Influence of the speed of deflation of the stent delivery system in the myocardial blush and ST-segment resolution in primary angioplasty: a randomized study

Introduction

Distal embolization may compromise the results of primary angioplasty. Our aim is to analyze the influence of the speed of deflation of the stent delivery system on the myocardial blush ≥2 and on the ST-Segment resolution ≥70%.

Methods

From December 2016 to February 2019, all consecutive patients with ST-elevation myocardial infarction who underwent urgent coronary angiography at our institution who were susceptible of thrombectomy, IIB-IIIA inhibitors and direct stenting were randomized 1:1 to fast deflation of the stent delivery system (group 1, n=103) or to slow deflation at 1 atm/second (group 2, n=107). Pre- and postdilatation was not allowed per protocol. The primary outcomes were the myocardial blush ≥2 and the ST-Segment resolution ≥70% while the size of myocardial damage, ejection fraction at discharge and at 12 months and total and cardiovascular mortality at 12 months were the secondary outcomes. A multivariate analysis was performed to analyze the influence of the speed of deflation of the stent delivery system in both primary end-points in case of possible imbalances among groups despite the randomization.

Results

Both groups represented 47% of the 447 procedures of primary angioplasty performed in that period. Baseline characteristics of the whole cohort: female gender 46 (21.9%), age 59.5±10.6 years, diabetes 35 (16.7%), Killip class IV 5 (2.4%), total ischemic time 177.5 (124–275) minutes and door to balloon time 84 (66–120.5) minutes. There were not differences in clinical or angiographic characteristics between both groups, although there was a non-significant trend towards larger reference vessel diameter in the slow deflation group (2.74±0.42 vs. 2.86±0.47, p=0.07). The study was prematurely stopped with 50% of the calculated sample size due to futility. The primary endpoint of myocardial blush ≥2 occurred in 77 (74.7%) vs. 79 (75.2%), p=0.93 and ST-Segment resolution ≥70% in 54 (53.9%) vs. 59 (55.5%), p=0.75 in group 1 and 2, respectively, without differences in any of the secondary endpoints. The speed of deflation of the stent delivery system did not show any influence on the MB or ST-Segment resolution ≥70% in the multivariate analysis. Predictors of myocardial blush ≥2 were systolic blood pressure at admission, creatinine clearance <60 ml/min and maximal diameter postprocedure. Diabetes, previous infarction, left anterior descending, TIMI ≥2 before intervention, TIMI 3 after intervention and collateral supply grade ≥2 were predictors of ST segment resolution≥70% with an area under the curve of 0.71 (0.63–0.80) and 0.75 (0.68–0.82), respectively.

Conclusions

In our series, the speed of deflation of the stent delivery system in primary angioplasty did not modified the myocardial blush ≥2 or ST-Segment resolution ≥70% and neither showed any influence in clinical outcomes, size of myocardial infarction by biomarkers and ejection fraction.

Funding Acknowledgement

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Abbott Laboratories

Synthetic hepcidin from fish: Uptake and protection against Vibrio anguillarum in sea bass (Dicentrarchus labrax)

The generation of a variety of new therapeutic agents to control and reduce the effects of pathogen in aquaculture is urgently needed. The antimicrobial peptides (AMPs) are one of the major components of the innate defenses and typically have broad-spectrum antimicrobial activity. However, absorption and distributions of exogenous AMPs for therapeutics application on farmed fish species need to be studied. Previous studies in our laboratory have shown the properties of hepcidin as an effective antimicrobial peptide produced in fish in response to LPS and iron. Therefore, we decided to investigate the antimicrobial activity of four synthetic variants of hepcidin against Vibrio anguillarum in vitro, and using the more effective peptide we demonstrated the pathogen's ability to protect against the infection in European Sea bass. Additionally the uptake of this peptide after ip injection was demonstrated, reaching its distribution organs such as intestine, head kidney, spleen and liver. The synthetic peptide did not show cytotoxic effects and significantly reduced the accumulated mortalities percentage (23.5%) compared to the European Sea bass control (72.5%) at day 21. In conclusion, synthetic hepcidin shows antimicrobial activity against V. anguillarum and the in vivo experiments suggest that synthetic hepcidin was distributed trough the different organs in the fish. Thus, synthetic hepcidin antimicrobial peptide could have high potential for therapeutic application in farmed fish species.

