377 research outputs found
Bibliophilism of the Nobility as an Element of the Cultural Environment of the Central Chernozem Region in the First Half of the 19th Century
Introduction. The article examines the issue of the development of book collecting as a special feature that is formed in the provincial Russian reader in the first half of the XIX century. An important part of the formation of reading culture in the provincial environment was the gradual transition from traditional values to new behavioral and spiritual practices. Materials and methods. An important part of the formation of the reading culture in the provincial environment was the gradual transition from traditional values to new behavioral and spiritual practices. Historical experience shows that in Russia, as in European countries, reading is an attribute of the life of modernized groups of the population. The dominant social structures in established societies, based on ingrained patterns of behavior, were closely associated with oral communication. And only in modernized communities does the need for the printed word appear as a universal source of information transmission. Results. Drawn into the processes of social and economic modernization ofRussia in the XVIII century, the nobility intensively assimilated European culture, including its information transmitter – the works of foreign writers. As a result, by the end of the century, reading becomes an important component of the lifestyle of the upper class. At the same time, the development of foreign literature contributed to the transfer of Western socio-economic and cultural ideas to the Russian soil, catalyzed theprocess of intellectual "Europeanization" of the upper class. Conclusion. The prevalence of Frenchlanguage literature during this period was characteristic of the majority of the nobility and testified to the active involvement of the upper class in the process of "gallomania". The high level of education of the owners allowed them to have rich collections of literature in foreign languages, expanding the horizons of bibliophiles. The main role here was played by the works of French enlighteners, who formed the freethinking views of landowners, educating the ideas of freedom and equality
Association between time to reperfusion and echocardiography assessed left ventricular filling pressure in patients with first ST-segment elevation myocardial infarction undergoing primary coronary intervention
 Background: Diastolic dysfunction and elevated left ventricular (LV) filling pressure folÂlowing acute myocardial infarction are associated with adverse outcomes. Although time to reperfusion is a powerful prognostic marker following acute myocardial infarction, little is known about its impact on diastolic function and LV filling pressure. We hypothesized that delayed time to reperfusion will be associated with worse diastolic function. Methods: This study included 180 consecutive patients with first ST elevation myocardial inÂfarction (STEMI) treated by primary percutaneous coronary intervention (PCI). They presenÂted of chest pain within 24 h and underwent echocardiography within 3 days of primary PCI. Results: Median time to reperfusion, defined as the time from symptom onset to reperfusion at the end of primary PCI, was 185 min (interquartile range 120–660). Patients with reperfuÂsion time > 185 min (n = 92) had a significantly higher E/septal e’ (13.3 ± 5.0 vs. 9.7 ± 2.3, p < 0.001) and E/lateral e’ (9.8 ± 3.5 vs. 7.8 ± 2.2, p < 0.001) ratios, and more advanced diastolic grade (p < 0.001) compared to those having early reperfusion (n = 88). There were no significant differences in LV ejection fraction and left atrial volume between the two groups. Time to reperfusion was an independent predictor of early E/average e’ ratio. The adverse efÂfect of late reperfusion on diastolic dysfunction was more prominent in patients with anterior myocardial infarction. Conclusions: Longer time to reperfusion is associated with early elevated LV diastolic presÂsure in primary PCI-treated patients with STEMI.
