Regular Dog-Walking Improves Physical Capacity in Elderly Patients after Myocardial Infarction

Various positive effects of pet ownership on cardiovascular health are well known. The aim of this prospective and controlled longitudinal study was to determine the effects of everyday dog-walking on physical capacity in elderly patients during the first year after myocardial infarction. Regularly dog-walking for at least 15 minutes three times a day is related to significantly higher work load on the bicycle exercise test (72.5 ± 10.75 versus 67.6 ± 11.6 W, p<0.05) in the »dog-walking« group (N=29, mean age 72.5 years) at 12 months compared to the control group (N=30, mean age 71.7 years). Our results suggest that dogs may help to maintain continuous physical activity in elderly cardiovascular patients promoting their physical capacity. Further researches are needed to confirm this association as well to identify other possible influences of dog ownership on the cardiovascular health and on the outcome in patients after myocardial infarction

Mucins help to avoid alloreactivity at the maternal fetal interface

During gestation, many different mechanisms act to render the maternal immune system tolerant to semi-allogeneic trophoblast cells of foetal origin, including those mediated via mucins that are expressed during the peri-implantation period in the uterus. Tumour- associated glycoprotein-72 (TAG-72) enhances the already established tolerogenic features of decidual dendritic cells with the inability to progress towards Th1 immune orientation due to lowered interferon (IFN)- γ and interleukin (IL)-15 expression. Mucine 1 (Muc 1) supports alternative activation of decidual macrophages, restricts the proliferation of decidual regulatory CD56(+) bright natural killer (NK) cells, and downregulates their cytotoxic potential, including cytotoxic mediator protein expression. Removing TAG-72 and Muc 1 from the eutopic implantation site likely contributes to better control of trophoblast invasion by T cells and NK cells and appears to have important immunologic advantages for successful implantation, in addition to mechanical advantages. However, these processes may lead to uncontrolled trophoblast growth after implantation, inefficient defence against infection or tumours, and elimination of unwanted immunocompetent cells at the maternal-foetal interface. The use of mucins by tumour cells to affect the local microenvironment in order to avoid the host immune response and to promote local tumour growth, invasion, and metastasis confirms this postulation

Regular Dog-Walking Improves Physical Capacity in Elderly Patients after Myocardial Infarction

Various positive effects of pet ownership on cardiovascular health are well known. The aim of this prospective and controlled longitudinal study was to determine the effects of everyday dog-walking on physical capacity in elderly patients during the first year after myocardial infarction. Regularly dog-walking for at least 15 minutes three times a day is related to significantly higher work load on the bicycle exercise test (72.5 ± 10.75 versus 67.6 ± 11.6 W, p<0.05) in the »dog-walking« group (N=29, mean age 72.5 years) at 12 months compared to the control group (N=30, mean age 71.7 years). Our results suggest that dogs may help to maintain continuous physical activity in elderly cardiovascular patients promoting their physical capacity. Further researches are needed to confirm this association as well to identify other possible influences of dog ownership on the cardiovascular health and on the outcome in patients after myocardial infarction

Regular Dog-Walking Improves Physical Capacity in Elderly Patients after Myocardial Infarction

Various positive effects of pet ownership on cardiovascular health are well known. The aim of this prospective and controlled longitudinal study was to determine the effects of everyday dog-walking on physical capacity in elderly patients during the first year after myocardial infarction. Regularly dog-walking for at least 15 minutes three times a day is related to significantly higher work load on the bicycle exercise test (72.5 ± 10.75 versus 67.6 ± 11.6 W, p<0.05) in the »dog-walking« group (N=29, mean age 72.5 years) at 12 months compared to the control group (N=30, mean age 71.7 years). Our results suggest that dogs may help to maintain continuous physical activity in elderly cardiovascular patients promoting their physical capacity. Further researches are needed to confirm this association as well to identify other possible influences of dog ownership on the cardiovascular health and on the outcome in patients after myocardial infarction

Patohophysiological and molecular bases of cognitive dysfunction in cancer patients

