Correlation of intra operative specimen imaging with final histopathology in breast conserving surgery for breast cancer

Objectives

To determine the effectiveness of specimen mammography in breast conserving surgery cases with respect to reduction in margin positivity rate, and to see whether the rate of secondary surgeries is decreased by intra-operative excision based on specimen mammography evaluation.

METHODS

The retrospective study was conducted at the Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised data from January 2018 to December 2019 related to all female breast cancer patients who underwent mastectomy or breast conserving surgery with the involvement of specimen mammography. Sensitivity, specificity, positive predictive value and negative predictive value of specimen mammography were calculated. Data was analysed using SPSS 20.

RESULTS

Of the 226 patients initially assessed, 65(28.7%) were excluded, and the final sample comprised 161(71.2%) women with mean age 46.71±10.47 years. The sensitivity, specificity, positive predictive value and negative predictive value of specimen mammography for the sample were 65.8%, 80.8%, 54% and 87.3%, respectively. Performing specimen mammography for intra-operative margin assessment in 12 patients was likely to spare one patient from re-excision.

CONCLUSIONS

Intra-operative specimen mammography was found to be a reliable tool for assessing margin status.

In vivo analysis the effect of antibiotic growth promoters (AGPs), Oxytetracycline di-hydrate and Tylosin phosphate on the intestinal microflora in broiler chicken

Abstract The study was aimed to analyse the effects of antibiotic growth promoters (AGPs), Oxytetracycline di-hydrate and Tylosin phosphate on the intestinal microflora in broiler chicken. The AGPs were provided in different concentrations solely or in combinations for 42 days of rearing. Faecal samples were collected from the intestine (duodenum, jejunum and caeca) of broiler chicken on 14th, 28th and 42nd days of trial. Samples were cultured on different selective medium and bacterial identification was performed by different biochemical and molecular diagnostic tools. Results showed a significant effect of AGPs on the growth of pathogenic microorganisms such as Escherichia coli and Clostridium perfringens in the intestine. Interestingly, an impaired growth was observed for both bacterium showing a significant effect (P<0.05) of AGPs on E. coli and C. perfringens on day 14th, 28th, and 42nd. This effect was observed solely and in combination while using AGPs. Data further showed that the effect was more prominent in combination and with an increase concentration of AGPs. Remarkably, no impairment was seen on the growth of L. reuteri at different sites of intestine and duration (14th, 28th, and 42nd days). The results showed that the use of AGPs in diet has no harmful effect on beneficial bacteria, however, an impaired growth was seen on the harmful bacteria. It is suggested that a combination of AGPs (OXY-1.0+TP-0.5) is economical and have no harmful effect on the broiler chicken. The use of AGPs in a recommended dose and for a specific period of time are safe to use in poultry both as growth promoter and for the prevention of diseases.

Prevalence and treatment of HIV/AIDS in Pakistani population: A retrospective study

HIV/AIDS epidemic poses an emerging threat around the world. An estimated 0.1% of people aged 15 to 49 years have been infected with HIV/AIDS in Pakistan during the last few years. This research study aims to analyse the prevalence and treatment/management of HIV/AIDS among the Pakistani population aged 15 to 45 years from 1990 to 2020 and this research data was collected during the year 2021. The analysis was done by using E-views software. Descriptive statistical analysis, correlation coefficient, unit root analysis, and linear regression analysis were used. Results indicated that there is low awareness regarding AIDS in the population and there is a significant link between prevalence and population increase, i.e. with the increase in population the prevalence of AIDS also increases. Findings are discussed in terms of implications for prevention and education of HIV/AIDS in Pakistan's population.

Heat and mass transfer with entropy optimization in hybrid nanofluid using heat source and velocity slip: a Hamilton-Crosser approach

The modeling and analysis of hybrid nanofluid has much importance in industrial sector where entropy optimization is the key factor in different processes. This mechanism is also used in medical industry, where it can be used for separation of blood cells (red and white blood cells, platelets and plasma) by centrifuge process, treating cancers, and drug transport. In light of this importance, current study is focused on mathematical modeling and analysis of blood based hybrid nanofluid between rotating disks with various shapes of nanoparticles. The shape factors are taken into account with Hamilton-Crosser model as spherical, brick, cylinder and platelet in the current scenario, with special reference to entropy optimization. In order to solve modeled nonlinear and non-dimensional system, optimal homotopy analysis approach is utilized through Wolfram MATHEMATICA 11.3 software. Error estimation and convergence analysis confirms that obtained semi-analytical solutions are valid and reliable. Velocity, temperature and concentration profiles are analyzed against important fluid parameters. Fluid velocity decreased in all directions when unsteady parameter [Formula: see text] and Darcy number Da increased while the slip parameters [Formula: see text] and [Formula: see text] decreased the nanofluid velocity. It is observed that in case of brick shaped nanoparticles, fluid temperature is enhanced as compared to other shape factors in the study. Minimal entropy generation is captured in case of spherical nanoparticles, while highest heat transfer is observed in platelet shaped nanoparticles. Furthermore, numerical optimization of entropy is performed against different values of [Formula: see text] and volume fractions [Formula: see text] and [Formula: see text]. Minimized entropy is recovered to be zero when [Formula: see text], [Formula: see text] and [Formula: see text].

Analysis of blood flow of unsteady Carreau-Yasuda nanofluid with viscous dissipation and chemical reaction under variable magnetic field

Blood flow analysis through arterial walls depicts unsteady non-Newtonian fluid flow behavior. Arterial walls are impacted by various chemical reactions and magnetohydrodynamic effects during treatment of malign and tumors, cancers, drug targeting and endoscopy. In this regard, current manuscript focuses on modeling and analysis of unsteady non-Newtonian Carreau-Yasuda fluid with chemical reaction, Brownian motion and thermophoresis under variable magnetic field. The main objective is to simulate the effect of different fluid parameters, especially variable magnetic field, chemical reaction and viscous dissipation on the blood flow to help medical practitioners in predicting the changes in blood to make diagnosis and treatment more efficient. Suitable similarity transformations are used for the conversion of partial differential equations into a coupled system of ordinary differential equations. Homotopy analysis method is used to solve the system and convergent results are drawn. Effect of different dimensionless parameters on the velocity, temperature and concentration profiles of blood flow are analyzed in shear thinning and thickening cases graphically. Analysis reveals that chemical reaction increases blood concentration which enhance the drug transportation. It is also observed that magnetic field elevates the blood flow in shear thinning and thickening scenarios. Furthermore, Brownian motion and thermophoresis increases temperature profile.

