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Background: After acute myocardial infarction (AMI), inflammatory processes promote tissue remodeling at the infarct site. Procollagen III amino-terminal propeptide (PIIINP) is a circulating biomarker of type III collagen synthesis that has been shown to be associated with changes in left ventricular ejection fraction (LVEF) and predicts the occurrence of heart failure after AMI. We hypothesize that sleep-disordered breathing (SDB) promotes inflammation and myocardial fibrosis, leading to reduced myocardial salvage. Therefore, in patients with first-time AMI successfully treated with percutaneous coronary intervention (PCI), we aimed to investigate whether circulating levels of high-sensitivity C-reactive protein (hs-CRP) and PIIINP are elevated in patients with SDB compared to patients without SDB., Methods and Results: This cross-sectional analysis included a total of 88 eligible patients with first AMI and PCI pooled from two prospective studies and stratified according to the apnea-hypopnea index (AHI, with SDB: AHI ≥ 15 h -1 ). We analyzed circulating levels of hs-CRP and PIIINP 3-5 days after PCI. Patients with SDB had significantly higher levels of hs-CRP (18.3 mg/L [95% CI, 8.0-42.6] vs. 5.8 mg/L [95% CI, 4.2-19.8], p = 0.002) and PIIINP (0.49 U/mL [95% CI, 0.40-0.60] vs. 0.33 U/mL [95% CI, 0.28-0.43], p < 0.001). In a multivariable linear regression model accounting for important clinical confounders, SDB significantly predicted circulating levels of hs-CRP ( p = 0.028). Similarly, only SDB was independently associated with PIIINP ( p < 0.001). Only obstructive but not central AHI correlated with circulating levels of hs-CRP ( p = 0.012) and PIIINP ( p = 0.006) levels., Conclusions: The presence of obstructive SDB after AMI was independently associated with increased circulating levels of hs-CRP and PIIINP. Our results emphasize the important role of SDB as a common comorbidity and indicate increased inflammation and myocardial fibrosis in these patients.

Background: Coronary collateral flow in angiography has been linked with lower mortality rates in patients with coronary artery disease. However, the relevance of the underlying mechanism is sparse. Therefore, we tested the hypothesis that in patients with acute myocardial infarction (AMI), relevant coronary collateral flow is associated with more salvaged myocardium and lower risk of developing heart failure., Methods and Results: Patients with first AMI who received a percutaneous coronary intervention within 24 h after symptom onset were classified visually by assigning a Cohen-Rentrop Score (CRS) ranging between 0 (no collaterals) and 3 (complete retrograde filling of the occluded vessel). All 36 patients included in the analysis underwent cardiac magnetic resonance examination within 3 to 5 days after myocardial infarction and after 12 weeks. Patients with relevant collateral flow (CRS 2-3) to the infarct-related artery had significantly smaller final infarct size compared to those without (7 ± 4% vs. 20 ± 12%, p < 0.001). In addition, both groups showed improvement in left ventricular ejection fraction early after AMI, whereas the recovery was greater in CRS 2-3 (+8 ± 5% vs. +3 ± 5%, p = 0.015)., Conclusion: In patients with first AMI, relevant collateral flow to the infarct-related artery was associated with more salvaged myocardium at 12 weeks, translating into greater improvement of systolic left ventricular function. The protective effect of coronary collaterals and the variance of infarct location should be further investigated in larger studies.

