Where are we in 2021 with heart failure with reduced ejection fraction?-current outlook and expectations from new promising clinical trials.

Guideline-directed optimal medical therapy is a well-established therapy in treating patients with heart failure with reduced ejection fraction (HFrEF). Despite clear recommendations, the prognosis in this group of patients is still poor with high mortality. After publishing results of the PARADIGM-HF trial (Prospective Comparison of ARNI-Angiotensin Receptor/Neprilysin Inhibitors-with ACEI-Angiotensin-Converting Enzyme Inhibitor-to Determine Impact on Global Mortality and Morbidity in Heart Failure) clinical investigators accelerated their research. Recently, many new trials have been designed to evaluate the efficacy and safety of promising management, taking into account heterogeneity of population with chronic HFrEF. Determining target doses still poses the biggest problem in standard pharmacotherapy. Implementation of new substances for the HFrEF therapy makes it possible to formulate simple rules of treatment-in most cases, administering a dose of drug in one tablet provides a faster therapeutic effect. The aim of this article is to summarize current knowledge on recently announced findings on novel molecules and to propose a new revolutionary and individualised approach to treatment of HFrEF patients.

TP10-Dopamine Conjugate as a Potential Therapeutic Agent in the Treatment of Parkinson's Disease.

Parkinson's disease (PD) is a common progressive neurodegenerative disorder for which the current treatment is not fully satisfactory. One of the major drawbacks of current PD therapy is poor penetration of drugs across the blood-brain barrier (BBB). In recent years, cell-penetrating peptides (CPPs) such as Tat, SynB, or TP10 have gained great interest due to their ability to penetrate cell membranes and to deliver different cargos to their targets including the central nervous system (CNS). However, there is no data with respect to the use of CPPs as drug carriers to the brain for the treatment of PD. In the presented research, the covalent TP10-dopamine conjugate was synthesized and its pharmacological properties were characterized in terms of its ability to penetrate the BBB and anti-parkinsonian activity. The results showed that dopamine (DA) in the form of a conjugate with TP10 evidently gained access to the brain tissue, exhibited low susceptibility to O-methylation reaction by catechol- O-methyltransferase (lower than that of DA), possessed a relatively high affinity to both dopamine D1 and D2 receptors (in the case of D1, a much higher than that of DA), and showed anti-parkinsonian activity (higher than that of l-DOPA) in the MPTP-induced preclinical animal model of PD. The presented results prove that the conjugation of TP10 with DA may be a good starting point for the development of a new strategy for the treatment of PD.

Association between a urinary biomarker for exposure to PAH and blood level of the acute phase protein serum amyloid A in coke oven workers.

BACKGROUND: Coke oven workers are exposed to both free and particle bound PAH. Through this exposure, the workers may be at increased risk of cardiovascular diseases. Systemic levels of acute phase response proteins have been linked to cardiovascular disease in epidemiological studies, suggesting it as a marker of these conditions. The aim of this study was to assess whether there was association between PAH exposure and the blood level of the acute phase inflammatory response marker serum amyloid A (SAA) in coke oven workers. METHODS: A total of 87 male Polish coke oven workers from two different plants comprised the study population. Exposure was assessed by means of the individual post-shift urinary excretion of 1-hydroxypyrene, as internal dose of short-term PAH exposure, and by anti-benzo[a]pyrene diolepoxide (anti-B[a]PDE)-DNA), as a biomarker of long-term PAH exposure. Blood levels of acute phase proteins SAA and CRP were measured by immunoassay. C-reactive protein (CRP) levels were included to adjust for baseline levels of SAA. RESULTS: Multiple linear regression showed that the major determinants of increased SAA levels were urinary 1-hydroxypyrene (beta = 0.56, p = 0.030) and serum CRP levels (beta = 7.08; p < 0.0001) whereas anti-B[a]PDE-DNA, the GSTM1 detoxifying genotype, diet, and smoking were not associated with SAA levels. CONCLUSIONS: Urinary 1-hydroxypyrene as biomarker of short-term PAH exposure and serum levels of CRP were predictive of serum levels of SAA in coke oven workers. Our data suggest that exposure of coke oven workers to PAH can lead to increased systemic acute response and therefore potentially increased risk of cardiovascular disease.

