Background: Evidence points to the pivotal role of vitamin D in the pathogenesis of metabolic syndrome (MetS), including deterioration of the endogenous endothelial repair system. Objectives: This study was conducted to investigate links between serum 25-hydroxyvitamin D3 (25(OH)3D) concentrations and the numbers of circulating progenitor mononuclear cells in MetS individuals. Methods: The cross-sectional study involved 47 patients with MetS. The circulating level of 25(OH)D3 and other biomarkers were measured at the start of the study. The number of mononuclear progenitor cells was determined using the flow cytometric technique (FCT). Results: MetS patients from the entire group of 47 patients were divided into four cohorts depending on 25(OH)D3 levels. The groups comprised patients with 25(OH)D3 levels above 100 nmol/L (n = 10), patients with levels from 50 to 100 nmol/L (n = 12), patients with levels from 30 to 50 nmol/L (n = 14), and patients with levels below 30 nmol/L (n = 11). There were significant differences between the MetS cohorts in terms of haemoglobin A1c (HbA1c) (P = 0.038), the homeostasis model assessment for insulin resistance (HOMA-IR) (P = 0.042), triglycerides (P = 0.044), osteoprotegerin (P=0.028), adiponectin (P = 0.018), high density lipoprotein cholesterol (HDL-C) (P=0.036), and CD14⁺D309⁺Tie-2⁺ cells. Vitamin D deficiency in a multivariate log-linear regression model appeared to be an independent predictor of the numbers of CD14⁺D309⁺ Tie-2⁺ cells (OR 1.12; 95% CI 1.06 to 1.19; P = 0.002). Osteoprotegerin, high sensitivity C-reactive protein (hs-CRP), and adiponectin have been shown to make an independent impact on the numbers of CD14⁺D309⁺ Tie-2⁺ cells. Using C-statistics, we found that the use of three biomarkers (osteoprotegerin, hs-CRP, and adiponectin) can significantly improve a predictive model based on vitamin D deficiency for decreased numbers of CD14⁺ D309⁺Tie-2⁺ cells. Conclusions: We found that low levels of 25(OH)D3 were associated with depleted numbers of proangiogenic progenitor mononuclear cells in MetS patients.

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Background: Coronary endarterectomy (CE) can be used in patients with diffused coronary artery disease (CAD) as an adjunct technique to coronary artery bypass grafting (CABG) for complete revascularization. Because the impact of CE has been debated, hospital outcomes are of concern. Objectives: The aim of the current study is to compare hospital outcomes of patients undergoing off-pump CABG with and without CE. Methods: We performed a retrospective analysis of data on patients undergoing CABG and CE between 2011 and 2012 by a single surgeon using off-pump technique. Patients were divided into CABG and CABG + CE groups. Preoperative, perioperative, and postoperative data were collected from the data bank. Results: CABG was performed in 478 patients, of whom 69 had a CE. Hospital mortality was 0.7% in CABG and 0% in CABG + CE group (P > 0.05). The duration of stay in the intensive care unit (ICU) was 37.23 ± 0.88 hours in the CABG group and 51.31 ± 5.59 hours in the CABG + CE group (P = 0.015). Logistic regression confirms that CE is one of the factors affecting longer ICU stay. Blood transfusion was 324.71±22 milliliters in the CABG group and 650.62±110 milliliters in the CABG + CE group (P = 0.001). There were no significant differences between myocardial infarction (MI) rate, arrhythmia, intra-aortic balloon pump insertion, or low cardiac output between the two groups. Conclusions: The current study demonstrates that the results of CE are acceptable with respect to hospital outcome. CE as an adjunct to CABG offers a valuable surgical option for patients in whom complete revascularization cannot be obtained. With careful selection of patients, a well-judged and well-executed surgical technique, and good postoperative care, excellent results can be obtained.

