A Comprehensive Overview on Chemotherapy-Induced Cardiotoxicity: Insights into the Underlying Inflammatory and Oxidative Mechanisms

While oncotherapy has made rapid progress in recent years, side effects of anti-cancer drugs and treatments have also come to the fore. These side effects include cardiotoxicity, which can cause irreversible cardiac damages with long-term morbidity and mortality. Despite the continuous in-depth research on anti-cancer drugs, an improved knowledge of the underlying mechanisms of cardiotoxicity are necessary for early detection and management of cardiac risk. Although most reviews focus on the cardiotoxic effect of a specific individual chemotherapeutic agent, the aim of our review is to provide comprehensive insight into various agents that induced cardiotoxicity and their underlying mechanisms. Characterization of these mechanisms are underpinned by research on animal models and clinical studies. In order to gain insight into these complex mechanisms, we emphasize the role of inflammatory processes and oxidative stress on chemotherapy-induced cardiac changes. A better understanding and identification of the interplay between chemotherapy and inflammatory/oxidative processes hold some promise to prevent or at least mitigate cardiotoxicity-associated morbidity and mortality among cancer survivors.

White blood cell subtypes and neutrophil extracellular traps content as biomarkers for stroke etiology in acute ischemic stroke clots retrieved by mechanical thrombectomy

BACKGROUND

Lymphocytes, macrophages, neutrophils, and neutrophil extracellular traps (NETs) associate with stroke risk factors and form a thrombus through different mechanisms. We investigated the total WBCs, WBC subtypes and NETs composition in acute ischemic stroke (AIS) clots to identify possible etiological differences that could help us further understand the process of thrombosis that leads to AIS.

METHODS

AIS clots from 100 cases each of atherothrombotic (AT), cardioembolic (CE) and cryptogenic stroke etiology were collected per-pass as part of the CÚRAM RESTORE registry of AIS clots. Martius Scarlet Blue stain was used to identify the main histological components of the clots. Immunohistochemical staining was used to identify neutrophils, lymphocytes, macrophages, and NETs patterns. The cellular and histological components were quantified using Orbit Image Analysis software.

RESULTS

AT clots were larger, with more red blood cells and fewer WBCs than CE clots. AT clots had more lymphocytes and cryptogenic clots had fewer macrophages than other etiologies. Most significantly, CE clots showed higher expression of neutrophils and extracellular web-like NETs compared to AT and cryptogenic clots. There was also a significantly higher distribution of web-like NETs around the periphery of the CE clots while a mixed distribution was observed in AT clots.

CONCLUSION

The difference in neutrophil and NETs expression in clots from different etiologies may provide insight into the mechanism of clot formation.

Review on flower-visiting behaviour of orthopterans and setting priorities for further studies

The importance of pollination and pollinators is easy to underestimate and impossible to overstate, since its importance goes far beyond the crop production and even the maintenance of plant populations. Most terrestrial ecosystems ultimately depend on the plant-pollinator interactions formed by million years coevolution. This is essential for both the daily functioning of the ecosystems and the long-term development of biodiversity. At the same time, the loss of biodiversity caused by climate change and human activities will soon lead to an ecological crisis, a catastrophe, which could endanger our life: For example, through the decline and loss of various ecosystem services. Such may be the pollination crisis, resulted from a significant loss of pollinating insects' diversity and abundance. The discovery of a pollinator Orthoptera species has encouraged researchers in the densely populated region of Indo-Malaysia to explore the potential role of orthopterans as pollinators. Although the flower visitation of some species has been already known, the role of orthopterans in pollination is scarcely revealed. Here, we collected and reviewed the available data in order to point out some factors of their importance and set priorities that may serve as a basis for further investigations regarding ecological, evolutionary and practical points of view.

Setting priorities and evaluation of habitats for the conservation of orthopterans: case study in the Aggtelek National Park (N Hungary)

The biodiversity conservation needs recent high-quality data and efficient methods for prioritizing species and sites for conservation. Here we prioritized Orthoptera habitats of the Aggtelek National Park, based on revised and actualized distribution data of 69 Orthoptera species living at 98 sites. The simple ranking and complementary areas methods were used with species richness (S), rarity weighted species richness (SR), and number of rare species (SQ). Additionally, the Grasshopper Conservation Indexes (GCI" and GCIn") combining European and local rarity and dispersal capacity of the species were also tested. Contrary to simple ranking the complementary areas method represented the whole fauna and significant part of the species-site data records. All the used indices performed similar except the standardized GCIn" which is highly affected by the differences in study intensity of sites. High-priority areas of the Aggtelek National Park were designated in the plateau above Jósvafő and Aggtelek villages and in the small, isolated hill near Jósvafő (Szőlő-hegy) covered with remained mosaic of former vineyards, orchards and hayfields. The combined use of the efficient indices provides additional ranking that allows the best selection of hotspots to support efficient use of limited resources in nature conservation.

Multidisciplinary management of acute cholecystitis during the COVID-19 pandemic

The coronavirus disease 2019 pandemic had a major impact on most medical services. Our aim was to assess the outcome of acute cholecystitis during the nationwide lockdown period. All patients admitted to our emergency department for AC were analysed. Patient characteristics, performance status, AC severity, treatment modality and outcome of AC were assessed during the lockdown period (Period II: 1 April 2020-30 November 2021) and compared to a historical control period (Period I: 1 May 2017-31 December 2018). AC admissions increased by 72.8% in Period II. Patients were younger (70 vs. 74 years, p = 0.017) and greater in number in the CCI 1 group (20.4% vs. 11.2%, p = 0.043) in Period II. The unplanned readmission rate (6.3 vs. 0%, p = 0.004) and the gallbladder perforation (GP) rate was higher (18.0 vs. 7.3%, p = 0.006) in Period II. Percutaneous transhepatic gallbladder drainage (PTGBD) was more frequent (24.1 vs. 12.8%, p = 0.012) in Period II. In addition to a drop in patient age and CCI, a significant rise in the prevalence of acute cholecystitis, GP and unplanned readmissions was observed during the nationwide lockdown due to the COVID-19 pandemic. PTGBD was more frequent during this period, whereas successful conservative treatment was less frequent.

The Interplay of Lifestyle and Adipokines in the Non-Obese Stroke-Prone Spontaneously Hypertensive Rats

Although the morphological features and functions of adipose tissue are well-described in obesity-prone animal models, less information is available on animals such as the stroke-prone spontaneously hypertensive (SHRSP) strain with cardiovascular abnormalities, which is not characterized by excessive adiposity. Our aim was to focus on lifestyle-induced (type of diet and physical exercise) effects on adipokine profile and lipid peroxidation in SHRSP rats. In our study, male Wistar-kyoto (control) and SHRSP rats were used. SHRSP rats were fed either standard chow or a high-fat diet with 40% fat content (HFD). One group of the animals was placed into cages fitted with a running-wheel; thus, the dietary and training period started at the same time and lasted for 12 weeks. At the end of the experimental period, adiponectin, leptin, omentin, and chemerin concentrations were determined from adipose tissue and serum. Besides adipokines, malondialdehyde (MDA) levels were also measured. Twelve weeks of HFD significantly decreased adiponectin and omentin concentrations of both adipose tissue and serum, which were ameliorated by physical exercise. Serum leptin, chemerin, and MDA values were elevated in HFD groups; however, physical exercise was able to mitigate these adverse changes. Our results underpin the crosstalk between lifestyle changes and dysfunctional adipose tissue in SHRSP rats.

