A avaliação perioperatória é uma etapa importante antes de encaminhar o paciente para a realização de uma operação. Algoritmos e escores podem ajudar durante este processo de estratificação de risco e na tomada de decisões. Entretanto, a maior parte deles foram descritos e desenvolvidos em um contexto diferente que pode não representar a realidade médico atual. O índice tornozelo-braquial (ITB) é capaz de quantificar o risco cardiovascular na população em geral. É um método barato e passível de ser realizado ambulatorialmente e poderia ser útil antes da realização de procedimentos cirúrgicos. O trabalho atual é um estudo observacional e prospectivo que avaliou pacientes de risco cardiovascular perioperatório intermediário a alto antes de serem submetidos a cirurgias não cardíacas. O ITB foi aferido em todos os pacientes. Um valor <=0,9 foi considerado alterado, definindo o grupo portador de doença arterial periférica. Os demais pacientes constituíram o grupo controle. Traçados eletrocardiográficos e dosagem sérica de troponina foram obtidos em todos os pacientes nas primeiras 72 horas após o procedimento. Todos os pacientes foram seguidos por um período de 30 dias, sendo o desfecho primário um combinado de eventos cardiovasculares (mortalidade cardiovascular, síndrome coronariana aguda, elevação isolada de troponina, insuficiência cardíaca descompensada, choque cardiogênico, arritmias instáveis, parada cardíaca não fatal, edema agudo de pulmão, acidente vascular cerebral e doença arterial periférica descompensada). Foram avaliados 132 pacientes (61,3% do sexo masculino; idade média 65,4 anos). Durante o período de acompanhamento especificado 57,9% dos pacientes com ITB <= 0,9 apresentaram o desfecho primário vs 25,7% no grupo controle (p=0,011). Após análise multivariada por regressão logística, o odds ratio (OR) para a ocorrência desta complicação foi de 7,4 (IC 95% 2,2-25,0, p=0,001) e o valor de P para o teste de Hosmer-Lemeshow foi de 0,626. A elevação isolada de troponina foi o principal evento encontrado (78,9%). Análise de desfecho secundário mostrou um OR de 13,4 para a ocorrência de elevação isolada de troponina após regressão logística (IC 95% 3,0-59,9, p=0,001) com o valor de P do teste de Hosmer-Lemeshow de 0,922. Concluímos então que, no período perioperatório, a presença de ITB anormal está associado a pior prognóstico cardiovascular, principalmente devido à elevação isolada de troponina / Perioperative evaluation is an important step before referring a patient to surgery. Scores and algorithms can help during this process. However, most of them were developed in different context that may not represent the actual medical scenario. The ankle-brachial index (ABI) can quantify cardiovascular risk in general population. It is inexpensive and easy to perform in office care and could be useful before surgery. This is a prospective and observational study that evaluated intermediate to high cardiovascular risk patients referred for general surgery. ABI were performed in all patients before surgery. A value <= 0.9 was considered abnormal and defined the peripheral artery disease group, and the remaining patients constituted the control group. Troponin-I and electrocardiogram were provided in the first 72 hours. All patients were followed for 30 days and primary endpoint was a composite of cardiovascular events (cardiovascular mortality, acute coronary syndrome, isolated troponin elevation, decompensated heart failure, cardiogenic shock, unstable arrhythmias, non fatal cardiac arrest, pulmonary edema, stroke and peripheral artery disease decompensation). We evaluated 132 patients (61.3% male; mean age 65.4 years). During the specified period 57.9% of patients with ABI <= 0.9 had a cardiovascular event vs 25.7% in the control group (p=0.011). After logistic regression, the odds ratio (OR) was 7.4 (CI 95% 2.2-25.0, p=0.001) and Hosmer-Lemeshow P=0.626. Isolated troponin elevation was the main event (78.9%). Secondary analysis revealed an OR of 13.4 for the occurrence of secondary endpoint after logistic regression (CI 95% 3.0-59.9, p=0.001) and Hosmer-Lemeshow P = 0.922. In conclusion, in the perioperative setting, an abnormal ankle-brachial index is associated with a worse cardiovascular prognosis, especially due to isolated troponin elevation

