AC Group Research Articles

STUDY OF PLATELET AND ITS INDICES IN ACUTE CORONARY SYNDROME

Background: Approximately 10-15% of acute chest pain is secondary to ACS which occur due to sudden blockage in a coronary artery the blood supply to the heart muscles get reduced signicantly or cuts off completely. ACS is a life-threatening condition that requires urgent intervention where saving time in diagnosis means saving cardiac muscles. Aims and Objectives: To study platelet indices in acute coronary syndrome and non acute coronary syndrome and to explore the role of mean platelet volume as an additional marker in diagnostic workup of acute coronary syndrome. Material and Methods: This cross-sectional, comparative & observational study was conducted in Department of Medicine, MGM Medical College and Hospital, Navi Mumbai from December 2018 – October 2020. A total of 102 patients presented with chest pain in the Emergency Department and diagnosed as having either ACS or NON-ACS were included. Results: ACS predominantly affects the male population i.e. 73.53% in the present study. STEMI was present in 78.43% than NSTEMI 19.61%. Diabetes was present in 20.59% and hypertension in 27.45% patients. Mean Hb was higher in the ACS group than in the NON-ACS group (p value: 0.001). Similarly, mean TLC, MPV, PDW, P-LCR and Mean Trop T was higher in the ACS group than in the NON-ACS group (p value: 0.001). Mean EF was lower in the ACS group than in the NON-ACS group (p <0.0001). The area under the ROC curve for classifying ACS and Non-ACS using Platelets as marker was 57.3% (p value: 0.206). A threshold value of Platelets ≥ 2.59 for ACS patients yields a sensitivity of 54.90%, Specicity of 50.98%, PPV of 52.83%, NPV of 53.06% and Accuracy of 52.94%. The area under the ROC curve for classifying ACS and Non-ACS using MPV as marker was 74.7% (P value: < 0.001). A threshold value of MPV ≥ 10.1 for ACS patients yields a sensitivity of 76.47%, Specicity of 64.71%, PPV of 68.42%, NPV of 73.33% and Accuracy of 70.59%. For MPV ≥ 10.1, the odds in favour of ACS was 5.958 i.e., the chances of ACS is 5.95 times that of Non-ACS. Conclusion: It can be concluded from the present study that the platelet indices, viz, MPV, PDW and P-LCR, are higher in ACS than in NON-ACS. Thus, they may be used to differentiate the ACS cases. More research needs to be done in this regard, to develop the platelet indices as an early diagnostic tool for the ACS cases, especially in a limited resource country, like India.

845 THE PREDICTIVE ROLE OF HIGH-SENSITIVITY CARDIAC TROPONIN T IN THE EMERGENCY ROOM: COMBINING BIOMARKERS WITH CLINICAL DATA LEADS TO THE DIAGNOSIS OF CARDIOVASCULAR DISEASE

Abstract Background Small amounts of high-sensitivity cardiac troponin (hs-cTn) I and T can be detected in healthy individuals or can occur in the absence of any clinical features of myocardial ischemia (myocardial injury). However, it is not possible to clinically distinguish whether and which increase in hs-cTn are due to which mechanisms. Moreover, predictive data regarding hs-cTnT in an emergency room (ER) setting are scanty. Consequently, with this monocentric retrospective study, we aimed at expanding the knowledge of this biomarker in this setting. Methods Consecutive adult patients presenting at the ER and hospitalized with a first abnormal hs-cTnT value (≥14 ng/L) were enrolled for 6 months. The baseline hs-cTnT value and the ensuing variations were correlated with the clinical presentation and diagnosis. Subsequently, multivariable models were built to assess which clinical and laboratory variables most influenced hospital admissions. Results At a first screening, 4660 patients were considered, and 4149 patients were enrolled (Figure 1). Of these, 1555 (37.5%) had a first hs-cTnT ≥14 ng/L, and 1007 (65%) were hospitalized according to the following diagnoses: acute coronary syndrome (ACS, 182; 18%), non-ACS cardiovascular disease (337; 34%) and non-cardiovascular disease (487; 48%). Higher hs-cTnT values as well as significant hs-cTnT variations were found in the ACS group (p < 0.01). Furthermore, in the latter, the mean percentage of variation of hs-cTnT was higher, while it was intermediate in the non-ACS group, and low in those with non-cardiovascular disease (407.5%, 270.6% and 12.4%, respectively). Only syncope and CRP (OR: 0.08, 95% CI: 0.02–0.39, p <0.01 and OR: 0.9988, 95% CI: 0.9979–0.9998, p = 0.02, respectively) or CRP (OR: 0.9948, 95% CI: 0.9908–0.9989, p = 0.01) and NT-proBNP (OR: 1.0002, 95% CI: 1.0000–1.0004, p = 0.02) were independent predictors of a cardiovascular disease diagnosis. On the other hand, only chest pain (OR: 22.91, 95% CI: 3.97–132.32, p < 0.01) and eGFR (OR: 1.04, 95% CI: 1.004–1.083, p = 0.03) were significantly associated with the ACS diagnosis. Conclusion In our study, differently from the investigated hs-cTnT, only clinical variables predicted hospitalizations in different patients’ subgroups.

