Mariola Sznapka

Platelet reactivity in thromboelastometry. Revision of the FIBTEM test: a basic study

Abstract This study aimed to investigate modifications to the FIBTEM test to better assess fibrinogen levels and the quality of fibrin polymerization in citrated blood using Multiplate impedance aggregometry to verify platelet inhibition. Blood samples from 26 healthy volunteers were subjected to thromboelastometry studies (EXTEM/FIBTEM tests) in accordance with the standard study protocol (cytochalasin D) and according to a modified protocol (synthetic IIbIIIa receptor antagonist vs. acetylsalicylic acid [ASA] + synthetic IIbIIIa receptor antagonist instead of cytochalasin D). Independent of thromboelastometry, Multiplate impedance aggregometry was used to assess the degree of restriction by the platelet blocked with the following treatments: (1) cytochalasin D, (2) synthetic IIbIIIa antagonist or (3) ASA + synthetic IIbIIIa antagonist to assess the aggregation response to activation with an agonist (ADP, collagen, thrombin receptor activating peptide-6 [TRAP-6], and arachidonic acid). Via aggregometry, cytochalasin D more weakly inhibited platelet aggregation than simultaneous administration of the -IIbIIIa receptor antagonist with ASA. However, total platelet aggregation inhibition was observed after simultaneous administration of cytochalasin D combined with a synthetic IIbIIIa receptor antagonist. In the thromboelastometry, a significant decrease of the A10, A20 and MCF parameters were observed in the EXTEM/FIBTEM tests after they were modified by the addition of a synthetic IIbIIIa receptor antagonist alone or in combination with ASA. In conclusion, in this Multiplate- and ROTEM-based laboratory approach, a two-way blockade (IIbIIIa-antagonist + cytochalasine D) was sufficient to completely inhibit procoagulant platelet function as observed by aggregometry and thromboelastometry.

The Hemodynamics of Blood Flow through the Internal Jugular Veinsafter CCSVI Endovascular Treatment and its Impact on the Quality of Lifein Patients with Chronic Cerebrospinal Venous Insufficiency

Objectives: The aim of the study was to compare pre- and post-operative blood flow through the internal jugular veins (IJVs) in patients with multiple sclerosis and chronic cerebrospinal venous insufficiency, who were subjected to endovascular treatment. The results were correlated with respect to changes in the quality of life. Methods: 144 MS patients underwent endovascular treatment of the IJVs. The blood flow through the IJVs was assessed by the means of the Doppler ultrasonography. The clinical neurological evaluation was based on the various diagnostic tools (scales). The assessment of the blood flow through the IJVs and an evaluation of the quality of life changes were performed before surgery, and at 1, 3 and 6 months after surgery. Results: A statistically significant increase in the blood flow through the IJVs was identified on both sides during all three postoperative controls. The relationship between the IJV flow changes and the parameters related to the quality of life assessment, a statistically significant positive correlation between the flow improvement in the right IJV and Multiple Sclerosis Impact Scale, as well as Fatigue Severity Scale scores, were found. For the remaining evaluated scales (Expanded Disability Status Scale, Heat Intolerance Scale and Epworth Sleepiness Scale), as well for the flow in the left IJV, there were no statistically significant correlations confirmed. Conclusion: Despite a significant improvement in the blood flow through the IJVs after endovascular interventions on the IJVs in CCSVI patients, it has not demonstrated that hemodynamic changes improve the quality of life in MS patients.

Intraluminal thrombus thickness is not related to lower concentrations of trace elements in the wall of infrarenal abdominal aortic aneurysms

BACKGROUND Intraluminal thrombus (ILT) formation plays a significant role in the progression of infrarenal abdominal aortic aneurysms (AAA). Potentially, as ILT thickness increases the availability of trace elements in the aneurysm wall could decrease thereby leading to oxidative stress and intensifying pro-inflammatory cytokine generation. AIM To determine if thrombus thickness is related to the concentration of trace elements in the wall of infrarenal AAA. PATIENTS AND METHODS The concentrations of trace elements in the wall of the aneurysm sack and ILT obtained from 19 consecutive patients during surgery for infrarenal AAA were determined using emission spectrometry. RESULTS The concentrations of magnesium, zinc, manganese, and lead in the wall of AAA were significantly greater than in the ILT. Only the concentration of copper was lower in the AAA wall compared with the thrombus. The concentration of calcium, phosphorus, zinc, lead, copper, and magnesium increased with ILT thickness. The concentrations of no other trace elements in the wall of AAA were found to be related to the ILT thickness. CONCLUSIONS Intraluminal thrombus thickness is not associated with a lower concentration of trace elements in the wall of the infrarenal AAA. Thus, the intraluminal thrombus participates in the progression of AAA by mechanisms independent of trace element supply to the wall of the aneurysm sack.

Trace elements in the wall of abdominal aortic aneurysms with and without coexisting iliac artery aneurysms.

Iliac artery aneurysms (IAA) and abdominal aortic aneurysms (AAA) frequently coexist. It remains unknown whether the content of trace elements in AAA walls depends on the coexistence of IAAs. The aim of this study was to compare the content of selected trace elements in AAA walls depending on the coexistence of IAAs. The content of trace elements was assessed in samples of AAA walls harvested intraoperatively in 19 consecutive patients. In the studied group, coexisting IAAs were diagnosed in 11 out of the 19 patients with AAA. The coexistence of IAAs was associated with a slightly lower content of nickel (0.28 (0.15–0.40) vs. 0.32 (0–0.85) mg/g; p = 0.09) and a significantly higher content of cadmium (0.71 (0.26–1.17) vs. 0.25 (0.20–0.31) mg/g; p = 0.04) in AAA walls. The levels of the remaining studied elements, copper, zinc, manganese, magnesium and calcium, were comparable. The elevated levels of cadmium in the walls of AAA coexisting with IAAs may suggest an impact of the accumulation of this trace element on the greater damage of the iliac artery wall.