Aims: Sleep disordered breathing (SDB) is known to cause left atrial (LA) remodeling. However, the relationship between SDB severity and LA dysfunction is insufficiently understood and may be elucidated by detailed feature tracking (FT) strain analysis of cardiac magnetic resonance images (CMR). After myocardial infarction (MI), both the left ventricle and atrium are subjected to increased stress which may be substantially worsened by concomitant SDB that could impair consequential healing. We therefore analyzed atrial strain in patients at the time of acute MI and 3 months after., Methods and Results: 40 patients with acute MI underwent CMR and polysomnography (PSG) within 3-5 days after MI. Follow-up was performed 3 months after acute MI. CMR cine data were analyzed using a dedicated FT software. Atrial strain (ε) and strain rate (SR) for atrial reservoir ([ε s ]; [SR s ]), conduit ([ε e ]; [SR e ]) and booster function ([ε a ]; [SR a ]) were measured in two long-axis views. SDB was defined by an apnea-hypopnea-index (AHI) ≥15/h. Interestingly, LA ε s and ε e were significantly reduced in patients with SDB and correlated negative with AHI as a measure of SDB severity at both baseline and follow-up. Intriguingly, patients that exhibited a reduced AHI at follow-up were more likely to have developed improved atrial reservoir and conduit strain (linear regression, p =0.08 for ε s and ε e ). Patients with improved SDB (ΔAHI < -5/h) exhibited a mean improvement of LA reservoir strain of +7.2 ± 8.4% whereas patients with SDB deterioration (ΔAHI> + 5/h) showed a mean decrease of -5.3 ± 11.0% ( p = 0.0131). Similarly, the difference for LA conduit function was +4.8 ± 5.9% (ΔAHI < -5/h) vs -3.6 ± 8.8% (ΔAHI> +5/h). Importantly, conventional volumetric parameters for atrial function (LA area, LA volume index) did not correlate with AHI at baseline or follow-up., Conclusion: Our results show that LA function measured by CMR strain but not by volumetry is impaired in patients with SDB during acute cardiac injury. Consistent with a mechanistic association, improvement of SBD at follow-up resulted in improved LA strain. LA strain measurement might thus provide insight into atrial function in patients with SDB., Competing Interests: MA received lecture and consulting fees from ResMed, Philips Respironics, Boehringer-Ingelheim, NRI, Novartis, JAZZ pharmaceuticals, Bayer, Inspire and Bresotec and grant support from ResMed Foundation, ResMed, and Philips Respironics outside the submitted work. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Wester, Pec, Lebek, Fisser, Debl, Hamer, Poschenrieder, Buchner, Maier, Arzt and Wagner.)

Sleep-disordered breathing (SDB) is highly prevalent in patients with cardiovascular disease. We have recently shown that an elevation of the electrocardiographic (ECG) parameter P wave terminal force in lead V 1 (PTFV 1 ) is linked to atrial proarrhythmic activity by stimulation of reactive oxygen species (ROS)-dependent pathways. Since SDB leads to increased ROS generation, we aimed to investigate the relationship between SDB-related hypoxia and PTFV 1 in patients with first-time acute myocardial infarction (AMI). We examined 56 patients with first-time AMI. PTFV 1 was analyzed in 12-lead ECGs and defined as abnormal when ≥4000 µV*ms. Polysomnography (PSG) to assess SDB was performed within 3-5 days after AMI. SDB was defined by an apnea-hypopnea-index (AHI) >15/h. The multivariable regression analysis showed a significant association between SDB-related hypoxia and the magnitude of PTFV 1 independent from other relevant clinical co-factors. Interestingly, this association was mainly driven by central but not obstructive apnea events. Additionally, abnormal PTFV 1 was associated with SDB severity (as measured by AHI, B 21.495; CI [10.872 to 32.118]; p < 0.001), suggesting that ECG may help identify patients suitable for SDB screening. Hypoxia as a consequence of central sleep apnea may result in atrial electrical remodeling measured by abnormal PTFV 1 in patients with first-time AMI independent of ventricular function. The PTFV 1 may be used as a clinical marker for increased SDB risk in cardiovascular patients.

