This article examines the status of religion in a global and a local (Bulgarian) context today. A parallel reading of key texts on the subject, written by sociologist Peter Berger and philosopher ...Charles Taylor, outlines the main characteristics of the religious situation in the contemporary world. Many different aspects of the relationship between religion and the fast globalizing modernity are examined. The main conclusion reached is that the renewed vitality of religion today is both a reaction against the advancing modernization and a realisation of opportunities created by itself. This global picture is used as a background against which the characteristics of the current religious situation in Bulgaria are analyzed.
Carotid stenting is used with an expanding indications. The neurotrophins are a family of proteins that induce the survival, development, and function of neurons. Carotid stenting alters cerebral ...blood flow and can affect neurotrophins' levels.
We included 78 people: 39 with significant carotid stenoses (CS) referred for carotid stenting (mean age 67.79 ± 10.53 years) and relatively healthy control group of 39 people without carotid and vertebral artery disease (mean age 57.42 ± 15.77 years). Brain derived reurotrophic factor (BDNF) and neuronal growth factor (NGF) concentrations were evaluated with ELISA method from venous blood - once for the control group; and for the carotid stenting group: before (n33), 24 h after (n22) and at least 1 month after (n18) carotid stenting.
There was a difference between the mean neurotrophins' concentration of patients with significant carotid stenoses and the group without: BDNF p = 0.001, CI (-5.11 to −1.44) (3.10 ± 3.10 ng/ml in CS vs. 6.37 ± 4.67 ng/ml in controls); NGF p = 0.049, CI (0.64-347.75), 195.67 ± 495.34 pg/ml in CS vs. 21.48 ± 52.81 pg/ml in controls. BDNF levels before carotid stenting (3.10 ± 3.10 ng/ml) were significantly lower than the postprocedural (4.99 ± 2.57 ng/ml) - p < 0.0001, CI (-2.86 to −0.99). For NGF there was a tendency for lower values after stenting: 195.67 ± 495.34 pg/ml before vs. 94.92 ± 120.06 pg/ml after, but the result did not reach statistical significance. The neurotrophins levels one month after carotid stenting and controls' were not significantly different p < 0.01 (BDNF 5.03 ± 4.75 ng/ml vs. 6.37 ± 4.67 ng/min; NGF 47.89 ± 54.68 pg/ml vs. 21.48 pg/ml).
Periprocedural and mid-term concentrations of neurotrophins after carotid stenting change in non-linear model. This may be due to changes in cerebral perfusion and also might be involved in neuronal recovery and reparation after reperfusion.
KEY MESSAGES
Periprocedural and mid-term concentrations of neurotrophins after carotid stenting change in non-linear model.
As the majority of them are not specific, their periprocedural change can be used as a clinical correlate to guide changes or even success in carotid stenting.
Changes in neutrophins' concentrations may be due to changes in cerebral perfusion and also might be involved in neuronal recovery and reparation after reperfusion.
This goes in analogy with cardiac high-sensitive troponin, used as procedural guidance in coronary interventions.
Considerable progress has been made in the treatment of coronary bifurcation stenosis. Anatomical characteristics of the vessel and lesion, however, fail to give information about the functional ...significance of the bifurcation stenosis. To the best of our knowledge, there is no study that systematically establishes the baseline functional significance of coronary stenosis and its effect on procedural and clinical outcomes. Patients with significant angiographic bifurcation lesions defined as diameter stenosis > 50% in main vessel and/or side branch were included. FFR was performed in main vessel (MV) and side branch (SB) before and after percutaneous coronary intervention (PCI). 169 patients from Fiesta study (derivation cohort) and 555 patients from prospective bifurcation registry (clinical effect cohort) were analyzed to validate angiographic prediction score (BFSS) used to determine the potentially functional significance of coronary bifurcation stenosis. Bifurcation functional significance score (including the following parameters-SYNTAX ≥ 11, SB/MB BARI score, MV %DS ≥ 55%, main branch (MB) %DS ≥ 65%, lesion length ≥ 25 mm) with a maximum value of 11 was developed. A cut-off value of 6.0 was shown to give the best discriminatory ability-with accuracy 87% (sensitivity 77%, specificity 96%, p < 0.001). There was also a significant difference in all-cause mortality between patients with BFSS ≥ 6.0 vs. BFSS < 6.0-25.5% vs. 18.4%, log-rank p = 0.001 as well as cardiac mortality: BFSS ≥ 6.0 vs. BFSS < 6.0-17.7% vs. 14.5%, log-rank (p = 0.016). The cardiac mortality was significantly lower in patients with smaller absolute SB territory, p = 0.023. An angiographic score (BFSS) with good discriminatory ability to determine the functional significance of coronary bifurcation stenosis was developed. The value for BFSS ≥ 6.0 can be used as a discriminator to define groups with higher risk for all-cause and cardiac mortality. Also, we found that the smaller side branches pose greater mortality risk.
