Piotr Grzelak

Risk factors for Anterior Cruciate Ligament injury in skeletally immature patients: analysis of intercondylar notch width using Magnetic Resonance Imaging.

The necessity for identification of risk factors for Anterior Cruciate Ligament, ACL injury has challenged many investigators. Many authors have reported lower Notch Width Index, NWI measured on radiographs in patients with midsubstance ACL lesions compared to control groups. Since a narrow intercondylar notch has been implicated as a possible risk factor related to ACL injury we decided to compare NWI measured on MRI scans between age-matched groups with acute ACL injury with those of the normal population. The purpose of this study was to measure intercondylar notch width on MRI scans in an immature population to determine if there was a difference between the population with ACL tears and a control group. We also wanted to assess age as a risk factor in an ACL injury population. We retrospectively analysed the MRI scans of 46 patients with ACL injuries and 44 patients with normal MRI findings who served as a control group for NWI measurements. For the ACL injury group we collected information from medical charts including age at the time of injury, gender, mechanism of injury, type of activity practised at the time of injury and prevalence of meniscal injury. Demographic data of the control group were comparable with those from the study group. We found a statistically significant (p < 0.001) difference in the mean value of the intercondylar notch width between normal knees (0.2691) and the ACL injury population (0.2415). In the ACL injury group we did not find differences in NWI values with regard to gender, involved side, mechanism of injury and type of sport practised at the time of injury. A narrower intercondylar notch was found to be associated with the risk of ACL rupture in an immature population. The young group of athletes with ACL injury needs further study to prospectively assess the risk of knee injuries.

Serum osteoprotegerin is a predictor of progression of atherosclerosis and coronary calcification in hemodialysis patients.

Background: The aim of this prospective cohort study was to evaluate the progression of coronary artery calcification (CAC), and atherosclerosis in hemodialysis (HD) patients and to relate them to novel biomarkers, i.e. serum osteoprotegerin (OPG) and fibroblast growth factor 23 (FGF-23). Material and Methods: Forty-seven HD patients were followed up for 30 months or until death. Intima media thickness (CCA-IMT), atherosclerotic plaques and CAC were assessed at baseline and after 30 months. Serum mineral parameters, lipids, OPG and plasma FGF-23 were also measured. Results: At baseline, 70% HD patients presented detectable CAC. The patients without calcification at baseline remained calcification free at 30 months and presented lower serum OPG and FGF-23 than those with CAC. A 64.4% progression of CAC was observed in all patients with CAC at baseline. In parallel, a 13% increase in CCA-IMT was found. Both ΔCAC and ΔCCA-IMT correlated positively with baseline and follow-up serum OPG. The patients who died had significantly higher baseline CAC and serum OPG. Conclusion: The plasma level of OPG could serve as a surrogate marker of progression of atherosclerosis and calcification in patients with end-stage renal disease. Therefore, the serum OPG may be a candidate biomarker of cardiovascular complications and poor outcome among dialysis patients.

Hand exercise test for the assessment of endothelium-dependent vasodilatation in subjects with type 1 diabetes.

BACKGROUND At present, endothelial dysfunction is best assessed in vivo with measurement of flow-mediated dilatation (FMD) with Doppler ultrasound scanning. This test, however, does not account for the subjects age and is uncomfortable for patients. The aim of the study was to compare a new test for endothelium function assessment using hand exercise load. METHODS The study group comprised 31 male patients with type 1 diabetes and 72 healthy men as controls. The subjects in both groups were subdivided into three age groups: 18-30 (subgroup A), 31-45 (subgroup B), and 46-60 (subgroup C) years. FMD of the brachial artery with induction of hand ischemia was conducted in all the subjects. Afterwards, an originally designed test using standardized hand exercise with the use of a training device was performed. RESULTS In the youngest group of type 1 diabetes patients the effect of hand ischemia on brachial artery diameter was greater than in the two older age subgroups: baseline artery diameter increased by 0.23 +/- 0.11 mm (5.7%), 0.19 +/- 0.09 mm (4.3%), and 0.13 +/- 0.02 mm (2.8%), respectively (P < 0.01). In the hand exercise test, artery diameter increased in the youngest subjects by 0.39 +/- 0.11 mm (9.5%) and in the two older groups by 0.26 +/- 0.07 mm (5.6%) and 0.18 +/- 0.09 mm (4.5%) (P < 0.05), respectively. In subgroups A, B and C, vasodilation after hand exercise test was greater by 67%, 30%, and 32% (P < 0.01), respectively, compared with the effect of the ischemic test. In the controls similar effects and relationship between ischemic and hand exercise tests were noted, however, with a smaller difference between the two tests. CONCLUSIONS The hand exercise test results in a greater difference in vessel diameter before and after the test stimulus, which might substantially improve its feasibility. The hand exercise test could be a useful alternative tool for endothelial function assessment, especially in type 1 diabetes subjects.

