Soil Contamination Interpretation by the Use of Monitoring Data Analysis

The presented study deals with the interpretation of soil quality monitoring data using hierarchical cluster analysis (HCA) and principal components analysis (PCA). Both statistical methods contributed to the correct data classification and projection of the surface (0–20 cm) and subsurface (20–40 cm) soil layers of 36 sampling sites in the region of Burgas, Bulgaria. Clustering of the variables led to formation of four significant clusters corresponding to possible sources defining the soil quality like agricultural activity, industrial impact, fertilizing, etc. Two major clusters were found to explain the sampling site locations according to soil composition—one cluster for coastal and mountain sites and another—for typical rural and industrial sites. Analogous results were obtained by the use of PCA. The advantage of the latter was the opportunity to offer more quantitative interpretation of the role of identified soil quality sources by the level of explained total variance. The score plots and the dendrogram of the sampling sites indicated a relative spatial homogeneity according to geographical location and soil layer depth. The high-risk areas and pollution profiles were detected and visualized using surface maps based on Kriging algorithm

Stable or improved neurological manifestations during miglustat therapy in patients from the international disease registry for Niemann-Pick disease type C: an observational cohort study

Background: Niemann-Pick disease type C (NP-C) is a rare neurovisceral disease characterised by progressive neurological degeneration, where the rate of neurological disease progression varies depending on age at neurological onset. We report longitudinal data on functional disease progression and safety observations in patients in the international NPC Registry who received continuous treatment with miglustat. Methods: The NPC Registry is a prospective observational cohort of NP-C patients. Enrolled patients who received ≥1 year of continuous miglustat therapy (for ≥90 % of the observation period, with no single treatment interruption >28 days) were included in this analysis. Disability was measured using a scale rating the four domains, ambulation, manipulation, language and swallowing from 0 (normal) to 1 (worst). Neurological disease progression was analysed in all patients based on: 1) annual progression rates between enrolment and last follow up, and; 2) categorical analysis with patients categorised as 'improved/stable' if ≥3/4 domain scores were lower/unchanged, and as 'progressed' if <3 scores were lower/unchanged between enrolment and last follow-up visit. Results: In total, 283 patients were enrolled from 28 centers in 13 European countries, Canada and Australia between September 2009 and October 2013; 92 patients received continuous miglustat therapy. The mean (SD) miglustat exposure during the observation period (enrolment to last follow-up) was 2.0 (0.7) years. Among 84 evaluable patients, 9 (11 %) had early-infantile (<2 years), 27 (32 %) had late-infantile (2 to <6 years), 30 (36 %) had juvenile (6 to <15 years) and 18 (21 %) had adolescent/adult (≥15 years) onset of neurological manifestations. The mean (95%CI) composite disability score among all patients was 0.37 (0.32,0.42) at enrolment and 0.44 (0.38,0.50) at last follow-up visit, and the mean annual progression rate was 0.038 (0.018,0.059). Progression of composite disability scores appeared highest among patients with neurological onset during infancy or childhood and lowest in those with adolescent/adult-onset. Overall, 59/86 evaluable patients (69 %) were categorized as improved/stable and the proportion of improved/stable patients increased with age at neurological onset. Safety findings were consistent with previous data. Conclusions: Disability status was improved/stable in the majority of patients who received continuous miglustat therapy for an average period of 2 years

Hemorheological system in coronary heart disease patients: prognostic value

Aim. To develop highly sensitive prognostic methods for coronary heart disease (CHD) and acute coronary event (ACE) risk stratification, on the basis of biophysical hemorheological system assessment. Material and methods. Seven-year follow-up data on CHD patients were analyzed: re-hospitalization rate and reasons; main hemorheological parameters, their temporal and velocity characteristics; hemorheological system modeling by creating phase fragments in multi-dimensional phase space. Results. Whole blood viscosity was significantly higher in patients with 3 or more ACE, comparing to ACE-free individuals or participants with &lt;3 ACE. Velocity parameter dynamics correlated with ACE hospitalization rate. Phase fragment method demonstrated hemorheological system destabilization, maximal in patients with 3 or more ACE. Conclusion. Prognostic value of whole blood viscosity and velocity assessment was demonstrated in CHD patients. Various CHD therapy algorithms, depending on hemorheological parameters and ACE risk, were developed

