acquired Immunodeficiency Syndrome (AIDS) Center were evaluated. Data from the first patients admitted between 1989 and 2018, and the statuses of the infected persons as per 31 December 2018 were analyzed. Results: Nine hundred and fourteen patients were included in the study. The patients' ages varied from 0 (newborns from HIV-infected mothers) to 72 years old, and most patients were men (596 men vs. 318 women). The main mode of transmission was sexual (>50%), with an increased number of men who have sex with men (MSM) in the last years (from two cases in 2006 to thirty-four cases in 2018), and a very small percentage of intravenous drug users (IDU; <1%). The patients from the Romanian cohort were more frequently women as compared with men (p-value <0.0001), women were more frequently later presenters than men (p-value <0.0001), and the women more frequently had candidosis (p-value = 0.0372), cerebral toxoplasmosis (p-value = 0.0404), and co-infection with hepatitis B virus (p-value = 0.0018). One hundred and sixty patients died by the end of 2018 (17.5%). Sixty-eight children had been born from HIV-infected mothers, and 17 were HIV infected (25%). Conclusion: The main mode of HIV transmission in our sample was sexual, with an increased number of MSM over the last years and a low number of cases of intravenous drug users. A quarter of children borne from HIV-infected mothers were HIV infected.

Comparison of Ex-PRESS P-200 mini-shunt implantation and standard trabeculectomy for open-angle glaucoma: four-year follow-up

INTRODUCTION

The study aimed to evaluate the efficacy and safety in 4-year follow-up of Ex-PRESS P-200 mini-shunt implantation versus standard trabeculectomy.

MATERIAL AND METHODS

A single-center retrospective study on patients diagnosed with open-angle glaucoma with failed medical treatment and who underwent Ex-PRESS device implantation or standard trabeculectomy was conducted. Seventy-three eyes were included in the analysis, 33 with Ex-PRESS P-200 implantation and 40 with standard trabeculectomy.

RESULTS

Significant decreases in the intraocular pressure (IOP) were observed after surgery and at all follow-ups in both groups (p < 0.001) with no significant difference between the two groups (p > 0.40). No significant differences with regard to post-operative medications were observed (p > 0.10). Excepting the 3-year follow-up, when just a borderline significant difference regarding the visual acuity between the Ex-PRESS and standard trabeculectomy group was observed (p = 0.0504), the Ex-PRESS groups showed significantly better visual acuity at 6 weeks (p = 0.0324), 1 year (p = 0.0168), 2 years (p = 0.0162), and 4 years (p = 0.0111). Hypotony occurred more frequently among the Ex-PRESS group, while cataract occurred more frequently among those with standard trabeculectomy, without significant differences between groups (p > 0.09). No difference in hazard of failure was observed between interventions (HR = 0.72, p = 0.523).

CONCLUSIONS

Both procedures provided good control of IOP and decreased the number of postoperative medications. The advantage of the Ex-PRESS shunt is the better visual acuity, but its main limitation is the cost.

Comparative Effect Of Curcumin Versus Liposomal Curcumin On Systemic Pro-Inflammatory Cytokines Profile, MCP-1 And RANTES In Experimental Diabetes Mellitus

Purpose

Anti-inflammatory proprieties of curcumin were proved to be useful in various diseases, including diabetes mellitus. The aim of this study was to assess the anti-inflammatory comparative effect of curcumin solution with liposomal curcumin formula, regarding the improvement of serum levels of TNF-α (tumor necrosis factor-alpha), IL-6 (interleukin), IL-1α, IL-1β, MCP-1 (monocyte chemoattractant protein-1) and RANTES in experimental diabetes, induced by streptozotocin (STZ), in rats.

Materials and methods

Six groups of 7 rats were investigated regarding the effect of i.p. (intraperitoneal) administration of two concentrations of curcumin solution (CC1 and CC2) and two concentrations of liposomal curcumin (LCC1 and LCC2): group 1 – control group with i.p. administration of 1 mL saline solution, group 2 – i.p. STZ administration (60mg/kg bw, bw=body weight), group 3 – STZ+CC1 administration, group 4 – STZ+CC2 administration, group 5 – STZ+ LCC1 administration and group 6 – STZ+ LCC2 administration. The concentrations of curcumin formulas were 1 mg/0.1 kg bw for CC1 and LCC1 and 2 mg/0.1 kg bw for CC2 and LCC2, respectively. Serum levels of C-peptide (as an indicator of pancreatic function) and TNF-α, IL-6, IL-1α, IL-1β, MCP-1, and RANTES (as biomarkers for systemic inflammation) were assessed for each group.