Immunization of sea bream (Sparus aurata) juveniles against Photobacterium damselae subsp. piscicida by short bath: Effect on some pro-inflammatory molecules and the Mx gene expression

Cytokines are a family of proteins derived from macrophages, lymphocytes, granulocytes, mast cells and epithelial cells and can be divided into interferons (IFNs), Interleukins (ILs) and Tumor Necrosis factors (TNFs) among others. The presence of cytokines in a wide number of fish species has been proved and several molecules types have been already cloned and sequenced. In this work some proinflamatory molecules and Mx gene were detected in the liver of vaccinated sea bream juveniles with an average body weight of 5 g. The method of immunization was by short bath and three different bacterins against the marine pathogen Photobacterium damselae subsp. piscicida were designed and used to immunize fish. Five genes encoding for five different molecules were analyzed by real time PCR: IL-1β, IL Ir-2, Cox-2, Mx and TNFα. Gene expression was quantified along four days after fish immunization and results were compared among groups. Results show that the heat-inactivated vaccine stimulates the up-regulation of IL-1β, IL Ir-2, Cox-2 and TNFα genes whereas the UV-light inactivated vaccine was the unique vaccine which stimulates the expression of Mx gene. The present is a novel study that shows by the first time the effect of the inactivation process of vaccines on the expression levels of genes involved in the defense against Photobacterium damselae subsp piscicida.

Extracellular vesicles and their synthetic analogues in aging and age-associated brain diseases

Multicellular organisms rely upon diverse and complex intercellular communications networks for a myriad of physiological processes. Disruption of these processes is implicated in the onset and propagation of disease and disorder, including the mechanisms of senescence at both cellular and organismal levels. In recent years, secreted extracellular vesicles (EVs) have been identified as a particularly novel vector by which cell-to-cell communications are enacted. EVs actively and specifically traffic bioactive proteins, nucleic acids, and metabolites between cells at local and systemic levels, modulating cellular responses in a bidirectional manner under both homeostatic and pathological conditions. EVs are being implicated not only in the generic aging process, but also as vehicles of pathology in a number of age-related diseases, including cancer and neurodegenerative and disease. Thus, circulating EVs-or specific EV cargoes-are being utilised as putative biomarkers of disease. On the other hand, EVs, as targeted intercellular shuttles of multipotent bioactive payloads, have demonstrated promising therapeutic properties, which can potentially be modulated and enhanced through cellular engineering. Furthermore, there is considerable interest in employing nanomedicinal approaches to mimic the putative therapeutic properties of EVs by employing synthetic analogues for targeted drug delivery. Herein we describe what is known about the origin and nature of EVs and subsequently review their putative roles in biology and medicine (including the use of synthetic EV analogues), with a particular focus on their role in aging and age-related brain diseases.

The in vitro immunomodulatory effect of extracellular products (ECPs) of Vagococcus fluvialis L21 on European sea bass (Dicentrarchus labrax) leucocytes

The immune associated genes, interleukin-1β (IL-1β), interleukin-6 (IL-6), interleukin 10 (IL-10), tumor necrosis factor-α (TNF-α), ciclo-oxigenase-2 (COX-2), and Mx gene were studied by real-time PCR in head-kidney leucocytes of sea bass after incubation with the extracellular products (ECPs) of the probiotic strain Vagococcus fluvialis L21 and polyinosinic:polycytidylic acid (POLY I:C), at different times (T1.5, T6, T12, T24, T48 and T72). In general, we can observe how pro-inflammatory cytokines IL-1β, TNF-α, IL-6 and COX-2 studied displayed a strong peak after stimulation with 1.5 h of ECPs of V. fluvialis L21, significant differences (P < 0.05) exist with other periods and with the POLY I: C at the same time. Similarly to the case of IL-10 also produced a statistically significant (P < 0.05) peak of expression on leukocytes that were stimulated with the ECPs of V. fluvialis L21. In the case of Mx gene expression, we note that in almost all sampling times there is an up-regulation of the Mx gene in leucocytes incubated with ECPs and POLY I:C compared to the control and Mx expression was higher in leucocytes that were stimulated with the ECPs of V. fluvialis for all times, except in T24. With these results we can consider that the ECPs of V. fluvialis L21 have a great power of stimulating the in vitro expression of immune-related genes and may even be useful as adjuvants for vaccine in aquaculture.