Unsteady hybrid nanofluid (Cu-UO2/blood) with chemical reaction and non-linear thermal radiation through convective boundaries: An application to bio-medicine

This study is focused on modeling and simulations of hybrid nanofluid flow. Uranium dioxide UO2 nanoparticles are hybrid with copper Cu, copper oxide CuO and aluminum oxide Al2O3 while considering blood as a base fluid. The blood flow is initially modeled considering magnetic effect, non-linear thermal radiation and chemical reactions along with convective boundaries. Then for finding solution of the obtained highly nonlinear coupled system we propose a methodology in which q-homotopy analysis method is hybrid with Galerkin and least square Optimizers. Residual errors are also computed in this study to confirm the validity of results. Analysis reveals that rate of heat transfer in arteries increases up to 13.52 Percent with an increase in volume fraction of Cu while keeping volume fraction of UO2 fixed to 1% in a base fluid (blood). This observation is in excellent agreement with experimental result. Furthermore, comparative graphical study of Cu,CuO and Al2O3 for increasing volume fraction is also performed keeping UO2 volume fraction fixed. Investigation indicates that Cu has the highest rate of heat transfer in blood when compared with CuO and Al2O3. It is also observed that thermal radiation increases the heat transfer rate in the current study. Furthermore, chemical reaction decreases rate of mass transfer in hybrid blood nanoflow. This study will help medical practitioners to minimize the adverse effects of UO2 by introducing hybrid nano particles in blood based fluids.

Unsteady hybrid nanofluid ([Formula: see text], MWCNTs/blood) flow between two rotating stretchable disks with chemical reaction and activation energy under the influence of convective boundaries

Hybrid nanofluids are extensively analyzed in recent studies due to their better performance in numerous areas such as heat and mass transfer enhancement, biological fluid movement, medical equipment, heat exchangers, electronic cooling and automotive industry. In current study the nanoparticle concentration utilized is much important in biomedical industry. Major applications include drug delivery, radio-pharmaceuticals, centrifuging blood to obtain red blood cells and plasma, medical implants, onco therapeutics and photo thermal cancer therapy. In this regard, the primary focus of this study is to simulate a blood based unsteady hybrid nanofluid flow between two rotating, stretching disks and convective boundaries. The two nanoparticles in this study are uranium dioxide [Formula: see text] and multi-walled carbon nanotubes MWCNTs. The hybrid nanofluid is under the influence of magnetohydrodynamic effects and chemical reaction with activation energy. The governing partial differential equations (PDEs) are transformed into ordinary differential equations (ODEs) using suitable similarity transform. Homotopy analysis method is used to solve the non-linear system of ODEs and [Formula: see text]-curves are plotted to find suitable region of [Formula: see text] for convergent series solution. Velocity profile is examined for axial, radial and tangential direction against various fluid parameters. Temperature and concentration profiles are analyzed for both convective and non-convective cases. It is observed that convective boundaries result in elevated temperature when compared with non-convective case. Moreover, skin friction, heat and mass transfer rates are also examined with respect to changing volume fraction [Formula: see text].The results revealed that skin friction and rate of heat transfer increases with increase in volume fraction of both nanoparticles [Formula: see text] and MWCNTs while the mass transfer rate depicts contrasting behavior.

Efficacy of pre - operative axillary ultrasonography in excluding nodal disease: Can it replace sentinel lymph node biopsy in early stage breast cancer?

OBJECTIVE

To determine false negative rate, negative predictive value and the factors predicting false negativity of pre-treatment axillary ultrasound.

METHODS

The retrospective study was conducted at Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan, and comprised data from January 2019 to December 2020 of patients with normal lymph nodes on ultrasound, tumour stages T1, T2 or T3 having invasive cancer who underwent sentinel lymph node biopsy. Ultrasound findings were compared with the biopsy results, dividing the sample into false negative group A and true negative group B. Clinical, radiological, histopathological parameters and therapeutic strategies were compared between the two groups. Data was analysed using SPSS 20.

RESULTS

Of the 781 patients with mean age 49.39±11.51 years, 154(19.7%) were in group A and 627(80.2%) were in group B, with negative predictive value of 80.2%. Initial tumour size, histopathology, tumour grade, receptors, timing of chemotherapy, and type of surgery has significant difference between the groups (p<0.05). Multivariate analysis showed larger, high-grade, progesterone receptor negative and human epidermal growth factor receptor 2 positive tumours were significantly associated with lower false negative rate on axillary ultrasound (p<0.05).

CONCLUSIONS

Axillary ultrasound was found to be effective in ruling out axillary nodal disease, especially in patients with high-burden axillary disease, aggressive tumour biology, larger tumour size and higher timour grade.

Fractional analysis of unsteady squeezing flow of Casson fluid via homotopy perturbation method

The objective of this article is to model and analyze unsteady squeezing flow of fractional MHD Casson fluid through a porous channel. Casson fluid model is significant in understanding the properties of non-Newtonian fluids such as blood flows, printing inks, sauces and toothpaste etc. This study provides important results as unsteady flow of Casson fluid in fractional sense with aforementioned effects has not been captured in existing literature. After applying similarity transformations along with fractional calculus a highly non-linear fractional-order differential equation is obtained. Modeled equation is then solved along with no-slip boundary conditions through a hybrid of Laplace transform with homotopy perturbation algorithm. For validity purposes, solution and errors at various values in fractional domain are compared with existing results. LHPM results are better in terms of accuracy than other available results in literature. Effects of fractional parameter on the velocity profile, skin friction and behaviors of involved fluid parameters is the focal point of this study. Comprehensive, quantitative and graphical analysis is performed for investigating the effects of pertinent fluid parameters on the velocity profile and skin friction. Analysis revealed that fractional parameter depicts similar effect in case of positive and negative squeeze number. Also, skin friction decreases with an increasing fractional parameter. Moreover, in fractional environment Casson parameter has shown similar effect on the velocity profile in case of positive and negative squeeze number.

The impact of age on the 99th percentile of cardiac troponin

Introduction

The 99th percentile upper reference limit (URL) of cardiac troponin (cTn) is diagnostic cutoff for myocardial infarction (MI). Several factors are known to lead to an increase in cTn including sex, kidney function, left ventricular function and various comorbidities. Similarly, studies have shown that cTn concentration of patients increase with age. However, the impact of age on the concentration of cTn in healthy individuals is unclear as several studies of healthy populations showed little to no impact of age.

Purpose

To determine the effect of age on the URL of cTn for the Danish population.

Methods

We invited active and retired blood donors with the aim of including 250 participants of each sex in each of four age groups, &lt;50, 50–60, 60–70 and &gt;70 years, for a total of about 2000 participants. cTn levels were measured by 4 cTn assays (Siemens Atellica and Vista cTnI, Roche cTnT and Abbott Alinity cTnI). The age specific URL were calculated using the non-parametric method. Quantile regression for the 99th percentile was adjusted for sex and creatinine concentration.