Indiana University-Purdue University Indianapolis (IUPUI) / Noble metal nanostructures display collective oscillation of the surface conduction electrons upon light irradiation as a form of localized surface plasmon resonance (LSPR) properties. Size, shape, and refractive index of the surrounding environment are the key features that control the LSPR properties. Surface passivating ligands on to the nanostructure can modify the charge density of nanostructures. Further, allow resonant wavelengths to match that of the incident light. This unique phenomenon called the “plasmoelectric effect.” According to the Drude model, red and blue shifts of LSPR peak of nanostructures are observed in the event of reducing and increasing charge density, respectively. However, herein, we report unusual LSPR properties of gold triangular nanoprisms (Au TNPs) upon functionalization with para-substituted thiophenols (X-Ph-SH, X = -NH2, -OCH3, -CH3, -H, -Cl, -CF3, and -NO2). Accordingly, we hypothesized that an appropriate energy level alignment between the Au Fermi energy and the HOMO or LUMO of ligands allows the delocalization of surface plasmon excitation at the hybrid inorganic-organic interface. Thus, provides a thermodynamically driven plasmoelectric effect. We further validated our hypothesis by calculating the HOMO and LUMO levels and work function changes of Au TNPs upon functionalization with para-substituted thiol. This reported unique finding then utilized to design ultrasensitive plasmonic substrate for biosensing of cancer microRNA in bladder cancer and cardiovascular diseases. In the discovery of early bladder cancer diagnosis platform, for the first time, we have been utilized to analyze the tumor suppressor microRNA for a more accurate diagnosis of BC. Additionally, we have been advancing our sensing platform to mitigate the false positive and negative responses of the sensing platform using surface-enhanced fluorescence technique. This noninvasive, highly sensitive, highly specific, also does not have false positives techniques that provide the strong key to detect cancer at a very early stage, hence increase the cancer survival rate. Moreover, the electromagnetic field enhancement of Surface-Enhanced Raman Scattering (SERS) and other related surface-enhanced spectroscopic processes resulted from the LSPR property. This dissertation describes the design and development of entirely new SERS nanosensors using a flexible SERS substrate based on the unique LSPR property of Au TNPs. The developed sensor shows an excellent SERS activity (enhancement factor = ~6.0 x 106) and limit of detection (as low as 56 parts-per-quadrillions) with high selectivity by chemometric analyses among three commonly used explosives (TNT, RDX, and PETN). Further, we achieved the programmable self-assembly of Au TNPs using molecular tailoring to form a 3D supper lattice array based on the substrate effect. Here we achieved the highest reported sensitivity for potent drug analysis, including opioids and synthetic cannabinoids from human plasma obtained from the emergency room. This exquisite sensitivity is mainly due to the two reasons, including molecular resonance of the adsorbate molecules and the plasmonic coupling among the nanoparticles. Altogether we are highly optimistic that our research will not only increase the patient survival rate through early detection of cancer but also help to battle the “war against drugs” that together are expected to enhance the quality of human life.

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No description available.

<p>Kardijalni biomarkeri u predviđanju operativnog rizika kardiohirur&scaron;kih bolesnika sa oslabljenom sistolnom funkcijom leve komore Evaluacija rezultata u kardiohirurgiji podrazumeva praćenje ishoda operativnog lečenja u određenom vremenskom periodu. Najče&scaron;će je to interval od 30 dana od datuma intervencije. Najče&scaron;ći kriterijumi za praćenje su stopa mortaliteta i morbiditeta, dužina boravka u jedinici intenzivnog lečenja, ukupna dužina hospitalizacije i tro&scaron;kovi lečenja. Stratifikacija rizika podrazumeva da se bolesnici mogu podeliti u grupe u zavisnosti od broja i važnosti preoperativno utvrđenih faktora rizika, odnosno da se pre operacije može predvideti ishod hirur&scaron;ke intervencije kod svakog od njih pojedinačno. U Evropi je, u periodu između 1995. i 1999. godine, na osnovu multicentrične studije u 8 evropskih zemalja i 128 kardiohirur&scaron;kih centara u kojima je operisano 19.030 odraslih bolesnika, kreiran EvroSKOR - EuroSCORE (European System for Cardiac Operative Risk Evaluation) model za stratifikaciju rizika u kardiohirurgiji. Međutim, neminovne promene i napredak u operativnom lečenju doveli su do toga da je neophodno ažurirati postojeći sistem stratifikacije. Tako je 2012. godine u rutinsku upotrebu uveden novi sistem Euroscore II. Na Klinici za kardiohirurgiju Instituta za kardiovaskularne bolesti Vojvodine (IKVBV), EuroSCORE model uveden je u rutinsku upotrebu od početka 2001. godine. Analizom rezultata, posle dvogodi&scaron;nje primene, pokazalo se da je model bio precizan, odnosno da nije postojala značajna razlika između očekivanog (3,7%) i stvarnog mortaliteta (3,47%). U poslednjih nekoliko godina, kod bolesnika kojima sledi kardiohirur&scaron;ka intervencija, u smislu razmatranja njihove prediktivne vrednosti, sve