Expanding the epidemiological understanding of hepatitis C in South Africa: Perspectives from a patient cohort in a rural town.

BACKGROUND: The epidemiology of hepatitis C virus (HCV) in the general population of South Africa (SA) is incompletely understood. A high HCV prevalence in key populations is known, but data are limited in terms of a broader understanding of transmission risks in our general population. OBJECTIVES: To investigate a patient cohort with HCV infection clustering in a rural SA town, in order to identify possible HCV transmission risks, virological characteristics, phylogenetic data and treatment outcomes. METHODS: A cluster of patients with positive HCV serology, previously identified from laboratory records, were contacted by a local district hospital and offered confirmatory testing for HCV viraemia where needed. Those with confirmed HCV RNA were invited to a local hospital visit, where relevant demographic information was recorded, clinical assessment performed and a confidential questionnaire administered. HCV population-based sequencing was performed on HCV NS3/4A, NS5A and NS5B using polymerase chain reaction-specific or M13 universal primers, and sequences were aligned using BioEdit 7.2.5. Phylogenetic trees were constructed. Clinical assessments included liver fibrosis determination with FibroScan (cut-off ≥12.5 kPa = F4). Patients were offered treatment, and sustained virological response (SVR) was confirmed by undetectable HCV RNA at least 12 weeks after the end of treatment. RESULTS: Twenty-one patients, all from the same town, median (interquartile range (IQR)) age 64 (59 - 70) years, 57% female, were evaluated. Of these, 24% (n=5) were HIV co-infected, stable on antiretrovirals. The median (IQR) alanine aminotransferase level was 51 (31 - 89) U/L, with fibrosis distribution including 29% F1, 29% F2, 9% F3 and 33% F4 METAVIR fibrosis. Virologically, two genotypes were observed: 62% (n=13) genotype (GT) 1b and 38% (n=8) GT5a. No patient had ever used injecting drugs, 14% (n=3) had received blood products before 1992, and 9.5% (n=2) had undergone traditional healer-administered scarification. All (n=21) reported attendance at a single primary care clinic in the past, with most (n=20) recalling having received parenteral therapies at the clinic. Phylogenetic analysis of the HCV NS5A and NS5B regions confirmed GT1b and GT5a genotypes and formed two separate clusters within their respective genotypes, suggesting a common source for each genotype infection. Most patients received treatment with sofosbuvir/daclatasvir, 1 was treated with sofosbuvir/velpatasvir, and 1 was re-treated with sofosbuvir/velpatasvir/voxilaprevir. Per protocol SVR was 95%, with the non-SVR patient successfully re-treated. CONCLUSIONS: Data from a rural town cluster of patients suggest parenteral medical exposure as the probable common source of hepatitis C transmission risk. The cohort was of older age with a significant number having advanced fibrosis or cirrhosis, suggesting HCV acquisition in the distant past. Using a simplified care approach, treatment outcomes were very good.

[Growth Guidance System in Treatment of Early Onset Scoliosis]. / Systémy usmernovaného rustu v lécbe raných detských skolióz.

