Objective: The objective of the study was to estimate how the pro-inflammatory and pro-thrombotic imbalances correlate with endothelial dysfunction at hypertensive patients (pts) with or without diabetes mellitus (DM). Design and method: 40 hypertensive pts (mean age 58.4 ± 7.3 years, 52.5% males) group 1 and 40 hypertensive pts with DM, matched for age and sex (mean age 56.5 ± 7.6 years, 55% males) group 2.Endothelial function was evaluated using ultrasound assessment of flow mediated vasodilatation of the brachial artery (FMD). FMD smaller than 10% was considered abnormal. Inflammation profile was estimated by serum measurement of C reactive protein (CRP) and fibrinogen (F). Pro-thrombotic profile was determinated by serum measurement of von Willebrand factor (vWf), antithrombin III (AT III), plasminogen activator inhibitor (PAI 1) and homocysteine (H). Results: In group 1, 13 pts (32.5%) had reduced FMD (%): 7.3 ± 1.6. In group 2, 16 pts (40%) had reduced FMD (%): 6.8 ± 1.9. The difference is not significantly statistic between the two groups (p = 0.44). In group 1, reduced FMD was significantly associated with higher level of CRP (2.65 ± 1.17 mg/l vs 7.84 ± 1.68 mg/l, p = 0.02). In group 2, low FMD was found in a significantly higher proportion at pts with higher level of CRP (2.87 ± 1.33 mg/l vs 9.25 ± 2.03 mg/l, p = 0.008) and also with greater proportion of vWf (87.21 ± 31.73% vs 148.15 ± 42.33%, p = 0.001). In the same group, reduced FMD was significantly associated with higher level of PAI 1 (0.42 ± 0.24 u/ml vs 0.92 ± 0.35 u/ml, p = 0.03) and higher proportion of H (4.2 ± 1.3 μm/l vs 17.4 ± 1.2 μm/l, p = 0.02). Conclusions: Hypertensive pts with DM have endothelial dysfunction in a greater but not significant proportion than hypertensive pts without DM. Endothelial dysfunction at hypertensive pts seems to reflect a pro-inflammatory status. Moreover, endothelial dysfunction at hypertensive pts with DM appears to express both pro-inflammatory status and pro-thrombotic imbalance.
Coronary computed tomography angiography (CCTA) is becoming increasingly useful for the diagnosis of coronary artery disease (CAD). Coronary calcium score (CCS), epicardial fat volume (EFV), and number of coronary plaques (NoP) add important information for the risk stratification and prognosis prediction of these patients. However, evidence about their ability to predict obstructive CAD is limited. We sought to evaluate the ability of CCTA parameters in predicting obstructive CAD.We conducted a cross-sectional, single-center study on patients at risk to develop CAD. CAD was defined as coronary stenosis > 50% after the other one (CCS, EFV and NoP were determined by CCTA). CCS was then ranked 5 severity groups: 0, 1-99, 100-399,400-999, and ≥1000. NoPs were classified in four categories: no plaques, 1-5, 6-10 and ≥10. Logistic regression analyses were performed, and statistical analysis was considered significant if p<0.05.Of all 540 patients (55.8±11.1 years) who met the enrolment criteria, 98 had obstructive CAD. CCS, EFV and NoP were significantly associated with the presence of obstructive CAD (p<0.0001). The area under the receiver operating characteristics (ROC) analysis revealed significant cut-off values (p<0.0001) of CCS (70.3), EFV (40.8), NoP (4) for predicting obstructive CAD. Their association proved to have an AUC of 0.969, and a specificity of 95%. A scoring system based on regression coefficients which proved to have statistical significance for obstructive CAD as further constructed. It included EFV, CCS and left ventricular ejection fraction. This scoring system significantly predicted obstructive CAD for a cut-off value of 62.46, with a NPV of 96.3%.The combined use of CCS, EFV and NoPs increases the predictive ability for obstructive CAD of each parameter used alone. These could be useful for developing a novel scoring system.
