Pub Date : 2024-06-03DOI: 10.18786/2072-0505-2024-52-010
N. Potemkina, M. G. Glezer, P. Chomakhidze, P. A. Zeynalova, G. Petrova, A. I. Novikova, Artur N. Gasymov, Maria G. Poltavskaya
Rationale: Electrocardiography (ECG) is an objective and widely available method for the diagnosis of cardiovascular disorders recommended for identification of abnormalities, including those in patients with malignancies. A few studies have been published on the assessment of changes in ECG over time in patients with hemoblastoses under high-dose chemotherapy (HDCT) with subsequent transplantation of autologous hematopoietic stem cells (autoHSCT). Aim: To study ECG abnormalities before HDCT with autoHSCT and after treatment and their association with cardiac dysfunction in patients with hematological malignancies. Materials and methods: This prospective cohort observational study included 71 patients with confirmed hemoblastoses. Before HDCT with autoHSCT and at the average of 20 weeks thereafter, a 12-lead standard ECG, echocardiography, and measurement of cardiac biomarkers (troponin T [TnT] and N-terminal pro-peptide of brain natriuretic peptide (NT-proBNP) were performed. We assessed P wave abnormalities, PQ duration, QRS, ST segment, and T wave. The following cut-off values were considered abnormal: duration of P wave above 110 ms, of PQ interval above 210 ms, of QRS above 110 ms. The QTc intervals were calculated according to Bazett and Fridericia. QTc above 450 ms in men and above 460 in women was considered as prolonged. Results: After HDCT with autoHSCT, increased left ventricular myocardial mass index (LVMMI) was more commonly found in the patients with prolonged P wave ( 110 ms) at baseline (χ2 = 7.214; odds ratio (OR) 4.179; 95% confidence interval [CI] 1.425–12.250; p = 0.015), and increased left atrial volume index (LAVI) was more common for those with initially two-humped P wave (χ2 = 11.169; OR 19.231; 95% CI 2.064–179.212; p = 0.004). Before HDCT with autoHSCT, flattened T wave was present in 14 (19.7%) of the study patients. After the treatment, 8 (11.3%) of the patients demonstrated a new T wave abnormalities, associated with more frequent new TnT increase ( 14 pg/mL) (χ2 = 7.945; p = 0.025), as well as with increased LAVI (p = 0.018) and LVMMI (p = 0.018). Before HDCT with autoHSCT, 10 (14.1%) of the study patients had a prolonged QTc interval, which correlated to the increased NT-proBNP level ( 125 pg/mL) (r = 0.247; p = 0.038). The assessment of the QTc length after HDCT with autoHSCT showed, that the increase of NT-proBNP levels by 1 pg/mL was associated with an increase of the QTc duration by 0.003 mc(p = 0.027). Conclusion: In patients with hematological malignancies, baseline P wave abnormalities are the risk factor for increased LVMMI and LAVI after HDCT with autoHSCT. New T wave abnormalities and QTc prolongation after HDCT with autoHSCT are associated with the signs of myocadial injury and dysfunction.
{"title":"Electrocardiogram abnormalities in patients with hematological malignancies before and after high dose chemotherapy and autologous hematopoietic stem cell transplantation","authors":"N. Potemkina, M. G. Glezer, P. Chomakhidze, P. A. Zeynalova, G. Petrova, A. I. Novikova, Artur N. Gasymov, Maria G. Poltavskaya","doi":"10.18786/2072-0505-2024-52-010","DOIUrl":"https://doi.org/10.18786/2072-0505-2024-52-010","url":null,"abstract":"Rationale: Electrocardiography (ECG) is an objective and widely available method for the diagnosis of cardiovascular disorders recommended for identification of abnormalities, including those in patients with malignancies. A few studies have been published on the assessment of changes in ECG over time in patients with hemoblastoses under high-dose chemotherapy (HDCT) with subsequent transplantation of autologous hematopoietic stem cells (autoHSCT). \u0000Aim: To study ECG abnormalities before HDCT with autoHSCT and after treatment and their association with cardiac dysfunction in patients with hematological malignancies. \u0000Materials and methods: This prospective cohort observational study included 71 patients with confirmed hemoblastoses. Before HDCT with autoHSCT and at the average of 20 weeks thereafter, a 12-lead standard ECG, echocardiography, and measurement of cardiac biomarkers (troponin T [TnT] and N-terminal pro-peptide of brain natriuretic peptide (NT-proBNP) were performed. We assessed P wave abnormalities, PQ duration, QRS, ST segment, and T wave. The following cut-off values were considered abnormal: duration of P wave above 110 ms, of PQ interval above 210 ms, of QRS above 110 ms. The QTc intervals were calculated according to Bazett and Fridericia. QTc above 450 ms in men and above 460 in women was considered as prolonged. \u0000Results: After HDCT with autoHSCT, increased left ventricular myocardial mass index (LVMMI) was more commonly found in the patients with prolonged P wave ( 110 ms) at baseline (χ2 = 7.214; odds ratio (OR) 4.179; 95% confidence interval [CI] 1.425–12.250; p = 0.015), and increased left atrial volume index (LAVI) was more common for those with initially two-humped P wave (χ2 = 11.169; OR 19.231; 95% CI 2.064–179.212; p = 0.004). Before HDCT with autoHSCT, flattened T wave was present in 14 (19.7%) of the study patients. After the treatment, 8 (11.3%) of the patients demonstrated a new T wave abnormalities, associated with more frequent new TnT increase ( 14 pg/mL) (χ2 = 7.945; p = 0.025), as well as with increased LAVI (p = 0.018) and LVMMI (p = 0.018). Before HDCT with autoHSCT, 10 (14.1%) of the study patients had a prolonged QTc interval, which correlated to the increased NT-proBNP level ( 125 pg/mL) (r = 0.247; p = 0.038). The assessment of the QTc length after HDCT with autoHSCT showed, that the increase of NT-proBNP levels by 1 pg/mL was associated with an increase of the QTc duration by 0.003 mc(p = 0.027). \u0000Conclusion: In patients with hematological malignancies, baseline P wave abnormalities are the risk factor for increased LVMMI and LAVI after HDCT with autoHSCT. New T wave abnormalities and QTc prolongation after HDCT with autoHSCT are associated with the signs of myocadial injury and dysfunction.","PeriodicalId":502611,"journal":{"name":"Almanac of Clinical Medicine","volume":"21 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141272906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-22DOI: 10.18786/2072-0505-2024-52-009
Irena A. Ilovayskaya, E. Kruchinina
Real world clinical practice frequently poses the question on the advisability of diagnostic and/or treatment interventions for increased prolactin levels of below 2500 mU/mL (100 ng/mL), which is commonly considered as mild and not unequivocally indicating a prolactinoma. The aim of the review is to critically analyze the body of literature within the last 10 years on clinical and biochemical particulars of patients with mildly increased prolactin levels. We performed the search in Pubmed and RISC (Russian Index of Science Citation) databases with the keywords of “mild hyperprolactinemia” and “women” (or their Russian equivalents). After exclusion of the studies in patients with primary hypothyroidism or treatment with agents inducing prolactin secretion, as well as of clinical case descriptions, we selected 21 original papers with clinical and biochemical data of female patients with mild hyperprolactinemia (prolactin levels of less than 2500 mU/mL or less than 100 ng/mL). Symptoms of mild hyperprolactinemia include menstrual cycle disorders, anovulatory infertility and/or early pregnancy losses, breast disorders, psychoemotional and sexual disorders, and metabolic abnormalities. Repeated testing of prolactin levels to exclude potential stress related to the vein puncture allows for exclusion of 27% to 28% of the patients from further diagnostic work up. Confirmation of persistently increased prolactin levels warrants a magnetic resonance imaging study of the pituitary. Most patients with persistently increased prolactin levels by repeated tests would have pituitary abnormalities (in most cases, pituitary microadenoma). Taking into account the data on negative effects of even mildly increased prolactin levels on reproductive and metabolic health, it is reasonable to administer a first line agent cabergoline at doses ensuring normoprolactinemia. The results of studies indicate that treatment with cabergoline at doses necessary to normalize prolactin levels would lead to regression of menstrual dysfunction, decrease the probability of early pregnancy losses, improve metabolic parameters, promotes restoration of the sexual function, and diminishes the level of depression. This is especially important when planning pregnancy in patients with menstrual cycle disorders, infertility and/or early pregnancy losses.
