Mean Platelet Volume Has Prognostic Value in Chronic Lymphocytic Leukemia

Purpose

Mean platelet volume (MPV) is a readily accessible and commonly tested hematological indicator. Recent studies revealed a significant impact of MPV on the course and prognosis of many diseases, including some types of cancer, as well as on the incidence of atrial fibrillation and bleeding. The study aimed to perform a retrospective analysis of MPV in terms of time to first treatment (TTFT) and to determine its prognostic value in the group of patients with chronic lymphocytic leukemia (CLL). Moreover, the study includes a retrospective analysis of platelet parameters in patients treated with ibrutinib concerning bleeding and atrial fibrillation.

Patients and Methods

The study included 523 patients with CLL, for 344 the most important cytogenetic aberrations were reported. The Mann–Whitney, Kruskal–Wallis, Kaplan–Meier, chi-squared, log‑rank tests and multivariate Cox proportional hazard regression model were used to analyze collected data.

Results

The receiver operating characteristic curve analysis was performed to identify optimal cut-off value for MPV. The analysis of survival curves showed that in the group of patients with higher values of MPV TTFT was significantly longer than in the group with lower MPV (17.9 vs 36 months, p=0.0015, cut-off value for MPV= 10.4 fl). In multivariate Cox proportional hazard regression model low MPV, the presence of del11q and del13q provided independent prognostic value for TTFT (HR=0.69, 95%-CI, 0.5293 to 0.9081; p=0.0078; HR=1.76, 95%-CI, 1.3000 to 2.3882, p=0.0003, HR=0.74, 95%-Cl, 0.5674 to 0.9588, p=0.0229, respectively). In the group treated with ibrutinib, 59 patients had no significant correlation between MPV level and the incidence of therapy complications, although in the group of patients with low MPV there was a tendency for more frequent occurrence of atrial fibrillation (p=0.259).

Conclusion

Low MPV values are associated with unfavorable prognosis and might represent a novel, independent prognostic factor in CLL.

Endoparasites of lizards (Lacertilia) from captive breeding and trade networks

Parasitic infections are widespread among exotic lizards and cause serious problems in both private captive breeding and trade networks. Among 168 lizards obtained from captive breeding (Zoological Garden in Wrocław and private owners) and trade (pet shops and wholesale) the total prevalence of endoparasites was 42.35 %. We detected species of Protozoa, Cestoda, Trematoda - Digenea and Nematoda as well as pseudoparasites. The prevalence of endoparasites was higher in the reptiles obtained from captive breeding (59.5 %) than in those from trade network, however the parasite species spectrum was wider in the animals form pet shops and wholesales.

Myocardial perfusion SPECT with dipyridamole stress test in cardiac syndrome X

Cardiac syndrome X defines patients with typical anginal chest pain, a positive exercise ECG stress test and angiographically normal coronary arteries. AIM of this study was to evaluate the role of myocardial perfusion SPECT with dipyridamole stress in the diagnosis of cardiac syndrome X.

PATIENTS, METHODS

68 patients with syndrome X aged 32 to 60 years were subjected to myocardial imaging using (99m)Tc-MIBI according to the two-days protocol: at rest and after dipyridamole infusion. Semiquantitative evaluation of the images was based on the assessment of (99m)Tc-MIBI uptake in 17 myocardial segments using a 5-points scale (0 point -- normal uptake, 4 points -- no uptake). Scores obtained in each segment were summed up, constituting the summed rest score (SRS) and summed stress score (SSS).

RESULTS

Mean SRS was 7.9 +/- 4.8 and mean SSS was 7.2 +/- 4.4 (non-significant difference). Individual comparison of SRS and SSS values revealed three patterns of scintigraphic images: 1) in 25 patients (36.8%), a paradoxical improvement of perfusion at stress images was found, 2) in 23 patients (33.8%), the myocardial perfusion deteriorated after dipyridamole, 3) in 20 patients (29.4%), no significant change of the myocardial perfusion between rest and stress images occurred.

CONCLUSIONS

In cardiac syndrome X, myocardial SPECT with dipyridamole stress shows different patterns of myocardial perfusion that reflects heterogeneity of this pathology.