PURPOSE OF THE STUDY The Growth Guidance System (GGS) represent a relatively new alternative to the traditional growing systems used for the treatment of early onset scoliosis. Ranking among the main aims of this surgical treatment is a three-dimensional correction of the deformity, maintenance of spinal growth and postponement of the necessity of final treatment by spondylodesis. MATERIAL AND METHODS Our study retrospectively evaluates the results of surgical correction in a group of 35 patients treated by GGS technique. The group consisted of patients with idiopathic, neuromuscular and syndromic spine deformity with the average age of 8 years and 2 months at the time of the surgery. The time of the follow-up is 3 years and 5 months on average. We evaluated the correction of the curve itself, the growth of the spine measured in the thoracic and lumbar part separately, and the growth of the trunk as a whole in the mentioned range on X-ray pictures. RESULTS The average correction of the scoliotic curve was 67%, from 75 preoperative degrees to 20 postoperative degrees. After the first operation 11% elongation of the trunk (from 321 mm to 356 mm) was reached, the thoracic spine was elongated by 10% (from 196 to 217 mm) and the lumbar spine was elongated by 11% (from 125 to 139 mm). The elongation of the trunk by 16% (from 322 to 375 mm) was observed in the cohort of patients with two years postoperative follow-up (21 patients). The total protraction of the trunk by 21% (from 318 to 386 mm) was reached in patients treated by definitive fusion (7 patients). DISCUSSION There is a very low number of studies analysing the long-term clinical results with the use of GGS. The first pilot results indicate that it is a technique allowing to achieve at least comparable results in correction of frontal plane compared with the distraction type of instrumentations. A negative aspect of this method is the abrasion of metal followed by metallosis. The new types of fixation screws enable more effective sliding of rods, maintenance of continuity of body grow by the shifting of rods as well as lower abrasion of the instrumentation. CONCLUSIONS The main advantage of GGS is the limited continuous growth of the spine, partial three-dimensional correction of the deformity, minimisation of inevitable reoperations under general anaesthesia and the possibility to quit a brace. Key words: growth guided system, early onset scoliosis, distraction, spinal growth, spondylodesis.

The effects of within stand disturbance in plantation forests indicate complex and contrasting responses among and within beetle families.

Plantation forests with timber production as the major function are highly fragmented and disturbed regarding the tree species composition and stand area. Their closed canopies also have different microclimatic conditions compared with better studied conservation areas. We studied three beetle families (click, longhorn, and rove beetles) with different ecological demands in lowland plantation forests dominated by Sessile oak and Norway spruce in the Czech Republic. Our main interest was how their species richness, abundance, diversity, body length, rarity, red-list status, species composition and individual species were driven by the main tree species, stand area and canopy openness. We analyzed 3466 individuals from 198 beetle species and the results revealed complex and contrasting responses of the studied beetle families - click beetles mostly preferred sun-exposure and spruce as the dominant tree species, longhorn beetles mainly preferred large stands, whereas rove beetles were mostly influenced by oak as the dominant tree species and increasing area. We also observed that some species had different preferences in plantation forests than is known from the literature. The main conclusions of our results are that the dominance of non-natural spruce plantations and a large stand area (both originating from artificially replanted large clear-cuts) did not affect the majority of the studied taxa as we expected. On the other hand, our results might have been influenced by other factor, such as the current small total area of the former vegetation, which in the past might have led to extinction debt; or a large area of other conifers in the surroundings that might have promoted conifer-associated fauna.

Cystatin C Is Associated with the Extent and Characteristics of Coronary Atherosclerosis in Patients with Preserved Renal Function.

Cystatin C (CysC), an endogenous inhibitor of cysteine proteases and a sensitive and accurate marker of renal function, is associated with the severity of coronary atherosclerosis assessed by angiography and future cardiovascular events according to previous studies. We aimed to evaluate the association between CysC levels and coronary plaque volume, composition and phenotype assessed by intravascular ultrasound and intravascular ultrasound-derived virtual histology in patients with preserved renal function. Forty-four patients with angiographically documented coronary artery disease and complete intravascular imaging were included in the study. Patients were categorized into tertiles by CysC levels. Subjects in the high CysC tertile had significantly higher mean plaque burden (48.0 % ± 6.9 vs. 42.8 % ± 7.4, P = 0.029), lower mean lumen area (8.1 mm2 ± 1.7 vs. 9.9 mm2 ± 3.1, P = 0.044) and a higher number of 5-mm vessel segments with minimum lumen area < 4 mm2 (17.9 ± 18.9 vs. 6.8 ± 11.7, P = 0.021) compared to patients in the lower tertiles. In addition, CysC levels demonstrated significant positive correlation with the mean plaque burden (r = 0.35, P = 0.021). Neither relative, nor absolute plaque components differed significantly according to CysC tertiles. The Liverpool Active Plaque Score was significantly higher in the high CysC tertile patients (0.91 ± 1.0 vs. 0.18 ± 0.92, P = 0.02). In conclusion, our study demonstrated a significant association of increased CysC levels with more advanced coronary artery disease and higher risk plaque phenotype in patients with preserved renal function.