Heart and longevity — clinical and instrumental features

Aim. Due to the leading position of cardiovascular disease in the mortality and morbidity structure, it is important to investigate specific cardiovascular system features in the long-living elderly. Material and methods. In total, 200 long-living Saratov citizens were examined, 161 as out-patients and 39 as inpatients. Results. The clinical parameters of senile heart were identified, as well as the main characteristics of cardiac rhythm and conductive system in long-living individuals. Specific features of the heart failure clinical course were described. Conclusion. InSaratov citizens, the main medical and social predictors of longevity included female gender, regular physical activity, moderation-focussed lifestyle, absence of alcohol abuse or smoking, and positive personalit

A variation of palmaris longus muscle: clinical significance for hand surgery

The palmaris longus muscle (PL) is one of the most variable muscles in the human body. The PL may be agenetic, double, split, tendinous, digastric and may have various insertions. It may be inserted on the flexor retinaculum, the fascia of the forearm, the fascia and the muscles of the hypothenar, the short abductor of the thumb, near the metacarpophalangeal joints, the tendon of the flexor carpi ulnaris muscle, the pisiform bone or the scaphoid bone.A digastric PL was observed in one left forearm from a 69-year-old formol-carbol fixed Caucasian male cadaver. It originated in a usual way through a short, flat tendon from the medial epicondyle of the humerus which then prolonged into a fusiform muscle belly. Approximately halfway through the forearm, this muscle belly sharply transformed into a wide tendon, situated superficially along the midline of the forearm. In the distal fourth of the forearm, this tendon gradually prolonged into a second muscle belly with a thinner proximal end and wider distal portion, which resembled a teardrop. This muscle belly arched over the flexor retinaculum and inserted into the palmar aponeurosis. The innervation of the two muscle bellies was provided by multiple branches extending from the median nerve.In conclusion, the possible presence of PL variations must be considered by clinicians during clinical examination of the forearm, during surgical interventions in that region, or while searching for an entrapment site of the median and/or ulnar nerve. Due to its limited action in carpal flexion and the fact that there is no functional loss in the forearm and hand after its removal, it is an ideal donor for plastic and reconstructive surgery. However, this muscle can also be responsible for median and/or ulnar nerve compression syndromes. It may also simulate a tumor in the region of the antebrachium

Anatomical variations of the abductor pollicis longus muscle tendon-relation to de Quervain`s disease

Anatomical variations of the abductor pollicis longus muscle tendons are essential for successful treatment of de Quervain`s disease. Surgery includes tenosynovectomy and decompression of the first extensor compartment of the hand. Many patients have additional tendons, usually the abductor pollicis longus.Materials and Methods: A total of 30 formol-carbol fixed human upper extremities from the autopsy material available at the Department of Anatomy, Histology and Embryology at the Medical University of Sofia were precisely examined for the presence of accessory tendons of the abductor pollicis longus muscle.Results: In all of the examined upper extremities, accessory tendons of the abductor pollicis longus muscle were detected. Accessory tendons of this muscle were established in 26 hands (86.7%), 18 of which had one accessory tendon (69.2%), 6 hands had two accessory tendons (23.1%), and 2 hands had three accessory tendons (7.7%). Mean length, width, and thickness of the accessory tendons were 63.2 mm, 4.9 mm, 1.9 mm respectively. The presence of accessory tendons showed no side-to side differences.Conclusion: Due to the high incidence of accessory tendons of the abductor pollicis longus muscle, we consider that such variation requires to pay close attention and could lead to misinterpretations during surgery of de Quervain disease

MONITORING OF THE EFFECTIVENESS OF ANTIPLATELET THERAPY IN CARDIOLOGY PRACTICE

Monitoring of the effectiveness of drug therapy is one of the most debated issues in everyday clinical practice. The emergence of new drugs,  methods of analysis, standards, management protocols, and clinical guidelines increases the information load on practitioners and requires a significant investment of time and efforts for self-education. The purpose of the review is to help practitioners in summary form to obtain the necessary information on the issue of control of antiplatelet therapy. The review brings together data  from current  clinical recommendations on antiplatelet therapy in patients with ischemic heart disease, gives information of existing approaches to control of antiplatelet therapy specified in the guidelines and the consensuses of experts. It presents information on the most common modern methods of monitoring of the antiplatelet therapy effectiveness