Results

A total of 2287 participants were sampled in the study, of which 4 (0.2%) were excluded due to a history of heart disease and 7 (0.3%) were excluded due to insufficient plasma for screening biomarkers. The median age was 58.6 (IQR 48.2–69.7), and 52.6% were female. Figure 1 shows the distribution of cTn concentrations in age intervals. There was a significant increase in cTn with age for all assays (all p&lt;0.001). After adjusting for sex and creatinine concentration, increasing age was only significantly associated with cTnT (0.40 ng/L increase per year, p=0.03). Figure 2 panel A shows the age specific URL for each assay, where we observed a significant difference for cTnT with the URL increasing from 15.8 ng/L (90% CI 12.4–33.9 ng/L) for participants &lt;50 years to 37.6 ng/L (90% CI 34.6–41.5 ng/L) for participants &gt;70 years. The proportion of participants with concentrations above the manufacturers URL increased with age for cTnT from 1.5% in participants &lt;50 years to 25.6% for participants &gt;70 years (p&lt;0.001), figure 2 panel B. This changed little when removing participants with decreased kidney function (eGFR &lt;60 mL/min/1.73 m2) as 24.3% of the remaining participants &gt;70 years had a cTnT above the URL.

Conclusions

The concentration of cTn increased with age for all assays. This was clearest for cTnT in which the 99th percentiles of participants were significantly different for participants age &gt;70 years of whom a quarter had cTnT levels above the level for myocardial injury according to the manufacturer's URL.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): HelsefondenMauritzen La Fountaine Foundation

Breast conservation surgery (BCS) for breast cancer in a resource limited country- Are we upto the challenge!

Objective: To analyse outcomes of breast conservation surgery and to identify the factors that could have affected the outcomes. Method: The retrospectively study was conducted at the Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised data of breast conservation surgery cases done between January 2011 and October 2014 in order to cover up for the 5-year follow-up of the last enrolled patient. Data, obtained through the institutional information and database system, included disease-recurrence, 5-year disease-free survival and overall survival. Data was statistically analysed using SPSS 20. Results: Of the 553 cases, 417(75%) had no loco-regional recurrence or distant metastasis, while 136(25%) had some form of loco-regional, distant or contralateral metastasis at 5-year follow-up. In patients who had recurrence or metastasis, only progesterone receptor status, nodal status and mode of treatment showed significant association (p<0.05). Mortality at 5-year follow-up was 77(14%). Amongst the patients who died, only progesterone receptor status and nodal status had significant association (p<0.05). Five-year overall survival for the cohort was 476(86%), whereas 5-year disease-free survival was 409(74%). Conclusion: Breast conservation surgery was found to have favourable outcomes, while progesterone status, nodal involvement and mode of treatment significantly affected the outcome. Key Words:  Breast cancer, Breast conserving surgery, 5-year disease free survival, 5-year overall survival Continuous...

Study of human knowledge and attitude toward urban birds in Faisalabad city, Pakistan

Birds are very valuable indicators of species richness and endemic patterns in a specified ecosystem, which eventually help the scientist to measure the environmental degradation. The aim of present study was to know human knowledge and attitude toward urban birds in Faisalabad city, Pakistan. The study conducted in four consecutive months: November 2019 to February 2020. Population of birds was noted from eight residential towns of Faisalabad city, data were collected through questionnaire. Faisalabad has a reasonably large population of birds and present data show that, there is a significant difference between favorite bird of residential areas and institutions. The pigeon received the most likeness in bird population among residential area residents, while the myna received the least. The most popular bird in Faisalabad institutions was the sparrow, while the least popular bird was the common myna. Bird adaptation percentage of residential areas and institutional areas of Faisalabad was the highest for parrot and sparrow respectively. People in residential areas and institutions, on the other hand, adapted least to common myna. It is concluded that people of the study area like birds and offered food and high population of birds are present in study area.

Rapid pacing is an independent predictor for high implantation depth using self-expandable devices in TAVR

Background/Introduction

Optimizing valve implantation depth (ID) plays a crucial role in minimizing conduction disturbances and achieving optimal functional integrity. Until now, the impact of intraprocedural fast (FP) or rapid ventricular pacing (RP) on the implantation depth has not been investigated.

Purpose

Therefore, we aimed to 1) evaluate the impact of different pacing maneuvers on ID, and 2) identify the independent predictors of deep ID.

Methods

562 TAVR patients with newer-generation self-expandable devices were retrospectively enrolled and further separated into patients undergoing TAVR under FP (n=331; 58.9%) and RP (n=231; 41.1%). The final ID was analyzed, and the underlying functional, anatomical, and procedural conditions were evaluated by univariate and multivariate analysis.

Results

The highest ID was reached under RP in severe aortic valve calcification and valve size 26 mm. Multivariate analysis identified left ventricular outflow (LVOT) calcification (OR 0.56 [0.37–0.85], p=0.006*), a bicuspid valve (OR 0.34 [0.11–1.0], p=0.049*), valve size 26 mm (OR 0.47 [0.28–0.81], p=0.006*), and RP (OR 0.57 [0.37–0.87], p=0.010*) as independent and highly preventable predictors for deep valve deployment. Independent risk factors for deep ID were the use of a 34 mm device (OR 1.96 [1.22–3.15], p=0.005*) and mild aortic valve calcification (OR 1.62 [0.01–2.61], p=0.046*). In a model of protective factors, ID was significantly reduced with the number of protective criteria (0–2 criteria: −5.6±2.6 mm vs. 3–5 criteria: −4.5±2.0 mm; p&lt;0.0001*).

Conclusion

Data from this retrospective analysis indicate that RP is an independent predictor to reach a higher implantation depth using self-expandable devices.

Funding Acknowledgement

Type of funding sources: None.

Electrocardiographic predictors of recovery from pacemaker dependency after transcatheter aortic valve implantation: a meta-analysis

Background

Transcatheter aortic valve implantation (TAVI) is a well-established alternative to surgery for the treatment of patients with severe symptomatic aortic stenosis at high and intermediate surgical risk. The occurrence of electrical conduction disturbances with the need for permanent pacemaker (PPM) implantation remains one of the most frequent complications of the procedure. But PPM dependency after TAVI is often transient and conduction abnormalities may improve over time.

Purpose

We performed a meta-analysis to summarize available studies that reported the incidence of new PPM after TAVI and investigated the rate and possible predictors of recovery from PPM dependency during follow-up.

Methods

The authors conducted a literature search in PubMed and MEDLINE databases from January of 2012 until February of 2021. Eleven observational studies (n=6794) met inclusion criteria for the final analysis. The effect size was estimated using a random-effects model with 95% confidence interval (CI).