Treadmill training mitigates bone deterioration via inhibiting NLRP3/Caspase1/IL-1β signaling in aged rats

IntroductionAlthough aerobic physical exercise may improve osteoporosis during ageing, the underlying mechanism of the favorable effects remains unclear. The aim of this study was to examine the localized and generalized proinflammatory indicators and the adaptive skeletal responses to treadmill training in aged rats to explore the potential mechanisms by which treadmill training impacts bone deterioration in a natural aged rat model.Materials and methodsA total of 24 Sprague Dawley (SD) rats were included in this study. Sixteen of all these animals were twenty-four months natural aged male SD rats, which were distributed into two groups (n = 8/group): AC group with sham treadmill training, and AT group with 8 weeks treadmill training. The remaining 8 were six months male SD rats matched subline and supplier, which were used as the adult control group with sham treadmill training (YC group, n = 8). The serum, bone marrow, fresh femur, tibia, and lumbar spine were harvested for molecular biological analysis, bone mineral density (BMD) testing, and micro-CT analysis after 8 weeks of treadmill training.ResultsAfter 8 weeks of intervention, the results showed that treadmill training increased BMD and inhibited deterioration of bone microarchitecture of hind limb bones. Further analysis showed that treadmill training increased serum P1CP concentration and decreased serum CTX-1level. Interestingly, treadmill training down-regulated the protein expressions of proinflammatory indicators, including NLRP3, proCaspase1, cleaved Caspase1, IL-1β, and GSDMD-N, and the mRNA levels of NLRP3, Caspase1, and IL-1β of the bone marrow. In addition, treadmill training also inhibited serum TNF-α and IL-1β concentration. However, 8 weeks of treadmill training did not increase BMD and bone microarchitecture in the lumbar spine.ConclusionTreadmill training mitigates the ageing-induced bone loss and reverses the deterioration of bone microarchitecture in hind limbs probably through inhibiting NLRP3/Caspase1/IL-1β signaling to attenuate low-grade inflammation and improve the inflammatory bone microenvironment.

Arrhythmogenic cardiomyopathy is under-recognized in end-stage pediatric heart failure: A 36-year single-center experience.

Although ventricular failure is a late finding in adults with AC, we hypothesize that this is a presenting symptom in pediatric heart failure patients who undergo HT and that their ventricular arrhythmia burden could differentiate AC from other cardiomyopathies. We performed a single-center retrospective cohort study reviewing 457 consecutive pediatric (≤18 years) HT recipients at our institution. Explanted hearts were examined to establish the primary diagnosis, based on pathologic findings. Demographic and clinical variables were compared between AC versus non-HCM cardiomyopathy cases. Forty-five percent (n= 205/457) had non-HCM cardiomyopathies as the underlying primary diagnosis. Ten cases (10/205=4.9%) were diagnosed with AC. All 10 had biventricular disease. In 8/10 patients (80%), AC diagnosis was unrecognized pre-HT. Compared with non-AC cardiomyopathies, the AC group was older at diagnosis (9.3 years vs. 4.3 years, p= .012) and transplant (11.1 years vs. 6.5 years, p= .010), had more ventricular arrhythmias (80.0% vs 32.8%, p= .003), and required more anti-arrhythmic use (80.0% vs 32.3%, p= .001). Genetic testing yielded causative pathogenic variants in all tested individuals (n= 5/5, 100%). AC is often an unrecognized cardiomyopathy pretransplant in children who undergo HT. Pediatric non-HCM phenotypes with heart failure who have a significant ventricular arrhythmia burden should be investigated for AC.

