The ESC ACCA EAPCI EORP acute coronary syndrome ST-elevation myocardial infarction registry

Aims 

The Acute Cardiac Care Association (ACCA)–European Association of Percutaneous Coronary Intervention (EAPCI) Registry on ST-elevation myocardial infarction (STEMI) of the EurObservational programme (EORP) of the European Society of Cardiology (ESC) registry aimed to determine the current state of the use of reperfusion therapy in ESC member and ESC affiliated countries and the adherence to ESC STEMI guidelines in patients with STEMI.

Methods and results 

Between 1 January 2015 and 31 March 2018, a total of 11 462 patients admitted with an initial diagnosis of STEMI according to the 2012 ESC STEMI guidelines were enrolled. Individual patient data were collected across 196 centres and 29 countries. Among the centres, there were 136 percutaneous coronary intervention centres and 91 with cardiac surgery on-site. The majority of centres (129/196) were part of a STEMI network. The main objective of this study was to describe the demographic, clinical, and angiographic characteristics of patients with STEMI. Other objectives include to assess management patterns and in particular the current use of reperfusion therapies and to evaluate how recommendations of most recent STEMI European guidelines regarding reperfusion therapies and adjunctive pharmacological and non-pharmacological treatments are adopted in clinical practice and how their application can impact on patients’ outcomes. Patients will be followed for 1 year after admission.

Conclusion 

The ESC ACCA-EAPCI EORP ACS STEMI registry is an international registry of care and outcomes of patients hospitalized with STEMI. It will provide insights into the contemporary patient profile, management patterns, and 1-year outcome of patients with STEMI.

Prevalence and predictors of lower urinary tract symptoms in Pakistani men: A cross-sectional study

Objective:

The purpose of this study was to investigate the prevalence and severity of the condition of lower urinary tract symptoms in Pakistani men, determine its predictors and assess its impact on the quality of life.

Methods:

A cross-sectional, population-based study was conducted among men aged 30 years and over in three districts of Punjab province, Pakistan. The modified Urdu version of the International Prostate Symptom Score was used to assess the prevalence and severity of lower urinary tract symptoms. Individuals with total symptom score ⩾8 were considered as having lower urinary tract symptoms. The data were analysed using SPSS version 22. The chi-square test and Mann-Whitney U test were used to assess the difference among categorical and continuous variables, respectively. Moreover, binary logistic regressions were performed to determine the predictors of lower urinary tract symptoms.

Results:

The overall prevalence of lower urinary tract symptoms in our sample was 33.7%. The frequency of individuals having mild, moderate and severe lower urinary tract symptoms was 66.3, 30.3 and 3.4%, respectively. Storage symptoms were more common than voiding symptoms (35.6% vs 28.2%, respectively). Increasing age (one-decade interval age stratum), higher education levels, working status (currently not working), smoking, hypertension, diabetes and renal impairment were positive predictors of lower urinary tract symptoms. Moreover, the condition of lower urinary tract symptoms was associated with a significant reduction in an individual’s quality of life.

Conclusion:

Around one-third of adult Pakistani men suffer from clinically relevant urinary symptoms, with lower urinary tract symptoms sufferers having poor quality of life as compared to non-sufferers. We recommend that the aging population should be made aware of conventional measures to mitigate mild urinary symptoms affecting their routine activities. Level of evidence: 2c

Control rod material effect on safety parameters of research reactors

Control rods provide adjustable manipulation of reactivity and prevent fission reaction from accelerating beyond control. In this paper, the Monte Carlo Code, MCNP6 was used to study the effect of using various control rod materials on the main safety parameters of a typical plate type material test research reactor. Three types of control rod materials were considered, Ag-In-Cd, B4C, and Hafnium. Parameters investigated are reactivity worth, excess reactivity and shutdown margin of absorber materials. The model was used to evaluate the effect of various materials on the flux and power shaping of the core. The resulting multiplication factor for this study was compared with previous work and found acceptable. It was found that boron carbide has the largest effect on safety parameters, as well as flux and power distribution.

