Sex and age-related differences in the quality of treatment, morbidity and mortality in heart failure patients

Cilj rada: Procena razlika u lečenju, jednogodišnjem mortalitetu i hospitalizacijama bolesnika sa hroničnom srčanom insuficijencijom prema polu i godinama starosti. Metode i rezultati: Od 16,354 bolesnika koji su uključeni u Registar bolesnika sa srčanom insuficijencijom Evropskog udruženja za srčanu slabost (European Society of Cardiology Heart Failure Long-Term Registry), analizirano je 9,428 bolesnika sa hroničnom srčanom insuficijencijom srednje starosti 66 godina, od toga 28.5% žena, srednje ejekcione frakcije leve komore (EFLK) oko 37%. Primena medikamentne terapije za srčanu insuficijencijum u skladu sa preporukama (eng. guideline-directed medical therapy-GDMT) je bila visoka (inhibitora angiotenzin konvertujućeg enzima ili blokatora angiotenzinskih receptora kod 85.7%, beta blokatora u 88.7% i antagonista mineralokortikoidnih receptora kod 58.8% bolesnika sa srčanom insuficijencijom). Primena GDMT je bila manja kod žena u poređenju sa muškarcima (p≤0.001 za sve lekove), a primena GDMT sa smanjivala sa godinama starost kod oba pola, kako na početku, tako i nakon jedne godine praćenja. Pol nije bio nezavisan prediktor propisivanja GDMT, ali je starost > 75 godina bila značajan prediktor za manju primenu GDMT. U poređenju sa muškarcima, žene su imale manji ukupni mortalitet (žene 7.1%; muškarci 8.7%, p=0.015) i ukupne hospitalizacije (žene 21.9%; muškarci 27.3%, p˂0.001), ali nije bilo razlike u uzrocima mortaliteta. Ukupan mortalitet i ukupne hospitalizacije su se povećavale sa starošću bolesnka kod oba pola. Pol nije bio nezavisan prediktor jednogodišnjeg mortaliteta u populaciju sa EFLK ≤45%. Rizik od mortaliteta je bio značajno manji kod mlađih bolesnika u poređenju sa grupom starijom od >75 godina. Zaključci. Sa starenjem se smanjuje primena GDMT kod oba pola. Pol nije nezavisan prediktor primenene GDMT ili neželjenih ishoda kod bolesnika sa srčanom insuficijencijom. Međutim, starost >75 godina je nezavisan prediktor manje primene GDMT i većeg ukupnog mortaliteta kod bolesnika sa EFLK ≤45%.Aim: To assess sex and age-related differences in the management, and 1-year risk of all-cause mortality and hospitalization in chronic heart failure (HF) patients. Methods and results: Of 16,354 patients included in the European Society of Cardiology Heart Failure Long-Term Registry, 9428 chronic HF patients were analyzed (median age 66 years; 28.5% women; mean left ventricular ejection fraction (LVEF), 37%). Use of guideline-directed medical therapy (GDMT) was high (angiotensin-converting enzyme inhibitors / angiotensin receptor blockers, beta blockers, and mineralocorticoid receptor antagonists, 85.7%, 88.7% and 58.8% respectively). Crude GDMT utilization rates were lower in women compared with men (p for all ≤0.001), and GDMT use was lower with aging in both sexes, at baseline and 1-year follow-up. Sex was not an independent predictor of GDMT prescription; however, age > 75 years was a significant predictor GDMT underutilization. Compared with men, women had lower rates of all-cause mortality (7.1% vs 8.7%, p=0.015) and all-cause hospitalization (21.9% vs 27.3%, p˂0.001) and there were no differences in causes of death. All-cause mortality and all-cause hospitalization increased with increasing age in both sexes. Sex was not an independent predictor of 1-year all-cause mortality (restricted to LVEF ≤45%). Mortality risk was significantly lower in patients of younger age, compared to patients >75 years. Conclusions. There was a decline in GDMT use with advanced age in both sexes. Sex was not an independent predictor of GDMT or adverse outcomes. However, age >75 years independently predicted lower GDMT use and a higher all-cause mortality in patients with LVEF ≤45%

