Evaluation and implications of mitral regurgitation using cMRI in patients with hypertrophic cardiomyopathy

OBJECTIVE

Mitral regurgitation (MR) represents an important feature in patients with hypertrophic cardiomyopathy (HCM) due to left ventricular outflow tract (LVOT) obstruction and mitral valve systolic anterior motion (SAM). Mitral valve anatomical variants associated with HCM also contribute to the severity of MR. The aim of this study is to evaluate MR severity and its correlation with different parameters in patients with HCM using cardiac magnetic resonance imaging (cMRI).

PATIENTS AND METHODS

130 patients with HCM underwent cMRI. Parameters assessed for the quantification of MR severity were mitral regurgitation volume (MRV) and mitral regurgitation fraction (MRF). cMRI was also used to characterize LV function, left atrium volume (LAV) index, filling pressures and structural abnormalities associated with HCM, all in correlation to MR.

RESULTS

Patients with HCM had mild (26.9%), moderate (52.3%) or severe (20.7%) MR. Most relevant parameters related to MR severity were MRV and MRF; other parameters with strong correlation with MR were LAV index and E/E' ratio, both increasing with its severity. Patients with LVOT obstruction had more severe MR (70.3%), 79% of them due to SAM. LV ejection fraction (LVEF) increased proportionally with the severity of MR, while LV strain (LAS) was inversely correlated with it. Independent predictors for quantifying the severity of MR, after the adjustment for covariates, were MRV, MRF, SAM, LAV index and E/E'.

CONCLUSIONS

cMRI can accurately assess MR in patients with HCM, especially by using novel indicators, MRV and MRF respectively, along with LAV index and E/E' ratio. Severe MR, due to SAM, is more frequent in the obstructive form of HCM (HOCM). Also, the severity of MR is significantly associated with significantly associated with MRV, MRF, LAV index and E/E' ratio.

Early Antioxidative Response to Desiccant-Stimulated Drought Stress in Field-Grown Traditional Wheat Varieties

Extended drought affects the production and quality of wheat (Triticum aestivum L.), one of the world's most important food crops. Breeding for increased drought resistance is becoming increasingly important due to the rising demand for food production. Four old traditional Croatian wheat cultivars were used in the present study to examine the early antioxidant response of flag leaves to desiccant-stimulated drought stress and to identify drought-tolerant cultivars accordingly. The results indicate that the enzymatic antioxidant system plays the most significant role in the early response of adult wheat plants to drought stress and the removal of excessive H₂O₂, particularly GPOD and APX. Nada and Dubrava cultivars revealed the strongest activation of the enzymatic defense mechanism, which prevented H₂O₂ accumulation and lipid peroxidation. Additionally, the Nada cultivar also showed increased synthesis of proline and specific phenolic compounds, which both contribute to the increased stress tolerance. Among the cultivars investigated, cultivar Nada has the broadest genetic base, which may explain why it possesses the ability to activate both enzymatic and non-enzymatic defense mechanisms in an early response to drought stress. This suggests that old traditional wheat cultivars with broad genetic bases can be a valuable source of drought tolerance, which is especially important given the current climate change.

Characterization of Forage Quality, Phenolic Profiles, and Antioxidant Activity in Alfalfa (Medicago sativa L.)

Alfalfa (Medicago sativa L.) is one of the most important forage species and is recently more in focus for human consumption mainly due to its content of bioactive phenolics. Samples of the seventeen alfalfa cultivars/populations were collected at the Agricultural Institute Osijek with the aim to evaluate their forage quality, phenolic profiles, and antioxidant potential. Significant differences (p < 0.05) existed among studied alfalfa in all analyzed traits. The cultivar OS 99 and populations L7 and L20 were characterized by high crude protein content (22.5−24.7%) and the lowest neutral (40.2−42.9%) and acid detergent fibres (33−35.5%). The soluble-free phenolics from alfalfa leaves were extracted by methanol while insoluble cell-wall bound phenolics were released by alkaline hydrolysis. The bound phenolic extract showed a stronger DPPH scavenging capacity (20.8 mg TE/g dm) than the soluble (11.4 mg TE/g dm). The HPLC data revealed that more phenolics were found in the bound (3638.0 μg/g dm) than in the soluble form (912.3 μg/g dm). In the soluble extract of the alfalfa leaves, the major compound was catechin (338.3 μg/g dm), while rutin, epicatechin, and ferulic acid were minor ones. In the bound phenolic extract, the most abundant was ferulic (2198.2 μg/g dm) and p-coumaric acid (983.7 μg/g dm), followed by myricetin, apigenin, and quercetin. The principal component analysis revealed that alfalfa cultivars/populations were better discriminated based on the data on phenolics, rather than on forage quality. The cultivars/populations Florida 66, OS 66, L 40, L 42, Seed Force 4, and Torlesse were the most interesting in terms of phenolic health-promoting characteristics.

The joint role of collagen turn-over biomarkers and late gadolinium enhancement to predict cardiovascular outcome in nonischemic dilated cardiomyopathy

Background

Myocardial scarring is a primary pathogenetic process in nonischemic dilated cardiomyopathy (NIDCM) which is responsible for progressive cardiac remodeling and heart failure, severely impacting the survival of these patients. Although several collagens turn-over biomarkers have been associated with myocardial fibrosis, their clinical utility is still limited. Late gadolinium enhancement (LGE) determined by cardiac magnetic resonance imaging (CMR) has become a feasible method to detect myocardial replacement fibrosis.

