Is Balneotherapy Protective Against Oxidative Stress? A Pilot Study.

BACKGROUND/AIM: This study aimed to research the effects of Harkány healing water on oxidative stress. The study was performed in a randomized, placebo-controlled, double-blind setup. PATIENTS AND METHODS: Twenty patients with psoriasis who underwent a 3-week-long inward balneotherapy-based rehabilitation were enrolled. Psoriasis Area and Severity Index (PASI) score and Malondialdehyde (MDA) - a marker of oxidative stress - were determined, on admission and before discharge. Patients were treated with dithranol. RESULTS: The mean PASI score - determined on admission and before discharge - decreased significantly after the 3-week-long rehabilitation 8.17 vs. 3.51 (p<0.001). The baseline MDA value of patients with psoriasis was significantly higher compared to controls (3.0±3.5 vs. 8.4±7.4) (p=0.018). MDA levels of patients receiving placebo water increased significantly compared to MDA levels of patients receiving healing water (p=0.049). CONCLUSION: The effectiveness of dithranol resides in the formation of reactive oxygen species. No increased oxidative stress was found in the patients treated with healing water, thus healing water seems to be protective against oxidative stress. However, further research is needed to confirm these preliminary results.

Physical Vascular Therapy (BEMER) Affects Heart Rate Asymmetry in Patients With Coronary Heart Disease.

BACKGROUND/AIM: The aim of this study was to assess the acute effects of physical vascular therapy (PVT) on the autonomous nervous system by heart rate variability (HRV) and heart rate asymmetry (HRA) analysis. The low-frequency, pulsed electromagnetic field (<35 µTesla) with a patented BEMER pattern can improve vasomotion and microcirculation. A non-invasive confirmation of the instant effects of PVT may provide an opportunity to give an immediate feedback to the patient and therapist. PATIENTS AND METHODS: Altogether 48 patients on inward rehabilitation with coronary heart disease (CHD) were involved, their treatment included PVT with B.Box Professional and B.Body Pro applicator (BEMER International AG, Triesen, Lichtenstein). After 15 min of postural adaptation, 6-min electrocardiograms (ECG) were taken immediately before, in the first and in the last 6 min of the 20-min PVT, and one hour after the treatment. Of the 48 patients, the last twenty patients received sham PVT with the same protocol. Off-line analysis was blinded. We used linear mixed statistical model to compare HRV and HRA parameters. RESULTS: The time domain parameters did not show any statistically significant differences between the changes in the real PVT and sham groups but, in the first stage of the treatment, Porta and Guzik indices significantly rose everywhere except in the sham group. CONCLUSION: PVT significantly increases the Guzik and Porta indices in chronic ischemic heart disease patients reflecting a delicate autonomic response. HRA as a measure of autonomic regulation seems to be more sensitive than time domain parameters.

A New and Validated, Randomised, Controlled Placebo Water Development Trial for Medicinal Water-based Research.

BACKGROUND/AIM: To develop and validate an easy-to-use and cheap method capable of producing placebo from tap water for medicinal water efficacy trials. PATIENTS AND METHODS: Patients were divided into two groups, medicinal water and tap water group. A single 20-minute-long treatment was performed in bathtubs. Patients were asked four times during the bath to tell if they were treated with medicinal water, tap water, or could not decide. Patients were scored, one point was given for each correct answer. RESULTS: A total of 174 patients were enrolled. No significant differences were found either between the average scores or the answers of the two groups. Being familiar with the Harkány medicinal water did not influence the rate of correct answers either. There was no statistically significant difference in the number of changes of opinions between the two groups. CONCLUSION: The used method is appropriate for producing a validated placebo from tap water.

Urinary orosomucoid: a new marker of cardiovascular risk in psoriatic patients?