U suvremenoj znanstvenoj i stručnoj literaturi sve je više navoda o kognitivnim poremećajima u oboljelih od zloćudnih bolesti koji mogu biti uzrokovani samim zloćudnim procesom (smještaj unutar središnjeg živčanog sustava ili oštećenje tkiva u sklopu paraneoplastičkog sindroma), njegovim liječenjem (radioterapijom, kemoterapijom ili kirurškim tehnikama), genetskim čimbenicima, infekcijom, anemijom, promjenama u imunološkom sustavu, metaboličkim poremećajem i/ili nutritivnim deficitima. Mogu se pojaviti u ranoj fazi zloćudne bolesti, neposredno prije njezinog otkrivanja ili započinjanja liječenja, u tijeku liječenja, a mogu trajati dugo nakon uspješnog izlječenja. Poremećaji pamćenja, učenja, koncentracije, računanja ili razmišljanja bilježe se u rasponu od blagih do vrlo teških poremećaja, koji sliče presenilnoj demenciji. Kognitivni poremećaji za oboljele od zloćudne bolesti predstavljaju značajne smetnje zbog svog utjecaja na kvalitetu života, radnu sposobnost i društvene aktivnosti, stoga se danas u svjetu podupiru istraživanja patofizioloških mehanizama nastanka kognitivnih poremećaja u takvih pacijenata. Cilj je otkriti pacijente sa zloćudnom bolešću koji imaju povećanu sklonost razvoja kognitivnih poremećaja u času postavljanja dijagnoze ili na samom početku liječenja na osnovi svoje genske predispozicije, kako bi se terapija zloćudne bolesti mogla tome prilagoditi i po mogućnosti spriječiti posljedice kognitivnih oštećenja. U ovom radu prikazujemo pregled literature i dosadašnje spoznaje o patofiziološkim i imunopatofiziološkim mehanizmima povezanosti zloćudne bolesti i kognitivnih funkcija.Recent studies showed clear evidence of neurocognitive deficits in patients with malignant disease. Cognitive disorders in these patients may be due to the malignant tumor (localization in the CNS or tissue damage as a part of the paraneoplastic syndrome), its treatment, infection, anemia, immune, genetic and metabolic disorders, nutritional deficiency, or a combination of these and many other factors. The first studies on this topic have focused on cognitive dysfunction as a side effect of chemotherapy, but recent evidence shows that they can occur at any stage of the malignancy, even before diagnosis, during therapy and long time after succsessful cure. Learning, memorizing, concentration, thinking and other cognitive and psychomotor disturbances could vary from very mild to serious deficits like dementia. Cognitive dysfunction in cancer patients is an important issue, because of its impact on the everyday quality of life, especially in the working, cognitive and social activities. Although many previous studies on the subject found some role of various cytokines, genes and other factors, scientists agree that we are still far from complete explanation of complex etiology of cognitive impairment in patients with malignant diseases. The aim of those studies was to discover and prevent cognitive deterioration in vulnerable cancer patients.We present here the literature review and the findings on patophysiological and immunopatophysiological mechanisms of cognitive disfunctions in cancer patients

Patohophysiological and molecular bases of cognitive dysfunction in cancer patients

U suvremenoj znanstvenoj i stručnoj literaturi sve je više navoda o kognitivnim poremećajima u oboljelih od zloćudnih bolesti koji mogu biti uzrokovani samim zloćudnim procesom (smještaj unutar središnjeg živčanog sustava ili oštećenje tkiva u sklopu paraneoplastičkog sindroma), njegovim liječenjem (radioterapijom, kemoterapijom ili kirurškim tehnikama), genetskim čimbenicima, infekcijom, anemijom, promjenama u imunološkom sustavu, metaboličkim poremećajem i/ili nutritivnim deficitima. Mogu se pojaviti u ranoj fazi zloćudne bolesti, neposredno prije njezinog otkrivanja ili započinjanja liječenja, u tijeku liječenja, a mogu trajati dugo nakon uspješnog izlječenja. Poremećaji pamćenja, učenja, koncentracije, računanja ili razmišljanja bilježe se u rasponu od blagih do vrlo teških poremećaja, koji sliče presenilnoj demenciji. Kognitivni poremećaji za oboljele od zloćudne bolesti predstavljaju značajne smetnje zbog svog utjecaja na kvalitetu života, radnu sposobnost i društvene aktivnosti, stoga se danas u svjetu podupiru istraživanja patofizioloških mehanizama nastanka kognitivnih poremećaja u takvih pacijenata. Cilj je otkriti pacijente sa zloćudnom bolešću koji imaju povećanu sklonost razvoja kognitivnih poremećaja u času postavljanja dijagnoze ili na samom početku liječenja na osnovi svoje genske predispozicije, kako bi se terapija zloćudne bolesti mogla tome prilagoditi i po mogućnosti spriječiti posljedice kognitivnih oštećenja. U ovom radu prikazujemo pregled literature i dosadašnje spoznaje o patofiziološkim i imunopatofiziološkim mehanizmima povezanosti zloćudne bolesti i kognitivnih funkcija.Recent studies showed clear evidence of neurocognitive deficits in patients with malignant disease. Cognitive disorders in these patients may be due to the malignant tumor (localization in the CNS or tissue damage as a part of the paraneoplastic syndrome), its treatment, infection, anemia, immune, genetic and metabolic disorders, nutritional deficiency, or a combination of these and many other factors. The first studies on this topic have focused on cognitive dysfunction as a side effect of chemotherapy, but recent evidence shows that they can occur at any stage of the malignancy, even before diagnosis, during therapy and long time after succsessful cure. Learning, memorizing, concentration, thinking and other cognitive and psychomotor disturbances could vary from very mild to serious deficits like dementia. Cognitive dysfunction in cancer patients is an important issue, because of its impact on the everyday quality of life, especially in the working, cognitive and social activities. Although many previous studies on the subject found some role of various cytokines, genes and other factors, scientists agree that we are still far from complete explanation of complex etiology of cognitive impairment in patients with malignant diseases. The aim of those studies was to discover and prevent cognitive deterioration in vulnerable cancer patients.We present here the literature review and the findings on patophysiological and immunopatophysiological mechanisms of cognitive disfunctions in cancer patients

