A pilot-scale assessment of five common weeds in the sustainable treatment of sewage utilizing SHEFROL®, with prospects of a closed-loop biorefinery

Relative efficacy of five common weeds-of the kind that are either rooted in soil or which freely float over water-was assessed in rapid, effective and sustainable treatment of sewage at pilot plant scale in the recently developed and patented SHEFROL® bioreactors. The plants were utilized in a unit of capacity 12,000 liters/day (LPD) which, after two years of use, was enlarged to handle 40,000 LPD of sewage. It was then further expanded after an year to treat 57,000 LPD. All the five weeds, of which none has previously been tested in a pilot-scale SHEFROL, were able to foster highly efficient primary treatment (in terms of suspended and total solids) and secondary treatment (in terms of BOD and COD) to levels exceeding 85% in most cases. Additionally, the weeds also helped in achieving significant tertiary treatment. At different hydraulic retention times, and at steady state, the five weeds achieved treatment of BOD, COD, suspended solids, nitrogen, phosphorous, copper, nickel, zinc, and manganese in the ranges, 80-95, 79-91, 82-95, 61-71, 51-73, 37-43, 30-38, 39-47, and 27-35%, respectively. It all occurred in a single process step and without the use of any machine or chemical. This made the system not only simple and inexpensive to install but also to maintain. Over continuous long-term operation for four years, the system was seen to be very robust as it was able to handle wide variations in the volumes and characteristics of sewage, as well as absorb shock loads without compromising the reactor performance. The sustainability of the system can be further enhanced by upgrading it to a circular biorefinery. Energy sources in the form of volatile fatty acids (VFAs) can be extracted from the weeds removed from SHEFROL and then the weeds can be converted into organic fertilizer using high-rate vermireactors recently developed by the authors.

AI-based prediction of the improvement in air quality induced by emergency measures

Several cities in the developing world, of which the capital city of India, New Delhi, is an example, often experience air quality in which pollutant levels go way above the levels considered hazardous for human health. To bring down the air quality to within permissible limits quickly, the measures typically taken involve shutting down certain high-polluting activities for some time to enable the air quality to recover temporarily. This paper presents a first-ever model based on artificial neural networks to forecast the extent of reduction in air quality parameters that can be achieved and the time period within which a change can be experienced when the source of the emissions is cut off temporarily. The model is based on the extensive data on the extent of reduction in air quality parameters that occurred during the lockdown that was imposed during the COVID-19 pandemic. The non-linear autoregressive exogenous network-based model chosen for the purpose employs the hour since stopping of emissions, relative humidity, wind speed, wind direction, and ambient temperature as input parameters to predict the rate of change of PM2.5 with respect to the concentration at the start of the stopping of the emissions. Air quality data from a key monitoring station in New Delhi was used to develop the model. The model predicted the rate of drop in PM2.5 with an R and MSE of 0.0044 and 0.9736, respectively, while training and 0.0095 and 0.9583 while testing. The model was then tested with data from 19 other stations in New Delhi, and accuracy of the model was found to be exceptionally accurate, with the correlation between the measured and the predicted PM2.5 levels ranging from 0.74 to 0.94 and the MSE ranging from 0.0110 to 1.0746. Thus, the model can be employed to determine the number of hours of temporary stoppage of emissions required for the PM2.5 concentration to reach safe levels. The methodology of development of the model can be extrapolated to construct models tailored for use in other parts of the world as well.

The Effect of Omecamtiv Mecarbil in Hospitalized Patients as Compared With Outpatients With HFrEF: An Analysis of GALACTIC-HF

BACKGROUND

In the Global Approach to Lowering Adverse Cardiac Outcomes Through Improving Contractility in Heart Failure (GALACTIC-HF) trial, omecamtiv mecarbil, compared with placebo, reduced the risk of worsening heart failure (HF) events, or cardiovascular death in patients with HF and reduced ejection fraction. The primary aim of this prespecified analysis was to evaluate the safety and efficacy of omecamtiv mecarbil by randomization setting, that is, whether participants were enrolled as outpatients or inpatients.

METHODS AND RESULTS

Patients were randomized either during a HF hospitalization or as an outpatient, within one year of a worsening HF event (hospitalization or emergency department visit). The primary outcome was a composite of worsening HF event (HF hospitalization or an urgent emergency department or clinic visit) or cardiovascular death. Of the 8232 patients analyzed, 2084 (25%) were hospitalized at randomization. Hospitalized patients had higher N-terminal prohormone of B-type natriuretic peptide concentrations, lower systolic blood pressure, reported more symptoms, and were less frequently treated with a renin-angiotensin system blocker or a beta-blocker than outpatients. The rate (per 100 person-years) of the primary outcome was higher in hospitalized patients (placebo group = 38.3/100 person-years) than in outpatients (23.1/100 person-years); adjusted hazard ratio 1.21 (95% confidence interval 1.12-1.31). The effect of omecamtiv mecarbil versus placebo on the primary outcome was similar in hospitalized patients (hazard ratio 0.89, 95% confidence interval 0.78-1.01) and outpatients (hazard ratio 0.94, 95% confidence interval 0.86-1.02) (interaction P = .51).

CONCLUSIONS

Hospitalized patients with HF with reduced ejection fraction had a higher rate of the primary outcome than outpatients. Omecamtiv mecarbil decreased the risk of the primary outcome both when initiated in hospitalized patients and in outpatients.

A First-in-Human Study of AMG 986, a Novel Apelin Receptor Agonist, in Healthy Subjects and Heart Failure Patients

PURPOSE

AMG 986 is a novel apelin receptor (APJ) agonist that improves cardiac contractility in animal models without adversely impacting hemodynamics. This phase 1b study evaluated the safety/tolerability, pharmacokinetics, and pharmacodynamics of AMG 986 in healthy subjects and patients with heart failure (HF).

METHODS

Healthy adults (Parts A/B) and HF patients (Part C) aged 18-85 years were randomized 3:1 to single-dose oral/IV AMG 986 or placebo (Part A); multiple-dose oral/IV AMG 986 or placebo (Part B); or escalating-dose oral AMG 986 or placebo (Part C).

PRIMARY ENDPOINT

treatment-emergent adverse events, laboratory values/vital signs/ECGs; others included AMG 986 pharmacokinetics, left ventricular (LV) function.

RESULTS

Overall, 182 subjects were randomized (AMG 986/healthy: n = 116, placebo, n = 38; AMG 986/HF: n = 20, placebo, n = 8). AMG 986 had acceptable safety profile; no clinically significant dose-related impact on safety parameters up to 650 mg/day was observed. AMG 986 exposures increased nonlinearly with increasing doses; minimal accumulation was observed. In HF with reduced ejection fraction patients, there were numerical increases in percent changes from baseline in LV ejection fraction and stroke volume by volumetric assessment with AMG 986 vs placebo (stroke volume increase not recapitulated by Doppler).

CONCLUSIONS

In healthy subjects and HF patients, short-term AMG 986 treatment was well tolerated. Consistent with this observation, clinically meaningful pharmacodynamic effects in HF patients were not observed. Changes in ejection fraction and stroke volume in HF patients suggest additional studies may be needed to better define the clinical utility and optimal dosing for this molecule.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov NCT03276728.

DATE OF REGISTRATION

September 8, 2017.

Abstract P674: Associations Between Visceral Adipose Tissue Area and Density With Renal Artery Calcification

Introduction: Visceral adipose tissue (VAT) has been associated with higher levels of atherosclerosis. Renal artery calcification (RAC) secondary to atherosclerosis has been found to be associated with hypertension and an increase in all-cause mortality.

Hypothesis: There are significant associations between VAT area and density with the presence and extent of renal artery calcification.

Methods: Within the Multi-Ethnic Study of Atherosclerosis (MESA) abdominal aortic calcification ancillary study, 1,978 participants from five of the six field centers around the US underwent abdominal CT imaging to measure VAT and RAC. Standardized questionnaires were used to obtain demographic and health history data. Blood samples were assayed for lipid, glucose, creatinine, and adipokine levels. Rate ratio regression was used to estimate prevalence ratios (PRs) for the presence of RAC, while linear regression was used to estimate linear coefficients for the severity of RAC among participants with RAC > 0.