Aims: There is a lack of diagnostic and therapeutic options for patients with atrial cardiomyopathy and paroxysmal atrial fibrillation. Interestingly, an abnormal P-wave terminal force in electrocardiogram lead V 1 (PTFV 1 ) has been associated with atrial cardiomyopathy, but this association is poorly understood. We investigated PTFV 1 as a marker for functional, electrical, and structural atrial remodelling., Methods and Results: Fifty-six patients with acute myocardial infarction and 13 kidney donors as control cohort prospectively underwent cardiac magnetic resonance imaging to evaluate the association between PTFV 1 and functional remodelling (atrial strain). To further investigate underlying pathomechanisms, right atrial appendage biopsies were collected from 32 patients undergoing elective coronary artery bypass grafting. PTFV 1 was assessed as the product of negative P-wave amplitude and duration in lead V 1 and defined as abnormal if ≥4000 ms*μV. Activity of cardiac Ca/calmodulin-dependent protein kinase II (CaMKII) was determined by a specific HDAC4 pull-down assay as a surrogate for electrical remodelling. Atrial fibrosis was quantified using Masson's trichrome staining as a measure for structural remodelling. Multivariate regression analyses were performed to account for potential confounders. A total of 16/56 (29%) of patients with acute myocardial infarction, 3/13 (23%) of kidney donors, and 15/32 (47%) of patients undergoing coronary artery bypass grafting showed an abnormal PTFV 1 . In patients with acute myocardial infarction, left atrial (LA) strain was significantly reduced in the subgroup with an abnormal PTFV 1 (LA reservoir strain: 32.28 ± 12.86% vs. 22.75 ± 13.94%, P = 0.018; LA conduit strain: 18.87 ± 10.34% vs. 10.17 ± 8.26%, P = 0.004). Abnormal PTFV 1 showed a negative correlation with LA conduit strain independent from clinical covariates (coefficient B: -7.336, 95% confidence interval -13.577 to -1.095, P = 0.022). CaMKII activity was significantly increased from (normalized to CaMKII expression) 0.87 ± 0.17 to 1.46 ± 0.15 in patients with an abnormal PTFV 1 (P = 0.047). This increase in patients with an abnormal PTFV 1 was independent from clinical covariates (coefficient B: 0.542, 95% confidence interval 0.057 to 1.027, P = 0.031). Atrial fibrosis was significantly lower with 12.32 ± 1.63% in patients with an abnormal PTFV 1 (vs. 20.50 ± 2.09%, P = 0.006), suggesting PTFV 1 to be a marker for electrical but not structural remodelling., Conclusions: Abnormal PTFV 1 is an independent predictor for impaired atrial function and for electrical but not for structural remodelling. PTFV 1 may be a promising tool to evaluate patients for atrial cardiomyopathy and for risk of atrial fibrillation., (© 2021 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Abstract: The objective of this study was to ascertain changes in symptoms of patients with borderline personality disorder undergoing psychodynamic day treatment with a duration of 9 months and the factors that predict clinical outcome or dropouts from the program.In an observational study, demographic characteristics (age, number of psychiatric hospitalizations, number of suicide attempts, current involvement in work or study activities), day doses of antipsychotic and antidepressant medication, psychiatric symptoms, and social functioning (Health of the Nation Outcome Scales), and symptoms of dissociation (Dissociative Experiences Scale) were assessed in patients at the beginning of treatment (N = 105). Further, psychiatric symptoms and social functioning were assessed at 3 stages: beginning of the program, end of the program, and 1-year follow-up. To study the differences between baseline values and values at the end of the treatment and follow-up values, the Wilcoxon signed-rank test was used. To discover baseline factors related to the effect of the treatment, Spearman correlation coefficients were calculated. To evaluate the differences between patients who completed the program (N = 67) and patients who dropped out (N = 38), differences in baseline factors between both groups were compared, using the Mann-Whitney test for independent samples.Improvement in symptoms (Health of the Nation Outcome Scales - version for external evaluators) at the end of the therapy (N = 67, P < .001) and at the 1-year follow-up (N = 46, P < .001) was found. Experience of an intimate relationship was positively related to clinical improvement at follow-up examinations (P < .001). Predictors of dropout included a higher number of psychiatric hospitalizations (P = .004), suicide attempts (P = .004), more severe pretreatment symptoms (P = .002), and symptoms of dissociation (P = .046).The results indicate that a psychodynamic day treatment is feasible for the treatment of less clinically disturbed patients with a history of intimate relationships. Patients with a higher number of previous psychiatric hospitalizations, more suicide attempts in the past, more severe pretreatment symptoms, and symptoms of dissociation are more likely not to complete the program., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objectives: The purpose of this study was to test whether a psychodynamically based group psychotherapeutic programme might improve symptoms, social functions, or quality of life in patients with schizophrenia spectrum disorders and to investigate factors that might predict clinical improvement or dropouts from the programme., Design: A quantitative prospective cohort study., Methods: We have investigated 81 patients with schizophrenia spectrum disorders who participated in a 9-month psychodynamically based psychotherapeutic day programme. The patients were assessed at the beginning and end of the programme, and then at 1-year follow-up. The assessment included psychotic manifestations (HoNOS), quality of life (WHOQOL-BREF), demographic data, and daily doses of medication. 21 patients dropped out from the programme, and 46 patients succeeded in undergoing follow-up assessment., Results: The psychotic manifestations (self-rating version of HoNOS) and quality of life measured with WHOQOL-BREF (domains of social relationships and environment) were significantly improved at the end of the programme and at follow-up. However, the manifestations on the version for external evaluators of HoNOS were improved only at follow-up. Years of psychiatric treatment, number of hospitalizations or suicide attempts, and experience of relationships with a partner were negatively related to clinical improvement, whereas symptom severity, current working, or study activities were related positively., Conclusions: The results show that a group psychodynamic programme may improve the clinical status and quality of life of patients with schizophrenia spectrum disorders. This type of programme is more beneficial for patients with higher pre-treatment symptom severity and the presence of working or study activities., Practitioner Points: A psychodynamically based group programme improves the clinical status and quality of life in patients with schizophrenia spectrum disorders. Data indicate that changes on the subjective level are detectable by the end of the programme, while changes on the objective level are detectable at follow-up assessment. Symptom severity and working or study activities are positively related to the clinical improvement in this type of programme, while a high number of years in psychiatric treatment or psychiatric hospitalizations are negatively related. The doses of medication (antipsychotics or antidepressants) show no significant relationship to clinical improvement., (© 2017 The British Psychological Society.)

