Sharper angle,higher risk? The effect of cutting angle on knee mechanics in invasion sport athletes

IntroductionCutting is an important skill in team-sports, but unfortunately is also related to non-contact ACL injuries. The purpose was to examine knee kinetics and kinematics at different cutting angles.Material and methods13 males and 16 females performed cuts at different angles (45°, 90°, 135° and 180°) at maximum speed. 3D kinematics and kinetics were collected. To determine differences across cutting angles (45°, 90°, 135° and 180°) and sex (female, male), a 4 × 2 repeated measures ANOVA was conducted followed by post hoc comparisons (Bonferroni) with alpha level set at α ≤ 0.05 a priori.ResultsAt all cutting angles, males showed greater knee flexion angles than females (p < 0.01). Also, where males performed all cutting angles with no differences in the amount of knee flexion −42.53° ± 8.95°, females decreased their knee flexion angle from −40.6° ± 7.2° when cutting at 45° to −36.81° ± 9.10° when cutting at 90°, 135° and 180° (p < 0.01). Knee flexion moment decreased for both sexes when cutting towards sharper angles (p < 0.05). At 90°, 135° and 180°, males showed greater knee valgus moments than females. For both sexes, knee valgus moment increased towards the sharper cutting angles and then stabilized compared to the 45° cutting angle (p < 0.01). Both females and males showed smaller vGRF when cutting to sharper angles (p < 0.01).ConclusionIt can be concluded that different cutting angles demand different knee kinematics and kinetics. Sharper cutting angles place the knee more at risk. However, females and males handle this differently, which has implications for injury prevention.     

Haemodynamics and stresses in abdominal aortic aneurysms: A fluid-structure interaction study into the effect of proximal neck and iliac bifurcation angle

Our knowledge of how geometry influences abdominal aortic aneurysm (AAA) biomechanics is still developing. Both iliac bifurcation angle and proximal neck angle could impact the haemodynamics and stresses within AAA. Recent comparisons of the morphology of ruptured and intact AAA show that cases with large iliac bifurcation angles are less likely to rupture than those with smaller angles. We aimed to perform fluid-structure interaction (FSI) simulations on a range of idealised AAA geometries to conclusively determine the influence of proximal neck and iliac bifurcation angle on AAA wall stress and haemodynamics.Peak wall shear stress (WSS) and time-averaged WSS (TAWSS) in the AAA sac region only increased when the proximal neck angle exceeded 30°. Both peak WSS (p < 0.0001) and peak von Mises wall stress (p = 0.027) increased with iliac bifurcation angle, whereas endothelial cell activation potential (ECAP) decreased with iliac bifurcation angle (p < 0.001) and increased with increasing neck angle.These observations may be important as AAAs have been shown to expand, develop thrombus and rupture in areas of low WSS. Here we show that AAAs with larger iliac bifurcation angles have higher WSS, potentially reducing the likelihood of rupture. Furthermore, ECAP was lower in AAA geometries with larger iliac bifurcation angles, implying less likelihood of thrombus development and wall degeneration. Therefore our findings could help explain the clinical observation of lower rupture rates associated with AAAs with large iliac bifurcation angles.     

Effect of patient positioning on carbon-ion therapy planned dose distribution to pancreatic tumors and organs at risk

