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DETERMINATION OF LEFT VENTRICULAR SYSTOLIC DYSFUNCTION PROGRESSION IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION AND TYPE 2 DIABETES MELLITUS
TAKING INTO ACCOUNT OF TENASCIN C
Koteliukh M.Y
Candidate of Medical Sciences, Department of internal medicine № 2, clinical immunology and allergology, Kharkiv National Medical University, Kharkiv, Ukraine
Kravchun P.
Doctor of Medical Sciences, Department of internal medicine № 2, clinical immunology and allergology,
Kharkiv National Medical University, Kharkiv, Ukraine
Ryndina N.
Doctor of Medical Sciences, Department of internal medicine № 2, clinical immunology and allergology, Kharkiv National Medical University, Kharkiv, Ukraine
Kreis I.
1 head of cardiology department Kharkiv hospital railroad №1
Zaikina T.
Candidate of Medical Sciences, Department of internal medicine № 2, clinical immunology and allergology, Kharkiv National Medical University, Kharkiv, Ukraine
Borzova-Kosse S.
Assistant of Department of internal medicine № 2, clinical immunology and allergology,
Kharkiv National Medical University, Kharkiv, Ukraine
Abstract
At present the role of tenascin C in patients with acute myocardial infarction and type 2 diabetes mellitus has remained unclear.
The aim of the study - construction of a model prediction of left ventricular systolic dysfunction in patients with acute myocardial infarction and type 2 diabetes, taking into account the level of tenascin C.
Methods. The content of tenascin C was determined by the immunoassay method using a set of "Human Tenascin-C Large (FNIII-C)" reagents (Immuno-Biological Laboratories Co. Ltd. (IBL), Takasaki-Shi, Japan ).
The results. The study showed that over time the content of tenascin C at the 10-14th day decreased in patients with acute myocardial infarction and type 2 diabetes mellitus compared with patients with AMI without type 2 DM. It has been established practical to elaborate a model taking into account tenascin C to predict of development of left ventricular systolic dysfunction in patients with acute myocardial infarction and type 2 diabetes mellitus. Consideration of tenascin C, creatinine, BMI and diastolic blood pressure indices in one model makes it possible to increase the specificity to 77% in high sensitivity of 89%.
Conclusion. This suggests that diabetes may be associated with exhaustion of tenascinemia. Tenascin C are found the prediction properties of development of left ventricular systolic dysfunction in patients with acute myo-cardial infarction and concomitant type 2 diabetes mellitus.
Keywords: acute myocardial infarction, tenascin C, diabetes mellitus type 2, left ventricular systolic dysfunction.
Ischemic heart disease (IHD) is ranked first among cardiovascular diseases and is the leading cause of mortality worldwide and in Ukraine [3; 7]. The course and prognosis of IHD depends on the presence of comorbid pathology. Type 2 diabetes mellitus (type 2 DM) is a significant factor that predisposes an unfavorable course of coronary artery disease [2].
Currently, 347 million people are suffering from diabetes, 90% have type 2 DM [6]. The prevalence of diabetes mellitus in Ukraine is 1264500 individuals. Thus, type 2 diabetes is a global problem not only in Ukraine but also in the world [3; 6].
Tenascin C is known to be a non-matrix protein that plays an important role in the development of cardiovascular diseases, namely: regulating the behavior of cells and matrix organization in tissue remodeling; differentiation of cardiomyocytes; angiogenesis. Tenascin C is found in blood in pathological conditions such as myocarditis, myocardial infarction, atherosclerosis, heart aneurysm. Therefore, it can be a promising biomarker for diagnosis of cardiovascular disease. Tenascin C reduces cellular adhesion, regulates the expression and activity of matrix metalloproteinases, and enhances fibrosis [4].
Scientists Yao H.C., Han QF [10] investigated the prognostic value of tenascin C in patients with chronic heart failure and coronary heart disease. They demonstrated a correlation between the level of tenascin C and left ventricular ejection fraction in patients with coronary heart disease and chronic heart failure (CHF).
The study [9] analysed cases of re-hospitalization due to deterioration of heart failure and mortality throughout the year. The obtained results indicated that the level of tenascin C in patients with heart failure was higher compared to the control group. It is important to note that the level of tenascin C in patients with class IV CHF according to the New York Heart Association (NYHA) classification was higher compared to patients with NYHA Class II CHF. The level of tenascin C negatively correlated with the left ventricular ejection fraction. It has been shown that elevated levels of tenascin C are the first signs for the endpoint of re-hospitaliza-tion and mortality.
