Background: Although laparoscopic appendectomy (LA) is considered to be minimally invasive compared with open appendectomy (OA), there are few studies showing this in terms of cytokines and oxidative stress markers.

Aim: LA and OA techniques have been compared in terms of different conditions such as operation time and complication rate. Here, we compared how oxidative DNA damage and some cytokines levels change in relation to LA and OA.

Method: This study was performed in children diagnosed with acute appendicitis in our hospital. The study was conducted on 30 children with acute appendicitis in each group. Oxidative DNA damage and malondialdehyde levels were determined by high-performance liquid chromatography, and interleukin-1β, interleukin-37, ischaemia-modified albumin and total thiol levels were determined by enzyme-linked immunosorbent assays.

Results: There was a dramatic decrease in ischaemia-modified albumin (IMA) levels after LA. However, there were no statistically significant differences in pre- and postoperative IMA levels in the OA group. Oxidative DNA damage and malondialdehyde levels were low significantly according to preoperative levels after the LA and OA. Total thiol levels were high in children who underwent LA while they were low after OA. In addition, postoperative interleukin-1β levels were low in both groups. Furthermore, IL-37 levels postoperatively were low in the LA group, while there was no significant change in the OA group.

Conclusion: LA had a more positive effect on oxidative DNA damage, IL-1β and IL-37 than the OA. In addition, surgical stress was reduced with LA.

Keywords: Appendectomy; Cytokines; Laparoscopy; Open surgery; Oxidative stress.

BACKGROUND

The detection of biomarkers such as ischemia-modified albumin (IMA) and heart fatty acid-binding protein (HFABP) is used in the early diagnosis of acute myocardial infarction. As these biomarkers are not organ specific, we tested them in the neurovascular field.

METHODS

A total of 41 patients with acute stroke were enrolled (31 ischemic strokes and 10 intracerebral hemorrhages). IMA and HFABP levels were measured in serum samples collected within 4.5 hours of stroke onset. Clinical, imaging, and outcome data were recorded.

RESULTS

No difference in baseline IMA or HFABP was found between patients with ischemic and hemorrhagic stroke. There was no correlation among biomarker levels at admission, National Institutes of Health Stroke Scale score, or stroke volume. Neither of the biomarkers could predict short-term prognosis.

CONCLUSIONS

IMA and HFABP do not appear to be relevant in acute stroke management.

OBJECTIVE

To assess the value of combined detection of copeptin and ischemia modified albumin (IMA) in early diagnosis and prognostic evaluation of myocardial damage in patients with acute organic phosphorus pesticide poisoning (AOPP).

METHODS

A total of 126 AOPP patients were examined for blood copepin and IMA levels and myocardial injury markers within 1 h after admission.

RESULTS

Copeptin and IMA levels significantly increased in patients with AOPP compared with those in the control subjects. Copeptin and IMA levels were significantly higher in severe AOPP cases than in mild to moderate cases (P<0.05). Logistic regression analysis showed that increased copeptin and IMA levels and severe complications of AOPP were associated with an increased risk of cardiovascular events.

CONCLUSIONS

Early detection of copeptin and IMA levels has important clinical value in early diagnosis and prognostic evaluation of myocardial damage in patients with AOPP, and their levels are positively correlated with the severity of the condition.

OBJECTIVE

To investigate serum ischemia-modified albumin (IMA), oxidized low-density lipoprotein (ox-LDL) levels, and paraoxonase 1 (PON1) activity in patients with diabetic foot.

METHODS

Thirty patients with diabetes mellitus (DM), 30 patients with diabetic foot (29 and 27 of these patients had type 2 DM, respectively), and 30 healthy volunteers as the control group were included in the study. The patients with diabetic foot were divided into 2 groups, as those who had or had not undergone lower extremity amputation. Serum PON1 activity, ox-LDL, and IMA levels were measured.

RESULTS

Serum PON1 activity was lower (P < 0.05) and ox-LDL levels were higher (P < 0.05) in the diabetic foot group than in the control and diabetes groups. Albumin-adjusted IMA values were higher (P < 0.001) in the diabetic foot group compared to the diabetes group. The postamputation levels of IMA were decreased compared to the preamputation condition (P < 0.05).

