The Prognostic Effect of Circadian Blood Pressure Pattern on Long-Term Cardiovascular Outcome is Independent of Left Ventricular Remodeling

We aimed to investigate the predictive value of 24 h blood pressure (BP) patterns on adverse cardiovascular (CV) outcome in the initially untreated hypertensive patients during long-term follow-up. This study included 533 initially untreated hypertensive patients who were involved in this study in the period between 2007 and 2012. All participants underwent laboratory analysis, 24 h BP monitoring, and echocardiographic examination at baseline. The patients were followed for a median period of nine years. The adverse outcome was defined as the hospitalization due to CV events (atrial fibrillation, myocardial infarction, myocardial revascularization, heart failure, stroke, or CV death). During the nine-year follow-up period, adverse CV events occurred in 85 hypertensive patients. Nighttime SBP, non-dipping BP pattern, LV hypertrophy (LVH), left atrial enlargement (LAE), and LV diastolic dysfunction (LV DD) were risk factors for occurrence of CV events. However, nighttime SBP, non-dipping BP pattern, LVH, and LV DD were the only independent predictors of CV events. When all four BP pattern were included in the model, non-dipping and reverse dipping BP patterns were associated with CV events, but only reverse-dipping BP pattern was independent predictor of CV events. The current study showed that reverse-dipping BP pattern was predictor of adverse CV events independently of nighttime SBP and LV remodeling during long-term follow-up. The assessment of BP patterns has very important role in the long-time prediction in hypertensive population

Effect of weekend admission on in-hospital mortality and functional outcomes for patients with acute subarachnoid haemorrhage (SAH)

BACKGROUND: Aneurysmal subarachnoid haemorrhage (aSAH) is an acute cerebrovascular event with high socioeconomic impact as it tends to affect younger patients. The recent NCEPOD study looking into management of aSAH has recommended that neurovascular units in the United Kingdom should aim to secure cerebral aneurysms within 48 h and that delays because of weekend admissions can increase the mortality and morbidity attributed to aSAH. METHOD: We used data from a prospective audit of aSAH patients admitted between January 2009 and December 2011. The baseline demographic and clinical features of the weekend and weekday groups were compared using the chi-squared test and T-test. Cox proportional hazards models (Proc Phreg in SAS) were used to calculate the adjusted overall hazard of in-hospital death associated with admission on weekend, adjusting for age, sex, baseline WFNS grade, type of treatment received and time from scan to treatment. Sliding dichotomy analysis was used to estimate the difference in outcomes after SAH at 3 months in weekend and weekday admissions. RESULTS: Those admitted on weekends had a significantly higher scan to treatment time (83.05 ± 83.4 h vs 40.4 ± 53.4 h, P < 0.0001) and admission to treatment (71.59 ± 79.8 h vs 27.5 ± 44.3 h, P < 0.0001) time. After adjustments for adjusted for relevant covariates weekend admission was statistically significantly associated with excess in-hospital mortality (HR = 2.1, CL [1.13–4.0], P = 0.01). After adjustments for all the baseline covariates, the sliding dichotomy analysis did not show effects of weekend admission on long-term outcomes on the good, intermediate and worst prognostic bands. CONCLUSIONS: This study provides important data showing excess in-hospital mortality of patients with SAH on weekend admissions served by the United Kingdom’s National Health Service.; However, there were no effects of weekend admission on long-term outcomes. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00701-016-2746-z) contains supplementary material, which is available to authorized users

The impact of climate change on soil water balance and agricultural production sustainability in Mediterranean part of Bosnia and Herzegovina

The world agriculture uses about 70% of the world water resources in irrigation. The concern over the sustainability of water use as demand for agricultural, industrial, and domestic uses continues to increase. Conflicts between particular sectors result in tensions, which sometimes lead to “water wars” in different parts of the world. It is the reason why many national and international organizations are putting the water quantity and quality questions on the top of the world’s open questions/problems. The main aim of this paper is to present soil water balance of the Mediterranean region of Bosnia and Herzegovina, prepared for a long-term time series for two locations (Trebinje and Mostar) annually and during the vegetation period. The mean long-term data has been used as a base for future predicted calculation. The predicted PET was based on an increase in air temperature by 2°C and predicted decrease in precipitation by 25%. With so predicted calculated data of monthly PET and monthly precipitation the predicted soil water balance was done