Results: Of the 1,978 participants, 1,196 participants had complete visceral adiposity and renal artery measurements. After controlling for sociodemographic variables, CVD risk factors, adipokine levels, and VAT density, VAT area was not associated with RAC presence (PR 1.02, 95% CI 0.89, 1.16, p = 0.80), while greater VAT density was borderline protective for RAC presence (PR 0.89, 95% CI 0.78, 1.02, p = 0.10) when controlling for the same factors and VAT area. 354 participants had RAC > 0 and were included in linear regression analyses assessing RAC severity. After controlling for sociodemographic variables, CVD risk factors, adipokine levels, and VAT density, VAT area was significantly associated with RAC severity (slope 63.32, 95% CI 11.84, 114.81, p = 0.02), while VAT density was not associated with RAC severity (slope 9.78, 95% CI -40.87, 60.44, p = 0.71).

Conclusions: In this relatively large, multi-ethnic cohort of adults from five communities in the US, we have demonstrated that higher density VAT may be protective for RAC presence, while greater VAT area is significantly associated with RAC severity. While this is the first study examining the relationship between VAT and RAC, our results are consistent with previous studies describing associations between increased VAT area and decreased VAT density with outcomes including hypertension, hypercholesterolemia, and metabolic syndrome.

Category: Subclinical Cardiovascular Disease

An inexpensive phytoremediation system for treating 50,000 L/day of sewage

The paper describes the setting up and long-term continuous operation of the first real-life, pilot scale, sewage treatment plant based on the recently patented phytoremediation technology, trademarked as SHEFROL^®. The unit was about three times cheaper to install, operate and maintain than the least expensive of the other wetland-based technologies presently in vogue. Its semi-permanent version is 30 times cheaper. Monitoring of flow rates and levels of treatment intermittently over a 3 year course of continuous operation indicated the constancy and robustness of the reactor in treating total solids, suspended solids, chemical oxygen demand, biological oxygen demand, total Kjeldahl nitrogen, and soluble phosphorous to the average extents of 94, 84, 79, 70, 62 and 28% respectively. Earlier experience with bench-scale SHEFROL^® units has indicated that removal of metals like Cu, Ni, Co, Zn, and Mn also takes place to the extent of 25-45% in these systems. These primary, secondary, and tertiary treatments occurred in a single unit process with no necessity of any pumping, aeration, or recycling. Models based on artificial intelligence were developed which enable forecasting the reactor performance in terms of secondary and tertiary treatment, respectively.

Effects of omecamtiv mecarbil in heart failure with reduced ejection fraction according to blood pressure: the GALACTIC-HF trial

AIM

Patients with heart failure with reduced ejection fraction and low systolic blood pressure (SBP) have high mortality, hospitalizations, and poorly tolerate evidence-based medical treatment. Omecamtiv mecarbil may be particularly helpful in such patients. This study examined its efficacy and tolerability in patients with SBP ≤100 mmHg enrolled in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC-HF).

METHODS AND RESULTS

The GALACTIC-HF enrolled patients with baseline SBP ≥85 mmHg with a primary outcome of time to cardiovascular death or first heart failure event. In this analysis, patients were divided according to their baseline SBP (≤100 vs. >100 mmHg). Among the 8232 analysed patients, 1473 (17.9%) had baseline SBP ≤100 mmHg and 6759 (82.1%) had SBP >100 mmHg. The primary outcome occurred in 715 (48.5%) and 2415 (35.7%) patients with SBP ≤100 and >100 mmHg, respectively. Patients with lower SBP were at higher risk of adverse outcomes. Omecamtiv mecarbil, compared with placebo, appeared to be more effective in reducing the primary composite endpoint in patients with SBP ≤100 mmHg [hazard ratio (HR), 0.81; 95% confidence interval (CI), 0.70-0.94] compared with those with SBP >100 mmHg (HR, 0.95; 95% CI, 0.88-1.03; P-value for interaction = 0.051). In both groups, omecamtiv mecarbil did not change SBP values over time and did not increase the risk of adverse events, when compared with placebo.

CONCLUSION

In GALACTIC-HF, risk reduction of heart failure outcomes with omecamtiv mecarbil compared with placebo was large and significant in patients with low SBP. Omecamtiv mecarbil did not affect SBP and was well tolerated independent of SBP values.

Assessment of Omecamtiv Mecarbil for the Treatment of Patients With Severe Heart Failure: A Post Hoc Analysis of Data From the GALACTIC-HF Randomized Clinical Trial

Importance

Heart failure with reduced ejection fraction is a progressive clinical syndrome, and many patients' condition worsen over time despite treatment. Patients with more severe disease are often intolerant of available medical therapies.

Objective

To evaluate the efficacy and safety of omecamtiv mecarbil for the treatment of patients with severe heart failure (HF) enrolled in the Global Approach to Lowering Adverse Cardiac Outcomes Through Improving Contractility in Heart Failure (GALACTIC-HF) randomized clinical trial.

Design, Setting, and Participants

The GALACTIC-HF study was a global double-blind, placebo-controlled phase 3 randomized clinical trial that was conducted at multiple centers between January 2017 and August 2020. A total of 8232 patients with symptomatic HF (defined as New York Heart Association symptom class II-IV) and left ventricular ejection fraction of 35% or less were randomized to receive omecamtiv mecarbil or placebo and followed up for a median of 21.8 months (range, 15.4-28.6 months). The current post hoc analysis evaluated the efficacy and safety of omecamtiv mecarbil therapy among patients classified as having severe HF compared with patients without severe HF. Severe HF was defined as the presence of all of the following criteria: New York Heart Association symptom class III to IV, left ventricular ejection fraction of 30% or less, and hospitalization for HF within the previous 6 months.

Interventions

Participants were randomized at a 1:1 ratio to receive either omecamtiv mecarbil or placebo.

Main Outcomes and Measures

The primary end point was time to first HF event or cardiovascular (CV) death. Secondary end points included time to CV death and safety and tolerability.

Results

Among 8232 patients enrolled in the GALACTIC-HF clinical trial, 2258 patients (27.4%; mean [SD] age, 64.5 [11.6] years; 1781 men [78.9%]) met the specified criteria for severe HF. Of those, 1106 patients were randomized to the omecamtiv mecarbil group and 1152 to the placebo group. Patients with severe HF who received omecamtiv mecarbil experienced a significant treatment benefit for the primary end point (hazard ratio [HR], 0.80; 95% CI, 0.71-0.90), whereas patients without severe HF had no significant treatment benefit (HR, 0.99; 95% CI, 0.91-1.08; P = .005 for interaction). For CV death, the results were similar (HR for patients with vs without severe HF: 0.88 [95% CI, 0.75-1.03] vs 1.10 [95% CI, 0.97-1.25]; P = .03 for interaction). Omecamtiv mecarbil therapy was well tolerated in patients with severe HF, with no significant changes in blood pressure, kidney function, or potassium level compared with placebo.

Conclusions and Relevance

In this post hoc analysis of data from the GALACTIC-HF clinical trial, omecamtiv mecarbil therapy may have provided a clinically meaningful reduction in the composite end point of time to first HF event or CV death among patients with severe HF. These data support a potential role of omecamtiv mecarbil therapy among patients for whom current treatment options are limited.

Trial Registration

ClinicalTrials.gov Identifier: NCT02929329.

Effect of Ejection Fraction on Clinical Outcomes in Patients Treated With Omecamtiv Mecarbil in GALACTIC-HF

BACKGROUND

In GALACTIC-HF (Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure) (n = 8,256), the cardiac myosin activator, omecamtiv mecarbil, significantly reduced the primary composite endpoint (PCE) of time-to-first heart failure event or cardiovascular death in patients with heart failure and reduced ejection fraction (EF) (≤35%).

OBJECTIVES

The purpose of this study was to evaluate the influence of baseline EF on the therapeutic effect of omecamtiv mecarbil.

METHODS

Outcomes in patients treated with omecamtiv mecarbil were compared with placebo according to EF.

RESULTS

The risk of the PCE in the placebo group was nearly 1.8-fold greater in the lowest EF (≤22%) compared with the highest EF (≥33%) quartile. Amongst the pre-specified subgroups, EF was the strongest modifier of the treatment effect of omecamtiv mecarbil on the PCE (interaction as continuous variable, p = 0.004). Patients receiving omecamtiv mecarbil had a progressively greater relative and absolute treatment effect as baseline EF decreased, with a 17% relative risk reduction for the PCE in patients with baseline EF ≤22% (n = 2,246; hazard ratio: 0.83; 95% confidence interval: 0.73 to 0.95) compared with patients with EF ≥33% (n = 1,750; hazard ratio: 0.99; 95% confidence interval: 0.84 to 1.16; interaction as EF by quartiles, p = 0.013). The absolute reduction in the PCE increased with decreasing EF (EF ≤22%; absolute risk reduction, 7.4 events per 100 patient-years; number needed to treat for 3 years = 11.8), compared with no reduction in the highest EF quartile.

