Prevalence of oral complications in the course of severe SARS-CoV-2 infection under mechanical non-invasive ventilation.

BACKGROUND: The management of oral health during severe symptoms of Covid-19 is still a challenge, especially in intensive care units under invasive/noninvasive ventilation in hospital. Understanding the cause-and-effect relationships may allow for individual adjustment of oral care recommendations during Covid-19 disease. The study's objective was to assess Covid-19 patients' oral health status under hospital treatment due to pulmonary adverse Covid-19 outcomes. MATERIAL AND METHODS: Covid-19 patients (mean age 74.4 ± 15.4; n = 120, male n = 50/female n = 70) were admitted to hospital in the acute phase of Covid-19 between January and March 2022 who required oxygen therapy due to pneumonia, rapid respiratory failure, low saturation. Blood and radiological tests were taken according to National Health Fund guidelines. The condition of teeth (Decayed, Missing, Filled teeth as DMFT index), dental hygiene (Plaque Control Record as PCR index), periodontal status (probing depth PD, clinical attachment CAL, bleeding on probing BOP) and oral mucosa (BRUSHED and Beck scores) were examined. RESULTS: Charateristics of the teeth (dental caries 35.2%, DMFT Median 22), plaque retention (83.4%), advanced periodontitis (48.3%), xerostomia (74.2%), oral mucosa inflammation (80.8%), angular cheilitis (53.3%), hemorrhagic (21.7%) showed a high incidence of harmful oral conditions. BRUSHED model and Beck score indicated moderate oral dysfunction and need for oral care every 8 h. Spearman's analysis revealed a significant positive correlation between pneumonia and neutrophile, interleukin-6 IL-6, C-reactive protein CRP (p = 0.01, p < 0.001, p < 0.001), negative to lymphocyte count (p < 0.001). Multiple and logistic regressions selected the following risk predictors for pneumonia as IL-6, CRP, obesity and for severe COVID-19 symptoms D-dimer level and a lack of targeted vaccination (p < 0.001). Among oral predictors, the PCR index and Beck score were significant for both outcomes (respectively p < 0.001, p < 0.012). Patients who received oxygen therapy with face masks had more often angular heilitis and debris (p = 0.025, p = 0.035). CONCLUSIONS: COVID-19 hospitalised patients with severe symptoms crossing with poor oral health-related conditions. This may exacerbate a response for COVID infection, and play a role in cytokine storm. For Covid-19 management, to inhibit extraoral/intraoral complications, it is recommended to adjust oral hygiene procedures, including antibacterial, protective, moisturising agents after individual oral health assessment.

Clinical significance of basic laboratory parameters in predicting the use of various methods of oxygen supplementation in COVID-19.

INTRODUCTION: The severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection resulted in significant worldwide morbidity and mortality. The aim of our study was to evaluate the results of laboratory tests performed on patients on admission to the hospital between groups of patients requiring and not requiring oxygen supplementation, and to find predictive laboratory indicators for the use of high-flow nasal oxygen therapy (HFNOT)/continuous positive airway pressure (CPAP)/bilevel positive airway pressure (BPAP). MATERIALS AND METHODS: We retrospectively analysed the data of consecutive patients hospitalised in the Pulmonology Department of the Temporary COVID Hospital in Poznan from February to May 2021. On admission to the department, the patients had a panel of laboratory blood tests. RESULTS: The study group consisted of 207 patients with a mean age of 59.2 ± 15.0 years of whom 179 (72%) were male. During hospitalisation, oxygen supplementation was required by 87% of patients. Patients requiring oxygen supplementation and/or the use of HFNOT/CPAP/BPAP had lower lymphocyte counts and higher levels of urea, C-reactive protein, D-dimer, troponin, glucose, lactate dehydrogenase (LDH) as well as higher white blood cell and neutrophil counts, The parameter that obtained the highest area under curve value in the receiver operator curve analysis for the necessary use of HFNOT/CPAP/BPAP or CPAP/BPAP was LDH activity. CONCLUSIONS: Among the basic parameters assessed on admission to the temporary hospital, LDH activity turned out to be the most useful for assessing the need for CPAP/BPAP active oxygen therapy. Other parameters that may be helpful for predicting the need for HFNOT/CPAP/BPAP are serum levels of urea, D-dimer and troponin.

