Impact of lead position on tricuspid regurgitation, ventricular function, and heart failure exacerbation and mortality after cardiac implantable electronic device implantation. Preliminary results from the PACE-RVTR Registry

BACKGROUND

The most frequent mechanism of lead-related tricuspid regurgitation (LRTR), which occurs in 7.2% to 44.7% of patients implanted with a cardiac implantable electronic device (CIED), is leaflet impingement or the restriction of its movement by a ventricular lead. It is unclear if the position of the lead tip - in the right ventricular apex (RVA) or other location (non-RVA) - has any influence on the development of LRTR. The study aimed to determine the impact of the CIED lead tip position on the development or progression of tricuspid regurgitation (TR) and its potential impact on heart failure exacerbation and mortality.

METHODS

One hundred and two consecutive patients who received CIEDs between March 2020 and October 2021 were included in the prospective registry (PACE-RVTR). Patients were assigned to two groups depending on the lead position - the RVA group and the non-RVA group. All patients underwent echocardiographic evaluation before implantation and one year later.

RESULTS

In terms of baseline clinical characteristics, the two groups did not differ. Before CIED implantation, patients in the non-RVA group had better left ventricular systolic function (P = 0.004). Pacemakers were implanted more often in the non-RVA group (P = 0.001) while implantable cardioverter-defibrillators in the RVA group (P = 0.008). Progression to severe or massive TR was more common in the non-RVA group (P = 0.005).

CONCLUSION

Severe and massive TR occurred more often in patients with the non-RVA position of the lead. The right ventricular lead position did not impact heart failure progression or all-cause mortality at two-year follow-up.

Lead-related tricuspid regurgitation and ventricle dysfunction: Current management and future perspectives

The implantation of cardiac implantable electronic devices (CIEDs) may result in or worsen previously existing tricuspid regurgitation (TR). The prevelence of lead-related tricuspid regurgitation (LRTR) in patients with CIEDs is between 7.2% and 44.7% when the degree of worsening TR is not reported, or from 9.8% and 38% when it is diagnosed as worsening of TR severity by at least 2 grades after a CIED has been implanted. It has been suggested that a CIED lead positioned over or pinning a leaflet may be the main cause of TR in this patient population. The septal and posterior leaflets of the tricuspid valve have been reported to be the most affected by CIED leads. Severe LRTR is related to the development of heart failure (HF) or worsening of previously existing dysfunction; it is also associated with elevated mortality. However, there are no definitive predictors of LRTR development or standardized methods of treatment. Some studies have suggested that imaging-guided lead placement can reduce the occurrence of LRTR. This review summarizes current knowledge concerning the development, evaluation, consequences, and management of LRTR.

Tricuspid Regurgitation (TR) after Implantation of a Cardiac Implantable Electronic Device (CIED)-One-Year Observation of Patients with or without Left Ventricular Dysfunction

The frequency of tricuspid regurgitation (TR) progression after cardiac implantable electronic devices (CIEDs) implantation varies from 7.2% to 44.7%. TR is associated with increased mortality and hospitalizations due to heart failure (HF) decompensation. The aim of this study was to assess the rate of early TR progression after CIED implantation and the frequency of HF decompensation and mortality. The 101 patients, who received a CIED between March 2020 and October 2021, before the procedure were divided into two groups-one with left ventricle ejection fraction (LVEF) ≥ 40% (n = 60) and one with LVEF < 40% (n = 41). Lead-related tricuspid regurgitation (LRTR) was defined as an increase of TR by at least one grade. The follow-up period was similar between both groups and was on average 13 (12-16) months. In the whole study group, TR progression by one grade was 34.6% and by two or more grades 15.8%. The significant changes in the dynamic of TR degree were as follows before and after implantation: none/trivial TR in group 1 (61.7% vs. 28.3%, p = 0.01) and severe/massive TR in group 2 (0.0% vs. 14.6%, p = 0.03). The groups did not differ from each other in terms of survival from decompensation of HF (18.3% vs. 36.6%, p = 0.70) and survival from death (1.7% vs. 4.9%, p = 0.16). At the one-year follow-up, the baseline LVEF did not affect the survival rate from death or HF decompensation among patients with a progression of TR after CIED implantation. In this study, a progression by one grade was more common in group 1, but the occurrence of severe/massive TR after implantation was more specific for group 2.

