Abnormal shortened diastolic time length at increasing heart rates in patients with abnormal exercise-induced increase in pulmonary artery pressure

<p>Abstract</p> <p>Background</p> <p>The degree of pulmonary hypertension is not independently related to the severity of left ventricular systolic dysfunction but is frequently associated with diastolic filling abnormalities. The aim of this study was to assess diastolic times at increasing heart rates in normal and in patients with and without abnormal exercise-induced increase in pulmonary artery pressure (PASP). Methods. We enrolled 109 patients (78 males, age 62 ± 13 years) referred for exercise stress echocardiography and 16 controls. The PASP was derived from the tricuspid Doppler tracing. A cut-off value of PASP ≥ 50 mmHg at peak stress was considered as indicative of abnormal increase in PASP. Diastolic times and the diastolic/systolic time ratio were recorded by a precordial cutaneous force sensor based on a linear accelerometer.</p> <p>Results</p> <p>At baseline, PASP was 30 ± 5 mmHg in patients and 25 ± 4 in controls. At peak stress the PASP was normal in 95 patients (Group 1); 14 patients (Group 2) showed an abnormal increase in PASP (from 35 ± 4 to 62 ± 12 mmHg; P < 0.01). At 100 bpm, an abnormal (< 1) diastolic/systolic time ratio was found in 0/16 (0%) controls, in 12/93 (13%) Group 1 and 7/14 (50%) Group 2 patients (p < 0.05 between groups).</p> <p>Conclusion</p> <p>The first and second heart sound vibrations non-invasively monitored by a force sensor are useful for continuously assessing diastolic time during exercise. Exercise-induced abnormal PASP was associated with reduced diastolic time at heart rates beyond 100 beats per minute.</p

Medical genetics in developing countries in the Asia-Pacific region: challenges and opportunities

Advances in genetic and genomic technology changed health-care services rapidly in low and middle income countries (LMICs) in the Asia-Pacific region. While genetic services were initially focused on population-based disease prevention strategies, they have evolved into clinic-based and therapeutics-oriented service. Many LMICs struggled with these noncommunicable diseases and were unprepared for the needs of a clinical genetic service. The emergence of a middle class population, the lack of regulatory oversight, and weak capacity-building in medical genetics expertise and genetic counseling services led to a range of genetic services of variable quality with minimal ethical oversight. Some of the current shortcomings faced include the lack of awareness of cultural values in genetic health care, the variable stages of socioeconomic development and educational background that led to increased demand and abuse of genetics, the role of women in society and the crisis of gender selection, the lack of preventive and care services for genetic and birth defects, the issues of gene ethics in medicine, and the lack of understanding of some religious controversies. These challenges provide opportunities for both developing and developed nations to work together to reduce the inequalities and to ensure a caring, inclusive, ethical, and cost-effective genetic service in the region

Nanohybrid Resin Composites: Nanofiller Loaded Materials or Traditional Microhybrid Resins?

Nanohybrid resin composites present conventional particles to be mixed with nanomeric fillers and, therefore, it is unknown whether they may perform similarly to nanofilled or microhybrid resins. The current study investigated the properties of nanohybrid resins (TPH(3), Grandio, Premise, Concept Advanced) in comparison with a nanofilled (Supreme XT) and a microhybrid (Z250) composite. The inorganic fillers were characterized by SEM/EDS analysis. Diametral tensile strength (DTS), surface roughness before and after toothbrush abrasion, Knoop Hardness (KHN), water sorption and solubility were evaluated. The data were separately analyzed by ANOVA and the Student-Newman-Keuls' tests (p<0.05). The results of all analyses were material-dependent. Noticeable differences in filler size and shape were detected among the materials. Supreme XT generally showed higher DTS and KHN compared to all the nanohybrids and also showed lower surface roughness before and after toothbrush abrasion compared to most of the materials tested. Similar results were generally detected for the nanohybrids compared with the microhybrid material. In conclusion, the nanohybrid resins generally presented inferior properties compared with the nanofilled composite and either similar or slightly better properties compared to the microhybrid material. Under clinical conditions, nanohybrid resins may not perform similarly to nanofilled materials.34555155