Effects of Low-Dose Atorvastatin on the Peripheral Blood Mononuclear Cell Secretion of Angiogenic Factors in Type 2 Diabetes.

The aim of this study was to investigate the influence of statins on the secretion of angiogenesis mediators by the peripheral blood mononuclear cells (PBMCs) derived from patients suffering from type 2 diabetes. The study group comprised 30 participants and included: 10 statin-treated patients with diabetes, 10 statin-free diabetic subjects, and 10 statin-free non-diabetic individuals. PBMCs isolated from the blood were cultured in vitro in standard conditions and in an environment mimicking hyperglycemia. Culture supernatants were evaluated for VEGF, MCP-1, Il-10, and Il-12 by flow cytometry using commercial BDTM. Cytometric Bead Array tests. The secretion of VEGF, MCP-1 and Il-12 by PBMCs, cultured both in standard and hyperglycemic conditions, was significantly lower in the statin-treated patients with type 2 diabetes in comparison with the statin-free diabetic patients. Conversely, the secretion of Il-10 was higher in the statin-treated than in the statin-free diabetic patients. VEGF, MCP-1 and Il-12 levels in PBMCs supernatants from the glucose-containing medium were higher than those from the standard medium in each of the diabetic groups. The results of the study suggest that statins in low doses exhibit an antiangiogenic activity, reducing the secretion of potent proangiogenic factors, such as VEGF and MCP-1, and increasing the secretion of antiangiogenic Il-10 by PBMCs, also under hyperglycemic conditions characteristic for type 2 diabetes.

The Effect of Homocysteine on the Secretion of Il-1ß, Il-6, Il-10, Il-12 and RANTES by Peripheral Blood Mononuclear Cells-An In Vitro Study.

The contemporary theory of the inflammatory-immunological pathomechanism of atherosclerosis includes the participation of interleukin-1ß (Il), Il-6, Il-10, Il-12, RANTES, and homocysteine in this process. The knowledge on the direct effect of hyperhomocysteinemia on inflammatory-state-related atherosclerosis is rather scarce. Our study is the first to account for the effects of homocysteine on the secretion of Il-10 and RANTES in vitro conditions. For this purpose, human mitogen-stimulated peripheral blood mononuclear cells (PBMNCs) were cultured in vitro and exposed to homocysteine at high concentrations. Subsequently, the concentrations of cytokines were assayed in the cell culture supernatant using flow cytofluorimetry. It has been shown that, in the presence of homocysteine, the secretion of IL-1, IL-6 and RANTES by PBMNCs was increased, whereas IL-10 concentration was significantly lower than that of the supernatant derived from a mitogen-stimulated cell culture without homocysteine. The secretion of Il-12 by PBMNCs exposed exclusively to mitogen, did not differ from homologous cells also treated with homocysteine. Therefore, in our opinion, high-concentration homocysteine affects the progression of atherosclerosis by increasing the secretion of proinflammatory cytokines secreted by PBMNCs, such as Il-1ß, Il-6, RANTES, and by attenuating the secretion of Il-10.

Differential Influence of Pueraria lobata Root Extract and Its Main Isoflavones on Ghrelin Levels in Alcohol-Treated Rats.

The study was carried out on alcohol-preferring male Wistar rats. The following drugs were repeatedly (28×) administered: acamprosate (500 mg/kg, p.o.), naltrexone (0.1 mg/kg, i.p), and Pueraria lobata (kudzu) root extract (KU) (500 mg/kg, p.o.) and its isoflavones: daidzin (40 mg/kg, p.o.) and puerarin (150 mg/kg, p.o.). Their effects on a voluntary alcohol intake were assessed. KU and alcohol were also given for 9 days in an experiment on alcohol tolerance development. Finally, total and active ghrelin levels in peripheral blood serum were measured by ELISA method. Acamprosate, naltrexone, daidzin, and puerarin, reducing the alcohol intake, caused an increase in both forms of ghrelin levels. On the contrary, though KU inhibited the alcohol intake and alcohol tolerance development, it reduced ghrelin levels in alcohol-preferring rats. The changes of ghrelin concentration could play a role as an indicator of the currently used drugs. The other effect on the KU-induced shift in ghrelin levels in the presence of alcohol requires further detailed study.