Purpose

We sought to evaluate the association between collagen turn-over biomarkers and replacement myocardial scarring by CMR and, also, to test their ability to predict outcome in conjunction with LGE in patients with NIDCM.

Method

We conducted a prospective study on 194 patients (48.7±14.3 years of age; 74% male gender) with NIDCM. CMR was used to determine the presence and extent of LGE. Several collagen turn-over biomarkers were determined at the diagnosis, comprising galectin-3 (Gal3), procollagen type I carboxy-terminal pro-peptide (PICP) and N-terminal pro-peptide of procollagen type III (PIIINP). A composite outcome (all-cause mortality, ventricular tachyarrhythmias, heart failure hospitalization) was ascertained over a median of 26 months. Of all, 17% (n=33) of patients reached the outcome: all-cause mortality (n=6), malignant ventricular tachyarrhythmia (n=14) and HF hospitalization (n=13).

Results

Gal3, PICP and PIIINP were considerably increased in those with LGE+ (p&lt;0.001), being also directly correlated with LGE mass (r2=0.42; r2=0.44; r2=0.31; all p&lt;0.001). Receiver operating characteristic (ROC) analysis revealed significant ability to diagnose LGE, with area under the ROC: 0.816 for Gal3, 0.705 for PICP, and 0.757 for PIIINP (all p&lt;0.0001). Kaplan-Meier analysis showed that at a threshold of &gt;13.8 ng/dL for Gal3 and &gt;97 ng/dL for PICP, they significantly predicted the outcome (HR=2.66, p&lt;0.001; HR=1.93, p&lt;0.002). Moreover, for a combined model of LGE+/Gal3+/PICP+, time-to-event analysis demonstrated the highest ability to predict composite outcome, as compared to any other models (p=0.004). Nevertheless, in multivariate analysis, after adjustment for covariates, only LGE+ and Gal3+ remained independent predictors for outcome (p=0.008; p=0.04).

Conclusion

In patients with NIDCM, serum collagen turn-over biomarkers such as Gal3, PICP and PIIINP are closely related to the presence and extent of LGE and can significantly predict cardiovascular outcome. The joint use of LGE with Gal3 and PICP significantly improved outcome prediction.

Funding Acknowledgement

Type of funding sources: None.

Characterization of left atrial geometry and function in patients with non-obstructive hypertrophic cardiomyopathy: a cardiac magnetic resonance imaging study

Background

Left atrial (LA) function and geometry are important predictors of cardiac dysfunction and prognosis in cardiovascular disease, however studies that evaluate their role in patients with hypertrophic cardiomyopathy (HCM) are scarce. Furthermore, altered LA phasic functions might become predictors for disease progression, even in these patients. This study sought to assess the use of cardiac magnetic resonance imaging (CMR) in the assessment of LA function and geometry in patients with HCM.

Methods

We conducted a prospective case-control study on eighty-six patients with first non-obstructive HCM (NO-HCM) diagnosis. They underwent standard cardiovascular examinations and CMR. LA geometry was assessed using LA maximum, minimum and pre-A volumes (LAVmax, LAVmin, LAVpre-A), LA sphericity index (LASI), and LA late gadolinium enhancement (LA-LGE). LA phasic functions were assessed using LA total emptying fraction (LATF), LA passive emptying fraction (LAPF) and LA active emptying fraction (LAAF). LA strain parameters of all three phasic functions were quantified by total strain (et); passive strain (ep), active strain (ea).

Results

86 HCM patients (51±13.7) and 86 healthy volunteers (51±13.6) were enrolled. LA volumes parameters were significantly increased in NO-HCM group (LAVmax: 39.7 vs 33.9 mL/m2; LAVmin: 20.4 vs 13.9 mL/m2; LAVpre-A31.7 vs 24.1 mL/m2, all p&lt;0.001). LA geometry was significantly altered by an increased LASI (56.3 vs 39.7, p&lt;0.001). All three LA phasic functions and strain were impaired in those withHCM (LATF: 49.2±6.5% vs. 58.8±3.1%, et 30.9% vs 39.8%; LAPF: 19.9±5.9% vs. 29.1±8.4%, ep 15.9% vs 18.1%; LAAF: 36.3±8.8% vs. 41.2±8.2%, ea: 20.5% vs 29.1%; all p&lt;0.001). Last but not least, LA replacement fibrosis was present in 39.5% (n=34) of patients with NO-HCM. In multivariable analysis, increased LA-LGE was associated with lower LAPF, peak global longitudinal LA strain (p&lt;0.001).

Conclusion

LA function, strain and geometry are significantly impaired in patients with NO-HCM, even before left ventricular outflow tract obstruction occurs. These parameters might have predictive ability, however further studies are required.

Funding Acknowledgement

Type of funding sources: None.

