Jacek Budzyński

Background/Objectives: Heart failure with reduced ejection fraction (HFrEF) involves coexisting inflammatory and hemostatic dysregulation contributing to thromboembolic and bleeding risk. Ten-eleven translocation (TET1-3) proteins regulate immune-cell phenotype, but their relationship to plasma coagulation parameters in HFrEF is poorly defined. We aimed to determine whether TET1-3 protein expression in peripheral blood leukocyte subpopulations is associated with routinely available plasma coagulation parameters in HFrEF, and whether associations differ by direct oral anticoagulant (DOAC) exposure and clinical phase. Methods: In this cross-sectional, observational, two-center study, 107 patients with HFrEF were enrolled (39 receiving a DOAC, non-randomized; 68 not receiving a DOAC, of whom seven received a vitamin K antagonist and 61 received no oral anticoagulant). TET1-3 protein expression was assessed by flow cytometry in T lymphocytes, B lymphocytes, natural killer (NK) cells, monocytes, and granulocytes, expressed as the ratio of test-to-negative-control geometric mean fluorescence intensity. Associations with activated partial thromboplastin time (aPTT) and international normalized ratio (INR) were analyzed using nonparametric tests and Spearman correlations; DOAC samples were drawn at steady-state trough. Results: DOAC-treated patients constituted a distinct clinical subgroup (older, predominantly AF/AFL) and showed longer aPTT and higher TET expression in selected immune-cell subsets; these between-group differences cannot be attributed to DOAC therapy. Patients with aPTT at or above the median showed higher TET expression in T cells, B cells, NK cells, and selected leukocyte indices, whereas INR-based stratification did not. In continuous analyses, TET indices showed multiple moderate positive Spearman correlations (R = 0.25–0.49) with both aPTT and INR—with INR showing the strongest single association—and no associations with composite inflammatory indices (NLR, SII, SIRI); all comparisons were exploratory and uncorrected for multiplicity. Associations appeared stronger in stable than in worsening HFrEF (exploratory). Conclusions: Peripheral leukocyte TET protein expression was associated with plasma coagulation parameters in HFrEF; the aPTT-specific pattern was confined to the categorical (median-split) analysis, whereas continuous analyses showed associations with both aPTT and INR. Because of the cross-sectional design, moderate sample size, and potential confounding by indication, these findings should be considered hypothesis-generating. TET-related immune-cell phenotyping may capture a non-redundant immune–coagulation signal in HFrEF and warrants prospective validation.

Background: Several studies reveal an inverse relation between serum 25-hydroxyvitamin D [25(OH)D] concentration and the risk of acute ischemic stroke (AIS). The aim of this study was to determine relationships between 25(OH)D concentration and the course and outcomes of AIS treatment and the level of indices of inflammatory response to brain injury. Patients and Methods: Retrospective analysis of medical documentation of 1381 real-world AIS patients hospitalized in a single center between 1 January 2020 and 31 May 2025. Serum 25(OH)D level, several inflammatory indices, and clinical data were assessed. Results: Compared to patients in the lowest quartile of 25(OH)D concentration, those in the highest quartile had a shorter length of in-hospital stay, a lower risk of all-cause death, and a lower score for disability on a modified Rankin scale (mRS). Along with an increase in 25(OH)D quartiles, we found: a decrease in neutrophil count; a decrease in glucose, HbA1c, albumin, C-reactive protein (CRP), and CRP-to-albumin, -lymphocyte, -neutrophil, and -platelet ratios; lower neutrophil-to-lymphocyte and -albumin ratios, and lower systemic immune inflammation, and systemic inflammation response indices. In multifactorial logistic regression, the quartile of 25(OH)D (OR, 95% CI: 1.52, 1.09–2.12; p = 0.012) was the only variable to have a positive association with a mRS score ≤ 2 at discharge from hospital, and neutrophil-to-lymphocyte ratio, age, diabetes, and treatment with endovascular mechanical thrombectomy were biomarkers of poor functional status at discharge. Conclusions: Higher 25(OH)D concentration in AIS patients is related to better survival and a lower level of inflammatory response indices and disability at discharge.

