The effectiveness and safety of one-stage iStent-based micro-invasive glaucoma surgery-A retrospective study.

Purpose: Micro-invasive glaucoma surgery involves a group of treatment methods associated with a low rate of side effects and good effectiveness outcomes. One of the most frequently performed procedures belonging to this group is iStent microstent implantation. The aim of this study was to perform a retrospective evaluation of the safety and efficacy of a combined procedure involving cataract phacoemulsification and single iStent microstent implantation, performed simultaneously. Materials and methods: The complete medical records of 62 patients (91 eyes) were analyzed retrospectively, including the best corrected visual acuity, intraocular pressure, the mean defect of visual fields, and the number of active substances used in eye drops. The follow-up times were 1, 3, 6, 9, and 12 months after the surgical procedure. Results: A significant improvement in the best corrected visual acuity and a reduction of the intraocular pressure were achieved after the surgery. On average, after 12 months, the best corrected visual acuity improved from 0.70 (0.25) to 0.91 (0.18; p = 0.001), the intraocular pressure reduced from 17.76 (3.95) to 14.91 (3.04; p = 0.0001), and the number of active substances used in eye drops reduced from 2.07 (1.08) to 0.70 (0.06; p = 0001). In addition, we found that patients who initially showed higher intraocular pressure values did not benefit from surgery in the aspect of the number of active substances used in their eye drops. Intraoperative and postoperative adverse events were transient and ultimately did not affect the outcomes. Conclusion: Simultaneous cataract phacoemulsification with single iStent implantation in patients with open-angle glaucoma is a safe and effective method for reducing intraocular pressure and the number of topical medications that must be used. Having initially higher intraocular pressure values may limit the beneficial effects of iStent implantation by subordinating patients from topical treatment; thus, single iStent implantation may not be the most favorable choice in uncontrolled glaucoma cases.

Effects of scaling direction on adults' spatial scaling in different perceptual domains.

The current study investigated adults' strategies of spatial scaling from memory in three perceptual conditions (visual, haptic, and visuo-haptic) when scaling up and down. Following previous research, we predicted the usage of mental transformation strategies. In all conditions, participants (N = 90, aged 19-28 years) were presented with tactile, colored graphics which allowed to visually and haptically explore spatial information. Participants were first asked to encode a map including a target. Then, they were instructed to place a response object at the same place on an empty, constant-sized referent space. Maps had five different sizes resulting in five scaling factors (3:1, 2:1, 1:1, 1:2, 1:3). This manipulation also allowed assessing potentially symmetric effects of scaling direction on adults' responses. Response times and absolute errors served as dependent variables. In line with our hypotheses, the changes in these dependent variables were best explained by a quadratic function which suggests the usage of mental transformation strategies for spatial scaling. There were no differences between perceptual conditions concerning the influence of scaling factor on dependent variables. Results revealed symmetric effects of scaling direction on participants' accuracy whereas there were small differences for response times. Our findings highlight the usage of mental transformation strategies in adults' spatial scaling, irrespective of perceptual modality and scaling direction.

Implicit spatial sequential learning facilitates attentional selection in covert visual search. An event-related potentials study.

Introduction: While most studies on implicit sequential learning focus on object learning, the hidden structure of target location and onset time can also be a subject of implicitly gathered knowledge. In our study, we wanted to investigate the effect of implicitly learned spatial and temporal sequential predictability on performance in a localization task in a paradigm in which covert selective attention is engaged. We were also interested in the neural mechanism of the facilitating effect of the predictable spatio-temporal context on visual search processes. Specifically, with the use of an event-related potential technique, we wanted to verify whether perceptual, attentional, and motor processes can be enhanced by the predictive spatio-temporal context of visual stimuli. Methods: We analyzed data from 15 young, healthy adults who took part in an experimental electroencephalographic (EEG) study and performed a visual search localization task. Predictable sequences of four target locations and/or target onset times were presented in separate blocks of trials that formed the Space, Space- Time, and Time conditions. One block of trials with randomly presented stimuli served as a control condition. Results: The behavioral results revealed that participants successfully learned only the spatial dimension of target predictability. Although spatial predictability was a response-relevant dimension, we found that attentional selection-instead of motor preparation-was the facilitation mechanism in this type of visual search task. This was manifested by a shorter latency and more negative amplitude of the N2pc component and the lack of an effect on the sLRP component. We observed no effect of predictability on perceptual processing (P1 component). Discussion: We discuss these results with reference to the current knowledge on sequential learning. Our findings also contribute to the current debate on the predictive coding theory.

