Our aim was to compare left ventricular (LV) deformation in subjects with masked hypertension (MH) to normotensive and sustained hypertensive patients. This cross-sectional study included 185 ...untreated subjects who underwent 24-hour ambulatory blood pressure (BP) monitoring and complete two-dimensional echocardiographic (2DE) examination including multilayer strain analysis. MH was diagnosed if clinic BP was normal (<140/90 mm Hg), and 24-hour BP was increased (≥130/80 mm Hg). 2DE LV longitudinal and circumferential strains gradually and significantly decreased from normotensive controls across MH individuals to sustained hypertensive patients. 2DE radial strain was not different between groups. 2DE longitudinal and circumferential endocardial and midmyocardial layer strains progressively decreased from normotensive control to sustained hypertensive individuals. Longitudinal and circumferential epicardial layer strains were lower in sustained hypertensive patients than in normotensive controls. Clinic and 24-hour systolic BP were associated with 2DE LV longitudinal endocardial strain, midmyocardial strain, and 2DE circumferential endocardial strain in the whole-study population independent of LV structure and diastolic function. MH significantly affect LV deformation assessed by 2DE traditional strain and 2DE multilayer strain. Clinic and 24-hour systolic BP were associated with LV mechanics evaluated with comprehensive 2DE strain analysis independent of LV structure and diastolic function.
In heart failure, a holistic approach incorporating the patient's perspective is vital for prognosis and treatment. Self-rated health has strong associations with adverse events and short-term ...mortality risk, but long-term data are limited. We investigated the predictive value of two consecutive self-rated health assessments with regard to long-term mortality in a large, well characterised sample of elderly patients with stable chronic heart failure.
We measured self-rated health by asking 'In general, would you say your health is: 1, excellent; 2, very good; 3, good; 4, fair; 5, poor?' twice: at baseline and the end of a 12-week beta-blocker up-titration period in the CIBIS-ELD trial. Mortality was assessed in an observational follow-up after 2-4 years. A total of 720 patients (mean left ventricular ejection fraction 45±12%, mean age 73±5 years, 36% women) rated their health at both time points. During long-term follow-up, 144 patients died (all-cause mortality 20%). Fair/poor self-rated health in at least one of the two reports was associated with increased mortality (hazard ratio 1.42 per level; 95% confidence interval 1.16-1.75; P<0.001). It remained independently significant in multiple Cox regression analysis, adjusted for N-terminal pro B-type natriuretic peptide (NTproBNP), heart rate and other risk prediction covariates. Self-rated health by one level worse was as predictive for mortality as a 1.9-fold increase in NTproBNP.
Poor self-rated health predicts mortality in our long-term follow-up of patients with stable chronic heart failure, even after adjustment for established risk predictors. We encourage clinicians to capture patient-reported self-rated health routinely as an easy to assess, clinically meaningful measure and pay extra attention when self-rated health is poor.
Many studies support the hypothesis that oxidative stress is involved in the pathogenic process of a variety of diseases including hypertension. In humans, hypertension is also considered a state of ...oxidative stress that can contribute to the development of arteriosclerosis and other hypertension-induced organ damage. The aim of this study was to evaluate an influence of acute physical exercise on antioxidative enzymes activity and lipid status in patients with hypertension.
Fourty patients with hypertension and 20 age-matched controls were included in the study. To assess an influence of acute exercise on lipids and antioxidative enzymes activity the following parameters were determined at rest and immediately after the acute cardiopulmonary exercise cycloergometer test: triglycerides (TG), total cholesterol, low density cholesterol (LDL), oxidised LDL cholesterol (OxLDL), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and plasminogen activator inhibitor (PAI).
In basal condition, hypertensive patients compared to the control group had increased, but not significantly, level of Ox LDL (88.61 +/- 14.06 vs 79.00 +/- 29.26 mmol/L), PAI (3.06 +/- 0.56 vs 2.6 +/- 0.35 U/mL) and activity of GSH-Px (50.22 +/- 15.20 vs 44.63 +/- 13.73 U/g Hb). After acute exercise test, there was significantly greater level of Ox LDL (79.0 +/- 29.26 vs 89.3 +/- 29.07 mmol/L; p < 0.05) only in the control group. GSH-Px activity was significantly decreased only in hypertensive patients after acute exercise (50.22 +/- 15.2 vs 42.82 +/- 13.42 U/g Hb; p < 0.05), but not in the controls.