Correlation of elongation factor 1A accumulation with photosynthetic pigment content and yield in winter wheat varieties under heat stress conditions

Heat stress is one of the most important environmental factors that influences wheat growth and development, leading to significant losses in grain yield and has become a significant detrimental factor for worldwide wheat production. In recent years, several studies suggested that eukaryotic elongation factor 1A (eEF1A), may contribute to heat tolerance in plants, therefore the aim of this study was: to investigate the accumulation of eEF1A in wheat under conditions of moderate and high air temperatures; to determine the amount of photosynthetic pigments and to determine the yield traits; and to examine whether there is a correlation between eEF1A accumulation, photosynthetic pigments, and yield in different wheat varieties. The results showed that heat stress induced accumulation of eEF1A significantly different among wheat varieties and showed that varieties with a higher accumulation of eEF1A under heat stress are characterized by a smaller decrease in the photosynthetic pigments. A correlation between higher accumulation of eEF1A under heat stress and yield traits was found. Analyzed parameters from two growing seasons, indicated that the higher accumulation of eEF1A and a smaller decrease in photosynthetic pigments distinguishes the varieties more resistant to heat stress. The analysis of the molecular mechanisms by immunoblot, under conditions of high and moderate air temperatures in two growing seasons, aims to develop agricultural strategy and develop wheat varieties tolerant to heat stress.

Comparative Study of Drought Stress Effects on Traditional and Modern Apple Cultivars

Genotype-dependent responses of apples to drought stress were evaluated between commercial and traditional apple cultivars. The results indicate different mechanisms of tolerance to investigated drought stress conditions. Chlorophyll fluorescence induction (OJIP) parameters, chlorophyll and carotenoid content, malondialdehyde (MDA), hydrogen peroxide (H2O2), proline, phenols and leaf water content (WC) were measured. The traditional cultivar "Crvenka" confirmed the best tolerance to a drought stress condition, presenting higher photosynthetic efficiency, higher leaf water content, higher levels of chlorophyll content and lower lipid peroxidation with greater membrane stability. The commercial cultivar "Golden Delicious Reinders" showed decreased water content in leaves, increased lipid peroxidation levels and photoinhibition. Considering all results, the commercial cultivar "Golden Delicious Reinders" was adversely affected by drought, while traditional cultivars exhibited better tolerance to drought stress.

Performance of coronary calcium score and epicardial fat volume in early diagnostic of coronary artery disease

Background

Coronary artery disease (CAD) remains a world leading cause of death, despite the development of traditional risk scores based on the quantification of cardiovascular risk factors. Coronary calcium score (CCS) determined by cardiac computed tomography (CCT) is a noninvasive tool with major implications in early diagnosis and in outcome prediction in CAD patients. Epicardial fat volume (EFV) is a recently described CCT-based diagnostic and prognostic tool of CAD and outcome.

Purpose

This study sought to investigate the performance of coronary calcium score and EFV in early diagnosing CAD.

Methods

We conducted a prospective, single-center, cross-sectional study on patients suspected of CAD. All patients were submitted to detailed clinical data, 12-lead electrocardiogram, estimating pretest probability, stress test, echocardiography, CCT imaging. In the study subjects was assessed CCS, EFV and the number of calcified plaques (NoP). The total CCS load was then ranked in the following scoring groups: 0 (no evidence of coronary calcium; reference group), 1–99 (minimal to mild), 100–399 (moderate), and 400–999 (extensive) and ≥1000 (very extensive). The subjects in the study were classified according to the NoP derived from their CCS scans (no plaques, 1–5, 6–10 and more than 10 calcified plaques). CAD was defined as coronary stenosis over 50% of the vessel.

Results

Among 540 patients (55.8±11.2 years of age; 52% women) met the enrollment criteria, 98 patients presented CAD. Spearman correlation analysis revealed strong correlations between EFV index and CCS (r=0.45; p&lt;0.0001) and between EFV index and NoP (r=0.44; p&lt;0.0001), after adjustment for age, sex, body mass index, hypertension, diabetes and low-density lipoprotein cholesterol. The area under the curve of the receiver-operator curve for CAD prediction by CCS &gt;70.3 UH (cut-off value) was significantly higher (AUC=0.927; p&lt;0.0001) by comparison with EFV index &gt;40.8 ml/m2 (AUC=0.816; p&lt;0.0001) and NoP &gt;4 (AUC=0.928; p&lt;0.0001). The association of all three parameter, CCS, EFV and NoP, increases the prediction power of CAD, providing an AUC of 0.969 with a 0.70 sensibility and 0.95 specificity.

Conclusion

The combined use of EPV, CCS and NoP has a very high predictive capacity for CAD, regardless of the classic cardiovascular risk factors. This increases the diagnostic capacity of CAD beyond every parameter used alone.

Funding Acknowledgement

Type of funding source: None

Aging influences pulmonary artery flow and stiffness in healthy individuals: non-invasive assessment using cardiac MRI

AIM

To investigate age-related changes of the pulmonary artery (PA) using cardiac magnetic resonance imaging (cMRI) in healthy subjects.

MATERIALS AND METHODS

A cross-sectional observational study was conducted on apparently healthy subjects who underwent PA velocity-encoded cMRI. cMRI was used to determine PA stiffness parameters such as PA elasticity, relative area change (PA-RAC) and pulse-wave velocity (PA-PWV), and PA flow parameters by subtracting simultaneous forward flow (FF) and backward flow (BF) velocity across the PA cross-section. Data were presented in five age and sex matched groups.