Yeni tanı dipper ve non-dipper hipertansif hastalarda strain analiz metoduyla sol ventrikül global sistolik fonksiyonlarının değerlendirilmesi

Non-dipper hypertension has been associated with enhanced target organ damage and adverse cardiovascular outcomes. The effect of dipper and non-dipper status on cardiac target organ damage has not been comprehensively investigated by two-dimensional (2D) strain echocardiography. We aimed to investigate myocardial deformational strain parameters in dipper and non-dipper untreated hypertensive patients. Material and Methods: We included 42 newly diagnosed hypertensive patients without a previous history of cardiovascular disease and coexisting chronic disease. Study population consisted of two groups of patients, 23 dipper patients and 19 non-dipper patients. Global longitudinal strain (GLS), radial strain and circumferential strain analysis were measured by 2D speckle tracking method. Results: The study population included 42 patients (15 male) with a mean age of 54.5±9 years. The assessment of left ventricular (LV) systolic function by GLS showed decreased values in non-dippers compared with dippers (-18.13±2.07 vs. -13.7±1.95; p=0.001). But no significant intergroup differences were observed in circumferential and radial strain. The analysis showed that night-time mean arterial pressure (MAP), nighttime systolic and diastolic blood pressures, 24-hr systolic blood pressure, dipping rate and nocturnal reduction rate of MAP were the parameters that correlated with GLS. Only dipping rate was independently associated with LV GLS. Conclusion: An isolated non-dipper BP was found to cause impaired LV systolic function detected by myocardial strain.Non-dipper hipertansiyon, artmış hedef organ hasarı ve olumsuz kardiyovasküler olaylarla ilişkilidir. Dipper ve non-dipper hipertansif hastalarda 2 boyutlu strain ekokardiyografi ile kardiyak hasar değerlendirilmesi, daha önce kapsamlı bir şekilde araştırılmamıştır. Biz daha önceden tedavi almamış, yeni tanı hipertansif hastalarda dipper ve non-dipper paternin miyokardiyal deformasyon strain parametreleri üzerine olan etkisini araştırdık. Gereç ve Yöntemler: Çalışmamıza daha önceden kardiyovasküler veya kronik hastalığı olmayan 42 yeni tanı hipertansif hastayı dâhil ettik. Hastalar 23 dipper ve 19 non-dipper olarak 2 gruba ayrıldı. 'Global longitudinal strain (GLS)', radyal strain ve sirkümferansiyel strain analizleri 2 boyutlu 'speckle tracking' metodu ile yapıldı. Bulgular: Çalışmaya dâhil edilen 42 hastanın (15 erkek), ortalama yaşı 54,5±9 idi. Sol ventrikül sistolik fonksiyonlarının analizinde dipper grupta GLS, non-dipper gruba göre anlamlı olarak daha yüksek bulundu (-18,13±2,07 vs. -13,7±1,95; p=0,001). Fakat radyal veya sirkümferansiyel strainde 2 grup arasında anlamlı fark yoktu. Gece ortalama arter basıncı, gece ve gündüz sistolik kan basıncı, 24 saat sistolik kan basıncı, dipping oranı, gece ortalama arter basınç düşme oranı, GLS ile korele bulundu. Fakat bu parametrelerden sadece dipping oranı, GLS ile bağımsız olarak ilişkili bulundu. Sonuç: İzole non-dipper kan basıncı paterni, miyokardiyal strain ile saptanan sol ventrikül fonksiyonlarında bozulmayla ilişkilidir

