Organosolv Pretreatment of Cocoa Pod Husks: Isolation, Analysis, and Use of Lignin from an Abundant Waste Product

Cocoa pod husks (CPHs) represent an underutilized component of the chocolate manufacturing process. While industry's current focus is understandably on the cocoa beans, the husks make up around 75 wt % of the fruit. Previous studies have been dominated by the carbohydrate polymers present in CPHs, but this work highlights the presence of the biopolymer lignin in this biomass. An optimized organosolv lignin isolation protocol was developed, delivering significant practical improvements. This new protocol may also prove to be useful for agricultural waste-derived biomasses in general. NMR analysis of the high quality lignin led to an improved structural understanding, with evidence provided to support deacetylation of the lignin occurring during the optimized pretreatment. Chemical transformation, using a tosylation, azidation, copper-catalyzed click protocol, delivered a modified lignin oligomer with an organophosphorus motif attached. Thermogravimetric analysis was used to demonstrate the oligomer's potential as a flame-retardant. Preliminary analysis of the other product streams isolated from the CPHs was also carried out.

Natural farming improves crop yield in SE India when compared to conventional or organic systems by enhancing soil quality

Zero Budget Natural Farming (ZBNF) is a grassroot agrarian movement and a state backed extension in Andhra Pradesh, and has been claimed to potentially meet the twin goals of global food security and environmental conservation. However, there is a lack of statistically evaluated data to support assertions of yield benefits of ZBNF compared to organic or conventional alternatives, or to mechanistically account for them. In order to fill this gap, controlled field experiments were established in twenty-eight farms across six districts, spanning over 800 km, over three cropping seasons. In these experiments, we compared ZBNF (no synthetic pesticides or fertilisers, home-made inputs comprising desi cow dung and urine with mulch) to conventional (synthetic fertilisers and pesticides) and organic (no synthetic pesticides or fertilisers, no mulch, purchased organic inputs, e.g. farmyard manure and vermicompost) treatments, all with no tillage. Comparisons were made in terms of yield, soil pH, temperature, moisture content, nutrient content and earthworm abundance. Our data shows that yield was significantly higher in the ZBNF treatment (z score = 0.58 ± 0.08), than the organic (z= -0.34 ± 0.06) or conventional (-0.24 ± 0.07) treatment when all farm experiments were analysed together. However, the efficacy of the ZBNF treatment was context specific and varied according to district and the crop in question. The ZBNF yield benefit is likely attributed to mulching, generating a cooler soil, with a higher moisture content and a larger earthworm population. There were no significant differences between ZBNF and the conventional treatment in the majority of nutrients. This is a particularly important observation, as intensive use of synthetic pesticides and fertilisers comes with a number of associated risks to farmers' finances, human health, greenhouse gas emissions, biodiversity loss and environmental pollution. However, long-term field and landscape scale trials are needed to corroborate these initial observations.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s13593-023-00884-x.

'Raising the Pulse': The environmental, nutritional and health benefits of pulse-enhanced foods

Diet is a key modulator of non-communicable diseases, and food production represents a major cause of environmental degradation and greenhouse gas emissions. Yet, 'nudging' people to make better food choices is challenging, as factors including affordability, convenience and taste often take priority over the achievement of health and environmental benefits. The overall 'Raising the Pulse' project aim is to bring about a step change in the nutritional value of the UK consumers' diet, and to do so in a way that leads to improved health and greater sustainability within the UK food system. To achieve our objectives, UK-specific faba bean production systems that optimise both end users' diets and environmental and economic sustainability of production will be implemented in collaboration with key stakeholders (including industry, the retail sector and government). Palatable faba bean flours will be produced and used to develop 'Raising the Pulse' food products with improved nutritional profile and environmental value. Consumer focus groups and workshops will establish attitudes, preferences, drivers of and barriers to increased consumption of such products. They will inform the co-creation of sensory testing and University-wide intervention studies to evaluate the effects of pulses and 'Raising the Pulse' foods on diet quality, self-reported satiety, nutritional knowledge, consumer acceptance and market potential. Nutrient bioavailability and satiety will be evaluated in a randomised-controlled postprandial human study. Finally, a system model will be developed that predicts changes to land use, environment, business viability, nutrition and human health after substitution of existing less nutritionally beneficial and environmentally sustainable ingredients with pulses. Government health and sustainability priorities will be addressed, helping to define policy-relevant solutions with significant beneficial supply chain economic impacts and transformed sustainable food systems to improve consumer diet quality, health and the environment.

Effects of application of horticultural soil amendments on decomposition, quantity, stabilisation and quality of soil carbon

Application of organic soil amendments is commonplace in horticulture to improve soil fertility. Whether this practice can also augment the soil carbon (C) pool has been of increasing interest in recent years. We used a controlled field experiment that has received annual applications of six different horticultural soil amendments for seven consecutive years. Each amendment was examined in terms of its contribution to bulk C and the distribution of C between theoretical pools, as defined by physical fractionation. Physical fractionation was combined with ¹³C nuclear magnetic resonance spectroscopy with cross-polarization and magic angle spinning (CPMAS NMR) analysis. Results indicated that the difference in total C concentration between treatments resulted from an increase in unprotected, free, particulate organic matter (fOM), rather than an increase in soil organic matter being occluded in aggregates or in organo-mineral complexes, and that C persisted in the fOM fraction as a result of accumulation in the alkyl C region. Unlike fresh litter or plant residues, organic amendments have undergone decomposition during the composting process (or during formation in the case of peat), in the absence of mineral soil components. This ex situ decomposition (and possible stabilization through acquired recalcitrance) could reduce the opportunity to become physically or chemically protected through association with the soil mineral phase following addition to soil. Carbon:Nitrogen (C:N) of amendment material likely influenced the rate of amendment decomposition. In addition, C:N determines the decomposition of plant litter inputs, as determined by the tea bag index.

Cardiometabolic predictors of quantitative high-risk plaque features in a diverse patient population

Background/Introduction

Little is known about the prevalence of high-risk plaque features or cardiometabolic predictors in diverse patient populations with underrepresented minorities, in the setting of stable chest pain.

Purpose

The goals of our study are to 1) describe plaque characteristics in a diverse patient population with underrepresented minorities and 2) characterize cardiometabolic risk factors associated with high prevalence of high-risk quantitative low attenuation noncalcified plaque (LDNCP) burden.

Methods

Our study included patients with chest pain undergoing CCTA between June 2016 and October 2021 for stable chest pain, who had a complete cardiometabolic panel including lipoprotein(a) and lipid panel, and at least one blood pressure recording before CCTA. Patients with prior PCI or CABG where excluded. CACS was performed before CCTA as per Agatston method and quantified in Agatston Units (AU). Stenosis was graded as per SCCT guidelines by cardiologists and radiologists with level 3 cardiac CT expertise. Plaque measurements were performed using previously validated semiautomated software (AutoPlaque version 2.5) in all patients with CAD-RADS >0 by expert readers blinded from patients' characteristics. Coronary atherosclerotic plaque volumes were measured. Independent predictors for plaque on CCTA among patients were examined using Wilcox multivariate logistic regression.

Results

A total of 227 consecutive patients were included in our study (see table; age 55.00 [47.50–62.00] years, 63% female, 16% diabetes, 44% hypertension, 40% hyperlipidemia and 32% with current or previous smoking history). Majority of patients were Hispanic (64%) and the rest were Black (27%), White (6%) and Asian (3%).

Patients with LDNCP burden >4% were older (60.00 [52.00–66.50] vs 53.00 [43.75–61.00]; p<0.001), more likely to be diabetic (27.7 vs 11.5%; p=0.005), hypertensive (67.7 vs 33.8%; p<0.001), hyperlipidemic (64.6 vs 29.9%; p<0.001) and present smokers (31.3 vs 13.9%; p=0.003). Almost all patients (63/67) with LDNCP burden >4% had non-obstructive disease (CAD-RADS<4).

Patient with LDNCP burden >4% were more likely to be on statin therapy (46.0 vs 30.4%; p=0.041). There was no differences in ethnicity, hemoglobin A1C, TC, LDL-C, HLD-C, TGs, lipoprotein(a), SBP or DBP.

By logistic regression analysis, age (OR [CI]: 1.06 [1.01–1.08]), hypertension (2.20, [1.06–4.63]) and hyperlipidemia (2.73 [1.37–5.47]) increased the likelihood of LDNCP burden >4%, but not Lipoprotein (a)>175 nmol/L (OR [CI]: 1.07 [0.48–2.31].

Conclusions

In our cohort of patients with high number of unrepresented minorities presenting with stable chest pain, almost all patients (94%) with LDNCP burden >4% had non-obstructive CAD (CAD-RADS<4). There were no differences in prevalence of LDNCP or CAD-RADS among different ethnic groups. Age, hypertension and hyperlipidemia, were the cardiometabolic factors related to LDNCP burden >4%.