CONCLUSIONS

In heart failure patients with reduced EF, omecamtiv mecarbil produced greater therapeutic benefit as baseline EF decreased. These findings are consistent with the drug's mechanism of selectively improving systolic function and presents an important opportunity to improve the outcomes in a group of patients at greatest risk. (Registrational Study With Omecamtiv Mecarbil/AMG 423 to Treat Chronic Heart Failure With Reduced Ejection Fraction [GALACTIC-HF]; NCT02929329).

Cardiac Myosin Activation with Omecamtiv Mecarbil in Systolic Heart Failure

BACKGROUND

The selective cardiac myosin activator omecamtiv mecarbil has been shown to improve cardiac function in patients with heart failure with a reduced ejection fraction. Its effect on cardiovascular outcomes is unknown.

METHODS

We randomly assigned 8256 patients (inpatients and outpatients) with symptomatic chronic heart failure and an ejection fraction of 35% or less to receive omecamtiv mecarbil (using pharmacokinetic-guided doses of 25 mg, 37.5 mg, or 50 mg twice daily) or placebo, in addition to standard heart-failure therapy. The primary outcome was a composite of a first heart-failure event (hospitalization or urgent visit for heart failure) or death from cardiovascular causes.

RESULTS

During a median of 21.8 months, a primary-outcome event occurred in 1523 of 4120 patients (37.0%) in the omecamtiv mecarbil group and in 1607 of 4112 patients (39.1%) in the placebo group (hazard ratio, 0.92; 95% confidence interval [CI], 0.86 to 0.99; P = 0.03). A total of 808 patients (19.6%) and 798 patients (19.4%), respectively, died from cardiovascular causes (hazard ratio, 1.01; 95% CI, 0.92 to 1.11). There was no significant difference between groups in the change from baseline on the Kansas City Cardiomyopathy Questionnaire total symptom score. At week 24, the change from baseline for the median N-terminal pro-B-type natriuretic peptide level was 10% lower in the omecamtiv mecarbil group than in the placebo group; the median cardiac troponin I level was 4 ng per liter higher. The frequency of cardiac ischemic and ventricular arrhythmia events was similar in the two groups.

CONCLUSIONS

Among patients with heart failure and a reduced ejection, those who received omecamtiv mecarbil had a lower incidence of a composite of a heart-failure event or death from cardiovascular causes than those who received placebo. (Funded by Amgen and others; GALACTIC-HF ClinicalTrials.gov number, NCT02929329; EudraCT number, 2016-002299-28.).

Vermicompost of the widespread and toxic xerophyte prosopis (Prosopis juliflora) is a benign organic fertilizer

Prior to the work described in this paper, no report has existed on the use of any xerophyte is generating vermicompost. Now these authors have been able to develop a process with which the highly invasive xerophyte prosopis (Prosopis juliflora) can be vermicomposted. But does prosopis vermicompost (PVC) have any fertilizer value, given that prosopis has strong allelopathy and toxicity? To seek an answer, the authors have assessed the effect of the PVC on the germination and early growth of five common food plants: brinjal (Solanum melongena), chilly (Capsicum annuum), cucumber (Cucumissativus), ladies finger (Abelmoschus esculentus), and tomato (Lycopersicon esculentum). Thereafter the tomato and the brinjal plants were grown to fruition to assess their yield and nutrient value. Whereas no germination of any seed occurred when the soil was fortified with prosopis leaves, there was 20-100% germination of seeds in different plant species when fertilized with equivalent quantities of PVC. The carbohydrate, potassium, and magnesium contents of prosopis fertilized brinjal and tomato fruits were significantly (p ≤ 0.5) higher than the levels of these nutrients present in the market produce. The prosopis vermicompost displayed pest-repellant attributes as well. The findings indicate that the millions of tonnes of prosopis leaves, which have no utility value and of which falling on earth is harmful to the soil, can be used to generate organic fertilizer.

Effects of Omecamtiv Mecarbil on Symptoms and Health-Related Quality of Life in Patients With Chronic Heart Failure: Results From the COSMIC-HF Study

Chronic heart failure with reduced ejection fraction impairs health-related quality of life (HRQL). Omecamtiv mecarbil (OM)—a novel activator of cardiac myosin—improves left ventricular systolic function and remodeling and reduces natriuretic peptides. We sought to evaluate the effect of OM on symptoms and HRQL in patients with chronic heart failure with reduced ejection fraction and elevated natriuretic peptides enrolled in the COSMIC-HF trial (Chronic Oral Study of Myosin Activation to Increase Contractility in Heart Failure).

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction: GALACTIC-HF baseline characteristics and comparison with contemporary clinical trials

AIMS

The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is being tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC-HF) trial. Here we describe the baseline characteristics of participants in GALACTIC-HF and how these compare with other contemporary trials.

METHODS AND RESULTS

Adults with established HFrEF, New York Heart Association (NYHA) functional class ≥II, ejection fraction ≤35%, elevated natriuretic peptides and either current hospitalization for heart failure or history of hospitalization/emergency department visit for heart failure within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic-guided dosing: 25, 37.5, or 50 mg bid). A total of 8256 patients [male (79%), non-white (22%), mean age 65 years] were enrolled with a mean ejection fraction 27%, ischaemic aetiology in 54%, NYHA class II 53% and III/IV 47%, and median N-terminal pro-B-type natriuretic peptide 1971 pg/mL. Heart failure therapies at baseline were among the most effectively employed in contemporary heart failure trials. GALACTIC-HF randomized patients representative of recent heart failure registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure <100 mmHg (n = 1127), estimated glomerular filtration rate <30 mL/min/1.73 m² (n = 528), and treated with sacubitril/valsartan at baseline (n = 1594).

CONCLUSIONS

GALACTIC-HF enrolled a well-treated, high-risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation.

Elemental analysis of sage (herb) using calibration-free laser-induced breakdown spectroscopy

In this work, laser-induced breakdown spectroscopy (LIBS) has been used for the quantitative and qualitative analysis of the sage sample using the calibration-free LIBS (CF-LIBS) technique. The sage plasma is generated by focusing the second harmonics (532 nm) of a Q-switched Nd:YAG laser with a repetition rate of 10 Hz and pulse duration of 5 ns. The emission spectra are recorded using a LIBS 2000 detection system spectrometer consisting of five high-resolution spectrometers covering a wavelength range from 200 to 720 nm. The optical emission spectra of the sage sample reveal the spectral lines of Fe, Ca, Ti, Co, Mn, Ni, and Cr. The plasma temperature and electron number density of the neutral spectral lines of the pertinent elements have been deduced using the Boltzmann plot and Stark-broadening line profile method, with average values 8855±885K and 3.89×10¹⁶cm^-3, respectively. The average values of the plasma parameters were used for the quantification of the detected elements in the sample. Based on the calibration-free method, the measured results demonstrate that Fe is the major constituent in the sample, having a percentage concentration of 48.1%, while the remaining elements are Ca, Ti, Co, Mn, Ni, and Cr, with percentage concentrations 0.7%, 5.3%, 8%, 11%, 12.3%, and 14.6%, respectively. This study demonstrates the feasibility of LIBS for the compositional analysis of major and trace elements present in the plant samples and its further applications in medicine.

Potential of joyweed Alternanthera sessilis for rapid treatment of domestic sewage in SHEFROL® bioreactor

In a first-ever report on this subject, it is shown that a common amphibious plant joyweed (Alternanthera sessilis) can be used in rapid and efficient treatment of biodegradable wastewaters, typified by domestic sewage. The plant was effective when used indoors under artificial lighting, as well as outdoors. It enabled treatment of sewage, varying widely in strength (from 300 mg/L to 1800 mg/L in chemical oxygen demand), to the extent of 78.9-83.9%. It was also able to remove biological oxygen demand, suspended solids, phosphorous, nitrogen, and the heavy metal copper to the extent of 87%, 93%, 45%, and 43%, respectively. Over 99% of total coliforms, faecal coliforms, and faecal streptococci were also removed. The treatment was very swiftly achieved, at a hydraulic retention time of just 6 h, in the "sheet flow root level" (SHEFROL^®) bioreactor developed earlier by us and of which a patent claim has been registered. The findings indicate that A. sessilis has the potential to affect primary, secondary, and tertiary treatment of domestic sewage along with significant pathogen removal in a single process step when used in SHEFROL^® bioreactors.