THE EFFECT OF INFILL PATTERN AND DENSITY PARAMETERS ON TENSILE STRENGTH OF POLYMER MATERIALS IN 3D PRINTING

One of the references for selecting materials in designing a machine component is its mechanical property which is tensile strength. However, the current tensile strength from the materials used in 3D printing products has not been standardized due to many parameters in the design and process that affect them. The selection of correct design and process parameters may result in the proper mechanical properties and minimize the time and amount of materials used during the printing process. The parameters expected to affect the mechanical properties are density and infill pattern. This study was conducted to observe how far the effect of them on the mechanical properties of 3D printing product's tensile strength. The specimen standard of tensile strength used was ASTM D638, while the tested infill pattern was Grid, Triangles, and Tri-Hexagon patterns, with the percentage of total infill density of 20%, 40%, and 60%. PLA (Polylactic Acid) was chosen as the material used in this study. The 3D print machine operated was 3D Print MakerGear M2 with the tensile testing machine of HTE Hounsfield. The results of this study concluded that the percentage of infill density 20%, 40%, and 60% with different infill patterns had different tensile strengths. The specimen with a Tri-Hexagon infill pattern and 60% density had the biggest tensile strength value, followed by the Triangles infill pattern and the smallest one was the Grid pattern with 20% density

Indeterminacy in the cultural property restitution debate

The debate over the restitution of cultural property is usually framed as the dispute between what John Henry Merryman defined as 'cultural nationalism' and 'cultural internationalism': the opposite viewpoints that argue whether cultural heritage objects should be returned to their countries of origin or spread around the world as determined by other principles. I argue, however, that the concepts are problematic both in their definition and their perception as two dialectically opposed sides of a dispute. This article analyses the restitution debate by examining some of the most important arguments and counterarguments used in the debate and by comparing them to the international law 'New Stream' theory. It is revealed that a similar indeterminacy which defines international law in the theory also defines the restitution debate, and that cultural nationalism and internationalism do not in fact provide answers to the debate but only function as two entry points that echo each other without a way to end the debate. Therefore, it is necessary to see beyond the two concepts in order to find solutions to the disputes.Peer reviewe

Sex-related differences in contemporary biomarkers for heart failure:a review

The use of circulating biomarkers for heart failure (HF) is engrained in contemporary cardiovascular practice and provides objective information about various pathophysiological pathways associated with HF syndrome. However, biomarker profiles differ considerably among women and men. For instance, in the general population, markers of cardiac stretch (natriuretic peptides) and fibrosis (galectin-3) are higher in women, whereas markers of cardiac injury (cardiac troponins) and inflammation (sST2) are higher in men. Such differences may reflect sex-specific pathogenic processes associated with HF risk, but may also arise as a result of differences in sex hormone profiles and fat distribution. From a clinical perspective, sex-related differences in biomarker levels may affect the objectivity of biomarkers in HF management because what is considered to be 'normal' in one sex may not be so in the other. The objectives of this review are, therefore: (i) to examine the sex-specific dynamics of clinically relevant HF biomarkers in the general population, as well as in HF patients; (ii) to discuss the overlap between sex-related and obesity-related effects, and (iii) to identify knowledge gaps to stimulate research on sex-related differences in HF

ST2 and copeptine – modern biomarkers for monitoring the effectiveness of treatment of decompensated heart failure in patients after acute myocardial infarction