The analysis of blood lead levels changeability over the 5-year observation in workers occupationally exposed to lead.

The aim of the present study was to compare a group of workers with stable lead levels with a group of workers with fluctuating lead levels in terms of selected hematological, biochemical, and immunological parameters. The examined group included male workers occupationally exposed to lead. Blood lead (PbB) levels were measured every 3 months during the 5-year observation. Based on standard deviation of mean PbB levels, the examined population was divided into two groups: low level of fluctuation (L-SD) and high level of fluctuation (H-SD) groups. The mean and maximal PbB levels were significantly higher in the H-SD group than in the L-SD group by 9 and 22%, respectively. At the same time, the maximal level of zinc protoporphyrin (ZPP) and standard deviation of mean ZPP level were higher in the H-SD group by 29 and 55%, respectively. The maximal level of hemoglobin and white blood cell (WBC) count as well as standard deviation of the mean hemoglobin level and WBC count were higher in the H-SD group by 2, 8, 58, and 24%, respectively. The expression of nuclear factor kappa-B1 gene and telomerase reverse transcriptase gene was significantly greater in the H-SD group than in the L-SD group by 11 and 28%, respectively. Workers occupationally exposed to lead do not represent a homogenous population. Some present stable lead levels, whereas others have fluctuating lead levels. These fluctuations are related to secondary changes in ZPP and hemoglobin levels as well as WBC count.

Telomere length, telomerase expression, and oxidative stress in lead smelters.

The negative health effects caused by lead (Pb) exposure are widely recognized; however, the molecular mechanisms remain unknown. The aim of this study was to assess the effect of occupational Pb exposure on telomere length and to investigate the potential mechanisms leading to telomere shortening. A cohort of 334 male Pb smelters (exposed group) and 60 age-adjusted males unexposed to Pb (control group) were examined. Assessments of relative telomere length (rTL) and telomerase reverse transcriptase (TERT) gene expression were performed using quantitative real-time polymerase chain reactions. Assessments of whole blood Pb (B-Pb) and whole blood cadmium (B-Cd) concentrations and serum selenium concentration (S-Se) were performed using graphite furnace atomic absorption spectrometry. We analyzed total oxidation status (TOS), lipid hydroperoxides (LHPs), malonylodialdehyde levels in serum (MDA) and in erythrocyte hemolysates (MDA-hgb), and 8-hydroxy-deoxy-guanosine (8-OHdG). The Pb-exposed group had higher B-Pb values and shorter rTL than the control group. The arithmetic mean values calculated for B-Pb were 33 µg/dL versus 2.2 µg/dL (p < 0.0001), and the rTL values were 0.928 and 1.126 relative units (p = 0.001), respectively, for the Pb-exposed and control groups. The rTL was found to gradually shorten in response to the increasing levels of Pb exposure. The Pb-exposed group also demonstrated a higher level of oxidative stress than the control group, which was indicated by increased TOS and MDA-hgb values. rTL was negatively associated with parameters that indicated increased oxidative stress, including TOS (Spearman's rank coefficient (rS) = -0.16; p < 0.01) and MDA-hgb (rS = -0.17; p < 0.001). No correlations were found between rTL and B-Cd and S-Se or smoking and MDA and LHP levels. Univariate analysis indicated that B-Pb was associated with decreased rTL (ß =-0.0041; p = 0.0063) and that the association between B-Pb and rTL remained significant, even when adjusting for age (ß = -0.0041; p = 0.0065) and in multivariable-adjusted model (ß = -0.0042; p = 0.0063). In conclusion, occupational Pb exposure resulted in decreased rTL and may represent a mechanism that contributes to Pb-related diseases.

Telomere length in children environmentally exposed to low-to-moderate levels of lead.