[Cholangitis and cholecystitis: diagnostic criteria and management]

In developed countries, diseases of the gallbladder and the biliary tract count as some of the most frequent gastrointestinal disorders. The inflammation of the gallbladder/biliary tree is a potentially severe, even lethal condition that requires rapid diagnosis and early multidisciplinary approach to be treated. Although the frequency of these diseases is high, the treatment is not unified in Hungary yet. The aim of the evidence-based recommendation is to clarify the diagnostic criteria and severity grading of these diseases and to highlight the indications and rules of proper application of the numerous available therapeutic interventions. The recent guideline is based on the consensus of the Board members of the Endoscopic Section of the Hungarian Gastroenterology Society in contribution with renown experts of surgery, infectology as well as interventional radiology and it counts as a clear and easy applicable guide during the all-day healthcare practice. Our guidelines are based on Tokyo guidelines established on the basis of the consensus reached in the International Consensus Meeting held in Tokyo which were revised in 2013 (TG13) and in 2018 (TG18). Orv Hetil. 2023; 164(20): 770-787.

[Role of interventional radiology in the treatment of primary and metastatic renal cancer]

More and more asymptomatic renal lesions are diagnosed as a result of the growing number of routine imaging examinations. Lesion characterization is often only possible with percutaneous biopsy. Stage T1 renal cell carcinoma is potentially curable not only by partial nephrectomy, but also with thermoablations. The most common ones used in renal cell carcinoma are radiofrequency (RFA), microwave (MWA) and cryoablation (CA). All of them have different physical background with different advantages. They have excellent oncological results, though only a few prospective trials compare their results to surgery. Apart from local renal cell carcinoma, metastatized renal cell carcinomas are also possible to treat with interventional radiological procedures. Renal artery embolization may be done prior to nephrectomy or as a palliative step. Furthermore, hypervascularized renal cell carcinoma metastases can also be embolized preoperatively. Interventional radiological tools may be used for the diagnosis, curative and palliative treatment and also as an aid to surgical procedures of renal cell carcinoma.

Size distribution and relationship of airborne SARS-CoV-2 RNA to indoor aerosol in hospital ward environments

Aerosol particles proved to play a key role in airborne transmission of SARS-CoV-2 viruses. Therefore, their size-fractionated collection and analysis is invaluable. However, aerosol sampling in COVID departments is not straightforward, especially in the sub-500-nm size range. In this study, particle number concentrations were measured with high temporal resolution using an optical particle counter, and several 8 h daytime sample sets were collected simultaneously on gelatin filters with cascade impactors in two different hospital wards during both alpha and delta variants of concern periods. Due to the large number (152) of size-fractionated samples, SARS-CoV-2 RNA copies could be statistically analyzed over a wide range of aerosol particle diameters (70-10 µm). Our results revealed that SARS-CoV-2 RNA is most likely to exist in particles with 0.5-4 µm aerodynamic diameter, but also in ultrafine particles. Correlation analysis of particulate matter (PM) and RNA copies highlighted the importance of indoor medical activity. It was found that the daily maximum increment of PM mass concentration correlated the most with the number concentration of SARS-CoV-2 RNA in the corresponding size fractions. Our results suggest that particle resuspension from surrounding surfaces is an important source of SARS-CoV-2 RNA present in the air of hospital rooms.

The effect of radiofrequency heat treatment on trypsin inhibitor activity and in vitro digestibility of soybean varieties (Glycine max. (L.) Merr.)

Kunitz (KTI) and Bowman-Birk (BBI) trypsin inhibitors were characterized in soybean seeds. Cultivars having KTI/BBI (Pannónia Kincse, PK) or lacking KTI (Aries; Hilario; Bahia) were assessed with well-characterized soybean varieties having Ti-a or ti types of KTI mobility. The TIA values of Pannónia Kincse (9.8 ± 0.48 mg/g) were not significantly different (p ≤ 0.05) from Ti-a samples (10.07 ± 1.86 mg/g), while of Aires, Bahia, Hilario (6.19 ± 1.89) were identical (p ≤ 0.05) with ti samples (6.63 ± 1.99). Radiofrequency heat treatment (RF) decreased TIA values (p ≤ 0.05) at ≥ 100 °C. However, in the traditional soybean variety, the RF at 110 °C was more effective in eliminating the residual KTI activity. The remaining or the disapperaing bioactive form of trypsin inhibitors were succesfully characterized by the means of a standardized in vitro digestion model. It showed that residual BBI-originated trypsin inhibitor activity was in the stomach even after RF at 110 °C, whereas its chymotrypsin inhibitor activity was not detectable at all. Although PK and KTI null types of soybean seeds still required an energy-saving, gentle heat treatment to inactive the trypsin inhibitors before using them as food or feed, the physicochemical properties and processing quality of soybean products were protected, improved.

Clinical determinants of non-invasive global myocardial work index before and after transcatheter aortic valve implantation: a prospective study

 

The estimation of non-invasive global myocardial work indices is a novel method of the left ventricular (LV) functional assessment, which may overcome the load-sensitvity of the traditional functional measures. The diagnostic and prognostic role of this approach may gain particular importance in pressure overload states, such as in patients with severe aortic stenosis. However, the longitudinal changes of this recently introduced measure are scarcely investigated, and data are also lacking about the main determinants of these measures.

Accordingly, our aim was to investigate the clinical determinants of preoperative and also postoperative GMWI in patients undergoing transcatheter aortic valve replacement (TAVR).

Fifty patients (62% male, age: 78±5 years) were enrolled. Prior to the procedure, subjects underwent echocardiographic investigation and the detailed medical history was also recorded. Speckle-tracking analysis was performed and global longitudinal strain (GLS) was measured. LV pressure curve was estimated by adding the mean aortic valve gradient to the systolic blood pressure. Using these measures, global myocardial work index (GMWI) and global constructive work index (CMWI) was quantified by commercially available software. A 6 months follow-up examination was also performed and at that time point we determined the aforementioned parameters.

At follow-up, GLS has significantly increased (−13.0±4.1 vs. −14.8±3.8%; p<0.001), while GMWI was significantly lower compared to baseline (1789±748 vs. 1506±561 mmHg%, p<0.01). CMWI did not differ between the two time points (2309±782 vs. 2086±609 mmHg%, p=0.11). Using multivariable analysis, age (β=0.30; p<0.05) preoperative New York Heart Association (NYHA) class (β=−0.48; p<0.001) and having a pacemaker (β=−0.44; p<0.01) were found to be independent predictors of the preoperative GMWI (R2=0.39; overall p<0.001). On the other hand, postoperative GMWI was determined (R2=0.48; overall p<0.001) by gender (β=−0.25; p<0.05), the presence of diabetes mellitus (β=−0.37; p<0.01) and also by having a pacemaker (β=−0.38; p<0.01).

TAVR significantly alters LV functional measures. Different clinical factors influence GMWI before and after the procedure: age, NYHA class-based symptom severity and having a pacemaker were found to be independently associated with preoperative GMWI, while gender, the presence of diabetes mellitus and pacemaker device are the most important clinical determinants of the postoperative GMWI value.

Funding Acknowledgement

Type of funding sources: None.

