A Critical Review of Clinical Arteriogenesis Research

In human hearts, an extensive pre-existing collateral network is present. This was shown unequivocally some 50 years ago in a series of very detailed post-mortem angiographic studies. In these studies, it was also observed that the pre-existent collateral vessels enlarge upon closure of an epicardial coronary artery, resulting in large collateral conduit arteries, in sharp contrast to earlier claims that human coronary arteries are functional end arteries. These insights still form the basis for the concept of arteriogenesis as positive remodeling of pre-existent arteriolar connections. Subsequent experimental studies disclosed the putative role of circulating cells, especially monocytes, which invade the proliferating vessel wall and secrete growth factors, degrading enzymes and survival factors that are required for the development of a mature collateral circulation. Experimental stimulation of arteriogenesis is feasible but to date a relatively low number of clinical studies, with no or limited success, have been performed. The use of intracoronary derived collateral flow index can increase the sensitivity to detect the effects of pharmacological compounds on arteriogenesis, which is important in first proof-of-principle studies. These invasive measurements also allow the detection of patients with an innate defect in their arteriogenic response to coronary obstruction. In a reversed bedside-to-bench approach, the characterization of ribonucleic acid and protein expression patterns in these patients generated new targets for therapeutic arteriogenesis

A Clinical Investigation of Motivation to Change Standards and Cognitions about Failure in Perfectionism

Background: Clinical perfectionism is a transdiagnostic process that has been found to maintain eating disorders, anxiety disorders and depression. Cognitive behavioural models explaining the maintenance of clinical perfectionism emphasize the contribution of dichotomous thinking and resetting standards higher following both success and failure in meeting their goals. There has been a paucity of research examining the predictions of the models and motivation to change perfectionism. Motivation to change is important as individuals with clinical perfectionism often report many perceived benefits of their perfectionism; they are, therefore, likely to be ambivalent regarding changing perfectionism. Aims: The aim was to compare qualitative responses regarding questions about motivation to change standards and cognitions regarding failure to meet a personal standard in two contrasting groups with high and low negative perfectionism. Negative perfectionism refers to concern over not meeting personal standards. Method: A clinical group with a range of axis 1 diagnoses who were elevated on negative perfectionism were compared to a group of athletes who were low on negative perfectionism. Results: Results indicated that the clinical group perceived many negative consequences of their perfectionism. They also, however, reported numerous benefits and the majority stated that they would prefer not to change their perfectionism. The clinical group also reported dichotomous thinking and preferring to either keep standards the same or reset standards higher following failure, whilst the athlete group reported they would keep standards the same or set them lower. Conclusions: The findings support predictions of the cognitive behavioural model of clinical perfectionism

Науково-інформаційні ресурси порталу бібліотеки: формування, використання

Визначено шляхи вдосконалення процесів формування та використання електронних ресурсів порталу національної бібліотеки як базової компоненти єдиного науково-інформаційного простору держави.Определены пути усовершенствования процессов формирования и использования электронных ресурсов портала национальной библиотеки как базовой компоненты единого научно-информационного пространства государства.The ways of improvement of formation and usage processes of the electronic resources of the national library portal as a base component of unified scientific information space of the state are determined

Characterization of quantitative flow ratio and fractional flow reserve discordance using doppler flow and clinical follow-up

The physiological mechanisms of quantitative flow ratio and fractional flow reserve disagreement are not fully understood. We aimed to characterize the coronary flow and resistance profile of intermediate stenosed epicardial coronary arteries with concordant and discordant FFR and QFR. Post-hoc analysis of the DEFINE-FLOW study. Anatomical and Doppler-derived physiological parameters were compared for lesions with FFR+QFR− (n = 18) vs. FFR+QFR+ (n = 43) and for FFR−QFR+ (n = 34) vs. FFR−QFR− (n = 139). The association of QFR results with the two-year rate of target vessel failure was assessed in the proportion of vessels (n = 195) that did not undergo revascularization. Coronary flow reserve was higher [2.3 (IQR: 2.1–2.7) vs. 1.9 (IQR: 1.5–2.4)], hyperemic microvascular resistance lower [1.72 (IQR: 1.48–2.31) vs. 2.26 (IQR: 1.79–2.87)] and anatomical lesion severity less severe [% diameter stenosis 45.5 (IQR: 41.5–52.5) vs. 58.5 (IQR: 53.1–64.0)] for FFR+QFR− lesions compared with FFR+QFR+ lesions. In comparison of FFR−QFR+ vs. FFR-QFR- lesions, lesion severity was more severe [% diameter stenosis 55.2 (IQR: 51.7–61.3) vs. 43.4 (IQR: 35.0–50.6)] while coronary flow reserve [2.2 (IQR: 1.9–2.9) vs. 2.2 (IQR: 1.9–2.6)] and hyperemic microvascular resistance [2.34 (IQR: 1.85–2.81) vs. 2.57 (IQR: 2.01–3.22)] did not differ. The agreement and diagnostic performance of FFR using hyperemic stenosis resistance (> 0.80) as reference standard was higher compared with QFR and coronary flow reserve. Disagreement between FFR and QFR is partly explained by physiological and anatomical factors. Clinical Trials Registration https://www.clinicaltrials.gov; Unique identifier: NCT01813435. Graphical abstract: Changes in central physiological and anatomical parameters according to FFR and QFR match/mismatch quadrants