RESULTS

One hundred and fifty subjects (20-70 years, 75 men) met the enrolment criteria. PA elasticity and PA-RAC significantly decreased with age (p<0.001), while PA-PWV, regurgitant volume (V_reg) and backward flow volume (V_BF) increased in the elderly (p<0.001). Linear regression analysis indicated that PA elasticity (r=-0.441, p<0.0001) and PA-RAC (r=-0.484, p<0.0001) were indirectly and negatively associated with advancing age, whereas PA_min (r=0.331, p<0.0001), PA-PWV (r=0.490, p<0.0001), V_Reg (r=0.335, p<0.0001) and V_BF (r=0.349, p<0.0001) were directly associated with age. Multivariate analysis indicated that age was independently associated with V_reg and V_BF, and the addition of PA_min and PA-PWV marginally increased its predictive capacity.

CONCLUSION

Aging significantly increases cMRI-based PA flow and stiffness parameters. These could become relevant markers of subclinical changes of the PA geometry in healthy subjects.

Assessing post-radiotherapy handover notes from a family physician perspective

Background

Across our province, post-radiotherapy (rt) handover notes are sent to family physicians (fps) after rt. Based on previous fp feedback, we created a revised post-radiotherapy handover note with more information requested by fps. The purpose of this study was to determine whether the revised handover note improved the note as a communication aid.

Methods

Potential common and rare treatment side effects, oncologist contact information, and treatment intent were added to the revised handover note. Both versions were sent alongside a questionnaire to fps. Paired t-tests were carried out to compare satisfaction differences.

Results

There was a response rate of 37% for the questionnaires. Significantly greater clarity in the following categories was observed: responsibility for patient follow-up (mean score improvement of 1.2 on a 7-point Likert scale, p < 0.001), follow-up schedule (1.1, p < 0.001) as well as how and when to contact the oncologist (1.4, p = 0.001). Family physicians were also more content with how the institute transitioned care back to them (1.5, p = 0.012). Overall, fps were generally satisfied with the content of the revised post-rt handover note and noted improvement over the previous version. The frequency of investigations and institute supports initiated such as counselling services were suggested further additions.

Conclusions

The inclusion of potential treatment side effects, oncologist contact information, treatment intent and a well-laid out follow-up schedule were essential information needed by fps for an effective post-rt completion note. With these additions, the revised post-rt handover note showed significant improvement.

Performance Indices in Wheat Chlorophyll a Fluorescence and Protein Quality Influenced by FHB

Very little is known about the physiological interactions between wheat quality and Fusarium head blight (FHB), which substantially reduces wheat grain yield and quality worldwide. In order to investigate stress-induced changes in flag leaves from plants artificially inoculated with Fusarium, we screened for chlorophyll a fluorescence transient at 1, 2, 4, 7 and 14 days after Fusarium inoculation. Our results indicate that the maximum quantum yield of photochemistry (Fv/Fm) and the performance index (PI) were not affected by FHB, but there were significant differences in those two traits between different varieties and measurement times. FHB caused a significant reduction in the percentage of glutenins (GLU), high-molecular-weight (HMW), and low-molecular-weight (LMW) subunits in 'Kraljica' and 'Golubica', unlike 'Vulkan', where the percentage of GLU increased.

e-Derma - a Novel Wireless Dermatoscopy System

Cutaneous Melanoma (CM) is a malignant tumour, and is one of the most rapidly growing cancers. Discovering a melanoma in the early stages of the disease is extremely difficult and, as such, only an invasive disease stage can be identified easily with the naked eye. Dermatoscopy is a diagnostic method intended to maximise early detection of CM performed by the dermatoscopy system. To address the limitations of existing systems a novel, wireless digital dermatoscopy system is presented for providing high-resolution images. It integrates a wire-free camera operation and offers a safe transfer of captured images to the computer. The working process of available dermatoscopy systems was studied, which are the most commonly used in everyday dermatology practice. Some findings, like operability, image quality, scalability, user-friendliness, and safeness, were used for the development of an e-Derma dermatoscopy system. An assessment method was performed by a group of dermatoscopy trained dermatologists to evaluate the quality of the testing images. Finally, a laboratory evaluation of images in regard to different parameters like sharpness, colour representation and illumination was performed with the side-by-side comparison of images of available dermatoscopy systems. e-Derma is a novel dermatoscopy system, which eliminates some limitations of existing systems and provides high-quality images. A novel low-budget highly capable dermatoscopy system is presented. The integrated wireless image transfer technology eliminates the movement limitations of a therapist. The image resolution is not limited by the integrated camera; it is easily upgradable with a wide range of on market alternative or improved camera models.

Contribution of angiogenic factors in a rat model of pre-eclampsia

BACKGROUND/AIMS

Pre-eclampsia is a disorder that results in significant feto-maternal complications with yet no definitive pharmacologic intervention. One postulated etiologic mechanism is an imbalance between circulating pro-angiogenic and anti-angiogenic factors. We investigated these factors sequentially throughout pregnancy (19-21 days) in our rat model of pre-eclampsia, which involves the imposition of excessive volume expansion.

METHODS

We evaluated the status of the pro-angiogenic and anti-angiogenic factors at the following time points: 3-5, 7-10 and 17-20 days of gestation.

