Intensity of Stripping and Sugar Content in the Bark and the Bast of European Beech (Fagus Sylvatica).

The choice of particular trees for stripping by deer is puzzling because a preference is observed for trees of the highest social class. Trees ranked highest in the stand can produce more carbohydrates as a product of carbon assimilation. Among the many important nutrient and defense groups of metabolites in plants, high sugar content is postulated to be an attractant due to its impact on the sense of taste of different herbivores. Thus, we hypothesize that the carbohydrate content in the bast of the European beech is the most important factor by which deer make their choice. Our aim was to assess whether the sugar content in the bark and in the bast can be a factor which influences the intensity of bark stripping of particular trees in a beech thicket by red deer. A single episode connected with tree damaging pertained to 7% of the trees on the analyzed sampling plots. In total, 27% of the trees were damaged, including old damages. The mean size of damage to a given tree equaled 36% of the tree's circumference and 0.06 m2 of the trunk's surface. Analysis of the sugar content in the bast and in the bark jointly indicates that the trees subjected to bark stripping possessed a distinctly higher sugar content than the trees which were not damaged. The probability of bark stripping grows together with an increase in the sugar content of the bark and of the bast.

Role of impaired glucose tolerance in patients with acute myocardial infarction in relation to sex.

INTRODUCTION: Impaired glucose tolerance (IGT) has a negative impact on the outcome of patients with acute myocardial infarction (AMI). OBJECTIVES: The aim of the study was to compare the effect of IGT on early and late prognosis in women and men with AMI treated with percutaneous coronary intervention (PCI). PATIENTS AND METHODS: Based on the results of oral glucose tolerance test, 560 patients with IGT (395 men, 165 women) were selected out of a single center registry of 2733 consecutive patients with AMI. Sex­related mortality and major adverse cardiovascular events (MACEs) including myocardial reinfarction, stroke, or repeat revascularization during hospitalization and long­term follow­up were compared in the whole study population and within the high­risk subgroups. RESULTS: Mortality and MACE rates were comparable between men and women except for a higher stroke rate in women (4.8% vs. 1.5%, P <0.05). No significant differences were observed in the subgroups of patients with reduced ejection fraction (<35%) and those aged above 70 years, during both short and long­term follow­up. However, in women compared with men, higher stroke rates were observed in the subgroup of patients with incomplete revascularization (6.9% vs. 1.1%, P <0.05) and higher total mortality rates in the subgroup with renal dysfunction (40% vs. 16%, P <0.05). Female sex was an independent risk factor for stroke (hazard ratio [HR], 2.94; P = 0.048) and MACEs (HR, 1.45; P = 0.009), but not for death, in the population of patients with AMI and IGT. CONCLUSIONS: Mortality in women and men with AMI treated with PCI with concomitant IGT is comparable, but female sex is an independent risk factor for stroke and MACEs, particularly worsening prognosis in patients with renal dysfunction.

Effect of type of atrial fibrillation on prognosis in acute myocardial infarction treated invasively.

To assess the incidence of atrial fibrillation (AF) and the clinical impact of AF types on outcomes in patients with acute myocardial infarction (AMI) treated invasively, we analyzed 2,980 consecutive patients with AMI admitted to our department from 2003 through 2008. Data collected by the insurer were screened to identify patients who died during the median follow-up of 41 months. AF was recognized in 282 patients (9.46%, AF group); the remaining 2,698 patients (90.54%) were free of this arrhythmia (control group). The AF group was divided into 3 subgroups: prehospital paroxysmal AF (n = 92, 3.09%), new-onset AF (n = 109, 3.66%), and permanent AF (n = 81, 2.72%). In-hospital and long-term mortalities were significantly higher (p <0.001 for the 2 comparisons) in the AF than in the control group (14.9% vs 5.3%, 37.2% vs 17.0%, respectively). Long-term mortality was significantly higher (p <0.001 for the 2 comparisons) in the new-onset AF (35.8%) and permanent AF (54.3%) groups than in the control group but did not differ significantly between the prehospital AF and control groups (21.7% vs 17.0%, p = NS). Considering types of arrhythmia separately, only permanent AF (hazard ratio 2.59) was an independent risk factor for death in the studied population. In conclusion, AF occurs in 1 of 10 patients with AMI treated invasively, with nearly equal distributions among prehospital, new-onset, and permanent forms. Although arrhythmia is a marker of worse short- and long-term outcomes, only permanent AF is an independent predictor for death in this population.