Ambulatory electrocardiographic evaluation of the heart in patients treated by megachemotherapy and bone marrow transplantation

The aim of the study was evaluation of the frequency of conduction defects and cardiac arrhythmias before and one month (once a week) after bone marrow transplantation (BMT). It was evaluated by 24-hour electrocardiography based on the Holter's method. There were 50 patients (mean age 29.0 years) examined who were treated with megachemotherapy based on BuCy2, BuCy4 (busulphan and cyclophosphamide), BEAM (carmustine, etoposide, cytarabine, melphalan) and dexaBEAM (dexa-dexamethason) programs before BMT. No heart conduction defects occurred. The mean heart rate increased after BMT. Tachycardia (> 100/min) was observed in 92.5-98.1% of patients and bradycardia (< 60/min) in 41.6-68.0% patients. In 6% of patients bradycardia below 40/min occurred. The heart rate was increased in patients who previously used anthracycline antibiotics, had anaemia or fever, and in patients after autologous BMT (p < 0.05). The complex ventricular extrasystoles were detected in 20% of patients before megachemotherapy. They were more frequently observed in patients with hypokalemia (p < 0.05). After therapy these extrasystoles were observed in a total of 24% patients. There was a statistically significant correlation between this kind of extrasystole and age. The extrasystoles developed mainly in young men. In 10% they occurred de novo and also mainly in men. The heart failure (III degrees, IV degrees according to NYHA) occurred in 14% of patients and death caused by heart (or multiorgan) damage in 18%. Older patients and those who had higher mean heart rate during the first month after BMT were dying more frequently (p < 0.05).

The effects of dipyridamole stress test on plasma levels of soluble adhesion molecules intracellular adhesion molecule-1, vascular cell adhesion molecule-1, E-selectin and L-selectin in patients with ischemic heart disease and patients with syndrome X

BACKGROUND

Adhesion of activated leukocytes to the endothelium as a result of myocardial ischemia/reperfusion has been shown to be involved in the development of tissue injury. Leukocyte adhesion to the endothelium occurs via adhesion molecules expressed on the surface of both cell types. Upon cell activation these proteins may be released into the circulation and measured in a soluble form.

AIM

To verify whether the dipyridamole stress test, performed in patients with ischemic heart disease (IHD) and in patients with syndrome X, modifies plasma levels of the soluble adhesion molecules vascular cell adhesion molecule-1 (VCAM-1), intracellular adhesion molecule-1 (ICAM-1), E-selectin and L-selectin.

METHODS

Plasma levels of the soluble endothelial adhesion molecules ICAM-1, VCAM-1 and E-selectin, as well as of the soluble leukocyte adhesion molecule L-selectin, were measured in venous blood samples taken before and 7 min after administration of dipyridamole in patients with IHD, patients with syndrome X and healthy individuals. Myocardial perfusion was evaluated using single photon emission tomography. The plasma levels of soluble VCAM-1, ICAM-1, E-selectin and L-selectin were all measured using enzyme-linked immunosorbent assays.

RESULTS

After infusion of dipyridamole, plasma levels of ICAM-1 increased significantly in patients with IHD, whereas they remained unchanged in patients with syndrome X and in the control group. In patients with IHD, the initial plasma levels of VCAM-1, E-selectin and L-selectin, before administration of dipyridamole, were higher than those observed in patients with syndrome X and than those in the control group. Plasma levels of soluble VCAM-1, E-selectin and L-selectin decreased significantly in patients with IHD following the dipyridamole stress test, whereas they remained unchanged in patients with syndrome X, and in the control group.

CONCLUSION

In patients with IHD, administration of dipyridamole induces myocardial ischemia resulting in modification of plasma levels of the soluble adhesion molecules.

Intense acute phase response in ischemic patients

The aim of this study was to estimate the qualitative and quantitative changes of acute phase proteins in patients suffering from coronary heart disease. The study was carried out on 74 patients and 12 healthy volunteers. The patients were divided into three groups as follows: patients with myocardial infarction (n=37), Group I--without heart failure, Group II--with heart failure (II-III NYHA), Group III--patients with unstable angina pectoris (n=35); controls-healthy volunteers (n=12). The immunological measurements were performed at the beginning of hospitalisation (point 0), after 4, 8, 12 and 72 h, and after 6, 9 and 12 days of hospitalisation. The concentrations of C-reactive protein (CRP), alpha1-acid glycoprotein (AGP) and alpha1-antichymotrypsin (ACT) were measured using rocket immunoelectrophoresis according to Laurell. Glycosylation profiles of AGP and ACT were determined using crossed affinity immunoelectrophoresis with Con A as ligand according to Bøg-Hansen. Between Groups I and II statistically significant differences were observed for all investigated parameters. Highest concentration values were observed for Groups II and III; for Group II they appeared earlier than for Group III. The maximal values for reactivity coefficients (AGP-RC and ACT-RC) were observed earlier than the respective maximal values of concentrations. Continuous activation occurring in unstable angina leads to a more rapid increase in the concentrations of acute phase proteins and more marked alterations in their glycosylation profiles. In a way these patients seem to be 'primed' with constant stimulation, so that they respond dramatically to the stimulus of ischemia.