RESULTS

We have previously determined that the urinary excretion of the circulating bufodienolide, marinobufagenin, is elevated at the 3- to 5-day time period, prior to the advent of hypertension and proteinuria. At 3-5 days of pregnancy, there was no evidence of angiogenic imbalance in the normal pregnant (NP) and 'pre-eclamptic' (PDS) rats. At the 7- to 10-day time point, plasma PlGF was greater in the NP rats than in the PDS group (p < 0.05). The plasma sFlt-1/PlGF ratio in the PDS animals was greater than that in the NP rats (p < 0.05). The placental sFlt-1 and sFlt-1/PlGF ratio were greater in the PDS rats than in NP rats (p < 0.05). These changes were also present at the 17- to 20-day time point in both plasma and placenta. The administration of resibufogenin, an antagonist of marinobufagenin, early in pregnancy, prevented angiogenic imbalance.

CONCLUSION

We conclude that angiogenic imbalance plays a role in the pathogenesis of pre-eclampsia in this rat model. Furthermore, the earliest event in the pathogenetic sequence appears to be the secretion and elaboration of marinobufagenin.

Effects of resibufogenin in experimental hypertension

BACKGROUND/AIMS

There are two major pathophysiologic processes involved in the development of hypertension: (1) expanded extracellular fluid volume and (2) vasoconstriction. We have developed a model of preeclampsia in the rat, in which excessive volume expansion (VE) plays a role. These animals excrete increased amounts of the bufodienolide, marinobufagenin (MBG), even before their hypertension and proteinuria become established. Furthermore, their hypertension is corrected by administration of resibufogenin (RBG), a compound structurally similar to MBG.

METHOD

We studied two models of experimental hypertension in the nonpregnant animal, produced either by deoxycorticosterone acetate (DOCA)-salt administration or by angiotensin infusion.

RESULTS

RBG administered to the DOCA-salt rats lowered blood pressure and reduced proteinuria in the VE animals, but had no affect on the rats infused with angiotensin. Furthermore, although the production of superoxide anion in the aortas of both groups of hypertensive rats was increased over control, RBG reduced these levels to normal in the VE (DOCA-salt) animals only. RBG had no effect in the angiotensin-infused rats. The urinary excretion of angiotensinogen did not rise in VE-mediated hypertension, but did increase in the angiotensin-infused rats.

CONCLUSIONS

MBG plays an important role in the causation of hypertension in the VE rats, but not in the vasoconstrictive model. RBG is effective only in VE-mediated hypertension.

[Reconstruction of mental health services in Bosnia and Herzegovina]

Psychiatric services in Bosnia-Herzegovina before the war disaster was fairly developed and one of the best organized services amongst the republics of the former Yugoslavia. The psychiatric care system was based on psychiatric hospitals and small neuropsychiatric wards within general hospitals, accompanied by psychiatric services in health centers. The onset of war in B&H brought devastation and destruction in all domains of life, including the demolition and closing of numerous traditional psychiatric institutions, together with massive psychological suffering of the whole civilian population. Already during the war, and even more so after the war, the reconstruction and reorganization of the mental health services was undertaken. The basis of mental health care for the future is designed as a system where majority of services is located in the community, as close as possible to the habitat of the patients. The key aspect of the system of the comprehensive health care is primary health care and the main role is assigned to family practitioners and mental health professionals working in the community. Large psychiatric institutions were either closed or devastated, or have their capacities extensively reduced. There will be no reconstructions or reopening of the old psychiatric facilities, nor the new ones will be built. The most integrated part of the psychiatric system are the Community based mental health centers. Each of these centers will serve a particular geographic area. The centers will be responsible for prevention and treatment of psychiatric disorders, as well as for the mental health well being. Chronic mental health patients without families and are not able to independently live in the community will be accommodated in designated homes and other forms of protected accommodation within their communities. The principal change in mental health policy in B&H was a decision to transfer psychiatric services from traditional facilities into community, much closer to the patients. Basic elements of the mental health policy in B&H are: Decentralization and sectorization of mental health services; Intersectorial activity; Comprehensiveness of services; Equality in access and utilization of psychiatric service resources; Nationwide accessibility of mental health services; Continuity of services and care, together with the active participation of the community. This overview discusses the primary health care as the basic component of the comprehensive mental health care in greater detail, including tasks for family medicine teams and each individual member. 1. Comprehensive psychiatric care is implemented by primary health care physicians, specialized Centers for community-based mental health care, psychiatric wards of general hospitals and clinical centers in charge of brief, "acute" inpatient care; 2. Primary mental health care is implemented by family practitioners (primary care physicians) and their teams; 3. Specialized psychiatric care in community is performed professional teams specialized mental health issues' within Mental health centers in corresponding sectors; 4. A great deal of relevance is given to development of confidence and utilization of links between primary health care teams and specialized teams in Mental health centers and psychiatric in patient institutions; 5. Psychiatric wards within general cantonal hospitals, departments of psychiatric clinics in Sarajevo, Tuzla, and Mostar, and Cantonal Psychiatric hospital in Sarajevo (Jagomir) shall admit acute patients as well as chronic (with each new relapse). Treatment in these facilities is brief an patients are discharged to return to their homes, with further treatment referral to their family practitioner or designated Mental health center; 6. Chronic mental patients with severe residual impairment in social, psychological, and somatic functioning, shall live in the community with their families or independently. Those chronic patients without families and economic and other resources to live independently shall be placed in supervised Homes in the communities where they live. The above delineated strategy of mental health care program in B&H has several fundamental and specific objectives, among which the most important are: Reduction of incidence and prevalence of some mental disorders, particularly war stress-related disorders and suicide; Reduction of level of functional disability caused by mental disorders through improvement of treatment and care of individuals with mental health problems; Improvement of psychosocial well being of people with mental health problems, through implementation of comprehensive and accessible service for community mental health care; and Respect of basic human rights of individuals with mental health disabilities. The program has been updated since 1996, after the two-year pilot program. The main goals for current two- and five-year period are: Implement the mental health care reform program by launching all 38 Mental health centers in the Federation of BiH by 2002; Complete the 10-day education and re-education of at least 50% of all professionals employed in mental health services in FB&H by 2002; and Achieve that 80 percent of all mental health problems are treated by family medicine teams (primary care practitioners) and specialized mental health services (Community mental health care centers) by 2005.