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Background: The globally reported links between physical and psychiatric conditions has increased significantly in the last few years and this also rings true in the field of cardiology where the reported links between cardiovascular disease and psychiatric conditions have shown that one in four psychiatric patients' suffers from a cardiovascular co-morbidity. Objectives: In light of this we investigated the prevalence of psychiatric co-morbidities and tendencies in patients with HCM over a 14 year period. Methods: We compiled an anonymous database of all adult patients diagnosed with HCM across 7 hospitals in the north of England over a 14 year period (n = 248). We analysed the data for prevalence of psychiatric co-morbidities such as; anxiety disorder, schizophrenia, bipolar disease and depression and substance abuse. We traced our patients with the ACALM study protocol, which uses ICD-10 and OPCS-4 codes to allocate patients for statistical analysis using SPSS V. 20.0. Results: Out of 248 patients with HCM, 8.87% had a psychiatric co-morbidity. We found that in our cohort 4.03% of patients had depression and 1.61% patients suffered from either from a phobic disorder or schizophrenia. In addition to this, in 9.68% of cases in our cohort we found that patients suffered from some form of substance misuse with 2.02% abusing alcohol and a further 7.26% whom smoke tobacco. Conclusions: Ca. 1 in 10 patients (8.87%) with HCM suffer from a psychiatric co-morbidity and ca. 1 in 10 (9.68%) patients with HCM suffer from substance abuse. All patients withHCMshould be approached holistically with a psychiatric assessment which includes social history.

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Introduction: Pulmonary embolism results from thrombus migration into the pulmonary artery, with the most common cause being deep vein thrombosis. However, pulmonary embolism might not necessarily originate in the lower extremities, which necessitates specific diagnostic and therapeutic choices. Case Presentation: An 84-year-old man presented with acute pulmonary embolism, but with no sign of deep vein thrombosis or a thrombophilic state. He experienced complete resolution with medical therapy involving parenteral and oral anticoagulants. During the patient's hospital stay, an abdominal CT scan revealed a 23 mm lumbar osteophyte compressing and displacing the inferior vena cava. The turbulent blood flow through the stenotic area might have caused a thrombus and the consequent pulmonary embolism. Conclusions: This is the first report of pulmonary embolism caused by inferior vena cava extrinsic compression due to an osteophyte. Such a diagnosis should be suspected if the patient lacks deep vein thrombosisandhypercoagulative states. Acutepulmonary embolism could be a rare consequence of osteoarthritis in the spine, although correct assessment is crucial to initiating lifelong oral anticoagulant therapy following the first episode of pulmonary embolism. Indeed, spinal surgery is generally avoided due to the high risks and the fact that extrinsic compression of the inferior vena cava cannot be radically resolved.

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Background: Several physiological and pathological processes affect the diameter of coronary arteries. It seems that the pathological increase or decrease in the size of coronary arteries is associated with cardiovascular events. Objectives: The aim of this study is to determine the relationship between the diameter of coronary arteries, gender, and traditional cardiovascular risk factors. Methods: In this cross-sectional study, we enrolled 96 patients who underwent coronary angiography at our tertiary research center. The patients' demographic data, cardiovascular risk factors, and coronary artery diameters were recorded using a digital sliding caliper. Results: Out of 96 patients with a mean age of 56.3 ± 9.8 years, 62 (64.6%) were female. Among cardiovascular risk factors dyslipidemia was the most prevalent (55 patients or 57.3%) followed by hypertension (45 patients or 46.9%) and smoking (17 patients or 17.7%). The means of the right coronary artery (RCA), left main coronary artery (LMCA), left anterior descending (LAD) and left circumflex (LCX) diameters were 3.27 ± 0.7 mm, 4.35 ± 0.7 mm, 3.5 ± 0.6 mm and 3 ± 0.7 mm, respectively. The female and participants and participants with diabetes had smaller coronary arteries: these differences have become statistically significant for LMCA and LAD in both groups (in women, the p value for LMCA and LAD were 0.04 and 0.02, respectively, and in those with diabetics, the p value for LMCA and LAD were 0.02 and 0.04, respectively). Conclusions: In our study, female participants and participants with diabetes have smaller coronary arteries. No statistically significant relationships were found between traditional coronary risk factors and the diameters of coronary arteries.