vi&scaron;e pažnje se poklanja kardijalnim biomarkerima. Najznačajniji biomarkeri u kardiovaskularnoj medicini su: Troponin, Kreatin kinaza MB izoenzim (CKMB), N-terminalni pro B-tip natriuretski peptid (NT-proBNP), C-reaktivni protein (CRP), Laktat dehidrogenaza (LDH), Mokraćna kiselina (Acidum uricum). Ciljevi ovog rada su bili da se kreira model za predviđanje preoperativnog rizika kardiohirur&scaron;kih bolesnika sa oslabljenom sistolnom funkcijom leve komore na osnovu preoperativnih vrednosti određenih biomarkera i da se kreira novi model sa kombinacijom prethodnog modela i već postojećeg modela EuroSCORE II. Ispitana su 704 bolesnika sa oslabljenom sistolnom funkcijom leve komore, ejekcione frakcije manje ili jednake 50%. Bolesnici su operisani na Institutu za kardiovaskularne bolesti Vojvodine, od 20. januara 2014. do 20. aprila 2016. Kod bolesnika su urađene tri vrste operacija: revaskularizacija miokarda-koronarna hirurgija, hirurgija stečenih srčanih mana - valvularna hirurgija i kombinovane operacije. Od biohemijskih analiza, 24 sata pre operacije, urađene su sledeće analize: troponin I, kreatin kinaza, kreatin kinaza MB izoenzim, masena kreatin kinaza, laktat dehidrogenaza, C-reaktivni protein, NT-proBNP i mokraćna kiselina. Praćen je postoperativni mortalitet, postoperativni infarkt miokarda i postoperativni cerebrovaskularni incident i njihova povezanost sa preoperativnim vrednostima nabrojanih biomarkera. U studiju su bili uključeni svi bolesnici sa stečenim bolestima srca, stariji od 18 godina, kod kojih je ejekciona frakcija leve komore bila manja ili jednaka 50% i kod kojih su izvr&scaron;ene sledeće vrste operacija: revaskularizacija miokarda - koronarna hirurgija, hirurgija stečenih srčanih mana - valvularna hirurgija i kombinovane operacije - koronarna i valvularna hirurgija. Rezultati su pokazali da je postoperativni mortalitet bio 3,13%, da je postoperativni infarkt miokarda imalo 7,95% a postoperativni cerebrovaskularni incident 9,23% od ukupnog broja ispitanika. 1. Povezanost vrednosti biomarkera sa postoperativnim infarktom miokarda kod bolesnika sa oslabljenom ejekcionom frakcijom leve komore: povi&scaron;ene preoperativne vrednosti troponina I su bile povezane sa postoperativnim infarktom miokarda. Povezanost preoperativnih vrednosti biomarkera sa postoperativnim cerebrovaskularnim incidentom kod bolesnika sa oslabljenom ejekcionom frakcijom leve komore: povi&scaron;ene preoperativne vrednosti troponina I i CRP-a su bile povezane sa postoperativnim cerebrovaskularnim incidentom. 2. Analiziran je uticaj preoperativnog nivoa svih biomarkera, pojedinačno, na značajne neželjene kardijalne i cerebrovaskularne događaje - Major Adverse Cardiac and Cerebrovascular Events (MACCE) kao ishod posle operacije na srcu, kod bolesnika sa oslabljenom ejekcionom frakcijom leve komore. Dobijeni su sledeći rezultati: Preoperativna vrednost nivoa troponina I veća od 0,01&mu;g/L i MACCE bili su povezani. Povećane preoperativne vrednosti nivoa C-reaktivnog proteina (CRP) i postoperativni MACCE bili su povezani. Povećane preoperativne vrednosti nivoa laktat dehidrogenaze (LDH) i MACCE bili su povezani. Zaključci ove teze su: 1. Nezavisni prediktor postoperativnog infarkta miokarda i značajnih neželjenih kardijalnih i cerebrovaskularnih događaja, kod kardiohirur&scaron;kih bolesnika sa oslabljenom sistolnom funkcijom leve komore, ejekcionom frakcijom manjom ili jednakom 50%, jeste povi&scaron;ena preoperativna vrednost troponina I. 2.Vrednost preoperativnog troponina I je slab marker za predviđanje postoperativnog infarkta miokarda i značajnih neželjenih kardijalnih i cerebrovaskularnih događaja, kod kardiohirur&scaron;kih bolesnika sa oslabljenom sistolnom funkcijom leve komore, ejekcionom frakcijom manjom ili jednakom 50%. 3. Na pojavu postoperativnog cerebrovaskularnog incidenta, kod kardiohirur&scaron;kih bolesnika sa oslabljenom sistolnom funkcijom leve komore, ejekcionom frakcijom manjom ili jednakom 50%, ne utiče nijedna od ispitivanih varijabli. 4. Nezavisni prediktori postoperativnog mortaliteta kod kardiohirur&scaron;kih bolesnika sa oslabljenom sistolnom funkcijom leve komore, ejekcionom frakcijom manjom ili jednakom 50%, na osnovu kojih je moguće kreirati prediktivni Model su godine starosti i povi&scaron;ene preoperativne vrednosti NT-proBNP. 5. Kreirani Model je dobar marker za predikciju ishoda posle operacije na srcu, kod kardiohirur&scaron;kih bolesnika sa oslabljenom sistolnom funkcijom leve komore, ejekcionom frakcijom manjom ili jednakom 50%. 6. Povi&scaron;ena preoperativna vrednost NT- proBNP može da bude dobar marker u predikciji smrtnog ishoda posle operacije na srcu kod bolesnika sa oslabljenom sistolnom funkcijom leve komore, ejekcionom frakcijom manjom ili jednakom 50%. 