CONCLUSIONS

The low activity of PON1 and the high levels of ox-LDL and IMA may play an important role in the pathogenesis of diabetic foot. The use of these parameters in the follow-up of patients with DM may prevent the development of diabetic foot. In order to reach a definitive judgment, further studies with a larger number of subjects are necessary.

OBJECTIVE

Critical illnesses are assessed according to the sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation (APACHE) II. Circulating ischemia-modified albumin (IMA) is a biomarker generated under ischemic and oxidative conditions and may reflect disease severity in preoperative patients. This study investigated the correlations of IMA with SOFA and APACHE II scores in inpatients admitted for colorectal surgery.

METHODS

We examined 27 patients with advanced colorectal cancers (mean age 69 years, men/women=15/12). Correlations between SOFA and APACHE II scores in addition to preoperative serum IMA and C-reactive protein (CRP) levels were analyzed.

RESULTS

The mean IMA level was 0.5 AU, and the median CRP level was 0.6 mg/dL. Median scores for SOFA and APACHE II were 2 and 12 points, respectively. Significant positive correlations between IMA and SOFA (r=0.45, P<0.05) and IMA and APACHE II (r=0.45, P<0.05) were identified which remained significant in confounder-adjusted analyses. In contrast, weak correlations were observed between CRP and the SOFA and APACHE II scores.

CONCLUSIONS

The positive correlations between IMA and both SOFA and APACHE II scores suggest that serum IMA measurements reflect the severity of systemic failure in patients admitted for colorectal surgery in the preoperative phase.

OBJECTIVE

Ischemia modified albumin (IMA) levels significantly increased and may be used as a diagnostic marker in ovarian torsion. The aim of this study is to investigate whether there was any correlation between IMA levels and histopathologic changes in experimental ovarian torsion.

METHODS

Fourteen Sprague-Dawley rats, each weighing 220-250 g were divided randomly into 2 groups; in Group 1, the control group (n = 7), only laparotomy was performed and in Group 2, the experimental group (n = 7), ovarian torsion was performed. Ischemia was performed for 3 h; following the ischemia period, the torsion was relieved by detwisting the adnexa and then the ovarian I/R protocol was applied for 3 h. Blood samples were taken from all of the rats to measure the IMA levels and the ovaries were surgically removed for histologic examination. A blinded pathologist examined and scored the samples.

RESULTS

The median (minimum-maximum) IMA values were 921.00 (870.00-966.00) ABSUs in the ovarian torsion group and 853.00 (782.00-869.00) ABSUs in the control group. The difference was statistically significant. In the correlation analysis, a significant and strong correlation was found between IMA levels and histopathologic changes (Spearman's rho = +0.987, p < 0.001).

CONCLUSIONS

Positive correlation was found between the IMA levels and the histopathologic severity of the disease. This finding is important for both diagnosis of the disease and patient follow-up. As a new marker in ovarian torsion, IMA may also indicate the severity of the ovarian histopathology.

BACKGROUND

Ischaemia-modified albumin (IMA) is a relatively new marker of ischaemia. IMA has not been studied previously in pleural effusions due to congestive heart failure (CHF). The aim of our study was to assess the diagnostic value of IMA in the pleural fluid (PF) and serum for the identification of pleural effusion due to CHF.

METHODS

The concentrations of pleural fluid and serum IMA were measured in a total of 40 patients: 10 with CHF and 30 with non-cardiac failure (10 with acute pulmonary embolism, 10 with parapneumonic effusion and 10 with malignancy). The area under the curve (AUC) quantified the overall diagnostic accuracy of the tests.

