Efficacy of pentamidine-loaded chitosan nanoparticles as a novel drug delivery system for Leishmania tropica

The present study compares the in vitro effects of nanoparticles loaded pentamidine drug and conventional pentamidine on Leishmania tropica. Herein, pentamidine-loaded chitosan nanoparticles (PTN-CNPs) have been synthesized through an ionic gelation method with sodium tripolyphosphate (TPP). Next, the physical characteristics of PTN-CNPs were determined through the surface texture, zeta potential, in vitro drug release, drug loading content (DLC), and encapsulation efficacy (EE) and compared its efficacy with free pentamidine (PTN) drug against promastigotes and axenic amastigotes forms of L. tropica in vitro. The PTN-CNPs displayed a spherical shape having a size of 88 nm, an almost negative surface charge (-3.09 mV), EE for PTN entrapment of 86%, and in vitro drug release of 92% after 36 h. In vitro antileishmanial activity of PTN-CNPs and free PTN was performed against Leishmania tropica KWH23 promastigote and axenic amastigote using 3-(4, 5- dimethylthiazol-2-yl)-2, 5-diphenyletetrazolium bromide (MTT) assay. It was observed that the effect of PTN-CNPs and free PTN on both forms of the parasite was dose and time dependent. Free PTN presented low efficacy even at higher dose (40 µg/ml) with 25.6 ± 1.3 and 26.5 ±1.4 mean viability rate of the promastigotes and axenic amastigotes, respectively after 72 hrs incubation. While PTN-CNPs showed strong antileishmanial effects on both forms of parasite with 16 ± 0.4 and 19 ± 0.7 mean viability rate at the same higher concentration (40 µg/ml) after 72 hrs incubation. Half maximal inhibitory concentration (IC50) values of PTN-CNPs toward promastigotes and amastigotes were obtained as 0.1375 µg/ml and 0.1910 µg/ml, respectively. In conclusion, PTN-CNPs effectively inhibited both forms of the L. tropica; however, its effect was more salient on promastigotes. This data indicates that the PTN-CNPs act as a target drug delivery system. However, further research is needed to support its efficacy in animal and human CL.

A step towards routine for stereotactic radioablation in refractory ventricular tachycardia – interim analysis on short term safety of the first prospective, multi-centre, multi-platform study RAVENTA

Background

Ventricular tachycardia (VT) is a potentially life-threatening heart rhythm disorder originating in heterogeneous conduction velocity in the ventricular myocardium, e.g. by scar formation in ischaemic or dilated cardiomyopathy. Current guideline-directed medical therapy comprises implantable cardioverter defibrillator (ICD), antiarrhythmic drugs, and endocardial/epicardial catheter ablation. There is a serious recurrence rate for example due to diffuse fibrosis, progress of disease, or insufficient ablation depth or volume.

In cases when Catheter ablation and antiarrhythmic medication failed to reduce VT burden, stereotactic body radiation therapy (SBRT) may become an additional treatment option. To date there have been several small retrospective case series and some single-centre prospective studies showing promising results.

Purpose

For the purpose of obtaining the authorization of a randomized trial, a feasibility study was designed. The primary objective is to demonstrate sufficient safety of cardiac SBRT for the non-invasive treatment of VT and whether the dose needed can be delivered while sparing sensitive surrounding structures (e.g. stomach, oesophagus, vena cava, coronary arteries, ICD). Secondarily, the effect on VT burden is reported.

Methods

The RAVENTA study (RAdiosurgery for VENtricular TAchycardias) is the first prospective, multicentre study on SBRT in patients suffering from refractory VTs worldwide. Patients were enrolled according to strict inclusion criteria. First, an electrophysiology study using a high definition mapping system was performed to identify the substrate (target region). In order to plan SBRT a planning computed tomography scan was obtained. Finally, a single dose of 25 Gy was administered to the target region. Neither sedation nor anaesthesia is necessary during SBRT.

Primary endpoint is feasibility defined as complete dose application and absence of severe (grade ≥3) treatment-related toxicity within 30 days of treatment. RAVENTA is powered to reject the hypothesis of 70% feasibility, if in fact feasibility is 95%. This is a pre-defined interim analysis with the aim of stopping early for futility.

Results

Between October 2019 and December 2021, the first 5 patients (characteristics shown in Table 1) could be enrolled and radiotherapy was delivered without major complications. Cardiac SBRT took on average 30 minutes. There was no treatment-related severe toxicity. Furthermore, we could not record any negative effect on functionality of the ICD: constant sensing amplitude and pacing capture threshold. In the short-term, patients showed a clear decrease in VT burden.

Conclusion

These preliminary data of the first multi-centre, multi-platform study on cardiac SBRT on refractory VT demonstrated sufficient short-term feasibility to continue the RAVENTA study. Meanwhile the study has been expanded to 6 centres in Germany.

Funding Acknowledgement

Type of funding sources: None.

Anthracycline chemotherapy and its effects on left ventricular mechanics: insights into the PROACT PLUS study

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): South Tees Research and Development Fund

Background

Anthracyclines continue to form the backbone of chemotherapy treatment for breast cancer and lymphoma. However, their use has been directly associated with dose-dependent cardiotoxicity. Most studies to date have focused on the effects of high dose anthracyclines on left ventricular (LV) systolic function with a particular interest in peak global longitudinal strain (GLS). Not much attention has been directed to the effects of lower dose anthracyclines and other strain parameters of LV systolic and diastolic function.

Purpose

In this prospective study, we performed a comprehensive 2-dimensional echocardiographic assessment on the effects of anthracyclines on both the LV systolic and diastolic strain measures. We focused on the changes in the LV end-systolic (ES) GLS, myocardial GLS (myoGLS), global radial strain (GRS), global circumferential strain (GCS), myocardial GCS (myoGCS), twist and torsion. Additionally, peak systolic (PS), ES, early-diastolic (ED), and late-diastolic (LD) strain-rates were measured.

Methods

Patients with a new diagnosis of breast cancer or lymphoma undergoing anthracycline chemotherapy (any dose) were recruited between October 2018 to March 2020. Echocardiograms were performed pre-chemotherapy (V1) and 1 month post treatment (V2). These were analysed offline using vendor-independent software (TomTec 2D CPA). The study was ethically approved by the Health Research Association (REC reference 18/EM/0177).

Results

A total number of 62 were recruited into the study of which 7 patients passed away during treatment and 5 failed to attend their follow-up appointment at V2. Of the remaining patients, 6 dropped their LV ejection fraction (EF) to < 53% at V2 (G1). In these patients, a significant reduction in the LV ES-GLS (-19.3% vs. -15.3%, p = 0.0041), myoGLS (-16.8% vs. -12.8%, p = 0.0014), LV longitudinal PS strain-rate (-1 1/s vs. 0.78 1/s, p = 0.0063), and LV longitudinal ED strain-rate (1.1 1/s vs. 0.67 1/s, p = 0.026) was seen from V1 to V2. There was no statistically significant change in the other systolic and diastolic strain parameters in this group of patients. In patients with a normal EF at V2 (G2), a reduction in the LV ES-GLS (-20.8% vs. -19.9%, p = 0.013) and myoGLS (-17.9% vs. -16.9%, p = 0.012) was also seen from V1 to V2. Additionally, a deterioration in the LV radial ED strain-rate (-1.37 1/s vs. -1.2 1/s, p = 0.009), LV longitudinal ED strain-rate (0.98 1/s vs. 0.85 1/s, p = 0.01), and LV circumferential ED strain rate (1.62 1/s vs. 1.33 1/s, p = 0.045) was observed.

Conclusion

In G1, a more extensive deterioration (>15%) in the LV ES-GLS, myoGLS, and longitudinal ED strain-rate was evident when compared to G2. The additional reduction in LV early diastolic strain-rate in both patient groups highlights the global insult that anthracyclines can pose on both LV systolic and diastolic function. However, whether these findings translate into future development of cardiotoxicity is not yet known.

Right ventricular mechanics in anthracycline chemotherapy: insights into the PROACT PLUS study

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): South Tees Research and Development Fund

Background

Anthracyclines are highly effective chemotherapy agents used in the treatment of many breast and haematological malignancies. However, one of the well-recognised associated risks with their use includes cardiotoxicity which can lead to heart failure and poor prognosis. Most studies have focused on the effects of these agents on the left ventricular systolic function. Right ventricular (RV) mechanics in anthracycline chemotherapy have so far been neglected.

Purpose

The PROACT PLUS study is an observational, prospective, cohort study which assesses the effects of anthracyclines on the RV systolic and diastolic measures using 2 dimensional conventional echocardiography and speckle tracking imaging (STE).