New aspects in the biology of Photobacterium damselae subsp. piscicida: pili, motility and adherence to solid surfaces

We describe for the first time the presence of pilus-like structures on the surface of Photobacterium damselae subsp. piscicida (Phdp). The hint to this discovery was the ability of one strain to hemagglutinate human erythrocytes. Further analysis of several Phdp strains ultrastructure by electron microscopy revealed the presence of long, thin fibers, similar to pili of other Gram-negative bacteria. These appendages were also observed and photographed by scanning, transmission electron microscopy and immunofluorescence. Although this fish pathogen has been described as non-motile, all strains tested exhibit twitching motility, a flagella-independent type IV-dependent form of bacterial translocation over surfaces. As far as we are aware, the movement of Phdp bacteria on semi-solid or solid surfaces has not been described previously. Moreover, we speculate that Phdp twitching motility may be involved in biofilm formation. Microscopic examination of Phdp biofilms by microscopy revealed that Phdp biofilm architecture display extensive cellular chaining and also bacterial mortality during biofilm formation in vitro. Based on our results, standardized analyses of Phdp surface appendages, biofilms, motility and their impact on Phdp survival, ecology and pathobiology are now feasible.

Studies on the fibre surfaces modified with xylan polyelectrolytes

Xylan was isolated from birch wood chips by using pressurized hot water extraction (PHWE). The extracted xylan was chemically modified yielding three different xylan derivatives (XDs): xylan sulfate (XS), carboxymethyl xylan (CMX) and xylan-4-[N,N,N-trimethylammonium]butyrate chloride (XTMAB). The structure and molecular weight of XDs was determined by using NMR spectroscopy and size exclusion chromatography (SEC). The potential utilization of xylan polyelectrolytes for modifying fibre surfaces was assessed by sorption experiments using bleached pine Kraft pulp as substrate. Polyelectrolyte titration method was chosen for estimating the amount of sorbed XDs onto the fibres. The cationic xylan derivative XTMAB had a strong interaction with fibres while the anionic derivatives did not show any sorption. X-ray photoelectron spectroscopy (XPS) and time of flight secondary ion mass spectrometry (ToF-SIMS) were selected as advanced surface analyses for studying the amount of surface anionic groups and the surface distribution of the XTMAB. XPS and polyelectrolyte titration results suggested that the XTMAB is sorbed onto the fibre surfaces. ToF-SIMS imaging showed that XTMAB was evenly distributed on fibre surfaces.

Study of the Influence of Microwaves in the Mechanism of Sulfenamide Accelerated Vulcanization of Natural Rubber Using Squalene as a Model Compound

The natural rubber vulcanization mechanism has been studied using microwaves as a heating source. The influence of such heating system on the mechanism reaction has been elucidated. In order to simplify the study of this process, squalene has been used as a Model Compound Vulcanization (MCV) for natural rubber and N-cyclohexyl-2-benzothiazolesulfenamide (CBS) as an accelerator. The accelerator fading, the crosslinking degree, the reversion process and the effect of the double bond have been studied and the results have been compared with previous results of our group using MCV with conventional heating. As well as the expected reaction rate increase, a noticeable change in the crosslink degree has been observed. Furthermore, some differences have been detected in the amount of the intermediate compounds formed during the reaction and in the sulfur transfer to the squalene chain. Strong differences have been also observed regarding the role of the activator in the vulcanization when microwaves are used.

[Comparison of 2 schedules based on pantoprazole for eradication of Helicobacter pylori in patients with active duodenal ulcer]

OBJECTIVE

To compare the efficacy and tolerability of a triple vs dual pantoprazole based therapy to eradicate Helicobacter pylori (H. pylori) in mexican patients with florid duodenal ulcer.

BACKGROUND

The treatment of peptic ulcer disease was revolutionized by the fact that H. pylori generally induces chronic gastritis and peptic ulcer disease and that the cure of the infection prevents ulcer relapses.

