Fractional flow reserve in patients with intermediate values of Duke Treadmill Score and borderline coronary lesions

Despite the wide usage of exercise ECG tests and Duke Treadmill Score (DTS) in clinical practice, no comparison between this scoring system and Fractional Flow Reserve (FFR) has yet been made, particularly in cases of angiographically verified borderline lesions. Thirty patients with single coronary lesions and angiographically assessed borderline stenosis (between 30-70%) and previously calculated intermediate values of DTS between -10 to +4 were examined using FFR. Adequate specificity and sensitivity (0.769 and 0.556, respectively) were in a more narrow range of -0.5 to -10. Sex and age did not have an influence on the DTS values. There was a correlation between the values of FFR and age (r=0.395, p=0.031) and between angiographic assessment of stenosis and quantitative coronary angiography (QCA) (r=0.648, p<0.0001). In the study population, a decision on revascularization could not be based solely on angiographic or QCA assessment of the artery or on the values of DTS

Renovascular hypertension: Clinical features, differential diagnoses and basic principles of treatment

© 2016, University of Kragujevac, Faculty of Science. All rights reserved. Renovascular hypertension is caused by renal artery stenosis. Its prevalence in populations of hypertensive patients is 1-8%, and in populations of patients with resistant hypertension, it is up to 20%. The two main causes of stenosis are atherosclerosis and fibromuscular dysplasia of the renal artery. The main clinical consequences of renal artery stenosis include renovascular hypertension, ischemic nephropathy and flash acute pulmonary oedema. Unilateral stenosis of the renal artery causes angiotensin II-dependent hypertension, and bilateral stenosis of the renal arteries produces volume-dependent hypertension. Renovascular aetiology of hypertension should be questioned in patients with resistant hypertension, hypertension with a murmur identified upon auscultation of the renal arteries, and a noticeable side-to-side difference in kidney size. Non-invasive diagnostic tests include the determination of concentrations of peripheral vein plasma renin activity, the captopril test, captopril scintigraphy, colour Doppler ultrasonography, computed tomography angiography, and nuclear resonance angiography. Renovasography represents the gold standard for the diagnosis of renovascular hypertension. The indications for revascularization of the renal artery include haemodynamically significant renal artery stenosis (with a systolic pressure gradient at the site of stenosis of - ΔP ≥ 20 mmHg, along with the ratio of the pressure in the distal part of the renal artery (Pd) and aortic pressure (Pa) less than 0.9 (Pd/Pa 0.8, chronic kidney disease (GFR <30 ml/min/1.73 m2) and negative captopril scintigraphy (lack of lateralization)

The effect of two types of mould inoculants on the microbiological composition, physicochemical properties and protein hydrolysis in two Gorgonzola-type cheese varieties during ripening

The aim of this paper was to investigate the role of two types of Penicillium roqueforti moulds (type esportazione and dolce) in the ripening of two Gorgonzola-type cheese varieties. Cheeses were analysed after 4, 14, 30 and 60 days of ripening. Microbiological analysis showed high numbers of total bacterial count, yeasts and moulds in both 60-day-old cheese varieties. The concentration of water-soluble N, nonprotein N and 5% phosphotungstic acid-soluble N increased significantly during ripening. Patterns of proteolysis by urea-polyacrylamide gel electrophoresis showed that rind-to-core gradients and age-related changes in moisture and salt content influenced mould and other enzyme activities, which are reflected in various rates of protein degradation. The hydrolysis of alpha s(1)- and beta-caseins was more extensive in the core than under the rind of both cheese varieties

Association of coronary ischemia estimated by fractional flow reserve and Psychological characteristics of patients