Results

PPM implantation was performed in 902 patients after TAVI (13.3%), mostly due to high degree atrioventricular (AV) block (81.3%). A follow-up of 683 patients was performed after a median period of 139 days. 322 of the patients examined during follow-up (48.6%) showed recovery from PPM dependency. Regarding secondary endpoints' analysis of relative risk (RR) and mean difference (MD) predictors of PPM recovery during follow-up were female sex (RR 1.37; 95% CI 1.10–1.71; p=0.006), preexisting coronary artery disease (RR 1.12; 95% CI 0.99–1.27; p=0.08) and reduced left ventricular ejection fraction (MD −2.08%; 95% CI 0.23–3.93%; p=0.03). ECG predictors for long-term PPM dependency after TAVI appeared to be preexisting right bundle branch block (RBBB) (RR 1.84; 95% CI 1.38–2.45; p&lt;0.0001), bifascicular block (RR 4.41; 95% CI 1.64–11.86; p=0.003) and prolonged QRS duration (MD 8.69 ms; 95% CI 0.11–17.28 ms; p=0.05). While postprocedural complete heart block was highly predictive for long-term PPM dependency after TAVI (RR 1.35; 95% CI 0.97–1.89; p&lt;0.0001), patients with recovery of PPM dependency showed more indications other than complete heart block for PPM implantation like lower degree AV block or sick sinus syndrome (RR 2.28; 95% CI 1.53–3.38; p&lt;0.0001). Especially postprocedural AV block grade I (RR 1.73; 95% CI 0.96–3.14; p=0.07) and new left bundle branch block (LBBB) (RR 1.94; 95% CI 1.22–3.08; p=0.005) turned out to be predictors of PPM recovery during follow-up.

Conclusion

This structured meta-analysis proved new PPM implantation in 13.3% of patients following TAVI with half of the cases (48.6%) recovering from PPM dependency during follow-up. Therefore, it should be considered to carefully reassess the indication for PPM rather than to immediately implant PPM after TAVI, especially regarding postprocedural ECG predictors for early pacemaker recovery (lower degree AV block, postprocedural LBBB).

Funding Acknowledgement

Type of funding sources: None.

Comparative analysis of various sources of selenium on the growth performance and antioxidant status in broilers under heat stress

The supplementation of Selenium-enriched probiotics is effective in reducing oxidative stress and maintaining meat quality stability in broiler chicken especially under heat stress. An experimental study was conducted to perform Comparative analysis of Selenium yeast with inorganic Se in broilers under heat stress. A total of 120 broilers chicks of one day were assigned to 4 groups each consisting 30 chicks fed on same basal diet but different selenium sources. The basal diet of group D1 was not supplemented with Se source (Negative control), group D2 basal diet was supplemented with inorganic selenium (Sodium selenite 0.22mg/Kg starter phase and 0.15mg/Kg finisher phase), group D3 basal diet was supplemented with commercially available organic selenium (Seleno-methionine 0.22mg/Kg starter phase and 0.15mg/Kg finisher phase) and group D4 basal diet was supplemented with self-developed organic selenium (Se-enriched yeast 0.22mg/Kg starter phase and 0.15mg/Kg finisher phase). The performance parameters i.e. feed intake (FI), live body weight (BW) and FCR were not significantly (p>0.05) effected by selenium supplementation in the starter phase but were significantly (p<0.05) effected in the finisher phase. Selenium supplementation significantly (p<0.05) effected serum Se level in different supplemented groups. Higher serum Se value (58.20±0.06) was recorded in D4 group. Similarly significantly lower selenium value was recorded for D4 and higher was recorded for D1 (11.36±0.08). However lower serum Paraoxonase (PON) value was recorded for D4 (13.24±0.01) and higher for D1 (13.33±0.03). Comparatively self-developed Se enriched yeast increased the Se accumulation and improved antioxidant system. Glutathione peroxidase (GPx) was found higher in D4 (12.333±0.03) followed by D3, D2 and D1 respectively. Whereas superoxide dismutase (SOD) was significantly lower (p<0.05) in D4 (0.1437±0.003) followed by D3 (0.1457±0.002). Selenium supplementation increased the bird's survival rate. Birds fed on Se enriched yeast showed higher Se deposition and better antioxidant capacity as compared to other sources of selenium. Se-enriched yeast displayed an improved result on Se deposition in tissues, and oxidative capacity, meat tenderness and immune response level as compared to other sources of selenium.

Aesthetic outcome and patient’s quality of life in breast cancer patients undergoing mastectomy with or without immediate reconstruction

e12587

Background: : Although post mastectomy Immediate breast reconstruction has shown to improve physical and psychosocial well-being of breast cancer patients, this is not a usual procedure in Pakistan due to limited resources and lack of awareness. The aim of our study is to evaluate patient’s satisfaction/ aesthetic outcomes between the patients undergoing mastectomy alone (Group A) and the ones undergoing mastectomy followed by immediate reconstruction (Group B). Methods: This is a prospective study conducted at Shaukat Khanum Hospital Pakistan comparing aesthetic outcome, patient’s satisfaction and Quality of life between two groups using Breast Q module. All patients undergoing mastectomy with and without reconstruction between April 2017 to July 2019 are included. Sample size of 84 was calculated (42 in each group). Results: The mean Q score of satisfaction with the breast in group B is 82.64 and in group A is 35.82 (P = 0.001). The mean Q score of Psychosocial well-being in group B is 89 vs 44.95 in group A (P = 0.001). The mean Q score of Physical well-being in group B is 98.23 vs 90.41 in group A (P = 0.002). The mean Q score of sexual well-being in group B is 81.93 vs 43 in Group A (P = 0.001). [Mean difference in score of 5-10 - little change, 10-20 - moderate change, > 20 - significant change].The mean difference between two groups in satisfaction with breast , psychosocial well-being and sexual well-being is more than 20 with a statistically significant p-value, while in physical well-being the mean difference is 7.8 which falls in little change group. Conclusions: Our study shows that reconstruction helps breast cancer patients in providing comprehensive care in a manner that they achieve a higher satisfaction with their appearance, psychological and sexual well-being without compromising oncological safety and this should be practiced more in our country. Also patients education about these procedures should be raised to help them fighting against this disease

Role of digital health in improving physical and mental well-being during COVID-19 pandemic

Introduction

Due to the COVID-19 pandemic, there is a steep rise in the acceptance of telemedicine and digital health, including increased interest in pursuing mental health treatment through telepsychiatry. Digital health helps following social distancing measures and increases the health outcomes.

Objectives

To see the role of digital health in improving physical and mental well-being during COVID-19 Pandemic

Methods

This study is a part of a large global project where 240 people inquired advice on phone app during COVID-19-Pandemic. Later on, a short study was conducted on the same population through survey to evaluate the effectiveness of digital health/tele-mental health. We also searched PubMed, Google Scholar, PsychInfo, and Medline for words “Digital Health, Tele-mental health, COVID-19-Pandemic”. Reviewed 40 articles and included 3 in this review1,4,5.