[Assisted Reproduction and Preimplantation Genetic Diagnosis in Patients Susceptible to Breast Cancer]. / Asistovaná reprodukce a preimplantacní genetická diagnostika u pacientek ohrozených karcinomem prsu.

BACKGROUND: Assisted reproduction, as well as pregnancy itself, in patients with breast cancer or other hereditary type of cancer, is a widely discussed topic. In the past, patients treated for breast cancer were rarely involved in the discussion about reproductive possibilities or infertility treatment. However, current knowledge suggests, that breast cancer is neither a contraindication to pregnancy, nor to assisted reproduction techniques. On the contrary, assisted reproduction and preimplantation genetic diagnosis methods might prevent the transmission of genetic risks to the fetus. AIM: In this review we summarize data concerning pregnancy risks in patients with increased risk of breast cancer. In addition, we introduce current possibilities and approaches to fertility preservation prior to assisted reproduction treatment as well as novel methods improving the safety of fertility treatment. In the second part of this review, we focus on karyomapping--an advanced molecular genetic tool for elimination of germinal mutations in patients with predisposition to cancer. Moreover, the rapid development of preimplantation genetic diagnosis methods contributes to detection of both chromosomal aneuploidy and causal mutations in a relatively short time-span.

Self-assembled magnetic bead chains for sensitivity enhancement of microfluidic electrochemical biosensor platforms.

In this paper, we present a novel approach to enhance the sensitivity of microfluidic biosensor platforms with self-assembled magnetic bead chains. An adjustable, more than 5-fold sensitivity enhancement is achieved by introducing a magnetic field gradient along a microfluidic channel by means of a soft-magnetic lattice with a 350 µm spacing. The alternating magnetic field induces the self-assembly of the magnetic beads in chains or clusters and thus improves the perfusion and active contact between the analyte and the beads. The soft-magnetic lattices can be applied independent of the channel geometry or chip material to any microfluidic biosensing platform. At the same time, the bead-based approach achieves chip reusability and shortened measurement times. The bead chain properties and the maximum flow velocity for bead retention were validated by optical microscopy in a glass capillary. The magnetic actuation system was successfully validated with a biotin-streptavidin model assay on a low-cost electrochemical microfluidic chip, fabricated by dry-film photoresist technology (DFR). Labelling with glucose oxidase (GOx) permits rapid electrochemical detection of enzymatically produced H2O2.

Can rove beetles (Staphylinidae) be excluded in studies focusing on saproxylic beetles in central European beech forests?

Monitoring saproxylic beetle diversity, though challenging, can help identifying relevant conservation sites or key drivers of forest biodiversity, and assessing the impact of forestry practices on biodiversity. Unfortunately, monitoring species assemblages is costly, mainly due to the time spent on identification. Excluding families which are rich in specimens and species but are difficult to identify is a frequent procedure used in ecological entomology to reduce the identification cost. The Staphylinidae (rove beetle) family is both one of the most frequently excluded and one of the most species-rich saproxylic beetle families. Using a large-scale beetle and environmental dataset from 238 beech stands across Europe, we evaluated the effects of staphylinid exclusion on results in ecological forest studies. Simplified staphylinid-excluded assemblages were found to be relevant surrogates for whole assemblages. The species richness and composition of saproxylic beetle assemblages both with and without staphylinids responded congruently to landscape, climatic and stand gradients, even when the assemblages included a high proportion of staphylinid species. At both local and regional scales, the species richness as well as the species composition of staphylinid-included and staphylinid-excluded assemblages were highly positively correlated. Ranking of sites according to their biodiversity level, which either included or excluded Staphylinidae in species richness, also gave congruent results. From our results, species assemblages omitting staphylinids can be taken as efficient surrogates for complete assemblages in large scale biodiversity monitoring studies.

