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Background/Objectives: Sudden cardiac death (SCD) remains a major global health concern and represents one of the most common causes of mortality due to cardiovascular diseases. The wearable cardioverter–defibrillator (WCD) is an innovative, non-invasive medical device designed to provide continuous heart monitoring and immediate defibrillation in patients at risk for SCD. The study aimed to assess the efficacy of WCD usage in patients awaiting decision on therapy with implantable cardioverter–defibrillators (ICDs). Methods: We explored the clinical applications, benefits, and limitations of WCD usage within the BIA-VEST registry in Poland over the years 2021–2023. The study included 10 patients with a mean age of 49.1 ± 12.02 years. Results: All patients demonstrated good tolerance and compliance with the LifeVest WCD, wearing it for an average of 93.1 days, about 22.8 h per day (95.7% of the time). No interventions from LifeVests were recorded, and there were no effective, ineffective, or inadequate discharges. After the first follow-up echocardiography, five patients still required ICDs. Due to improved LVEF and overall condition in six out of ten patients undergoing WCD bridge therapy, ICD implantation was finally waived. Conclusions: The WCD acts as a bridge to therapy, such as ICD implantation or cardiac surgery, and may be particularly beneficial for patients with transient or evolving conditions, such as structural heart diseases and life-threatening ventricular arrhythmias. [ABSTRACT FROM AUTHOR]

Air pollution is a pervasive global challenge with profound implications for public health. This review explores the intricate relationship between air pollution and atrial fibrillation (AF), a prevalent cardiac arrhythmia associated with significant morbidity and mortality. Drawing on a comprehensive analysis of the existing literature, this review synthesizes current evidence linking various air pollutants, including particulate matter, nitrogen dioxide, ozone, and carbon monoxide, to the development and exacerbation of AF. The review delves into the role of air pollution as a global health issue alongside its specific sources, such as traffic-related emissions and industrial pollutants. It also examines the underlying mechanisms through which air pollution may contribute to the pathogenesis of AF, encompassing oxidative stress, inflammation, and autonomic nervous system dysregulation. In addition, it explores the impact of individual pollutants and the results of meta-analyses. It considers the results of vulnerable populations, including sex differences between the individuals and those with pre-existing cardiovascular conditions, who may be disproportionately affected. We also address critical research gaps in this area. Overall, air pollution has been increasingly recognized as a significant trigger for AF, with evidence linking exposure to particulate matter and gaseous pollutants to an increased incidence in short- as well as long-term exposure, highlighting the need for targeted public health interventions and further research to mitigate its cardiovascular impact. [ABSTRACT FROM AUTHOR]

Transformed roots of Salvia austriaca were cultivated for 45 days in various systems, including Erlenmeyer flasks, a temporary immersion system (TIS) bioreactor, and a mist-trickling bioreactor, under controlled light conditions. The mist-trickling bioreactor yielded the highest biomass, with fresh and dry weights of 155.4 g/L and 10.2 g/L, respectively. Quantitative UHPLC analysis of hydromethanolic extracts revealed the biosynthesis of significant phenolic acids: caffeic acid, rosmarinic acid, and salvianolic acid A. Among these, rosmarinic acid was the most abundant, with its concentration varying based on the cultivation system. The highest total phenolic acid content, 165 mg/L, was obtained in the mist-trickling bioreactor, demonstrating its superiority in both biomass production and phenolic acid biosynthesis. This study highlights the potential of mist-trickling bioreactors for optimizing growth and metabolite production in S. austriaca transformed root cultures. [ABSTRACT FROM AUTHOR]

Background: The rate of in-stent restenosis (ISR) is decreasing; however, it is still a challenge for contemporary invasive cardiologists. Therapeutic methods, including drug-eluting balloons (DEBs), intravascular lithotripsy, excimer laser coronary atherectomy, and imaging-guided percutaneous coronary intervention (PCI) with drug-eluting stents (DES), have been implemented. Patients with diabetes mellitus (DM) are burdened with a higher risk of ISR than the general population. Aims: DM-Dragon is aimed at evaluating the clinical outcomes of ISR treatment with DEBs vs. DES, focusing on patients with co-existing diabetes mellitus. Methods: The DM-Dragon registry is a retrospective study comprising data from nine high-volume PCI centers in Poland. A total of 1117 patients, of whom 473 individuals had DM and were treated with PCI due to ISR, were included. After propensity-score matching (PSM), 198 pairs were created for further analysis. The primary outcome of the study was target lesion revascularization (TLR). Results: In DM patients after PSM, TLR occurred in 21 (10.61%) vs. 20 (10.1%) in non-diabetic patients, p = 0.8690. Rates of target vessel revascularization (TVR), target vessel myocardial infarction, device-oriented composite endpoint (DOCE), and cardiac death did not differ significantly. Among diabetic patients, the risk of all-cause mortality was significantly lower in the DEB group (2.78% vs. 11.11%, HR 3.67 (95% confidence interval, CI) [1.01–13.3), p = 0.0483). Conclusions: PCI with DEBs is almost as effective as DES implantation in DM patients treated for ISR. In DM-Dragon, the rate of all-cause death was significantly lower in patients treated with DEBs. Further large-scale, randomized clinical trials would be needed to support these findings. [ABSTRACT FROM AUTHOR]

