Abstract The total soluble sugar content and antioxidant enzyme activities were studied for the first time during axillary shoot formation in Magnolia × ‘Spectrum’ in vitro in response to BAP (0.3 mg l−1), different levels of gibberellic acid (GA3; 0.0, 0.1, 0.5, 1.0 mg l−1), sucrose (20 and 30 g l−1) and nitrogen salts (KNO3/NH4NO3; 100/100% and 75/50% relative to MS medium). Among various GA3 and sucrose/nitrogen salts ratios, the most effective axillary multiplication (5.9 shoots/explant) and leaf formation (25.7 leaves per multiplied clumps) were obtained after addition of GA3 at 0.1 mg l−1 to a BAP medium containing 20 g l−1 sucrose and reduced levels of nitrogen salts (75% KNO3 and 50% NH4NO3). The addition of GA3 to the BAP medium enhanced shoot formation by 36% and leaf formation by 27%. The highest shoot formation capacity of M. × ‘Spectrum’ in vitro coincided with enhanced levels of soluble sugar and peroxidase (POD) activity. Increasing GA3 concentration from 0.1 to 1.0 mg l−1 in the above medium resulted in inhibition of shoot and leaf formation and a decrease in the soluble sugar content. The influence of GA3 on the activities of catalase (CAT) and POD depended on its concentration and the levels of sucrose and nitrogen salts in the medium. The highest increase in CAT and POD activities, that coincided with the enhanced shoot formation capacity of M. × ‘Spectrum’ in vitro, was observed after addition of GA3 to the medium containing high levels of sucrose and nitrogen salts.
Congestive heart failure (CHF) is the fi nal stage in several heart diseases. The diagnosis of CHF in older patients is a challenge. Preserved left ventricular systolic function is a characteristic type of CHF in seniors. The purpose of the study was to characterize elderly patients with CHF and to highlight specific features of the conditions in seniors. The most common etiology of HF in this group of patients is hypertension and coronary heart disease. In seniors atypical presentations of chronic heart failure is much more common than in younger patients. Malnutrition, limitations of exercise and sedentary lifestyles or comorbid diseases have an influence on asymptomatic, early stage of HF. Th ere are better outcomes of treatment in obese individuals. It is called the obesity paradox. Open communication with a patient and his/her family may improve their response to therapy. When heart failure becomes an incurable disease and aggressive treatment is ineffective, palliative care should be considered in end-of-life heart failure patients. The goal of treatment in the remaining moments of life last moments of life should be maximizing the patient’s comfort.
B a c k g r o u n d: The aim of the study was to evaluate the usefulness of the modified Peyton’s four-step approach in the teaching of cardiac auscultation and to determine students’ perception of Peyton’s four-step approach. Me t h o d s: The opinion of the participants on the usefulness of the modifi ed four-step approach was attained through the use of anonymous questionnaires, voluntarily completed by students, and on the basis of semi-structured interviews conducted with a subset of students. 187 second-year students of our 6-year long curriculum were enrolled. They attended an obligatory Laboratory Training of Clinical Skills course. The average group size was 16 students. R e s u l t s: The survey findings identified that 88.1% of participants found it helpful in developing their understanding of cardiac auscultation. 89.8% of all participants claimed that the new modified four-step approach facilitated memorization. The modified Peyton’s four-step method allows for better organization of classes in the opinion of 87.6% students. The advantages of the method were noticed by the majority of students. C on c l u s i o n s: The modified Peyton’s four-step approach in the teaching of cardiac auscultation under laboratory conditions was perceived by students to be a comprehensible method that facilitates understanding and memorization. Th is approach allows for improved organization of classes. From the student’s perspective this method allows one to master the technique of cardiac auscultation in the classroom, through the increased demand of the participants’ attention, activity and involvement.