Prediction of coronary vessel involvement on the basis of atherosclerosis risk factor analysis.

The prediction of coronary vessel involvement by means of noninvasive tests is one of the fundamental objectives of preventive cardiology. This review describes the current possibilities of coronary vessel involvement prediction by means of ultrasonographic examination of carotid arteries, analysis of polymorphisms in the genes encoding enzymes responsible for production of nitric oxide and carbon monoxide and assessment of levels of certain proinflammatory cytokines. In the presented work these noninvasive markers are correlated with the extent of coronary vessel involvement as assessed by coronary angiography, intravascular ultrasound and virtual histology (Fig. 5, Ref. 40).

Regulations of sugar transporters: insights from yeast.

Transport across the plasma membrane is the first step at which nutrient supply is tightly regulated in response to intracellular needs and often also rapidly changing external environment. In this review, I describe primarily our current understanding of multiple interconnected glucose-sensing systems and signal-transduction pathways that ensure fast and optimum expression of genes encoding hexose transporters in three yeast species, Saccharomyces cerevisiae, Kluyveromyces lactis and Candida albicans. In addition, an overview of GAL- and MAL-specific regulatory networks, controlling galactose and maltose utilization, is provided. Finally, pathways generating signals inducing posttranslational degradation of sugar transporters will be highlighted.

Intracoronary injection of autologous bone marrow-derived mononuclear cells in patients with large anterior acute myocardial infarction and left ventricular dysfunction: a 24- month follow up study.

OBJECTIVE AND BACKGROUND: Despite the use of reperfusion therapies, outcomes in patients with large myocardial infarction (MI), late reperfusion and left ventricular (LV) dysfunction are poor. We investigated long-term safety and efficacy of intracoronary injections of autologous bone marrow-derived mononuclear cells (BMNCs). METHODS: 27 patients with anterior MI (age 59±12 years, mean baseline LV ejection fraction (LVEF) 39±5 %), who underwent percutaneous coronary intervention 4-24 hours after the onset of symptoms, were randomly assigned either to intracoronary BMNCs injection (n=17, BMNCs group, out of which 14 underwent long-term follow-up), or to standard therapy (n=10, Control group). The LVEF, the LV end-diastolic and end-systolic volumes (LVEDV, LVESV) were assessed by echocardiography at discharge, Month 4 and 24. Myocardial perfusion was assessed using SPECT at baseline and Month 4. RESULTS: At 24-month, there was no difference in rates of serious clinical events (36 % vs 50 %, p=0.54). At Month 4 LVEF improved to similar extent in both groups (absolute change +5.8 % vs +7.6 %, p=0.75), with similar infarct size reductions (-10.9 % vs -12.2 %, p=0.47). However, at Month 24, LVEF further improved in BMNCs patients (+12 % vs +8.5 %, p=0.03). This effect resulted from a more pronounced reduction in LVESV (-2.6 ml vs -1.8 ml, p=0.26) and a smaller increase in LVEDV (+16.7 ml vs +17.9 ml, p=0.27) suggesting beneficial long-term effects on LV remodeling. CONCLUSIONS: BMNCs injections in patients with MI and LV dysfunction were associated with a significant improvement of global LVEF during long term follow-up compared to standard therapy (Tab. 3, Fig. 1, Ref. 50). Full Text in PDF www.elis.sk.

Genetic variants in haem oxygenase-1 and endothelial nitric oxide synthase influence the extent and evolution of coronary artery atherosclerosis.

