Search

Background Congenitally corrected transposition of the great arteries (ccTGA) is a rare congenital heart anomaly with atrioventricular and ventriculoarterial discordance that is often associated with other cardiac and coronary artery anomalies. Here, we report a case of a patient with ccTGA and non-ST elevation myocardial infarction (NSTEMI) with challenging coronary anatomy that was treated with stress-perfusion cardiac magnetic resonance imaging (spCMR) guided percutaneous coronary intervention (PCI). Case summary A 46-year-old male smoker with ccTGA, dyslipidaemia, diabetes Type 2 managed with dietary restrictions and a family history of premature myocardial infarction, presented with typical chest pain, elevated cardiac troponin levels and ECG-changes indicative of ischaemia. The patient was diagnosed with NSTEMI and underwent initial urgent coronary angiography (CA) without apparent significant stenosis, although the right coronary artery (RCA) could not be selectively investigated. The patient had coronary anatomy 1R-2LCX according to the Leiden convention, which is the usual anatomy in patients with ccTGA. Despite this, CA was challenging due to the different anatomy compared with individuals with normally positioned great vessels. The patient remained highly symptomatic with chest pain at moderate exertion. To improve identification of the anatomic location and extent of ischaemia, we performed spCMR with adenosine. This revealed a limited septal infarction (likely embolic) in the right ventricle and reversible ischaemia in two inferior right ventricular segments. A second angiography, selectively investigating RCA demonstrated a significant stenosis in the distal RCA that was successfully treated with a drug-eluting stent. Fractional flow reserve (FFR) measurements of the left coronary arteries demonstrated hemodynamically non-significant stenosis. The patient’s symptoms resolved, and he remained asymptomatic at one month follow-up. Discussion This ccTGA patient had multiple risk factors for coronary artery disease and presented with NSTEMI. Diagnosis and treatment were challenging due to complex cardiac anatomy and associated different origins of the coronary arteries. We highlight the importance of careful evaluation of the coronary anatomy and functional testing using for example spCMR and FFR to target the culprit coronary vessel(s) in ccTGA complicated by NSTEMI.

„Within the framework of the tender, we sought the answer to the question of what production technology can be used to successfully grow soybeans in the Central Hungarian region. This region has the lowest national soybean production area (637 ha), which is particularly difficult to increase further due to high production costs and extreme weather conditions. At the same time, the demand of the domestic processing industry for soybeans is constantly increasing, which is mainly covered by foreign imports. In this article we present three varieties of the Hungarian feed company (Galldorf Zrt.) with very high protein content and drought tolerance, which are marketed and grown in this special production area. The goal is to have a yield of more than 2 t ha-1 with a ProFat content more than 50%, which is suitable for full-fat soybeans for dynamic pork upbringing and the production of high-quality pork.”

Aflatoxins (AFs) are a group of secondary metabolites that cause several diseases in both animals and humans. Since the discovery of this group of toxins, several effects were revealed, such as hepatic changes, carcinoma, failure, and cancer of the liver. In the European Union, there are concentration limits for this group of mycotoxins in food and feed products; thus, these substances are required in their pure forms to prepare reference standards or certified reference materials. In our present work, a liquid–liquid chromatographic method utilizing a toluene/acetic acid/water ternary system was improved. In order to enhance the purification and gain a higher amount of pure AFs in one separation run, a scale-up of the previous separation was carried out. In several scale-up steps—including the determination of the maximum concentration and volume to load on a 250 mL rotor via a loop and via a pump as well, and the quadruplication of the entire separation procedure to a 1000 mL rotor—an efficient scale-up was achieved. Utilizing a 250 mL rotor in an 8-hour workday, altogether approximately 2.2 g of total AFs could be purified with 8.2 liters of solvent, while on a 1000 mL column, approximately 7.8 g AFs could be prepared, utilizing around 31 liters of solvents.

[Purpose] In the photography of new-borns, there is an epidemic trend in the posing of 0-14-day-old neonates that induces ethical and competence issues. The aim of this study is to map the key concepts underpinning the contraindications of this type of passive positioning of the new-borns. [Methods] During the search for literature, the following keywords were used in the PubMed database: neonates; new-born; neck position; hyperextension; rotation; atlanto-occipital joint; sudden infant death; prone sleeping position; white noise; and pain perception. [Results] The white noise applied has been described as a pain perception modulator and an alternative pain reducing method in new-born care. There is evidence warning of the potential danger of passively produced cervical spine positions, considering the primary unstable atlanto-occipital joint during early infancy, the possible compression on vertebral arteries, and the intradural diameter decreasing the effect of extension. These factors may have an impact on healthy motor and cognitive development. [Conclusion] This perspective suggests that a wider debate should be called for concerning the role of medical professions to control this very dangerous practice, and that future cohort studies are necessary to monitor and follow up on the potential negative effects of this current trend.

[Purpose] Childhood flexible flat foot is the most common lower limb deformity. Observational evaluation of the underlying elements of reactive balance during static positions is an accepted tool besides the timed measures. We aim to assess the effects of combined balance training on the foot function and to test the usefulness of our observational static balance score. [Participants and Methods] A total of 19 healthy primary school students with flexible flat foot deformity volunteered for the study. We evaluated the foot's dynamic properties and static postural stability before and after a 20-week combined balance training. On the basis of the observational findings, the time vs. quality observational static balance score was developed. All data were subjected to Wilcoxon's test and Friedman's ANOVA to compare the effects of the training on foot trajectory and observational static balance score. [Results] Better strength and endurance in the foot extensors and improved foot function were noted after the training. Using our observational static balance score, the quality of the balance performance remarkably changed. [Conclusion] The quality domain of our new scale seems to be a useful tool in daily clinical practice and a more sensitive measure in eyes-closed situations.

The earth's population is growing steadily, currently accounting for about 7.3 billion people. Population growth causes food demand to rise, approximately 36 million people die each year due to starvation or related diseases. One solution to this problem is the continuous examination and development of the agricultural economy. In this study, matrix-assisted laser desorption/ionization time-of-flight mass spectrometer (MALDI -TOF MS) were used to analyse of sunflower, soybean and hemp. In order to analyse the protein of maize, this method has already been applied. However, for sunflower, soy and hemp, it is necessary to develop a sample preparation method. Choosing the optimal matrix solution for ionization the traget molecule is an essential part of developing the method. Our aim is to compare two different matrix solutions (α-HCCA, SA matrix), based on the properties (intensity, noise ratio, value of spectra) of the spectra.

