Long-term outcomes of cardiac resynchronization therapy are worse in patients who require atrioventricular junction ablation for atrial fibrillation than in those with sinus rhythm

Background: The aim of the study was to assess the impact of atrial fibrillation (AF) with and without the need for atrioventricular junction (AVJ) ablation on outcomes in patients undergoing cardiac resynchronization therapy (CRT).Methods: A single center cohort of 200 consecutive CRT patients was divided into three groups: 1) AF with CRT pacing < 95% in which AVJ ablation was performed (AF-ABL, n = 40; 20%), 2) AF without the need for AVJ ablation (AF-non ABL, n = 40; 20%), 3) sinus rhythm (SR, n = 120; 60%). All patients were assessed before CRT implantation and at 6-month follow-up. Positive clinical response to CRT was considered alive status without the need for heart transplantation and improvement ≥ 1 NYHA after 6 months. The comparative analysis among all study groups with respect to response-rate and long-term survival was performed.Results: The 6-month response-rate in both AF-ABL and AF-nonABL was significantly lower than in SR (52.5 and 50 vs.77.5%, respectively; both p < 0.017), though there were no differences in baseline characteristics among study groups apart from higher baseline NT-proBNP levels in AF-ABL. However, after adjustment for this confounder, and despite optimal CRT pacing burden in study groups, the remote all-cause mortality during median follow-up of 36.1 months was significantly higher in AF-ABL than in SR (adjusted HR = 2.57, 95% CI 1.09–6.02, p = 0.03). What is more, no difference in long-term survival between SR and AF-nonABL was observed.Conclusions: Despite the improvement of CRT pacing burden and thus response-rate up to the level of AF subjects without the need for ablation, the long-term survival of AF patients requiring AVJ ablation remains still worse than in SR

Browsers, grazers or mix-feeders? Study of the diet of extinct Pleistocene Eurasian forest rhinoceros Stephanorhinus kirchbergensis (J¨ager, 1839) and woolly rhinoceros Coelodonta antiquitatis (Blumenbach, 1799)

The wooly rhinoceros (Coelodonta antiquitatis) and forest rhinoceros (Stephanorhinus kirchbergensis) were prominent representatives of the Middle and Late Pleistocene glacial and interglacial faunas of Eurasia. Their diet has traditionally been inferred on functional morphology of the dentition and skull. In rare cases, food remains are preserved in the fossas of the teeth or as gut content. New approaches to infer diet include the study of isotopes and mesowear. Here we apply all four methods to infer the diet of these emblematic rhinoceros’ species and compare the food actually taken with the food available, as indicated by independent botanical data from the localities where the rhinoceros’ fossils were found: Gorz´ow Wielkopolski (Eemian) and Starunia (Middle Vistulian) as well as analysis of literature data. We also made inferences on the season of death of these individuals. Our results indicate that the woolly rhino in both Europe and Asia (Siberia) was mainly a grazer, although at different times of the year and depending on the region its diet was also supplemented by leaves of shrubs and trees. According to the results of isotope studies, there were important individual variations. The data show a clear seasonal variation in the isotope composition of this rhino’s diet. In contrast, Stephanorhinus kirchbergensis was a browser, though its diet included low-growing vegetation. Its habitat consisted of various types of forests, from riparian to deciduous and mixed forests, and open areas. The diet of this species consisted of selected items of vegetation, also including plants growing near both flowing and standing waters. The food remains from the fossae of the teeth indicated flexible browsing, confirming the previous interpretations based on functional morphology and stable isotopes. Long-term data from mesowear and microwear across a wider range of S. kirchbergensis fossils indicate a more mixed diet with a browsing component. The different diets of both of rhinoceros reflect not only the different habitats, but also climate changes that occurred during the Late Pleistocene

The Buddhist Concept of Transmigration as a Structural Trick in Mishima Yukio’s „The Sea of Fertility”

The article takes up the problem of the structure of the last work of Mishima Yukio, the tetralogy Hōjō no umi (The Sea of Fertility). The book is considered to be Mishima’s opus magnum and his literary testament for the next generations. The article focuses on the Buddhist concept of transmigration which seems to be the writer’s structural trick on readers, a kind of perversive play in which the readers are not able to judge whether Mishima really believes in the concept of transmigration (jap. tenshō, sanskr. saṃsāra) or he is only mocking. Why did Mishima make this particular concept the axis of his book? The article aims at giving the answer to this question and suggests that the ultimate conclusion is yuishiki “consciousness only” (sanskr. vijñapti-mātratā)

Echokardiograficzna kwalifikacja i ocena odpowiedzi na terapię resychronizującą wśród pacjentów z przewlekłą niewydolnością serca. Metaloproteinaza macierzy zewnątrzkomórkowej−9 — subanaliza