The genetic basis for atherosclerosis development and progression is poorly characterized. We aimed to assess the relationship between endothelial nitric oxide synthase (ENOS) 894 G/T, haem oxygenase-1 (HO1) dinucleotide-length promoter polymorphisms and coronary artery atherosclerotic invol vement and its changes during statin therapy. Coronary angiography, intravascular ultrasound (IVUS), IVUS-derived virtual histology (VH) and genetic polymorphism analysis were performed at study entry. Patients were randomized 1:1 to standard or aggressive hypolipidaemic treatment, and a follow-up evaluation was performed after twelve months. Plaque magnitude was significantly higher in carriers of HO1 risk variants when compared with carriers of the protective variants (< 25 GT repeats). Similarly, the total coronary atherosclerotic burden was significantly greater in HO1 risk variant carriers than in HO1 protective variant carriers. Both parameters did not differ with respect to the ENOS genotype. A higher prevalence of thin-cap fibroatheroma (TCFA) in HO1 risk variant carriers was observed, compared with the HO1 protective variant carriers. The prevalence of TCFA was not influenced by the ENOS genotype. Baseline plaque composition did not differ significantly with respect to both polymorphisms. Significant interactions between plaque composition changes and ENOS and HO1 genotypes were observed during statin treatment. In conclusion, the protective HO1 promoter polymorphism correlates with a lower coronary artery plaque burden, whereas the protective ENOS 894 G/T polymorphism seems to favourably influence changes of coronary artery plaque composition during statin therapy, but has no significant correlation to the magnitude of coronary atherosclerosis.

A review of a newly established ECMO program in a university affiliated cardiac center.

Extracorporeal membrane oxygenation (ECMO) is an established rescue treatment option for severe respiratory and cardiac failure in infants and neonates and has recently become widely utilised in adults. ECMO support can be initiated rapidly in an emergency setting both by percutanous implantation and surgically; it allows transportation of patients in cardio-pulmonary collapse and bridging of critically ill patients to be recovered, other support measures or transplantation. The aim of this study was to report authors' initial experience after starting an ECMO program in a university-based cardiac center. The institutionally approved ECMO team bears responsibility for adjudication regarding indication and implementation of ECMO in all patients. Since the establishment of the ECMO team in October 2007, one elective and nine urgent patients in deep cardiogenic and/or ventilatory collapse were treated by ECMO support up to December 2008. Three patients suffered severe acute right heart dysfunction, two patients suffered postcardiotomy refractory cardiogenic shock, two patients had a cardiogenic shock due to postinfarction interventricular septal rupture, two patients experienced severe respiratory failure and one had elective ECMO implantation as a back-up support during high-risk percutaneous coronary intervention. Veno-arterial ECMO was used in eight cases and veno-venous in two cases of isolated respiratory failure. In nine patients, ECMO circuit was instituted by peripheral cannulation, in eight out of nine cases by percutaneous puncture. On one occasion central surgical cannulation was used. In urgent patients, immediate hemodynamic and oxygenation improvement was observed. Average support duration was 6.8 days (range 1-16 days). Five (50 %) patients were successfully weaned from ECMO and survived to hospital discharge. The illness severity in urgent patients defined by SOFA score ranged from 10 to 17, patients dying while on ECMO had higher SOFA scores (14.8±1.6 vs. 10.8±1.5; P=0.0065). Complications included mainly bleeding. ECMO support allows treatment of severely ill patients in imminent cardiovascular and/or ventilatory collapse. Therefore, establishment of an ECMO program in university affiliated cardiac center is fully justified. A multidisciplinary approach is essential. Despite adequate training and education of ECMO team members, this highly invasive therapeutic modality bears an inherent risk of complications.

Reduced thrombin generation and soluble P-selectin after intravenous enoxaparin during PCI.

