Dysregulation of the endogenous lipid mediators endocannabinoids and their G-protein-coupled cannabinoid receptors 1 and 2 (CB
R and CB
R) has been implicated in a variety of cardiovascular ...pathologies. Activation of CB
R facilitates the development of cardiometabolic disease, whereas activation of CB
R (expressed primarily in immune cells) exerts anti-inflammatory effects. The psychoactive constituent of marijuana, Δ
-tetrahydrocannabinol (THC), is an agonist of both CB
R and CB
R, and exerts its psychoactive and adverse cardiovascular effects through the activation of CB
R in the central nervous and cardiovascular systems. The past decade has seen a nearly tenfold increase in the THC content of marijuana as well as the increased availability of highly potent synthetic cannabinoids for recreational use. These changes have been accompanied by the emergence of serious adverse cardiovascular events, including myocardial infarction, cardiomyopathy, arrhythmias, stroke, and cardiac arrest. In this Review, we summarize the role of the endocannabinoid system in cardiovascular disease, and critically discuss the cardiovascular consequences of marijuana and synthetic cannabinoid use. With the legalization of marijuana for medicinal purposes and/or recreational use in many countries, physicians should be alert to the possibility that the use of marijuana or its potent synthetic analogues might be the underlying cause of severe cardiovascular events and pathologies.
Despite major advances in mechanical and pharmacological reperfusion strategies to improve acute myocardial infarction (MI) injury, substantial mortality, morbidity, and socioeconomic burden still ...exists. To further reduce infarct size and thus ameliorate clinical outcome, the focus has also shifted towards early detection of MI with high-sensitive troponin assays, imaging, cardioprotection against pathophysiological targets of myocardial reperfusion injury with mechanical (ischaemic post-conditioning, remote ischaemic pre-conditioning, therapeutic hypothermia, and hypoxemia) and newer pharmacological interventions (atrial natriuretic peptide, cyclosporine A, and exenatide). Evidence from animal models of myocardial ischaemia and reperfusion also demonstrated promising results on more selective anti-inflammatory compounds that require additional validation in humans. Cardiac stem cell treatment also hold promise to reduce infarct size and negative remodelling of the left ventricle that may further improves symptoms and prognosis in these patients. This review focuses on the pathophysiology, detection, and reperfusion strategies of ST-segment elevation MI as well as current and future challenges to reduce ischaemia/reperfusion injury and infarct size that may result in a further improved outcome in these patients.
Summary The relationship between the dental occlusion and temporomandibular disorders (TMDs) has been one of the most controversial topics in the dental community. In a large epidemiological ...cross‐sectional survey – the Study of Health in Pomerania (Germany) – associations between 15 occlusion‐related variables and TMD signs or symptoms were found. In other investigations, additional occlusal variables were identified. However, statistical associations do not prove causality. By using Hill’s nine criteria of causation, it becomes apparent that the evidence of a causal relationship is weak. Only bruxism, loss of posterior support and unilateral posterior crossbite show some consistency across studies. On the other hand, several reported occlusal features appear to be the consequence of TMDs, not their cause. Above all, however, biological plausibility for an occlusal aetiology is often difficult to establish, because TMDs are much more common among women than men. Symptom improvement after insertion of an oral splint or after occlusal adjustment does not prove an occlusal aetiology either, because the amelioration may be due to the change of the appliance‐induced intermaxillary relationship. In addition, symptoms often abate even in the absence of therapy. Although patients with a TMD history might have a specific risk for developing TMD signs, it appears more rewarding to focus on non‐occlusal features that are known to have a potential for the predisposition, initiation or perpetuation of TMDs.
Positron emission tomography (PET) myocardial perfusion imaging in concert with tracer-kinetic modeling affords the assessment of regional myocardial blood flow (MBF) of the left ventricle in ...absolute terms (milliliters per gram per minute). Assessment of MBF both at rest and during various forms of vasomotor stress provides insight into early and subclinical abnormalities in coronary arterial vascular function and/or structure, noninvasively. The noninvasive evaluation and quantification of MBF and myocardial flow reserve (MFR) extend the scope of conventional myocardial perfusion imaging from detection of end-stage, advanced, and flow-limiting, epicardial coronary artery disease (CAD) to early stages of atherosclerosis or microvascular dysfunction. Recent studies have shown that impaired hyperemic MBF or MFR with PET, with or without accompanying CAD, is predictive of increased relative risk of death or progression of heart failure. Quantitative approaches that measure MBF with PET identify multivessel CAD and offer the opportunity to monitor responses to lifestyle and/or risk factor modification and to therapeutic interventions. Whether improvement or normalization of hyperemic MBF and/or the MFR will translate to improvement in long-term cardiovascular outcome remains clinically untested. In the meantime, absolute measures of MBF with PET can be used as a surrogate marker for coronary vascular health, and to monitor therapeutic interventions. Although the assessment of myocardial perfusion with PET has become an indispensable tool in cardiac research, it remains underutilized in clinical practice. Individualized, image-guided cardiovascular therapy may likely change this paradigm in the near future.