{"title":"Mild hyperprolactinemia in clinical practice: the diagnostic “traps” and treatment strategy","authors":"Irena A. Ilovayskaya, E. Kruchinina","doi":"10.18786/2072-0505-2024-52-009","DOIUrl":"https://doi.org/10.18786/2072-0505-2024-52-009","url":null,"abstract":"Real world clinical practice frequently poses the question on the advisability of diagnostic and/or treatment interventions for increased prolactin levels of below 2500 mU/mL (100 ng/mL), which is commonly considered as mild and not unequivocally indicating a prolactinoma. \u0000The aim of the review is to critically analyze the body of literature within the last 10 years on clinical and biochemical particulars of patients with mildly increased prolactin levels. We performed the search in Pubmed and RISC (Russian Index of Science Citation) databases with the keywords of “mild hyperprolactinemia” and “women” (or their Russian equivalents). After exclusion of the studies in patients with primary hypothyroidism or treatment with agents inducing prolactin secretion, as well as of clinical case descriptions, we selected 21 original papers with clinical and biochemical data of female patients with mild hyperprolactinemia (prolactin levels of less than 2500 mU/mL or less than 100 ng/mL). Symptoms of mild hyperprolactinemia include menstrual cycle disorders, anovulatory infertility and/or early pregnancy losses, breast disorders, psychoemotional and sexual disorders, and metabolic abnormalities. Repeated testing of prolactin levels to exclude potential stress related to the vein puncture allows for exclusion of 27% to 28% of the patients from further diagnostic work up. Confirmation of persistently increased prolactin levels warrants a magnetic resonance imaging study of the pituitary. Most patients with persistently increased prolactin levels by repeated tests would have pituitary abnormalities (in most cases, pituitary microadenoma). Taking into account the data on negative effects of even mildly increased prolactin levels on reproductive and metabolic health, it is reasonable to administer a first line agent cabergoline at doses ensuring normoprolactinemia. The results of studies indicate that treatment with cabergoline at doses necessary to normalize prolactin levels would lead to regression of menstrual dysfunction, decrease the probability of early pregnancy losses, improve metabolic parameters, promotes restoration of the sexual function, and diminishes the level of depression. This is especially important when planning pregnancy in patients with menstrual cycle disorders, infertility and/or early pregnancy losses.","PeriodicalId":502611,"journal":{"name":"Almanac of Clinical Medicine","volume":"34 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140674628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-12DOI: 10.18786/2072-0505-2024-52-008
L. Velikanova, Natalia V. Vorokhobina, V. Kalugina, Zulfiya R. Shafigullina, E. Malevanaya, E. Strelnikova, V. Y. Bokhyan
Background: The effectiveness of polychemotherapy (PCT) for adrenocortical cancer (ACC) is assessed by imaging tests with the RECIST 1.1 criteria. However, the presence of subclinical tumor foci does not allow for an objective measurement of the true tumor burden. As shown previously, postoperative assessment of the steroid metabolome by gas chromatography-mass spectrometry (GCMS) in ACC patients makes it possible to identify early signs of adrenal steroidogenesis abnormalities and of the recurrence of adrenocortical carcinoma. Aim: To identify biomarkers of response to PCT by GCMS study of the urine steroid profile in ACC patients after surgical resection of the tumor. Materials and methods: Urine steroid profiles were studied by GCMS (Shimadzu GCMS-TQ8050 gas chromatography-mass spectrometer) in 30 ACC patients (stages II, III and IV) after surgery and first line (combination of etoposide, doxorubicin and cisplatin with daily mitotane) and second line (gemcitabine combined with capecitabine and mitotane) PCT. The control group included 25 patients with hormonally inactive adenomas. Results: The response to PCT according to RECIST 1.1 criteria was obtained in 23 patients (Group 1, responders) and in 7 patients ACC progressed under PCT (Group 2, non-responders). In the responders, the urinary excretion of etiocholanolone, pregnanediol and pregnanetriol was lower than in the control group. The non-responders had higher urinary excretion of androgens, progestogens and tetrahydro-11-deoxycortisol (THS), compared to the responders and the control group. The patients with ACC progression under PCT had an increase in 3β,16,20-pregnenetriol (3β,16,20-dP3) levels and a decrease of the 3α,16,20-dP3/3β,16,20-dP3 ratio, compared to those in the PCT responders. The threshold values for urinary excretion of dehydroepiandrosterone (DHEA, ≤ 469 mcg/24h; AUC = 1.0), THS (≤ 223 mcg/24h; AUC = 1.0), and 3β,16,20-dP3 (≤ 130 mcg/24h; AUC = 0.986), as well as the 3α,16,20-dP3/3β,16,20-dP3 ratio (≥ 2.13; AUC = 1.0) had 100% sensitivity and specificity for the assessment of the PCT effectiveness. Conclusion: Different urine steroid profiles were obtained by GCMS in the ACC patients after PCT with and without treatment response. The 100% sensitivity and specificity of the threshold values for urinary excretion of DHEA, THS, 3β,16,20-dP3 and the 3α,16,20-dP3/3β,16,20-dP3 ratio for the assessment of PCT results indicate the potential to use these parameters as biomarkers of response or progression of the disease in the monitoring of PCT effects in ACC patients.