PURPOSE: Psoriasis is one of the most common lifelong lasting dermatologic diseases. According to the latest studies, psoriatic patients have a higher risk of developing cardiovascular diseases. Psoriasis is considered as a systemic inflammatory disease. Several oxidative stress markers have been shown to be elevated in psoriasis. However, a panel of biomarkers has not been used yet. This study was aimed at exploring the connection between a panel of biomarkers (C-reactive protein, asymmetric dimethylarginine, uric acid, total antioxidant capacity, malondialdehyde, and orosomucoid [ORM]) and cardiovascular risk in psoriatic patients. PATIENTS AND METHODS: The inclusion criterion was the onset of psoriasis with skin lesions. Exclusion criteria were impaired renal function (eGFR<60 mL/min/1.73 m2), acute inflammations (urinary, respiratory, skin inflammation, etc), autoimmune disorders (rheumatoid arthritis, systemic lupus erythematosus, or inflammatory bowel disease), and any kind of biological antipsoriatic treatment. Patients with a medical history of myocardial infarction, coronary heart disease, stroke, transient ischemic attack, and carotid artery stenosis were also excluded. Biomarkers were measured by routine procedures, ELISA and HPLC. QRISK®2-2017 was used to assess 10-year risk of cardiovascular disease development. Psoriasis severity was measured by the Psoriasis Area and Severity Index. RESULTS: One hundred and fourteen psoriatic patients were enrolled. Only urinary orosomucoid and urinary orosomucoid/urinary creatinine (u-ORM/u-CREAT) ratio showed significant correlation with QRISK score (u-ORM, r=0.245; u-ORM/u-CREAT, r=0.309). When comparing mild psoriatic patients to moderate psoriatic patients, significant differences could only be found in u-ORM and u-ORM/u-CREAT ratio. CONCLUSION: There seems to be a connection between urinary ORM and cardiovascular risk. U-ORM and u-ORM/u-CREAT ratio could be used as an indicator of low-grade inflammation in mild and moderate psoriasis. However, it is the 10-year follow-up of cardiovascular events that will determine the usefulness of this biomarker panel.

Left ventricular longitudinal strain is associated with mitral annular fractional area change in healthy subjects-Results from the three-dimensional speckle tracking echocardiographic MAGYAR-Healthy Study.

BACKGROUND: The mitral annulus (MA) plays a significant role in promoting left atrial and left ventricular (LV) filling and emptying, which is dependent on LV functional properties. The present study aimed to investigate the relationship between LV strains, quantitative features of longitudinal contractility and MA size and function in healthy subjects. METHODS: The present study comprised 295 healthy adults; 117 subjects were excluded due to inferior image quality (40%). Finally, 178 healthy adults (mean age: 32.0±11.3 years, 92 males). Complete two-dimensional Doppler echocardiography and three-dimensional speckle-tracking echocardiography were performed in all cases. RESULTS: The global and mean segmental left ventricular longitudinal strain (LV-LS) proved to be -16.1%±2.5% and -16.9%±2.4%, respectively. In the present study, LV-LS ≤-13% was considered to be reduced. In ROC analysis, the cut-off value for MA fractional area change (MAFAC) to predict impaired LV-LS was ≤44%, with 67% sensitivity and 69% specificity and ROC area under curve 0.73 (P=0.0005). Significantly increased LV volumes and LV mass and reduced MAFAC could be demonstrated in healthy subjects with global LV-LS ≤-13%. Significantly larger ratio of subjects with global LV-LS ≤-13% had MAFAC ≤44% (31% vs. 67%, P=0.009). Patients with MAFAC ≤44% had significantly reduced global and mean segmental LV-LS. Significantly larger ratio of subjects with MAFAC ≤44% had global LV-LS ≤-13% (4% vs. 16%, P=0.009). CONCLUSIONS: There is a strong relationship between MA and LV longitudinal function. MA fractional area change predicts global LV-LS.