Kezdeti tapasztalataink az infrarenalis aorta atherothromboticus obliteratív megbetegedéseinek sztentgraftokkal történő kezelésében

Bevezetés: A perifériás érbetegségek kezelésében napjainkban az endovascularis technikák az elsőként választandó módszerek. Az infrarenalis aorta atherothromboticus betegségeinek kezelésében a nyitott műtéteknek is van létjogosultságuk, különösen, amikor már kritikus szűkületet, illetve perifériás embolisatiót okoznak. Ezekben az esetekben a hagyományos sztentek használata nagyobb szövődménnyel járna, ugyanakkor újabb közlemények szerint sztentgraftok alkalmazásával kitűnő eredmények érhetők el. Célkitűzés: Retrospektíven elemeztük az infrarenalis aorta atherothromboticus érbetegsége miatt sztentgraftbeültetésen átesett betegeinket és kezdeti tapasztalatainkat. Módszer: Vizsgálatunkba a Szegedi Tudományegyetem Érsebészeti Osztályán sztentgraftbeültetésen átesett betegeket válogattuk be. A beavatkozásokat az infrarenalis aortában kialakult tünetképző atherothromboticus betegség miatt végeztük, melynek endovascularis rekonstrukcióra való alkalmasságát előzetes CT-angiográfiás vizsgálat alapján döntöttük el. Valamennyi esetben a beavatkozást követően 6 héttel kontroll-CT-angiográfia történt. Eredmények: Osztályunkon 2021. február 25. és 2021. szeptember 15. között az infrarenalis aorta atherothromboticus érbetegsége miatt 6 betegnél végeztünk sztentgrafttal rekonstrukciót, 2 esetben krónikus kritikus végtagi ischaemia, 4 esetben claudicatiós panaszok miatt. Korai posztintervenciós szövődmény nem fordult elő. A kontrollvizsgálaton minden beteg jelentős klinikai javulásról számolt be; a kontroll-CT-angiográfia minden esetben átjárható sztentgraftrendszert igazolt, jó pozícióban, szűkület nélkül. Késői posztintervenciós szövődményt 1 esetben észleltünk: a jobb arteria iliaca communisba helyezett sztentgraft elzáródott, mely 24 órás perifériás thrombolysist követően átjárhatóvá vált, további beavatkozásra nem volt szükség. Következtetés: Saját kezdeti tapasztalataink a nemzetközi irodalmi adatokkal egybecsengően megerősítik, hogy a sztentgraftok jó eredménnyel alkalmazhatók az infrarenalis aorta atherothromboticus szűkületeinek kezelésében. Az eszközök magas ára miatt azonban a perifériás obliteratív megbetegedések sztentgraftokkal történő kezelése hazánkban még nem rendelkezik megfelelő finanszírozással, jelenleg ezek a kezelések csak egyedi finanszírozással vehetők igénybe, ami korlátozza rutinszerű alkalmazásukat. Orv Hetil. 2022; 163(34): 1353–1361.

[Changes in the care of peripheral vascular disease at the University of Szeged]

Introduction and aims. In recent decades health care changes have accelerated enormously. Previously, by learning an effective procedure, the doctor could guarantee his patients the highest level of care for many years. Nowadays, due to the dynamics of development, the renewal cycles of the methods have been shortened, without continuous learning and training, it is already inconceivable to provide the up-to-date care required by patients. Patients and methods. Instead of vascular replacements with prosthetic grafts, which played an important role in vascular reconstructions, the primacy of endovascular techniques has become decisive. It can be significant for aortic aneurysms that can be operated with high invasiveness. The learning of catheter techniques by vascular surgeons made it possible to treat more successfully those limb-threatening cases, which are often associated with extensive vascular involvement, through the so-called hybrid operations. In addition to the increasing prevalence of diabetes worldwide, the higher proportion of critical limb ischemia and the highlighted pathogenic role of multi-resistant bacteria in the disease caused the marginaliation of the use of previously preferred prosthetic grafts. The effectiveness of the treatment of graft infections, which thus become less frequent, is improved by the use of homografts and negative pressure therapy. An effective method of preventing stroke is carotid endarterectomy, the morbidity of which is reduced by the introduction of locoregional anaesthesia allowing direct neuromonitoring. Results/conclusions. Although the acquisition and implementation of new methods has posed a continuous challenge for our specialists and doctors over the past 10 years, our achievements have made our department one of the leading vascular surgery centres in the country.

Internet Use Related to Suicidal Thoughts and Help-Seeking – Preliminary Results of a Study with Depressive Patients

Introduction

Suicide-related Internet use is becoming more common, and many research study its potential risks and benefits.

Objectives

Data on suicidal thoughts and Internet use of patients with depressive disorders were collected to assess their suicide-related Internet use and its relation to help-seeking preferences.

Methods

Semi-structured interviews were completed to assess Internet use patterns and suicidal thoughts among patients treated with depressive disorders, and preferred forms of help-seeking were also examined.

Results

113 patients completed the interviews, most of them spend more hours a day using the Internet. More than 80% came across suicide-related contents while browsing, a quarter reported specific search for suicidal contents. In case of suicidal thoughts, three-quarters of depressed patients would seek help from a mental health professional, two-thirds from their partners, half from friends, and nearly one-third from parents, other relatives or from GPs. Most patients would prefer offline (personal) help for their psychological problems and suicidal thoughts, online methods were less preferred, with only one-fifth choosing these options. However, a third of them also considered it probable that they would not ask anyone for help.

Conclusions

Despite of the frequent use of the Internet, online help-seeking is less common in depressive patients. However, in the times of pandemic, online help facilities may provide an opportunity to prevent suicidal behavior for those, who have suicidal thoughts and use the Internet regularly, especially searching for suicide-related contents. In the future, further research is needed to develop more effective online suicide prevention programs and applications.

Disclosure

No significant relationships.

Changes of the non-invasive myocardial work in patient undergoing transcatheter aortic valve replacement: the influence of left bundle branch block

Funding Acknowledgements

Type of funding sources: None.

Patients with left bundle branch block (LBBB) are known to have substantially increased afterload sensitivity. It gains particular importance in subjects with aortic stenosis: patients with pre-existing LBBB may benefit more from interventions such as transcatheter aortic valve replacement (TAVR) by an effective and rapid reduction of the left ventricular (LV) pressures.

Accordingly, our aim was to investigate the changes of LV myocardial work indices in patients undergoing TAVR by the presence of preoperative LBBB. Non-invasive myocardial work indices are novel echocardiographic parameters which adjust LV deformation to the instantaneous LV pressure, overcoming the the load-sensitivity of the traditional LV functional measures.

Thirty patients undergoing TAVR were enrolled (37% female; age: 78±6 years; aortic valve area [AVA]: 0.7±0.3 cm2). Fourteen patients (47%; LBBB group) showed LBBB pattern on ECG, by demonstrating native LBBB (n=6; 20%) or having ventricular pacing dependency (n=8; 27%), while 16 patients had narrow QRS (53%; non-LBBB group). Prior to the procedure, subjects underwent a detailed echocardiographic investigation. Speckle-tracking analysis was performed and global longitudinal strain (GLS) was measured. LV pressure curve was estimated by adding the mean aortic valve gradient to the aortic systolic pressure. Using these measures, LV global constructive work index (CMWI) and global work efficiency (GWE). were quantified by commercially available software. A 6 months follow-up examination was also performed and at that time point we determined the aforementioned parameters.