Despite evidence suggesting the benefit of prophylactic regional antibiotic delivery (RAD) to sternal edges during cardiac surgery, it is seldom performed in clinical practice. The value of topical vancomycin and gentamicin for sternal wound infections (SWI) prophylaxis was further questioned by recent studies including randomized controlled trials (RCTs). The aim of this systematic review and meta-analysis was to comprehensively assess the safety and effectiveness of RAD to reduce the risk of SWI.We screened multiple databases for RCTs assessing the effectiveness of RAD (vancomycin, gentamicin) in SWI prophylaxis. Random effects meta-analysis was performed. The primary endpoint was any SWI; other wound complications were also analysed. Odds Ratios served as the primary statistical analyses. Trial sequential analysis (TSA) was performed.Thirteen RCTs (N = 7,719 patients) were included. The odds of any SWI were significantly reduced by over 50% with any RAD: OR (95%CIs): 0.49 (0.35–0.68); p < 0.001 and consistently reduced in vancomycin (0.34 [0.18–0.64]; p < 0.001) and gentamicin (0.58 [0.39–0.86]; p = 0.007) groups (psubgroup = 0.15). Similarly, RAD reduced the odds of SWI in diabetic and non-diabetic patients (0.46 [0.32–0.65]; p < 0.001 and 0.60 [0.44–0.83]; p = 0.002 respectively). Cumulative Z-curve passed the TSA-adjusted boundary for SWIs suggesting adequate power has been met and no further trials are needed. RAD significantly reduced deep (0.60 [0.43–0.83]; p = 0.003) and superficial SWIs (0.54 [0.32–0.91]; p = 0.02). No differences were seen in mediastinitis and mortality, however, limited number of studies assessed these endpoints. There was no evidence of systemic toxicity, sternal dehiscence and resistant strains emergence. Both vancomycin and gentamicin reduced the odds of cultures outside their respective serum concentrations’ activity: vancomycin against gram-negative strains: 0.20 (0.01–4.18) and gentamicin against gram-positive strains: 0.42 (0.28–0.62); P < 0.001. Regional antibiotic delivery is safe and effectively reduces the risk of SWI in cardiac surgery patients. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES The aim of this study was to evaluate in-hospital outcomes and long-term survival of patients undergoing cardiac surgery with preoperative atrial fibrillation (AF). We compared different strategies, including no-AF treatment, left atrial appendage occlusion (LAAO) alone, concomitant surgical ablation (SA) alone or both. METHODS A retrospective analysis using the KROK registry included all patients with preoperative diagnosis of AF who underwent cardiac surgery in Poland between between January 2012 and December 2022. Risk adjustment was performed using regression analysis with inverse probability weighting of propensity scores. We assessed 6-year survival with Cox proportional hazards models. Sensitivity analysis was performed based on index cardiac procedure. RESULTS Initially, 42 510 patients with preoperative AF were identified, and, after exclusion, 33 949 included in the final analysis. A total of 1107 (3.26%) received both SA and LAAO, 1484 (4.37%) received LAAO alone, 3921 (11.55%) SA alone and the remaining 27 437 (80.82%) had no AF-directed treatment. As compared to no treatment, all strategies were associated with survival benefit over 6-year follow-up. A gradient of treatment was observed with the highest benefit associated with SA + LAAO followed by SA alone and LAAO alone (log-rank P  < 0.001). Mortality benefits were reflected when stratified by surgery type with the exception of aortic valve surgery where LAAO alone fare worse than no treatment. CONCLUSIONS Among patients with preoperative AF undergoing cardiac surgery, surgical management of AF, particularly SA + LAAO, was associated with lower 6-year mortality. These findings support the benefits of incorporating SA and LAAO in the management of AF during cardiac surgery. [ABSTRACT FROM AUTHOR]

The study aimed to validate the European System for Cardiac Operative Risk Evaluation score (EuroSCORE II) in patients with atrial fibrillation (AF). All data were retrieved from the National Registry of Cardiac Surgery Procedures (KROK). EuroSCORE II calibration and discrimination performance was evaluated. The final cohort consisted of 44,172 patients (median age 67, 30.8% female, 13.4% with AF). The in-hospital mortality rate was 4.14% (N = 1830), and 5.21% (N = 2303) for 30-day mortality. EuroSCORE II significantly underestimated mortality in mild- and moderate-risk populations [Observed (O):Expected (E)—1.1, 1.16). In the AF subgroup, it performed well [O:E—0.99), whereas in the very high-risk population overestimated mortality (O:E—0.9). EuroSCORE II showed better discrimination in AF (−) [area under curve (AUC) 0.805, 95% CI 0.793–0.817)] than in AF (+) population (AUC 0.791, 95%CI 0.767–0.816), P < 0.001. The worst discriminative performance for the AF (+) group was for coronary artery bypass grafting (CABG) (AUC 0.746, 95% CI 0.676–0.817) as compared with AF (−) population (AUC 0.798, 95% CI 0.774–0.822), P < 0.001. EuroSCORE II is more accurate for patients with AF. However, it underestimated mortality rates for low-to-moderate-risk patients and had a lower ability to distinguish between high- and low-risk patients with AF, particularly in those undergoing coronary artery bypass grafting. [ABSTRACT FROM AUTHOR]

Hypertension remains a global threat to public health, affecting the worldwide population. It is one of the most common risk factors for cardiovascular disease. Today's treatments focus on creating a hypotensive effect. However, there is a constant search for additional factors to reduce the potential of developing hypertension complications. These factors may act as a parallel treatment target with a beneficial effect in specific populations. Some studies suggest that uric acid may be considered such a factor. This study investigated the potential effect of uric acid concentrations over 5 mg/dL on the incidence of hypertension complications among patients with very high cardiovascular risk. A total of 705 patients with hypertension and very high cardiovascular risk were selected and included in the analysis. The patients were divided and compared according to serum uric acid levels. The study showed a higher occurrence of heart failure (OR = 1.7898; CI: 1.2738–2.5147; p = 0.0008), atrial fibrillation (OR = 3.4452; CI: 1.5414–7.7002; p = 0.0026) and chronic kidney disease (OR = 2.4470; CI: 1.3746–4.3558; p = 0.0024) among individuals with serum uric acid levels over 5 mg/dL, males and those with a BMI > 25 kg/m2. These findings suggest that even serum uric acid concentrations over 5 mg/dL may affect the prevalence of hypertension-related complications among patients with very high cardiovascular risk. [ABSTRACT FROM AUTHOR]