Adults' spatial scaling from memory: Comparing the visual and haptic domain.

The current study compared adults' spatial scaling from memory in the visual and haptic domain. Adults (N = 32, ages 19-27 years) were presented with a spatial-scaling task in a visual condition as well as a haptic condition (in which participants were blindfolded throughout the experimental session). In both conditions, they were presented with an embossed graphic including a target (i.e., a map). Then, they were asked to encode this map and to place a disc at the same spot on an empty referent space from memory. Maps had three different sizes whereas the referent space had a constant size, resulting in three different scaling factors (1:1, 1:2, 1:4). Participants' response times and absolute errors were measured. Order of perceptual condition was counterbalanced across participants. Analyses indicated that response times and absolute errors increased linearly with higher scaling factors in the visual as well as the haptic perceptual condition. In analogy to mental imagery research, these results suggest the usage of mental transformation strategies for spatial scaling.

The influence of resistance training on muscle strength, irisin concentration, and metabolic parameters in type 1 diabetic patients.

INTRODUCTION: Resistance effort has a beneficial effect on muscle mass, body composition, bone density, and cardiac parameters. It is also a modulator of the inflammatory reaction. The aim of the study was to assess the impact of 3 months of resistance training on muscle strength, irisin levels, and metabolic parameters in patients with long-term type 1 diabetes. MATERIAL AND METHODS: Eleven type 1 male diabetic patients with low levels of physical activity were recruited, with mean age 38 ± 6 years, body mass index (BMI) 28.4 ± 2.6 kg/m², and diabetes duration 23 ± 7 years. All subjects participated in 60-minute resistance training sessions twice a week, for three months. At baseline and after 3 months in all patients, maximal muscle strength level, serum irisin concentration, metabolic control parameters, and anthropometric measures were assessed. RESULTS: After 3 months there was a statistically significant increase of maximal muscle strength in comparison to baseline. There was no significant change in serum irisin concentration, HbA1c, or other assessed parameters. CONCLUSION: A 3-month resistance training programme in patients with long-term type 1 diabetes and low level of physical activity significantly affects their maximum strength level. This indicates that people with diabetes are more adaptive to additional loads, which allows them to increase their load faster.

Differences in adults' spatial scaling based on visual or haptic information.

The present study examined differences in adults' spatial-scaling abilities across three perceptual conditions: (1) visual, (2) haptic, and (3) visual and haptic. Participants were instructed to encode the position of a convex target presented in a simple map without a time limit. Immediately after encoding the map, participants were presented with a referent space and asked to place a disc at the same location from memory. All spaces were designed as tactile graphics. Positions of targets varied along the horizontal dimension. The referent space was constant in size while sizes of maps were systematically varied, resulting in three scaling factor conditions: 1:4, 1:2, 1:1. Sixty adults participated in the study (M = 21.18; SD = 1.05). One-third of them was blindfolded throughout the entire experiment (haptic condition). The second group of participants was allowed to see the graphics (visual condition); the third group were instructed to see and touch the graphics (bimodal condition). An analysis of participants' absolute errors showed that participants produced larger errors in the haptic condition as opposed to the visual and bimodal conditions. There was also a significant interaction effect between scaling factor and perceptual condition. In the visual and bimodal conditions, results showed a linear increase in errors with higher scaling factors (which may suggest that adults adopted mental transformation strategies during the spatial scaling process), whereas, in the haptic condition, this relation was quadratic. Findings imply that adults' spatial-scaling performance decreases when visual information is not available.

The effects of handedness on sensorimotor rhythm desynchronization and motor-imagery BCI control.

