Late cardiac effect of anthracycline therapy in physically active breast cancer survivors - a prospective study

The late-onset cardiotoxic effect of anthracycline is known, however the early detection and prevention of subclinical myocardial damage has not been fully understood yet. Besides medical therapy regular physical activities may also play a role in the prevention and reduction of side effects of chemotherapy. The aim of our present study was to detect the effect of regular physical activities on the diastolic function and on the symptoms of late heart failure in case of anthracycline chemotherapy. The prospective study included 55 female patients (age 31-65 year, average 49.5 years) with breast cancer and no cardiovascular risk factors. Proper cardiologic checkup included physical examination (blood pressure, pulse, etc.), ECG, standard echocardiography parameters (EF, LV dimensions etc.) and specific tissue Doppler (TDI) measurements. Symptoms of heart failure were also recorded. After five years of follow-up, symptoms of heart failure were evaluated again. Patients were assigned into two groups depending on their physical activity: 36 patients did perform regular physical activities (mean age 49.2 years) and 19 patients did not (average age 50.1 years). There was no significant difference between the two groups in basic physiological or standard echocardiography parameters neither at the baseline nor at the later time points. Diastolic dysfunction (decreased E/A) was detected 6 months after the beginning of the treatment (T2 time point) in both groups. In the inactive group this value fell below one however there was no significant difference (1.1+/-0.25 vs. 0.95+/-0.22). One year after the beginning of the treatment (T3) a significant difference could be detected between the two groups (1.05+/-0.28 vs. 0.86+/-0.25. P=0.038). Consistent change in diastolic function (Ea/Aa) could be detected with the more sensitive TDI (Tissue Doppler Imaging) measurements after treatments in both groups, especially in the septal segment (in the non active group the Ea/Aa decreased markedly but not significantly at T2 - 1.1+/-0.55 vs. 0.81+/-0.44, and this difference became significant at T3 and 2 years after treatment (T4), p=0.007 and p=0.065). The filling pressure (E/Ea) rose above 10 (p=0.09) in the non active group at T2; and it kept rising in both groups and became significant at T3 (p=0.012). Five years after the onset of the treatment symptoms of heart failure were less frequently reported in the physically active group than in the inactive one (19.45% vs. 68.42%). The data of our study show that the diastolic dysfunction of the left ventricle related to the anthracycline therapy became evident in the physically active group later and the symptoms of heart failure were less frequent than in the non active group after five years period. Enrollment in sport activities could be a good means for partial prevention in this group of patients. Cardiologic checkup at proper intervals plays a pivotal role in detection of possible cardiotoxicity. This is a strong indication for changes in the lifestyle of the patient and the treatment protocol alike

Fracture Behavior of Short Fiber-Reinforced Direct Restorations in Large MOD Cavities

The aim of this research was to study the impact of using a short fiber-reinforced composite (SFRC) core on the fatigue performance and fracture behavior of direct large posterior composite restorations. Moreover, the influence of the consistency (flowable or packable) of occlusal composite coverage was assessed. A total of 100 intact molars were collected and randomly distributed into five groups (n = 20). Deep mesio-occlusal-distal (MOD) cavities were prepared in all groups. After adhesive treatment and rebuilding the missing interproximal walls with conventional composite, the specimens in four experimental groups were restored by an SFRC core (everX Flow), which was applied and cured either in bulk or in oblique layers (each 2 mm thick). Packable (G-aenial Posterior) or flowable (G-aenial Injectable) conventional composites were used as a final occlusal layer. The control group was restored with only packable conventional composite. Fatigue survival was measured for all specimens using a cyclic loading machine until a fracture occurred or a total of 25,000 cycles was achieved. Kaplan–Meyer survival analyses were conducted, followed by pairwise log-rank post hoc comparisons. The static load-bearing capacity of surviving teeth was tested using a universal testing machine. Fracture patterns were evaluated visually. There was no statistically significant (p > 0.05) difference in terms of survival between the tested groups. All groups for which flowable SFRC was used showed statistically significantly higher load-bearing capacities compared to the control group (p < 0.05). There were no significant differences regarding fracture resistance among the fiber-reinforced study groups. Regarding the fracture pattern during the survival analysis, all specimens that received SFRC showed a dominantly restorable type of fracture, while the control specimens presented a dominantly non-restorable type. The use of flowable SFRC as a reinforcing core for large MOD direct restorations showed promising achievements regarding fracture behavior

