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Using B-mode ultrasound, we studied the prevalence of abdominal aortic aneurysm (AAA; diameter > or =3 cm) and its predictive risk factors in 109 consecutive patients who were >60 years of age and had coronary artery disease (CAD). A group of 60 age-matched patients who did not have CAD served as controls. The prevalence of AAA was higher in the CAD group than in the control group (14%, 16 of 109, vs 3%, 2 of 60, p <0.05). By multivariate analysis, only smoking was strongly associated with AAA (odds ratio 4.86, 95% confidence interval 1.55 to 15.25). In contrast, presence of diabetes mellitus was negatively associated with AAA in univariate analysis (odds ratio 0.11, 95% confidence interval 0.01 to 0.83) and a strong trend of inverse association remained in multivariate analysis (odds ratio 0.12, 95% confidence interval 0.01 to 1.03). Thus, systematic screening can detect AAA in 1 of 7 patients who are >60 years of age and have CAD. AAA shares some, but not all, risk factors of atherosclerosis. [ABSTRACT FROM AUTHOR]

Social isolation deprives rodents of social interactions that are critical for normal development of brain and behavior. Several studies have indicated that postweaning isolation rearing may affect nitric oxide (NO) production. The aim of this study was to compare selected behavioral and biochemical changes related to NO production in the brain of rats reared in social isolation for different duration. At the age of 21 days, male Sprague Dawley rats were randomly assigned into four groups reared in isolation or socially for 10 or 29 weeks. At the end of the rearing, open-field and prepulse inhibition (PPI) tests were carried out. Furthermore, in several brain areas we assessed NO synthase (NOS) activity, protein expression of nNOS and iNOS isoforms and the concentration of conjugated dienes (CD), a marker of oxidative damage and lipid peroxidation. Social isolation for 10 weeks resulted in a significant decrease in PPI, which was accompanied by a decrease in NOS activity in the cerebral cortex and the cerebellum, an increase in iNOS in the hippocampus and an increase in CD concentration in cortex homogenate. On the other hand, a 29 week isolation had an opposite effect on NOS activity, which increased in the cerebral cortex and the cerebellum in animals reared in social isolation, accompanied by a decrease in CD concentration. The decrease in NOS activity after 10 weeks of isolation might have been caused by chronic stress induced by social isolation, which has been documented in previous studies. The increased oxidative state might result in the depleted NO bioavailability, as NO reacts with superoxide radical creating peroxynitrite. After 29 weeks of isolation, this loss of NO might be compensated by the subsequent increase in NOS activity.

It is known that early-life stress events induce profound consequences on emotional brain regions including amygdala, involved in emotional processing and the ventral tegmental area (VTA), which contains neuron cell bodies of the mesolimbic dopaminergic system. The aim of this study is to test the hypothesis that stress induced by long-term social isolation from weaning in female rats is associated with alterations in amygdalar dopamine receptor gene expression and VTA dopamine concentrations. Rats were weaned on postnatal day 21 and then exposed to stress of chronic isolation for 9 weeks. Control animals were housed socially. Amygdalar dopamine D1 but not D2 receptor gene expression was decreased in isolated rats compared to controls. Dopamine concentrations in the VTA were enhanced following chronic isolation. A negative correlation was observed between amygdalar D1 gene expression and dopamine concentrations in the VTA. In conclusion, a reduction of dopamine D1 receptor gene expression in the amygdala in response to stress induced by chronic isolation in female rats was accompanied by an increase in dopamine concentration in the VTA. Further studies are needed to understand the physiological significance, if any, of negative association of amygdalar dopamine receptor D1 gene expression and dopamine concentrations in the VTA.

