Incidence of major adverse cardiovascular events with genotype test guided antiplatelet treatment strategy after percutaneous coronary intervention

Objective

To estimate the incidence of major adverse cardiovascular events (MACE) with genotype test-guided antiplatelet therapy in patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome.

Methods

Patients who had undergone PCI for acute coronary syndrome as well as stable coronary artery disease were recruited. Salivary samples were obtained from these patients and genotyped for CYP2C19∗2, CYP2C19∗3 variations by sequencing method (GAAP x method). Patients were categorized as normal (GG, GG) (29%), intermediate (AG) (52%) or poor metabolizes (homozygous variant AA) (19%). Dual antiplatelets were given based on the genotyping data. Poor metabolizes received newer agent (ticagrelor), intermediate metabolizes received double-dose of clopidogrel and normal metabolizes received therapeutic doses of clopidogrel. All subjects were followed-up for six months.

Results

Based on the genotyping data of CYP2C19∗2 and CYP2C19∗3 variations, it was found that most patients were categorized as ‘intermediate’ (78, 51.65%), followed by ‘normal’ (43, 28.48%) and ‘poor’ metabolizes (30, 19.87%). Only 3 (1.5%) of 151 patients reported MACE at follow-up.

Conclusions

Genotyping for CYP2C19 variations to assess clopidogrel resistance in patients undergoing PCI and subsequent drug selection helps reduce MACE after coronary intervention.

A novel design, analysis and 3D printing of Ti-6Al-4V alloy bio-inspired porous femoral stem

The current study is proposing a design envelope for porous Ti-6Al-4V alloy femoral stems to survive under fatigue loads. Numerical computational analysis of these stems with a body-centered-cube (BCC) structure is conducted in ABAQUS. Femoral stems without shell and with various outer dense shell thicknesses (0.5, 1.0, 1.5, and 2 mm) and inner cores (porosities of 90, 77, 63, 47, 30, and 18%) are analyzed. A design space (envelope) is derived by using stem stiffnesses close to that of the femur bone, maximum fatigue stresses of 0.3σ_ys in the porous part, and endurance limits of the dense part of the stems. The Soderberg approach is successfully employed to compute the factor of safety N_f > 1.1. Fully porous stems without dense shells are concluded to fail under fatigue load. It is thus safe to use the porous stems with a shell thickness of 1.5 and 2 mm for all porosities (18-90%), 1 mm shell with 18 and 30% porosities, and 0.5 mm shell with 18% porosity. The reduction in stress shielding was achieved by 28%. Porous stems incorporated BCC structures with dense shells and beads were successfully printed.

Geochemistry data of the nadergul granodiorite of the late archean hyderabad granite batholith, part of eastern dharwar craton, india; implications for composition of the lower continental crust

The Nadergul granodiorite (NG), is a part of Hyderabad Granite Batholith (HGB), exposed at ground level covering an area of 6 km². Field observational data suggests that the NG is involved in the magma mixing mingling process. Petrographical data shows holocrystaline, phaneritic, coarse grained, inequigranular, mesocratic characteristics, essentially consists of quartz, orthoclase, plagioclase and microcline. The common accessory minerals are hornblende, biotite, clinopyroxene, zircon, fluorite, apatite and opaque. The myrmekitic texture is the most common intergrowth texture which seems to be magmatic origin. Geochemical data suggest that the NG is metaluminous and show calc-alkaline trend. It is charecterised by SiO₂ content ranging from 63.55 % to 64.54%, moderate alkali content (Na₂O + K₂O = 5.6%), relatively high MgO content ranging from 2.8 % to 3.5 %. The total CaO-Na₂O-K₂O content ranges from 9.5 % to10.4 %. The normalised REE patterns show LREEs enrichment with slight negative europium anomaly. The High Field Strength Elements such as Zr (67.3 to 114.3 ppm), Y (21.1 to 30.1 ppm), Nb (6.3 to 8.5 ppm) and Th (8.4 to 13.8 ppm) are relatively enriched. The granodiorite is I type, falls in the Volcanic Arc Granitoid (VAG) field in tectonic discrimination diagram.

Intra-Arterial Chemotherapy for Retinoblastoma in Infants ≤10 kg: 74 Treated Eyes with 222 IAC Sessions

BACKGROUND AND PURPOSE

Intra-arterial chemotherapy for retinoblastoma has dramatically altered the natural history of the disease. The remarkable outcomes associated with a high safety profile have pushed the envelope to offer treatment for patients weighing ≤10 kg. The purpose was to determine the efficacy and safety of IAC infusions performed in infants weighing ≤10 kg with intraocular retinoblastoma.

MATERIALS AND METHODS

A retrospective chart review was performed for patients diagnosed with retinoblastoma and managed with intra-arterial chemotherapy.