Methods

From October 2018 to March 2020, patients with a new diagnosis of lymphoma or breast cancer undergoing anthracycline chemotherapy were recruited into the PROACT PLUS study. Echocardiography was performed pre-chemotherapy (V1) and 1 month post chemotherapy (V2). Using vendor-independent software (TomTec Imaging Systems, 2D Cardiac Performance Analysis, Unterschleisshiem, Germany), offline analysis of tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (FAC), tricuspid annular systolic velocity (S’), RV global longitudinal strain (RV GLS), RV myocardial longitudinal strain (RV myoGLS), RV free wall strain (RV FWS), RV- and RV free wall peak systolic (PS) strain-rates, end-systolic (ES) strain-rates, early-diastolic (ED) strain-rates and late-diastolic (LD) strain-rates were measured. This study was ethically approved by the Health Research Association (REC reference 18/EM/0177).

Results

62 patients were recruited into this study. Of these, 7 passed away during treatment and 5 failed to attend their follow-up appointment at V2. Of the remaining patients, a significant deterioration in the RV GLS (-25.4% vs. -22.5%, p < 0.0001), RV myoGLS (-22.4% vs. -20.9%, p = 0.005), RV ED strain-rate (1.08 1/s vs. 0.9 1/s, p = 0.01) and RV free wall ED strain-rate (1.24 1/s vs. 1.07 1/s, p = 0.02) was seen between V1 and V2. No statistical significant change was observed in the conventional and other strain measures of RV function. A total number of 6 patients developed left ventricular systolic dysfunction at V2 with ≥ 10% drop in the LV ejection fraction (LVEF) to < 53%. In this group of patients, there was a statistical significant reduction in the RV FWS (-25.5% vs. -22.7%, p = 0.03) which was not evident in the group of patients with preserved LVEF.

Conclusion

These findings suggest that adverse effects of anthracyclines are not purely confined to the LV, and RV systolic and diastolic changes are evident during treatment with anthracyclines, emphasising the global effect of these agents. A comprehensive RV assessment needs to be taken into consideration during the assessment of cardiotoxicity in patients undergoing chemotherapy treatment.

Atrial mechanics in anthracycline chemotherapy: insights into a prospective study

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): South Tees Research and Development Fund

Background

In cancer treatment, detection of anthracycline induced cardiotoxicity (AIC) has been dependent on serial cardiac imaging to identify a reduction in left ventricular ejection fraction (LVEF) and more recently LV global longitudinal strain (GLS). However, studies have failed to assess the adverse effects of these agents on other cardiac chambers such as the left (LA) and right atria (RA).

Purpose

The PROACT PLUS study is an observational, prospective, cohort study investigating the effects of anthracyclines on the left and right atrial mechanics using 2 dimensional speckle tracking echocardiography (STE). We hypothesize that anthracyclines can affect the heart as a whole rather than solely affecting the LV.

Methods

From October 2018 to March 2020, patients with a new diagnosis of lymphoma or breast cancer receiving anthracycline chemotherapy were recruited into this study. Echocardiography was performed pre-chemotherapy (V1) and 1 month post-chemotherapy (V2). LA and RA volumes, LA (4-chamber)- and RA GLS, reservoir strains (RS), conduit strains (CS), contractile strains (CoS), peak-systolic (PS) strain-rates, early-diastolic (ED) strain-rates, and late-diastolic (LD) strain-rates were measured offline using vendor-independent software. This study was ethically approved by the Health Research Association (REC reference 18/EM/0177).

Results

A total number of 62 patients were recruited into this study. Unfortunately, 7 patients passed away during their treatment and 5 failed to attend their follow-up appointment at V2. From V1 to V2, there was a significant deterioration in the LA CS (-18.1% vs. -14.5%, p = 0.02) and LA ED strain-rate (-1.24 1/s vs. -0.86 1/s, p = 0.001). There was no other statistical significant change in the LA volume or other strain parameters. Additionally, there was a statistically significant decline in RA GLS (34.9% vs. 30.8%, p = 0.029), RA RS (41.1% vs. 37.1%, p = 0.03), RA CS (-23.8 vs. -20.6, p = 0.05), and RA ED strain-rate (-1.17 vs. -0.99, p = 0.02) with no significant change in the RA volume and other measures of RA strain.

Conclusion

These findings support our hypothesis that anthracyclines exert their cardiotoxic effects on all cardiac chambers including the atria. Whether these changes lead to subsequent permanent structural abnormalities in the atria hence increasing the future risk of atrial arrhythmias, or whether these changes predate subsequent cardiac dysfunction and poor prognosis, remains unknown. Long-term follow up and assessment of atrial mechanics is crucial in better understanding of AIC to help guide the future monitoring and management of patients undergoing cancer treatment.

Measurement of Prompt D^{0}, Λ_{c}^{+}, and Σ_{c}^{0,++}(2455) Production in Proton-Proton Collisions at sqrt[s]=13 TeV

The p_{T}-differential production cross sections of prompt D^{0}, Λ_{c}^{+}, and Σ_{c}^{0,++}(2455) charmed hadrons are measured at midrapidity (|y|<0.5) in pp collisions at sqrt[s]=13  TeV. This is the first measurement of Σ_{c}^{0,++} production in hadronic collisions. Assuming the same production yield for the three Σ_{c}^{0,+,++} isospin states, the baryon-to-meson cross section ratios Σ_{c}^{0,+,++}/D^{0} and Λ_{c}^{+}/D^{0} are calculated in the transverse momentum (p_{T}) intervals 2<p_{T}<12 and 1<p_{T}<24  GeV/c. Values significantly larger than in e^{+}e^{-} collisions are observed, indicating for the first time that baryon enhancement in hadronic collisions also extends to the Σ_{c}. The feed-down contribution to Λ_{c}^{+} production from Σ_{c}^{0,+,++} is also reported and is found to be larger than in e^{+}e^{-} collisions. The data are compared with predictions from event generators and other phenomenological models, providing a sensitive test of the different charm-hadronization mechanisms implemented in the models.

Effects of Pasturella Multocida B:2 and its immunogens (LPS and OMP) on reproductive hormones in Nili-Ravi Buffaloes

Abstract Livestock is a fundamental part of the agriculture industry in Pakistan and contributes more than 11.53% to GDP. Among livestock species, the buffaloes are regarded as the black gold of Pakistan. Being the highest milk producers globally, Nili-Ravi buffaloes are the most famous ones. Buffaloes are affected by many endemic diseases, and "Hemorrhagic septicemia" (HS) is one of them. This study was designed to ascertain the effects of experimental exposure ofP. multocida B:2 (oral) and its immunogens, i.e., LPS (oral and intravenous) and OMP (oral and subcutaneous) on reproductive hormonal profiles in Nili-Ravi buffaloes. Repeated serum samples were collected from the jugular vein of experimental animals for 21 days (0, 02, 04, 08, 12, 16, 20, 24, 36, 48, 72, 120, 168, 216, 264, 360, 456 and 504 hours). Hormonal assays to determine the serum concentrations of Gonadotropin-releasing hormone (GnRH), Follicle-stimulating hormone (FSH), Luteinizing hormone (LH), Estrogen (E2) and progesterone (P4) were performed using (MyBioSource) commercial Elisa kits. The hormonal profile of all treatment groups of the buffalo heifers exhibited significant (P<0.05) variations as compared to the control group (G-1). These results indicate suppression in Nili-Ravi buffaloes' reproductive hormonal profile on exposure to P. multocida B:2 and its immunogens. This influence warrants that exposure to H.S may be a possible reason for delayed puberty and poor reproduction performance in Nili-Ravi buffaloes.

Measurement of the Cross Sections of Ξ_{c}^{0} and Ξ_{c}^{+} Baryons and of the Branching-Fraction Ratio BR(Ξ_{c}^{0}→Ξ^{-}e^{+}ν_{e})/BR(Ξ_{c}^{0}→Ξ^{-}π^{+}) in pp Collisions at sqrt[s]=13 TeV

The p_{T}-differential cross sections of prompt charm-strange baryons Ξ_{c}^{0} and Ξ_{c}^{+} were measured at midrapidity (|y|<0.5) in proton-proton (pp) collisions at a center-of-mass energy sqrt[s]=13  TeV with the ALICE detector at the LHC. The Ξ_{c}^{0} baryon was reconstructed via both the semileptonic decay (Ξ^{-}e^{+}ν_{e}) and the hadronic decay (Ξ^{-}π^{+}) channels. The Ξ_{c}^{+} baryon was reconstructed via the hadronic decay (Ξ^{-}π^{+}π^{+}) channel. The branching-fraction ratio BR(Ξ_{c}^{0}→Ξ^{-}e^{+}ν_{e})/BR(Ξ_{c}^{0}→Ξ^{-}π^{+})=1.38±0.14(stat)±0.22(syst) was measured with a total uncertainty reduced by a factor of about 3 with respect to the current world average reported by the Particle Data Group. The transverse momentum (p_{T}) dependence of the Ξ_{c}^{0}- and Ξ_{c}^{+}-baryon production relative to the D^{0} meson and to the Σ_{c}^{0,+,++}- and Λ_{c}^{+}-baryon production are reported. The baryon-to-meson ratio increases toward low p_{T} up to a value of approximately 0.3. The measurements are compared with various models that take different hadronization mechanisms into consideration. The results provide stringent constraints to these theoretical calculations and additional evidence that different processes are involved in charm hadronization in electron-positron (e^{+}e^{-}) and hadronic collisions.