Cell viability and collagen metabolism of MCF-7 breast cancer cells are affected by carbon monoxide released from CORM-2

Carbon monoxide (CO), despite its reputation as a deadly poison, is being recognized as a powerful physiological regulatory agent with potential anti-cancer properties. To harness the potential of CO towards a safe therapy, CO-Releasing Molecules (CO-RMs) have been developed. In the present study, the effects of tricarbonyldichlororuthenium(II) dimer (CORM-2) on MCF-7 breast cancer cell cultures were evaluated, with particular regard to mechanisms affecting collagen biosynthesis. In our model, CORM-2 exerted dose-dependent cytotoxic and antiproliferative effects, i.e., attenuated cell viability, induced apoptosis and reduced autophagy. Collagen biosynthesis was significantly reduced, with signs of the involvement of nuclear factor kappa B, integrin β1, insulin-like growth factor 1 and proline metabolism as the probable underlying mechanism. No effects of CO-depleted CORM-2 were found, thereby demonstrating that CORM-2 activity is associated with carbon monoxide. Additionally, it was found that CORM-2 had no influence on control fibroblasts cultures. Our results confirm both the cytotoxic and collagen-related properties of CO-releasing molecule in a breast cancer cell culture, and therefore serve to encourage further research in a pre-clinical setting. To the best of our knowledge, this study is the first to attempt to relate the effects of CORM-2 on cell viability and collagen metabolism in a cancer cell culture.

Climber exhibits first clinical manifestation of spinocerebellar ataxia on Karakoram expedition

Spinocerebellar ataxias are rare, genetically inherited diseases. Their typical symptoms include disturbances in gait, balance and uncoordinated movements, but these abnormalities, when appear at altitude, might also suggest high-altitude cerebral edema. We described the first clinical manifestation of spinocerebellar ataxia of a climber from Poland on a Karakoram expedition.

Paradoxical embolism to the central nervous system in a young Polish woman on a trek in the Himalayas

Paradoxical embolism to the central nervous system through a patent foramen ovale (PFO) is considered one mechanism of ischaemic stroke. We present a case of stroke in a young woman with PFO trekking in the Himalayas. Paradoxical embolism should be considered in the differential diagnosis of high-altitude cerebral oedema.

Prolonged Sojourn at Very High Altitude Decreases Sea-Level Anaerobic Performance, Anaerobic Threshold, and Fat Mass

Background: The influence of high altitude on an organism’s physiology depends on the length and the level of hypoxic exposure it experiences. This study aimed to determine the effect of a prolonged sojourn at very high altitudes (above 3,500m) on subsequent sea-level physical performance, body weight, body composition, and hematological parameters.

Materials and Methods: Ten alpinists, nine males and one female, with a mean age of 27±4years, participated in the study. All had been on mountaineering expeditions to 7,000m peaks, where they spent 30±1days above 3,500m with their average sojourn at 4,900±60m. Their aerobic and anaerobic performance, body weight, body composition, and hematological parameters were examined at an altitude of 100m within 7days before the expeditions and 7days after they descended below 3,500m.

Results: We found a significant (p<0.01) decrease in maximal anaerobic power (MAP_WAnT) from 9.9±1.3 to 9.2±1.3W·kg⁻¹, total anaerobic work from 248.1±23.8 to 228.1±20.1J·kg⁻¹, anaerobic threshold from 39.3±8.0 to 27.8±5.6 mlO₂·kg⁻¹·min⁻¹, body fat mass from 14.0±3.1 to 11.5±3.3%, and a significant increase (p<0.05) in maximal tidal volume from 3.2 [3.0–3.2] to 3.5 [3.3–3.9] L after their sojourn at very high attitude. We found no significant changes in maximal aerobic power, maximal oxygen uptake, body weight, fat-free mass, total body water, hemoglobin, and hematocrit.

Conclusion: A month-long exposure to very high altitude led to impaired sea-level anaerobic performance and anaerobic threshold, increased maximal tidal volume, and depleted body fat mass, but had no effect on maximal aerobic power, maximal oxygen uptake, or hemoglobin and hematocrit levels.

