Memory, neurogenic protein and oxidative deficits of frontal cortex following chlorpyrifos/dichlorvos exposure in rats

Objective: The use of xenobiotics to boost agricultural productivity has led to toxic chemicals exposure including organophosphates, causing adverse health outcomes including behavioral and neuronal impairments. This study aimed to evaluate the memory indices, possible oxidative and cholinesterase outturnson the frontal cortices of rats exposed to organophosphates.Methodology: Thirty-two Wistar rats were grouped into four. They received 1ml/kg of Normal, 8.8 mg/kg dichlorvos, 14.9 mg/kg chlopyrifos, and 8.8 mg/kg dichlorvos plus 14.9mg/kg chlorpyrifos respectively. They had training trials in the Y Maze paradigm then spatial working memory assessment. They were euthanized 24hours following exposure and tissues excised for analysis.Results: A marked reduction in metabolic markers, Acetylcholine Esterase (AChE) activity, spatial memory indices and proliferative neuron marker (Ki67) were observed. Also, increase in oxidative stress markers in the frontal cortices of the organophosphates exposed rats.Conclusion: The findings demonstrated neurotoxic effects of organophosphates in rats.

community pharmacists’ experiences and beliefs towards providing pharmacy services to deaf and hard of hearing patients: a mixed-method study in Riyadh, Saudi Arabia

Introduction

Provision of pharmacy services to patients requires the pharmacist to well communicate with the patients. Research has shown that healthcare providers, including community pharmacists, face many challenges while providing services to deaf and hard-of-hearing patients (DHOH).

Aim

To investigate community pharmacists’ experiences and beliefs about providing pharmacy services to DHOH in Riyadh, Saudi Arabia.

Methods

This was a sequential explanatory mixed-method study involving a survey and semi-structured interviews. At first, a web-based, self-administered survey was disseminated to community pharmacists in Riyadh, Saudi Arabia during the period October to November 2020. The survey was disseminated through the official twitter account of Saudi Pharmaceutical Society. Two reminders were sent. It was made clear that the survey targeted community pharmacists working in Riyadh city. To calculate an appropriate sample size, according to Hair et al, the general rule to have a minimum sample size would be five observations per variable (5:1), and an acceptable sample size would be ten observations per variable (10:1). In this survey, there are 16 items, and hence the acceptable sample size was 160 participants. The semi-structured telephone-based interviews were conducted with a purposive sample of survey respondents to gather in-depth information on experiences, beliefs, and barriers about providing pharmacy services to DHOH. The interviews were conducted until saturation occurred. Survey data was analysed using Statistical Package for Social Sciences (SPSS version 24), and the semi-structured interviews were analysed by Framework analysis.

Results

A total of 175 community pharmacists completed the survey. The majority were: male (84.6%), aged between 25 to 35 years (74.9%). Of the respondents, 32.2% and 29.1% had experience in community pharmacy of 1-5 and 6-10 years, respectively. The number of DHOH patients the pharmacists met during the past 6 months were as follows: 68 (38.9%) pharmacists met 1-2 patients, 71 (40.6%) %) pharmacists met 3-4 patients, and 19 (11%) %) pharmacists met ≥ 5 patients. The provided services included: prescription medications (by 82.9%), counselling on prescription medications (by 56.6%), OTC medication dispensing (by 4.3%), and counselling on OTC medications (by 52.6%). Forty participants (22.8%) reported their awareness of the basics of Saudi sign language (SSL). Of the participants, 101 (57.7%) believed that they have handled communication barriers appropriately, while 61(35%) acknowledged unmanageable communication barriers. Among the main barriers identified were the lack of knowledge of the basics of SSL. (70.9%) and the inability to recognize disability (52.6%). The semi-structured interviews further explored pharmacists’ experiences and views on providing such a service. Of the main themes emerged were: (1) Experience; interviewees preferred written communication with DHOH patients regardless of their literacy level, while spontaneous hand gesturing was the least preferred method of communication, and they also acknowledged that their roles in providing services, to the DHOH, need to be improved (2) Beliefs; interviewees believed that awareness of the basics of SSL is important to ensure safe medication use. The barriers emerged from the interview were classified as pharmacist-related, system-related, and patient-related.

Conclusion

To our knowledge, this is the first study of its kind to be conducted in Saudi Arabia. The study highlighted that when providing pharmacy services to DHOH patients, community pharmacists encountered multiple barriers. These barriers need to be addressed for better support and provision of pharmacy services to DHOH. Further studies with large sample size, are warranted to better understand the situation.