Pantoprazole versus omeprazole in the treatment of reflux esophagitis

Pantoprazole is a new proton pump inhibitor with a potent antisecretory activity, well defined pharmacokinetics and safety profile. The aim of this single blind, randomized clinical trial was to compare the efficacy of pantoprazole (PAN) 40 mg/day and omeprazole (OME) 20 mg/day in patients with grade I and II GERD (Savary-Miller classification). A total of 120 patients were included (PAN = 60 and OME = 60). In the per protocol/analysis, healing rates at 4 weeks were 76.3% PAN and 71.2% OME (ns), and at 8 weeks 94.7% PAN and 92.9% OME (ns). In the intention to treat analysis, healing rates at 4 weeks were 75% PAN and 70% OME (ns), and at 8 weeks 90% PAN and 86.6% OME (ns). Both pantoprazole and omeprazole were well tolerated with no serious drug related adverse events. Pantoprazole 40 mg/day was found to be safe and effective therapy comparable to omeprazole 20 mg/day in the short-term treatment for reflux esophagitis (grade I and II).

Pharmacokinetics and acute tolerance of a double virus inactivated plasma derived factor VIII concentrate

To further reduce the risk of possible viral disease transmission, an additional virucidal step was performed in the manufacturing process of a solvent/detergent treated factor VIII concentrate, which consisted of heating the lyophilized preparation at 100 degrees C for 30 min (Emoclot DI; ISI, Italy). Because thermal treatment may modify factor VIII bioavailability, the pharmacokinetic parameters and the acute tolerance of the single viral inactivated concentrate (preparation A) were compared with that of the double viral inactivated one (preparation B). Fifteen patients with severe haemophilia A and positive for HAV Ab were enrolled in a double-blind cross-over study and injected with 32.5 IU kg-1 of preparation A and 27 IU kg-1 of the preparation B. No significant differences between terminal half-life, area under the curve/dose, clearance/kg, volume of distribution at the steady state, in vivo recovery and acute tolerance of the two preparations was observed. The only statistical difference was restricted to Cmax.

In vitro assessment of asbestos fibers genotoxicity

This study was carried out in order to assess the genotoxic effect of in vitro exposure to commercial chrysotile asbestos. V 79 cell line, known as a well-established cellular model, was used for detection of asbestos genotoxic potency. Conventional structural chromosomal aberration analysis and sister chromatid exchange (SCE) method were both used for asbestos genotoxicity assessment. Within the experimental protocol applied, V 79 cells were treated with asbestos in concentrations of 100 and 200 micrograms/ml F-10 (HAM) media during 90 days, respectively. Analysis of changes in chromosome structure as well as of cell ploidy was performed each tenth day of the experimental course, consecutively. Two hundred well spread metaphases were taken into account for chromosomal aberration analysis. Frequency of sister chromatid exchanges was observed in 50 cells per sample. The results of cytogenetic tests revealed structural chromosomal damages, SCE-elevation and changes in cell ploidy. Cytogenetic effect of asbestos obviously depended on the dose applied and on the period of incubation. The results of this study suggest that significant cytogenetic changes occurring after asbestos treatment might directly or indirectly be the part of the biological events responsible for eliciting asbestos-induced carcinogenesis.

Chromosome aberrations induced in human lymphocytes by U-235 fission neutrons. Part III: Evaluation of the effect of the induced alpha and beta activity on the chromosomal aberration yield

AIM

Further experiments were performed to explain a difference in chromosomal aberration yield found between samples cultivated immediately after fission neutron irradiation and samples which were cultivated with 96 h delay after irradiation.

MATERIAL AND METHOD

Human peripheral blood samples were irradiated in mixed fission neutron/gamma field (1800 s) and biological effect assessed in the mean of analysis of unstable chromosome aberrations with a time delay in culturing cells of 12, 24, 48, and 96 h. Additional measurements were performed on irradiated and blank blood samples with the aim to detect any increase in alpha and beta activity after fission neutron irradiation. No difference was found. Results were compared to theoretically calculated values of the alpha and beta activity released from natural radioactive isotopes.

RESULT AND CONCLUSION

As a conclusion it is shown that in our experimental conditions the secondary effects resulting from nuclear transformations of natural or induced radioactive isotopes, recoil reactions and accompanying alpha, beta, and gamma radiation are not the reason for the increase observed in chromosomal aberration yield in blood samples cultured with a time delay of at least 24 hours.

