Utilizing the open-source programming language Python to create interactive Quality Assurance dashboards for diagnostic and screening performance in Cytology

INTRODUCTION

Effective feedback on cytology performance relies on navigating complex laboratory information system data, which is prone to errors and lacks flexibility. As a comprehensive solution, we used the Python programming language to create a dashboard application for screening and diagnostic quality metrics.

MATERIAL AND METHODS

Data from the 5-year period (2018-2022) were accessed. Versatile open-source Python libraries (user developed program code packages) were used from the first step of LIS data cleaning through the creation of the application. To evaluate performance, we selected 3 gynecologic metrics: the ASC/LSIL ratio, the ASC-US/ASC-H ratio, and the proportion of cytologic abnormalities in comparison to the total number of cases (abnormal rate). We also evaluated the referral rate of cytologists/cytotechnologists (CTs) and the ratio of thyroid AUS interpretations by cytopathologists (CPs). These were formed into colored graphs that showcase individual results in established, color-coded laboratory "goal," "borderline," and "attention" zones based on published reference benchmarks. A representation of the results distribution for the entire laboratory was also developed.

RESULTS

We successfully created a web-based test application that presents interactive dashboards with different interfaces for the CT, CP, and laboratory management (https://drkvcsstvn-dashboards.hf.space/app). The user can choose to view the desired quality metric, year, and the anonymized CT or CP, with an additional automatically generated written report of results.

CONCLUSIONS

Python programming proved to be an effective toolkit to ensure high-level data processing in a modular and reproducible way to create a personalized, laboratory specific cytology dashboard.

Host space, not energy or symbiont size, constrains feather mite abundance across passerine bird species

Comprehending symbiont abundance among host species is a major ecological endeavour, and the metabolic theory of ecology has been proposed to understand what constrains symbiont populations. We parameterized metabolic theory equations to investigate how bird species' body size and the body size of their feather mites relate to mite abundance according to four potential energy (uropygial gland size) and space constraints (wing area, total length of barbs and number of feather barbs). Predictions were compared with the empirical scaling of feather mite abundance across 106 passerine bird species (26,604 individual birds sampled), using phylogenetic modelling and quantile regression. Feather mite abundance was strongly constrained by host space (number of feather barbs) but not by energy. Moreover, feather mite species' body size was unrelated to the body size of their host species. We discuss the implications of our results for our understanding of the bird-feather mite system and for symbiont abundance in general.

CT-Assessment of Epicardial Fat Identifies Increased Inflammation at the Level of the Left Coronary Circulation in Patients with Atrial Fibrillation

Background: Atrial fibrillation (AF) can often be triggered by an inflammatory substrate. Perivascular inflammation may be assessed nowadays using coronary computed tomography angiography (CCTA) imaging. The new pericoronary fat attenuation index (FAI HU) and the FAI Score have prognostic value for predicting future cardiovascular events. Our purpose was to investigate the correlation between pericoronary fat inflammation and the presence of AF among patients with coronary artery disease. Patients and methods: Eighty-one patients (mean age 64.75 ± 7.84 years) who underwent 128-slice CCTA were included in this study and divided into two groups: group 1 comprised thirty-six patients with documented AF and group 2 comprised forty-five patients without a known history of AF. Results: There were no significant differences in the absolute value of fat attenuation between the study groups (p > 0.05). However, the mean FAI Score was significantly higher in patients with AF (15.53 ± 10.29 vs. 11.09 ± 6.70, p < 0.05). Regional analysis of coronary inflammation indicated a higher level of this process, especially at the level of the left anterior descending artery (13.17 ± 7.91 in group 1 vs. 8.80 ± 4.75 in group 2, p = 0.008). Conclusions: Patients with AF present a higher level of perivascular inflammation, especially in the region of the left coronary circulation, and this seems to be associated with a higher risk of AF development.

Association of Atrial Fibrillation Recurrence with Right Coronary Atherosclerosis and Increased Left Arterial Epicardial Fat Following Catheter Ablation-Results of a Multimodality Study

BACKGROUND

Identification of predictors for atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) can lead to better long-term results. Our aim was to investigate the association between novel CT imaging markers reflecting the severity of coronary atherosclerosis and the risk of recurrence following PVI.

METHODS

This study included 80 patients with paroxysmal/persistent AF who underwent PVI. The patients were divided into two groups: Group 1-23 patients with recurrence and Group 2-57 patients without recurrence.

RESULTS

Patients with recurrence presented with a more enlarged left atrial diameter and reduced left ventricle EF, as assessed by echocardiography. Elevated calcium scores and right coronary artery (RCA) stenosis were correlated with a higher risk of AF recurrence (25.38 ± 4.1% vs. 9.76 ± 2.32%, p = 0.001). Patients with AF recurrence presented a higher left atrial volume index (LAVI) (61.38 ± 11.12 mm3/m2 vs. 46.34 ± 12.27 mm3/m2, p < 0.0001). The bi-atrial volume index (BAVI) was similarly higher in the AF recurrence group (98.23 ± 14.44 mm3/m2 vs. 76.48 ± 17.61 mm3/m2, p < 0.0001). Increased EAT volumes located around the LA (EAT-LA) were correlated with recurrence (25.55 ± 6.37 vs. 15.54 ± 8.44, p < 0.0001).

CONCLUSIONS

RCA stenosis, together with atrial volumes and EAT-AS evaluated by CCTA, is associated with the risk of AF recurrence following PVI.

