Histological and immunohistochemical features of atherosclerotic plaques retrieved from patients with restenosis after carotid endarterectomy

Wstęp. Restenoza stanowi istotny problem u chorych po operacjach miażdżycowego zwężenia tętnic szyjnych, przeprowadzonych zarówno metodą klasyczną, jak i wewnątrznaczyniową. Pomimo licznych badań patogeneza zjawiska pozostaje nadal niejasna. Celem pracy było określenie histopatologicznych i immunohistochemicznych cech pierwotnej blaszki miażdżycowej pobranej podczas endartrektomii tętnic szyjnych u pacjentów z następową restenozą w kontrolnych badaniach ultrasonograficznych. Materiał i metody. Oceniono 130 chorych operowanych z powodu miażdżycowego zwężenia tętnic szyjnych. Na podstawie wyników pooperacyjnych badań ultrasonograficznych wyodrębniono 52 chorych. Blaszki miażdżycowe oceniano histopatologicznie i barwiono metodą immunohistochemiczną przy użyciu przeciwciał mono- i poliklonalnych (DAKO) w celu określenia fenotypu komórek zapalenia, komórek mięśni gładkich i śródbłonków oraz złogów fibrynogenu i antygenów HLADPQR. Wyniki. Na podstawie badania ultrasonograficznego wykonanego w okresie 6&#8211;18 miesięcy po zabiegu chirurgicznym wyodrębniono dwie grupy chorych: z wyraźną restenozą (grupa I) i bez rozrostu neointimy (grupa II). Blaszki miażdżycowe zaawansowane, typu włóknisto-komórkowego z zakrzepami, wylewami śródblaszkowymi, przerwaniem ciągłości czapeczki, hiperplazją intimy, ogniskami martwicy oraz złogami wapnia i cholesterolu częściej występowały u pacjentów z grupy I. Ponadto w tej grupie stwierdzono statystycznie znamienny większy procentowy udział komórek mięśni gładkich (SMA+) i fibrynogenu (Fbg+) (p < 0,005). U chorych z grupy II blaszki miażdżycowe częściej były typu włóknisto-szklistego i charakteryzowały się obecnością liczniejszych makrofagów (Mac 387+) (p = 0,007). Nacieki zapalne złożone głównie z limfocytów T (CD3+, OPD4+) oraz komórek tucznych (tryptaza komórek tucznych +), limfocytów T (CD8+) oraz limfocytów B (CD20+) nieco częściej występowały w grupie I. Wnioski. Chociaż klasyczne czynniki ryzyka miażdżycy nie odgrywają roli w powstawaniu restenozy, badania histopatologiczne i immunohistochemiczne (SMA, Fbg, Mac 387) pierwotnych blaszek miażdżycowych mogą być pomocne w wyodrębnieniu pacjentów, u których występuje ryzyko pooperacyjnej restenozy tętnic szyjnych.Background. Restenosis is an important issue after classic and endovascular revascularization of atherosclerotic carotid arteries. Pathogenesis of this phenomenon remains unclear and unsolved. The aim of this study was to evaluate the histopathological and immunohistochemical features of atherosclerotic plaques retrieved at carotid endatrerectomy in patients who developed restenosis at ultrasound follow-up. Material and methods. One hundred thirty patients operated because of atherosclerotic carotid artery stenosis were evaluated. On the base of postoperative ultrasound examinations 52 patients were qualified for this study. Atherosclerotic plaques were investigated histopathologically and with immunohistochemical methods with monoclonal and polyclonal antibodies (DAKO) to define the phenotype of inflammatory, smooth muscle and endothelial cells as well as fibrinogen deposits and HLADPQR antigens. Results. By means of the ultrasonography, in a period of 6&#8211;18 months following the surgery, patients were classified into two, significantly different groups: group I with an evident restenosis and group II without restenosis nor intimal hyperplasia. Advanced and fibrocellular atherosclerotic plaques with thrombosis, intraplaque haemorrhages, fibrous cap rupture, intimal hyperplasia, necrosis, calcium and cholesterol deposits were found more often in patients of group I. Moreover, the percentage of vascular smooth muscle cells (SMA+) and fibrinogen (Fbg+) deposits was significantly higher in this group (p < 0.005). Atherosclerotic plaques from group II patients were more frequently fibrosclerotic and were rich in macrophages (Mac 387+) (p = 0.007). Inflammatory infiltrates consisting mainly of lymphocytes T (CD3+, OPD 4+) and mast cells (mast cells tryptase +), limfocytes T (CD8+), limfocytes B ( CD20+) were more frequent in group I. Conclusion. Although classic risk factors of atherosclerosis do not play a role in the development of restenosis, histological and immunohistochemical (SMA, Fbg, Mac 387) studies of primary atherosclerotic plaques may be useful to selected the patients at risk of carotid postendartrectomy restenosis