Funding Acknowledgement

Type of funding sources: None.

Applying cover crop residues as diverse mixtures increases initial microbial assimilation of crop residue-derived carbon

Increasing the diversity of crops grown in arable soils delivers multiple ecological functions. Whether mixtures of residues from different crops grown in polyculture contribute to microbial assimilation of carbon (C) to a greater extent than would be expected from applying individual residues is currently unknown. In this study, we used ¹³C isotope labelled cover crop residues (buckwheat, clover, radish, and sunflower) to track microbial assimilation of plant residue-derived C using phospholipid fatty acid (PLFA) analysis. We also quantified microbial assimilation of C derived from the soil organic matter (SOM) because fresh residue inputs also prime the decomposition of SOM. To consider the initial stages of residue decomposition, and preclude microbial turnover, we compared a quaternary mixture of residues with the average effect of their four components 1 day after incorporation. Our results show that the microbial biomass carbon (MBC) in the treatment receiving the mixed residue was significantly greater, by 132% (3.61 μg C g^-1), than the mean plant residue-derived MBC in treatments receiving the four individual components of the mixture. However, there was no evidence that the mixture resulted in any additional assimilation of C derived from native SOM than the average observed in individual residue treatments. We surmise that, during the initial stages of crop residue decomposition, a greater biodiversity of residues increases microbial assimilation to a greater extent than would be expected from applying individual residues either due to faster decomposition or greater carbon use efficiency (CUE). This might be facilitated by functional complementarity in the soil microbiota, permitted by a greater diversity of substrates, reducing competition for any single substrate. Therefore, growing and incorporating crop polycultures (e.g., cover crop mixtures) could be an effective method to increase microbial C assimilation in the early stages of cover crop decomposition.

HIGHLIGHTS

The effect of mixing crop residues on assimilation of C by soil microbial biomass was investigated.The study is important due to recent interest in diverse cover crop mixtures for arable systems.Mixing crop residues enhanced the assimilation of plant residue-derived C into microbial biomass.Growing and incorporating cover crop polycultures may enhance C storage in arable soils.

Management impacts on the dissolved organic carbon release from deadwood, ground vegetation and the forest floor in a temperate Oak woodland

The forest floor is often considered the most important source of dissolved organic carbon (DOC) in forest soils, yet little is known about the relative contribution from different forest floor layers, understorey vegetation and deadwood. Here, we determine the carbon stocks and potential DOC production from forest materials: deadwood, ground vegetation, leaf litter, the fermentation layer and top mineral soil (Ah horizon), and further assess the impact of management. Our research is based on long-term monitoring plots in a temperate deciduous woodland, with one set of plots actively managed by thinning, understorey scrub and deadwood removal, and another set that were not managed in 23 years. We examined long-term data and a spatial survey of forest materials to estimate the relative carbon stocks and concentrations and fluxes of DOC released from these different pools. Long-term soil water monitoring revealed a large difference in median DOC concentrations between the unmanaged (43.8 mg L^-1) and managed (18.4 mg L^-1) sets of plots at 10 cm depth over six years, with the median DOC concentration over twice as high in the unmanaged plots. In our spatial survey, a significantly larger cumulative flux of DOC was released from the unmanaged than the managed site, with 295.5 and 230.3 g m^-2, respectively. Whilst deadwood and leaf litter released the greatest amount of DOC per unit mass, when volume of the material was considered, leaf litter contributed most to DOC flux, with deadwood contributing least. Likewise, there were significant differences in the carbon stocks held by different forest materials that were dependent on site. Vegetation and the fermentation layer held more carbon in the managed site than unmanaged, whilst the opposite occurred in deadwood and the Ah horizon. These findings indicate that management affects the allocation of carbon stored and DOC released between different forest materials.

Association of coronary artery calcium score groups with qualitative and quantitatively assessed adverse plaque

Introduction

Coronary artery calcification is a marker of cardiovascular risk, but its association with qualitatively and quantitatively assessed plaque subtypes on coronary computed tomography (CT) angiography (CCTA) is unknown.

Methods

In this post-hoc analysis, CT images and clinical outcomes were assessed in SCOT-HEART trial participants. Agatston coronary artery calcium score (CACS) was measured on non-contrast CT and was stratified as zero (0 Agatston units, AU), minimal (1 to 9AU), low (10 to 99AU), moderate (100 to 399AU), high (400 to 999AU) and very high (≥1000AU). Adverse plaques were investigated with qualitative (visual categorisation of positive remodelling, low-attenuation plaque, spotty calcification, napkin ring sign) and quantitative (calcified, non-calcified, low-attenuation and total plaque burden) methods.

Results

Images of 1769 patients were assessed (mean age 58±9 years, 56% male, median Agatston score 21 [interquartile range 0 to 230] AU). Of these 36% had a zero, 9% minimal, 20% low, 17% moderate, 10% high and 8% very high CACS. Amongst patients with a zero CACS, 14% had nonobstructive disease, 2% had obstructive disease, 2% had visually assessed adverse plaques and 13% had quantitative low-attenuation plaque (LAP) burden >4% (Figure 1). Non-calcified and low-attenuation plaque burden increased between patients with zero, minimal and low CACS (p<0.001), but there was no difference between those with medium, high and very high CACS. Over a median follow-up of 4.8 [4.1 to 5.7] years, fatal or non-fatal myocardial infarction occurred in 41 patients, 10% of whom had zero CACS. CACS ≥1000AU (Hazard ratio (HR) 4.55 [1.20 to 17.3], p=0.026) and low-attenuation plaque burden (HR 1.74 [1.19 to 2.54], p=0.004) were the only predictors of myocardial infarction, independent of obstructive disease and cardiovascular risk score. Figure 2 shows example CCTA images in a patient with zero CACS, non-calcified plaque (red), low attenuation plaque (orange) burden >4% and obstructive disease in the left anterior descending coronary artery.

Conclusions

In patients with stable chest pain, a zero CACS is associated with a good prognosis, but 1 in 6 have coronary artery disease, including the presence of adverse plaques.

Funding Acknowledgement

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): British Heart Foundation, National Institute of Health/National Heart, Lung, and Blood Institute

Ecotoxicity of oil sludges and residuals from their washing with surfactants: soil dehydrogenase and ryegrass germination tests

Oil sludge washing (OSW) with surfactants and co-solvents is used to recover the oil, and this process leaves some residuals (sediments and surfactant solution). Currently, there are no data on the ecotoxicological effects of these OSW residuals from different sludges. This study evaluated the toxicity of OSW residuals from washing four types of oil sludges with five surfactants (Triton X-100 and X-114, Tween 80, sodium dodecyl sulphate (SDS) and rhamnolipid) and a co-solvent (cyclohexane). The toxicity of the residuals was evaluated with the impact on the soil microbial dehydrogenase activity (DHA) and ryegrass (Lolium perenne) seed germination. There was a high DHA detected directly in the sludges and all OSW residual combinations, but this activity could not be attributed to the DHA itself but to some chemical interferences. The DHA was then tested in the soils amended with the OSW residuals to simulate a bioremediation scenario. There were no chemical interferences in this case. In general, the INTF concentrations were significantly higher at low concentrations, 1 and 5% (p < 0.01). There were no significant differences in the DHA at high concentrations of OSW residuals (10, 25 and 50%) which implied that the concentration of the contaminants is not directly proportional to the levels of ecotoxicity. Unexpectedly, the INTF values of the 10, 25 and 50% rhamnolipid-OSW residuals were significantly lower than the Triton X-100 residuals. The ryegrass germination rates were higher than 70% with no apparent phytotoxicity symptoms in the seedlings. Particularly, there was a highly significant negative effect of the residuals on the germination rates at high concentrations (p < 0.01). Given that the extractable petroleum hydrocarbon (EPH) concentrations in the OSW residual-amended soils in both DHA and germination tests were very low (13-21 ppm), other co-contaminants could be contributing to the toxicity. These findings implied that biotreatment techniques can be applied to treat the OSW residuals if necessary.

Oil sludge washing with surfactants and co-solvents: oil recovery from different types of oil sludges

Different physicochemical and biological treatments have been used to treat oil sludges, and oil recovery techniques are preferred such as oil sludge washing (OSW) with surfactants and co-solvents. Toluene is commonly used as co-solvent, but it is non-benign to the environment. This study tested alternative co-solvents (n-pentane, n-hexane, cyclohexane, and isooctane) at 1:1 and 2:1 C/OS (co-solvent to oil sludge ratio). Also, this study evaluated the effect on the oil recovery rate (ORR) of three main parameters in the washing: type, concentration, and application ratio (S/OS) of surfactants to oil sludges. To date, no study has assessed these parameters in the washing of oil sludges from different sources. Four types of oil sludges and five surfactants (Triton X-100 and X-114, Tween 80, sodium dodecyl sulphate (SDS), and rhamnolipid) were used. The results showed that cyclohexane had high ORR and could be used instead of toluene because it is more benign to the environment. The S/OS ratio had a high effect on the ORR and depended on the type of oil sludge. Rhamnolipid, Triton X-100, and Triton X-114 had the highest oil recovery rates (40 - 70%). In addition, it was found that the surfactant concentration had no effect on the ORR. Consequently, the addition of surfactant was not significantly different compared to the washing with no surfactants, except for one sludge. The use of the surfactant in the washing solution can help in the selective extraction of specific oil hydrocarbon fractions in the recovered oil to assess its potential reuse as fuel. Further recommendations were given to improve the OSW process.