The study aimed to validate the European System for Cardiac Operative Risk Evaluation score (EuroSCORE II) in patients with atrial fibrillation (AF). All data were retrieved from the National Registry of Cardiac Surgery Procedures (KROK). EuroSCORE II calibration and discrimination performance was evaluated. The final cohort consisted of 44,172 patients (median age 67, 30.8% female, 13.4% with AF). The in-hospital mortality rate was 4.14% (N = 1830), and 5.21% (N = 2303) for 30-day mortality. EuroSCORE II significantly underestimated mortality in mild- and moderate-risk populations [Observed (O):Expected (E)—1.1, 1.16). In the AF subgroup, it performed well [O:E—0.99), whereas in the very high-risk population overestimated mortality (O:E—0.9). EuroSCORE II showed better discrimination in AF (−) [area under curve (AUC) 0.805, 95% CI 0.793–0.817)] than in AF (+) population (AUC 0.791, 95%CI 0.767–0.816), P < 0.001. The worst discriminative performance for the AF (+) group was for coronary artery bypass grafting (CABG) (AUC 0.746, 95% CI 0.676–0.817) as compared with AF (−) population (AUC 0.798, 95% CI 0.774–0.822), P < 0.001. EuroSCORE II is more accurate for patients with AF. However, it underestimated mortality rates for low-to-moderate-risk patients and had a lower ability to distinguish between high- and low-risk patients with AF, particularly in those undergoing coronary artery bypass grafting. [ABSTRACT FROM AUTHOR]

The in vitro cultures of Rindera graeca, a rare endemic plant, were developed as a sustainable source of phenolic acids. Various shoot and root cultures were established and scaled up in a sprinkle bioreactor. A multiplication rate of 7.2 shoots per explant was achieved. HPLC–PDA–ESI–HRMS analysis revealed the presence of rosmarinic acid (RA) and lithospermic acid B (LAB) as the main secondary metabolites in both the shoot and root cultures. The maximum RA (30.0 ± 3.2 mg/g DW) and LAB (49.3 ± 15.5 mg/g DW) yields were determined in root-regenerated shoots. The strongest free radical scavenging activity (87.4 ± 1.1%), according to 2,2-diphenyl-1-picrylhydrazyl-hydrate assay, was noted for roots cultivated in a DCR medium. The highest reducing power (2.3 µM ± 0.4 TE/g DW), determined by the ferric-reducing antioxidant power assay, was noted for shoots cultivated on an SH medium containing 0.5 mg/L 6-benzylaminopurine. A genetic analysis performed using random amplified polymorphic DNA and start codon targeted markers revealed genetic variation of 62.8% to 96.5% among the investigated shoots and roots. This variability reflects the capacity of cultivated shoots and roots to produce phenolic compounds. [ABSTRACT FROM AUTHOR]

The EP-PARTICLES study was created to assess the impact of air pollution on the health and mortality of the population of Eastern Poland. The biggest cities of the region are Lublin, Białystok, Olsztyn, Rzeszow, and Kielce, whose inhabitants constitute less than 25% of the total population of the analyzed region. The vast majority of air pollution studies to date have been conducted in heavily polluted areas, where patients are exposed to moderate to extreme concentrations of pollutants. The composition of the pollution itself is also not without significance, as it differs significantly from the types of smog we are familiar with. The type of air pollution known as Polish smog is rich in compounds such as PM2.5, PM10, and polycyclic aromatic hydrocarbons (benzo(a)pyrene) from low emissions associated with household heating with solid fuels (coal, wood, and often also waste) and imposes detrimental effects on the health and life of the population, in particular in the context of cardiovascular effects. In this publication, we aimed to present the baseline results of the EP-PARTICLES investigators' research up to this point and propose steps aimed at changing the state of air quality and reducing existing exposure. Fields covered so far include atrial fibrillation, acute coronary syndromes, ischemic stroke, heart failure, renal function, and cardiovascular mortality. [ABSTRACT FROM AUTHOR]

The presented study describes the regulation of the promoter region of the Salvia miltiorrhiza kaurene synthase-like gene (SmKSL) by ethylene and yeast extract. The isolated fragment is 897 bp and is composed of a promoter (763 bp), 5′UTR (109 bp), and a short CDS (25 bp). The initial in silico analysis revealed the presence of numerous putative cis-active sites for trans-factors responding to different stress conditions. However, this study examines the influence of ethylene and yeast extract on SmKSL gene expression and tanshinone biosynthesis regulation. The results of 72h RT-PCR indicate an antagonistic interaction between ethylene, provided as ethephon (0.05, 0.10, 0.25, and 0.50 mM), and yeast extract (0.5%) on SmKSL gene expression in callus cultures of S. miltiorrhiza. A similar antagonistic effect was observed on total tanshinone concentration for up to 60 days. Ethylene provided as ethephon (0.05, 0.10, 0.25, and 0.50 mM) is a weak inducer of total tanshinone biosynthesis, increasing them only up to the maximum value of 0.67 ± 0.04 mg g−1 DW (60-day induction with 0.50 mM ethephon). Among the tanshinones elicited by ethephon, cryptotanshinone (52.21%) dominates, followed by dihydrotanshinone (45.00%) and tanshinone IIA (3.79%). In contrast, the 0.5% yeast extract strongly increases the total tanshinone concentration up to a maximum value of 13.30 ± 1.09 mg g−1 DW, observed after 50 days of induction. Yeast extract and ethylene appear to activate different fragments of the tanshinone biosynthesis route; hence the primary tanshinones induced by yeast extract were cryptotanshinone (81.42%), followed by dihydrotanshinone (17.06%) and tanshinone IIA (1.52%). [ABSTRACT FROM AUTHOR]

