Type 2 diabetes as a modifier of fibrin clot properties in patients with coronary artery disease

Altered fibrin clot structure has been reported both in patients with coronary artery disease (CAD) and those with type 2 diabetes mellitus (DM2). The aim of the present study was to evaluate plasma fibrin clot permeability and susceptibility to lysis in patients with DM2 and CAD. We studied 132 consecutive CAD patients, including 67 subjects with DM2, scheduled for elective coronary artery bypass grafting surgery. Ex vivo plasma fibrin clot permeability (K(s)) and lysis time (t(50%)) induced by 1 μg/mL recombinant tissue plasminogen activator (tPA), along with plasma levels of plasminogen activator inhibitor-1 (PAI-1), thrombin activatable fibrinolysis inhibitor (TAFI), tPA, von Willebrand factor (vWF), P-selectin, soluble CD40 ligand (sCD40L), were measured. Diabetic and non-diabetic patients did not differ in regard to demographics and remaining cardiovascular risk factors. Concomitant DM2 was associated with higher glucose (+24.3 %, p < 0.001), fibrinogen (+9.0 %, p = 0.037), PAI-1 (+58.7 %, p < 0.001), tPA (+24.0 %, p < 0.001) and P-selectin (+12.2 %, p < 0.001). Compared with the non-diabetic group, the CAD patients with DM2 had lower K(s) (-6.1 %, p = 0.02) and prolonged t(50%) (+5.1 %, p = 0.04). Multiple regression analysis of the whole study group showed that vWF, PAI-1, fibrinogen and DM2 were the independent predictors of t(50%) (R(2) = 0.58, p < 0.001), while only vWF was an independent predictor of K(s) (R(2) = 0.22, p < 0.001). This study indicates that DM2 is potent enough to unfavorably affect plasma fibrin clot characteristics despite abnormal clot phenotype typically observed in CAD. Of note, platelet and endothelial markers appear to contribute to fibrin clot properties in CAD concomitant with DM2

Left main disease management strategy: Indications and revascularization methods in particular groups of subjects

Surgical revascularization with coronary artery by-pass grafting is still recommended in vast majority of patients with unprotected left main disease. The aim of the paper was to analyze optimal treatment of left main disease in selected groups of patients, on the basis of current guidelines and information gained from literature data. We focused on data in relation to treatment of elderly patients, diabetics and those hemodynamically unstable. Additionally we discussed the issue of anti-platelet therapy and informed consent. As far as efficacy of treatment is concerned, not only method of revascularization but also general condition of the patient, the factors influencing peri-operative risk and optimal pharmacotherapy should be taken into account. Therefore establishment of the heart team is crucial when choosing the most suitable method of invasive treatment of left main disease

Climatologically based warning system against meteorological hazards and weather extremes : the example for Poland

This work presents a detailed scientific concept of an operational warning system concerning weather hazards, which is a component of the IT System for Country’s Protection against extreme hazards currently under development in Poland. The system displays eight weather hazards that prevail in Poland (air temperature extremes, heavy rainfall, strong wind, intensive snowfall, fog, glaze, rime, and thunderstorms with hail), which are presented on the maps. The information will also be made available to the public in the form of warnings sent automatically via the Internet or text messages. The weather hazard maps consist of two highly complementary components. The first contains maps of areas vulnerable to the hazards’ occurrence (climatological maps). These are based on observational and measurement data covering the period of 1951/1966-2010. The second component consists of operational maps based on current weather conditions, including primarily predictive data provided by the mesoscale numerical weather prediction model ALADIN (warning maps). The climatological information has been applied to the operational maps for several extremes not directly predicted by the ALADIN model

Compliance with pharmacological treatment among patients after minimally invasive coronary bypass grafting

Background: We sought to evaluate patients’ adherence to optimal pharmacotherapy as recommended by the European Society of Cardiology, together with the assessment of potential clinical determinants of medical non-compliance in a large cohort of patients after endoscopic atraumatic coronary artery bypassing (EACAB).Methods: This cross sectional study was conducted in a group of 706 individuals who underwent EACAB between April 1998 and December 2010. Data covering current pharmacological treatment with antiplatelet agents, beta-blockers (BB) (or heart rate lowering calcium channel blockers [CCB] in case of intolerance and/or poor efficacy of beta-blockade), angiotensin-converting enzyme (ACE) inhibitors (or angiotensin receptor blockers [ARB]) and statins was acquired. Mean duration of observation after the surgery was 2132 ± 1313 days.Results: Complete follow-up data has been obtained from 415 living patients (341 males). Amongst them, 353 (85%) received antiplatelet agents, while BB or CCB were routinely ingested by 349 (84%) patients. Statins were used by 310 (74.7%) individuals and 274 (66%) subjects took ACE inhibitors or ARB. Baseline demographic and clinical features, including major co-morbidities had no impact on patients’ compliance with all investigated medications. There was no clear association between adherence to treatment and risk of rehospitalization or occurrence of major cerebral and cardiovascular events.Conclusions: EACAB patients’ compliance with pharmacotherapy guidelines is insufficient and is unrelated to demographic and clinical features of the subjects. Multidisciplinary approach involving health education, enhancement in prescription drug affordability and a better rapport between doctors and patients should be incorporated into clinical practice to overcome therapeutic disobedience

Study of phase transition in Bi3TiNbO9-BaBi2Nb2O9 ceramics

The subject of the paper is lead free bismuth layer structure oxides (1-x)Bi3TiNbO9-xBaBi2Nb2O9 (x=0; 1; 2; 3 mol). The influence of Bi3TiNbO9-xBaBi2Nb2O9 ratio on dielectric and structural properties was studied in a wide range of temperatures. Change in the ratio causes a decrease in the maximum value of dielectric permittivity and shifts the temperature of 'max to low values, leading to linear decreasing of average grain size and linear increasing of ceramics density. These results indicate an augment of the packing degree and the participation of pores are significantly decreased with the increase of BaBi2Nb2O9 compound intake. Moreover, for 0.7Bi3TiNbO9-0.3BaBi2Nb2O9 ceramics the dielectric phase transition is broadened and the properties characteristic for the ferroelectric relaxor appear