Purpose We examined the effects of exercise therapy on postural stability, multifidus thickness, and pain intensity in patients with low-back pain. Materials and methods Subjects were divided into a chronic low-back pain (CLBP; n = 10) group and a healthy control (C; n = 10) group. Group CLBP took part in an 8-week training programme, whereas group C did not. The thickness of the multifidus in both groups was assessed using ultrasonography before and after 8 weeks, in prone and kneeling positions, in relaxed and contracted states. A standing heel-raising test was used to assess postural stability. Results After the intervention in group CLBP, the thickness of the contracted multifidus increased in the prone position, whereas the thickness of both the contracted and relaxed multifidus decreased in the kneeling position. In group C after 8 weeks, multifidus thickness decreased in both positions, while both relaxed and contracted. Group C performed the standing heel-raising test significantly better than group CLBP before the 8-week period. After the training, group CLBP improved significantly, but no changes were found in group C. Discussion and conclusions Changes in thickness of the multifidus correlate with improved postural stability and decreased pain intensity. Decreasing thickness in healthy individuals may be an early sign of developing CLBP.

Purpose The aim of this study was to assess the effects of diaphragm training on low back pain and thickness of stabilizer muscles of the lumbar spine. Patients and methods Fifty-two individuals were recruited with a history of chronic low back pain in our randomized controlled trial. The participants were divided randomly into two groups. One of the groups took part in a complex training program and completed with diaphragm training (DT group, n=26). The control (C) group took part only in the complex training (n=21). The thickness of transversus abdominis, diaphragm, and lumbar multifidus muscle was measured with ultrasonography in two positions: lying and sitting. All muscles were assessed in relaxed and in contracted state in the lying position and in a relatively relaxed (calm sitting) and relatively contracted state (during weightlifting) in the sitting position. Results After the training, severity of the pain was significantly reduced in both the groups. Regarding the thickness of the muscles, there were no changes in group C. The thickness of transversus abdominis increased significantly in relaxed and in relatively relaxed state, but there were no changes in contracted and relatively contracted state in group DT. As for the diaphragm muscle, there were significant increase in the state of supine position and in relatively contracted state, but there was no notable change in relatively relaxed state. With regard to the thickness of lumbar multifidus, a significant increase was only found in the left-sided muscle in relaxed, relatively relaxed, and relatively contracted state and in case of the right-sided one in relatively contracted state in group DT. Conclusion Our results suggest that diaphragm training has an effect also on the thickness of other active stabilizers of the lumbar spine, such as transversus abdominis and lumbar multifidus muscles., Video abstract

Weight-bearing (WB) on the lower extremities is an important outcome parameter in the rehabilitation of poststroke hemiparesis. However, the patients often regain this ability by compensatory movement patterns.Our goal was to characterize with a simple method the trunk alignment of healthy subjects and stroke patients (n = 17 for both groups) during standing and following lateral weight shift (WS). To describe trunk alignment, five markers were placed on the subjects' back, and the angles of the trunk at both sides were defined by the lines drawn from the posterior angle of the acromion and the iliac crest on the same body side to the seventh thoracic spinal process. Weight distributions on the lower extremities during standing and lateral WS were determined with a force platform.The patients had significantly limited WB capacity on their paretic limb, which was accompanied with significant asymmetry in the trunk alignment during standing and following WS to the paretic side.Our results show that this patient population tends to use abnormal compensatory movement patterns to optimize weight shifting, and changes of trunk alignment play a key role in this. This should be taken into consideration during rehabilitation.

Background: Patients with cyanotic congenital heart disease (CCHD) may have a low burden of atherosclerosis. Endothelial dysfunction is an early stage of atherosclerosis and endothelial function is previously studied in smaller CCHD groups with different techniques and variable results. We aimed to examine endothelial function and carotid atherosclerosis in a larger group of CCHD patients.Methods: This multicentre study assessed endothelial function in adults with CCHD and controls by measuring the dilatory response of the brachial artery to post-ischemic hyperaemia (endothelium-dependent flow-mediated-vasodilatation (FMD)), and to nitroglycerin (endothelium-independent nitroglycerin-induced dilatation (NID)). Flow was measured at baseline and after ischaemia (reactive hyperaemia). Carotid-intima-media-thickness (CIMT), prevalence of carotid plaque and plaque thickness (cPT-max) were evaluated ultrasonographically. Lipoproteins, inflammatory and vascular markers, including sphingosine-1-phosphate (S1P) were measured.Results: Forty-five patients with CCHD (median age 50 years) and 45 matched controls (median age 52 years) were included. The patients presented with lower reactive hyperaemia (409 +/- 114% vs. 611 +/- 248%, p Conclusion: Adults with CCHD had preserved FMD in the brachial artery, but impaired NID response and lower reactive hyperaemia than controls. The preserved FMD and the comparable prevalence of carotid atherosclerosis indicate that CCHD patients have the same risk of atherosclerosis as controls. (C) 2020 The Authors. Published by Elsevier B.V.

Objective To determine the effects of diaphragm-strengthening training on the stability limits of the trunk and inspiratory function in patients with low back pain. Design A randomized comparative trial including a diaphragm training group that took part in conventional training together with diaphragm strengthening, and a control group that took part in conventional training only. Both groups participated in an 8-week training, 2 times/week. All subjects underwent the same measurement protocol before and after the intervention. Patients The study included 52 subjects with chronic low back pain. Methods The inspiratory functions (chest excursion, maximal inspiratory pressure, peak inspiratory flow, and volume of inspired air) and stability limits of the trunk with the subject in the sitting position (modified functional and lateral reach test) were assessed. Results Maximal inspiratory pressure and stability limit tests showed a statistically significant improvement only in the diaphragm training group. Statistically significant improvements in chest excursion and peak expiratory flow tests were found in both groups; however, the improvement was more greater in the diaphragm training group. Conclusion Conventional exercises together with diaphragm training result in a greater improvement than conventional exercises alone in patients with chronic low back pain.

Motor learning is possible in dystonia, but distorted feedback results in distorted motor performance and information-seeking compensatory behavior, as observed in this case. With globus pallidus internal segment deep brain stimulation, the postural background of hand writing improved, but the learned left compensatory grip did not change.