[Borderline left ventricular ejection fraction is associated with alterations in mitral annular size and function. Results from the three-dimensional speckle-tracking echocardiographic MAGYAR-Healthy Study]. / A határérték bal kamrai ejekciós frakció együtt jár a mitralis anulus méretének és funkciójának eltéréseivel. Eredmények a MAGYAR-Healthy Tanulmányból.

INTRODUCTION: Morphology and function of the mitral annulus (MA) shows alterations in different valvular (for instance in mitral regurgitation) and non-valvular disorders (for instance in certain cardiomyopathies, cardiac amyloidosis). AIM: The aim of the present study was to examine the relationship between MA morphologic and functional properties and three-dimensional speckle-tracking echocardiography- (3DSTE) derived left ventricular (LV) ejection fraction (EF) in subjects with normal versus borderline LV-EF. METHOD: The present study comprised 146 volunteers (mean age: 32.0 ± 11.4 years; 74 males) in whom complete two-dimensional Doppler echocardiography was performed with a negative result extended with 3DSTE. The population was further divided into two groups according to their 3DSTE-derived LV-EF (borderline 50-54% versus ≥55%). RESULTS: In cases with borderline LV-EF, higher LV end-systolic LV volumes and lower LV longitudinal strain could be measured. All end-systolic and end-diastolic MA diameter, area and perimeter data proved to be higher in cases with borderline LV-EF. In these subjects, MA functional parameters proved to be lower as well. In contrast, LV-EF showed correlations neither with end-systolic and end-diastolic MA dimensions nor with MA functional parameters. CONCLUSIONS: 3DSTE-derived borderline LV-EF is associated with MA dilatation and functional impairment. Orv Hetil. 2018; 159(50): 2129-2135.

Transcutaneous Carbon Dioxide Treatment Is Capable of Reducing Peripheral Vascular Resistance in Hypertensive Patients.

AIM: We aimed to investigate the effects of a single carbon dioxide (CO2) treatment on arterial stiffness by monitoring the changes of aortic pulse-wave velocity (PWV) and aortic augmentation index (AIXao), which are indicators of arterial stiffness. PATIENTS AND METHODS: PWV and AIXao were measured by an invasively validated oscillometric device. The measurements of stiffness parameters were performed before the CO2 treatment, and at 1, 4 and 8 h after the first treatment. RESULTS: Thirty-one patients were included. No significant changes were found in PWV. AIXao decreased significantly 1 h and 4 h after CO2 treatment compared to baseline values (p=0.034 and p<0.001). AIXao increased 8 h after the CO2 treatment, but remained significantly lower than baseline AIXao values (p=0.016). CONCLUSION: CO2 treatment is capable of reducing peripheral vascular resistance. We hypothesize that CO2 is not only a temporal vasodilator but is also capable of activating vasodilation pathways.

Urinary Orosomucoid A Potential Marker Of Inflammation In Psoriasis.

Background: Psoriasis is one of the most common chronic, life-long dermatologic diseases, which has considerable negative effects on quality of life. Psoriasis is considered as a systemic inflammatory disease, thus acute phase proteins such as C-reactive protein (CRP) and orosomucoid (ORM) have been shown to play a role in its pathophysiology. This study was aimed to compare CRP, serum ORM (se-ORM) and urinary ORM (u-ORM) levels of psoriatic patients to healthy individuals. Methods: 87 psoriatic patients and 41 healthy individuals were enrolled. Simultaneously obtained venous blood and spot urine samples were analysed. High sensitivity CRP and se-ORM levels were determined by routine procedures on automated analyzers. Urinary ORM was measured by a novel automated turbidimetric assay. U-ORM was referred to urinary creatinine (u-ORM/u-CREAT, mg/mmol). Results: Significantly higher hsCRP (p<0.001) and u-ORM/u-CREAT (p=0.001) levels were found among psoriatic patients compared to controls. No significant differences were found between the groups regarding se-ORM levels. HsCRP, se-ORM and u-ORM/u-CREAT levels were significantly higher in patients with severe psoriasis than in mild and moderate cases (p<0.05). Conclusion: As a highly sensitive, easily available biomarker u-ORM shows itself capable of becoming a new inflammatory marker in psoriasis providing clinically useful information on disease severity.