Ultrasonograficzny obraz niestabilnej szyjnej blaszki miażdżycowej: analiza porównawcza wybranych metod komputerowej analizy cyfrowej

Background. The aim of this study was to compare the precision and sensitivity of ultrasound picture of carotid plaque in relation to two computer programs: a GSM histogram analysis and a detailed pixel distribution analysis. Material and methods. The material consisted of 130 carotid plaques acquired from patients treated and operated in the Department of Vascular Surgery and Angiology in the period 2002-2003. The analysis was performed with the use of two computer programs: the widely applied assessment of grey scale median (GSM) and detailed pixel distribution analysis. The plaques were evaluated intraoperatively (visual assessment) and subjected to comparative histopatological examination. The microembolisation (TCD) was monitored in each patient. All possible perioperative complications were monitored and documented with a CT or NMR examination. In statistics, a multivariate statistical analysis was applied, supplemented by a logit regression model. The propriety of the model was verified with the help of the Hosmer-Lemeshow test. Its predictive value was checked using an ROC curve. The presence of linear trends was assessed with the help of linear regression models. Results. Analysis of the components of risk of the appearance of events showed a decisive superiority of pixel analysis with the use of Image-Pro program over the hitherto applied technique based on analysis of grey scale median (GSM). Conclusions. Computer analysis of ultrasound picture remains a valuable tool in the preoperative assessment of carotid plaque character and in foreseeing the degree of perioperative risk. Multivariate statistical analysis proved to be superior to the detailed pixel distribution analysis program in the computer assessment of ultrasound carotid plaque picture. Plaques, which, in the detailed pixel distribution, contain more than 72% of tissue with features of blood, fat and muscle in their surface, augment the risk of perioperative complications.Wstęp. Celem pracy było porównanie dokładności i czułości ultrasonograficznej oceny obrazu blaszki szyjnej za pomocą dwóch programów komputerowych: dotychczas stosowanej analizy histogramowej GSM oraz szczegółowej analizy rozkładu pikseli w ultrasonograficznej ocenie tej zmiany. Materiał i metody. Materiał stanowiło 130 szyjnych zmian miażdżycowych u chorych leczonych i operowanych w Klinice Chirurgii Naczyniowej i Angiologii w latach 2002-2003 z powodu zwężenia tętnicy szyjnej. Do analizy porównawczej zastosowano dwa programy komputerowe: stosowaną już ocenę mediany skali szarości (GSM) oraz szczegółową analizę rozkładu pikseli uzyskiwanego obrazu USG w prezentacji B. Zmianę oceniano śródoperacyjnie (ocena wizualna) i poddawano porównawczemu badaniu histopatologicznemu. U każdego chorego rejestrowano zjawisko mikrozatorowości (TCD). Notowano również występowanie powikłań, które we wszystkich koniecznych przypadkach dokumentowano, przeprowadzając tomografię komputerową (CT) lub jądrowy rezonans magnetyczny (NMR). W analizie statystycznej wykorzystano analizę wieloczynnikową, uzupełnioną o model regresji logitowej. Dopasowanie modelu sprawdzono za pomocą testu Hosmer-Lemeshowa. Wartość predykcyjną modelu potwierdzono, wykorzystując krzywą ROC. Występowanie trendów liniowych zbadano za pomocą modelu regresji liniowej. Wyniki. Analiza składowych ryzyka wystąpienia zdarzenia wykazała zdecydowaną przewagę analizy obrazu za pomocą programu Image-Pro nad stosowaną dotychczas techniką opartą na ocenie mediany skali szarości (GSM). Wnioski. Analiza komputerowa obrazu ultrasonograficznego pozostaje cennym narzędziem w przedoperacyjnej ocenie charakteru szyjnej blaszki miażdżycowej i prognozowaniu stopnia ryzyka okołooperacyjnego. Wielowariantowa analiza statystyczna wykazała, że w komputerowej analizie obrazu ultrasonograficznego blaszki miażdżycowej najlepszym (najbardziej specyficznym i czułym) programem jest ocena z zastosowaniem szczegółowej analizy rozkładu pikseli. W blaszkach, w których w szczegółowym rozkładzie pikseli łączna zawartość tkanek o cechach krwi, tkanki tłuszczowej i mięśniowej przekracza 72% powierzchni, ryzyko wystąpienia powikłań okołooperacyjnych jest istotnie większe