The relationship between subjective stress perception and the objective stress response to acute stress stimuli is not sufficiently understood. The aim of the present study was to test the hypothesis that the neuroendocrine response in socially evaluated cold pressor test (CPT) depends on the extent of perceived stressfulness of the stimulus. The test was performed in 24 healthy male volunteers. Subjective stress perception was assessed using nine visual analog scales. The subjects were divided to low and high stress perception groups according to the median split of the scores. Subjects with high stress perception exhibited slightly lower values of systolic blood pressure and lower overall concentrations of salivary cortisol compared to subjects with low stress perception. Salivary alpha-amylase activity did not show significant changes. Salivary aldosterone decreased in time in subjects with low but increased early after the test in subjects with high stress perception. Interestingly, salivary concentrations of the pro-inflammatory cytokine interleukin-1beta were considerably higher in subjects with high stress perception, particularly immediately before the test. The differences in salivary cortisol and interleukin-1beta were confirmed by the analysis with distress as a continuous covariate. Distress scores correlated negatively with salivary cortisol and positively with interleukin-1beta. The rate pressure product, which is a global measure of energy consumption by the heart, was significantly higher immediately before than after the stress exposure. The present findings show that concentrations of interleukin-1beta are a sensitive component of the stress response at the time before the stressful event.Lay summaryIt is generally expected that higher perceived stressfulness of a stimulus is accompanied by higher activation of stress-related systems. This study evaluating a combined psychosocial and physical stress situation in healthy men provides evidence that individual parameters of the stress response are differently related to perceived stress intensity. Subjects with high stress perception exhibited lower systolic blood pressure and salivary cortisol, higher interleukin-1beta, marginal differences in alpha amylase and aldosterone compared to subjects with low stress perception, which might be important for stress coping.

The role of vascular endothelial growth factor (VEGF) in chronic stress and neurodevelopmental disorders is of growing research interest. Here we show that post-weaning isolation rearing of rats decreased gene expression of VEGF in the hippocampus. Gene expression of VEGF upstream regulator fibroblast growth factor-2 (FGF-2) or its downstream mediator endothelial nitric oxide synthase (eNOS) was unchanged. Other signaling pathways appear to be involved in isolation-induced reduction in VEGF gene expression. Sex differences in VEGF and eNOS gene expression with significantly higher mRNA levels in females than males were revealed.

Background: TMS has high potential as smoking cessation treatment. However, the neural mechanisms underlying TMS induced reduction of tobacco craving remain unclear. Electroencephalographic (EEG) delta frequency has been associated with the activity of the dopaminergic brain reward system, which is crucial for nicotine induced effects, and decreases after nicotine admission in smokers., Objective: The aim of this study was to investigate EEG delta power changes induced by hf rTMS of the left dorsolateral prefrontal cortex (DLPFC) in nicotine deprived smokers and it's relation to cue-induced nicotine craving., Methods: Fourteen healthy smokers meeting ICD-10 criteria for tobacco addiction participated in this within-subject sham controlled study. Participants had to abstain from smoking 6 h before the experiment. Effects of high-frequency repetitive TMS (hf rTMS) (10 Hz) for verum (left DLPFC) and sham (vertex) stimulations on cue-induced nicotine craving and resting state EEG delta power were assessed before and three times within 40 min after rTMS., Results: Both craving (P = 0.046) and EEG delta power (P = 0.048) were significantly lower after verum stimulation compared to sham stimulation across the whole post stimulation time period assessed. However, changes of craving ratings and delta power did not correlate., Conclusion: Hf rTMS applied to the left DLPFC reduces nicotine craving in short-term abstinent smokers. Changes in delta activity support the idea that stimulation induced effects are mediated by the dopaminergic brain reward system, which presumably plays a prominent, but probably not exclusive, role in this stimulation induced behavioral modulation, making this method a promising smoking cessation treatment candidate., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Cardiovascular diseases associated with molecular variants of individual components of renin-angiotensin system are reported to constitute inherited predisposition in humans. Molecular variant frequencies are race- and population-dependent. We examined frequencies of the M235T variant of angiotensinogen gene and I/D polymorphism of gene for angiotensin-converting enzyme in Slovak population: in hypertensive patients, coronary heart disease (CHD), dilated cardiomyopathy (DCM) and myocardial infarction (MI) patients compared to healthy subjects. Frequency of M235T was significantly increased in hypertensive, CHD and DCM patients compared to controls (0.48 and 0.50 vs. 0.40, p < 0.001). Significant increase in D allele frequency compared to controls was observed in the group of patients after MI (0.58 vs. 0.50, p < 0.001), CHD (0.59 vs. 0.50, p < 0.001) and DCM (0.60 vs. 0.50, p < 0.001). These results correlate with other Caucasian populations. In Slovak population, M235T is associated with increased blood pressure and D allele of ACE gene is associated with MI, chronic CHD and DCM, rather than with hypertension. Our results suggest that in Slovak population, D alelle and M235T variant represent a risk factor for several cardiovascular diseases and these polymorphisms might have a cumulative effect on development of cardiovascular diseases.