PURPOSE: The objective of our study was to identify changes in the coagulation and serum concentration of soluble P-selectin (sP-sel) after i.v. bolus of 0.75 mg/kg enoxaparin in a group of 33 patients during PCI. METHODS AND RESULTS: As compared to baseline, i.v. enoxaparin increased anti -Xa activity and FIIa inhibition together with APTT and thrombin time tests within 20 min, that persisted for 60 min. At 6 h, the results of all tests had returned to baseline. In contrast, the level of prothrombin fragments (F1 + 2) decreased persistingly for a period of 6 h (baseline 1.19 ± 0.42 nmol/l, after 20 min 1.03 ± 0.46 nmol/l, after 60 min 1.06 ± 0.43 nmol/l, after 6 h 0.95 ± 0.40 nmol/l, p < 0.001 vs. baseline for all values). In addition, i.v. enoxaparin decreased serum sP-sel level (baseline 111.80 ± 37.05 ng/ml, after 20 min 87.80 ± 33.17 ng/ml, after 60 min 86.45 ± 29.15 ng/ml, after 6 h 92.24 ± 31.34 ng/ml, p < 0.001 vs. baseline value for all). sP-sel level mildly correlated with both F Xa inhibition (r = -0.275, p < 0.05) and F1 + 2 level (r = 0.274, p < 0.05). CONCLUSION: Intravenous enoxaparin induced target F Xa inhibition (>0.6 IU/ml) for 60 min in 82% of study patients. During the 6 h of monitoring, a decrease of thrombin generation (F1 + 2) and sP-selectin levels were observed.

Adhesive bowel strangulation after caesarean section, the rare puerperal complication.

Caesarean section is the most frequent abdominal operation carried out in obstetric practice. Parturients undergoing this operation are still exposed to a substantial rate of short- and long-term complications. The incidence of re-laparotomy after caesarean section is 0.12-0.70%. The most common indication for re-laparotomy is intra-abdominal bleeding, uterine atony, eventration, haematoma in the muscle and intra-abdominal abscesses. We present the case report of an unusual life-threatening complication of caesarean section that led to re-laparotomy. Caesarean section rate has been continually increasing globally in the last few decades, thus we also have to take into account unusual complications e.g. intestinal complication.

[Nalbuphine at maternal analgesia]. / Vyuzití nalbuphinu v porodnické analgezii.

OBJECTIVE: Comparison between particular methods of obstetrics analgesia, their analgetic efects and influence on progress of delivery and postpartum adaptation of fetus. DESIGN OF THE STUDY: Prospective study. SETTING: The Department of Gynecology and Obstetrics of the Teaching Hospital and the 2nd Medical Faculty of the Charles University in Prague. METHODS: A prospective study of 644 patients who received intravenous increments of nalbuphine (196 women) or epidural analgesia (217 women) or pethidin (231 women). Assessment of maternal analgesia, satisfaction was carried out. Apgar scores and resuscitative measures required for the neonate were noted at delivery. RESULTS: The best analgetic effect was in the group with using peridural analgesia, where max. score was 3. The highest value was in the group of women who received pethidin. The most decrease of score after aplication of analgesia was in group with epidural analgesia, the least decrease of score was in group with pethidin. The Apgar score at 1. minute was the lowest in the group with epidural analgesia, the highest score was in the group with nalbuphine. CONCLUSION: The mixed agonist/antagonist narcotic analgesic like nalbuphine have the place in clinical practice. The obstetric analgesia is very common in obstetrics practice. The epidural analgesia is very popular but not everytimes accessible. Nalbuphine is the option who is analgetic effective and have minimal side-effect.

[Receiver operating characteristic analysis and the cost--benefit analysis in determination of the optimal cut-off point]. / ROC analýza a vyuzití analýzy nákladu a prínosu k urcení optimálního delícího bodu.

An overview of the use of Receiver Operating Characteristic (ROC) analysis within medicine is provided. A survey of the theory behind the analysis is offered together with a presentation on how to create a ROC curve and how to use Cost--Benefit analysis to determine the optimal cut-off point or threshold. The use of ROC analysis is exemplified in the "Cost--Benefit analysis" section of the paper. In these examples, it can be seen that the determination of the optimal cut-off point is mainly influenced by the prevalence and the severity of the disease, by the risks and adverse events of treatment or the diagnostic testing, by the overall costs of treating true and false positives (TP and FP), and by the risk of deficient or non-treatment of false negative (FN) cases.

Increase in plasma free haemoglobin during cardiopulmonary bypass in heart valve surgery: assessment of renal dysfunction by RIFLE classification.