PurposePancreatic tumor treatment dose distribution variations associated with supine and prone patient positioning were evaluated.MethodsA total of 33 patients with pancreatic tumors who underwent CT in the supine and prone positions were analyzed retrospectively. Gross tumor volume (GTV), planning target volume (PTV), and organs at risk (OARs) (duodenum and stomach) were contoured. The prescribed dose of 55.2 Gy (RBE) was planned from four beam angles (0°, 90°, 180°, and 270°). Patient collimator and compensating boli were designed for each field. Dose distributions were calculated for each field in the supine and prone positions. To improve dose distribution, patient positioning was selected from supine or prone for each beam field.ResultsCompared with conventional beam angle and patient positioning, D2cc of 1st-2nd portion of duodenum (D1-D2), 3rd-4th portion of duodenum (D3-D4), and stomach could be reduced to a maximum of 6.4 Gy (RBE), 3.5 Gy (RBE), and 4.5 Gy (RBE) by selection of patient positioning. V10 of D1-D2, D3-D4, and stomach could be reduced to a maximum of 7.2 cc, 11.3 cc, and 11.5 cc, respectively. D95 of GTV and PTV were improved to a maximum of 6.9% and 3.7% of the prescribed dose, respectively.ConclusionsOptimization of patient positioning for each beam angle in treatment planning has the potential to reduce OARs dose maintaining tumor dose in pancreatic treatment.     

Performances diagnostiques des tomoscintigraphies myocardiques de stress,réalisées avec une caméra à semi-conducteurs et un protocole très faible dose

IntroductionThis retrospective study aimed to assess the performances in the detection of coronary artery disease patients of the stress myocardial perfusion imaging (MPI) performed with a semiconductor camera, a very low dose stress-rest protocol and short recording times.Material and methodsWe analyzed consecutive MPI exams, which has been routinely planed with the “D-SPECT” semiconductor camera, a 1-day stress-rest protocol, very low doses of Sestamibi-^99mTc (120 MBq at stress and 360 MBq at rest for a 75 kg body weight patient) and short acquisition-times targeting the recording of 500 myocardial kcounts (on average, 8 min for stress and 3 min for rest). The ability to detect coronary artery stenosis (> 50% diameter reduction) was assessed in a group of 118 patients, who had coronary angiography at ≤ 3 months from MPI, and normalcy rate was assessed in a group of 74 patients showing a low pretest probability of coronary artery disease (< 10%).ResultsSensitivity, positive predictive value and global accuracy for identifying the 81 patients with ≥ 1 coronary artery stenosis were 85%, 83% and 78%, respectively; and normalcy rate was 96%. Mean effective doses were: (1) 4.9 ± 1.4 mSv in the group with coronary angiography and where most exams (90%) comprised both stress and rest MPI; and (2) 1.9 ± 1.5 mSv in the low probability group and where most exams (70%) comprised only stress MPI.ConclusionWhen performed with a sensitive semiconductor camera and a very low dose stress-rest protocol, MPI provides high diagnostic performances, equivalent to those documented with conventional cameras in the same study setting, but with dramatic reduction of patients’ radiation.     

The severity of coronary artery disease and reversible ischemia revealed by N-terminal pro-brain natriuretic peptide in patients with unstable angina and preserved left ventricular function

The association between the levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and the severity of coronary artery disease (CAD) diagnosed by coronary angiography and other approaches has been investigated. The clinical application of NT-proBNP is restricted by the drawbacks of these techniques now available in screening out patients who need intensive or conservative treatment. Fractional flow reserve (FFR) is superior to coronary angiography and other functional indicators. Accordingly, we designed to investigate the association between NT-proBNP and myocardial ischemia from the perspective of anatomy and physiology in patients with unstable angina and preserved left ventricular function. Plasma samples were collected from 110 patients and NT-proBNP levels were measured by radioimmunoassay. The severity of coronary artery stenosis in patients was measured by coronary angiography and FFR. Stenosis ≥50% in the left main artery or stenosis of 70%, and fractional flow reserve (FFR) ≤0.80 in one or more coronary branches with diameter ≥2 mm were defined as “positive”, which require revascularization. NT-proBNP levels increased progressively between patients with negative and positive angiographic results (p < 0.05), and between FFR-negative and FFR-positive patients (p < 0.05). A significant correlation was observed between log NT-proBNP and log GS (GS = Gensini score, p < 0.001). NT-proBNP level serves as a predictor of positive results of angiographic stenosis and FFR, with the area under the receiver operating characteristic curve being 0.697 and 0.787, respectively. NT-proBNP levels are correlated with the severity of anatomic coronary obstruction and inducible myocardial ischemia, but NT-proBNP per se is insufficient to identify clinically significant angiographic and physiological stenoses.     