It is well known that exceeded levels of particulate matter in the air and other air pollutants harmfully affect the cardiovascular system. Empirical analyses of the effects of these factors on stroke incidence and mortality are still limited. The main objective of our analyses was to determine the association between short-term exposure to air pollutants and stroke incidence in non-industrial areas, more specifically in north-eastern Poland. To achieve this aim, we used data from the National Health Fund on patients hospitalized for stroke between 2011 and 2020 in the largest city of the region described as the Green Lungs of Poland. The pollution levels and atmospheric conditions data were obtained from the Provincial Inspectorate for Environmental Protection and the Institute of Meteorology and Water Management. Using daily data on hospitalizations, atmospheric conditions, and pollution, as well as ordered logistic regression models the hypotheses on the impact of weather and air pollution conditions on ischemic strokes were tested. The study group included 4838 patients, 45.6% of whom were male; the average patient age was approximately 74 years. The average concentrations of PM2.5 were 19.09 µg/m3, PM10 26.66 µg/m3 and CO 0.35 µg/m3. Analyses showed that an increase in PM2.5 and PM10 concentrations by 10 µg/m3 was associated with an increase in the incidence of stroke on the day of exposure (OR = 1.075, 95% CI 0.999–1.157, P = 0.053; OR = 1.056, 95% CI 1.004–1.110, P = 0.035) and the effect was even several times greater on the occurrence of a stroke event in general (PM2.5: OR = 1.120, 95% CI 1.013–1.237, P = 0.026; PM10: OR = 1.103, 95% CI 1.028–1.182, P = 0.006). Furthermore, a short-term (up to 3 days) effect of CO on stroke incidence was observed in the study area. An increase of 1 μg/m3 CO was associated with a lower incidence of stroke 2 days after the exposure (OR = 0.976, 95% CI 0.953–0.998, P = 0.037) and a higher incidence 3 days after the exposure (OR = 1.026, 95% CI 1.004–1.049, P = 0.022). [ABSTRACT FROM AUTHOR]

Salvia miltiorrhiza is a medicinal plant that synthesises biologically-active tanshinones with numerous therapeutic properties. An important rate-limiting enzyme in the biosynthesis of their precursors is 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGR). This study presents the organ-specific expression profile of the S. miltiorrhiza HMGR4 gene and its sensitivity to potential regulators, viz. gibberellic acid (GA3), indole-3-acetic acid (IAA) and salicylic acid (SA). In addition, it demonstrates the importance of the HMGR4 gene, the hormone used, the plant organ, and the culture environment for the biosynthesis of tanshinones. HMGR4 overexpression was found to significantly boost the accumulation of dihydrotanshinone I (DHTI), cryptotanshinone (CT), tanshinone I (TI) and tanshinone IIA (TIIA) in roots by 0.44 to 5.39 mg/g dry weight (DW), as well as TIIA in stems and leaves. S. miltiorrhiza roots cultivated in soil demonstrated higher concentrations of the examined metabolites than those grown in vitro. GA3 caused a considerable increase in the quantity of CT (by 794.2 µg/g DW) and TIIA (by 88.1 µg/g DW) in roots. In turn, IAA significantly inhibited the biosynthesis of the studied tanshinones in root material. [ABSTRACT FROM AUTHOR]

Salvia miltiorrhiza synthesises tanshinones with multidirectional therapeutic effects. These compounds have a complex biosynthetic pathway, whose first rate limiting enzyme is 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGR). In the present study, a new 1646 bp fragment of the S. miltiorrhiza HMGR4 gene consisting of a promoter, 5′ untranslated region and part of a coding sequence was isolated and characterised in silico using bioinformatics tools. The results indicate the presence of a TATA box, tandem repeat and pyrimidine-rich sequence, and the absence of CpG islands. The sequence was rich in motifs recognised by specific transcription factors sensitive mainly to light, salicylic acid, bacterial infection and auxins; it also demonstrated many binding sites for microRNAs. Moreover, our results suggest that HMGR4 expression is possibly regulated during flowering, embryogenesis, organogenesis and the circadian rhythm. The obtained data were verified by comparison with microarray co-expression results obtained for Arabidopsis thaliana. Alignment of the isolated HMGR4 sequence with other plant HMGRs indicated the presence of many common binding sites for transcription factors, including conserved ones. Our findings provide valuable information for understanding the mechanisms that direct transcription of the S. miltiorrhiza HMGR4 gene. [ABSTRACT FROM AUTHOR]