{"title":"Biomarkers for assessment of the polychemotherapy results in patients with adrenocortical cancer based on gas chromatography-mass spectrometry studies of urine steroid profiles","authors":"L. Velikanova, Natalia V. Vorokhobina, V. Kalugina, Zulfiya R. Shafigullina, E. Malevanaya, E. Strelnikova, V. Y. Bokhyan","doi":"10.18786/2072-0505-2024-52-008","DOIUrl":"https://doi.org/10.18786/2072-0505-2024-52-008","url":null,"abstract":"Background: The effectiveness of polychemotherapy (PCT) for adrenocortical cancer (ACC) is assessed by imaging tests with the RECIST 1.1 criteria. However, the presence of subclinical tumor foci does not allow for an objective measurement of the true tumor burden. As shown previously, postoperative assessment of the steroid metabolome by gas chromatography-mass spectrometry (GCMS) in ACC patients makes it possible to identify early signs of adrenal steroidogenesis abnormalities and of the recurrence of adrenocortical carcinoma. \u0000Aim: To identify biomarkers of response to PCT by GCMS study of the urine steroid profile in ACC patients after surgical resection of the tumor. \u0000Materials and methods: Urine steroid profiles were studied by GCMS (Shimadzu GCMS-TQ8050 gas chromatography-mass spectrometer) in 30 ACC patients (stages II, III and IV) after surgery and first line (combination of etoposide, doxorubicin and cisplatin with daily mitotane) and second line (gemcitabine combined with capecitabine and mitotane) PCT. The control group included 25 patients with hormonally inactive adenomas. \u0000Results: The response to PCT according to RECIST 1.1 criteria was obtained in 23 patients (Group 1, responders) and in 7 patients ACC progressed under PCT (Group 2, non-responders). In the responders, the urinary excretion of etiocholanolone, pregnanediol and pregnanetriol was lower than in the control group. The non-responders had higher urinary excretion of androgens, progestogens and tetrahydro-11-deoxycortisol (THS), compared to the responders and the control group. The patients with ACC progression under PCT had an increase in 3β,16,20-pregnenetriol (3β,16,20-dP3) levels and a decrease of the 3α,16,20-dP3/3β,16,20-dP3 ratio, compared to those in the PCT responders. The threshold values for urinary excretion of dehydroepiandrosterone (DHEA, ≤ 469 mcg/24h; AUC = 1.0), THS (≤ 223 mcg/24h; AUC = 1.0), and 3β,16,20-dP3 (≤ 130 mcg/24h; AUC = 0.986), as well as the 3α,16,20-dP3/3β,16,20-dP3 ratio (≥ 2.13; AUC = 1.0) had 100% sensitivity and specificity for the assessment of the PCT effectiveness. \u0000Conclusion: Different urine steroid profiles were obtained by GCMS in the ACC patients after PCT with and without treatment response. The 100% sensitivity and specificity of the threshold values for urinary excretion of DHEA, THS, 3β,16,20-dP3 and the 3α,16,20-dP3/3β,16,20-dP3 ratio for the assessment of PCT results indicate the potential to use these parameters as biomarkers of response or progression of the disease in the monitoring of PCT effects in ACC patients.","PeriodicalId":502611,"journal":{"name":"Almanac of Clinical Medicine","volume":"4 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140708982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-11DOI: 10.18786/2072-0505-2024-52-007
S. V. Khromova, G. G. Karmazanovsky, Natalia A. Karelskaya, I. Gruzdev
Background: Differentiation of tumor grade at the preoperative stage is of utmost importance for the modification of the treatment strategy and the extent of operation. However, the routine analysis of computed tomography (CT) data in clear cell renal cell carcinoma (ccRCC) does not allow for reliable determination of the tumor grade. Aim: To assess the reproducibility of the results of 2D and 3D segmentation of a kidney tumor in the cortico-medullary and nephrographic phases of CT studies, as well as the reproducibility of the first order texture parameters for 2D and 3D tumor segmentation in patients with verified ccRCC. Materials and methods: This retrospective study included the CT data of 50 patients with morphologically verified ccRCC obtained before their surgical treatment. The first patient group included the patients with the renal tumor size in the axial plane of ≥ 4 cm (28 patients, 29 CT studies), and the second patient group included those with the renal tumor size in axial plane of 4 cm (22 patients, 23 CT studies). Two radiologists independently performed segmentation of the renal tumor in the cortico-medullary and nephrographic phases of CT procedures done under a standard protocol with the bolus intravenous contrast enhancement. A two-dimensional region of interest (2D ROI) was selected by the investigators on a subjectively selected axial slice, where the tumor had the largest size. When forming a three-dimensional region of interest (3D ROI), the entire tumor volume was segmented. Next, the statistical analysis of the segmentation results and the results of calculation of the first order texture indices was performed with calculation of the intra-class correlation coefficient (ICC) to assess the strength of the data correlation. The ICC of ≥ 0.75 demonstrated the reproducibility of the segmentation results and the first order texture indices. Results: The 3D segmentation method for ccRCC demonstrated the best ROI reproducibility results, regardless of the tumor size and the phase of contrast enhancement, with the ICC values of 0.961 (95% confidence interval: 0.946–0.971) for the cortico-medullary phase and 0.969 (95% CI: 0.958–0.977) for the nephrographic phase. The 2D tumor segmentation method showed unsatisfactory ROI reproducibility, with the ICC values of ≤ 0.058; however, the unsatisfactory reproducibility of the segmentation results in the patients with ccRCC tumor size of ≥ 4 cm did not significantly affect the reproducibility of the Entropy and Energy texture indices (good to excellent correlation). With the 3D segmentation of ccRCC, most first-order texture metrics were reproducible, with the exception of the Kurtosis parameter. The Entropy and Energy scores in both patient groups demonstrated a high degree of reproducibility. In the 2D tumor segmentation, high reproducibility of the first order texture metrics was obtained for the Entropy and Energy indices. Conclusion: The 3D segmentation of the CT data for ccRC
{"title":"The texture analysis of computed tomography studies in clear cell renal cell carcinoma: reproducibility of 2D and 3D segmentation","authors":"S. V. Khromova, G. G. Karmazanovsky, Natalia A. Karelskaya, I. Gruzdev","doi":"10.18786/2072-0505-2024-52-007","DOIUrl":"https://doi.org/10.18786/2072-0505-2024-52-007","url":null,"abstract":"Background: Differentiation of tumor grade at the preoperative stage is of utmost importance for the modification of the treatment strategy and the extent of operation. However, the routine analysis of computed tomography (CT) data in clear cell renal cell carcinoma (ccRCC) does not allow for reliable determination of the tumor grade. \u0000Aim: To assess the reproducibility of the results of 2D and 3D segmentation of a kidney tumor in the cortico-medullary and nephrographic phases of CT studies, as well as the reproducibility of the first order texture parameters for 2D and 3D tumor segmentation in patients with verified ccRCC. \u0000Materials and methods: This retrospective study included the CT data of 50 patients with morphologically verified ccRCC obtained before their surgical treatment. The first patient group included the patients with the renal tumor size in the axial plane of ≥ 4 cm (28 patients, 29 CT studies), and the second patient group included those with the