RESULTS

The study demonstrated that IMA concentration was higher in both pleural fluid and serum of CHF patients compared with non-cardiac patients. PF and serum IMA demonstrated AUCs of 0.927 (95% CI: 0.844-1.00, P < 0.001), and 0.792 (95% CI: 0.653-0.930, P = 0.006), respectively, for diagnosing effusions due to CHF. The sensitivity and specificity of PF-IMA for CHF at the cut-off concentration of ≥1.0 absorbance units was 90% and 80%, respectively. Its negative predictive value (NPV) was quite high (96%). Positive correlation was found between PF-IMA concentrations and serum-IMA (r = 0.540, P < 0.001).

CONCLUSIONS

Measuring IMA concentrations in serum and pleural fluid may be helpful in distinguishing pleural effusion due to a cardiac or non-cardiac aetiology.

BACKGROUND

Approximately 40-60% of patients with acute coronary syndrome (ACS) have normal cardiac troponin I (cTnI) concentrations on admission. Ischaemia modified albumin (IMA) has been suggested as a new biomarker of myocardial ischaemia.

METHODS

A total of 43 patients presenting with symptoms suggestive of ACS but with normal (< 0.1 μg/L) cTnI concentrations and 45 healthy subjects were studied. The patients from the study group were divided into two groups: STEMI (n = 28) and NSTEMI (n = 15). All these patients were undergoing percutaneous coronary intervention (PCI) with stenting. The concentrations of cTnI, myoglobin and IMA were determined on admission and 4 h after PCI.

RESULTS

Mean (SD) IMA concentrations were higher in patients with ACS (114.39 ± 25.18 U/ml) as compared to the control group (96.24 ± 6.28 U/ml, p < 0.005). IMA concentrations ≥ 104.0 U/ml demonstrated 72.1% sensitivity and 75.6% specificity for the diagnosis of ACS. The area under the receiver operator characteristic curve was 0.766 (95% CI 0.664-0.868) for ACS patients (NSTEMI + STEMI). In both groups increased median (IQR) cTnI concentration after PCI was observed (STEMI patients to 65.4 (10.9-106.9) μg/L and NSTEMI to 17.6 (0.77-84.0) μg/L). In contrast, no increase in IMA concentration was observed.

CONCLUSIONS

IMA may be a useful biomarker for the identification of ACS patients presenting with typical acute chest pain and/or abnormal electrocardiograms but negative cTnI.

Background: In this study, we assessed thiol/disulfide homeostasis (TDH) parameters and ischemia-modified albumin (IMA) levels in children with irritable bowel syndrome (IBS) compared with healthy children.

Methods: Fifty-six children with IBS and fifty-three healthy children were included in the study after assessment of inclusion and exclusion criteria. Plasma thiol/disulfide and IMA levels were compared between children with and without IBS.

Results: The mean values of native thiol, total thiol, and disulfide were 343.779 ± 138.654 μmol/L, 365.398 ± 140.148 μmol/L, and 23.190 ± 4.978 μmol/L, respectively, in the IBS group and 409.908 ± 69.288 μmol/L, 433.481 ± 76.891 μmol/L, and 20.090 ± 4.252 μmol/L, respectively, in the control group. Native thiol and total thiol values were significantly reduced in the IBS group compared with the control group. The mean IMA values were 0.835 ± 0.083 (g/L) and 0.778 ± 0.072 in the IBS and control groups, respectively. The IMA value was significantly increased in the IBS group (p=0.002).

Conclusion: Impaired thiol/disulfide homeostasis and increased IMA levels can be considered etiological factors in children with IBS.

Keywords: irritable bowel syndrome; oxidative stress; thiol.

Aim: The aim is to compare the markers of oxidative stress in iron deficient children to that of non-anemic children. Method: Serum thiol-disulfide level, ferroxidase activity and ischemia-modified albumin (IMA) levels were compared between iron deficiency anemia (IDA) and non-anemic children. Results: A total of 117 children, 66 with IDA and 51 non-anemic children were included in the study. Disulfide, disulfide/native thiol, and disulfide/total thiol levels were significantly higher in the IDA group (p: 0.001). Serum ferroxidase levels were significantly lower in the IDA group (p: 0.04); but there was no significant difference between the two groups regarding serum IMA levels (p: 0.42). There was a weak negative correlation between disulfide and serum hemoglobin (p: 0.004), iron (p: 0.041), and ferritin (p: 0.023) levels while there was a weak positive correlation between ferroxidase activity and these parameters. Conclusion: There is an increased protein oxidation in children with IDA compared with non-anemic controls.