Endothelial dysfunction plays an important role in all stages of atherosclerosis, and is characterized by an increased activity of vasoconstricting factors, proinflammatory and prothrombotic mediators. The aim of the review is to evaluate the role of angiotensin II (Ang II) and especially of angiotensin type 1 (AT1) receptor in inflammation and endothelial dysfunction. Ang II with AT(1) receptor are through several mechanisms implicated in the progression of atherosclerosis. Stimulation of AT(1) receptor increases oxidative stress especially through activation of NADH/NADPH oxidase in the vascular cells. Oxidative stress is associated with activation of the inflammatory processes. Ang II via AT(1) receptor increases expression of adhesion molecules and stimulates the induction of monocyte chemoattractant protein-1 (MCP-1). AT(1) receptor enhances the activation of nuclear factor NF-kappaB, which stimulates the production of proinflammatory cytokines. Proinflammatory cytokines on the other side may induce acute-phase response in the liver. Activation of AT(1) receptor via inducible cyclooxygenase (COX)-2 promotes biosynthesis of matrix metalloproteinases (MMPs). Ang II is implicated in the process of angiogenesis. Via AT(1) receptor takes part in the regulation of vascular endothelial growth factor (VEGF), which is one of the most angiogenic factors and stimulates the activity of endothelial progenitor cells (EPC). Recently some patents were reported discussing role of different compounds for the treatment of cardiovascular disease, renovascular disease nephropathy, peripheral vascular disease, portal hypertension and ophthalmic disorders, are cyclooxygenase-2 inhibitors.

Pulmonary hypertension (PH) is the most serious and potentially devastating chronic disorder of the pulmonary circulation with diverse etiologies and pathogenesis characterized by abnormal increased vasoconstriction and vascular remodelling. Current specific therapy of PH is based on an understanding of its pathogenesis and is acting through pathogenic pathways and therefore changes therapeutic strategy, effectively improves clinical course and prolongs life. The authors discuss the actual classification, pathogenesis in short and particularly actual treatment modalities and the impact on the natural history of this disorder. In chronic thromboembolic pulmonary hypertension is pulmonary endarterectomy if correct indicated the curable method, warranted substantial improvement of life quality and survival. These novel therapies of PH were absent in Slovakia until recently. The authors present initial experiences, results of PH management up to date on the basis of cooperation with PH centres in Austria and Czech Republic (Tab. 1, Fig. 6, Ref. 32).

Chaotic transitions likely emerge in a wide variety of cognitive phenomena and may be linked to specific changes during the development of mental disorders. They represent relatively short periods in the behavior of a system, which are extremely sensitive to very small changes. This increased sensitivity has been suggested to occur also during retrieval of stressful emotional experiences because of their fragmentary, temporally and spatially disorganized character. To test this hypothesis we recorded EEG during retrieval of fearful memories related to panic attack in 7 patients and retrieval of anxiety-related memories in 11 healthy controls. Nonlinear data analysis of EEG records showed a statistically significant increase in degree of chaotic dynamics after retrieval of stressful memories in majority of patients as well as in control subjects. This change correlated with subjective intensity of anxiety induced during the memory retrieval. The data suggest a role of nonlinear changes of neural dynamics in the processing of stressful anxiety-related memories, which may play an important role in the pathophysiology of panic disorder.

