Additive prognostic value of high baseline coronary flow velocity to ejection fraction during resting echocardiography: 3-year prospective study.

BACKGROUND: There is a lack of information about the prognostic value of high velocity in coronary arteries during echocardiography. The present study was aimed at investigating the three-year prognostic value of coronary velocity assessment in all patients who were referred for echocardiography examination. METHODS: The prospective study comprises 747 consecutive patients. Death, myocardial infarction (MI), acute coronary syndrome (ACS), and/or revascularisation were defined as major adverse cardiac events (MACE). Routine echocardiography was added with coronary velocity assessment in the left main, anterior descending, or circumflex coronary arteries by the Doppler method. RESULTS: During a median follow-up of 36 months, 192 patients experienced MACE. Deaths occurred more frequently in patients with high local velocity in proximal left-sided segments vs. in middle left-sided segments vs. patients without high coronary velocity (9 vs. 3 vs. 1%, p < 0.0001). Death/MI/ACS occurred in 17 vs. 7 vs. 1%, p < 0.0001, respectively. Age (HR 1.04, 95% CI 1.00; 1.06; p < 0.04), a velocity more than 65 cm/s in any proximal segments of the arteries (HR 4.7, 95% CI 1.9; 11.9; p < 0.002), ejection fraction (HR 0.97, 95% CI 0.94; 0.99; p < 0.007) were strong independent prognostic predictors of death/MI/ACS. The maximal velocity of coronary flow velocity had a significant additive prognostic value to ejection fraction. CONCLUSIONS: The coronary velocity parameters give long-term prognostic information that can be used to identify persons with a high risk of MACE in consecutive non-selected patients.

Prognostic value of Doppler echocardiographic coronary flow velocity assessment at rest in elderly patients.

BACKGROUND: Atherosclerosis and coronary artery disease (CAD) are a common condition and cause of death in the elderly population. There are difficulties with risk assessment in the elderly as the objectification of their symptomatic status can be challenging due to neuromuscular weakness, physical deconditioning or neurological, orthopaedic, peripheral vascular, or respiratory limitations. Non-invasive coronary artery velocity assessment by Doppler method at rest could be helpful in the elderly population. To evaluate the prognostic role of coronary artery ultrasound assessment in a non-selected elderly population in everyday clinical practice. METHODS: One hundred forty-five patients, aged ≥75years (99 women; 80 ± 4 years), formed the study group. Left coronary artery flows were scanned in addition to conventional echocardiography. During a median follow-up of 26 months, 16 deaths and 2 non-fatal MI occurred. RESULTS: In multivariable analysis, maximal coronary velocity was the only independent predictor for mortality (heart rate [HR]: 1.02, 95%, CI: 1.01-1.04, p < .0005) and for mortality/MI (HR: 1.02, 95%, CI: 1.01-1.03, p < .0001). The value of 110 cm/s maximal coronary flow velocity (CFL) in the proximal segments of left arteries was the best predictor for death, sensitivity 50%, specificity 90%, p < .005. The annual mortality rate was 16.6% persons/year for patients with elevated CFL ≥110 cm/s. The value 81 cm/s was the best predictor for death/MI, sensitivity 61%, specificity 80%, p < .0005; annual mortality rate was 11.2% persons/year for patients with elevated CFL ≥81 cm/s (p < .0001). CONCLUSION: Doppler CFL scanning during routine echocardiography is a feasible and valuable tool for assessment of short-term prognosis in elderly patients.

Character Strengths of Czech Army Excellent Officers as Perceived by Cadets and Soldiers Serving in Reconnaissance Units.

INTRODUCTION: A deeper understanding of personality specifics in military personnel may increase the efficacy of health care professionals in this field. Changes in modern warfare require army officers to make decisions in complicated situations with increasing levels of autonomy. Character is traditionally regarded as a key quality in these dynamics. However, it remains unclear which character strengths are conducive to effective leadership in the military. The present study aims at mapping Czech Army cadets' and professional soldiers' perceptions of the character strengths of those officers, who they consider the best they served under. The study also examined how these perceptions vary across soldiers at different stages of their careers and how much they overlap with the same soldiers' ratings of their own strengths. In addition, a regression analysis, to outline combinations of strengths for various aspects of character-based leadership, was performed. MATERIALS AND METHODS: Respondents (N = 199) were recruited from three different subpopulations of the Czech Army-serving members of two reconnaissance units (N = 38), and 1st (N = 81) and 5th (N = 80) year cadets at the University of Defense. They rated the character strengths of chosen officers and themselves on the Character Strengths Leadership Inventory and the Values in Action Inventory of Strengths Revised. This study was approved by the units' commanding officer and the representatives of the University of Defense. RESULTS: Subordinates rated honesty, leadership, perspective, teamwork, fairness, creativity, love of learning, and zest highest in their chosen officers. These officers' mean profiles strongly correlated in all the three groups (rs = .82-.86). The mean correlation between officers' and respondents' self-reported strengths was not strong (rs = .18). Multiple regression models of the perception of an officer's success, success of their team, them as a leadership example, and them as having a good character, most frequently, involved fairness, honesty, kindness, and social intelligence, while forgiveness was negatively associated with these parameters. CONCLUSIONS: The present study achieved its aims. First, it suggests the officers' character strengths that tend to be most valued by their subordinates among Czech Army cadets and soldiers serving in reconnaissance units. Second, the strong overlap of best officers' character profiles in all groups suggests that this perception may remain stable throughout a soldier's career. Third, the relationship between chosen officers' and respondents' self-reported strengths was negligible, suggesting that the perception of officer's strengths may not be an individual's projection. Fourth, regression models of character-based leadership proposed a combination of character strengths that may contribute to the officer's perceived efficacy. Compared to other studies, the sample included both cadets and military professionals with a proportional number of females being included. These results imply that health care practitioners working with military clients may benefit from the acknowledgment of their specific character strengths, most notably honesty and fairness, while providing care to this population.

