Pro- and Anti-Angiogenic Factors: Their Relevance in Diabetic Foot Syndrome-A Review.

Peripheral arterial disease can involve tissue loss in up to 50% of patients with diabetic foot syndrome (DFS). Consequently, revascularization of narrowed or occluded arteries is one of the most common forms of comprehensive treatment. However, technically successful angioplasty does not always result in the healing of ulcers. The pathomechanism of this phenomenon is still not fully understood, but inadequate angiogenesis in tissue repair may play an essential role. Changes in pro- and anti-angiogenic factors among patients with DFS are not always clear and conclusive. In particular, some studies underline the role of decreased concentration of pro-angiogenic factors and higher levels of anti-angiogenic mediators. Nevertheless, there are still controversial issues, including the paradox of impaired wound healing despite high concentrations of some pro-angiogenic factors, dynamics of their expression during the healing process, and their mutual relationships. Exploring this process among diabetic patients may provide new insight into well-known methods of treatment and show their real benefits and chances for improving outcomes.

Gastrointestinal Dopamine in Inflammatory Bowel Diseases: A Systematic Review.

BACKGROUND: an increased prevalence of gastro-duodenal ulceration was described almost sixty years ago as prodromal to idiopathic Parkinson's disease, while duodenal ulcers have been rarely diagnosed in patients with schizophrenia. The cytoprotective role of dopamine in animal models of gastrointestinal ulcerations has also been described. Interestingly, Parkinson's disease (PD) might share common pathophysiological links with inflammatory bowel disease (IBD) as epidemiological and genetic links already suggest. Thus, the aim of our study was to review the existing literature on the role of the gastrointestinal dopaminergic system in IBD pathogenesis and progression. METHODS: a systematic search was conducted according to the PRISMA methodology. RESULTS: twenty-four studies satisfied the predetermined criteria and were included in our qualitative analysis. Due to different observations (cross-sectional studies) as well as experimental setups and applied methodologies (in vivo and in vitro studies) a meta-analysis could not be performed. No ongoing clinical trials with dopaminergic compounds in IBD patients were found. CONCLUSIONS: the impairment of the dopaminergic system seems to be a significant, yet underestimated, feature of IBD, and more in-depth observational studies are needed to further support the existing preclinical data.

Extended Precordial T Wave Inversions Are Associated with Right Ventricular Enlargement and Poor Prognosis in Pulmonary Hypertension.

In pulmonary hypertension (PH), T wave inversions (TWI) are typically observed in precordial leads V1-V3 but can also extend further to the left-sided leads. To date, the cause and prognostic significance of this extension have not yet been assessed. Therefore, we aimed to assess the relationship between heart morphology and precordial TWI range, and the role of TWI in monitoring treatment efficacy and predicting survival. We retrospectively analyzed patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) treated in a reference pulmonary hypertension center. Patients were enrolled if they had a cardiac magnetic resonance (cMR) and 12-lead surface ECG performed at the time of assessment. They were followed from October 2008 until March 2021. We enrolled 77 patients with PAH and 56 patients with inoperable CTEPH. They were followed for a mean of 51 ± 33.5 months, and during this time 47 patients died (35.3%). Precordial TWI in V1-V6 were present in 42 (31.6%) patients, while no precordial TWI were observed only in 9 (6.8%) patients. The precordial TWI range correlated with markers of PH severity, including right ventricle to left ventricle volume RVEDVLVEDV (R = 0.76, p < 0.0001). The presence of TWI in consecutive leads from V1 to at least V5 predicted severe RV dilatation (RVEDVLVEDV ≥ 2.3) with a sensitivity of 88.9% and specificity of 84.1% (AUC of 0.90, 95% CI = 0.83-0.94, p < 0.0001). Presence of TWI from V1 to at least V5 was also a predictor of mortality in Kaplan-Meier estimation (p = 0.02). Presence of TWI from V1 to at least V5 had a specificity of 64.3%, sensitivity of 58.1%, negative predictive value of 75%, and positive predictive value of 45.5% as a mortality predictor. In patients showing a reduction in TWI range of at least one lead after treatment compared with patients without this reduction, we observed a significant improvement in RV-EDV and RV-EDVLV-EDV. We concluded that the extension of TWI to left-sided precordial leads reflects significant pathological alterations in heart geometry represented by an increase in RV/LV volume and predicts poor survival in patients with PAH and CTEPH. Additionally, we found that analysis of precordial TWI range can be used to monitor the effectiveness of hemodynamic response to treatment of pulmonary hypertension.

Advancing European nutrition - are pharmacists eligible partners in the process?

BACKGROUND/OBJECTIVES: Pharmacists may play an important role in disease prevention through the public education about dietary and lifestyle behaviors, however their expertise is constantly ignored. The study primarily aimed to identify nutrition knowledge and dietary habits among Polish pharmacists. SUBJECTS: A total sample screened consisted of 1412 respondents, yet 667 (573 females and 94 males) pharmacists finally participated in the study. A validated questionnaire for Polish population, the Dietary Habits and Nutrition Beliefs Questionnaire, was used for the evaluation. RESULTS: The majority of pharmacists (94%) were current non-smokers with BMI levels below 25 kg/m2 (66.5%). Female pharmacists had higher the Pro-Healthy (pHDI-10) score (p < 0.001) and lower the Non-Healthy (nHDI-14) score (p = 0.004) compared to the males. In the self-assessment of nutritional habits, the pHDI-10 was significantly higher in the "very good" group compared to the "poor" (p < 0.001) and the "very poor" (p = 0.015) group, and the "poor group" had higher nHDI-14 when compared to "very good" (p < 0.001) and "good" (p < 0.001) groups. The nutrition knowledge test score was above average in over 72% of respondents, was correlated with the pHDI-10 (r = 0.16), yet the score decreased with age (r = -0.19). CONCLUSIONS: We believe that our analysis justifies the inevitability to benefit from pharmacists' expertise. Pharmacists with around-the-clock accessibility should be eligible partners, as members of an interdisciplinary team, in the process of advancing population-based nutrition.