In calcific aortic valve disease (CAVD), activated T lymphocytes localize with osteoclast regions; however, the functional consequences of this association remain unknown. We hypothesized that CD8 + T cells modulate calcification in CAVD. CAVD valves ( n = 52) dissected into noncalcified and calcified portions were subjected to mRNA extraction, real-time quantitative PCR, enzyme-linked immunosorbent assay, and immunohistochemical analyses. Compared with noncalcified portions, calcified regions exhibited elevated transcripts for CD8, interferon (IFN)-γ, CXCL9, Perforin 1, Granzyme B, and heat shock protein 60. Osteoclast-associated receptor activator of NK-κB ligand (RANKL), tartrate-resistant acid phosphatase (TRAP), and osteoclast-associated receptor increased significantly. The stimulation of tissue with phorbol-12-myristate-13-acetate and ionomycin, recapitulating CAVD microenvironment, resulted in IFN-γ release. Real-time quantitative PCR detected mRNAs for CD8 + T-cell activation (Perforin 1, Granzyme B). In stimulated versus unstimulated organoid cultures, elevated IFN-γ reduced the mRNAs encoding for RANKL, TRAP, and Cathepsin K. Molecular imaging showed increased calcium signal intensity in stimulated versus unstimulated parts. CD14 + monocytes treated either with recombinant human IFN-γ or with conditioned media-derived IFN-γ exhibited low levels of Cathepsin K, TRAP, RANK, and tumor necrosis factor receptor-associated factor 6 mRNAs, whereas concentrations of the T-cell co-activators CD80 and CD86 increased in parallel with reduced osteoclast resorptive function, effects abrogated by neutralizing anti–IFN-γ antibodies. CD8 + cell–derived IFN-γ suppresses osteoclast function and may thus favor calcification in CAVD.

We examined the light sources and illuminated environments in Sopron’s public areas and studied the impact they had on the composition of macrolepidopteran moth communities. We employed light traps with three different light sources in three differently illuminated environments (seminatural, transitional, urban) on 60 occasions during the summer period of 2012-2013 and 20 times in the seminatural area in the spring and autumn of 2014. In the first two years, we evaluated the number of individuals; in year three, we evaluated the number of species. In the first two years, the high-pressure sodium light in the seminatural site trapped the largest number of nocturnal lepidopteran specimens (2,569), while the mixed HMLI light trapped the most individuals in the transitional (1,098) and urban (822) areas. Based on the average number of individuals the first two years, we compared the locations and light sources. In terms of average number of specimens collected, significant differences emerged between two light sources and two locations. When we completed the species diversity index, we determined the compact fluorescent tube in spring and the high-pressure sodium light in the autumn showed the greatest values.

Providing continuous follow-up care to patients with congenital heart disease (CHD) remains a challenge in many settings. Previous studies highlight that patients with CHD experience discontinuation of follow-up care, but mainly describe a single-centre perspective, neglecting inter-institutional variations. Hospital-related factors above and beyond patient-related factors are believed to affect continuity of care. The present multicentre study therefore investigated (i) proportion of "no follow-up care"; (ii) transfer destinations after leaving paediatric cardiology; (iii) variation in proportions of no follow-up between centres; (iv) the association between no follow-up and outpatient volumes, and (v) its relationship with staffing resources at outpatient clinics.An observational, multicentre study was conducted in seven university hospitals. In total, 654 adolescents with CHD, born between 1991 and 1993, with paediatric outpatient visit at age 14-18 years were included. Transfer status was determined 5 years after the intended transfer to adult care (23y), based on medical files, self-reports and registries.Overall, 89.7% of patients were receiving adult follow-up care after transfer; 6.6% had no follow-up; and 3.7% were untraceable. Among patients in follow-up care, only one remained in paediatric care and the majority received specialist adult CHD care. Significant variability in proportions of no follow-up were identified across centres. Higher outpatient volumes at paediatric outpatient clinics were associated with better continued follow-up care after transfer (OR = 1.061; 95% CI = 1.001 - 1.124). Medical staffing resources were not found predictive.Our findings support the theory of hospital-related factors influencing continuity of care, above and beyond patient-related characteristics.

Introduction Survival in patients with cyanotic congenital heart disease (CCHD) has improved dramatically. The result is an ageing population with risk of acquired heart disease. Previous small uncontrolled studies suggested that these patients are protected against the development of atherosclerosis. To test this hypothesis, we sought to determine the prevalence of subclinical atherosclerosis in a larger population of patients with CCHD. Method We compared the prevalence of subclinical atherosclerosis in adult CCHD patients from Denmark, Sweden, Norway and Australia, with that in age-, sex-, smoking status-, and body mass index matched controls. Coronary artery atherosclerosis was assessed on computed tomography with coronary artery calcification (CAC) score. Subclinical atherosclerosis was defined by CAC-score > 0. Carotid artery atherosclerosis was evaluated using ultrasound by measuring carotid plaque thickness (cPT-max) and carotid intima media thickness (CIMT). Lipid status was evaluated as an important atherosclerotic risk factor. Results Seventy-four patients with CCHD (57% women, median age 49.5 years) and 74 matched controls (57% women, median age 50.0 years) were included. There were no differences between the groups in: CAC-score > 0 (21% vs. 19%, respectively; p = 0.8), carotid plaques (19% vs. 9%, respectively; p = 0.1), cPT-max (2.3 mm vs. 2.8 mm, respectively; p = 0.1) or CIMT (0.61 mm vs. 0.61 mm, respectively; p = 0.98). And further no significant differences in lipoprotein concentrations measured by ultracentrifugation. Conclusion Young adults with CCHD have similar cardiovascular risk factor profiles and measures of subclinical atherosclerosis, compared with controls. Given their increasing life expectancies, athero-preventive strategies should be an important part of their clinical management.

Classical Hodgkin lymphoma (cHL) has a unique pathological feature characterized by a minority of malignant Hodgkin Reed-Sternberg (H-RS) cells surrounded by numerous inflammatory cells. Cysteinyl-leukotrienes (CysLTs) are produced by eosinophils, macrophages and mast cells in the HL tumor microenvironment. In the present study we have explored the signal transduction pathways leading to leukotriene (LT) D4 induced expression of cytokines in the Hodgkin lymphoma cell line L1236 and KM-H2. Stimulation of L1236 and KM-H2 cells with LTD4 led to a concentration- and time-dependent increase at the transcriptional level of tumor necrosis factor-alpha (TNF-α), interleukin (IL)-6, IL-8, chemokine (C-C motif) ligand 3 (CCL3) and CCL4. The expression of several transcription factors was induced upon stimulation of Hodgkin cell lines with LTD4. Among these, EGR-1 was required for cytokine production. Inhibition of EGR-1 expression using shEGR-1 transduced by lentivirus led to suppression of the expression of TNF-α and IL-6. The effect of LTD4 on the expression of transcription factors and cytokines were also blocked by the specific CysLT1 receptor antagonist zafirlukast. These results demonstrate that EGR-1 plays a critical role in LTD4-induced cytokine transcription in Hodgkin cell lines.