renal tumor size in axial plane of 4 cm (22 patients, 23 CT studies). Two radiologists independently performed segmentation of the renal tumor in the cortico-medullary and nephrographic phases of CT procedures done under a standard protocol with the bolus intravenous contrast enhancement. A two-dimensional region of interest (2D ROI) was selected by the investigators on a subjectively selected axial slice, where the tumor had the largest size. When forming a three-dimensional region of interest (3D ROI), the entire tumor volume was segmented. Next, the statistical analysis of the segmentation results and the results of calculation of the first order texture indices was performed with calculation of the intra-class correlation coefficient (ICC) to assess the strength of the data correlation. The ICC of ≥ 0.75 demonstrated the reproducibility of the segmentation results and the first order texture indices. \u0000Results: The 3D segmentation method for ccRCC demonstrated the best ROI reproducibility results, regardless of the tumor size and the phase of contrast enhancement, with the ICC values of 0.961 (95% confidence interval: 0.946–0.971) for the cortico-medullary phase and 0.969 (95% CI: 0.958–0.977) for the nephrographic phase. The 2D tumor segmentation method showed unsatisfactory ROI reproducibility, with the ICC values of ≤ 0.058; however, the unsatisfactory reproducibility of the segmentation results in the patients with ccRCC tumor size of ≥ 4 cm did not significantly affect the reproducibility of the Entropy and Energy texture indices (good to excellent correlation). With the 3D segmentation of ccRCC, most first-order texture metrics were reproducible, with the exception of the Kurtosis parameter. The Entropy and Energy scores in both patient groups demonstrated a high degree of reproducibility. In the 2D tumor segmentation, high reproducibility of the first order texture metrics was obtained for the Entropy and Energy indices. \u0000Conclusion: The 3D segmentation of the CT data for ccRC","PeriodicalId":502611,"journal":{"name":"Almanac of Clinical Medicine","volume":"12 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140715718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-10DOI: 10.18786/2072-0505-2024-52-006
O. Urazova, G. V. Reyngardt, Yuliya V. Kolobovnikova, A. V. Kurnosenko, V. S. Poletika, Olga A. Vasil'yeva, A. Avgustinovich
Background: Galectin-1 plays an important role in the pathogenesis of colorectal cancer (CRC). The blood and tumoral levels of galectin-1 could be dependent on the polymorphism of the promotor region of LGALS1 gene. Aim: To analyze an association between galectin-1 levels in tumor tissue and plasma and the genotype of the rs4820293 and rs4820294 polymorphisms of the LGALS1 gene in CRC patients. Materials and methods: The study included a total of 70 inpatients with pathologically verified CRC (International Classification of Diseases 10th Revision codes C18-C20, 39 men and 31 women, mean age 65.4 ± 5.7 years), who were receiving treatment in the Tomsk Regional Oncology Center and Cancer Research Institute of the Tomsk National Research Medical Center from 2020 to 2022. The control group consisted of 70 healthy volunteers (34 men and 36 women, mean age 62.3 ± 7.2 years). Venous blood samples were taken from all study participants and tumor tissue samples were obtained from the CRC patients. Galectin-1 expression in the tumor tissue was assessed by immunohistochemistry and plasma galectin-1 levels by enzyme-linked immunosorbent assay. The LGALS1 gene polymorphisms rs4820293 and rs4820294 were identified by restriction fragment length polymorphism analysis. Results: The distributions of genotype and allele frequencies of polymorphic variants rs4820293 and rs4820294 of the LGALS1 gene in the CRC patients and in the healthy donors were comparable (p 0.05). Calculation of odds ratios did not confirm any association between LGALS1 gene polymorphisms and CRC. However, the rs4820294 polymorphism had a strong association with regional metastasis and tumor differentiation grade (Cramer's V above 0.4, p 0.001). The plasma galectin-1 levels in the CRC patients with the AA genotype of the rs4820294 polymorphism were higher than in the healthy carriers (17.42 versus 12.92 ng/ml, p = 0.040). However, there were no significant differences in the content of galectin-1+ cells in the tumor and galectin-1 in plasma of the CRC patients depending on the genotype of the LGALS1 gene polymorphisms (p 0.05). Conclusion: The LGALS1 gene polymorphism is not associated with CRC, but in the carriers of the rs4820294 variant is related to clinical and morphological parameters of the tumor process. The intratumoral expression and blood levels of galectin-1 in CRC patients are not dependent on the genotype of rs4820293 and rs4820294 polymorphisms of the LGALS1 gene.
{"title":"The LGALS1 gene polymorphism is not associated with galectin-1 levels in tumor tissue and blood of colon cancer patients","authors":"O. Urazova, G. V. Reyngardt, Yuliya V. Kolobovnikova, A. V. Kurnosenko, V. S. Poletika, Olga A. Vasil'yeva, A. Avgustinovich","doi":"10.18786/2072-0505-2024-52-006","DOIUrl":"https://doi.org/10.18786/2072-0505-2024-52-006","url":null,"abstract":"Background: Galectin-1 plays an important role in the pathogenesis of colorectal cancer (CRC). The blood and tumoral levels of galectin-1 could be dependent on the polymorphism of the promotor region of LGALS1 gene. \u0000Aim: To analyze an association between galectin-1 levels in tumor tissue and plasma and the genotype of the rs4820293 and rs4820294 polymorphisms of the LGALS1 gene in CRC patients. \u0000Materials and methods: The study included a total of 70 inpatients with pathologically verified CRC (International Classification of Diseases 10th Revision codes C18-C20, 39 men and 31 women, mean age 65.4 ± 5.7 years), who were receiving treatment in the Tomsk Regional Oncology Center and Cancer Research Institute of the Tomsk National Research Medical Center from 2020 to 2022. The control group consisted of 70 healthy volunteers (34 men and 36 women, mean age 62.3 ± 7.2 years). Venous blood samples were taken from all study participants and tumor tissue samples were obtained from the CRC patients. Galectin-1 expression in the tumor tissue was assessed by immunohistochemistry and plasma galectin-1 levels by enzyme-linked immunosorbent assay. The LGALS1 gene polymorphisms rs4820293 and rs4820294 were identified by restriction fragment length polymorphism analysis. \u0000Results: The distributions of genotype and allele frequencies of polymorphic variants rs4820293 and rs4820294 of the LGALS1 gene in the CRC patients and in the healthy donors were comparable (p 0.05). Calculation of odds ratios did not confirm any association between LGALS1 gene polymorphisms and CRC. However, the rs4820294 polymorphism had a strong association with regional metastasis and tumor differentiation grade (Cramer's V above 0.4, p 0.001). The plasma galectin-1 levels in the CRC patients with the AA genotype of the rs4820294 polymorphism were higher than in the healthy carriers (17.42 versus 12.92 ng/ml, p = 0.040). However, there were no significant differences in the content of galectin-1+ cells in the tumor and galectin-1 in plasma of the CRC patients depending on the genotype of the LGALS1 gene polymorphisms (p 0.05). \u0000Conclusion: The LGALS1 gene polymorphism is not associated with CRC, but in the carriers of the rs4820294 variant is related to clinical and morphological parameters of the tumor process. The intratumoral expression and blood levels of galectin-1 in CRC patients are not dependent on the genotype of rs4820293 and rs4820294 polymorphisms of the LGALS1 gene.","PeriodicalId":502611,"journal":{"name":"Almanac of Clinical Medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140718361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-10DOI: 10.18786/2072-0505-2024-52-005