As expected, AVA significantly improved after the procedure in the pooled study group (1.8±0.4 cm2; p<0.001). GLS also significantly increased (-13.2±4.2 vs. -15.2±3.9 %; p<0.01), while CMWI only showed a tendential decrease (2422±788 vs. 2166±640 mmHg%; p=NS) at the follow-up. GLS (-10.6±3.7 vs. -15.5±3.4%; p<0.001), CMWI (1877±679 vs. 2898±529 mmHg%; p<0.001), and also GWE (82±9 vs. 91±4%; p<0.01) was significantly lower in the LBBB-group compared to the non-LBBB patients. At the follow-up, GLS was still significantly lower in the LBBB patients (-13.2±4.6 vs. -16.9±2.1%; p<0.01), however, CMWI was comparable between the two groups (1956±776 vs. 2350±439 mmHg%, p=NS).

Pressure overload of the LV may affect patients with LBBB substantially more than subjects without it. TAVR causes an immediate and significant decrease in the LV afterload, which results in a more pronounced improvement in the LBBB group compared to those with no LBBB.

Global perspective of familial hypercholesterolaemia: a cross-sectional study from the EAS Familial Hypercholesterolaemia Studies Collaboration (FHSC)

BACKGROUND

The European Atherosclerosis Society Familial Hypercholesterolaemia Studies Collaboration (FHSC) global registry provides a platform for the global surveillance of familial hypercholesterolaemia through harmonisation and pooling of multinational data. In this study, we aimed to characterise the adult population with heterozygous familial hypercholesterolaemia and described how it is detected and managed globally.

METHODS

Using FHSC global registry data, we did a cross-sectional assessment of adults (aged 18 years or older) with a clinical or genetic diagnosis of probable or definite heterozygous familial hypercholesterolaemia at the time they were entered into the registries. Data were assessed overall and by WHO regions, sex, and index versus non-index cases.

FINDINGS

Of the 61 612 individuals in the registry, 42 167 adults (21 999 [53·6%] women) from 56 countries were included in the study. Of these, 31 798 (75·4%) were diagnosed with the Dutch Lipid Clinic Network criteria, and 35 490 (84·2%) were from the WHO region of Europe. Median age of participants at entry in the registry was 46·2 years (IQR 34·3-58·0); median age at diagnosis of familial hypercholesterolaemia was 44·4 years (32·5-56·5), with 40·2% of participants younger than 40 years when diagnosed. Prevalence of cardiovascular risk factors increased progressively with age and varied by WHO region. Prevalence of coronary disease was 17·4% (2·1% for stroke and 5·2% for peripheral artery disease), increasing with concentrations of untreated LDL cholesterol, and was about two times lower in women than in men. Among patients receiving lipid-lowering medications, 16 803 (81·1%) were receiving statins and 3691 (21·2%) were on combination therapy, with greater use of more potent lipid-lowering medication in men than in women. Median LDL cholesterol was 5·43 mmol/L (IQR 4·32-6·72) among patients not taking lipid-lowering medications and 4·23 mmol/L (3·20-5·66) among those taking them. Among patients taking lipid-lowering medications, 2·7% had LDL cholesterol lower than 1·8 mmol/L; the use of combination therapy, particularly with three drugs and with proprotein convertase subtilisin-kexin type 9 inhibitors, was associated with a higher proportion and greater odds of having LDL cholesterol lower than 1·8 mmol/L. Compared with index cases, patients who were non-index cases were younger, with lower LDL cholesterol and lower prevalence of cardiovascular risk factors and cardiovascular diseases (all p<0·001).

INTERPRETATION

Familial hypercholesterolaemia is diagnosed late. Guideline-recommended LDL cholesterol concentrations are infrequently achieved with single-drug therapy. Cardiovascular risk factors and presence of coronary disease were lower among non-index cases, who were diagnosed earlier. Earlier detection and greater use of combination therapies are required to reduce the global burden of familial hypercholesterolaemia.

FUNDING

Pfizer, Amgen, Merck Sharp & Dohme, Sanofi-Aventis, Daiichi Sankyo, and Regeneron.

Known but not called by name: recreational fishers' ecological knowledge of freshwater plants in Hungary

BACKGROUND

Documenting local ecological knowledge (LEK) has recently become a topic of considerable interest. LEK can contribute to various areas of ecology, including habitat management and conservation biology. It has been recently revealed that recreational fishers' ecological knowledge (FEK) can also provide valuable information about different organisms and habitats, while recreational fishers' ecological knowledge is understudied in many aspects and regions of the world.

METHODS

We aimed to record Hungarian recreational FEK on plant species related to freshwater habitats. Our research was conducted in three regularly fished water bodies in Hungary, namely Lake Velence, Keleti Main Canal, and Lake Látóképi, where a total of 72 interviews were conducted with recreational anglers. During interviews, 24 plant species occurring at freshwater habitats with common or sporadic distribution were shown to anglers as single species or in congeneric pairs. Miscellaneous plant-related knowledge of anglers was also collected.

RESULTS

Anglers identified a total of 16 plant species. They used 45 botanical or folk names. An angler knew the name of 4.6 plants on average and recognized 7.4 other species without naming it. According to our detailed analysis, anglers were able to name or at least recognize those plant species which are somehow related to fishing activities, are salient, and/or common. Moreover, anglers at Lake Velence recognized less plant species; however, they also had less years of fishing experience compared to anglers of the other two locations.

CONCLUSION

We found that recreational FEK exists even in the case of freshwater plants which are not the main focus of anglers. It is highly presumable that recreational fishers would be able to provide reliable ecologically related data for scientific research establishing future citizen science projects of nature conservation.

Using metabolic markers to identify insulin resistance in premenopausal women with and without polycystic ovary syndrome

BACKGROUND

Insulin resistance (IR) is associated with increased risk for type 2 diabetes mellitus and cardiovascular disease. Quantifying IR is invasive and time-consuming, and thus not routinely used in clinical practice. Simple metabolic markers to predict IR exist, but have not been validated in premenopausal women or women with polycystic ovary syndrome (PCOS).

OBJECTIVE

To evaluate the ability of metabolic markers to identify premenopausal women with/without PCOS who are insulin resistant.

DESIGN/SETTING

Cross-sectional analysis.

PARTICIPANTS

One hundred and seventy-one non-diabetic premenopausal overweight/obese women without PCOS and 71 women with PCOS.

METHODS

IR was quantified by the steady-state plasma glucose during the modified insulin-suppression test. Metabolic markers (BMI, lipid/lipoprotein concentrations, and fasting glucose) were evaluated for their discriminative ability to identify IR, using area under the receiver-operating-characteristic curve (AUROC) analysis. Optimal cut-points were evaluated for predictive power.

RESULTS

In the non-PCOS group, the triglyceride/HDL cholesterol ratio (TG/HDL-C) was the best marker (AUROC 0.73). Optimal diagnostic cut-point was 1.9. In the PCOS group, the TG/HDL-C ratio, cholesterol/HDL-C ratio (TC/HDL-C), and HDL-C performed well (AUROC > 0.80), with optimal cut-points for TG/HDL-C 1.3, TC/HDL-C 3.4, and HDL-C 52 mg/dL: TG/HDL-C was more sensitive, but HDL-C had a higher PPV for IR.

