Prognostic value of red blood cell distribution width in patients with left ventricular systolic dysfunction: Insights from the COMMIT-HF registry

Background: Previous studies have reported that in patients with heart failure, an increased value of red cell distribution width (RDW) is associated with adverse outcomes. Nonetheless, data regarding the association between RDW values and long-term mortality in patients with left ventricular systolic dysfunction (LVSD) are lacking. The aim of this investigation was to examine the relationship between mortality and RDW in patients with ischemic and non-ischemic LVSD. Methods: Under analysis was 1734 patients with a left ventricular ejection fraction (LVEF) ≤ 35% of whom were hospitalized between 2009 and 2013. Patients were divided into three groups based on RDW tertiles. Low, medium and high tertiles were defined as RDW ≤ 13.4%, 13.4% < RDW ≤ 14.6% and RDW > 14.6%, respectively. Results: There was a stepwise relationship between RDW intervals and comorbidities. Patients with the highest RDW values were older and more often diagnosed with anemia, diabetes, atrial fibrillation and chronic kidney disease. The main finding of our analysis was the presence of an 8-fold increase in all-cause mortality in the entire cohort between high and low RDW tertile. Cox hazard analysis identi­fied RDW as an independent predictive factor of mortality in all patients (HR 2.8; 95% CI 2.1–3.8; p < 0.0001) and in subgroups of patients with ischemic (HR 2.8; 95% CI 2.0–3.9; p < 0.0001) and non-ischemic (HR 3.3; 95% CI 2.01–5.5; p < 0.0001) LVSD. Conclusions: The highest RDW tertile was independently associated with higher long-term mortality compared with low and medium tertiles, both in all patients with a LVEF ≤ 35% and in subgroups of patients with ischemic and non-ischemic LVSD

Postępowanie okołooperacyjne u pacjentów z wszczepionymi stentami typu DES

Considering the fact that the majority of stents implanted during percutaneous coronary intervention are drug-eluting stents (DES) and 5–25% of patients require a non-cardiac surgery within 5 years of implanting the stent, appropriate therapeutic procedures in the perioperative period are clinically significant. To prevent late thrombosis in patients with implanted DES, it is recommended to prolong — compared to implantation of bare metal stents — dual antiplatelet therapy. In the perioperative period, it is crucial to maintain balance between the risk of a potentially fatal haemorrhage and stent thrombosis. Taking into account the fact that premature cessation of dual antiplatelet therapy is the most significant risk factor of stent thrombosis, correct perioperative actions in patients with high risk of bleeding may present many clinical difficulties. In the study, factors that impact the risk of thrombosis and haemorrhage, as well as up-to-date guidelines and methods regarding the perioperative period procedures in patients with implanted DES have been presented.W związku z tym, że obecnie większość stentów implantowanych w trakcie przezskórnej interwencji wieńcowej to stenty uwalniające lek (DES), a 5–25% pacjentów wymaga zabiegu niekardiochirurgicznego w okresie 5 lat od wszczepienia stentu, to odpowiednie postępowanie w okresie okołooperacyjnym staje się istotnym problemem klinicznym. W celu prewencji późnej zakrzepicy u pacjentów z wszczepionymi stentami typu DES zaleca się przedłużony, w porównaniu ze stentami metalowymi, czas stosowania podwójnej terapii przeciwpłytkowej (DAPT). W okresie okołozabiegowym bardzo ważne jest odpowiednie balansowanie między ryzykiem niebezpiecznego dla życia krwawienia oraz zakrzepicy w stencie. Zważając na fakt, że przedwczesne przerwanie DAPT jest najbardziej znaczącym czynnikiem ryzyka zakrzepicy w stencie, to odpowiednie postępowanie w okresie okołooperacyjnym u pacjentów obciążonych wysokim ryzykiem krwawienia może przysporzyć wielu problemów klinicznych. W pracy przedstawiono czynniki wpływające na ryzyko zakrzepicy oraz krwawienia w okresie okołozabiegowym, a także najnowsze wytyczne i metody postępowania okołooperacyjnego u pacjentów z wszczepionymi stentami typu DES

The Role of Mesenchymal Stem Cells (MSCs) in Veterinary Medicine and Their Use in Musculoskeletal Disorders

Regenerative medicine is a dynamically developing field of human and veterinary medicine. The animal model was most commonly used for mesenchymal stem cells (MSCs) treatment in experimental and preclinical studies with a satisfactory therapeutic effect. Year by year, the need for alternative treatments in veterinary medicine is increasing, and other applications for promising MSCs and their biological derivatives are constantly being sought. There is also an increase in demand for other methods of treating disease states, of which the classical treatment methods did not bring the desired results. Cell therapy can be a realistic option for treating human and animal diseases in the near future and therefore additional research is needed to optimize cell origins, numbers, or application methods in order to standardize the treatment process and assess its effects. The aim of the following work was to summarize available knowledge about stem cells in veterinary medicine and their possible application in the treatment of chosen musculoskeletal disorders in dogs and horses