Λ_{c}^{+} Production and Baryon-to-Meson Ratios in pp and p-Pb Collisions at sqrt[s_{NN}]=5.02 TeV at the LHC

The prompt production of the charm baryon Λ_{c}^{+} and the Λ_{c}^{+}/D^{0} production ratios were measured at midrapidity with the ALICE detector in pp and p-Pb collisions at sqrt[s_{NN}]=5.02  TeV. These new measurements show a clear decrease of the Λ_{c}^{+}/D^{0} ratio with increasing transverse momentum (p_{T}) in both collision systems in the range 2<p_{T}<12  GeV/c, exhibiting similarities with the light-flavor baryon-to-meson ratios p/π and Λ/K_{S}^{0}. At low p_{T}, predictions that include additional color-reconnection mechanisms beyond the leading-color approximation, assume the existence of additional higher-mass charm-baryon states, or include hadronization via coalescence can describe the data, while predictions driven by charm-quark fragmentation processes measured in e^{+}e^{-} and e^{-}p collisions significantly underestimate the data. The results presented in this Letter provide significant evidence that the established assumption of universality (colliding-system independence) of parton-to-hadron fragmentation is not sufficient to describe charm-baryon production in hadronic collisions at LHC energies.

Experimental Evidence for an Attractive p-ϕ Interaction

This Letter presents the first experimental evidence of the attractive strong interaction between a proton and a ϕ meson. The result is obtained from two-particle correlations of combined p-ϕ⊕ p[over ¯]-ϕ pairs measured in high-multiplicity pp collisions at sqrt[s]=13  TeV by the ALICE Collaboration. The spin-averaged scattering length and effective range of the p-ϕ interaction are extracted from the fully corrected correlation function employing the Lednický-Lyuboshits approach. In particular, the imaginary part of the scattering length vanishes within uncertainties, indicating that inelastic processes do not play a prominent role for the p-ϕ interaction. These data demonstrate that the interaction is dominated by elastic p-ϕ scattering. Furthermore, an analysis employing phenomenological Gaussian- and Yukawa-type potentials is conducted. Under the assumption of the latter, the N-ϕ coupling constant is found to be g_{N-ϕ}=0.14±0.03(stat)±0.02(syst). This work provides valuable experimental input to accomplish a self-consistent description of the N-ϕ interaction, which is particularly relevant for the more fundamental studies on partial restoration of chiral symmetry in nuclear medium.

Multiharmonic Correlations of Different Flow Amplitudes in Pb-Pb Collisions at sqrt[s_{NN}]=2.76 TeV

The event-by-event correlations between three flow amplitudes are measured for the first time in Pb-Pb collisions, using higher-order symmetric cumulants. We find that different three-harmonic correlations develop during the collective evolution of the medium when compared to correlations that exist in the initial state. These new results cannot be interpreted in terms of previous lower-order flow measurements since contributions from two-harmonic correlations are explicitly removed in the new observables. A comparison to Monte Carlo simulations provides new and independent constraints for the initial conditions and system properties of nuclear matter created in heavy-ion collisions.

Soft-Dielectron Excess in Proton-Proton Collisions at sqrt[s]=13 TeV

A measurement of dielectron production in proton-proton (pp) collisions at sqrt[s]=13  TeV, recorded with the ALICE detector at the CERN LHC, is presented in this Letter. The data set was recorded with a reduced magnetic solenoid field. This enables the investigation of a kinematic domain at low dielectron (ee) invariant mass m_{ee} and pair transverse momentum p_{T,ee} that was previously inaccessible at the LHC. The cross section for dielectron production is studied as a function of m_{ee}, p_{T,ee}, and event multiplicity dN_{ch}/dη. The expected dielectron rate from hadron decays, called hadronic cocktail, utilizes a parametrization of the measured η/π^{0} ratio in pp and proton-nucleus collisions, assuming that this ratio shows no strong dependence on collision energy at low transverse momentum. Comparison of the measured dielectron yield to the hadronic cocktail at 0.15<m_{ee}<0.6  GeV/c^{2} and for p_{T,ee}<0.4  GeV/c indicates an enhancement of soft dielectrons, reminiscent of the "anomalous" soft-photon and soft-dilepton excess in hadron-hadron collisions reported by several experiments under different experimental conditions. The enhancement factor over the hadronic cocktail amounts to 1.61±0.13(stat)±0.17(syst,data)±0.34(syst,cocktail) in the ALICE acceptance. Acceptance-corrected excess spectra in m_{ee} and p_{T,ee} are extracted and compared with calculations of dielectron production from hadronic bremsstrahlung and thermal radiation within a hadronic many-body approach.

Vaccination against COVID-19 in Bangladesh: Perception and Attitude of Healthcare Workers in COVID-dedicated Hospitals

Healthcare professionals are the crucial and influencing source of information for vaccines and their communication among patients and communities that can accelerate successful vaccination in a country. This cross-sectional study was one of the first and foremost ones in Bangladesh to observe the basic perception and attitudes towards vaccination against COVID-19 among the healthcare workers (HCWs) - doctors, interns, nurses, ward boys, cleaners, and medical technologists of major COVID-dedicated hospitals. The cross-sectional questionnaire-based study was conducted in February 2021 among 550 HCWs to assess the perception and attitude towards vaccination against COVID-19. The study participants were targeted as the priority group for COVID-19 vaccination, working in two major COVID-dedicated hospitals, Holy Family Red Crescent Medical College Hospital (HF-center), and Sheikh Russel National Gastro-liver Institute and Hospital (SR-center) in Dhaka, Bangladesh during the pandemic. The questionnaire was structured with a three-point scale of responses from 'true', 'false', and 'do not know'. The responses were calculated on point-score as +1 for the correct response, -1 for the wrong response, and 0 for 'do not know' with an overall highest and the lowest possible score of +5 to -5. Absolute (n) and relative frequencies (%) were presented for qualitative variables, while quantitative variables were presented as mean (± standard deviation). Chi-square test was done for univariate analysis of qualitative variables and Student's t-test for quantitative variables. With the 95.27% response rate, including 204 males and 320 were female and the male: female ratio was 1: 1.56. The majority of the participants were doctors (45.8%) followed by nurses (27.9%), and MLSS (26.3%) respectively. The respondents were between 18 to 64 years of age with a mean of 36.17±10.94 years. Most of the respondents (95.99%) responded correctly about the cost-free availability of a vaccine against COVID-19 in the country, 87.40% preferred vaccination as safe and effective. Again 29.77% HCWs think the vaccine might not be safe or effective due to emergency authorization. Only 38.93% of respondents could respond correctly about the necessity of vaccines for children, 31.10% think the vaccination was not required instead of natural immunity. The positive perception and attitude of the frontline HCWs in COVID-dedicated hospitals in Bangladesh are crucial which will positively influence motivation and wide acceptance among the general population for the attainment of the nationwide vaccination program, and adopt effective strategic modification to minimize the gaps for a low-middle income country like Bangladesh with its resource constrain.

Prevalence, predictors and outcomes of thyroid dysfunction in patients with acute myocardial infarction: the ThyrAMI-1 study

PURPOSE

Thyroid dysfunction in patients with cardiac disease is associated with worse outcomes. This study aimed to evaluate the prevalence and analyse predictors and outcomes of thyroid dysfunction in patients presenting with an acute myocardial infarction (AMI).

METHODS

A prospective multicentre observational study of patients recruited from six acute hospitals within the North of England. Consecutive patients without previous thyroid disease presenting with both ST-elevation AMI (STEMI) and non-ST-elevation AMI (NSTEMI) were recruited to the Thyroxine in Acute Myocardial Infarction 1 (ThyrAMI-1) cohort study between December 2014 and 2016. Thyroid profile, standard biochemistry measurements and demographic information were obtained within 12 h of admission to hospital. Multivariable logistic regression analyses were performed to assess the predictors of thyroid dysfunction and Cox proportional hazards analyses were utilised to compare all-cause mortality by categories of thyroid dysfunction up to June 2019.

RESULTS

Of the 1802 participants analysed, 1440 (79.9%) were euthyroid, 312 (17.3%) had subclinical hypothyroidism (SCH), 22 (1.2%) had subclinical hyperthyroidism (SHyper) and 25 (1.3%) had low T3 syndrome (LT3S). Predictors for SCH were increasing age, female sex, higher thyroid peroxidase antibody (TPOAb) levels, higher serum creatinine levels and early morning sampling time (between 00:01-06:00 h). The predictors of SHyper were lower body mass index and afternoon sampling time (between 12:01 and 18:00 h). Predictors of LT3S were increasing age, higher creatinine levels and presence of previous ischaemic heart disease. Compared to the euthyroid group, patients with LT3S had higher all-cause mortality; adjusted hazard ratio (95% CI) of 2.02 (1.03-3.95), p = 0.04, whereas those with SCH and SHyper did not exhibit significantly increased mortality; adjusted hazard ratios (95% CI) of 1.05 (0.74-1.49), p = 0.79 and 0.27 (0.04-1.95), p = 0.19, respectively.