Palladium-Catalyzed Double Carbopalladation/syn-Insertion Cascade toward a Pragmatic Synthesis of Aminated Polyheterocyclic 1,2-Benzothiazepine 1-Oxides

AbstractA palladium-catalyzed tandem cyclization reaction was developed, which offers a pragmatic synthesis of aminated tetracyclic 1,2-benzothiazepine 1-oxides bearing a highly fused medium-sized cyclic unit. An acetyl (Ac) group was found to be the optimal protecting group for sulfoximines to reduce the nucleophilic ability of the N atom, thus efficiently suppressing the formation of intramolecular 5-exo-dig cyclization side products. The transformation proceeds through a double syn-carbopalladation/annulation sequence to construct the rigid tetracyclic carbo-heterocyclic framework with excellent chemoselectivity and regioselectivity.

Real-World Safety and Health Care Resource Utilization Analysis of Venetoclax and Hypomethylating-Agent Treatment for AML in an Academic-Affiliated Urban Community Oncology Network

Introduction Acute Myeloid Leukemia (AML) is a disease that affects predominantly older patients with a median age at diagnosis of 68 years. Elderly patients often have medical comorbidities and are ineligible for intensive induction chemotherapy. Recently, the FDA approved the combination of HMA/venetoclax for patients with newly diagnosed AML who are 75 years or older, or who have comorbidities precluding intensive induction chemotherapy. Through this retrospective analysis of patients treated at a metropolitan academic leukemia center and academic-affiliated community oncology practice network, our goal was to evaluate the safety and health care resource utilization of HMA/venetoclax treatment in a real-world experience. Methods We performed a retrospective analysis of patients treated for AML with HMA/venetoclax as standard-of-care at UCLA from 2018 to 2021. Patients treated with first-line HMA/venetoclax at UCLA community clinics (CC) and at UCLA main campus (academic centers, AC) and had a treatment record available in the electronic medical system were included. We specifically sought to collect safety parameters. Short-term efficacy outcomes were secondary endpoints. Results Thirty-three patients were eligible for analysis: eleven patients who received care in CC and 22 patients who were treated at AC. Baseline characteristics and treatment information are presented in Table 1. The average age was 76 years old for CC and 71 years old for AC. The proportion of patients older than 60 years old is 100% in CC, and 82% at AC. ECOG performance status was predominantly 0 and 1, irrespective of treatment location. Both groups have predominantly a secondary AML diagnosis (CC 64%, AC 59%). According to ELN 2017 criteria, 36.4% of CC had adverse risk disease, compared to 72% of AC patients. CC patients had median of 30% bone marrow blasts at diagnosis and AC had 59% blasts. Forty percent of CC patients and 64% of AC patients had baseline platelet counts <50x103/uL. Regarding treatment, eight out of 11 CC patients had consultation with a physician from the academic leukemia group. Twenty-seven percent of CC patients and 82% of AC patients were treated inpatient for cycle 1. Eighteen percent of CC patients and 66.6% AC patients received venetoclax at a starting dose lower than 400mg daily. Eighty-six percent of the dose reductions were due to concurrent azoles use. Finally, prophylactic antibiotics were used in 45% of CC patients compared to 64% of AC patients, and antifungal prophylaxis was used in 27% of CC patients compared to 64% of AC patients. Safety data, health care resource utilization, and clinical outcome information are reported in Table 2. The percentage of patients with grade 4 neutropenia duration >30 days after cycle 1 was 50% in CC vs. 43% at AC. There were no deaths before 30 days at CC and there were 2 deaths (10%) in AC. Thirty- to sixty-day mortality was zero in both groups. Thirty-six percent of CC patients and 59% of AC required hospitalization (infectious related: 43% CC, 52% AC; cytopenia: 29% CC, 10% AC). The median number of hospital days was 3 (range, 0-17) in CC, and 27 (range, 6-81) in AC; and 0% of CC vs. 18% of AC patients required an ICU stay. Regarding clinical response, bone marrow biopsy was done after cycle 1 in 91% of CC vs. 41% of AC patients. Of these patients, CR/CRi rate was 80% in CC patients vs. 56% in AC patients. Discussion Our study suggests that AML treatment with HMA/venetoclax can be administered safely in real-world community setting. The high number of CC patients that had consultation with AC group reflects the integrative collaborative practice model at our urban academic affiliated oncology community practice. Patients treated in CC tend to be older, with more favorable AML, and better BM function reserve at baseline. The CR rate for patients treated in CC is comparable to previously published data. The high number of patients treated inpatient for cycle one at AC likely indicates AC carries a more acutely ill AML patient population compared to CC, which likely resulted in more health care resource utilization. It is interesting to observe that in the CC group, 29% of the complications leading to hospitalization are from cytopenia, suggesting that health care resource utilization could be further optimized with pre-emptive transfusion scheduling. Limitations of this analysis include that this is a small, single center, retrospective analysis. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