Summary
Human posture is characterised by inherent body sway which forces the sensory and motor systems to counter the destabilising oscillations. Although the potential of biting to increase ...postural stability has recently been reported, the mechanisms by which the craniomandibular system (CMS) and the motor systems for human postural control are functionally coupled are not yet fully understood. The purpose of our study was, therefore, to investigate the effect of submaximum biting on postural stability and on the kinematics of the trunk and head. Twelve healthy young adults performed force‐controlled biting (FB) and non‐biting (NB) during bipedal narrow stance and single‐leg stance. Postural stability was quantified on the basis of centre of pressure (COP) displacements, detected by use of a force platform. Trunk and head kinematics were investigated by biomechanical motion analysis, and bite forces were measured using a hydrostatic system. The results revealed that FB significantly improved postural control in terms of reduced COP displacements, providing additional evidence for the functional coupling of the CMS and human posture. Our study also showed, for the first time, that reductions in the sway of the COP were accompanied by reduced trunk and head oscillations, which might be attributable to enhanced trunk stiffness during FB. This physiological response to isometric activation of the masticatory muscles raises questions about the potential of oral motor activity as a strategy to reduce the risk of falls among the elderly or among patients with compromised postural control.
Abstract Positron-emitting myocardial flow radiotracers such as15 O-water,13 N-ammonia and82 Rubidium in conjunction with positron-emission-tomography (PET) are increasingly applied in clinical ...routine for coronary artery disease (CAD) detection, yielding high diagnostic accuracy, while providing valuable information on cardiovascular (CV) outcome. Owing to a cyclotron dependency of15 O-water and13 N-ammonia, their clinical use for PET myocardial perfusion imaging is limited to a few centers. This limitation could be overcome by the increasing use of82 Rubidium as it can be eluted from a commercially available82 Strontium generator and, thus, is independent of a nearby cyclotron. Another novel F-18-labeled myocardial flow radiotracer is flurpiridaz which has attracted increasing interest due to its excellent radiotracer characteristics for perfusion and flow imaging with PET. In particular, the relatively long half-life of 109 minutes of flurpiridaz may afford a general application of this radiotracer for PET perfusion imaging comparable to technetium-99 m-labeled single-photon emission computed tomography (SPECT). The ability of PET in conjunction with several radiotracers to assess myocardial blood flow (MBF) in ml/g/min at rest and during vasomotor stress has contributed to unravel pathophysiological mechanisms underlying coronary artery disease (CAD), to improve the detection and characterization of CAD burden in multivessel disease, and to provide incremental prognostic information in individuals with subclinical and clinically-manifest CAD. The concurrent evaluation of myocardial perfusion and MBF may lead to a new era of a personalized, image-guided therapy approach that may offer potential to further improve clinical outcome in CV disease patients but needing validation in large-scale clinical trials.
Rapid loss of biodiversity worldwide has raised concerns about the consequences to ecosystem functioning, including processes such as litter decomposition. Consequent experiments with litter mixtures ...to assess effects of changing tree composition and diversity on decomposition have given mixed results, but the causes are not clear. Reasoning that such conflicting accounts reported in the literature may be reconciled by considering differences in functional litter traits, we conducted a field experiment in a stream with leaf litter from nine deciduous tree species mixed in a total of 40 combinations. Fine-mesh and coarse-mesh litter bags were used to distinguish between potential effects mediated by microbial decomposers and detritivores. We hypothesized that diversity effects would emerge in species mixtures containing functionally dissimilar leaves but be absent in mixtures of functionally similar litter as assessed by determining proximate lignin, nitrogen, and phosphorus contents of the litter. Mean decomposition rates of litter mixtures did not lend support to our hypothesis for either microbial decomposition (as inferred from mass loss in fine-mesh litter bags) or decomposition caused by both microbes and detritivores (mass loss from coarse-mesh bags). Decomposition rates were largely controlled by litter lignin content, whereas P and especially N were not important. In line with our hypothesis, the most recalcitrant (slowly decomposing) and most labile (rapidly decomposing) species decomposed slower and faster, respectively, in litter mixtures comprising different decay categories than in homogenous mixtures composed of a single decay category or in single-species litter bags. However, across decay categories, evidence was weak in support of the idea that functional litter dissimilarity matters, in spite of plausible mechanisms that could cause such effects.
Chest pain in patients without obstructive coronary artery disease has been realized as a frequent problem encountered in clinical practice. Invasive flow investigations have suggested that up to ...two-thirds of patients with nonobstructive coronary atherosclerosis may have microvascular dysfunction (MVD). Positron emission tomography myocardial perfusion imaging in conjunction with tracer-kinetic modeling enables the concurrent quantification of myocardial blood flow (MBF) in milliliters per minute per gram of tissue. This allows the assessment of hyperemic MBFs and myocardial flow reserve for the noninvasive identification and characterization of MVD as an important functional substrate for angina symptoms amenable to intensified and individualized medical intervention with nitrates, calcium-channel blockers, statins, angiotensin-converting enzyme inhibitors, and/or angiotensin II type 1 receptor blockers. Recent investigations suggest that cardiac magnetic resonance and computed tomography may also be suitable for the noninvasive detection of MVD. Whether intensified and individualized treatment related improvement or even normalization of hyperemic MBF and/or myocardial flow reserve may lead to a persistent reduction in angina symptoms and/or improved cardiovascular outcome as compared to standard care, deserves further testing in large-scale randomized clinical trials.
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