Prognostic value of left ventricle global constructive work in patients with cardiac amyloidosis

Background

Left ventricle (LV) global longitudinal strain (LVGLS) has demonstrated incremental diagnostic and prognostic value in patients with cardiac amyloidosis (CA), however it is sensitive to loading conditions (1). Therefore, myocardial work (MW) analysis emerged as a novel echocardiographic method that incorporates both GLS and afterload for a better assessment of LV performance in several pathologies (2). Nevertheless, data regarding its additional value in patients with CA remains limited.

Purpose

We aimed to evaluate the additional prognostic value of global constructive work (GCW), assessed using MW analysis, in patients with CA.

Method

Seventy-one unselected CA patients were included retrospectively between 2015 and 2021. Patients underwent comprehensive clinical, biochemical and imaging evaluation including two-dimentional (2D) echocardiography with MW analysis. The primary endpoint was defined as all-cause mortality and heart failure requiring hospitalization.

Results

The population (mean age 76,76±11.52 years, 73.2% males) consisted of 53 (74.6%) patients with transthyretin (ATTR), 14 (19.7%) patients with light-chain (AL), and 4 (5.6%) patients with unknown phenotype of CA. The primary endpoint was reached in 37 (52.1%) patients. Patient with the primary endpoint had a significantly lower LV ejection fraction (LVEF) (40.54% vs. 49.31%, p=0.003), LVGLS (−9.26% vs. −11.32%, p=0.017) and GCW (1034.47mmHg% vs. 1424.86 mmHg%, p=0.005) than those without. No significant clinical differences were found between the two groups. Multivariable analysis (Figure 1) showed that LVEF (p=0.003; odds ratio (OR): 0.881; 95% confidence interval (CI): 0.810–0.959), LVGLS (p=0.021; OR: 0.688; 95% CI: 0.502–0.944) and GCW (p=0.016; OR: 0.995; 95% CI: 0.991–0.999) were independent predictors for the primary outcome. The model including GCW had the best discriminative ability to predict the primary endpoint (C-index = 0.900; 95% CI: 0.781–1.000, p=0.001). A GCW less than 1443mmHg% was able to predict the primary endpoint with a sensitivity of 94.1% and a specificity of 64.3% (Figure 2; area under the curve (AUC): 0.771 (95% CI: 0.581–0.961; p=0.005).

Conclusion

In patients with CA, a decrease in GCW as a reflection of an impaired systolic performance of the LV was independently associated with an increase in heart failure hospitalization and all-cause mortality. Further prospective studies are warranted in order to confirm the potential role of GCW to improve the prognosis of CA patients.

Funding Acknowledgement

Type of funding sources: None.

Scope and limitations of ring-opening copolymerization of trimethylene carbonate with substituted γ-thiolactones

The reactivity of functional γ-thiolactones has been investigated in Ring Opening Copolymerization with trimethylene carbonate.

Reinvestigation of the mechanism of polymerization of β-butyrolactone from 1,5,7-triazabicyclo[4.4.0]dec-5-ene

The questionable mechanism initially proposed to explain how 1,5,7-triazabicyclo[4.4.0]dec-5-ene (TBD) allows us to ring-open β-lactones, such as β-butyrolactone (BL), is reinvestigated here.

The value of postpartum ultrasound for the diagnosis of retained products of conception: A systematic review

BACKGROUND

The goal of this review is to evaluate the value of ultrasound for detection of retained products of conception (RCOP) after delivery.

METHODS

A systematic search was performed using 'postpartum', 'retained placenta', 'retained products' and 'ultrasound' resulting 82 publications, after screening titles and abstracts, 30 remained.

RESULTS

On gray scale ultrasound, one must be focus on a thickened endometrial echo complex (EEC) with a cut off value of 10 mm and on an intracavitary mass. If these features are not visible, RPOC is rare. However, these findings are neither specific nor conclusive for RPOC and can even be seen in a normal postpartum uterus. Detection of hypervascularity in a thickened EEC or intracavitary mass with color Doppler ultrasound is very sensitive for RPOC but still not specific nor can it exclude RPOC. MRI seems best in differentiating RPOC, arteriovenous malformations and gestational trophoblastic disease.

CONCLUSION

There is no consensus on a standardised method for postpartum ultrasound. More research and standardization are necessary to differentiate of normal and pathological findings in the postpartum uterus.