Contribution of Ventricular Diastolic Dysfunction to Pulmonary Hypertension Complicating Chronic Systolic Heart Failure
ObjectivesThe aim of the study is to clarify the clinical role of Doppler-echocardiographic parameters of left ventricular diastolic dysfunction (LVDD) as determinants of pulmonary hypertension in patients experiencing left ventricular systolic dysfunction (LVSD) with and without the presence of functional mitral valve regurgitation (FMR).BackgroundPulmonary hypertension (pulmonary venous or mixed pulmonary venous-arterial hypertension) complicating LVSD is associated with poor outcomes beyond that of LVSD alone. The view of the contribution of LVDD as a determinant of pulmonary hypertension is controversial and not well defined as a tool in clinical practice.MethodsData from patients with LVEF ≤40% undergoing Doppler-echocardiography evaluations during the period from August 2001 to December 2004 were analyzed. Pulmonary systolic pressure (PSP), parameters of diastolic function (mitral valve [MV] transmitral flow velocity [E]/mitral annular diastolic velocity [e′] ratio, MV deceleration time [DT]), quantitated effective regurgitant orifice area (EROA) of FMR, and clinical characteristics were evaluated. Pulmonary hypertension was defined as an estimated PSP ≥45 mm Hg.ResultsCriteria were met in 1,541 patients; one-third (n = 533) demonstrating PSP ≥45 mm Hg (58 ± 10 mm Hg, range 45 to 102 mm Hg). Patients with pulmonary hypertension were older with higher E/e′ ratio, EROA, and lower DT and LVEF. In multivariate analysis, pulmonary hypertension was independently predicted not only by severity of FMR (EROA ≥20 mm2, odds ratio: 3.8, p < 0.001) but also by parameters of LVDD (E/e′ ratio ≥15, odds ratio: 3.31, p < 0.001; DT ≤150 ms, odds ratio: 3.8, p < 0.001). Receiver-operating characteristics curve analysis showed that EROA, E/e′ ratio, and DT provided significant incremental value in predicting pulmonary hypertension (c-statistic 0.830, p < 0.001).ConclusionsPatients with LVSD commonly have secondary pulmonary hypertension, which is largely determined by the severity of LVDD even with adjustment for FMR and low LVEF. Thus, measures of LVDD in routine clinical practice where PSP may not be estimated are important physiologic descriptors of hemodynamic status and are cumulatively linked in the prediction of pulmonary hypertension
Focused Review on Transthoracic Echocardiographic Assessment of Patients with Continuous Axial Left Ventricular Assist Devices
Left ventricular assist devices (LVADs) are systems for mechanical support for patients with end-stage heart failure. Preoperative, postoperative and comprehensive followup with transthoracic echocardiography has a major role in LVAD patient management. In this paper, we will present briefly the hemodynamics of axial-flow LVAD, the rationale, and available data for a complete and organized echocardiographic assessment in these patients including preoperative assessment, postoperative and long-term evaluation
Differential Proliferative Characteristics of Alveolar Fibroblasts in Interstitial Lung Diseases: Regulative Role of IL-1 and PGE2
Fibroblasts (Fb) from patients with sarcoidosis (SA) and
hypersensitivity pneumonitis (HP) exhibited a lower proliferative
capacity compared with Fb obtained from control (CO) and diffuse
interstitial fibrosis patients (DIF). Proliferation of Fb from SA or
lip patients was suppressed by autologous LPS-stimulated alveolar
macrophages (AM) supernatants but not by those from CO patients.
Similarly, alveolar macrophages (AM) derived supernatant, obtained
from CO, did not suppress the proliferation of SA and HP Fb. AM from
SA and HP patients secreted higher amounts of IL-1α and β
compared with controls and compared with Fb from SA and HP patients.
Steady levels of IL-1α and βmRNA were expressed in
unstimulated and stimulated cultures. Fb from SA and HP patients
could be stimulated by LPS to secrete significantly higher levels of
PGE2 than those detected in supernatants from LPS
stimulated Fb of DIF patients. Only the proliferation of Fb from SA
and HP patients was sensitive to amounts of IL-1 equivalent to those
detected in the lung of these diseases. As SA and HP are two
diseases where irreversible deterioration occurs in only 20%
of the patients, we hypothesize that mediators in the lung may
modulate Fb proliferation. IL-1 of AM origin and PGE2 of
Fb origin secreted at high levels, may be candidates for this
suppression because it was abrogated by anti IL-1β and indomethacin
Tricuspid Valve Academic Research Consortium Definitions for Tricuspid Regurgitation and Trial Endpoints.