Dental Anomalies in Rare, Genetic Ciliopathic Disorder-A Case Report and Review of Literature.

BACKGROUND: Primary ciliary dyskinesia (PCD) is a rare, ciliopathic disorder. In many ciliopathies, dental anomalies are observed alongside other symptoms of the disease. To date, there are no published reports concerning the dental developmental problems that are associated with ciliary defects in PCD patients. METHODS: Patients suffering from PCD underwent dental clinical examination, which included the assessment of developmental disorders regarding the number and morphological structure of the teeth (size and shape) as well as developmental disorders of mineralised dental tissues. Then, three-dimensional radiographic examination was performed utilising Cone Beam Computed Tomography (CBCT). RESULTS: Four PCD patients, aged 31-54, agreed to enter the study. Dental examinations showed the presence of dental developmental disorders in three of them. Additionally, CBCT showed abnormalities in those patients. CONCLUSIONS: 1. The dental phenotype in PCD patients seems to be heterogeneous. Tooth developmental disorders resulting from abnormal odontogenesis may be a symptom of PCD that is concomitant with other developmental abnormalities resulting from malfunctioning primary cilia. 2. Patients with ciliopathies are likely to develop dental developmental defects. Therefore, beginning in early childhood, they should be included in a targeted specialised dental programme to enable early diagnosis and to ensure dedicated preventive and therapeutic measures.

Does nesfatin-1 influence the hypothalamic-pituitary-gonadal axis in adult males with obstructive sleep apnoea?

There is growing evidence that obstructive sleep apnoea (OSA) influences the hypothalamic-pituitary-gonadal axis (HPG axis) in men. The aim of the study was to assess the association of nesfatin-1 with HPG axis disturbances in OSA. This is a prospective study with consecutive enrolment. It comprises 72 newly diagnosed OSA patients ((AHI: apnoea-hypopnea index) 18 subjects: 5 ≤ AHI < 15; 24: 15 ≤ AHI < 30; 30: AHI ≥ 30) and a control group composed of 19 patients (AHI < 5). All patients underwent polysomnography and fasting blood collection for nesfatin-1, testosterone, luteinising hormone (LH), high-sensitivity C-reactive protein (hsCRP), aspartate transaminase (AST), alanine aminotransferase (ALT), creatinine and glucose. Groups had similar levels of LH, nesfatin-1 and testosterone (p = 0.87; p = 0.24; p = 0.08). Nesfatin-1 was not correlated to LH (p = 0.71), testosterone (p = 0.38), AHI (p = 0.34) or the oxygen desaturation index (ODI) (p = 0.69) either in the whole group, or in sub-groups. The study did not reveal any association between the HPG axis and nesfatin-1 in OSA adult males. It is possible that nesfatin-1 is not a mediator of HPG axis disturbances in adult patients with OSA.

The effectiveness of bronchial artery embolisation in patients with haemoptysis.

INTRODUCTION: Bronchial artery embolisation (BAE) is one of the methods used in massive and recurring haemoptysis. The aim of the study is to determine the effectiveness and complications of bronchial artery embolisation in recurring haemoptysis. MATERIAL AND METHODS: The analysis included 47 embolisation procedures performed on 30 patients treated between 2011 and 2017 in the Department of Respiratory Medicine, Allergology and Pulmonary Oncology due to haemoptysis. The patient's age ranged between 18 and 71 years, while mean age at the time of BAE was 33.5 years. Patients with tuberculosis constituted 73.33% (n = 22) of the sample and underwent 31 embolisation procedures in total. The remaining part of the sample (n = 8) collectively underwent 16 BAEs. The analysis was conducted by verifying the medical documentation, as well as carrying face-to-face and phone conversations. RESULTS: Immediate control due to the inhibition of bleeding was obtained in 95.75% of cases. Recurrence within 3 days of BAE was reported in 5 patients (10.63%), and 4 re-embolisation procedures were conducted. In 10 patients (33.33%), recurrence was observed during the first year post-BAE, while it was reported in 17 cases during the whole observation period (56.66% of patients). The subjects who underwent re-embolisation demonstrated recurrence-free periods lasting from 2 days to 63 months. In patients with recurrence but no re-embolisation, the shortest and longest haemoptysis-free time was 2 and 35 months, respectively. 11 patients (36.66%) required several embolisation procedures during the whole observation period. CONCLUSIONS: BAE is a highly successful procedure in treating haemoptysis. The risk of complications is low.