Results

We received a total of 98 responses. 65.6% people reported that online health resources are helpful in relieving pandemic-induced anxiety/stress, 66.2% reported to continue online health services after pandemic, 37.7% noted that digital health saves times in waiting areas, 46% reported lack of physical interaction with doctor as a disadvantage of digital health, and 40.3% reported comfort in using tele-mental health. Our literature review has shown barriers like privacy concerns and technological issues1. Provision of tele-psychiatry is safe and effective in continuity of mental health care.4,5

Conclusions

There has been an increased inclination towards digital health during any disaster. During COVID-19-Pandemic, digital health has increased access to mental health care and reduced risk of infection. The drawbacks include poor patient-doctor relationship, reimbursement concerns, and lack of confidentiality.

Stroke after transcatheter aortic valve implantation: new insights into risk prediction

Background

Stroke is still a feared complication following transcatheter aortic valve implantation (TAVI), associated with increased mortality and severe impact on patients' daily living. Despite technological development and knowledge improvement, cerebrovascular events (CVE) are still not predictable so far and simple risk scores are lacking.

Purpose

This study aimed to evaluate different preprocedural factors that may favour stroke after TAVI, especially regarding severity of aortic calcification.

Methods

From May 2011 to January 2018 a total of 1365 patients underwent TAVI with a balloon-expandable (n=442, 32.4%) or self-expandable (n=923, 67.6%) device at our institution. All patients underwent multi-slice computed tomography (MSCT) before TAVI. To obtain the significant factors for stroke risk prediction we performed multivariate regression analysis and selected the optimal cut-off values according to the maximum Youden index for dichotomization of the risk score items. Finally, we used receiver operating characteristics (ROC) analysis and areas under the ROC curves (AUC) to validate our risk score in comparison to other existing models.

Results

60 of 1365 patients (4.4%) had new neurological impairment after TAVI during hospital stay (mean 11.2±6.7 days). We performed propensity score matching (1:10) to balance baseline characteristics between patients with and without stroke following TAVI, resulting in 56 patients with in-hospital stroke and 521 patients without. Preprocedural factors associated with stroke turned out to be history of prior stroke (OR 1.94; 95% CI 0.85–4.43; p=0.114), aortic valve area ≥0.545 cm2 (OR 3.11; 95% CI 1.16–8.34; p=0.024), atrioventricular angle ≥48.5° (OR 2.32; 95% CI 1.20–4.49; p=0.013), RCC Agatston Score ≥447.2 AU (OR 1.8; 95% CI 0.94–3.44; p=0.077), LVOT Agatston Score ≥262.4 AU (OR 2.01; 95% CI 1.08–3.75; p=0.028) and ascending thoracic aorta Agatston Score ≥116.4 AU (OR 2.21; 95% CI 1.17–4.17; p=0.015). ROC analysis showed that our risk model had an AUC of 0.73 (95% CI 0.66–0.80; p&lt;0.001), a sensitivity of 70.6%, a specificity of 69.0%, a positive predictive value of 19.5% and a high negative predictive value of 95.7%. Our risk model appeared to be the best for stroke prediction after TAVI compared to other risk scores used in literature before like EuroSCORE II (AUC 0.50; 95% CI 0.43–0.58; p=0.950) or CHA2DS2-VASc Score (AUC 0.62; 95% CI 0.55–0.70; p=0.004).

Conclusion

Especially aortic root calcium volume assessed by MSCT predicts CVE after TAVI and could be integrated into a six items risk model for preprocedural prediction of stroke after TAVI. This model could guide us in identifying those patients who are most likely to benefit from transcatheter cerebral embolic protection devices.

Funding Acknowledgement

Type of funding source: None

Use and success evaluation of percutaneous aortic balloon valvuloplasty in different hemodynamic entities of severe aortic stenosis in the TAVR era

Background

In the era of transcatheter aortic valve replacement (TAVR), there is renewed interest in percutaneous balloon aortic valvuloplasty (BAV), which may qualify as the primary treatment option of choice in special clinical situations. Success of BAV is commonly defined as a significant mean pressure gradient reduction after the procedure.

Purpose

To evaluate the correlation of the mean pressure gradient reduction and increase in the aortic valve area (AVA) in different flow and gradient patterns of severe aortic stenosis (AS).

Methods

Consecutive patients from 01/2010 to 03/2018 undergoing BAV were divided into normal-flow high-gradient (NFHG), low-flow low-gradient (LFLG) and paradoxical low-flow low-gradient (pLFLG) AS. Baseline characteristics, hemodynamic and clinical information were collected and compared. Additionally, the clinical pathway of patients (BAV as a stand-alone procedure or BAV as a bridge to aortic valve replacement) was followed-up.

Results

One-hundred-fifty-six patients were grouped into NFHG (n=68, 43.5%), LFLG (n=68, 43.5%) and pLFLG (n=20, 12.8%) AS. Underlying reasons for BAV and not TAVR/SAVR as the primary treatment option are displayed in Figure 1. Spearman correlation revealed that the mean pressure gradient reduction had a moderate correlation with the increase in the AVA in patients with NFHG AS (r: 0.529, p&lt;0.001) but showed no association in patients with LFLG (r: 0.145, p=0.239) and pLFLG (r: 0.030, p=0.889) AS. Underlying reasons for patients to undergo BAV and not TAVR/SAVR varied between groups, however cardiogenic shock or refractory heart failure (overall 46.8%) were the most common ones. After the procedure, independent of the hemodynamic AS entity, patients showed a functional improvement, represented by substantially lower NYHA class levels (p&lt;0.001), lower NT-pro BNP levels (p=0.003) and a numerical but non-significant improvement in other echocardiographic parameters like the left ventricular ejection fraction (p=0.163) and tricuspid annular plane systolic excursion (TAPSE, p=0.066). An unplanned cardiac re-admission due to heart failure was necessary in 23.7% patients. Less than half of the patients (44.2%) received BAV as a bridge to TAVR/SAVR (median time to bridge 64 days). Survival was significantly increased in patients having BAV as a staged procedure (log-rank p&lt;0.001).