Tight relations between coronary calcification and atherosclerotic lesions in the carotid artery in chronic dialysis patients.

Aim:  Both vascular calcification and atherosclerosis are highly prevalent in patients with end‐stage renal disease (ESRD) and have been associated with increased cardiovascular morbidity. Because those two phenomena might be only coincidentally related in chronic haemodialysis (HD) patients, in this study, coronary artery calcification (CAC), common carotid artery intima media thickness (CCA‐IMT) and thickness of atherosclerotic plaques in the carotid artery were simultaneously measured.

Endothelium‐dependent and ‐independent vasodilation is more attenuated in ischaemic than in non‐ischaemic heart failure

Endothelial dysfunction in chronic heart failure (CHF) contributes to vasoconstriction. Underlying atherosclerosis may increase vascular abnormalities in ischaemic CHF. We aimed to compare flow‐mediated dilation (FMD) and nitroglycerin‐mediated dilation (NMD) of the brachial artery between patients with ischaemic and non‐ischaemic CHF.

Supplementation of antipsychotic treatment with sarcosine – GlyT1 inhibitor – causes changes of glutamatergic 1NMR spectroscopy parameters in the left hippocampus in patients with stable schizophrenia

Glutamatergic system, the main stimulating system of the brain, plays an important role in the pathogenesis of schizophrenia. Hippocampus, a structure crucial for memory and cognitive functions and rich in glutamatergic neurons, is a natural object of interest in studies on psychoses. Sarcosine, a glycine transporter (GlyT-1) inhibitor influences the function of NMDA receptor and glutamate-dependent transmission. The aim of the study was to assess the effects of sarcosine on metabolism parameters in the left hippocampus in patients with schizophrenia. Assessments were performed using proton nuclear magnetic resonance ((1)H NMR) spectroscopy (1.5T). Fifty patients diagnosed with schizophrenia (DSM-IV-TR), with dominant negative symptoms, in stable clinical condition and stable antipsychotics doses were treated either with sarcosine (n=25) or placebo (n=25). Spectroscopic parameters were evaluated within groups and between two groups before and after 6-month intervention. All patients were also assessed with the Positive and Negative Syndrome Scale (PANSS). In the sarcosine group, after 6-month treatment, we found significant decrease in hippocampal Glx/Cr (Glx-complex of glutamate, glutamine and GABA, Cr-creatine) and Glx/Cho (Cho-choline), while N-acetylaspartate (NAA), myo-inositol (mI), Cr and Cho parameters remained stable along the study and also did not differ significantly between both groups. This is the first study showing that a pharmacological intervention in schizophrenia, particularly augmentation of the antypsychotic treatment with sarcosine, may reverse the pathological increase in glutamatergic transmission in the hippocampus. The results confirm involvement of glutamatergic system in the pathogenesis of schizophrenia and demonstrate beneficial effects of GlyT-1 inhibitor on the metabolism in the hippocampus and symptoms of schizophrenia.

Detection of transplant renal artery stenosis in the early postoperative period with analysis of parenchymal perfusion with ultrasound contrast agent.

BACKGROUND Transplant renal artery stenosis (TRAS) is a serious vascular complication due to non-specific clinical manifestations, causing serious diagnostic difficulties. Contrast-enhanced ultrasound (CE-US) can complement standard sonographic examination in evaluation of TRAS. MATERIAL AND METHODS Standard ultrasound B presentation, extended with color Doppler assessment of the flow spectrum and CE-US, was carried out in the early postoperative period in a group of 180 patients who underwent kidney transplantation. In CE-US analysis, the maximum contrast agent perfusion to the cortex and renal pyramids was evaluated. In 15 patients with sonographically diagnosed TRAS, magnetic resonance angiography and computer tomography angiography were performed to confirm the diagnosis. RESULTS In patients with TRAS, significantly longer time of contrast agent (CE) inflow was observed in comparison to patients without perfusion disturbances (3.47 s vs. 1.5 s, p<0.000 for cortex; 6.01 vs. 2.09 s for pyramids, p<0.000). The rate of CE inflow was strongly positively correlated with severity of stenosis assessed on the basis of CTA/MRA examination (R=0.97 for cortex and 0.9 for pyramids; p<0.001). Six months after kidney transplantation, patients with a history of TRAS had significantly higher serum creatinine level than recipients with normal renal artery blood flow (1.76 mg/dL vs. 1.53 mg/dl, p<0.02). Estimated GFR was decreased to 35.9 ml/min vs. 46.5 ml/min, respectively (p<0.05). CONCLUSIONS Contrast-enhanced ultrasound allows for quick and non-invasive assessment of parenchymal kidney graft perfusion. It enables confirmation of TRAS diagnosis in the early postoperative period and helps assess the degree of stenosis.