Purpose: Atrial fibrillation (AF) can be a valuable indicator of non-obstructive coronary artery disease (CAD) among older patients indicated for elective coronary angiography (CAG). Appropriate stratification of AF patients is crucial for avoiding unnecessary complications. The objective of this study was to identify independent predictors that can allow diagnosing obstructive CAD in AF patients over 65 years who were indicated to undergo elective CAG. Patients and methods: This cross-sectional study included 452 (23.9%) AF patients over 65 years old who were directed to the Department of Invasive Cardiology at the Medical University of Bialystok for elective CAG during 2014–2016. The participants had CAD and were receiving optimal therapy (median age: 73 years, interquartile range: 69–77 years; 54.6% men). The prevalence and health correlates of obstructive CAD were determined, and a multivariate logistic regression model was generated with predictors (p < 0.1). Predictive performance was analyzed using a receiver-operating characteristic (ROC) curve analysis. Results: Stenosis (affecting ≥ 50% of the diameter of the left coronary artery stem or ≥70% of that of the other important epicardial vessels) was significant in 184 (40.7%) cases. Multivariate regression analysis revealed that only the male sex (odds ratio [OR]: 1.80, 95% confidence interval [CI]: 1.14–2.84, p = 0.01) and the newly created CHA2DS2-VA score (OR: 3.96, 95% CI: 2.96–5.31, p < 0.001) significantly increased the chance of obstructive CAD, while controlling for chronic kidney disease and anemia. The ROC curve analysis indicated that the CHA2DS2-VA scale may be a useful screening tool for the diagnosis of obstructive CAD (area under the ROC curve: 0.79, 95% CI: 0.75–0.84, p < 0.001), with ≥4 being the optimal cutoff value. Conclusions: Our study has proven that several older AF patients who are advised to undergo elective CAG have nonobstructive CAD. The CHA2DS2-VA score can contribute to improving the selection of patients for invasive diagnosis of CAD, but further investigation is required. [ABSTRACT FROM AUTHOR]

Background: Whereas the efficacy and safety of intravascular lithotripsy (IVL) have been confirmed in de novo calcified coronary lesions, little is known about its utility in treating stent underexpansion. This study aimed to investigate the impact of IVL in treating stent underexpansion. Methods and Results: Consecutive patients with stent underexpansion treated with IVL entered the multicenter IVL-Dragon Registry. The procedural success (primary efficacy endpoint) was defined as a relative stent expansion >80%. Thirty days device-oriented composite endpoint (DOCE) (defined as a composite of cardiac death, target lesion revascularization, or target vessel myocardial infarction) was the secondary endpoint. A total of 62 patients were enrolled. The primary efficacy endpoint was achieved in 72.6% of patients. Both stent underexpansion 58.5% (47.5–69.7) vs. 11.4% (5.8–20.7), p < 0.001, and the stenotic area 82.6% (72.4–90.8) vs. 21.5% (11.1–37.2), p < 0.001, measured by quantitative coronary angiography improved significantly after IVL. Intravascular imaging confirmed increased stent expansion following IVL from 37.5% (16.0–66.0) to 86.0% (69.2–90.7), p < 0.001, by optical coherence tomography and from 57.0% (31.5–77.2) to 89.0% (85.0–92.0), p = 0.002, by intravascular ultrasound. Secondary endpoint occurred in one (1.6%) patient caused by cardiac death. There was no target lesion revascularization or target vessel myocardial infarction during the 30-day follow-up. Conclusions: In this real-life, largest-to-date analysis of IVL use to manage underexpanded stent, IVL proved to be an effective and safe method for facilitating stent expansion and increasing luminal gain. [ABSTRACT FROM AUTHOR]

The present study characterizes the 5′ regulatory region of the SmMEC gene. The isolated fragment is 1559 bp long and consists of a promoter, 5′UTR and 31 nucleotide 5′ fragments of the CDS region. In silico bioinformatic analysis found that the promoter region contains repetitions of many potential cis-active elements. Cis-active elements associated with the response to methyl jasmonate (MeJa) were identified in the SmMEC gene promoter. Co-expression studies combined with earlier transcriptomic research suggest the significant role of MeJa in SmMEC gene regulation. These findings were in line with the results of the RT-PCR test showing SmMEC gene expression induction after 72 h of MeJa treatment. Biphasic total tanshinone accumulation was observed following treatment of S. miltiorrhiza solid callus cultures with 50–500 μM methyl jasmonate, with peaks observed after 10–20 and 50–60 days. An early peak of total tanshinone concentration (0.08%) occurred after 20 days of 100 μM MeJa induction, and a second, much lower one, was observed after 50 days of 50 μM MeJa stimulation (0.04%). The dominant tanshinones were cryptotanshinone (CT) and dihydrotanshinone (DHT). To better understand the inducing effect of MeJa treatment on tanshinone biosynthesis, a search was performed for methyl jasmonate-responsive cis-active motifs in the available sequences of gene proximal promoters associated with terpenoid precursor biosynthesis. The results indicate that MeJa has the potential to induce a significant proportion of the presented genes, which is in line with available transcriptomic and RT-PCR data. [ABSTRACT FROM AUTHOR]

Due to the presence of phytochemicals, plants have been known to be used in the treatment and management of various diseases. Vernonia amygdalina, belonging to the Asteraceae family, is a plant known for its many applications in traditional medicine for various purposes. Previous studies on the methanolic leaf extract of this plant have proved the antibacterial, cytotoxic, anticancer and antioxidant effects indicative of promising therapeutic potentials. In this work, chromatographic and spectroscopic techniques along with high-performance liquid chromatography quantitative analysis were adopted to isolate, identify and quantify polyphenolic compounds in V. amygdalina leaf extract. UHPLC-DAD-ESI-MS/MS and UHPLC-DAD methods were adopted for qualitative and quantitative analysis, respectively. In the case of polyphenol separation, some reference substances were isolated by preparative HPLC. Seven polyphenols were identified and quantified in this study: 5-O-caffeoylquinic acid, luteolin hexoside, 3,4-O-dicaffeoylquinic acid, 1,5-O-dicaffeoylquinic acid, 3,5-O-dicaffeoylquinic acid, 4,5-O-dicaffeoylquinic acid and luteolin dihexoside, with 3,5-O-dicaffeoylquinic acid being isolated in the highest quantity of 27.49 mg g−1 extract. [ABSTRACT FROM AUTHOR]