Conclusion

In daily clinical practice, the mean pressure gradient reduction might be an adequate surrogate of BAV success in patients with NFHG AS but is not suitable for patients with other hemodynamic entities of AS. In those patients, TTE should be directly performed in the catheter laboratory to correctly assess the increase of the AVA. BAV as a staged procedure in selected clinical scenarios increases survival and is a considerable option in all flow states of severe AS. (NCT04053192)

Figure 1

Funding Acknowledgement

Type of funding source: None

Performance of the Corevalve Evolut R and PRO in severely calcified anatomies: a propensity-score matched analysis

Background

The Corevalve Evolut R and PRO belong to the newer generation of self-expandable valves and are increasingly used to treat patients with severe aortic stenosis. Over the years, technical advancements and increasing experience with the procedure itself are responsible for excellent clinical and hemodynamic results. Patients with severely calcified native aortic valve anatomies still pose a special task to the implanting team since the risk for intraprocedural complications might be increased.

Purpose

To evaluate the hemodynamic and clinical performance of the CoreValve Evolut R and PRO in patients with severely calcified native aortic valve anatomies.

Methods

Baseline characteristics, imaging data and procedural outcome of patients undergoing transfemoral transcatheter aortic valve implantation with the CoreValve Evolut R and PRO from 09/2015 to 03/2018 were prospectively collected. Patients underwent high-resolution multisclice computed tomography (MSCT). A pre-specific threshold of 600 Hounsfield units was set to account for the hyperdensity of the applied contrast medium and to enable comparability with MSCT thresholds, derived by non-contrast enhanced MSCT scans. Patients were divided by the extent of calcification into a severely calcified anatomy group (men &gt;2062AU, woman &gt;1377AU) or a not severely calcified anatomy group (men &lt;2062AU, woman &lt;1377AU). Propensity score matching with the variables log EuroSCORE, LVOT calcium load and the cover index in a 1:2 fashion was performed and clinical and hemodynamic results in accordance with VARC II were collected.

Results

Ninety-eight patients with severely calcified anatomies (SC) could be identified and were matched with 196 patients with lower calcified (LC) anatomies. Patients with severely calcified anatomies were older (SC: 83.1 years vs. LC: 80.3 years, p&lt;0.001) and had a smaller aortic valve area (SC: 0.63cm2 vs. LC: 0.70cm2, p=0.028). The mean implantation depth did not differ (SC 5.4mm±2.4 vs. LC: 5.1±2.2, p=0.554). Pre-dilatation was more often performed in the SC group (SC: 30.6% vs. LC: 15.8%, p=0.003) and the stroke/TIA rate did not differ (SC: 5.1% vs. LC: 3.5%, p=0.532). In SC patients, a permanent pacemaker implantation was significantly more often needed (SC: 28.5% vs. LC:7.6%, p&lt;0.001). The mean pressure gradient after the procedure was effectively reduced (SC: 7.1mmHg±3.9 vs. LC: 7.8±3.7mmHg, p=0.477). No aortic regurgitation (AR) was more often present in patients with SC anatomies (SC: 72.5% vs. LC: 85.2%, p=0.011). The aortic regurgitation index numerically differed between groups without reaching statistical significance (SC: 24.1±7.1 vs. LC: 27.3±6.7, p=0.067).

Conclusion

The CoreValve Evolut R and PRO show a good clinical safety profile and excellent hemodynamic results even in patients with severely calcified anatomies. In those patients, a permanent pacemaker implantation was more often necessary.

Funding Acknowledgement

Type of funding source: None

Theoretical and numerical investigation of Carreau-Yasuda fluid flow subject to Soret and Dufour effects

BACKGROUND

Newtonian fluids can be categorized by a single coefficient of viscosity for specific temperature. This viscosity will change with temperature; it doesn't change with strain rate. Just a small group of liquids show such steady consistency. A fluid whose viscosity changes subject to relative flow velocity is called non-Newtonian liquids. Here we have summarized a result for the flow of Carreau-Yasuda fluid over a porous stretchable surface. Mixed convection is considered. Modeling of energy expression is performed subject to Soret and Dufour effects.

METHOD

The nonlinear PDE's are changed to ODE's through suitable transformations and then solved for numerical solutions via Built-in shooting method (bvp4c).

RESULTS

Variation of important variables is studied on the concentration, temperature and velocity fields. Tabular representation for study of skin friction and heat transfer rate is presented for important variables. Our results show that velocity decreases versus higher estimations of Weissenberg number, porosity parameter, buoyancy ratio and mixed convection parameter. Temperature decays via Weissenberg number and porosity parameter. Increase in concentration is noticed through higher Soret number and porosity parameter. Skin friction and heat transfer rate (Nusselt number) boosts versus larger porosity parameter and Prandtl number respectively while it decays against Weissenberg number and Dufour and Eckert number.

P3742Transcatheter aortic valve implantation in large annuli: incidence and predictors of specific adverse events with the largest self-expanding device

Background

The recently released largest self-expanding transcatheter aortic valve device (STHV-34) is characterized by good results but nevertheless demands an experienced team for the implantation in large annuli.

Purpose

Looking at multi slice computed tomography (MSCT) and procedural data, we tried to identify characteristics that could explain intraprocedural VARC-2 and valve specific non-VARC-2 events.

Methods

We performed a single center retrospective analysis in 80 patients treated with STHV-34. STHV-34 patients were separated into subjects without events (NE, n=43, 54%) and the following adverse events: resheathing/-capture processes (RS/C, n=19, 24%), valve dislodgments (VD, n=21; 26%), infolding (IF, n=6, 8%) and complete dislocation with bail-out valve-in-valve implantation (ViV, n=3, 4%). Events were further categorized in non-VARC-2 and VARC-2. The analysis sought for underlying anatomical conditions and defined risk factors by multivariate analysis.

Results

Primary device success was reached in 96% and immediate postprocedural absence of moderate-to-severe aortic regurgitation was 100%. We identified specific anatomical conditions predisposing for non-VARC-2 and VARC-2 events: RS/C: annular calcium load<1600 AU (OR 47 [CI 1.4–216], p=0.0004). IF: peripheral kinking (RR 5.0 [CI 1.0–24], p=0.0478) and previous RS/C maneuvers (83%). ViV: annular ellipticity index (NS 1.2±0.1 vs. ViV 1.4±0.1, p=0.0049), aortic angulation (AA) angle (NS 54.0±7.0° vs. ViV 61.7±1.5°, p=0.0240) and LVOT-AO angle (NS 149.1±18.9° vs. ViV 130.3±3.5°, p=0.0470).

Conclusion

We confirm high procedural success for the largest currently available STHV-34. The incidence of intraprocedural non-VARC-2 and VARC-2 events are associated with anatomical characteristics that may influence valve selection and implantation strategy.

P5583Micro-movement during transcatheter aortic valve implantation with a contemporary self-expandable prosthesis

Background

Precise positioning of the prosthesis is a crucial step during transcatheter aortic valve implantation. In some cases, contemporary self-expandable prostheses show micro-movement (MM) during the final phase of release.

Purpose

We aimed to establish a definition for MM, evaluated the incidence of MM using the CoreValve Evolut RTM, investigated potential risk factors for MM and the associated clinical outcomes.