CONCLUSION

TG/HDL-C can identify IR in premenopausal women with and/without PCOS; diagnostic cut-points differ from those of men and postmenopausal women. HDL-C is an alternative predictor in women with PCOS. These simple metabolic markers, which are standardized between labs, inexpensive, and routinely measured, can be used to tailor lifestyle and medical interventions to improve health outcomes in insulin-resistant premenopausal women.

Real-life measurement of size-fractionated aerosol concentration in a plethysmography box during the COVID-19 pandemic and estimation of the associated viral load

Introduction

There are concerns about pulmonary function tests (PFTs) being associated with aerosol generation and enhanced virus transmission. As a consequence, the number of PFTs was reduced significantly during the coronavirus disease 2019 pandemic. However, there are no robust data supporting this fear.

Objectives

To perform real-life measurement of aerosol concentrations in a PFT laboratory to monitor the concentration of particles near the patient, and to model the associated potential viral load.

Methods

Two optical particle counters were used to sample the background concentration and the concentration of particles near the patient's mouth in a whole-body plethysmography box. Statistical evaluation of the measured particle concentration time series was completed. The particle exhalation rate was assessed based on the measured particle concentration data by applying the near-field/far-field theory. The number of exhaled viruses by an infected patient during the test was compared with the emission of viruses during quiet breathing and speaking.

Results

Twenty-five patients were included in the study. Eighteen patients showed a significant increase in aerosol concentration [mean 1910 (standard deviation 593) particles/L]. Submicron particles dominated the number size distribution of the generated particles, but large particles represented a higher volume fraction in the generated particles compared with background. An average gene exhalation rate of 0.2/min was estimated from this data. This is one order of magnitude higher than the release rate for the same infected person during quiet breathing, and of the same order of magnitude as the release rate during normal speaking.

Conclusions

This study demonstrated that PFTs are aerosol-generating procedures. Based on these results, the moderate increase in viral load does not underpin stopping such examinations.

Surgical outcome of percutaneous transhepatic gallbladder drainage in acute cholecystitis: Ten years' experience at a tertiary care centre

Background

Percutaneous transhepatic gallbladder drainage (PTGBD) plays an important role in the treatment of elderly patients and/or patients in poor health with acute cholecystitis (AC). The primary aim of this study is to determine how these factors influence the clinical outcome of PTGBD. Moreover, we assessed the timing and results of subsequent cholecystectomies.

Patients and Methods

We retrospectively examined the results of 162 patients undergoing PTGBD between 2010 and 2020 (male–female ratio: 51.23% vs. 48.77%; mean age: 71.43 ± 13.22 years). Patient’s performance status and intervention outcomes were assessed with clinical success rates (CSR) and in-hospital mortality. The conversion rate (CR) of possible urgent or delayed, elective laparoscopic cholecystectomies (LC) after PTGBD were analysed.

Results

PTGBD was the definitive treatment in 42.18% of patients, while it was a bridging therapy prior to cholecystectomy (CCY) for the other patients. CSR was 87.97%, it was only 64.29% in grade III AC. In 9.87% of the cases, urgent LC was necessary after PTGBD, and its conversion rate was approximately equal to that of elective LC (18.18 vs. 17.46%, respectively, p = 0.2217). Overall, the post-PTGBD in-hospital mortality was 11.72%, while the same figure was 0% for grade I AC, 7.41% for grade II and 40.91% for grade III. Based on logistic regression analyses, in-hospital mortality (OR 6.07; CI 1.79–20.56), clinical progression (OR 7.62; CI 2.64–22.05) and the need for emergency CCY (OR 14.75; CI 3.07–70.81) were mostly determined by AC severity grade.

Conclusion

PTGBD is an easy-to-perform intervention with promising clinical success rates in the treatment of acute cholecystitis. After PTGBD, the level of gallbladder inflammation played a decisive role in the course of AC. In a severe, grade III inflammation, we have to consider low CSR and high mortality.

Does prior administration of rtPA influence acute ischemic stroke clot composition? Findings from the analysis of clots retrieved with mechanical thrombectomy from the RESTORE registry

BACKGROUND AND PURPOSE

There is still much debate whether bridging-therapy [intravenous thrombolysis (IVT) prior to mechanical thrombectomy (MT)] might be beneficial compared to MT alone. We investigated the effect of IVT on size and histological composition of the clots retrieved from patients undergoing bridging-therapy or MT alone.

METHODS

We collected mechanically extracted thrombi from 1000 acute ischemic stroke (AIS) patients included in RESTORE registry. Patients were grouped according to the administration (or not) of IVT before thrombectomy. Gross photos of each clot were taken and Extracted Clot Area (ECA) was measured using ImageJ software. Martius Scarlett Blue stain was used to characterize the main histological clot components [red blood cells (RBCs), fibrin (FIB), platelets/other (PTL)] and Orbit Image Analysis was used for quantification. Additionally, we calculated the area of each main component by multiplying the component percent by ECA. Chi-squared and Kruskal-Wallis tests were used for statistical analysis.

RESULTS

451 patients (45%) were treated with bridging-therapy while 549 (55%) underwent MT alone. When considering only percent histological composition, we did not find any difference in RBC% (P = 0.895), FIB% (P = 0.458) and PTL% (P = 0.905). However, bridging-therapy clots were significantly smaller than MT-alone clots [32.7 (14.8-64.9) versus 36.8 (20.1-79.8) mm², N = 1000, H1 = 7.679, P = 0.006*]. A further analysis expressing components per clot area showed that clots retrieved from bridging-therapy cases contained less RBCs [13.25 (4.29-32.06) versus 14.97 (4.93-39.80) mm², H1 = 3.637, P = 0.056] and significantly less fibrin [9.10 (4.62-17.98) versus 10.54 (5.57-22.48) mm², H1 = 7.920, P = 0.005*] and platelets/other [5.04 (2.26-11.32) versus 6.54 (2.94-13.79) mm², H1 = 9.380, P = 0.002*] than MT-alone clots.

CONCLUSIONS

Our results suggest that previous IVT administration significantly reduces thrombus size, proportionally releasing all the main histological components.

Paradigm shift in the vascular surgery of the lower extremity at the Department of Vascular Surgery, University of Szeged, Hungary