Mini-review: A possible role for galanin in post-traumatic stress disorder.

Several neuroendocrine systems have been implicated in post-traumatic stress disorder, including the mesocortical and mesolimbic dopamine, the norepinephrine, the ß-endorphin, the serotonin, and the oxytocin systems. The interaction between these different systems remains, however, largely unknown and a generally accepted unifying theory is thus far lacking. In this review, we suggest that galanergic suppression of dopaminergic neurons in the ventral tegmental may constitute the missing link in a post-traumatic feedback loop. In addition, we address the literature on the negative cross-antagonism in this brain region between the galanin 1 and µ-opioid receptors, which suggests that behavioural patterns which stimulate ß-endorphin, a natural µ-opioid receptors ligand, secretion may provide novel avenues for the treatment and prevention of PTSD, as well as for recruitment, training, and leadership processes in high-stress/high-risk professions such as the military, first responders and the police.

Flavonoids against the SARS-CoV-2 induced inflammatory storm.

The disease severity of COVID-19, especially in the elderly and patients with co-morbidities, is characterized by hypercytokinemia, an exaggerated immune response associated with an uncontrolled and excessive release of proinflammatory cytokine mediators (cytokine storm). Flavonoids, important secondary metabolites of plants, have long been studied as therapeutic interventions in inflammatory diseases due to their cytokine-modulatory effects. In this review, we discuss the potential role of flavonoids in the modulation of signaling pathways that are crucial for COVID-19 disease, particularly those related to inflammation and immunity. The immunomodulatory ability of flavonoids, carried out by the regulation of inflammatory mediators, the inhibition of endothelial activation, NLRP3 inflammasome, toll-like receptors (TLRs) or bromodomain containing protein 4 (BRD4), and the activation of the nuclear factor erythroid-derived 2-related factor 2 (Nrf2), might be beneficial in regulating the cytokine storm during SARS-CoV-2 infection. Moreover, the ability of flavonoids to inhibit dipeptidyl peptidase 4 (DPP4), neutralize 3-chymotrypsin-like protease (3CLpro) or to affect gut microbiota to maintain immune response, and the dual action of angiotensin-converting enzyme 2 (ACE-2) may potentially also be applied to the exaggerated inflammatory responses induced by SARS-CoV-2. Based on the previously proven effects of flavonoids in other diseases or on the basis of newly published studies associated with COVID-19 (bioinformatics, molecular docking), it is reasonable to assume positive effects of flavonoids on inflammatory changes associated with COVID-19. This review highlights the current state of knowledge of the utility of flavonoids in the management of COVID-19 and also points to the multiple biological effects of flavonoids on signaling pathways associated with the inflammation processes that are deregulated in the pathology induced by SARS-CoV-2. The identification of agents, including naturally occurring substances such as flavonoids, represents great approach potentially utilizable in the management of COVID-19. Although not clinically investigated yet, the applicability of flavonoids against COVID-19 could be a promising strategy due to a broad spectrum of their biological activities.

A novel theory on the predictive value of variation in the ß-endorphin system on the risk and severity of PTSD.

Despite growing interest in genetic and psychosocial indicators of heightened susceptibility to posttraumatic stress disorder (PTSD), a predictive model, which explains why some individuals develop PTSD in response to life-threatening traumatic events, while others, when faced with the same or similar experiences, do not, has thus far remained out of reach. In this paper, we review the literature on gene-environment interactions in ß-endorphin system functioning with regard to PTSD and suggest that variation, both genetic and with regard to environmental stimuli, in systems which, like the ß-endorphin system, distort human perception of life-threatening traumatic experiences may account for some of the variance in resilience to the disorder. Given the role of ß-endorphin in both social connections and physical exercise, this becomes especially relevant with regard to military selection, training, and leadership processes.