Associations of coronary plaque characteristics and coronary calcification with bone mineral density in postmenopausal women.

OBJECTIVE: We aimed at investigating the association of postmenopausal osteoporosis in different measurement locations, with the coronary plaque burden and morphology detected by coronary computed tomography angiography (CCTA). PATIENTS AND METHODS: We analyzed a total of 223 postmenopausal women who had undergone both dual-energy X-ray absorptiometry (DXA) and CCTA. Coronary plaque characteristics were analyzed using CCTA. RESULTS: The number of burdens was higher in the osteoporosis/osteopenia group of patients than in the normal group. Agatston score and BMI were not significantly different between the two groups. T-score femur and bone mineral density (BMD) femur were higher in patients with severe coronary artery disease (CAD as compared to those with mild CAD (p=0.036 and p=0.049, respectively), whereas T-score lumbar and BMD lumbar were not significantly different. Non-calcified/mixed plaque burden was an independent predictor of osteopenia/osteoporosis (OR: 1.396, 95% CI 1.007-1.934; p=0.045) together with age (OR: 1.053, 95% CI 1.015-1.093; p=0.006). CONCLUSIONS: Non-calcified/mixed plaque burden was significantly and independently associated with osteoporosis/osteopenia at femoral neck but not at lumbar spine. Osteopenia/osteoporosis was not significantly associated with CAC.

The association between the lymphocyte-to-monocyte ratio and coronary artery disease severity in patients with stable coronary artery disease.

OBJECTIVE: Inflammation plays an important role in the pathogenesis of atherosclerosis. The lymphocyte-to-monocyte ratio (LMR) may reflect a systemic inflammatory status. We investigated the association between the LMR and coronary artery disease (CAD) in patients with stable angina pectoris. PATIENTS AND METHODS: A total of 221 consecutive patients who had been routinely referred for coronary angiography, for stable angina pectoris and 72 patients with normal coronary arteries were included in the present study. We analyzed the relation between the LMR and the angiographic severity of CAD. The SYNTAX score (SxS) was used for assessing the severity of coronary atherosclerosis. RESULTS: The neutrophil-to-lymphocyte ratio (N/L ratio), platelet size distribution width (PDW), neutrophil and uric acid levels were significantly higher in the stable angina pectoris group than in the control group. The LMR was significantly lower in the stable angina pectoris group than in the control group (4.5±3.2 vs. 6±2.9, p < 0.001). The MPV/L ratios were similar in both groups. Patients with elevated SYNTAX scores (>32) had lower LMR values (3.2±1.5 vs. 4.6±3, p = 0.002). The monocyte count/HDL-C ratio (MHR) was significantly higher in patients with stable CAD than in the control group (0.015±0.008 vs 0.009±0.004, p < 0.001); however, it was similar in the higher SYNTAX score (>32) and lower SYNTAX score groups (0.018±0.007 vs. 0.014±0.008, p = 0.056). Using multivariate logistic regression analysis, we found that only the LMR was an independent predictor of the high SYNTAX scores in patients with stable angina pectoris. CONCLUSIONS:  The LMR, an inexpensive and easily measurable laboratory variable, is significantly associated with the presence of CAD and high SYNTAX scores in patients with stable angina pectoris.

The effects on peripheral nerve damage of the application of local and systemic erythropoietin.

OBJECTIVE: To investigate the histopathological and biochemical effects of topical and systemic administrations of erythropoietin (EPO) on crush and transection type peripheral nerve injuries in an experimental rat model. METHODS: 128 male Wistar-Albino rats were allocated to 8 groups according to the route of administration of EPO (local/systemic) and type of peripheral nerve injury (crush/transection). groups were compared with respect to histopathological examination and number of axons as well as levels of IL-1ß, IL-6, and IL-10. RESULTS: Groups receiving EPO either locally or intraperitoneally revealed less scar tissue formation index, lower number of inflammatory cells, reduced number of perineural fibroblasts and increased number of axons (p < 0.001 for all). Levels of IL-1ß and IL-6 were lower and IL-10 levels were higher in groups receiving EPO locally or intraperitoneally (p < 0.001). CONCLUSION: Iatrogenic nerve injury has remained an area with few therapeutic options. Our results indicated that local and systemic applications of EPO might have a promising potential therapeutic agent for crush or transection type of peripheral nerve injuries. Dose, route of administration and indications should be elucidated in further prospective, randomized, controlled trials (Tab. 3, Fig. 4, Ref. 32).

Association of epicardial fat thickness with clinical and polysomnographic parameters in non-obese obstructive sleep apnoea patients.

OBJECTIVES: This study aimed to investigate the relationship of epicardial fat thickness with severity of obstructive sleep apnoea, and clinical and polysomnographic parameters, and to determine independent predictors for epicardial fat thickness. METHODS: A total of 84 patients with a body mass index of less than 30 kg/m2 and suspected sleep-disordered breathing were included in the study. The correlations of epicardial fat thickness with polysomnographic and clinical data, and severity of obstructive sleep apnoea, were investigated. RESULTS: Mean epicardial fat thickness was 3.75 ± 1.07 mm in the study group (n = 62) and 2.97 ± 0.62 mm in the control group (n = 22) (p < 0.001). There were significant positive correlations between epicardial fat thickness and: apnoea/hypopnoea index, oxygen desaturation index 3 and minimum oxygen saturation, as well as with age, body mass index, and neck and waist circumferences. CONCLUSION: Non-obese obstructive sleep apnoea patients have thicker epicardial fat compared to controls. Oxygen desaturation index 3 has a strong correlation with epicardial fat thickness and is an independent predictor of it.