Shorter relative telomere length in peripheral blood is a risk marker for some types of cancers and cardiovascular diseases. Several environmental hazards appear to shorten telomeres, and this shortening may predispose individuals to disease. The aim of the present cross-sectional study was to assess the effect of environmental exposure to lead on relative telomere length (rTL) in children. A cohort of 99 8-year-old children was enrolled from 2007-2010. Blood lead concentrations (B-Pb) were measured by graphite furnace atomic absorption spectrometry, and blood rTL was measured by quantitative PCR. The geometric mean of B-Pb was 3.28 µg/dl (range: 0.90-14.2), and the geometric mean of rTL was 1.08 (range: 0.49-2.09). B-Pb was significantly inversely associated with rTL in the children (rS = -0.25, p = 0.013; in further analyses both log-transformed-univariate regression analysis ß = -0.13, p = 0.026, and R(2)adj 4%; and ß = -0.12, p = 0.056 when adjusting for mothers' smoking during pregnancy, Apgar score, mother's and father's ages at delivery, sex and mother's education, R(2)adj 12%, p = 0.011). The effect of lead remained significant in children without prenatal tobacco exposure (N = 87, rS = -0.24, p = 0.024; in further analyses, ß = -0.13, p = 0.029, and R(2)adj 4%). rTL was not affected by sex, the concentrations of other elements in the blood (i.e., cadmium and selenium concentrations), or oxidative injury parameters (total antioxidant status, 8-hydroxydeoxyguanosine and thiobarbituric acid-reactive substances). Lead exposure in childhood appears to be associated with shorter telomeres, which might contribute to diseases, such as cardiovascular disease. The inverse association between blood lead level and the telomeres in children emphasizes the importance of further reducing lead levels in the environment.

New therapeutic options for patients with heart failure with reduced ejection fraction and acute decompensated heart failure.

BACKGROUND: Patients with acute decompensated heart failure (ADHF) are at severe risk of death and rehospitalization. Several clinical studies have been designed to evaluate the efficacy and safety of new molecules administered before discharge or shortly after ADHF. The aim of this article is to summarize current knowledge on recently published findings on treatment of patients with heart failure with reduced ejection fraction (HFrEF) and ADHF. METHODS: We performed a thorough search for literature pertaining to our review via the PubMed database. RESULTS: In this review, we summarize original papers concerning the efficacy and safety of new molecules in patients with HFrEF and ADHF. CONCLUSIONS: Peri-discharge initiation of treatment with new molecules is possible and safe for patients with HFrEF and ADHF. New molecules, if administered before discharge or shortly after, reduce the risk of cardiovascular death or worsening heart failure within the vulnerable phase, and are also nephroprotective.

Profiling of genetic markers useful for breeding decision in Selle Francais horse.

Genetic disorders are recognised as hereditary diseases with the most significant economic impact on horse breeding, causing important foal losses, costs of treatments of horses, and maintenance of the mare during the pregnancy. The Selle Francais horses are recognized in many countries and are showing great results in equestrian sports around the world (dressage, show jumping and eventing). The study aimed to detect the presence of three mutant alleles associated with inherited diseases including Fragile Foal Syndrome (FFS), Cerebellar Abiotrophy (CA), Polysaccharide Storage Myopathy (PSSM1) and variant impacting gait type in DMRT3. This trait is important for breeding decision in Selle Francais horses and sheds new light on genetic potential and risks on this breed. The genotyping was performed on 91 Selle Francais horses using PCR-RFLP (for POLD1; GYS1 and DMRT3 genes) and PCR-ACRS (TOE1 gene) methods. The presented report indicated the presence of mutant allele A casual for PSSM1 and allele T associated with FFS syndrome occurrence, in 4% and 6% of analysed horses, respectively. Regarding CA, the present survey did not register any cases of this genetic disorder in Selle Francais horses. Our results show also that about 1% of all the Sell Francais horses studied carry the A allele of DMRT3 gene. The present findings have provided data for these fulness of monitoring genetic diseases and gait type in the investigated breed to avoid losses of offspring.

Enhancing Healthcare Access-Smartphone Apps in Arrhythmia Screening: Viewpoint.

Atrial fibrillation is the most commonly reported arrhythmia and, if undiagnosed or untreated, may lead to thromboembolic events. It is therefore desirable to provide screening to patients in order to detect atrial arrhythmias. Specific mobile apps and accessory devices, such as smartphones and smartwatches, may play a significant role in monitoring heart rhythm in populations at high risk of arrhythmia. These apps are becoming increasingly common among patients and professionals as a part of mobile health. The rapid development of mobile health solutions may revolutionize approaches to arrhythmia screening. In this viewpoint paper, we assess the availability of smartphone and smartwatch apps and evaluate their efficacy for monitoring heart rhythm and arrhythmia detection. The findings obtained so far suggest they are on the right track to improving the efficacy of early detection of atrial fibrillation, thus lowering the risk of stroke and reducing the economic burden placed on public health.