Association between bone remodeling and inflammatory markers in obstructive sleep apnea in relation to disease severity.

INTRODUCTION    There is growing evidence that obstructive sleep apnea (OSA) influences both bone metabolism and structure. Chitinase­3­like protein 1 (YKL­40) is a novel inflammatory and remodeling marker, the levels of which were shown to increase in OSA. YKL­40 can probably alter the bone turnover. OBJECTIVES    The aim of the study was to assess a possible interplay between YKL­40 and bone turnover markers in patients with different stages of OSA, and to evaluate the relation between bone mass, severity of OSA, and YKL­40 levels. PATIENTS AND METHODS    The study involved 72 male patients with OSA. They were divided into 3 groups according to disease severity, using the apnea-hypopnea index (AHI): group 1 (n = 18; 5≤ AHI <15), group 2 (n = 25; 15≤ AHI <30), and group 3 (n = 29; AHI ≥30). All patients underwent polysomnography and densitometry. Fasting blood samples were collected for YKL­40, C­terminal telopeptide of typeI collagen (CTX), procollagen type 1 N­terminal propeptide (P1NP), and other markers. RESULTS    P1NP differed between groups 1 and 2, as well as groups 1 and 3 (P = 0.02). Group 2 had higher CTX levels than group 1 (borderline significance, P = 0.05). A simple linear regression analysis showed that serum YKL­40 levels were associated with the levels of CTX (P <0.0001, ß = 0.9871) and P1NP (P <0.0001, ß = 0.9780). CONCLUSIONS    Our study might suggest that YKL­40 is associated with bone turnover in OSA. We may assume that this marker influences both bone formation and destruction; thus, OSA could be characterized by preserved bone mineral density.

Homocysteine as a non-classical risk factor for atherosclerosis in relation to pharmacotherapy of type 2 diabetes mellitus.

AIMS: The aim of our study was to evaluate which of the pharmacotherapeutic methods that are frequently used to treat type 2 diabetes is associated with the most beneficial profile in relation to pro-atherogenic homocysteine levels. PATIENTS AND METHODS: We measured the serum homocysteine level in 182 patients with type 2 diabetes treated with metformin (89), treated with insulin in combination with metformin (31), receiving sulfonylureas (31) and treated conventionally with insulin (31). The total homocysteine levels in the serum were assayed. To exclude the influence of selected metabolic and anthropometric factors on the differences between the examined groups, multivariate analysis of covariance was used (ANCOVA). In this analysis, serum homocysteine concentration was the dependent variable, while diabetes duration, waist circumference, HbA1c, 1,5-anhydro-D-glucitol, fasting glycaemia and peptide C were used as covariates. RESULTS: The serum homocysteine levels in patients treated with insulin in monotherapy were significantly higher than what was observed in the metformin treated subjects and in the patients receiving insulin combined with metformin. The analysis of covariance also confirmed that the differences between the therapeutic groups were affected by waist circumference and the C-peptide levels. CONCLUSION: We conclude that conventional insulin therapy may have a negative effect on pro-atherogenic homocysteine levels in patients with type 2 diabetes. This study revealed that pro-atherogenic homocysteine levels may not only be modified by pharmacotherapy of type 2 diabetes, but also by beta cell secretory function and abdominal obesity.

The Impact of Pharmacotherapy of Type 2 Diabetes Mellitus on IL-1ß, IL-6 and IL-10 Secretion.

BACKGROUND: The aim of this study was to assess the impact of pharmacotherapy of diabetes on atherosclerosis, as reflected in interleukin (IL)-1ß, IL-6 and IL-10 serum levels. METHODS: We studied patients with type 2 diabetes, treated with metformin, insulin combined with metformin and conventional insulin. IL-1ß, IL-6 and IL-10 serum levels were assayed using BD™ Cytometric Bead Array. Multivariate analysis of covariance was performed to exclude the impact of some metabolic and anthropometric factors on differences in cytokines concentrations among the participants receiving different pharmacotherapy. RESULTS: The serum concentrations of IL-1ß and IL-6 were significantly higher and IL-10 serum levels were significantly lower in the insulin-treated group than in other therapeutic groups. Covariance analysis confirmed that differences in IL-1ß and IL-6 levels were determined by pharmacotherapy and fasting plasma glucose, whereas in IL-10 levels by the therapy only. Additionally, peptide C modified differences in IL-1ß levels and HbA1c in IL-6 concentrations. CONCLUSION: This study revealed that both pharmacotherapy and glycemic control may modify some pro-atherogenic factors, such as IL-1ß and IL-6. The therapy with metformin and insulin combined with metformin seems to be much more beneficial in terms of their impact on pro-inflammatory cytokines secretion in comparison to conventional insulinotherapy.