The aim of the study was to increase the efficiency of diagnostic methods to find means to improve the treatment of patients with decompensated heart failure in the post-infarction period. Materials and methods. This study is based on an examination of 120 patients with decompensated HF (60 patients with STEMI and 60 with non-STEMI). Patients with previous STEMI complicated by decompensated heart failure were divided into groups, depending on their treatment. The studied groups were homogeneous in terms of age, sex, the severity of the course of the disease, duration of the post-infarction period, and the presence of clinical manifestations of decompensation. The patients were observed on the first day after hospitalization, after 1 and 2 months after treatment. Copeptin serum levels were assayed using the EK 065-32, EIA Copeptine kit (RayBiotech, Inc., USA). ST-2 in blood serum was determined with the help of the Presage ST-2 kit (Critical Diagnostics, USA). The level of ST2 was determined in ng/ml. Results. We analysed the effect of therapy on the level of ST2 in the blood serum of examined patients with STEMI and non-STEMI complicated by decompensated heart failure. All the treatment regimens we proposed led to a significant decrease in the level of this peptide in blood serum after the end of the treatment. In patients of group I who received basic therapy drugs, the average ST2 concentration was (49.47±1.77) ng/ml before treatment. After 1 and 2 months of therapy, it was (44.92±1.22) ng/ml and (41.67±1.18) ng/ml, respectively (p˂0.05). The patients with decompensated heart failure after non-STEMI from group I had a copeptin level of (18.13±0.10) pg/ml before treatment and probably decreased to levels of (16.29±0.15) pg/ml and (15.09±0.14) pg/ml after 1 and 2 months under the influence standard therapy. Conclusions. We found the dependence of copeptin and ST2 levels on decompensated HF in the early and late post-infarction periods. It was established that the use of the therapy with a combination of the studied drugs led to a more intense decrease in serum copeptin, compared to therapy with succinic acid, arginine drugs, and standard therapy (p˂0.05). Using a differentiated treatment algorithm for patients with decompensated heart failure in the post-infarction period, copeptin and ST2 in blood serum increases the effectiveness of treatment and prevents complications

Толерантность к физической нагрузке у больных с дисфункцией правого желудочка на раннем этапе после реваскуляризации миокарда

