Clotting state after cardioversion of atrial fibrillation: a haemostasis index could detect the relationship with the arrhythmia duration

BACKGROUND: Fibrin D-dimer levels have been advocated as an useful clinical marker of thrombogenesis. HYPOTHESIS: We hypothesized that i) there is a hyperclotting state after the return of atrial fibrillation to sinus rhythm, ii) the measurement of plasma D-Dimer levels might be a good screening tool of this clotting status, and iii) the duration of arrhythmia influences the haemostasis measured by plasma D-Dimer levels. METHODS: Forty-two patients with atrial fibrillation undergoing cardioversion were divided into two groups: in Group A (n = 24,14 male, 56 ± 11 years) the duration of atrial fibrillation was 72 hours or more (142.7 ± 103.8 hours), in Group B (n = 18, 10 male, 61 ± 13 years) the duration of atrial fibrillation was less than 72 hours (25 ± 16 hours). Plasma fibrin D-dimer levels were measured by enzyme immunoassay before, and 36 hours after, cardioversion. The change of plasma D-dimer levels 36 hours after cardioversion was calculated as delta-D-dimer. RESULTS: There were no significant differences in demographic, clinical, and echocardiographic data, and the success of cardioversion between the two groups. Compared to the control, the baseline D-dimer levels were significantly higher in both groups. The delta D-dimer levels were significantly higher in Group A than in Group B (p < 0.005). Furthermore, plasma D-dimer levels 36 hours after cardioversion (r = 0.52, p = 0.0016) and delta-D-dimer levels (r = 0.73, p < 0.0001) showed significant correlations with the duration of atrial fibrillation. CONCLUSION: The longer duration of the atrial fibrillation episode could lead to a more prominent cardiovascular hyperclotting state after cardioversion, and the mean changes of plasma D-Dimer levels could be used as an useful clinical marker of the clotting state after atrial systole return

The relationship between professional burnout and satisfaction: a case study for physical education teachers in a Greek urban area

The aim of the present study is two-fold. Firstly, this research investigates the relationship between the variables of professional burnout and satisfaction among physical education teachers who work in sports organizations of large municipalities in the region of Attica, Greece. Secondly, the relationship between organizational factors and the variables of professional burnout and satisfaction was examined. All the teachers who took part in the survey are occupied in a municipal program called “Sports for all”. With the method of random sampling, a total of 100 questionnaires, representing 10% of the survey population, were filled out by physical education teachers, occupied in 9 municipalities of Attica (Marousi, Kifissia, Heraklion, Metamorfosi-Pefki, N. Ionia, N. Philadelphia, Ilion, Haidari). The analysis reveals that Greek physical education teachers reported low levels of professional burnout and high levels of professional satisfaction. Moreover the results confirm the existence of a relationship between organizational factors, professional burnout and satisfaction

An authoring tool for educators to make virtual labs

This paper focuses on the design and implementation of a tool that allows educators to author 3D virtual labs. The methodology followed is based on web 3D frameworks such as three.js and WordPress that allowed us to develop simplified interfaces for modifying Unity3D templates. Two types of templates namely one for Chemistry and one for Wind Energy labs were developed that allow to test the generalization, user-friendliness and usefulness of such an approach. Results have shown that educators are much interested on the general concept, but several improvements should be made towards the user-friendliness and the intuitiveness of the interfaces in order to allow the inexperienced educators in 3D gaming to make such an attempt.peer-reviewe

Prognostic significance of adhesion molecules and anti-inflammatory cytokine interleukin-10 in patients with acute coronary indromes