CONCLUSIONS

Thyroid dysfunction is common in AMI patients on admission to hospital and our data provide an understanding regarding which factors might influence thyroid dysfunction in these patients. Furthermore, the negative association between LT3S and increased mortality post-AMI has once again been highlighted by this study. More research is required to assess if treatment of thyroid dysfunction improves clinical outcomes.

Elliptic Flow of Electrons from Beauty-Hadron Decays in Pb-Pb Collisions at sqrt[s_{NN}]=5.02 TeV

The elliptic flow of electrons from beauty hadron decays at midrapidity (|y|<0.8) is measured in Pb-Pb collisions at sqrt[s_{NN}]=5.02  TeV with the ALICE detector at the LHC. The azimuthal distribution of the particles produced in the collisions can be parametrized with a Fourier expansion, in which the second harmonic coefficient represents the elliptic flow, v_{2}. The v_{2} coefficient of electrons from beauty hadron decays is measured for the first time in the transverse momentum (p_{T}) range 1.3-6  GeV/c in the centrality class 30%-50%. The measurement of electrons from beauty-hadron decays exploits their larger mean proper decay length cτ≈500  μm compared to that of charm hadrons and most of the other background sources. The v_{2} of electrons from beauty hadron decays at midrapidity is found to be positive with a significance of 3.75  σ. The results provide insights into the degree of thermalization of beauty quarks in the medium. A model assuming full thermalization of beauty quarks is strongly disfavored by the measurement at high p_{T}, but is in agreement with the results at low p_{T}. Transport models including substantial interactions of beauty quarks with an expanding strongly interacting medium describe the measurement within uncertainties.

Next-day discharge after transcatheter aortic valve implantation

Background

Transcatheter aortic valve implantation (TAVI) is being used increasingly in patients with severe symptomatic aortic stenosis. Few studies focused on hospital length of stay (LOS) and feasibility of next-day discharge.

Purpose

This study aims to evaluate the feasibility and factors associated with next-day discharge post TAVI, which can be used to help selecting suitable patients for a “fast-track” TAVI admission.

Methods

Data from all TAVI procedures conducted at our centre from January 2014 to March 2019 were collected in our local TAVI registry, and analysed retrospectively. Patients discharged within 1 day of TAVI (early discharge group) were compared with consecutive patients discharged after 24 h (late discharge group). Degree of frailty was assessed by the Canadian Study of Health and Aging (CSHA) frailty scale, and baseline functional status was assessed by Katz index of independence in activities of daily living.

Results

Of 502 patients, 274 (54.6%) were male, mean age 83.2±7.3 years, and 87 (17.7%) patients were considered frail by CSHA frailty scale. Median Katz index was 6 (i.e. functionally independent, interquartile range [IQR] 1), and mean logistic Euroscore 17.4±10.7. Percutaneous transfemoral access was performed in 468 (95.5%), and general anaesthesia was used in 64 (14.4%) patients. Early complications before discharge were comparable to national standards: death in 11 (2.3%), myocardial infarction (MI) in 1 (0.2%), permanent pacemaker (PPM) in 20 (4.3%), gastrointestinal bleed in 3 (0.6%), and tamponade in 5 (1.1%) patients. Median LOS post procedure was 2 (IQR 3), median length of total hospital stay was 3 (IQR 5). Early discharge was achieved in 213 (44.7%) patients. Multivariate logistic regression analysis showed that male gender (odds ratio [OR]: 2.81, 95% confidence interval [CI]: 1.68 to 4.7; p&lt;0.001), baseline New York Heart Association (NYHA) class below III (OR: 2.04, 95% CI 1.19 to 3.51; p=0.01) were associated with early discharge after TAVI. Furthermore, advancing age (OR: 0.96, 95% CI 0.93–0.99; p=0.02), and presence of extensive ascending aorta calcification (OR: 0.38, 95% CI 0.16–0.88; p=0.025) were associated with less probability of early discharge (i.e. presence of these features were associated with delayed discharge).

Conclusions

Next-day discharge after TAVI can be achieved in nearly half of all patients. Male younger patients with minimal symptoms at baseline (NYHA &lt; III), without feature of extensive ascending aorta calcification (porcelain aorta) are a potential suitable group to be considered for a “fast-track” next-day TAVI discharge.

Funding Acknowledgement

Type of funding source: None

A prospective multicentre randomized all-comers trial to assess the safety and effectiveness of the ultra-thin-strut sirolimus-eluting coronary stent Supraflex: 2-year results of the TALENT trial

Background and purpose

Supraflex is a sirolimus-eluting stent with a biodegradable polymeric coating and 60um ultra-thin struts. In the TALENT study, we found the Supraflex stent was non-inferior to the Xience stent for a device-oriented composite endpoint (DOCE, defined as cardiac death, target-vessel myocardial infarction, or clinically indicated target lesion revascularisation) at 12 months in an all-comer population. Additionally, per-protocol analysis showed a significantly lower clinically indicated target lesion revascularisation (CI-TLR) in the Supraflex group than in the Xience group. We now present the 2-year follow-up results.

Methods

The TALENT study was a prospective, randomised, single-blind, multicentre study across 23 centres in Europe. Eligible participants underwent percutaneous coronary intervention in an all-comers fashion in vessels of 2.25–4.5 mm. Patients were randomized (1:1) to implantation of either Supraflex or Xience (NCT02870140).

Results

Between October 21, 2016 and July 3, 2017, 720 patients with 1046 lesions were randomly assigned to Supraflex, and 715 patients with 1030 lesions to Xience. At 24 months, DOCE had occurred in 49 patients (6.9%) in the Supraflex group and in 56 patients (7.9%) in the Xience group (absolute difference −1.0% [95% CI: −3.7 to 1.7], Plog-rank=0.491). Per-protocol analysis at 24 months showed CI-TLR occurred in 21 and 30 patients in the Supraflex and Xience, respectively (3.3% versus 4.5%, absolute difference −1.2%, [95% CI: −3.3 to 0.9], Plog-rank=0.267).

Conclusion

In an all-comer population, at 2-year follow-up, the use of Supraflex stent was at least as safe and efficacious as Xience stent. However, the significantly lower rate of CI-TLR shown in patients treated with Supraflex at 1-year was no longer retained in the 2-year results. Whether theoretical advantage of ultra-thin strut drug eluting stents Supraflex can translate into clinical benefit or not will be further elucidated through a total of 3 years of follow-up.

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): SMT

The predictive value of CHA2DS2-VASc score on adverse in-hospital outcomes among patients with the acute coronary syndrome and atrial fibrillation who undergo PCI

Background

Patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) and having concomitant atrial fibrillation (AF) have a greater risk of adverse short- and long-term outcomes and death compared with patients in the same setting but without AF. On the other hand, the predictive value of CHA2DS2-VASc score in terms of in-hospital mortality and periprocedural adverse events following PCI among patients with ACS and AF is unknown.

Purpose

We retrospectively analyzed data of patients with the main admission diagnosis of ACS that underwent PCI and had AF during the 2004–2014 period from the large nationwide US National Inpatient Sample (NIS) database.

Methods

A CHA2DS2-VASc score was calculated for each patient and incorporated into a multivariable-adjusted logistic regression to determine its independent impact on in-hospital outcomes consisting of death, acute kidney injury (AKI), bleeding, vascular injury, and stroke/transient ischemic attack (TIA).

Results

A total of 283,890 patients with AF who underwent PCI following ACS were included in the analysis. The average reported prevalence of the AF in the whole cohort was 10.0% with a significant trend (p&lt;0.001) of increase during the observed 10-year period. The average age of the cohort was 72.1±11 years, 63.4% were male while the median CHA2DS2-VASc score was 3 (IQR 2–4). Crude rates of adverse in-hospital outcomes were significantly higher among patient groups with higher CHA2DS2-VASc score (Table 1). Following adjustment for baseline covariates, incremental increase in CHA2DS2-VASc score was independently associated with an increased odds of in-hospital death (OR 1.20, CI 95% 1.18–1.22), periprocedural vascular injury (OR 1.18, 95% CI 1.17–1.20), bleeding (OR 1.17, 95% CI 1.16–1.18), stroke/TIA (OR 1.17, 95% CI 1.15–1.19), and AKI (OR 1.05, 95% CI 1.04–1.06) (Figure 1).

Conclusions

The CHA2DS2-VASc score provides important prognostic information in ACS patients with AF undergoing PCI and is independently associated with in-hospital death and periprocedural adverse events. Therefore, CHA2DS2-VASc score could be used as a practical and inexpensive tool for risk stratification in this population.

