Large-scale proteomic analysis of patients with type 2 diabetes mellitus and atherosclerosis using a label-free LC-MS/MS approach

Objective: Type 2 diabetes mellitus (T2D) is a metabolic disease whose molecular events have not yet been fully clarified. However, next-generation powerful molecular approaches such as mass spectrometry (MS)-based proteomics holds promise. In this study, we aimed to reveal the protein profile of serum samples obtained from patients with T2D and atherosclerotic cardiovascular disease using the high-resolution liquid chromatography (LC)-MS/MS system. Materials and Methods: Immune depletion was performed for the top 12 abundant proteins in 10 μl serum samples taken from individuals. Then, tryptic peptides were obtained from total proteins by applying a digestion protocol. Accordingly, reduction, alkylation, and digestion with trypsin enzyme were carried out, respectively. Tryptic peptides were analyzed in an ultra-high-pressure LC-MS/MS system with a label-free proteomic approach. The raw data were processed using the software program. Results: LC-MS/MS analyses revealed 120 proteins with significant expression changes. Some of these proteins were associated with inflammation, lipid transport, and oxidative stress, which are known to play an important role in T2D and its complications. Conclusion: As a result, LC-MS/MS analyses highlighted the proteins that will provide predictions in the treatment and course of T2D. We believe that validation of these proteins with targeted proteomic approaches in a larger sample in further studies will contribute to the development of clinically usable panels

Are perioperative near-infrared spectroscopy values correlated with clinical and biochemical parameters in cyanotic and acyanotic infants following corrective cardiac surgery?

WOS: 000371172200007PubMed ID: 26034194Background: Near-infrared spectroscopy (NIRS) is a useful non-invasive tool for monitoring infants undergoing cardiac surgery. In this study, we aimed to determine the NIRS values in cyanotic and acyanotic patients who underwent corrective cardiac surgery for congenital heart diseases. Methods: Thirty consecutive infants who were operated on with the diagnosis of ventricular septal defect (n=15) and tetralogy of Fallot (n=15) were evaluated retrospectively. A definitive repair of the underlying cardiac pathology was achieved in all cases. A total of six measurements of cerebral and renal NIRS were performed at different stages of the perioperative period. The laboratory data, mean urine output and serum lactate levels were evaluated along with NIRS values in each group. Results: The NIRS values differ in both groups, even after the corrective surgical procedure is performed. The recovery of renal NIRS values is delayed in the cyanotic patients. Conclusion: Even though definitive surgical repair is performed in cyanotic infants, recovery of the renal vasculature may be delayed by up to two days, which is suggestive of a vulnerable period for renal dysfunction

Tissue factor and vascular endothelial growth factor in detecting thromboembolic complications in diabetic atherosclerotic patients

BackgroundAtherosclerosis, which is one of the leading causes of death all over the world, can create major or minor thromboembolic complications with the exponentially increasing diabetic status. Despite all the studies, the mechanism by which endothelial damage in atherosclerosis is triggered in diabetic setting is still not fully understood. MethodsIn this study, tissue factor (TF), which is thought to act together in the formation of vasular endothelial growth factor (VEGF-A) and coagulopathy in diabetic atherosclerotic patients, may be an important indicator in this regard, a total of 100 cases who were undergone off-pump coronary artery bypass (OPCAB) which were at same risk group examined by dividing into diabetic status. Early postoperative process and biochemical parameters analyzed in terms of TF and VEGF-A levels measured before and after the operation. ResultsTF and VEGF-A expression of the T1DM group were statistically high compared to non-diabetics. Significantly longer hospital stays with changes in TF and VEGF-A were found in patients in the diabetic group compared to pre- and postoperatively, respectively; TF (95% CI: 0.879-0.992; p = 0.025), VEGF-A (95% CI: 0.964-0.991; p = 0.001) and hospital stay (95% CI: 1.96-7.49; p = 0.0001). Preoperatively measured carotid intima-media thickness (CT) was higher in diabetics and was significantly associated with atrial fibrillation (AF), (r = 0.873). Surgical team and protocols were same and OPCAB procedures were routinely applied to all patients in our clinic. No minor or major events were observed in any of the cases. ConclusionTF and VEGF-A values in patients with diabetic atherosclerosis may be important in the early detection of thromboembolic complications

Biomarkers in cardiovascular surgery biomarkers as early predictors for organ damage after cardiac surgery