Death Zone Weather Extremes Mountaineers Have Experienced in Successful Ascents

Background

Few data are available on mountaineers’ survival prospects in extreme weather above 8000 m (the Death Zone). We aimed to assess Death Zone weather extremes experienced in climbing-season ascents of Everest and K2, all winter ascents of 8000 m peaks (8K) in the Himalayas and Karakoram, environmental records of human survival, and weather extremes experienced with and without oxygen support.

Materials and Methods

We analyzed 528 ascents of 8K peaks: 423 non-winter ascents without supplemental oxygen (Everest–210, K2–213), 76 ascents in winter without oxygen, and 29 in winter with oxygen. We assessed environmental conditions using the ERA5 dataset (1978–2021): barometric pressure (BP), temperature (Temp), wind speed (Wind), wind chill equivalent temperature (WCT), and facial frostbite time (FFT).

Results

The most extreme conditions that climbers have experienced with and without supplemental oxygen were: BP 320 hPa (winter Everest) vs. 329 hPa (non-winter Everest); Temp –41°C (winter Everest) vs. –45°C (winter Nanga Parbat); Wind 46 m⋅s^–1 (winter Everest) vs. 48 m⋅s^–1 (winter Kangchenjunga). The most extreme combined conditions of BP ≤ 333 hPa, Temp ≤ −30°C, Wind ≥ 25 m⋅s^–1, WCT ≤ −54°C and FFT ≤ 3 min were encountered in 14 ascents of Everest, two without oxygen (late autumn and winter) and 12 oxygen-supported in winter. The average extreme conditions experienced in ascents with and without oxygen were: BP 326 ± 3 hPa (winter Everest) vs. 335 ± 2 hPa (non-winter Everest); Temp −40 ± 0°C (winter K2) vs. −38 ± 5°C (winter low Karakoram 8K peaks); Wind 36 ± 7 m⋅s^–1 (winter Everest) vs. 41 ± 9 m⋅s^–1 (winter high Himalayan 8K peaks).

Conclusions

Comparison of Environmental Conditions on Summits of Mount Everest and K2 in Climbing and Midwinter Seasons

(1) Background: Today’s elite alpinists target K2 and Everest in midwinter. This study aimed to asses and compare weather at the summits of both peaks in the climbing season (Everest, May; K2, July) and the midwinter season (January and February). (2) Methods: We assessed environmental conditions using the ERA5 dataset (1979–2019). Analyses examined barometric pressure (BP), temperature (Temp), wind speed (Wind), perceived altitude (Alt), maximal oxygen uptake (VO₂max), vertical climbing speed (Speed), wind chill equivalent temperature (WCT), and facial frostbite time (FFT). (3) Results: Most climbing-season parameters were found to be more severe (p < 0.05) on Everest than on K2: BP (333 ± 1 vs. 347 ± 1 hPa), Alt (8925 ± 20 vs. 8640 ± 20 m), VO₂max (16.2 ± 0.1 vs. 17.8 ± 0.1 ml·kg⁻¹·min⁻¹), Speed (190 ± 2 vs. 223 ± 2 m·h⁻¹), Temp (−26 ± 1 vs. −21 ± 1°C), WCT (−45 ± 2 vs. −37 ± 2 °C), and FFT (6 ± 1 vs. 11 ± 2 min). Wind was found to be similar (16 ± 3 vs. 15 ± 3 m·s⁻¹). Most midwinter parameters were found to be worse (p < 0.05) on Everest vs. K2: BP (324 ± 2 vs. 326 ± 2 hPa), Alt (9134 ± 40 vs. 9095 ± 48 m), VO₂max (15.1 ± 0.2 vs. 15.3 ± 0.3 ml·kg⁻¹·min⁻¹), Speed (165 ± 5 vs. 170 ± 6 m·h⁻¹), Wind (41 ± 6 vs. 27 ± 4 m·s⁻¹), and FFT (<1 min vs. 1 min). Everest’s Temp of −36 ± 2 °C and WCT −66 ± 3 °C were found to be less extreme than K2’s Temp of −45 ± 1 °C and WCT −76 ± 2 °C. (4) Conclusions: Everest presents more extreme conditions in the climbing and midwinter seasons than K2. K2’s 8° higher latitude makes its midwinter BP similar and Temp lower than Everest’s. K2’s midwinter conditions are more severe than Everest’s in the climbing season.