Elevated FAI Index of Pericoronary Inflammation on Coronary CT Identifies Increased Risk of Coronary Plaque Vulnerability after COVID-19 Infection

Inflammation is a key factor in the development of atherosclerosis, a disease characterized by the buildup of plaque in the arteries. COVID-19 infection is known to cause systemic inflammation, but its impact on local plaque vulnerability is unclear. Our study aimed to investigate the impact of COVID-19 infection on coronary artery disease (CAD) in patients who underwent computed tomography angiography (CCTA) for chest pain in the early stages after infection, using an AI-powered solution called CaRi-Heart^®. The study included 158 patients (mean age was 61.63 ± 10.14 years) with angina and low to intermediate clinical likelihood of CAD, with 75 having a previous COVID-19 infection and 83 without infection. The results showed that patients who had a previous COVID-19 infection had higher levels of pericoronary inflammation than those who did not have a COVID-19 infection, suggesting that COVID-19 may increase the risk of coronary plaque destabilization. This study highlights the potential long-term impact of COVID-19 on cardiovascular health, and the importance of monitoring and managing cardiovascular risk factors in patients recovering from COVID-19 infection. The AI-powered CaRi-Heart^® technology may offer a non-invasive way to detect coronary artery inflammation and plaque instability in patients with COVID-19.

Effects of paramedical counselling on anxio-depressive symptoms, perceived stress and self-esteem in male factor infertility

Introduction

Elevated levels of anxio-depressive symptoms and perceived stress are widely researched in case of female factor infertility; however, there is scant information on their emergence in case of male factor infertility.

Objectives

The aim of the present study is to assess whether a 5-course paramedical counselling accompanying infertility treatment would have a decreasing impact on anxio-depressive symptom severity and perceived stress and would increase the level of self-esteem in infertile men.

Methods

108 patients were divided into control (n = 51) and experimental (n = 57) groups, where the latter participated in the aforementioned paramedical counselling. Anxio-depressive symptom severity was measured with the Beck Depression Inventory and the Spielberger’s State Anxiety Inventory; perceived stress was registered with the Perceived Stress Scale and Brief Stress and Coping Inventory, while self-esteem was evaluated by the Rosenberg Self-Esteem Scale.

Results

Participation in an infertility programme itself affected positively patients’ self-esteem and decreased their levels of depressive symptom severity (t(50) = 2.738, p = 0.009, 95%CI = 0.167 – 1.088), but an additional 5-session paramedical counselling resulted in a significant lowering of state anxiety symptoms (t(106) = -2.093, p = 0.039, 95%CI = -6.372 – 0.173) contrasted with infertile men not receiving this additional counselling.

Conclusions

Conclusion: Screening for psychological factors is advisable in the course of an infertility treatment, and the implementation of an accompanying paramedical counselling focusing on the alleviation of concomitant psychopathological symptoms would be advisable among male infertile patients.

Disclosure

No significant relationships.

Uncommon Surgical Management by AVF between the Great Saphenous Vein and Anterior Tibial Artery for Old Radiocephalic AVF Failure

Introduction: Autologous native arteriovenous fistula (AVF) created in the non-dominant arm is the gold standard vascular access for dialysis in end-stage renal disease, but the post-surgical vascular access dysfunction causes a reduction in the patient’s quality of life. Creating a functional upper extremity permanent arteriovenous access is limited by the upper limb’s vascular resources, so good management of a complicated arteriovenous fistula may improve patient outcomes. This article highlights the importance of new surgical options in treating complicated AVFs. Case report: We present the case of a patient with a 17-year-old complex radio-cephalic arterio-venous fistula and a series of surgical interventions performed for life salvage in the first place and functional vascular access in the second place. Furthermore, we describe a successfully created uncommon type of fistula in the lower extremity between the great saphenous vein and the anterior tibial artery as the last possible access for hemodialysis in this patient. Results: The patient underwent the first successful dialysis using the newly created lower limb fistula 1 month after the surgery. Conclusion: Applying new surgical techniques to manage AVFs gives a unique chance to improve the quality of life and reduce morbidity and mortality in these patients.

Fecal expression of Escherichia coli lysine decarboxylase (LdcC) is downregulated in E-cadherin negative lobular breast carcinoma

Breast cancer is characterized by oncobiosis, the abnormal composition of the microbiome in neoplastic diseases. The biosynthetic capacity of the oncobiotic flora in breast cancer is suppressed, as suggested by metagenomic studies. The microbiome synthesizes a set of cytostatic and antimetastatic metabolites that are downregulated in breast cancer, including cadaverine, a microbiome metabolite with cytostatic properties. We set out to assess how the protein expression of constitutive lysine decarboxylase (LdcC), a key enzyme for cadaverine production, changes in the feces of human breast cancer patients (n = 35). We found that the fecal expression of Escherichia coli LdcC is downregulated in lobular cases as compared to invasive carcinoma of no special type (NST) cases. Lobular breast carcinoma is characterized by low or absent expression of E-cadherin. Fecal E. coli LdcC protein expression is downregulated in E-cadherin negative breast cancer cases as compared to positive ones. Receiver operating characteristic (ROC) analysis of LdcC expression in lobular and NST cases revealed that fecal E. coli LdcC protein expression might have predictive values. These data suggest that the oncobiotic transformation of the microbiome indeed leads to the downregulation of the production of cytostatic and antimetastatic metabolites. In E-cadherin negative lobular carcinoma that has a higher potential for metastasis formation, the protein levels of enzymes producing antimetastatic metabolites are downregulated. This finding represents a new route that renders lobular cases permissive for metastasis formation. Furthermore, our findings underline the role of oncobiosis in regulating metastasis formation in breast cancer.

