Progress in the Optical Sensing of Cardiac Biomarkers

Biomarkers play key roles in the diagnosis, risk assessment, treatment and supervision of cardiovascular diseases (CVD). Optical biosensors and assays are valuable analytical tools answering the need for fast and reliable measurements of biomarker levels. This review presents a survey of recent literature with a focus on the past 5 years. The data indicate continuing trends towards multiplexed, simpler, cheaper, faster and innovative sensing while newer tendencies concern minimizing the sample volume or using alternative sampling matrices such as saliva for less invasive assays. Utilizing the enzyme-mimicking activity of nanomaterials gained ground in comparison to their more traditional roles as signaling probes, immobilization supports for biomolecules and for signal amplification. The growing use of aptamers as replacements for antibodies prompted emerging applications of DNA amplification and editing techniques. Optical biosensors and assays were tested with larger sets of clinical samples and compared with the current standard methods. The ambitious goals on the horizon for CVD testing include the discovery and determination of relevant biomarkers with the help of artificial intelligence, more stable specific recognition elements for biomarkers and fast, cheap readers and disposable tests to facilitate rapid testing at home. As the field is progressing at an impressive pace, the opportunities for biosensors in the optical sensing of CVD biomarkers remain significant.

P-697 The association between serum prolactin levels and outcomes of in vitro fertilization

Study question

Is there an association between serum prolactin levels and outcomes of in vitro fertilization (IVF) in infertile women?

Summary answer

Serum prolactin levels are negatively associated with the proportion of good quality embryos from the total number of embryos obtained at IVF

What is known already

It is widely known that hyperprolactinemia is a powerful inhibitor of the hypothalamic-pituitary-ovarian axis leading to anovulation. However, few studies have tried to establish the impact of slightly higher PRL levels on the outcomes of in-vitro fertilization. Although some researchers have stipulated that PRL may play a positive role in oogenesis, embryo development and luteal function, due to the scarcity of data, this matter is considered an ongoing debate.

Study design, size, duration

We performed a retrospective study in the Department of Reproductive Medicine of a private hospital. The medical records of all consecutive patients who underwent IVF between January 2014 and December 2021 with all causes of infertility were reviewed.

Participants/materials, setting, methods

Patients with various causes of infertility undergoing IVF-ICSI were included in the study. Outcomes such as numbers of oocytes obtained, numbers of embryos were assessed and the proportion of good quality embryos from the total number of embryos (GQE/TNE) obtained was calculated. The study group included 544 patients with a mean age of 34.4±4.46 years, mean AMH of 3.99 1.34 ng/mL and mean serum prolactin levels of 25.07±23.7 ng/ml.

Main results and the role of chance

we found no association between serum prolactin levels and oocytes or embryos number. Serum level of prolactin was negatively correlated with the proportion of GQE/TNE (r = 0.101, p = 0.042). When patients were divided in subgroups according to ovarian reserve, the patients in the fourth quartile of prolactin had a lower proportion of GQE/TNE (p = 0.041) in comparison with those from the inferior quartiles only in the reduced ovarian reserve group (serum AMH below 1.1 ng/ml).

Limitations, reasons for caution

Patients included in this study are infertile patients with indications for IVF treatment. Therefore, the results of this study should be used with caution in other populations.

Wider implications of the findings

Our study suggest that serum prolactin levels might be negatively associated with in-vitro fertilization outcomes. If confirmed by further studies, treatment could be given to lower prolactin levels, even if mildly elevated, thus assuring more successful outcomes.

Trial registration number

NA

RV function in obesity: before and after laparoscopic gastric sleeve

 

Left ventricular (LV) changes associated with obesity, including LV hypertrophy and impaired LV function, have been shown to be reverted by bariatric surgery. Little is known about the effect of bariatric procedures on right ventricle (RV) function.

Aim

We analyzed RV functional changes, as assessed by echocardiography, after laparoscopic gastric sleeve (LGS) bariatric surgery.

Methods

22 consecutive obese subjects with good acoustic windows (mean age 40.2±6.7 years, 41% men, mean body mass index (BMI) 43.5±6 kg/m2) scheduled for LGS were prospectively studied before and 12 months after surgery.