BackgroundPercutaneous recanalization of coronary chronic total occlusions (CTO) remains one of the biggest challenges in interventional cardiology and is known to be associated with higher ...complication rate compared to regular coronary angioplasty. The aim of the current study is to explore the frequency and clinical outcomes of patients with procedural complications.MethodsAll patients with CTOs were included in prospective registry. CTO was defined as a total obstruction of a coronary artery with thrombolysis in myocardial infarction (TIMI) grade flow of 0 and duration of more than three months. Frequency of periprocedural complications were analyzed and all patients were followed-up for vital status.ResultsFor the purpose of current analysis we included 595 patients (66±10 years, 78% males) who underwent a total of 661 PCIs of chronic total occlusions. 623 procedures (94.3%) were successful with TIMI 3 final flow. In 10.9% (n=72) of the procedures there was a periprocedural complication defined ascoronary perforation (type I-III) 3.02% (n=20), puncture site haematoma 1.7%(n=11), coronary intramural haematoma 1.5%(n=10), coronary dissection n=5(0.8%). In 4 people (0.6%) there was perforation with formation of haemopericardium (type IV coronary perforation). On logistic regression analysis factors found to be significantly predictive for occurrence of complication were carotid artery disease (OR=4.794, CI1.718-13.374, p = 0.038) and renal failure (OR=1.774, CI1.060-2.967, p=0.016). At a median follow-up of 31 months (IQR 13-49) the overall death rate was 20.7% (n=123) and was significantly lower in noncomplicated vs complicated group (104/525, 19.8% vs 19/69, 27.5%, log-rank p=0.042). On Cox-regression analysis procedural complication was independent predictor of death (OR= 1.650, CI 1.011- 2.692, p= 0.042).ConclusionIn patients undergoing PCI for CTO the presence of periprocedural complication was independent predictors of mortality and these subjects had higher mortality rate at a median follow-up of 31 months.
Objective:
The explanation of the genetic aspects of dilatative cardiomyopathy (DCM) is important for at least two major reasons: 1. there is a phenotypic and clinical overlap between the various ...cardiomyopathies with DCM - thus it might be suggested DCM may be an end phenotype; 2. genetic predisposition to DCM might render the myocardium susceptible to various exogenous factors such as infections, alcohol, toxins, etc.
Design and method:
We share the results from the Next Gene sequencing of 10 patients with DCM. They were of various ages, with the inclusion requirement to be without coronary or hypertensive disease, and clinical manifestations of the DCM from yearly age. Bioinformatics analysis of the data was done with the appropriate protocol on a Dragen server, as well as VarSeq (Goldenhelix) for all NGS data.
Results:
This case series of Caucasian patients with DCM presented with mutations in TTN, TTN-AS1, SCN5A, RYR2, DSG2, DSG2-AS1, FLNC, LAMA4, ACTN2, GATA6, DMD genes. All these genes are responsible for structural sarcomere, nucleus proteins or ion transporters. They are common also in arrhythmogenic right ventricular dysplasia, hypertrophic cardiomyopathy, muscular dystrophy and Brugada syndrome. Omim search found them as VUS or weak pathogenic and only a mutation in TTN as likely pathogenic. Nevertheless, the cumulation of data for the genetic aspects of cardiomyopathies is important. The echocardiographic ejection fraction of the patients varied with the medical treatment and could not be used as guiding in their risk assessment.
Conclusions:
As far as the ejection fraction and left ventricular morphology are modifiable factors, we need a more specific way to assess the inherent risk in our cardiac patients. NGS might provide the necessary information, but we need to accumulate clinical and genetic data to make specific cardiomyopathy risk profiles. These risk profiles should be based on genetic analysis and not on ejection fraction or other morphological criteria, as we have cardiomyopathies’ overlap.
...the coronary wire was placed in every distal vessel with reference caliber >1.0mm, as well as in MB just below the stent, “mapping” zones for ischemia presence and distribution. On multivariate ...analysis independent predictor for mortality were parameter of i.c. ECG: residual icECG ST elevation in the side branch after stent placement in MB (p=.005), the difference in QRS complex width (pre-post PCI) in SB region, the R/S amplitude ratio of SB QRS complex.
Background The aim of this study is to explore and compare intracoronary electrocardiography (i.c.ECG) abilities to detect acute ischemia with FFR hemodynamic assessment during PCI of bifurcation ...lesions. The only other parameter which correlated significantly with both FFR and icECG STSE was SB maximum ST-segment elevation during first balloon implantation or during stent implantation (SB icECG STSE: r = 0.798, p < 0.001, SB FFR: r = -0.455, p = 0.020).
PDF