WOS: 000435265600008“Biyo-belirteç” vücut tarafından üretilen, ölçülebilir ve biyolojik durumun teşhis ve ayrımını yansıtan kimyasal maddelerdir. Klinik tıpta kullanılan birçok “biyo-belirteç” gen, protein ve diğer kimyasal maddeler olup patoloji ve organ hasarını erken, hızlı tanı ve tedavi için yönlendirmektedir. Hiçbir biyo-belirteç ideal olmamakla birlikte genel özellikleri bakımından yüksek duyarlı olmalı, erken teşhis yaptırabilmeli, belli bir kesim noktasına göre ilgili olguda risk değerlendirmesi yapılabilmesini sağlamalı, ayrıca tedaviye yanıtı yönlendirebilmeli ve ilgili hasar veya hastalık durumu için prognostik olmalıdır. İlgili yanıt ya da karakteristiği istatistiksel olarak güçlü olmalıdır. Ek olarak biyobelirteçler patoloji için özgün olmalı, diğer nedenlerden ayırt ettirebilmeli, hastalığın şiddeti ve klinik sonuçlar ile paralel olmalıdır. Kardiyopulmoner bypas (KPB), bir ekstrakorporeal dolaşım modeli olup esas olarak bir pompa, rezervuar ve oksijeneratörden oluşur. KPB’ın başlangıcında kan hastadan bu endotelyal yüzey içermeyen ekstrakorporeal dolaşıma katılarak hastanın genotipi, peroperatif parametreler ve patolojinin kompleksitesine göre kalp cerrahisi sonrasında değişik derecelerde gelişen ve kanın hücresel, hücre dışı veya humoral bileşenleri tarafından yönetilen inflamatuvar süreci başlatır. Günümüzde güvenli klinik biyo-belirteçler gen teknolojileri ve proteomiks teknikleri ile tespit edilmektedir. Bu yenilikçi tekniklerin kullanımı ile birçok değişik biyobelirteçler keşfedilip klinik uygulamaya girmiş ve diğer majör tıp dallarında olduğu gibi kalp cerrahisi alanında da çığır açmıştır.A biomarker is a measureable substance produced by the body and used to diagnose or determine the biologic state. Most biomarkers used in the clinical medicine are the genes, proteins or other chemical substances that are expressed in the pathology or organ damage, allowing for early and fast diagnosis and treatment. Ideally, biomarkers must be generally highly sensitive in order to make an early diagnosis; provide certain cut-off values to enable risk assessment, therapeutic guidance and have prognostic value. Cardiopulmonary bypass (CPB) is a model of extracorporeal circulation consisting primarily of a pump, a reservoir and an oxygenerator. At the initiation of CPB, blood is drained from the patient into the extracorporeal circuit which has non-endothelial surface. The inflammatory process occurs after cardiac surgery in varied degrees depending on the genotypes and peroperative parameters or complexity of the cardiac pathology. This process is mediated by cellular, noncellular or humoral components of the blood. Today, safe clinical biomarkers are detected by gene technology and proteomics techniques. Using these innovative technologies, the discovery, validation and clinical use of several biomarkers have revolutionized the diagnosis and management in the field of cardiovascular surgery as well as other major medical disciplines

eComment. Combined surgical strategies for anomalous connection of coronary artery to pulmonary artery in adults

WOS: 000350199500030PubMed ID: 25605826We read with great interest the article by Gurbuz et al. [1]. We congratulate them on their successful effort in the surgical treatment of such a rare case, presenting with both carotid artery stenosis and coronary artery disease accompanied by an anomalous origin of the left coronary artery from pulmonary artery (ALCAPA). In fact, the traditionally-named ALCAPA leads to a left-to-right shunting into pulmonary arteries, resulting in ventricular ischaemia [2]. Although the terminology defines an origin of left anterior descending artery (LAD) from pulmonary artery, the actual flow direction of the blood is from the coronary circulation to main pulmonary artery. This reversed coronary flow leads to a coronary steal phenomenon. In general, in such cases, re-establishment of a dual coronary circulation is the preferred treatment modality [2]. However, we would like to discuss some points about the surgical treatment strategy for the case presented by Gurbuz and colleagues. Coronary artery bypass grafting (CABG) for the revascularization of LAD with the left internal thoracic artery (LITA) will provide the antegrade flow to the distal segment of LAD; however the proximal part will still have the reversed flow pattern. The coronary steal phenomenon will possibly affect the septal or diagonal branches originating proximally to the lesion at the LAD. We would prefer the addition of a pulmonary arteriotomy to the CABG procedure in this case, in order to close the origin of the LAD simply with a pericardial patch, as reported by Tseng and colleagues [3]. In our opinion, this surgical strategy will provide both anatomical and physiological correction of the underlying pathology with prevention of the reversed flow from LAD to pulmonary artery as well as the distal perfusion by means of LITA-LAD anastomosis. In conclusion, in such congenital abnormalities related to the origin of the coronary arteries, the surgical strategy might be determined depending on both the anatomical and physiological effects of the disease

eComment. Prompt decision making on the site of surgical approach in patients with chest trauma-a brief communication