Identification of butterfly based on their shapes when viewed from different angles using an artificial neural network

Identification of butterfly species is essential because they are directly associated with crop plants used for human and animal consumption. However, the widely used reliable methods for butterfly identification are not efficient due to complicated butterfly shapes. We previously developed a novel shape recognition method that uses branch length similarity (BLS) entropy, which is a simple branching network consisting of a single node and branches. The method has been successfully applied to recognize battle tanks and characterize human faces with different emotions. In the present study, we used the BLS entropy profile (an assemble of BLS entropies) as an input feature in a feed-forward back-propagation artificial neural network to identify butterfly species according to their shapes when viewed from different angles (for vertically adjustable angle, θ = ± 10°, ± 20°, …, ± 60° and for horizontally adjustable angle, φ = ± 10°, ± 20°, …, ± 60°). In the field, butterfly images are generally captured obliquely by camera due to butterfly alignment and viewer positioning, which generates various shapes for a given specimen. To generate different shapes of a butterfly when viewed from different angles, we projected the shapes captured from top-view to a plane rotated through angles θ and φ. Projected shapes with differing θ and φ values were used as training data for the neural network and other shapes were used as test data. Experimental results showed that our method successfully identified various butterfly shapes. In addition, we briefly discuss extension of the method to identify more complicated images of different butterfly species.     

Innervation zone location of the biceps brachii,a comparison between genders and correlation with anthropometric measurements

Avoiding the innervation zone (IZ) is important when collecting surface electromyographic data. The purposes of this study were threefold: (1) to examine the precision of two different techniques for expressing IZ location for the biceps brachii, (2) to compare these locations between men and women, and (3) to determine if IZ movement with changes in elbow joint angle is related to different anthropometric measures. Twenty-four subjects (mean ± SD ages = 21.8 ± 3.5 yr) performed isometric contractions of the right forearm flexors at each of three separate elbow joint angles (90°, 120°, and 150° between the arm and forearm). During each contraction, the location of the IZ for the biceps brachii was visually identified using a linear electrode array. These IZ locations were expressed in both absolute (i.e. as a distance (mm) from the acromion process) and relative (i.e. as a percentage of humerus length) terms. The results suggested that the estimations of IZ location were more precise when expressed in relative versus absolute terms, and were generally different for men and women. The shift in IZ location with changes in elbow joint angle was not, owever, related to height, weight, or humerus length.     

Isometric torque–angle relationships of the elbow flexors and extensors in the transverse plane

Maximal voluntary isometric torque–angle relationships of elbow extensors and flexors in the transverse plane (humerus elevation angle of 90°) were measured at two different horizontal adduction angles of the humerus compared to thorax: 20° and 45°. For both elbow flexors and extensors, the torque–angle relationship was insensitive to this 25° horizontal adduction of the humerus. The peak in torque–angle relationship of elbow extensors was found at 55° (0° is full extension). This is closer to full elbow extension than reported by researchers who investigated this relationship in the sagittal plane. Using actual elbow angles during contraction, as we did in this study, instead of angles set by the dynamometer, as others have done, can partly explain this difference.We also measured electromyographic activity of the biceps and triceps muscles with pairs of surface electrodes and found that electromyographic activity level of the agonistic muscles was correlated to measured net torque (elbow flexion torque: Pearson’s r = 0.21 and extension torque: Pearson’s r = 0.53). We conclude that the isometric torque–angle relationship of the elbow extensors found in this study provides a good representation of the force–length relationship and the moment arm–angle relationship of the elbow extensors, but angle dependency of neural input gives an overestimation of the steepness.     