Water in the upper mantle and deep crust of eastern China: concentration, distribution and implications

Understanding the concentration and distribution of water in the Earth's mantle plays a substantial role in studying its chemical, physical and dynamic processes. After a decade of research, a comprehensive dataset of water content in upper-mantle samples has been built for eastern China, which is now the only place with water-content data from such diverse types of natural samples, and provides an integrated picture of the water content and its distribution in the upper mantle at a continental scale. The main findings include the following: (i) the temporal heterogeneity of the water content in the lithospheric mantle from early Cretaceous (∼120 Ma) to Cenozoic (<40 Ma) was tightly connected with the stability of the North China Craton (from its destruction to its consolidation); (ii) the heterogeneous water content in the Cenozoic lithospheric mantle beneath different blocks of eastern China was not only inherited from tectonic settings from which they came, but was also affected later by geological processes they experienced; (iii) the distinct water content between the lowermost crust and lithospheric mantle of eastern China and its induced rheological contrast at the base of the crust indicate that the continental crust–mantle boundary could behave either in a coupled or decoupled manner beneath different areas and/or at different stages; (iv) the alkali basalts of eastern China demonstrate a heterogeneous distribution of water content in the mantle; local and regional comparisons of the water content between the lithospheric mantle and basalts' source indicate that the Cenozoic alkali basalts in eastern China were not sourced from the lithospheric mantle. Instead, the inferred high water contents in the mantle sources suggest that the Cenozoic eastern China basalts were likely sourced from the mantle transition zone (MTZ); and (v) both oceanic and continental crusts may carry a certain amount of water back into the deep mantle of eastern China by plate subduction. Such recycled crustal materials have not only created a local water-rich zone, but have also introduced crustal geochemical signatures into the mantle, both accounting for crustal geochemical imprints in the intra-plate magmatic rocks of eastern China.

Investigation of surface and filtration properties of TiO2 coated ultrafiltration polyacrylonitrile membranes

In the present work, the surface and filtration properties of TiO₂ coated polyacrylonitrile ultrafiltration membranes were investigated. The membranes were coated using the physical deposition method. The appropriate TiO₂ coverage proved to be 0.3 mg/cm², which formed a hydrophilic cake layer on the membrane surface. The cleanability without chemicals and the retention of the coated membranes was compared to the neat membrane after model oily wastewater filtration. The cleaning sustained of rinsing with distilled water and ultraviolet (UV) irradiation of the fouled membranes. The coated membranes have better antifouling properties; higher flux values during oily water filtration and by the mentioned cleaning process a significantly better flux recovery can be achieved. The amount of the catalyst and the irradiation time are limiting factors to the effectiveness of the cleaning process. The UV irradiation increases the wettability of the fouled membrane surface by degrading the oil layer. The coating, the continuous use, and the cleaning process do not significantly affect the membrane retention expressed in chemical oxygen demand.

Imaging-derived Biomarkers Associated with Atrial FIBROsis, Structural Remodeling and the Risk of Cardioembolic Events in Patients with Atrial Fibrillation – the FIBROS Study

Recent studies demonstrated that despite restoration of the sinus rhythm, patients with a positive history of atrial fibrillation (AF) are still at risk of thromboembolic events. The primary objective of this study is to identify new imaging-derived biomarkers provided by modern imaging technologies, such as cardiac computed tomography angiography, delayed enhancement magnetic resonance imaging, or speckle tracking echocardiography, as well as hematological biomarkers, associated with the risk of intracavitary thrombosis in patients with AF, in order to identify the imaging-derived characteristics associated with an increased risk of cardioembolic events. Imaging data collected will be post-processed using advanced techniques of computational modeling, in order to fully characterize the degree of structural remodeling and the amount of atrial fibrosis. The primary endpoint of the study is represented by the rate of thromboembolic events. The rate of cardiovascular death, the rate of major adverse cardiovascular events, and the rate of AF recurrence will also be determined in relation to the degree of structural remodeling and atrial fibrosis.

Therapeutic Angiogenesis for Severely Ischemic Limbs — from Bench to Bedside in Acute Vascular Care

Severe limb ischemia represents a critical condition, being associated with high morbidity and mortality rates. Patients with critical limb ischemia (CLI) require urgent initiation of interventional or surgical treatment, as restoration of the blood flow is the only way to ensure limb salvage in these critical cases. At the same time, in acute limb ischemia, a dramatic form of sudden arterial occlusion of the lower limbs, the integrity of the limb is also seriously threatened in the absence of urgent revascularization. From patients with CLI, 40% are “no option CLI”, meaning patients in whom, due to anatomical considerations or to the severity of the lesions, there is no possibility to perform interventional or surgical treatment or they have failed. Therapeutic angiogenesis has been proposed to serve as an effective and promising alternative therapy for patients with severe limb ischemia who do not have any other option for revascularization. This review aims to present the current status in therapeutic angiogenesis and the role of different approaches (gene or cell therapy, intra-arterial vs. intramuscular injections, different sources of cells) in increasing the rates of limb salvage in patients with severe ischemia of the lower limbs.

Computed Tomography Assessment of Coronary Fistulas

Coronary artery fistulas, a rare anomaly, are represented by an abnormal communication between the coronary arteries and other vascular structures or cardiac chambers and, in most cases, are detected incidentally. Regularly, they do not cause important pathological changes, but if the symptoms persist, they need to be treated. The hemodynamic impact depends on the localization and size of the fistulas. Noninvasive imaging techniques, such as magnetic resonance imaging and multislice computed tomography, are widely used for the detection of coronary anomalies. The presence of symptoms (angina, dyspnea) is the primary indication for the surgical or percutaneous closure of the communications; therefore, a systematic follow-up is indicated in all cases. We present four cases of coronary artery fistulas, without important hemodynamic complications, detected by multislice computed tomography coronary angiography.