Effects of acidity on dissolved organic carbon in organic soil extracts, pore water and surface litters

Over the past 30-40 years, dissolved organic carbon (DOC) concentrations have increased in soil solutions and surface waters in many acid-sensitive areas of Europe and North America. This has been linked to recovery from acidification in response to decreasing levels of atmospheric pollution. Evidence from radiocarbon dating suggests that DOC in surface waters is typically derived from recently photosynthesised organic matter such as plant litter and exudates, yet there is little information on the pH-sensitivity of organic matter solubility, or its decomposition, in litter layers and in different organic soils. Therefore the purpose of this study was to determine a) the sensitivity of DOC to acidity in different surface layers and soil types, in order to b) improve understanding of the key sources contributing to the increasing DOC trend. Such information is vital for understanding site specific characteristics contributing to inconsistencies in DOC release between catchments, and for improving predictions of carbon fluxes and budgets. Based on data collected at four established field pH-manipulation experiments in upland areas of the United Kingdom, we examined the sources, composition and acid-sensitivity of DOC export from the litter and organic soils. We found that litter generated nearly three times more DOC than the organic soils, consistent with radiocarbon evidence that recent plant inputs are a major source of DOC. Furthermore, litter derived DOC had lower specific ultraviolet light absorbance (SUVA) than organic soil DOC, suggesting greater biodegradability, and was not acid sensitive. In contrast, organic soil DOC concentrations were more strongly related to experimentally manipulated pH, implying that the mobility of this DOC may be subject to physicochemical rather than biotic controls. Our results suggest that physicochemically mediated controls on organic matter solubility may be a key driver behind the widely observed increases in surface water DOC in areas undergoing recovery from acidification.

P861A quantitative CCTA evaluation in non-obstructive coronary artery disease for the diagnosis of vessel-specific ischemia: results from the prospective, multicenter, international CREDENCE trial

Aim

To improve the diagnosis of coronary vessel-specific ischemia in non-obstructive coronary artery disease (CAD) using a quantitative whole-heart coronary computed tomography angiography (CCTA) evaluation. To date, predictors of ischemia in non-obstructive CAD remain underexplored.

Methods

Within the CREDENCE trial, 612 patients with suspected CAD at 13 sites (64±10 years, 70% men) underwent coronary computed tomography angiography (CCTA) and invasive coronary angiography with 3-vessel fractional flow reserve (FFR) measurements. For this specific analysis, only vessels with non-obstructive plaque (1–49% maximal diameter stenosis) by CCTA were included. The primary endpoint was coronary vessel-specific ischemia which was defined as FFR ≤0.80 (or ≥90% stenosis). Multivariable logistic regression modeling was performed to evaluate the effect of quantitative CCTA features beyond coronary stenosis on the prevalence of vessel-specific ischemia.

Results

FFR ≤0.80 (or ≥90% stenosis) was prevalent in 22.8% of 1,102 vessels with non-obstructive plaque. Using a step-wise approach, in addition to diameter stenosis (χ2=72), non-calcified PAV (χ2=126, P<0.001), lumen volume (χ2=175, P<0.001) and number of lesions with >30% stenosis (χ2=187, P=0.001) were independent CCTA-predictors of coronary vessel-specific ischemia (Figure 1). In the final model, diameter stenosis was no longer significantly associated with ischemia (P=0.236).

Figure 1

Conclusion

In vessels with non-obstructive plaque on CCTA, ischemia was present in approximately 20%. Measures of overall non-calcified plaque burden and smaller lumen volume were more important determinants of vessel-specific ischemia than maximal diameter stenosis.

Acknowledgement/Funding

NIH R01-HLL118019; Dalio Foundation and Michael J. Wolk Foundation

P6165Sex differences in compositional plaque volume progression in patients with stable coronary artery disease: observations from a serial CCTA registry

Background

It is unclear whether sex impacts the plaque volume (PV) progression in patients with stable coronary artery disease (CAD).

Purpose

To explore whether the total and compositional PV progression rate differ according to sex.

Methods

We performed a prospective multinational registry of consecutive patients who underwent serial CCTA at ≥2-year interval. Total and compositional PV at baseline and follow-up were quantitatively analysed and normalized using the analysed total vessel length. Multivariate linear regression models were constructed for each women and men.

Results

Of the 1,255 patients included (median CT interval 3.8 years), 543 were women and 712 were men. Women were older (62±9 years vs. 59±9 years, p<0.001) and had higher total cholesterol level (195±41mg/dL vs. 187±39mg/dL, p=0.002). Prevalence of hypertension, diabetes, and family history of CAD were not different (all p>0.05).

At baseline, men possessed greater total PV (131.5±230.5mm3 vs. 97.7±193.6mm3, p=0.005) and a higher prevalence of high-risk plaques (HRP) than women (31% vs. 20%, p<0.001). Annual total PV progression rate was greater in men, driven by the greater non-calcified PV progression (TABLE).

In multivariate analysis (TABLE), although total PV progression rate was not different, women were associated with greater calcified PV progression (β=2.83, p=0.004) but slower non-calcified PV progression (β=-3.39, p=0.008) and less development of HRP (β=-0.18, p=0.049) than men.

CCTA findings according to sex Univariate analysis Female Sex in Multivariable Analysis Women (n=543) Men (n=712) P β SE P Agatston CACS, /year 0.44±0.7 0.4±0.7 0.332 0.106 0.04 0.006 Total PVnormalized, mm3/year 14.7±23.4 17.8±26.2 0.026 -0.56 1.33 0.677 Calcified PVnormalized, mm3/year 10.5±21.5 10.0±19.1 0.670 2.83 0.98 0.004 Non-calcified PVnormalized, mm3/year 4.2±17.3 7.8±21.2 0.001 -3.39 1.28 0.008 Development of high-risk plaque*, n (%) 86 (15.8) 139 (19.5) 0.092 -0.18 0.09 0.049 In linear multivariate regression analysis adjusted with age, race, HTN, DM, family history, smoking, LDL, statin, anti-platelets, beta-blockers, and PV at baseline, women were associated with greater calcified PV progression and slower non-calcified PV progression. (High-risk plaque was defined as ≥2 of low-attenuation plaque, spotty calcification, and positive remodelling.)

Conclusion

In this large CCTA cohort, we found that the compositional PV progression differs according to sex. These findings, which are hypothesis generating, suggest that comprehensive plaque evaluation may contribute to further refine risk stratification according to sex.

Acknowledgement/Funding

This work was supported by the National Research Foundation of Korea funded by the Ministry of Science and ICT (Grant No. 2012027176).

P6162Difference in progression to obstructive lesions according to the presence of high-risk plaque features

Background

It is still debatable whether the so-called high-risk plaque (HRP) simply represents a certain phase during the natural history of coronary atherosclerotic plaques or the disease progression would differ according to the presence of HRP.

Purpose

We determined whether the pattern of non-obstructive lesion progression into obstructive lesions would differ according to the presence of HRP.

Methods

Patients with non-obstructive coronary artery disease, defined as % diameter stenosis (%DS) ≥50%, were enrolled from a prospective, multinational registry of consecutive patients who underwent serial coronary computed tomography angiography at an inter-scan interval of ≥2 years. HRP was defined as lesions with ≥2 of positive remodelling, spotty calcification, and low-attenuation plaque. The total and compositional percent atheroma volume (PAV) at baseline and annualized PAV change were compared between non-HRP and HRP lesions.

Results

A total of 1,115 non-obstructive lesions were identified from 327 patients (61.1±8.9 years old, 66.0% male). There were 690 non-HRP and 425 HRP lesions. HRP lesions possessed greater PAV and %DS at baseline compared to non-HRP lesions. However, the annualized total and non-calcified PAV change were greater in non-HRP lesions than in HRP lesions. On multivariate analysis, addition of baseline PAV and %DS to clinical risk factors improved the predictive power of the model (Table). When clinical risk factors, PAV, %DS, and HRP were all adjusted on Model 3, only baseline PAV and %DS independently predicted the development of obstructive lesions (hazard ratio (HR) 1.046 [95% confidence interval (CI): 1.026–1.066] and HR 1.087 [95% CI: 1.055–1.119], respectively, all p<0.001), while HRP did not (p>0.05).