Brain-computer interfaces (BCIs) allow control of various applications or external devices solely by brain activity, e.g., measured by electroencephalography during motor imagery. Many users are unable to modulate their brain activity sufficiently in order to control a BCI. Most of the studies have been focusing on improving the accuracy of BCI control through advances in signal processing and BCI protocol modification. However, some research suggests that motor skills and physiological factors may affect BCI performance as well. Previous studies have indicated that there is differential lateralization of hand movements' neural representation in right- and left-handed individuals. However, the effects of handedness on sensorimotor rhythm (SMR) distribution and BCI control have not been investigated in detail yet. Our study aims to fill this gap, by comparing the SMR patterns during motor imagery and real-feedback BCI control in right- (N = 20) and left-handers (N = 20). The results of our study show that the lateralization of SMR during a motor imagery task differs according to handedness. Left-handers present lower accuracy during BCI performance (single session) and weaker SMR suppression in the alpha band (8-13 Hz) during mental simulation of left-hand movements. Consequently, to improve BCI control, the user's training should take into account individual differences in hand dominance.

The Role of Depression and Self-Esteem in Facebook Intrusion and Gaming Disorder among Young Adult Gamers.

In the modern day, it is important to identify the determinants of Facebook addiction and game disorder. The main aim of our study is to examine the relationship between Facebook intrusion, gaming disorder and depression to verify whether depression mediates the relationship between these types of addiction and self-esteem. A total of 235 video game players took place in the study. We used the Facebook Intrusion Scale, Problem Videogame Playing Questionnaire, Patient Health Questionnaire and Rosenberg Self-Esteem Scale. The findings indicate that depression and frequency of use are associated with Facebook intrusion and gaming disorder. Symptoms of depression and time spent using games or Facebook are predictors of these behavioural addictions. The results indicate that depression fully mediated the relationship between self-esteem and these types of addiction. Also, our results demonstrated that the model assuming a correlation between gaming disorder and Facebook intrusion was fitted to data, while the model assuming no correlation was not fitted to data. While previous studies indicated low self-esteem as a predictor of Facebook intrusion and gaming disorder, the current findings indicate that this association is mediated by the depression. Also, our results may support hypotheses of similar addiction mechanisms in the case of gaming disorder and Facebook intrusion.

Aspirin 'resistance': impact on no-reflow, platelet and inflammatory biomarkers in diabetics after ST-segment elevation myocardial infarction.

BACKGROUND: The no-reflow (NR) phenomenon exists despite percutaneous coronary intervention (PCI), and is especially prevalent in diabetics. The causes(s) of NR are not fully elucidated, but may be associated with impaired residual platelet and inflammatory reactivity during dual-antiplatelet therapy. OBJECTIVE: To assess the relationship between dual-antiplatelet therapy, NR and conventional biomarkers suggestive of platelet and inflammatory response in diabetics following ST-segment elevation myocardial infarction (STEMI) treated with PCI. METHODS: Sixty diabetics with (n = 27) and without NR (n = 33) were prospectively enrolled. All patients were treated with clopidogrel and aspirin. Platelet and inflammatory biomarkers were assessed serially in the peripheral blood and right atrium before and after PCI and then at 24 h, 7 days and 30 days. RESULTS: Arachidonic acid (AA)-induced platelet aggregation and the serum thromboxane B2 level before and after PCI (in the peripheral and right atrium blood) were significantly higher in the NR patients than in those with no NR. AA-induced aggregation >100 (AUC*min) before PCI predicted NR in diabetic patients with 96.2% sensitivity and 38.5% specificity (AUC 0.66; 95% CI 0.52-0.71; p = 0.029). There were no other correlations between NR and platelet reactivity (collagen, adenosine diphosphate, thrombin receptor agonist peptide-induced aggregation, vasodilator-stimulated phosphoprotein platelet reactivity index, soluble P-selectin, soluble CD40 ligand, platelet-derived growth factor AB and the level of platelet-monocyte aggregates) or between NR and inflammatory indices (i.e. high-sensitivity C-reactive protein, interleukin 6 and interleukin 10). CONCLUSION: An inadequate response to aspirin, but not to clopidogrel, may be associated with the occurrence of the NR phenomenon in diabetics with STEMI who have been treated with primary PCI.