A Two-Phase VIKOR Model for Track Layout Evaluation of Passenger Rail Stations

Passenger stations are transit hubs where several railway lines interchange. They have important roles in providing train operations and passenger services. Interrelations between track layouts and technological performances are important for reducing bottleneck effects and raising the operational effectiveness of rail networks. To the best of our knowledge, in previous research the assessment of track layouts has not been considered with respect to various technological aspects including railway operations, safety, and passenger services but rather as a single criterion for analysis of different individual performance indicators. We propose a new two-phase decision making approach for the complex evaluation of track layout alternatives. The first phase model is a VIKOR method for ranking track layouts by criteria related to: railway capacity, safety issue, and passenger-pedestrian fluctuations. Next, in the second phase, we use marginal analysis to find Pareto front and compare the alternatives ratings by calculating performance-benefit coefficients. To show the applicability of the proposed model, we employ an illustrative example of a passenger rail station and evaluate six different track layout alternatives. The effectiveness of the proposed model is demonstrated comparing the proposed two-phase model with traditional VIKOR

How Supplementation with SOD-Rich Plant Extract, Combined with Gliadin, Can Affect Oxidative Stress Markers and Zonulin Levels in Exercise-Induced Oxidative Stress

A randomized, double-blind, placebo-controlled study was conducted to investigate the influence of supplementation with a superoxide dismutase (SOD)-rich plant extract on markers of oxidative stress, zonulin levels and the performance of elite athletes. Participants were 30 international-level rowers, divided into an experimental group (n = 15) and a control group (n = 15). The rowers performed a maximal effort incremental test on a rowing ergometer at the beginning and at the end of the study. Markers of oxidative stress (total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI), superoxide dismutase (SOD), glutathione peroxidase (GPx), advanced oxidation protein products (AOPPs), malondialdehyde (MDA), sulfhydryl (SH) groups, bilirubin, uric acid, albumin and zonulin) were determined in serum. A lower TOS (p = 0.010) and OSI (p = 0.004), a lower MDA (p = 0.001) and a higher level of SH groups (p = 0.031) were observed in the experimental group after supplementation. Physical performance was evaluated through metabolic efficiency, taking lactate levels and power output on the ergometer into account. After 6 weeks of supplementation, the relative increase in metabolic efficiency at a 4 mmol/L lactate concentration and maximal effort was significantly higher in the experimental group (p = 0.004 and p = 0.015, respectively). These results suggest that supplementation with a SOD-rich extract promotes lower oxidative stress, better antioxidant protection and, consequently, the better work performance of athletes

Effects of 6-Week Supplementation with GliSODin on Parameters of Muscle Damages, Metabolic, and Work Performance at International Level Rowers after Specific Maximal Effort

This study aimed to investigate the effect of supplementation with plant origin superoxide dismutase (SOD), GliSODin, on parameters of muscle damage, metabolic, and work performance at international level rowers. Twenty-eight rowers were included in a randomized, double-blind study. The study was conducted during a 6-week preparation period. At the beginning of the study and after 6 weeks of the supplementation period, all rowers were tested on a rowing ergometer. Blood samples were taken from the antecubital vein before and after every ergometer testing. Muscle damage markers creatine kinase (CK) and lactate dehydrogenase (LDH), total antioxidant capacity (TAC), inflammation parameters interleukin-6 (IL-6), and C-reactive protein (CRP) were measured. Rowing performance was assessed by lactate level in capillary blood and power output on the rowing ergometer. After supplementation, experimental group had significantly lower CK (p = 0.049) and IL-6 (p = 0.035) before and IL-6 (p = 0.050) after exhausting exercise on ergometer. Relative change of power output at 4 mmol/L concentration of lactate in blood, considering the initial and final test, was significantly higher (p = 0.020) in the supplemented group. It was concluded that GliSODin could be considered a good supplement in preventing some deleterious effects of intensive physical activity, including inflammation and muscle damage, and consequently, to enable a better rowing performance of elite rowers

Usporedba masenih koncentracija PAU-a u lebdećim česticama zraka priobalnog područja srednjeg Jadrana i središnje Hrvatske