Impact of concentration of apelin-13 and chosen proangiogenic factors on the left ventricle function in echocardiographic assessment after myocardial infarction

Introduction

Myocardial infarction (MI) is one of the main factors of heart failure (HF) development, therefore it is essential to search possibilities of prevention of its occurance in that condition.

Purpose

The study aimed to determine the association between serum concentrations of apelin-13, vascular endothelial growth factor-A (VEGF-A), angiopoietin-1 (Ang-1), angiopoietin-2 (Ang-2) and systolic function of the left ventricle after MI.

Methods

Study group included 67 consecutive patients with acute MI (STEMI and NSTEMI) and lack of previous diagnosis of systolic HF. Venous blood samples were drawn prior to coronary intervention, on the third and fifth day of MI. The blood samples were centrifuged (3000g /15 minutes), serum was frozen and stored at −80°C before further analysis. Concentrations of the studied substances were determined by ELISA tests. Ejection fraction (Simpson's method) and mass (linear method) of the left ventricle were calculated in echocardiographic examination on the fifth day of MI. Cut off values for impaired left ventricular ejection fraction (LVEF) were 54% (women) and 52% (men). The concentrations of the studied factors were indexed to the left ventricle mass. In statistical analysis Mann-Whitney test and the logistic regression were used. Two models for proper LVEF occurance were tested. 1st model included time from pain onset to coronary intervention, type of MI, sex, eptifbatide use and heparin total dose; 2nd model included hypertension, diabetes mellitus, BMI, LDL concentration, smoking and age; each model included indexed concentration of one of the studied factors.

Results

STEMI was diagnosed in 45 (67%) patients. 53 patients (79%) did not achieve normal LVEF. Persons with normal LVEF exhibited statistically significant higher value of indexed concentrations of apelin-13 and VEGF-A on the first (respectively p=0.02 and p=0.03) and fifth (respectively p=0.004 and p=0.03) day of MI. In the logistic regression, odds ratio (OR) of indexed apelin-13 from the fifth day of MI, in the 1st model was 1.36 (95% CI: 1.04–1.78, p=0.02) and in the 2nd model was 1.43 (95% CI: 1.11–1.84, p=0.01); OR of indexed VEGF-A from the fifth day, in the 2nd model, was 13.65 (95% CI: 1.18–158.11, p=0.03). Indexed VEGF-A from the fifth day in the 1st model and indexed concentrations of both factors from the first day, notwithstanding type of model, did not obtain statistically significant OR. In the logistic regression inluded only indexed apelin-13 and VEGF-A from the fifth day of MI, OR was respctively 1.54 (95% CI: 1.15–2.06, p=0.003) and 22.39 (95% CI: 1.68–298.59, p=0.02). Ang-1 and Ang-2 did not exhibit statistically significant impact on LVEF.

Conclusions

Apelin-13 and VEGF-A exhibit properties, which may prevent deterioration of LVEF and thus avoid HF in patients with MI. Dose adjustment should be based on the left ventricle mass. Optimal time of administration of both substances is an issue of further studies.

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): Medical University of Silesia

Stack of two III-nitride laser diodes interconnected by a tunnel junction

We demonstrate a stack of two III-nitride laser diodes (LDs) interconnected by a tunnel junction grown by plasma-assisted molecular beam epitaxy. Hydrogen-free growth is used to obtain as-grown p-type conductivity essential for buried tunnel junctions (TJ). We show the impact of the design of tunnel junction. In particular, we show that, apart from the beneficial piezoelectric polarization inside the TJ, heavy doping reduces the differential resistivity even further. The device starts to lase at a wavelength of 459 nm with a slope efficiency (SE) of 0.7 W/A followed by lasing at 456 nm from the second active region doubling the total SE to 1.4 W/A. This demonstration opens new possibilities for the fabrication of stacks of ultraviolet and visible high power pulsed III-nitride LD.