Comparing CMR Mapping Methods and Myocardial Patterns Toward Heart Failure Outcomes in Nonischemic Dilated Cardiomyopathy

OBJECTIVES

In patients with nonischemic dilated cardiomyopathy (NIDCM), native T1, partition coefficient (λ_Gd), and extracellular volume fraction (ECV) mapping may offer prognostic values beyond late gadolinium enhancement (LGE), by scaling the range of myocardial changes.

BACKGROUND

In patients with NIDCM, LGE is seen in 30% of patients and it indicates adverse prognosis.

METHODS

The study mapped 6 anatomical locations using all 4 cardiac magnetic resonance (CMR) tissue-characterizing methods and associated with outcome. The authors performed T1 mapping of the myocardium and the blood pool, before and serially after contrast injection, using a Look-Locker cine gradient-echo technique to obtain T1 and the corresponding reciprocal R1 values. λ_Gd values were derived from the slopes of the least-squares regression lines for myocardial versus blood R1, then adjusted to serum hematocrit to yield ECV.

RESULTS

Consecutive 240 NIDCM patients (49 ± 16 years of age; 38% women) underwent CMR for cardiac function, LGE, native T1, λ_Gd, and ECV. After a median of 3.8 years, 36 (15%) experienced major adverse cardiac events (MACE), including 22 heart failure hospitalizations and 14 deaths. Nonischemic LGE was detected in 34%, whereas ECV was elevated (≥1 location) in 58%. Comparing the 4 methods, mean ECV and λ_Gd both demonstrated strong association with MACE (both p < 0.001). In contrast to native T1 and LGE, ECV values from all 6 locations were associated with MACE and death, with the anteroseptum being the most significant (p < 0.0001). The number of abnormal ECV locations correlated linearly with annual MACE rates (p = 0.0003). Mean ECV was the only predictor to enter a prognostic model that contained age, sex, New York Heart Association functional class, and left ventricular ejection fraction. For every 10% increase, mean ECV portended to a 2.8-fold adjusted increase risk to MACE (p < 0.001).

CONCLUSIONS

In this study of patients with NIDCM, mapping the myocardial extent of abnormality using ECV offers prognostication toward heart failure outcomes incremental to LGE or native T1 mapping.

Use of the terrestrial weed Alternanthera ficoidea in treating greywater in soil-less SHEFROL® bioreactors

The ornamental plant Alternanthera ficoidea (also named A. tenella), which is common and widespread throughout the tropics and is being increasingly regarded as an invasive, problematic weed, has been explored as a bioagent in greywater treatment. In the recently developed SHEFROL^® bioreactor, it was seen to treat greywater of varying strengths (250-1,300 mg/L chemical oxygen demand, COD) quickly and substantially to the extent of 75-77%. Biological oxygen demand (BOD), nitrogen, phosphorus, suspended solids, and heavy metals copper, nickel, manganese, and zinc were also removed to the extents of 83.5, 94.9, 33.1, 27.0, 44.8, 27.5, 38.2, and 43.2%, respectively. As all this was achieved in a single pot, single step, and in a simple reactor operation, at hydraulic retention times of a mere 6 h, it shows the process to be several times more efficient as well as potentially less expensive than the conventional treatment systems which utilize macrophytes in tanks or constructed wetlands.

Left Atrial structure and function in hypertrophic cardiomyopathy sarcomere mutation carriers with and without left ventricular hypertrophy

BACKGROUND

Impaired left atrial (LA) function is an early marker of cardiac dysfunction and predictor of adverse cardiac events. Herein, we assess LA structure and function in hypertrophy in hypertrophic cardiomyopathy (HCM) sarcomere mutation carriers with and without left ventricular hypertrophy (LVH).

METHOD

Seventy-three participants of the HCMNet study who underwent cardiovascular magnetic resonance (CMR) imaging were studied, including mutation carriers with overt HCM (n = 34), preclinical mutation carriers without HCM (n = 24) and healthy, familial controls (n = 15).

RESULTS

LA volumes were similar between preclinical, control and overt HCM cohorts after covariate adjustment. However, there was evidence of impaired LA function with decreased LA total emptying function in both preclinical (64 ± 8%) and overt HCM (59 ± 10%), compared with controls (70 ± 7%; p = 0.002 and p = 0.005, respectively). LA passive emptying function was also decreased in overt HCM (35 ± 11%) compared with controls (47 ± 10%; p = 0.006). Both LAtotal emptying function and LA passive emptying function were inversely correlated with the extent of late gadolinium enhancement (LGE; p = 0.005 and p < 0.05, respectively), LV mass (p = 0.02 and p < 0.001) and interventricular septal thickness (p < 0.001 for both) and serum NT-proBNP levels (p < 0.001 for both).

CONCLUSION

LA dysfunction is detectable by CMR in preclinical HCM mutation carriers despite non-distinguishable LV wall thickness and LA volume. LA function appears most impaired in subjects with overt HCM and a greater extent of LV fibrosis.

Ultrasonic Assessment of Myocardial Microstructure in Hypertrophic Cardiomyopathy Sarcomere Mutation Carriers With and Without Left Ventricular Hypertrophy

BACKGROUND

The noninvasive assessment of altered myocardium in patients with genetic mutations that are associated with hypertrophic cardiomyopathy (HCM) remains challenging. In this pilot study, we evaluated whether a novel echocardiography-based assessment of myocardial microstructure, the signal intensity coefficient (SIC), could detect tissue-level alterations in HCM sarcomere mutation carriers with and without left ventricular hypertrophy.

METHODS AND RESULTS

We studied 3 groups of genotyped individuals: sarcomere mutation carriers with left ventricular hypertrophy (clinical HCM; n=36), mutation carriers with normal left ventricular wall thickness (subclinical HCM; n=28), and healthy controls (n=10). We compared measurements of echocardiographic SIC with validated assessments of cardiac microstructural alteration, including cardiac magnetic resonance measures of interstitial fibrosis (extracellular volume fraction), as well as serum biomarkers (NTproBNP, hs-cTnI, and PICP). In age-, sex-, and familial relation-adjusted analyses, the SIC was quantitatively different across subjects with overt HCM, subclinical HCM, and healthy controls (P<0.001). Compared with controls, the SIC was 61% higher in overt HCM and 47% higher in subclinical HCM (P<0.001 for both). The SIC was significantly correlated with extracellular volume (r=0.72; P<0.01), with left ventricular mass and E' velocity (r=0.45, -0.60, respectively; P<0.01 for both), and with serum NTproBNP levels (r=0.36; P<0.001).

CONCLUSIONS

Our findings suggest that the SIC could serve as a noninvasive quantitative tool for assessing altered myocardial tissue characteristics in patients with genetic mutations associated with HCM. Further studies are needed to determine whether the SIC could be used to identify subclinical changes in patients at risk for HCM and to evaluate the effects of interventions.

Characterization of the Changes in Cardiac Structure and Function in Mice Treated With Anthracyclines Using Serial Cardiac Magnetic Resonance Imaging

BACKGROUND

Anthracyclines are cardiotoxic; however, there are limited data characterizing the serial changes in cardiac structure and function after anthracyclines. The aim of this study was to use cardiac magnetic resonance to characterize anthracycline-induced cardiotoxicity in mice.

METHODS AND RESULTS

This was a longitudinal cardiac magnetic resonance and histological study of 45 wild-type male mice randomized to doxorubicin (n=30, 5 mg/kg of doxorubicin/week for 5 weeks) or placebo (n=15). A cardiac magnetic resonance was performed at baseline and at 5, 10, and 20 weeks after randomization. Measures of primary interest included left ventricular ejection fraction, myocardial edema (multiecho short-axis spin-echo acquisition), and myocardial fibrosis (Look-Locker gradient echo). In doxorubicin-treated mice versus placebo, there was an increase in myocardial edema at 5 weeks (T2 values of 32±4 versus 21±3 ms; P<0.05), followed by a reduction in left ventricular ejection fraction (54±6 versus 63±5%; P<0.05) and an increase in myocardial fibrosis (extracellular volume of 0.34±0.03 versus 0.27±0.03; P<0.05) at 10 weeks. There was a strong association between the early (5 weeks) increase in edema and the subacute (10 weeks) increase in fibrosis (r=0.90; P<0.001). Both the increase in edema and fibrosis predicted the late doxorubicin-induced mortality in mice (P<0.001).