RV function was assessed by RV Fractional Area Change (FAC), TDI RV free wall S wave (RV S) and free wall RV longitudinal strain (LS) and strain rate (L-SR), calculated by 3D speckle tracking echocardiography (STE). The estimated systolic pulmonary artery pressure (sPAP) was evaluated by tricuspid regurgitation velocity.

Results

Preoperative and postoperative obesity measures, as well as RV function measures significantly improved 12 months postoperatively versus baseline (all p<0.05 vs baseline): BMI decreased from 43.5±2.8 to 30.3±2.9 kg/m2, abdominal circumference from 124.8±4.7 to 98.4±5 cm, RV S changed from 12.8±1.1 to 13.4±1.3 cm/s, FAC from 44.2±3.8 to 52.8±2.8%, 3D LS from 15±1.3% to 17.8±2.2% and 3D L-SR from −1.1±1.4 to −2±0.9 s–1.

Patients had similar sPAP before and after surgery.

Conclusion

By successful weight loss, 12 months after LGS, subclinical RV function parameters improved, in association with favorable metabolic changes. These findings may contribute to the cardioprotective effects of bariatric surgery.

Funding Acknowledgement

Type of funding source: None

Relationship between preterm birth and post-partum periodontal maternal status: a hospital-based Romanian study

PURPOSE

This cross-sectional case-control study of post-partum women aimed to estimate whether maternal periodontitis was a predictive contributor to preterm birth and to identify other risk factors associated with preterm birth in our target population.

METHODS

The case group included women who delivered preterm (74 cases) and the control group included women who had a normal term delivery (120 controls). Medical records, a 16-item questionnaire, and a full-mouth periodontal examination were used to collect information about socio-demographic characteristics, general health problems, birth-related information, behavioral factors and periodontal status. Logistic regression analysis was used to estimate the strength of the relationship between predictors and the categorical outcome variable, preterm birth.

RESULTS

The bivariate analysis revealed the significant associations between preterm birth and socio-demographic factors (educational level, p = 0.003), antepartum smoking habit (p = 0.001) and birth weight lower than 2500 g (p < 0.001). The multivariate analysis highlighted that the presence of post-partum maternal periodontitis and its severity remained independent risk factors of preterm birth in the presence of antepartum smoking habit and route of delivery [adjusted OR 2.26, 95% CI (1.06; 4.82), respectively, OR 3.46, 95% CI (1.08; 11.15)].

CONCLUSION

Post-partum maternal periodontal disease and its severity might, in part, be considered as contributor to preterm deliveries before 37 weeks of gestation.

Electrochemical Aptamer-Based Biosensors for the Detection of Cardiac Biomarkers

Rapid and accurate diagnostic technologies for early-state identification of cardiovascular abnormalities have become of high importance to prevent and attenuate their progression. The capability of biosensors to determine an increase in the concentration of cardiovascular protein biomarkers in circulating blood immediately after a myocardial infarction makes them ideal point-of-care platforms and alternative approaches to electrocardiograms, chest X-rays, and different laboratory-based immunoassays. We report here a generic approach toward multianalyte sensing platforms for cardiac biomarkers by developing aptamer-based electrochemical sensors for brain natriuretic peptide (BNP-32) and cardiac troponin I (cTnI). For this, commercial gold-based screen-printed electrodes were modified electrophoretically with polyethyleneimine/reduced graphene oxide films. Covalent grafting of propargylacetic acid integrates propargyl groups onto the electrode to which azide-terminated aptamers can be immobilized using Cu(I)-based "click" chemistry. To ensure low biofouling and high specificity, cardiac sensors were modified with pyrene anchors carrying poly(ethylene glycol) units. In the case of BNP-32, the sensor developed has a linear response from 1 pg mL^-1 to 1 μg mL^-1 in serum; for cTnI, linearity is observed from 1 pg mL^-1 to 10 ng mL^-1 as demanded for early-stage diagnosis of heart failure. These electrochemical aptasensors represent a step further toward multianalyte sensing of cardiac biomarkers.