Introduction: Psychological characteristics of patients, depression, stress and anxiety are recognized as important confounding risk factors for ischemic heart disease. However, the impact of psychological characteristics on coronary ischemia and vice versa remain poorly understood. Aim: To demonstrate the interplay of psychological characteristics, depression, stress and anxiety with coronary ischemia estimated with fractional flow reserve (FFR). Material and methods: From 2014 to 2016, 147 patients who were planned for FFR measurement were included in this study. Psychological characteristics of patients were evaluated using the Depression, Anxiety and Stress Scale 21 items (DASS 21) self-report questionnaire. Results: Comparing the FFR ischemic vs. FFR non-ischemic groups, a significant difference was observed regarding results achieved for the depression, anxiety and stress scales. Multivariate logistic regression analysis was used to model the correlation between FFR and the DAS scale. It was clear, when controlling for previous myocardial infarction, that FFR was significant in all analyses. However, when the Canadian Cardiovascular Society grading of angina pectoris (CCS) class was entered in the model, FFR was not a significant predictor of anxiety, but was significant in other analysis. Conclusions: Higher degrees of the psychological characteristics depression, stress and anxiety were observed in the group of patients with coronary ischemia, corresponding to lower fractional flow values

Three-dimensional biomechanical model of benign paroxysmal positional vertigo in the semi-circular canal

© 2017, Strojarski Facultet. All rights reserved. Benign Paroxysmal Positional Vertigo (BPPV) is one of the most common vestibular disorders occuring due to the presence of basophilic particles in the semicircular canals (SCC). Three-dimensional biomechanical model of the SCC is described with full 3D fluid-structure interaction of particles, wall, cupula deformation and endolymph fluid flow. The model of the SCC with parametric defined dimension and fully 3D three SCC from patient specific 3D reconstruction is presented. Navier-Stokes equations with continuity equations described fluid flow while Arbitrary-Lagrangian Eulerian (ALE) formulation is used for mesh motion. Fluid-structure interaction for fluid coupling with cupula deformation is used. Particle tracking algorithm has been used for particle motion. Different size and number of particles with their full interaction between themselves, wall and cupula deformation are used. Velocity distribution, shear stress and force from endolymph side are presented for parametric one SCC and patient specific three SCC. All the models are used for correlation with the same experimental protocols with head moving and nystagmus eye tracking. Full fluid-structure interaction of otoconia particles, wall, cupula deflection and endolymph flow in three-dimension give more details and understanding of the pathology of the specific patient in standard clinical diagnostic and therapy procedure for BPPV