Hemodynamically significant ductus arteriosus (hsPDA) may alter organ perfusion by interfering blood flow to the tissues. Therefore, in infants with hsPDA, hypoxia occurs in many tissues. In this study, we aimed to investigate the diagnostic significance of serum (ischemia-modified albumin) IMA levels as a screening tool for hsPDA, and its relation to the severity of the disease in the preterm neonates. For this purpose, seventy-two premature infants with gestation age <34 weeks were included in the study. Thirty premature infants with hsPDA were assigned as the study group and 42 premature infants without PDA were determined as the control group. Blood samples were collected before the treatment and 24 h after the treatment, and analyzed for IMA levels. IMA levels in the study group (1.26 ± 0.36 ABSU) were found to be significantly higher than control group (0.65 ± 0.12 ABSU) (p < 0.05). In infants with hsPDA, a positive correlation was found between IMA and PDA diameter (ρ = 0.876, p = 0.022), and LA/Ao ratio (ρ = 0.863, p = 0.014). The cut-off value of IMA for hsPDA was measured as 0.78 ABSU with 88.89 % sensitivity, and 90.24 % specificity, 85.71 % positive predictive, 92.5 % negative predictive value [area under the curve (AUC) = 0.96; p < 0.001]. The mean IMA value of the infants with hsPDA before treatment was 1.26 ± 0.36 ABSU, and the mean IMA value of infants after medical treatment was 0.67 ± 0.27 ABSU (p = 0.03). We concluded that IMA can be used as a marker for the diagnosis and monitoring of a successful treatment of hsPDA.

BACKGROUND

The unique positioning of the patient at steep Trendelenburg with prolonged and increased intra-abdominal pressure (IAP) during robotic radical prostatectomy may increase the risk of splanchnic ischemia. We aimed to investigate the acute effects of IAP and steep Trendelenburg position on the level of ischemia modified albumin (IMA) and to test if serum IMA levels might be used as a surrogate marker for possible covert ischemia during robotic radical prostatectomies.

METHODS

Fifty ASA I-II patients scheduled for elective robotic radical prostatectomy were included in this investigation.

METHODS

The patients were excluded from the study when an arterial cannulation could not be accomplished, if the case had to be converted to open surgery or if the calculated intraoperative bleeding exceeded 300ml. All the patients were placed in steep (45 degrees) Trendelenburg position following trocar placement. Throughout the operation the IAP was maintained between 11-14mmHg. Mean arterial blood pressure (MAP), cardiac output (CO) were continuously monitored before the induction and throughout the surgery. Blood gases, electrolytes, urea, creatinine, alanine transferase (ALT), aspartate transferase (AST) were recorded. Additionally, IMA levels were measured before, during and after surgery.

RESULTS

(1) MAP, CO, lactate and hemoglobin (Hb) did not significantly change in any period of surgery (p>0.05); (2) sodium (p<0.01), potassium (p<0.05) and urea (p<0.05) levels decreased at postoperative period, and no significant changes at creatinine, AST, ALT levels were observed in these patients; (3) At the end of surgery (180 min) pCO2, pO2, HCO3 and BE did not change compared to after induction values (p>0.05) but mild acidosis was present in these patients (p<0.01 vs. after induction); (4) IMA levels were found to be comparable before induction (0.34±0.04), after induction (0.31±0.06) and at the end of surgery (0.29±0.05) as well.

CONCLUSIONS

We did not demonstrate any significant mesenteric-splanchnic ischemia which could be detected by serum IMA levels during robotic radical prostatectomies performed under steep Trendelenburg position and when IAP is maintained in between 11-14 mmHg.

