Neurophysiological status of patients with non-valvular atrial fibrillation

Funding Acknowledgements

Type of funding sources: None.

The reduction of the risk of stroke in patients with AF is achieved with the help of continuous administration of oral anticoagulants (OAC). The presence of cognitive impairment in a patient may be a significant risk factor for low adherence to antithrombotic therapy, therefore, the medico-social significance of impaired cognitive functions in patients with AF is high. At the same time, it is still unclear which neurophysiological mechanisms and areas of the brain are responsible for the development of cognitive disorders in this pathology. Thus, further studies are needed to assess the state of higher cortical functions in patients with AF.

Materials and methods

The study included 50 patients with nonvalvular AF and a high risk of hemorrhagic and ischemic events, with a risk of thromboembolic complications on the CHA2DS2-VASc scale of at least 2 points and a risk of bleeding on the HAS-BLED scale of at least 3 points. The control group consisted of 17 relatively healthy individuals.

Research results

The analysis of indicators of extended neuropsychological testing made it possible to establish that, compared with healthy individuals of the same age, patients with AF perform worse on tests of neurodynamics, attention and short-term memory, Table. Patients with AF have a lower rate of complex sensorimotor reactions, a greater number of errors, especially in tests with biofeedback (brain performance test). Also, patients with AF have worse performance indicators and higher focused attention depletion (characterized by the number of characters processed in the 1st and 4th minutes of the proofreading test, respectively). As for the indicators of short-term memory, healthy subjects were superior to patients with AF in memorizing meaningless syllables and words, but not numbers.

The power indicators of the theta EEG rhythms at rest with eyes closed were taken. The factors were identified - GROUP (2 levels: patients with AF; healthy individuals), AREA (5 levels: (frontal, central, temporal, parietal, occipital) and LATERALITY (2 levels: left, right hemisphere). In patients with cardiac arrhythmias, the increase in the power of the theta-2 rhythm biopotentials in the direction from the anterior to the posterior cortex is significantly pronounced (p = 0.000001), while in healthy individuals the gradient curve is flatter (p = 0.009).

Conclusions

It was found that about half of the examined AF patients have syndrome mild cognitive impairment (MCI). The most significant cognitive decline in these patients compared with relatively healthy individuals was noted for the speed of sensorimotor response, performance control indicators, and short-term memory, while decreased cognitive test scores were associated with a greater representation of slow waves in the resting EEG, mainly in the posterior regions of the cerebral cortex.

Single molecule vs. large area design of molecular electronic devices incorporating an efficient 2-aminepyridine double anchoring group

When a molecule is bound to external electrodes by terminal anchor groups, the latter are of paramount importance in determining the electrical conductance of the resulting molecular junction. Here we explore the electrical properties of a molecule with bidentate anchor groups, namely 4,4'-(1,4-phenylenebis(ethyne-2,1-diyl))bis(pyridin-2-amine), in both large area devices and at the single molecule level. We find an electrical conductance of 0.6 × 10-4G0 and 1.2 × 10-4G0 for the monolayer and for the single molecule, respectively. These values are approximately one order of magnitude higher than those reported for monodentate materials having the same molecular skeleton. A combination of theory and experiments is employed to understand the conductance of monolayer and single molecule electrical junctions featuring this new multidentate anchor group. Our results demonstrate that the molecule has a tilt angle of 30° with respect to the normal to the surface in the monolayer, while the break-off length in the single molecule junction occurs for molecules having a tilt angle estimated as 40°, which would account for the difference in their conductance values per molecule. The bidentate 2-aminepyridine anchor is of general interest as a contact group, since this terminal functionalized aromatic ring favours binding of the adsorbate to the metal contact resulting in enhanced conductance values.

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.

An evaluation of a common elements treatment approach for youth in Somali refugee camps

BACKGROUND

This paper reports on: (1) an evaluation of a common elements treatment approach (CETA) developed for comorbid presentations of depression, anxiety, traumatic stress, and/or externalizing symptoms among children in three Somali refugee camps on the Ethiopian/Somali border, and (2) an evaluation of implementation factors from the perspective of staff, lay providers, and families who engaged in the intervention.