High resolution ion chamber array delivery quality assurance for robotic radiosurgery: Commissioning and validation

PurposeHigh precision radiosurgery demands comprehensive delivery-quality-assurance techniques. The use of a liquid-filled ion-chamber-array for robotic-radiosurgery delivery-quality-assurance was investigated and validated using several test scenarios and routine patient plans.Methods and materialPreliminary evaluation consisted of beam profile validation and analysis of source–detector-distance and beam-incidence-angle response dependence. The delivery-quality-assurance analysis is performed in four steps: (1) Array-to-plan registration, (2) Evaluation with standard Gamma-Index criteria (local-dose-difference ⩽ 2%, distance-to-agreement ⩽ 2 mm, pass-rate ⩾ 90%), (3) Dose profile alignment and dose distribution shift until maximum pass-rate is found, and (4) Final evaluation with 1 mm distance-to-agreement criterion. Test scenarios consisted of intended phantom misalignments, dose miscalibrations, and undelivered Monitor Units. Preliminary method validation was performed on 55 clinical plans in five institutions.ResultsThe 1000SRS profile measurements showed sufficient agreement compared with a microDiamond detector for all collimator sizes. The relative response changes can be up to 2.2% per 10 cm source–detector-distance change, but remains within 1% for the clinically relevant source–detector-distance range. Planned and measured dose under different beam-incidence-angles showed deviations below 1% for angles between 0° and 80°. Small-intended errors were detected by 1 mm distance-to-agreement criterion while 2 mm criteria failed to reveal some of these deviations. All analyzed delivery-quality-assurance clinical patient plans were within our tight tolerance criteria.ConclusionWe demonstrated that a high-resolution liquid-filled ion-chamber-array can be suitable for robotic radiosurgery delivery-quality-assurance and that small errors can be detected with tight distance-to-agreement criterion. Further improvement may come from beam specific correction for incidence angle and source–detector-distance response.     

Influence of the knee flexion on muscle activation and transmissibility during whole body vibration

The influence of the knee flexion on muscle activation and transmissibility during whole body vibration is controversially discussed in the literature. In this study, 34 individuals had electromyography activity (EMG) of the vastus lateralis and the acceleration assessed while squatting with 60° and 90° of knee flexion either with or without whole-body vibration (WBV). The conditions were maintained for 10 s with 1 min of rest between each condition. The main findings were (1) the larger the angle of knee flexion (90° vs. 60°), the greater the EMG (p < 0.001), with no difference on acceleration transmissibility; (2) for both angles of knee flexion, the addition of WBV produced no significant difference in EMG and higher acceleration compared to without WBV (p < 0.001). These results suggest that the larger the knee flexion angle (60° vs. 90°), the greater the muscle activation without acceleration modification. However, the addition of WBV increases the transmissibility of acceleration in the lower limbs without modification in EMG of vastus lateralis.     

Levels of l-ascorbic acid and cadmium in the saphenous vein of patients with coronary artery disease are negatively correlated

BackgroundThe aim of this study was the simultaneous determination of levels of cadmium and l-ascorbic Acid (AA) in human saphenous vein (SV) used in coronary artery bypass grafting (CABG) and check whether there is a relationship between these levels.MethodsHuman SV were collected from 40 patients (20 men and 20 women; age, 40–75 years) at the time of routine coronary artery surgical revascularization. The concentration of cadmium in the tissue was determined according to the GF AAS—atomic absorption method. The concentration of AA was assayed in supernatant by FIA method with spectrophotometric detection.ResultsAA concentration (mean ± SD); men: 98,7 ± 13,18 μg/g tissue, women: 96,06 ± 11,98 μg/g tissue. Cadmium concentration(mean ± SD); men: 309 ± 103,71 ng/g tissue, women: 348,5 ± 255,71 ng/g tissue. Correlations among concentrations of AA and cadmium were insignificant negative in the group of men (Pearson r = −0,1504, p = 0,5269) and in the group women (Pearson r = −0339, p = 0144).ConclusionsNegative correlations among concentrations of AA and cadmium in human SV obtained in our study may indicate a protective effect of this vitamin in relation to toxic cadmium.     