Radial vs femoral approach with StarClose clip placement for primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction. RADIAMI II: a prospective, randomised, single centre trial.

BACKGROUND: Compared to the transfemoral approach (TFA), the transradial approach (TRA) for primary percutaneous coronary intervention (PCI) is associated with less risk of access site complications, greater patient comfort and faster mobilisation. Using vascular closure devices during TFA can offer similar advantages. AIM: To compare the results of TRA and TFA using a StarClose device for primary PCI in patients with ST-elevation myocardial infarction (STEMI). METHODS: Patients were randomised to PCI using TRA (n = 49) or PCI using TFA and StarClose (n = 59). RESULTS: Door-to-balloon inflation time was 67.4 ± 17.1 vs 57.5 ± 17.5 min (p = 0.009) in the TRA and TFA groups respectively. Procedural success rate was 100% and 98.3%, respectively (NS). There were no significant differences in the incidence of major adverse cardiac events (MACE) or bleeding complications between the groups: 2.1% and 8.2% in the TRA group vs 1.7% and 10.2% in the TFA group (NS). Time to resume an upright position and time to full mobility was comparable in both groups. CONCLUSIONS: The TRA for PCI in patients with STEMI is related to a significantly longer door to balloon time compared to the TFA. This had no influence on the incidence of MACE. The duration and efficacy of PCI were comparable in both groups. Using StarClose after PCI performed via the TFA resulted in an incidence of access site and bleeding complications comparable to that found when using TRA.

The impact of unsuccessful percutaneous coronary intervention on short- and long-term prognosis in STEMI and NSTEMI.

OBJECTIVES: To compare the impact of the efficacy of percutaneous coronary intervention (PCI) on prognosis in ST and non-ST elevation myocardial infarction (STEMI and NSTEMI) patients with respect to infarct-related artery (IRA). BACKGROUND: The significance of the efficacy of PCI in STEMI and NSTEMI depending on the type of IRA has yet to be clarified. METHODS: Study population consisted of 2,179 STEMI and 554 NSTEMI consecutive patients treated with urgent PCI. The efficacy of PCI (TIMI [thrombolysis in myocardial infarction] 3 vs. TIMI < 3) was assessed with regard to the type of IRA (left anterior descending artery, circumflex artery [Cx] or right coronary artery). The mean follow-up was 37.5 months. RESULTS: The rate of unsuccessful PCI was similar in STEMI and NSTEMI irrespectively of IRA (14.1 vs. 17.7%; P = 0.062). In STEMI, unsuccessful PCI was associated with significantly higher early (23.1 vs. 5.6%; P < 0.001) and late (29.9 vs. 12.8%; P < 0.001) mortality regardless of IRA. In NSTEMI, the inefficacious PCI significantly increased early (19.0% vs. 0.9%; P < 0.001) and late (27.3% vs. 6.3%; P < 0.001) mortality only in patients with Cx-related infarction. Unsuccessful PCI of IRA was an independent risk factor for death in STEMI (HR 1.64; P < 0.05), but not in NSTEMI (P = 0.64). Further analysis showed that whilst unsuccessful PCI of any vessel in STEMI is an independent risk factor for death, in NSTEMI this applies to unsuccessful PCI of Cx only. CONCLUSIONS: The significance of unsuccessful PCI of IRA seems to be different in STEMI and NSTEMI. Unsuccessful PCI is an independent risk factor for death in STEMI regardless of IRA and in NSTEMI with the involvement of Cx.

Prognostic significance of hyperuricemia in patients with different types of renal dysfunction and acute myocardial infarction treated with percutaneous coronary intervention.