Alteration of sarcoplasmic reticulum Ca2+ ATPase expression in lower limb ischemia caused by atherosclerosis obliterans

Atherosclerosis is a disease caused by a build-up of fatty plaques and cholesterol in the arteries. The lumen of the vessels is obliterated resulting in restricted blood supply to tissues. In ischemic conditions, the cytosolic Ca²⁺ level of skeletal muscle may increase, indicating the alteration of Ca²⁺ removal mechanisms. Ca²⁺ is transported from cytosol into the sarcoplasmic reticulum by Ca²⁺ ATPase (SERCA), with its 1a isoform expressed in adult, while its 1b isoform in neonatal and regenerating fast-twitch skeletal muscle. To investigate the role of these isoforms in ischemic skeletal muscle, biopsies from musculus biceps femoris of patients who underwent amputation due to atherosclerosis were examined. Samples were removed from the visibly healthy and hypoxia-affected tissue. Significantly increased SERCA1a expression was detected under the ischemic conditions (246 ± 69%; p < 0.05) compared with the healthy tissue. Furthermore, the ratio of SERCA1a-positive fibers was slightly increased (46 ± 4% in healthy tissue and 60 ± 5% in ischemic tissue; p > 0.05), whereas SERCA2a did not change. In addition, in primary cultures derived from hypoxia-affected tissue, the diameter and fusion index of myotubes were significantly increased (30 ± 1.6 µm vs. 41 ± 2.4 µm and 31 ± 4% vs. 45 ± 3%; p < 0.05). We propose that the increased SERCA1a expression indicates the existence and location of compensating mechanisms in ischemic muscle.

Case report. Multiple Mediastinal Arteriovenous Fistulas in a Patient with Myocardial Ischemia Symptoms and Tachy-Brady Arrhythmias

Arteriovenous fistulas are abnormal vascular communications between the arterial and venous system and may lead to the development of arteriovenous shunts. These malformations are extremely rare, and their diagnosis can be difficult due to the lack of symptoms or the absence of hemodynamic consequences. In many cases, arteriovenous fistulas are discovered by chance. In this brief report, we present the case of a 31-year-old male with symptoms suggestive of angina pectoris, tachycardia-bradycardia syndrome and multiple episodes of syncope. Multi-slice computed tomography revealed the presence of multiple mediastinal fistulas connecting the aorta, superior vena cava, pulmonary veins and azygos system.

Noninvasive Assessment of Coronary Arteries in Patients with Hematologic Disorders

Hematological conditions and their treatments have an increased risk of cardiovascular events, and invasive interventions have a higher risk of periprocedural complications in this group of patients. The aim of this review was to evaluate the risk of invasive interventions in patients with hematologic disorders and to underline the role of noninvasive cardiovascular screening in patients with hematological disorders such as Hodgkin and non-Hodgkin lymphoma, anemia, hemophilia, thrombocythemia, polycythemia vera, and leukemia. Based on present knowledge in the field, our opinion is that the screening of patients with hematological diseases is very important to reduce the morbidity and mortality due to cardiovascular events. Noninvasive assessments are suitable for this purpose with a significantly lower risk compared to invasive interventions.

New Imaging-Based Tools for the Assessment of Ventricular Function in Ischemic Heart Diseases

Ischemic heart disease morbidity and mortality are closely related to global and regional left ventricular function. The evaluation of left ventricular global function is a relevant part in the evolution of ischemic heart disease because it plays a significant role in prognosis prediction and patient management after revascularization. Regional function is also a critical part of the evolution, offering a possible and reliable mode for the assessment of myocardial disease. Currently several techniques for the evaluation of left ventricular parameters and function are in use. In this review we will discuss and compare currently available methods for the evaluation of global and regional left ventricular function such as 2D and 3D echocardiography, 3D speckle-tracking echocardiography, multi-slice computed tomography, and cardiac magnetic resonance imaging.

Computed Tomography Biomarkers of Vulnerable Coronary Plaques

An unstable plaque has a high risk of thrombosis and at the same time for a fast progression of the stenosis degree. Also, “high-risk plaque” and “thrombosis-prone plaque” are used as synonym terms for characterization of a vulnerable plaque. The imaging biomarkers for vulnerable coronary plaques are considered to be spotty calcifications, active remodeling, low-density atheroma and the presence of a ring-like attenuation pattern, also known as the napkin-ring sign. Computed cardiac tomography can determine the plaque composition by assessing the plaque density, which is measured in Hounsfield units (HU). The aim of this manuscript was to provide an update about the most frequently used biomarkers of vulnerability in a vulnerable plaque with the help of computed cardiac tomography.

Myocardial Fibrosis and the Risk of Recurrence in Atrial Fibrillation

Atrial fibrillation (AF) is the most frequent cardiac arrhythmia increasing the risk of stroke and mortality from heart failure. Magnetic resonance imaging was used by several authors for assessment of atrial fibrosis and to predict the rate of recurrence following AF ablation. The aim of this manuscript was to summarize the new data in the literature regarding the role of atrial fibrosis in AF imaging and the role of cardiac fibrosis in predicting AF recurrence after radio-frequency ablation.

Imaging Techniques for the Assessment of Myocardial Perfusion

One of the most significant causes of heart failure is coronary heart disease and subsequent left ventricular dysfunction. The prognosis and perioperative mortality are influenced by left ventricular function, which is also an important predictor marker following revascularization. The evaluation of myocardial perfusion is of utmost importance in patients who present several symptoms before choosing cardiac catheterization as treatment. The evaluation of myocardial perfusion and myocardial viability leads to superior diagnostic and treatment algorithms, thus resulting in an important improvement in the outcomes of patients with coronary artery disease. Color Doppler myocardial imaging, single-photon emission computed tomography (SPECT), contrast perfusion echocardiography, positron emission computed tomography (PET) and magnetic resonance imaging (MRI) are currently used methods for assessing myocardial perfusion. This review aims to summarize the benefits and disadvantages of each of these techniques.