A new approach to ticagrelor-based de-escalation of antiplatelet therapy after acute coronary syndrome. A rationale for a randomized, double-blind, placebo-controlled, investigator-initiated, multicenter clinical study

© 2021 Via Medica. This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license. https://creativecommons.org/licenses/by/4.0/The risk of ischemic events gradually decreases after acute coronary syndrome (ACS), reaching a stable level after 1 month, while the risk of bleeding remains steady during the whole period of dual antiplatelet treatment (DAPT). Several de-escalation strategies of antiplatelet treatment aiming to enhance safety of DAPT without depriving it of its efficacy have been evaluated so far. We hypothesized that reduction of the ticagrelor maintenance dose 1 month after ACS and its continuation until 12 months after ACS may improve adherence to antiplatelet treatment due to better tolerability compared with the standard dose of ticagrelor. Moreover, improved safety of treatment and preserved anti-ischemic benefit may also be expected with additional acetylsalicylic acid (ASA) withdrawal. To evaluate these hypotheses, we designed the Evaluating Safety and Efficacy of Two Ticagrelor-based De-escalation Antiplatelet Strategies in Acute Coronary Syndrome — a randomized clinical trial (ELECTRA-SIRIO 2), to assess the influence of ticagrelor dose reduction with or without continuation of ASA versus DAPT with standard dose ticagrelor in reducing clinically relevant bleeding and main-taining anti-ischemic efficacy in ACS patients. The study was designed as a phase III, randomized, multicenter, double-blind, investigator-initiated clinical study with a 12-month follow-up.Peer reviewedFinal Published versio

Current status and achievements of Polish haemato-oncology

The number of newly diagnosed haematological malignancies in Polish adults and children is about 9,000 a year, which constitutes about 5.5% of all malignancies in the country. Adult patients with haematological malignancies are diagnosed and treated in 42 institutions in Poland. The scientific and educational support for this activity is provided under the umbrella of the Polish Society of Haematologists and Transfusiologists (PTHiT, Polskie Towarzystwo Hematologów i Transfuzjologów), the Polish Adult Leukemia Group (PALG), the Polish Lymphoma Research Group (PLRG), the Polish Myeloma Study Group (PMSG), the Polish Myeloma Consortium (PMC), and consultants in haematology. The aim of this position paper is to present the current status and progress in therapy of haematological malignancies in Polish haematology adult centres, focusing on the activity of PALG, PLRG, and PMSG. The achievements of Polish haemato-oncology at the beginning of the third decade of the 21st century are set out in this paper. Polish haemato-oncology today has an important international position based on contributions to the development of knowledge, international cooperation, and a high quality of patient care. In many instances, clinical trials run by Polish collaborative groups have influenced international standards. Polish haematologists have been the authors of treatment recommendations, and their research has indicated areas for further research

Prevention of Major industrial accidents – Case Study Using the Example of the Mazowieckie Voivodeship