CONCLUSIONS

Our data suggest that, in mice, anthracycline-induced cardiotoxicity is associated with an early increase in cardiac edema and a subsequent increase in myocardial fibrosis. The early increase in edema and subacute increase in fibrosis are strongly linked and are both predictive of late mortality.

Left Atrial Structure and Function in Heart Failure with Preserved Ejection Fraction: A RELAX Substudy

Given the emerging recognition of left atrial structure and function as an important marker of disease in heart failure with preserved ejection fraction (HF-pEF), we investigated the association between left atrial volume and function with markers of disease severity and cardiac structure in HF-pEF. We studied 100 patients enrolled in the PhosphdiesteRasE-5 Inhibition to Improve CLinical Status and EXercise Capacity in Diastolic Heart Failure (RELAX) trial who underwent cardiac magnetic resonance (CMR), cardiopulmonary exercise testing, and blood collection before randomization. Maximal left atrial volume index (LAVi; N = 100), left atrial emptying fraction (LAEF; N = 99; including passive and active components (LAEFP, LAEFA; N = 80, 79, respectively) were quantified by CMR. After adjustment for multiple testing, maximal LAVi was only associated with age (ρ = 0.39), transmitral filling patterns (medial E/e' ρ = 0.43), and N-terminal pro-BNP (NT-proBNP; ρ = 0.65; all p<0.05). Lower LAEF was associated with older age, higher transmitral E/A ratio and higher NT-proBNP. Peak VO2 and VE/VCO2 slope were not associated with left atrial structure or function. After adjustment for age, sex, transmitral E/A ratio, CMR LV mass, LV ejection fraction, and creatinine clearance, NT-proBNP remained associated with maximal LAVi (β = 0.028, p = 0.0007) and total LAEF (β = -0.033, p = 0.001). Passive and active LAEF were most strongly associated with age and NT-proBNP, but not gas exchange or other markers of ventricular structure or filling properties. Left atrial volume and emptying function are associated most strongly with NT-proBNP and diastolic filling properties, but not significantly with gas exchange, in HFpEF. Further research to explore the relevance of left atrial structure and function in HF-pEF is warranted.

Transitions in Metabolic Risk and Long-Term Cardiovascular Health: Coronary Artery Risk Development in Young Adults (CARDIA) Study

Background

Despite evidence suggesting that early metabolic dysfunction impacts cardiovascular disease risk, current guidelines focus on risk assessments later in life, missing early transitions in metabolic risk that may represent opportunities for averting the development of cardiovascular disease.

Methods and Results

In 4420 young adults in the Coronary Artery Risk Development in Young Adults (CARDIA) study, we defined a “metabolic” risk score based on components of the Third Report of the Adult Treatment Panel's definition of metabolic syndrome. Using latent class trajectory analysis adjusted for sex, race, and time‐dependent body mass index, we identified 6 distinct metabolic trajectories over time, specified by initial and final risk: low‐stable, low‐worsening, high‐stable, intermediate‐worsening, intermediate‐stable, and high‐worsening. Overall, individuals gained weight over time in CARDIA with statistically but not clinically different body mass index trend over time. Dysglycemia and dyslipidemia over time were highest in initially high or worsening trajectory groups. Divergence in metabolic trajectories occurred in early adulthood (before age 40), with 2 of 3 individuals experiencing an increase in metabolic risk over time. Membership in a higher‐risk trajectory (defined as initially high or worsening over time) was associated with greater prevalence and extent of coronary artery calcification, left ventricular mass, and decreased left ventricular strain at year 25. Importantly, despite similar rise in body mass index across trajectories over 25 years, coronary artery calcification and left ventricular structure and function more closely tracked risk factor trajectories.

Conclusions

Transitions in metabolic risk occur early in life. Obesity‐related metabolic dysfunction is related to subclinical cardiovascular phenotypes independent of evolution in body mass index, including coronary artery calcification and myocardial hypertrophy and dysfunction.

Effect of Late Gadolinium Enhancement on the Recovery of Left Ventricular Systolic Function After Pulmonary Vein Isolation

BACKGROUND

The factors that predict recovery of left ventricular (LV) systolic dysfunction among patients with atrial fibrillation (AF) are not completely understood. Late gadolinium enhancement (LGE) of the LV has been reported among patients with AF, and we aimed to test whether the presence LGE was associated with subsequent recovery of LV systolic function among patients with AF and LV dysfunction.

METHODS AND RESULTS

From a registry of 720 consecutive patients undergoing a cardiac magnetic resonance study prior to pulmonary vein isolation (PVI), patients with LV systolic dysfunction (ejection fraction [EF] <50%) were identified. The primary outcome was recovery of LVEF defined as an EF >50%; a secondary outcome was a combined outcome of subsequent heart failure (HF), admission, and death. Of 720 patients, 172 (24%) had an LVEF of <50% prior to PVI. The mean LVEF pre-PVI was 41±6% (median 43%, range 20% to 49%). Forty-three patients (25%) had LGE (25 [58%] ischemic), and the extent of LGE was 7.5±4% (2% to 19%). During follow-up (mean 42 months), 91 patients (53%) had recovery of LVEF, 68 (40%) had early recurrence of AF, 65 (38%) had late AF, 18 (5%) were admitted for HF, and 23 died (13%). Factors associated with nonrecovery of LVEF were older age, history of myocardial infarction, early AF recurrence, late AF recurrence, and LGE. In a multivariable model, the presence of LGE and any recurrence of AF had the strongest association with persistence of LV dysfunction. Additionally, all patients without recurrence of AF and LGE had normalization of LVEF, and recovery of LVEF was associated with reduced HF admissions and death.

CONCLUSIONS

In patients with AF and LV dysfunction undergoing PVI, the absence of LGE and AF recurrence are predictors of LVEF recovery and LVEF recovery in AF with associated reduction in subsequent death and heart failure.

Vermicomposting transforms allelopathic parthenium into a benign organic fertilizer

Vermicompost, which had been derived solely by the action of the epigeic earthworm Eisenia fetida on parthenium (Parthenium hysterophorus), was tested for its impact on the germination and early growth of green gram (Vigna radiata), ladies finger (Abelmoschus esculentus) and cucumber (Cucumis sativus). Seedlings were germinated and grown in soil amended with 0 (control), 0.75, 1.5, 2, 4, 8, 20 and 40% (by weight) parthenium vermicompost. Even though parthenium is known to possess strong negative allelopathy, as also plant/animal toxicity in other forms, its vermicompost (VC) manifested none of these attributes. Rather the VC enhanced germination success, introduced plant-friendly physical features in the container media, increased biomass carbon, and was seen to promote early growth as reflected in several morphological and biochemical characteristics in plants which had received parthenium VC in comparison to those which had not. All these effects were statistically significant. Fourier Transform Infrared (FTIR) Spectrometry revealed that the phenols and the sesquiterpene lactones that are responsible for the negative allelopathic impact of parthenium were largely destroyed in the course of vermicomposting. FTIR spectra also indicated that lignin content of parthenium was reduced during its vermicomposting. The findings open up the possibility that several other invasives known for their negative allelopathy and toxicity may also produce vermicompost which may be plant-friendly and soil-friendly. It also makes it appear possible that the huge quantities of phytomass that is generated annually by parthenium can be gainfully utilized in producing organic fertilizer via vermicomposting, thereby providing a means of exercising some control over parthenium's rampant growth and invasion.

Transformation of toxic and allelopathic lantana into a benign organic fertilizer through vermicomposting

In a first study of its kind, the composition of vermicompost derived solely from the toxic and allelopathic weed lantana has been investigated using UV-visible and Fourier transform infrared (FT-IR) spectroscopy, thermogravimetric (TG) and differential scanning calorimetry (DSC), gas chromatography-mass spectometry (GC-MS), and scanning electron microscopy (SEM). The studies reveal that a sharp reduction in humification index, substantial mineralization of organic matter and degradation of complex aromatics such as lignin and polyphenols into simpler carbohydrates and lipids occur in the course of vermicomposting. GC-MS analysis shows significant fragmentation, bio-oxidation and molecular rearrangements of chemical compounds in vermicompost in comparison to those in lantana. SEM micrographs of vermicompost reflect strong disaggregation of material compared to the much better formed lantana matrices. The phenols and sesquiterpene lactones which are specifically responsible for the toxicity and allelopathy of lantana are seen to get significantly degraded in the course of vermicomposting - turning it into a plant-friendly organic fertilizer. The study leads to the possibility that the millions of tons of phytomass that is generated annually by lantana can be gainfully utilized in producing organic fertilizer via vermicomposting.