RESULTS

The total study cohort included 207 retinoblastoma tumors of 207 eyes in 196 consecutive patients who underwent 658 intra-arterial chemotherapy infusions overall. Of these, patient weights were ≤10 kg in 69 (35.2%) and >10 kg in 127 (64.8%) patients. Comparison (≤10 kg versus >10 kg) revealed that the total number of intra-arterial chemotherapy infusions was 222 versus 436. Periprocedural complications were not significantly different (2 [0.9%] versus 2 [0.5%]; P = .49). Cumulative radiation exposure per eye was significantly lower in infants weighing ≤10 kg (5.0 Gym² versus 7.7 Gym²; P = .01). Patients weighing ≤10 kg had a greater frequency of complete tumor regression (82.6% versus 60.9%; P = .02). Mean fluoroscopy time was not significantly different (7.5 versus 7.2; P = .71). There was a significant difference in the frequency of enucleation (16 [21.6%] versus 52 [39.1%]; P = .01). Patients weighing ≤10 kg had greater number of aborted procedures (12 [5.4%] versus 7 [1.6%]; P = .01). On multivariate analysis, weight ≤10 kg was not an independent predictor of complications or procedure failure.

CONCLUSIONS

Intra-arterial chemotherapy in patients weighing ≤10 kg is a safe and effective treatment.

Effect of 1-Hexyl-3-Methylimidazolium Iodide Ionic Liquid on Ionic Conductivity and Energy Conversion Efficiency of Solid Polymer Electrolyte-Based Nano-Crystalline Dye-Sensitized Solar Cells

Solid polymer electrolytes (SPEs) were prepared using rice starch as the polymer, sodium iodide (NaI) as the salt and 1-hexyl-3-methylimidazolium iodide (HMII) as the ionic liquid (IL). The solution casting technique was used for preparation of the PEs. The ionic conductivity and temperaturedependent properties of the PEs were measured and all the SPEs were found to follow the Arrhenius thermal activated model. Ionic conductivity increased as the percentage of ILs increased. The SPE containing 20% (wt) of HMII IL showed the highest ionic conductivity of 1.83×10^-3 S/cm. Spectral and structural characterization of the PEs were performed by Fourier transform infrared spectroscopy (FTIR) and X-ray diffraction (XRD), respectively. The results of thermogravimetric analysis (TGA) and differential scanning calorimetry (DSC) indicate that the decomposition temperature (T_dc), glass transition temperatures (T_g) and melting points (T_m) shifted when complexation with HMII occurred. The PEs were used to fabricate dye-sensitized solar cells (DSSCs) and the DSSCs were analyzed under a 1-sun simulator. The SPE with the highest ionic conductivity displayed a short circuit current density (J_sc) of 9.07 (mA cm^-2), open circuit voltage (V_oc) of 0.58 (V), a fill factor (FF) of 0.65 and had the highest energy conversion efficiency of 3.42%.

Patient deprivation and perceived scan burden negatively impact the quality of whole-body MRI

AIM

To evaluate the association between the image quality of cancer staging whole-body magnetic resonance imaging (WB-MRI) and patient demographics, distress, and perceived scan burden.

MATERIALS AND METHODS

A sample of patients recruited prospectively to multicentre trials comparing WB-MRI with standard scans for staging lung and colorectal cancer were invited to complete two questionnaires. The baseline questionnaire, administered at recruitment, collated data on demographics, distress and co-morbidity. The follow-up questionnaire, completed after staging investigations, measured perceived WB-MRI scan burden (scored 1 low to 7 high). WB-MRI anatomical coverage, and technical quality was graded by a radiographic technician and grading combined to categorise the scan as "optimal", "sub-optimal" or "degraded". A radiologist categorised 30 scans to test interobserver agreement. Data were analysed using the chi-square, Fisher's exact, t-tests, and multinomial regression.

RESULTS

One hundred and fourteen patients were included in the study (53 lung, 61 colorectal; average age 65.3 years, SD=11.8; 66 men [57.9%]). Overall, 45.6% (n=52), scans were classified as "optimal" quality, 39.5% (n=45) "sub-optimal", and 14.9% (n=17) as "degraded". In adjusted analyses, greater deprivation level and higher patient-reported scan burden were both associated with a higher likelihood of having a sub-optimal versus an optimal scan (odds ratio [OR]: 4.465, 95% confidence interval [CI]: 1.454 to 13.709, p=0.009; OR: 1.987, CI: 1.153 to 3.425, p=0.013, respectively). None of the variables predicted the likelihood of having a degraded scan.

CONCLUSIONS

Deprivation and patients' perceived experience of the WB-MRI are related to image quality. Tailored protocols and individualised patient management before and during WB-MRI may improve image quality.

