Background: Kawasaki disease (KD) affects mainly children younger than five years of age, leading to coronary artery lesions, and even to life-threatening myocardial infarctions. Since 1976, Kawasaki disease has occurred among thousands of children in Taiwan. Evidence suggests that inflammation plays a key role in the pathogenesis of atherosclerosis. Significant determinants of high sensitivity C-reactive protein (hs-CRP), which is a sensitive indicator of inflammation, as well as white blood cell (WBC) count, and high-density lipoprotein cholesterol (HDLc) and coronary artery lesion were identified. The relationships between these factors¡¦ concentration and arterial lesion were likewise investigated and had reported. The aim of this study was to determine the serum levels of the hs-CRP, WBC count, and plasma HDLc levels in patients with later phase of KD. Methods and Materials: From July 2005 to June 2006, 97 children with Kawasaki disease at least 1 year after diagnosis were recruited in this study. These participated children had been diagnosed as KD and collected at the interval of 2001 to 2004. Diagnosis was based on the 1984 revised by the KD Research Committee in Japan. The participants were grouped into 45 patients with KD and coronary aneurysms (Group I), 52 patients with KD and normal coronary arteries (Group II), and 50 healthy age-matched children (Control Group III). Their WBC count, systemic and diastolic blood pressures, body mass index, age, sex, fasting total cholesterol concentrations, triglyceride, high-density lipoprotein cholesterol (HDLc), low-density lipoprotein cholesterol, serum hs-CRP levels, and coronary artery lesion by cardioechography were recorded and compared. The analytical differences between hs-CRP, WBC count, and plasma HDLc levels and the coronary artery events in KD were examined. Results: Serum hs-CRP levels of Group I patients (mean 0.264 mg/dl) was significantly greater than that of Group II (mean 0.155 mg/dl, p=0.006) and Group III patients (mean 0.116 mg/dl, p =0.017). Similarly, the WBC count of Group I patients (mean 6,543.11/mm3) was significantly greater than that of Group II (mean 5,720.19/mm3, p=0.029), and Group III patients (mean 5,611.27/mm3, p =0.012). However, plasma HDLc levels of Group I patients (mean 41.42 mg/dl) was significantly lesser than that of Group II (mean 44.79 mg/dl, p=0.035), and Control Group III patients (mean 46.58 mg/dl, p=0.027). There was a positive association between hs-CRP and WBC count levels (r = 0.641, p < 0.05), but none between hs-CRP and plasma HDLc levels. Conclusions: There is the possibility of ongoing low-grade inflammation late after the convalescent phase of Kawasaki disease in children with coronary aneurysms, which may have a role in increasing coronary artery dysfunction. These results also suggest that hs-CRP, WBC count, and plasma HDLc levels are useful parameters for predicting formation of coronary artery lesion even in children after onset of KD.

Background: Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia. There is a need for new pharmacological treatment strategies since the current antiarrhythmic drugs have a modest efficacy and may have severe side effects. Cardioversion (CV) of AF offers an opportunity to study related conditions in sinus rhythm (SR) and during AF. Since catheter ablation of AF is a symptomatic treatment, it is important to have tools for measurement of arrhythmia-related symptoms. Aims: To evaluate the effect of atorvastatin on maintaining SR after CV of persistent AF. To assess if highsensitivity C-reactive protein (hsCRP) predicts the recurrence of AF after CV in a population randomized to treatment with either atorvastatin or placebo. To quantify the symptomatic effect of left atrial catheter ablation of AF. To assess if the restoration of SR by CV, in a population with persistent AF, affects sleep apnea. Methods: Paper I: A total of 234 patients were randomized to treatment with either high dose atorvastatin or placebo prior to CV. Paper II: In a pre-specified substudy which included 128 of the patients in study I, hsCRP was analyzed before and after CV. Paper III: Umea 22 Arrhythmia Questions (U22) is a questionnaire that quantifies paroxysmal tachycardia symptoms. A total of 105 