Flexibilis és merev üvegszál megerősítésű intraradikuláris csapok törési ellenállásának in vitro összehasonlító vizsgálata - pilot study = Fracture strength of elastic and conventional fibre-reinforced composite intraradicular posts - an in vitro pilot study

Jelen vizsgálat célja a gyökérkezelt üvegszál megerősítésű kompozit csapokkal, különféle technikákkal és anyagokkal helyreállított kisörlő fogak töréssel szembeni ellenállásának és megerősítő hatásának összehasonlítása. Anyag és módszer: 32 darab kihúzott és gyökérkezelt kisörlő fogat 4 csoportba osztottunk (n = 8) a használt csap(ok) száma és anyaga alapján (1–4. csoport). 1: egyetlen hagyományos merev üvegszálas csap, 2: egy merev fő és egy járulékos üvegszálas csap, 3: egyetlen elasztikus csap, 4: egy elasztikus fő és egy járulékos csap. A csapok beragasztását és a csonkfelépítést követően a fogakat statikus terhelési tesztnek tettük ki törésig. A töréssel szembeni ellenállás mellett a törés mintázatát is vizsgáltuk. Eredmények: a 4. csoport nyújtotta a töréssel szembeni legjobb ellenállási eredményeket a tesztelt csoportok között. A több csapot használó restaurátumok (2. és 4. csoport) szignifikánsan jobban teljesítettek, mint az 1. csoport (p = 0,041; p = 0,032). A törési mintázat tekintetében a csoportok többnyire homogének voltak. Megbeszélés: jelen vizsgálat alapján több üvegszálas csap alkalmazása egyazon gyökércsatornában mindig előnyös a végleges restaurátum szempontjából, függetlenül a csap rugalmasságától. A csapok elaszticitása nem befolyásolta a létrejött törés mintázatát

A teljes ischaemiás idő prognosztikus jelentősége az ST-elevációval járó szívinfarktus miatt kezelt betegekben = Prognostic significance of the total ischemic time in patients with ST-elevation myocardial infarction