Heart valve surgery carries a high risk of renal insufficiency as an independent risk factor due to prolonged cardiopulmonary bypass. Multiple causes of cardiopulmonary bypass-associated renal damage have been described, and haemoglobin-induced renal injury is presently being investigated. Forty-three patients scheduled for heart valve surgery (mostly combined) were enrolled in the prospective study. Plasma free haemoglobin (PFH) levels were evaluated by photocolorimetric measurement at the start of procedures (t(0)) and before the end of extracorporeal circulation (t(1)). A statistically significant increase in PFH levels during cardiopulmonary bypass was detected [median values (interquartile range) - t(0): 62.0 (53.4) mg/L, t(1): 320.4 (352.2) mg/L], P < 0.001. A significant regression relationship between the duration of cardiopulmonary bypass and the increased PFH was found (Spearman's correlation coefficient 0.628, P < 0.001). In some elderly patients, the tendency towards a high release of PFH during cardiopulmonary bypass was more pronounced, but the overall association between age and PFH levels was of borderline significance (P = 0.077). The correlation between PFH and post-operative serum creatinine was low and non-significant, but the latter correlated highly with the pre-operative serum creatinine values (Spearman's correlation coefficient reached values of 0.6-0.7, P < 0.001). Patients were classified according to the Risk of renal failure, Injury to the kidney, Failure of kidney function, Loss of kidney function and End-stage renal failure (RIFLE) classification for acute renal dysfunction during post-operative days 1 - 4; the influence of PFH levels at t(1) on the consequent RIFLE classification was not proven (P=0.648), but 4 patients in the Injury category had shown a higher median value of PFH (433.6 mg/L) in comparison with the others (29 patients with no acute renal dysfunction - 313.7 mg/L, 10 patients at Risk - 330.1 mg/L).

[Myocardial infarction, left ventricle remodeling and cellular therapy]. / Infarkt myokardu, remodelace levé komory a bunecná terapie.

The paper brings an overview of results of the most important and significant clinical studies dealing with the issues of bone marrow stem cell implantation in patients with acute myocardial infarction. On the world scale, research has been focused on this area for several years. Much hope is put primarily on the possibility to prevent the process of progressive remodelling of the left ventricle, the substitution of necrotic or fibrotic tissue and the resulting prevention of development and progression of heart failure. In the centre of attention are especially patients whose long-term prognosis is often very poor in spite of progress in contemporary medicine.

Intravascular ultrasound assessment of coronary artery involvement in Fabry disease.

AIM: We used intravascular ultrasound (IVUS) to characterize coronary artery involvement in patients with Fabry disease (FD). METHODS: Nine FD patients (5 women) were matched to 10 control patients (5 women) chosen from our IVUS database. Standard volumetric IVUS analyses were performed along with assessment of plaque echodensity. RESULTS: Plaques in FD patients were diffuse and hypoechogenic compared with more focal and more echogenic lesions in control patients. Echogenicity of plaques was significantly lower in FD patients (median 30.7 +/- 12.9 vs 55.9 +/- 15.7, p = 0.0052, mean 37.2 +/- 15.6 vs 66.2 +/- 13.3, p = 0.0014). Diffusiveness was assessed as differences between mean and median plaque burden versus the plaque burden in each of the analysed cross-sections. These differences were lower in FD vs controls (5.8 +/- 4.8 vs 8.7 +/- 6.6, p < 0.001 for mean, and 5.8 +/- 4.9 vs 8.8 +/- 7.3, p < 0.001 for median) indicating a more diffuse involvement. The occurrence of lipid cores was significantly higher in FD patients than in controls (2.4 +/- 1.5 vs 1.0 +/- 0.94, p = 0.02). CONCLUSION: IVUS showed diffuse hypoechogenic plaques in patients with FD. The explanation may be higher lipid content in plaques and accumulation of glycosphingolipid in smooth-muscle and endothelial cells.