Myokardiale Leistung und Leistungseffizienz bei chronisch erhöhter Druck- und Volumenlast des linken Ventrikels

Einleitung: Die myokardiale Effizienz bildet das Verhältnis aus externer mechanischer Arbeit und myokardialem Energieverbrauch des linken Ventrikels (LV) ab. Die myokardiale Effizienz ist bei chronisch erhöhter Druck- und Volumenlast des LV beeinträchtigt. Ihre Quantifizierung hat jedoch keinen Stellenwert in der klinischen Diagnostik gefunden, da ihre Quantifizierung meist invasive Verfahren oder ionisierende Strahlung erforderte. Ziel dieser Arbeit war es die LV myokardiale Leistung und Effizienz bei Patienten mit chronisch erhöhter Druck- und Volumenlast mittels Magnetresonanztomographie (MRT) zu quantifizieren. Methodik: Die LV myokardiale Leistung, zirkulatorische Effizienz und externe myokardiale Effizienz wurden bei Patienten mit Aortenklappenstenose (AS, n=59), kombinierter Aortenklappenstenose/Aortenklappenregurgitation (AS/AR, n=21) und bei einer Kontrollgruppe (n=14) quantifiziert. Diese wurden aus Blutfluss- und LV-Volumetrie Messdaten der kardialen Magnetresonanztomographie berechnet. Ergebnisse: Die zirkulatorische Effizienz war signifikant niedriger bei AS, 8,6% (6,8–11,1;p 6,8W/m2) und klinische Symptome einer Herzinsuffizienz, während EF, LV Volumen und Masse im Normbereich waren. Zusammenfassung: Wir konnten die LV myokardiale Leistung und Effizienz bei Patienten mit chronisch erhöhter Druck- und Volumenlast nicht-invasiv und ohne ionisierende Strahlung quantifizieren. Traditionelle Parameter der kardialen Hypertrophie und der Funktion zeigten sich noch kompensiert, während die LV myokardiale Leistung und die zirkulatorische Effizienz bei erhöhter Druck-Volumenlast bereits beeinträchtigt waren. Das Myokard zeigte sich zudem in seiner Leistung und Effizienz nicht nur durch die erhöhte Druck- und Volumenlast, sondern auch durch das kardiale Remodeling belastet. Weitere longitudinal angelegte Studien sollten den Nutzen einer nicht-invasiven Quantifizierung myokardialer Leistung und Effizienz bei der Evaluierung von medikamentösen Therapien oder chirurgischen Interventionen untersuchen.Myocardial efficiency reflects the ratio of external mechanical work to myocardial energy consumption of the left ventricle (LV). Myocardial efficiency is reduced in pressure- and volume-overload conditions. However, this concept has not become clinical routine as its quantification has required usage of invasive tools or ionizing radiation. Aim of this work was to quantify LV myocardial power and power efficiency in patients with chronic pressure- and volume-overload using magnetic resonance imaging (MRI). Methods: LV myocardial power, circulatory efficiency and external myocardial efficiency were quantified in patients with aortic stenosis (AS, n=59), combined aortic stenosis/aortic regurgitation (AS/AR, n=21) and controls (n=14). Power and efficiency were calculated using blood flow and LV volumetric measurements obtained from cardiac MRI. Results: Circulatory efficiency was significantly lower in AS 8,6% (6,8–11,1;p 6,8W/m2) and patients presented clinical symptoms of heart failure while EF, LV volume indices and mass were in normal range. Conclusion: We quantified LV myocardial power and efficiency in patients with chronic pressure-volume overload non-invasively and without usage of ionizing radiation. Traditional parameters of cardiac hypertrophy and pump function were still compensated, while myocardial power and circulatory efficiency were gradually impaired in pressure-volume overload condition. Myocardial power and efficiency were not only influenced by pressure and volume load but also by cardiac remodeling. Longitudinal studies should investigate the value of a non-invasive quantification of myocardial power and efficiency in the monitoring of medical and surgical therapies