N. E. Kushlinskii, O. Kovaleva, Arseniy G. Basov, Yu. B. Kuzmin, Aleksandr A. Alferov, S. Bezhanova, Aleksey V. Kolpashchikov, I. A. Klimanov, Alexey N. Grachev, N. N. Zybina, V. Matveev, O. Yanushevich, I. Stilidi
Background: Galectins are a family of β-galactoside binding proteins that regulate the vast majority of cellular functions, including proliferation, migration, adhesion, and phagocytosis in both health and disease. More and more experimental and clinical evidence indicates that galectins are involved in many stages of carcinogenesis, including patients with renal cell carcinoma (RCC). Aim: To analyze the clinical significance of soluble forms of galectins -1, -3, -4, -7, -9 in patients with various histological RCC types. Materials and methods: We performed a retrospective analysis of the clinical significance of galectins -1, -3, -4, -7, -9 in the serum of 140 RCC patients (84 with clear cell RCC (ccRCC), 38 with papillary (papRCC), 18 with chromophobe (chrRCC)) and in 73 healthy donors (control group), who were examined and treated from 2019 to 2023 in the N. N. Blokhin National Medical Research Center of Oncology. Galectin levels were measured in serum (obtained according to standard methods before the initiation of specific treatment) with an enzyme-linked immunosorbent assay. Results: There was a significant increase in serum galectin -1, -3, -9 levels in the whole RCC patient group, compared to the healthy donor control group; no increase was found for galectins -4 and -7. Serum galectin-1 levels in the ccRCC and papRCC patients were significantly higher than those in the controls (p = 0.0003 and p = 0.0135, respectively). No association between the serum galectins -1 and -7 and the clinical and morphological characteristics of RCC was found; however, serum galectin-7 levels in the papRCC patients correlated with the grade of tumor differentiation (r = -0.592; p = 0.001). The area under the ROC curve (AUC) for galectin-1 in ccRCC was 0.721 (p 0.0001), in papRCC 0.673 (p = 0.0086), and in chrRCC 0.576 (p = 0.355). For galectin-7, the ROC AUC values were 0.527 (p = 0.634) in ccRCC, 0.513 (p = 0.845) in papRCC, and 0.566 (p = 0.425) in chrRCC. In all histological types of RCC, there was a significant increase in serum galectin-3 compared to the controls (ccRCC, p = 0.0208; papRCC, p = 0.0014; chrRCC, p = 0.0041). The ROC analysis for galectin-3 in patients with RCC of various histological types showed AUC = 0.721 (p 0.0001) for ccRCC, 0.673 (p = 0.0086) for papRCC, and 0.576 (p = 0.355) for chrRCC. Galectin-9 levels was directly and significantly associated with the tumor size, as well as with regional metastases (r = 0.251, p = 0.021; r = 0.239, p = 0.028, respectively). The AUC values for galectin-4 were 0.619 (p = 0.021) in ccRCC, 0.577 (p = 0.214) in papRCC, and 0.534 (p = 0.666) for chrRCC. For galectin-9, they were 0.649 (p = 0.0075), 0.613 (p = 0.087), and 0.539 (p = 0.637), respectively. Conclusion: The study has demonstrated a certain association between serum galectin -1, -3, -4, -7, and -9 in the patients with RCC of various histological types. Although the results of the ROC analysis indicated average quality of the model, whic
{"title":"The content of soluble forms of galectins -1, -3, -4, -7, -9 in patients with renal cell cancer of various morphological types","authors":"N. E. Kushlinskii, O. Kovaleva, Arseniy G. Basov, Yu. B. Kuzmin, Aleksandr A. Alferov, S. Bezhanova, Aleksey V. Kolpashchikov, I. A. Klimanov, Alexey N. Grachev, N. N. Zybina, V. Matveev, O. Yanushevich, I. Stilidi","doi":"10.18786/2072-0505-2024-52-005","DOIUrl":"https://doi.org/10.18786/2072-0505-2024-52-005","url":null,"abstract":"Background: Galectins are a family of β-galactoside binding proteins that regulate the vast majority of cellular functions, including proliferation, migration, adhesion, and phagocytosis in both health and disease. More and more experimental and clinical evidence indicates that galectins are involved in many stages of carcinogenesis, including patients with renal cell carcinoma (RCC). \u0000Aim: To analyze the clinical significance of soluble forms of galectins -1, -3, -4, -7, -9 in patients with various histological RCC types. \u0000Materials and methods: We performed a retrospective analysis of the clinical significance of galectins -1, -3, -4, -7, -9 in the serum of 140 RCC patients (84 with clear cell RCC (ccRCC), 38 with papillary (papRCC), 18 with chromophobe (chrRCC)) and in 73 healthy donors (control group), who were examined and treated from 2019 to 2023 in the N. N. Blokhin National Medical Research Center of Oncology. Galectin levels were measured in serum (obtained according to standard methods before the initiation of specific treatment) with an enzyme-linked immunosorbent assay. \u0000Results: There was a significant increase in serum galectin -1, -3, -9 levels in the whole RCC patient group, compared to the healthy donor control group; no increase was found for galectins -4 and -7. Serum galectin-1 levels in the ccRCC and papRCC patients were significantly higher than those in the controls (p = 0.0003 and p = 0.0135, respectively). No association between the serum galectins -1 and -7 and the clinical and morphological characteristics of RCC was found; however, serum galectin-7 levels in the papRCC patients correlated with the grade of tumor differentiation (r = -0.592; p = 0.001). The area under the ROC curve (AUC) for galectin-1 in ccRCC was 0.721 (p 0.0001), in papRCC 0.673 (p = 0.0086), and in chrRCC 0.576 (p = 0.355). For galectin-7, the ROC AUC values were 0.527 (p = 0.634) in ccRCC, 0.513 (p = 0.845) in papRCC, and 0.566 (p = 0.425) in chrRCC. In all histological types of RCC, there was a significant increase in serum galectin-3 compared to the controls (ccRCC, p = 0.0208; papRCC, p = 0.0014; chrRCC, p = 0.0041). The ROC analysis for galectin-3 in patients with RCC of various histological types showed AUC = 0.721 (p 0.0001) for ccRCC, 0.673 (p = 0.0086) for papRCC, and 0.576 (p = 0.355) for chrRCC. Galectin-9 levels was directly and significantly associated with the tumor size, as well as with regional metastases (r = 0.251, p = 0.021; r = 0.239, p = 0.028, respectively). The AUC values for galectin-4 were 0.619 (p = 0.021) in ccRCC, 0.577 (p = 0.214) in papRCC, and 0.534 (p = 0.666) for chrRCC. For galectin-9, they were 0.649 (p = 0.0075), 0.613 (p = 0.087), and 0.539 (p = 0.637), respectively. \u0000Conclusion: The study has demonstrated a certain association between serum galectin -1, -3, -4, -7, and -9 in the patients with RCC of various histological types. Although the results of the ROC analysis indicated average quality of the model, whic","PeriodicalId":502611,"journal":{"name":"Almanac of Clinical Medicine","volume":"169 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140719903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-09DOI: 10.18786/2072-0505-2024-52-004
Natalia V. Vorokhobina, V. Kalugina, L. Velikanova, Zulfiya R. Shafigullina, Ekaterina V. Malevanaya, A. A. Lisitsyn