Objectives: The aim of the present study was to evaluate the antihypertensive efficacy of the highly beta(1)-selective adrenergic antagonist nebivolol in comparison with bisoprolol in the treatment of mild to moderate essential hypertension., Methods: This multicenter, single-blind, randomized, parallel-group 16-week study involved a 4-week placebo run-in, followed by a 12-week treatment period (5 mg nebivolol or 5 mg bisoprolol). Patients (n = 273) eligible for the study had a sitting diastolic blood pressure (DBP) between 95 and 110 mm Hg and a systolic blood pressure (SBP)

Aims: To determine whether the loss of repetitive slow pathway conduction identifies a successful radiofrequency ablation of atrioventricular nodal reentry tachycardia (AVNRT)., Methods and Results: Thirty nine consecutive patients undergoing ablation of AVNRT using the slow pathway approach were included. At baseline and after each radiofrequency application with an episode of junctional rhythm, repetitive slow pathway conduction was assessed as follows: Effective refractory period of the fast pathway was determined. The coupling interval of the first atrial extrastimulus (A2) was set at 30 ms below the effective refractory period of the fast pathway to ensure its conduction via the slow pathway. The second atrial extrastimulus (A3) was introduced at progressively longer coupling intervals starting from 200 ms until: (1) it propagated to the His bundle or (2) an anterogradely blocked AV nodal echo of A2 appeared before a conducted A3 depolarized the atrium in the His bundle electrogram. The response was termed repetitive slow pathway conduction if A3 was conducted with an AH > 200 ms. Application was considered successful if no AVNRT could be induced. Repetitive slow pathway conduction was present after 1 of 39 successful and after 34 of 40 ineffective applications (P < 0.0001). Repetitive slow pathway conduction identified a successful application with 97% sensitivity, 86% specificity, 86% positive predictive value, and 97% negative predictive value., Conclusion: The presence of repetitive slow pathway conduction identifies an unsuccessful application with a clinically meaningful negative predictive value.

The vascular endothelium is a large organ that secretes numerous factors regulating vascular tone, cell growth, platelet and leukocyte interactions and thrombogenesis. Endothelial dysfunction is an early event in atherogenesis and is also important in establish coronary artery disease. Over the past decade a noninvasive technique has evolved to evaluate flow-mediated vasodilation, an endothelium-dependent function. Procedure is realised on the brachial artery. The stimulus provokes the endothelium to release nitric oxide with subsequent vasodilation that can be imaged and quantitated as the index of vasomotor function. (Fig. 1, Ref. 2.).

Transcatheter closure of secundum atrial septal defect using Amplatzer occluder is accepted treatment modality. Transthoracic (TTE) and transoesophageal (TEE) echocardiography provides indispensable informations in the selection of eligible atrial septal defects, evaluates the exact size, location and morphology of the defect. In the closure procedure assistance of TEE enables precise determination of device size, correct placement of the device and immediate and follow-up closure results assessment. The present prospective study was performed in order to investigate the value of both approaches--TTE and TEE in the intermediate-term follow-up. Before, during transcatheter defect closure and in the follow-up echocardiography studies [TTE and TEE] were performed in 33 adult patients with secundum atrial septal defect with fulfilled TEE criteria. Correct placement of the device without interference with surrounding structures under TEE monitoring was possible in all patients. Immediate complete closure was achieved in 49% of patients, after 3 months in 94%. TEE findings corresponded well with TTE. In the follow-up echocardiographic signs of right ventricle overload retreated. Results indicate that TEE provides valued data for the selection and closure procedure. TTE is a sufficient reliable approach for results evaluation in intermediate follow-up. Echocardiography plays crucial role in the safety and efficacy assessment of transcatheter treatment of secundum atrial septal defect.

