Prispevek se osredotoča na upravno pravo EU, ki je ena od sodobnih pojavnih oblik upravnega prava in katerega obseg in pomen v zadnjih letih skokovito naraščata. Prispevek uvodoma opredeli, kaj ...upravno pravo EU sploh je. Temu sledi analiza ustvarjalcev upravnega prava EU, kakor tudi njegovih naslovnikov. V okviru teh je osrednja pozornost namenjena posamezniku. Predstavljeni so različni načini, kako upravno pravo EU vpliva na položaj posameznika in, z druge strani, kako lahko posameznik zavaruje svoje pravice in pravne interese v upravnih postopkih z evropskimi upravnimi organi. Prispevek sklene s kratko oceno pravnega položaja posameznika v upravnem pravu EU in z nekaj predlogi za njegovo izboljšavo.
Abstract Background The multifractal approach of HRV analysis offers new insight into the mechanisms of autonomic modulation of the diseased hearts and has a potential to depict subtle changes in ...cardiac autonomic nervous control not revealed by conventional linear and non-linear analyses in various conditions like heart failure or stable angina pectoris. The aim of this study was to employ the multifractality approach in cardiac surgery patients and evaluate the multifractality before and after beating-heart myocardial revascularization (off-pump CABG). Methods Twenty-four hour Holter recordings were performed pre- and postoperatively in 60 patients undergoing off-pump CABG. Selected conventional time- and frequency-domain linear HRV indices were calculated from the 24 h and 5 min ECG segments, and preselected multifractal parameters τ ( q=2 ), τ ( q=3 ), h _top and Δ h were determined for daytime (12:00–18:00) and nighttime (00:00–06:00) periods of the ECG recordings using Ivanov׳s method. Mean differences over time were tested using paired-samples t -test and exact Wilcoxon matched-pairs test. The results are reported as mean±SD and median with interquartile range. A p value of <0.05 was considered statistically significant. Results All selected conventional linear HRV parameters decreased significantly after off pump CABG ( p from <0.001–0.015). Preoperatively, multifractal parameter τ ( q=2 ) was −0.60±0.12 and −0.54±0.12, τ ( q=3 ) −0.52±0.18 and −0.49±0.17, h _top 0.20±0.07 and 0.15±0.07 and Δ h 0.31±0.14 and 0.17±0.14 for daytime and nighttime periods, respectively. Postoperatively, τ ( q=2 ) and τ ( q=3 ) were significantly higher for daytime (−0.49±0.15, p <0.001 and −0.43±0.23, p =0.015), whereas h _top and Δ h were significanly higher for both daytime and nighttime (0.25±0.07, p <0.001 and 0.19±0.06, p =0.002 for h _top and 0.41±0.20, p =0.003 and 0.31±0.19, p <0.001 for Δ h , respectively). All pre- and postoperative parameters, except τ ( q=2 ) and τ ( q=3 ) preoperatively, were significantly lower for nighttime as compared to daytime periods. Conclusions A significant breakdown of multifractal complexity and anti-correlation behavior with a significant sympathetic overdrive and a concomitant parasympathetic withdrawal occurs after off-pump CABG. The circadian pattern of multifractality regains its day–night variation in the first week after the surgical procedure.
Cardiovascular disease is among the leading causes of mortality in chronic obstructive pulmonary disease (COPD). Nonlinear heart rate variability (NHRV) measures are markers and predictors of ...cardiovascular disease, particularly arrhythmias. Our aim was to investigate NHRV in patients with COPD and changes after pulmonary rehabilitation. 20-minute ECGs were used to compare NHRV (a) in 45 healthy individuals and 31 patients with COPD and (b) in 16 patients who completed rehabilitation versus 13 age- and sex-matched control patients. We studied detrended fluctuation analysis (DFA1, DFA2), fractal dimension (low, high, average FD) and sample entropy. Compared to healthy individuals, patients with COPD had lower DFA1 (p=.038). During rehabilitation high FD decreased (p=.018) and DFA2 increased (p=.043). Cluster analysis displayed an increase of DFA1 in the rehabilitation cluster with DFA1 values below 1 (p=.032). NHRV reflects altered autonomic regulation in patients with COPD. Reduced DFA1 in patients with COPD implies a stronger pro-arrhythmic substrate and altered parasympathetic modulation.