MATERIAL AND METHODS

74 H. pylori positive patients with florid duodenal ulcer were randomized to receive either pantoprazole 40 mg bid in combination with clarithromycin 500 mg tid and amoxicillin 1 g bid (triple regimen PAC) or pantoprazole in combination with clarithromycin and placebo (dual regimen PC) during 14 days. To ensure complete ulcer healing all patients received an additional 2 weeks treatment with pantoprazole 40 mg od. 14C Urea Breath test (UBT) was the main criteria used to determine eradication rate with < 150 disintegrations per minute (DPM) to consider a patient eradicated. In all patients culture, antibiotic susceptibility (E-test) and histology were performed.

RESULTS

In the per protocol analysis (n = 66) the eradication rate was: PAC 93.5% vs PC 54.3% (p < 0.001). 76% of H. pylori strains were resistant to metronidazole. Tolerance and compliance were excellent in both groups.

CONCLUSIONS

Triple therapy (PAC) was shown to be superior to dual therapy (PC) for H. pylori eradication in mexican patients with florid duodenal ulcer.

[Granulomatous hepatitis caused by Q fever]

We inform of one case of fever and characteristic hepatic granuloma in which the final diagnosis was Q fever. The interest of this case lies in the fact that the patient did not have the usual epidemiological antecedent and its typical clinical presentation.

Cardiac involvement in acromegaly: specific myocardiopathy or consequence of systemic hypertension?

To evaluate the relative contributions of past or present GH hypersecretion and of hypertension to the cardiac abnormalities present in acromegaly, we have studied the serum GH and insulin-like growth factor I concentrations, systolic and diastolic blood pressures, and morphological and functional cardiac indexes as measured by echocardiography-Doppler, in 39 patients with active or cured acromegaly, 16 hypertensive controls, and 17 normotensive controls. Hypertension was present in 42.8% of patients with active acromegaly and in 28.0% of patients in which acromegaly was cured. Hypertension was independently related to an increase in indexes of cardiac morphology (left ventricular mass, left ventricular posterior wall thickness, interventricular septum thickness, relative wall thickness with respect to the diastolic diameter of the left ventricle, and left atrial end-systolic diameter), systolic function (stroke volume, fractional shortening, and end-systolic stress), and diastolic function (isovolumic relaxation time and maximal late diastolic flow velocity) and to a reduction in the early to late maximal diastolic flow velocity ratio. Acromegaly was related to an increase in left ventricular mass, stroke volume, cardiac output, and isovolumic relaxation time, which were independent from the presence of hypertension. End-systolic stress was reduced by acromegaly. In the five patients in which active acromegaly was successfully treated, left ventricular mass and left ventricular posterior wall thickness were reduced 1 yr later. In conclusion, the asymptomatic morphological and functional cardiac abnormalities present in acromegalic patients are independently related to acromegaly and hypertension, pointing to the existence to a specific acromegalic myocardiopathy that might be aggravated by the coexistence of hypertension.

Neoplastic colonic polyps in acromegaly

A high prevalence of neoplastic colorectal polyps has been described in acromegalic patients. The aim of the present report was to confirm the high prevalence of neoplastic colorectal polyps in acromegaly and the existence of special risk factors for this type of polyps among acromegalic patients. A fiberoptic colonoscopy was performed in 27 active acromegalic patients, followed by both polypectomy and biopsy when indicated. Several prognostic variables were analysed a potential risk factors, in all cases. The prevalence of neoplastic colorectal polyps found in our series (22.2%) was similar to that in previous studies, and did not show any apparent increment compared to that in the populations in which it is known. None of the prognostic variables studied were related to the presence of neoplastic colorectal polyps.

[Cardiac tamponade as a presentation of primary hypothyroidism in a young woman]

Pericardial effusion (PE) as a hypothyroidism associated sign, is something that can be found with relative frequency; nevertheless, cardiac tamponade (CT) as the first sign of this disease may be considered exceptional especially in young patients. We report a 31 years old woman with clinical symptoms and signs of CT that in the forward workshop was diagnosed of primary hypothyroidism as cause of the CT. We shortly describe the case and review the literature, emphasizing the importance of the knowledge of CT trigger factors in myxedematous PE, as well as its usual benign evolution with hormonal treatment, without recurrences of the CT after pericardiocentesis is performed. This justify a conservative approach, in spite of the slow resolution of the PE what can take as long as 1.5 years.