Potential beneficial effect of some adipokines positively correlated with the adipose tissue content on the cardiovascular system

Obesity is a risk factor of cardiovascular diseases. However, in the case of heart failure, obese and overweight patients have a more favourable prognosis compared to patients who have a normal body weight. This phenomenon is referred to as the "obesity paradox," and it is explained by, among others, a positive effect of adipokines produced by adipose tissue, particularly by the tissue located in the direct vicinity of the heart and blood vessels. The favourable effect on the cardiovascular system is mostly associated with adiponectin and omentin, but the levels of these substances are reduced in obese patients. Among the adipokines which levels are positively correlated with the adipose tissue content, favourable activity is demonstrated by apelin, progranulin, chemerin, TNF-α (tumour necrosis factor-)α, CTRP-3 (C1q/tumour necrosis factor (TNF) related protein), leptin, visfatin and vaspin. This activity is associated with the promotion of regeneration processes in the damaged myocardium, formation of new blood vessels, reduction of the afterload, improvement of metabolic processes in cardiomyocytes and myocardial contractile function, inhibition of apoptosis and fibrosis of the myocardium, as well as anti-inflammatory and anti-atheromatous effects. The potential use of these properties in the treatment of heart failure and ischaemic heart disease, as well as in pulmonary hypertension, arterial hypertension and the limitation of the loss of cardiomyocytes during cardioplegia-requiring cardiosurgical procedures, is studied. The most advanced studies focus on analogues of apelin and progranulin.

Design and optimization of an adaptive optics system for a high-average-power multi-slab laser (HiLASE)

We report numerical and experimental results obtained with an optical setup that simulates the heating and cooling processes expected in a multi-slab high-average-power laser head. We have tested the performance of an adaptive optics system consisting of a photo-controlled deformable mirror (PCDM) and a Shack-Hartmann wavefront sensor for the effective correction of the generated wavefront aberrations. The performance of the adaptive optics system is characterized for different layouts of the actuator array and for different configurations of the heating mechanisms. The numerical results are benchmarked using a PCDM, which allowed us to experimentally compare the performances of different deformable mirrors.

[Treatment of hypertension in chronic kidney disease]

Adequate treatment of hypertension in patients with chronic kidney disease reduces the risk of cardiovascular complications, slows down the progression of renal failure, and is an important element in nephroprotection, delaying the onset of renal replacement therapy. Non-pharmacological methods, especially salt restriction, and most of the available antihypertensive medicines are in use. It is often necessary to combine drugs from different groups, among which inhibitors of renin-angiotensin-aldosterone (RAA) system and diuretics are the most important. The choice of an appropriate combination depends on the degree of renal failure, concomitant diseases, extent of proteinuria, and the presence or absence of edema and hypervolemia. Recommended blood pressure is below 140/90 mmHg in patients with proteinuria less than 0.5 g/24 h, and below 130/80 mmHg if daily proteinuria exceeds 0.5 g/24 h.

[Pathophysiology of hypertension in chronic kidney disease]

Hypertension is both an important cause and consequence of chronic kidney disease (CKD). It is present in 80-85% of the patients. The article summarizes the main pathogenetic factors of hypertension in CKD such as: sodium retention, increased activity the renin-angiotensin-aldosterone system and sympathetic nervous system, impaired nitric oxide synthesis and endothelium-mediated vasodilatation, oxidative stress, disorders of calcium metabolism and parathyroid hormone secretion, vascular calcification and increased arterial stiffness.