7. Model EuroSCORE II se pokazao kao slabiji marker za predikciju ishoda posle operacije na srcu kod kardiohirur&scaron;kih bolesnika sa oslabljenom sistolnom funkcijom leve komore, ejekcionom frakcijom manjom ili jednakom 50%. 8. Testiranjem kreiranog modela, podelom na manje rizične i vi&scaron;e rizične bolesnike, u odnosu na visinu ejekcione frakcije leve komore, pokazalo se da je model dobar marker za predviđanje smrtnog ishoda posle operacije na srcu, u obe grupe.</p> / <p>Cardiac surgery operative risk assessment in patients with imapired systolic left ventricular function using cardial biomarkers Evaluation of results in cardiac surgery involves monitoring the outcomes of operative treatment in a given time period. Typically, this interval includes 30 days from the date of operation. The most common criteria used for monitoring are the rate of mortality and morbidity, length of stay in the intensive care unit, the total length of hospitalization and medical costs. Risk stratification means that patients can be divided into groups depending on the number and importance of preoperatively identified risk factors, and that the outcome of surgery for each of the patients can be predicted preoperatively. In Europe, in the period of 1995-1999 on the basis of a multi-center study in 8 European countries and 128 cardiac centers in which 19,030 adult patients were operated on, EuroSCORE (European System for Cardiac Operative Risk Evaluation) model for risk stratification in cardiac surgery was developed. However, the inevitable changes and progress in the surgical treatment rendered the EuroSCORE model obsolete warranting updated system. It was in 2012 when a new system EuroSCORE II was introduced into practice At the Clinic for Cardiac Surgery of the Institute of Cardiovascular Diseases, EuroSCORE model was introduced in routine clinical use since the beginning of 2001. By analyzing the results, two years after application, it was shown that the model was accurate, and that there was no significant difference between the expected (3.7%) and the actual mortality (3.47%) In recent years, in patients who are candidates for cardiac surgery, more attention is paid to cardiac biomarkers in terms of evaluating their predictive power. The most significant biomarkers in cardiovascular medicine are: Troponin, creatine kinase MB isoenzyme (CKMB), N-terminal pro B-type natriuretic peptide (NT-proBNP), C-reactive protein (CRP), Lactate dehydrogenase (LDH), and uric acid (Uric uricum). The objectives of this study were to create a model to predict preoperative risk for cardiac surgery patients with impaired systolic left ventricular function on the basis of preoperative levels of certain biomarkers and to create a new model with a combination of the previous model and already existing EuroSCORE II model. The study included 704 patients with impaired systolic left ventricular function, ejection fraction less than or equal to 50%. All patients underwent cardiac surgery at the Institute of Cardiovascular Diseases, from January 20th 2014 until 20th April 2016. Patients were submitted to three types of operations: revascularization - coronary surgery, surgery of acquired heart defects - valvular surgery and combined operations. Following biochemical analyses were performed 24 hours prior to surgery: troponin I, creatine kinase, creatine kinase MB isoenzyme, mass creatine kinase, lactate dehydrogenase, C-reactive protein, NT-proBNP and uric acid. Postoperative mortality, postoperative onset of myocardial infarction and occurence of cerebrovascular accident and their correlation with preoperative values of listed biomarkers were registered. The study included all patients with acquired heart disease, older than 18 years, with the left ventricular ejection fraction less than or equal to 50% who were submitted to the following types of operations: revascularization - coronary surgery, surgery of acquired heart diseases - valvular surgery and combined operations - coronary and valvular surgery. The results showed that the postoperative mortality was 3.13%, new onset of postoperative myocardial infarction was detected in 7.95% of the patients and postoperative cerebrovascular accident developed in 9.23% of patients. Correlation of preoperative biomarkers values with postoperative myocardial infarction in patients with impaired left ventricular ejection fraction - elevated preoperative troponin I were associated with postoperative myocardial infarction. Correlation of preoperative biomarkers values with postoperative cerebrovascular incident occurence in patients with impaired left ventricular ejection fraction - elevated preoperative troponin I and CRP were associated with postoperative cerebrovascular incident. The influence of preoperative levels of all biomarkers, separetly, on the rate of significant adverse cardiac and cerebrovascular events - Major Adverse Cardiac and