The Significance of Renal Function in Response to Cardiac Resynchronisation Therapy - A Piece of a Much Larger Puzzle.

BACKGROUND: Although cardiac resynchronisation therapy (CRT) is an important player in the treatment of patients with heart failure (HF), the proportion of CRT patients with no improvement in either echocardiographic or clinical parameters remains consistently high and accounts for about 30% despite meeting CRT implantation criteria. Furthermore, in patients suffering from HF, renal dysfunction accounts for as many as 30-60%. Accordingly, CRT may improve renal function inducing a systemic haemodynamic benefit leading to increased renal blood flow. OBJECTIVES: The aim of the present study was to evaluate the importance of renal function in response to resynchronisation therapy during a 12-month follow-up period. MATERIALS AND METHODS: The study consisted of 46 HF patients qualified for implantation of cardiac resynchronisation therapy defibrillator (CRT-D). A CRT responder is defined as a person without chronic HF exacerbations during observation whose physical efficiency has improved owing to the New York Heart Association (NYHA) class improvement ≥1. RESULTS: A statistically significant difference was noted between responders and non-responders regarding creatinine level at the 3rd month (p=0.04) and, particularly, at the 12th month (p=0.02) of follow-up (100±23 vs 139±78 µmol/l). Moreover, there was a remarkable difference between both study groups with regard to GFR CKD-EPI (glomerular filtration rate (GFR) assessed using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula) at the 6th (p=0.03) and 12th month (p=0.01) of follow-up. The reference values for initial creatinine concentrations (101 µmol/l) as well as GFR CKDEPI (63 ml/min/1.73m2) were empirically evaluated to predict favourable therapeutic CRT response. CONCLUSION: Predictive value of GFR CKD-EPI and creatinine concentration for a positive response to CRT was found relevant.

Physical Effects of Radiation Modification of Biodegradable Xylitol-Based Materials Synthesized Using a Combination of Different Monomers.

There is a possibility of obtaining xylitol-based elastomers sharing common characteristics of biodegradability, thermal stability, and elastomeric behavior by using monomers with different chain-lengths. Therefore, we have synthesized eight elastomers using a combination of four different diols (ethanediol, 1.3-propanediol, 1.4-buanediol, and 1.5-pentanediol) and two different dicarboxylic acids (succinic acid and adipic acid). The obtained materials were further modified by performing e-beam treatment with a dose of 100 kGy. Materials both before and after radiation modification were tested by DSC, DMTA, TGA, tensile tests, gel fraction determination, hydrolytic and enzymatic degradation tests, 1H NMR and 13C NMR and FTIR.

E-Beam Effects on Poly(Xylitol Dicarboxylate-co-diol Dicarboxylate) Elastomers Tailored by Adjusting Monomer Chain Length.

Poly(xylitol dicarboxylate-co-diol dicarboxylate) elastomers can by synthesized using wide variety of monomers with different chain lengths. Obtained materials are all biodegradable, thermally stable elastomers, but their specific properties like glass transition temperature, degradation susceptibility, and mechanical moduli can be tailored for a specific application. Therefore, we synthesized eight elastomers using a combination of two dicarboxylic acids, namely suberic and sebacic acid, and four different diols, namely ethanediol, 1,3-propanediol, 1,4-buanediol, and 1,5-pentanediol. Materials were further modified by e-beam treatment with a dose of 100 kGy. Materials both before and after radiation modification were tested using tensile tests, gel fraction determination, 1H NMR, and 13C NMR. Thermal properties were tested by Differential Scanning Calorimetry (DSC), Dynamic Thermomechanical Analysis (DMTA) and Thermogravimetric Analysis (TGA). Degradation susceptibility to both enzymatic and hydrolytic degradation was also determined.

Tailoring the Physico-Chemical Properties of Poly(xylitol-dicarboxylate-co-butylene dicarboxylate) Polyesters by Adjusting the Cross-Linking Time.