Cerebrolysin and early neurorehabilitation in patients with acute ischemic stroke: a prospective, randomized, placebo-controlled clinical study

Background - Stroke represents one of the most important causes of permanent physical or mental disability. A number of recent advances in recovery have reinforced the idea that pharmacological intervention combined with a specific rehabilitation therapy can reduce disability after stroke. Objective - The aim of this trial was to demonstrate the hypothesis that the association of pharmacological treatment with Cerebrolysin to early physical therapy can significantly stimulate the endogenous processes underlying the recovery after an ischemic stroke. Methods and Results - It was a prospective, randomized, double-blind, placebo-controlled clinical study. 60 patients were randomized either to 30 ml/ day Cerebrolysin or to Placebo for 10 consecutive days, starting in the first 24-48 hours after stroke. The pharmacological treatment was paired with early physical rehabilitation. The robust nonparametric evaluation of the National Institute for Health Stroke Scale (NIHSS) demonstrated a large superiority of Cerebrolysin relative to placebo on day 10 with a MW=0.79 (95% CI, 0.65-0.94), respectively on day 30 with MW=0.75 (95% CI, 0.60-0.89). Similar results were found with modified Ranking Scale (mRS) and Barthel Index (BI). Cerebrolysin was safe and well tolerated. Conclusions - Cerebrolysin had a beneficial effect on global neurological status and disability. The beneficial results of this study can be easily applied in the current clinical practice. Abbreviations: BI = Barthel Index; CB = Changes from Baseline; CI = Confidence interval; ICH = International Conference on Harmonization; ITT = intention-to-treat; LB = Lower Bound of Confidence Interval; mRS = modified Rankin Scale; MW = Mann-Whitney; NIHSS = National Institute for Health Stroke Scale; P = P-value; R = Valid Number Reference Group (Placebo); SD = standard deviation; T = Valid Number Test Group (Cerebrolysin); UB = Upper Bound of Confidence Interval.

P235Relation between myocardial deformation by three-dimensional speckle tracking analysis , control of the hypertension and functional capacity in patients with systemic hypertension

The purpose of this study was to investigate left ventricular (LV) function in hypertensive patients by 3-dimensional (3D) speckle tracking imaging, and determine the relation between the LV mechanics and functional capacity in this population. This cross-sectional study included 20 treated subjects with well-controlled arterial hypertension (group B) and 20 treated participants with uncontrolled hypertension (group A), adjusted by gender and age. All the subjects underwent 24-hour blood pressure monitoring, complete 2-dimensional and 3D examination, and exercise testing. Patients had similar 3D LV ejection fraction. LV mass was higher in group of uncontrolled hypertension (154.71 ± 49.7 g/m2 versus 147.12±44.8 g/m2 p < 0.01), as well as E/E'ratio (11.4 versus 8.9, p =0.02). 3D global longitudinal and circumferential strain and strain rate were significantly decreased in patients with inadequately controlled hypertension (LS 16.25% versus -19.24%, p=0.007, L-SR -0.97/sec versus -1.48/sec, p=0.04, CS -17.89%versus -21.76%, p=0.04, respectively), while the difference of radial strain and strain rate did not reach statistical significance. Group A of patients had also a significantly lower functional capacity (mean duration of test 13,3 min. versus 17,4 min, nr. of METS 9.4 versus 13.7). Duration of exercise was independently associated with LV mass , mean BP at daytime , E/E' ratio and 3D global longitudinal strain (β = 0.34, p = 0.02) in the whole hypertensive population in our study. In conclusion, LV longitudinal strain and functional capacity are significantly impaired in the patients with uncontrolled hypertension in comparison with the well-controlled hypertensive patients and are independently associated.