Figure 1

Funding Acknowledgement

Type of funding source: None

Onyx ONE: outcomes in patients with acute coronary syndrome

Background/Introduction

The Onyx ONE Global Study (Onyx ONE), a randomized, single-blind, international trial, demonstrated non-inferiority of a zotarolimus-eluting stent (ZES) to a polymer-free drug-coated stent (DCS) in high-bleeding risk patients treated with 1-month dual antiplatelet therapy (DAPT) followed by single antiplatelet therapy (SAPT). More than half of the Onyx ONE patients presented with an acute coronary syndrome (ACS). The safety and effectiveness of ZES and DCS in ACS patients treated with SAPT after 30 days remains unknown.

Purpose

To evaluate the safety and effectiveness outcomes for ZES and DCS in Onyx ONE patients presenting with ACS.

Methods

The primary outcome of the trial was a composite of cardiac death, myocardial infarction, or stent thrombosis at 1 year. To align with the time that DAPT is interrupted, we also evaluated the primary endpoint between the 2 stent groups in a landmark analysis between 30 days and 1 year. All analyses were performed in ACS patients (includes unstable angina, non ST-elevation myocardial infarction and ST-elevation myocardial infarction).

Results

Among the 1996 patients randomized in Onyx ONE, 982/1902 (51.6%) presented with ACS, of which 511/982 (52.0%) and 471/982 (48.0%) were treated with ZES and DCS respectively. In a pre-defined subgroup analysis in ACS patients, the event rates between the two stent groups regarding the primary outcome at one year were similar (18.5% ZES; 20.8% DCS; HR: 0.91; 95% CI [0.68, 1.22]; p=0.523). In the landmark analysis beyond day 30, the primary outcome rate tended to be lower among those treated with the ZES (8.4%) compared with the DCS (12.1%) [HR: 0.66 (95% CI: 0.43, 1.01), p=0.055] (Figure). This was primarily driven by lower rates of myocardial infarction with ZES (6.5% ZES; 10.2% DCS; [HR: 0.58 (95% CI: 0.36, 0.93); p=0.025], while other components were similar: cardiac death, 2.6% ZES vs. 2.8% DCS [HR: 1.00 (95% CI: 0.44, 2.27); p&gt;0.99) and stent thrombosis, 1.4% ZES vs. 1.4% DCS [HR: 0.93 (95% CI: 0.27, 3.21); p=0.91].

Conclusions

In Onyx ONE, high-bleeding risk patients presenting with ACS had similar safety and efficacy at 1 year in both the ZES and DCS stent groups. However, a trend was present for greater safety with the ZES with SAPT treatment beyond 30 days driven by lower myocardial infarction rates in that time period thus warranting additional confirmatory studies.

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Medtronic sponsored the Onyx ONE Global Study

Measurement of the Low-Energy Antideuteron Inelastic Cross Section

In this Letter, we report the first measurement of the inelastic cross section for antideuteron-nucleus interactions at low particle momenta, covering a range of 0.3≤p<4  GeV/c. The measurement is carried out using p-Pb collisions at a center-of-mass energy per nucleon-nucleon pair of sqrt[s_{NN}]=5.02  TeV, recorded with the ALICE detector at the CERN LHC and utilizing the detector material as an absorber for antideuterons and antiprotons. The extracted raw primary antiparticle-to-particle ratios are compared to the results from detailed ALICE simulations based on the geant4 toolkit for the propagation of (anti)particles through the detector material. The analysis of the raw primary (anti)proton spectra serves as a benchmark for this study, since their hadronic interaction cross sections are well constrained experimentally. The first measurement of the inelastic cross section for antideuteron-nucleus interactions averaged over the ALICE detector material with atomic mass numbers ⟨A⟩=17.4 and 31.8 is obtained. The measured inelastic cross section points to a possible excess with respect to the Glauber model parametrization used in geant4 in the lowest momentum interval of 0.3≤p<0.47  GeV/c up to a factor 2.1. This result is relevant for the understanding of antimatter propagation and the contributions to antinuclei production from cosmic ray interactions within the interstellar medium. In addition, the momentum range covered by this measurement is of particular importance to evaluate signal predictions for indirect dark-matter searches.

Probing the Effects of Strong Electromagnetic Fields with Charge-Dependent Directed Flow in Pb-Pb Collisions at the LHC

The first measurement at the LHC of charge-dependent directed flow (v_{1}) relative to the spectator plane is presented for Pb-Pb collisions at sqrt[s_{NN}]=5.02  TeV. Results are reported for charged hadrons and D^{0} mesons for the transverse momentum intervals p_{T}>0.2  GeV/c and 3<p_{T}<6  GeV/c in the 5%-40% and 10%-40% centrality classes, respectively. The difference between the positively and negatively charged hadron v_{1} has a positive slope as a function of pseudorapidity η, dΔv_{1}/dη=[1.68±0.49(stat)±0.41(syst)]×10^{-4}. The same measurement for D^{0} and D[over ¯]^{0} mesons yields a positive value dΔv_{1}/dη=[4.9±1.7(stat)±0.6(syst)]×10^{-1}, which is about 3 orders of magnitude larger than the one of the charged hadrons. These measurements can provide new insights into the effects of the strong electromagnetic field and the initial tilt of matter created in noncentral heavy ion collisions on the dynamics of light (u, d, and s) and heavy (c) quarks. The large difference between the observed Δv_{1} of charged hadrons and D^{0} mesons may reflect different sensitivity of the charm and light quarks to the early time dynamics of a heavy ion collision. These observations challenge some recent theoretical calculations, which predicted a negative and an order of magnitude smaller value of dΔv_{1}/dη for both light flavor and charmed hadrons.

Evidence of Spin-Orbital Angular Momentum Interactions in Relativistic Heavy-Ion Collisions

The first evidence of spin alignment of vector mesons (K^{*0} and ϕ) in heavy-ion collisions at the Large Hadron Collider (LHC) is reported. The spin density matrix element ρ_{00} is measured at midrapidity (|y|<0.5) in Pb-Pb collisions at a center-of-mass energy (sqrt[s_{NN}]) of 2.76 TeV with the ALICE detector. ρ_{00} values are found to be less than 1/3 (1/3 implies no spin alignment) at low transverse momentum (p_{T}<2  GeV/c) for K^{*0} and ϕ at a level of 3σ and 2σ, respectively. No significant spin alignment is observed for the K_{S}^{0} meson (spin=0) in Pb-Pb collisions and for the vector mesons in pp collisions. The measured spin alignment is unexpectedly large but qualitatively consistent with the expectation from models which attribute it to a polarization of quarks in the presence of angular momentum in heavy-ion collisions and a subsequent hadronization by the process of recombination.

Scattering Studies with Low-Energy Kaon-Proton Femtoscopy in Proton-Proton Collisions at the LHC

The study of the strength and behavior of the antikaon-nucleon (K[over ¯]N) interaction constitutes one of the key focuses of the strangeness sector in low-energy quantum chromodynamics (QCD). In this Letter a unique high-precision measurement of the strong interaction between kaons and protons, close and above the kinematic threshold, is presented. The femtoscopic measurements of the correlation function at low pair-frame relative momentum of (K^{+}p⊕K^{-}p[over ¯]) and (K^{-}p⊕K^{+}p[over ¯]) pairs measured in pp collisions at sqrt[s]=5, 7, and 13 TeV are reported. A structure observed around a relative momentum of 58  MeV/c in the measured correlation function of (K^{-}p⊕K^{+}p[over ¯]) with a significance of 4.4σ constitutes the first experimental evidence for the opening of the (K[over ¯]^{0}n⊕K^{0}n[over ¯]) isospin breaking channel due to the mass difference between charged and neutral kaons. The measured correlation functions have been compared to Jülich and Kyoto models in addition to the Coulomb potential. The high-precision data at low relative momenta presented in this work prove femtoscopy to be a powerful complementary tool to scattering experiments and provide new constraints above the K[over ¯]N threshold for low-energy QCD chiral models.

Measurement of ϒ(1S) Elliptic Flow at Forward Rapidity in Pb-Pb Collisions at sqrt[s_{NN}]=5.02 TeV

The first measurement of the ϒ(1S) elliptic flow coefficient (v_{2}) is performed at forward rapidity (2.5<y<4) in Pb-Pb collisions at sqrt[s_{NN}]=5.02  TeV with the ALICE detector at the LHC. The results are obtained with the scalar product method and are reported as a function of transverse momentum (p_{T}) up to 15  GeV/c in the 5%-60% centrality interval. The measured ϒ(1S)v_{2} is consistent with 0 and with the small positive values predicted by transport models within uncertainties. The v_{2} coefficient in 2<p_{T}<15  GeV/c is lower than that of inclusive J/ψ mesons in the same p_{T} interval by 2.6 standard deviations. These results, combined with earlier suppression measurements, are in agreement with a scenario in which the ϒ(1S) production in Pb-Pb collisions at LHC energies is dominated by dissociation limited to the early stage of the collision, whereas in the J/ψ case there is substantial experimental evidence of an additional regeneration component.