A one-pot synthesis of stereomer cross-linked copolymers of l-malic acid with tuned properties is reported. The β-cyclodextrin, as co-monomer with several OH groups, was applied to promote the polyester formation with higher, pre-defined molecular weight. The importance of the experimental conditions for preparation of polymers with tailor-made, optically active compositions is described, and their structures are characterized by different techniques such as thermogravimetry–differential scanning calorimetry−mass spectrometric evolved gas analysis, infrared spectroscopy and specific rotation. To our knowledge, first time was used the specific optical rotation for characterization of retention of the optical activity in the course of the synthesis.

Background— The Fontan procedure has improved survival in children with functionally univentricular hearts. With time, however, complications such as reduced exercise capacity are seen more frequently. Exercise intolerance is multifactorial, but pulmonary vascular resistance probably plays a crucial role. Elevated pulmonary vascular resistance has been associated with raised levels of endothelin-1, which are common both before and after Fontan operations. Treatment with endothelin-1 receptor antagonists could theoretically improve cardiopulmonary hemodynamics and exercise capacity. The aim of this study was therefore to examine the efficacy and safety of bosentan in Fontan patients. Methods and Results— Seventy-five adolescents and adults were randomized 1:1 to 14 weeks of treatment with bosentan or placebo. Cardiopulmonary exercise test, functional class, blood samples, and quality-of-life questionnaires were evaluated at baseline and at the end of treatment. Sixty-nine patients (92%) completed the study. Peak oxygen consumption increased 2.0 mL·kg −1 ·min −1 (from 28.7 to 30.7 mL·kg −1 ·min −1 ) in the bosentan group compared with 0.6 mL·kg −1 ·min −1 (from 28.4 to 29.0 mL·kg −1 ·min −1 ) in the placebo group ( P =0.02). Cardiopulmonary exercise test time increased by 0.48 minute (from 6.79 to 7.27 minutes) versus 0.08 minute (from 6.94 to 7.02 minutes; P =0.04). Nine bosentan-treated patients improved 1 functional class, whereas none improved in the placebo group ( P =0.0085). Side effects were mild and occurred equally in both groups. No serious adverse effects were seen, and no patients had liver enzyme levels above the 3-fold upper limit. Conclusions— Bosentan improves exercise capacity, exercise time, and functional class in Fontan patients without serious adverse events or hepatotoxicity. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01292551.

In calcific aortic valve disease (CAVD), activated T lymphocytes localize with osteoclast regions; however, the functional consequences of this association remain unknown. We hypothesized that CD8+ T cells modulate calcification in CAVD. CAVD valves (n = 52) dissected into noncalcified and calcified portions were subjected to mRNA extraction, real-time quantitative PCR, enzyme-linked immunosorbent assay, and immunohistochemical analyses. Compared with noncalcified portions, calcified regions exhibited elevated transcripts for CD8, interferon (IFN)-γ, CXCL9, Perforin 1, Granzyme B, and heat shock protein 60. Osteoclast-associated receptor activator of NK-κB ligand (RANKL), tartrate-resistant acid phosphatase (TRAP), and osteoclast-associated receptor increased significantly. The stimulation of tissue with phorbol-12-myristate-13-acetate and ionomycin, recapitulating CAVD microenvironment, resulted in IFN-γ release. Real-time quantitative PCR detected mRNAs for CD8+ T-cell activation (Perforin 1, Granzyme B). In stimulated versus unstimulated organoid cultures, elevated IFN-γ reduced the mRNAs encoding for RANKL, TRAP, and Cathepsin K. Molecular imaging showed increased calcium signal intensity in stimulated versus unstimulated parts. CD14+ monocytes treated either with recombinant human IFN-γ or with conditioned media-derived IFN-γ exhibited low levels of Cathepsin K, TRAP, RANK, and tumor necrosis factor receptor-associated factor 6 mRNAs, whereas concentrations of the T-cell co-activators CD80 and CD86 increased in parallel with reduced osteoclast resorptive function, effects abrogated by neutralizing anti–IFN-γ antibodies. CD8+ cell–derived IFN-γ suppresses osteoclast function and may thus favor calcification in CAVD.

Aims Eisenmenger syndrome (ES) is associated with considerable morbidity and mortality. Therapeutic strategies have changed during the 2000s in conjunction with an emphasis on specialist follow-up. The aim of this study was to determine the cause-specific mortality in ES and evaluate any relevant changes between 1977 and 2015. Methods and results This is a retrospective, descriptive multicentre study. A total of 1546 patients (mean age 38.7 ± 15.4 years; 36% male) from 13 countries were included. Cause-specific mortality was examined before and after July 2006, ‘early’ and ‘late’, respectively. Over a median follow-up of 6.1 years (interquartile range 2.1–21.5 years) 558 deaths were recorded; cause-specific mortality was identified in 411 (74%) cases. Leading causes of death were heart failure (34%), infection (26%), sudden cardiac death (10%), thromboembolism (8%), haemorrhage (7%), and peri-procedural (7%). Heart failure deaths increased in the ‘late’ relative to the ‘early’ era (P = 0.032), whereas death from thromboembolic events and death in relation to cardiac and non-cardiac procedures decreased (P = 0.014, P = 0.014, P = 0.004, respectively). There was an increase in longevity in the ‘late’ vs. ‘early’ era (median survival 52.3 vs. 35.2 years, P Conclusion The study shows that despite changes in therapy, care, and follow-up of ES in tertiary care centres, all-cause mortality including cardiac remains high. Patients from the ‘late’ era, however, die later and from chronic rather than acute cardiac causes, primarily heart failure, whereas peri-procedural and deaths due to haemoptysis have become less common. Lifelong vigilance in tertiary centres and further research for ES are clearly needed.

