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A retrospective study of ultrasound characteristics and macroscopic findings in confirmed malignant pleural effusion
Get PDFBACKGROUND:
A definitive diagnosis of malignant pleural effusion (MPE) is reached by cytological or histological assessment, but thorough analysis of the ultrasound features of the effusion as well as pleural thickening or nodularity can also be of significant diagnostic help.
----- OBJECTIVE:
To assess the relationship of specific ultrasound characteristics and macroscopic features of confirmed malignant pleural effusion, thus increasing the diagnostic potential of thoracic ultrasound.
----- METHODS:
The findings of thoracic ultrasonography performed prior to initial thoracentesis in 104 patients with subsequently confirmed malignant pleural effusion were analyzed with regard to the macroscopic features of the pleural effusion.
----- RESULTS:
Distribution in terms of frequency of hemorrhagic/sanguinolent (n=64) in relation to nonhemorrhagic transparent/opaque (n=40) MPE, regardless of their ultrasound characteristics, did not yield a statistically significant correlation (p=0.159). Conversely, the frequency distribution of hemorrhagic pleural effusions (n=8) in relation to nonhemorrhagic effusions (n=1), in the group of septated MPE, showed a statistically significant difference (p<0.001). The least number of patients (0.96%) had a complex septated MPE combined with the macroscopic appearance of a serous/transparent nonhemorrhagic effusion, which suggests that this combination is a sporadic occurrence and may have a diagnostic significance for this patient group.
----- CONCLUSION:
The incidence of specific combinations of the ultrasound characteristics and macroscopic appearance of MPEs showed different frequency distributions, which may improve the diagnostic value of thoracic ultrasound in this patient population
Comparable genomic copy number aberrations differ across astrocytoma malignancy grades
Get PDFA collection of intracranial astrocytomas of different malignancy grades was analyzed
for copy number aberrations (CNA) in order to identify regions that are driving cancer
pathogenesis. Astrocytomas were analyzed by Array Comparative Genomic Hybridization (aCGH)
and bioinformatics utilizing a Bioconductor package, Genomic Identification of Significant Targets
in Cancer (GISTIC) 2.0.23 and DAVID software. Altogether, 1438 CNA were found of which losses
prevailed. On our total sample, significant deletions affected 14 chromosomal regions, out of which
deletions at 17p13.2, 9p21.3, 13q12.11, 22q12.3 remained significant even at 0.05 q-value. When divided
into malignancy groups, the regions identified as significantly deleted in high grades were: 9p21.3;
17p13.2; 10q24.2; 14q21.3; 1p36.11 and 13q12.11, while amplified were: 3q28; 12q13.3 and 21q22.3.
Low grades comprised significant deletions at 3p14.3; 11p15.4; 15q15.1; 16q22.1; 20q11.22 and 22q12.3
indicating their involvement in early stages of tumorigenesis. Significantly enriched pathways were:
PI3K-Akt, Cytokine-cytokine receptor, the nucleotide-binding oligomerization domain (NOD)–like
receptor, Jak-STAT, retinoic acid-inducible gene (RIG)-I-like receptor and Toll-like receptor pathways.
HPV and herpex simplex infection and inflammation pathways were also represented. The present
study brings new data to astrocytoma research amplifying the wide spectrum of changes that could
help us identify the regions critical for tumorigenesis
Comparison of irrigated multi-electrode radiofrequency ablation and point-by-point ablation for pulmonary vein isolation in patients with persistent atrial fibrillation with persistent atrial fibrillation
Get PDFAtrial fibrillation is the most common supraventricular arrhythmia in the general population. It is related
to increased morbidity and mortality and reduced quality of life. Pulmonary vein isolation has emerged
and today remains the cornerstone of atrial fibrillation ablation. There are multiple different tools and
technologies used to achieve pulmonary vein isolation, and irrigated multi-electrode ablation was a
novel tool to perform pulmonary vein isolation. It has been evaluated in patients with paroxysmal atrial
fibrillation; however there is no data on use of this technology in patients with persistent atrial
fibrillation. The aim of our study was to compare irrigated multi-electrode ablation with point-by-point
radiofrequency (RF) ablation in patients with persistent atrial fibrillation under-going PVI.