Biological responses of MC3T3-E1 on calcium carbonate coatings fabricated by hydrothermal reaction on titanium

Titainum (Ti) implants have been successfully used in orthopaedic and dental surgery. However, poor early bone tissue integration is still a common cause of implant failure. This could be modulated by improving the material bonding or adhesion directly to the bone by surface roughening and/or a bioresorbable and osteoconductive coating. In this study, we report on the biological behaviours of the Ti substrate with modified surface roughness and/or a calcium carbonate (CaCO₃) coating. The roughened Ti surface was prepared using an acid etching reaction, and the CaCO₃ coating on the substrates was synthesized by the hydrothermal treatment of Ti in calcium citrate complexes. This study demonstrates that surface roughening of Ti alone does not improve the biological response of the MC3T3-E1 cells, but a CaCO₃ coating on the smooth Ti surface increases cell responses, and these effects are further enhanced by the combination of coating a roughened Ti surface with CaCO₃. The larger the cell area, the greater the cell proliferation and increased bone-like nodule formation were observed on the CaCO₃ coating of the roughened Ti surface. This observation was also supported by a higher ALP value. The cell behaviours found in the current study further support the development of CaCO₃ coatings towards clinical application.

Socio-Demographic and Clinical Correlates of Exclusive Breastfeeding practices up to Six Months of Age

Background

According to the recommendations from The World Health Organization, exclusive breast feeding (EBF) should be given to infants for the first six months for healthy growth and development. However, developing countries have a wide range of variation in the practice of EBF. From this study, we aim to estimate the duration of EBF and find the impact of socio-demographic characteristics on EBF.

Materials and Methods

This study was conducted at PSG Institute of Medical Sciences and Research, Coimbatore in the month of July 2018. Mothers with children aged below 4 years attending the paediatric outpatient department were included in the study. Kaplan-Meier curve analysis and logistic regression analysis were employed.

Results

Our analysis indicates that the prevalence of EBF was 58.4% among infants up to 6 months of age with mean duration of EBF 4.52 months. It was observed that mothers of a younger age (15-24 years) and with lower socio-economic status were negatively associated with the practice of providing EBF to infants up to six months of age.

Conclusion

The findings clearly indicate that the interventions related to EBF up to six months of age should be targeted at women in the lower socio-economic status and at younger ages.

Compression after Impact Behaviour and Failure Analysis of Nanosilica-Toughened Thin Epoxy/GFRP Composite Laminates

Nanosilica particles were utilized as secondary reinforcement to enhance the strength of the epoxy resin matrix. Thin glass fibre reinforced polymer (GFRP) composite laminates of 3 ± 0.25 mm were developed with E-Glass mats of 610 GSM and LY556 epoxy resin. Nanosilica fillers were mixed with epoxy resin in the order of 0.25, 0.5, 0.75 and 1 wt% through mechanical stirring followed by an ultrasonication method. Thereafter, the damage was induced on toughened laminates through low-velocity drop weight impact tests and the induced damage was assessed through an image analysis tool. The residual compression strength of the impacted laminates was assessed through compression after impact (CAI) experiments. Laminates with nanosilica as secondary reinforcement exhibited enhanced compression strength, stiffness, and damage suppression. Results of Fourier-transform infrared spectroscopy revealed that physical toughening mechanisms enhanced the strength of the nanoparticle-reinforced composite. Failure analysis of the damaged area through scanning electron microscopy (SEM) evidenced the presence of key toughening mechanisms like damage containment through micro-cracks, enhanced fiber-matrix bonding, and load transfer.

Genetics of fruit yield and its component traits under different fruiting habit backgrounds in chilli (Capsicum annuum L.)

The six basic generations (two parents, F₁, F₂ and backcrosses) of 14 crosses developed from nine parents differing in fruits node^-1 and fruit orientation were evaluated to decipher the genetics of three quantitative traits (average fruit weight, fruits plant^-1 and green fruit yield plant^-1) during the rainly season of 2016 and 2017. The magnitude and direction of the additive genetic effects [a], dominance genetic effects [d], magnitudes of additive genetic variance (σ² _A) and dominance genetic variance (σ² _D) varied with the genetic background of the crosses and traits. In the genetic background of crosses involving parents differing in fruit node^-1, the inheritance of average fruit weight, fruits plant^-1 and fruit yield plant^-1 were controlled by the genes with both additive and ambidirectional dominant effects. On the contrary, genes with only additive effects controlled the inheritance of average fruit weight, fruits plant^-1 and fruit yield plant^-1 in most genetic backgrounds of crosses involving parents differing in fruit orientation and those differing in both fruits node^-1 and fruit orientation. Further, the genes controlling the inheritance of all the traits are dispersed among the parents used in the investigation. These results are discussed in relation to strategies to be used in breeding chilli.