Neutrophil extracellular traps (NETs) have been implicated in the pathogenesis of abdominal aortic aneurysms (AAAs). This study has addressed the notion that NET components might serve as AAA biomarkers or novel targets of AAA therapy. Thus, parameters of neutrophil activation and NET formation were measured in plasma. Their diagnostic marker value was explored in 41 AAA patients and 38 healthy controls. The NET parameter citrullinated histone H3 (citH3) was then validated in 63 AAA patients and 63 controls matched for cardiovascular disease. The prognostic marker potential was investigated in 54 observation periods of AAA growth over 6 months. NETs were further assessed in conditioned medium and sections of aortic tissue. CitH3 was found to be increased in blood (median 362 vs 304 ng/mL, P = 0.004) and aortic tissue (50 vs 1.5 ng/mg, P < 0.001) of AAA patients compared to healthy controls and accumulated in the intraluminal thrombus (629 ng/mg). The diagnostic potential of citH3 ranged at 0.705 area under the ROC curve (AUROC) and was validated with the independent sample set. Furthermore, plasma citH3 predicted AAA growth over the next 6 months (AUROC: 0.707, P = 0.015) and dropped significantly after surgical aneurysm repair. In an angiotensin II -based mouse model of experimental AAA, an inhibitor of histone citrullination was applied to
Background&Aims:The COVID-19 pandemic necessitated down-scaling of in-hospital care to prohibit the spread of severe acute respiratory syndrome-coronavirus-2(SARS-CoV-2). We (i)assessed patient perceptions on quality of care by tele-survey(cohort 1) and written questionnaire(cohort 2) and (ii)analyzed trends in elective and non-elective admissions prior to (12/2019- 02/2020) and during (03/2020-05/2020) the COVID-19 pandemic in Austria. Methods:Two-hundred seventy-nine outpatients were recruited into cohort 1 and 138 patients into cohort 2. All admissions from 12/2019 to 05/2020 to the Division of Gastroenterology/Hepatology at the Vienna General Hospital were analyzed. Results:Thirty-two point six percent (n=91/279) of cohort 1 and 72.5%(n=95/131) of cohort 2 had tele-medical contact, while 59.5%(n=166/279)and 68.2%(n=90/132) had face-to-face visits. 24.1%(n=32/133) needed acute medical help during healthcare restrictions, however, 57.3%(n=51/89) reported that contacting their physician during COVID-19 was difficult or impossible. Patient-reported satisfaction with treatment decreased significantly during restrictions in cohort 1 (visual analog scale[VAS] 0-
(1) Background: Pregnant women are at risk of vitamin D deficiency. Data on pregnancy outcomes in women with vitamin D deficiency during pregnancy are controversial, and prospective longitudinal data on vitamin D deficiency with consistent definitions in pregnant women are scarce. (2) Methods: The aim of this prospective longitudinal cohort study was to investigate 25-hydroxyvitamin D levels over the course of pregnancy and postpartum in singleton and twin pregnancies with regard to dietary and supplemental vitamin D intake and environmental factors influencing vitamin D levels, evaluated by a standardized food frequency questionnaire. (3) Results: We included 198 healthy singleton and 51 twin pregnancies for analysis. A total of 967 study visits were performed over a 3-year period. Overall, 59.5% of pregnant women were classified as vitamin D deficient in the first trimester, 54.8% in the second trimester, 58.5% in the third trimester, 66.9% at birth, and 60% 12 weeks postpartum, even though 66.4% of the study population reported daily pregnancy vitamin intake containing vitamin D. Dietary vitamin D intake did not affect vitamin D levels significantly. (4) Conclusions: The majority of pregnant women evaluated in this study were vitamin D deficient, despite administration of pregnancy vitamins containing vitamin D. Individualized vitamin D assessment during pregnancy should be considered to ensure adequate supplementation and prevention of hypovitaminosis D.
ObjectivesAngiogenic marker assessment such as the ratio of soluble fms‐like tyrosine kinase 1 (sFlt‐1) to placental growth factor (PlGF), is known to be a useful tool in the prediction of pre‐eclampsia. However, evidence on surveillance strategies in pregnancies with pre‐eclampsia diagnosis is lacking. Therefore, we aimed to assess the predictive performance of longitudinal maternal serum angiogenic marker assessment for adverse maternal and perinatal outcomes compared to standard laboratory parameters in pregnancies with confirmed pre‐eclampsia.MethodsThis was a retrospective analysis of prospectively collected data from January 2013 to December 2020 at the Medical University of Vienna. The inclusion criteria were singleton pregnancies with confirmed pre‐eclampsia and post‐diagnosis maternal serum angiogenic marker assessment in at least two time points. The primary outcome was the predictive performance of longitudinal sFlt‐1 and PlGF assessment for adverse maternal and perinatal outcomes compared to longitudinal conventional laboratory monitoring measured at the same time as the angiogenic markers in pregnancies with confirmed pre‐eclampsia. Composite maternal adverse outcomes included intensive care unit (ICU) admission, pulmonary edema, eclampsia, and death. Composite adverse perinatal outcomes included stillbirth, neonatal death, placental abruption, neonatal intensive care unit (NICU) admission, intraventricular hemorrhage, necrotizing enterocolitis, respiratory distress syndrome, and mechanical ventilator support.ResultsIn total 885 post‐diagnosis sFlt‐1/PlGF ratio measurements were taken from 323 pregnant women with confirmed pre‐eclampsia. For composite maternal adverse outcome, the highest stand‐alone predictive accuracy was obtained using maternal serum sFlt‐1/PlGF ratio (AUROC 0.72, 95% CI 0.62–0.81), creatinine (AUROC 0.71, 95% CI 0.62–0.81), and lactate dehydrogenase (LDH) levels (AUROC 0.73, 95% CI 0.65–0.81). Maternal platelet levels (AUROC 0.65, 95% CI 0.55–0.74), serum alanine transaminase (ALT) (AUROC 0.59, 95% CI 0.49–0.69) and aspartate aminotransferase (AST) (AUROC 0.61, 95% CI 0.51–0.71) levels had poor stand‐alone predictive accuracy. The best prediction model consisted of a combination of maternal serum LDH, creatinine levels and sFlt‐1/PlGF ratio, which had an AUROC of 0.77 (95% CI 0.68–0.85), significantly higher than sFlt‐1/PlGF ratio alone (P=0.037). For composite perinatal adverse outcome, the highest stand‐alone predictive accuracy was obtained using maternal serum sFlt‐1/PlGF ratio (AUROC 0.82, 95% CI 0.75–0.89) and creatinine (AUROC 0.74, 95% CI 0.67–0.80) levels, while sFlt‐1/PlGF ratio was superior to creatinine alone (P<0.001). Maternal serum LDH levels (AUROC 0.65, 95% CI 0.53–0.74), platelet count (AUROC 0.57, 95% CI 0.44–0.67), ALT (AUROC 0.58, 95% CI 0.48–0.67) and AST (AUROC 0.58, 95% CI 0.48–0.67) levels had poor stand‐alone predictive accuracy. No combination of biomarkers was superior to maternal serum sFlt‐1/PlGF ratio alone for composite perinatal adverse outcome (P>0.05 for all).ConclusionsLongitudinal maternal serum angiogenic marker assessment is a good predictor of adverse maternal and perinatal outcomes and superior to some of the conventional laboratory parameters in pregnancies with pre‐eclampsia. More studies should focus on the optimal surveillance following the diagnosis of pre‐eclampsia.This article is protected by copyright. All rights reserved.
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