Background: The concept of cardiac resynchronisation therapy (CRT) is based on biventricular pacing in symptomatic, chronic heart failure (HF) patients with systolic left ventricular (LV) dysfunction and QRS &#8805; 120 ms. The response to CRT is determined by clinical and echocardiographic parameters. The change of biochemical status (e.g. natriuretic peptides or metalloproteinase levels) caused by CRT is not well explored. Aim: To analyse the clinical and haemodynamic changes caused by CRT in relation to patients&#8217; biochemical status and to assess factors determining a favourable response to CRT. Methods: Fifty patients with chronic systolic HF (NYHA IV: two patients), wide QRS complex (160 &#177; 31 ms) and reduced LV ejection fraction (26 &#177; 5.8%) under optimal pharmacotherapy, who underwent CRT, were enrolled. Data on NT-proBNP and C-reactive protein serum levels, as well as standard echocardiography with tissue Doppler measurements, were collected before CRT and after six months of pacing. The levels of matrix metalloproteinase-9 (MMP-9) were assessed in a subgroup of 18 patients. Patients were regarded as responders if LV end-systolic volume decreased by 10% compared to baseline. Results: Thirty five (70%) patients responded favourably to CRT. Cardiac resynchronisation therapy resulted in an improvement of max. ventilatory oxygen uptake (12.9 &#177; 3.8 vs 16.6 &#177; 4.7 mL/kg/min; p < 0.05), a of NT-proBNP decrease (2,579 &#177; 2,598 vs 1,339 &#177; 1,088 pg/mL, p < 0.05), and decrease of atrio-, inter- and intra-LV dyssynchrony. A greater baseline dyssynchrony was observed in responders. A decrease of MMP-9 level following CRT was observed in 12 (67%) patients. Significant MMP-9 decrease was observed only in the subgroup of ischaemic HF patients (26,100 &#177; 7,624 pg/mL vs 23,360 &#177; 6,258 pg/mL; p = = 0.03). In patients with MMP-9 decrease during CRT, a lower C-reactive protein concentration at baseline was observed (2.12 &#177; 1.6 vs 4.7 &#177; 4.1 mg/L). The reduction in LV end-diastolic diameter correlated with the changes in MMP-9 level (r = = 51; p = 0.03). Baseline left atrial end-diastolic diameter measured in parasternal long-axis view &#163; 46 mm had a sensitivity of 83% and a specificity of 67% in predicting MMP-9 decrease (AUC 0.83; 95% CI 0.59&#8211;0.96). Conclusions: The CRT induces favourable myocardial remodelling, resulting in NT-proBNP level decrease, improvement of regional and global biventricular function, and MMP-9 level reduction, in ischaemic HF patients. The changes of MMP-9 level may be predicted by baseline left atrial end-diastolic diameter and correlate with LV end-diastolic diameter change during CRT. Kardiol Pol 2011; 69, 10: 1043&#8211;1051Wstęp: Terapia resynchronizująca (CRT) jest oparta na koncepcji synchronicznej stymulacji prawej i lewej komory (LV) u pacjentów z zaawansowaną przewlekłą niewydolnością w przebiegu dysfunkcji skurczowej LV i poszerzonym zespołem QRS &#8805; 120 ms. Korzystna odpowiedź na CRT jest definiowana za pomocą klinicznych i echokardiograficznych kryteriów. Zmiany stanu pacjenta na poziomie biochemicznym (peptydy natriuretyczne, metaloproteinazy macierzy zewnątrzkomórkowej) wymagają przeprowadzenia dalszych badań. Cel: Celem pracy była analiza klinicznych, hemodynamicznych i biochemicznych zmian pod wpływem CRT oraz znalezienie czynników determinujących korzystną odpowiedź na CRT. Metody: Do badania włączono 50 pacjentów ze skurczową niewydolnością serca (NYHA IV &#8212; 2 pacjentów), poszerzonym zespołem QRS (160 &#177; 31 ms) i obniżoną frakcją wyrzutową LV (26 &#177; 5,8%), optymalnie leczonych farmakologicznie, u których zastosowano CRT. Analizie poddano dane echokardiograficzne (z włączeniem doplera tkankowego) i biochemiczne (NT-proBNP i CRP) zebrane przed terapią i po 6 miesiącach CRT. Stężenie metaloproteinazy macierzy zewnątrzkomórkowej- 9 (MMP-9) oceniono w podgrupie 18 pacjentów. Korzystną odpowiedź na CRT definiowano jako spadek objętości końcowoskurczowej LV o 10% w porównaniu z wartością wyjściową. Wyniki: Na CRT korzystnie odpowiedziało 35 (70%) pacjentów. Pod koniec obserwacji zarejestrowano poprawę maksymalnego zużycia tlenu w teście spiroergometrcznym (VO2 , z 12,9 &#177; 3,8 do 16,6 &#177; 4,7 ml/kg/min; p < 0,05), zmniejszenie stężenia NT-proBNP (z 2579 &#177; 2598 do 1339 &#177; 1088 pg/ml; p < 0.05) oraz redukcję dyssynchronii między-, przedsionkowo- i śródkomorowej. Przed CRT większą dyssynchronię zaobserwowano w grupie korzystnej odpowiedzi na CRT. Obniżenie stężenia MMP-9 zanotowano u 12 (67%) pacjentów, w tym istotne statystycznie wśród osób z niedokrwienną etiologią niewydolności serca (26 100 &#177; 7624 pg/ml v. 23 360 &#177; 6258 pg/ml; p = 0,03). W grupie pacjentów z redukcją MMP-9 stwierdzono niższe wyjściowe stężenie CRP (2,12 &#177; 1,6 v. 4,7 &#177; 4,1 mg/l). Zmniejszenie wymiaru końcoworozkurczowego LV korelowało ze zmianami MMP-9 (r = 51; p = 0,03). Wymiar lewego przedsionka przed CRT mierzony w przymostkowej osi długiej &#163; 46 mm z 83-procentową czułością i 67-procentową swoistością przewidywał spadek stężenia MMP-9 (AUC 0,83; 95% CI 0,59&#8211;0,96). Wnioski: Terapia resynchronizująca powoduje korzystną przebudowę mięśnia sercowego ze zmniejszeniem stężenia NT-proBNP, poprawę funkcji globalnej i regionalnej komór serca i redukcję stężenia MMP-9 wśród pacjentów z niedokrwienną niewydolnością serca. Zmiany stężenia MMP-9 podczas CRT dobrze korelują ze zmianami wymiaru końcoworozkurczowego LV i można je przewidywać, oceniając wyjściowy wymiar lewego przedsionka. Kardiol Pol 2011; 69, 10: 1043&#8211;105