Background: Endogenous hypercortisolism of adrenal origin is commonly associated with immune suppression. However, these patients also have signs characteristic of chronic inflammatory diseases. Better understanding of the mechanisms that alter the functioning of the immune system would allow for the development of a patient-centered approach to the treatment of corticotropin-independent endogenous Cushing's syndrome (CS). Aim: To assess the association between full blood count and gas chromatography-mass spectrometry-based urinary steroid excretion in patients with adrenal masses depending on malignancy grade and presence of hypercortisolism. Materials and methods: We retrospectively analyzed data from 42 patients with adrenal masses who had not received chemotherapy. The median age of the patients was 54 [Q25; Q75: 37; 63] years, and 76% of them were female. Preoperatively, all patients had hematology tests with differential leukocyte count. Steroid metabolome was assessed with Shimadzu GCMS-TQ8050 gas chromatography-mass spectrometer. Results: Twelve (12) patients had adrenocortical cancer (ACC) and CS, 9 patients had ACC without CS, 11 had adrenocortical adenomas (ACA) and CS, and 10 patients had ACA without CS. ACC patients had a higher neutrophil-to-lymphocyte ratio (NLR) than those with ACA: 3.35 [2.5; 6.3] vs 1.99 [1.41; 2.65] (р = 0.001). There was a linear correlation between NLR and serum cortisol levels after the 1 mg overnight dexamethasone suppression test (r = 0.41, p = 0.01), urinary excretion of 5β-tetrahydrocortisol (5β-THF) (r = 0.71, p 0.001) and 11β-hydroxyandrosterone (11β-OH-An) (r = 0.74, p 0.001). The ACC patients without CS had lower 5β-THF urinary excretion values, compared to ACA with CS patients: 931 [616; 1610] and 3139 [1480; 4375] mcg/24h, respectively (р = 0.007). 11β-OH-An urinary excretion in ACC patients without CS was higher than in ACA patients with CS: 1170 [806; 1266] и 602 [320; 739] mcg/24h (р = 0.007). The NLR cut-off value for adrenal mass malignancy in patients with CS exceeded 2.72 (sensitivity 90.0%, specificity 80.0%), and for the patients without hypercortisolism was above 1.92 (sensitivity 71.4%, specificity 100.0%). Conclusion: This is the first association identification between NLR, which is the marker of systemic inflammation, inflammation, and urinary excretion of 11β-OH-An, a metabolite of 11-hydroxyandrostenedione (a member of 11-oxygenated androgen family). This extends our understanding of the impact of hormonal activity of adrenal mass cells on the immune system.
{"title":"Association between full blood count and urine steroid metabolome in patients with adrenal masses","authors":"Natalia V. Vorokhobina, V. Kalugina, L. Velikanova, Zulfiya R. Shafigullina, Ekaterina V. Malevanaya, A. A. Lisitsyn","doi":"10.18786/2072-0505-2024-52-004","DOIUrl":"https://doi.org/10.18786/2072-0505-2024-52-004","url":null,"abstract":"Background: Endogenous hypercortisolism of adrenal origin is commonly associated with immune suppression. However, these patients also have signs characteristic of chronic inflammatory diseases. Better understanding of the mechanisms that alter the functioning of the immune system would allow for the development of a patient-centered approach to the treatment of corticotropin-independent endogenous Cushing's syndrome (CS). \u0000Aim: To assess the association between full blood count and gas chromatography-mass spectrometry-based urinary steroid excretion in patients with adrenal masses depending on malignancy grade and presence of hypercortisolism. \u0000Materials and methods: We retrospectively analyzed data from 42 patients with adrenal masses who had not received chemotherapy. The median age of the patients was 54 [Q25; Q75: 37; 63] years, and 76% of them were female. Preoperatively, all patients had hematology tests with differential leukocyte count. Steroid metabolome was assessed with Shimadzu GCMS-TQ8050 gas chromatography-mass spectrometer. \u0000Results: Twelve (12) patients had adrenocortical cancer (ACC) and CS, 9 patients had ACC without CS, 11 had adrenocortical adenomas (ACA) and CS, and 10 patients had ACA without CS. ACC patients had a higher neutrophil-to-lymphocyte ratio (NLR) than those with ACA: 3.35 [2.5; 6.3] vs 1.99 [1.41; 2.65] (р = 0.001). There was a linear correlation between NLR and serum cortisol levels after the 1 mg overnight dexamethasone suppression test (r = 0.41, p = 0.01), urinary excretion of 5β-tetrahydrocortisol (5β-THF) (r = 0.71, p 0.001) and 11β-hydroxyandrosterone (11β-OH-An) (r = 0.74, p 0.001). The ACC patients without CS had lower 5β-THF urinary excretion values, compared to ACA with CS patients: 931 [616; 1610] and 3139 [1480; 4375] mcg/24h, respectively (р = 0.007). 11β-OH-An urinary excretion in ACC patients without CS was higher than in ACA patients with CS: 1170 [806; 1266] и 602 [320; 739] mcg/24h (р = 0.007). The NLR cut-off value for adrenal mass malignancy in patients with CS exceeded 2.72 (sensitivity 90.0%, specificity 80.0%), and for the patients without hypercortisolism was above 1.92 (sensitivity 71.4%, specificity 100.0%). \u0000Conclusion: This is the first association identification between NLR, which is the marker of systemic inflammation, inflammation, and urinary excretion of 11β-OH-An, a metabolite of 11-hydroxyandrostenedione (a member of 11-oxygenated androgen family). This extends our understanding of the impact of hormonal activity of adrenal mass cells on the immune system.","PeriodicalId":502611,"journal":{"name":"Almanac of Clinical Medicine","volume":"37 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140724268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.18786/2072-0505-2024-52-003
O. Efremova, O. V. Dudchenko, L. A. Kamyshnikova, T. N. Proskokova, O. A. Bolkhovitina, Ekaterina V. Lysenko
Background: Cognitive impairment (CI) is present in 25–50% of chronic heart failure (CHF) patients. Doctors who monitor patients with cardiovascular disorders do not have clearly set criteria for their referral to a neurologist in case of suspected CI. Therefore, CHF patients do not receive treatment for CI on time. Aim: To identify significant clinical markers of CI in patients with CHF of ischemic origin. Materials and methods: This cross-sectional cohort study included 134 patients with CHF of ischemic origin (mean age 63.36 ± 10.63 years; men, 76.12%), who were regularly monitored in a municipal polyclinic. All patients were tested for CI with the Montreal Cognitive Assessment Scale (MoCA); basic hemodynamic parameters, lipid profile, brain natriuretic peptide (NT-proBNP) were assessed, and triglyceride-glucose index (TyG) and body mass index (BMI) were calculated. Cardio-ankle vascular index (CAVI) was measured, echocardiography and a 6-minute walk test (SMWТ) were performed and past history of CHF, arterial hypertension (AH) and diabetes mellitus (DM) was collected. Results: CI (MoCA score ≤ 25) was detected in 85 (63.43%) outpatients with CHF of ischemic origin; the group without CI (MoCA score 26) included 49 (36.67%) patients. There were significant correlations between MoCA and CAVI scores (partial correlation coefficient, r = -0.802, p 0.001; adjusted squared multiple correlation coefficient (adj. R2) = 0.881, p 0.001), MoCA and TyG (r = -0.357, p = 0.029; adj. R2 = 0.363, p 0.001), MoCA and SMWТ (r = -0.211, p = 0.037; adj. R2 = 0.696, p 0.001). The multivariate test for significance of planned comparisons between CAVI and MoCA scores (Wilks' lambda) was 0.005 (F = 4.74; p 0.001). Conclusion: CAVI, TyG and SMWТ values are the clinical markers of CI in patients with CHF of ischemic origin. There is a direct association between increased CAVI and the presence of CI, regardless of age, lipid metabolism parameters, structural and functional heart parameters, CHF duration, AH and DM. Identification of these markers could be an indication for an in-depth assessment of CHF patients by a neurologist.