Binding of monoclonal antibodies to platelet glycoproteins Ib and IIb/IIIa in uremic patients

In this study, we have found a reduced binding of monoclonal antibodies (CD42b and CD41a) to glycoproteins Ib and IIb/IIIa of uremic platelets. Presumably, this was due to the altered structure of the sugary part of these glycoproteins. Change in the glycoprotein composition may have effected the disturbed adhesion and aggregation of uremic platelets.

The first 15 minutes of hemodialysis does not affect platelets

In the study, platelet count and volume, granulocyte number, binding of monoclonal antibodies to platelet glycoproteins Ib and IIb/IIIa were evaluated in hemodialyzed patients. Exclusively, the granulocyte count dropped significantly at 15 minutes after the initiation of dialysis as compared to predialysis samples. It seems that contemporary used cuprophane dialyzer membrane is more biocompatibile and does not have major impact on platelets.

Changes of acute phase proteins glycosylation profile as a possible prognostic marker in myocardial infarction

In 24 consecutive patients with myocardial infarction, the concentrations of C-reactive protein, alpha 1-acid glycoprotein and alpha 1-antichymotrypsin, as well as acid alpha 1-glycoprotein and alpha 1-antichymotrypsin glycosylation profiles were estimated. Blood samples were taken at admission, after 4, 8, 12 and 24 h, on 2, 3, 6, 9, and 12 days of hospitalization. All studied patients were divided into 2 groups: 12 patients without clinical or radiological symptoms of acute heart failure and 12 patients with acute heart failure. The results of all investigations were tested statistically to appraise significance of differences between the two investigated groups. At admission, as well as after 6 and 12 h, C-reactive protein concentration was significantly higher in patients who developed heart failure. Similarly, the glycosylation profile of alpha 1-antichymotrypsin, reported as reactivity coefficient, was of good prognostic value from the first time-point on. Development of acute cardiac failure seemed to correlate more with the magnitude of inflammatory reaction (measured by changes in acute phase proteins) than with enzymatically estimated infarct size.

Metabolic control quality and free radical activity in diabetic patients

The role of oxidative/reductive balance derangement in the pathogenesis of diabetic microangiopathy has often been discussed in the last few years. Therefore, we decided to evaluate the influence of intensive insulin therapy on selected indicators of free radical production. The levels of plasma hydrogen peroxide (H2O2) and serum malonyldialdehyde (MDA) were estimated in 15 patients with Type 1 and 15 with Type 2 diabetes before and after 2 weeks of intensive treatment. The initial H2O2 and MDA levels in all cases were significantly higher than in controls. After 2 weeks of treatment, the values for both estimated parameters were significantly lower; however, they were still higher than in the control group. Our results seem to confirm the previous suggestions concerning the relation between metabolic disturbances and oxidative stress in diabetic patients.

[Actions of new iminium compounds against bacteria and fungi. 30. 3-alkoxymethyl-1-hexyl-, 3-alkylthiomethyl-1-hexyl-, 3-alkoxymethyl-1-octyl- and 3-alkylthiomethyl-1-octylbenzimidazolium chlorides]

Syntheses and antimicrobial activity of the title compounds are described. They were obtained by reaction of 1-hexyl- or 1-octylbenzimidazol with chloromethylalkyl ether or chloromethylalkyl sulfide. The antibacterial properties were tested on 13 strains of bacteria and fungi. The best antibacterial activity was exhibited by chlorides with octylthiomethyl and decyloxymethyl groups.

Peroxide plasma level in patients with coronary heart disease as a possible indicator of ischemia during exercise test

BACKGROUND

This study evaluated the possible changes in production of free oxygen species during myocardial ischemia in the course of exercise testing of ischemic coronary disease.

METHODS

Exercise testing was performed on 58 patients with suspected ischemic coronary disease. Plasma hydrogen peroxide (H2O2) level was assayed according to Frew et al. (Anal Chim Acta 1983, 155:139-150) in venous blood samples obtained before the test, at submaximal and maximal work loads, and after 30 minutes of rest.