[Termination of slow ventricular tachycardia which is below ICD detection rate - a case report]. / Przerywanie wolnego czestoskurczu komorowego, ponizej czestosci wyzwalajacej wyladowania kardiowertera-defibrylatora - opis przypadku.

Slow ventricular tachycardia (VT), which is below the detection rate of implantable cardioverter-defibrillator may cause haemodynamical instability, when pharmacological agents or antitachycardia pacing are unsuccessful, electrical cardioversion is necessary. We present another method of termination of slow VT by ICD, in which transcutaneous pacing mimics faster VT and triggers ICD discharge.

IL-12 serum levels in patients with type 2 diabetes treated with sulphonylureas.

Interleukin-12 (IL-12) has been identified as a pro-inflammatory cytokine which is thought to contribute to the development of atherosclerosis. However, to date, the various associations between factors related to the course of type 2 diabetes, like metabolic compensation, beta cell secretory dysfunction, insulin resistance and IL-12 serum levels, remain unclear. Our study involved 41 patients with type 2 diabetes, 19 patients with coronary artery disease (CAD), and 19 healthy controls. We measured serum levels of fasting glucose, HbA(1)c, 1,5-anhydro-d-glucitol, and lipids. In addition, serum levels of C-peptide, insulin, proinsulin and IL-12 were assayed. HOMA(IR) score was calculated. The serum concentrations of IL-12 were higher in diabetics than in either patients with CAD or healthy controls, and were correlated with BMI, C-peptide, insulin, HOMA(IR), proinsulin and HDL serum levels. Multiple regression analysis revealed that the IL-12 serum level in type 2 diabetics primarily is dependent upon fasting proinsulin concentration. Our results demonstrate that elevated IL-12 serum levels in type 2 diabetics treated with sulphonylureas are induced especially by peripheral insulin resistance and beta cells dysfunction, as expressed by fasting serum proinsulin levels. This finding gives us hope that treatment to decrease peripheral insulin resistance and to avoid excessive proinsulin secretion might be successful in the prevention of IL-12-induced atherosclerosis.

[Termination of atrio-ventricular reentrant tachycardia in a pregnant woman using transoesophageal atrial pacing and pharmacotherapy]. / Czestoskurcz wezlowy nawrotny u ciezarnej wyzwalany ektopia komorowa - opis postepowania stymulacyjno-farmakologicznego przywracajacego rytm zatokowy.

We describe a case of a 19-year-old pregnant woman with paroxysmal atrio-ventricular reentrant tachycardia (AVNRT). Transoesophageal atrial pacing (TAP) successfully terminated the arrhythmia, however, AVNRT restarted after 20 min and was initiated by ventricular ectopy. Intravenous metoprolol effectively suppressed ventricular ectopy and AVNRT did not recur. A modification of the ESC algorithm, with the inclusion of pacing techniques to terminate AVNRT, is proposed.

Pro-atherogenic alterations in T-lymphocyte subpopulations related to acute hyperglycaemia in type 2 diabetic patients.