Diet and adipose tissue distributions: The Multi-Ethnic Study of Atherosclerosis

BACKGROUND AND AIMS

Dietary quality affects cardiometabolic risk, yet its pathways of influence on regional adipose tissue depots involved in metabolic and diabetes risk are not well established. We aimed to investigate the relationship between dietary quality and regional adiposity.

METHODS AND RESULTS

We investigated 5079 individuals in the Multi-Ethnic Study of Atherosclerosis (MESA) who had food-frequency questionnaires and measurement of pericardial fat and hepatic attenuation at the baseline study visit in MESA, as well as a subgroup with imaging for visceral and subcutaneous fat (N = 1390). A dietary quality score (DietQuality) was constructed to include established food group constituents of a Mediterranean-type diet. Linear models estimated associations of dietary score as well as its constituents with regional adiposity. Baseline mean age was 61 (± 10) years, and approximately half of the participants (47%) were male. Those with a higher DietQuality score were generally older, female, with a lower body mass index, C-reactive protein, and markers of insulin resistance. After adjustment, a higher DietQuality score was associated with lower visceral fat (lowest vs. highest dietary score quartile: 523.6 vs. 460.5 cm(2)/m; P < 0.01 for trend), pericardial fat (47.5 vs. 41.3 cm(3)/m; P < 0.01 for trend), lesser hepatic steatosis (by hepatic attenuation; 58.6 vs. 60.7 Hounsfield units; P < 0.01 for trend), but not subcutaneous fat (P = 0.39). Greater fruits, vegetables, whole grains, seeds/nuts and yogurt intake were associated with decreased adiposity, while red/processed meats were associated with greater regional adiposity.

CONCLUSION

A higher quality diet pattern is associated with less regional adiposity, suggesting a potential mechanism of beneficial dietary effects on diabetes, metabolic, and cardiovascular risk.

Abdominal fat radiodensity, quantity and cardiometabolic risk: The Multi-Ethnic Study of Atherosclerosis

BACKGROUND AND AIMS

Fat radiodensity, as measured by fat attenuation on computed tomography (CT), has emerged as a potential biomarker of "fat quality." We sought to characterize the relationship between fat radiodensity and quantity in subcutaneous, visceral, and intermuscular fat depots, and its role in inflammation, insulin resistance, and metabolic syndrome (MetS).

METHODS AND RESULTS

We studied 1511 individuals from the Multi-Ethnic Study of Atherosclerosis who underwent CT for measurement of regional fat distribution and radiodensity, along with biomarker assessments and adjudication of incident metabolic syndrome (MetS). Linear, logistic and Cox regression analyses were used to measure association between fat radiodensity and (1) fat quantity, (2) biomarkers of cardiometabolic dysfunction, and (3) both prevalent and incident MetS. In each fat depot, radiodensity was strongly and inversely associated with quantity (e.g., visceral fat radiodensity vs. quantity: ρ = -0.82, P < 0.01). After adjustment for age, sex and race, lower visceral fat radiodensity was associated with greater C-reactive protein, leptin and insulin, but lower adiponectin (P < 0.01 for all). After full adjustment for cardiovascular disease risk factors, visceral (but not subcutaneous or intermuscular) fat radiodensity was associated with prevalent MetS (OR = 0.96, 95% CI = 0.93-0.99, P = 0.01). Moreover, lower visceral fat radiodensity was associated with incident MetS after the same adjustment (HR = 0.95, 95% CI 0.93-0.98, P < 0.01). However, this association became non-significant after further adjustment for visceral fat quantity.

CONCLUSION

Fat radiodensity is strongly correlated with fat quantity and relevant inflammatory biomarkers. Fat radiodensity (especially for visceral fat) may be a complementary, easily assessed marker of cardiometabolic risk.

Association of Fitness in Young Adulthood With Survival and Cardiovascular Risk: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

IMPORTANCE

Although cardiorespiratory fitness (CRF) is prognostic in older adults, the effect of CRF during early adulthood on long-term cardiovascular structure, function, and prognosis is less clear.

OBJECTIVE

To examine whether CRF in young adults is associated with long-term clinical outcome and subclinical cardiovascular disease (CVD).

DESIGN, SETTING, AND PARTICIPANTS

Prospective study of 4872 US adults aged 18 to 30 years who underwent treadmill exercise testing at a baseline study visit from March 25, 1985, to June 7, 1986, and 2472 individuals who underwent a second treadmill test 7 years later. Median follow-up was 26.9 years, with assessment of obesity, left ventricular mass and strain, coronary artery calcification (CAC), and vital status and incident CVD. Follow-up was complete on August 31, 2011, and data were analyzed from recruitment through the end of follow-up.

MAIN OUTCOMES AND MEASURES

The presence of CAC was assessed by computed tomography at years 15 (2000-2001), 20 (2005-2006), and 25 (2010-2011), and left ventricular mass was assessed at years 5 (1990-1991) and 25 (with global longitudinal strain). Incident CVD and all-cause mortality were adjudicated.

RESULTS

Of the 4872 individuals, 273 (5.6%) died and 193 (4.0%) experienced CVD events during follow-up. After comprehensive adjustment, each additional minute of baseline exercise test duration was associated with a 15% lower hazard of death (hazard ratio [HR], 0.85; 95% CI, 0.80-0.91; P < .001) and a 12% lower hazard of CVD (HR, 0.88; 95% CI, 0.81-0.96; P = .002). Higher levels of baseline CRF were associated with significantly lower left ventricular mass index (β = -0.24; 95% CI, -0.45 to -0.03; P = .02) and significantly better lobal longitudinal strain (β = -0.09; 95% CI, -0.14 to -0.05; P < .001) at year 25. Fitness was not associated with CAC. A 1-minute reduction in fitness by year 7 was associated with 21% and 20% increased hazards of death (HR, 1.21; 95% CI, 1.07-1.37; P = .002) and CVD (HR, 1.20; 95% CI, 1.06-1.37; P = .006), respectively, along with a more impaired strain (β = 0.15; 95% CI, 0.08-0.23; P < .001). No association between change in fitness and CAC was found.

CONCLUSIONS AND RELEVANCE

Higher levels of fitness at baseline and improvement in fitness early in adulthood are favorably associated with lower risks for CVD and mortality. Fitness and changes in fitness are associated with myocardial hypertrophy and dysfunction but not CAC. Regular efforts to ascertain and improve CRF in young adulthood may play a critical role in promoting cardiovascular health and interrupting early CVD pathogenesis.

The role of NADPH-derived reactive oxygen species production in the pathogenesis of endometriosis: a novel mechanistic approach

Endometriosis is defined as endometriotic tissue growing outside the uterine cavity. It is a common gynecological disorder in women of reproductive age and is associated with chronic pelvic pain and infertility. Despite several studies and theories to explain its cause, the exact pathogenesis of endometriosis remains unclear. Retrograde menstruation is the most plausible theory, however, it is not exclusive. The disparity between the actual prevalence of retrograde menstruation and the prevalence of endometriosis suggests that other factors may determine the susceptibility to endometriosis development. Oxidative stress has been associated with endometriosis. This study aimed to explore the role of NADPH oxidase family in the production of reactive oxygen species (ROS) and to determine whether ROS induce the proliferation of endometriotic implants via mammalian target of rapamycin (mTOR) signaling. Anonymous endometriotic tissue samples were collected from women undergoing laparoscopy for endometriosis. The samples were stained with dihydroethidium and fluorescent images of the slides were taken to detect ROS production. After extraction of RNA from the samples and c-DNA generation, quantitative real-time PCR, protein extraction and Western blot were performed to study gene and protein expression of NADPH oxidase 1 (NOX 1), mTOR and fibronectin. The results showed an increase in ROS levels and NOX 1 gene and protein expression in the endometriotic tissues compared to the normal surrounding tissue control. Also, mTOR and fibronectin, gene expression was found to be increased. Up regulation of NOX at gene and protein level leads to increased production of ROS in the endometriotic tissue, which in turn causes proliferation of the ectopic tissue via alteration of the mTOR signaling pathway. Increased fibronectin gene expression points towards tissue injury in endometriosis as compared to the normal surrounding tissue. This manuscript adds a new insight into the pathogenesis of endometriosis and serves as a background for development of new treatments for the disease-associated pain and infertility.