Degradation of pristine and oxidized single wall carbon nanotubes by CYP3A4

Carbon nanotubes (CNTs) are a class of carbon based nanomaterials which have attracted substantial attention in recent years as they exhibit outstanding physical, mechanical and optical properties. In the last decade many studies have emerged of the underlying mechanisms behind CNT toxicity including malignant transformation, the formation of granulomas, inflammatory responses, oxidative stress, DNA damage and mutation. In the present investigation, we studied the biodegradation of single-walled carbon nanotubes (SWCNTs) by Cytochrome P450 enzymes (CYP3A4) through using Raman spectroscopy. CYP3A4 is known isozyme accountable for metabolizing various endogenous and exogenous xenobiotics. CYP3A4 is expressed dominantly in the liver and other organs including the lungs. Our results suggest that CYP3A4 has a higher affinity for p-SWNTs compared to c-SWNTs. HEK293 cellular viability was not compromised when incubated with SWNT. However, CYP3A4 transfected HEK293 cell line showed no digestion of c-SWNTs after incubation for 96 h. Cellular uptake of c-SWNTs was observed by electron microscopy and localization of c-SWNTs was confirmed in endosomal vesicles and in the cytoplasm. This is the first study CYP3A4 degrading both p-SWNTs and c-SWNTs in an in vitro setup. Interestingly, our results show that CYP3A4 is more proficient in degrading p-SWNTs than c-SWNTs. We also employed computational modeling and docking assessments to develop a further understanding of the molecular interaction mechanism.

Development and validation of TaqMan real-time PCR for the detection of Burkholderia pseudomallei isolates from Malaysia

Rapid detection of Burkholderia pseudomallei, the etiologic agent of melioidosis, allows for timely initiation of appropriate treatment and better clinical outcomes. In the current gold standard, the culture method is time consuming and suffers from low sensitivity. Meanwhile, previously reported molecular assays are fast and sensitive, but their performance on isolates from Malaysia, an endemic region of melioidosis is under reported. This study designed oligonucleotides targeting orf2 of Type III secretion system (TTSS) genes cluster for the detection of Malaysian B. pseudomallei isolates and evaluated the assay on 95 local B. pseudomallei strains, 58 other microorganisms and 71 clinical specimens from patients. The developed assay exclusively detected all tested B. pseudomallei isolates with a detection limit of 20 fg per reaction (equivalent to ~2.5 copies). Subsequent testing on clinical samples showed that the assay detected all confirmed specimens with the growth of B. pseudomallei (n = 10/10). None of the negative specimens had a detectable signal of our TTSS-orf2 assay (n = 0/61). In conclusion, the present study provides crucial preliminary data for a subsequent study and should be considered as a potential alternative to current time-consuming culture method for the detection of B. pseudomallei.

New Routes for Novel Pyrazolo[3,4-b][1,6]-naphthyridine, Pyrazolo[3,4-b]pyridine and Pyrazolo[3,4:2,3]pyrido[6,1-a]benzimidazole Derivatives

Pyrazolo[3,4- b] [1,6] naphthyridine, pyrazolo[3,4- b] pyridine and pyrazolo[3,4:2,3] pyrido [6,1 -a] benzimidazole derivatives are synthesized starting from the isomeric 3-substituted 5-chloro-1-phenylpyrazole-4-carbaldehyde.

Facilitating patient-centered care: the development of illustrated multidimensional patient-reported outcome measures for children/adolescents with juvenile idiopathic arthritis

OBJECTIVES

To assess the validity, reliability, comprehensibility, and responsiveness to change of an illustrated child/parent multidimensional patient-reported outcome measures (PROMs) questionnaire which can assess construct outcome measures of children with juvenile inflammatory arthritis.

METHODS

A total of 122 children with juvenile idiopathic arthritis were included in this work in a multicenter study. The questionnaire included seven categories: (1) functional ability; (2) health-related quality of life; (3) disease activity measures: pain, global assessment, fatigue, and morning stiffness; (4) self-reported joint tenderness; (5) current medication, side effects, and adherence to therapy; (6) comorbidities; and (7) patient motivation. All the items were supported by illustrations to provide children with a visual impression of what was meant by the questions. The questionnaire has parent and patient versions. The disease activity status was assessed using JADAS-27.