Methods

MM was defined as movement of the prosthesis of at least 1.5 mm from its position directly before release compared to its final position. Patients were grouped according to the occurrence (+MM) or absence (-MM) of MM. Baseline characteristics, imaging data and outcome parameters in accordance with the updated valve academic research consortium (VARC-2) criteria were retrospectively analyzed.

Results

We identified 258 eligible patients. MM occurred in 31.8% (n=82) of cases with a mean magnitude of 2.8±2.2 mm in relation to the left coronary cusp and 3.0±2.1 mm to the non-coronary cusp. Clinical and hemodynamic outcomes were similar in both groups. The mean pressure gradient was effectively reduced after TAVI (-MM vs. +MM: 7±3.4 mmHg vs. 8±3.9 mmHg, p=0.326) with consistency over a follow-up period of at least three months (-MM vs. +MM: 6.7±3.7 mmHg vs. 7.9±8.4 mmHg, p=0.168). At three months follow-up most of the patients presented with no aortic regurgitation (-MM vs. +MM: 64% vs. 67.9%, p=0.569). Mild aortic regurgitation was observed in 34.2% of the -MM group and in 29.5% of the +MD group (p=0.414). Moderate aortic regurgitation occurred in 1.9% of all patients with no differences between groups (-MM vs. +MM: 1.9% vs. 2.6%, p=0.662). Patients with MM presented with a more symmetric calcification pattern (-MM vs. +MM: 27.3% vs. 40.2%; p=0.037) and a larger aortic valve area (-MM vs. +MM: 0.6 cm2 ± 0.3 vs. 0.7 cm2 ± 0.2; p=0.014), which was found to be a potential risk factor for the occurrence of MM in a multivariate regression analysis (OR 3.5; 95% CI: 1.1–10.9; p=0.032)

Conclusion

MM occurred in nearly one third of patients and did not affect clinical and hemodynamic outcome. A larger aortic valve area was the only independent risk factor for the occurrence of MM.

P2467Fusion imaging (Anatomical Intelligence) enables automated left atrial appendage sizing in real-time a single center pilot study

Background and purpose

Percutaneous left atrial appendage occlusion (LAAO) depicts an alternative treatment for patients with atrial fibrillation who are deemed for long-term oral anticoagulation therapy. In order to perform a successful LAAO accurate sizing of left atrial appendage (ostium, landing zone and depth) for device selection is essential. Echo-Fluoro fusion imaging in real-time offers with its latest prototype a patient-specific segmented automated 3D heart model and sizing of left atrial appendage (LAA). We therefore aimed to evaluate the automated segmented LAA sizing by comparing to 2D transesophageal (TOE) and MSCT measurements as gold standard.

Methods

We studied prospectively data of 8 consecutive patients who were admitted to our clinic for left atrial appendage closure. MSCT was performed preprocedural and analyzed with commercially available 3mensio software (Pie medical imaging). 2D TOE measurements and automated segmentation of the LAA and sizing were performed during the procedure by a highly experienced team of periinterventional cardiac imaging specialist and structural heart disease interventionalist who were blinded to the prior MSCT analysis. Dimension of ostium, landing zone (10 mm into the LAA parallel to the ostial plane at the level of the left circumflex for Amplatzer device) and depth (perpendicular to the ostial plane) were obtained in different TOE views according to instructions for use of Amulet Occluder. In order to generate an automated 3 D heart model, a high-quality 3D TOE image of the LAA volume and surrounding structures was acquired. After successful ECG-gated segmentation a 3 D heart model was generated. Automated LAA sizing followed in real-time. All measurements were taken into consideration before device selection. A Kruskal Wallis test was used to compare mean ranks of independent samples. A concordance analysis according to Kendall W was carried out to investigate reliability.

Results

The mean age of the patients was 82,6±4.15 years and half of the patients were female. All procedures were conducted successfully. The mean values of ostium and landing zone were comparable in TOE, automated sizing and MSCT sizing (ostium: 23,78±2,15 mm vs 25,71±5,25 mm vs 27,35±3,3 mm; (p=0,175); landing zone 22,13±3,18 mm vs 23,57±3,31 mm vs 24,00±3,51 mm; (p=0,377)). Furthermore, a significant concordance between the measurements was shown (ostium W= 0,991; p=0.045, landing zone W=0,835, p=0.014).

Conclusion

Automated LAA sizing acquired by fusion imaging may be an elegant real-time alternative for precise LAA Occluder device selection and needs to be investigated further.

P2274Single-center experience with different regimes of antiplatelet therapy and oral anticoagulation in transcatheter aortic valve replacement

Background

Antithrombotic therapy in transcatheter aortic valve replacement (TAVR) is highly controversial. Dual antiplatelet therapy (DAPT) for 3–6 months with aspirin and clopidogrel is the current recommendation. Whereas in patients with indication for OAC several regimes were described, ranging from OAC monotherapy to dual and even triple therapy. Besides vitamin K antagonists (VKA), non-Vitamin K oral anticoagulants (NOAC) are frequently used in TAVR patients with indication for permanent OAC.

Purpose

We therefore aimed to evaluated different antithrombotic regimes and their impact on outcome.

Methods

We performed a single center retrospective analysis in 1160 patients treated by transfemoral approach (TF TAVR). Primary endpoints were 30-day mortality, stroke and bleeding according to VARC-2 criteria. Secondary endpoint was all-cause mortality at 1 year.

Results

In 1160 patients with TF TAVR, a broad range of regimes occurred in clinical practice. The majority of patients were on DAPT (637 patients, 55.0%), followed by VKA + clopidogrel (186 patients, 16%). Other patients received OAC mono (98 patients; 9%), triple therapy (93 patients; 8%), NOAC mono (31 patients; 3%), single antiplatelet therapy (SAPT, 40 patients; 4%) or NOAC + clopidogrel (31 patients, 3%).

All-cause mortality 30 days after TF TAVR differed between the regimens. (SAPT/OAC+SAPT/N-OAC+DAPT 0.0% vs DAPT 3.6% vs OAC 10.2% vs. NOAC 1.3% vs NOAC+SAPT 0.3%; pANOVA<0.0001). Severe bleeding events were comparable (SAPT 5.0% vs DAPT 2.4% vs OAC 7.1% vs NOAC 1.3% vs OAC+SAPT 3.2% vs NOAC+SAPT 0.0% vs. N-OAC+SDPT 4.3%; pANOVA=0.15). Stroke rates were comparable in all subcohorts as well (SAPT 5.0% vs DAPT 3.0% vs OAC 7.1% vs NOAC 2.7% vs OAC+SAPT 1.6% vs NOAC+SAPT 0.0% vs. N-OAC+DAPT 1.1%; pANOVA=0.13). Only 2 hemorrhagic strokes (5.6%) appeared under DAPT and OAC mono respectively, whereas all others were of thromboembolic origin (94.4%). Surprisingly, all-cause mortality at one-year after TF TAVR was higher in OAC patients compared to all other used regimes (logrankoverallp=0.0012).