Cellular Phone Irradiation of the Head Affects Heart Rate Variability Depending on Inspiration/Expiration Ratio.

BACKGROUND: Mobile phones may have harmful health effects and clinical examinations report ambiguous results of exposure concerning neurophysiological and cardiovascular actions. MATERIALS AND METHODS: This study investigated heart rate asymmetry (HRA) and heart rate variability (HRV) parameters with 1:2 and 1:1 metronome-paced inspiration/expiration ratios during short-term 1,800MHz GSM cellular phone exposure in 20 healthy volunteers. RESULTS: Significant HRA changes by Porta and Guzik indices were not found on exposure compared to sham exposure. Time-domain HRV parameters on exposure showed significant differences at 1:1 paced, but not at 1:2 paced breathing compared to sham exposure. A mild post-exposure effect was observed regarding root mean square of successive RR-differences. CONCLUSION: The findings reflect persisting acute effects of GSM handset emission on the autonomic nervous system. Exploring its influences on health status and survival needs further studies. Symmetrical breathing can be used as a sensitizing factor in other HRV/HRA analysis studies.

Transcutaneous Carbon Dioxide Treatment Affects Heart Rate Variability - A Pilot Study.

BACKGROUND: The aim of this study was to investigate the effects of carbon-dioxide treatment on heart rate variability (HRV) parameters: mean RR interval (RRI), standard deviation of RR intervals (SDNN), root mean square of successive RR differences (RMSSD); and Porta and Guzik indices, as measures of heart rate asymmetry. MATERIALS AND METHODS: Twenty patients were enrolled (mean±SD, age=59±7.8 years). Measurements were performed before CO2 treatment, at the beginning of treatment, at 15 min of treatment, immediately after and 1 h after the treatment. RESULTS: Significant increase in SDNN was found 1 h after the treatment when compared to that before it (p=0.011). There were no significant changes in other parameters. CONCLUSION: CO2 treatment can influence the autonomic nervous system identified by SDNN changes. However, larger studies are required to confirm these results.

Left atrial dysfunction in light-chain cardiac amyloidosis and hypertrophic cardiomyopathy - A comparative three-dimensional speckle-tracking echocardiographic analysis from the MAGYAR-Path Study.

INTRODUCTION: While cardiac amyloidosis (CA) is a rare systemic disease characterized by extracellular deposition of protein-derived fibrils, hypertrophic cardiomyopathy (HCM) is histopathologically characterized by myocyte hypertrophy and disarray, interstitial fibrosis, and small intramural coronary arteriole dysplasia. The aim of the present study was to compare left atrial (LA) volumetric and functional characteristics between light-chain (AL) CA and HCM by three-dimensional (3D) speckle-tracking echocardiography (STE). METHODS: The AL-CA group initially consisted of 17 patients with AL-CA, but one patient was excluded due to inadequate image quality, and so the study population consisted of 16 patients (mean age: 64.0±9.6 years, five men). Their results were compared with data on 20 age-matched HCM patients (mean age: 59.8±5.2 years, 10 men) and on 16 age-matched healthy controls (mean age: 58.2±7.2 years, six men). Complete two-dimensional Doppler echocardiography and 3D-STE were performed in all cases. RESULTS: Significantly increased LA volumes were observed in both AL-CA and HCM compared with the control group. Only active atrial emptying fraction was found to be significantly reduced in AL-CA patients compared to controls. Peak global and mean segmental circumferential, longitudinal and area strains showed significant reductions in AL-CA patients compared with controls, but only peak mean segmental longitudinal strain differed significantly between HCM patients and controls. While no differences were demonstrated in global and mean segmental strain at atrial contraction between HCM patients and controls, AL-CA patients showed reductions in certain strain parameters compared to controls and HCM patients. CONCLUSIONS: Different patterns of LA functional characteristics were demonstrated in AL-CA and HCM patients by 3D-STE.