Összefoglaló. Bevezetés: Az endovascularis intervenciókat kezdetben radiológusok alkalmazták, manapság, megfelelő képzést követően, jó eredménnyel végeznek ilyen beavatkozásokat érsebészek is. Ezt a világszerte uralkodóvá váló szemléletet kívántuk meghonosítani a Szegedi Tudományegyetemen, melynek bevezetése nélkül előrevetíthető az érsebészet működésének átalakulása az érrekonstrukciós beavatkozások csökkenésével. Célkitűzés: Egyetemünkön radiológus- és érsebész-munkacsoport végez perifériás érintervenciókat. Célunk a két intézet alsó végtagi endovascularis tevékenységének összehasonlítása volt. Módszer: Vizsgálatunkba a Szegedi Tudományegyetemen 2012. 01. 01. és 2019. 12. 31. között alsó végtagi endovascularis beavatkozásokon átesett betegeket válogattuk be. A betegeket a rizikófaktoraik, a kezelt anatómiai régiók, a hospitalizációs idő és a szövődmények tekintetében hasonlítottuk össze. Egyéves utánkövetés során vizsgáltuk a 'redo' műtétek , az amputációk és a halálozások gyakoriságát. Eredmények: A beavatkozásokat 653 esetben radiológus, 573 esetben érsebész végezte. Az érműtőben infrainguinalis (63,2%), a radiológián suprainguinalis érintervenciók (68,6%) történtek nagyobb arányban. A percutan végzett beavatkozásokat vizsgálva a hospitalizációs időben (2,5 ± 4,4 nap vs. 2,4 ± 2,5 nap, p = 0,78), valamint a minimálisan invazív módon végzett beavatkozások utáni szövődmények gyakoriságában (30/653 - 4,6% és 11/257 - 4,3%, p = 0,837) nem volt különbség a két betegcsoport között. 'Redo' műtétek (73/485 - 15,1% és 33/562 - 5,9%, p<0,001) és amputációk (31/485 - 6,4% és 12/562 - 2,1%, p<0,001) gyakrabban fordultak elő az érműtőben kezelt betegek körében, ebben a csoportban azonban a kritikus végtagischaemia előfordulása is gyakoribb volt (45,4% és 38,6%, p = 0,016). A mortalitásban nem volt szignifikáns különbség (5,8% és 3,9%, p = 0,16). Következtetés: A szoliter érelváltozások kezelését mindkét intézet hasonló hatásfokkal végezte. A több anatómiai régiót érintő betegség miatt érműtőben végzett beavatkozások utáni szövődmények előfordulása kissé magasabbnak bizonyult. Orv Hetil. 2021; 162(24): 943-951.

SUMMARY

INTRODUCTION

Endovascular interventions were initially performed by radiologists. Nowadays properly trained vascular surgeons also effectively perform these interventions. We wished to apply this widespread practice at our university because without this advancement the number of reconstructive surgeries was expected to decrease significantly.

OBJECTIVE

Both radiologists and vascular surgeons perform endovascular interventions at our university. We compared the outcomes of lower extremity endovascular interventions between the two institutes.

METHOD

We included patients who underwent lower extremity endovascular interventions between 01. 01. 2012 and 31. 12. 2019. We compared the risk factors, treated anatomical regions, hospitalization time and complication rate. During the one-year follow-up, we examined the occurrence of redo surgeries, amputations and mortality.

RESULTS

653 interventions were performed by radiologists and 573 by vascular surgeons. Vascular surgeons carried out more interventions in the infrainguinal region (63.2%), while radiologists in the suprainguinal region (68.6%). The hospitalization time after percutaneous interventions (2.5 ± 4.4 days vs. 2.4 ± 2.5 days, p = 0.78), and the rate of complications after minimally invasive interventions did not show significant difference (30/653 - 4.6% vs. 11/257 - 4.3%, p = 0.837). Redo surgeries (73/485 - 15.1% vs. 33/562 - 5.9%, p<0.001) and amputations (31/485 - 6.4% vs. 12/562 - 2.1%, p<0.001) occurred more frequently in the surgical group. However, the incidence of chronic limb ischaemia was also higher (45.4% vs. 38.6%, p = 0.016). There was no significant difference in the mortality (5.8% vs. 3.9%, p = 0.16).

CONCLUSION

Both institutes had similar efficacy in performing peripheral interventions on solitary vascular lesions. Complications occurred more frequently in the surgical group, but the majority of these patients had extended atherosclerotic diseases. Orv Hetil. 2021; 162(24): 943-951.

Mechanically deboned turkey meat with improved digestibility and biological value

Enzymatic hydrolysates of mechanically deboned meat (MDM) for a long time have been used as flavouring and functional food ingredients in the food industry and also as the bases of formula foods for special dietary uses.

The aim of the present study was to produce MDM hypo-antigenic products with improved digestibility and high biological value to be used as a milk protein alternative. turkey MDM was treated with digestive enzymes (trypsin and/or α-chymotrypsin, or pancreatin), followed by freeze drying. The optimised reaction conditions of hydrolysis were at 6% (w/v) of meat protein in 0.1% NaHCO3 buffer, pH 7.5; pancreatin enzyme with 50 TAME units/g meat protein substrate, 37 °C and 60 min). Hydrolysates (MDMH) were assessed for degree of hydrolyses (DH, %) by using trinitrobenzenesulphonic acid method and MW distribution by SDS-PAGE. Modification of immune reactive binding sites in MDMHs was monitored by immunoblot with cow’s milk, chicken egg or meat allergic human patients’ sera. Biological value indices (True Digestibility (TD), Net Protein Utilisation (NPU), Biological Value (BV)) were determined using rat feeding trials. Among the MDMH products, the pancreatic hydrolysate proved to be the most favourable in terms of biological value and digestibility as well as hypoallergenic property.

A 1D Lyman-alpha profile camera for plasma edge neutral studies on the DIII-D tokamak

A one dimensional, absolutely calibrated pinhole camera system was installed on the DIII-D tokamak to measure edge Lyman-alpha (Ly-α) emission from hydrogen isotopes, which can be used to infer neutral density and ionization rate profiles. The system is composed of two cameras, each providing a toroidal fan of 20 lines of sight, viewing the plasma edge on the inboard and outboard side of DIII-D. The cameras' views lie in a horizontal plane 77 cm below the midplane. At its tangency radius, each channel provides a radial resolution of ∼2 cm full width at half maximum (FWHM) with a total coverage of 22 cm. Each camera consists of a rectangular pinhole, Ly-α reflective mirror, narrow-band Ly-α transmission filter, and a 20 channel AXUV photodetector. The combined mirror and transmission filter have a FWHM of 5 nm, centered near the Ly-α wavelength of 121.6 nm and is capable of rejecting significant, parasitic carbon-III (C-III) emission from intrinsic plasma impurities. To provide a high spatial resolution measurement in a compact footprint, the camera utilizes advanced engineering and manufacturing techniques including 3D printing, high stability mirror mounts, and a novel alignment procedure. Absolutely calibrated, spatially resolved Ly-α brightness measurements utilize a bright, isolated line with low parasitic surface reflections and enable quantitative comparison to modeling to study divertor neutral leakage, main chamber fueling, and radial particle transport.

Absolute calibration of the Lyman-α measurement apparatus at DIII-D

The LLAMA (Lyman-Alpha Measurement Apparatus) diagnostic was recently installed on the DIII-D tokamak [Rosenthal et al., Rev. Sci. Instrum. (submitted) (2020)]. LLAMA is a pinhole camera system with a narrow band Bragg mirror, a bandpass interference filter, and an absolute extreme ultraviolet photodiode detector array, which measures the Ly-α brightness in the toroidal direction on the inboard, high field side (HFS) and outboard, low field side (LFS). This contribution presents a setup and a procedure for an absolute calibration near the Ly-α line at 121.6 nm. The LLAMA in-vacuum components are designed as a compact, transferable setup that can be mounted in an ex situ vacuum enclosure that is equipped with an absolutely calibrated Ly-α source. The spectral purity and stability of the Ly-α source are characterized using a vacuum ultraviolet spectrometer, while the Ly-α source brightness is measured by a NIST-calibrated photodiode. The non-uniform nature of the Ly-α source emission was overcome by performing a calibration procedure that scans the Ly-α source position and employs a numerical optimization to determine the emission pattern. Nominal and measured calibration factors are determined and compared, showing agreement within their uncertainties. A first conversion of the measured signal obtained from DIII-D indicates that the Ly-α brightness on the HFS and LFS is on the order of 10²⁰ Ph sr^-1 m^-2 s^-1. The established calibration setup and procedure will be regularly used to re-calibrate the LLAMA during DIII-D vents to monitor possible degradation of optical components and detectors.

