Ultrasound – An Underutilized Diagnostic Tool For Ventricular Assist Device Driveline Infections

Patients with ventricular assist device (VAD) driveline infections (DLI) have reduced quality of life and increased risk of severe complications, such as sepsis, hemorrhagic or ischemic stroke, and wound infections. The management of VAD patients imposes a significant financial burden due to prolonged in-hospital stays, frequent re-admissions, expensive diagnostics, and the need for antibiotic therapy and/or surgical intervention. There is considerable room for improvement in DLI management, particularly in the early detection and treatment stages. Ultrasound, an easily applicable device available in almost every hospital, offers an unrecognized potential for the early detection of DLI. By increasing awareness about the potential advantages of ultrasound in DLI management, especially in specialized tertiary centers with a high number of VAD patients, this method may contribute to creating valuable databases, establishing recommendations, and improving outcomes

Radioprotektivni učinci amifostina i melatonina na ljudske limfocite izložene gama-zračenju u uvjetima in vitro

Radioprotective effects of amifostine and melatonin as well as their ability to modulate the level of spontaneous and gamma-irradiation-induced genetic changes on human peripheral blood lymphocytes were investigated using the cytokinesis-block micronucleus (CBMN) assay and sister chromatid exchange (SCE). Parallel blood samples were pre-treated with amifostine, melatonin and their combination for 30 minutes. Negative controls were also included. After the treatment with radioprotectors, one blood sample of each experimental group was exposed to gamma-rays from a 60Co source. The radiation dose absorbed was 2 Gy. Our research confirmed the radioprotective effects of both chemicals in vitro, with no significant genotoxicity. Pre-treated irradiated blood samples showed a decrease in the total number of micronuclei (MN) and in the number of cells with more than one MN. They also showed significantly lower mean SCE values. This study shows that it is possible combine these radioprotectors by adjusting the doses of amifostine to achieve the best radioprotective effect with as few side effects as possible. However, further in vitro and clinical studies are needed to clarify their mechanisms of action and possible interactions.Primjena zračenja u liječenju zloćudnih bolesti (radioterapija) značajno pridonosi preživljenju bolesnika, ali izaziva i niz neželjenih učinaka na zdrave stanice i tkiva. Nuspojave ionizirajućeg zračenja mogu se značajno smanjiti s pomoću kemijskih spojeva s antioksidativnim učinkom koji djeluju kao ‘hvatači’ slobodnih radikala i štite vrlo osjetljivu molekulu DNA. Među spojeve s pretpostavljenim ili dokazanim radioprotektivnim učincima ubrajaju se amifostin i melatonin, koji su predmet istraživanja ovog rada. U literaturi nema dovoljno podataka o njihovoj genotoksičnosti ni međusobnim interakcijama. Stoga smo primjenom mikronukleusnog testa i analize izmjena sestrinskih kromatida (SCE) u uvjetima in vitro istražili djelovanje amifostina i melatonina na genom neozračenih i ozračenih ljudskih limfocita periferne krvi. Pojedinačno ili u kombinaciji, amifostin i melatonin dodavani su u uzorke pune krvi 30 minuta prije jednokratnog ozračivanja gama-zrakama izvora 60Co. Doza zračenja iznosila je 2 Gy, a koncentracije radioprotektora odgovaraju onima prije upotrebljavanim u kliničkoj primjeni ili u preliminarnim istraživanjima na ljudskoj populaciji. Ozračena krv kultivirana je 72 h u uvjetima in vitro prema standardnim protokolima za mikronukleusni test i test izmjena sestrinskih kromatida. Učinci amifostina i melatonina usporedo su istraživani i na kontrolnim, neozračenim uzorcima krvi. Dobiveni rezultati upućuju na značajno smanjenje ukupnog broja mikronukleusa i smanjenje udjela stanica s više od jednog mikronukleusa te sniženje ukupnog broja i raspona izmjena sestrinskih kromatida u pretretiranim uzorcima krvi. Potvrđen je vrlo dobar radioprotektivni učinak svakog spoja testiranog posebno, a ujedno je utvrđeno da oba spoja sinergistički djeluju na snižavanje razina oštećenja izazvanih u genomu limfocita pod utjecajem gama-zraka. S obzirom na to da primjenom citogenetičkih testova nije dokazana genotoksičnost navedenih radioprotektora za ljudske limfocite u uvjetima in vitro, dobiveni rezultati govore u prilog daljnjih istraživanja ovih spojeva i njima srodnih tvari u uvjetima in vivo te njihove moguće zajedničke primjene u kliničkoj praksi