Cerebrovascular Events (MACCE) as the heart surgery outcome, in patients with impaired left ventricular ejection fraction. The following results were obtained: Increased preoperative levels of C-reactive protein (CRP) and postoperative MACCE were related. Increased preoperative levels of lactate dehydrogenase (LDH) and MACCE were related. The conclusions of this thesis are: 1. Independent predictor of postoperative myocardial infarction onset and significant adverse cardiac and cerebrovascular events in cardiac surgery patients with impaired systolic left ventricular function (ejection fraction less than or equal to 50%) is elevated preoperative value of troponin I. 2. Preoperative Troponin I value was poor marker for predicting postoperative myocardial infarction and significant adverse cardiac and cerebrovascular events in cardiac surgery patients with impaired systolic left ventricular function (ejection fraction less than or equal to 50%). 3. None of the studied variables showed influence on the postoperative cerebrovascular accident occurence, in cardiac surgery patients with impaired systolic left ventricular function (ejection fraction less than or equal to 50%). 4. Independent predictors of postoperative mortality in cardiac surgery patients with impaired systolic left ventricular function (ejection fraction less than or equal to 50%), that could be used to create a predictive model are: age and elevated preoperative value of NT-proBNP. 5. Developed model showed satisfactory results for predicting outcome after heart surgery in cardiac surgery patients with impaired systolic left ventricular function (ejection fraction less than or equal to 50%). 6. Elevated preoperative value of NT-proBNP may be a good marker for mortality prediction after the cardiac surgery in patients with impaired systolic left ventricular function (ejection fraction less than or equal to 50%). 7. EuroSCORE II model showed poor performance when predicting outcomes after cardiac surgery in patients with impaired systolic left ventricular function (ejection fraction less than or equal to 50%). 8. Validation of the newly-created model, considering low and medium risk patients, based on the value of left ventricular ejection fraction, showed that the model is a good marker for the mortality prediction in both groups.</p>

[ES] El cuidado de la salud es un campo en el que la detección precoz de enfermedades está cobrando cada vez más importancia. Hoy en día, profesionales y ciudadanos demandan que las técnicas de diagnóstico sean de alta calidad, tanto para el sistema de sanidad privado como para el público. Cuando se utilizan técnicas de diagnóstico de manera inadecuada, eso puede acarrear bastantes consecuencias, tales como un serio peligro sobre la salud y la sobrecarga técnica y económica de los servicios de salud. Eso es debido a que las técnicas de diagnóstico disponibles hoy en día son demasiado costosas, centralizadas en laboratorios y necesitan profesionales altamente cualificados para poder llevar a cabo dichas tareas, lo que conllevaría una demora en el tiempo, siendo este muchas veces vital para los enfermos. Es muy necesario, por lo tanto, reflexionar sobre la necesidad y emergencia de tales prácticas preventivas, especialmente para enfermedades de alto riesgo como el cáncer, el Alzheimer o la primera causa de muerte en el mundo, las enfermedades cardiovasculares. En este contexto, el objetivo principal del trabajo realizado durante esta Tesis Doctoral es ayudar a superar estos problemas mediante la exploración de la posibilidad de utilizar tecnología fotónica para el desarrollo de sistemas de análisis que puedan ser utilizados para el diagnóstico y pronóstico de las enfermedades cardiovasculares. Este objetivo se ha abordado mediante la combinación de la tecnología nanofotónica, consistiendo en la nanofabricación de las estructuras PBG de sensado que ofrece varios beneficios, como una alta sensibilidad, una extrema reducción de tamaño y un proceso de fabricación compatible con el de la industria microelectrónica, con un método de biofuncionalización obteniendo una capa de bioreconocimiento estable y selectiva mediante el uso de la reacción TEC asistida por luz capaz de proporcionar unas capas de bio-reconocimiento extremadamente finas con una inmovilización espacialmente selectiva. / [CA] L'atenció a la salut és un camp en què la detecció precoç de malalties està cobrant cada vegada més importància. Hui en dia, professionals i ciutadans demanen que les tècniques de diagnòstic siguin d'alta qualitat, tant per al sistema de sanitat privat com per al públic. Quan s'utilitzen tècniques de diagnòstic de manera inadequada, això pot comportar bastants conseqüències, com ara, un seriós perill sobre la salut i la sobrecàrrega tècnica i econòmica dels serveis de salut. Això és degut al fet que