Aim: The aim of this paper is to assess the state of implementation in Poland of the current doctrine for the prevention of major industrial accidents in the context of providing safety distance in the process of shaping the spatial order.Introduction: The obligation to perform an analysis and assessment of the risk of a major industrial accident lies above all with operators of upper-tier establishments. The security reports for such establishments contain detailed assumptions and the description of the analytical evaluation and risk assessment process and present its results together with their graphical visualisation. One of the most important elements of such a risk assessment is the identification of representative emergency events developed in representative emergency scenarios. The end value of the risk analysis and its evaluation depends on the degree of their accuracy and relevance for the type of establishment and industrial process parameters.Methodology: The research conducted for the purposes of this article included a review of the legislation and available guidelines, an analysis of safety reports and data contained in them on representative emergency scenarios in 18 establishments with a high risk of a major industrial accident in the Mazowieckie Voivodeship.Conclusions: The national land use and spatial planning system does not take into account the assumptions of the doctrine of prevention of major industrial accidents. There is no specific risk assessment methodology, resulting in individual risk assessments in safety reports being based on non-uni-form rules, and thereby discrepancies between similar establishments. There is a lack of standardisation of requirements regarding the presentation of analysis results and risk assessments, in particular with regard to the ranges of thermal radiation, overpressure and toxicity. As a result, these results are presented arbitrarily in a way that prevents their clear interpretation. The exact interpolation of data is impossible without the use of specific software. The results of the risk analysis performed in 2017 for the Mazowieckie Voivodeship showed that the area affected by the upper-tier establishments with a high risk of a major accident outside of their territory in the Mazowieckie Voivodeship is approx. 2,300 ha. An important problem is also the lack of national guidelines for establishing safety distances for land use and spatial planning purposes, which means that the above-mentioned area is subject to certain types of land use, disregarding or providing insufficient attention to information on the impact of major industrial accidents

Clinical Significance of TNFRSF1A36T/C Polymorphism in Cachectic Patients with Chronic Heart Failure

Introduction: One of the main factors contributing to the development of nutritional deficits in chronic heart failure (CHF) patients is the systemic inflammatory process. Progressing inflammatory response leads to exacerbation of the disease and could develop into cardiac cachexia (CC), characterized by involuntary weight loss followed by muscle wasting. The aim of this study was to assess the relationship between rs767455 (36 T/C) of the TNFRSF1A and the occurrence of nutritional disorders in CHF patients with cachexia. Materials and Methods: We enrolled 142 CHF individuals who underwent cardiac and nutritional screening in order to assess cardiac performance and nutritional status. The relationship between TNFRSF1A rs767455 genotypes and patients’ features was investigated. Results: A greater distribution of the TT genotype among cachectic patients in contrast to non-cachectic individuals was found (TT frequencies of 62.9% and 37.1%, respectively; p = 0.013). We noted a significantly lower albumin concentration (p = 0.039) and higher C-reactive protein (CRP) levels (p = 0.019) in patients with the TT genotype. Regarding cardiac parameters, CHF individuals bearing the TT genotype demonstrated a significant reduction in ejection fraction (EF) (p = 0.033) in contrast to other genotype carriers; moreover, they had a significantly higher concentration of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) in the blood (p = 0.018). We also noted a lower frequency of TT genotype carriers among individuals qualified as grades I or II of the New York Heart Association (NYHA) (p = 0.006). The multivariable analysis selected the TT genotype as an unfavorable factor related to a higher chance of cachexia in CHF patients (Odds ratio (OR) = 2.56; p = 0.036). Conclusions: The rs767455TT genotype of TNFRSF1A can be considered as an unfavorable factor related to a higher risk of cachexia in CHF patients