{"title":"Clinical markers of cognitive impairment in patients with chronic heart failure of ischemic origin during out-patient regular follow-up: a cross-sectional study","authors":"O. Efremova, O. V. Dudchenko, L. A. Kamyshnikova, T. N. Proskokova, O. A. Bolkhovitina, Ekaterina V. Lysenko","doi":"10.18786/2072-0505-2024-52-003","DOIUrl":"https://doi.org/10.18786/2072-0505-2024-52-003","url":null,"abstract":"Background: Cognitive impairment (CI) is present in 25–50% of chronic heart failure (CHF) patients. Doctors who monitor patients with cardiovascular disorders do not have clearly set criteria for their referral to a neurologist in case of suspected CI. Therefore, CHF patients do not receive treatment for CI on time. \u0000Aim: To identify significant clinical markers of CI in patients with CHF of ischemic origin. \u0000Materials and methods: This cross-sectional cohort study included 134 patients with CHF of ischemic origin (mean age 63.36 ± 10.63 years; men, 76.12%), who were regularly monitored in a municipal polyclinic. All patients were tested for CI with the Montreal Cognitive Assessment Scale (MoCA); basic hemodynamic parameters, lipid profile, brain natriuretic peptide (NT-proBNP) were assessed, and triglyceride-glucose index (TyG) and body mass index (BMI) were calculated. Cardio-ankle vascular index (CAVI) was measured, echocardiography and a 6-minute walk test (SMWТ) were performed and past history of CHF, arterial hypertension (AH) and diabetes mellitus (DM) was collected. \u0000Results: CI (MoCA score ≤ 25) was detected in 85 (63.43%) outpatients with CHF of ischemic origin; the group without CI (MoCA score 26) included 49 (36.67%) patients. There were significant correlations between MoCA and CAVI scores (partial correlation coefficient, r = -0.802, p 0.001; adjusted squared multiple correlation coefficient (adj. R2) = 0.881, p 0.001), MoCA and TyG (r = -0.357, p = 0.029; adj. R2 = 0.363, p 0.001), MoCA and SMWТ (r = -0.211, p = 0.037; adj. R2 = 0.696, p 0.001). The multivariate test for significance of planned comparisons between CAVI and MoCA scores (Wilks' lambda) was 0.005 (F = 4.74; p 0.001). \u0000Conclusion: CAVI, TyG and SMWТ values are the clinical markers of CI in patients with CHF of ischemic origin. There is a direct association between increased CAVI and the presence of CI, regardless of age, lipid metabolism parameters, structural and functional heart parameters, CHF duration, AH and DM. Identification of these markers could be an indication for an in-depth assessment of CHF patients by a neurologist.","PeriodicalId":502611,"journal":{"name":"Almanac of Clinical Medicine","volume":"356 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140779512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-18DOI: 10.18786/2072-0505-2024-52-002
E. G. Akramova, Ekaterina P. Kapustina
Rationale: Thrombosis of the iliac (IV) and femoral veins (FV) is one of the most common causes of pulmonary embolism (PE). Modern ultrasound scanners are equipped with the technology of shear wave elastography, which gives a quantitative assessment of thrombus stiffness by Young's modulus reconstruction. However, the lack of convincing data on the role of thrombus stiffness for clinical manifestations of PE hinders the active use of shear wave elastography to diagnose the risk of embolism. Aim: To determine the threshold values of the venous thrombus Young’s modulus for deep venous thrombosis (DVT) of the lower extremities complicated by massive PE and/or PE with acute cor pulmonale (ACP). Materials and methods: This was a single center cross-sectional study in 101 patients who were hospitalized with the diagnosis of acute (duration of less than 2 weeks) or subacute (from 2 weeks to 3 months) IV and FV thrombosis. Doppler ultrasound of the lower extremity veins and echocardiography were done in all patients. Forty eight patients with clinical signs of PE had chest computed tomography. The venous thrombus stiffness was assessed by shear wave elastography with the Young's modulus reconstruction. We performed the ROC analysis for mean values of the Young's modulus for proximal segments of IV and FV thrombi in patients with DVT and massive PE and ACP. Results: PE was diagnosed in 40.6% (26/64) of the patients hospitalized with acute DVT and in 54.1% (20/37) of those with subacute DVT. Echocardiographic signs of ACP in massive PE were found in 47.4% (9/19) of the patients, in submassive and minor PE in 55.6% (15/27). In DVT complicated with PE, the ROC analysis of the shear wave elastography results gave the following threshold values of the mean Young’s modulus for the proximal thrombus segment: for acute IV thrombosis + PE and ACP, ≤ 16.7 kPa (AUC 0.714, sensitivity 100%, specificity 42.1%), in subacute IV thrombosis + PE and APC, ≤ 23.7 kPa (0.939, 100 and 90.9%, respectively), in acute FV thrombosis + massive PE, ≥ 9.5 kPa (0.706, 100 and 50%, respectively), in subacute FV thrombosis + massive PE, ≥ 24.4 kPa (0.550, 60.0 and 68.8%, respectively). Conclusion: Shear wave elastography of deep vein thrombi of the lower extremities makes it possible to identify patients with PE and ACP during acute and subacute IV thrombosis and to determine massive PE in acute FV thrombosis.