AbstractChronic obstructive pulmonary disease negatively affects the autonomic nervous system and increases risks of arrhythmias and sudden cardiac death. Electrocardiogram (ECG) recordings were used ...to compare parameters of heart rate variability and QTc interval in patients with COPD and healthy individuals. The effects of a 4-week program of rehabilitation in patients with COPD were also evaluated by comparing pre- and post-rehabilitation ECGs with age- and sex-matched control COPD patients not participating in the program. Heart rate, average NN, SDNN, RMSSD, pNN50, TP, LF, HF, LF/HF, and QTc were analyzed. Rehabilitation effects were evaluated using the St. George's respiratory questionnaire (SGRQ), the 6-min walk test (6MWT), and the incremental shuttle walking test (ISWT). In comparison with the healthy individuals, the patients with COPD had higher heart rate (p < 0.05) and reduced average NN, SDNN, RMSSD, pNN50, HF, LF, and TP (all p < 0.05) but similar QTc interval (p = 0.185). During rehabilitation, SDNN and TP (p < 0.05 for both) increased, as did the results for 6MWT, ISWT, and SGRQ (all p < 0.05). No significant change of QTc interval was observed within or between the two groups of patients with COPD. Change in SDNN correlated with a clinically relevant difference in SGRQ (r = 0.538, p = 0.021). It is concluded that patients with COPD demonstrate reduced parameters of heart rate variability and that these can be improved in a rehabilitation program, thus improving health-related quality of life.
Postoperative atrial fibrillation (POAF) is a frequent complication after heart surgery. It has been shown that cardiac autonomic derangement plays a significant role in the genesis of atrial ...fibrillation (AF) and that AF might also be promoted by altered repolarization. Thus, the aim of our study was to determine the levels of cardiac autonomic modulation and repolarization properties in patients developing POAF.
Seventy-nine patients scheduled for aortic and/or coronary artery bypass grafting surgery with cardiopulmonary bypass were enrolled prospectively. High-resolution 20-minute electrocardiogram recordings were obtained day before surgery to determine P, PR, QT, and QTc intervals, as well as linear (time and frequency domain) and nonlinear heart rate variability parameters (fractal dimension and detrended fluctuation analysis). QTc interval was calculated using Framingham correction.
Twenty-nine patients developed POAF (AF group), and 50 did not (non-AF group). Groups were similar regarding demographics, surgery type, and perioperative characteristics, except for older age in the AF group. QT and QTc intervals (Framingham) were longer in the AF group 442 (44) vs 422 (28) milliseconds, P = 0.018; and 448 (44) vs 431 (24) milliseconds, P = 0.031 and P = 0.019, respectively. Time domain heart rate variability parameter PNN50 (percentage of pairs of adjacent NN intervals differing >50 milliseconds) was higher 14% (21%) vs 8% (16%), P = 0.015, and nonlinear parameter detrended fluctuation analysis α2 was lower in the AF group 0.81 (0.21) vs 0.91 (0.20), P = 0.031.
Profound cardiac autonomic derangement, suggestive of parasympathetic excessive modulation, exists preoperatively in patients inclined to POAF after cardiac surgery, whereby parameters PNN50 and α2 differentiated the AF from the non-AF group. Prolonged QTc intervals are associated with an increased risk of POAF.
The introduction of information and communication technologies (ICT) into the integrated healthcare system could increase the self-management of health and therefore increase the efficacy and ...decrease the costs of overall health management. A personal mobile health monitoring system (PCARD) has been developed, which uses moderately-priced and user-friendly technological solutions, e.g. wireless body sensors for data acquisition, advanced algorithms for data analysis, widely available smart phones for visualization of measurements, and the existing communication infrastructure for data transfer. The solution is unobtrusive, works with existing devices, and provides useful information to both direct users and to the health care system. The PCARD system starts with measurement of ECG signal that incorporates significant information about the global health state. It then continues with display of the signal and its analysis on a personal terminal, such as smartphone and on Cloud-based storage, processing, and visualization software. Four pilot studies have been designed to validate to which extent the continuous measured ECG data could contribute to improved quality and efficiency of the healthcare. Also, the level of safety and reliability, the acceptance from users, and the potential for commercialization will be validated in the scope of the pilots.