Comparison of C-statistics of per-lesion analysis to predict progression to obstructive lesion C-statistics (95% CI) P Model 1: Baseline PAV 0.880 (0.879–0.884) – Model 2: Model 1 + baseline %DS 0.938 (0.937–0.939) vs. Model 1: <0.001 Model 3: Model 2 + HRP 0.935 (0.934–0.937) vs. Model 2: 0.004 Adjusted for age, male sex, hypertension, diabetes mellitus, hyperlipidemia, family history of coronary artery disease, smoking, body mass index, and statin use.

Conclusion

The pattern of individual coronary atherosclerotic plaque progression differed according to the presence of HRP. Baseline PAV was the most important predictor for lesions developing into obstructive lesions rather than the presence of HRP features at baseline.

Acknowledgement/Funding

This work was supported by the National Research Foundation of Korea funded by the Ministry of Science and ICT (Grant No. 2012027176).

P868Temporal remodeling of coronary arteries during progression of atherosclerosis with serial coronary CT angiography using 3D metrics: results from the PARADIGM study

Aim

To determine compensatory enlargement and luminal reduction of coronary arteries during the progression of atherosclerosis with serial coronary computed tomography angiography (CCTA) by using volumetric measurements. To date, the impact of coronary plaque progression on temporal remodeling, as opposed to the static remodeling, has only been studied with invasive imaging modalities and primarily two-dimensional areas rather than three-dimensional volumes.

Methods

In total, 1,245 patients with suspected coronary artery disease (CAD) at 13 sites (61±9 years, 39% women) underwent serial CCTA with interscan interval of ≥2 years. The primary objective was to assess volumetric temporal remodeling, defined as the linear association between the change in coronary plaque, lumen and vessel volume at follow-up CCTA on a per-segment level. Temporal remodeling was determined in strata of low and high baseline plaque burden as well as different coronary segments at baseline. Linear regression analysis and Pearson's correlation coefficients were calculated to assess associations.

Results

Amongst 1,245 patients with 19,920 segments, the median interscan interval was 3.3 (IQR 2.6–4.8) years. For each 1 mm3 increase in plaque volume, the increase in vessel volume was 0.72 mm3 and the decrease in lumen volume was 0.28 mm3 (Figure 1, both p<0.001). Volumetric temporal remodeling was similar in low versus high PAV [0.70 mm3 vs 0.73 mm3 (p for interaction=0.491)] and left-main arteries versus all other segments [0.78 mm3 vs. 0.72 mm3 (p for interaction=0.336)], but not in proximal versus distal segments at baseline [0.75 mm3 vs. 0.61 mm3 (p for interaction=0.020)].

Figure 1. Volumetric temporal remodeling

Conclusion

In general, coronary plaque grows approximately 70% outward and 30% into the coronary lumen during the progression of atherosclerosis. Volumetric temporal remodeling is not limited by baseline plaque burden, but is potentially dependent on its location within the coronary artery tree.

Acknowledgement/Funding

NRF of Korea (Grant No. 2012027176); Dalio Institute of Cardiovascular Imaging and Michael J. Wolk Foundation

4182Sex specific patterns in the onset and manifestation of coronary atherosclerotic plaque; insights from the multi-center CCTA CONFIRM registry

Background

Pathobiologic data support varied atherosclerotic plaque characteristics which uniquely define risk in women as compared to men (i.e., plaque erosion versus rupture). The advent of noninvasive coronary computed tomographic angiography (CCTA) allows for further exploration as to a sex-specific signature of atherosclerotic plaque features unique to women and different from that of men. In this analysis, we compared sex differences in the age of onset of coronary atherosclerosis and varied plaque findings between women and men.

Methods

From the multicenter CONFIRM registry, the Leiden CCTA score (based on segmental plaque extent, location, severity, and composition) was calculated in women and men without prior CAD, with imputation for missing plaque data. First, women and men were matched on the Leiden CCTA score to allow assessment of differences in atherosclerotic profile. Second, the earliest age of women and men to display a median Leiden CCTA score >0, >2, >6, >8 was evaluated. Third, the prognostic value of previously established thresholds of the Leiden CCTA score was examined for all-cause mortality with Cox-proportional hazard analysis, and specifically a sex interaction.

Results

In total, 11,678 women (age 58.5±12.4 years) and 13,272 men (age 55.6±12.5 years) were included. Of the patient subset matched on Leiden CCTA score (10,266 women, score 4.1±6.0 and 10,266 men, Leiden score 4.1±6.0, P=0.589), women were characterized by less obstructive CAD (≥50% stenosis) (17.5% vs 19.1%, P=0.003), more frequent non-obstructive left main plaque (10.1% vs 8.9%, P=0.004) and a lower number of segments with non-calcified or mixed plaque, but an equal number of calcified plaques. The earliest age when women and men have a median Leiden CCTA score above 0, 2, 4, 6, or 8 was consistently 14 to 16 years later for women. A visual representation of the CAD development delay is shown in Figure 1. Adjusted for age, the hazard ratio for death (827 events) for a score 6–20, and >20 (compared with 0–6) was 1.95 (95% CI 1.56–2.42), and 3.44 (95% CI 2.40–4.93) for women, respectively, and 1.63 (95% CI 1.31–2.03), 2.22 (95% CI 1.64–3.00) for men, respectively (P-interaction 0.006). Despite the low number of events, women <50 years with a score >20 were at 12.8 (95% CI 3.58–45.73) times increased risk.

Conclusion

There is an approximate 15-year delay in onset of coronary atherosclerosis for women compared to men. The burden of atherosclerotic plaque is associated with a higher relative hazard for death among women than men. The pattern of more nonobstructive CAD, especially in the left main coronary artery, but also less non-calcified plaque supports a sex-specific plaque signature which may uniquely define risk among women as compared to men.

Acknowledgement/Funding

The research reported in this manuscript was funded, in part, by the National Institute of Health (Bethesda, MD, USA) under award number R01 HL115150.

Apportioning bacterial carbon source utilization in soil using 14 C isotope analysis of FISH-targeted bacterial populations sorted by fluorescence activated cell sorting (FACS): 14 C-FISH-FACS

An unresolved need in microbial ecology is methodology to enable quantitative analysis of in situ microbial substrate carbon use at the population level. Here, we evaluated if a novel combination of radiocarbon-labelled substrate tracing, fluorescence in situ hybridisation (FISH) and fluorescence-activated cell sorting (FACS) to sort the FISH-targeted population for quantification of incorporated radioactivity (¹⁴ C-FISH-FACS) can address this need. Our test scenario used FISH probe PSE1284 targeting Pseudomonas spp. (and some Burkholderia spp.) and salicylic acid added to rhizosphere soil. We examined salicylic acid-¹⁴ C fate (mineralized, cell-incorporated, extractable and non-extractable) and mass balance (0-24 h) and show that the PSE1284 population captured ∼ 50% of the Nycodenz extracted biomass ¹⁴ C. Analysis of the taxonomic distribution of the salicylic acid biodegradation trait suggested that PSE1284 population success was not due to conservation of this trait but due to competitiveness for the added carbon. Adding 50KBq of ¹⁴ C sample^-1 enabled detection of ¹⁴ C in the sorted population at ∼ 60-600 times background; a sensitivity which demonstrates potential extension to analysis of rarer/less active populations. Given its sensitivity and compatibility with obtaining a C mass balance, ¹⁴ C-FISH-FACS allows quantitative dissection of C flow within the microbial biomass that has hitherto not been achieved.

Appropriate use of noninvasive ischemia testing to guide revascularization decision making following acute ST elevation myocardial infarction in Latin American countries: Results from an expert panel meeting of the International Atomic Energy Agency

Across Latin American and Caribbean countries, cardiovascular disease and especially ischemic heart disease is currently the main cause of death both in men and in women. For most Latin American and Caribbean countries, public and community health efforts aim to define care strategies which are both clinically and cost effective and promote primary and secondary prevention, resulting in improved patient outcomes. The optimal approach to deal with acute events such as ST-elevation myocardial infarction (STEMI) is a matter of controversy; however, there is an expanding role for assessing residual ischemic burden in STEMI patients following primary percutaneous coronary intervention. Although randomized clinical trials have established the value of staged fractional flow reserve-guided revascularization, the use of noninvasive functional imaging modalities may play a similar role at a much lower cost. For LAC, available stress imaging techniques could be applied to define residual ischemia in the non-infarct related artery and to target revascularization in a staged procedure after primary percutaneous coronary intervention The use of nuclear cardiac imaging, supported by its relatively wide availability, moderate cost, and robust quantitative capabilities, may serve to guide effective care and to reduce subsequent cardiac events in patients with coronary artery disease. This noninvasive approach may avert potential safety issues with repeat and lengthy invasive procedures, and serve as a baseline for subsequent follow-up stress testing following the index STEMI event. This consensus document was devised from an expert panel meeting of the International Atomic Energy Agency, highlighting available evidence with a focus on the utility of stress myocardial perfusion imaging in post-STEMI patients. The document could serve as guidance to the prudent and appropriate use of nuclear imaging for targeting therapeutic management and avoiding unnecessary invasive procedures within Latin American and Caribbean countries, where resources could be scarce.