les tècniques de diagnòstic disponibles hui en dia són molt costoses, centralitzades en laboratoris i necessiten professionals altament qualificats per poder realitzar aquestes tasques, lo que comportaria a una demora en el temps que moltes vegades es vital pels malalts. És molt necessari, per tant, reflexionar sobre la necessitat i emergència de tals practiques preventives, especialment per a malalties d'alt risc com el càncer, l'Alzheimer o la primera causa de mort al món, les malalties cardiovasculars. En aquest context, l'objectiu principal del treball realitzat durant aquesta Tesi Doctoral és ajudar a superar aquests problemes mitjançant l'exploració de la possibilitat d'utilitzar tecnologia fotònica per al desenvolupament de sistemes d'anàlisis que puguin ser utilitzats per al diagnòstic i pronòstic de les malalties cardiovasculars. Aquest objectiu s'ha abordat mitjançant la combinació de la tecnologia nanofotònica, consistint en la nanofabricació de les estructures de detecció de PBG fotòniques que ofereix diversos beneficis, com una alta sensibilitat, una extrema reducció de mida i un procés de fabricació compatible amb el de la indústria microelectrònica, amb un mètode de biofuncionalització obtenint una capa de bio-reconeixement estable i selectiva mitjançant l'ús de la reacció TEC assistida per llum capaç de proporcionar unes capes de bioreconeixement extremadament fines amb una immobilització espacialment selectiva. preventives, especialment per a malalties d'alt risc com el càncer, l'Alzheimer o la primera causa de mort al món, les malalties cardiovasculars. En aquest context, l'objectiu principal del treball realitzat durant aquesta Tesi Doctoral és ajudar a superar aquests problemes mitjançant l'exploració de la possibilitat d'utilitzar tecnologia fotònica per al desenvolupament de sistemes d'anàlisis que puguin ser utilitzats per al diagnòstic i pronòstic de les malalties cardiovasculars. Aquest objectiu s'ha abordat mitjançant la combinació de la tecnologia nanofotònica, consistint en la nanofabricació de les estructures de detecció de PBG fotòniques que ofereix diversos beneficis, com una alta sensibilitat, una extrema reducció de mida i un procés de fabricació compatible amb el de la indústria microelectrònica, amb un mètode de biofuncionalització obtenint una capa de bio-reconeixement estable i selectiva mitjançant l'ús de la reacció TEC assistida per llum capaç de proporcionar unes capes de bioreconeixement extremadament fines amb una immobilització espacialment selectiva. / [EN] Healthcare is a field where the early detection of diseases is becoming more and more important. Nowadays, professionals and citizens demand high quality diagnosis techniques offered by both private and public health systems. When the application of diagnostic tests is not adequate, different consequences can be observed such as health hazard and technical and economic overload of health services. This is due to the fact that the diagnostic techniques available are expensive, centralized in laboratories and with the need for highly qualified professionals to carry out these tasks, what can fundamentally lead to delays in time, being critical for the patient's health. It is very necessary, therefore, to reflect on the need and emergency of such preventive practices, especially for high-risk diseases such as cancer, Alzheimer or the first cause of death in the world, the cardiovascular diseases. Within this context, the main objective of the work done during this PhD Thesis is to help on overcoming these problems by exploring the possibility of using photonic technology for the development of analysis devices which might be used for the early diagnosis and prognosis of cardiovascular diseases. This objective has been addressed by combining nanophotonic technology, by the nanofabrication of the photonic PBG sensing structures, which provides several benefits such as a high sensitivity, an extreme size reduction and a fabrication process being compatible with that from the microelectronics industry, with a light-assisted biofunctionalization method forming a stable and selective biorecognition layer using TEC reaction able to provide extremely thin biorecognition layers with a spatially-selective immobilization. / Sabek, J. (2019). Combination of nanophotonic biosensors and light-assisted immobilization procedures for the detection of cardiac biomarkers [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/124821