Advanced nonlinear methods of measuring heart rate variability (HRV) derived from the mathematics of complex dynamics and fractal geometry have provided new insights into the abnormalities of heart ...rate behavior in various pathologic conditions. These methods have provided additional prognostic information compared with traditional HRV measures and clearly have complemented the conventional linear methods. Knowledge about the behavior of complex cardiac dynamics indices after different cardiac procedures is very limited, however. We aimed to clarify how nonlinear heart rate dynamics are affected by beating-heart revascularization (off-pump coronary artery bypass graft CABG surgery) within the first week after the procedure.
Included in the study were 66 patients who had isolated stable multivessel coronary artery disease and were in normal sinus rhythm. The patients were on chronic beta-blocker therapy and were scheduled for off-pump CABG. We performed 15-minute high-resolution electrocardiographic recordings preoperatively and on the third and seventh postoperative days to assess linear and nonlinear heart rate dynamics. Frequency-domain measurements, detrended fluctuation analysis (DFA) with short-term (<or=11 beats, alpha1) and long-term (>11 beats, alpha2) correlation properties of RR-intervals, and fractal dimension (FD) measurements (average, high, and low) were made. Arrhythmia was monitored preoperatively with 24-hour Holter recordings, postoperatively by continuous monitoring for the first 4 days after the procedure, and subsequently by clinical monitoring; 24-hour Holter recordings were obtained again on the seventh postoperative day. We used the paired-samples Student t test, the Mann-Whitney U test, and the Fisher exact test for statistical analyses. Differences in arrhythmia occurrence before and after the procedure were tested with the Wilcoxon signed rank test and the McNemar test. A P level < .05 was considered statistically significant.
Values for all frequency-domain parameters decreased significantly after off-pump CABG (P< .001). Values for the alpha1 and high FD parameters decreased significantly after the procedure (P= .028 and .001, respectively), whereas alpha2 increased significantly (P= .023). DFA alpha1 was significantly lower in patients with postoperative atrial fibrillation than in patients remaining in sinus rhythm (mean +/- SD, 0.79+/-0.32 versus 1.13+/-0.45 P= .003 on the third postoperative day; 0.89+/-0.31 versus 1.22+/-0.34 P< .001 on the seventh postoperative day), whereas low and average FDs were significantly higher (1.84+/-0.16 versus 1.68+/-0.19 P= .003 on the third postoperative day and 1.77+/-0.18 versus 1.66+/-0.17 P= .01 on the seventh postoperative day for the low FD; 1.83+/-0.09 versus 1.76+/-0.10 P= .011 on the third postoperative day and 1.80+/-0.11 versus 1.73+/-0.10 P= .014 on the seventh postoperative day for the average FD). The low FD was significantly higher on the third postoperative day in patients with postoperative deterioration of ventricular ectopy than in patients with improved ventricular ectopy (1.74+/-0.17 versus 1.48+/-0.08, P= .03).
The decreases in alpha1, average FD, and high FD indicate that a profound decay of cardiac complexity and fractal correlation can be observed after off-pump CABG. Furthermore, a more extensive impairment of nonlinear indices was observed in patients who developed postoperative arrhythmias than in those who remained in stable sinus rhythm. Our findings suggest that the postoperative hyperadrenergic setting acts as a preliminary condition in which both reduced and enhanced vagal activity may predispose patients to arrhythmia, indicating that postoperative rhythm disturbances are an end point associated with divergent autonomic substrates.
Abstract Reduced cardiac vagal modulation increases propensity to arrhythmias. Right decubitus position is a vagal enhancer in coronary and congestive heart disease. We evaluated vagal modulation ...before and after coronary artery bypass grafting (CABG) in 30 patients. Heart rate variability (HRV) indexes in frequency domain were calculated from 10-min digital electrocardiograms. Kolmogorov–Smirnov and paired t -tests were applied, p < 0.05 was considered significant. The HRV indexes decreased after CABG. Higher LF/HF ratio and shorter mean RR were observed in right recumbent position postoperatively. Right lateral decubitus position did not give rise to higher vagal modulation after heart surgery.