AIM: This study evaluated the impact of hyperuricemia (HUR) on outcome in patients with different types of impaired renal function (IRF) and acute myocardial infarction (AMI) treated invasively. METHODS: Out of 3,593 consecutive AMI patients treated invasively, 1,015 IRF patients were selected. The IRF group consisted of patients with baseline kidney dysfunction (BKD group) and/or patients with contrast-induced nephropathy (CIN group). HUR was defined as a serum uric acid concentration (SUAC) >420 µmol/l (>7 mg/dl). Independent predictors of death and major adverse cardiovascular events (MACE) were selected by the multivariate Cox-regression model. RESULTS: Remote mortality rates were higher in HUR patients: IRF (32.7 vs. 18.6%), BKD (41.3 vs. 25.9%), CIN (35.4 vs. 16.7%); all p < 0.001. HUR was an independent predictor of death in BKD (hazard ratio (HR) 1.38, p < 0.05). Each 100-µmol/l increase in SUAC was associated with a significant increase of HR for mortality: 1.087 in IRF patients, 1.108 in BKD patients, 1.128 in CIN patients; all p < 0.05. Remote major adverse cardiovascular event rates were higher in HUR patients: IRF (55.4 vs. 48.9%), CIN (56.8 vs. 48%); both p < 0.05. CONCLUSIONS: In AMI patients treated invasively, an increase in SUAC is an independent predictor of death within all types of renal dysfunction; HUR defined as SUAC >420 µmol/l (>7 mg/dl) is a predictor only in BKD patients.

Effect of anemia in high-risk groups of patients with acute myocardial infarction treated with percutaneous coronary intervention.

The significance of anemia in patients with acute myocardial infarction (AMI) treated with percutaneous coronary intervention (PCI) remains controversial. The aim of the present study was to evaluate the effect of anemia on the short- and long-term prognosis of patients with AMI treated with PCI, including high-risk subgroups. The study group consisted of 1,497 consecutive patients with AMI treated in the acute phase with PCI. Anemia was defined using World Health Organization criteria (hemoglobin level <13 g/dl for men and <12 g/dl for women). The study population was divided into 2 major groups (patients with [n = 248, 16.6%] and without [n = 1,249, 83.4%] anemia) and 6 subgroups (diabetes mellitus, impaired renal function, age >70 years, left ventricular dysfunction, incomplete revascularization, and multivessel disease). A comparative analysis was performed between both groups within the whole population and within the particular subgroups. Significantly greater 30-day (13.2% vs 7.3%), 1-year (20.5% vs 11.3%), and total (24.1% vs 12.7%; all p <0.05) mortality rates were observed in the anemic group. Multivariate analysis identified anemia as an independent predictor of any-cause death in the whole population during the observation period (covariate-adjusted hazard ratio 1.46, 95% confidence interval 1.31 to 1.61, p <0.05). Anemia was significantly associated with excessive long-term mortality in the multivessel disease group (adjusted hazard ratio 1.54, 95% confidence interval 1.34 to 1.74) and in the incomplete revascularization group (hazard ratio 1.67, both p <0.05). In conclusion, anemia on admission in patients with AMI treated in the acute phase with PCI was independently associated with increasing short- and long-term mortality, especially in the subgroups with incomplete revascularization and multivessel disease.

RADIal versus femoral approach for percutaneous coronary interventions in patients with Acute Myocardial Infarction (RADIAMI): A prospective, randomized, single-center clinical trial.

BACKGROUND: The transradial approach for percutaneous coronary intervention (PCI) seems to be superior to transfemoral. The safety and efficacy of transradial approach for PCI in acute myocardial infarction is not well-established. METHODS: Hundred patients with acute myocardial infarction qualified to PCI were randomly assigned to transradial (group I; n = 50) and transfemoral (group II; n = 50) approaches. RESULTS: PCI was successful for almost all patients, except one from group II. There were no significant differences between groups in X-ray exposition, volume of contrast and total procedure duration. Small but significant elongation of door to stent time in group I was caused mostly by a longer time between beginning of procedure and arterial sheath introduction. Major bleeding complications occurred in three patients from group I and seven from group II. There were no significant differences observed between the two groups. Time to ambulation in group I was significantly shorter then in group II (22.6 +/- 10.3 h vs. 34.7 +/- 34.6 h; p = 0.003). CONCLUSIONS: The transradial approach for PCI in acute myocardial infarction has the same efficacy as transfemoral. There are no differences in total procedure duration, X-ray exposition or volume of contrast between the two approaches. A longer time from the patient's admission to the individual stages of the PCI procedure in group I was mostly due to the longer times of the initial stages of the procedure. The use of transradial approach reduces the time to ambulation and allows rehabilitation to begin sooner. In both groups, bleeding complications occurred rarely.

Risk stratification according to the type of impaired renal function in patients with acute myocardial infarction treated with percutaneous coronary intervention.