Perforin Expression after Acute Myocardial Infarction – A Pilot Study

Perforin is an important mediator of inflammatory reactions. It is a quick-action cytotoxic mediator accumulated in the cytoplasmic granules of effector immunity cells (T lymphocytes, NK and NKT cells) which provide death signal in infected or transformed cells. Perforin-positive cells were previously detected in myocardial tissue during Trypanosoma cruzi infection and viral myocarditis while its role in chronic and progressive cardiovascular inflammatory disease such as atherosclerosis is almost completely unexplored. The perforin activity is also untested during acute coronary events that represent unexpected atherosclerotic complications due to the inflammatory destabilisation and atherosclerotic plaque rupture. The aim of this study was to investigate the presence of perforin, an important immunological inflammatory molecule in peripheral blood lymphocytes during the early period after acute myocardial infarction. We analyzed three subject groups: women with ST-segment elevation acute myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI), conservatively treated women with acute myocardial infarction without ST-segment elevation (NSTEMI) and a control group of healthy volunteers. The STEMI and NSTEMI groups did not basically differ in medication neither in levels of routine laboratory tests, while troponin I were significantly higher in the STEMI group. In the study, we detected an early decrease of perforin-positive lymphocytes in STEMI patients that were in contrast with their persisting elevation among NSTEMI patients. Despite greater myocardial necrosis in the STEMI group, results of this pilot-study indicated the prolonged perforin-mediated inflammatory response in patients with NSTEMI. This perforin down-regulation that follows the coronary interventional reperfusion in STEMI emphasized the possible anti-inflammatory role of primary PCI among patients with acute myocardial infarction. Given that the issue of routine primary PCI in NSTEMI is nowadays highly topical, the results we expect in the wake of this pilot study could demonstrate a significant impact on clinical practice. Further research is needed to confirm these results, compare the perforin- mediated activity to other inflammatory mediators in acute coronary events and to examine their impact on the long-term outcome

Endothelial dysfunction in sepsis

U fiziološkim uvjetima, endotel predstavlja dinamičku strukturu važnu u održavanju tonusa krvnih žila, regulaciji protoka krvi uz stijenke krvnih žila, vaskularne propusnosti, puteva zgrušavanja i adhezije leukocita. U sepsi, djelovanjem patogena i njihovih topljivih čimbenika dolazi do aktivacije endotela, oštećenja endotelnog glikokaliksa (EG) te pokretanja brojnih mehanizama koji imaju ključnu ulogu u razvoju i progresiji sepse. Nadalje, disfunkcija endotela i oštećenje EG ima za posljedicu snažni proupalni, prokagulacijski, proadhezivni i proapoptotični odgovor koji dovodi do disregualacije vaskularnog tonusa, povećane propusnosti krvnih žila, povećane adhezije i migracije leukocita uzrokujući razvoj šoka i višeorganskog zatajenja. U ovom preglednom radu prikazani su struktura i funkcija endotela i EG, opisani su mehanizmi njihovoga oštećenja tijekom sepse te posljedice koje nastaju njihovom disfunkcijom. Nadalje, iznijete su do sada poznate činjenice o metodama detekcije endotelne disfunkcije te mogućnostima njenog liječenja u sepsi s ciljem unapređenja liječenja septičnih bolesnika.Under physiological conditions, the endothelium is a dynamic structure important for maintaining blood vessel tone, regulating blood flow along vessel walls, vascular permeability, coagulation pathways, and leukocyte adhesion. In sepsis, exposure to pathogens and their soluble factors leads to activation of the endothelium, damage to the endothelial glycocalyx (EG), and initiation of numerous mechanisms that play a key role in the development and progression of sepsis. In addition, endothelial dysfunction and damage to the EG result in a potent proinflammatory, procoagulant, proadhesive, and proapoptotic response, leading to dysregulation of vascular tone, increased vascular permeability, increased leukocyte adhesion and migration, and the development of shock and multiorgan failure. In this review, the structure and function of the endothelium and EG are summarized and the mechanisms of their damage during sepsis as well as the consequences of their dysfunction are described. In addition, available knowledge about the methods of detecting endothelial dysfunction and the possibilities of its treatment in sepsis are presented, with the aim of improving the treatment of septic patients