Background: The aim of the study was the assessment of functional characteristics of the left internal mammary artery (LIMA) bypass in patients after coronary artery bypass grafting (CABG) in comparison with the native LIMA using colour-duplex ultrasound as the non-invasive diagnostic method., Methods: We examined 303 patients after myocardial revascularization with the internal mammary artery bypass using the Hewllett Packard 2500, 5500 ultrasound units. Using the 7.5 MHz linear transducer we detected the LIMA from the left supraclavicular approach. We assessed the peak systolic velocity (PSV--cm/s), peak diastolic velocity (PDV--cm/s), end-diastolic velocity (EDV--cm/s) and we calculated the peak systolic/peak diastolic velocity ratio (SDVR) and resistance index RI (PSV-EDV/PSV). The obtained parameters were compared with the native LIMA flow characteristics of the 70 consecutive patients before CABG., Results: We observed the transformation of internal mammary artery flow from the predominantly systolic high resistance type of the native LIMA, to the low resistance biphasic waveform after its use as a coronary artery graft. We detected a significant increase of diastolic flow velocities and a significant decrease of resistance and of the SDVR ratio. In dysfunctional grafts we found a decrease of diastolic flow and an increase of LIMA resistance and SDVR., Conclusion: The colour-duplex ultrasound is a perspective non-invasive method for the postoperative follow-up of patients with the LIMA graft. It allows the assessment of the bypass flow characteristics, functional status and patency and it could contribute to the early diagnosis of bypass failure. (Fig. 6, Tab. 4, Ref. 21.)

The coronary disease of the heart (CDH) will be the most frequent cause of mortality and inability to work in the 21st century not only in industrially advanced countries but also in the developing countries. This unfavourable, assumedly paradoxical tendency persevering despite the significant progress in diagnosis and therapy is caused by two circumstances: ageing of population (prolonged mean life expectancy) and the increase in the number of individuals afflicted with (CDH) and living up to high age. In result of this development, the rapid increase in the prevalence of heart failure, especially in the aged, becomes the main cause of mortality, morbidity and hospitalisation.

The authors present epidemiological data about congestive heart failure, its most common etiology and prognosis. They justify the performance of heart transplantation (HTx) in the treatment of congestive heart failure. They analyze the present state of HTx in the world and describe also the history of HTx in Slovakia. They present the review of contraindications and indications for the inclusion of recipients into the HTx programme and describe the further fates of these patients. They regard the HTx as an integral component of the therapeutical approach to the precisely defined group of patients with otherwise refractory congestive heart failure. (Tab. 4, Fig. 6, Ref. 38.)

In eighteen consecutive patients (14 male, 4 females, in the age 37-52 years, mean = 43 years) with dilated cardiomyopathy in NYHA functional classification groups III-IV, the efficacy of ambulatory long-term (mean = 6 years) vasodilator therapy by means mechanocardiography (systolic and diastolic time intervals) and echocardiography (1-D, 2-D) in half-year intervals was evaluated. A combination of slow-release nitroglycerin (Nitro-Mack retard) as venodilator in the dosage of 20 mg/day and Dihydralazin SPOFA as arteriodilator in dosage of 100-200 mg/day under continuing cardiotonic and diuretic treatment were used. Vasodilator therapy had a favourable effect on systolic and diastolic function of the left ventricle with the mostly marked effect at the beginning of treatment. Amidst noninvasive parameters, the diastolic amplitude time index measured by apexcardiography and left ventricular hypertrophy-dilation index obtained by echocardiography had the greatest prognostic value regarding the treatment efficacy and survival of patients. This objective evidence of the efficacy of vasodilator therapy in patients with severe congestive heart failure coincided with the improvement of clinical status (subjective relief, moderation of decompensation, shift to the lower NYHA functional classes) and thus with improvement of life quality and prognosis.

The study has been carried out in 73 patients (63 men and 10 women), aged between 22 and 59 years, suffering from angina pectoris. The localization in space of the extremities of the initial QRS vectors (10 and 20 ms) is an indicator which is relatively very sensitive to the disturbance in the myocardial irrigation in the regions around the septum and the adjacent ventricular wall. A good relationship has been found namely with the data obtained with thallium scintigraphy after effort. The sensitivity of the vectocardiographic method, like that of dipolar chronotopocardiography, was clearly superior to that of scalar graphs.