Determining the cross-linking time resulting in the best achievable properties in elastomers is a very important factor when considering their mass production. In this paper, five biodegradable polymers were synthesized-poly(xylitol-dicarboxylate-co-butylene dicarboxylate) polymers, based on xylitol obtained from renewable sources. Five different dicarboxylic acids with even numbers of carbon atoms in the aliphatic chain were used: succinic acid, adipic acid, suberic acid, sebacic acid, and dodecanedioic acid. Samples were taken directly after polycondensation (prepolymer samples) and at different stages of the cross-linking process. Physiochemical properties were determined by a gel fraction test, differential scanning calorimetry (DSC), Fourier-transform infrared spectroscopy (FTIR), quasi-static tensile tests, nuclear magnetic resonance spectroscopy (1H NMR and 13C NMR), and an in vitro biodegradation test. The best cross-linking time was determined to be 288h. Properties and degradation time can be tailored for specific applications by adjusting the dicarboxylic acid chain length.

Influence of e-Beam Irradiation on the Physicochemical Properties of Poly(polyol Succinate-co-Butylene Succinate) Ester Elastomers.

The purpose of this research was synthesis and electron beam modification of novel ester elastomers consisting of sugar alcohol-succinic acid block and butylene glycol-succinic acid block. Four different alditols were used in the synthesis-sorbitol, erythritol, xylitol, and glycerol. The materials were irradiated with doses of 50, 100, and 150 kGy in order to determine which dose is the most beneficial. As expected, irradiation of the materials has led to the cross-link density becoming higher and improvement of the mechanical properties. Additionally, the materials were also sterilized in the process. The great advantage of elastomers described in the paper is the fact that they do not need chemical cross-linking agents or sensitizers in order to undergo radiation modification. The following tests were performed on cross-linked poly(polyol succinate-co-butylene succinate) elastomers: quasi-static tensile test, determination of cross-link density, differential scanning calorimetry (DSC), dynamic thermomechanical analysis (DMTA), wettability (water contact angle), and Fourier transform infrared spectroscopy (FTIR). In order to confirm successful synthesis, prepolymers were analyzed by nuclear magnetic resonance spectroscopy (1H NMR and 13C NMR).

Effect of E-Beam Irradiation on Thermal and Mechanical Properties of Ester Elastomers Containing Multifunctional Alcohols.

The aim of this work was to investigate the thermal and mechanical properties of novel, electron beam-modified ester elastomers containing multifunctional alcohols. Polymers tested in this work consist of two blocks: sebacic acid-butylene glycol block and sebacic acid-sugar alcohol block. Different sugar alcohols were utilized in the polymer synthesis: glycerol, sorbitol, xylitol, erythritol, and mannitol. The polymers have undergone an irradiation procedure. The materials were irradiated with doses of 50 kGy, 100 kGy, and 150 kGy. The expected effect of using ionizing radiation was crosslinking process and improvement of the mechanical properties. Additionally, a beneficial side effect of the irradiation process is sterilization of the affected materials. It is also worth noting that the materials described in this paper do not require either sensitizers or cross-linking agent in order to perform radiation modification. Radiation-modified poly(polyol sebacate-co-butylene sebacate) elastomers have been characterized in respect to the mechanical properties (quasi-static tensile tests), cross-link density, thermal properties (Differential Scanning Calorimetry (DSC)), chemical properties: Fourier transform infrared spectroscopy (FTIR), and wettability (water contact angle). Poly(polyol sebacate-co-butylene sebacate) preopolymers were characterized with nuclear magnetic resonance spectroscopy (1H NMR and 13C NMR) and gel permeation chromatography (GPC). Thermal stability of cross-linked materials (directly after synthesis process) was tested with thermogravimetric analysis (TGA).

[Air quality vs. morbidity to lung cancer in selected provinces and localities of the Silesian region]. / Jakosc powietrza atmosferycznego a zapadalnosc na nowotwory pluc w wybranych miejscowosciach i powiatach województwa slaskiego.

The objective of the study was analysis of the relationship between the quality of ambient air and icidence of lung cancer based on the results of measurements of selected indicator substances and epidemiological data from the localities/provinces in the Silesian Region. The levels of pyrene, benzoanthracene, benzopyrene and dibenzo(a,h)anthracene were analysed, as well as the concentrations of PM10 fractions sampled on glass fibre filters at sampling stations in 5 localities and 8 provinces in the Silesian Region. The classification of morbidity to lung cancer for the localities and provinces in the study was presented based on the data from the Regional Silesian Cancer Registry. In the group of males a relationship was observed between an increased morbidity to lung cancer and an increasing concentration of pyrene and PM10 respirable dust fraction in ambient air. The preliminary analyses confirmed the strong effect of the quality of ambient air on incidence of lung cancer in the Silesian Region.