The estimation of anemia degree in patients after heart valve replacement and coronary artery bypass surgery

Cilj: Utvrditi prisutnost, vrstu i stupanj anemije u bolesnika nakon operacije zamjene srčanih zalistaka i aortokoronarnog premoštenja tijekom prva tri tjedna rane stacionarne medicinske rehabilitacije. Ispitanici i postupci: Podaci su dobiveni analizom medicinske dokumentacije na temelju odobrenja Etičkog povjerenstva Specijalne bolnice za medicinsku rehabilitaciju bolesti srca, pluća i reumatizma „Thalassotherapia – Opatija” iz Opatije u skladu sa svim primjenjivim smjernicama Osnova dobre kliničke prakse i Helsinške deklaracije. Istraživanje je obuhvatilo 145 bolesnika s aortokoronarnim premoštenjem i 67 bolesnika sa zamijenjenim srčanim zaliskom. Obje skupine podijeljene su na skupinu muškaraca i žena, a rezultati uspoređivani sa zdravim ispitanicima korištenjem neparametrijskih testova Kruskal-Wallis i Mann-Whitneyjeva U-testa. Rezultati: U skupini žena i muškaraca nakon operacije zamjene srčanih zalistaka i nakon učinjenog aortokoronarnog premoštenja broj eritrocita, koncentracija hemoglobina i hematokrit statistički su značajno sniženi (sva tri P < 0,001) u odnosu na skupinu zdravih ispitanika, no nismo utvrdili značajnu razliku u hematološkim indeksima između navedenih skupina. Rasprava: U ispitivanih bolesnika postoje promjene u eritrogramu u smislu smanjenja broja normokromnih i normocitnih eritrocita, iako promjene nisu dostatne za proglašenje anemije. Zbog poznate povećane stope smrtnosti od anemije u srčanih bolesnika potrebno je tragati za razvojem anemije, procjenjivati stupanj i odrediti njezin uzrok, s ciljem pravovremenog i odgovarajućeg liječenja. Zaključak: Radi se o stanju koje se relativno jednostavno može liječiti preparatima željeza i vrlo oprezno lijekovima koji potiču eritrocitopoezu u bolesnika sa zatajivanjem bubrežne funkcije, što može spriječiti ili smanjiti potrebu za transfuzijama deplazmatiziranih eritrocita, koje u srčanih bolesnika nose više neželjenih reakcija.Aim: To determine the presence, type and degree of anemia in patients after heart valve replacement and coronary artery bypass grafting during the first three weeks of early stationary medical rehabilitation. Patients and methods: Data were obtained by analyzing medical records of the subjects following the approval of the Ethics Committee of Special hospital for medical rehabilitation of heart, lungs and rheumatism „Thalassotherapy – Opatija” from Opatija in accordance with all applicable guidelines in basics of good clinical practice and the Declaration of Helsinki. Research included 145 patients with coronary artery bypass and 67 patients with heart valve replacement. Both groups were divided into a group of men and women, and the results were compared with healthy subjects using nonparametric Kruskal- Wallis and Mann-Whitney U test. Results: In the group of women and men after heart valve replacement surgery and coronary artery bypass grafting the number of erythrocytes, hemoglobin concentration and hematocrit were significantly decreased compared to the control group (all P < 0,001), but no significant difference in hematological indexes were found. Discussion: In patients under observation there are changes in erythrogram in reducing the number of normochrome and normocyte erythrocytes, although the changes are not profound to declare the anemia. Because of the known increased mortality rates of anemia in cardiac patients, we should look for anemia, evaluate and determine its cause, in order to provide appropriate treatment in time. Conclusions: It is a condition that can be treated relatively easily with iron and very cautiously with drugs stimulating erythropoesis, particularly in patients with kidney insufficiency. It can prevent or decrease need for blood transfusions, which carry more side effects in cardiac patients