BACKGROUND: T cells are among the earliest cells to infiltrate the arterial intima during the initial stages of atherosclerosis. Alterations in the peripheral blood lymphocyte distribution might be associated with intensive lymphocytes extravasation and stimulation of atherosclerotic plaque development. Epidemiological data reveal that short-term postprandial hyperglycemia is a significant risk factor for coronary heart disease. Using a parameter that indicates recently-past acute hyperglycemia, 1,5-anhydro-D-glucitol (1,5-AG), the aim of the present study was to elucidate which alterations in peripheral blood T-lymphocytes, if any, are associated with acute hyperglycemia in patients with type 2 diabetes mellitus (DM) and, thus, might be involved in the progression of atherosclerosis. METHODS AND RESULTS: Measurement of fasting glucose level, glycated hemoglobin A(1c), 1,5-AG, lipid profile and lymphocyte receptors expression (CD3+, CD4+, CD8+, CD8+28+, CD+28 -) was performed in 97 patients with type 2 DM, 23 patients with coronary heart disease, and 15 healthy controls. The mean CD3+, CD4+, CD8+28 - and CD8+28+ lymphocyte counts were significantly higher in the DM patients than in both control groups. Multiple regression analysis revealed that CD4+ and CD8+28- lymphocyte counts primarily were dependent on 1,5-anhydro-D-glucitol plasma levels. CONCLUSIONS: These results suggest that acute hyperglycemia results in the progression of atherosclerosis in type 2 DM, at least in part through changes in CD4+ and CD8+28- lymphocyte subsets.

Hypoglycaemic effect of quinolizidine alkaloids--lupanine and 2-thionosparteine on non-diabetic and streptozotocin-induced diabetic rats.

The hypoglycaemic effects of two quinolizidine alkaloids: lupanine and 2-thionosparteine were examined in non-diabetic and in streptozotocin-induced diabetic rats. The model of experimental diabetes can be considered to be related to diabetes mellitus type 2 with regards to the impairment of beta-cells' secretory function. A single intraperitoneal injection of 2-thionosparteine at a dose of 8.6 mg/kg lowered the blood glucose levels in diabetic rats at 90 and 120 min after administration and showed similar hypoglycaemic effects to glibenclamide and sparteine, which were used as reference substances. In contrast to glibenclamide, 2-thionosparteine did not result in a significant increase in plasma insulin levels in diabetic rats; an increase was only observed in the non-diabetic group. It was found that lupanine did not exert hypoglycaemic potency in diabetic and in non-diabetic animals and did not significantly increase plasma insulin concentration independent of the group examined. From this study we can state that 2-thionosparteine, but not lupanine, is confirmed to be a possible plasma glucose lowering agent. It is possible that 2-thionosparteine-dependent decrease in blood glucose level is not the only result of this drug's related insulin secretion.

Impact of the sulfonylurea receptor 1 (SUR1) exon 16-3c/t polymorphism on acute hyperglycaemia in type 2 diabetic patients.

Epidemiological data collected over the last few decades have demonstrated the significant role of acute (especially postprandial) hyperglycaemia in the development of macrovascular complications in patients with type 2 diabetes. However, the influence of SUR1 exon 16-3c/t polymorphism on impaired insulin secretion during acute hyperglycaemic episodes has not yet been evaluated. We studied 40 type 2 diabetic patients. Single nucleotide polymorphism in the sulfonylurea receptor gene was examined by means of PCR-RLFP. In every patient, fasting insulin, proinsulin, C-peptide and 1,5-anhydro-d-glucitol concentrations were assayed as markers of insulin secretion, peripheral resistance to insulin, and acute hyperglycaemia. The distribution of SUR1 exon 16-3c/t polymorphism was tt 35%, tc -40%, and cc -25%. By means of analysis of covariance, it was revealed that 1,5-anhydro-d-glucitol plasma levels are associated with SUR1 exon 16-3c/t polymorphism. However, the HOMA(IR) score influenced 1,5-anhydro-d-glucitol levels in plasma at a higher level of statistical power than the genetic variant. Our results suggest that SUR1 exon 16-3c/t polymorphism is only a partial determinant of acute hyperglycaemia-cardiovascular risk factor in type 2 diabetes.

Six-minute walk test on a special treadmill: Primary results in healthy volunteers.