Objective: The objective of the study was to estimate how the endothelial dysfunction (ED) correlates with cardiovascular and renal events at hypertensive patients (pts) with or without diabetes mellitus (DM). Design and method: 30 hypertensive pts (mean age = 58.2 ± 7.6 years, 53.3% males)-group 1 and 30 hypertensive pts with DM, matched for age and sex (mean age = 59.8 ± 7.3 years, 56.6% males)-group 2. ED was evaluated using ultrasound assessment of flow-mediated vasodilatation (FMD) of the brachial artery. FMD smaller than 10% was considered abnormal. All pts were evaluated during one year, in order to detect the following complications: unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI), ischemic stroke (IS), renal dysfunction (RD): microalbuminuria, proteinuria, chronic kidney disease. Results: In group 1, 13 pts (43.3%) had reduced FMD: 7.6 ± 1.5%. In group 2, 16 patients (53.3%) had reduced FMD: 6.3 ± 2.1%. The difference is not significantly statistic between the two groups (p = 0.07). In group 1, UA was significantly associated with reduced FMD (7.1 ± 1.5% vs 11.3 ± 2.2%, p = 0.03). In the same group, RD was found in a significantly higher proportion at patients with reduced FMD (7.8 ± 1.8% vs 12.1 ± 2.3%, p = 0.02). In group 2, UA was also significantly associated with reduced FMD (6.8 ± 2.1% vs 10.9 ± 2.8%, p = 0.01). NSTEMI was significantly more frequent at pts with reduced FMD (6.3 ± 1.7% vs 11.4 ± 3.1%, p = 0.01). In the same group, RD was found in a significantly higher proportion at pts with reduced FMD (6.9 ± 2.7% vs 10.5 ± 2.6%, p = 0.02). Conclusions: Hypertensive pts with DM have ED in a greater, but not significant proportion than hypertensive pts without DM. ED seems to predict a worse mid term outcome (one year) concerning cardiovascular and renal events at hypertensive pts, especially with DM. Moreover, ED appears to have more powerful mid term prognostic value for incidence of acute coronary syndromes without ST-segment elevation at hypertensive pts with DM.
To determine the sensitivity and specificity of a single volumetric ultrasound (US) marker in screening for major congenital heart diseases (MCHDs): the normal spatial arrangement between the inflows and the outflows. This marker was quantified by measuring the angle between two lines, traced along the interventricular septum and the main pulmonary trunk (the septal-truncus angle – the STA). Spatial temporal image correlation (STIC) datasets from pregnant women were analysed, using a standard protocol for storing and post processing data. We measured the STA prospectively, in 100 normal cases. We subsequently applied this measurement in 26 confirmed (by pathological examination or subsequently assessment) MCHDs first trimester diagnosed cases. 12 of them were isolated. The STA value variation is very low (median 140.43°, range 136.68°–146.02°; SD = 1.52°) in normal cases. The sensitivity, specificity and positive and negative predictive values of 4DUS in determining the presence or absence of MCHD were 84.62%, 99.70%, 73.33%, 99.84%. The diagnostic odds ratio of the 4DUS method was 1806.75. Supporting information can be found in the online version of this abstract Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
To establish the feasibility of applying three-dimensional transvaginal ultrasound (3DTVUS) in an unselected population of premenopausal women, in screening for congenital uterine anomalies (CUA). Secondary aims were to estimate the incidence of CUA in this population and to determine the on-line added information of 3DTVUS. The prospective study used 3DTVUS as a screening tool for CUA, after 2D gynecological scanning. Two observers were involved in the study, interpreted on-line the acquired volumes of the uterus, and classified them using the ASRM (American Society for Reproductive Medicine) classification system, with a further division, in major and minor anomalies. The study included 3155 volume datasets for interpretation, from which 3004 (95.21%) were declared as interpretable. We had an incidence of 2.25% major CUA and 6.75% - minor ones. Age range was 16 to 53 and mean age was 31.4. 2902 (91.9%) women were Caucasian. The main indication for imaging was routine medical examination. The most common reason for inadequate assessment of uterine shape was the poor visibility of the endometrium, related to the menstrual cycle day. Associated pathology (like fibroids, adenomyosis, polyps and endometriosis) rarely interfered the proper visualisation of the internal contour. In a subset of 145 cases with CUA with corporeal distortion only, magnetic resonance imaging (MRI) offered no additional information. The 3DTVUS modified the 2D classification in 21 (29.5%) cases of major CUA and excluded 54 minor CUA. In our unselected patient population the 3DTVUS assessment of the shape of the uterus was possible in 95.21% of cases. This study demonstrates the feasibility of incorporating the on-line 3D sonographic evaluation of corpus uterine anatomy in routine gynecology scanning. This simple and low time consuming examination may serve as a screening tool to identify patients in need of increase surveillance in pregnancy or in those undergoing endouterine manoeuvres.