METHODS

This project was conducted in three refugee camps and utilized locally validated mental health instruments for internalizing, externalizing, and posttraumatic stress (PTS) symptoms. Participants were recruited from either a validity study or from referrals from social workers within International Rescue Committee Programs. Lay providers delivered CETA to youth (CETA-Youth) and families, and symptoms were re-assessed post-treatment. Providers and families responded to a semi-structured interview to assess implementation factors.

RESULTS

Children who participated in the CETA-Youth open trial reported significant decreases in symptoms of internalizing (d  =  1.37), externalizing (d  =  0.85), and posttraumatic stress (d  =  1.71), and improvements in well-being (d  =  0.75). Caregivers also reported significant decreases in child symptoms. Qualitative results were positive toward the acceptability and appropriateness of treatment, and its feasibility.

CONCLUSIONS

This project is the first to examine a common elements approach (CETA: defined as flexible delivery of elements, order, and dosing) with children and caregivers in a low-resource setting with delivery by lay providers. CETA-Youth may offer an effective treatment that is easier to implement and scale-up versus multiple focal interventions. A fullscale randomized clinical trial is warranted.

Photochemistry of 1- and 2-Methyl-5-aminotetrazoles: Structural Effects on Reaction Pathways

The influence of the position of the methyl substituent in 1- and 2-methyl-substituted 5-aminotetrazoles on the photochemistry of these molecules is evaluated. The two compounds were isolated in an argon matrix (15 K) and the matrix was subjected to in situ narrowband UV excitation at different wavelengths, which induce selectively photochemical transformations of different species (reactants and initially formed photoproducts). The progress of the reactions was followed by infrared spectroscopy, supported by quantum chemical calculations. It is shown that the photochemistries of the two isomers, 1-methyl-(1H)-tetrazole-5-amine (1a) and 2-methyl-(2H)-tetrazole-5-amine (1b), although resulting in a common intermediate diazirine 3, which undergoes subsequent photoconversion into 1-amino-3-methylcarbodiimide (H₂N-N═C═N-CH₃), show marked differences: formation of the amino cyanamide 4 (H₂N-N(CH₃)-C≡N) is only observed from the photocleavage of the isomer 1a, whereas formation of the nitrile imine 2 (H₂N-C^-═N⁺═N-CH₃) is only obtained from photolysis of 1b. The exclusive formation of nitrile imine from the isomer 1b points to the possibility that only the 2H-tetrazoles forms can give a direct access to nitrile imines, while observation of the amino cyanamide 4 represents a novel reaction pathway in the photochemistry of tetrazoles and seems to be characteristic of 1H-tetrazoles. The structural and vibrational characterization of both reactants and photoproducts has been undertaken.

Exploring saccharinate-tetrazoles as selective Cu(ii) ligands: structure, magnetic properties and cytotoxicity of copper(ii) complexes based on 5-(3-aminosaccharyl)-tetrazoles

Saccharinate-tetrazolesTSand2MTSbind selectively to copper(ii). The resulting copper complexes have shown a huge increase in thein vitrocytotoxicity against hepatic carcinoma cells (HepG2) compared to the corresponding nontoxic free ligands.

Structure and photochemistry of a saccharyl thiotetrazole

The molecular structure and photochemistry of 5-thiosaccharyl-1-methyltetrazole (TSMT) were studied by means of matrix-isolation FTIR spectroscopy, X-ray crystallography, and theoretical calculations. The calculations predicted two conformers of TSMT that differ in energy by more than 15 kJ mol(-1). The infrared spectrum of TSMT isolated in solid argon was fully assigned on the basis of the spectrum calculated (O3LYP/6-311++G(3df,3pd)) for the most stable conformer. In the crystal, TSMT molecules were found to assume the same conformation as for the isolated molecule, with each molecule forming four hydrogen bonds with three neighboring molecules, leading to a network of TSMT oligomers. Upon UV (λ = 265 nm) irradiation of the matrix-isolated TSMT, two photodegradation pathways were observed, both arising from cleavage of the tetrazolyl ring. Pathway a involves cleavage of the N1-N2 and N3-N4 bonds with extrusion of N2, leading to photostable diazirine and thiocarbodiimide derivatives. The photostability of the photoproduced diazirine under the conditions used precluded its rearrangement to the nitrile imine, as reported for 5-phenyltetrazole by Bégué et al. ( J. Am. Chem. Soc. 2012 , 134 , 5339 ). Pathway b involves cleavage of the C5-N1 and N4-N3 bonds, leading to a thiocyanate and methyl azide, the latter undergoing subsequent fragmentation to give CNH.