BACKGROUND: The guidelines approved by the American Thoracic Society in 2002 definitely recognize the six-minute walk test (6MWT) as a useful tool for the evaluation of physical efficiency in individuals with at least moderate chronic obstructive pulmonary disease, heart failure and intermittent dysbasia. So far, the American Thoracic Society has not approved the use of a treadmill to determine the six-minute walking distance (6MWD) because patients are unable to pace themselves on a treadmill. The purpose of our work was to prove that these problems could be avoided if physical efficiency is evaluated with the use of a modified treadmill. METHODS: The work evaluates the function of a treadmill able to adjust its speed to the walking speed of healthy volunteers. The evaluation is based on a comparison of the distance covered by the healthy volunteers and the comfort of the test on the treadmill during six minutes with the distance covered and comfort during the same period in a 22-metre-long hallway in 29 healthy volunteers. Non-invasive blood pressure and pulse measurements were taken immediately before and after the test. RESULTS: The average distance covered during the six-minute period on the treadmill was 57.1 m longer than in the hallway. The comfort of the treadmill test was indicated to be better by 18 subjects, worse by 4 subjects and identical by 7 subjects. CONCLUSIONS: The tests confirm that the speed of the modified treadmill adjusts properly to the walking speed of the healthy volunteers. The hemodynamic effects were identical for the healthy volunteers both in the hallway and treadmill tests. The distance differences were caused by turnarounds in the corridor test. The results obtained with the special treadmill allow us to develop a new method and, at present, provide a basis for a second stage of research comprising subjects with diagnosed heart failure. (Cardiol J 2007; 14: 447-452).

Evaluation of the defibrillation threshold in atrial fibrillation by transoesophageal cardioversion using a biphasic impulse.

INTRODUCTION: Recurrent atrial fibrillation (AF) in the setting of haemodynamic disturbances requires frequently repeated cardioversions, which is associated with the risk of myocardial damage. It is thus necessary to identify methods which can minimise the cardioverter impulse energy. AIM: To define the defibrillation threshold in recent-onset AF using a biphasic impulse, following an infusion of magnesium, potassium, and amiodarone. METHODS: Transoesophageal cardioversion was performed in 32 patients with AF lasting < or =48 hours, in whom prior administration of 40 mEq K+, 4.0 g MgSO4 and 300 mg amiodarone did not restore sinus rhythm. Cardioversion was performed under short intravenous anaesthesia using a biphasic impulse travelling from a multi-annular oesophageal electrode to two electrodes on the anterior chest wall. The initial energy was set to 1 J, which was subsequently increased according to the following protocol: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 40, 50 and 70 J. RESULTS: Electrical cardioversion following the administration of electrolytes and amiodarone restored sinus rhythm in all the patients (100% efficacy). The mean defibrillation threshold was 12.9+/-14.3 J, with a minimal effective energy of 1 J and a maximum effective energy of 70 J. The defibrillation threshold was in the range from 1 to 10 J in 75% of the patients. The mean cumulative energy transferred between electrodes during evaluation of the defibrillation threshold was 39.7 J (SD, 38.8). CONCLUSIONS: Transoesophageal cardioversion using a low-energy (mean, 12.9 J; range, 1-70 J) biphasic impulse, following the intravenous administration of potassium chloride and amiodarone, was 100% effective in restoring sinus rhythm in AF.

The application of plasma 1,5-anhydro-D-glucitol for monitoring type 2 diabetic patients.

AIM: Recent data have suggested that effective control of postprandial blood glucose can reduce the risk of macroangiopathic complications of diabetes, especially cardiovascular risk. 1,5-Anhydro-D-glucitol (1,5-AG) has been proposed as a marker of short-term hyperglycaemic excursions. We aimed to evaluate its usefulness in patients with type 2 diabetes and have attempted to indicate when 1,5-AG monitoring should be used in ordinary diabetes care settings. METHODS: The study group consisted of 130 type 2 diabetic patients aged 36-69 years. 1,5-AG plasma level, HbA_1c concentrations and daily glucose profile were measured. Mean blood glucose (MBG), M-value were calculated and maximal daily glycaemia (MxG) was established as indicators of short-term hyperglycaemic episodes. RESULTS: 1,5-AG plasma level was negatively and HbA_1c was positively correlated with fasting glycaemia (FG), MBG, M-value and MxG. Multivariate regression analysis revealed that 1,5-AG plasma level is determined by MxG only, while FG determined HbA_1c concentration in blood. The analysis of 1,5-AG level and HbA_1c distributions in well and poorly controlled patients revealed that persons with low HbA_1c values may have decreased 1,5-AG plasma level. CONCLUSION: 1,5-AG plasma level monitoring is the useful method to identify well controlled, exclusively based on HbA_1c levels type 2 diabetic patients with transient hyperglycaemia, accordingly patients at high risk of macroangiopathic complications.