原理：髂静脉（IV）和股静脉（FV）血栓形成是肺栓塞（PE）最常见的原因之一。现代超声扫描仪配备了剪切波弹性成像技术，可通过杨氏模量重建对血栓的硬度进行定量评估。然而，由于缺乏关于血栓僵硬度对 PE 临床表现的作用的令人信服的数据，因此无法积极使用剪切波弹性成像来诊断栓塞风险。目的：确定下肢深静脉血栓形成（DVT）并发大面积 PE 和/或 PE 并发急性肺栓塞（ACP）时静脉血栓杨氏模量的阈值。材料和方法：这是一项单中心横断面研究，研究对象为 101 名被诊断为急性（病程少于 2 周）或亚急性（2 周至 3 个月）静脉血栓和深静脉血栓的住院患者。所有患者均接受了下肢静脉多普勒超声检查和超声心动图检查。48名有 PE 临床症状的患者接受了胸部计算机断层扫描。通过杨氏模量重建剪切波弹性成像技术评估了静脉血栓的硬度。我们对深静脉血栓、大面积 PE 和 ACP 患者 IV 和 FV 血栓近段的杨氏模量平均值进行了 ROC 分析。结果显示急性深静脉血栓形成住院患者中有 40.6%（26/64）被诊断为 PE，亚急性深静脉血栓形成住院患者中有 54.1%（20/37）被诊断为 PE。47.4% 的患者（9/19）在大面积 PE 中发现了 ACP 超声心动图征象，55.6% 的患者（15/27）在亚大面积和轻微 PE 中发现了 ACP 超声心动图征象。在伴有 PE 的深静脉血栓中，剪切波弹性成像结果的 ROC 分析得出了血栓近端段平均杨氏模量的以下阈值：急性静脉血栓 + PE 和 ACP，≤ 16.7 kPa（AUC 0.714，敏感性 100%，特异性 42.1%），亚急性静脉血栓 + PE 和 APC，≤ 23.7 kPa（分别为 0.939、100 和 90.9%），急性 FV 血栓 + 大量 PE，≥ 9.5 kPa（分别为 0.706、100 和 50%），亚急性 FV 血栓 + 大量 PE，≥ 24.4 kPa（分别为 0.550、60.0 和 68.8%）。结论对下肢深静脉血栓进行剪切波弹性成像可识别急性和亚急性静脉血栓形成时的 PE 和 ACP 患者，并确定急性静脉血栓形成时的大面积 PE。
{"title":"Shear wave elastography values of thrombus in patients with lower extremity deep vein thrombosis for pulmonary embolism detection: the ROC analysis","authors":"E. G. Akramova, Ekaterina P. Kapustina","doi":"10.18786/2072-0505-2024-52-002","DOIUrl":"https://doi.org/10.18786/2072-0505-2024-52-002","url":null,"abstract":"Rationale: Thrombosis of the iliac (IV) and femoral veins (FV) is one of the most common causes of pulmonary embolism (PE). Modern ultrasound scanners are equipped with the technology of shear wave elastography, which gives a quantitative assessment of thrombus stiffness by Young's modulus reconstruction. However, the lack of convincing data on the role of thrombus stiffness for clinical manifestations of PE hinders the active use of shear wave elastography to diagnose the risk of embolism. \u0000Aim: To determine the threshold values of the venous thrombus Young’s modulus for deep venous thrombosis (DVT) of the lower extremities complicated by massive PE and/or PE with acute cor pulmonale (ACP). \u0000Materials and methods: This was a single center cross-sectional study in 101 patients who were hospitalized with the diagnosis of acute (duration of less than 2 weeks) or subacute (from 2 weeks to 3 months) IV and FV thrombosis. Doppler ultrasound of the lower extremity veins and echocardiography were done in all patients. Forty eight patients with clinical signs of PE had chest computed tomography. The venous thrombus stiffness was assessed by shear wave elastography with the Young's modulus reconstruction. We performed the ROC analysis for mean values of the Young's modulus for proximal segments of IV and FV thrombi in patients with DVT and massive PE and ACP. \u0000Results: PE was diagnosed in 40.6% (26/64) of the patients hospitalized with acute DVT and in 54.1% (20/37) of those with subacute DVT. Echocardiographic signs of ACP in massive PE were found in 47.4% (9/19) of the patients, in submassive and minor PE in 55.6% (15/27). In DVT complicated with PE, the ROC analysis of the shear wave elastography results gave the following threshold values of the mean Young’s modulus for the proximal thrombus segment: for acute IV thrombosis + PE and ACP, ≤ 16.7 kPa (AUC 0.714, sensitivity 100%, specificity 42.1%), in subacute IV thrombosis + PE and APC, ≤ 23.7 kPa (0.939, 100 and 90.9%, respectively), in acute FV thrombosis + massive PE, ≥ 9.5 kPa (0.706, 100 and 50%, respectively), in subacute FV thrombosis + massive PE, ≥ 24.4 kPa (0.550, 60.0 and 68.8%, respectively). \u0000Conclusion: Shear wave elastography of deep vein thrombi of the lower extremities makes it possible to identify patients with PE and ACP during acute and subacute IV thrombosis and to determine massive PE in acute FV thrombosis.","PeriodicalId":502611,"journal":{"name":"Almanac of Clinical Medicine","volume":"308 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140233093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-11DOI: 10.18786/2072-0505-2023-51-050
S. A. Gasparyan, A. G. Topuzov, I. A. Orfanova, S. M. Akhmedova
The review summarizes current understanding of neutrophil extracellular traps (NETs) and their role in the development of inflammation and thrombus formation during physiological and complicated pregnancy. The main initiation factors and molecular and cellular reactions leading to the generation of NETs are described. During gestation, various pregnancy-associated triggers (cytokines, hormones, colony-stimulating factors, etc.) contribute to increased activity of innate immune factors associated with the processes of neutrophil migration into gestational tissues, adhesion, degranulation, phagocytosis and release of extracellular neutrophil traps. It has been established that the uncontrolled aberrant generation of NETs, as well as their products, including reactive oxygen species, can exert a cytotoxic effect on maternal cells and tissues, adverse fetal effects and contribute to placental damage, resulting in such pregnancy complications as placental disorders, immunothrombosis and preeclampsia. The emergence of new data on the morphological and functional characteristics of the cellular component of innate immunity necessitates their advanced research with consideration of the functional potential and conditions for NETs formation, clarification and determination of their pathophysiological significance in normal and complicated pregnancy. It seems promising to study the possibility of assessment of the DNA traps levels for early diagnosis and prognosis of gestational complications, as well as for the development of new treatment strategies including targeted therapy.
这篇综述总结了目前对中性粒细胞胞外捕获物（NETs）及其在生理性妊娠和复杂妊娠期间炎症发展和血栓形成过程中作用的认识。文中描述了导致 NETs 生成的主要启动因子以及分子和细胞反应。在妊娠期间，各种与妊娠相关的诱发因素（细胞因子、激素、集落刺激因子等）会增加与中性粒细胞迁移到妊娠组织、粘附、脱颗粒、吞噬和释放细胞外中性粒细胞捕获物等过程相关的先天性免疫因子的活性。已经证实，不受控制的嗜中性粒细胞的异常生成及其产物，包括活性氧，可对母体细胞和组织产生细胞毒性作用，对胎儿产生不利影响，并造成胎盘损伤，导致胎盘功能紊乱、免疫血栓和子痫前期等妊娠并发症。有关先天性免疫细胞成分的形态和功能特征的新数据的出现，要求对其进行深入研究，考虑 NETs 的功能潜力和形成条件，阐明并确定其在正常妊娠和复杂妊娠中的病理生理意义。研究对 DNA 陷阱水平进行评估的可能性似乎很有希望，以用于妊娠并发症的早期诊断和预后，以及开发新的治疗策略，包括靶向治疗。
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