Association Between Common Cardiovascular Risk Factors and Clinical Phenotype in Patients with Hypertrophic Cardiomyopathy From the European Society of Cardiology (ESC) EurObservational Research Programme (EORP) Cardiomyopathy/Myocarditis Registry

The interaction between common cardiovascular risk factors (CVRF) and hypertrophic cardiomyopathy (HCM) is poorly studied. We sought to explore the relation between CVRF and the clinical characteristics of patients with HCM enrolled in the EURObservational Research Programme (EORP) Cardiomyopathy registry.1739 patients with HCM were studied. The relation between hypertension (HT), diabetes (DM), body mass index (BMI) and clinical traits was analyzed. Analyses were stratified according to the presence or absence of a pathogenic variant in a sarcomere gene.The prevalence of HT, DM and obesity (Ob) was 37%, 10%, and 21%, respectively. HT, DM and Ob were associated with older age (p<0.001), less family history of HCM (HT and DM p<0.001), higher New York Heart Association (NYHA) class (p<0.001), atrial fibrillation (HT and DM p<0.001; Ob p = 0.03) and LV (left ventricular) diastolic dysfunction (HT and Ob p<0.001; DM p = 0.003). Stroke was more frequent in HT (p<0.001) and mutation-positive patients with DM (p = 0.02). HT and Ob were associated with higher provocable LV outflow tract gradients (HT p<0.001, Ob p = 0.036). LV hypertrophy was more severe in Ob (p = 0.018). HT and Ob were independently associated with NYHA class (OR 1.419, p = 0.017 and OR 1.584, p = 0.004, respectively). Other associations, including a higher proportion of females in HT and of systolic dysfunction in HT and Ob, were observed only in mutation-positive patients.Common CVRF are associated with a more severe HCM phenotype, suggesting a proactive management of CVRF should be promoted. An interaction between genotype and CVRF was observed for some traits

A koherencia mint a lelki és testi egészség alapvető meghatározója a mai magyar társadalomban = Sense of coherence as an important determinant of mental and physical health

Az ún. salutogenezis modell olyan keretet kínál, amelyben a koherencia élmény bevezetésével lehetőség nyílik az „egész”-ség dinamikus értelmezésére. Vizsgálatunkban a Richard Rahe-féle, az „élet értelme” koherencia kérdőív összefüggéseit vizsgáltuk az egészségi állapottal. A Hungarostudy 2002 felmérés a 18 évesnél idősebb magyar népességet életkor, nem és terület szerint képviseli. 12 640 személlyel vettünk fel otthoni interjút. Az így vizsgált koherencia mutatót az egészségi állapot igen fontos előrejelzőjének találtuk. Ha az adatokat életkor, nem és iskolázottság szerint korrigáltuk, az egészségi állapot önbecslése mintegy 10-szer, a munkaképesség 8-szor jobb, a depresszió valószínűsége 7-szer alacsonyabb volt. Az „élet értelme” mutató igen szoros kapcsolatban áll az önhatékonysággal, a problémaorientált megbirkózással, a társas támogatással, ezzel szemben kevésbé függ az iskolázottságtól, az életkortól és a nemtől

Up-regulation of expression and lack of 5' CpG island hypermethylation of p16 INK4a in HPV-positive cervical carcinomas

BACKGROUND: High risk type human papilloma viruses (HR-HPV) induce carcinomas of the uterine cervix by expressing viral oncogenes E6 and E7. Oncogene E7 of HR-HPV disrupts the pRb/E2F interaction, which negatively regulates the S phase entry. Expression of tumor suppressor p16(ink4a )drastically increases in majority of HR-HPV associated carcinomas due to removal of pRb repression. The p16(ink4a )overexpression is an indicator of an aberrant expression of viral oncogenes and may serve as a marker for early diagnostic of cervical cancer. On the other hand, in 25–57% of cervical carcinomas hypermethylation of the p16 INK4a promoter has been demonstrated using a methylation-specific PCR, MSP. To evaluate a potential usage of the p16 INK4a 5' CpG island hypermethylation as an indicator of tumor cell along with p16(ink4a )overexpression, we analyzed the methylation status of p16 INK4a in cervical carcinomas METHODS: Methylation status of p16 INK4a was analyzed by MSP and by bisulfite-modified DNA sequencing. The expression of p16(ink4a )was analyzed by RT-PCR and by immunohistochemical technique. RESULTS: The extensive methylation within p16 INK4a 5' CpG island was not detected either in 13 primary cervical carcinomas or in 5 cancer cell lines by bisulfite-modified DNA sequencing (including those that were positive by MSP in our hands). The number and distribution of rare partially methylated CpG sites did not differ considerably in tumors and adjacent normal tissues. The levels of the p16 INK4a mRNA were increased in carcinomas compared to the normal tissues independently of the number of partially methylated CpGs within 5'CpG island. The transcriptional activation of p16 INK4a was accompanied by p16(ink4a )cytoplasmic immunoreactivity in the majority of tumor cells and presence of a varied number of the p16 positive nuclei in different tumors. CONCLUSION: Hypermethylaion of the p16INK4a 5' CpG island is not a frequent event in HR-HPV-positive cervical carcinomas and cannot be an effective marker of cancer cells with up-regulated expression of p16(ink4a). Our data confirm other previous studies claiming specific p16INK4a up-regulation in the majority of cervical carcinomas at both the protein and mRNA levels. Cytoplasmic accumulation of p16(ink4a )is a feature of cervical carcinomas