Capacity to improve fine motor skills in Williams syndrome

BACKGROUND

Individuals with Williams syndrome (WS) are known to have difficulties in carrying out fine motor movements; however, a detailed behavioural profile of WS in this domain is still missing. It is also unknown how great the capacity to improve these skills with focused and extensive practice is.

METHOD

We studied initial performance and learning capacity in a sequential finger tapping (FT) task in WS and in typical development. Improvement in the FT task has been shown to be sleep dependent. WS subjects participating in the current study have also participated in earlier polysomnography studies, although not directly related to learning.

RESULTS

WS participants presented with great individual variability. In addition to generally poor initial performance, learning capacity was also greatly limited in WS. We found indications that reduced sleep efficiency might contribute to this limitation.

CONCLUSIONS

Estimating motor learning capacity and the depth of sleep disorder in a larger sample of WS individuals might reveal important relationships between sleep and learning, and contribute to efficient intervention methods improving skill acquisition in WS.

Distance-related Differences in Critical Times, Protocol Activation and Mortality in a Regional STEMI Network

Introduction: The aim of the study was to assess the differences in critical network times and mortality in STEMI patients presenting to hospitals in the same STEMI network, but located at different distances from the pPCI center.

Methods: Four-hundreed sixteen patients with STEMI were studied. Group 1: 101 patients presenting to any of the six regional hospitals in the network located at less than 70 km from the pPCI center, with a maximum transport time of 30 minutes. Group 2: 81 patients presenting to any of the three territorial hospitals in the network located at 70–150 km from the pPCI center, with a transport time between 30 and 70 minutes. Group 3: 93 patients presenting to any of the four territorial hospitals in the network located at 150–250 km from the pPCI center, with a transport time between 70 and 150 minutes. Group 4: 141 patients presenting directly to the emergency room of the pPCI center. The following time intervals were recorded: presentation time (PT), from the onset of symptoms to arrival at the pPCI center; protocol initiation time (PIT), from arrival at the pPCI center to STEMI protocol initiation; ischemic time (IT), from the onset of symptoms to repermeabilisation; door to balloon time (DTB), from arrival in the pPCI center to balloon.

Results: PT showed no significant difference between the groups – 183.08 ± 25.2 minutes vs. 199.1 ± 32.4 minutes vs. 166.7 ± 42.5 minutes vs. 161.91 ± 36.8 minutes, respectively (p=0.4). PIT was significantly lower in Group 3 (61.66 ± 15.4 minutes in Group 3 vs. 92 ± 11.5 minutes in Group 2 vs. 107.4 ± 12.5 minutes in Group 1, p = 0.002). DTB time was significantly longer for patients presenting directly to the pPCI center compared to those arriving from Zone 1, 2 or 3 hospitals, 86.96 ± 11.6 minutes vs. 52.27 ± 11.2 minutes vs. 39.94 ± 10.3 minutes vs. 43.9 ± 5.3 minutes, p <0.001). Despite the differences in distance to the pPCI center, there was no significant difference in total IT between the groups (Group 1, 344.6 ± 53.4 minutes; Group 2, 369.3 ± 42.6 minutes; Group 3, 366.65 ± 36.4 minutes; and 340.2 ± 26.9 minutes in the pPCIcenter, p = 0.2), and this was reflected in similar rates of mortality (Group 1, 3.9%; Group 2, 3.7%; Group 3, 3.2%; and 3.5% in the pPCI center).

Conclusion: A well organized STEMI network can shorten protocol initiation and DTB times, achieving similar ischemic times and resulting in similar mortality rates with the centers located closer to the pPCI center. Early activation of the STEMI protocol could lead to superior results even in areas situated at longer distances from the pPCI center.

Late Maturation (Age >5 Years) of Long-Range Spatial Interactions in Humans

We have studied the development of long-range spatial interactions in children (age 5 – 14 years) with normal vision. In our field study involving 410 normal children we used a battery of contour-integration cards that were developed earlier to test amblyopic patients (Kovács, Polat, and Norcia, paper presented at ARVO 1996). Each card consisted of a closed chain of collinearly aligned Gabor patches (contour) and a background of randomly oriented and positioned Gabor patches (noise). Subjects were asked to identify the location of the contour, and also to trace the contour within each card. The value of P was varied across cards (1.1 > P > 0.65), where P is the ratio of noise spacing to contour spacing. It is assumed that long-range, orientation-specific facilitatory interactions connect collinear contour segments together for P < 1. The strength of long-range interactions is defined by the minimal value of P yielding contour segregation. Children in the 13 – 14 years age group were able to see most of the contours ( Pmin < 0.7), while 5 – 6-year-old children missed the contours in about half of the cards ( Pmin < 0.9). This result indicates a very late maturation of long-range spatial interactions. It is possible that the late formation of horizontal connections in superficial layers of the human primary visual cortex (Burkhalter et al, 1993 Journal of Neuroscience13 1916 – 1931) is the neural basis of our developmental finding.

Association Between Severity of Peripheral Artery Disease Angio CT-derived Coronary Syntax Score in Patients with Critical Limb Ischemia

Introduction: Peripheral artery disease, a frequent consequence of atherosclerosis, is usually associated with concomitant ischaemic coronary artery disease and with a high rate of cardiovascular mortality.