Polycyclic aromatic hydrocarbons (PAHs) are considered priority pollutants due to their distribution, persistence, bioaccumulation, and adverse effects on human health. The aim of this study was to obtain the first insight into PAHs mass concentrations bound to airborne particulate matter (PM) in the mid Adriatic coast area of Croatia, and compare them with the PAH levels in Croatia’s urban central area. Relatively low values of PAH mass concentrations were measured in the coastal area, compared to the continental urban region of Croatia impacted by increased emissions due to intensive traffic, industry, and residential heating. A high PM10 contribution of four-ring PAHs (Flu and Pyr) at Martinska site indicated that wood burning heating as well as open fire events, including waste incineration, could be important emission sources of PAHs in the mid Adriatic coast region. This work is licensed under a Creative Commons Attribution 4.0 International License.Policiklički aromatski ugljikovodici (PAU) zbog rasprostranjenosti, postojanosti, bioakumulacije i štetnih utjecaja na zdravlje ljudi te biljnog i životinjskog svijeta smatraju se prioritetnim onečišćujućim tvarima. Cilj istraživanja je po prvi put dobiti uvid u masene koncentracije specifičnih PAU-a u lebdećim česticama u zraku priobalnog područja srednjeg Jadrana te napraviti usporedbu s razinama PAU-a urbanog područja središnje Hrvatske. Koncentracije PAU-a u priobalnom području bile su relativno niske u odnosu na koncentracije u urbanoj središnjoj Hrvatskoj, gdje se i očekuju njihove povišene emisije uslijed znatno jačeg intenziteta prometa, industrije te izgaranja biomase uslijed loženja u kućanstvima. Veća zastupljenost PAU-a četirima aromatskim prstenovima (Flu i Pyr) u ukupnoj masi PM10 čestica na mjernoj postaji Martinska upućuju na to da izgaranje drvne biomase uslijed grijanja kućanstava te uslijed požara otvorenog tipa mogu biti važan izvor PAU-a na obalnom dijelu srednjeg Jadrana. Ovo djelo je dano na korištenje pod licencom Creative Commons Imenovanje 4.0 međunarodna

In*uencia de añadidura de selenio en la comida y de congelación sobre las características tecnológicas de la carne de los broiler

U radu je istraživan utjecaj dodatka selena u obrok i postupka smrzavanja na tehnološka svojstva mesa brojlera. Istraživanje je prove- deno na pilićima (n=300) hibridima teške pasmine Cobb 500 koji su razdijeljeni s obzirom na oblik i količinu dodanog Se u hrani u tri skupine. Dodatak Se u hrani nije imao značajan utjecaj na električnu provodljivost i boju pilećega mesa (P>0,05). Duboko smrzavanje imalo je značajan utjecaj na električnu provodljivost (P<0,001) i svijetloću mesa, tj. na L* vrijednost (P<0,05), dok su samo zanemarive razlike utvrđene za parametre boje a* i b* (P>0,05).The paper researches the e&ects of selenium addition to the diet and freezing process to technological characteristics of broiler meat. The research was conducted on hybrid broilers (n=300) of Cobb 500 genotype which were separated into three groups considering the form and content of added selenium in their diet. Selenium addition in the feed had no signi-cant e&ect to electrical conductivity and color of chicken meat (P>0.05). Deep freezing had a signi-cant in0uence to electrical conductivity (P<0.001) and brightness, that is, to L* value (P0.05).In der Arbeit wurde der Eni5uss von Selen-Zusätzen in der Nahrung und des Einfrierens auf technologische Eigenschaften des Fleisches bei Broilern untersucht. Die Untersuchung erfolgte auf Hühnern (n=300) Hybriden der schweren Rasse Cobb 500, die mit Bezug auf die Form und die Menge der Selen-Zusätze in der Nahrung gruppiert wurden. Die Selen-Zusätze hatten keinen bedeutenden Ein5uss auf elektrische Leitfähigkeit und Farbe des Hühner5eisches (P>0,05). Tiefes Einfrie- ren hatte einen bedeutenden Ein5uss auf elektrische Leitfähigkeit (P0,05) festegestellt worden sind.En este trabajo fue estudiada la in5uencia de añadidura de selenio en la comida y del procedimiento de congelación sobre las caracte- rísticas tecnológicas de la carne de los broiler. La investigación fue realizada en los polluelos (n=300) híbridos de la raza pesada Cobb 500, divididos en tres grupos en vista de forma y cantidad de selenio añadido en la comida. La añadidura de selenio en la comida no tuvo signi9cante in5uencia sobre la conductividad eléctrica ni el color de la carne de pollos (P > 0,05). La congelación tuvo una in5uen- cia signi9cante sobre la conductividad eléctrica (P 0,05)