The aims of this study were to evaluate the outcome of the cases over the last three years in our centre and to investigate the capability of the prenatal sonographic examination to establish the correct diagnosis of the fetal intra-abdominal cystic masses. We performed a retrospective three-year analysis and reviewed the cases with cystic abdominal pathology from our centre. The main characteristics of the intra-abdominal masses were evaluated, and the concordance with the perinatal follow-up. In the first trimester (FT) three cases of megacystis were diagnosed and one abdominal cyst was noted but not confirmed at the sonographic and neonatal follow-up. 21 cases of intra-abdominal cystic were diagnosed mass in the second (ST) and third trimesters (TT) of pregnancy, at a mean gestational age of 25 weeks: 13 ovarian cysts, 2 mesenteric cysts, 3 multicystic dysplastic kidneys, one urogenital sinus anomaly and 2 intestinal obstructions (duodenal atresia and intestinal duplication cyst). All the ovarian cysts were unilateral, and 7 of them were homogenous. In 5 ovarian cysts spontaneous resolution was noted in the TT. Termination of pregnancy was performed in the FT megacystis cases and 3 ST cases. Postnatally, surgery was performed in 3 cases: one ovarian torsion, one intestinal obstruction and one mesenteric cyst. There were no intrauterine or neonatal deaths. The sonographic diagnosis was correctly established in 17 of the 19 cases and chromosomal abnormalities were detected in one case. In most cases the nature of the intra-abdominal cystic mass can be established antepartum, and the most prevalent is the ovarian cyst. Although the outcome is generally good, this is strongly influenced by the etiology of the cyst.
To assess the accuracy of a simplified standard first trimester (FT) conventional two-dimensional ultrasound (2DUS) examination protocol in detecting congenital heart diseases (CHDs) in an unselected population. This is a single centre study, performed in a FT screening for aneuploidies program. We stored the cardiac sweep digital video clips, in duplex two-dimensional colour, from an oblique lateral insonation from the right shoulder, transabdominally acquired. By the standard protocol, the interventricular septum was oblique, at approximately 450 to the US beam, with the fetal spine positioned posteriorly. The sweep was used to assess two planes: the four chamber view plane and the three vessels and trachea view plane (and in addition – the transversal abdominal plane for confirming the situs). We used 2DUS re-examination by a team of specialists, pathological examination, and subsequent re-examination as the reference standard methods. The study design allowed us to construct a 2x2 table of true positive, false positive, false negative and true negative values. We calculated estimates of sensitivity, specificity, with 95% confidence intervals, by confronting antenatal findings with subsequent verification of diagnosis. From 4260 fetuses, we obtained confirmation in 3797 cases (lost to follow up rate 10.86%). 49 heart defects were diagnosed (32 major, 17 minor). FT US correctly identified 26/32 (81.25%) of major CHDs and 4/17(23.52%) of minor CHDs. Sensitivity was much lower for minor than for major defects. Transabdominal 2DUS became a highly accurate tool for MCHDs and great arteries anomalies screening in late FT, even when using a simplified protocol. A standardised low time-consuming technique could raise detection rates, by lowering the operator dependency and by eliminating the fetal position-dependency, two main reasons for delayed diagnosis of CHDs.
(1) Background: During IVF (in vitro fertilization) procedures, endometrial thickness has a significant role in the success of pregnancy outcomes for embryo transfers. Endometrial thickness, a crucial component of endometrial receptivity, is a contentious issue. The regenerative properties of PRP have been shown in recent research to have positive effects on the endometrium. PRP increases the pregnancy rate in IVF patients with thin endometrium and recurrent implantation failure. In order to demonstrate the efficacy of PRP therapies, this work compares the administration of injectable and infusible PRP during endometrial preparation. (2) Methods: This prospective single-arm control study was conducted at an IVF center in Oradea, Romania. This study included 50 patients; 27 were included in the group with Injectable PRP and 23 in the group with Infusible PRP. The outcome was compared between the two groups, with the primary outcome being the endometrial thickness after the PRP infusion or injection and the secondary outcome being the pregnancy rate in both groups. (3) Results: Patients who were treated with Injectable PRP had a higher pregnancy rate. An improvement in the quality of the endometrium, in terms of thickness, was also observed in the patients who were injected with PRP. (4) Conclusions: Compared to PRP infusions inside the uterus, sub-endometrial PRP injections in frozen embryo transfer methods have a greater pregnancy rate.