No significantly elevated Ox LDL, GSH-Px and PAI-1 levels were found in hypertensive patients during basal condition in comparison with healthy subjects. Decreased GSH-Px activity was associated with those in acute exercise only in hypertensive patients. It could be an important indicator of deficiency of physiological antioxidative defense mechanism in hypertensive patients during an acute exercise.
Bone morphogenetic protein-9 (BMP-9) is a member of the transforming growth factor beta (TGF-β) superfamily of cytokines, which regulate cell growth and differentiation during embryogenesis. Apart of ...that, the hypoglycemic potential of BMP-9 is of great interest. It has been confirmed that BMP-9, like insulin, improves glycemia in diabetic mice and regulates directional glucose metabolism in hepatocytes; therefore it is proposed to be a candidate hepatic insulin-sensitizing substance (HISS). In liver fibrosis, due to the portocaval shunt, insulin bypasses the organ and the liver undergoes atrophy. Parenteral administration of insulin reverses atrophy by stimulating mitogenic activity of the hepatocytes. Because BMP-9 has a signaling pathway similar to other BMPs and insulin, it is to be expected that BMP-9 has a certain regenerative role in the liver, supporting the above-mentioned is evidence of BMP-9 expression in Dissè's spaces and BMP-7's mitogenic activity in mucosal cells. However, further studies are needed to confirm the possible regenerative role of BMP-9.
The term "tinea incognita" refers to diverse clinical presentation of mycotic infections modified by inappropriate use of topical or systemic corticosteroids. A 67-year-old male patient with a ...five-year history of generalized erythematous plaques on the trunk and extremities, previously treated with topical corticosteroids, is described. The lesions mainly showed a psoriasiform, some eczematous appearance, few of them showing a clinical picture of folliculitis. The native mycologic specimen was negative. The diagnosis was made on the basis of mycologic culture finding of Trichophyton interdigitale growth. Systemic and topical antimycotic therapy administered for two months resulted in complete regression of skin lesions.
Xanthoma disseminatum is a rare, benign, non-Langerhans' cell histiocytic disorder of unknown etiology. A case is presented of a 71-year-old man with a three-year history of disseminated symmetric ...yellowish papules and plaques on the skin of the face, neck, flexor regions, trunk, extremities and oral mucosa, with fatty infiltration of the liver and pancreas, and cardiac complaints. Xanthomatous rhinophyma predominated on the face. Clinical, immunohistochemistry and histology findings indicated the diagnosis of xanthoma disseminatum. Although the patient had a positive family history of cardiovascular diseases and a number of symptoms that are often associated with hyperlipidemia, repeat plasma levels were always within the normal limits. The case was interesting because of a number of etiologic factors that could be connected with the appearance of xanthomas in our patient. Therefore it was difficult to classify the disease into one of well-defined nosologic entities. The case report is supplemented with a review of relevant literature.
Mnogi dijagnostički i rekonstruktivni procesi u stomatologiji traže da se osnovne kretnje donje čeljusti, odnosi zubnih lukova i međusobni doticaji zuba vizualiziraju i analiziraju izvan pacijentovih ...usta. Zbog toga se nametnula potreba za mehaničkom napravom koja bi oponašala pokrete donje čeljusti i različite odnose unutar gornje i donje čeljusti. Osnovna namjena artikulatora jest da se model gornje i donje čeljusti učvrsti u određenom odnosu i omoguće kontrolirane kretnje tih modela tako da se dijagnostički i rekonstruktivni postupci mogu izvesti izvan pacijentovih usta.
Xanthoma disseminatum is a rare, benign, non-Langerhans´ cell histiocytic disorder of unknown etiology. A case is presented of a 71-year-old man with a
three- year his tory of disseminated ...symmetricyel low ish papules and plaques on the
skin of the face, neck, flexor regions, trunk, extremities and oral mucosa, with fatty
in filtration of the liver and pancreas, and cardiac complaints. Xanthomatous rhinophyma predominated on the face. Clinical, immunohistochemistry and histology
findings indicated the diagnosis of xanthoma disseminatum. Although the patient
had a positive family history of cardiovascular diseases and a number of symptoms
that are often associated with hyperlipidemia, repeat plasma levels were always
within the normal limits. The case was in teresting because of a number of etiologic
factors that could be connected with the appearance of xanthomas in our patient.
Therefore it was difficult to classify the disease into one of well-de fined nosologic
entities. The case report is supplemented with a review of rele vant literature.
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