Conclusion

Data from our retrospective analysis indicate that a variety of different antithrombotic regimes occur even in a single centre analysis. All-cause mortality was enhanced in patients with oral anticoagulation. Therefore, clinical trials need to investigate if this is only explained by additional atrial fibrillation.

P1857Risk calculator for prediction of iatrogenic atrial septal defect persistence following percutaneous mitral valve repair

Background

The rising number of new percutaneous interventions for left-sided heart disease leads to increased occurrence of iatrogenic atrial septal defect (iASD). The percutaneous mitral valve repair (PMVR) for severe, symptomatic mitral regurgitation (MR) also requires intraprocedural puncture of the interatrial septum. In some cases iASD is persisting and becomes haemodynamically relevant with enhanced right heart overload due to significant left-to-right-shunting.

Purpose

This study aimed to evaluate pre- and periprocedural factors that may favour persistence and haemodynamic relevance of iASD in patients after PMVR.

Methods

In 2015, 75 consecutive patients with severe MR (age 74.8±10.5y) and following PMVR were enrolled. After 12 months, 57 patients completed their follow up (FU) including clinical conditions, transthoracic echocardiography (TTE), and cardiovascular magnetic resonance (CMR) whenever feasible. We evaluated the impact of comorbidities as well as intraprocedural, haemodynamic and functional characteristics that may favour persistence of iASD by multivariate analysis. Haemodynamic relevance of iASD was defined as right heart overload with predominantly significant enlargement of the right atrium (RA), impairment of right heart function as defined by fractional area shortening (FAC), and ratio of pulmonary to systemic blood flow (Qp/Qs>1) when available.

Results

18 out of 57 patients (32%) showed a persistent iASD (+iASD), being associated with a specific combination of comorbidities as well as pre-procedural and periprocedural factors that can be summarised by a multifactorial iASD risk calculator (+iASD vs. -iASD: 6.3±2.9 vs. 3.9±2.7; p=0.0058). 11 iASD (61%) became haemodynamically relevant (+hd iASD) with a significant right heart overload (RA area +hd iASD vs. -hd iASD: baseline 23.1±4.1 vs. 23.2±4.3; FU 30.7±6.3 vs. 20.1±4.6; p<0.0001), reduced RV function (FAC +hd iASD vs. -hd iASD: baseline 41.0±10.3 vs. 29.9±7.2; FU 25.3±7.2 vs. 29.1±13.2; p<0.0156) and left-to-right shunting (Qp/Qs -iASD vs. +hd iASD vs. -hd iASD: 1.0±0.3 vs. 1.7±0.4 vs. 0.8±0.1 L/min; p=0.0011).

Conclusion

This study shows for the first time, that persistence of iASD can be predicted by pre- and periprocedural factors using a risk calculator that may additionally guide careful follow up imaging and therapeutic action after PMVR to avoid development of progressive heart failure.

High performance liquid chromatographic method validation for determination of rosuvastatin calcium in tablet dosage forms

A precise, sensitive and quick High Performance Liquid Chromatographic (HPLC) method for the determination of rosuvastatin calcium in bulk and tablet dosage forms has been validated. The chromatographic scheme involved: Sil-20A auto sampler, LC-20A pump, SPD-20A UV/visible detector with separation attained by C₁₈ column at 40ºC temperature through a mobile phase of acetonitrile and buffer (50:50) at a flow rate of 1.0ml/min. The method is precise (%RSD for intra-day and inter-day extended between 1.06-1.54% and 0.103-1.78%) and linear (r²=0.9997). Limit of detection and quantification (LOD & LOQ) of the adopted method were 0.78 and 1.56μg/ml. The proposed HPLC method was established to be sensitive, precise and swift that can be proficiently adopted in quality control/quality assurance laboratories for predictable investigation of the bulk and oral solid dosage forms of rosuvastatin calcium.

Association between the antioxidant uric acid and depression and antidepressant medication use in 96 989 individuals

OBJECTIVE

In the last decade, several studies have suggested that depression is accompanied by increased oxidative stress and decreased antioxidant defenses. We tested the hypothesis that high levels of the antioxidant uric acid are associated with lower risk of hospitalization with depression and use of prescription antidepressant medication.

METHOD

We examined plasma levels of the antioxidant uric acid in 96 989 individuals from two independent cohort studies. Logistic regression and Cox proportional hazards regression models were multivariable adjusted for age, gender, alcohol, smoking, income, body mass index, C-reactive protein, hemoglobin, triglycerides, cardiovascular disease, diabetes, and intake of meat and vegetables. Results were performed separately in each study and combined in a meta-analysis.

RESULTS

In both studies, high uric acid was associated with lower risk of hospitalization as in-patient or out-patient with depression and antidepressant medication use. A doubling in uric acid was associated with an effect estimate of 0.57 (95% CI 0.49-0.65) and 0.77 (0.73-0.81) for hospitalization with depression and antidepressant medication use. The association was consistent across strata of all covariates. Results were attenuated in Cox regression analyses with less statistical power.

CONCLUSION

High plasma levels of uric acid were associated with low risk of depression hospitalization and antidepressant medication use.

Safety and efficacy of transseptal puncture guided by real-time fusion of echocardiography and fluoroscopy

Aims

Visual guidance through echocardiography and fluoroscopy is crucial for a successful transseptal puncture (TSP) in a prespecified region of the fossa ovalis. The novel EchoNavigator system Release II (EchoNav II, Philips Healthcare, Andover, Massachusetts, USA) enables the real-time fusion of fluoroscopic and echocardiographic images. We evaluated this new imaging method in respect to safety and efficacy of TSP during MitraClip implantation and left atrial appendage closure.

Methods

Forty-four patients before (−EchoNav) and 44 patients after (+EchoNav) the introduction of real-time fusion were included in our retrospective, single-centre study. The primary endpoint was the occurrence of adverse events due to TSP. Secondary endpoints were successful puncture at the prespecified region and time until TSP (min).

Results

In both groups TSP was performed successfully in the prespecified region and no adverse events occurred during or due to the accomplishment of TSP. Time until TSP was significantly reduced in the +EchoNav group in comparison with the EchoNav group (18.48 ± 5.62 min vs. 23.20 ± 9.61 min, p = 0.006).

Conclusions

Real-time fusion of echocardiography and fluoroscopy proved to be as safe and successful as standard best practice for TSP. Moreover, efficacy was improved through significant reduction of time until TSP.