Investigations of Anisotropic Flow Using Multiparticle Azimuthal Correlations in pp, p-Pb, Xe-Xe, and Pb-Pb Collisions at the LHC

Measurements of anisotropic flow coefficients (v_{n}) and their cross-correlations using two- and multiparticle cumulant methods are reported in collisions of pp at sqrt[s]=13  TeV, p-Pb at a center-of-mass energy per nucleon pair sqrt[s_{NN}]=5.02  TeV, Xe-Xe at sqrt[s_{NN}]=5.44  TeV, and Pb-Pb at sqrt[s_{NN}]=5.02  TeV recorded with the ALICE detector. The multiplicity dependence of v_{n} is studied in a very wide range from 20 to 3000 particles produced in the midrapidity region |η|<0.8 for the transverse momentum range 0.2<p_{T}<3.0  GeV/c. An ordering of the coefficients v_{2}>v_{3}>v_{4} is found in pp and p-Pb collisions, similar to that seen in large collision systems, while a weak v_{2} multiplicity dependence is observed relative to nucleus-nucleus collisions in the same multiplicity range. Using a novel subevent method, v_{2} measured with four-particle cumulants is found to be compatible with that from six-particle cumulants in pp and p-Pb collisions. The magnitude of the correlation between v_{n}^{2} and v_{m}^{2}, evaluated with the symmetric cumulants SC(m,n) is observed to be positive at all multiplicities for v_{2} and v_{4}, while for v_{2} and v_{3} it is negative and changes sign for multiplicities below 100, which may indicate a different v_{n} fluctuation pattern in this multiplicity range. The observed long-range multiparticle azimuthal correlations in high multiplicity pp and p-Pb collisions can neither be described by pythia 8 nor by impact-parameter-Glasma, music, and ultrarelativistic quantum molecular dynamics model calculations, and hence, provide new insights into the understanding of collective effects in small collision systems.

P676Percutaneous coronary intervention and clinical outcomes in patients with lymphoma: a 10-year period United States nationwide inpatient sample (NIS) analysis

Background

Clinical outcomes and characteristics of patients with lymphoma undergoing percutaneous coronary intervention (PCI) are unknown.

Purpose

To describe clinical characteristics and procedural outcomes in patients that underwent PCI and had a concurrent diagnosis of Hodgkin (HL) or non-Hodgkin (NHL) lymphoma and compare risks of complications and in-hospital mortality in lymphoma subtypes to patients without lymphoma.

Methods

A total of 6,413,175 PCI procedures undertaken in the United States between 2004 and 2014 in the Nationwide Inpatient Sample were included in the analysis. Multivariable regression analysis was performed in order to examine the association between lymphoma diagnosis and clinical outcomes post-PCI including complications and in-hospital mortality.

Results

Patients with lymphoma generally had a significantly higher incidence of post-PCI complications and in-hospital mortality compared to patients without lymphoma (Figure 1). Patients with lymphoma were more likely to experience in-hospital mortality (OR 1.34, 95% CI 1.20–1.49), stroke or transient ischemic attack (TIA) (OR 1.59, 95% CI 1.47–1.73), and any in-hospital complication (OR 1.19, 95% CI 1.14–1.25), following PCI. In the lymphoma subtype-analysis, diagnosis of HL was associated with an increased likelihood of in-hospital death (OR 1.31, 95% CI 1.17–1.48), any in-hospital complication (OR 1.20, 95% CI 1.14–1,26), bleeding complications (OR 1.12 95% CI 1.05–1.19) and vascular complications (OR 1.10 95% CI 1.03–1.17) while these risks were not significantly associated with NHL diagnosis. Finally, both types of lymphoma were associated with an increased likelihood of stroke/TIA following PCI, with this effect being twice greater for HL than NHL diagnosis (OR 1.66, 95% CI 1.52–1.81 and OR 1.33, 95% CI 1.06–1.66, respectively) (Table 1).

Table 1. ORs for clinical outcomes Variable HL vs. No Lymphoma NHL vs. No Lymphoma Bleeding complications 1.12 (1.05–1.19) 1.07 (0.89–1.27) Vascular complications 1.10 (1.03–1.17) 1.13 (0.92–1.27) Cardiac complications 0.94 (0.85–1.03) 0.86 (0.68–1.11) Post-procedural stroke/TIA 1.66 (1.52–1.81) 1.33 (1.06–1.66) Any complication 1.20 (1.14–1.26) 1.04 (0.91–1.18) In-hospital mortality 1.31 (1.17–1.48) 0.89 (0.65–1.21) HL, Hodgkin's Lymphoma; NHL, non-Hodgkin's Lymphoma; TIA, Transient Ischemic Attack.

Figure 1. Type of lymphoma and outcomes

Conclusions

While the incidence of lymphoma in the observed PCI cohort was low, a diagnosis of lymphoma was associated with an adverse prognosis following PCI, primarily in patients with a diagnosis of HL.

P4492Peripheral blood mononuclear cell expression of the stabilizing RNA-binding protein HuR is associated with incidence and extent of human atherosclerotic cardiovascular disease

Background

Human Antigen R (HuR) is a stabilizing RNA-binding protein that regulates the expression of several pro-inflammatory molecules. However, its regulation in human atherosclerotic cardiovascular disease remains unknown.

Purpose

To determine the association of peripheral blood mononuclear cell HuR expression with established markers of increased cardiovascular risk and atherosclerosis burden in patients with subclinical or clinically overt coronary artery disease (CAD).

Methods

HuR mRNA expression was measured in peripheral blood mononuclear cells derived from 289 patients with stable CAD or acute myocardial infarction (AMI) and 373 individuals without clinically overt cardiovascular disease (CVD). Structural and functional vascular measurements including intima-media thickness (IMT) and number of atheromatous plaques by carotid and femoral artery ultrasonophaphy, markers of arterial wave reflections by pulse wave analysis and pulse wave velocity were used as surrogate markers of subclinical CVD. The number of angiographically confirmed diseased coronary arteries (>50% stenosis) was used to assess the extent of CAD.

Results

HuR mRNA expression was significantly increased in patients with CAD (both stable and AMI) compared to controls (p=0.039). Subgroup analysis revealed that STEMI patients (n=107) had increased levels of HuR expression compared to NSTEMI (n=49, p=0.03). Among patients with stable CAD (n=133), high HuR expression was independently associated with the number of diseased coronary arteries (OR=1.35 for 1-SD increase in HuR, 95% CI 1.07–1.72, p=0.012), as well as with reduced ejection fraction (EF<45%, OR=1.32 per 1-SD increase, 95% CI 1.05–1.85, p=0.024). Among individuals without CVD, high HuR was associated with lower HDL levels (adjusted beta=-5.2 mg/dl for highest versus lowest quartile, p=0.03) and higher diastolic blood pressure (adjusted beta=3.6 mmHg, p=0.007), while, after adjustment for traditional cardiovascular risk factors, HuR levels in individuals without CVD were independently associated with increased IMT in the common carotid artery (mean increase 6.2% for highest versus lowest quartile, p=0.019).

Conclusion

HuR expression is associated with early subclinical arterial disease in individuals without clinically overt CVD and with the presence and severity of cardiac and vascular dysfunction in patients with clinically overt CAD. These findings imply a clinical role of the HuR pathway in cardiovascular disease and warrant further investigation.

2228Circulating serum extracellular matrix degradation enzyme cathepsin S predicts mortality and improves risk stratification over the GRACE score in patients with non-ST elevation acute coronary syndrom

Background

Blood-based biomarkers may be useful in the identification of residual risk for death or acute myocardial infarction (AMI) in patients with a previous acute coronary syndrome. Cathepsin S (CTSS) is a lysosomal cysteine protease with potent elastolytic and collagenolytic activity, which plays an important role in cardiovascular disease through extracellular matrix degradation, vasa vasorum development and atherosclerotic plaque rupture. The aim of the present study was to determine the prognostic and reclassification value of baseline circulating levels of CTSS after adjustment for the Global Registry of Acute Coronary Events (GRACE) score, which is widely recommended for risk stratification in non-ST-segment elevation acute coronary syndrome (NSTE-ACS).

Methods

CTSS was measured in blood samples collected from 1,129 consecutive patients with adjudicated NSTE-ACS presenting at an acute chest pain unit for evaluation of a possible acute coronary syndrome. Cardiovascular (CV) death and a composite of all-cause mortality and AMI were evaluated as the primary and secondary endpoints of the study, respectively. The additive prognostic value of CTSS over the GRACE score was estimated by the Net Reclassification Index (NRI) that examines the net upward and downward reclassification into correct pre-defined risk categories.