Impact of QRS morphology on heart rate turbulence and heart rate variability after cardiac resynchronization therapy in patients with heart failure.

OBJECTIVE: Impairment of heart rate turbulence (HRT) and heart rate variability (HRV) are associated with poor prognosis in chronic heart failure (CHF). Although previous studies have demonstrated that patients with a left bundle branch block (LBBB) have a better outcome with cardiac resynchronization therapy (CRT), the effect of QRS morphology on HRV and HRT is not known. We aimed to evaluate the effect of QRS morphology on HRV and HRT after CRT implantation in patients with CHF. PATIENTS AND METHODS: Patients who had been implanted a CRT device with cardioversion-defibrillation feature were included to the study. Forty-three patients with LBBB (group 1) were compared with 21 patients without LBBB (group 2). HRV and HRT parameters were compared before and one month after CRT implantation. RESULTS: We compared the echocardiographic and electrocardiographic changes in both groups after CRT. Cardiac output (CO) was found to be significantly much more increased in group 1 (1.1 ± 0.4 vs. 0.6 ± 0.4, p = 0.001). Similarly, except SDNN and LF, all HRT and HRV parameters were significantly changed in the patients with LBBB (TO 1.4 ± 0.3 vs. 1.2 ± 0.2, p = 0.001; TS -1.8 ± 0.7 vs. -0.9 ± 0.7, p = 0.001; RMSSD -15.7 ± 9.9 vs. -6.3 ± 6.2, p = 0.001; PNN50 -7.0 ± 4.6 vs. -1.7 ± 1.1, p = 0.001; HF -13.3 ± 6.7 vs. -4.3 ± 3.5, p = 0.001; LF/HF 1.9 ± 0.4 vs. 1.5 ± 0.2, p = 0.001) compared to those without LBBB. Lineer regression analysis showed that the CO (ß = 0.2, t = 2.8, p = 0.007) and QRS configuration (ß = 0.6, t = 0.5, p = 0.001) were independent parameters affecting TO. CONCLUSIONS: HRV and HRT are improved after CRT but these improvements are more remarkable in patients with LBBB. CO, QRS configuration (but not duration) were two independent parameters affecting TO, LF and LF/HF ratio after CRT.

Vasorelaxant and blood pressure lowering effects of alchemilla vulgaris: A comparative study of methanol and aqueous extracts.

BACKGROUND: In the last decade, a growing interest particularly in determining the cardiovascular effects of herbal extracts took place among researchers. OBJECTIVE: Herein, we aimed to investigate the microvascular and blood pressure lowering effects of two differently processed extracts of the same herb, Alchemilla vulgaris (Rosaceaea), which was revealed to contain high levels of vasoactive compounds. MATERIALS AND METHODS: For the purpose, endothelium intact rat mesenteric arteries were mounted in a myograph system and contracted with prostaglandin F2α (PGF2α: 3 × 10(-5) M) or potassium chloride (K(+): 40 mM). Then, aqueous and methanol extracts were added at 0.01-10 mg/ml concentrations in a cumulative manner. RESULTS: Both extracts produced relaxations in PGF2α (3 × 10(-5) M) precontracted arteries which were insensitive to the inhibitors of endothelium derived vasoactive substances namely, L(G)-nitro-L-arginine (10(-4) M), ODQ (10(-5) M) and indomethacin (10(-5) M) or removal of endothelium. Opposite vascular effects were observed when extracts were applied in K(+) precontracted arteries. In addition, oral administration of the methanol extract of Alchemilla vulgaris, but not the aqueous extract, reduced blood pressure significantly in L-NAME hypertensive rats. CONCLUSION: Our results demonstrated that the methanol extract of Alchemilla vulgaris has more prominent and favourable vascular effects in normal and experimental hypertensive conditions reinforcing its traditional use in cardiovascular disorders, in particular hypertension. These results most likely give rise to further studies to reveal its mechanism of action and clinical value of this herb.

The anterior extraperitoneal approach to the rare presacral/ retroperitoneal schwannoma.

Presacral/retroperitoneal schwannomas are extremely unusual and their surgical approach is challenging. Various surgical approaches have been proposed. Here we describe our experience with the anterior extraperitoneal approach for the Type 3 presacral/retroperitoneal schwannoma. A 33-year-old woman presented with a history of infertility and a presacral/retroperitoneal mass. The patient underwent abdominal/pelvic CT and MRI that demonstrated presence of a solid, well circumscribed Type 3 presacral/retroperitoneal schwannoma. The anterior extraperitoneal approach was successfully used to remove the presacral/retroperitoneal schwannoma. The histopathological evaluation confirmed the preoperative diagnosis. The anterior extraperitoneal approach is helpful as an alternative approach in the surgical management of benign Type 3 presacral/retroperitoneal schwannomas (Fig. 4, Ref. 15).

Effect of a health promotion course on health promoting behaviours of university students.

The purpose of this pilot study in Turkey was to determine the effects of a health promotion course on enhancement of self-care agency and health-promoting behaviours of University of Kocaeli students. A group of 41 civil engineering students attended a 15-week course developed by the investigator, which included 30 hours of classroom lectures. The success of the education was measured by pre- and post-intervention tests using the Exercise of Self-care Agency scale and the Health Promotion Lifestyle Profile II scale. After the course, the self-care agency and health-promoting lifestyle scores of the university students increased significantly. University students with the lowest scores before the course displayed the most progress after the course.