Vermicomposting eliminates the toxicity of Lantana (Lantana camara) and turns it into a plant friendly organic fertilizer

In evidently the first study of its kind, vermicompost derived solely from a weed known to possess plant and animal toxicity was used to assess its impact on the germination and early growth of several plant species. No pre-composting or supplementation of animal manure was done to generate the vermicompost in order to ensure that the impact is clearly attributable to the weed. Whereas the weed used in this study, Lantana (Lantana camara), is known to possess strong negative allelopathy, besides plant/animal toxicity in other forms, its vermicompost was seen to be a good organic fertilizer as it increased germination success and encouraged growth of all the three botanical species explored by the authors - green gram (Vigna radiata), ladies finger (Abelmoschus esculentus) and cucumber (Cucumis sativus). In terms of several physical, chemical and biochemical attributes that were studied, the vermicompost appeared plant-friendly, giving best results in general when employed at concentrations of 1.5% in soil (w/w). Fourier transform infrared spectrometry revealed that the phenols and the sesquiterpene lactones that are responsible for the allelopathic impact of Lantana were largely destroyed in the course of vermicomposting. There is also an indication that lignin content of Lantana was reduced during its vermicomposting. The findings open up the possibility that the billions of tons of phytomass that is generated annually by Lantana and other invasives can be gainfully utilized in generating organic fertilizer via vermicomposting.

Liver fat, statin use, and incident diabetes: The Multi-Ethnic Study of Atherosclerosis

BACKGROUND AND AIMS

To balance competing cardiovascular benefits and metabolic risks of statins, markers of type 2 diabetes (T2D) susceptibility are needed. We sought to define a competing risk/benefit of statin therapy on T2D and cardiovascular disease (CVD) events using liver attenuation and coronary artery calcification (CAC).

METHODS AND RESULTS

3153 individuals from the Multi-Ethnic Study of Atherosclerosis (MESA) without CVD, T2D/impaired fasting glucose, or baseline statin therapy had CT imaging for CAC and hepatic attenuation (hepatic steatosis). Cox models and rates of CVD and T2D were calculated to assess the role of liver attenuation in T2D and the relative risks/benefits of statins on CVD and T2D. 216 T2D cases were diagnosed at median 9.1 years follow-up. High liver fat and statin therapy were associated with diabetes (HR 2.06 [95%CI 1.52-2.79, P < 0.0001] and 2.01 [95%CI 1.46-2.77, P < 0.0001], respectively), after multivariable adjustment. With low liver fat and CAC = 0, the number needed to treat (NNT) for statin to prevent one CVD event (NNT 218) was higher than the number needed to harm (NNH) with an incident case of T2D (NNH 68). Conversely, those with CAC >100 and low liver fat were more likely to benefit from statins for CVD reduction (NNT 29) relative to T2D risk (NNH 67). Among those with CAC >100 and fatty liver, incremental reduction in CVD with statins (NNT 40) was less than incremental risk increase for T2D (NNH 24).

CONCLUSIONS

Liver fat is associated with incident T2D and stratifies competing metabolic/CVD risks with statin therapy. Hepatic fat may inform T2D surveillance and lipid therapeutic strategies.

Visceral adiposity and left ventricular remodeling: The Multi-Ethnic Study of Atherosclerosis

BACKGROUND AND AIMS

Visceral fat (VF) is a source of pro-inflammatory adipokines implicated in cardiac remodeling. We sought to determine the impact of visceral fat and subcutaneous fat (SQ) depots on left ventricular (LV) structure, function, and geometry in the Multi-Ethnic Study of Atherosclerosis (MESA).

METHODS AND RESULTS

We performed a post-hoc analysis on 1151 participants from MESA with cardiac magnetic resonance quantification of LV mass and LV mass-to-volume ratio (LVMV, an index of concentricity) and computed tomographic-derived SQ and VF area. Multivariable regression models to estimate association between height-indexed SQ and VF area (per cm(2)/m) with height-indexed LV mass (per height(2.7)) and LVMV were constructed, adjusted for clinical, biochemical, and demographic covariates. We found that both VF and SQ area were associated with height-indexed LV mass (ρ = 0.36 and 0.12, P < 0.0001, respectively), while only VF area was associated with LVMV (ρ = 0.28, P < 0.0001). Individuals with above-median VF had lower LV ejection fraction, greater indexed LV volumes and mass, and higher LVMV (all P < 0.001). In multivariable models adjusted for weight, VF (but not SQ) area was associated with LV concentricity and LV mass index, across both sexes.

CONCLUSION

Visceral adiposity is independently associated with LV concentricity, a precursor to heart failure. Further study into the role of VF in LV remodeling as a potential therapeutic target is warranted.

Liver steatosis and the risk of albuminuria: the multi-ethnic study of atherosclerosis

OBJECTIVE

To measure association between hepatic fat and albuminuria (an early marker of renal injury) in individuals without diabetes or hypertension.

METHODS

2,281 individuals in the Multi-Ethnic Study of Atherosclerosis without diabetes or hypertension, renal disease, or excess alcohol consumption underwent computed tomography (CT) for assessment of liver attenuation (marker of hepatic lipid content) and urinalysis (for albuminuria) at initial study visit, with assessment of incident and prevalent albuminuria by logistic regression in follow-up.

RESULTS

After adjustment for age, gender, race, smoking, blood pressure, insulin resistance, and body mass index, individuals with less liver fat (higher liver CT attenuation) had a lower probability of having albuminuria at Exam 1 (OR per 10 unit increase in attenuation 0.77, 95 % CI 0.61-0.97, P = 0.02). At median 9.3 years follow-up, albuminuria was identified in 129 individuals were (5.8 %). In fully adjusted models (with age, smoking, body mass index, blood pressure, diabetes and hypertension as time-dependent covariates), lower liver attenuation (greater liver fat) was associated with higher risk of incident albuminuria (OR 0.79, 95 % CI 0.66-0.94, P = 0.008).

CONCLUSIONS

Hepatic attenuation is associated with prevalent and incident albuminuria, an early, potent risk factor for renal risk in a population not clearly at risk for future renal failure.

Diltiazem treatment for pre-clinical hypertrophic cardiomyopathy sarcomere mutation carriers: a pilot randomized trial to modify disease expression

OBJECTIVES

The study sought to assess the safety, feasibility, and effect of diltiazem as disease-modifying therapy for at-risk hypertrophic cardiomyopathy (HCM) mutation carriers.

BACKGROUND

HCM is caused by sarcomere mutations and characterized by left ventricular hypertrophy (LVH) with increased risk of heart failure and sudden death. HCM typically cannot be diagnosed early in life, although subtle phenotypes are present. Animal studies indicate that intracellular calcium handling is altered before LVH develops. Furthermore, early treatment with diltiazem appeared to attenuate disease emergence.

METHODS

In a pilot, double-blind trial, we randomly assigned 38 sarcomere mutation carriers without LVH (mean 15.8 years of age) to therapy with diltiazem 360 mg/day (or 5 mg/kg/day) or placebo. Treatment duration ranged from 12 to 42 months (median 25 months). Study procedures included electrocardiography, echocardiography, cardiac magnetic resonance imaging, and serum biomarker measurement.

RESULTS

Diltiazem was not associated with serious adverse events. Heart rate and blood pressure did not differ significantly between groups. However, mean left ventricular (LV) end-diastolic diameter improved toward normal in the diltiazem group but decreased further in controls (change in z-scores, +0.6 vs. -0.5; p < 0.001). Mean LV thickness-to-dimension ratio was stable in the diltiazem group but increased in controls (-0.02 vs. +0.15; p = 0.04). Among MYBPC3 mutation carriers, LV wall thickness and mass, diastolic filling, and cardiac troponin I levels improved in those taking diltiazem compared with controls. Four participants developed overt HCM, 2 in each treatment group.

CONCLUSIONS

Pre-clinical administration of diltiazem is safe and may improve early LV remodeling in HCM. This novel strategy merits further exploration. (Treatment of Preclinical Hypertrophic Cardiomyopathy With Diltiazem; NCT00319982).