Results

The plasma level of C-peptide showed significant improvements when LCC was administrated, with better results for LCC2 when compared to LCC1 (P<0.003). LCC2 pretreatment proved to be more efficient in reducing the level of TNF-α (P<0.003) and RANTES (P<0.003) than CC2 pretreatment. Upon comparing LCC2 with LCC1 formulas, the differences were significant for TNF-α (P=0.004), IL-1β (P=0.022), and RANTES (P=0.003) levels.

Conclusion

Liposomal curcumin in a dose of 2 mg/0.1 kg bw proved to have an optimum therapeutic effect as a pretreatment in DM induced by STZ. This result can constitute a base for clinical studies for curcumin efficiency as adjuvant therapy in type 1 DM.

Antioxidant and Anti-Inflammatory Effects of Curcumin Nanoparticles on Drug-Induced Acute Myocardial Infarction in Diabetic Rats

We have investigated the cardio-protective effects of pretreatment with curcumin nanoparticles (CUN) compared to conventional curcumin (CUS) on the changes in oxidative stress parameters and inflammatory cytokine levels during induced acute myocardial infarction (AMI) in rats with diabetes mellitus (DM). DM was induced with streptozotocin, and AMI with isoproterenol. Eight groups of seven Wister Bratislava rats were included in the study. The N-C was the normal control group, AMI-C was the group with AMI, DM-C was the group with DM, and DM-AMI-C was the group with DM and AMI. All four groups received saline solution orally during the whole experiment. S-DM-CUS-AMI and S-DM-CUN-AMI groups received saline for seven days prior to DM induction and continued with CUS (200 mg/kg bw, bw = body weight) for S-DM-CUS-AMI and CUN for S-DM-CUN-AMI (200 mg/kg bw) for 15 days before AMI induction. The CUS-DM-CUS-AMI group received CUS (200 mg/kg bw), while the CUN-DM-CUN-AMI received CUN (200 mg/kg bw) for seven days prior to DM induction, and both groups continued with administration in the same doses for 15 days before AMI induction. CUS and CUN prevented elevation of creatine kinase, creatine kinase-MB, lactate dehydrogenase in all groups, with better results in the CUN (S-DM-CUN-AMI and CUN-DM-CUN-AMI groups). CUS and CUN significantly reduced serum levels of oxidative stress markers (malondialdehyde, the indirect assessment of nitric oxide synthesis, and total oxidative status) and enhanced antioxidative markers (total antioxidative capacity and thiols, up to 2.5 times). All groups that received CUS or CUN showed significantly lower serum levels of tumor necrosis factor-alpha, interleukin-6, and interleukin-1β. The best antioxidative and anti-inflammatory effects were obtained for the group that received CUN before DM induction (CUN-DM-CUN-AMI group). Pretreatment with CUN proved higher cardio-protective effects exerting an important antioxidative and anti-inflammatory impact in the case of AMI in DM.

Curcumin Nanoparticles Protect against Isoproterenol Induced Myocardial Infarction by Alleviating Myocardial Tissue Oxidative Stress, Electrocardiogram, and Biological Changes

Curcumin from Curcuma longa is a nutraceutical compound reported to possess strong antioxidant activity that makes it a candidate for use in counteracting oxidative stress-induced damage. The effect of pre-treatment with curcumin nanoparticles (nC) compared to conventional curcumin (Cs) on blood pressure, electrocardiogram, and biological changes on isoproterenol (ISO)-induced myocardial infarction (MI) in rats had been investigated. The Cs doses of 150 and 200 mg/kg bw and all nC doses (100, 150 and 200 mg/kg bw) significantly reduced heart rate before ISO administration and prevented QRS complex enlargement after MI induction (p < 0.026). All doses of Cs and nC prevented prolongation of the QT and QT corrected (QTc) intervals, with better results for higher doses (p < 0.048). The nC solution had more significant results than Cs in all metabolic parameters assessed (lactate dehydrogenase, glycaemia, aspartate transaminase, and alanine transaminase, p < 0.009). nC was more efficient than Cs in limiting myocardial oxidative stress and enhancing antioxidative capacity (p < 0.004). Compared to Cs, nC better prevented myocardial damage extension, reduced interstitial oedema, and inflammation. Curcumin nanoparticles as compared to conventional curcumin exert better antioxidative effects. Moreover, nC better prevent cardiomyocytes damage, and electrocardiogram alterations, in the case of ISO-induced MI in rats.