Background: Significant changes in the coronary vessels are not confirmed in a large proportion of patients undergoing cardiac catheterization. Aims: The present study aimed to determine correlates and independent predictors of nonobstructive coronary artery disease (CAD) in older adults referred for elective coronary angiography. Methods: A cross-sectional study was conducted involving 2,214 patients referred to two medical centers (in Poland and Russia) between 2014 and 2016 for elective coronary angiography due to exacerbated angina, despite undergoing optimal therapy for CAD. The median age was 72 years (IQR: 68–76), and 49.5% patients were women. Results: Significant stenosis (defined as stenosis of 50% or more of the diameter of the left main coronary artery stem or stenosis of 70% or more of the diameter of the remaining major epicardial vessels) was diagnosed only in 1135 (51.3%) patients. Female sex (odds ratio [OR], 3.01; 95% confidence interval [CI], 2.44–3.72; p < 0.001) and atrial fibrillation (OR, 1.87; 95% CI 1.45–2.40; p < 0.001) were the main independent predictors of nonobstructive CAD. Significantly lower ORs were observed for diabetes (OR, 0.75; 95% CI 0.59–0.95; p = 0.02), chronic kidney disease (OR, 0.76; 95% CI 0.61–0.96; p = 0.02), and anemia (OR, 0.69; 95% CI 0.50–0.95; p = 0.02) after controlling for age, chronic heart failure, BMI, and study center. Discussion and conclusions: The results confirmed that nonobstructive CAD occurs in a high percentage of older patients referred for elective coronary angiography. This suggests the need to improve patient stratification for invasive diagnosis of CAD, especially for older women and patients with atrial fibrillation. Trial registration number and date of registration: NCT04537507, September 3, 2020. [ABSTRACT FROM AUTHOR]

Plant cell and organ cultures are potential sources of valuable secondary metabolites that can be used as food additives, nutraceuticals, cosmeceuticals, and pharmaceuticals. Phytochemical biosynthesis in various in vitro plant cultures, in contrast to that in planta, is independent of environmental conditions and free from quality fluctuations. Pharmaceutical application of plant biotechnology is of interest to almost all departments of the Faculty of Pharmacy and Institute of Pharmacology in Poland with a botanical profile (Pharmaceutical Botany, Pharmacognosy, and Pharmacology). This study discusses the advances in plant biotechnology for the production of known metabolites and/or biosynthesis of novel compounds in plant cell and organ in vitro cultures in several scientific centers in Poland. [ABSTRACT FROM AUTHOR]

Carica papaya L. belongs to Caricaceae family. It is an evergreen tree or shrub with usually unbranched trunk. Previous studies on the methanolic leaf extract of this plant proved the antibacterial, cytotoxic, anticancer and antioxidant effects indicative of promising therapeutic potentials. Chromatographic and spectroscopic techniques along with high performance liquid chromatography quantitative analysis were performed to isolate, tentatively identify and quantify polyphenolic compounds in MeOH extract of C. papaya leaves. UHPLC-DAD-ESI-MS/MS and UHPLC-DAD methods were adopted for qualitative and quantitative analysis respectively. In the case of polyphenol separation, some reference substances were isolated by preparative HPLC. Six polyphenols were isolated and quantified from C. papaya leaf extract, including three phenolic acids: derivatives of caffeic acid, p-coumaric acid, ferulic acid and three flavonoids: quercetin dirhamnosylhexoside, kaempferol dirhamnosyl-hexoside, quercetin 3-O-rutinoside. Among them quercetin dirhamnosyl-hexoside was significantly higher (1.9 mg/g extract) than other identified compounds. The results of present study provide a new data on polyphenols composition of C. papaya plant derived from Uganda and promote research on its possible standardization and use as a dietary supplement and/or herbal medicine. [ABSTRACT FROM AUTHOR]

Air pollution contributes to the premature death of approximately 428,000 citizens of Europe every year. The adverse effects of air pollution can be observed in respiratory, circulatory systems but also in renal function. We decide to investigate the hypothesis indicating that we can observe not only long- but also short-term impact of air pollution on kidney function. We used linear, log-linear, and logistic regression models to assess the association between renal function and NO2, SO2, and PMs. Results are reported as beta (β) coefficients and odds ratios (OR) for an increase in interquartile range (IQR) concentration. 3554 patients (median age 66, men 53.2%) were included into final analysis. Chronic kidney disease (CKD) was diagnosed in 21.5%. The odds of CKD increased with increase in annual concentration of PM2.5 (OR for IQR increase = 1.07; 95% CI 1.01–1.15, P = 0.037) and NO2 (OR for IQR increase = 1.05; 95% CI 1.01–1.10, P = 0.047). The IQR increase in weekly PM2.5 concentration was associated with 2% reduction in expected eGFR (β = 0.02, 95% CI − 0.03; − 0.01). Medium- and short-term exposure to elevated air pollution levels was associated with a decrease in eGFR and development CKD. The main pollutants affecting the kidneys were PM2.5 and NO2. [ABSTRACT FROM AUTHOR]