Lansoprazole versus omeprazole in the treatment of reflux esophagitis

To evaluate the therapeutic potential of the newly developed proton pump inhibitor lansoprazole in patients with reflux esophagitis (grade I and II according to Savary Müller criteria), the authors performed a single blind, randomized clinical trial comparing 20 mg omeprazole and 30 mg lansoprazole, involving 60 patients at two clinical hospitals. The treatment period was or 8 weeks, and main efficacy variables were healing of endoscopic changes and relief of reflux symptoms. No significant difference in terms of healing and relief of reflux symptoms was found either after 4 or after 8 weeks of treatment. In conclusion, 30 mg lansoprazole daily was found to be safe and effective therapy comparable to omeprazole in the short-term treatment for reflux esophagitis (grade I and II).

Another therapeutic schedule in eradication of Helicobacter pylori

In this study, the efficacy and tolerability of two different therapeutic schedules in eradicating Helicobacter pylori and healing duodenal ulcer were evaluated. The study included 60 patients with duodenal ulcer and Helicobacter pylori infection. They were randomly allocated to either of two groups: group 1 (N = 30) received omeprazole 20 mg for 28 days, amoxicillin 3 x 500 mg for 7 days and metronidazole 3 x 500 mg for 5 days, and group 2 (N = 30) received omeprazole 20 mg for 28 days, ACA (amoxicillin 500 mg plus clavulanic acid 125 mg) 3 x 625 mg for 7 days and metronidazole 3 x 500 mg for 5 days. Endoscopic examination, bioptic urease test and histologic examination were performed before, and 30 and 90 days after the treatment. Endoscopic examination was also performed one month after the beginning of the treatment, when healing of duodenal ulcer was observed in 90% (27/30) of the group 1 patients and in 93.3% (28/30) of the group 2 patients. The Helicobacter pylori eradication achieved in group 1 and 2 was 76.7% (23/30) and 83.3% (25/30), respectively. Side effects were present in 20% (6/30) of the group 1 patients and in 23.3% (7/30) of the group 2 patients. Side effects were mild and did not require interruption of the treatment. A higher rate of eradication was achieved in group 2 than in group 1, but the difference was not statistically significant.

Work environment influence on cytostatics-induced genotoxicity in oncologic nurses

The aim of the study was to point out the influence of workplace conditions on chromosomal damage incidence in nurses handling cytostatics. The study comprised two groups of 17 oncologic nurses each and the same number of matched controls. Sister chromatid exchange method (SCE) was used for genotoxicity assessment. In the group of nurses provided with a safe working environment, the SCE-frequency was insignificantly increased when compared to the controls (p > 0.8), although wide SCE-ranges were obtained. By contrast, in the group of nurses provided with neither such an environment nor with the appropriate personal protective equipment, the SCE-frequency was significantly higher, not only compared to the controls (p < 0.001), but also to the first test group (p < 0.001).

Potential genotoxic risk related to simultaneous exposure to radionuclides and cytostatics

The aim of the study was to evaluate the genotoxic risk to medical personnel concurrently exposed to ionizing radiation and antineoplastics, using changes in their lymphocyte cell genome as a bioindicator. The study comprised 12 female nurses employed in the nuclear medicine hospital department and an equal number of matched controls. For each examinee, both conventional structural chromosomal aberration analysis and sister chromatid exchange test (SCE) were carried out. According to Student's t-test, neither the incidence of structural chromosomal aberrations (p > 0.6) nor the mean SCE-frequency rate (p > 0.3) were significantly increased among the exposed subjects. Nevertheless, in those exposed, irreparable chromosomal damages and wide SCE-ranges were observed. Such findings suggest the possibility of genotoxic implications of concurrent occupational exposure to ionizing radiation and antineoplastic drugs.

[The capillaroscopy method and possibilities of its clinical use]

The aim of this paper is to point out the purpose and possibilities of practical application of capillaroscopy in the peripheral blood vessel alterations diagnosis and follow-up. The paper gives a detailed technical description of the method as well as the capillaroscopic findings interpretation criteria. A special attention has been paid to the most important external factors as well as to the diseases that may affect the peripheral blood flow condition.

Evaluation of serial application of capillaroscopy, photoplethysmography, and dermothermometry in diagnosis and prevention of radiolesions of peripheral microvessels

This study was performed with the aim of evaluating the justifiability of serial application of nailfold capillaroscopy, digital dermothermometry and digital photoplethysmography in the diagnosis of vascular radiolesions in subjects occupationally exposed to ionizing radiation. Thirty-eight exposed examinees, as well as 30 control persons, were included in the study. In order to establish the condition of the peripheral blood flow, each subject was examined by all the three methods. The results of this work and their statistical evaluation showed the nailfold capillaroscopy and digital dermothermometry to be the most suitable combination of methods for detection of initial changes on the smallest skin blood vessels, subsequent to skin irradiation, while the use of photoplethysmography should be limited to such cases where alterations of digital arterioles are expected.

[Potential genotoxic effects of cytostatics in occupationally-exposed persons]

The aim of the study was to determine possible mutagenic implications of occupational exposure to cytostatic agents. Twenty-one nurses handling antineoplastic drugs and a matching control group were examined. The conventional method for testing chemical mutagens, that of sister chromatid exchanges, SCE, was used. Although the results obtained in the exposed group did not significantly differ from those obtained for the controls, wide ranges of SCE values observed among the medical personnel handling cytostatic drugs confirm the suspicion of the genotoxic effect of those agents.