Material and methods: The study population consisted of 24 patients, admitted to our clinic with peripheral artery disease, 10 of them with critical limb ischaemia. In all cases, cardiovascular risk factors, left ventricular dysfunction and ejection fraction were analyzed. Peripheral Multislice Angio CT examination was used to determine the TASC class and to assess the peripheral arterial lesions. The Coronary Calcium Score and the Syntax Score were determined with angio CT of the coronary arteries.

Results: Patients were between 39 and 84 years of age, and 54% were in Fontaine class 2B, 21% in Fontaine class 3 and 25% in Fontaine class 4. 12.5% of patients presented TASC class A, 33.3% TASC class B, and 54.2% TASC class C. Coronary Calcium Scores were between 0 and 100 in 16.6% of patients, between 100 and 400 in 41.8%, and >400 in 41.6% of patients. The SYNTAX Score was <22 in 54% of patients, between 22 and 32 in 37.5%, and >32 in 8.5% of patients. A significant correlation was found between the Coronary Calcium Score and the SYNTAX Score (r = 0.82, p = 0.03). The Syntax Score was 22.43 ± 3.2 in TASC A patients, 26.2 ± 5.4 in TASC B patients, 32.1 ± 2.3 in TASC C patients (p = 0.005).

Conclusions: The severity of coronary artery disease characterized by the Syntax Score, by the presence of left main stenosis and segmental left ventricular hypokinesis presents significant correlation with the severity of peripheral artery disease, characterized by the TASC classification.

Correlations Between the Contrast Density Gradient along the Coronary Stents and Functional Significance of In-stent Restenosis

Introduction: Coronary artery disease (CAD) is the leading cause of death worldwide and is associated with a significant socio-economic impact. In many cases, patients are treated with implanted coronary stents that carry a significant risk for reobstruction. The aim of our study was to evaluate the importance of coronary computed tomography angiography (CCTA) in evaluating the significance of in-stent restenosis lesions and for establishing the indication for reintervention in these cases.

Materials and methods: We evaluated 25 patients who underwent CCTA examination. We determined the contrast density, expressed in Hounsfield units at two levels, proximal and distal to the stent.

Results: There were no statistically significant differences between the study groups in terms of gender (41.17% females in Group 1 vs. 37.5% in Group 2, p = 1), presence of hypertension (41.17% in Group 1 vs. 62.5% in Group 2, p = 0.31), smoking status (41.17% in Group 1 vs. 37.5% in Group 2, p = 0.31), incidence of dyslipidemia (47.05% vs. 50%, p = 1) and diabetes mellitus (35.29% vs. 0%, p = 0.31). However, the age of the study population was significantly higher in the groups with significant ISR (58.94 ± 8.35 vs. 47.25 ± 11.2, p = 0.02). Patients who showed significant angiographic in-stent stenosis (more than 70%) were found to have a higher transluminal attenuation gradient, compared with those with less severe lesions (14.5 ± 5.4 vs. 5.14 ± 2.4, p = 0.02).

Conclusions: The transluminal attenuation gradient, assessed by CCTA is a non-invasive-derived parameter that can help the clinician to determine the right time for revascularization in case of in-stent restenosis.

Radiofrequency Catheter Ablation of Parahisian Accessory Pathway

Radiofrequency catheter ablation of parahisian accessory pathways in pre-excitation syndrome is a challenging task, due to the extremely high risk of complete atrioventricular block. In this brief report we describe the case of a 32 year-old man presenting a parahisian accessory pathway, who has been successfully treated by radiofrequency ablation. Radiofrequency catheter ablation using low-power radiofrequency current is considered to be the most appropiate method of ablation in adult patients.

Treatment Difficulties in High Risk Pulmonary Embolism. A Case Report

Pulmonary embolism (PE) remains a common and potentially life-threatening cardiovascular emergency. Systemic thrombolysis with intravenous infusion of a thrombolytic agent is generally recommended for treatment of high risk PE. However, this method has known limitations in the presence of high bleeding risk. Catheter-directed thrombolysis has the potential to achieve the same benefits as systemic thrombolysis, with a lower risk of haemorrhage. The case presented is of a 67-year-old male patient with a high risk of pulmonary embolism and contraindications for systemic thrombolysis, in whom the presence of severe comorbidities presented an increased risk of surgical embolectomy, who was successfully treated by catheter-directed thrombolysis.

A Massive Aortic Intramural Haematoma – an Aortic Emergency

Aortic intramural haematoma (AIH) is a rarely recognized disease characterized by a sudden haemorrhage into aortic media in the absence of any intimal tear. The clinical evolution and mortality rates of AIH are similar to those of acute aortic dissection. However, in the acute clinical care of patients presenting with chest pain of aortic origin, it is important to differentiate intramural haematoma from aortic dissection. A case of an elderly patient with an intramural hematoma (IMH), which progressed to very large dimensions and involved the entire aortic wall, resulting in fatal complications is presented here.

Correlation Between Acute Impairment of Regional Contractility and Left Ventricular Remodeling after Revascularized Acute Myocardial Infarction

Introduction: The present study aims to demonstrate the role of acute impairment of regional contractility, as assessed by 3D echocardiography, in predicting LV remodeling in post acute myocardial infarction (AMI) patients.

Methods: We enrolled in the study a number of 48 subjects with AMI who underwent primary PCI followed by optimum medical therapy. In all these cases we followed the correlation between the amplitude of ventricular remodeling at 6 months postinfarction and regional contractility in the immediate postinfarction period, as assessed by 3D echo parameters at baseline: regional index of contraction amplitude (RICA) and the index of contraction amplitude (ICA). Positive remodeling (PR) was defined as an increase in LV end-diastolic global volume with >15% compared with baseline.