The authors emphasize the role of physical exercises in the prevention and treatment of osteoporosis through reviewing the most important evidences. With the increase of life expectancy, it becomes more and more challenging to fight against osteoporosis related fracture complications and functional restrictions. The article gives an insight into the different physical exercises that are able to influence the condition as prevention and also as treatment possibilities without having adverse side effects. Since improving balance and postural control are essential part of the interventions and they are under the influence of multiple sensory, motor and cognitive systems, this multisystem nature of balance should take into account in falls prevention even in terms of osteoporosis.

OBJECTIVE: Improved diagnostic tools, timely closure of the shunt and a better understanding of the complexity of Eisenmenger syndrome (ES) have led to improved care and treatment in tertiary centres. These may have decreased the incidence of ES and improved survival of patients with ES, although evidence is still lacking. The aim of this study was to investigate temporal changes in incidence, prevalence and mortality in patients with ES for 35 years in the Nordic region.METHODS: This was a retrospective population-based study including 714 patients with ES. Survival analysis was performed based on all-cause mortality and accounting for immortal time bias.RESULTS: The incidence of ES decreased from 2.5/million inhabitants/year in 1977 to 0.2/million inhabitants/year in 2012. Correspondingly, prevalence decreased from 24.6 to 11.9/million inhabitants. The median survival was 38.4 years, with 20-year, 40-year and 60-year survival of 72.5%, 48.4%, and 21.3%, respectively. Complex lesions and Down syndrome were independently associated with worse survival (HR 2.2, pCONCLUSIONS: The incidence and prevalence of ES in the Nordic region have decreased markedly during the last decades. Furthermore, the median age at death increased throughout the study period, indicating prolonged life expectancy in the ES population. However, increasing age represents decreased incidence, rather than improved survival. Nonetheless, longevity with ES is still shorter than in the background population.

International audience; OBJECTIVE:Whereas circulating levels of C-reactive protein (CRP) have been associated with, for example, arterial stiffness, subclinical atherosclerosis and metabolic syndrome, other inflammatory biomarkers with potential interest for these conditions may not be measurable systemically. The predictive value of salivary biomarkers in these contexts has remained largely unexplored. The aim of the present study was to establish the association of different salivary biomarkers of inflammation with subclinical cardiovascular disease.METHODS:Two hundred and fifty-nine individuals were included in the study. Saliva and plasma samples were collected, and each individual underwent carotid ultrasound and measures of pulse wave velocity and blood pressure. Medical history of previous cardiovascular disease, current medications and smoking were collected by questionnaire.RESULTS:Salivary levels of CRP, leukotriene B4 (LTB4), prostaglandin E2 (PGE2), matrix metalloproteinase 9 (MMP-9), creatinine and lysozyme were measured. Salivary levels of CRP were significantly correlated with plasma levels (r = 0.73, P

BackgroundBone remodeling in calcified aortic valves is thought to originate from microfractures at multiple sites of the valve, at which osteoclasts and osteoblasts are recruited. The aim of the present study was to assess circulating mediators of bone homeostasis, correlate them to the severity of stenosis and explore the spatio-temporal distribution of bone turnover in different parts of calcified aortic valve tissue.Methods and resultsPlasma and explanted aortic valves were obtained from 46 patients undergoing aortic valve replacement surgery. Plasma levels of tartrate-resistant acid phosphatase (TRAP), receptor activator of nuclear-κB (RANK) ligand and Runt-related transcription factor 2 (Runx2/Cbfa1) exhibited a significant correlation to the severity of aortic stenosis. mRNA levels in normal, thickened and calcified parts of aortic valves assessed by quantitative real-time PCR were significantly elevated in calcified parts of valves for TRAP (5.08±1.6-fold, P

Background Patients with cyanotic congenital heart disease (CCHD) have haemostatic abnormities associated with bleeding and thrombo-embolic events. The haemostatic abnormalities are not fully understood, but recent studies indicate that elevated haematocrit and fibrinogen function may be of importance. The aim of this study was to characterise the haemostatic profile and examine the potential role of haematocrit on clot formation and strength in CCHD patients. Furthermore to examine whether CCHD patients with history of haemoptysis have diminished fibrinogen function compared to those without haemoptysis. Methods In a prospective study 75 adult CCHD patients had haematocrit, platelet count, and plasma fibrinogen concentration examined. Furthermore thrombelastography(TEG) as well as TEG Functional Fibrinogen(TEG FF) assay evaluating fibrinogen function(FLEV) was performed. Data were compared with historical data regarding previous haemoptysis in CCHD patients. Results Haematocrit was 57±8% and platelet counts in the lower normal range. TEG revealed a hypocoagulable condition with impaired clot formation. TEG values were correlated to haematocrit, indicating that elevated haematocrit causes impaired clot formation and strength. Despite high levels of plasma fibrinogen, TEG FF demonstrated that FLEV was diminished and negatively correlated to haematocrit. Furthermore CCHD patients with previous history of haemoptysis had significantly lower FLEV compared to CCHD patients without haemoptysis. Conclusion Patients with CCHD are hypocoagulable mainly due to impaired fibrinogen function. Despite a low platelet count, platelet function does not seem to be severely affected in CCHD patients. Haemostasis, and especially fibrinogen function, is negatively affected by elevated haematocrit, and fibrinogen function is diminished in CCHD patients with haemoptysis.

In Graves' ophthalmopathy (GO), there is a demand to differentiate the immunologically active disease state, when immunosuppressive therapy is necessary, from the inactive state, when the patient would not benefit from it. We measured the inflammatory activity in the retrobulbar region using Tc-diethylene triamine pentaacetic acid (DTPA) SPECT before and after external radiation to determine whether this method is suitable for predicting the effectiveness of this therapy.Thirty-two patients with suspected active GO were involved in this retrospective study. The initial image, DTPA uptake value (UV) and its change after therapy were assessed to monitor the effect of the therapy and investigate whether a pretreatment scan is capable of predicting the outcome.Depending on the change in DTPA UV after radiotherapy, three patient groups were formed: decreased, increased or minimally changed (less than 1×10 injected dose (ID)/ml). The initial DTPA UVs of these groups were significantly different (P0.001). Improvement was observed mainly in patients with higher initial values. When comparing the groups with low (12×10 ID/ml) versus high (≥12×10 ID/ml) initial uptake, an unexpected increase was observed in the first group after therapy (mean: +2.89±2.66×10 ID/ml), whereas the average change in the DTPA UV was negative in the latter group as anticipated (-2.24±4.47×10 ID/ml, P0.00001).We found that in GO patients a high DTPA UV may predict the response to orbital radiation therapy. DTPA orbital SPECT may be a suitable technique for the selection of GO patients for radiation therapy.