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Introduction: Pulmonary embolism results from thrombus migration into the pulmonary artery, with the most common cause being deep vein thrombosis. However, pulmonary embolism might not necessarily originate in the lower extremities, which necessitates specific diagnostic and therapeutic choices. Case Presentation: An 84-year-old man presented with acute pulmonary embolism, but with no sign of deep vein thrombosis or a thrombophilic state. He experienced complete resolution with medical therapy involving parenteral and oral anticoagulants. During the patient's hospital stay, an abdominal CT scan revealed a 23 mm lumbar osteophyte compressing and displacing the inferior vena cava. The turbulent blood flow through the stenotic area might have caused a thrombus and the consequent pulmonary embolism. Conclusions: This is the first report of pulmonary embolism caused by inferior vena cava extrinsic compression due to an osteophyte. Such a diagnosis should be suspected if the patient lacks deep vein thrombosisandhypercoagulative states. Acutepulmonary embolism could be a rare consequence of osteoarthritis in the spine, although correct assessment is crucial to initiating lifelong oral anticoagulant therapy following the first episode of pulmonary embolism. Indeed, spinal surgery is generally avoided due to the high risks and the fact that extrinsic compression of the inferior vena cava cannot be radically resolved.

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Background: Pulmonary complications following cardiac valvular surgery are common and contribute to increased rate of hospital stay, morbidity and mortality. This study was conducted to determine the incidence of pulmonary complications after cardiac valvular surgery and to investigate perioperative clinical factors for postoperative pulmonary complications at a tertiary university hospital. Methods: Overall, 180 consecutive adult patients (> 18 years), whounderwent nonemergency aortic, mitral, pulmonary or tricuspid valvular surgery were enrolled. Before surgery, lung function and gas exchange were measured. Complete history taking, vital signs and clinical examination was done and Chest X-Ray, Electrocardiogram (ECG), echocardiography, blood gas analysis, and complete blood tests were obtained and patients were followed throughout surgery and after that, till discharge from the hospital for detection of respiratory complications. The relevant pre-, intra-, and post-operative data of all patients were investigated and analyzed. Results: The cumulative incidence of pulmonary complications was 50 (90 of 180) with a mortality rate of 6.6% (6 of 90) and the overall mortality among all patients was 3.3% (6 of 180). Type of valvular surgery was significantly associated with postoperative pulmonary complications (POPC). With regards to cardiac risk factors, Hypertension (HTN) and smoking had a significant relationship with POPC (P < 0.0001, P 0.003 respectively). Bivariate analyses showed that older patients were more susceptible to POPC (P < 0.0001). There was no significant difference in POPC (P = 0.55) between males and females. Prolongation of operation time (P = 0.03), cross clamp time (P = 0.04) and pump time (P < 0.0001) were associated with POPC. There was a significant relationship between PaO₂ in AIR and 100% FIO₂, and POPC (P = 0.02, P = 0.007, respectively).There was a significant relationship between death and POPC (P = 0.01). Conclusions: Type of valvular surgery, hypertension, smoking, older age, pump time, operation time, cross clamp time and Pao₂ in air and 100% O₂ were the most important factors associated with postoperative pulmonary complications.

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Background: One of the adverse effects following cardiac surgery is cognitive dysfunction. The prevalence of cognitive dysfunction after heart surgery is reportedly 30% - 80%. Objective: The purpose of this study was to evaluate the prevalence and risk factors of cognitive dysfunction in the ICU after heart surgery. Methods: In this observational study, 99 adult patients who underwent elective cardiac surgery (valve and coronary) in a tertiary university hospital were examined. The cognitive state of the patients in the ICU 2 or 3 days after the operation was assessed using the MMSE scale. Perioperative predisposing factors were simultaneously considered. Results: The results showed that the majority of the patients (55.5%) had no cognitive impairment, while 39.4% had mild cognitive impairment and 5.1% had moderate cognitive impairment. Cognitive dysfunction had a significant relationship with the following factors: age (P = 0.11), cardiopulmonary bypass time (P = 0.002), aortic cross-clamp time (P = 0.002), and literacy (P = 0.019). The results also showed that cognitive dysfunction had no significant relationship with sex, previous history of surgery, preoperative and postoperative hemoglobin, blood glucose, diabetes, type of operation, and duration of operation. Conclusion: The results of this study showed that 39.4% of our patients had mild cognitive impairment and 5.1% experienced moderate cognitive impairment following cardiac surgery. Significant relationships between cognitive dysfunction and age, education level, cardiopulmonary bypass time, and aortic clamp time were seen. In the logistic regression analysis, only age was related to cognitive impairment.

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