Die Wirkung psychologischer Spiele auf die mentale Gesundheit in der Erziehung

The percentage of those who have mental health problems is much higher in the group of people who chose supporting occupations (teachers, psychologists, etc.), than in the whole society. Teachers need personal development as psychotherapists do. In Rumania the realisation of such a project would involve many difficulties. Because of a misbelief (education is unidirectional) there is an expectation, indeed a very strong one, that teachers adopt the role of the Rescuer, somebody who tries to solve other people’s problems, even if the other refuses help. Experimental data confirm the tendency of teachers to adopt the role of the Rescuer. Adopting this role can have two negative consequences. 1) It negatively affects the maturation process of the child and 2) it becomes a source of psychological games in which participants make efforts both to suffer and to make others suffer. For prevention, an education for maturation is necessary, which is possible only in assertive conflict solving and in OK–OK life positions. Different psychological schools are analysed. This life position is adopted by humanist psychology and by transactional analysis. The promotion of humanistic psychology or transactional analysis-based pedagogy in Rumania can be helpful, but is not the only solution and is not the solution. The problem is that humanistic Gordon pedagogy is unknown, and there are no certified transactional analysis trainers in Rumania today. Menschen, die mit mentalen Problemen zu kämpfen haben, entscheiden sich häufiger für einen helfenden Beruf (Lehrer, Psychologe etc.). Auch Lehrer benötigen Selbsterfahrung, wie sie für Psychotherapeuten vorgeschrieben ist. Deren Einführung in Rumänien stößt jedoch auf großen Widerstand. Aufgrund des Irrglaubens, Erziehung sei ein unidirektionaler Prozess, stehen die Lehrer unter Druck, die Rolle des Retters zu übernehmen. Ein Retter versucht, nach eigenen Maßstäben die Probleme eines anderen gegen dessen Widerstand zu lösen. Die Ergebnisse von Experimenten bestätigen die Tendenz von Lehrern, als „Retter“ zu handeln. Die Rolle des Retters hat zwei negative Konsequenzen: Sie bremst die Reifung des Kindes und fördert die Entstehung von psychologischen Spielen. Bei diesen Spielen bemühen sich die Partner darum, selbst zu leiden bzw. den Partner leiden zu lassen, daher bedeuten diese eine ernsthafte Gefährdung der mentalen Gesundheit der Schule. Als Vorbeugung wird ein der Reifung des Kindes förderlicher Erziehungsstil verwendet, der nur mit Hilfe des assertiven Umgangs mit Konflikten und einer OK–OK-Haltung möglich ist. Der Autor kommt zu dem Schluss, dass diese Lebenseinstellung inbesondere von der humanistischen Psychologie und der Transaktionsanalyse vertreten wird. Die Einführung einer auf diesen psychologischen Schulen basierenden Pädagogik in Rumänien ist eine verlockende Möglichkeit, aber nicht die einzige und nicht die Möglichkeit. Die Schwierigkeit besteht darin, dass die Gordon-Pädagogik in der rumänischen Fachliteratur unbekannt ist, während die rumänische Transaktionsanalyse noch in den Kinderschuhen steckt

Differences between familial and sporadic dilated cardiomyopathy: ESC EORP Cardiomyopathy & Myocarditis registry

Aims: Dilated cardiomyopathy (DCM) is a complex disease where genetics interplay with extrinsic factors. This study aims to compare the phenotype, management, and outcome of familial DCM (FDCM) and non-familial (sporadic) DCM (SDCM) across Europe. Methods and results: Patients with DCM that were enrolled in the prospective ESC EORP Cardiomyopathy & Myocarditis Registry were included. Baseline characteristics, genetic testing, genetic yield, and outcome were analysed comparing FDCM and SDCM; 1260 adult patients were studied (238 FDCM, 707 SDCM, and 315 not disclosed). Patients with FDCM were younger (P\ua0<\ua00.01), had less severe disease phenotype at presentation (P\ua0<\ua00.02), more favourable baseline cardiovascular risk profiles (P\ua0 64\ua00.007), and less medication use (P\ua0 64\ua00.042). Outcome at 1\ua0year was similar and predicted by NYHA class (HR 0.45; 95% CI [0.25\u20130.81]) and LVEF per % decrease (HR 1.05; 95% CI [1.02\u20131.08]. Throughout Europe, patients with FDCM received more genetic testing (47% vs. 8%, P\ua0<\ua00.01) and had higher genetic yield (55% vs. 22%, P\ua0<\ua00.01). Conclusions: We observed that FDCM and SDCM have significant differences at baseline but similar short-term prognosis. Whether modification of associated cardiovascular risk factors provide opportunities for treatment remains to be investigated. Our results also show a prevalent role of genetics in FDCM and a non-marginal yield in SDCM although genetic testing is largely neglected in SDCM. Limited genetic testing and heterogeneity in panels provides a scaffold for improvement of guideline adherence