A Randomized Trial of Clopidogrel vs Ticagrelor After Off-Pump Coronary Bypass

BackgroundThis study aimed to compare the outcomes of aspirin in combination with either ticagrelor or clopidogrel after off-pump coronary artery bypass (OPCAB) in patients with clopidogrel resistance. MethodsBetween November 2014 and November 2020, 1739 patients underwent OPCAB. Aspirin and clopidogrel treatment was initiated the day after surgery. On postoperative days 7 to 9, clopidogrel resistance was evaluated using a point-of-care assay. A total of 278 (18.9%) patients had clopidogrel resistance ( platelet reaction unit >208) and were enrolled in the study. The study investigators excluded patients with coresistance to aspirin (n = 74) and divided the remaining patients (mean age, 67.4 ± 8.5 years) into 2 groups (an aspirin and ticagrelor group [AT group; n = 102] and an aspirin and clopidogrel group [AC group; n = 102]), randomly assigned using a 1:1 ratio block table. The primary end point was graft patency and major adverse cardiovascular events (MACEs; defined as the composite of cardiovascular mortality, myocardial infarction, and repeat revascularization at 1 year after OPCAB), and the coprimary end point was the graft patency rate. The data were analyzed using the intent-to-treat method. ResultsThe graft occlusion rates in the AT and AC groups were 3.9% and 5.9%, respectively (P = .52). Neither death from cardiovascular causes (1.0% vs 2.9%; P = .32) nor myocardial infarction showed significant differences (1.0% vs 3.9%; P = .18). No significant difference in the rates of major bleeding were found between the 2 groups (P = .75). However, the AT group was associated with a lower rate of MACEs after OPCAB (hazard ratio, 0.77; 95% CI, 0.684-0.891; P = .01). ConclusionsThese results suggest that ticagrelor may be associated with reducing MACEs in patients with clopidogrel resistance after OPCAB.

Efficacy and safety of adjuvant chemotherapy in T1N0M0 intrahepatic cholangiocarcinoma after radical resection