It has been proved today that the content of tenas-cin C increases in patients with acute myocardial infarction [8, 9]. However, the issue of changes in tenascin C levels in type 2 diabetes in patients with acute myocardial infarction (AMI) remains disputable.
The aim of the study is to evaluate the progression of left ventricular systolic dysfunction in patients with acute myocardial infarction and type 2 diabetes, taking into account tenascin C levels.
Materials and methods of the study
The study involved examination of 120 patients, including 46 women (42.6%) and 74 men (57.4%) who underwent inpatient treatment in myocardial infarction unit of Kharkiv City Clinical Hospital No. 27 (clinical center of the Department of Internal Medicine No. 2,
The content of tenascin C and troponin I in patients
2 diabet
Clinical Immunology and Allergology of Kharkiv National Medical University of the Ministry of Health of Ukraine) and in the first cardiology department of the Central Clinical Hospital "Ukrzaliznytsia". All the patients were divided into the following groups: the main group included 60 patients with AMI accompanied by type 2 DM (among them 31 men, 29 women aged 4588); comparison group comprised 40 patients with AMI without type 2 DM (among them 32 men, 8 women aged 45-75). Control group involved 20 practically healthy individuals (including 11 men and 9 women aged 22-27).
The content of tenascin C was determined by im-munoassay method using a set of human Tenascin-C Large (FNIII-C) (Immuno-Biological Laboratories Co. Ltd. (IBL), Takasaki-Shi, Japan), troponin I by immunoenzyme method using "Troponin I" (HEMA, Moscow, Russia). The immunoassay studies were conducted in the Central Research Biochemical Laboratory at Kharkiv National Medical University.
Statistical computer processing of results was carried out using Microsoft Office Excel and Statistica 6.0 software. Comparative analysis of samples was carried out by calculation of arithmetic mean and statistical error of the mean arithmetic (M ± m). Differences between the groups in the distribution close to normal were estimated using Student t-test. The differences were considered statistically significant at (p <0.05). Pearson criterion was used in analysis of the difference in frequencies in two independent samples.
Results and their discussion
The study showed that tenascin C level on the 1-2nd day (Table 1) was significantly higher by 34% (p<0.05) in patients with AMI without type 2 DM as compared to the control group. In patients with AMI and type 2 DM the content of tenascin C was higher than in the control group by 14.9% (p = 0.07). The level of tenascin C on the 10-14th day in patients with AMI and type 2 DM was 38% lower as compared to patients with AMI without type 2 DM (p<0.05). The content of tenascin C on the 10-14th day in patients with AMI without type 2 DM was 71% higher than in the control group (p<0.05). Taking into account possible influence of tenascin C on the system of extracellular matrix [4], the results of the study indicate that type 2 DM is associated with the depletion of tenascin C in patients with AMI.
Table 1
ith acute myocardial infarction with or without type mellitus
Index, unit of measurement AMI with type 2 DM (n = 60 patients) AMI without type 2 DM (n = 40 patients) Control group (n = 20 patients)
M ± m
Tn C on the 1-2nd day, ng/ml 18.64±1.28 20.12±1.48* 14.93±0.97
Tn C on the 10-14th day, ng/ml 15.90±1.34# 25.67±1.92* 14.93±0.97
Troponin I, ng/ml 2.75±0.79 3.95±0.66 0.19±0.68
Note: n is the number of examined patients; M ± m is the arithmetic mean ± standard deviation; Tn C is tenascin C, * - p < 0.05 in comparison of patients with the control group; # - p < 0.05 in comparison of patients with AMI depending on the presence or absence of type 2 DM.
The study showed a correlation between tenascin C and troponin I. Patients with AMI and type 2 DM were found to have a negative correlation between tenascin C and troponin I (r = -0.26; p <0.05), in contrast, patients with AMI without type 2 DM were shown to have a direct relationship (r = 0.28; p<0.05). That is, in the absence of metabolic disturbances in the form of type 2 DM in AMI, an increase in tenascinemia in response to hypertroponininemia, taking into account positive effects on the intercellular matrix, may indicate adaptive responses. In contrast to the comparison group in patients with type 2 DM, the reciprocal nature of associations indicates an exhaustion of the effects of tenascinemia. The results of the study do not contradict
the literary data. According to literary sources [8; 9], the development of AMI is associated with an increase in tenascin C level.
According to the design of the study, we have provided a possibility of using tenascin C as a predictor of the development of left ventricular systolic dysfunction in patients with AMI and type 2 DM. ROC-curve showed prognostic properties of tenascin C regarding the development of left ventricular myocardial systolic dysfunction in patients with AMI and type 2 DM at its level <15 ng / ml, taking into account sensitivity (72%) and specificity (66%) (Figure 1). Tenascin C content is an independent variable, binary variable is a dependent variable, which is "1" in EF <40% and "0" in EF>40%.