Results

After a median follow-up of 21 months, 101 (8.95%) deaths were reported, of which 63 (5.6%) were of cardiac origin. The combined endpoint occurred in 176 (15.6%) patients. Patients with CTSS in the highest tertile presented the greatest risk for all-cause mortality (HR=1.84 for highest versus lowest tertile of CTSS distribution, 95% CI 1.1–3.08, P=0.02) and CV death (HR=2.5 for highest versus lowest tertile of CTSS distribution, 95% CI 1.24–5.05, P=0.011) after adjustment for age, gender, diabetes mellitus, hs-cTnT, hsCRP, revascularization and index diagnosis. Similarly, CTSS was associated with increased risk of cardiovascular death after adjusting for the GRACE Score (adjusted HR for highest versus lowest tertile of CTSS distribution=2.34, 95% CI 1.18–4.64, P=0.015). Further, CTSS predicted the combined endpoint of all-cause death or non-fatal MI independently of the GRACE Score (adjusted HR for highest versus lowest tertile of CTSS distribution=1.67, 95% CI 1.15–2.42, P=0.007). When CTSS was added over the GRACE Score, it conferred significant reclassification value for CV death (NRI=21.4%, P=0.008). Similarly, CTSS correctly reclassified risk for all-cause death or non-fatal MI (P=0.006) in 15.9% of the population.

Conclusions

Circulating CTSS predicts mortality and improves risk stratification of patients with NSTE-ACS over the GRACE score recommended by clinical guidelines. The clinical application of CTSS as a novel biomarker in NSTE-ACS should be further explored and validated.

P2797Clinical outcomes of an ultra-thin strut sirolimus-eluting stent with biodegradable polymer in all-comers patients undergoing coronary intervention

Background

Thin stent struts may be associated with reduced vessel injury and use of biodegradable polymers may further improve long term outcomes. However, data with earlier stents has been inconsistent; thus further studies with newer devices are needed.

Purpose

To evaluate the efficacy and safety of a new ultra-thin (65um) strut cobalt chromium sirolimus-eluting stent with a hybrid design (closed cell at ends and open cells in middle to reduce edge injury and optimise conformability) in all-comers patients undergoing percutaneous coronary intervention (PCI).

Methods

We enrolled 752 patients from 14 sites undergoing PCI into a prospective, non-randomised, multi-centre, open-label, observational registry. Inclusion of patients with complex anatomy (long stent lengths, bifurcations and chronic total occlusions) was encouraged. Clinical follow-up was scheduled at 1, 9, 12 and 24 months. The primary endpoint was incidence of major adverse cardiac events (MACE) - cardiac death, non-fatal myocardial infarction (MI), or target vessel revascularization (TVR) - at 9 months.

Results

Mean patient age was 64.7±12.2 years, 20.7% had diabetes, 58.8% had dyslipidaemia, 40.4% had multi-vessel disease, 22% had previous PCI, 4.7% had previous coronary-artery bypass graft, and 19.6% had a clinical history of previous MI. Mean lesion length was 25.7±17.3 mm. The primary endpoint of cumulative MACE up to 9 months (from 624 patients reaching 9 months follow-up) occurred in 12 patients (1.92%), including 6 (0.96%) cardiac death, 5 (0.80%) MI and 6 (0.96%) clinically indicated TVR. Definite stent thrombosis was reported in 3 patients (0.48%) and probable stent thrombosis in 2 patients (0.32%).

Conclusions

Use of an ultra-thin strut biodegradable polymer sirolimus-eluting stent in all-comers patients undergoing PCI was associated with good clinical efficacy and safety.

Acknowledgement/Funding

Meril Life

Morphological Changes of Length of Prostate in Different Age Groups of Bangladeshi Cadaver

Benign prostatic hyperplasia is the most common prostatic problem for men older than age 50. It is a condition in men in which the prostate is enlarged but it is not cancerous. The prostate goes through 2 (two) main growth periods as a person ages. The first happens early in pubescence, when the prostate doubles in size. The second stage of growth begins around age twenty five and continues throughout most of a man's life. Benign prostatic hyperplasia often occurs with second growth phase. In the treatment of prostatic disorders, estimation of the length of prostate has been used to select the surgical approach. Transurethral resection of prostate (TURP) is preferred for small glands and open prostatectomy for larger ones. As the prostate gland is dependent on androgen for its growth, the prostatic length reflects the hormonal status of the subjects. This cross sectional descriptive study was conducted in Department of Anatomy, Mymensingh Medical College, Mymensingh, Bangladesh from April 2015 to September 2015 to find out the difference in length of the prostate of Bangladeshi people in relation to age. The present study was performed on 67 postmortem human prostate glands collected from the morgue in the Department of Forensic Medicine, Mymensingh Medical College, by non random purposive sampling technique. The specimens were collected from Bangladeshi dead body, age starting from 10-80 years. All the specimens were classified into 3(three) classes - Group A (upto 18 years), Group B (19-45 years) and Group C (>45 years) according to age. Dissection was performed according to standard autopsy techniques. The length of the prostate was measured and recorded. The mean±SD length of the prostate was 1.76±0.60cm, 2.65±0.56cm and 2.88±0.70cm in Group A, B and C respectively. The maximum mean length of the prostate was in Group C (2.88cm) and minimum was in Group A (1.76cm). It was observed that the length of the prostate was increased with age. Variance analysis shows that mean differences of length of the prostate were highly significant among all age groups. The length of prostate gland was found to be increase with age. For statistical analysis, variations between age groups were analyzed by students unpaired 't' test. The present study will help to increase the information pool on the length of prostate gland of Bangladeshi people.

First Observation of an Attractive Interaction between a Proton and a Cascade Baryon

This Letter presents the first experimental observation of the attractive strong interaction between a proton and a multistrange baryon (hyperon) Ξ^{-}. The result is extracted from two-particle correlations of combined p-Ξ^{-}⊕p[over ¯]-Ξ[over ¯]^{+} pairs measured in p-Pb collisions at sqrt[s_{NN}]=5.02  TeV at the LHC with ALICE. The measured correlation function is compared with the prediction obtained assuming only an attractive Coulomb interaction and a standard deviation in the range [3.6, 5.3] is found. Since the measured p-Ξ^{-}⊕p[over ¯]-Ξ[over ¯]^{+} correlation is significantly enhanced with respect to the Coulomb prediction, the presence of an additional, strong, attractive interaction is evident. The data are compatible with recent lattice calculations by the HAL-QCD Collaboration, with a standard deviation in the range [1.8, 3.7]. The lattice potential predicts a shallow repulsive Ξ^{-} interaction within pure neutron matter and this implies stiffer equations of state for neutron-rich matter including hyperons. Implications of the strong interaction for the modeling of neutron stars are discussed.

Exploring the limits of semiconductor-laser-based optical frequency combs

We report a study on the performance limits of stabilized optical frequency combs from semiconductor mode-locked diode lasers. Operating characteristics such as the number of comb lines, comb tooth linewidth, the physical parameters that affect the independent control of pulse repetition rate and offset frequency, and the potential for self-stabilization, are explored.

Azimuthal Anisotropy of Heavy-Flavor Decay Electrons in p-Pb Collisions at sqrt[s_{NN}]=5.02 TeV

Angular correlations between heavy-flavor decay electrons and charged particles at midrapidity (|η|<0.8) are measured in p-Pb collisions at sqrt[s_{NN}]=5.02  TeV. The analysis is carried out for the 0%-20% (high) and 60%-100% (low) multiplicity ranges. The jet contribution in the correlation distribution from high-multiplicity events is removed by subtracting the distribution from low-multiplicity events. An azimuthal modulation remains after removing the jet contribution, similar to previous observations in two-particle angular correlation measurements for light-flavor hadrons. A Fourier decomposition of the modulation results in a positive second-order coefficient (v_{2}) for heavy-flavor decay electrons in the transverse momentum interval 1.5<p_{T}<4  GeV/c in high-multiplicity events, with a significance larger than 5σ. The results are compared with those of charged particles at midrapidity and those of inclusive muons at forward rapidity. The v_{2} measurement of open heavy-flavor particles at midrapidity in small collision systems could provide crucial information to help interpret the anisotropies observed in such systems.

Erratum to: Measurement of the W boson polarisation in t t ¯ events from pp collisions at s = 8 TeV in the lepton + jets channel with ATLAS

[This corrects the article DOI: 10.1140/epjc/s10052-017-4819-4.].

Search for electroweak production of supersymmetric particles in final states with two or three leptons at s = 13 TeV with the ATLAS detector

A search for the electroweak production of charginos, neutralinos and sleptons decaying into final states involving two or three electrons or muons is presented. The analysis is based on 36.1 fb- 1 ofs = 13  TeV proton-proton collisions recorded by the ATLAS detector at the Large Hadron Collider. Several scenarios based on simplified models are considered. These include the associated production of the next-to-lightest neutralino and the lightest chargino, followed by their decays into final states with leptons and the lightest neutralino via either sleptons or Standard Model gauge bosons; direct production of chargino pairs, which in turn decay into leptons and the lightest neutralino via intermediate sleptons; and slepton pair production, where each slepton decays directly into the lightest neutralino and a lepton. No significant deviations from the Standard Model expectation are observed and stringent limits at 95% confidence level are placed on the masses of relevant supersymmetric particles in each of these scenarios. For a massless lightest neutralino, masses up to 580 GeV are excluded for the associated production of the next-to-lightest neutralino and the lightest chargino, assuming gauge-boson mediated decays, whereas for slepton-pair production masses up to 500 GeV are excluded assuming three generations of mass-degenerate sleptons.