Coronary stent implantation for acute basilar artery occlusion with underlying stenosis

AIMS

Our aim was to study the effectiveness of coronary stent implantation during the endovascular treatment (EVT) of acute basilar artery occlusion (BAO) with occlusion-underlying intracranial atherosclerotic stenosis (ICAS).

METHODS AND RESULTS

We retrospectively analysed 91 consecutive BAO patients who underwent EVT between February 2014 and January 2019 in a single, high-volume neurointerventional centre. We studied the effect of immediate coronary stent implantation on the clinical outcome of BAO with occlusion-underlying stenosis. BAO patients with underlying ICAS (n=41) were characterised by longer symptom-onset-to-reperfusion times (231 min vs 173 min, p=0.0020), lower TICI 2b-3 reperfusion rates (65.85% vs 90.00%, p=0.0084), and higher overall mortality (HR 2.021, p=0.0417) compared to the BAO cases without ICAS (n=50). The patients undergoing stenting (n=18) had lower residual basilar artery (BA) stenosis (14.7% vs 81.0%, p<0.0001), higher chance for functional recovery (OR 7.6, p=0.0250) and higher chance of survival (HR 4.163, p=0.0026) compared to the BAO-ICAS cases treated without coronary stents (n=21).

CONCLUSIONS

The immediate treatment of the occlusion-underlying stenosis with coronary stents and dual antiplatelet therapy (DAPT) in BAO was associated with improved overall survival and better functional outcomes.

Per-pass analysis of acute ischemic stroke clots: impact of stroke etiology on extracted clot area and histological composition

Background

Initial studies investigating correlations between stroke etiology and clot composition are conflicting and do not account for clot size as determined by area. Radiological studies have shown that cardioembolic strokes are associated with shorter clot lengths and lower clot burden than non-cardioembolic clots.

Objective

To report the relationship between stroke etiology, extracted clot area, and histological composition at each procedural pass.

Methods

As part of the multi-institutional RESTORE Registry, the Martius Scarlett Blue stained histological composition and extracted clot area of 612 per-pass clots retrieved from 441 patients during mechanical thrombectomy procedures were quantified. Correlations with clinical and procedural details were investigated.

Results

Clot composition varied significantly with procedural passes; clots retrieved in earlier passes had higher red blood cell content (H4=11.644, p=0.020) and larger extracted clot area (H4=10.730, p=0.030). Later passes were associated with significantly higher fibrin (H4=12.935, p=0.012) and platelets/other (H4=15.977, p=0.003) content and smaller extracted clot area. Large artery atherosclerotic (LAA) clots were significantly larger in the extracted clot area and more red blood cell-rich than other etiologies in passes 1–3. Cardioembolic and cryptogenic clots had similar histological composition and extracted clot area across all procedural passes.

Conclusion

LAA clots are larger and associated with a large red blood cell-rich extracted clot area, suggesting soft thrombus material. Cardioembolic clots are smaller in the extracted clot area, consistent in composition and area across passes, and have higher fibrin and platelets/other content than LAA clots, making them stiffer clots. The per-pass histological composition and extracted clot area of cryptogenic clots are similar to those of cardioembolic clots, suggesting similar formation mechanisms.

Impact assessment of the TFA regulation on fatty acid composition of foods in Hungary

Trans fatty acids are formed during the industrial processing of food, and are proven to be harmful for the human body. They have been associated with increased risk of cardiovascular disease, abdominal obesity, diabetes, and certain types of cancer. Decree 71/2013. (XI. 20.) of the Ministry of Human Capacities, which has been in force since 2014, defines the highest permitted amount of trans fats in food products placed on the market in Hungary. The impact of the decree on the industrially produced trans fatty acids (iTFA) availability and population intake was assessed in 2017. Results demonstrated that iTFA were replaced by other fatty acids due to the legislation. In 2019, we investigated food groups which had high measured TFA content before the regulation entered into force and compared the total fat and fatty acid profiles to the same brand or similar products being on the market afterwards. In collaboration with the World Health Organization, this was the first assessment to determine to which extent manufacturers increased saturated fat (SFA) content of foodstuffs to reduce iTFA content. In those product groups, which were identified as significant food sources of iTFA before introducing the regulation (biscuits, coffee creamers and flavorings, sweets, bakery products, confectionary, wafers, margarines) we found no significant changes in the total fat content, while in most foodstuffs the average proportion of SFA was higher after reformulation, as iTFA were mainly substituted with SFA in 61% of the products, with cis-MUFA in 25% and cis-PUFA in 14% of the products, respectively. Evidence from this analysis supports concerns that eliminating iTFA in certain foodstuffs leads to unwanted substitution with saturated fat, hence reducing the possible health benefits. Given the high SFA intake and the unfavourable cardiovascular statistics in Hungary, the consumption frequency and portion size control of these products are advised.

Key messages

Monitoring the changes of food composition is important in order to evaluate the effect of the regulation. Manufacturers should be encouraged to reduce the SFA content to a technologically feasible level.

STUDY OF CHITINASE AND CHITINOLYTIC ACTIVITY OF LACTOBACILLUS STRAINS

The increasing consumer demand for less processed and more natural food products – while improving those products’ quality, safety, and shelf-life – has raised the necessity of chemical preservative replacement. Biopreservation refers to extended storage life and enhanced safety of foods using the natural microflora and (or) their antibacterial products. Chitinolytic enzymes are of biotechnological interest, since their substrate, chitin, is a major structural component of the cell wall of fungi, which are the main cause of the spoilage of food and raw plant material. Among the several organisms, many bacteria produce chitinolytic enzymes, however, this behaviour is not general. The chitinase activity of the lactic acid bacteria is scarcely known and studied.

The aim of the present study was to select Lactobacillus strains that have genes encoding chitinase, furthermore, to detect expressed enzymes and to characterise their chitinase activity. Taking into consideration the importance of chitin-bindig proteins (CBPs) in the chitinase activity, CBPs were also examined. Five Lactobacillus strains out of 43 strains from 12 different species were selected by their chitinase coding gene. The presence of the chitinase and chitin-biding protein production were confirmed, however, no chitinolytic activity has been identified.

1642 Mitral annulus disjunction, a rare form of focal arrhythmogenic cardiomyopathy

Funding Acknowledgements

Project no. NVKP_16-1-2016-0017 has been implemented with the support provided from the National Research, Development and Innovation Fund of Hungary

The rate of sudden cardiac death in mitral valve prolapse (MVP) patients is roughly twice that observed in the general population. Arrhythmogenic bileaflet MVP syndrome has been recently described and mitral annulus disjunction (MAD) has been found associated with papillary muscle fibrosis and ventricular arrhythmias even without severe mitral regurgitation. An underlying primary structural myocardial disease might be expected and the non-invasive imaging techniques are playing an increasingly important role in the detection of myocardial fibrosis as a focal arrhythmogenic substrate. Standard 2D-, 3D- and speckle tracking echocardiography and cardiac MRI can help to differentiate between the benign and malignant forms of MVP.