Balneotherapy in Psoriasis Rehabilitation.

BACKGROUND/AIM: This study aimed to report a balneotherapy-based psoriasis rehabilitation protocol and assess its effectivity. PATIENTS AND METHODS: Eighty psoriatic patients who underwent a 3-week-long inward balneotherapy-based rehabilitation were enrolled. Psoriasis Area and Severity Index (PASI) score and high sensitivity C-reactive protein (CRP) were determined on admission and before discharge. RESULTS: The mean PASI score and CRP level -determined on admission and before discharge-decreased significantly after the 3-week-long rehabilitation 7.15±7.3 vs. 2.62±3.05 (p<0.001) and 4.1±3.8 vs. 3.5±3.1 (p=0.026). A negative correlation was found between PASI delta and the number of spa therapies received (r=-0.228). CONCLUSION: After completing the 3-week-long spa therapy based rehabilitation, both PASI score and CRP levels showed improvement of psoriasis. The complex spa therapy used during the rehabilitation is an effective tool to reduce the symptoms of psoriasis and improve the patient's well-being.

Monitoring urinary orosomucoid in patients undergoing cardiac surgery: A promising novel inflammatory marker.

BACKGROUND: Urinary biomarkers might provide non-invasive tool for monitoring of systemic processes. We aimed to investigate the time-course of urinary orosomucoid (u-ORM) excretion after cardiac surgery hypothesizing that u-ORM is an early and sensitive marker of systemic inflammatory activation. METHODS: During a 5-day follow-up study we monitored u-ORM levels in cardiovascular patients who underwent on-pump cardiac surgery (n=38). The patients baseline data were compared to healthy control individuals (n=40). u-ORM was measured by a newly developed automated turbidimetric assay and values were referred to urinary creatinine and expressed as u-ORM/u-CREAT (mg/mmol). RESULTS: The cardiovascular patients showed slightly increased baseline u-ORM excretion compared to healthy controls (0.29 vs 0.08mg/mmol, p<0.001). After cardiac surgery, a rapid 10-fold elevation in u-ORM/u-CREAT levels was found. The values remained high till the 3rd postoperative day, and they then decreased significantly (p<0.01) on the 5th day after surgery. u-ORM/u-CREAT mirrored well the perioperative tendency of hs-CRP levels, but it did not follow the non-decreasing kinetics of serum ORM concentrations during the follow-up. u-ORM/u-CREAT correlated significantly (p<0.001) with inflammatory parameters (hs-CRP, se-ORM, WBC). CONCLUSIONS: We described u-ORM as an early and sensitive marker of inflammatory activation. The rapid elevation of u-ORM/u-CREAT after surgery and its postoperative kinetics could reflect the magnitude of inflammatory response better than serum ORM and similar to hs-CRP. u-ORM measurements might provide a novel non-invasive tool for real-time monitoring of systemic inflammation, however further investigations are required to confirm it.

The issue of plasma asymmetric dimethylarginine reference range - A systematic review and meta-analysis.

BACKGROUND: Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide synthase, marker and mediator of endothelial dysfunction. Several studies have demonstrated its value in cardiovascular risk stratification and all-cause mortality prediction. The aim was to determine the reference range of plasma ADMA in healthy adults. METHODS AND RESULTS: Taking into account the most widely used ADMA measurement methods, only studies using either high performance liquid chromatography (HPLC) -with fluorescence or mass spectrometric detection-, or enzyme-linked immunosorbent assay (ELISA) to quantify plasma ADMA concentrations were enrolled. 66 studies were included in the quantitative analysis (24 using ELISA and 42 using HPLC) reporting a total number of 5528 non-diabetic, non-hypertensive, non-obese adults without any medication (3178 men and 2350 women, 41.6 ± 16.9 years old). The reference range of ADMA (in µmol/l with 95% confidence interval in parenthesis) was 0.34 (0.29-0.38)- 1.10 (0.85-1.35) with a mean of 0.71 (0.57-0.85) (n = 4093) measured by HPLC and 0.25 (0.18-0.31)- 0.92 (0.76-1.09) with a mean of 0.57 (0.48-0.66) (n = 1435) by ELISA. CONCLUSIONS: Numerous publications suggested that asymmetric dimethylarginine is not only an outstanding tool of disease outcome prediction but also a new potential therapeutic target substance; the reference range provided by this meta-analysis can become of great importance and aid to further investigations. However, developing a standard measurement method would be beneficial to facilitate the clinical usage of ADMA.