BACKGROUND: It has been shown that successful reperfusion improves in-hospital and long-term outcome of patients with acute myocardial infarction (AMI). Nevertheless, some patients are still at high risk due to AMI despite achievement of reperfusion. Impaired renal function (IRF) is one of the recently recognised risk factors in this population. However, the prognostic value of different types of IRF in patients with AMI treated with percutaneous coronary intervention (PCI) has not been well characterised. AIM: To evaluate the prognostic value of different types of IRF in AMI patients treated with PCI. METHODS: The single centre AMI registry encompassed 1486 consecutive AMI patients treated with PCI, who were followed for a mean of 29.7 months. Subjects with at least 1 measurement of serum creatinine >133 micromol/l (>1.5 mg/dl) during hospitalisation were selected (n=194; 13.1%) and incorporated into the IRF group. The control group consisted of 1292 (86.9%) subjects with normal renal function. The IRF patients were divided into subgroups: contrast-induced nephropathy--CIN (n=90; 6.1%); and chronic kidney disease--CKD (n=66; 4.4%). Thirty-eight patients from the IRF group (2.6%) had normal value of serum creatinine on admission and did not match criteria of CIN. Patients with creatinine value >133 micromol/l on admission were incorporated into the CKD group. CIN was defined as a serum creatinine level <134 micromol/l on admission and a 25% increase of that parameter, with a value >133 micromol/l within 48 hours after PCI. Among CIN patients 2 subgroups were identified with respect to coexisting diabetes mellitus: CIN-DM and CIN-nDM (both n=45; 3.05%). RESULTS: Remote mortality rate was significantly higher in the IRF group (38.7%) and in particular subgroups--CKD (51.5%), CIN-DM (46.7%), CIN-nDM (28.9%)--than in controls (10.3%, p <0.001 for all study groups vs. controls). Multivariate analysis identified IRF as an independent predictor of any-cause death in the whole population [hazard ratio (HR) 2.23; 95% CI 1.99-2.47, p <0.001]. All defined types of IRF had a significant and independent influence on remote survival in the study population (CIN-DM - HR 3.52; 95% CI 3.23-3.81; CIN-nDM--HR 2.60; 95% CI 2.29-2.91; CKD--HR 1.98; 95% CI 1.68-2.28). CONCLUSIONS: Impaired renal function and all defined types of renal impairment have been shown to worsen the long-term prognosis of AMI patients treated with PCI. The most important risk factor of mortality is CIN in diabetic patients, which is associated with an over 3.5-fold increase of death hazard in this study population.

A comparison of the clinical course of preexcitation syndrome in children and adolescents and in adults.

BACKGROUND: Atrioventricular reentrant tachycardia (AVRT) in patients with preexcitation syndrome (PS) is the main cause of paroxysmal regular arrhythmias in children and adolescents. While the previously published data most commonly concern clinical consequences of PS in adults, few researchers have evaluated the problem in children and adolescents. The aim of the study was to compare the clinical course of PS between the population of children and adolescents below 19 years of age and the population of adult patients. METHOD: The study population consisted of 302 consecutive PS patients managed between January 2001 and June 2005 with radiofrequency catheter ablation (RFCA). The study population was divided into two groups: Group 1 consisting of 52 patients aged 15.38 years on average (7-18 +/- +/- 2.53) and Group 2 consisting of 250 adult patients aged 38.67 years on average (19-72 +/- 13.1). RESULTS: Patients from Groups 1 and 2 experienced their first episode of AVRT at the mean age of 13.3 years and 29.1 years, respectively (p < 0.05). The mean annual numbers of AVRT episodes in Groups 1 and 2 were 12.97 (range, 2-96; median, 8) and 8.86 (range, 2-25; median, 6), respectively (p = non-significant). Two patients from Group 1 (3.85%) and 42 patients from Group 2 (16.8%) experienced episodes of atrial fibrillation (AF) (p < 0.05). Location of the accessory pathways (AP): In Group 1, the right free wall and anteroseptal AP locations were significantly more common [11 (21.15%) and 9 (17.31%) patients, respectively, vs.q 19 (7.6%) and 13 (5.2%) patients in Group 2; p < 0.01]. In Group 2, the left anterolateral AP location was more common [81 (32.4%) vs. 4 (7.69%) in Group 1; p < 0.01]. CONCLUSIONS: In children and adolescents with PS, a significantly lower incidence of AF was found. In Group 1, RFCA was performed significantly more frequently due to the development of AVRT caused by right free wall and right anteroseptal AP, while in the group of adults, the left anterolateral AP location was found more commonly. (Cardiol J 2007; 14: 384-390).