Expectations and perspectives of ovarian cancer patients about cancer management in Romania. The international NOGGO-ENGOT trial: EXPRESSION III

We have investigated a relational model of expectations and preferences among ovarian cancer patients centred on physician-patient communication, treatment approach, and the need for information. Consecutive patients anonymously filled in the EXPRESSION III questionnaire between 2009 and 2012. Following descriptive statistics, structural equation modelling was used to analyse the relationships between physician's evaluation by the patient (PEP), result of therapy (RT), need for changes in treatment (NCT) and patient's desire to be informed (PD). From a total of 108 patients, 53 (49.1%) knew their disease stage, 103 (95.4%) underwent surgery, 91 (84.3%) had chemotherapy and 51 (46.3%) relapsed. The final model demonstrated a good fit of data with fit indices >0.90. There was a significant positive effect of PEP on RT and a significant negative effect of PEP on NCT, with the final model explaining 84% of the NCT variance. Physicians represent the main point of contact, not only as a source of information about the disease and various treatment options, but also in the coping processes. As patients benefit from completeness of medical consultations, their awareness of the treatment outcome increases, while a negative perception of the physician leads to a desire to make changes in therapy.

Laparoscopic sleeve gastrectomy reduces the predicted coronary heart disease risk and the vascular age in obese subjects

BACKGROUND

Obesity is associated with high prevalence of coronary heart disease (CHD) and long term increased cardiovascular morbi-mortality. There are no data regarding the effect of laparoscopic sleeve gastrectomy (LSG) on long-term CHD - risk. It is known that "a man is as old as his arteries" and this concept is illustrated by Framingham coronary risk score, which can predict vascular age.

PURPOSE

To assess the 10-year CHD risk in patients with obesity, preoperatively, and 6 and 12 months after LSG.

METHODS

47 consecutive obese subjects (44.7% males, mean age 39.8 years) scheduled for LSG were prospectively studied before and 6 and 12 months after surgery. The 10 years CHD risk and corresponding vascular age were calculated using Framingham risk score.

RESULTS

The body mass index (BMI) decreased from 44.6 ± 10.6 kg m2 preoperatively to 32.2 ± 6.9 kg m2 and to 29.4 ± 5.4 kg m2 at 6 and 12 months follow-up (both p 0.05). Mean excessive weight loss (EWL) was 67.3 ± 23.7% and 78.3 ± 23.4% at 6 and 12 months postoperatively. At 6 and 12 months after LSG, there was a marked improvment of lipid profile(decrease of total cholesterol, LDL-cholesterol, triglycerides and increase of HDL-cholesterol) and a significant decrease in prevalence of diabetes mellitus, systemic hypertension and smoking. The 10-year CHD risk reduced from 10.1% preoperatively to 3.5% and to 2.2% at 6 and 12 months after surgery (both p 0.05). Patients' mean vascular age was 65.6 years preoperatively and decreased to 45.8 years 6 month spostoperatively (p 0.05) and to 40.7 years one year after LSG (p 0.05 vs. 6 months postoperatively, p=NS vs.chronological age).

CONCLUSIONS

In obese subjects, CHD risk is significantly reduced early, beginning with 6 months after LSG and is diminished with 80% one year postoperatively. Despite the fact that not all patients had achieved the ideal weight yet,mean vascular age is similar to their chronological age one year after surgery.

Multi-organ resections for colorectal cancer: analysis of potential factors with role in the occurrence of postoperative complications and deaths

AIM

Multi-organ resection for colorectal malignancy is a topic of interest nowadays as it raises the issue of benefits versus increased morbidity. This study aims to identify factors that may influence the development of postoperative complications and death following multivisceral resection.

METHODS

The study included 107 patients hospitalized in the Surgical Clinic III of Cluj-Napoca, who underwent multivisceral resections for colorectal cancer pathology. This is a retrospective study covering the period between 2006 and 2010. This study compares the morbidity and mortality following multi-organ resections for locally advanced colorectal cancer, with results in patients with uncomplicated colorectal resections. The study also highlights the impact that certain factors have on the development of postoperative complications.

RESULTS

This study shows a higher incidence of death and postoperative complications in the case of multiorgan resections. The differences were found to be statistically significant as follows: postoperative complications: 26% after multiorgan resection and 14% after uncomplicated resection respectively (p = 0.001); postoperative death: 11% after multi-organ resection and 3% after uncomplicated resection respectively (p < 0.001). The factors that have influenced in a negative way the postoperative evolution of the patients were: diabetes, personal history of malignant disease, associated heart disease, major abdominal surgery prior enrolling, the number of resected organs and increased intraoperative blood loss (over 500 ml).