Objective: The objective of the study was to estimate how the ultrasound parameters of the carotid arteries correlate with prognostic of hypertensive patients (pts) with or without metabolic syndrome (MS). Design and method: 40 hypertensive pts (mean age = 57.3 ± 7.5 years, 52.5% males)-group1 and 40 hypertensive pts with MS, matched for age and sex (mean age = 58.6 ± 7.4 years, 55% males)-group2. Vascular ultrasound parameters performed were: thickness of intima-media layer (IMT) in common carotid arteries (CCA), peak systolic velocity (PSV) in internal carotid arteries (ICA), end diastolic velocity (EDV) in ICA, resistance index (RI) in ICA, peak systolic velocity ratio (PSVR) in ICA and CCA. All pts were evaluated during one year in order to detect the following complications: unstable angina (UA), non-ST-segment-elevation myocardial infarction (NSTEMI), transient ischemic stroke (TIS), ischemic stroke (IS), renal dysfunction (RD): microalbuminuria, proteinuria, chronic kidney disease. Results: In group1, UA was significantly associate with higher EDV in ICA (29.3 ± 2.9 cm/s vs 16.5 ± 1.8 cm/s, p = 0.03). In the same group, TIS was found in a significantly higher proportion at pts with greater IMT in CCA (1 ± 0.2 mm vs 0.4 ± 0.3 mm, p = 0.01). In group2, UA was significantly associated with a greater RI in ICA (0.75 ± 0.08 vs 0.57 ± 0.12, p = 0.02). NSTEMI was significantly more frequent in group2 pts with greater RI in ICA (0.76 ± 0.11 vs 0.56 ± 0.13, p = 0.03) and with higher PSVR in ICA and CCA (2.61 ± 0.12 vs 1.25 ± 0.2, p = 0.008). In the same group, TIS was found in a significantly greater proportion at pts with higher EDV in ICA (28.7 ± 2.6 cm/s vs 17.3 ± 2.2 cm/s, p = 0.03). RD was significantly associated with greater PSVR in ICA and CCA at hypertensive pts with MS (2.58 ± 0.19 vs 1.14 ± 0.21, p = 0.001). Conclusions: Greater IMT in CCA and higher level of EDV in ICA seem to predict a worse mid term outcome (one year) concerning cardiovascular and cerebrovascular events at hypertensive pts, especially with MS. Moreover, higher RI in ICA and greater PSVR in ICA and CCA appears to have more powerful mid term prognostic value (one year) for incidence of acute coronary syndromes without ST-segment elevation at hypertensive pts with MS. In this group, higher PSVR in ICA and CCA reflects unfavorable evolution of renal function.
Introduction: LGG represent the largest group of cerebral tumors in the pediatric population. Although a complete tumor resection is the main purpose in these lesions management, in many cases is not so easy, due to the difficulty in determination of oncologyc limits of surgical procedures. This raises several important questions on the long-term behavior of the residual tumor and the role of adjuvant therapy in the management of theese lesions. Material and Methods: The authors reviewed their experience in more than 400 cases of LGG (including spinal) and literature-review. We consider: pilocytic astrocytoma (62.99%), fibrillary astrocytoma (15.44%), ganglioglioma (11.03%), gangliocytoma (1.71%), oligodendroglioma (1.96%), oligoastrocytoma (4.9%), pleomorphic xanthoastrocytoma (0.49%), dysembrioplastic neuroepithelial tumor (1.23%), ependimoma (0.24%); et.al. Results: In our serie, surgical resection was 49.26% total and 50.73% subtotal. Recurrencies at 5 years were 7.35% and at 10 years 7.59%.. The use of radiotherapy was not associated with such a significant improvement in overall survival. In our opinion, according to SIOP LGG study Master Protokoll 2004 and 2010, chemotherapy (Carboplatin, et.al.) has a consolidating role in the treatment of children with LGG . The progression free survival datas are increasing but still not so satisfactory. Conclusions: We advocate as much as possible for surgical resection. After aggressive surgery, and also in recurrencies, radiotherapy and chemotherapy should be re-considered. Multimodal treatment and a good colaboration between neurosurgeons and oncologysts represent the main goal to achieve better results in LGG pathology.