A new process for the rapid and direct vermicomposting of the aquatic weed salvinia (Salvinia molesta)

Background

The concept of high-rate vermicomposting was successfully used to achieve direct vermicomposting of the aquatic weed salvinia - without any precomposting or cow dung supplementation as previously reported processes for the vermicomposting of phytomass had necessitated.

Results

Both the epigeic species of earthworms that were explored, Eudrilus eugeniae and Eisenia fetida, provided efficient vermicast production with no mortality, persistent gain in body mass, and good fecundity over the 270-day-long course of the reactor operation. In this period, all reactors were pulse-fed at the solid retention time of 15 days and were operated in the pseudo-discretized continuous operation protocol developed earlier by the authors. With this, it was possible to almost completely dampen the influence of natural biodegradation of the feed or grazing by the earthworm born in the vermireactors. This has made it possible to link vermicast production directly to the ability of the earthworm to feed upon, and digest, salvinia. In turn, this enables accurate process monitoring and provides clear pointers on how to improve process efficiency.

Conclusion

The paper establishes the capability of high-rate vermicomposting technology developed earlier by the authors in direct and efficient vermicomposting of salvinia without any precomposting or manure supplementation. The findings have very significant implications in improving process economics and consequently process utility. No previous report exists in primary literature on the vermicomposting of salvinia.

Visceral adiposity and the risk of metabolic syndrome across body mass index: the MESA Study

OBJECTIVES

This study sought to evaluate differential effects of visceral fat (VF) and subcutaneous fat and their effects on metabolic syndrome (MetS) risk across body mass index (BMI) categories.

BACKGROUND

The regional distribution of adipose tissue is an emerging risk factor for cardiometabolic disease, although serial changes in fat distribution have not been extensively investigated. VF and its alterations over time may be a better marker for risk than BMI in normal weight and overweight or obese individuals.

METHODS

We studied 1,511 individuals in the MESA (Multi-Ethnic Study of Atherosclerosis) with adiposity assessment by computed tomography (CT). A total of 253 participants without MetS at initial scan underwent repeat CT (median interval 3.3 years). We used discrete Cox regression with net reclassification to investigate whether baseline and changes in VF area are associated with MetS.

RESULTS

Higher VF was associated with cardiometabolic risk and coronary artery calcification, regardless of BMI. After adjustment, VF was more strongly associated with incident MetS than subcutaneous fat regardless of weight, with a 28% greater MetS hazard per 100 cm(2)/m VF area and significant net reclassification (net reclassification index: 0.44, 95% confidence interval [CI]: 0.29 to 0.60) over clinical risk. In individuals with serial imaging, initial VF (hazard ratio: 1.24 per 100 cm(2)/m, 95% CI: 1.08 to 1.44 per 100 cm(2)/m, p = 0.003) and change in VF (hazard ratio: 1.05 per 5% change, 95% CI: 1.01 to 1.08 per 5% change, p = 0.02) were associated with MetS after adjustment. Changes in subcutaneous fat were not associated with incident MetS after adjustment for clinical risk and VF area.

CONCLUSIONS

VF is modestly associated with BMI. However, across BMI, a single measure of and longitudinal change in VF predict MetS, even accounting for weight changes. Visceral adiposity is essential to assessing cardiometabolic risk, regardless of age, race, or BMI, and may serve as a marker and target of therapy in cardiometabolic disease.

Effect of vermicast generated from an allelopathic weed lantana (Lantana camara) on seed germination, plant growth, and yield of cluster bean (Cyamopsis tetragonoloba)

In perhaps the first-ever study of its kind, the effect of vermicompost, derived solely from an allelopathic weed, on the germination, growth, and yield of a botanical species, has been carried out. In test plots, the soil was treated with the vermicompost of lantana (Lantana camara) at the rates of 5, 7.5, and 10 t ha(-1), and cluster bean (Cyamopsis tetragonoloba) was grown on it. The performance of these systems was compared with the systems in which the soil was fortified with inorganic fertilizers (IFs) in concentrations equivalent to those present in the respective vermicompost (VC) treatments. Additionally, a set of control was studied in which the soil was used without fortification by either VC or IF. It was seen that up to 51.5 % greater germination success occurred in the VC treatments compared to controls. VC also supported better plant growth in terms of stem diameter, shoot length, shoot mass, number of leaves, and leaf pigments. The positive impact extended up to fruit yield. In addition, vermicast application enhanced root nodule formation, reduced disease incidence, and allowed for a smaller number of stunted plants. The results indicate that allelopathic ingredients of lantana seem to have been totally eliminated during the course of its vermicomposting and that lantana vermicompost has the potential to support germination, growth, and fruit yield better than equivalent quantities of IFs.

Risk stratification by regadenoson stress magnetic resonance imaging in patients with known or suspected coronary artery disease

The aim of this study was to investigate the association between major adverse cardiovascular events (MACEs) and inducible ischemia on regadenoson cardiac magnetic resonance (CMR) myocardial perfusion imaging (MPI) performed at 3.0 T. Regadenoson stress CMR MPI is increasingly used to assess patients with suspected ischemia; however, its value in patient prognostication and risk reclassification is only emerging. A total of 346 patients with suspected ischemia who were referred for regadenoson CMR were studied. The prognostic association of presence of inducible ischemia by CMR with MACEs was determined. In addition, we assessed the extent of net reclassification improvement by CMR beyond a clinical risk model. There were 52 MACEs during a median follow-up period of 1.9 years. Patients with inducible ischemia were fourfold more likely to experience MACEs (hazard ratio, 4.14, 95% confidence interval 2.37 to 7.24, p <0.0001). In the best overall model, presence of inducible ischemia conferred a 2.6-fold increased hazard for MACEs adjusted to known clinical risk markers (adjusted hazard ratio 2.59, 95% confidence interval 1.30 to 5.18, p = 0.0069). Patients with no inducible ischemia experienced a low rate of cardiac death and myocardial infarction (0.6% per patient-year), whereas those with inducible ischemia had an annual event rate of 3.2%. Net reclassification improvement across risk categories (low <5%, intermediate 5% to 10%, and high >10%) by CMR was 0.29 (95% confidence interval 0.15 to 0.44), and continuous net reclassification improvement was 0.58. In conclusion, in patients with clinical suspicion of myocardial ischemia, regadenoson stress CMR MPI provides robust risk stratification. CMR MPI negative for ischemia was associated with a very low annual rate of hard cardiac events. In addition, CMR MPI provides effective risk reclassification in a substantial proportion of patients.

Infarct tissue heterogeneity by contrast-enhanced magnetic resonance imaging is a novel predictor of mortality in patients with chronic coronary artery disease and left ventricular dysfunction

BACKGROUND

Strategies for prevention of sudden cardiac death focus on severe left ventricular (LV) dysfunction, although most sudden cardiac death postmyocardial infarction occurs in patients with mild/moderate LV dysfunction. We tested the hypothesis that infarct heterogeneity by cardiac magnetic resonance is associated with mortality beyond LV ejection fraction (LVEF) in patients with coronary artery disease and LV dysfunction. In addition, we examined the association between infarct heterogeneity and mortality in those with LVEF >35%.

METHODS AND RESULTS

We studied 301 patients with coronary artery disease and LV dysfunction referred for cardiac magnetic resonance. We quantified total infarct mass, infarct core mass, and peri-infarct zone (PIZ) normalized for total infarct mass (%PIZ) using signal-intensity criteria of >2 SDs, >3 SDs, and 2- to -3 SDs above remote myocardium, respectively. Mean LVEF was 41 ± 14%. After 3.9 years median follow-up, 66 (22%) patients died (13 sudden cardiac death; 33 with LVEF >35%). In patients with LVEF >35%, below-median %PIZ carried an annual death rate of 2.8% versus 12% in patients with above-median %PIZ (P<0.001). In a multivariable model, %PIZ maintained strong association with mortality adjusted to patient age, LVEF, right ventricular ejection fraction, prolonged QT interval, and total infarct size and resulted in improve risk reclassification 0.492 (95% confidence interval, 0.183-0.817).

CONCLUSIONS

Cardiac magnetic resonance infarct heterogeneity has a strong association with mortality independent of LVEF in patients with coronary artery disease and LV dysfunction, particularly in patients with mild or moderate LV dysfunction. Further studies incorporating cardiac magnetic resonance in clinical decision making for defibrillator therapy are warranted.