A szerzők jelen tanulmanyukban ket kulonboző korosztalynal ravilagitanak a medencealapi izmokat gyengitő tenyezőkre, amelyek okozhatnak vizeletvesztesi tuneteket. Vizsgaltak a fiatal nem szult nőknel jelentkező vizelettartasi zavar kezelesere alkalmas gatizomtorna hatasat. A vizsgalatokban a serdulő korosztaly (n=111; atlageletkor 16± SD 1.4) es a felnőtt nők (n=311; atlageletkor 40 ev± SD 10,4) vettek reszt. A resztvevők kerdőiveket toltottek ki. 14 fiatal nem szult nő ezen kivul izomerő felmeresen vettek reszt, akiknel a gatizomtorna 10 hetig heti 1x1 ora iranyitott tornaztatasbol es otthoni gyakorlasbol allt. Az eredmenyek alapjan a problema nem csak a felnőtt populaciot, hanem a fiatal korosztalyt is erinti. A kerdőivekből kiderult, hogy az inkontinencia rizikotenyezői kozul a helytelen szokasok jelenlete szamottevő. A tornacsoportnal a gatizmok izometrias feszites mertekenek valtozasa szignifikansan novekedett a tornaprogram vegere (25 masodperccel atlagosan), csakugy, mint a gatizmok dinamikus allokepesseget jelző 1 perc alatti osszehuzodasok szama is (atlagosan 13 ismetlesszammal). A gatizomtorna program eredmenyesseget tamasztja ala, hogy a resztvevők a tunetek csokkeneset vagy megszűneset tapasztaltak. Az eredmenyek eszkozos bizonyitasa tovabbi kutatasi celok felallitasat surgetik.

IV. IRI Társadalomtudományi Konferencia. TARTALMI ÖSSZEFOGLALÓK – ABSTRAKTY. STÚROVO, 2016. ÁPRILIS 24-25. Stúrovo (Párkány), Szlovákia. International Research Institute s.r.o., Komárno, 2016 (ISBN 978-80-89691-36-4)

Collste O, Sorensson P, Frick M, Agewall S, Daniel M, Henareh L, Ekenback C, Eurenius L, Guiron C, Jernberg T, Hofman-Bang C, Malmqvist K, Nagy E, Arheden H, Tornvall P (Sodersjukhuset, Stockholm; Karolinska Hospital, Karolinska Institutet, Stockholm, Sweden; University of Oslo, Oslo, Norway; Sankt Goran Hospital Capio, Karolinska Institutet, Stockholm; Huddinge, Stockholm; Danderyd Hospital, Karolinska Institutet, Stockholm; and Skane University Hospital, Lund University, Lund, Sweden). Myocardial infarction with normal coronary arteries is common and associated with normal findings on cardiovascular magnetic resonance imaging: results from the Stockholm Myocardial Infarction with Normal Coronaries study. J Intern Med 2013; 273: 189-196. Objectives Myocardial infarction with angiographically normal coronary arteries (MINCA) is an important subtype of myocardial infarction; however, the prevalence, underlying pathophysiology, prognosis and optimal management of this condition are still largely unknown. Cardiovascular magnetic resonance (CMR) imaging has the potential to clarify the underlying pathology in patients with MINCA. The objective of this study was to investigate the diagnostic value of CMR imaging in this group of patients. Design The prospective, multicentre, observational Stockholm Myocardial Infarction with Normal Coronaries (SMINC) study. Setting Coronary care units in the Stockholm metropolitan area. Subjects Patients between 35 and 70 years of age with MINCA were consecutively included in the screening phase of the SMINC study. All patients had a typical clinical presentation, fulfilling the universal definition of myocardial infarction and had normal coronary angiography finding. Patients with known structural or coronary heart disease or other known causes of elevated troponin levels were excluded. Results In total, 176 patients with MINCA were screened from 2007 to 2011. Of these, 152 underwent CMR imaging. The investigation was performed a median of 12 (interquartile range 628) days after hospital admission; 67% of the findings were normal, whereas 19% of patients had signs of myocardial necrosis and 7% had signs of myocarditis. The remaining patients (7%) had either unrecognized hypertrophic cardiomyopathy or could not be classified. Conclusion In this consecutive series of patients with MINCA, CMR imaging may help to differentiate between those with myocarditis, myocardial necrosis and normal myocardium. The incidence of MINCA was higher than previously reported. After excluding cases of myocarditis, MINCA consists of a large group of patients with normal CMR imaging results and a smaller group with myocardial necrosis. The aetiologies of these different imaging findings need to be explored.

Oxidative stress may contribute to the hemodynamic progression of aortic valve stenosis, and is associated with activation of the nuclear enzyme poly(ADP-ribose) polymerase (PARP) 1. The aim of the present study was to assess the transcriptional profile and the topological distribution of PARP-1 in human aortic valves, and its relation to the stenosis severity. Human stenotic aortic valves were obtained from 46 patients undergoing aortic valve replacement surgery and used for mRNA extraction followed by quantitative real-time PCR to correlate the PARP-1 expression levels with the non invasive hemodynamic parameters quantifying the stenosis severity. Primary isolated valvular interstitial cells (VICs) were used to explore the effects of cytokines and leukotriene C4 (LTC4) on valvular PARP-1 expression. The thickened areas of stenotic valves with tricuspid morphology expressed significantly higher levels of PARP-1 mRNA compared with the corresponding part of bicuspid valves (0.501 vs 0.243, P = 0.01). Furthermore, the quantitative gene expression levels of PARP-1 were inversely correlated with the aortic valve area (AVA) (r = −0.46, P = 0.0469) and AVA indexed for body surface area (BSA) (r = −0.498; P = 0.0298) only in tricuspid aortic valves. LTC4 (1 nM) significantly elevated the mRNA levels of PARP-1 by 2.38-fold in VICs. Taken together, these data suggest that valvular DNA-damage pathways may be associated with inflammation and the stenosis severity in tricuspid aortic valves.

