P838Is multi-biomarker combination approach comparable to the GRACE risk score for short-term mortality prediction in acute myocardial infarction cases?

Introduction

The Global Registry of Acute Coronary Events (GRACE) score is said to be a superior predictor of mortality in acute myocardial infarction (AMI) patients, and same applies to biochemical parameters as N-terminal pro-B-type natriuretic peptide (N-BNP), Troponin-T (TnT) and high-sensitivity C- reactive protein (hs-CRP) levels.

Purpose

We validated that whether each or combination of biochemical parameters are comparable to GRACE score or not for mortality prediction in AMI patients.

Method

We investigated about clinical background including The GRACE score, above parameters and in-hospital mortality in 754 AMI patients (mean age 66±13y/o, 609 ST-elevated AMI cases) received emergency percutaneous coronary intervention (PCI) successfully during 8 years in a single center retrospectively. Combination of biochemical parameters are derived from N-BNP, TnT and hs-CRP by logistic regression analyses. We compared The GRACE score with each or combination of biochemical parameters between survival (SG) and non-survival group (nSG) on receiver operating characteristic (ROC) analysis.

Result

In-hospital mortality was 6.8%. The GRACE score (106±33 versus 161±32; p<0.005) and N-BNP level (2458±7058 versus 8880±11331pg/ml; p<0.005) were significantly lower in SG than nSG. Area under the ROC curve about in-hospital mortality of The GRACE score were higher (0.868) than N-BNP (0.787; p=0.007), TnT (0.613; p<0.005), hs-CRP levels (0.614; p<0.005) and multi-biomarker combination (0.742; p=0.016) as Figure 1.

Area under the curve of the composite with the GRACE score and multi-biomarker is not increased compared with the GRACE score alone (0.868 versus 0.865; p=n.s.).

Figure 1

Conclusion

The GRACE score is a superior predictor about in-hospital mortality than each or combination of biochemical parameters in AMI patients. Multi-biomarker combination dose not refine the accuracy of the GRACE score.

Good manufacturing practices production of a purification-free oral cholera vaccine expressed in transgenic rice plants

The first Good Manufacturing Practices production of a purification-free rice-based oral cholera vaccine (MucoRice-CTB) from transgenic plants in a closed cultivation system yielded a product meeting regulatory requirements. Despite our knowledge of their advantages, plant-based vaccines remain unavailable for human use in both developing and industrialized countries. A leading, practical obstacle to their widespread use is producing plant-based vaccines that meet governmental regulatory requirements. Here, we report the first production according to current Good Manufacturing Practices of a rice-based vaccine, the cholera vaccine MucoRice-CTB, at an academic institution. To this end, we established specifications and methods for the master seed bank (MSB) of MucoRice-CTB, which was previously generated as a selection-marker-free line, evaluated its propagation, and given that the stored seeds must be renewed periodically. The production of MucoRice-CTB incorporated a closed hydroponic system for cultivating the transgenic plants, to minimize variations in expression and quality during vaccine manufacture. This type of molecular farming factory can be operated year-round, generating three harvests annually, and is cost- and production-effective. Rice was polished to a ratio of 95 % and then powdered to produce the MucoRice-CTB drug substance, and the identity, potency, and safety of the MucoRice-CTB product met pre-established release requirements. The formulation of MucoRice-CTB made by fine-powdering of drug substance and packaged in an aluminum pouch is being evaluated in a physician-initiated phase I study.

Acupuncture in children and adolescents with bronchial asthma: a randomised controlled study

OBJECTIVE

This randomised controlled trial evaluates the immediate effects of acupuncture as an add-on therapy in in-patient rehabilitation of children and adolescents with bronchial asthma.

PATIENTS AND METHODS

In a pre-post design, the severity of symptoms, lung function, illness-specific quality of life (Paediatric Asthma Quality of Life Questionnaire - PAQLQ) and general and asthma-specific level of anxiety (State-Trait Anxiety Inventory for Children - STAIC) were investigated in 46 acupuncture and 47 control patients. In addition to asthma sports, climate therapy and behavioural training, the intervention group received acupuncture treatment with a standardised needle pattern (12 × 30 min.).

RESULTS

With acupuncture, the peak expiratory flow variability differs significantly (p<0.01) from that of the control patients' group. Moreover, the acupuncture group differs significantly in their rehabilitation response at the time of discharge concerning perceived anxiety (STAIC-S). The lung function tests do not present differences between groups.

CONCLUSION

After additional acupuncture, amelioration of peak expiratory flow variability and anxiety can be shown, without any difference in objective lung function tests and quality of life between study groups. Further studies might evaluate the effects of acupuncture on childhood asthma in an outpatient setting.