BACKGROUND

Ischaemia-modified albumin (IMA) has recently been shown to be an early and sensitive marker of ischaemia. It is generally accepted that cardiac arrest causes the most severe form of global ischaemia. The aim of the present study was to identify whether IMA is an independent predictor of return of spontaneous circulation (ROSC) in a swine model of cardiac arrest.

METHODS

Ventricular fibrillation (VF) was induced in 30 piglets, which were left untreated for 8 min before attempting resuscitation with precordial compression, mechanical ventilation and electrical defibrillation. Electrical defibrillation was attempted after 10 min of VF. Blood samples for IMA determination were drawn at baseline, after 8 min of VF and before delivery of each shock. A binary logistic regression model was implemented for the prediction of animals achieving ROSC from data available before the first defibrillation attempt. Backward stepwise selection was used to extract the final model. Inclusion and exclusion significance levels were 0.1 and 0.05, respectively. Receiver operating characteristic curves were used to determine the diagnostic accuracy, sensitivity and specificity of the parameters and to obtain the appropriate cut-off points.

RESULTS

IMA exhibited 100% sensitivity and 93.8% specificity in defining the subgroup of animals that will achieve ROSC. This high-accuracy prediction had a very early onset (from eighth VF minute) and remained at the same level until the end of the experiment. When combining IMA and coronary perfusion pressure (CPP) measurements from the first CPR cycle in the form of the simple ratio IMA/CPP, a cut-off point of 7 could provide 100% sensitivity and specificity in distinguishing the animals that will achieve ROSC in the upcoming defibrillation attempts.

CONCLUSIONS

Until today, CPP has been found to be the only key determinant of successful resuscitation. Our study suggests that IMA can be a predictive index of ROSC even before the initiation of CPR.

OBJECTIVE

The aim was to evaluate the role of high sensitivity troponin T and ischemia modified albumin (IMA) and in the early diagnosis of acute coronary syndrome (ACS).

METHODS

This was a cross-sectional study that comprised of 120 individuals of which 75 were cases and 45 healthy controls. On the basis of clinical history and 12-lead electrocardiogram, initial diagnosis of ACS was made in the cases. High sensitive cardiac troponin T (hs-cTnT) and IMA were measured in all the individuals.

RESULTS

Levels of IMA were significantly higher in patients of ACS as compared to those in control group (means: 101.83 [95% confidence interval (CI): 91.96-111.70] vs. 41.11 [95% CI: 38.55-43.67]). By taking the cut-off as >65.23 U/mL for IMA, which was obtained from receiver operating characteristic (ROC) curve, the sensitivity was 91.3%, specificity was 81.1%, positive predictive value (PPV) was 74.4%, and negative predictive value (NPV) was 93.9%. Positive likelihood ratio was 4.83 while negative likelihood ratio was 0.11, whereas the corresponding values in case of hs-cTnT were 95.6% (95% CI: 85.2-99.5), 61.3% (95% CI: 49.5-72.6), 59.7%, 95.8%, 2.47 and 0.07 by taking cut-off as >14 pg/mL. The area under the ROC curves (AUC) of IMA and hs-cTnT at 0-6 h were 0.932 (95% CI: 0.87-0.97, P < 0.001) and 0.797 (95% CI: 0.71-0.86, P < 0.001), respectively. The logistic model combining the two markers yielded sensitivity, specificity, PPV, and NPV of 95.7%, 81.1%, 88.6%, and 92.5% respectively.

CONCLUSIONS

hs-cTnT and IMA may be useful tools for risk stratification of ACS and can be used together with better accuracy in the early diagnosis of ACS.

OBJECTIVE

Our aim was to examine the potential roles of ischemia modified albumin(IMA) and D-dimer as reliable early diagnostic markers of ovarian torsion.

METHODS

24 Wistar albino rats were included and randomized into three groups. Control (sham) rats underwent laparotomy then bilateral ovaries removed for histopathological examination and concomitant blood sampling for IMA and D-dimer assays after 4 h. In the remaining groups, ovarian ischemia was achieved by rotating bilateral ovaries 1080° clockwise then blood samples were obtained and ovaries were removed after 4 h and 24 h. IMA and D-dimer levels as well as the histopathological injury scores were assessed in all groups.