Тенасцмн C Ha 10-14 flo6y
1 00-Specificity
100 80 60 40 20 0
Figure 1. Prognostic value of tenascin C in patients with acute myocardial infarction and type 2 diabetes
mellitus in the development of left ventricular myocardial systolic dysfunction. Note: whole x - specificity, in%; whole y - sensitivity, in%.
Conclusions
1. The study showed an inverse relationship between tenascin C and troponin I in patients with acute myocardial infarction and type 2 diabetes mellitus, indicating the exhaustion of the effects of tenascinemia.
2. A combination in the model of prediction of the left ventricular systolic dysfunction after acute myocar-dial infarction of tenascin C concentration, diastolic blood pressure, body mass index; creatinine allowed to obtain specificity up to 78% in high-sensitivity conditions (89%).
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MATHEMATICAL MODELING OF THE STRESS-STRAIN STATE OF BONE TISSUE USING INTRAOSSEOUS DENTAL IMPLANTS. (LITERATURE REVIEW)
Savransky Ph.
MD, professor, Department of General Dentistry, University of Jerusalem, Jerusalem, Israel
Grishin P.
Candidate of Medical Sciences, Associate Professor of the Department of Maxillofacial Surgery, GOU VPO
Kazan State Medical University, Kazan, Russia
Simakhov R.
Assistant of the Department of Maxillofacial Surgery, Omsk State Medical Academy of the Ministry of
Health, Omsk, Russia
Khaikin M.
Candidate of Medical Sciences, Assistant of the Department of Maxillofacial Surgery and Dentistry of the Samara State Medical University, Chief Medical Officer of the City Clinical Hospital of the Samara City Dental
Clinic No. 1, Samara, Russia Chigarina S.
Candidate of Medical Sciences, Associate Professor of the Department of Therapeutic Dentistry, Samara
State Medical University, Samara, Russia
Kalinnikova E.
student of the stomatological faculty, GOU VPO Kazan State Medical University, g. Kazan, Russia
Abstract
In this article, we give a brief review of the literature on the use of the method of mathematical modeling of stress-strain state and finite-element analysis during dental implantation. Based on the analysis, it was concluded that the application of this method in practice will make the implantation process and further prosthetics more reliable and predictable, especially in atypical clinical situations.
Keywords: implantation, mathematical modeling, stress-strain state, finite element analysis.
The biomechanical aspects of planning implantation and the functioning of intraosseous implants have not been adequately studied. This is due to the difficulty in measuring in vivo stresses in bone tissue when loading both the teeth and implants. Gnathodynamometric, strain-gauge, frequency-resonance measurements (RFA) give a relative and local view of the stress-strain state (VAT) in bone tissue with implant loads.
The most informative and promising experimental method for studying jaw biomechanics is three-dimensional mathematical modeling of the stress-strain state in various clinical situations during implantation [1, p.11; 2, p.103].
Work in this direction is based on mathematical models and calculations of different levels of complexity and compliance with clinical conditions give conflicting results on the magnitude and nature of stress in bone tissue [3, p.34; 4, p. 58; 5, p. 47].) In this case, it is rare in an identical model to compare the biomechan-ical parameters with the load of the intact dentition and in the presence of implants [6, p. 106]
Three-dimensional mathematical modeling of the stress-strain state of bone tissue around the implants is an informative tool for biomechanical planning of the number, size of implants, features of the surgical stage
and prosthetics based on the established values of maximum stresses (nomograms) depending on the volume of bone tissue (according to computed tomography) and the size of the implants [7, p.29].
In their work [8 ,p.34], data from the results of three-dimensional mathematical modeling of the state of the cortical bone around the dental implants in different parts of the dentition are cited. At the same time, the study demonstrated the possibilities of modern three-dimensional modeling of VAT in implantology using the example of implant biomechanics in different parts of the jaw in standard conditions. The authors came to the conclusion about the possibility of individual changes in jaw parameters and places of planned implant placement for predicting maximum stresses in bone tissue.
The majority of authors [9, p. 28; 10.20p; 11, p. 177] believe that the most informative and promising experimental method for studying biomechanics in dentistry and implantology is three-dimensional mathematical modeling of stress-strain state under various atypical clinical conditions.
The studies carried out in this direction on the creation of a mathematical model of stress-strain state did not always take into account the level of complexity of implantation in a particular clinical situation. This is