patients underwent first-time pulmonary vein isolation and answered U22 forms at baseline and follow-up 304 (SD 121) days after ablation. Paper IV: Polysomnography was performed before and after CV in 23 patients with persistent AF scheduled for elective CV. Results: Paper I: An intention-to-treat analysis with the available data, by randomization group, showed that 57 (51%) in the atorvastatin group and 47 (42%) in the placebo group were in SR 30 days after CV (OR 1.44, 95%CI 0.85–2.44, P=0.18). Paper II: HsCRP did not significantly predict recurrence of AF at 30 days. However, after adjusting for treatment with atorvastatin, hsCRP predicted the recurrence of AF (OR 1.14, 95% CI 1.01–1.27). Six months after CV, hsCRP at randomization predicted recurrence of AF in both univariate analysis (OR 1.30, 95% CI 1.06–1.60) and in multivariate logistic regression analysis (OR 1.33, 95% CI 1.06– 1.67). Paper III: The U22 scores for well-being, arrhythmia as cause for impaired well-being, derived timeaspect score for arrhythmia, and discomfort during attack detected relevant improvements of symptoms after the ablation. U22 showed larger improvement in patients undergoing only one procedure than in patients who later underwent repeated interventions. Paper IV: Obstructive sleep apnea occurred in 17/23 patients (74%), and central sleep apnea in 6/23 patients (26%). Five patients had both obstructive and central sleep apnea. SR at follow-up was achieved in 16 patients. The obstructive apnea-hypopnea index, central apneahypopnea index, and the number of patients with obstructive or central sleep apnea did not differ before and after restoration of SR. Conclusions: Atorvastatin is not a treatment option with regards to maintaining SR after CV in patients with persistent AF. HsCRP was associated with AF recurrence 1 and 6 months after successful CV of persistent AF. U22 quantifies the symptomatic improvement after AF ablation with adequate internal consistency and construct validity. Both obstructive and central sleep apneas are highly prevalent in patients with persistent AF. Obstructive sleep apneas are unaffected by the CV of AF to SR.

Our study provided an analysis and comparison of specific blood values, dietary intake, body composition, and inflammatory markers (high sensitivity-C-reactive protein (HS-CRP), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6)) between adults with type 2 diabetes mellitus (T2DM) and prediabetes (PDM) to adults without diabetes. A total of 22 participants (PDM/T2DM n=12, controls n=10) in the San Luis Obispo, CA area completed the study prior to our ending recruitment due to Covid-19. Body composition data were collected through DXA scans. Dietary intake was assessed using a 3-day food record survey and nutritional analysis conducted using ESHA food processing software. In addition, participants completed an overnight fast and early morning blood draw for evaluation of blood glucose regulation, blood lipid profile and inflammatory biomarkers. Analysis included a series of randomization tests that were conducted to determine possible statistical differences between the mean of basic characteristics (age, BMI, weight, HbA1C, fasting plasma glucose, fasting insulin, triglycerides, LDL, HDL, and total cholesterol levels) of the control group and the PDM/T2DM group. Secondly, 2-way ANOVA statistical analyses were conducted to determine the interaction between sex and diabetes status on caloric intake, macronutrient distribution, quality of fat intake, visceral adipose tissue (VAT), and inflammatory biomarkers. We found there was a significant difference in fasting plasma glucose (FPG) and hemoglobin A1C (HbA1C) between the control group and the PDM/T2DM group. We did not find a statistically significant difference in caloric intake, macronutrient distribution, quality of fat intake, visceral adipose tissue (VAT), and inflammatory biomarkers between the PDM/T2DM and control group. Due to the lack of studies that include adults with PDM, we concluded additional future research needs to focus on blood biochemistry values, dietary intake, body composition, and inflammatory markers health-risk factors in both adults with PDM and T2DM since these values can improve diagnosis and treatment of T2DM.