Transluminal attenuation-gradient coronary CT angiography on a 320-MDCT volume scanner: Effect of scan timing,coronary artery stenosis,and cardiac output using a contrast medium flow phantom

PurposeTransluminal-attenuation-gradient (TAG) may reflect patient characteristics and physiological parameters. Furthermore, TAG may be affected by factors such as the CT scanner speed, scanning method, scan timing after contrast-medium (CM) injection, and the injection methods. The purpose of our study was to investigate quantitative TAG at different scan timing points after CM injection for coronary CT angiography.Materials and methodsUsing a CM flow phantom and two types of connecting tube mimicking 0% and 70% coronary artery stenosis, we performed 320-detector volume scanning. The heart rate was set at 60 bpm and cardiac-output (CO) at 2.0 and 4.0 l/min, respectively. The acquisition time repeated at 0.5-s intervals for 40 and 25 s at a CO of 2.0- and 4.0 l/min. We measured the CT number on the same slice level, calculated the time-density-curve (TDC) and the TAG at each time point.ResultsAt COs of 2.0 and 4.0 l/min at 0% stenosis, TAG exhibited smaller variations (−3.02 to +0.55 HU/cm at 2.0 l/min, −2.63 to +0.43 HU/cm at 4.0 l/min) than at 70% stenosis at each time point along the TDC. Compared with a CO at 2.0 l/min with 70% stenosis, the TAG curve for a CO at 4.0 l/min gradually changed with time (−6.64 to +1.18 HU/cm at 2.0 l/min vs. −3.46 to +2.75 HU/cm at 4.0 l/min).ConclusionThe TAG value was affected by scan timing after CM injection and by CO although the size of the connecting tube with and without stenosis was identical.     

Three-dimensional comparison of static and dynamic scapular motion tracking techniques

The shoulder is complex and comprised of many moving parts. Accurately measuring shoulder rhythm is difficult. To classify shoulder rhythm and identify pathological movement, static measures have been the preferred method. However, dynamic measures are also used and can be less burdensome to obtain. The purpose of this paper was to determine how closely dynamic measures represent static measures using the same acromion marker cluster scapular tracking technique. Five shoulder angles were assessed for 24 participants using dynamic and static tracking techniques during humeral elevation in three planes (frontal, scapular, sagittal). ANOVAs were used to identify where significant differences existed for the factors of plane, elevation angle, and tracking technique (static, dynamic raising, dynamic lowering). All factors were significantly different for all shoulder angles (p < 0.001), except for elevation plane in scapulothoracic protraction/retraction (p = 0.955). Tracking techniques were influential (p < 0.001), but the grouped mean differences fell below a clinically relevant 5° benchmark. There was large variation in mean differences of the techniques across individuals. While population averages are similar, individual static and dynamic shoulder assessments may be different. Caution should be taken when dynamic shoulder assessments are performed on individuals, as they may not reflect those obtained in static scapular motion tracking.     

Effect of various upper limb multibody models on soft tissue artefact correction: A case study

Soft tissue artefacts (STA) introduce errors in joint kinematics when using cutaneous markers, especially on the scapula. Both segmental optimisation and multibody kinematics optimisation (MKO) algorithms have been developed to improve kinematics estimates. MKO based on a chain model with joint constraints avoids apparent joint dislocation but is sensitive to the biofidelity of chosen joint constraints. Since no recommendation exists for the scapula, our objective was to determine the best models to accurately estimate its kinematics. One participant was equipped with skin markers and with an intracortical pin screwed in the scapula. Segmental optimisation and MKO for 24-chain models (including four variations of the scapulothoracic joint) were compared against the pin-derived kinematics using root mean square error (RMSE) on Cardan angles. Segmental optimisation led to an accurate scapula kinematics (1.1° ≤ RMSE ≤ 3.3°) even for high arm elevation angles. When MKO was applied, no clinically significant difference was found between the different scapulothoracic models (0.9° ≤ RMSE ≤ 4.1°) except when a free scapulothoracic joint was modelled (1.9° ≤ RMSE ≤ 9.6°). To conclude, using MKO as a STA correction method was not more accurate than segmental optimisation for estimating scapula kinematics.     