[5-Hydroxy-3-phenyl-1-(pyridin-2-yl)pyrazol-5-olato]diphenylboron

In the title compound, C26H20BN3O, the B atom has tetra­hedral geometry and is linked to two phenyl rings, the O atom of the hy­droxy­pyrazole ring and the N atom of the pyridinyl ring. A six-membered BOCNCN ring forms by coordination of the B atom and the pyridinyl N atom. The BOCNCN ring has an envelope conformation [dihedral angle = 36.7 (1)° between the planar ring atoms and the flap] with the B atom out of the plane. In the 1-(2-pyridin­yl)-3-phenyl-5-hy­droxy­pyrazole group, the pyridinyl ring, the phenyl ring and the pyrazole ring are almost coplanar: the pyrazole ring makes a dihedral angle of 9.56 (8)° with the pyridinyl ring and 17.68 (7)° with the phenyl ring. The crystal structure is stabilized by π–π stacking inter­actions involving the pyridinyl and pyrazole rings of centrosymmetrically related mol­ecules, with ring centroid separations of 3.54 (5) Å

Surrogates for myocardial power and power efficiency in patients with aortic valve disease

We aimed to assess surrogate markers for left ventricular (LV) myocardial power and efficiency in patients with isolated aortic stenosis (AS) and combined stenosis/regurgitation (AS/AR). In AS (n = 59), AS/AR (n = 21) and controls (n = 14), surrogates for LV myocardial power and circulatory/external myocardial efficiency were obtained from cardiac MRI. Median surrogate LV myocardial power was increased in AS, 7.7 W/m2 (interquartile range 6.0-10.2; p = 0.010) and AS/AR, 10.8 W/m2 (8.9-13.4; p < 0.001) when compared to controls, 5.4 W/m2 (4.2-6.5), and was lower in AS than AS/AR (p < 0.001). Surrogate circulatory efficiency was decreased in AS, 8.6% (6.8-11.1; p < 0.001) and AS/AR, 5.4% (4.1-6.2; p < 0.001) when compared to controls, 11.8% (9.8-16.9). Surrogate external myocardial efficiency was higher in AS, 15.2% (11.9-18.6) than in AS/AR, 12.2% (10.1-14.2; p = 0.031) and was significantly lower compared to controls, 12.2% (10.7-18.1) in patients with reduced ejection fraction (EF), 9.8% (8.1-11.7; p = 0.025). In 16% of all cases, left ventricular mass/volume indices and EF were within normal ranges, wheras surrogate LV myocardial power was elevated and patients were symptomatic. Although influenced by pressure/volume load, the myocardium is additionally affected by remodelling processes. Surrogates for circulatory efficiency and LV myocardial power gradually reflect alterations in patients with AS and AS/AR, even when surrogate external myocardial efficiency, EF, mass and volume indices still remain compensated

Two cases of female hydrocele of the canal of nuck

The processus vaginalis within the inguinal canal forms the canal of Nuck, which is a homolog of the processus vaginalis in women. Incomplete obliteration of the processus vaginalis causes indirect inguinal hernia or hydrocele of the canal of Nuck, a very rare condition in women. Here, we report 2 cases of hydrocele of the canal of Nuck that were diagnosed with ultrasonography in both cases and magnetic resonance imaging in 1 case to confirm the sonographic diagnosis. High ligation and hydrocelectomy were conducted in both patients. In 1 patient, 14 months later, the occurrence of contralateral inguinal hernia was suspected, but did not require surgery. The other patient had a history of surgery for left inguinal hernia 11 months before the occurrence of right hydrocele of the canal of Nuck. In both cases, the occurrence of an inguinal hernia on the contralateral side was noted

Utjecaj prekurzora na hlapljive sastojke vina dobivenog fermentacijom soka papaje pomoću mješovite kulture kvasaca