Tautomer selective photochemistry in 1-(tetrazol-5-yl)ethanol

A combined matrix isolation FTIR and theoretical DFT/B3LYP/6-311++G(d,p) study of the molecular structure and photochemistry of 1-(tetrazol-5-yl)ethanol [1-TE] was performed. The potential energy surface landscapes of the 1H and 2H tautomers of the compound were investigated and the theoretical results were used to help characterize the conformational mixture existing in equilibrium in the gas phase prior to deposition of the matrices, as well as the conformers trapped in the latter. In the gas phase, at room temperature, the compound exists as a mixture of 12 conformers (five of the 1H tautomer and seven of the 2H tautomer). Upon deposition of the compound in an argon matrix at 10 K, only three main forms survive, because the low barriers for conformational isomerization allow extensive conformational cooling during deposition. Deposition of the matrix at 30 K led to further simplification of the conformational mixture with only one conformer of each tautomer of 1-TE surviving. These conformers correspond to the most stable forms of each tautomer, which bear different types of intramolecular H-bonds: 1H-I has an NH···O hydrogen bond, whereas 2H-I has an OH···N hydrogen bond. Upon irradiating with UV light (λ > 200 nm), a matrix containing both 1H-I and 2H-I forms, an unprecedented tautomer selective photochemistry was observed, with the 2H tautomeric form undergoing unimolecular decomposition to azide + hydroxypropanenitrile and the 1H-tautomer being photostable.

Incidence and seasonal variation of Type 1 diabetes in children in Farwania area, Kuwait (1995-1999)

The aim of our study was to confirm the continuing rise in the incidence of Type 1 diabetes among Kuwaiti children aged 0-14, and to assess the effect of seasonality on incidence. Data from all newly diagnosed diabetic children between the period of 1995 and 1999 were analyzed. A total of 129 cases of Type 1 diabetes were diagnosed during the study period, of whom 68 were Kuwaiti nationals and were included in the study. The incidence was 20.18 per 100,000 (95% CI 16.3-28.2). Incidence rates for the age-groups 0-4, 5-9 and 10-14 were 8.12, 21.07 and 34.06, respectively. There was a significant female predominance (F:M ratio was 1.4:1, P<0.05). More cases were diagnosed in the cool months (November-February) compared with the warm months (June-September, P<0.05). There was increase in incidence from 1995 to 1999, but compared with data from the 1980s on the same age group, incidence has increased. A positive family history of Type 1 diabetes in a close relative was recorded for 30% of the patients. Although, only data from one hospital were included, Kuwait is very small geographically and not likely to have differences between different areas. Stress factors, economic growth, changes in the nutritional habits and the adoption of the western lifestyle may explain some of this increase.

Long-term ciprofloxacin treatment for the prevention of biliary stent blockage: a prospective randomized study

OBJECTIVE

In vitro experimental and animal studies have shown that quinolones reduce the adherence of bacteria on a polyethylene tube and prevent stent blockage. Our aim was to see whether ciprofloxacin prevents stent blockage in patients with malignant stricture of the biliary tract.

METHODS

Patients with inoperable biliary or pancreatic tumor not involving the bifurcation of the common hepatic duct were recruited. They were randomized to receive either endoscopic stenting alone or stenting with prophylactic treatment of ciprofloxacin (200 mg i.v. before stenting, followed by 250 mg orally twice per day). In each follow-up visit, clinical symptoms of cholangitis were documented and blood samples taken for blood counts, serum levels of bilirubin, and alkaline phosphatase. Stent blockage was defined as clinical symptom(s) of cholangitis with biochemical or radiological evidence of stent dysfunction.