Background. Exercise capacity is strongly associated with morbidity, as well as all-cause and cardiovascular mortality in patients with heart failure. Right ventricular dysfunction (RVD) appears to be an independent predictor of exercise intolerance, but its influence on patients’ exercise capacitiy in the early period after myocardial revascularization remains unclear. Purpose: evaluation of exercise capacity in patients with DVD 3 months after myocardial revascularization. Methods. The research is a prospective analytical study which is part of the scientific project „ALTERICC” within the State Program 2020-2023. The research included 114 patients 3 months after myocardial revascularization by coronary artery by-pass grafting or percutaneous coronary angioplasty. They were divided into 2 groups according to the presence of RVD: Gr. RVD 35 patients and Gr. non-RVD -79 patients. All patients were investigated by echocardiography, cardiopulmonary exercise testing (CPET) and 6 minute walking test (6MWT).Results. Peak oxygen consumption (VO2p) achieved by patients in the RVD group was significantly lower (1018.0±400.6 ml/min) compared to those in the non-RVD group (1243.9±336, 6 ml/min), p&amp;lt;0.05. VO2p related to the maximum predicted value (VO2p%) was inferior in patients with RVD (49.2±13.3% vs 58.5±15.0%), p=0.01, as well as VO2p related to body mass was lower in the RVD group (VO2p/kg 11.9±3.9 ml/min/kg vs 14.6±4.1 ml/min/kg), p=0.01. S’ RV and TAPSE correlated positively and statistically significantly with VO2p, VO2p% and VO2p/kg. Patients with RVD performed a lower distance during 6MWT (313.5±72 m vs 338.1±65.5 m). However, the results of 6MWT correlatedpositively with the work rate performed during CPET and VO2p, VO2p/kg, VO2p%.Conclusion. Exercise capacity (expressed both by maximal work rate and by VO2p, VO2p/kg, VO2p%, but also by the distance performed during TM6M) was lower in patients with RVD at 3 months after myocardial revascularization.Introducere. Capacitatea de efort este puternic asociată cu morbiditatea și mortalitatea de orice cauză și de cauză cardiovasculară la pacienții cu insuficiență cardiacă. Disfuncția de ventricul drept (DVD) pare a fi un predictor independent al intoleranței la efort, însă influența acesteia asupra capacității de efort a bolnavilor în perioada precoce după revascularizare miocardică ramâne neclară. Scopul: evaluarea capacității de efort la pacienții cu DVD la 3 luni după revascularizare miocardică. Materiale și metode. Cercetarea în cauză este un studiu analitic prospectiv care face parte din proiectul științific„ALTERICC„ din cadrul Programului de Stat 2020-2023. Acesta a inclus 114 pacienți la 3 luni după revascularizare miocardică prin by-pass coronarian sau angioplastie coronariană percutană. Ei au fost divizați în 2 grupuri în funcție de prezența DVD: Gr. DVD 35 pacienți și Gr. non-DVD -79 pacienți. Pacienții au fost investigați prin ecocardiografie, test de efort cardiopulmonar (TECP) și test de mers 6 minute (TM6M).Rezultate. Consumul de oxigen de vârf (VO2p) atins de către pacienții din Gr. DVD a fost semnificativ mai redus (1018,0±400,6 ml/min) în comparație cu cei din Gr. non-DVD (1243,9±336,6 ml/min), p&amp;lt;0.05. VO2p raportat la valoarea maximă prezisă (VO2p%) a fost inferior la bolnavii cu DVD (49,2±13,3% vs 58,5±15,0%), p=0,01, similar cu VO2p raportat la masa corporală (VO2p/kg 11,9±3,9 ml/min/kg vs 14,6±4,1 ml/min/kg), p=0,01. S’ VD și TAPSE au corelat pozitiv și statistic semnificativ cu VO2p, VO2p% și VO2p/kg. Bolnavii cu DVD au parcurs o distanță nesemnificativ inferioară în timpul TM6M (313,5±72 m vs 338,1±65,5 m). Totuși, aceasta a corelat pozitiv cu sarcina efectuată în timpul TECP șiVO2p, VO2p/kg, VO2p%.Concluzii. Capacitatea de efort (exprimată atât prin sarcina maximă de efort, cât și prin VO2p, VO2p/kg, VO2p%, dar și distanța parcursă în timpul TM6M) a fost inferioară la pacienții cu DVD la 3 luni după revascularizare miocardică.Введение. Толерантность к физическим нагрузкам тесно связана с заболеваемостью и со смертностью у пациентов с сердечной недостаточностью. Дисфункция правого желудочка (ДПЖ) является независимым предиктором низкой толерантности к физическим нагрузкам. Цель исследования: оценка толерантности к физическим нагрузкам у больных с ДПЖ через 3 месяца после реваскуляризации миокарда. Методы. Данная работа является проспективным аналитическим исследованием, который является частью научного проекта «ALTERICC» в рамках Государственной программы 2020-2023 гг. В исследовании были включены 114 пациентов через 3 месяца после реваскуляризации миокарда методом коронарного шунтирования или коронарной ангиопластики. В зависимости от наличия ДПЖ они были разделены на 2 группы: Гр. ДПЖ 35 больных и Гр. без ДПЖ 79 больных. Все пациенты были обследованы методом эхокардиографии, кардио-респираторного нагрузочного теста и теста 6 минутной ходьбы (Т6МХ).Результаты. Пиковое потребление кислорода (VO2p), достигнутое у пациентов в группе ДПЖ было ниже (1018,0±400,6 мл/мин) по сравнению с больными с нормальной функцией ПЖ (1243,9±336,6 мл/мин), p&amp;lt;0,05. VO2p относительно максимального прогнозируемого значения (VO2p%) было ниже у больных с ДПЖ (49,2±13,3% vs 58,5±15,0%), p=0,01, аналогично VO2p относительно массы тела (VO2p/кг 11,9±3,9 мл/кг vs 14,6±4,1 мл/мин/кг), p=0,01. S’VD и TAPSE положительно коррелировали с VO2p, VO2p% и VO2p/кг. Пациенты с ДПЖ преодолели незначительно меньшее расстояние во время Т6МХ (313,5 ± 72 м vs 338,1 ± 65,5 м). Однако пройденное расстояние в Т6МХположительно коррелировало с параметрами кардио-респираторного нагрузочного теста (VO2p, VO2p/кг, VO2p%).Выводы. Толерантность к физической нагрузке (выраженная как VO2p, VO2p/кг, VO2p%, а также расстоянием пройденным при Т6МХ) была ниже у пациентов с ДПЖ через 3 месяца после реваскуляризации миокарда