Results: Patients with positive remodeling (PR) presented at baseline a significantly lower ejection fraction (44.75% versus 49.95%, p = 0.009), associated with a higher end-systolic volume (80.34 ml vs. 70.63 ml, p = 0.02) and lower values for index of contraction amplitude — ICA (3.05 vs. 3.53, p = 0.01) and for regional index of contraction amplitude — RICA (1.38 vs. 2.78, p <0.0001), in comparison with the patients who did not experience ventricular remodeling. RICA achieved the best statistical significance for predicting the development of LV remodeling during the evolution of the disease. For RICA, the ROC curve using logistic analysis showed an area under the curve (AUC) of 0.88, highly significant (p = 0.0001).

Conclusions: Impairment of regional contractility is associated with development of LV remodeling to a more significant extent than the global impairment of ventricular contractility.

The Value of Angio CT Multislice for Pre-operative Assessment and Prediction of Post PCI Successful Intervention in Acute Coronary Syndromes Associated by Left Main Disease

Introduction: The location of culprit lesions on the left main is associated with an increased procedural risk in acute coronary syndromes. Our study aims to evaluate the utility of CT angiography determined Syntax score (CCTA) in comparison with the classical angiographic Syntax score for predicting the procedural success in percutaneous coronary interventions (PCI) of left main lesions.

Methods: We included 23 patients presenting to the Cardiology Clinic with an acute coronary syndrome. All patients underwent coronary angiography ± angio CT multisclice for assessment of the target lesion, defined as a significant (>50%) left main disease. Patient population consisted in: group 1 – 13 patients (56.52%), in whom revascularization indication was based on lesion severity assessment by CCTA score correlated with the angio Syntax score (SS), and group 2 – 10 patients (43.48%), in whom revascularization indication was based only on angio SS. According to the SS, the study population was divided into subgroup A – low SS (<22), subgroup B – intermediate SS (23–32) and subgroup C –high SS (>32). All patients were followed for 1 year.

Results: Despite similar SS in both groups (35.38 in group 1 vs. 32.4 in group 2), the use of Angio CT multislice increased the rate of PCI indication – 76.92% PCI in group 1 versus 50% PCI in group 2. In patients with high SS, PCI rate was 66.66% in group 1 compared with 50% in group 2 (p<0.05). High calcium score >100 was recorded in 50% of patients in the low SS subgroup (<22), 50% in the medium SS subgroup (23–32) and 22.22% in the high SS (>33) subgroup. One-year follow-up showed an overall mortality of 8.69%, slightly higher in group 2 (10%), as compared to group 1 (mortality of 7.69%).

Conclusions: Additional evaluation by angio CT of culprit left main stenoses in acute coronary syndromes provides more information about the complexity of atherosclerotic plaques in this location, and could be extremely useful in establishing the indication for PCI in high risk stenoses, showing a predictive significance for post-procedural 1 year follow up mortality.

Reactive oxygen species-mediated bacterial killing by B lymphocytes

Regulated production of ROS is mainly attributed to Nox family enzymes. In neutrophil granulocytes and macrophages, Nox2 has a crucial role in bacterial killing, and the absence of phagocytic ROS production leads to the development of CGD. Expression of Nox2 was also described in B lymphocytes, where the role of the enzyme is still poorly understood. Here, we show that peritoneal B cells, which were shown recently to possess phagocytic activity, have a high capacity to produce ROS in a Nox2-dependent manner. In phagocytosing B cells, intense intraphagosomal ROS production is detected. Finally, by studying 2 animal models of CGD, we demonstrate that phagocyte oxidase-deficient B cells have a reduced capacity to kill bacteria. Our observations extend the number of immune cell types that produce ROS to kill pathogens.

[The role of aspiration cytology in tumor diagnostics]

Fine needle aspiration biopsy (FNAB) of focal lesions is a quick, relatively simple and cost-effective diagnostic method. However, performing aspirations and interpreting smears require skill and experience. Before initiating an aspiration the doctor needs to be aware of the limits of cytology as it is vital to know what kind of diagnostic issues can be answered upon a smear and what kind of questions cannot. Traditionally FNAB was performed without radiologic guidance, and therefore almost only palpable lesions were aspirated. Since ultrasound (US) has become widely used in medicine, it is axiomatical that FNAB is ideally performed with US guidance not only for the protection of the patients but also for targeting the lesion more safely. Several cytologists find US guidance unnecessary as a routinely used examination, which may lead to unsatisfactory smears and false negative results. This means not only a loss for the patient, but leads to a negative judgement of this diagnostic method. Our interventional cytology diagnostic team developed a working method resulting in excellent statistical results. In the followings we would like to share our experience refined the past two decades to restore the reputation of this diagnostic method.

Repeatability of feather mite prevalence and intensity in passerine birds

Understanding why host species differ so much in symbiont loads and how this depends on ecological host and symbiont traits is a major issue in the ecology of symbiosis. A first step in this inquiry is to know whether observed differences among host species are species-specific traits or more related with host-symbiont environmental conditions. Here we analysed the repeatability (R) of the intensity and the prevalence of feather mites to partition within- and among-host species variance components. We compiled the largest dataset so far available: 119 Paleartic passerine bird species, 75,944 individual birds, ca. 1.8 million mites, seven countries, 23 study years. Several analyses and approaches were made to estimate R and adjusted repeatability (R(adj)) after controlling for potential confounding factors (breeding period, weather, habitat, spatial autocorrelation and researcher identity). The prevalence of feather mites was moderately repeatable (R = 0.26-0.53; R(adj) = 0.32-0.57); smaller values were found for intensity (R = 0.19-0.30; R(adj )= 0.18-0.30). These moderate repeatabilities show that prevalence and intensity of feather mites differ among species, but also that the high variation within species leads to considerable overlap among bird species. Differences in the prevalence and intensity of feather mites within bird species were small among habitats, suggesting that local factors are playing a secondary role. However, effects of local climatic conditions were partially observed for intensity.