Multi-institutional comparison of simulated treatment delivery errors in ssIMRT,manually planned VMAT and autoplan-VMAT plans for nasopharyngeal radiotherapy

PurposeTo quantify the impact of simulated errors for nasopharynx radiotherapy across multiple institutions and planning techniques (auto-plan generated Volumetric Modulated Arc Therapy (ap-VMAT), manually planned VMAT (mp-VMAT) and manually planned step and shoot Intensity Modulated Radiation Therapy (mp-ssIMRT)).MethodsTen patients were retrospectively planned with VMAT according to three institution’s protocols. Within one institution two further treatment plans were generated using differing treatment planning techniques. This resulted in mp-ssIMRT, mp-VMAT, and ap-VMAT plans. Introduced treatment errors included Multi Leaf Collimator (MLC) shifts, MLC field size (MLCfs), gantry and collimator errors. A change of more than 5% in most selected dose metrics was considered to have potential clinical impact. The original patient plan total Monitor Units (MUs) were correlated to the total number of dose metrics exceeded.ResultsThe impact of different errors was consistent, with ap-VMAT plans (two institutions) showing larger dose deviations than mp-VMAT created plans (one institution). Across all institutions’ VMAT plans the significant errors included; ±5° for the collimator angle, ±5 mm for the MLC shift and +1, ±2 and ±5 mm for the MLC field size. The total number of dose metrics exceeding tolerance was positively correlated to the VMAT total plan MUs (r = 0.51, p < 0.001), across all institutions and techniques.ConclusionsDifferences in VMAT robustness to simulated errors across institutions occurred due to planning method differences. Whilst ap-VMAT was most sensitive to MLC errors, it also produced the best quality treatment plans. Mp-ssIMRT was most robust to errors. Higher VMAT treatment plan complexity led to less robust plans.     

Disturbed motor control of rhythmic movement at 2 h and delayed after maximal eccentric actions

The aim of this study was to examine the influence of exercise-induced muscle damage on elbow rhythmic movement (RM) performance and neural activity pattern and to investigate whether this influence is joint angle specific. Ten males performed an exercise of 50 maximal eccentric elbow flexions in isokinetic machine with duty cycle of 1:15. Maximal dynamic and isometric force tests (90°, 110° and 130° elbow angle) and both active and passive stretch reflex tests of elbow flexors were applied to the elbow joint. The intentional RM was performed in the horizontal plane at elbow angles; 60–120° (SA-RM), 80–140° (MA-RM) and 100–160° (LA-RM). All measurements together with the determination of muscle soreness, swelling, passive stiffness, serum creatine kinase were conducted before, immediately and 2 h as well as 2 days, 4 days, 6 days and 8 days post-exercise. Repeated maximal eccentric actions modified the RM trajectory symmetry acutely (SA-RM) and delayed (SA/MA/LA-RM) until the entire follow up of 8 days. Acutely lowered MA-RM peak velocity together with reduced activity of biceps brachii (BB) at every RM range, reflected a poorer acceleration and deceleration capacity of elbow flexors. A large acute drop of BB EMG burst amplitude together with parallel decrease in BB active stretch reflex amplitude, especially 2 h post-exercise, suggested an inhibitory effect originating most likely from groups III/IV mechano-nociceptors.     