Effects of radiofrequency electromagnetic radiation on male fertility

Elektromagnetsko se zračenje emitira iz prirodnog okruženja, ali i uporabom industrijskih i svakodnevnih uređaja za bežičnu komunikaciju, stoga su ljudski i životinjski organizmi stalno izloženi zračenju. Tijekom posljednjih godina, zbog brzog tehnološkog napretka, elektromagnetsko zračenje iz umjetnih izvora premašilo je vrijednosti zračenja prirodnog podrijetla. Opća zabrinutost svih nas, zbog sve većeg broja uređaja (mobilnih telefona, prijenosnih računala, Wi-Fi-ja i mikrovalnih pećnica), koji koriste radiofrekvencijsko elektromagnetsko zračenje (RF-EMZ) opravdana je zbog sve brojnijih dokaza o njihovoj štetnosti na žive organizme. Suvremeni uređaji moderne tehnologije emitiraju radiofrekvencijske elektromagnetske valove malih frekvencija koje ljudsko i životinjsko tijelo apsorbira što može imati potencijalne štetne učinke na: mozak, srce, endokrini sustav i reproduktivnu funkciju. Muški je reproduktivni sustav jedno od najosjetljivijih tkiva na RF-EMZ-e. Tako je primjerice, iz trenutno dostupnih studija provedenih in vitro i in vivo, jasno da RF-EMZ-e ima štetne učinke na spermatogenezu, odnosno kakvoću ejakulata ljudi i životinja – broj spermija u ejakulatu, preživljavanje, morfologiju i gibljivost spermija - utječe na stanični metabolizam i endokrini sustav i može prouzročiti genotoksičnost, genomsku nestabilnost i oksidativni stres, a to može prouzročiti neplodnost. Štetni učinci RFEMZ-a dijele se na toplinske i netoplinske. Većinanegativnih bioloških učinaka pripisuje se netoplinskim učincima, a toplinski se učinci nastali RF-EMZ mobilnog telefona, smatraju manje štetnima. Zbog stvaranja prevelike količine reaktivnih kisikovih spojeva u muškom spolnom sustavu hipertermija skrotuma i povećani oksidativni stres mogu biti ključni mehanizmi putem kojih RF-EMZ-e utječe na plodnost muškaraca. Navedeni su i negativni učinci povezani s vremenom korištenja, ponajprije mobilnog telefona. Stoga je cilj ovoga preglednog rada opisati neke od učinaka RF-EMZ-a na muški spolni sustav.Humans and animals are constantly exposed to electromagnetic radiation emitted from the natural environment, and through the use of industrial and everyday devices for wireless communication. In recent years, due to rapid technological progress, electromagnetic radiation from artificial sources has exceeded the values of radiation of natural origin. General concern about the increasing number of devices (mobile phones, laptops, Wi-Fi and microwave ovens) using radiofrequency electromagnetic radiation (RF-EMR) is justified due to increasing evidence of their harm to the living organism. Modern technology devices emit small frequency radiofrequency electromagnetic waves, which are then absorbed by the human and animal bodies and can potentially cause adverse effects on the brain, heart, endocrine system and reproductive function. It is believed that the male reproductive system is one of the most sensitive tissues to RF-EMR. It is clear from the literature that RF-EMR has harmful effects on ejaculate quality indicators (such as spermatozoa count in ejaculate and spermatozoa morphology and motility), affects cellular metabolism and the endocrine system, and causes genotoxicity, genomic instability and oxidative stress, which in turn may result in infertility. The adverse effects of RF-EMR are divided into thermal and non-thermal. Most negative biological effects are attributed to non-thermal effects, while the thermal effects from cell phone radiation are considered to be less harmful. However, scrotum hyperthermia and increased oxidative stress from the formation of excess reactive oxygen compounds in the male reproductive system can be key mechanisms by which RF-EMR affects male fertility. The negative effects associated with the duration of use of mobile phones are known and listed above. Therefore, the aim of this review article is to describe some of the effects of RF-EMR on the male reproductive system

Heart Failure Association of the ESC, Heart Failure Society of America and Japanese Heart Failure Society Position statement on endomyocardial biopsy

AbstractEndomyocardial biopsy (EMB) is an invasive procedure, globally most often used for the monitoring of heart transplant (HTx) rejection. In addition, EMB can have an important complementary role to the clinical assessment in establishing the diagnosis of diverse cardiac disorders, including myocarditis, cardiomyopathies, drug‐related cardiotoxicity, amyloidosis, other infiltrative and storage disorders, and cardiac tumours. Improvements in EMB equipment and the development of new techniques for the analysis of EMB samples have significantly improved diagnostic precision of EMB. The present document is the result of the Trilateral Cooperation Project between the Heart Failure Association of the European Society of Cardiology, the Heart Failure Society of America, and the Japanese Heart Failure Society. It represents an expert consensus aiming to provide a comprehensive, up‐to‐date perspective on EMB, with a focus on the following main issues: (i) an overview of the practical approach to EMB, (ii) an update on indications for EMB, (iii) a revised plan for HTx rejection surveillance, (iv) the impact of multimodality imaging on EMB, and (v) the current clinical practice in the worldwide use of EMB