Plasma Desphospho-Uncarboxylated Matrix Gla Protein as a Marker of Kidney Damage and Cardiovascular Risk in Advanced Stage of Chronic Kidney Disease

Background/Aims: Desphospho-uncarboxylated matrix Gla protein (dp-ucMGP) is formed as a result of vitamin K insufficiency. The aim of this study was to investigate the association between plasma dp-ucMGP, kidney function and cardiovascular risk factors before and after 9-months substitution of vitamin K2 in non-dialysis patients with chronic kidney disease (CKD) stage 4 and 5. Methods: 38 CKD patients were supplemented for 270±12 days with 90 µg vitamin K2 and 10 µg cholecalciferol or 10 µg cholecalciferol alone. At baseline and at follow-up circulating calcium, phosphate, lipids, hemoglobin, albumin and total protein, dp-ucMGP, osteoprotegerin, fetuin A, osteocalcin and fibroblast grown factor 23 (FGF-23) were assessed. Proteinuria was assessed in the first morning void. Results: Baseline plasma dp-ucMGP was 1018.6±498.3 pmol/l and was significantly higher in patients at stage 5 CKD (1388.3 ±505.4 pmol/l) than at stage 4 (885.1±419.7 pmol/l), p=0.04. Vitamin K2 supplementation resulted in a decrease of dp-ucMGP level by 10.7%. Plasma dp-ucMGP was positively associated with proteinuria, serum creatinine, PTH and FGF-23; and inversely associated with glomerular filtration rate, serum hemoglobin and albumin. Conclusions: High dp-ucMGP level, reflecting a poor vitamin K status seems to be associated with kidney damage and may be also a marker of cardiovascular risk in CKD patients. Supplementation with vitamin K2 may improve the carboxylation status of MGP.

Pancreatic cyst fluid analysis for differential diagnosis between benign and malignant lesions

The majority of pancreatic cysts are detected incidentally when abdominal imaging is performed during unrelated procedures. The aim of the present study was to assess the diagnostic utility and clinical value of carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9) and amylase analysis in pancreatic cyst fluid. The study included 52 patients with pancreatic cystic lesions, who underwent fine-needle aspiration biopsy to collect cystic fluid for cytological and biochemical analysis. Cysts were classified as benign (simple cysts, pseudocysts and serous cystadenomas) in 36 patients or premalignant/malignant (mucinous cyst-adenomas, intraductal papillary mucinous neoplasm and cystadenocarcinomas) in 16 patients. CEA and CA 19-9 were elevated in patients with malignant cysts (238±12.5 ng/ml and 222±31.5 U/ml, respectively) compared with benign lesions (34.5±3.7 ng/ml and 18.5±1.9 U/ml, respectively; P<0.001). Based on these results, the sensitivity and specificity of CEA were 91.8 and 63.9% and of CA 19-9 were 81.3 and 69.4%, respectively. Mean amylase levels in benign lesions (27825.7±91.9 U/l) were higher compared with malignant pancreatic cysts (8359.2±32.7 U/l; P<0.05). Cyst fluid analysis may prove a safe and useful adjunct for the differential diagnosis of pancreatic cystic lesions. In the present study, promising results for CEA and CA 19-9 have been demonstrated, however, the clinical value of these molecules must be confirmed.

Peripheral vascular stiffness, assessed with two-dimensional speckle tracking versus the degree of coronary artery calcification, evaluated by tomographic coronary artery calcification index

Introduction Even in asymptomatic patients, the result of atherosclerosis progression is deterioration of the function and morphology of the artery wall. Two-dimensional speckle-tracking (2DST) is a sonographic technique that allows for precise evaluation of arterial wall compliance. Together with measurement of intima-media thickness (IMT), it can be applied for quick and non-invasive assessment of the progression of peripheral artery atherosclerosis. Material and methods Fifty-eight patients of mean age 61 years (SD 10.6) underwent cardiac computed tomography (CT) and subsequent ultrasonographic evaluation of the left common carotid artery. The calcium score was calculated according to the Agatston method and compared with IMT, circumferential strain variables assessed by 2DST, conventional arterial stiffness parameters (β-stiffness index and elastic modulus) and clinical data. Intra-observer and inter-observer agreement was evaluated. Results Strain variables and IMT differed significantly in patients with calcium score (CS) > 0 and CS = 0. Moreover, they correlated with CS, systolic blood pressure and age of patients. Conventional stiffness parameters were not able to identify the group of patients with calcifications present in the coronary arteries. For the 2DST technique, interclass and intraclass agreements were 84.83% and 94.42% respectively. Conclusions Circumferential strain variables assessed by 2DST and measurement of IMT can be used for evaluation of peripheral artery deterioration in patients until the 6th decade of life. These parameters reflect the development of calcifications in coronary arteries and, more importantly, can be used for a more detailed estimation of the atherosclerosis risk in patients with CS = 0.