Thrombin generation and platelet reactivity at hospital discharge and 6-month outcome after the acute coronary syndrome in diabetic and nondiabetic patients.

OBJECTIVES: Increased plasma thrombogenesis and blood platelet reactivity are associated with a worse outcome in patients with the acute coronary syndrome (ACS). The aim of this study was to test the clinical utility of combining a thrombin generation test and platelet aggregation in predicting future ischemic events after ACS. METHODS: The study included patients hospitalized due to ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention with stent implantation. Blood for platelet aggregation and thrombin generation was collected at hospital discharge. We performed whole-blood platelet aggregation with arachidonic acid (AA), collagen, adenosine diphosphate and thrombin receptor-activating peptide (TRAP) as agonists and the thrombin generation test using a fluorescence method. Patients were followed for up to 6 months. The combined end point of the study consisted of death, stroke, myocardial infarction or repeated target vessel revascularization. RESULTS: The study enrolled 161 patients. The end point occurred in 30 patients (18.6%). Thrombin generation showed a significantly prolonged lag time, time to thrombogram peak and start of the tail of the thrombogram in diabetic patients who reached the study end point but not in nondiabetics. End point occurrence was not connected with platelet reactivity at hospital discharge in the whole group. In the diabetic subgroup, increased platelet aggregation induced with AA and TRAP at hospital discharge was connected with a more frequent occurrence of the study end point. CONCLUSIONS: In diabetic patients after STEMI, thrombin generation measures as well as TRAP- and AA-induced platelet aggregation at hospital discharge are associated with an ensuing ischemic event during the 6-month follow-up.

Influence of proliferation signal inhibitors on vascular endothelial growth factor production in heart transplant recipients - preliminary report.

Proliferation signal inhibitors (PSI) are especially beneficial for heart transplant recipients, but are rarely used due to frequent side effects. As they may be caused by vascular endothelial growth factor (VEGF), we performed a prospective cross-sectional pilot study to assess the influence of PSI and/or calcineurin inhibitors (CNI) presence in immunosuppressive protocols of heart transplant recipients on VEGF secretion. All electively screened heart transplant recipients willing to participate were enrolled in the study. The preliminary report was based on the results of the first 89 serum samples. The study group (n = 84) consisted of the PSI group (n = 14) further divided into the PSI + CNI subgroup (n = 10) and PSIw/oCNI subgroup (n = 4) based on concomitant CNI use, and the CNIw/oPSI group (n = 70) receiving CNI without PSI. The control group (n = 5) consisted of patients not requiring immunosuppression. VEGF was present in serum of 70 (83%) study group patients: median (range) 18 (0-316) pg/mL, mean 35 ± 57 pg/mL; in 13 (93%) PSI group patients: 22 (0-110) pg/mL, 28 ± 28 pg/mL, with 19 (8-20) pg/mL, 16 ± 6 pg/mL in the PSI + CNI subgroup, and 29 (0-110) pg/mL, 32 ± 32 pg/mL in the PSIw/oCNI subgroup. In the CNIw/oPSI group VEGF was present in 57 (81%) patients: 16 (0-316) pg/mL, 37 ± 62 pg/mL, and in the control group in 3 (60%) patients: 4 (0-110) pg/mL, 32 ± 48 pg/mL. None of the differences observed between any compared groups and/or subgroups was significant (χ(2) and Mann-Whitney U test). In conclusion, differences of VEGF concentration observed among groups imply the influence of PSI and CNI on VEGF production, but further studies involving higher numbers of participants are needed to prove it.

Effect of glycemic control on response to antiplatelet therapy in patients with diabetes mellitus and ST-segment elevation myocardial infarction.