Prediction of time-integrated activity coefficients in PRRT using simulated dynamic PET and a pharmacokinetic model

PurposeTo investigate the accuracy of predicted time-integrated activity coefficients (TIACs) in peptide-receptor radionuclide therapy (PRRT) using simulated dynamic PET data and a physiologically based pharmacokinetic (PBPK) model.MethodsPBPK parameters were estimated using biokinetic data of 15 patients after injection of (152 ± 15) MBq of ¹¹¹In-DTPAOC (total peptide amount (5.78 ± 0.25) nmol). True mathematical phantoms of patients (MPPs) were the PBPK model with the estimated parameters. Dynamic PET measurements were simulated as being done after bolus injection of 150 MBq ⁶⁸Ga-DOTATATE using the true MPPs. Dynamic PET scans around 35 min p.i. (P₁), 4 h p.i. (P₂) and the combination of P₁ and P₂ (P₃) were simulated. Each measurement was simulated with four frames of 5 min each and 2 bed positions. PBPK parameters were fitted to the PET data to derive the PET-predicted MPPs. Therapy was simulated assuming an infusion of 5.1 GBq of ⁹⁰Y-DOTATATE over 30 min in both true and PET-predicted MPPs. TIACs of simulated therapy were calculated, true MPPs (true TIACs) and predicted MPPs (predicted TIACs) followed by the calculation of variabilities v.ResultsFor P₁ and P₂ the population variabilities of kidneys, liver and spleen were acceptable (v < 10%). For the tumours and the remainders, the values were large (up to 25%). For P₃, population variabilities for all organs including the remainder further improved, except that of the tumour (v > 10%).ConclusionTreatment planning of PRRT based on dynamic PET data seems possible for the kidneys, liver and spleen using a PBPK model and patient specific information.     

Concentration of vascular endothelial growth factor in patients with acute coronary syndrome

Vascular endothelial growth factor (VEGF) is a regulator of vascular formation in physiological and pathological conditions. The aim of our study was to evaluate the value of VEGF as a surrogate marker of myocardial injury in acute ischemic conditions.Materials and methodsIn 104 consecutive patients with acute coronary syndrome (ACS) with and without ST segment elevation (STEMI and NSTEMI) the plasma and serum human VEGF (hVEGF) concentration was measured two times i.e. immediately after admission due to ACS and 24 h later. According to ECG findings and coronary angiography results, patients were divided into three groups. Group A represented major myocardial injury due to ST-segment elevation in precordial leads and/or in I and aVL leads and with left anterior descending (LAD) artery responsible for STEMI symptoms or additionally with significant atherosclerotic lesions (lumen vessel narrowed >50%) in other than LAD coronary arteries. Group B (medium myocardial injury) consisted of patients with ST-segment elevation in II, III and aVF leads and/or ST-segment depression in V2-V3 leads with one-vessel disease and the culprit artery was not LAD. Group C included patients with changes in ECG other than ST-segment elevation independently of the site of atherosclerotic lesions in coronary arteries.ResultsIn all 104 patients with ACS the highest values of serum hVEGF were observed in second measurement (357.9 ± 346 pg/ml, p < 0.01). Although in the first measurement, plasma and serum hVEGF concentration did not differentiate groups, the difference between deltas for serum hVEGF was observed (p < 0.05). Increased number of neutrophils in the first measurement increased the OR of the high serum hVEGF concentration in the first measurement (OR = 1.155; 95%CI: 1.011; 1.32) (p < 0.05). The number of neutrophils in the second measurement also revealed significant relationship with high serum hVEGF in the first assessment (OR = 1.318, 95%CI: 1.097; 1.583) (p < 0.01). Increased values of triglycerides (exceeding the upper limit) were connected with decreased OR of high serum hVEGF concentrations in the first measurement (OR = 0.152, 95%CI: 0.033; 0.695, p < 0.05).ConclusionsIn acute coronary syndrome, serum VEGF concentrations are elevated and can serve as a surrogate marker of myocardial injury. The elevated number of neutrophils increases odds ratio of high VEGF concentrations in ACS. In patients with high concentrations of triglycerides, odds ratio of low level of hVEGF is expected.