Follow-up after curative treatment for colorectal cancer: longitudinal evaluation of patient initiated follow-up in the first 12 months

PURPOSE

To compare patient-triggered follow-up (PTFU) for curatively treated colorectal cancer against traditional outpatient follow-up (OPFU).

METHODS

Questionnaires were mailed at four time points over one-year post-treatment to two prospectively-recruited cohorts: A, patients entering follow-up and receiving OPFU pre-implementation of PTFU; B, patients entering follow-up (FU) and receiving either OPFU (B1) or PTFU (B2) post-implementation of PTFU. Bi-variate tests were used to compare patient characteristics and outcomes eight months after entering follow-up (generic and cancer-specific quality of life (QoL), satisfaction). Regression analysis explored associations between follow-up model and outcomes. Resource implications and costs of models were compared.

RESULTS

Patients in Cohort B1 were significantly more likely to have received chemotherapy (p < 0.001), radiotherapy (p < 0.05), and reported poorer QoL (p = 0.001). Having a longstanding co-morbid condition was the most important determinant of QoL (p < 0.001); model of care was not significant. Patients were satisfied with their follow-up care regardless of model. Health service costs were higher in PTFU over the first year CONCLUSIONS: PTFU is acceptable to patients with colorectal cancer and can be considered to be a realistic alternative to OPFU for clinically suitable patients. The initial costs are higher due to provision of a self-management (SM) programme and remote surveillance. Further research is needed to establish long-term outcomes and costs.

Correlation between the shape of the ion mobility signals and the stepwise folding process of polylactide ions

In the field of polymer characterization, the use of ion mobility mass spectrometry (IMMS) remains mainly devoted to the temporal separation of cationized oligomers according to their charge states, molecular masses and macromolecular architectures in order to probe the presence of different structures. When analyzing multiply charged polymer ions by IMMS, the most striking feature is the observation of breaking points in the evolution of the average collision cross sections with the number of monomer units. Those breaking points are associated to the folding of the polymer chain around the cationizing agents. Here, we scrutinize the shape of the arrival time distribution (ATD) of polylactide ions and associate the broadening as well as the loss of symmetry of the ATD signals to the coexistence of different populations of ions attributed to the transition from opened to folded stable structures. The observation of distinct distributions reveals the absence of folded/extended structure interconversion on the ion mobility time scale (1-10 ms) and then on the lifetime of ions within the mass spectrometer at room temperature. In order to obtain information on the possible interconversion between the different observed populations upon ion activation, we performed IM-IM-MS experiments (tandem ion mobility measurements). To do so, mobility-selected ions were activated by collisions before a second mobility measurement. Interestingly, the conversion by collisional activation from a globular structure into a (partially) extended structure, i.e. the gas phase unfolding of the ions, was not observed in the energetic regime available with the used experimental setup. The absence of folded/extended interconversion, even upon collisional activation, points to the fact that the polylactide ions are 'frozen' in their specific 3D structure during the desolvation/ionization electrospray processes. Copyright © 2017 John Wiley & Sons, Ltd.

Unique alternating peptide–peptoid copolymers from dipeptides via a Ugi reaction in water

Unprecedented alternating poly(peptide-alt-peptoid) copolymers are prepared in a single step from dipeptides, aldehydes and isocyanidesviaa Ugi reaction in water.

The influence of the end-group on the chiral self-assembly of all-conjugated block copolymers

This research demonstrates the influence of the end-group on the self-assembly of conjugated polymers.

Two ruthenium complexes capable of storing multiple electrons on a single ligand – photophysical, photochemical and electrochemical properties of [Ru(phen)2(TAPHAT)]2+ and [Ru(phen)2(TAPHAT)Ru(phen)2]4+

The photophysical, photochemical and electrochemical properties of two newly synthesized ruthenium(ii) complexes are reported.

Simultaneous synthesis and chemical functionalization of emulsion-templated porous polymers using nitroxide-terminated macromolecular surfactants

The design of functional 3D macroporous monoliths has become a necessity for a wide range of applications.