Cannabis sativa L. plants produce a diverse array of secondary metabolites. Cannabis cell cultures were treated with jasmonic acid (JA) and pectin as elicitors to evaluate their effect on metabolism from two cell lines using NMR spectroscopy and multivariate data analysis. According to principal component analysis (PCA) and partial least square-discriminant analysis (PLS-DA), the chloroform extract of the pectin-treated cultures were more different than control and JA-treated cultures; but in the methanol/water extract the metabolome of the JA-treated cells showed clear differences with control and pectin-treated cultures. Tyrosol, an antioxidant metabolite, was detected in cannabis cell cultures. The tyrosol content increased after eliciting with JA.

Because data on the epidemiology of psoriasis in central and eastern Europe are scarce, a survey was carried out among dermatologists in the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania, Slovakia, and Slovenia. The objective of the survey was to determine disease severity, treatment patterns, proportions of dermatologists considering their patients' current treatments unsatisfactory, and proportions of physicians intending to prescribe biologicals to their patients. Data collection was based on physician- and patient-completed questionnaires. Data on 913 patients were available. The mean age at onset of psoriasis was 29±15 years, mean proportion of affected body surface area 29%±22%, mean Psoriasis Area and Severity Index (PASI) 15±12, and mean Dermatology Life Quality Index (DLQI) 11±7. Overall, 37% of patients had severe disease defined as a PASI of 10 or more and a DLQI above 10; 45% of all patients and 58% of patients with severe disease had received standard systemics. In 53% of cases, dermatologists were dissatisfied with their patients' treatments. In almost all of these patients, physicians considered switching treatments, and in 65% of these patients, or more than 30% of the entire patient sample, physicians considered switching to biologicals, suggesting that nonbiologic treatment options in this group had been exhausted. Significant between-country differences were found for most study parameters. This survey was the first to assess the profile of patients with psoriasis in countries of central and eastern Europe. Psoriasis has a substantial impact on the quality of life, regardless of disease severity. More than one third of patients had severe disease, more than half of patients were considered by their physicians to be receiving inappropriate treatment, and in more than one third of patients physicians intended to switch to biologicals.