RESULTS

A statistically higher significant difference in D-dimer levels in the 4-h torsion group (Group 2) than the other groups (P = 0.001, P < 0.01). Despite absence of statistical significance, the difference in IMA levels between the groups was close to statistical significance (P = 0.064; P>> 0.05); accordingly IMA levels were higher in the 24-h torsion group (Group 3), than in 4-h torsion (Group 2) or sham (Group 1) group.

CONCLUSIONS

Our results suggest that D-dimer may represent a valuable acute marker of ovarian torsion. The cut-off value for D-dimer was 402 ng/ml. Although rats in Group3 had higher IMA than in other groups, the difference was only close to statistical significance. Also, increasing duration of torsion was associated with reduced D-dimer levels, while IMA levels exhibited an increase during the 24 h period. In contrast with previous studies, IMA appeared to be a potential marker in the long term rather than the short term.

This study evaluated the relationships among copeptin, ischemia-modified albumin (IMA), and extent of myocardial injury in patients with acute carbon monoxide poisoning (ACOP). A total of 110 patients with different degrees of ACOP were selected as the poisoning group, and 30 healthy individuals as the control group. The levels of troponin I (cTnI), IMA, and copeptin were detected. Based on the presence of complications, the patients were assigned to the complication (26 patients) or non-complication (84 patients) group. Levels of cTnI, IMA, and copeptin were compared among the control, complication, and non-complication groups. Compared with the control group, in the 2 h after admission, the IMA levels decreased and copeptin levels increased in the poisoning group; these changes were more significant in patients with severe ACOP than in those with mild ACOP, and the difference was statistically significant (P < 0.05). There were no differences in the IMA and copeptin levels between the groups 7 days after admission; the cTnI levels increased more significantly in patients with severe ACOP than in patients with mild and moderate ACOP, and the differences were statistically significant (P < 0.05). In the complication group, at 7 days after admission, the IMA levels decreased whereas the copeptin and cTnI levels were significantly higher than in the non-complication group, with a statistically significant difference (P < 0.05). IMA was negatively correlated with copeptin. IMA and copeptin detection is clinically useful in the early diagnosis and prognosis of ACOP-related myocardial injury and in guiding early clinical drug application.

OBJECTIVE

A close association of oxidative stress (OS) and ischemia-modified albumin (IMA) with obstructive sleep apnea (OSA) has been reported in the literature, but the results on IMA are ambiguous. We conducted a meta-analysis to evaluate the association of IMA with OSA and the effect of continuous positive airway pressure (CPAP) therapy on IMA in patients with OSA.

METHODS

Relevant studies were identified by searching PubMed and other databases in addition to manual searching of cross-references. Using random-effects model, the standardized mean differences (SMDs), pooled correlation coefficients and summary of diagnostic test accuracies were obtained with 95% confidence intervals (CIs). The meta-regression, sub-group and sensitivity analyses were performed to explore heterogeneity. The presence of publication bias was tested using funnel plot analysis followed by Begg's and Egger's tests for statistical signidicance.

RESULTS

This meta-analysis finally included nine studies. When comparing with non-OSA controls, the OSA patients showed a significantly increased circulatory IMA levels (SMD = 1.15, p = 0.0001). And, this increase is even more pronounced in severe-OSA group as compared to mild-moderate OSA patients (SMD = 076, p = 0.0006). A decrease in post-CPAP treatment IMA was observed when compared with that of baseline values. Meta-analysis of correlations showed significant associations of IMA with polysomnographic parameters. The pooled diagnostic odds ratio and area under curve were 19.58 and 0.888 (Q* = 0.819), respectively. There was no evidence of publication bias for the association of IMA with OSA.

CONCLUSIONS

This meta-analysis suggests that OSA is associated with significantly increased IMA levels which may indicate OS, ischemia and subclinical cardiovascular risk. In the diagnostic test accuracy meta-analysis, IMA showed good accuracy for OSA detection. However, further studies are required to establish its clinical utility.