Karakteristike sireva sa dodatkom lekovitog i aromatičnog bilja

In the production of cheeses, the application of medicinal and aromatic herbs is reflected both in improving sensory characteristics, and increasing stability and shelf life of final products. Also, the final product gets new physiological properties, of the so-called functional food. The antimicrobial properties of aromatic and medical plants essential oils are well established against wide spectra of microbes including bacteria, viruses, yeasts and fungi. Cheeses with medicinal and aromatic herbs are traditionally produced in Turkey (mostly soft fresh cheese and white cheese in brine). However, there is a large assortment of this kind of cheeses that is produced throughout Europe, from the soft and semi-soft to semi-hard and hard cheeses. The main characteristic of all these cheeses is the use of medicinal and aromatic plants from the unique geographic area for each European country. There are numerous medical and aromatic plants used in cheese production. These include: mint, thyme, basil, parsley, sage, oregano, dill, pepper, cinnamon, cumin, ginger, rosemary, garlic, pepperoni, pepper, bay, mulberry, cloves, tarragon, fenugreek, celery, shallot, nettle, etc. Also, in many countries these cheeses are traditionally produced from cow, sheep and goat or mixed milk. In France, a country known for the production of many different cheese varieties, a large number of cheeses from goat milk is traditionally produced. Belgium is not far behind, where the large number of cheese varieties is produced as well as in the Netherlands and Germany. .U proizvodnji sireva, primena lekovitog i aromatičnog bilja se ogleda kako u poboljšanju senzornih karakteristika, tako i povećanju stabilnosti i roka trajanja finalnog proizvoda. Takođe se dobija proizvod sa novim fiziološkim svojstvima, tzv. Funkcionalna namirnica. Uloga ovog bilja u produžetku roka tajanja sireva se, između ostalog, ogleda u tome što etarska ulja mnogih lekovitih i aromatičnih biljaka imaju antimikrobnu aktivnost prema velikom broju bakterija, virusa, kvasaca i plesni, i predstavljaju potencijalno bogat izvor novih biocida i preservativa. Sirevi sa lekovitim i začinskim biljem tradicionalno se proizvode u Turskoj, i to su u pitanju pretežno meki beli sirevi i beli sirevi u salamuri. Ipak, postoji veliki asortiman ovih sireva koji se proizvode širom Evrope, od mekih, preko polumekih i polutvrdih do tvrdih. Ono što je karakteristično za sve ove sireve je da se upotrebljava lekovito i aromatično bilje, karakteristično za dato geografsko područje. Lekovito i aromatično bilje, koje se koristi u proizvodnji sireva, je brojno. Tu spadaju: nana, timijan, bosiljak, peršun, žalfija, origano, mirođija, biber, cimet, kim, đumbir, ruzmarin, beli luk, feferoni, aleva paprika, list lovora, list duda, karanfilić, estragon, piskavica, celer, vlašac, kumin, kopriva, itd. Takođe, u mnogim zemljama se već tradicionalno proizvode sirevi sa lekovitim i aromatičnim biljem, i to kako od kravljeg, tako i od ovčjeg i kozjeg ili mešanog mleka. Francuska, kao zemlja poznata po proizvodnji različitih varijeteta sireva, tradicionalno proizvodi veliki broj ovih sireva od kozjeg mleka. Ni Belgija mnogo ne zaostaje po asortimanu, a veliki broj ovih sireva proizvode i Holandija i Nemačka.

The mechanisms of the antihypertensive action of heparin in spontaneously hypertensive rats

The aim of this study was to examine the effects of heparin on blood pressure in spontaneously hypertensive rats (SHR). Chronic subcutaneous administration of heparin consistenly lowers blood pressure in hypertensive rats. This antihypertensive effect is related at least in part to a concomitant decrease in hematocrit. Spontaneously hypertensive rats were treated with subcutaneous heparin (700U/day) for 6 weeks. At the end of this period we determined cardiac output and total peripheral resistance. Weekly determinations of systolic blood pressure (tail-cuff) and hematocrit were done. Peripheral plasma renin activity, plasma aldosterone, plasma prostaglandins, and urinary kallikrein were measured. Blood pressure responses of acute and chronic heparin treatment to vasoconstrictor substances, including angiotensin I, angiotensin II and norepinephrine, were determined. Heparin produced a significant decrease in hematocrit and a parallel decrease in blood pressure. A significant increase in plasma renin activity was found in heparin treated SHR, but plasma aldosterone level significantly decreased. Plasma prostaglandins and urinary kallikrein levels were not different among the groups. The blood pressure responses to vasoactive substances were similar among the heparin treated and control groups. The results suggest that a reduced aldosterone level contributes to the antihypertensive mechanism of heparin

One year experience in treatment of multi-vessel coronary artery disease with PCI and TAXUS stent implantation in comparison to CABG

Objective. Previous experience in the treatment of multivessel coronary artery disease using PCI showed satisfactory short-term, but inferior long-term results in comparison to CABG. Certain groups of patients with multi-vessel disease treated with PCI may have long-term results equal to CABG. In the decision making process there is, apart from the angiographic finding, a need for careful evaluation of the patient's clinical state, treatment goals, previous knowledge and experience in order to reach the decision in the best interest of the patient. The aim of the study is to compare the outcome of PCI and TAXUS stent implantation with CABG in patients with multi-vessel coronary artery disease one year after the intervention. Methods. Our study included 114 patients in PCI group and 93 in CABG group, which were treated during 2004 and 2005. The outcome was expressed as the rate of MACCE which comprises death, reinfarction, CVI and reinterventions. Results. After one year follow-up composite MACCE rate was 17.5% in the PCI group and 14% in the CABG group (p=0.486). The rate of re-interventions between the PCI and CABG groups was 11,5% and 4.3% (p=0.064). There was no statistically significant difference between the incidence of MACCE (p=0.486) or between the frequency of reintervention between the groups (p=0.064). Conclusion. PCI with TAXUS stents implantation at one year follow up is equally effective as CABG in the treatment of multi-vessel coronary artery disease