Cannabis sativa L. plants produce a diverse array of secondary metabolites. Cannabis cell cultures were treated with biotic and abiotic elicitors to evaluate their effect on secondary metabolism. Metabolic profiles analysed by (1)H NMR spectroscopy and principal component analysis (PCA) showed variations in some of the metabolite pools. However, no cannabinoids were found in either control or elicited cannabis cell cultures. Tetrahydrocannabinolic acid (THCA) synthase gene expression was monitored during a time course. Results suggest that other components in the signaling pathway can be controlling the cannabinoid pathway.

Unlabelled: The anti-apoptotic protein survivin was detected in a panel of 27 dysplastic nevi. From each representative paraffin block 4 mm sections were cut and stained with anti-survivin antibody (DAKO, Clone 12C4). In each section, the labeling intensity, the subcellular location of survivin antigen, the percentage of labeled cells and the degree of dysplasia were assessed. Survivin was present in 23 out of 27 cases (85.2%), but absent in 4/27 cases (14.8%). Positive staining was confined to the cytoplasm (C) of nevus cells only in 18 cases (66.7%), while cytoplasmic as well as nuclear positivity (NC) was found in 5 cases (18.5%). In no case solely nuclear staining could be seen. Furthermore, in 4 out of 5 cases (80%) with NC staining, severe dysplasia was found. Our data point at usefulness of survivin staining, otherwise rarely performed in dysplastic nevi. We confirm the importance of nuclear location of the survivin antigen, which may be helpful for assessing the possible progression to melanoma., Keywords: survivin, immunohistochemistry, nevi, dysplasia, melanoma.

This work focused on the cultivation of S. baicalensis Georgii in vitro cultures and on the possibilities of increasing the production of secondary metabolites in these cultures. The aim of the Sstudy was to determine whether the baicalin transport through vacuolar membrane is dependent on the presence of Mg-ATP. Our results showed that Mg-ATP had a significant effect on the ratio of baicalin and baicalein content and on the transport speed of these flavonoids. Therefore, the transport mechanism for baicalin are probably some of the MRP proteins which are the subfamily of the ABC transporte

Cough sensitivity is increased in patients with atopic dermatitis, although they have no clinical symptoms from the lower airways. In the present study we examined the cough sensitivity to capsaicin in patients, who had no clinical respiratory symptoms, with sclerodermia localized to the skin. Cough sensitivity was defined as the lowest capsaicin concentration, which evokes 2 or more coughs. Twelve patients and 12 healthy matched volunteers, as a comparison group, inhaled deep breaths (2 L) of a capsaicin aerosol in doubled concentrations (from 0.02 to 200 micromol/L). Cough sensitivity, expressed as a geometric mean (95% CI) of capsaicin concentration, was 0.15 micromol/L (0.04 to 0.56) in the patients with localized sclerodermia and 4.96 micromol/L (2.50 to 9.85) in controls, which made a significant difference towards higher cough sensitivity in sclerodermia, respiratory symptom-free patients. Thus, disease processes localized outside the respiratory tract may have surreptitious pulmonary manifestation that is brought to light by the capsaicin cough test.