Coping with Environmental Eukaryotes; Identification of Pseudomonas syringae Genes during the Interaction with Alternative Hosts or Predators

Understanding the molecular mechanisms underpinning the ecological success of plant pathogens is critical to develop strategies for controlling diseases and protecting crops. Recent observations have shown that plant pathogenic bacteria, particularly Pseudomonas, exist in a range of natural environments away from their natural plant host e.g., water courses, soil, non-host plants. This exposes them to a variety of eukaryotic predators such as nematodes, insects and amoebae present in the environment. Nematodes and amoeba in particular are bacterial predators while insect herbivores may act as indirect predators, ingesting bacteria on plant tissue. We therefore postulated that bacteria are probably under selective pressure to avoid or survive predation and have therefore developed appropriate coping mechanisms. We tested the hypothesis that plant pathogenic Pseudomonas syringae are able to cope with predation pressure and found that three pathovars show weak, but significant resistance or toxicity. To identify the gene systems that contribute to resistance or toxicity we applied a heterologous screening technique, called Rapid Virulence Annotation (RVA), for anti-predation and toxicity mechanisms. Three cosmid libraries for P. syringae pv. aesculi, pv. tomato and pv. phaseolicola, of approximately 2000 cosmids each, were screened in the susceptible/non-toxic bacterium Escherichia coli against nematode, amoebae and an insect. A number of potential conserved and unique genes were identified which included genes encoding haemolysins, biofilm formation, motility and adhesion. These data provide the first multi-pathovar comparative insight to how plant pathogens cope with different predation pressures and infection of an insect gut and provide a foundation for further study into the function of selected genes and their role in ecological success.

Is there sufficient Ensifer and Rhizobium species diversity in UK farmland soils to support red clover (Trifolium pratense), white clover (T. repens), lucerne (Medicago sativa) and black medic (M. lupulina)?

Rhizobia play important roles in agriculture owing to their ability to fix nitrogen through a symbiosis with legumes. The specificity of rhizobia-legume associations means that underused legume species may depend on seed inoculation with their rhizobial partners. For black medic (Medicago lupulina) and lucerne (Medicago sativa) little is known about the natural prevalence of their rhizobial partner Ensifer meliloti in UK soils, so that the need for inoculating them is unclear. We analysed the site-dependence of rhizobial seed inoculation effects on the subsequent ability of rhizobial communities to form symbioses with four legume species (Medicago lupulina, M. sativa, Trifolium repens and T. pratense). At ten organic farms across the UK, a species-diverse legume based mixture (LBM) which included these four species was grown. The LBM seed was inoculated with a mix of commercial inocula specific for clover and lucerne. At each site, soil from the LBM treatment was compared to the soil sampled prior to the sowing of the LBM (the control). From each site and each of the two treatments, a suspension of soils was applied to seedlings of the four legume species and grown in axenic conditions for six weeks. Root nodules were counted and their rhizobia isolated. PCR and sequencing of a fragment of the gyrB gene from rhizobial isolates allowed identification of strains. The number of nodules on each of the four legume species was significantly increased when inoculated with soil from the LBM treatment compared to the control. Both the proportion of plants forming nodules and the number of nodules formed varied significantly by site, with sites significantly affecting the Medicago species but not the Trifolium species. These differences in nodulation were broadly reflected in plant biomass where site and treatment interacted; at some sites there was a significant advantage from inoculation with the commercial inoculum but not at others. In particular, this study has demonstrated the commercial merit of inoculation of lucerne with compatible rhizobia.

Adsorption of Pb and Zn from binary metal solutions and in the presence of dissolved organic carbon by DTPA-functionalised, silica-coated magnetic nanoparticles

The ability of diethylenetriaminepentaacetic acid (DTPA)-functionalised, silica-coated magnetic nanoparticles to adsorb Pb and Zn from single and bi-metallic metal solutions and from solutions containing dissolved organic carbon was assessed. In all experiments 10 mL solutions containing 10 mg of nanoparticles were used. For single metal solutions (10 mg L^-1 Pb or Zn) at pH 2 to 8, extraction efficiencies were typically >70%. In bi-metallic experiments, examining the effect of a background of either Zn or Pb (0.025 mmol L^-1) on the adsorption of variable concentrations (0-0.045 mmol L^-1) of the other metal (Pb or Zn, respectively) adsorption was well modelled by linear isotherms (R² > 0.60; p ≤ 0.001) and Pb was preferentially adsorbed relative to Zn. In dissolved organic carbon experiments, the presence of fulvic acid (0, 2.1 and 21 mg DOC L^-1) reduced Pb and Zn adsorption from 0.01, 0.1 and 1.0 mmol L^-1 solutions. However, even at 21 mg DOC L^-1 fulvic acid, extraction efficiencies from 0.01 to 0.1 mmol L^-1 solutions remained >80% (Pb) and >50% (Zn). Decreases in extraction efficiency were significant between initial metal concentrations of 0.1 and 1.0 mmol L^-1 indicating that at metal loadings between c. 100 mg kg^-1 and 300 mg kg^-1 occupancy of adsorption sites began to limit further adsorption. The nanoparticles have the potential to perform effectively as metal adsorbents in systems containing more than one metal and dissolved organic carbon at a range of pH values.

Novel European free-living, non-diazotrophic Bradyrhizobium isolates from contrasting soils that lack nodulation and nitrogen fixation genes - a genome comparison

The slow-growing genus Bradyrhizobium is biologically important in soils, with different representatives found to perform a range of biochemical functions including photosynthesis, induction of root nodules and symbiotic nitrogen fixation and denitrification. Consequently, the role of the genus in soil ecology and biogeochemical transformations is of agricultural and environmental significance. Some isolates of Bradyrhizobium have been shown to be non-symbiotic and do not possess the ability to form nodules. Here we present the genome and gene annotations of two such free-living Bradyrhizobium isolates, named G22 and BF49, from soils with differing long-term management regimes (grassland and bare fallow respectively) in addition to carbon metabolism analysis. These Bradyrhizobium isolates are the first to be isolated and sequenced from European soil and are the first free-living Bradyrhizobium isolates, lacking both nodulation and nitrogen fixation genes, to have their genomes sequenced and assembled from cultured samples. The G22 and BF49 genomes are distinctly different with respect to size and number of genes; the grassland isolate also contains a plasmid. There are also a number of functional differences between these isolates and other published genomes, suggesting that this ubiquitous genus is extremely heterogeneous and has roles within the community not including symbiotic nitrogen fixation.

HIV, highly active antiretroviral therapy and the heart: a cellular to epidemiological review

The advent of potent highly active antiretroviral therapy (HAART) for persons infected with HIV-1 has led to a "new" chronic disease with complications including cardiovascular disease (CVD). CVD is a significant cause of morbidity and mortality in persons with HIV infection. In addition to traditional risk factors such as smoking, hypertension, insulin resistance and dyslipidaemia, infection with HIV is an independent risk factor for CVD. This review summarizes: (1) the vascular and nonvascular cardiac manifestations of HIV infection; (2) cardiometabolic effects of HAART; (3) atherosclerotic cardiovascular disease (ASCVD) risk assessment, prevention and treatment in persons with HIV-1 infection.

Does ochre have the potential to be a remedial treatment for As-contaminated soils?

Ochre is an iron oxyhydroxide-rich waste that accumulates in water bodies associated with disused mines. Laboratory experiments were conducted to examine the potential of four different ochres to be used as remedial agents for As contaminated soils. The ochres removed As from solution (200 and 500 mg L(-1)) in adsorption experiments at pH 3 and 8 and, when added to As contaminated soil (5% w/w) significantly reduced As release to solution. In both these experiments the highest surface area ochres performed best. The impact of ochre amendments on uptake of As from soil by plants and humans and release of As to ground water was assessed in a year-long incubation study. Ochres increased soil pH and reduced CaCl2 extractable As but had no consistent effect on plant growth, plant As uptake or As extraction in physiologically-based extraction tests. Ochre may be better used for water treatment than soil remediation.

The role of soil microbes in the global carbon cycle: tracking the below-ground microbial processing of plant-derived carbon for manipulating carbon dynamics in agricultural systems

It is well known that atmospheric concentrations of carbon dioxide (CO2) (and other greenhouse gases) have increased markedly as a result of human activity since the industrial revolution. It is perhaps less appreciated that natural and managed soils are an important source and sink for atmospheric CO2 and that, primarily as a result of the activities of soil microorganisms, there is a soil-derived respiratory flux of CO2 to the atmosphere that overshadows by tenfold the annual CO2 flux from fossil fuel emissions. Therefore small changes in the soil carbon cycle could have large impacts on atmospheric CO2 concentrations. Here we discuss the role of soil microbes in the global carbon cycle and review the main methods that have been used to identify the microorganisms responsible for the processing of plant photosynthetic carbon inputs to soil. We discuss whether application of these techniques can provide the information required to underpin the management of agro-ecosystems for carbon sequestration and increased agricultural sustainability. We conclude that, although crucial in enabling the identification of plant-derived carbon-utilising microbes, current technologies lack the high-throughput ability to quantitatively apportion carbon use by phylogentic groups and its use efficiency and destination within the microbial metabolome. It is this information that is required to inform rational manipulation of the plant-soil system to favour organisms or physiologies most important for promoting soil carbon storage in agricultural soil.