RESULTS

Fifty-eight patients were recruited into the study. Three patients in the stenting group and three in the ciprofloxacin group were excluded after randomization. Eleven patients received stenting alone and five patients receiving ciprofloxacin had previous endoscopic stenting. Thirteen patients (50%) in the ciprofloxacin group and eight patients (31%) in the stenting group died before stent blockage. Ten patients (38%) in each group had stent blockage during the follow-up at 20 wk. The median stent patency was 11.6 wk and 11.9 wk in the ciprofloxacin group and the stenting group, respectively. Kaplan-Meier analysis of stent patency showed no difference between the two groups. Among patients who received endoscopic stenting for the first time, there was a trend favoring ciprofloxacin treatment, but the difference was not significant. The 30-day and 20-wk mortality between the groups were comparable.

CONCLUSION

Long-term use of ciprofloxacin does not prevent blockage of polyethylene biliary stents.

Clinical isolates of Staphylococcus aureus have osteolytic surface proteins and a proportion of the population have antibodies that block this activity: is this of prognostic significance?

Staphylococcus aureus is directly implicated in the bone destruction associated with infected orthopaedic implants and bacterial arthritis. The Oxford (laboratory) strain of this organism has surface-associated proteins (SAPs) which have potent osteolytic activity. In this study, we have examined the osteolytic activity of SAPs from clinical isolates and also investigated the role of the humoral immune response to such proteins. Nine patients with infected orthopaedic prostheses or infective arthritis, and six volunteers not suffering from overt S. aureus infection, were examined. The sera from 5/9 patients and 4/6 volunteers were able to neutralize the osteolytic activity of the SAPs. The SAPs were extracted from four clinical isolates and were found to have osteolytic activity, but with a wide range of efficacies and potencies. All four patients from whom the clinical isolates were obtained had serum IgG antibodies to the surface proteins from their autologous isolates as determined by ELISA. In conclusion, clinical isolates of S. aureus contain osteolytic SAPs which may be responsible for bone destruction. Apparently disease-free individuals and patients have antibodies able to block this activity. However, since the capacity of patients' sera to neutralize the activity of the SAPs derived from their own S. aureus isolate was not investigated, it is unclear whether these findings are of prognostic value.

Endemic kala-azar in eastern Sudan: post-kala-azar dermal leishmaniasis

In a longitudinal study between 1991 and 1993 in an endemic area in eastern Sudan, 85 cases of kala-azar (visceral leishmaniasis) were diagnosed, of whom 48 (56%) developed post-kala-azar dermal leishmaniasis (PKDL). Another four cases of PKDL had no clinical history of kala-azar. In children, PKDL was more frequent in the very young; seven of nine kala-azar cases (78%) in the group 0-1 years of age and 13 of 16 (81%) in the group 2-3 years of age developed PKDL. On the average, PKDL occurred 56 days (mean; range 0-180) after the end of treatment of kala-azar. To assess the severity of PKDL, a classification was developed using three grades of severity based on differences in density and distribution of lesions. In young children, PKDL was more severe. Incomplete treatment of kala-azar may be important in the pathogenesis of PKDL. Thirty-one patients were followed-up for at least six months; of these, 20 were not treated (17 healed, two improved, and in one, the condition was unchanged), three healed after incomplete treatment with sodium stibogluconate, and eight were cured after treatment but two required two courses. Considerable morbidity was caused by PKDL and should be taken into consideration in the management and follow-up of kala-azar patients. The high incidence of PKDL may have important implications in transmission.

Endemic kala-azar in eastern Sudan: a longitudinal study on the incidence of clinical and subclinical infection and post-kala-azar dermal leishmaniasis

Between April 1991 and April 1993, a longitudinal study was performed in the village of Um-Salala (1,430 inhabitants) in the endemic area of kala-azar (visceral leishmaniasis) in eastern Sudan. During the two years, a total of 92 kala-azar cases were diagnosed (male:female ratio = 1.8:1, mean age 6.6 years). The annual incidence rates were 38.4/1,000 and 38.5/1,000 person-years, respectively. The ratio of clinical to subclinical cases was 1.6:1 in the first year and 2.4:1 in the second year. Post-kala-azar dermal leishmaniasis occurred in 48 (56%) of 85 kala-azar cases that were followed-up for at least six months. Kala-azar occurred only in previously leishmanin-negative individuals. The majority of the population had a positive leishmanin skin test result, probably due to previous exposure to Leishmania major causing cutaneous leishmaniasis in their homeland in western Sudan from which they had migrated in the 1980s. It was thus postulated that previous cutaneous leishmaniasis might protect against kala-azar but this could not be proved.