Background: Data regarding the clinical outcomes of covered stents (CSs) used to seal coronary artery perforations (CAPs) in the all-comer population are scarce. The aim of the CRACK Registry was to evaluate the procedural, 30-days and 1-year outcomes after CAP treated by CS implantation. Methods: This multicenter all-comer registry included data of consecutive patients with CAP treated by CS implantation. The primary endpoint was the composite of major adverse cardiac events (MACEs), defined as cardiac death, target lesion revascularization (TLR), and myocardial infarction (MI). Results: The registry included 119 patients (mean age: 68.9 ± 9.7 years, 55.5% men). Acute coronary syndrome, including: unstable angina 21 (17.6%), NSTEMI 26 (21.8%), and STEMI 26 (21.8%), was the presenting diagnosis in 61.3%, and chronic coronary syndromes in 38.7% of patients. The most common lesion type, according to ACC/AHA classification, was type C lesion in 47 (39.5%) of cases. A total of 52 patients (43.7%) had type 3 Ellis classification, 28 patients (23.5%) had type 2 followed by 39 patients (32.8%) with type 1 perforation. Complex PCI was performed in 73 (61.3%) of patients. Periprocedural death occurred in eight patients (6.7%), of which two patients had emergency cardiac surgery. Those patients were excluded from the one-year analysis. Successful sealing of the perforation was achieved in 99 (83.2%) patients. During the follow-up, 26 (26.2%) patients experienced MACE [7 (7.1%) cardiac deaths, 13 (13.1%) TLR, 11 (11.0%) MIs]. Stent thrombosis (ST) occurred in 6 (6.1%) patients [4(4.0%) acute ST, 1(1.0%) subacute ST and 1(1.0%) late ST]. Conclusions: The use of covered stents is an effective treatment of CAP. The procedural and 1-year outcomes of CAP treated by CS implantation showed that such patients should remain under follow-up due to relatively high risk of MACE. [ABSTRACT FROM AUTHOR]

Objective: Unknown ethiology. Background: The main causes for takotsubo syndrome (TS) in oncological patients are stress related to cancer diagnosis and treatment, pain in the course of the disease, treatment complications, and paraneoplastic syndromes. Case Report: An obese 62-year-old female patient, with a 3-day history of chest pain, was admitted to the hospital with a suspected acute coronary event. She had been diagnosed with high-grade bladder cancer 6 months before. After the transurethral electroresection of the tumor 5 months before and subsequent chemotherapy (gemcitabine and cisplatin), the patient was qualified for the next cancer surgery. On admission, the patient remained without chest pain. The ECG record demonstrated inverted T waves in the leads from above the anterior and lateral wall. The coronarography demonstrated minor atherosclerotic changes in the coronary arteries. The left ventriculography presented akinesis of the apex and the apical and mid-segment of the anterior wall, and the ejection fraction (EF) was 38%. Takotsubo syndrome was diagnosed. Laboratory testing revealed elevated concentration of troponin and N-terminal pro-B-type natriuretic peptide. The subsequent ECG records demonstrated deeply inverted T waves and numerous ventricular premature beats and increased QTc (528 ms). A control echocardiography showed improved left ventricular contractive function (EF - 47%). On the 4th day of hospitalization, the patient was discharged and referred for further oncological treatment. Conclusions: The diagnosis of TS in oncology patients is difficult, especially in the presence of atherosclerotic lesions in coronary arteries. Takotsubo syndrome in cancer patients delays the next stages of oncological treatment, which worsens the prognosis of these patients. [ABSTRACT FROM AUTHOR]

Introduction: Valvular heart diseases (VHD) are becoming a significant problem in the Polish population. Coexistence of chronic kidney disease (CKD) in patients with VHD increases the risk of death and affects further therapeutic strategy. Aim: Analysis impact of CKD on long-term prognosis in patients with VHD. Material and methods: The inclusion criteria were met by 1025 patients with moderate and severe VHD. Mean observation time was 2528 ± 1454 days. Results: The average age of the studied population was 66.75 (SD = 10.34), male gender was dominant 56% (N = 579). Severe aortic valve stenosis (AVS) occurred in 28.2%, severe mitral valve insufficiency (MVI) in 20%. CKD occurred in 37.1% (N = 380) patients mostly with mitral stenosis (50%, N = 16) and those with severe MVI (44.8%, N = 94). During the observational period, 52.7% (N = 540) deaths were noted. Increased risk of mortality was associated mostly with age (OR: 1.02, 95% CI: 1.00–1.03, p < 0.001), creatinine (OR:1.27, 95% CI: 1.12–1.43, p < 0.001), CKD (OR: 1.30, 95% CI: 1.17–1.44, p < 0.001), reduced ejection fraction (EF) (OR: 0.98, 95% CI: 0.97–0.99, p = 0.01) and coexisting of AVS (OR: 1.19, 95% CI: 1.04–1.35, p = 0.01). Conclusions: Mitral valve defects more often than aortic valve defects coexist with chronic kidney disease. Regardless of the stage, chronic kidney disease is an additional factor affecting the prognosis in patients with heart defects. Factors increasing the risk of death were age, creatinine concentration and reduced EF. The monitoring of renal function in patients with VHD should be crucial as well as the implementation of treatment at an early stage. [ABSTRACT FROM AUTHOR]

Coexistence of chronic kidney disease (CKD) in the case of acute coronary syndromes (ACS) significantly worsens the outcomes. The aim of our study was to assess renal function impact on mortality among patients with ACS. The study was based on records of 21,985 patients hospitalized in the Medical University of Bialystok in 2009–2015. Inclusion criteria were ACS. Exclusion criteria were: death within 24 h of admission, eGFR <15 ml/min/1.73 m2, hemodialysis. Mean observation time was 2296 days. Criteria were met by 2213 patients. CKD occurred in 24.1% (N = 533) and more often affected those with NSTEMI (26.2 (337) vs. 21.2 (196), p =.006). STEMI patients had higher incidence of post-contrast acute kidney injury (PC-AKI) (5 (46) vs. 4.1 (53), p <.001). During the study, 705 people died (31.9%), more often with NSTEMI (33.2% (428) vs. 29.95% (277), p <.001). However, from a group of patients suffering from PC-AKI 57.6% died. The risk of PC-AKI increased with creatinine concentration (RR: 2.990, 95%CI: 1.567–5.721, p <.001), occurrence of diabetes mellitus (RR: 2.143, 95%CI: 1.029–4.463, p =.042), atrial fibrillation (RR: 2.289, 95%CI: 1.056–4.959, p =.036). Risk of death was greater with an increase in postprocedural creatinine concentration (RR: 2.254, 95%CI: 1.481–3.424, p <.001). PC-AKI is a major complication in patients with ACS, occurs more frequently in STEMI and may be a prognostic marker of long-term mortality in patients undergoing percutaneous coronary intervention (PCI). More attention should be given to the prevention and diagnosis of PC-AKI but necessary PCI should not be withheld in fear of PC-AKI. [ABSTRACT FROM AUTHOR]