In this prospective study, we included forty-nine patients (age 60 + 9 years, 82% male). In 24 patients,
the IMEA catheter was used in conjunction with an electroanatomic mapping system. Twenty-five
patients undergoing RF point-by-point ablation (RF-PVI) served as a control group. Patients were
followed for 12 months with 24 Holter ECG monitoring at 3, 6, and 9 months and 7 days Holter ECG
at 12 months follow up.
Results have confirmed our hypothesis that procedural parameters are similar between irrigated
multielectrode ablation and standard point-by-point radiofrequency ablation. Procedure time was 125 +
23 min in the IMEA group and 127 + 31 min in the RF-PVI group (P = 0.79). Fluoroscopy time was
12.2 (11 – 16.1) min with IMEA compared with 5.2 (4.1 – 9.3) min in the RF-PVI group (P, 0.001). Net
ablation time was 11.8 (10.2 – 15.4) min in the IMEA group compared with 33.6 (30.3 – 40.1) min in
the RF-PVI group (P, 0.001). However, cumulative ablation times were significantly longer in the IMEA
group compared to RF PVI group. Although complication rates were low in our study, longer cumulative
ablation times could have implications on complication rates, which needs to be verified in future
studies. Success rates, defined as freedom from any atrial fibrillation at 12 months were similar between the two
groups. At 12 months, 16 of 24 patients (67%) in the IMEA group compared with 17 of 25 patients
(68%) in RF-PVI group were free from AF (P. 0.99).
In conclusion, IMEA-PVI was associated with shorter net ablation time and longer fluoroscopy time
with similar procedure duration. Irrigated multi-electrode ablation recordings were not sufficient to
confirm isolation in 35% of PVs. Single procedure efficacy after 12 months was similar between the
two groups
Sex‐specific treatment effects after primary percutaneous intervention: a study on coronary blood flow and delay to hospital presentation
Get PDFBackground: We hypothesized that female sex is a treatment effect modifier of blood flow and related 30-day mortality after
primary percutaneous coronary intervention (PCI) for ST-segment–elevation myocardial infarction and that the magnitude of the
effect on outcomes differs depending on delay to hospital presentation. -----
Methods and Results: We identified 2596 patients enrolled in the ISACS-TC (International Survey of Acute Coronary Syndromes
in Transitional Countries) registry from 2010 to 2016. Primary outcome was the occurrence of 30-day mortality. Key secondary
outcome was the rate of suboptimal post-PCI Thrombolysis in Myocardial Infarction (TIMI; flow grade 0–2). Multivariate logistic
regression and inverse probability of treatment weighted models were adjusted for baseline clinical covariates. We characterized
patient outcomes associated with a delay from symptom onset to hospital presentation of ≤120 minutes. In multivariable
regression models, female sex was associated with postprocedural TIMI flow grade 0 to 2 (odds ratio [OR], 1.68; 95% CI, 1.15–
2.44) and higher mortality (OR, 1.72; 95% CI, 1.02–2.90). Using inverse probability of treatment weighting, 30-day mortality was
higher in women compared with men (4.8% versus 2.5%; OR, 2.00; 95% CI, 1.27–3.15). Likewise, we found a significant sex
difference in post-PCI TIMI flow grade 0 to 2 (8.8% versus 5.0%; OR, 1.83; 95% CI, 1.31–2.56). The sex gap in mortality was no
longer significant for patients having hospital presentation of ≤120 minutes (OR, 1.28; 95% CI, 0.35–4.69). Sex difference in post-
PCI TIMI flow grade was consistent regardless of time to hospital presentation. -----
Conclusions: Delay to hospital presentation and suboptimal post-PCI TIMI flow grade are variables independently associated with
excess mortality in women, suggesting complementary mechanisms of reduced survival
Poor warfarin anticoagulation in long-term thromboprophylaxis: a survey in a southern Croatian county