Nanoscale zerovalent iron alters soil bacterial community structure and inhibits chloroaromatic biodegradation potential in Aroclor 1242-contaminated soil

Nanoscale zerovalent iron (nZVI) has potential for the remediation of organochlorine-contaminated environments. Environmental safety concerns associated with in situ deployment of nZVI include potential negative impacts on indigenous microbes whose biodegradative functions could contribute to contaminant remediation. With respect to a two-step polychlorinated biphenyl remediation scenario comprising nZVI dechlorination followed by aerobic biodegradation, we examined the effect of polyacrylic acid (PAA)-coated nZVI (mean diameter = 12.5 nm) applied at 10 g nZVI kg(-1) to Aroclor-1242 contaminated and uncontaminated soil over 28 days. nZVI had a limited effect on Aroclor congener profiles, but, either directly or indirectly via changes to soil physico-chemical conditions (pH, Eh), nZVI addition caused perturbation to soil bacterial community composition, and reduced the activity of chloroaromatic mineralizing microorganisms. We conclude that nZVI addition has the potential to inhibit microbial functions that could be important for PCB remediation strategies combining nZVI treatment and biodegradation.

Assessing the impact of nano- and micro-scale zerovalent iron particles on soil microbial activities: particle reactivity interferes with assay conditions and interpretation of genuine microbial effects

The effects of nano-scale and micro-scale zerovalent iron (nZVI and mZVI) particles on general (dehydrogenase and hydrolase) and specific (ammonia oxidation potential, AOP) activities mediated by the microbial community in an uncontaminated soil were examined. nZVI (diameter 12.5 nm; 10 mg g⁻¹ soil) apparently inhibited AOP and nZVI and mZVI apparently stimulated dehydrogenase activity but had minimal influence on hydrolase activity. Sterile experiments revealed that the apparent inhibition of AOP could not be interpreted as such due to the confounding action of the particles, whereas, the nZVI-enhanced dehydrogenase activity could represent the genuine response of a stimulated microbial population or an artifact of ZVI reactivity. Overall, there was no evidence for negative effects of nZVI or mZVI on the processes studied. When examining the impact of redox active particles such as ZVI on microbial oxidation-reduction reactions, potential confounding effects of the test particles on assay conditions should be considered.

SPECT/PET myocardial perfusion imaging versus coronary CT angiography in patients with known or suspected CAD

Stress SPECT myocardial perfusion imaging (MPI) is the most commonly utilized stress imaging technique for patients with suspected or known coronary artery disease (CAD) and has a robust evidence base including the support of numerous clinical guidelines. Gated SPECT is a well-established noninvasive imaging modalities that is a core element in evaluation of patients with both acute and stable chest pain syndromes. Over the past decade, PET has become increasingly used for the same applications. By comparison, cardiac computed tomography (CT) is a more recently developed method, providing non-invasive approaches for imaging coronary atherosclerosis and coronary artery stenosis. Non-contrast CT for imaging the extent of coronary artery calcification (CAC), in clinical use since the mid-1990's, has a very extensive evidence base supporting its use in CAD prevention. While contrast-enhanced CT for noninvasive CT coronary angiography (CCTA) is relatively new, it has already developed an extensive base of evidence regarding diagnosing obstructive CAD and more recently evidence has emerged regarding its prognostic value. It is likely that non-contrast CT or CCTA for assessment of extent of atherosclerosis will become an increasing part of mainstream cardiovascular imaging practices as a first line test. In some patients, further ischemia testing with MPI will be required. Similarly, MPI will continue to be widely used as a first-line test, and in some patients, further anatomic definition of atherosclerosis with CT will also be appropriate. This review will provide a synopsis of the available literature on imaging that integrates both CT and MPI in strategies for the assessment of asymptomatic patients for their atherosclerotic coronary disease burden and risk as well as symptomatic patients for diagnosis and guiding management. We propose possible strategies through which imaging might be used to identify asymptomatic candidates for more intensive prevention and risk factor modification strategies as well as symptomatic patients who would benefit from referral to invasive coronary angiography for consideration of revascularization.

Impact of contrast echocardiography on diagnostic algorithms: pharmacoeconomic implications

The major goal of medicine in the era of managed care is to control escalating costs and to attain a high level of quality health care. Capitation has limited access to expensive and unnecessary testing, placing an emphasis on the prudent use of available technology. A vast armamentarium of available diagnostic screening tests are available within cardiology. Routine two-dimensional (2-D) echocardiography is a high-quality, low-cost test that provides enhanced portability and real-time test interpretation over other noninvasive test modalities. The echocardiogram may cost up to 50% less than competitive nuclear single-photon emission computed tomography (SPECT) imaging. However, on average 10% of routine and 33% of stress echocardiograms are suboptimal (disproportionately affecting obese patients and those with lung disease). Myocardial contrast echocardiography has been shown to provide enhanced endocardial border delineation and left ventricular opacification, to enhance Doppler signal, and to provide information on myocardial perfusion. In several recent phase II and III studies, the use of a contrast agent has been shown to improve the diagnostic accuracy of echocardiography substantially. Improvements in the diagnostic capabilities of echocardiography have been shown to (1) impact upon downstream repetitive testing in patients with an initially nondiagnostic echocardiogram, (2) potentially increase laboratory throughput, and (3) reduce the rate of false-positive and negative tests as a result of improved image quality. As clinical and cost-effectiveness parallel one another, the use of myocardial contrast echocardiography in selected patient cohorts will result in improved diagnostic accuracy and a cost-effective pattern of care.

Coronary heart disease in women: update 2008

Coronary heart disease (CHD) remains the leading cause of mortality for US women, responsible for almost 250,000 deaths annually. Preventive heart-health behavioral changes by women and aggressive coronary risk reduction can decrease the number of women disabled and killed by CHD. Angina is the predominant initial and subsequent presentation of CHD in women; categorization of chest pain and risk stratification of women assume pivotal roles. A robust evidence-based algorithm can guide cardiovascular imaging techniques to evaluate women with suspected myocardial ischemia to detect those with worsened survival. Restricted functional capacity (<5 METs) is a consistent marker of worsened prognosis. Younger women have substantially higher mortality rates than men following myocardial infarction and coronary bypass surgery. Although these women have more comorbidity and risk factors, other issues including biological differences, treatment differences, and psychosocial factors require management strategies tailored to the unique needs of women.

Biochemical and bioimaging markers for risk assessment and diagnosis in major cardiovascular diseases: a road to integration of complementary diagnostic tools

This report from the first International Course on Integrated Biomarkers, Biochemical and Bioimaging Endpoints in Cardiovascular Diagnosis, Prevention, Therapy and Drug Development provides the basis for optimizing diagnostic, prognostic and therapeutic information in four areas of cardiovascular medicine: primary prevention of cardiovascular diseases, acute coronary syndromes, heart failure and stroke. Risk stratification and treatment strategies can be refined and enhanced through integration of bioimaging and biochemical markers to characterize sub-clinical and clinical atherosclerosis. For the integrative approach to be useful, each of the biomarkers must be validated and cost-effective. Clinical decision is the primary level of integration and is based on clinical evaluation and the use of a combination of bioimaging and biochemical markers. The decision to initiate preventive or therapeutic intervention must take into account the factors affecting the levels of expression of the biomarker and the potential input the biomarker has on metabolic processes or modulation of other biomarkers. The optimal approach to intervention must take into consideration the risk-benefit and cost-effectiveness ratios.