Intrahospital switch of the P2Y12 inhibitors in patients with ST segment elevation myocardial infarction in ‘real-life’ clinical practice: the effect on the functional activity of thrombocytes and thrombocytopoiesis, prognostic value

Aim. To assess the P2Y12 inhibitors switch in patients ST segment elevation myocardial infarction (STEMI) in real-life’ clinical practice, evaluate the functional activity of thrombocytes and thrombocytopoiesis and determine the clinical and prognostic value of P2Y12 inhibitors switch in the framework of dual antiplatelet therapy in patients with STEMI.Material and methods. We conducted local, stratified, prospective study in which were involved 101 patients, hospitalized no later than 12hours after the STEMI manifestation. The antiplatelet therapy (APT), prescribed by the physicians at the pre-hospital and inpatient phases of treatment, was analyzed. Functional activity of thrombocytes, levels of thrombopoietin (THPO), stromal cell-derived factor 1 (SDF1) and thrombopoietic receptor (MPL) were investigated. The minimum observation period was 2 years. Death and repeated hospitalizations due to cardiovascular causes were monitored.Results. P2Y12 inhibitors were switched in 32,7% of patients with STEMI. In the hospital, clopidogrel, which was prescribed at the prehospital phase, was replaced with ticagrelor (early APT escalation) — 22,8%. Patients with early APT escalation by the seventh day had significantly greater inhibition of platelet aggregation activity parameters (slope of the aggregation curve, latent aggregation time and area under the aggregation curve). Activation of the collagen-induced platelet aggregation was detected. With the early escalation of APT, the THPO level was statistically significantly higher, both on the second and on the 7th day measurements: 256,2 (209,0; 396,8) pg/ml vs 137,5 (105,7; 179,1) pg/ml (p=0,000) and 283,4 (228,9; 334,3) pg/ml vs 226,5 (163,2; 287,3) pg/ml (p=0,045), respectively. The frequency of reaching the combined endpoint (death + re-hospitalization) was 7,9% in patients who had a P2Y12 switch, and 28,1% in patients who did not change the P2Y12 blocker.Conclusion. In actual clinical practice, patients with STEMI had the most frequent early APT escalation, which was characterized by a more significant suppression of adenosine diphosphate-induced platelet aggregation and secretion than in patients without P2Y12 inhibitors switch, but with activation of collagen-induced aggregation. An increase in thrombocytogenesis was revealed in early replacement of clopidogrel by ticagrelor. Intrahospital replacement of the P2Y12 inhibitor in patients with STEMI was accompanied by a decrease in the two-year death risk and repeated hospitalizations

ANTIPLATELET TREATMENT IN ST ELEVATION ACUTE CORONARY SYNDROME UNDER REAL CLINICAL CIRCUMSTANCES: THE DYNAMICS OF THROMBOCYTE FUNCTION

Aim. To evaluate the dynamics of thrombocyte functional activity (TFA) under antiplatelet treatment conditions which include the branded, and generic compounds as well, in ST elevation acute coronary syndrome patients (STEACS) in routine clinical practice.Material and methods. The open-label prospective study was done, including STEACS patients stratified according to the kind of antiplatelet in-patient treatment (original and/or generics). As an endpoint, we used the surrogate — functional activity of thrombocytes (TFA), measured by impedance and luminescent aggregatometry at 1 and 7 day from STEACS onset.Results. By the inclusion, baseline point all patients were comparable by TFA. On double antiplatelet therapy (DAT) by the 7th day of STEACS there was statistically significant difference of all ADP-induced thrombocyte aggregation. There was difference in ADP-induced platelet aggregation depending on the DAT variant, which included the original drug and generic.Conclusion. In STEACS patients the level of aggregation activity of platelets does significantly differ from the kind of antiplatelet treatment. Usage of the branded and generic compounds of the came antiplatelet agent by the same regimen does differ by different grade and dynamics of platelets activeness suppression