Prevalence and risk factors for prolonged QT interval and QT dispersion in patients with type 2 diabetes

© 2016, The Author(s). Aims: Prolonged QT interval is associated with cardiac arrhythmias and sudden death. The present study determined the prevalence of prolonged QT interval and QT dispersion and defined their clinical and metabolic predictors in patients with type 2 diabetes. Methods: Cross-sectional study included 501 patients with type 2 diabetes. A standard 12-lead electrocardiogram was recorded. QT corrected for heart rate (QTc) >440 ms and QT dispersion (QTd) >80 ms were considered abnormally prolonged. QTc ≥ 500 ms was considered a high-risk QTc prolongation. Demographic, clinical and laboratory data were collected. Independent risk factors for prolonged QTc and QTd were assessed using logistic regression analysis. Results: Prevalence of QTc > 440 ms and QTd > 80 ms were 44.1 and 3.6 %, respectively. Prevalence of high-risk QTc (≥500 ms) was 2 % only. Independent risk factors for QTc prolongation >440 ms were mean blood glucose (β = 2.192, p  440 ms is significant, the prevalence of high-risk QTc (≥500 ms) and QTd > 80 ms is very low in patients with type 2 diabetes. Hyperglycaemia and coronary heart disease are strong predictors of high-risk QTc

Platelet aggregability and anticoagulant proteins activity during dobutamine stress echocardiography in asymptomatic patients four months after percutaneous coronary intervention

© 2019 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved. Background/Aim. Platelets aggregability (PA) and the activation of hemostasis during myocardial ischemia within physical or mental stress, can be one of many factors that influence the process of stent thrombosis after the percutaneous coronary intervention (PCI). The aim of the study is to investigate the relationship between the PA and activity of anticoagulant proteins with myocardial ischemia during the dobutamine stress echocardiography (DSE) in the asymptomatic patients 4 months after the PCI. Methods. The study population included 74 asymptomatic patients who had a successful PCI 4 months before a high-dose DSE. PA on epinephrine (EPI) and adenosine diphosphate (ADP) were determined by the Light Transmission Aggregometry (LTA), together with plasma activity of protein C and antithrombin before the DSE and at the peak stage of the stress test. The patients were divided into several groups on the basis of whether they have baseline or induced disturbance of segmental myocardial kinetics or not. All patients were on the clopidogrel and aspirin therapy at the time of DSE. Results. There were no statistically significant difference in the PA ADP (47.50% vs 50.20%; p = 0.970) as well as on EPI (59.30% vs 60.30%, p = 0.600) before and at the peak of DSE. A statistically significant difference was found in the anticoagulant activity of the antithrombin (84.85% vs 74.75%, p = 0.001) and protein C (77.75% vs 67.60%, p < 0.001). A significance of differences in antithrombin and the protein C, refered to the result before and at the peak levels of the test. There was no significant difference in the PA and plasma activity of anticoagulant proteins in the patients with or without induced myocardial ischemia at the peak of DSE. The patients who had an increased wall motion score index at the peak of DSE, had a higher EPI induced PA than the patients with normal myocardial contractility (68.60% vs 54.70%, respectively; p = 0.017). Conclusion. There are no changes in the PA before and after DSE, however, plasma activity of anticoagulant proteins decreased at the peak level of the test. The PA on EPI significantly increases at the peak of DSE in the patients with segmental myocardial hypocontractility