Perception and modification of plant flavonoid signals by rhizosphere microorganisms

Flavonoids are a diverse class of polyphenolic compounds that are produced as a result of plant secondary metabolism. They are known to play a multifunctional role in rhizospheric plant-microbe and plant-plant communication. Most familiar is their function as a signal in initiation of the legume-rhizobia symbiosis, but, flavonoids may also be signals in the establishment of arbuscular mycorrhizal symbiosis and are known agents in plant defence and in allelopathic interactions. Flavonoid perception by, and impact on, their microbial targets (e.g. rhizobia, plant pathogens) is relatively well characterized. However, potential impacts on 'non-target' rhizosphere inhabitants ('non-target' is used to distinguish those microorganisms not conventionally known as targets) have not been thoroughly investigated. Thus, this review first summarizes the conventional roles of flavonoids as nod gene inducers, phytoalexins and allelochemicals before exploring questions concerning 'non-target' impacts. We hypothesize that flavonoids act to shape rhizosphere microbial community structure because they represent a potential source of carbon and toxicity and that they impact on rhizosphere function, for example, by accelerating the biodegradation of xenobiotics. We also examine the reverse question, 'how do rhizosphere microbial communities impact on flavonoid signals?' The presence of microorganisms undoubtedly influences the quality and quantity of flavonoids present in the rhizosphere, both through modification of root exudation patterns and microbial catabolism of exudates. Microbial alteration and attenuation of flavonoid signals may have ecological consequences for below-ground plant-microbe and plant-plant interaction. We have a lack of knowledge concerning the composition, concentration and bioavailability of flavonoids actually experienced by microbes in an intact rhizosphere, but this may be addressed through advances in microspectroscopic and biosensor techniques. Through the use of plant mutants defective in flavonoid biosynthesis, we may also start to address the question of the significance of flavonoids in shaping rhizosphere community structure and function.

Diagnostic and prognostic value of non-invasive imaging in known or suspected coronary artery disease

The role of non-invasive imaging techniques in the evaluation of patients with suspected or known coronary artery disease (CAD) has increased exponentially over the past decade. The traditionally available imaging modalities, including nuclear imaging, stress echocardiography and magnetic resonance imaging (MRI), have relied on detection of CAD by visualisation of its functional consequences (i.e. ischaemia). However, extensive research is being invested in the development of non-invasive anatomical imaging using computed tomography or MRI to allow detection of (significant) atherosclerosis, eventually at a preclinical stage. In addition to establishing the presence of or excluding CAD, identification of patients at high risk for cardiac events is of paramount importance to determine post-test management, and the majority of non-invasive imaging tests can also be used for this purpose. The aim of this review is to provide an overview of the available non-invasive imaging modalities and their merits for the diagnostic and prognostic work-up in patients with suspected or known CAD.

Nitrosospira spp. can produce nitrous oxide via a nitrifier denitrification pathway

Nitrous oxide (N(2)O) emission from soils is a major contributor to the atmospheric loading of this potent greenhouse gas. It is thought that autotrophic ammonia oxidizing bacteria (AOB) are a significant source of soil-derived N(2)O and a denitrification pathway (i.e. reduction of NO(2) (-) to NO and N(2)O), so-called nitrifier denitrification, has been demonstrated as a N(2)O production mechanism in Nitrosomonas europaea. It is thought that Nitrosospira spp. are the dominant AOB in soil, but little information is available on their ability to produce N(2)O or on the existence of a nitrifier denitrification pathway in this lineage. This study aims to characterize N(2)O production and nitrifier denitrification in seven strains of AOB representative of clusters 0, 2 and 3 in the cultured Nitrosospira lineage. Nitrosomonas europaea ATCC 19718 and ATCC 25978 were analysed for comparison. The aerobically incubated test strains produced significant (P < 0.001) amounts of N(2)O and total N(2)O production rates ranged from 2.0 amol cell(-1) h(-1), in Nitrosospira tenuis strain NV12, to 58.0 amol cell(-1) h(-1), in N. europaea ATCC 19718. Nitrosomonas europaea ATCC 19718 was atypical in that it produced four times more N(2)O than the next highest producing strain. All AOB tested were able to carry out nitrifier denitrification under aerobic conditions, as determined by production of (15)N-N(2)O from applied (15)N-NO(2) (-). Up to 13.5% of the N(2)O produced was derived from the exogenously applied (15)N-NO(2) (-). The results suggest that nitrifier denitrification could be a universal trait in the betaproteobacterial AOB and its potential ecological significance is discussed.

Diagnostic and clinical perspectives of fusion imaging in cardiology: is the total greater than the sum of its parts?

Positron emission tomography, cardiovascular magnetic resonance and multislice computed tomography have contributed to changing our pathophysiological understanding of many conditions. Clinically, they have provided new tools for the identification of preclinical disease and a better understanding of how disease progresses. The application of these imaging modalities to preclinical disease and the use of these techniques in patients with overt cardiovascular disease are reviewed.

Rhizodeposition and the enhanced mineralization of 2,4-dichlorophenoxyacetic acid in soil from the Trifolium pratense rhizosphere

Enhanced biodegradation of organic xenobiotic compounds in the rhizosphere is frequently recorded although the specific mechanisms are poorly understood. We have shown that the mineralization of 2,4-dichlorophenoxyacetic acid (2,4-D) is enhanced in soil collected from the rhizosphere of Trifolium pratense[e.g. maximum mineralization rate=7.9 days-1 and time at maximum rate (t1)=16.7 days for 12-day-old T. pratense soil in comparison with 4.7 days-1 and 25.4 days, respectively, for non-planted controls). The purpose of this study was to gain a better understanding of the plant-microbe interactions involved in rhizosphere-enhanced biodegradation by narrowing down the identity of the T. pratense rhizodeposit responsible for stimulating the microbial mineralization of 2,4-D. Specifically, we investigated the distribution of the stimulatory component(s) among rhizodeposit fractions (exudates or root debris) and the influence of soil properties and plant species on its production. Production of the stimulatory rhizodeposit was dependent on soil pH (e.g. t1 for roots grown at pH 6.5 was significantly lower than for those grown at pH 4.4) but independent of soil inorganic N concentration. Most strikingly, the stimulatory rhizodeposit was only produced by T. pratense grown in non-sterile soil and was present in both exudates and root debris. Comparison of the effect of root debris from plant species (three each) from the classes monocotyledon, dicotyledon (non-legume) and dicotyledon (legume) revealed that legumes had by far the greatest positive impact on 2,4-D mineralization kinetics. We discuss the significance of these findings with respect to legume-rhizobia interactions in the rhizosphere.

Enhanced mineralization of [U-(14)C]2,4-dichlorophenoxyacetic acid in soil from the rhizosphere of Trifolium pratense

Enhanced biodegradation in the rhizosphere has been reported for many organic xenobiotic compounds, although the mechanisms are not fully understood. The purpose of this study was to discover whether rhizosphere-enhanced biodegradation is due to selective enrichment of degraders through growth on compounds produced by rhizodeposition. We monitored the mineralization of [U-(14)C]2,4-dichlorophenoxyacetic acid (2,4-D) in rhizosphere soil with no history of herbicide application collected over a period of 0 to 116 days after sowing of Lolium perenne and Trifolium pratense. The relationships between the mineralization kinetics, the number of 2,4-D degraders, and the diversity of genes encoding 2,4-D/alpha-ketoglutarate dioxygenase (tfdA) were investigated. The rhizosphere effect on [(14)C]2,4-D mineralization (50 microg g(-1)) was shown to be plant species and plant age specific. In comparison with nonplanted soil, there were significant (P < 0.05) reductions in the lag phase and enhancements of the maximum mineralization rate for 25- and 60-day T. pratense soil but not for 116-day T. pratense rhizosphere soil or for L. perenne rhizosphere soil of any age. Numbers of 2,4-D degraders in planted and nonplanted soil were low (most probable number, <100 g(-1)) and were not related to plant species or age. Single-strand conformational polymorphism analysis showed that plant species had no impact on the diversity of alpha-Proteobacteria tfdA-like genes, although an impact of 2,4-D application was recorded. Our results indicate that enhanced mineralization in T. pratense rhizosphere soil is not due to enrichment of 2,4-D-degrading microorganisms by rhizodeposits. We suggest an alternative mechanism in which one or more components of the rhizodeposits induce the 2,4-D pathway.

Nitrogen control of atrazine utilization in Pseudomonas sp. strain ADP

Pseudomonas sp. strain ADP uses the herbicide atrazine as the sole nitrogen source. We have devised a simple atrazine degradation assay to determine the effect of other nitrogen sources on the atrazine degradation pathway. The atrazine degradation rate was greatly decreased in cells grown on nitrogen sources that support rapid growth of Pseudomonas sp. strain ADP compared to cells cultivated on growth-limiting nitrogen sources. The presence of atrazine in addition to the nitrogen sources did not stimulate degradation. High degradation rates obtained in the presence of ammonium plus the glutamine synthetase inhibitor MSX and also with an Nas(-) mutant derivative grown on nitrate suggest that nitrogen regulation operates by sensing intracellular levels of some key nitrogen-containing metabolite. Nitrate amendment in soil microcosms resulted in decreased atrazine mineralization by the wild-type strain but not by the Nas(-) mutant. This suggests that, although nitrogen repression of the atrazine catabolic pathway may have a strong impact on atrazine biodegradation in nitrogen-fertilized soils, the use of selected mutant variants may contribute to overcoming this limitation.