The aim of study was to investigate the cough sensitivity (C2) to capsaicin (CAPS) in patients with atopic dermatitis without clinical respiratory symptoms. Cough sensitivity (C2) is defined as the lowest CAPS concentration, which evokes two or more coughs. Forty eight dermatological patients (21 M, 27 F; mean age 44 yr) and 24 healthy volunteers (14 M, 10 F; mean age 37 yr) inhaled deep breath (2 l) of CAPS aerosol in doubled concentrations (from 0.02 to 200 micromol/l) (Pari Provokationstest I, PARI WERK; mass median diameter 1.2 microm). Cough sensitivity (C2) expressed as geometric mean (95% CI) of CAPS concentration was 0.13 micromol/l (0.06-0.31) in 26 patients with atopic dermatitis (10 M, 16 F; mean age 41 yr), 5.51 micromol/l (1.33-22.90) in 22 patients with psoriasis (11 M, 11 F; mean age 46 yr) and 4.29 micromol/l (2.54-7.26) in 24 controls. There is significant difference of cough sensitivity (C2) between patients with atopic dermatitis and healthy volunteers (p<0.001) and also between patients with atopic dermatitis and psoriasis (p<0.001). Cough sensitivity (C2) in atopic dermatitis patients without clinical respiratory symptoms is significantly increased. In patients with psoriasis cough sensitivity (C2) is not significantly changed.

A case of multiple, cutaneous metastases as the first sign of lung cancer in a patient with well-differentiated, papillary, transitional cell carcinoma of the urinary bladder is presented. In the left clavicular region were two, sharply demarcated, dark red tumors measuring 3 and 2 cm in diameter with a history of rapid growth and intermittent spontaneous bleeding. Thorough examination of the patient revealed 16 additional skin lesions, which were dark red macules and papules, 2-3 mm in diameter, situated on the left side of the chest. The skin biopsy material (tumors, macular and papular lesions) was studied using histological and immunohistochemical techniques and showed intact epidermis and massive dermal and subcutaneous metastatic involvement by a small cell carcinoma with neuroendocrine differentiation most likely originating in the lung.

A case of phaeohyphomycosis caused by strains of both Alternaria spp. and Phaeosclera dematioides is presented. The biopsy material was studied using histological, immunohistochemical and transmission electron microscopy techniques. The agent's dematiaceous mycelia are composed of thick-walled hyphae, branched and unbranched, with terminal vesicular formations. All the described structures occur alone or in chains within multinuclear giant foreign body-type cells or invading an abscess. Also present are budding forms. Immunostaining of histiocytic inflammatory cells in either. diffuse or granulomatous infiltrates revealed cytoplasmic positivity for lysozyme and Ki-MIP antibody. The lymphocytic infiltrates of the upper corium show predominantly small T lymphocytes (CD3 and CD45RO positive) and absence of CD20-positive B cells. Plasma cells occurring within the infiltrates of the deeper parts show polyclonal expression of both Ig light chains.

A case of phaeohyphomycosis caused by strains of both Alternaria spp. and Phaeosclera dematioides is presented. First clinical signs of mycosis appeared on the patient's face, after an injury with a straw stalk during the wheat harvest in Germany in 1942. Further signs developed in 1955 at one forearm, and again in 1968 in the mouth, leading to perforation of the palate. After treatment with amphotericin B (1973-75) she went into a 13-year-long, clinically asymptomatic remission. She relapsed in 1988, when eight foci of the disease developed, mostly on both forearms. Diabetes mellitus and asthma developed at this time. After pulse therapy with itraconazole the patient remains in a good clinical condition.

This study shows the antibacterial effect of amniotic fluid collected on 10 women from 32 to 38 weeks. Two techniques were used. The first is a quantitative analysis of a bacterial culture with amniotic fluid as compared to controls, with inhibition by the amniotic fluid demonstrated. The second is a morphologic analysis of gonorrheal cultures by electron microscopy, showing alteration of the bacteria when amniotic fluid is present. These facts are of interest when one tries to understand the discrepancy between high rates of discovery of bacteria during pregnancy and low rates of intra-amniotic infection by Neisseria gonorrhoeae.