Interest in the pathophysiology, etiology, management, and outcomes of patients with tricuspid regurgitation (TR) has grown in the wake of multiple natural history studies showing progressively worse outcomes associated with increasing TR severity, even after adjusting for multiple comorbidities. Historically, isolated tricuspid valve surgery has been associated with high in-hospital mortality rates, leading to the development of transcatheter treatment options. The aim of this first Tricuspid Valve Academic Research Consortium document is to standardize definitions of disease etiology and severity, as well as endpoints for trials that aim to address the gaps in our knowledge related to identification and management of patients with TR. Standardizing endpoints for trials should provide consistency and enable meaningful comparisons between clinical trials. A second Tricuspid Valve Academic Research Consortium document will focus on further defining trial endpoints and will discuss trial design options
Tricuspid Valve Academic Research Consortium Definitions for Tricuspid Regurgitation and Trial Endpoints.
Interest in the pathophysiology, etiology, management, and outcomes of patients with tricuspid regurgitation (TR) has grown in the wake of multiple natural history studies showing progressively worse outcomes associated with increasing TR severity, even after adjusting for multiple comorbidities. Historically, isolated tricuspid valve surgery has been associated with high in-hospital mortality rates, leading to the development of transcatheter treatment options. The aim of this first Tricuspid Valve Academic Research Consortium document is to standardize definitions of disease etiology and severity, as well as endpoints for trials that aim to address the gaps in our knowledge related to identification and management of patients with TR. Standardizing endpoints for trials should provide consistency and enable meaningful comparisons between clinical trials. A second Tricuspid Valve Academic Research Consortium document will focus on further defining trial endpoints and will discuss trial design options
Sex differences in heart failure patients assessed by combined echocardiographic and cardiopulmonary exercise testing
BackgroundWe aimed to test the differences in peak VO2 between males and females in patients diagnosed with heart failure (HF), using combined stress echocardiography (SE) and cardiopulmonary exercise testing (CPET).MethodsPatients who underwent CPET and SE for evaluation of dyspnea or exertional intolerance at our institution, between January 2013 and December 2017, were included and retrospectively assessed. Patients were divided into three groups: HF with preserved ejection fraction (HFpEF), HF with mildly reduced or reduced ejection fraction (HFmrEF/HFrEF), and patients without HF (control). These groups were further stratified by sex.ResultsOne hundred seventy-eight patients underwent CPET-SE testing, of which 40% were females. Females diagnosed with HFpEF showed attenuated increases in end diastolic volume index (P = 0.040 for sex Ă— time interaction), significantly elevated E/e' (P < 0.001), significantly decreased left ventricle (LV) end diastolic volume:E/e ratio (P = 0.040 for sex Ă— time interaction), and lesser increases in A-VO2 difference (P = 0.003 for sex Ă— time interaction), comparing to males with HFpEF. Females diagnosed with HFmrEF/HFrEF showed diminished increases in end diastolic volume index (P = 0.050 for sex Ă— time interaction), mostly after anaerobic threshold was met, comparing to males with HFmrEF/HFrEF. This resulted in reduced increases in peak stroke volume index (P = 0.010 for sex Ă— time interaction) and cardiac output (P = 0.050 for sex Ă— time interaction).ConclusionsCombined CPET-SE testing allows for individualized non-invasive evaluation of exercise physiology stratified by sex. Female patients with HF have lower exercise capacity compared to men with HF. For females diagnosed with HFpEF, this was due to poorer LV compliance and attenuated peripheral oxygen extraction, while for females diagnosed with HFmrEF/HFrEF, this was due to attenuated increase in peak stroke volume and cardiac output. As past studies have shown differences in clinical outcomes between females and males, this study provides an essential understanding of the differences in exercise physiology in HF patients, which may improve patient selection for targeted therapeutics
- …