Transportan 10 improves the pharmacokinetics and pharmacodynamics of vancomycin.

In the presented study, transportan 10 (TP10), an amphipathic cell penetrating peptide (CPP) with high translocation activity, was conjugated with vancomycin (Van), which is known for poor access to the intracellular bacteria and the brain. The antibacterial activity of the conjugates was tested on selected clinical strains of methicillin-resistant Staphylococcus aureus (MRSA) and Enterococcus sp. It turned out that all of them had superior antimicrobial activity in comparison to that of free Van, which became visible particularly against clinical MRSA strains. Furthermore, one of the conjugates was tested against MRSA - infected human cells. With respect to them, this compound showed high bactericidal activity. Next, the same conjugate was screened for its capacity to cross the blood brain barrier (BBB). Therefore, qualitative and quantitative analyses of the conjugate's presence in the mouse brain slices were carried out after its iv administration. They indicated the conjugate's presence in the brain in amount >200 times bigger than that of Van. The conjugates were safe with respect to erythrocyte toxicity (erythrocyte lysis assay). Van in the form of a conjugate with TP10 acquires superior pharmacodynamic and pharmacokinetic.

Publisher Correction: Transportan 10 improves the pharmacokinetics and pharmacodynamics of vancomycin.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Clinical Usefulness of N-terminal Prohormone of Brain Natriuretic Peptide and High Sensitivity Troponin T in Patients with Heart Failure Undergoing Cardiac Resynchronization Therapy.

BACKGROUND: Cardiac resynchronization therapy (CRT) is a valuable intracardiac device--based treatment option for a subgroup of patients with advanced heart failure (HF) and QRS prolongation. However, still a significant proportion of patients do not benefit from CRT implantation, labeled as non-responders. OBJECTIVES: The aim of the present study was to evaluate the N-terminal prohormone of brain natriuretic peptide (NT-pro BNP) and high sensitivity troponin T (cTnThs) value as predictors of CRT response in a 12-month observation. MATERIALS AND METHODS: The study included 46 patients with HF and implanted CRT-D. Levels of NT-pro BNP and cTnThs were assessed during a 12 month follow up. RESULTS: 46 consecutive patients (76% men) with a mean age of 64±8 were observed for 12 months. The CRT response criteria was met by 26 patients (56,5%). A significant decline in the NT-pro BNP concentrations was documented in responders (p=0.001). Moreover, ΔNT-pro BNP by at least 579 pg/ml had high sensitivity and specificity for identifying the CRT responders. There were no statistically significant differences in the results of cTnThs between the two study groups. CONCLUSION: The relative change in the level of NT-pro BNP by at least 43,5% allows to identify the responders to CRT after 12 months of follow-up. Serial measurements of NT-pro BNP can be a valuable tool for monitoring the effectiveness of CRT.

Is Product Placement Really Worse Than Traditional Commercials? Cognitive Load and Recalling of Advertised Brands.

Considering the large number of adverts inundating the average consumer every day, the marketing industry is seeking methods to reach clients in a more subtle manner than traditional marketing messages. One such tool is product placement. The article addresses issues of effectiveness of product placement in comparison to a traditional commercial. The objective of the study was to check how participants would recall the content of persuasive messages in conditions of artificially inducted cognitive load (in conditions of traditional advertisement and product placement). Two studies were conducted - a pre-study intended to assess the usefulness of the selected stimuli, and the main experiment. The experiment devoted to this question was planned using an ANOVA scheme 2 (Type of advert: traditional vs. product placement) × 2 (neutral conditions vs. cognitive load). It turned out that the commercial was better retained in neutral conditions than in conditions of cognitive load. The traditional commercial was remembered better than product placement. From the perspective of the study's ecological validity, of importance is also comparison of retention of brands viewed in a traditional commercial in conditions of cognitive load with retention of brands in conditions of product placement without load. These comparisons indicate the superiority of product placement - brands presented in this manner were more frequently recalled by viewers.