Postoperative atrial fibrillation is associated with high on-aspirin platelet reactivity

BACKGROUND: Atrial fibrillation (AF) contributes to a prothrombotic state through platelet activation. It is unclear whether increased platelet aggregability in patients with AF is caused by the underlying cardiovascular condition rather than the arrhythmia per se. We investigated the effect of postoperative atrial fibrillation (POAF) on platelet reactivity after coronary artery bypass grafting (CABG). ----- METHODS: This study is a post hoc analysis from a randomized controlled trial (ClinicalTrials.gov: NCT01159639) based on patients undergoing elective primary CABG. Patients were dichotomized according to POAF. Postoperative platelet function testing with arachidonic acid as the platelet agonist (ASPI test) was used to define high on-aspirin platelet reactivity (HAPR). ΔASPI presented the difference between pre- and postoperative ASPI test values. To account for the isolated effect of POAF on platelet reactivity, a propensity score analysis was applied. ----- RESULTS: Overall incidence of POAF was 23% (92 of 398 patients). HAPR was detected in 54% (214 of 398) of patients. HAPR was more prevalent among patients with POAF when compared with patients without POAF (64.1% versus 50.7%; odds ratio [OR], 1.74; 95% confidence interval [CI], 1.08-2.82; p = 0.023). The propensity score model produced a subcohort of patients that was well balanced for comorbidities. When compared with the matched group without POAF, the POAF group maintained its prevalence for HAPR (64.1% versus 45.7%; OR, 2.13; 95% CI, 1.18-3.85; p = 0.012) and had greater ΔASPI values (15.0 [IQR, 0.0-36.0] vs 8.0 [IQR, -5.5-19.5]; p = 0.030). ----- CONCLUSIONS: The main finding of our study indicates there is added platelet activation in patients with POAF after CABG before and after controlling for pathologic conditions through propensity matching. The present study does not prove a causal association between POAF and HAPR

PREVENTION OF GENOTOXIC EFFECT OF OCHRATOXIN A AND AFLATOXIN B1 BY ECHINACEA PURPUREA EXTRACTS

The aim of this work was to examine the polyphenol content in Echinacea purpurea (L.) Moench extracts and to determine their antioxidant and antigenotoxic effect. The antioxidant activity of extracts and main components is determined by the application of electronic spin resonance and spectophotometric methods of capturing DPPH, superoxide and hydroxyl radical. The antigenotoxic effect was evaluated with genotoxic mycotoxins – aflatoxin B1 (AFB1) and ochratoxin A (OTA). Herbe ehinacea extract contained 13.31% of total polyphenols. Ehinacea extract contained a sufficient amount of phenolic acids (primarily chicoric and caftaric acid). Ehinacea extract showed the ability to neutralize DPPH radicals (EC50 = 15.67 μg/mL). Similar results were also identified by testing the capture of hydroxyl and superoxide radicals. The strong antioxidant activity of the dominant components that indicate phenolic acids as the ingredients that contribute the most to the antioxidant and antigenotoxic effect of echinacea extract was also found. Genotoxic suppression of AFB1 and OTA was established by a comet test, establishing a significant reduction in tail, tail intensity and tail torque in leukocytes co-treated with mycotoxins and different concentrations of extracts