A 52-year-old man with a history of hypertension was referred for evaluation of frequent palpitations and presyncope. Ambulatory Holter monitoring showed paroxysmal atrial fibrillation and non-sustained ventricular tachycardias. Dilated left ventricle (LVEDD: 65mm, LVESD: 45 mm) and left atrium (LAVi: 52mL/m2), moderately reduced left ventricular (LV) systolic function (LVEF: 42%), and reduced LV global longitudinal strain (GLS: -13.5%) with severely decreased segmental longitudinal strain in the basal inferolateral segment were measured by transthoracic echocardiography. The diastolic function was preserved, however Pickelhaube sign was noticed in the lateral mitral annulus TDI curves. MAD (17 mm) and curling motion of the inferolateral basal segment of the left ventricle was observed. Transesophageal echocardiography showed bileaflet mitral valve prolapse with the involvement of all the six scallops (mitral valve prolapse volume: 10.2 mL). Severe mitral regurgitation (3D vena contracta area: 1cm2) and extremely dilated and dyskinetic mitral annulus (diameters: 55x72x12 mm, area: 34 cm2) was measured by 3D echocardiography. MRI showed transmural late gadolinium enhancement in the underlying myocardium of both papillary muscles and midmyocardial enhancement in the basal inferior, inferolateral and anteroseptal LV segments. During electrophysiology study ventricular fibrillation was easily induced and ICD was placed for primary prevention of sudden cardiac death. The patient was referred to the heart surgeon for mitral valve replacement.

This case highlights the importance of early recognition of MAD and arrhythmogenic MVP syndrome using novel non-invasive imaging techniques. The presence of MAD, the curling motion of the inferolateral basal LV segment, the Pickelhaube sign, the decreased LVEF and GLS, the characteristic segmental longitudinal strain pattern and the presence of late enhancement in the papillary muscles and the surrounding myocardium could be warning signs of the malignant form of MVP.

Abstract 1642 Figure. CMR images of arrhythmogenic MAD

Beliefs About Medicines: Differences in cholesterol treatment adherence among the Visegrad countries

Background

Raised cholesterol is a risk factor for cerebrovascular and cardiovascular diseases. New cholesterol guidelines highlight more personalized risk assessments and new cholesterol-lowering drugs for people at the highest risk for cardiovascular disease.

Methods

The aim of our study was to investigate the possible differences in the beliefs about the necessity and concerns regarding lipid-lowering drugs among the Visegrad Group countries. For this the Beliefs About Medicines Questionnaire (BMQ-Specific) was used. The statistical analyses included 235 Czech, 205 Hungarian, 200 Polish, and 200 Slovak respondents, all of who were taking cholesterol lowering drugs.

Results

After comparing the answers of the citizens of the Visegrad Group countries, no statistically significant difference could be found regarding the concerns about the lipid-lowering drugs. However, related to the beliefs in necessity, a significant difference was shown between Poland and Hungary for the benefit of Polish participants. These results suggest, that the citizens of Visegrad Group countries do not differ regarding their beliefs about the fear of the treatment, while the beliefs about benefits are the most emphasized among the Polish citizens and less among the Hungarian citizens.

Conclusions

While policy makers in the Visegrad Group countries can use the same strategy to address the concerns regarding cholesterol lowering medication, the reasons behind the difference in the beliefs in necessity should be further investigated in order to implement country specific interventions.

The research was funded by the GINOP-2.3.2-15-2016-00005 project which is co-financed by

the European Union under the European Regional Development Fund.

Key messages

No differences exist regarding the concerns for cholesterol lowering medication among the Visegrad Group countries. Concerning necessity significant differences were observed among the same countries, which prompts further research questions.

24-Hour Near-Infrared Spectroscopy Monitoring of Acute Ischaemic Stroke Patients Undergoing Thrombolysis or Thrombectomy: A Pilot Study

INTRODUCTION

Monitoring of acute ischaemic stroke patients during thrombolysis or thrombectomy is based mostly on frequent physical examinations, since no objective measurement of cerebrovascular haemodynamics is available in routine clinical practice. Near-infrared spectroscopy (NIRS) is a bed-side, noninvasive assessment tool that could help monitor these patients and potentially guide therapeutic interventions. Our goal in this pilot study was to investigate whether NIRS is a suitable method to monitor leptomeningeal collateral circulation via changes in cortical oxygen saturation in the first 24 hours of acute ischaemic stroke.

PATIENTS AND METHODS

Our study included 5 patients with acute anterior circulation infarcts. All patients received thrombolytic therapy and 1 had thrombectomy. 24-hour continuous NIRS monitoring was performed on all participants.

RESULTS

We aimed to give a detailed description of each NIRS recording and explain how the observed findings could correlate with changes in anterior watershed territory collateral circulation and clinical outcome.

CONCLUSION

Our pilot study supports the use of NIRS monitoring in acute ischaemic stroke. We believe that this technique could provide real-time information on the dynamic changes of leptomeningeal collateral circulation and help monitor the effects of thrombolysis and thrombectomy.

A multimodal pathway including the basal ganglia in the feline brain

The purpose of this paper is to give an overview of our present knowledge about the feline tecto-thalamo-basal ganglia cortical sensory pathway. We reviewed morphological and electrophysiological studies of the cortical areas, located in ventral bank of the anterior ectosylvian sulcus as well as the region of the insular cortex, the suprageniculate nucleus of the thalamus, caudate nucleus, and the substantia nigra. Microelectrode studies revealed common receptive field properties in all these structures. The receptive fields were extremely large and multisensory, with pronounced sensitivity to motion of visual stimuli. They often demonstrated directional and velocity selectivity. Preference for small visual stimuli was also a frequent finding. However, orientation sensitivity was absent. It became obvious that the structures of the investigated sensory loop exhibit a unique kind of information processing, not found anywhere else in the feline visual system.

In New-Onset Diabetes Mellitus, Metformin Reduces Fat Accumulation in the Liver, But Not in the Pancreas or Pericardium

Background: Nonalcoholic fatty pancreas and liver disease (NAFPD and NAFLD) and pericardial adipose tissue (PAT) are often associated with type 2 diabetes mellitus (T2DM). Our aim was to evaluate the incidence rate of NAFLD and NAFPD, PAT size, and the effect of metformin treatment on NAFLD, NAFPD, and PAT in new-onset T2DM (NODM). Methods: Seventeen patients with NODM and 10 subjects used as a control group were involved in the study. Computed tomography (CT) and laboratory tests were performed before the beginning of metformin therapy and 4 months afterward. PAT and the amount of fat in the pancreas and liver were determined by X-ray attenuation during unenhanced CT examination and compared with the values for the control subjects. Results: Metabolic parameters improved significantly after metformin therapy. NAFLD was diagnosed in 64.7% of the patients with NODM and in 10% of the control subjects. The radiation absorption of the liver was significantly lower in the patients with NODM compared with the control group and significantly higher after metformin therapy compared with the baseline values. Only six patients (35.3%) had NAFLD after metformin therapy. NAFPD was diagnosed in 82.3% of the patients with NODM and in 20% of the control subjects. The radiation absorption of the pancreas was significantly lower in the patients with NODM compared with the control group but did not change significantly after treatment. PAT size was significantly larger in the patients with NODM and did not change significantly after metformin treatment. Conclusions: NAFLD, NAFPD, and increased PAT were detected in the majority of patients with NODM. Metformin therapy decreased the amount of fat in the liver in parallel with an improvement in the metabolic parameters and may, thus, be beneficial for preventing the late consequences of NAFLD.