Continuous eclogite melting and variable refertilisation in upwelling heterogeneous mantle

Large-scale tectonic processes introduce a range of crustal lithologies into the Earth's mantle. These lithologies have been implicated as sources of compositional heterogeneity in mantle-derived magmas. The model being explored here assumes the presence of widely dispersed fragments of residual eclogite (derived from recycled oceanic crust), stretched and stirred by convection in the mantle. Here we show with an experimental study that these residual eclogites continuously melt during upwelling of such heterogeneous mantle and we characterize the melting reactions and compositional changes in the residue minerals. The chemical exchange between these partial melts and more refractory peridotite leads to a variably metasomatised mantle. Re-melting of these metasomatised peridotite lithologies at given pressures and temperatures results in diverse melt compositions, which may contribute to the observed heterogeneity of oceanic basalt suites. We also show that heterogeneous upwelling mantle is subject to diverse local freezing, hybridization and carbonate-carbon-silicate redox reactions along a mantle adiabat.

Towards high-siderophore-content foods: optimisation of coprogen production in submerged cultures of Penicillium nalgiovense

BACKGROUND

Fungal siderophores are likely to possess atheroprotective effects in humans, and therefore studies are needed to develop siderophore-rich food additives or functional foods to increase the siderophore uptake in people prone to cardiovascular diseases. In this study the siderophore contents of mould-ripened cheeses and meat products were analysed and the coprogen production by Penicillium nalgiovense was characterised.

RESULTS

High concentrations of hexadentate fungal siderophores were detected in penicillia-ripened Camembert- and Roquefort-type cheeses and also in some sausages. In one sausage fermented by P. nalgiovense, the siderophore content was comparable to those found in cheeses. Penicillium nalgiovense produced high concentrations of coprogen in submerged cultures, which were affected predominantly by the available carbon and nitrogen sources under iron starvation. Considerable coprogen yields were still detectable in the presence of iron when the fermentation medium was supplemented with the iron chelator Na₂-EDTA or when P. nalgiovense was co-cultivated with Saccharomyces cerevisiae.

CONCLUSION

These data may be exploitable in the future development of high-siderophore-content foods and/or food additives. Nevertheless, the use of P. nalgiovense fermentation broths for these purposes may be limited by the instability of coprogen in fermentation media and by the β-lactam production by the fungus.

Hydrogen peroxide-induced poly(ADP-ribosyl)ation regulates osteogenic differentiation-associated cell death

We set out to investigate the role of poly(ADP-ribosylation), the attachment of NAD(+)-derived (ADP-ribose)(n) polymers to proteins, in the regulation of osteogenic differentiation of SAOS-2 cells and mesenchymal stem cells. In osteogenic differentiation medium, SAOS-2 cells showed mineralization and expressed alkaline phosphatase and osteoblastic marker genes such as Runx2, osterix, BMP2, and osteopontin. The cells also released hydrogen peroxide, displayed poly(ADP-ribose) polymerase (PARP) activation, and showed commitment to cell death (apoptosis and necrosis). Scavenging reactive oxygen species by glutathione or decomposing hydrogen peroxide by the addition of catalase reduced differentiation, PARP activation, and cell death. We silenced the expression of the main PAR-synthesizing enzyme PARP-1 and the PAR-degrading enzyme poly(ADP-ribose) glycohydrolase (PARG) in SAOS-2 osteosarcoma cells (shPARP-1 and shPARG, respectively). Both shPARP-1- and shPARG-silenced cells exhibited altered differentiation, with the most notable change being increased osteopontin expression but decreased alkaline phosphatase activity. PARP-1 silencing suppressed both apoptotic and necrotic cell death, but the PARP inhibitor PJ34 sensitized cells to cell death, indicating that the effects of PARP-1 silencing are not related to the activity of the enzyme. PARG silencing resulted in more apoptosis and, in the last days of differentiation, a shift from apoptosis toward necrosis. In conclusion our data prove that hydrogen peroxide-induced poly(ADP-ribose) signaling regulates cell death and osteodifferentiation.

Different effects of bortezomib on the expressions of various protein kinase C isoenzymes in T cells of patients with systemic lupus erythematosus and in Jurkat cells

The effects of proteosome inhibitor Bortezomib (BZ) were studied in vitro for 24 h on the protein kinase C (PKC) profiles, rates of proliferation and apoptosis in Jurkat cells and lymphocytes of 10 patients with systemic lupus erythematosus (SLE) and nine healthy subjects. The expressions of PKC proteins, the rates of proliferation and apoptosis were determined. The effects of BZ were different in the Jurkat and lupus T cells. Whereas BZ elevated the expression of PKC θ, δ and ξ isoenzymes in the Jurkat cells, it was unable to do that in the lupus T cells. BZ induced a dose-dependent increase in the apoptosis of Jurkat cells, while decreased the proliferation. The same effect of BZ was observed on the apoptosis of lymphocytes both in SLE and healthy subjects at concentrations higher than the therapeutic dose. We conclude that BZ treatment in vitro was not able to restore the SLE-specific defect (decrease) in the expression of PKC isoenzymes in the T cells as it was expected. This can be a limiting factor in the positive clinical effects of BZ in lupus.