Physiological and inflammatory microflora of genital tract in bitches. Potential use of probiotics

Inflammatory diseases of reproductive system tract in bitches are a common problem in veterinary practice. The inflammation can lead to the serious health problems among which the most important are fertility disorders, embryos resorption and mortality, endometritis-pyometra syndrome and also disorders of urinary system. Research to determine the correlation between health status of females, phase of the cycle, age and bacterial flora of genital tract has been ongoing for years, but the results obtained by individual authors are often contradictory. An important aspect is the presence of probiotic bacteria in the female genital tract and the possible use of them in the prevention of inflammatory disorders. The aim of this paper was to gather the knowledge in this field and to present outcomes of current research projects

The in vitro effects of probiotic bacteria on genital pathogens of female dogs

Abstract Background An important aspect in the microbiology of the reproductive system of small animals is the potential occurrence of probiotic bacteria, such as lactic acid bacteria (LAB) of the genus Lactobacillus. The presence of these microorganisms is significant due to their strong antibacterial and antifungal properties. This study aimed to select probiotic strains from the oral cavity and vagina that have outstanding antibacterial properties against typical genital pathogens of the female dog reproductive tract. Results The antagonistic activity of ten LAB strains was tested against seven etiological agents isolated from the genital tract of female dogs with signs of inflammation. LAB strains with the greatest ability to inhibit the growth of indicator bacteria were Lactobacillus plantarum and L. acidophilus, while L. fermentum and L. brevis strains inhibited growth the least. Almost all strains showed a complete lack of adherence to Caco-2 epithelial cells. Conclusions All tested LAB isolates inhibited the in vitro growth of either Gram-positive or Gram-negative pathogens, suggesting that potential probiotic strains could contribute to the balance of the normal vaginal microbiota. Furthermore, they could be considered for use as prophylactic agents or as an alternative to antibiotic therapy for infections in dogs

Non-Invasive Measurement of Thyroid Hormones in Domestic Rabbits

Thyroid hormones are essential for metabolism, energy homeostasis and reproduction. Hormones can be measured in various biological source materials: blood, feces, urine, saliva and others. The aim of our study was to verify usefulness of thyroid hormone analysis in the urine and feces of the domestic rabbit (Oryctolagus cuniculus f. domesticus), comparing them with the serum analyses. Samples were collected from 27 does in the age of 12–14 weeks. Total thyroxine (tT4), total triiodothyronine (tT3), free thyroxine (fT4) and free triiodothyronine (fT3) were tested using the radioimmunological method in serum, feces and urine. The highest concentration of tT4 was found in feces (104.72 ± 59.52 nmol/mg) and the lowest in urine (3.03 ± 3.11 nmol/mL). The highest tT3 concentration was found in blood serum (3.19 ± 0.64 nmol/L) and the lowest in urine (0.31 ± 0.43 nmol/L). The highest concentration of fT4 was observed in feces (43.71 ± 4.79 pmol/mg) and the lowest in blood serum (14.97 ± 3.42 pmol/L). The statistically highest concentration of fT3 (28.56 ± 20.79 pmol/L) was found in urine, whereas the lowest concentration of this hormone was found in feces (3.27 ± 1.33 pmol/mg). There was a positive and statistically significant correlation between serum and urine fT3 (r = 0.76) and a high positive correlation between serum and feces fT3 concentration (r = 0.62). Correlations between concentrations of other thyroid hormones between serum, urine and feces were found to be insignificant. The results suggest that fT3 can be accurately and reliably measured in the feces and urine of the domestic rabbit