The fever of unknown origin from time to time constitutes a serious clinical problem and nearly all diagnostic methods are involved to discover urgently its cause. According to literature data 18F-fluoro-deoxyglucose PET/CT was successful in 25-70% of cases even in patients without any positive findings with conventional diagnostic techniques. The Hungarian National Health Fund does not include fever of unknown origin in the list of reimbursed 18F-fluoro-deoxyglucose PET/CT indications. The authors try to illustrate the clinical problem with this case report. Fever of unknown origin persisted in a patient for a year, but conventional diagnostic procedures were unsuccessful to find the cause of the fever. Finally, 18F-fluoro-deoxyglucose PET/CT indicated a metabolically active focus between the pancreas tail and the spleen. After a long-lasting antibiotic therapy the patient became symptomfree. Orv. Hetil., 2012, 153, 227–231.

Background Few studies investigated the postural control in patients with hip joint impairments; in some cases, balance impairments have been found, while other researchers have seen no significant changes. The goal of this study was to characterize postural stability in patients suffering from unilateral osteoarthritis or rheumatoid arthritis in different balance tasks and to reveal potential differences between the two diseases in this respect. Methods Ten patients with hip osteoarthritis (mean age: 62.3 years), 10 patients with rheumatoid arthritis (mean age: 55.4 years) and 10 healthy control subjects (mean age: 54.3 years) took part in the study. Displacement of centre of pressure was measured with a force plate in mediolateral and anteroposterior directions during two-leg standing on firm and compliant surfaces with eyes opened and closed. Findings Standing on a firm surface sway path increased significantly in the anteroposterior direction in both patient groups and in the mediolateral direction in all groups with eyes closed as compared to eyes opened condition. Standing on a compliant surface, sway paths increased significantly in both directions in all groups with eyes closed as compared to eyes opened condition; furthermore, sway paths were significantly longer with eyes closed in patients with rheumatoid arthritis in comparison with control and osteoarthritis groups. Interpretation Our data revealed that the manipulation of both visual and somatosensory information can reveal subtle impairments in balance control. Thus, this paradigm can unmask the effects of decreased proprioception due to joint capsule lesion in patients with rheumatoid arthritis.

Aims Aortic valve stenosis (AS) is the most common valvulopathy and is characterized by inflammation, extracellular matrix (ECM) remodelling and calcification, causing a narrowing of the valve and the consequential obstruction of the cardiac outflow. Although intraleaflet haemorrhage is associated with AS progression, the mechanisms involved are not known. The aims of this study were to identify valvular iron in relation to pathological changes associated with AS and the effects on valvular interstitial cells (VIC) in terms of iron uptake and iron-induced responses. Methods and results Valvular iron accumulation was detected by Perls' staining on aortic valve sections and shown to increase with the extent of calcification. Furthermore, qRT–PCR analysis revealed that iron-containing valve regions exhibited increased expression of genes involved in ECM remodelling and calcification. In addition, we demonstrate that iron transporters are regulated by pathways with major impact on AS and that VIC can take up and accumulate iron, which resulted in increased proliferation and decreased elastin production. Conclusion Iron, which may accumulate in the aortic valve by means of intraleaflet haemorrhages, can be taken up by VIC in a pro-inflammatory environment and actively contribute to VIC proliferation, ECM remodelling and calcification. These findings suggest a possible mechanism through which iron uptake by VIC may favour AS progression.

The purpose of this study was to investigate the effect of different types of mechanical stimulation of the sole on standing postural stability in healthy, young adults. Fifty subjects (34 women, 16 men; mean age 23 ± 2 (mean ± SE)) stood barefoot on fixed force plates both with open and closed eyes on firm surface and then on compliant surface (foam). A modified clinical test of sensory interaction on balance protocol was employed to assess the center of gravity (COG) excursions along anteroposterior (AP) and mediolateral (ML) axes on each surface and visual condition. After the baseline measurement, a stimulation was applied with an elastic spiked layer topped to the firm and then foam surface, and the COG excursions were measured during the stimulation, and then at least 30 min after the stimulation of the spiked layer, we used 10 min of manual static and glide pressure applied to the plantar surface of both feet. Immediately after manual stimulation, static balance parameters were measured again. Results showed that after manual stimulation, the sway path with closed eyes decreased significantly on the AP and ML directions on firm surface conditions. The spiked layer caused significantly decreased sway path on firm platform in both directions, but it was ineffective on compliant surface. Our results established that the activation of plantar mechanoreceptors by 10-min manual stimulation can partially compensate subjects for the absence of visual input and the lack of accurate pressure information from the supporting surface, too.

Background— The development of aortic valve stenosis is not only associated with calcification and extracellular matrix remodeling, but also with inflammation. The aim of this study was to determine the role of proinflammatory signaling through the leukotriene (LT) pathway in aortic stenosis. Methods and Results— After macroscopic dissection of surgically removed human aortic valves, RNA was extracted from 311 preparations derived from 68 patients to differentiate normal, thickened, and calcified areas from each cusp. Subsequently, quantitative polymerase chain reaction analysis was used to correlate gene expression patterns with preoperative echocardiographic parameters. The messenger RNA levels of the LT-forming enzyme 5-lipoxygenase increased 1.6- and 2.2-fold in thickened and calcified tissue, respectively, compared with normal areas of the same valves. In thickened tissues, messenger RNA levels for 5-lipoxygenase ( r =−0.35; P =0.03), its activating protein (5-lipoxygenase activating protein; r =−0.39; P =0.02), and LTA 4 hydrolase ( r =−0.48; P =0.01) correlated inversely with the velocity–time integral ratio. In addition, leukotriene A 4 hydrolase transcripts correlated inversely with aortic valve area, indexed for body surface area ( r =−0.52; P =0.007). Immunohistochemical stainings revealed LT receptor expression on valvular myofibroblasts. In primary cultures of human myofibroblasts derived from stenotic aortic valves, Leukotriene C 4 (LTC 4 ) increased intracellular calcium, enhanced reactive oxygen species production, reduced the mitochondrial membrane potential, and led to morphological cell cytoplasm changes and calcification. Conclusions— The upregulation of the LT pathway in human aortic valve stenosis and its correlation with clinical stenosis severity, taken together with the potentially detrimental LT-induced effects on valvular myofibroblasts, suggests one possible role of inflammation in the development of aortic stenosis.