Enthesopathies and enthesitis. Part 2: Imaging studies

The pathologies of tendon and ligament attachments are called enthesopathies. Enthesitis is one of enthesopathies and it is considered a characteristic sign of rheumatic diseases from the spondyloarthritis group, including peripheral spondyloarthritis. Therefore, enthesitis has been included in a number of clinical classifications for diagnosing these diseases. Clinical diagnosis of enthesitis is based on rather non-specific clinical signs and results of laboratory tests. It is believed that imaging examinations might improve diagnosis, particularly because numerous papers prove that differentiating enthesitis from other enthesopathic processes is possible. On the other hand, a number of authors report the lack of specific signs in imaging as well as typical histological and immunological features that would enable confirmation of clinical diagnosis of enthesitis. The first part of the publication presented theories on the etiopathogenesis of enthesitis (inflammatory, mechanical, autoimmune and associated with the synovio-entheseal complex) as well as on the formation of enthesophytes (inflammatory, molecular and mechanical). This paper – the second part of the article, is a review of the state-of-the-art on the ability of imaging examinations to diagnose enthesitis. It turns out that none of the enthesitis criteria used in imaging examinations is specific for inflammation. As enthesitis may be the only symptom of early spondyloarthritis (particularly in patients with absent HLA-B27 antigen), the lack of its unambiguous picture in ultrasound and magnetic resonance imaging prompts the search for other signs characteristic of spondyloarthritis and more specific features in imaging in order to make a diagnosis as early as possible.Patologie przyczepów ścięgien i więzadeł są określane mianem entezopatii. Jednym z rodzajów entezopatii jest zapalenie (enthesitis). Uznaje się je za charakterystyczny objaw chorób reumatycznych z grupy spondyloartropatii (spondyloarthritis), w tym głównie spondyloartropatii obwodowych. Z tego powodu enthesitis włączono do szeregu klasyfikacji klinicznych, służących m.in. do rozpoznawania tych chorób. Klinicyści diagnozują enthesitis na podstawie mało specyficznych objawów oraz wyników badań laboratoryjnych. Duże nadzieje na poprawę możliwości diagnostycznych są wiązane z badaniami obrazowymi. Niektóre prace naukowe dowodzą możliwości różnicowania zapalenia entez z innymi procesami entezopatycznymi. Z drugiej strony szereg doniesień wskazuje na brak specyficznych zmian w badaniach obrazowych oraz typowych cech histologicznych i immunologicznych pozwalających na potwierdzenie klinicznego rozpoznania enthesitis. W pierwszej części publikacji przedstawiono teorie etiopatogenezy entezopatii (teorię zapalną, mechaniczną, kompleksu entezy i autoimmunologiczną) oraz koncepcje powstawania entezofitów (zapalną, molekularną i mechaniczną). W niniejszej, drugiej części zaprezentowano zaś przegląd wiedzy na temat możliwości badań obrazowych w rozpoznawaniu enthesitis. Jak się okazuje, żadne z kryteriów enthesitis stosowanych w badaniach obrazowych nie jest specyficzne dla zapalenia. Zważywszy na to, że enthesitis bywa jedynym objawem spondyloartropatii w początkowym okresie (zwłaszcza u chorych z nieobecnym antygenem HLA-B27), brak jednoznacznego obrazu w badaniach ultrasonograficznych i rezonansu magnetycznego wymaga poszukiwania innych objawów charakterystycznych dla spondyloartropatii i bardziej specyficznych markerów w badaniach obrazowych w celu jak najszybszego ustalenia rozpoznania

Electrical Changes in Polish Patients with Chronic Heart Failure: Preliminary Observations

Introduction: Direct parameters resistance (R), reactance (Xc), phase angle (PA), capacitance of membrane (Cm), and impedance ratio (Z200/Z5)) determined by bioelectrical impedance analysis (BIA) detect changes in tissue electrical properties and have been found to be a marker of cell membrane function in various diseases. Materials and Method: The cross-sectional study was conducted to investigate whether direct bioimpedance parameters differ in a group of heart failure (HF) patients divided on the basis of the New York Heart Association (NYHA) functional classes I&ndash;II and III&ndash;IV. BIA was evaluated in 100 patients with HF treated in Clinic of Cardiology and Internal Medicine, Department of Cardiology, Military Hospital, Lublin. Results: In men, lower PA values (p = 0.01), Xc (p &lt; 0.01), Cm (p = 0.02), and higher values of the Z200/Z5 ratio (p &lt; 0.01) were observed in patients classified into NYHA groups III and IV in comparison to those with lower stages of disease. Similar correlations were noted in women (only Cm differences were insignificant). In addition, in men, C-Reactive Protein (CRP) correlated negatively with PA (p &lt; 0.01), Xc (p &lt; 0.01), and Cm (p &lt; 0.01) and positively with the Z200/Z5 index (p &lt; 0.01). There were no similar correlations observed in women. Conclusion: Patients with advanced CHF have altered electrical values. Changes in electrical values may directly reflect tissues as well as the whole-body condition