Myocardial perfusion scintigraphy: the evidence

This review summarises the evidence for the role of myocardial perfusion scintigraphy (MPS) in patients with known or suspected coronary artery disease. It is the product of a consensus conference organised by the British Cardiac Society, the British Nuclear Cardiology Society and the British Nuclear Medicine Society and is endorsed by the Royal College of Physicians of London and the Royal College of Radiologists. It was used to inform the UK National Institute of Clinical Excellence in their appraisal of MPS in patients with chest pain and myocardial infarction. MPS is a well-established, non-invasive imaging technique with a large body of evidence to support its effectiveness in the diagnosis and management of angina and myocardial infarction. It is more accurate than the exercise ECG in detecting myocardial ischaemia and it is the single most powerful technique for predicting future coronary events. The high diagnostic accuracy of MPS allows reliable risk stratification and guides the selection of patients for further interventions, such as revascularisation. This in turn allows more appropriate utilisation of resources, with the potential for both improved clinical outcomes and greater cost-effectiveness. Evidence from modelling and observational studies supports the enhanced cost-effectiveness associated with MPS use. In patients presenting with stable or acute chest pain, strategies of investigation involving MPS are more cost-effective than those not using the technique. MPS also has particular advantages over alternative techniques in the management of a number of patient subgroups, including women, the elderly and those with diabetes, and its use will have a favourable impact on cost-effectiveness in these groups. MPS is already an integral part of many clinical guidelines for the investigation and management of angina and myocardial infarction. However, the technique is underutilised in the UK, as judged by the inappropriately long waiting times and by comparison with the numbers of revascularisations and coronary angiograms performed. Furthermore, MPS activity levels in this country fall far short of those in comparable European countries, with about half as many scans being undertaken per year. Currently, the number of MPS studies performed annually in the UK is 1,200/million population/year. We estimate the real need to be 4,000/million/year. The current average waiting time is 20 weeks and we recommend that clinically appropriate upper limits of waiting time are 6 weeks for routine studies and 1 week for urgent studies.

Combined bioaugmentation and biostimulation to cleanup soil contaminated with high concentrations of atrazine

We developed a joint bioaugmentation and biostimulation approach for the clean up of soil contaminated with high (168.7 and 337.4 microg g(-1)) concentrations of the herbicide atrazine (2-chloro-4-(ethylamino)-6-isopropylamino-s-triazine). Pseudomonas sp. strain ADP (P. ADP) was used for bioaugmentation (approximately 10(7) cells g(-1) soil), and citrate (concentration range 5.8-40 mg g(-1) soil) and succinate (6.2-30.8 mg g(-1)) were used for biostimulation. The study soil had indigenous potential for atrazine mineralization (54.4 +/- 2% of 168.7 microg g(-1) mineralized after 67 day), but rapid mineralization only took place after a prolonged acclimation phase (approximately 28 days). Inoculation with P. ADP alone resulted in a limited improvement in mineralization (e.g., 30.6 +/- 1% mineralization of 168.7 microg g(-1) of atrazine in inoculated soil cf. < 0.5% in noninoculated in 7 days). Quantification of surviving numbers of P. ADP revealed a 10-fold decline from initial levels. However, bioaugmentation together with citrate or succinate biostimulation markedly increased P. ADP cell survival and atrazine mineralization (e.g., addition of 11.6 mg g(-1) of citrate increased mineralization of 337.4 microg g(-1) of atrazine from < 2 to 79.9 +/- 1% in 13 days). A critical parameter in determining the extent of atrazine mineralization by P. ADP was C(s):N(atz) (soluble carbon to atrazine nitrogen ratio): C(s):N(atz) > 40 was required for maximal atrazine mineralization. We suggest our observations may be used as a framework for rational bioremediation of field soils contaminated with atrazine.

Diagnostic, prognostic, and cost assessment of coronary artery disease in women

Women with obstructive coronary disease appear to be more challenging diagnostically and suffer a more adverse prognosis than men. More than one half of women with symptoms of ischemic heart disease have no obstructive coronary artery disease at coronary angiography, yet these women frequently have persistent symptom-related disability and consume large amounts of healthcare resources. Prior evidence has been limited regarding effective diagnostic strategies for the assessment of symptomatic women. The current report synthesizes existing evidence on diagnostic testing in women, including research from the ongoing National Heart, Lung, and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation (WISE) study. In addition to recent published evidence (drawn from much larger cohorts of women) that stress echocardiography and nuclear imaging are similar in their ability to risk-stratify women, the WISE study is exploring new pathophysiological mechanisms of microvascular dysfunction in women. An unfolding body of evidence suggests that as tests become more diagnostically and prognostically accurate, the process will become more cost efficient. The results from a growing number of large observational series and National Institutes of Health-sponsored studies are expected to be the foundation for cost-effective diagnostic and prognostic strategies for the approximately 5 million women who undergo evaluation for coronary disease annually.

The HCA National Disease Management Program for coronary disease detection and treatment in women

The diagnosis and treatment of heart disease in women continues to be one of the greatest challenges facing cardiovascular medicine today. Marked reductions in mortality rates during the past 2 decades did not result in improved outcomes for women. A major rate-limiting step to improving mortality rates for women is early diagnosis and initiation of effective lifesaving therapies for women. In 1999, HCA Healthcare Systems, Inc, Nashville, TN, initiated a coordinated effort among 208 hospitals in 26 states to improve the diagnosis of coronary disease and to target women who should receive aggressive risk factor modification and referral to cardiologists. We describe the initial phases of program development, including employee risk factor screening; citywide health risk assessment; nationwide educational programs for clinicians, staff, and consumers; and a dedicated outcomes assessment program for tracking women at risk for coronary disease. We believe that these efforts provide a venue for optimal care and improved outcomes for women served by HCA facilities.

Evidence-based risk assessment in noninvasive imaging

Assessment of important clinical and economic outcomes has become central to the evaluation of patient care. Outcome research is deeply rooted in epidemiology, including the use of multivariable, risk-adjusted regression analysis. In our current health care environment, these methods are increasingly being used to assess the quality of care and to profile physicians and laboratories. Nuclear medicine physicians therefore need to better understand outcome methodologies in order to evaluate patient outcomes, develop guidelines, and decide on patient management.

METHODS

This review describes the methods of assessing the diagnostic and prognostic value of nuclear medicine techniques and, briefly, the methodologic limitations of sample size, frequency and type of events, and follow-up periods and the incremental value of imaging. Also described are logistic regression and Cox proportional hazards modeling. Models for risk assessment are designed to identify whether patients require conservative (i.e., low-risk) or aggressive (i.e., high-risk) treatment. Treatment selection is currently based on risk assessment and the formation of an integrated, empiric risk stratification algorithm of care. This review also includes the methods of assessing economic effectiveness and quality-of-life issues for patients examined with nuclear medicine techniques.

CONCLUSION

In this era of constrained resources, low-cost outpatient-based care may be of increasing importance. High-quality evidence of the clinical and economic outcome of nuclear imaging is essential for helping health care providers and payers assess its value.

Serial changes on quantitative myocardial perfusion SPECT in patients undergoing revascularization or conservative therapy

BACKGROUND

Little is known about changes of myocardial perfusion in patients undergoing coronary revascularization or medical therapy. The purpose of this observational study was to assess the long-term effects of revascularization or conservative therapy on serial quantitative myocardial perfusion single photon emission computed tomography (SPECT).

METHODS AND RESULTS

The study population consisted of 421 patients who underwent serial rest thallium-201/stress technetium-99m sestamibi dual-isotope myocardial perfusion SPECT with at least a 1-year interval between the 2 studies and who had abnormal quantitative scan results on the first stress SPECT. The mean interval between scans was 32.7 +/- 15.9 months. Patients were divided into 3 groups according to stress defect extent: group 1 had small stress defects (4%-10%, n = 145), group 2 had intermediate stress defects (>10%-20%, n = 144), and group 3 had extensive stress defects (>20%, n = 132) at baseline. Forty patients in group 1, 44 in group 2, and 54 in group 3 underwent coronary revascularization between 2 SPECT studies; the others had conservative therapy. In group 3 patients with revascularization, stress defect extent and reversible defect extent were remarkably reduced (14.5% +/- 13.6% and 13.1% +/- 12.5%, respectively; both P <.0001), with greater improvement in those patients reporting increased use of cardiac medications; resting defect extent was slightly reduced (1.9% +/- 6.4%, P <.05). In group 3 patients with conservative therapy, a small reduction in stress defect extent was noted (2.3% +/- 8.3%, P <.05). In group 2, there were modest, similar reductions in reversible defect extent in both the patients with revascularization (2.7% +/- 7.7%, P <.05) and those with conservative therapy (1.8% +/- 7.3%, P <.05), as well as a small but significant reduction in stress defect extent in those with conservative therapy (2.1% +/- 8.2%, P <.05). In group 1 patients, no significant changes in stress, rest, or reversible defect extent were found with either therapy.

CONCLUSIONS

The findings of this study show that improvement in quantitative myocardial perfusion abnormalities over time occurs in some patients with either revascularization or conservative therapy and suggest that, in patients with extensive defects, greater improvement may be seen in those who undergo revascularization.