As proprioceptive training is popular for injury prevention and rehabilitation, we evaluated its effect on balance parameters and assessed the frequency spectra of postural sway linked with the various sensory channels. We recorded the Center of Mass displacement of 30 healthy student research participants (mean age = 21.63; SD = 1.29 years) with a single force plate under eyes open (EO) and eyes closed (EC) positions while standing on either a firm or foam surface, both before and after an 8-week balance training intervention on a foam surface with EC. We subjected the data to frequency power spectral analysis to find any differences between the frequency bands, linked with various sensory data. On the foam surface in the EC condition, the sway path decreased significantly after proprioceptive training, but, on the firm surface in the EC condition, there was no change. On the foam surface in the EC condition, there was also a significant decrease in frequency power postproprioceptive training in the medium-to-low frequency band. While our data indicate better posttraining balance skills, improvements were task specific to the trained condition, with no transfer of the acquired skill, even to a similar, easier condition. As training improved the middle-low frequency band, linked with vestibular signals, this intervention is better described as balance than "proprioceptive" training.

This study examined residents’ and caregivers’ conceptualization of quality of life (QOL) and quality of care (QOC). Resident interviews and caregiver questionnaire surveys were conducted based on the facet approach. Data were analyzed by multidimensional scaling. Apart from domains of QOL and QOC identified in western sudies, a new aspect, bathing, was distinguished. Residents perceived bathing as a pleasant activity, while caregivers perceived it as nursing. Residents also distinguished between emotional, perceptual, and cognitive elements of psychological responses to care but caregivers did not. Differences in basic conceptualization might explain perception gaps and difficulties in providing suitable care for residents.

While it is well known that the endogenous cannabinoid receptor ligand anandamide also activates the transient receptor potential vanilloid1 (TRPV1) receptors, there has been no in vivo study indicating the role of the TRPV1 receptors in the antinociceptive effect of anandamide at spinal level. The goal of this study was to determine the effect of inhibition of TRPV1 receptors by capsazepine on the antinociceptive potency of anandamide after intrathecal administration. Anandamide alone (1, 30 or 100 microg) dose-dependently decreased carrageenan-induced thermal hyperalgesia, however, the highest dose caused temporary excitation and vocalization, suggesting the pain-inducing potential of anandamide. Capsazepine (10 or 20 microg) by itself did not change the pain sensitivity markedly, but the lower dose increased it, and the higher dose decreased the antinociceptive effect of 30 microg anandamide. Furthermore, both doses of capsazepine decreased the efficacy of the largest dose of anandamide. These results show that TRPV1 receptor activation plays a substantial role in the antinociceptive effects of anandamide at spinal level. The effect of the inhibition on TRPV1 receptors depended on the dose applied. We presume that coactivation of the cannabinoid and TRPV1 receptors by anandamide provides elevated antinociception through the release of antinociceptive endogenous ligands at spinal level.

A szerzők a “Pannonia” multicentrikus serdulőpszichiatriai felmeres kereteben negy dunantuli gyermekpszichiatriai gondozoban egy ev alatt jelentkezett osszes uj beteg kozul az Ottawai Onsertő Kerdőiv alapjan onsertő magatartasunak bizonyult 72, 14-18 eves fiatal anyagabol attekintettek 48 lany (eletkori atlag 16.1 ev) M.I.N.I. Plusz diagnosztikai interjuval megerősitett klinikai diagnozisait. A gondozokban jelentkezőknel 10,2%-ban, a kezelesben reszesulő serdulőkoru fiatalok kozott mar tobb mint egynegyeduknel (25,6%) talaltak onsertő magatartast, ami a vartnal gyakoribb előfordulasi arany. Megallapitjak, hogy a serdulők tobbsege major depresszioban, vagy valamilyen szorongasos zavarban szenved, gyakori tovabba a szuicid magatartas is. Ezek a betegsegek mind monodiagnozis, mind pedig komorbid tarsbetegseg formajaban egyarant előfordulnak, ugyanis az allomany tobb mint ketharmada a tobbes diagnozis tuneti felteteleit is kielegitette. Az onsertő serdulők magatartastuneteit (a rizikomagatartas gyakorisaga, l...

The changes in postural control in elderly people after an 8-week training course were characterized. Static postural stability was measured during standing on a single force platform first with the eyes open and then with the eyes closed. Body sway was analysed on a force plate in groups of elderly and of young subjects. Half of the elderly subjects then took part in the training course. The posturographic measurements were repeated after the course. The sway in anteroposterior (AP) and mediolateral (ML) directions was subjected to spectral analysis. The frequency spectrum of the platform oscillations was calculated by fast Fourier transformation in the intervals 0.1-0.3, 0.3-1 and 1-3 Hz. It was found that the sway path was longer and the frequency power was higher in the elderly group. The training caused a significant improvement in functional performance, but a significantly longer sway path was observed after the training in the ML direction. The frequency analysis revealed a significantly higher power after 8 weeks without visual control in the ML direction in the training group in the low and the middle frequency bands. The results suggest that the participants' balance confidence and the control of ML balance improved in response to the training. The higher ML frequency power exhibited after the training may be indicative of a better balance performance. Thus, the increase in the sway path in this age group did not mean a further impairment of the postural control.

BACKGROUND: Patients with cyanotic congenital heart disease (CCHD) have a high prevalence of thrombosis, the most frequently described locations being the cerebral and pulmonary vessels. The reported prevalence of both cerebral infarction and pulmonary thrombosis has been highly variable. The aim of this study was to examine the prevalence of both cerebral and pulmonary thrombosis in CCHD according to medical history and imaging. In addition, the role of known erythrocytosis and haemostatic abnormalities as risk factors was evaluated.METHODS AND RESULTS: A cross-sectional descriptive study examining 98 stable adult patients with CCHD with a medical questionnaire, blood samples, MRI of the cerebrum (n=72), multidetector CT imaging (MDCT) of the thorax (n=76) and pulmonary scintigraphy (ventilation/perfusion/single-photon emission computerised tomography/CT) (n=66). The prevalence of cerebral infarction and pulmonary thrombosis according to imaging were 47% and 31%, respectively. Comparing the findings with previous medical history revealed a large under-reporting of thrombosis with only 22% of the patients having a clinical history of stroke and 25% of pulmonary thrombosis. There was no association between the degree of erythrocytosis or haemostatic abnormalities and the prevalence of thrombosis.CONCLUSIONS: Patients with CCHD have a prevalence of both cerebral and pulmonary thrombosis of around 30%-40%, which is much higher than that reported previously. Furthermore, there is a large discrepancy between clinical history and imaging findings, suggesting a high prevalence of silent thrombotic events. Neither erythrocytosis nor haemostatic abnormalities were associated with the prevalence of thrombosis in patients with CCHD.TRIAL REGISTRATION NUMBER: http://www.cvk.sum.dk/CVK/Home/English.aspx (H-KF-2006-4068).