The impact of the addition of fusel oil or amino acids on the volatile compounds in papaya wine fermented with a mixed culture of Saccharomyces cerevisiae var. bayanus R2 and Williopsis saturnus var. mrakii NCYC 2251 at a ratio of 1:1000 was studied. Fusel oil addition increased the fraction of alcohols and promoted the production of isoamyl octanoate, isoamyl decanoate and isobutyl decanoate, while decreased the fraction of ethyl acetate and 2-phenylethyl acetate. The addition of amino acids enhanced the formation of total volatile fatty acids, 2-phenylethanol and some ethyl esters. The papaya wine with added amino acids possessed more acidic and buttery notes than the control, while that with added fusel oil had an overall aroma profile comparable to that of the control. This study suggests that papaya juice fermentation with mixed yeasts in conjunction with the added fusel oil or selected amino acids may be another method of modulating the flavour of papaya wine.U ovom je radu ispitan utjecaj dodatka patočnog ulja ili aminokiselina na hlapljive sastojke vina dobivenog fermentacijom soka papaje pomoću mješovite kulture kvasaca Saccharomyces cerevisiae var. bayanus R2 i Williopsis saturnus var. mrakii NCYC 2251 u omjeru 1:1000. Dodatkom patočnog ulja povećan je udjel alkohola, te je poboljšana proizvodnja izoamilnog oktanoata, izoamilnog dekanoata i izobutilnog dekanoata, dok je smanjen udjel etilnog acetata i 2-feniletilnog acetata. Nastanak hlapljivih masnih kiselina, 2-feniletanola i nekih etilnih estera pospješen je dodatkom aminokiselina. U usporedbi s kontrolnim uzorkom, vino proizvedeno fermentacijom papaje uz dodatak aminokiselina imalo je izraženiju kiselu i putrastu notu, dok se aroma vina kojem je dodano patočno ulje nije razlikovala. Ovo je istraživanje pokazalo da se fermentacijom soka papaje pomoću mješovite kulture kvasaca uz dodatak patočnog ulja ili odabranih aminokiselina može promijeniti aroma vina

Circulatory efficiency in patients with severe aortic valve stenosis before and after aortic valve replacement

Background: Circulatory efficiency reflects the ratio between total left ventricular work and the work required for maintaining cardiovascular circulation. The effect of severe aortic valve stenosis (AS) and aortic valve replacement (AVR) on left ventricular/circulatory mechanical power and efficiency is not yet fully understood. We aimed to quantify left ventricular (LV) efficiency in patients with severe AS before and after surgical AVR. Methods: Circulatory efficiency was computed from cardiovascular magnetic resonance (CMR) imaging derived volumetric data, echocardiographic and clinical data in patients with severe AS (n = 41) before and 4 months after AVR and in age and sex-matched healthy subjects (n = 10). Results: In patients with AS circulatory efficiency was significantly decreased compared to healthy subjects (9 +/- 3% vs 12 +/- 2%; p = 0.004). There were significant negative correlations between circulatory efficiency and LV myocardial mass (r = - 0.591, p < 0.001), myocardial fibrosis volume (r = - 0.427, p = 0.015), end systolic volume (r = - 0.609, p < 0.001) and NT-proBNP (r = - 0.444, p = 0.009) and significant positive correlation between circulatory efficiency and LV ejection fraction (r = 0.704, p < 0.001). After AVR, circulatory efficiency increased significantly in the total cohort (9 +/- 3 vs 13 +/- 5%; p < 0.001). However, in 10/41 (24%) patients, circulatory efficiency remained below 10% after AVR and, thus, did not restore to normal values. These patients also showed less reduction in myocardial fibrosis volume compared to patients with restored circulatory efficiency after AVR. Conclusion: In our cohort, circulatory efficiency is reduced in patients with severe AS. In 76% of cases, AVR leads to normalization of circulatory efficiency. However, in 24% of patients, circulatory efficiency remained below normal values even after successful AVR. In these patients also less regression of myocardial fibrosis volume was seen. Trial Registration clinicaltrials.gov NCT03172338, June 1, 2017, retrospectively registered

Exploring how socioeconomic status affects neighbourhood environments? : effects on obesity risks : a longitudinal study in Singapore

Research on how socioeconomic status interacts with neighbourhood characteristics to influence disparities in obesity outcomes is currently limited by residential segregation-induced structural confounding, a lack of empirical studies outside the U.S. and other 'Western' contexts, and an over-reliance on cross-sectional analyses. This study addresses these challenges by examining how socioeconomic status modifies the effect of accumulated exposures to obesogenic neighbourhood environments on children and mothers' BMI, drawing from a longitudinal mother-child birth cohort study in Singapore, an Asian city-state with relatively little residential segregation. We find that increased access to park connectors was associated with a decrease in BMI outcomes for mothers with higher socioeconomic status, but an increase for those with lower socioeconomic status. We also find that increased access to bus stops was associated with an increase in BMIz of children with lower socioeconomic status, but with a decrease in BMIz of children with higher socioeconomic status, while increased access to rail stations was associated with a decrease in BMIz of children with lower socioeconomic status only. Our results suggest that urban interventions might have heterogeneous effects by socioeconomic status.Peer reviewe