Angiotensin-converting Enzyme Inhibition Improves the Effectiveness of Transcutaneous Carbon Dioxide Treatment.

AIM: To study the effect of carbon dioxide (CO2) therapy on the nitric oxide (NO) pathway by monitoring plasma asymmetric dimethylarginine (ADMA) concentrations. PATIENTS AND METHODS: Forty-seven hypertensive patients who underwent transcutaneous CO2 therapy were enrolled. Thirty healthy individuals were recruited for the control group. Blood samples were taken one hour before, as well as one hour, 24 hours and 3 weeks after the first CO2 treatment. Controls did not undergo CO2 treatment. Plasma ADMA levels were measured by ELISA. RESULTS: ADMA levels decreased significantly one hour after the first CO2 treatment compared to the baseline concentrations (p=0.003). Significantly greater reduction was found among patients in whom angiotensin converting enzyme inhibitors (ACEIs) were administered (p=0.019). CONCLUSION: The short- and long-term decrease of ADMA levels suggests that CO2 is not only a vasodilator, but also has a beneficial effect on the NO pathway. ACE inhibition seems to enhance the effect of CO2 treatment.

[Psoriasis and oxidative stress]. / A psoriasis és az oxidatív stressz.

Psoriasis is among the most common dermatological diseases worldwide. Its significance is emphasized by adverse effects on quality of life, caused by chronic pain, physical and psychical disability due to psoriatic plaques. Besides the development of psoriatic arthritis, which often causes permanent joint damage, former studies revealed an increased risk of inflammatory bowel disease, cardiovascular disease and certain types of cancer. Genetic predisposition and oxidative stress caused by exogenous and endogenous factors can contribute to abnormal differentiation and hyperproliferation of keratinocytes, accordingly the development and maintenance of psoriasis. Moreover, excessive oxidative stress can be responsible for the onset of psoriasis complications. After a brief pathophysiological summary the authors discuss the role of oxidative stress in the development of psoriasis and its complications through several well studied biomarkers (asymmetric dimethylarginine, malondialdehyde, superoxide dismutase, catalase). Orv. Hetil., 2016, 157(45), 1781-1785.

New Validated Signal-averaging-based Electrocardiography Method to Determine His-ventricle Interval.

BACKGROUND/AIM: The signal-averaging (SA) technique is used to record high-resolution electrocardiograms (HRECGs) showing cardiac micropotentials. We aimed to develop a non-invasive signal-averaging-based portable bedside device to determine His-ventricle interval. PATIENTS AND METHODS: After amplifying the HRECG recordings, signal duration and voltage can be measured up to four decimal precision. To validate our system, comparison of the invasively and non-invasively determined HV intervals has been performed in 20 patients. RESULTS: Our workgroup has developed a system capable of displaying and measuring cardiac micropotentials on storable ECG. Neither related paired-sample T-test (p=0.263) nor Wilcoxon's non-parametric signed ranks test (p=0.245) showed significant deviations of the HV intervals. Furthermore, related paired-sample T-test showed strong correlation (corr=0.910, p<0.001) between HV intervals determined by electrophysiology (EP) and non-invasive measurements. CONCLUSION: Our research group managed to assemble and validate an easy to use device capable of determining HV intervals even under ambulatory conditions.