Impaired glycemic control (GC) is a troubling clinical condition with an unclear prognostic value that is frequent in diabetics, especially in the setting of acute coronary syndrome. Residual platelet reactivity can be also affected by GC. We evaluated the relation between response to dual antiplatelet therapy and GC in diabetics with STEMI treated with primary coronary angioplasty (PCI). Sixty diabetic patients were prospectively enrolled in the study. All patients were treated with clopidogrel and aspirin. Platelet reactivity (whole blood aggregation and phosphorylation of vasodilator-stimulated phosphoprotein, VASP) were assessed serially before and 24 hours, 7 days, and 30 days after the PCI. Blood glucose >8.5 mmol/L on admission was an independent predictor of a impaired clopidogrel response measured with platelet reactivity index (PRI) >50% on admission (OR 7.8, 95% CI 1.4-17.7, p<0.02) and 24 hours after PCI (OR 13.1, 95% CI 3.4-28.1, p<0.01). In conclusion, diabetic patients with STEMI and glycemia >8.5 mmol/L on admission is related to a poorer response to clopidogrel. There were no interaction between glycated hemoglobin level or glycemia on admission and platelet reactivity measured with collagen, arachidonic acid or thrombin receptor agonist peptide-induced aggregation. Further clinical studies of the role of GC in the efficacy of antiplatelet agents are warranted.

Clinical application of monitoring mycophenolic acid trough concentration in heart transplant recipients--single center's experience.

UNLABELLED: The purpose of this study was to assess the clinical utility of mycophenolic acid (MPA) trough concentration monitoring in heart transplant recipients. METHODS: We reviewed 456 MPA plasma level measurements (EMIT/Dade-Behring) which were performed in 76 pts. after orthotopic heart transplantation (OHT): 57 M and 21 F, age 41.9 +/- 16, time after OHT (months) 17.6 +/- 24. Daily dose of mycophenolate mofetil (MMF) was 2-3 g before MPA measurement introduction, then it was adjusted to achieve MPA trough levels (TL) of 2-4 microg/ml. Additionally pts. received either cyclosporine-A (CyA) or tacrolimus and prednisone. We analyzed first MPA levels obtained in pts. without previous monitoring, then we looked for a relation between CyA or tacrolimus and MPA level, and finally we checked for a relation between MPA level and the side-effects of MMF RESULTS: In a group of 59 pts. without earlier MPA level monitoring we found that 36 pts. (61%) had MPA level below, 19 pts. (32%) within, and 4 pts. (7%) above target TL. We identified a group of 11 pts. (characterized by unstable CyA TLs and liver impairment) with a significant positive correlation between CyA and MPA level. For the remaining group of pts. we found a non-significant negative correlation between CyA and MPA concentrations. Target MPA TL was achieved in 40% of cases in pts. with CyA TL below 200 ng/ml (Axsym/Abbott), in 40% of cases in pts. with CyA TL 200-300 ng/ml, and in 27% of cases in pts. with CyA TL over 300 ng/ml. There was no correlation between tacrolimus and MPA level. MPA TL over 4 microg/ml occurred in 22% of results from pts. receiving tacrolimus (n=6) and 11% of pts. on CyA (n=17, p = 0.011). 90% of these pts. had symptoms of GI irritation, 33%--leucopoenia, and 14%--anemia. CONCLUSIONS: It is uncommon to achieve MPA TL of 2-4 microg/ml with typical doses of MMF, especially with concomitant high CyA TL. Typical side effects of MMF should be an indication to check MPA TL.

Influence of long term cyclosporine therapy on insulin and its precursors secretion in patients after heart transplantation.

Diabetes mellitus is a very well recognized risk factor for coronary artery disease in non-transplant patients. With the introduction of new immunosuppressive agents in solid organ recipients, there is an interest in medical complications of immunosuppressive therapy. An influence of long-term cyclosporine-A (CyA) therapy on glucose metabolism was analyzed in a group of 122 heart transplant recipients who developed hyperglycemia after heart transplantation. Based on WHO criteria for diagnosis of diabetes two groups were identified: group 1 (102 pts) included pts with impaired glycemic control and group 2 (20 pts) with clinical diabetes. Fasting insulin, proinsulin, C-peptide, HbA1c and cyclosporine-A trough levels were determined 12-18 months post surgery in clinically stable period without transplant rejection. The immunosuppressive treatment in both groups was the same and consisted of cyclosporine A, azathioprine and prednisone. We observed a statistically significant negative correlation between CyA concentration and insulin in both groups, a statistically significant negative correlation between CyA concentration and proinsulin, C-peptide blood level in group 1 and statistically significant positive correlation between CyA and glucose blood level in both groups.