Le syndrome vache à terre (SVT) est rencontré chez la vache laitière et est une condition d’urgence à évolution rapide où le pronostic est réservé à sombre. Les seuls tests complémentaires disponibles actuellement nécessitent l’utilisation des services d’un laboratoire commercial. La présence d’hypoperfusion locale et systémique ainsi que de lésions cardiaques à la nécropsie rend potentiellement intéressant le dosage de la lactatémie (LAC) et de la troponinémie (cTnI) sanguine. Ces deux biomarqueurs pouvant être analysés à l’aide d’appareils portatifs. L’objectif de la présente étude était d’évaluer la valeur pronostique de la LAC et de la cTnI dosées à la ferme, directement au chevet de la vache laitière atteinte de SVT. Le pourcentage d’issue négative (mort ou euthanasie) à sept jours suivant l’inclusion (d7) était de 63.1 %. La lactatémie n’était pas associée au pronostic vital de l’animal lors de SVT. Par contre, une valeur sanguine de cTnI >0.7 ng/mL était associée à une issue négative à d7 (sensibilité, spécificité, valeurs prédictives positive et négative respectivement de 54.1 %, 78.4 %, 82.0 % et 48.3 %). L’utilisation d’un modèle de régression logistique multivariable a montré que cette hypertroponinémie était associée à un risque d’issue négative à d7 5.5 fois (IC95%: 2.1-14.6) plus grand que le groupe présentant une cTnI ≤ 0.07 ng/mL. De plus, les animaux ayant une FC >100 BPM étaient 3.7 fois plus à risque (IC95%: 1.5-10.2) de subir une issue négative à d7 que ceux présentant une FC≤100 BPM. / Downer cow syndrome (DCS) is observed in dairy cattle and is an emergency condition that progresses rapidly and whose prognosis is reserved to poor. The only available complementary tests require the services of a commercial laboratory. The presence of local and/or systemic hypoperfusion, along with the presence of cardiac lesions at necropsy renders the dosage of lactatemia (LAC) and cardiac troponin I (cTnI) in the blood potentially interesting. These two biomarkers being measurable through the analysis of portable equipment, the present study objective was to evaluate the prognostic value of measuring LAC and cTnl directly at the side of the dairy cow affected by DCS. The percentage of negative outcome (death or euthanasia; NO) seven days following the study inclusion (d7) was 63.1%. LAC was not associated with the prognosis of the animal suffering from DCS. However, a blood cTnl value of ˃0.7ng/mL was associated with a NO before d7 (sensitivity, positive and negative predictive values of 54.1, 78.4, 82.0, and 48.3%, respectively). The use of a logistic multivariable model demonstrated that hypertroponinemia was associated with a NO risk 5.5 greater (95%CI: 2.1-14.6) by d7 than animals presented with a blood cTnl value of ≤ 0,07ng/mL. The animals presenting a HR > 100BPM were 3.7 times more at risk (95%CI: 1.5-10.2) of exiting the herd by d7 than the animals with a HR of ≤ 100BPM.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Introdução: A liberação de biomarcadores de necrose miocárdica após revascularização miocárdica cirúrgica (RM) ocorre com frequência. No entanto, a correlação entre a liberação de biomarcadores e o diagnóstico do infarto agudo do miocárdio (IAM) periprocedimento gera controvérsias, especialmente com o aumento da sensibilidade nos ensaios de troponina (Tn). Neste estudo, objetivou-se quantificar a liberação dos biomarcadores cardíacos em pacientes submetidos à RM, sem o uso de circulação extra corpórea (CEC), que não apresentaram evidências de infarto do miocárdio por meio da avaliação do realce tardio pelo gadolínio (RTG) na ressonância magnética cardíaca (RMC). Métodos: Pacientes portadores de doença arterial coronária estável e função ventricular preservada, com indicação eletiva para RM sem CEC, foram incluídos. RMC com RTG foi realizada em todos os pacientes antes e depois do procedimento. Aferições seriadas de Tn e creatinoquinase fração MB (CK-MB) foram realizadas antes do procedimento e até 72h após. Pacientes com RTG na RMC após o procedimento foram excluídos. Resultados: 73 pacientes foram referenciados para a realização eletiva da RM sem CEC e 20 (27%) foram excluídos, 14 (19%) por causa do surgimento de um novo RTG na RMC. Dentre os 53 pacientes sem evidência de IAM periprocedimento pela RMC, 37 (70%) eram do gênero masculino, a média da idade foi 63 (± 10) anos e o escore SYNTAX médio encontrado foi 20 (±7). Após a RM, todos os pacientes apresentaram um pico de elevação de Tn acima do percentil 99; em 48 (91%) pacientes a elevação foi superior a 10 vezes esse limite. Por outro lado, 41 (76%) pacientes apresentaram pico de CK-MB acima do percentil 99 e em apenas 7 (13%) este pico foi superior à10 vezes o percentil 99. A mediana do pico de liberação da Tn foi 2,0 (0,8 - 3,7) ng/mL, valor 50 vezes superior ao percentil 99. Conclusão: Diferente da CK-MB, a liberação da troponina I ocorre, frequentemente, após procedimento de RM sem CEC na ausência de realce tardio pela RMC / Background: The release of myocardial necrosis biomarkers after off-pump coronary artery bypass grafting (OPCAB) frequently occurs. However, the correlation between biomarker release and the diagnosis of procedurerelated myocardial