RESULTS

Hydrogen peroxide plasma level significantly increased (P < 0.001) at maximal work load in patients with positive exercise test results. Patients with negative exercise test results initially manifested a higher H2O2 level that dropped during maximal work load.

CONCLUSIONS

The rise in plasma H2O2 level during myocardial ischemia indicates that intensification of oxygen free radical production occurs. This may be the result of hypoxanthine conversion by xanthine oxidase, catecholamine auto-oxidation, polymorphonuclear neutrophil activation, and/or derangement within mitochondrial electron transfer. The noticed difference between patients with a positive exercise test and those diagnosed as without ischemia may be of clinical relevance.

[Effect of heparin on the interaction between platelets with collagen]

An effect of a standard heparin preparation on the interaction between blood platelets and collagen has been investigated. The experiments have shown, that the addition of heparin in the concentration of 0.3; 0.6 or 0.9 IU/mL did not change the interaction between blood platelets and collagen. Such interaction increased, when heparin concentration was 1,2 IU/mL, and remained unchanged despite the further increase in heparin concentration. The authors suggest that such a course of this interaction results from the stimulating action of heparin added in adequate concentration on protein release from platelet alpha granulations--which bound GP II b/III a complex with collagen.

[The effect of blood pressure changes during hemodialysis on left ventricular systolic function]

Echocardiographic study was performed in 31 uremic patients on maintenance hemodialysis (HD) with no apparent heart failure, valvular heart disease, pericardial effusion or coronary artery disease. On the basis of blood pressure patients were classified into two groups: 1) patients with normal arterial pressure (group I) (n = 19), 2) patients with blood hypertension (group II) (n = 12). Cardiac function was assessed immediately before and after HD session. Left ventricular end-diastolic diameter (EDD), left ventricular end-systolic diameter (ESD) and ejection fraction (EF) were calculated. Body weight, heart rate and mean blood pressure (mBP) were also measured. A significant decrease of EDD was noted in both groups during HD but it was less evident in group II (p < 0.05). ESD decreased significantly in group II (p < 0.01) when it did not change in group I. EF increased significantly only in group II (p < 0.05). Blood pressure decreased during HD in both groups. A significant inverse linear association between EF and ESD was noted during HD in both groups (r = -0.685; p < 0.001) but was more evident in group II. There was no association between and EDD (r = 0.199; NS). Similar analysis shows that ESD was significantly with mBP (group II--r = 0.914; p < 0.001, group I--r = 0.565; p < 0.05). Such association were not found for EDD and RR. Only in group II the decrease in mBP was statistical significantly correlated with the increase in EF. The decrease in EDD during HD exists probably due to changes in intravascular volume.(ABSTRACT TRUNCATED AT 250 WORDS)

[Unusually large thrombus in the left cardiac ventricle in a patient with a history of anterior wall infarction]

The giant size thrombus like a swallow's nest in the left cardiac ventricle in the patient with a history of anterior infarction was reported. In the autopsy a significant narrowing of the left coronary artery and two critical narrowings of the anterior interventricular artery were revealed. The relation between the localization of the pathological changes in the coronary arteries and the thrombi occurring during cardiac infarction was discussed.

[Spastic paralysis of the lower extremities as the first symptom of acute myeloblastic leukemia]

A case of acute myeloblastic leukemia (AML) with spastic paralysis of the lower extremities caused by a tumor of the spinal cord as the first symptoms of the disease is presented. The tumor consisted of leukaemic cells. A diagnosis of AML type M2, according to FAB classification, was established. A complete remission was achieved after 2 courses of chemotherapy. Patient started to walk after intensive rehabilitation. After 14 months of complete remission, recurrence was observed despite an intensified therapy.

Dialyzable factors from uremic serum increase 125I-fibrinogen binding by normal blood platelets

The influence of uremic serum on 125I-fibrinogen binding by normal blood platelets after induction with adenosine diphosphate was evaluated. The study was performed on 12 hemodialyzed uremic patients. The control group included 12 healthy subjects. It has been demonstrated that the uremic serum from the patients before hemodialysis significantly augmented fibrinogen binding by normal blood platelets (33.8 +/- 11.8%) in comparison with control subjects (14.4 +/- 8.9%). After hemodialysis, fibrinogen binding was comparable with the control group (14.9 +/- 10.1%). Uremic toxins removable during hemodialysis are probably responsible for the potentiation of 125I-fibrinogen binding by platelets.