Contemporary trends in the surgical management of aortic valve disease

Introduction: Aortic valve pathology carries a high mortality burden. Its incidence is growing in proportion to the continuous ageing of the population. Surgery remains the gold standard in the treat- ment of severe aortic valve disease. Methods: We performed a retrospective analysis of the University Hospital Center Zagreb’s cardiac sur- gical database from 2009 to 2020, focusing on surgical aortic valve replacement (SAVR). We dichoto- mized patients with respect to the date of their surgical procedures into two eras. Group 1 included patients operated from 2009-2014, whereas Group 2 included patients operated on from 2015-2020. Results: A total of 1012 SAVRs were identified during the study period. The procedural volume over the two identical 6-year time periods increased in the latter era from 413 to 598. When comparing groups 1 and 2, we have observed in increase in the number of patients with diabetes (19% vs. 26%, P=0.015) and coronary artery disease (14% vs. 18%, P=0.099). The composite risk assessment score increased significantly from 3.0±2.4 to 3.2±2.7, P=0.023. Despite an increase in the comorbidity burden of the targeted patient population, the periprocedural mortality remained the same (2.1% vs 2.5%, P=0.835). The per-patient averaged volume of transfused packed red blood cells decreased from 839±954 to 614±821 ml, P<0.001. An increase in the proportion of tissue valve implantations in com- parison to mechanical prostheses was also noted in the present era (58% vs 68%, P=0.001) Conclusion: Despite an increasingly more complex patient population referred for SAVR in the con- temporary era, the results have remained excellent. The introduction of transcatheter methods should measure up to the surgical standard

PREVENTION OF GENOTOXIC EFFECT OF OCHRATOXIN A AND AFLATOXIN B1 BY ECHINACEA PURPUREA EXTRACTS

The aim of this work was to examine the polyphenol content in Echinacea purpurea (L.) Moench extracts and to determine their antioxidant and antigenotoxic effect. The antioxidant activity of extracts and main components is determined by the application of electronic spin resonance and spectophotometric methods of capturing DPPH, superoxide and hydroxyl radical. The antigenotoxic effect was evaluated with genotoxic mycotoxins – aflatoxin B1 (AFB1) and ochratoxin A (OTA). Herbe ehinacea extract contained 13.31% of total polyphenols. Ehinacea extract contained a sufficient amount of phenolic acids (primarily chicoric and caftaric acid). Ehinacea extract showed the ability to neutralize DPPH radicals (EC50 = 15.67 μg/mL). Similar results were also identified by testing the capture of hydroxyl and superoxide radicals. The strong antioxidant activity of the dominant components that indicate phenolic acids as the ingredients that contribute the most to the antioxidant and antigenotoxic effect of echinacea extract was also found. Genotoxic suppression of AFB1 and OTA was established by a comet test, establishing a significant reduction in tail, tail intensity and tail torque in leukocytes co-treated with mycotoxins and different concentrations of extracts

Contemporary trends in the surgical management of aortic valve disease

Introduction: Aortic valve pathology carries a high mortality burden. Its incidence is growing in proportion to the continuous ageing of the population. Surgery remains the gold standard in the treat- ment of severe aortic valve disease. Methods: We performed a retrospective analysis of the University Hospital Center Zagreb’s cardiac sur- gical database from 2009 to 2020, focusing on surgical aortic valve replacement (SAVR). We dichoto- mized patients with respect to the date of their surgical procedures into two eras. Group 1 included patients operated from 2009-2014, whereas Group 2 included patients operated on from 2015-2020. Results: A total of 1012 SAVRs were identified during the study period. The procedural volume over the two identical 6-year time periods increased in the latter era from 413 to 598. When comparing groups 1 and 2, we have observed in increase in the number of patients with diabetes (19% vs. 26%, P=0.015) and coronary artery disease (14% vs. 18%, P=0.099). The composite risk assessment score increased significantly from 3.0±2.4 to 3.2±2.7, P=0.023. Despite an increase in the comorbidity burden of the targeted patient population, the periprocedural mortality remained the same (2.1% vs 2.5%, P=0.835). The per-patient averaged volume of transfused packed red blood cells decreased from 839±954 to 614±821 ml, P<0.001. An increase in the proportion of tissue valve implantations in com- parison to mechanical prostheses was also noted in the present era (58% vs 68%, P=0.001) Conclusion: Despite an increasingly more complex patient population referred for SAVR in the con- temporary era, the results have remained excellent. The introduction of transcatheter methods should measure up to the surgical standard