[Opinions and attitudes of Flemish pharmacists and general practitioners towards INN prescribing. A survery in Antwerp and East Flanders]

INTRODUCTION

Since 2002 in Belgium, physicians are allowed to prescribe by International Non-proprietary Name (INN). In 2005, the conditions for this decree were set. Examples from other countries have shown that INN prescribing can significantly contribute to controlling pharmaceutical expenditures. The share of INN prescriptions remains low in Belgium (7% in 2011).

OBJECTIVE

To formulate an answer to the question: what are the opinions and attitudes of pharmacists and general practitioners [GP's] with regards to INN prescribing?

METHOD

In the winter of 2011-2012, a questionnaire with closed-ended questions was send to pharmacists and GP's in the provinces of Antwerp and East-Flanders, through training days and personal visits. Pharmacists and GP's scored a list of statements with a 5-point Likert scale. The themes of the statements related to: delivering INN prescriptions, legislation, impact on expenditures, choices regarding patient concerns and interprofessional relations.

RESULTS

In total, 353 questionnaires were completed and returned of which 228 165%1 were by pharmacists and 125 (35%1 by GP's. Although both declared to be sufficiently up to date with regulations to prescribe (84%) or to deliver (95%] a INN prescription, only 13% of the pharmacists said all prescription they receive contain the correct information. Less GP's [36%) than pharmacists (82%] feel aided by their software program when prescribing or delivering an INN prescription. GP's rely mostly on NIHDI (National Institute for Health and Disability Insurance) as the main source for information on INN prescribing, pharmacists rely on the [Local) pharmacists association. The pharmacists and GP's in the study who relied on NIHDI as main information source, were less aware of legislation concerning INN [N2, p<0,05] than those who rely on the local professional association [N2, p<0,0001]. All pharmacists in the study said to consider the patients medication history when delivering an INN prescription for chronic treatment. However, 57% of the GP's preferred not to prescribe by INN for the reason that they are not sure whether the pharmacist will always consider the patients medication history in case of an INN prescription. Although the GP's showed certain motivation to prescribe by INN, it was no greater than for generic prescribing. And INN prescribing has no added value compared to generic prescribing, according to the GP's. For the pharmacists, INN prescribing does contain an opportunity. With the increase in numbers of dosages and sorts of packaging of generic products, it becomes more and more difficult for pharmacists to manage their stock. In case of an INN prescription, the pharmacist can choose between the different packages in his stock. This offers opportunities especially for acute conditions.

CONCLUSION

INN prescribing is a good example of where the collaboration between pharmacists and GP's still contains a lot of opportunities, as well for the two professions, as the government and the patient in terms of controlling the pharmaceutical expenditures. Also the education for pharmacist or GP can further contribute to the sensitization of INN prescribing. In practice, there remain a number of issues and differences in opinions between pharmacists and general practitioners regarding INN prescribing. GP's feel few motivation to prescribe by INN and the government has put no imperative demands towards prescribers. Further evaluation of the practicaL feasibility of the current conditions for prescribing and delivering INN prescriptions is needed.

"Stones in the eye": post cataract suture irritation--a transcultural study from Sierra Leone, West Africa

A retrospective study of 1214 outpatients in Sierra Leone, West Africa was done to answer the question, "What is the visual acuity following extracapsular cataract extraction (ECCE) with an intraocular lens (IOL) for patients in a developing country?" Only 24% achieved uncorrected pseudophakic visual acuity of 20/20 to 20/50. Additionally, postoperative complications and patient complaints were tracked. Results showed suture irritation was less prevalent in those patients when 10-0 nylon suture was used, cut close, and the knot rotated and buried.

Results of local excision and radical radiotherapy in early breast cancer

Twenty-seven patients with a T1 or T2 N0M0 breast carcinoma were treated by local excision of the lump followed by radical radiotherapy, using orthovoltage X-rays. The crude survival rate was 100% at three years, 92% at five years, 95% at 10 years. The local recurrence rate was 8% at three years, 12% at five years, 10.5% at 10 years. The radiation dose needed to be tumour lethal is discussed. Our results and those of papers quoted indicate that 4500--5000 cGy (rad) in five weeks, given in five fractions per week, is optimal, provided the primary tumour has ben removed. A further 1000--2000 cGy to the lumpectomy site reduces the incidence of local recurrence. The cosmetic results of our treatment are illustrated. Some telangiectasis was seen but the general appearance and texture of the treated breasts was satisfactory.