The specificity and patterns of staining in human cells and tissues of p16INK4a antibodies demonstrate variant antigen binding

The validity of the identification and classification of human cancer using antibodies to detect biomarker proteins depends upon antibody specificity. Antibodies that bind to the tumour-suppressor protein p16INK4a are widely used for cancer diagnosis and research. In this study we examined the specificity of four commercially available anti-p16INK4a antibodies in four immunological applications. The antibodies H-156 and JC8 detected the same 16 kDa protein in western blot and immunoprecipitation tests, whereas the antibody F-12 did not detect any protein in western blot analysis or capture a protein that could be recognised by the H-156 antibody. In immunocytochemistry tests, the antibodies JC8 and H-156 detected a predominately cytoplasmic localised antigen, whose signal was depleted in p16INK4a siRNA experiments. F-12, in contrast, detected a predominately nuclear located antigen and there was no noticeable reduction in this signal after siRNA knockdown. Furthermore in immunohistochemistry tests, F-12 generated a different pattern of staining compared to the JC8 and E6H4 antibodies. These results demonstrate that three out of four commercially available p16INK4a antibodies are specific to, and indicate a mainly cytoplasmic localisation for, the p16INK4a protein. The F-12 antibody, which has been widely used in previous studies, gave different results to the other antibodies and did not demonstrate specificity to human p16INK4a. This work emphasizes the importance of the validation of commercial antibodies, aside to the previously reported use, for the full verification of immunoreaction specificity.

Extreme ultraviolet interferometry of warm dense matter in laser plasmas

We demonstrate that interferometric probing with extreme ultraviolet (EUV) laser light enables determination of the degree of ionization of the "warm dense matter" produced between the critical and ablation surfaces of laser plasmas. Interferometry has been utilized to measure both transmission and phase information for an EUV laser beam at the photon energy of 58.5 eV, probing longitudinally through laser-irradiated plastic (parylene-N) targets (thickness 350 nm) irradiated by a 300 ps duration pulse of wavelength 438 nm and peak irradiance 10(12) W cm(-2). The transmission of the EUV probe beam provides a measure of the rate of target ablation, as ablated plasma becomes close to transparent when the photon energy is less than the ionization energy of the predominant ion species. We show that refractive indices η below the solid parylene N (η(solid) = 0.946) and expected plasma values are produced in the warm dense plasma created by laser irradiation due to bound-free absorption in C(+).

Coulomb excitation of neutron-rich Zn isotopes: first observation of the 2(1)+ state in 80Zn

Neutron-rich, radioactive Zn isotopes were investigated at the Radioactive Ion Beam facility REX-ISOLDE (CERN) using low-energy Coulomb excitation. The energy of the 2(1)+ state in 78Zn could be firmly established and for the first time the 2+ --> 0(1)+ transition in 80Zn was observed at 1492(1) keV. B(E2,2(1)+ --> 0(1)+) values were extracted for (74,76,78,80)Zn and compared to large scale shell model calculations. With only two protons outside the Z=28 proton core, 80Zn is the lightest N=50 isotone for which spectroscopic information has been obtained to date. Two sets of advanced shell model calculations reproduce the observed B(E2) systematics. The results for N=50 isotones indicate a good N=50 shell closure and a strong Z=28 proton core polarization. The new results serve as benchmarks to establish theoretical models, predicting the nuclear properties of the doubly magic nucleus 78Ni.

A review of selected anti-tumour therapeutic agents and reasons for multidrug resistance occurrence

It is assumed that proteins from the ABC family (i.e., glycoprotein P (Pgp)) and a multidrug resistance associated protein (MRP) play a main role in the occurrence of multidrug resistance (MDR) in tumour cells. Other factors that influence the rise of MDR are mechanisms connected with change in the effectiveness of the glutathione cycle and with decrease in expression of topoisomerases I and II. The aim of this review is to characterize drugs applied in anti-tumour therapy and to describe the present state of knowledge concerning the mechanisms of MDR occurrence, as well as the pharmacological agents applied in reducing this phenomenon.

Magnetic moment of the fragmentation-aligned 61Fe (9/2(+)) isomer

We report on the g factor measurement of an isomer in the neutron-rich (61)(26)Fe (E(*)=861 keV and T(1/2)=239(5) ns). The isomer was produced and spin aligned via a projectile-fragmentation reaction at intermediate energy, the time dependent perturbed angular distribution method being used for the measurement of the g factor. For the first time, due to significant improvements of the experimental technique, an appreciable residual alignment of the nuclear spin ensemble has been observed, allowing a precise determination of its g factor, including the sign: g=-0.229(2). In this way we open the possibility to study moments of very neutron-rich short-lived isomers, not accessible via other production and spin-orientation methods.