Cytogenetic Follow-Up in Testicular Seminoma Patients Exposed to Adjuvant Radiotherapy

Early stage testicular seminoma is a radiosensitive tumor. Its incidence has significantly increased during the last decade especially in the young population. Although the therapy for testicular seminoma gives very satisfying results, the evaluation of genome damage caused by the therapy is of a great importance in order to recognize possible related health risks. The present study was performed on ten patients diagnosed with seminoma stage I; pT1/2N0M0S0, treated with adjuvant radiotherapy (a radiation dose of 25 Gy divided in 16 fractions) after orchidectomy. To assess the possible existence of an increased baseline DNA/chromosome damage in patients we also selected the appropriate control group of ten healthy men. The levels of primary DNA/chromosome damage in peripheral blood lymphocytes, as well as the dynamics of their repair were studied using the alkaline comet assay, chromosome aberration and cytokinesis-block micronucleus assay. Altogether four blood samples per patient were collected in the course of the therapy: before and after receiving the first dose of radiotherapy, in the middle of the radiotherapy cycle, and after the last dose of radiotherapy. Other two follow-up blood samples were collected six and twelve months after the cessation of therapy. As observed, the administration of the first radiation dose significantly increased the levels of DNA damage in almost all patients compared to their baseline values. Specific patterns of DNA damage were recorded in samples analyzed in the middle of radiotherapy and after receiving the last dose, indicating the possibility of an adaptive response in some patients. The levels of chromosomal aberrations and the incidence of micronuclei also increased in the course of therapy but gradually declined during the follow-up period. Our results confirmed the existence of post-irradiation damage in peripheral blood lymphocytes (and possibly in other non-target cells) of cancer patients which may represent a risk for the secondary cancer development. Considering that the majority of patients with testicular cancer are of a younger age, they represent a population deserving special attention. As cytogenetic screening may detect high-risk individuals, it might be useful in regular medical monitoring of seminoma patients after the successful therapy

Cytogenetic Follow-Up in Testicular Seminoma Patients Exposed to Adjuvant Radiotherapy

Early stage testicular seminoma is a radiosensitive tumor. Its incidence has significantly increased during the last decade especially in the young population. Although the therapy for testicular seminoma gives very satisfying results, the evaluation of genome damage caused by the therapy is of a great importance in order to recognize possible related health risks. The present study was performed on ten patients diagnosed with seminoma stage I; pT1/2N0M0S0, treated with adjuvant radiotherapy (a radiation dose of 25 Gy divided in 16 fractions) after orchidectomy. To assess the possible existence of an increased baseline DNA/chromosome damage in patients we also selected the appropriate control group of ten healthy men. The levels of primary DNA/chromosome damage in peripheral blood lymphocytes, as well as the dynamics of their repair were studied using the alkaline comet assay, chromosome aberration and cytokinesis-block micronucleus assay. Altogether four blood samples per patient were collected in the course of the therapy: before and after receiving the first dose of radiotherapy, in the middle of the radiotherapy cycle, and after the last dose of radiotherapy. Other two follow-up blood samples were collected six and twelve months after the cessation of therapy. As observed, the administration of the first radiation dose significantly increased the levels of DNA damage in almost all patients compared to their baseline values. Specific patterns of DNA damage were recorded in samples analyzed in the middle of radiotherapy and after receiving the last dose, indicating the possibility of an adaptive response in some patients. The levels of chromosomal aberrations and the incidence of micronuclei also increased in the course of therapy but gradually declined during the follow-up period. Our results confirmed the existence of post-irradiation damage in peripheral blood lymphocytes (and possibly in other non-target cells) of cancer patients which may represent a risk for the secondary cancer development. Considering that the majority of patients with testicular cancer are of a younger age, they represent a population deserving special attention. As cytogenetic screening may detect high-risk individuals, it might be useful in regular medical monitoring of seminoma patients after the successful therapy