References

(1) Hair J, Black W, Babin B, Anderson R. Multivariate data analysis. 7th ed. Harlow: Pearson Education Limited; 2014

(2) Scheier DB. Barriers to health care for people with hearing loss: a review of the literature. J N Y State Nurses Assoc. 2009 Mar 22;40(1):4-11.

(3) Ferguson MC, Shan L. Survey evaluation of pharmacy practice involving deaf patients. Journal of pharmacy practice. 2016 Oct;29(5):461-6.

257 Comparing Practice Testing to Restudying in the Dissecting Room: An Experimental Study

Aim

Medical students employ many strategies for learning, most commonly restudying. However, evidence suggests that restudying is not as effective as other strategies, namely practice testing. Different studies have compared restudying to practice testing on a variety of subjects. Few studies have assessed the effect of practice testing in anatomy courses. To the best of the authors' knowledge, no studies have investigated practice testing in the dissecting room (DR). In this study, we aim to measure the effect of practice testing in a DR setting, as compared to restudying.

Method

Second-year medical students learning the cardiovascular system were included in the study. Two groups were randomly selected to participate in practice tests taken at the end of DR sessions. The other two groups were asked to restudy the material. At the end of the four-week course, all students took a 15 points multiple-choice exam on learned material. Authors of practice tests were blind to the final exam content and vice versa.

Results

One hundred eight students participated in the study. Fifty-three students were in the practice testing group, and 55 were in the restudying group. The practice testing group performed significantly better than the restudying group (p = .008), with a mean of 8.57 +/- 2.3 for the practice testing group and 7.27 +/- 2.6 for the restudying group.

Conclusions

Practice testing significantly improved retention of Anatomy. We recommend that practice testing is implemented regularly at the end of DR sessions to enhance the learning experience.

259 Effect of Telegram Videos on Anatomy Education Among 2nd Year Medical Students, University of Khartoum, 2021

Aim

COVID-19 had major effect on the health and medical education. In order to oblige with the social distancing and quarantine, universities shifted to online learning. This study aimed to assess the effect of online education on anatomy DR (dissection room) teaching by the use of telegram software.

Method

This was a cross-sectional, prospective interventional study, which was carried out among 2nd year medical students in University of Khartoum. Students undertook initial tests on the heart and anterior abdominal wall modules. Telegram videos, prepared by the author, on the anatomy of the heart and the anterior abdominal wall were distributed to students. Students took a second test after watching the videos. A total number of 41 students attended heart sessions and 40 students attended the anterior abdominal wall sessions were included.

Results

The pre-test mean score for the heart and abdomen modules were 4.56 ± 2.335 and 6.15 ± 2.94, respectively. The post-tests means were 9.98 ± 2.877 and 8.95 ± 3.14, respectively. 90% and 75% of the students were satisfied with these videos, respectively.

Conclusions

This study revealed that Telegram videos as a method of online teaching had a positive effect on the students' performance, which was evidenced by the significant improvement in student's scores after watching the videos. Additionally, most of the students were satisfied with the videos and give positive feedback.

255 An Audit on the Knowledge of Junior Doctors About DKA at a Local Hospital, Khartoum, Sudan

Aim

DKA is the most common cause of death in pediatric patients with insulin-dependent diabetes mellitus (IDDM). Junior doctors have a significant role in the management of those patients. We conducted this audit to assess and improve the knowledge of house officers about the characteristic features and management of DKA.

Method

The audit was conducted in Alshuhada hospital, Khartoum. It consisted of two cycles (2019–2021). A 14 items questionnaire based on Sudan Diabetes Mellitus guidelines 2011 was used for the assessment. All house officers in the department of pediatrics were involved in this study. Teaching sessions were used as an intervention in the first cycle, while poster presentations and teaching sessions were used in the second cycle.

Results

Nine house officers participated in the first cycle, while seven house officers were involved during the second cycle. The correct choice of initial fluid correction was selected by 55.5%, 88.8%, and 100% of the house officers before the first cycle, after the first cycle, and after the second cycle, respectively. The figures for the initial management of cerebral edema also rose from 33.3% to 66.7% after the first cycle and reached 100% after the second cycle. The percentage of house officers who identified Investigations needed in suspected cases of DKA improved with each cycle, from 66% to 77% in the first cycle and increased to 100% after the second cycle.