Monitoring of L-Arginine and Endogenous Dimethylarginines in Survivor Septic Patients - A Pilot Study.

BACKGROUND/AIM: Nitric oxide (NO) pathway plays a major role in the development and advancement of inflammation. We aimed to design a study and investigate its feasibility to show the changes of L-arginine, asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA), which are important regulators of the NO pathway. PATIENTS AND METHODS: Concentrations of L-arginine, ADMA and SDMA were measured by liquid chromatography-tandem mass spectrometry. Seventeen septic survival patients were enrolled and blood samples were obtained on the first, third and fifth day after the diagnosis of sepsis. Sixteen non-septic matched controls were recruited. RESULTS: ADMA levels on admission correlated well with sequential organ failure assessment (SOFA) score. During the follow-up, L-arginine/ADMA ratio increased significantly from day 1 to day 3 (p=0.005), then decreased from day 3 to day 5 (p=0.023). CONCLUSION: This study design seems feasible to investigate changes of L-Arginine, ADMA and SDMA in sepsis survival patients.

[Asymmetric dimethylarginine: predictor of cardiovascular diseases?]. / Aszimmetrikus dimetilarginin: a cardiovascularis betegségek prediktora?

Cardiovascular diseases are the most common diseases worldwide. They are responsible for one third of global deaths and they are the leading cause of disability, too. The usage of different levels of prevention in combination with effective risk assessment improved these statistical data. Risk assessment based on classic risk factors has recently been supported with several new markers, such as asymmetric dimethylarginine, which is an endogenous competitive inhibitor of nitric oxide synthase. Elevated levels of asymmetric dimethylarginine have been reported in obese, smoker, hypercholesterolemic, hypertensive and diabetic patients. According to previous studies, asymmetric dimethylarginine is a suitable indicator of endothelial dysfunction, which is held to be the preceding condition before atherosclerosis. Several researches found positive correlation between higher levels of asymmetric dimethylarginine and coronary artery disease onset, or progression of existing coronary disease. According to a study involving 3000 patients, asymmetric dimethylarginine is an independent risk factor of cardiovascular mortality in patients with coronary artery disease. This article summarizes the role of asymmetric dimethylarginine in prediction of cardiovascular diseases, and underlines its importance in cardiovascular prevention.

The assessment of neural injury following open heart surgery by physiological tremor analysis.

INTRODUCTION: The appearance of post-operative cognitive dysfunction as a result of open heart surgery has been proven by several studies. Focal and/or sporadic neuron damage emerging in the central nervous system may not only appear as cognitive dysfunction, but might strongly influence features of physiological tremor. MATERIAL AND METHODS: We investigated 110 patients (age: 34-73 years; 76 male, 34 female; 51 coronary artery bypass grafting (CABG), 25 valve replacement, 25 combined open heart surgery, 9 off-pump CABG) before surgery and after open-heart surgery on the 3(rd) to 5(th) post-operative day. The assessment of the physiological tremor analysis was performed with our newly developed equipment based on the Analog Devices ADXL 320 JPC integrated accelerometer chip. Recordings were stored on a PC and spectral analysis was performed by fast Fourier transformation (FFT). We compared power integrals in the 1-4 Hz, 4-8 Hz and 8-12 Hz frequency ranges and these were statistically assessed by the Wilcoxon rank correlation test. RESULTS: We found significant changes in the power spectrum of physiological tremor. The spectrum in the 8-12 Hz range (neuronal oscillation) decreased and a shift was recognised to the lower spectrum (p < 0.01). The magnitude of the shift was not significantly higher for females than for males (p < 0.157). We found no significant difference between the shift and the cross-clamp or perfusion time (p < 0.6450). CONCLUSIONS: The assessment of physiological tremor by means of our novel, feasible method may provide a deeper insight into the mechanism of central nervous system damage associated with open heart surgery.