Get PDFAim: To assess the quality of real-life warfarin anticoagulation in patients requiring chronic thromboprophylaxis in a southern Croatian county. Methods: We retrospectively analyzed international normalized ratio (INR) values determined over one year (2016-2017) at the Zadar County General Hospital in warfarin-treated patients requiring chronic thromboprophylaxis. The values represent 83.0% of all INRs and were determined in 84.0% of all warfarin-treated patients in the county during the observed period. Results: Overall 31 162 INRs were taken from 3697 patients, 2240 of whom (20 851 INRs, 3-56 per patient, median 9) were referred with diagnoses requiring chronic thromboprophylaxis: mainly atrial fibrillation/flutter (n = 1508, 14 902 INRs) but also cardiac implants, valvular disease, severe heart failure, and cerebrovascular disease (“other”, n = 732, 5949 INRs). Only 50.1% of all INRs were within the target range, 2.0-3.5, while 43.6% were 3.5. Median crude individual proportion of INRs within the range was 50.0%, while it was 42.0% for INRs <2.0. Only 23.0% of the patients had ≥70% of the INRs within the target range (adequately anticoagulated), while 35.5% had ≤33.3% of the INRs within the range. Conversely, 66.5% of the patients had ≥33.3% INRs <2.0. Adjusted probability of adequate anticoagulation in atrial fibrillation/flutter patients was consistently 25.5% to 27.7%, regardless of the number of determined INRs, while in patients with other conditions it increased from 9.5% to 25.2% with a higher number of INRs. Conclusion:
The achieved level of warfarin anticoagulation in this real-life setting is far below what is needed for effective long-term thromboprophylaxis
Tonsil-derived mesenchymal stem cells exert immunosuppressive effects on T cells
Get PDFAim: To assess the immunomodulatory effect of tonsil-derived mesenchymal stem cells (MSCs) on T-lymphocyte proliferation and cytokine production. Methods: Tonsils were obtained from children aged 3 to 12 years (n = 15) who underwent tonsillectomy for obstructive sleep apnea from April 2012-October 2014 at the Merkur University Hospital, Zagreb. Tonsil-derived MSCs were co-cultured with peripheral blood mononuclear cells (PBMCs) and phytohemagglutinin as a mitogen. PBMCs were induced to differentiate into T helper 1 or T helper 2 cells in the presence or absence of tonsil-derived MSCs, after which the production of interferon-gamma in T helper 1 and interleukin-4 in T helper 2 cells was assessed. Results: Tonsil-derived MSC suppressed phytohemagglutinin-induced proliferation of PBMCs. Compared with controls, tonsil-derived MSC co-culture significantly decreased interferon-gamma production (P < 0.001) and increased interleukin-4 production (P < 0.001). Conclusion: Tonsil-derived MSCs exert immunomodulatory effects on T lymphocyte proliferation and T helper 1- and T helper 2-specific cytokine production
Psihološka prilagodba i sociokulturni stavovi u adolescentica s anoreksijom nervozom [Psychological maladjustment and sociocultural attitudes towards appearance in adolescents with anorexia nervosa]
Get PDFAnorexia nervosa is severe psychiatric disorder with the high mortality rate and represents a significant psychiatric, pediatric and public-scientific problem. The treatment is long-lasting, followed by a series of complications, and a deathly outcome. Although most commonly occurs in adolescence, there is an increasing incidence of this disease in the pre-puberty age. This research comprehensively approaches anorexia nervosa as an entity whose development and maintenance are influenced by biological, psychological and socio-cultural factors. The study included 122 subjects, 62 subjects with restrictive type anorexia and 60 subjects in the control group. Adolescent with AN-R were divided into two groups, younger ( 14 years). The following questionnaires were used in the survey: General and Health Data Questionnaire, Inventory of Eating disoreders-3 (EDI-3), Difficulties in Emotion Regulation Scale (DERS), Basic Empathy Scale (BES), Socio-cultural attitudes towards physical appearance-3 (SATAQ-3). The aim of the study included the risk factors for eating disorder, and the comparison of the results between patients with anorexia nervosa and control group in terms of general psychological maladaptation, empathy, attachment style, and sociocultural attitudes towards physical appearance. The difference between younger and older adolescents with AN-R on these variables was investigated, as well as the correlation between psychological and socio-cultural factors with a risk for developing eating disorder. Finally, the aim was to examine the predictors of risk for developing eating disorders. Research findings confirm that there is a statistically significant difference between patients with anorexia nervosa and healthy group due to psychological and socio-cultural factors. Girls with AN-R have lower self-esteem, greater