Epigenetic mechanisms, including DNA methylation and hydroxymethylation, contribute to inflammation, cardiac remodelling and progression of heart failure. Ten–Eleven Translocation (TET) dioxygenases are key regulators of these processes, but the impact of statins on TET proteins in human heart failure is not well characterised. We investigated how statin therapy relates to TET1, TET2 and TET3 expression in circulating immune cells in heart failure with reduced ejection fraction (HFrEF). In this cross-sectional study, 106 patients with HFrEF were enrolled; 84 were receiving statins and 22 were not. Intracellular TET1/2/3 protein levels were measured by multiparameter flow cytometry in granulocytes, monocytes and lymphocytes, and clinical and laboratory characteristics were compared between groups. Statin-treated patients had lower NT-proBNP concentrations and lower neutrophil, lymphocyte and monocyte counts, and more often received guideline-directed medical therapy. Statin therapy was associated with a distinct TET expression profile, characterised by higher TET1 and TET3 indices in monocytes and lymphocytes and lower TET2 indices in granulocytes and monocytes. This pattern is compatible with a distinct immune-cell TET expression profile aligned with the anti-inflammatory and reparative profile attributed to statins, and the course of disease. These associations do not establish causality and require prospective validation. TET proteins may form part of an epigenetic signature associated with statin treatment in heart failure and warrant further study as potential biomarkers in larger, prospective cohorts.

Background: Acute ischemic stroke (AIS) induces a severity of inflammatory response that varies depending on the individual and may depend on the type of reperfusion treatment used. The aim of this study was to compare values of inflammatory response indices between AIS patients treated with endovascular mechanical thrombectomy (EMT) only and those in whom EMT was preceded by intravenous thrombolysis (IVT). Patients and methods: Retrospective analysis of medical documentation of 2242 consecutive, real-world patients hospitalized in one center due to AIS between 1 January 2014 and 31 May 2025. Several single and composite inflammatory indices were analyzed. Results: Patients who underwent double reperfusion treatment (IVT + EMT) (n = 1201; 53.57%) had lower C-reactive protein (CRP)-to-albumin, CRP-to-lymphocyte, CRP-to-neutrophil, and CRP-to-platelet ratios; lower platelet-to-lymphocyte, platelet-to-albumin, and platelet-to-hemoglobin ratios; and a lower inflammatory burden and systemic inflammatory index than those who were treated only with EMT (n = 1041; 46.43%). Compared to patients treated only with EMT, those treated with IVT + EMT also had a shorter length of in-hospital stay, were less likely to be readmitted within 14 days of discharge, and were more likely to achieve a modified Rankin score of 0–1 at discharge. Conclusions: Patients with AIS treated with IVT + EMT may exert a lower inflammatory magnitude of response and better functional status at discharge than those treated with EMT only. Biomarkers of inflammatory response to AIS require further study to confirm their usefulness in AIS patients’ management and personalized qualification for reperfusion and non-reperfusion targeted treatment.

Background: Ischemic stroke remains a leading cause of mortality and long-term disability worldwide. Reperfusion therapies, such as intravenous thrombolysis and mechanical thrombectomy, are crucial for restoring cerebral blood flow but may also trigger ischemia–reperfusion injury and systemic inflammatory activation, associated with poorer clinical outcomes. Methods: We retrospectively analyzed medical records of 8833 patients hospitalized for acute ischemic stroke between January 2014 and May 2025. Of these, 2242 (25.38%) underwent reperfusion therapy (mechanical thrombectomy ± intravenous thrombolysis), and 6591 (74.62%) were treated conservatively. Laboratory parameters, including leukocyte count, C-reactive protein (CRP), and albumin, and composite inflammatory indices (e.g., neutrophil-to-lymphocyte ratio (NLR), systemic immune–inflammation index (SII), systemic-inflammation response index (SIRI), and neutrophil percentage-to-albumin ratio (NPAR)), were assessed at admission. Clinical outcomes included in-hospital mortality and functional scale results (e.g., National Institutes of Health Stroke Scale, modified Rankin score (mRS), Barthel scale, and Glasgow Coma Scale (GCS)). Results: Patients treated with reperfusion therapy had higher inflammatory indices (white blood cells, CRP, NLR, SII, and NPAR) compared to patients treated conservatively. In multiple regression analysis, these indices were significantly determined only by GCS and mRS scores, but age, gender, comorbidities, biochemical determinations, and type of ischemic stroke treatment (reperfusion or conservative) remained non-statistically significant. Conclusions: Patients with acute ischemic stroke undergoing reperfusion therapy exhibited a stronger inflammatory response and higher in-hospital mortality than those treated conservatively. However, multivariate analysis showed that a stronger inflammatory response following reperfusion therapy results more from the severity of the patients’ state than the kind of therapy.