Endotelio funkcijos sutrikimas (disfunkcija) - būklė, apibūdinama padidėjusia adhezijos molekulių ekspresija, padidėjusia prouždegiminių veiksnių ir protrombotinių faktorių sinteze bei sutrikusia kraujagyslių tono reguliacija - yra mirties dėl kardiovaskulinės patologijos, miokardo infarkto bei poreikio revaskuliarizacijos procedūroms išsivystymo rizikos veiksnys. Darbo tikslas buvo nustatyti endotelio pažeidimą atspindinčių žymenų, hs-CRP, sVCAM-1 ir sICAM-1 reikšmę, nuspėjant kardiovaskulines komplikacijas po aortos vainikinių jungčių suformavimo operacijos, atliktos dirbtinės kraujo apytakos sąlygomis. Nustatėme, kad didesnės priešoperacinės hs-CRP ir sVCAM-1 koncentracijos buvo nepriklausomi didesnės kardiovaskulinių komplikacijų po aortos vainikinių jungčių suformavimo operacijų rizikos žymenys. Po aortos vainikinių jungčių suformavimo operacijos nustatyta reikšmingai didesnė hs-CRP, sVCAM-1 ir sICAM-1 koncentracija, palyginus su priešoperaciniu koncentracijos lygiu. Patikimos žymenų koreliacijos su aortos užspaudimo, dirbtinės kraujo apytakos bei operacijos trukme neradome. Pacientams po aortos vainikinių jungčių suformavimo operacijos koreliacijos tarp pooperacinio sICAM-1, sVCAM-1 bei hs-CRP koncentracijos lygio ir kardiovaskulinių komplikacijų išsivystymo rizikos nebuvo nenustatyta. / The endothelial cell damage/dysfunction is associated with increased expression of adhesion molecules, synthesis of proinflammatory, prothrombotic factors and abnormal modulation of vascular tone. A growing body of evidence suggests that endothelial dysfunction is associated with future cardiovascular events including cardiac death, myocardial infarction and the need for revascularization procedures. The aim of the study was to evaluate the impact of markers of endothelial damage as predictors of cardiovascular events after on-pump coronary artery bypass grafting surgery. We found that higher concentrations preoperatively of hs-CRP and sVCAM-1 were independent markers for higher risk of cardiovascular events after coronary artery bypass grafting surgery. Concentration of hs-CRP, sVCAM-1 and sICAM-1 increased significantly after on-pump coronary artery bypass grafting surgery compared to preoperative level. However correlation between the duration of aortic cross-clamp, cardiopulmonary bypass or surgery and markers of endothelial damage was not found. Correlation between postoperative concentration of hs-CRP, sVCAM-1 and sICAM-1 and risk for cardiovascular events after coronary artery bypass grafting surgery was not found.

Endotelio funkcijos sutrikimas (disfunkcija) - būklė, apibūdinama padidėjusia adhezijos molekulių ekspresija, padidėjusia prouždegiminių veiksnių ir protrombotinių faktorių sinteze bei sutrikusia kraujagyslių tono reguliacija - yra mirties dėl kardiovaskulinės patologijos, miokardo infarkto bei poreikio revaskuliarizacijos procedūroms išsivystymo rizikos veiksnys. Darbo tikslas buvo nustatyti endotelio pažeidimą atspindinčių žymenų, hs-CRP, sVCAM-1 ir sICAM-1 reikšmę, nuspėjant kardiovaskulines komplikacijas po aortos vainikinių jungčių suformavimo operacijos, atliktos dirbtinės kraujo apytakos sąlygomis. Nustatėme, kad didesnės priešoperacinės hs-CRP ir sVCAM-1 koncentracijos buvo nepriklausomi didesnės kardiovaskulinių komplikacijų po aortos vainikinių jungčių suformavimo operacijų rizikos žymenys. Po aortos vainikinių jungčių suformavimo operacijos nustatyta reikšmingai didesnė hs-CRP, sVCAM-1 ir sICAM-1 koncentracija, palyginus su priešoperaciniu koncentracijos lygiu. Patikimos žymenų koreliacijos su aortos užspaudimo, dirbtinės kraujo apytakos bei operacijos trukme neradome. Pacientams po aortos vainikinių jungčių suformavimo operacijos koreliacijos tarp pooperacinio sICAM-1, sVCAM-1 bei hs-CRP koncentracijos lygio ir kardiovaskulinių komplikacijų išsivystymo rizikos nebuvo nenustatyta. / The endothelial cell damage/dysfunction is associated with increased expression of adhesion molecules, synthesis of proinflammatory, prothrombotic factors and abnormal modulation of vascular tone. A growing body of evidence suggests that endothelial dysfunction is associated with future cardiovascular events including cardiac death, myocardial infarction and the need for revascularization procedures. The aim of the study was to evaluate the impact of markers of endothelial damage as predictors of cardiovascular events after on-pump coronary artery bypass grafting surgery. We found that higher concentrations preoperatively of hs-CRP and sVCAM-1 were independent markers for higher risk of cardiovascular events after coronary artery bypass grafting surgery. Concentration of hs-CRP, sVCAM-1 and sICAM-1 increased significantly after on-pump coronary artery bypass grafting surgery compared to preoperative level. However correlation between the duration of aortic cross-clamp, cardiopulmonary bypass or surgery and markers of endothelial damage was not found. Correlation between postoperative concentration of hs-CRP, sVCAM-1 and sICAM-1 and risk for cardiovascular events after coronary artery bypass grafting surgery was not found.