personal alienation, social insecurity, social alienation, interoceptive difficulties, perfectionism and asceticism, body dissatisfaction, drive for thinness, emotional regulation difficulties, and higher prevalence of insecure and avoiding attachment style. Additionally, girls with AN-R have greater thin internalization and social pressures to be slim. In older adolescents with AN-R there are more those with interoceptive difficulties and with emotional regulation difficulties, compared to young adolescent with AN-R. Insecure attachment style, emotional regulation, and psychological maladjustment are significant predictors of risk for developing eating disorders in girls with AN-R. In the final model, only psychological maladjustemnt has proved to be a significant predictor and shows a 50.4% variation of risk for eating disorders development. Insecure and avoiding attachment, social attitudes towards physical appearance and psychological maladjustment have been shown as significant predictors of the risk of developing eating disorders in the control group. In the final model, significant predicor was psychological maladjustemnt and social attitudes toeards physical appearance, with more than 64,7% of the eating disorder risk comosite variance explained
Polymethylmethacrylate cranioplasty using low-cost customised 3D printed moulds for cranial defects – a single Centre experience: technical note
Get PDFWe report our experience with 3D customised cranioplasties for large cranial defects. They were made by casting bone cement in custom made moulds at the time of surgery. Between October 2015 and January 2018, 29 patients underwent the procedure; 25 underwent elective cranioplasties for large cranial defects and four were bone tumour resection and reconstruction cases. The majority of patients (96.5%) reported a satisfactory aesthetic outcome. No infections related to the surgical procedure were observed in the follow-up period. The method proved to be effective and affordable
Autonomic symptom burden is an independent contributor to multiple sclerosis related fatigue
Get PDFObjectives: To investigate a possible association between autonomic dysfunction and fatigue in people with multiple sclerosis. -----
Methods: In 70 people with multiple sclerosis early in the disease course (51 females, mean age 33.8 ± 9.1), quantitative sudomotor axon reflex tests, cardiovascular reflex tests (heart rate and blood pressure responses to the Valsalva maneuver and heart rate response to deep breathing), and the tilt table test were performed. Participants completed the Composite Autonomic Symptom Score 31, the Modified Fatigue Impact Scale, and the Epworth Sleepiness Scale, as well as the Beck Depression Inventory. Cutoff scores of ≥ 38 or ≥ 45 on the Modified Fatigue Impact Scale were used to stratify patients into a fatigued subgroup (N = 17 or N = 9, respectively). -----
Results: We found clear associations between fatigue and scores in subjective tests of the autonomic nervous system: fatigued patients scored significantly worse on Composite Autonomic Symptom Score 31, and there was a strong correlation between the Modified Fatigue Impact Scale and the Composite Autonomic Symptom Score 31 (rs = 0.607, p < 0.001). On the other hand, we found only modest associations between fatigue and scores in objective tests of the autonomic nervous system: there was a clear trend for lower sweating outputs at all measured sites, which reached statistical significance for the distal leg and foot. We found weak correlations between the Modified Fatigue Impact Scale and the Valsalva ratio (rs = - 0.306, p = 0.011), as well as between the Modified Fatigue Impact Scale and quantitative sudomotor axon reflex tests of the forearm, proximal, and distal lower leg (rs = - 0.379, p = 0.003; rs = - 0.356, p = 0.005; and rs = - 0.345, p = 0.006, respectively). A multiple regression model showed that the Composite Autonomic Symptom Score 31, Beck Depression Inventory, and Epworth Sleepiness Scale were independent predictors of fatigue (p = 0.005, p = 0.019, and p = 0.010, respectively). -----
Conclusion: These results suggest that-even early in the course of the disease-people with multiple sclerosis suffer from objective and subjective impairments of the autonomic nervous system. The results also point to an association between autonomic nervous system impairment and multiple sclerosis related fatigue