Objectives: Healthcare-associated infections (HAIs) are persistent problem in contemporary in-hospital patients’ treatment but they are recognized as potentially preventable. The influence of HAI on patients’ outcomes after discharge is not fully acknowledged. The authors conducted the...

Introduction: Coronary subclavian steal syndrome (CSSS) is a rare occurring clinical problem concerning patients after coronary artery bypass grafting with use of left internal mammary artery (LIMA) with coexistence of significant stenosis or occlusion of left subclavian artery in proximal segment. This uncommon condition may have a significant impact on clinical outcomes of the cardiac surgery. Aim: Updating current medical knowledge about CSSS. Material and methods: A systematic review of recent literature on the topic. Results and discussion: Most cases of CSSS do not cause any symptoms due to other compensating mechanisms. However, in case of reverse flow occurrence in LIMA graft, patient can reveal picture of coronary syndrome, heart failure or arrhythmias. The stenosis of the subclavian artery usually is based on atherosclerosis. The diagnosis is based on clinical symptoms and radiology: ultrasonography, computed tomography and angiography. Most of the cases do not require any intervention. In symptomatic CSSS usually percutaneous angioplasty of subclavian artery is the first choice method of treatment. Conclusions: Considering growing population of patients after coronary artery bypass grafting and long live expectancy after this treatment, CSSS may be an increasing clinical problem, and still the awareness of it is not common among cardiologists. According to ESC guidelines, all patients referred to coronary artery bypass grafting with coincidence of peripheral atherosclerosis should routinely undergo aimed diagnostics towards potential subclavian artery stenosis.

Orexin regulates food intake, as well as the development and progression of neoplasms. The aim of this study was to determine associations between nutritional risk and status and neoplasm stage and prognosis in patients who underwent surgery for colorectal cancer (CRC). In 84 consecutive patients undergoing surgery for CRC, serum orexin, nutritional risk and body composition (assessed by bioelectrical impedance analysis and cross-sectional area determined using abdominal CT) were evaluated before the operation and 3 months after the surgery. The long-term follow-up lasted 1296.0 ±617.7 days. Compared to CRC patients with a serum orexin concentration lower than the cutoff value (197.9 pg/ml) determined in ROC curve analysis in prediction of all-cause mortality during long-term follow-up, those with orexin concentrations equal to or higher than the cutoff value were, at baseline and at the 3-month visit, more likely to have a lower score on the nutritional NRS2002 and a higher score on functional scales, greater handgrip strength, and higher skeletal muscle mass, and were less likely to suffer perioperative complications and all-cause mortality (OR = 0.34; 95% CI: 0.13–0.89; p = 0.026) during the follow-up period. No statistically significant differences in tumor size, histopathological grade or clinical stage were found between CRC patient groups divided according to orexin blood concentration. Serum orexin concentrations were found to be statistically significantly associated with patients’ nutritional risk and status before surgery and at a 3-month follow-up visit, and with all-cause mortality during the 3.6-year follow-up.

Background: The early identification of patients at risk of peri-procedural complications and poor prognosis is particularly important. We conducted our study to determine whether serum orexigenic neuropeptide Y (NPY) concentration is associated with nutritional status and prognosis among patients undergoing surgery for colorectal cancer (CRC). Materials and Methods: A cohort study with a 3-month follow-up was conducted with 84 consecutive inpatients who underwent elective surgery in one center between 2016 and 2019 for primary CRC. The clinical characteristics and nutritional status of all patients were assessed. In long-term follow-ups (median; IQR: 1322; 930–1788 days; average 3.6 years), the patients’ survival status was also checked during a telephone consultation. Results: Before CRC surgery, patients with serum NPY concentrations equal to or higher than the median value (661.70 pg/mL) had higher scores in their Mini Nutritional Assessment, Barthel, and Instrumental Activities of Daily Living (IADL) questionnaires, greater handgrip strength, a lower score in the Patient-Generated Subjective Global Assessment, and almost a three-times lower risk of perioperative complications, as well as higher Barthel and IADL scores and larger calf circumference at the 3-month follow-up visit in comparison to individuals with lower serum NPY concentrations. A higher serum NPY concentration was predictive of a low Nutritional Risk Screening 2002 score at the 3-month visit, and this was also found to have significantly influenced the patients’ survival during the 1200 days after CRC surgery. Conclusions: A higher preoperative serum NPY concentration may be related to lower nutritional risk, more favorable patient nutritional and functional status, and better survival, but further studies are required.