Consensus on the assessment of systemic sclerosis-associated primary heart involvement: World Scleroderma Foundation/Heart Failure Association guidance on screening, diagnosis, and follow-up assessment

INTRODUCTION: Heart involvement is a common problem in systemic sclerosis. Recently, a definition of systemic sclerosis primary heart involvement had been proposed. Our aim was to establish consensus guidance on the screening, diagnosis and follow-up of systemic sclerosis primary heart involvement patients. METHODS: A systematic literature review was performed to investigate the tests used to evaluate heart involvement in systemic sclerosis. The extracted data were categorized into relevant domains (conventional radiology, electrocardiography, echocardiography, cardiac magnetic resonance imaging, laboratory, and others) and presented to experts and one patient research partner, who discussed the data and added their opinion. This led to the formulation of overarching principles and guidance statements, then reviewed and voted on for agreement. Consensus was attained when the mean agreement was ⩾7/10 and of ⩾70% of voters. RESULTS: Among 2650 publications, 168 met eligibility criteria; the data extracted were discussed over three meetings. Seven overarching principles and 10 guidance points were created, revised and voted on. The consensus highlighted the importance of patient counseling, differential diagnosis and multidisciplinary team management, as well as defining screening and diagnostic approaches. The initial core evaluation should integrate history, physical examination, rest electrocardiography, trans-thoracic echocardiography and standard serum cardiac biomarkers. Further investigations should be individually tailored and decided through a multidisciplinary management. The overall mean agreement was 9.1/10, with mean 93% of experts voting above 7/10. CONCLUSION: This consensus-based guidance on screening, diagnosis and follow-up of systemic sclerosis primary heart involvement provides a foundation for standard of care and future feasibility studies that are ongoing to support its application in clinical practice

Cystic Fibrosis – results of CFTR modulators in Croatia

Cistična fibroza najčešća je nasljedna bolest, koja skraćuje životni vijek, a uzrokuje je defekt u genu za transmembranski regulator provodljivosti cistične fibroze (eng. cystic fibrosis transmembrane regulator – CFTR). Poremećena je homeostaza elektrolita, što se očituje simptomima u više organskih sustava. Plućne manifestacije, s kroničnim infekcijama, upalom i, na kraju, respiratornim zatajenjem, ostaju i dalje najvažnija prijetnja životnom vijeku bolesnika. Do prije jednog desetljeća bilo je dostupno samo simptomatsko liječenje. Od 2012. g. dostupno je liječenje tzv. modulatorima CFTR-proteina i njihovim kombinacijama za osobe s cističnom fibrozom koje nose različite varijante CFTR-gena. Pojavom tih lijekova uvelike se promijenila perspektiva i kvaliteta života ljudi s cističnom fibrozom, ali postavljeni i novi izazovi u vezi s dugoročnim komplikacijama, pitanje eventualnog smanjenja konvencionalnog liječenja, ali i financiranja terapije, koja je mnogim bolesnicima nedostupna. Iznesene su bazične spoznaje o cističnoj fibrozi i funkciji CFTR-proteina, klasifikaciji varijanata CFTR-gena, mogućnostima liječenja CFTR-modulatorima te osnovni ishodi liječenja bolesnika s cističnom fibrozom u Hrvatskoj, gdje se ta terapija primjenjuje od jeseni 2021. godine.Cystic fibrosis, the most frequent lifespan shortening hereditary disease in Caucasians, is caused by a defect in the CFTR (cystic fibrosis transmembrane regulator) gene. Disturbed electrolyte homeostasis leads to the development of different symptoms in multiple organs. Pulmonary manifestations with chronic infections and inflammation result in respiratory failure and remain the most important life-shortening factor. Until recently only symptomatic treatment was available. In year 2012. a new treatment approach with small molecules that modulate the CFTR protein was introduced. Different combinations of CFTR modulators are applicable to certain patients carrying different variants of the CFTR gene. CFTR modulators made a huge difference in the quality of life and perspectives of people with cystic fibrosis. At the same time, new challenges emerged regarding long term complications and possible reduction of conventional treatment options, as well as financial issues that are an obstacle to the use of these drugs for many patients. This paper brings basic insight into cystic fibrosis, the function of CFTR protein, the classification of CFTR gene variants and possibilities of treatment with CFTR modulators as well as basic outcomes of CFTR modulators treatment in Croatia, where this therapy was introduced in autumn 2021