Сardiac troponin I for assessment of myocardial damage and prediction of complications in cardiac surgery patients

The study analysed the level of troponin I (Tn) in the blood in patients with coronary artery disease after coronary artery bypass grafting in comparison with patients after aortic valve replacement surgery. The dynamics of troponin in the early postoperative period was studied, a parallelism was established between the occurrence of complications after surgery and the degree of myocardial damage. A new method has been developed for assessing the degree of intraoperative myocardial damage and the risk of complications using the «index of myocardial damage», the Tn level is determined twice after the operation, in the period up to 6 hours – Tn early and 12–24 hours later – Tn late, the index is calculated as the ratio of Tn late one to Tn early one. A correlation analysis of the «index» with other laboratory parameters was carried out, as a result of which no significant correlations were found, which indicates the absence of duplication and the significance of the developed indicator for assessing myocardial damage after cardiac surgery.

Monogenic Diabetes in Youth With Presumed Type 2 Diabetes: Results From the Progress in Diabetes Genetics in Youth (ProDiGY) Collaboration

<p>Objective: Maturity-onset diabetes of the young (MODY) is frequently misdiagnosed as type 1 or type 2 diabetes. Correct diagnosis may result in a change in clinical treatment and impacts prediction of complications and familial risk. In this study, we aimed to assess the prevalence of MODY in multi-ethnic youth under age 20 years with a clinical diagnosis of type 2 diabetes.</p> <p> </p> <p>Research design and methods: We evaluated whole-exome sequence data of youth with a clinical diagnosis of type 2 diabetes. We considered participants to have MODY if they carried a MODY gene variant classified as likely pathogenic (LP) or pathogenic (P) according to current guidelines.</p> <p> </p> <p>Results: 93 of 3,333 participants (2.8%) carried an LP/P variant in <i>HNF4A </i>(16 participants)<i>, GCK </i>(23)<i>, HNF1A </i>(44), <i>PDX1</i> (5), <i>INS</i> (4), and <i>CEL</i> (1). Compared with those with no LP/P variants, youth with MODY had a younger age at diagnosis (12.9 ± 2.5 <i>vs</i> 13.6 ± 2.3 years, <i>P</i>=0.002) and lower fasting C-peptide levels (3.0 ± 1.7 <i>vs</i> 4.7 ± 3.5 ng/mL, <i>P</i><0.0001). Youth with MODY were less likely to have hypertension (6.9% <i>vs</i> 19.5%, <i>P</i>=0.007) and had higher HDL cholesterol (43.8 <i>vs</i> 39.7 mg/dL, <i>P=</i>0.006). </p> <p> </p> Conclusions: By comprehensively sequencing the coding regions of all MODY genes, we identified MODY in 2.8% of youth with clinically diagnosed type 2 diabetes; importantly, in 89% (n=83) the specific diagnosis would have changed clinical management. No clinical criterion reliably separated the two groups. New tools are needed to find ideal criteria to select individuals for genetic testing.

Monogenic Diabetes in Youth With Presumed Type 2 Diabetes: Results From the Progress in Diabetes Genetics in Youth (ProDiGY) Collaboration

<p>Objective: Maturity-onset diabetes of the young (MODY) is frequently misdiagnosed as type 1 or type 2 diabetes. Correct diagnosis may result in a change in clinical treatment and impacts prediction of complications and familial risk. In this study, we aimed to assess the prevalence of MODY in multi-ethnic youth under age 20 years with a clinical diagnosis of type 2 diabetes.</p> <p> </p> <p>Research design and methods: We evaluated whole-exome sequence data of youth with a clinical diagnosis of type 2 diabetes. We considered participants to have MODY if they carried a MODY gene variant classified as likely pathogenic (LP) or pathogenic (P) according to current guidelines.</p> <p> </p> <p>Results: 93 of 3,333 participants (2.8%) carried an LP/P variant in <i>HNF4A </i>(16 participants)<i>, GCK </i>(23)<i>, HNF1A </i>(44), <i>PDX1</i> (5), <i>INS</i> (4), and <i>CEL</i> (1). Compared with those with no LP/P variants, youth with MODY had a younger age at diagnosis (12.9 ± 2.5 <i>vs</i> 13.6 ± 2.3 years, <i>P</i>=0.002) and lower fasting C-peptide levels (3.0 ± 1.7 <i>vs</i> 4.7 ± 3.5 ng/mL, <i>P</i><0.0001). Youth with MODY were less likely to have hypertension (6.9% <i>vs</i> 19.5%, <i>P</i>=0.007) and had higher HDL cholesterol (43.8 <i>vs</i> 39.7 mg/dL, <i>P=</i>0.006). </p> <p> </p> Conclusions: By comprehensively sequencing the coding regions of all MODY genes, we identified MODY in 2.8% of youth with clinically diagnosed type 2 diabetes; importantly, in 89% (n=83) the specific diagnosis would have changed clinical management. No clinical criterion reliably separated the two groups. New tools are needed to find ideal criteria to select individuals for genetic testing.

sABLATE: A Simplified ABLATE Score for Prediction of Complications and Outcome in Percutaneous Thermal Ablation of Renal Lesions

Objectives To evaluate the performance of a simplified-ABLATE score (sABLATE) in predicting complications and outcome in respect to RENAL, mRENAL and ABLATE scores. Methods This study included 136 renal lesions in 113 patients (M:F ratio=2.5; mean age 70.8 years). 98 tumors underwent cryoablation at San Raffaele hospital between 01/2015 and 03/2020, 37 microwave ablation at San Paolo or Policlinico hospitals between 07/2016 and 03/2020. RENAL, mRENAL, ABLATE and sABLATE scores were calculated using preprocedural imaging. Data regarding complications and follow-up were registered. Mann-Whitney U test, ROC analyses, and logistic regression analyses were used for complications. Cox-regression analyses were performed for outcome Results Mean tumor diameter was 23.2mm. Mean and median RENAL, mRENAL, ABLATE and sABLATE scores were 6.8 and 7, 6.9 and 7, 5.3 and 5, and 3.5 and 3, respectively. During a mean follow-up of 21.9 months (range 1-73) we registered 7 complications, 3 cases of residual disease and 10 local tumor progressions. Mann-Whitney U test p-values for complications for RENAL, mRENAL, ABLATE and sABLATE were 0.51, 0.49, 0.66 and 0.056 respectively. ROC analyses for complications showed an AUC for RENAL, mRENAL, ABLATE and sABLATE of 0.57, 0.57, 0.55 and 0.71 respectively. Regarding outcome, HR and p-values of Cox-regression analyses were 1.30 and 0.36 for RENAL, 1.33 and 0.35 for mRENAL, 2.16 and 0.01 for ABLATE, 2.29 and 0.004 for sABLATE.Conclusion sABLATE was the only score close to significance for complications, representing a progress even if not definitive. Regarding outcome, ABLATE confirmed its value, and sABLATE maintained validity despite being a simplification.