Background. Cardiovascular diseases (CVD) are the leading cause of death worldwide. Many studies have reported an association between serum uric acid (sUA) and CVD, and its role as a risk marker for mortality. Objectives. To assess the relationship between sUA levels and the long-term prognosis of patients with non-ST-elevation myocardial infarction (NSTEMI). Material and methods. The study was conducted at the Clinical Hospital of Białystok (Poland). Based on medical records, 9328 patients were hospitalized between 2011 and 2013, of which 726 had NSTEMI. The exclusion criteria were: any diagnosed neoplasms and estimated glomerular filtration rate (eGFR) <15 mL/min. The average observation time was 2324 days. Results. A total of 549 patients were qualified for the analysis; men were in the majority (69.03%, n = 379), and the mean age was 68.42 years (standard deviation (SD) = 11.66). The sUA norm was exceeded in 137 of the patients (24.95%). Hyperuricemia is more likely to occur in women (risk ratio (RR) = 1.52, 95% confidence interval (95% CI) = 1.016-2.288, p = 0.042), in patients with chronic kidney disease (CKD) (RR = 3.452, 95% CI = 2.432-4.854, p < 0.001) and in patients with higher body mass index (BMI)s (RR = 1.048, 95% CI = 1.008-1.090, p = 0.018). In the whole study group, during the study, 178 of the patients died (32.41.9%), more often those with hyperuricemia: (60/137 patients (43.8%)) compared to patients with normal sUA values (118/412 values (28.64%)); p < 0.001). There was a significant correlation between an increase in sUA levels and an increase in mortality (p < 0.001). Independent risk factors of death were age (RR = 1.086, 95% CI = 1.065-1.108, p < 0.001), sUA (RR = 1.245, 95% CI = 1.131-1.370, p = 0.041), ejection fraction (EF) (RR = 0.928, 95% CI = 0.910-0.946, p < 0.001) and hemoglobin concentration (RR = 0.685, 95% CI = 0.611-0.768, p < 0.001). Conclusions. Serum UA concentration is an independent risk factor of long-term mortality in patients who have undergone NSTEMI, and is associated with higher in-hospital death rates. Secondary prevention after NSTEMI should entail management of the patients' sUA levels. [ABSTRACT FROM AUTHOR]

Objective: Unusual or unexpected effect of treatment. Background: Although takotsubo syndrome (TTS) is usually mild, severe complications such as acute heart failure may occur in the acute phase. Because of the etiology of TTS, typical catecholamines are not recommended; the use of inotropic drugs with a different mechanism of action is recommended, mainly levosimendan. Case Report: An 84-year-old patient with cardiovascular risk factors, hospitalized in a city hospital because of exacerbation of chronic obstructive pulmonary disease (COPD), was transferred to the clinic with suspected myocardial infarction. At the time of admission, the patient was hemodynamically stable. The coronarography indicated insignificant atherosclerotic lesions in the coronary arteries. The echocardiography revealed apical akinesis and hypokinesis of the apical and middle left ventricular segments (LV). The ejection fraction (EF) was 40%. TTS was diagnosed. After 12 h of hospitalization, the patient developed symptoms of acute heart failure, with deterioration of the LV systolic function (EF 30%). Levosimendan was included in the treatment, which led to an increased blood pressure and clinical improvement after several hours. Over the next few days, the patient's condition improved and he was transferred to the referral center, from which he was discharged to home. Conclusions: In patients with COPD, exacerbation of the disease may be a trigger for TTS. In acute heart failure complicating TTS, administration of levosimendan improves the clinical condition of patients. [ABSTRACT FROM AUTHOR]

Introduction: Valvular heart diseases (VHD) are a significant problem in the Polish population. Coexistence of coronary artery disease (CAD) in patients with VHD increases the risk of death and affects the further therapeutic strategy. Aim: Analysis of atherosclerotic plaque burden distribution in coronary arteries and long-term prognosis among patients with VHD. Material and methods: Inclusion criteria were met by 1025 patients with moderate and severe VHD. Mean observation time was 2528 ±1454 days. Results: Severe aortic valve stenosis (AVS) occurred in 28.2%, severe mitral valve insufficiency (MVI) in 20%. CAD with severe angiographic stenoses was noted in 42.3% (n = 434). Among patients with severe MVI, CAD was noted in 47.1% of cases, and prior acute coronary syndromes (ACS) in 27.1% of patients (n = 58). In severe AVS patients, significant angiographic atherosclerotic changes were observed in 29.6% (n = 86), and prior ACS in 7.6% (n = 22) of patients. During the observation 52.7% of patients died, including 62.9% of patients with severe MVI and 51.6% of those with severe AVS. Age (OR = 1.038; 95% CI: 1.005-1.072; p = 0.022) and coexisting aortic valve insufficiency (AVI) (OR = 2.39, 95% CI: 5.370-11.065, p = 0.035) increased the mortality rate. Conclusions: Severe AVS is starting to be the most prevalent VHD. CAD is one of the most significant factors deteriorating prognosis of patients with VHD. AVI and age were significant risk factors for mortality. The worst prognosis was observed in severe MVI, which may result from more frequent occurrence of CAD in this group. A lesser burden of CAD and ACS in the group of patients with severe AVS did not affect survival. [ABSTRACT FROM AUTHOR]

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