Conclusions

Teaching sessions and posters helped to improve the knowledge of the House officers about the diagnosis and management of DKA.

Test-Retest Data for the Assessment of Breast MRI Radiomic Feature Repeatability

Background

Radiomic features extracted from breast MRI have potential for diagnostic, prognostic, and predictive purposes. However, before they can be used as biomarkers in clinical decision support systems, features need to be repeatable and reproducible.

Objective

Identify repeatable radiomics features within breast tissue on prospectively collected MRI exams through multiple test–retest measurements.

Study Type

Prospective.

Population

11 healthy female volunteers.

Field Strength/Sequence

1.5 T; MRI exams, comprising T2‐weighted turbo spin‐echo (T2W) sequence, native T1‐weighted turbo gradient‐echo (T1W) sequence, diffusion‐weighted imaging (DWI) sequence using b‐values 0/150/800, and corresponding derived ADC maps.

Assessment

18 MRI exams (three test–retest settings, repeated on 2 days) per healthy volunteer were examined on an identical scanner using a fixed clinical breast protocol. For each scan, 91 features were extracted from the 3D manually segmented right breast using Pyradiomics, before and after image preprocessing. Image preprocessing consisted of 1) bias field correction (BFC); 2) z‐score normalization with and without BFC; 3) grayscale discretization using 32 and 64 bins with and without BFC; and 4) z‐score normalization + grayscale discretization using 32 and 64 bins with and without BFC.

Statistical Tests

Features' repeatability was assessed using concordance correlation coefficient(CCC) for each pair, i.e. each MRI was compared to each of the remaining 17 MRI with a cut‐off value of CCC > 0.90.

Results

Images without preprocessing produced the highest number of repeatable features for both T1W sequence and ADC maps with 15 of 91 (16.5%) and 8 of 91 (8.8%) repeatable features, respectively. Preprocessed images produced between 4 of 91 (4.4%) and 14 of 91 (15.4%), and 6 of 91 (6.6%) and 7 of 91 (7.7%) repeatable features, respectively for T1W and ADC maps. Z‐score normalization produced highest number of repeatable features, 26 of 91 (28.6%) in T2W sequences, in these images, no preprocessing produced 11 of 91 (12.1%) repeatable features.

Data Conclusion

Radiomic features extracted from T1W, T2W sequences and ADC maps from breast MRI exams showed a varying number of repeatable features, depending on the sequence. Effects of different preprocessing procedures on repeatability of features were different for each sequence.

Level of Evidence

2

Technical Efficacy Stage

1

Inorganic nitrate attenuates endothelial dysfunction consequent to systemic inflammation

Introduction

Chronic cardiovascular diseases are characterised by low-grade systemic inflammation and attenuated nitric oxide (NO) bioavailability resulting in endothelial dysfunction. Inorganic nitrate augments NO bioavailability and improves markers of vascular dysfunction in patients with cardiovascular risk factors. However, the exact mechanism of this effect is uncertain.

Purpose

To determine whether inorganic nitrate supplementation alters systemic inflammation-induced endothelial dysfunction.

Methods

62 healthy male volunteers were randomised 1:1 to receive ∼8–10 mmol of dietary inorganic nitrate in beetroot juice or nitrate-free beetroot juice (placebo) once daily for 6 days. Measures of brachial artery flow-mediated dilatation (FMD), brachial blood pressure (BP), pulse wave analysis and carotid-femoral pulse wave velocity (PWV) by Vicorder were taken prior to and at 8 hours after a typhoid vaccine (to induce mild systemic inflammation). Plasma, urine and saliva samples were also collected. Clinicaltrials.gov: NCT02715635.

Results

Baseline characteristics were similar between the two groups. Inorganic nitrate significantly elevated plasma nitrite (placebo = Δ0.02±0.5 μM, inorganic nitrate = Δ0.63±1.2 μM; p=0.01) and nitrate levels (p<0.0001) compared to placebo. There were significant increases in urine nitrite (p<0.0001) and nitrate (p<0.0001) in addition to salivary nitrite (p<0.0001) and nitrate (p<0.0001) compared to placebo. After 8 hours, typhoid vaccine induced an increase in circulating white cells (placebo = Δ3.34±3.37x109/L, inorganic nitrate = Δ2.9±2.78x109/L; p=0.58) that was similar in in both arms. However, there was a significant reduction in the FMD response in the placebo group at 8-hours post vaccine; an effect that was absent in volunteers treated with inorganic nitrate (placebo = Δ−1.33±1.53%, inorganic nitrate = Δ−0.07±1.84%, p=0.005). Importantly, there were no statistically significant differences in baseline vessel diameter (p=0.78), time to peak diameter in response to flow (p=0.87) and peak shear rate (p=0.57) between the groups. When comparing change from baseline to 8 hours after the vaccine, there were no significant differences in brachial systolic BP (p=0.12), central systolic BP (p=0.12) and PWV (p=0.60) between groups, but a significant reduction in brachial diastolic BP in the inorganic nitrate group (p=0.048).