WOS: 000332033800024PubMed ID: 24443401We read with great interest the article by Chen et al. [1]. Haemothorax is an important finding in trauma patients, which may either be a self-limited condition or the evidence of a life-threatening injury to the thoracic or abdominal organs. We have encountered an extremely rare case of type B dissection in which the first finding was a right-sided haemothorax [2]. Considering the case presented by Chen et al., we would like to figure out the importance of the type and site of the surgical incision. In our experience, if the echocardiography does not reveal any significant cardiac injury or pericardial effusion in such a trauma patient, the easiest and safest approach is a lateral thoracotomy at the fifth intercostal space. This approach helps discriminate intra- and extra-thoracic etiologies of bleeding in such a patient. In case of a cardiac laceration or cardiopulmonary arrest, access to the heart or cannulation of the aorta and right atrium for the utilization of cardiopulmonary bypass is easy with or without a hemi-clamshell extension of the incision. The presented case could be a major pulmonary vessel branch or intercostal artery injury leading to massive right haemothorax in which the subxiphoid pericardial window or a full sternotomy will have a limited use, but a waste of time during an active bleeding. Even the cause of the right haemothorax is a cardiac injury; an uncontrolled subxiphoid access may lead to acute decompression and cardiopulmonary arrest as presented in this case. In this patient, considering the negative echocardiographic findings for a significant pericardial effusion, the mentioned surgical algorithm does not target the most frequent causes of a massive right haemothorax. In such cases we prefer a lateral thoracotomy with a hemi-clamshell extension towards midline when necessary. Such patients require prompt evaluation and surgical intervention is lifesaving in most of the cases

Evaluation of Perfusion Modes on Vital Organ Recovery and Thyroid Hormone Homeostasis in Pediatric Patients Undergoing Cardiopulmonary Bypass

6th International Conference on Pediatric Mechanical Circulatory Support Systems and Pediatric Cardiopulmonary Perfusion -- MAY 06-08, 2010 -- Boston, MAWOS: 000284588300004PubMed ID: 21092030The objectives of this study were: (i) to evaluate the effects of perfusion modes (pulsatile vs. nonpulsatile) on vital organs recovery and (ii) to investigate the influences of two different perfusion modes on the homeostasis of thyroid hormones in pediatric patients undergoing cardiopulmonary bypass (CPB) procedures. Two hundred and eighty-nine consecutive pediatric patients undergoing open heart surgery for repair of congenital heart disease were prospectively entered into the study and were randomly assigned to two groups: the pulsatile perfusion group (Group P, n = 208) and the nonpulsatile perfusion group (Group NP, n = 81). All patients received identical surgical, perfusional, and postoperative care. Study parameters included total drainage, mean urine output in the intensive care unit (ICU), intubation time, duration of ICU and hospital stay, the need for inotropic support, pre- and postoperative enzyme levels (ALT [ alanine aminotransaminase] and AST [ aspartate aminotransaminase]), c-reactive protein, lactate, albumin, blood count (leukocytes, hematocrit, platelets), creatinine levels, and thyroid hormones (thyroid stimulating hormone [ TSH], FT3 [ free triiodothyronine], FT4 [ free thyroxine]). All patients survived the perioperative and postoperative periods. There were no statistically significant differences in either preoperative or operative parameters between the two groups. Group P, compared to Group NP, required significantly less inotropic support, had a shorter intubation period, higher urine output in ICU, and shorter duration of ICU and hospital stay. Lower lactate levels and higher albumin levels were observed in Group P and there were no significant differences in creatinine, enzyme levels, blood counts, or drainage amounts between two groups. TSH, Total T-3, Total T-4, and FT3, FT4 levels were markedly reduced versus their preoperative values in both groups. FT3 and FT4 levels were reduced significantly further in the nonpulsatile group both during CPB and at 72 h postoperation. The results of this study confirm our opinion that pulsatile perfusion leads to better vital organ recovery and clinical outcomes in the early postoperative period as compared to nonpulsatile perfusion in pediatric patients undergoing CPB cardiac surgery. The plasma concentrations of thyroid hormones are dramatically reduced during and after CPB, but pulsatile perfusion seems to have a protective effect of thyroid hormone homeostasis compared to nonpulsatile perfusion

Anticoagulant and vasodilator therapy for nicolau syndrome following intramuscular benzathine penicillin injection in a 4 year old boy

7th IEEE Asia-Pacific Conference on Applied Electromagnetics, APACE 2016 -- 11 December 2016 through 13 December 2016 -- 127632Nicolau syndrome (NS) is a rare complication of intramuscular, intraarticular or subcutaneous injection of particular drugs leading to ischemic necrosis of the surrounding skin, soft tissue and muscular tissue. Benzathine penicilin one of the most widely used antibiotic for upper respiratory tract infections and has been rarely reported to cause NS. Here we describe a 4 year old boy with diagnosis of NS after the injection of benzathine penicillin who was successfuly treated with unfractionized heparin (enoxaparine) and pentoxifylline. The practitioners should pay attention for unnecessary use of benzathine penicillin to avoid from probable complications