CONCLUSION

In cases of locally advanced colorectal neoplasm, multiorgan resection should become the standard indication, as it offers patients their only chance of survival, comparable to that obtained in less advanced stages of the disease. This indication is underlined by the high resecability rate (R0) accomplished in our service. Preoperative compensation of the associated pathologies, the surgery performed by experienced teams, as well as providing an adequate intensive care are required to reduce the postoperative risks.

Respiratory maneuvers in echocardiography: a review of clinical applications

During echocardiographic examination, respiration induces cyclic physiological changes of intracardiac haemodynamics, causing normal variations of the right and left ventricle Doppler inflows and outflows and physiological variation of extracardiac flows. The respiration related hemodynamic variation in intra and extracardiac flows may be utilized in the echocardiography laboratory to aid diagnosis in different pathological states. Nevertheless, physiologic respiratory phases can cause excessive translational motion of cardiac structures, lowering 2D image quality and interfering with optimal Doppler interrogation of flows or tissue motion.

This review focuses on the impact of normal respiratory cycle and provocative respiratory maneuvers in echocardiographic examination, both in physiological and pathological states, emphasizing their applications in specific clinical situations.

Calcific aortic valve disease and aortic atherosclerosis--two faces of the same disease?

Calcific (degenerative) aortic valve disease is the most common etiology of acquired aortic valve stenosis. Historically, it was seen as a degenerative, "senile-like" process, resulting from aging--"wearing and tearing"--of the aortic valve. However, several lines of evidence suggest that calcific valve disease is not simply due to age-related degeneration but, rather, it is an active disease process with identifiable initiating factors, clinical and genetic risk factors, and cellular and molecular pathways that mediate disease progression. Histopathologically, the early lesions of aortic valve sclerosis resemble arterial atherosclerotic plaques. Furthermore, atherosclerotic risk factors and clinical atherosclerotic cardiovascular disease are independently associated with aortic sclerosis suggesting that it represents an atherosclerosis-like process involving the aortic valve. Until now, the only established treatment for symptomatic aortic valve stenosis has been valve replacement. Newer therapies that may modify or reduce the likelihood of developing aortic valve disease are highly desirable and are currently under investigation. In this article we tried to review the available data on calcific aortic valve disease, starting from histological and pathogenic aspects and finishing with therapeutic implications, in order to characterize its relationship with the atherosclerotic process.

Pancreatic disease in uremia and parathyroid hormone excess

To assess the coexistence of pancreatic alterations and elevation of parathyroid hormone (PTH) as contributors to morbidity, a study correlating evidence of histological pancreatitis with elevated PTH has been undertaken. A retrospective autopsy study of pancreatic histology in 21 patients who died during maintenance hemodialysis (MD) (group I) compared their level of serum PTH with a group of patients who died without historical or clinical evidence of renal insufficiency (group II). Each patient in this group had creatinine clearance of less than 5 ml/min and had been treated with hemodialysis from 4 to 120 months preceding death. There was a difference in the incidence of histological and PTH levels between groups I and II. A total of 15 out of 21 (71.4%) of group I patients had severe pancreatic disease. By contrast, none of the group II control patients had marked pancreatic disease (p less than 0.01). Also a statistically different demarcation was present between groups I and II on the basis of PTH levels. Group I patients with pancreatic disease (n = 5) had a higher PTH level (567 +/- 76 pg/ml) than those (n = 6) without diseased pancreata (218 +/- 6.5 pg/ml). These data infer that a possible correlation between measured iPTH excess and histological alterations in pancreas may exist.

An outbreak of Salmonella enteritis and septicemia in a population of uremic patients. A review of four cases, including infection of an arteriovenous fistula

An outbreak of enteritis and septicemia caused by Salmonella enteritidis occurred in a population of uremic patients treated in a nephrology unit. In one of the patients, an arteriovenous fistula was infected by this organism. The source of the outbreak was traced to the refrigerator and sink in the unit. This degree of morbidity and mortality far exceeds that previously reported in infections with nontyphoid Salmonella sp and is presumbly related to the decreased immune response seen in uremia.