RESULTS

The questionnaire was reliable as demonstrated by a high-standardized alpha (0.890-0.978). The questionnaire items correlated significantly (p < 0.01) with clinical parameters of disease activity. The patient-reported tender joints correlated significantly with the physician's scores (0.842). Changes in functional disability, quality of life, and the motivation score showed significant variation (p < 0.01) with disease activity status in response to therapy. The illustrated PROMs questionnaire showed also a high degree of comprehensibility (9.6).

CONCLUSIONS

Integrating PROMs into standard clinical practice is feasible and applicable. The illustrated questionnaire was valid and reliable. It provides an informative, quantitative measure for the disease activity score set data, and in the meantime, facilitates the assessment of the children's adherence to therapy, comorbidities, and motivation on an individual basis.

Cortical recruitment and functional dynamics in postural control adaptation and habituation during vibratory proprioceptive stimulation

OBJECTIVE

Maintaining upright posture is a complex task governed by the integration of afferent sensorimotor and visual information with compensatory neuromuscular reactions. The objective of the present work was to characterize the visual dependency and functional dynamics of cortical activation during postural control.

APPROACH

Proprioceptic vibratory stimulation of calf muscles at 85 Hz was performed to evoke postural perturbation in open-eye (OE) and closed-eye (CE) experimental trials, with pseudorandom binary stimulation phases divided into four segments of 16 stimuli. 64-channel EEG was recorded at 512 Hz, with perturbation epochs defined using bipolar electrodes placed proximal to each vibrator. Power spectra variation and linearity analysis was performed via fast Fourier transformation into six frequency bands (Δ, 0.5-3.5 Hz; θ, 3.5-7.5 Hz; α, 7.5-12.5 Hz; β, 12.5-30 Hz; [Formula: see text], 30-50 Hz; and [Formula: see text], 50-80 Hz). Finally, functional connectivity assessment was explored via network segregation and integration analyses.

MAIN RESULTS

Spectra variation showed waveform and vision-dependent activation within cortical regions specific to both postural adaptation and habituation. Generalized spectral variation yielded significant shifts from low to high frequencies in CE adaptation trials, with overall activity suppressed in habituation; OE trials showed the opposite phenomenon, with both adaptation and habituation yielding increases in spectral power. Finally, our analysis of functional dynamics reveals novel cortical networks implicated in postural control using EEG source-space brain networks. In particular, our reported significant increase in local θ connectivity may signify the planning of corrective steps and/or the analysis of falling consequences, while α band network integration results reflect an inhibition of error detection within the cingulate cortex, likely due to habituation.

SIGNIFICANCE

Our findings principally suggest that specific cortical waveforms are dependent upon the availability of visual feedback, and we furthermore present the first evidence that local and global brain networks undergo characteristic modification during postural control.

PI3K/Akt and Nrf2/HO-1 pathways involved in the hepatoprotective effect of verapamil against thioacetamide toxicity in rats

Liver is a precious organ to maintain body life. Hepatotoxicity is a worldwide health problem that is still a challenge for research. Although countless pharmaceutical drugs and herbal compounds were screened for their hepatoprotective effects, the death from hepatotoxicity is increasing. Thus, there is continuous necessity of searching for the hepatoprotective effect of commonly used drugs. Accordingly, our aim was to examine a hepatoprotective potential for the antihypertensive drug, verapamil, and searching for new insights underlie its protective mechanism. Four groups of adult male rats were randomly arranged as controls, thioacetamide (TAA) hepatotoxic, and TAA + verapamil treated. Serum liver enzyme, hepatic antioxidant, lipid peroxidation, and inflammatory parameters were assessed. Gene relative expression for heme oxygenase-1 (HO-1), nuclear factor-erythroid 2-related factor 2 (Nrf2), phosphoinositide 3-kinase (PI3K), and serine/threonine-specific protein kinase (Akt) were quantified in hepatic tissue. TAA caused hepatic injury evident both histopathologically and biochemically by a decrease in all gene expressions. Verapamil alleviated the injury via its antioxidant and anti-inflammatory effects that were suggested to be via upregulation of the previous gene expressions. In conclusion, the calcium channel blocker, verapamil, that is used widely as antihypertensive exhibits a valuable hepatoprotective effect. The protection partially rests on activation of Nrf2/HO-1 and PI3K/Akt pathways.