Conclusions

Inflammation-induced endothelial dysfunction was prevented in those receiving dietary inorganic nitrate suggesting that elevating circulating nitrite and delivering NO to the blood vessel wall, through dietary approaches may offer potential therapeutic benefit in those cardiovascular diseases which typically exhibit low grade inflammation and deficiencies in bioavailable NO.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): British Heart Foundation

280 The Use of Telemedicine in Plastics Surgery During COVID-19: A Single-Centre Correlation Study with Patient Reported Outcome Measures

Aim

With enforcement of social distancing measures during the COVID-19 pandemic, face-to-face patient contact was shifted to telemedicine consultations. There is limited evidence evaluating patient experience of follow-ups and expectations into quality metrics. Our aim was to perform a service evaluation by prospectively evaluating the management and outcomes of plastic surgery patients.

Method

Patients were consecutively assessed over the COVID-19 lockdown period, from March to May 2020. They ranged from urgent cancer cases to burns and trauma. We used a questionnaire to evaluate initial treatment, wound care, complications, and overall service. A validated health-related quality of life (HRQL) survey was used to assess the impact of injury or wound on lifestyle and we also assessed patient enablement. Correlation analysis determined relationships between outcomes, service evaluations and HRQL variables.

Results

77 patients were consecutively treated in our unit, of which 46 completed the questionnaire. 42.2% used multimedia as mode of follow-up, including smart phones for messages and videocalls, and trust e-mails. There was a 3-fold increase in number of infections for non-face-to-face consultations, with a correlation significance of 0.043. We found no correlation between age and wound complication rates. 72.7% of patients found overall service very good or excellent. Although overall service satisfaction was similar for multimedia use and face-to-face consultations (p = 0.02), less patients were confident looking after their wound without face-to-face follow-ups.

Conclusions

COVID-19 has brought upon an unprecedented change in practice in our department. Implementing multimedia use and educating patients on wound care can significantly improve efficiency and service provision.

1255 Crowdedness and Consequences of Long Waiting Time in Public and Private Health Centers Among Patients in Khartoum State, Sudan - 2016

Aim

Waiting time (WT) reflects quality of services delivered by Primary health care level. Long waiting time is due to various causes, among which crowdedness is a main cause. This prolonged time has negative impacts on PHC services utilization as well as patients’ outcomes. The aim of this study is to measure the total WT, assess the crowdedness in PHC centers, and to determine the possible consequences of this long waiting time.

Method

Descriptive cross sectional– health institution-based study done in 40 Health centres across Khartoum state using randomized multi-stage sampling. Patients, doctors and lab technicians were interviewed using three different pre-tested structured questionnaires.

Results

A total of 477 patients were included in the study. The average waiting time was found to be 168 minutes. Crowdedness was one of the main causes of delay in waiting time. The lab was the most perceived crowded service (74.4% of the respondents). This long WT had health consequences on patients, ranging from backache, joint pain, and headaches to hypoglycemic symptoms. These symptoms affected patients' willingness to return to the same center. 36.4% of the affected patients were unwilling to revisit the same center.

Conclusions

WT in this study is longer compared to studies from other countries. Crowdedness is one of the main causes of long WT. Due to this prolonged time, patients experienced physical symptoms. It also affected their future attitude regarding PHC centers utilization. There is a need to understand the underlying causes of this issue and address them appropriately.