Absztrakt: Bevezetés: Az ST-elevációval járó szívinfarktusban (STEMI) a panasz kezdetétől az ér megnyitásáig eltelt idő (teljes ischaemiás idő = TIT) jelentősége a szívizommentés tekintetében jól ismert. Célkitűzés: A magyarországi, ST-elevációval járó szívinfarktusos betegeknél a TIT meghatározása és prognosztikus jelentőségének vizsgálata Magyarországon. Módszer: A szívinfarktusos betegek klinikai paramétereit, ellátásuk adatait az ellátók 2014. január 1-je óta kötelező jelleggel rögzítik a Nemzeti Szívinfarktus Regiszter rendszerében. 2014. január 1. és 2016. március 31. között 27 157 beteg 28 408 infarktusos eseményének adata került rögzítésre. Vizsgálatunkban 7146, STEMI miatt kezelt beteg szerepelt, akiknél a panasz kezdetétől számított 24 órán belül percutan coronariaintervenció (PCI) történt, és ismertek voltak a részidők. Eredmények: Az utánkövetés átlaga 740 ± 346 nap volt. A TIT mediánja 260 perc, ezen belül a leghosszabbnak a prehospitális időt találtuk (medián 205 perc). A TIT befolyásolta a túlélést: amennyiben ez az idő 400 percnél rövidebb volt, akkor a 30 napos, illetve az 1 éves halálozás 7,5%, illetve 12,2% volt. Az ennél hosszabb idő esetén 9,2%, illetve 19,7% halálozási értékeket találtunk. A többváltozós elemzéskor rövid (<30 nap), közép- (30–364 nap) és hosszú távú (≥365 nap) túlélést vizsgáltunk. A diabetes a rövid, míg a kóros kreatininérték, a súlyos koszorúérstatus a rövid és a középtávú túlélést befolyásolta. A PCI a közép- és a hosszú távú túlélés szempontjából volt jelentős. A megelőző myocardialis infarctus és a TIT a hosszú távú túlélést befolyásolta szignifikáns mértékben. Következtetések: A TIT Magyarországon hosszú, az időveszteség döntő része a prehospitális időszakra esik. A TIT önálló prognosztikai tényező, az időveszteség csökkentése javíthatja a betegek késői életkilátásait. Orv Hetil. 2018; 159(27): 1113–1120. | Abstract: Introduction: The significance of the total ischemic time (from the beginning of the complaint to the opening of the vessel) is an important factor for myocardial salvage. Aim: The aim of the study was to determine the prognostic significance of the TIT in patients with ST elevation myocardial infarction in Hungary. Method: From 1 January 2014 all patients with myocardial infarction were recorded by law in an on-line database of the Hungarian Myocardial Infarction Registry. Between 1 January 2014 and 31 March 2016, 27 157 patients with 28 408 myocardial infarction events were recorded. To investigate TIT, 7146 STEMI patients were selected who were treated with percutaneous coronary intervention (PCI) within 24 hours of the beginning of the complaint and all of its components were known. Results: Average follow-up was 740 ± 346 days. The median time of the TIT is 260 minutes, within which the earliest prehospital time was found (median 205 minutes). The TIT influenced survival: if this time was less than 400 minutes, the 30-day and the 1-year deaths were 7.5% and 12.2%, respectively. In longer TIT, higher mortality rate was found (9.2% versus 19.7%, respectively). Multivariate analysis was performed for short (<30 days), medium (30–364 days) and long-term (≥365 days) survival. Diabetes mellitus is a short-term prognostic factor, abnormal creatinine, and severe coronary status have affected short and medium survival. PCI was significant in terms of medium and long-term survival. Previous myocardial infarction and TIT influenced the long-term survival significantly. Conclusions: In Hungary, TIT is too long, and its dominant part falls within the prehospital period. The TIT is an independent prognostic factor, so reducing this time can improve the long-term prognosis of patients with ST-elevation myocardial infarction. Orv Hetil. 2018; 159(27): 1113–1120

Increased Short-Term Beat-To-Beat Variability of QT Interval in Patients with Acromegaly.

Cardiovascular diseases, including ventricular arrhythmias are responsible for increased mortality in patients with acromegaly. Acromegaly may cause repolarization abnormalities such as QT prolongation and impairment of repolarization reserve enhancing liability to arrhythmia. The aim of this study was to determine the short-term beat-to-beat QT variability in patients with acromegaly. Thirty acromegalic patients (23 women and 7 men, mean age+/-SD: 55.7+/-10.4 years) were compared with age- and sex-matched volunteers (mean age 51.3+/-7.6 years). Cardiac repolarization parameters including frequency corrected QT interval, PQ and QRS intervals, duration of terminal part of T waves (Tpeak-Tend) and short-term variability of QT interval were evaluated. All acromegalic patients and controls underwent transthoracic echocardiographic examination. Autonomic function was assessed by means of five standard cardiovascular reflex tests. Comparison of the two groups revealed no significant differences in the conventional ECG parameters of repolarization (QT: 401.1+/-30.6 ms vs 389.3+/-16.5 ms, corrected QT interval: 430.1+/-18.6 ms vs 425.6+/-17.3 ms, QT dispersion: 38.2+/-13.2 ms vs 36.6+/-10.2 ms; acromegaly vs control, respectively). However, short-term beat-to-beat QT variability was significantly increased in acromegalic patients (4.23+/-1.03 ms vs 3.02+/-0.80, P<0.0001). There were significant differences between the two groups in the echocardiographic dimensions (left ventricular end diastolic diameter: 52.6+/-5.4 mm vs 48.0+/-3.9 mm, left ventricular end systolic diameter: 32.3+/-5.2 mm vs 29.1+/-4.4 mm, interventricular septum: 11.1+/-2.2 mm vs 8.8+/-0.7 mm, posterior wall of left ventricle: 10.8+/-1.4 mm vs 8.9+/-0.7 mm, P<0.05, respectively). Short-term beat-to-beat QT variability was elevated in patients with acromegaly in spite of unchanged conventional parameters of ventricular repolarization. This enhanced temporal QT variability may be an early indicator of increased liability to arrhythmia