Association of collagen type I alpha1 gene polymorphism with bone density in survivors of childhood cancer--preliminary report

A candidate gene, involved in the regulation of bone mass is the COLIA1 gene encoding type I collagen, the major protein of bone matrix. The disease per se, the age of its onset and treatment options might exert an impact on bone mineralization in survivors of childhood malignancy. We examined possible allelic influences of COLIA1 gene polymorphism on BMI, BMD spine and total body in 41 survivors (15 girls) of childhood cancer (the mean age 8.9 years). Genotype distribution was 33 (80.5%) SS and 8 (19.5%) Ss. There were no differences in SDS BMD and SDS BMI between patients with SS and Ss genotype. A tendency towards lower SDS values of BMD spine and BMI was observed (not significant). In conclusion, our preliminary observations suggest that COLIA1 genotype may affect bone accrual in a population treated for childhood cancer. Further investigations in a greater population are needed.

Oscillations of cerebrovascular resistance throughout the menstrual cycle in healthy women

OBJECTIVES

Increased concentration of endogenous estrogen during a typical menstrual cycle has been shown to correlate with augmentation of blood flow through the internal carotid arteries (ICAs), which may be related to changes in vascular resistance within the brain. In this study we investigated the effects of endogenous estrogen and progesterone on cerebrovascular impedance in young healthy women.

METHODS

The blood flow in the ICA and the common (CCA) and external (ECA) carotid arteries was studied with duplex Doppler sonography. The resistance index (RI) was determined and correlated with plasma 17beta-estradiol concentration in 14 young healthy women throughout their menstrual cycle.

RESULTS

The concentration of 17beta-estradiol increased in the follicular phase of the cycle and reached a peak on day 14, whereas concentration of progesterone remained low. Along with an increase in estrogen concentration, the ICA RI had decreased from its initial level on average by 9.2% on day 13 and by 6.7% on day 14 (P < 0.05). In contrast, the trend of the ECA RI was to increase during the peak of estrogen concentration. There were no significant changes in the CCA RI or in the systolic blood pressure, heart rate, hematocrit and hemoglobin concentration through the menstrual cycle.

CONCLUSIONS

Estrogen-related augmentation of blood flow through the ICA is caused mainly by decreased cerebrovascular impedance, as shown by a decrease in the ICA RI. These changes in RI suggest that estrogen influences cerebral impedance mainly by altering the resistance of cerebral microvasculature.

[The ability of modifying cognitive deficits in the area of social functioning in chronic schizophrenic patients]

The paper concerns the effectiveness of rehabilitation of chronically ill schizophrenic patients who participate in social skills training. The assumption was that the participation in a four-month training programme (as authored by R. P. Liberman) will improve emotional problem solving, ability to keep in norms and conflict solving as well as the ability of cause-effect thinking. 100 schizophrenic patients and their families participated in the study. Half of those studied participated in the social skills training programme and the half who did not, were the control group. The subjects were examined twice in the four months. The following tools were used: "Means Ends Problem Solving" by Platt and Spivack, "PANSS" by Kay and Fiszbein, "Social-demographic questionnaire". Before the study period the groups did not vary much in the aspect of interpersonal social skills solving. After the training, the participants benefited significantly in the effectiveness of their problem solving and other criteria improved as well. It was concluded that the study of a group of 100 chronic schizophrenic patients who participated in a four month social skills training programme has a significant effect on social skills problem solving. The improvement of those skills consisted of: interpersonal and emotional problem solving, prediction of the consequences of one's actions, cause-effect thinking and alternative thinking.

[Teaching schizophrenic patients self-care skills]

The level of knowledge and skills on self-care abilities has been examined among the group of 30 long-term patients suffering from schizophrenia. The research has been made four times during the period of 18 months after the training session had been completed. The final results show that three months duration of the training session exerts influence on the progress in learning and change of the view point. However, little change is observed as regards the daily functioning of patients.

[Nurses as leaders of medication management training module]

In the group of 71 schizophrenic patients the connection between therapist profession (psychiatrist/nurse) and patients' gains concerning medication management was examined. Nurses were as well efficient as psychiatrists as the leaders of behavioral training and nearly as well efficient in conducting educational classes.