infarction (MI) (type 5) has been controversial. This study aims to evaluate the amount and pattern of cardiac biomarker release after elective OPCAB in patients without the image of a new MI assessed by cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE). Methods: Patients with normal baseline cardiac biomarkers referred for elective OPCAB were prospectively included. CMR with LGE was performed in all patients before and after interventions. Measurements of troponin I (cTnI) and creatinekinase MB fraction (CK-MB) were systematically performed before and after the procedure. Patients with a new LGE on the post-procedure CMR were excluded. Results: Of the 53 patients without the evidence of a procedure-related MI assessed by the CMR after OPCAB, all patients exhibited cTnI elevation peak above the 99th percentile. In 48 (91%), the peak value was greater than 10 times this threshold. However, 41 (76%) had CK-MB peak above the limit of the 99th percentile, and this peak was greater than 10 times the 99th percentile in only 7 patients (13%). The median peak release of cTnI was 0.20 (0.8 - 3.7) ng/mL, which is 50-fold higher than the 99th percentile. Conclusions: In contrast to CK-MB, cTnI release often occurs after an elective OPCAB procedure, despite the absence of a new LGE on CMR

Introdução: A liberação de biomarcadores de necrose miocárdica após a intervenção coronária percutânea (ICP) ocorre frequentemente. No entanto, a correlação entre a liberação dos biomarcadores e o diagnóstico do infarto agudo do miocárdio (IAM) tipo 4a tem gerado controvérsia, especialmente com o aumento da sensibilidade nos ensaios de troponina (Tn). Neste estudo, objetivamos quantificar a liberação dos biomarcadores cardíacos em pacientes submetidos à ICP eletiva sem o surgimento de novo realce tardio pelo gadolínio (RTG) na ressonância magnética cardíaca (RMC) após o procedimento. Métodos: Foram incluídos pacientes consecutivos com doença arterial coronária estável e função ventricular preservada, com indicação eletiva para ICP em pelo menos duas artérias epicárdicas. RMC com RTG foi realizada em todos os pacientes antes e depois das intervenções. Medidas seriadas de Tn e creatinoquinase fração MB (CK-MB) foram realizadas imediatamente antes do procedimento até 48 horas após. Pacientes com novo RTG na RMC após o procedimento foram excluídos. Resultados: 71 pacientes foram referenciados para a realização eletiva da ICP sendo que 15 (21,1%) foram excluídos, 10 (14,1%) por causa do surgimento de um novo RTG na RMC após a ICP. Nos 56 pacientes sem a evidência de IAM tipo 4a pela RMC predominava o gênero masculino 37 (66,1%) com idade média de 61,7 (± 8,4) anos e escore de SYNTAX médio de 16,6 (± 7,7). Após a ICP, 48 (85,1%) pacientes apresentaram um pico de elevação de Tn acima do percentil 99 sendo que em 32 (57,1%) a elevação foi superior a 5 vezes esse limite, enquanto que apenas 2 (3,6%) apresentaram um pico de CK-MB maior do que 5 vezes o percentil 99. A mediana do pico de liberação da Tn foi de 0,290 (0,061 - 1,09) ng/mL, valor 7,25 vezes superior ao percentil 99. Conclusão: Diferentemente da CK-MB, a liberação da troponina I ocorre com frequência após procedimento de ICP mesmo na ausência de realce tardio pelo gadolínio na ressonância magnética cardíaca / Background: The release of myocardial necrosis biomarkers after percutaneous coronary intervention (PCI) frequently occurs. However, the correlation between biomarker release and the diagnosis of procedurerelated myocardial infarction (MI) (type 4a) has been controversial. This study aims to evaluate the amount and pattern of cardiac biomarker release after elective PCI in patients without the image of a new MI after the procedure assessed by cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE). Methods: Patients with normal baseline cardiac biomarkers referred for elective PCI were prospectively included. CMR with LGE was performed in all of the patients before and after the interventions. Measurements of troponin I (TnI) and creatinekinase MB fraction (CK-MB) were systematically performed before and after the procedure. Patients with a new LGE on the post-procedure CMR were excluded. Results: Of the 56 patients without the evidence of a procedure-related MI assessed by the CMR after PCI, 48 (85.1%) exhibited a TnI elevation peak above the 99th percentile. In 32 (57.1%), the peak was greater than 5 times this limit. On the other hand, 17 (30.4%) had a CK-MB peak above the limit of the 99th percentile, and this peak was greater than 5 times the 99th percentile in only 2 patients (3.6%). The median peak release of TnI was 0.290 (0.061 to 1.09) ng/ml, which is 7.25-fold higher than the 99th percentile. Conclusions: In contrast to CK-MB, TnI release often occurs after an elective PCI procedure, despite the absence of a new LGE on CMR