A series of histopathological, experimental and clinical studies have shown that pro-inflammatory cytokines and cell adhesion molecules are of pathological significance in all stages of atherosclerosis, from atherogenesis to atherosclerotic plaque rupture. In addittion, the protective and anti-atherogenic role of the anti-infammatory cytokines has also been shown. The balance or imbalance between pro-inflammatory and anti-inflammatory cytokines emerges as the main pathophysiologic mechanism that governs atherosclerosis. The aim of the present study was to investigate the prognostic value of the pro-inflammatory cytokine IL-18 / anti-inflammatory cytokine IL-10 ratio as well as the comparison of its prognostic value with the prognostic value of each of the pro-inflammatory cytokine IL-18 and the anti-inflammatory cytokine IL-10, in acute coronary syndrome patients regarding the prediction of adverse cardiovascular events both during hospitalization and 1 year follow up. Furthermore, the present study investigated the prognostic value of the adhesion molecules sICAM-1 and sVCAM-1 / anti-inflammatory cytokine IL-10 ratios as well as the comparison of their prognostic value with the prognostic value of each of the adhesion molecules sICAM-1 and sVCAM-1, in acute coronary syndrome patients regarding the prediction of adverse cardiovascular events both during hospitalization and 1 year follow up. We recruited 107 consecutive patients (79 men, mean age 65±12 years) who were admitted to the Coronary Care Unit of the University Cardiology Department of Democritus University of Thrace with a diagnosis of acute coronary syndrome (49 STEMI, 39 NSTEMI, 27 unstable angina). The primary study end-point was in-hospital cardiovascular mortality and morbidity. The composite of cardiac death, recurrence of unstable angina, re-infarction, life threatening arrhythmias and urgent revascularization during hospitalization was the pre-specified end point. The secondary study end-point was cardiovascular mortality and morbidity at 1 year follow up. The composite of cardiac death and re-hospitalization for re-infarction or recurrence of angina during the 1 year follow up was the pre-specified end point. We assessed the predictive value of the above under investigation variables using simple and multiple logistic regression analysis where we incorporated classic and novel predictors of in-hospital and long-term cardiovascular mortality and morbidity. Serum levels of cytokines and adhesion molecules were measured at study entry using immunoenzymic method ELISA During hospitalization 44 patients (41%) had adverse cardiac events and 63 (59%) had no events. During the 1 year follow up 28 patients (26%) had adverse cardiac events and 78 (74%) were events free.Ο παθογενετικός ρόλος των μορίων προσκολλήσεως και των προ-φλεγμονωδών κυτταροκινών σε όλα τα στάδια εξέλιξης της αθηροσκλήρωσης , από την αθηρογένεση μέχρι και την ρήξη της αθηροσκληρωτικής πλάκας έχει καταδειχθεί από σειρά ιστοπαθολογικών, πειραματικών και κλινικών μελετών. Επιπροσθέτως η προστατευτική και αντί-αθηρογόνος δράση των αντί-φλεγμονωδών κυτταροκινών έχει αποδειχθεί ότι παίζει κεντρικό ρόλο στις διαδικασίες της αθηροσκλήρωσης εντός του αρτηριακού τοιχώματος. Η ισορροπία ή η διαταραχή της ομοιόστασης μεταξύ προ-φλεγμονωδών και αντί-φλεγμονωδών κυτταροκινών αναδεικνύεται ως ο βασικός παθοφυσιολογικός μηχανισμός που διέπει την εξέλιξη της αθηροσκλήρωσης. Σκοπός της παρούσας μελέτης ήταν η διερεύνηση της προγνωστικής αξίας του λόγου της προ-φλεγμονώδους κυτταροκίνης IL-18, προς την αντί-φλεγμονώδη κυτταροκίνη IL-10 (ΙL-18 / IL-10) και την σύγκριση της με την προγνωστική αξία της προ-φλεγμονώδους κυτταροκίνης IL-18 και της αντί-φλεγμονώδους κυτταροκίνης IL-10 ξεχωριστά, σε ασθενείς με οξύ στεφανιαίο σύνδρομο όσον αφορά την πρόβλεψη καρδιαγγειακών συμβαμάτων τόσο κατά την διάρκεια της νοσηλείας τους όσο και κατά την 12μηνη παρακολούθηση τους. Παράλληλα σκοπός της μελέτης ήταν η διερεύνηση της προγνωστικής αξίας των λόγων των μορίων προσκολλήσεως sICAM-1 και s-VCAM-1 προς την αντί-φλεγμονώδη κυτταροκίνη IL-10 (sICAM-1 / IL-10, sVCAM-1 / IL-10) και την σύγκριση τους με την προγνωστική αξία των μορίων προσκολλήσεως sICAM-1 και sVCAM-1 ξεχωριστά, σε ασθενείς με οξύ στεφανιαίο σύνδρομο όσον αφορά την πρόβλεψη καρδιαγγειακών συμβαμάτων τόσο κατά την διάρκεια της νοσηλείας τους όσο και κατά την 12μηνη παρακολούθηση τους. Μελετήσαμε 107 διαδοχικούς ασθενείς (79 άνδρες, μέσης ηλικίας 65±12 έτη) που εισήχθησαν στην Στεφανιαία Μονάδα της Πανεπιστημιακής Καρδιολογικής Κλινικής του Δημοκρίτειου Πανεπιστημίου Θράκης με διάγνωση οξύ στεφανιαίο σύνδρομο (49 STEMI, 39 NSEMI, 27 ασταθή στηθάγχη). Το πρωτεύον τελικό σημείο της μελέτης ήταν η ενδονοσοκομειακή καρδιαγγειακή θνησιμότητα και νοσηρότητα. Ως πρωτεύον τελικό σημείο θεωρήθηκε ο συνδυασμός καρδιακού θανάτου, επαναλαμβανόμενης ισχαιμίας του μυοκαρδίου ή στηθάγχης, επανέμφραγμα του μυοκαρδίου, επικίνδυνες για την ζωή αρρυθμίες και επείγουσα επαναιμάτωση κατά την διάρκεια της νοσηλείας. Το δευτερεύον τελικό σημείο της μελέτης ήταν η καρδιαγγειακή νοσηρότητα και θνησιμότητα σε διάστημα παρακολούθησης 1 έτους από την είσοδο των ασθενών στο νοσοκομείο. Ως δευτερεύον τελικό σημείο θεωρήθηκε ο συνδυασμός καρδιακού θανάτου και νοσηλείας για νέο επεισόδιο εμφράγματος του μυοκαρδίου με ή χωρίς ανάσπαση του διαστήματος ST ή νέου επεισοδίου ασταθούς στηθάγχης κατά την διάρκεια 12 μηνών παρακολούθησης