Seasonal bias in global ocean color observations

In this study, we identify a seasonal bias in the ocean color satellite-derived remote sensing reflectances (Rrs(λ);sr-1) at the ocean color validation site, Marine Optical BuoY. The seasonal bias in Rrs(λ) is present to varying degrees in all ocean color satellites examined, including the Visible Infrared Imaging Radiometer Suite, Sea-Viewing Wide Field-of-View Sensor, and Moderate Resolution Imaging Spectrometer. The relative bias in Rrs has spectral dependence. Products derived from Rrs(λ) are affected by the bias to varying degrees, with particulate backscattering varying up to 50% over a year, chlorophyll varying up to 25% over a year, and absorption from phytoplankton or dissolved material varying by up to 15%. The propagation of Rrs(λ) bias into derived products is broadly confirmed on regional and global scales using Argo floats and data from the cloud-aerosol lidar with orthogonal polarization instrument aboard the cloud-aerosol lidar and infrared pathfinder satellite. The artifactual seasonality in ocean color is prominent in areas of low biomass (i.e., subtropical gyres) and is not easily discerned in areas of high biomass. While we have eliminated several candidates that could cause the biases in Rrs(λ), there are still outstanding questions regarding potential contributions from atmospheric corrections. Specifically, we provide evidence that the aquatic bidirectional reflectance distribution function may in part cause the observed seasonal bias, but this does not preclude an additional effect of the aerosol estimation. Our investigation highlights the contributions that atmospheric correction schemes can make in introducing biases in Rrs(λ), and we recommend more simulations to discern these influence Rrs(λ) biases. Community efforts are needed to find the root cause of the seasonal bias because all past, present, and future data are, or will be, affected until a solution is implemented.

The efficacy and safety of a nurse-led electrical cardioversion service for atrial fibrillation over a two-year time period

Funding Acknowledgements

Type of funding sources: None.

Background & Purpose

Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia worldwide, with a significant impact on morbidity, mortality and utilisation of healthcare resources. Electrical direct-current cardioversion (DCCV) is offered to patients with ongoing symptoms despite medical management. In this study we aim to evaluate the safety and efficacy of a specialised nurse-led DCCV cardioversion service. 

Methods

This was a retrospective cohort study analysing the outcome of patients presenting with atrial fibrillation or flutter, who were subsequently referred for a nurse-led DCCV procedure between August 2017 and December 2019. 

Results

Analysis included a total of 341 patients (mean age = 68.37; STDV = 10.96) who presented with either atrial fibrillation (N = 267; 78.30%) or atrial flutter (N = 74; 21.70%). Approximately 30% of patients were female (N = 101); and 70% were male (N = 240). Of the 341 patients who underwent DCCV, 299 were successfully cardioverted (87.68%), whilst 42 patients remained in AF (12.32%). Of those patients successfully cardioverted, 167 remained in sinus rhythm after 6 weeks (55.85%); 93 patients reverted back to AF (31.10%). 38 patients were lost to follow up (12.71%). Of all 341 patients who underwent DCCV, only 24 patients were admitted to hospital during the subsequent 3 month period (7.04%). Of these admissions, 11 were due to persistent AF (45.83%), and 13 were due to other non-related reasons (54.17%). Importantly, no patients were admitted as a direct complication of the DCCV procedure. 

Using a Chi-squared analysis, we found a significant difference in cardioversion success rates between patients presenting with atrial flutter (97% success rate) versus those in atrial fibrillation (85% success rate) (χ2 = 8.089; p = 0.004; α<0.05). We did not find a significant difference in cardioversion success rates between males and females (χ2 = 1.651; p = 0.199; α<0.05); nor did we witness a significant impact from the presence of ischaemic heart disease (χ2 = 1.545; p = 0.214; α<0.05) or hypertension (χ2 = 2.075; p = 0.150; α<0.05). Similarly, we found negligible impact of LV ejection fraction (χ2 = 1.494; p = 0.684; α<0.05) or LA size (χ2 = 1.310; p = 0.727; α<0.05) upon cardioversion success rates.  We witnessed a dramatic improvement in DC cardioversion success rates in patients taking antiarrhythmic medication in preference to a rate control strategy alone (χ2 = 11.825; p = 0.008; α<0.05). 

Conclusion

Overall, data gathered from this study provides positive evidence to support the use of a nurse-led DCCV service. In addition to obtaining very successful cardioversion rates, we found low remission rates, with a very low hospital readmission rate for AF related issues after successful DCCV.