Diagnosis and treatment of steroid resistant cellular rejection in heart transplant recipients--single center experience.

OBJECTIVES: Aim of the study was to assess frequency and risk factors of steroid resistant cellular rejection (SRR) in heart transplant recipients, to determine methods of its treatment, and to evaluate influence of steroid resistant rejection and method of its treatment on short- and long-term results. METHODS: All pts. received cyclosporine-A, azathioprine and prednisone. Biopsy results > or = 3A (ISHLT) were considered a significant rejection, requiring treatment with 1 g i.v. methylprednizolone for 3 days followed by oral prednisone. SRR was recognized in case of biopsy-proven progression of rejection, lack of improvement in 2 consecutive biopsies, or increasing hemodynamic compromise despite treatment of biopsy-proven rejection. 146 pts. eligible for the study were divided into: study group--15 pts. with SRR (10%), and control group--131 pts. SRR was treated with: cytolytic therapy--ATG (10 pts.), mycophenolate mofetil (3 pts.) or steroids (2 pts.). Number of biopsies > or = 3A, cumulative biopsy score, average biopsy result, effectiveness of SRR treatment, side effects of therapy, and survival were analysed. RESULTS: All parameters characterizing rejection were significantly higher in the study group. No risk factors of SRR were found. In 6 pts. with SRR and hemodynamic compromise (all treated with ATG) improvement was observed in 4 pts, while death occurred in 2 pts. There were no deaths in pts. without hemodynamic compromise--none of 3 methods of treatment was superior, however ATG increased the infection risk. Survival in the 1st year was significantly lower in the study group (67% vs. 89% in the control group). CONCLUSIONS: SRR is recognized in about 10% of heart transplant recipients, increasing risk of death in the 1st year after surgery. Cytolytic therapy increases risk of infection, and should be avoided in pts. without hemodynamic compromise.

[Tumor necrosis factor receptors sTNF-RI and sTNF-RII in advanced chronic heart failure]. / Receptory sTNF-RI i sTNF-RII w zaawansowanej przewleklej niewydolnosci serca. Doniesienie wstepne.

UNLABELLED: The inflammatory process in chronic heart failure (CHF) is the result of dysbalance between the function of inflammatory and natural antiinflammatory mediators. Tumor necrosis factor alpha (TNF-alpha) is increased in patients with severe CHF. Two soluble proteins, the extracellular domains of the TNF receptors (sTNF-RI and sTNF-RII) inhibit the TNF-alpha biological effect. The aim of the study was to examine the plasma levels of sTNF-RI and sTNF-RII in patients with CHF and its relation to clinical, biochemical parameters of CHF severity. 41 patients with CHF (NYHA III and NYHA IV) and 18 control subjects were enrolled in this study. Plasma levels of sTNF-RI and sTNF-RII were analyzed by immunosorbent assay (ELISA) kits R&D (Research and Diagnostics Systems) (pg/ml). RESULTS: CHF patients had significantly increased receptor plasma levels compared to controls (p < 0.001). Soluble sTNF-RI and sTNF-RII receptors levels were similar in class NYHA III and NYHA IV. Receptor sTNF-RII correlated negatively with sodium plasma levels (p < 0.001), and sTNF-RI positively correlated with urice acid plasma level (p < 0.05). No statistically significant correlations were found between those receptors and age and gender etiology and severity of CHF, body weight (BMI) or other examined parameters (clinical, hemodynamic, echocardiographic, holter). CONCLUSIONS: Plasma level of sTNF-RI and sTNF-RII are increased in patients with CHF.