C-terminal fragment of agrin (CAF) levels predict acute kidney injury after acute myocardial infarction

Abstract Background Patients with acute myocardial infarction are at high risk for acute kidney injury. Novel biomarkers that can predict acute kidney injury in AMI may allow timely interventions. C-terminal fragment of agrin (CAF), a proteoglycan of the glomerular and tubular basement membrane, have been recently associated with rapid renal function deterioration and proximal tubular dysfunction. It is unknown whether elevated CAF levels may serve as a novel AKI biomarker in patients presenting with AMI. Methods In 436 persons enrolled in a multicenter prospective observational cohort study of patients with acute myocardial infarction, we measured plasma and urine levels of several kidney injury biomarkers including CAF, neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18) and cystatin-C.The relationship between biomarker levels at baseline and the development of AKI and long-term mortality were analyzed after adjustment for demographic and clinical variables. Results AKI incidence was up to 15% during hospitalization. The predictive accuracy for AKI of urinary CAF was similar to NGAL and superior to other tested kidney injury biomarkers. In a multivariate model that included all possible confounding variables only urinary CAF continued to be an independent marker for AKI (OR 1.35 95%CI 1.05 -1.74). During the 2 years follow-up, only plasma CAF levels remained a significant independent predictor of mortality (OR 2.5 95%CI 1.02-6.2; P = 0.04). Conclusions Elevated CAF levels are associated with AKI in patients with acute myocardial infarction. Our study provides preliminary evidence that CAF levels may predict AKI and mortality after AMI in low risk patients with relative preserved kidney function at baseline

C-terminal fragment of agrin (CAF) levels predict acute kidney injury after acute myocardial infarction

Abstract Background Patients with acute myocardial infarction are at high risk for acute kidney injury. Novel biomarkers that can predict acute kidney injury in AMI may allow timely interventions. C-terminal fragment of agrin (CAF), a proteoglycan of the glomerular and tubular basement membrane, have been recently associated with rapid renal function deterioration and proximal tubular dysfunction. It is unknown whether elevated CAF levels may serve as a novel AKI biomarker in patients presenting with AMI. Methods In 436 persons enrolled in a multicenter prospective observational cohort study of patients with acute myocardial infarction, we measured plasma and urine levels of several kidney injury biomarkers including CAF, neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18) and cystatin-C.The relationship between biomarker levels at baseline and the development of AKI and long-term mortality were analyzed after adjustment for demographic and clinical variables. Results AKI incidence was up to 15% during hospitalization. The predictive accuracy for AKI of urinary CAF was similar to NGAL and superior to other tested kidney injury biomarkers. In a multivariate model that included all possible confounding variables only urinary CAF continued to be an independent marker for AKI (OR 1.35 95%CI 1.05 -1.74). During the 2 years follow-up, only plasma CAF levels remained a significant independent predictor of mortality (OR 2.5 95%CI 1.02-6.2; P = 0.04). Conclusions Elevated CAF levels are associated with AKI in patients with acute myocardial infarction. Our study provides preliminary evidence that CAF levels may predict AKI and mortality after AMI in low risk patients with relative preserved kidney function at baseline

Additional file 1: Table S1. of C-terminal fragment of agrin (CAF) levels predict acute kidney injury after acute myocardial infarction

Acute kidney injury incidence based on AKIN/RIFLE Criteria at 48 h after admission and based on KDIGO/RIFLE Criteria during hospitalization. Table S2. Diagnostic performance of markers after Indexing them to BMI, BSA, and urine creatinine or using their urine to plasma ratio. Table S3. Performance measures of biomarker multivariate models predicting AKI. (DOCX 16 kb