Changing susceptibility pattern of Neisseria Gonorrhoeae: A threat to management of sexually transmitted infections - Case series

Gonorrhoea is a sexually transmitted infection (STI) that increases the risk of infection with human immunodeficiency virus (HIV) and causes infertility and urethral stricture. We describe three cases of sexually active men, otherwise stable, who presented with a history of painful micturition and creamy white, urethral discharge. A clinical diagnosis of gonococcal urethritis was made and confirmed by microscopy, culture and 16SrRNA. Antimicrobial susceptibility revealed resistance to all the antimicrobial agents tested including ceftriaxone. A dual therapy was initiated using ceftriaxone and azithromycin, but at a higher dose for the patient with multi-drug resistant (MDR) Neisseria gonorrhoeae. Patients did well and were followed up for 5 months. Contact tracing was done for their sexual partners. While it is also important for healthcare workers to familiarize themselves with current treatment guidelines for gonococcal urethritis, the place of clinical laboratory in the management of STIs, with molecular techniques and the need for surveillance for MDR Neisseria gonorrhoeae cannot be overemphasized.

388 Detection of Cytomegalovirus Infection in Infants with Biliary Atresia: A Meta-analysis

Introduction

Biliary atresia (BA) is the most common indication of liver transplantation in children. Several reports attributed BA to both prenatal and perinatal aetiologies, including a viral infection-induced auto-immune response that targets the bile ducts. Cytomegalovirus (CMV) remains the most common virus being linked to BA. This meta-analysis estimates to what extent CMV infection is detected in patients with BA.

Method

This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The databases of MEDLINE/PubMed, WHO-Virtual Health Library (VHL), ScienceDirect, and Google Scholar were used for the systematic search. Random effects model was used to estimate the pooled prevalence estimate with the corresponding 95% confidence interval (CI) using StatsDirect statistical software.

Results

A total of 13 studies (covering 419 patients) that fulfilled the eligibility criteria were included in the meta-analysis. The pooled overall prevalence of CMV infection in patients with BA was 24.5% (95% CI 11.9 %– 33.9%).

Conclusions

The available data demonstrate that the detection of CMV infection is common in infants with BA. There is still a need for large studies with appropriate controls to examine various aspects of the association between CMV infection and BA.

Particulate Backscattering in the Global Ocean: A Comparison of Independent Assessments

How well do we know the particulate backscattering coefficient (b_bp) in the global ocean? Satellite lidar b_bp has never been validated globally and few studies have compared lidar b_bp to b_bp derived from reflectances (via ocean color) or in situ observations. Here, we validate lidar b_bp with autonomous biogeochemical Argo floats using a decorrelation analysis to identify relevant spatiotemporal matchup scales inspired by geographical variability in the Rossby radius of deformation. We compare lidar, float, and ocean color b_bp at the same locations and times to assess performance. Lidar b_bp outperforms ocean color, with a median percent error of 18% compared to 24% in the best case and a relative bias of -11% compared to -21%, respectively. Phytoplankton carbon calculated from ocean color and lidar exhibits basin-scale differences that can reach ±50%.

Detection of cardiac allograft vasculopathy by multi-layer left ventricular longitudinal strain in heart transplant recipients

Cardiac allograft vasculopathy (CAV) is an obliterative and diffuse type of coronaropathy that develops in the transplanted human heart, representing a major cause of graft failure and mortality. Nowadays the gold standard for the diagnosis of CAV is coronary angiography (CA). Non-invasive CAV detection, especially in the early stages of the disease, is still challenging. Our study aimed to investigate the role of speckle tracking echocardiography (STE), in particular three-layer STE, in predicting CAV at early stages, and if other traditional echocardiographic, clinical or biochemical parameters could relate to CAV. The study population was composed of a total of 33 heart transplanted patients, divided accordingly to the presence or absence of CAV (12 CAV+ , 22 CAV-). All subjects underwent a complete transthoracic echocardiographic examination on the same day of the CA, and all conventional parameters of myocardial function were obtained, including strain values assessed by STE. Strain values were significantly reduced in presence of CAV, at each myocardial layer but in particular the endocardial-epicardial gradient (- 4.15 ± 1.6 vs - 1.7 ± 0.4% < .0001) that was also highly predictive of CAV (AUC at ROC curve 0.97). Among diastolic parameters, the E wave deceleration time (DT) and the mean E/e' ratio were strongly positively associated with CAV. In our population, left ventricular global longitudinal strain (GLS), layer-specific GLS and the endocardial-epicardial LS gradient, E wave DT and E/e' ratio were the best independent non-invasive predictors of CAV.

Influence of the photoinitiating system on the properties of photopolymerized methylmethacrylate: the role of the ketyl radical in type II photoinitiators

The photopolymerization of methylmethacrylate using different initiating systems strongly affects its glass transition temperature and dispersity.