Chromosomal analysis of Chinese hamster V79 cells exposed to multiple gamma-ray fractions: induction of adaptive response to mitomycin C

Chinese hamster V79 cells were irradiated daily with 0.3 Gy of gamma-rays 5 times per week for 12 weeks (total 18 Gy). These cells were challenged with an additional dose of 15. Gy gamma-rays or treated with 5 micrograms/ml of mitomycin C (MMC) for 2 h. In spite of the high total accumulated dose of gamma-rays, the number of chromosomal aberrations and sister-chromatid exchanges (SCEs) did not significantly increase in the preirradiated cells, as compared to control cells. If preirradiated cells were challenged with an additional 1.5 Gy of gamma-rays, an insignificant decrease in the yield of chromatid aberrations was observed. In contrast, preirradiated cells became significantly more resistant to the induction of chromosomal damage when challenged with mitomycin C. Our results suggest that multiple fractions of gamma-rays can induce the adaptive response to mitomycin C in preirradiated cells.

Chromosome aberrations induced in human lymphocytes by U-235 fission neutrons. Part II: Evaluation of the effect of the induced Na-24 activity on the chromosomal aberration yield

Blood samples were spiked with Na-24 to study the separate effect of this nuclide on the incidence of chromosomal aberrations in neutron irradiated blood samples. A delay of 96 h was allowed before cultivation, so the results of chromosomal aberration analysis could be compared with the results obtained by direct irradiation of blood samples with U-235 fission neutrons [7]. The absorbed dose was calculated using a simple conservative model. From the results obtained we can conclude that Na-24 alone was not the reason for the difference in the incidence of chromosomal aberrations between blood samples cultivated immediately after "in vitro" irradiation by U-235 fission neutrons and samples which were cultivated after 96 h storage.

The correlation between the frequency of micronuclei and specific chromosome aberrations in human lymphocytes exposed to microwave radiation in vitro

Human whole-blood samples were exposed to continuous microwave radiation, frequency 7.7 GHz, power density 0.5, 10 and 30 mW/cm2 for 10, 30 and 60 min. A correlation between specific chromosomal aberrations and the incidence of micronuclei after in vitro exposure was observed. In all experimental conditions, the frequency of all types of chromosomal aberrations was significantly higher than in the control samples. In the irradiated samples the presence of dicentric and ring chromosomes was established. The incidence of micronuclei was also higher in the exposed samples. The results of the structural chromosome aberration test and of the micronucleus test were comparatively analyzed. The values obtained showed a positive correlation between micronuclei and specific chromosomal aberrations (acentric fragments and dicentric chromosomes). The results of the study indicate that microwave radiation causes changes in the genome of somatic human cells and that the applied tests are equally sensitive for the detection of the genotoxicity of microwaves.

Chromosome aberrations induced in human lymphocytes by U-235 fission neutrons: I. Irradiation of human blood samples in the "dry cell" of the TRIGA Mark II nuclear reactor

A set-up for irradiation of biological samples in the TRIGA Mark II research reactor in Ljubljana is described. Threshold activation detectors were used for characterisation of the neutron flux, and the accompanying gamma dose was measured by TLDs. Human peripheral blood samples were irradiated "in vitro" and biological effects evaluated according to the unstable chromosomal aberrations induced. Biological effects of two types of cultivation of irradiated blood samples, the first immediately after irradiation and the second after 96 h storage, were studied. A significant difference in the incidence of chromosomal aberrations between these two types of samples was obtained, while our dose-response curve fitting coefficients alpha 1 = (7.71 +/- 0.09) x 10(-2) Gy-1 (immediate cultivation) and alpha 2 = (11.03 +/- 0.08) x 10(-2) Gy-1 (96 h delayed cultivation) are in both cases lower than could be found in the literature.

The relationship between colony-forming ability, chromosome aberrations and incidence of micronuclei in V79 Chinese hamster cells exposed to microwave radiation

Cultured V79 Chinese hamster fibroblast cells were exposed to continuous radiation, frequency 7.7 GHz, power density 0.5 mW/cm2 for 15, 30 and 60 min. The effect of microwave radiation on cell survival and on the incidence and frequency of micronuclei and structural chromosome aberrations was investigated. The decrease in the number of irradiated V79 cell colonies was related to the power density applied and to the time of exposure. In comparison with the control samples there was a significantly higher frequency of specific chromosome aberrations such as dicentric and ring chromosomes in irradiated cells. The presence of micronuclei in irradiated cells confirmed the changes that had occurred in chromosome structure. These results suggest that microwave radiation can induce damage in the structure of chromosomal DNA.

[Mutagenic and carcinogenic effects of vinyl chloride monomers in humans]

The use of vinyl chloride monomer in industry dates back to the late 1930s. Today the number of occupationally exposed industrial workers is estimated to be several million. After the first described cases of cancer among workers exposed to high concentrations of this gas, extensive research was initiated into its possible mechanism of action on the living organism. This paper is a review of some current knowledge about the action of vinyl chloride monomer as a substance which after metabolic activation in the organism becomes a strong carcinogenic and mutagenic agent.