Performance of missing transverse momentum reconstruction with the ATLAS detector using proton-proton collisions at s = 13 TeV

The performance of the missing transverse momentum ( E T miss ) reconstruction with the ATLAS detector is evaluated using data collected in proton-proton collisions at the LHC at a centre-of-mass energy of 13 TeV in 2015. To reconstruct E T miss , fully calibrated electrons, muons, photons, hadronically decaying τ -leptons , and jets reconstructed from calorimeter energy deposits and charged-particle tracks are used. These are combined with the soft hadronic activity measured by reconstructed charged-particle tracks not associated with the hard objects. Possible double counting of contributions from reconstructed charged-particle tracks from the inner detector, energy deposits in the calorimeter, and reconstructed muons from the muon spectrometer is avoided by applying a signal ambiguity resolution procedure which rejects already used signals when combining the various E T miss contributions. The individual terms as well as the overall reconstructed E T miss are evaluated with various performance metrics for scale (linearity), resolution, and sensitivity to the data-taking conditions. The method developed to determine the systematic uncertainties of the E T miss scale and resolution is discussed. Results are shown based on the full 2015 data sample corresponding to an integrated luminosity of 3.2 fb - 1 .

Measurement of colour flow using jet-pull observables in t t ¯ events with the ATLAS experiment at s = 13 TeV

Previous studies have shown that weighted angular moments derived from jet constituents encode the colour connections between partons that seed the jets. This paper presents measurements of two such distributions, the jet-pull angle and jet-pull magnitude, both of which are derived from the jet-pull angular moment. The measurement is performed in t t ¯ events with one leptonically decaying W boson and one hadronically decaying W boson, using 36.1 fb - 1 of pp collision data recorded by the ATLAS detector ats = 13 TeV delivered by the Large Hadron Collider. The observables are measured for two dijet systems, corresponding to the colour-connected daughters of the W boson and the two b-jets from the top-quark decays, which are not expected to be colour connected. To allow the comparison of the measured distributions to colour model predictions, the measured distributions are unfolded to particle level, after correcting for experimental effects introduced by the detector. While good agreement can be found for some combinations of predictions and observables, none of the predictions describes the data well across all observables.

Measurement of the Soft-Drop Jet Mass in pp Collisions at sqrt[s]=13 TeV with the ATLAS Detector

Jet substructure observables have significantly extended the search program for physics beyond the standard model at the Large Hadron Collider. The state-of-the-art tools have been motivated by theoretical calculations, but there has never been a direct comparison between data and calculations of jet substructure observables that are accurate beyond leading-logarithm approximation. Such observables are significant not only for probing the collinear regime of QCD that is largely unexplored at a hadron collider, but also for improving the understanding of jet substructure properties that are used in many studies at the Large Hadron Collider. This Letter documents a measurement of the first jet substructure quantity at a hadron collider to be calculated at next-to-next-to-leading-logarithm accuracy. The normalized, differential cross section is measured as a function of log_{10}ρ^{2}, where ρ is the ratio of the soft-drop mass to the ungroomed jet transverse momentum. This quantity is measured in dijet events from 32.9  fb^{-1} of sqrt[s]=13  TeV proton-proton collisions recorded by the ATLAS detector. The data are unfolded to correct for detector effects and compared to precise QCD calculations and leading-logarithm particle-level Monte Carlo simulations.

Measurement of the inclusive and fiducial t t ¯ production cross-sections in the lepton+jets channel in pp collisions at s = 8 TeV with the ATLAS detector

The inclusive and fiducial t t ¯ production cross-sections are measured in the lepton+jets channel using 20.2 fb - 1 of proton-proton collision data at a centre-of-mass energy of 8 TeV recorded with the ATLAS detector at the LHC. Major systematic uncertainties due to the modelling of the jet energy scale and b-tagging efficiency are constrained by separating selected events into three disjoint regions. In order to reduce systematic uncertainties in the most important background, the W +\,jets process is modelled using Z + jets events in a data-driven approach. The inclusive t t ¯ cross-section is measured with a precision of 5.7% to beσ inc ( t t ¯ ) = 248.3 ± 0.7 ( stat . ) ± 13.4 ( syst . ) ± 4.7 ( lumi . ) pb , assuming a top-quark mass of 172.5 GeV. The result is in agreement with the Standard Model prediction. The cross-section is also measured in a phase space close to that of the selected data. The fiducial cross-section isσ fid ( t t ¯ ) = 48.8 ± 0.1 ( stat . ) ± 2.0 ( syst . ) ± 0.9 ( lumi . ) pb with a precision of 4.5%.

Search for a new heavy gauge-boson resonance decaying into a lepton and missing transverse momentum in 36 fb - 1 of pp collisions at s = 13 TeV with the ATLAS experiment

The results of a search for new heavy W ' bosons decaying to an electron or muon and a neutrino using proton-proton collision data at a centre-of-mass energy ofs = 13  TeV are presented. The dataset was collected in 2015 and 2016 by the ATLAS experiment at the Large Hadron Collider and corresponds to an integrated luminosity of 36.1 fb - 1 . As no excess of events above the Standard Model prediction is observed, the results are used to set upper limits on the W ' boson cross-section times branching ratio to an electron or muon and a neutrino as a function of the W ' mass. Assuming a W ' boson with the same couplings as the Standard Model W boson, W ' masses below 5.1 TeV are excluded at the 95% confidence level.

Search for a Structure in the B_{s}^{0}π^{±} Invariant Mass Spectrum with the ATLAS Experiment

A search for the narrow structure, X(5568), reported by the D0 Collaboration in the decay sequence X→B_{s}^{0}π^{±}, B_{s}^{0}→J/ψϕ, is presented. The analysis is based on a data sample recorded with the ATLAS detector at the LHC corresponding to 4.9  fb^{-1} of pp collisions at 7 TeV and 19.5  fb^{-1} at 8 TeV. No significant signal was found. Upper limits on the number of signal events, with properties corresponding to those reported by D0, and on the X production rate relative to B_{s}^{0} mesons, ρ_{X}, were determined at 95% confidence level. The results are N(X)<382 and ρ_{X}<0.015 for B_{s}^{0} mesons with transverse momenta above 10 GeV, and N(X)<356 and ρ_{X}<0.016 for transverse momenta above 15 GeV. Limits are also set for potential B_{s}^{0}π^{±} resonances in the mass range 5550 to 5700 MeV.

Search for heavy ZZ resonances in the ℓ + ℓ - ℓ + ℓ - and ℓ + ℓ - ν ν ¯ final states using proton-proton collisions at s = 13 TeV with the ATLAS detector

A search for heavy resonances decaying into a pair of Z bosons leading toℓ + ℓ - ℓ + ℓ - andℓ + ℓ - ν ν ¯ final states, where ℓ stands for either an electron or a muon, is presented. The search uses proton-proton collision data at a centre-of-mass energy of 13  TeV corresponding to an integrated luminosity of 36.1  fb - 1 collected with the ATLAS detector during 2015 and 2016 at the Large Hadron Collider. Different mass ranges for the hypothetical resonances are considered, depending on the final state and model. The different ranges span between 200 and 2000  GeV . The results are interpreted as upper limits on the production cross section of a spin-0 or spin-2 resonance. The upper limits for the spin-0 resonance are translated to exclusion contours in the context of Type-I and Type-II two-Higgs-doublet models, while those for the spin-2 resonance are used to constrain the Randall-Sundrum model with an extra dimension giving rise to spin-2 graviton excitations.

A search for pair-produced resonances in four-jet final states at s = 13 TeV with the ATLAS detector

A search for massive coloured resonances which are pair-produced and decay into two jets is presented. The analysis uses 36.7 fb- 1 of s = 13 TeV pp collision data recorded by the ATLAS experiment at the LHC in 2015 and 2016. No significant deviation from the background prediction is observed. Results are interpreted in a SUSY simplified model where the lightest supersymmetric particle is the top squark, t ~ , which decays promptly into two quarks through R-parity-violating couplings. Top squarks with masses in the range 100 GeV < m t ~ < 410   GeV are excluded at 95% confidence level. If the decay is into a b-quark and a light quark, a dedicated selection requiring two b-tags is used to exclude masses in the ranges 100 GeV < m t ~ < 470   GeV and 480 GeV < m t ~ < 610   GeV . Additional limits are set on the pair-production of massive colour-octet resonances.