ObjectiveAdjuvant chemotherapy is necessary for radical resection of intrahepatic cholangiocarcinoma (ICC) with a high risk of recurrence (T2–4, N1). However, its use in the treatment of early-stage ICC remains controversial. This study aimed to investigate the role of adjuvant chemotherapy after radical resection in patients with early-stage ICC (T1N0M0).Data and methodsThe data of 148 patients with pathologically diagnosed ICC (T1N0M0) who underwent radical resection from January 2012 to January 2018 at the Sun Yat-sen University Cancer Center were retrospectively analyzed. Using consistent baseline data, Kaplan–Meier survival curves were constructed to compare relapse-free survival (RFS) and overall survival (OS) between patients who received postoperative adjuvant chemotherapy (AC group) and those who received only surgical treatment (non-AC group). Univariate and multivariate Cox regression analyses were used to screen for independent prognostic factors affecting survival. The RFS and OS of patients were analyzed after the administration of three adjuvant chemotherapy regimens (gemcitabine + capecitabine [GX], gemcitabine + cisplatin [GP], and capecitabine monotherapy [X]). Finally, the safety of adjuvant chemotherapy was evaluated based on the incidence of grade 1–4 adverse events.ResultsThe median RFS was 18 months in the non-AC group and 25 months in the AC group. The median OS was 34 months in the non-AC group; however, it was not reached in the AC group. The OS of the AC group was significantly higher than that of the non-AC group (P = 0.005). Multivariate Cox analysis demonstrated that nerve invasion (P = 0.001), preoperative elevation of cancer antigen 19–9 (CA 19–9) levels (P = 0.009), and postoperative adjuvant chemotherapy (P = 0.009) were independent prognostic factors for early-stage ICC after radical resection. The OS rates of the GX, GP, X, and non-AC groups were significantly different (P = 0.023) and were higher in the GX group than in the non-AC group (P = 0.0052). Among patients with elevated preoperative CA 19–9 levels, the OS rate was higher in the AC group than in the non-AC group (P = 0.022). In terms of safety, the incidence of grade 3 or 4 adverse reactions was < 18.2% in the GX, GP, and X groups, without the occurrence of death owing to such reactions.ConclusionAdjuvant chemotherapy can prolong OS among patients with early-stage ICC who have undergone radical resection. Preoperative elevation of CA 19–9 levels and nerve invasion are independent prognostic factors for poor survival outcomes for early-stage ICC after radical resection. All chemotherapy regimens used in the study are safe.

Transarterial chemoembolization plus apatinib with or without camrelizumab for unresected hepatocellular carcinoma: A two-center propensity score matching study.

To compare the effectiveness and safety of transarterial chemoembolization (TACE) combined with apatinib and camrelizumab with those of TACE as well as apatinib among patients with unresectable hepatocellular carcinoma (HCC). The data of patients with unresectable HCC (uHCC) who received TACE-apatinib-camrelizumab combination (TACE + AC group) and TACE-apatinib combination (TACE + A group) were collected from two centers between January 2018 and January 2022. Propensity score matching (PSM) was conducted to diminish the bias between the two groups. The primary outcome measures of the study were overall survival (OS) and progression-free survival (PFS), and the secondary outcome measures were response rate (ORR), disease control rate (DCR), and adverse events (AEs). A total of 102 patients were enrolled in this study after PSM, with 34 patients in the TACE + AC group and 68 patients in the TACE + A group. Compared to the TACE + A group, TACE + AC had a significantly longer median OS (25.5 months, interquartile range [IQR], 23.5-33.0) than 18.5 months (IQR, 13.0-25.0; P = 0.001). Similarly, the PFS of the TACE + AC group was significantly improved (14.0 months, IQR, 9.0-NA) compared to that of the TACE + A group (5.0 months, IQR, 2.5-9.0; P = 0.001). The ORR rates (55.9% vs. 51.5%), and DCR rates (79.4% vs. 72.1%) were comparable between groups (P > 0.05). All treatment-related adverse events were tolerable and manageable, and no serious adverse events were observed. TACE combined with apatinib plus camrelizumab demonstrated superior efficacy to TACE plus apatinib for patients with unresectable HCC. The two combination therapies showed similar safety profiles.

Th17/Treg balance and factors related to autoimmune hepatitis

AbstractBackgroundAlthough Th17 cells and regulatory T cells play critical roles in autoimmune hepatitis, the balance between them in acute and chronic immune hepatitis is not well‐studied. The objective of this study was to explore the role of Th17/Treg balance in autoimmune hepatitis.MethodsThirty female Wistar rats were randomly divided into the following three groups: acute model (AC), chronic model (CC), and healthy control (HC). Aspartate aminotransferase, alanine aminotransferase, and bilirubin levels were measured. Peripheral blood interleukin (IL)‐17, IL‐6, IL‐10, and transforming growth factor‐β cytokine levels were also assessed. Flow cytometry was used to detect changes in the Th17 cell and Treg cell frequency, and the Th17/Treg ratio was calculated.ResultsThe frequency of Th17 cells and Treg cells were both increased (p &lt; 0.05) and the Th17/Treg ratio was higher in the AC group compared with those in the HC group (p &lt; 0.05). Th17 cell levels were significantly lower and Treg cell levels were significantly higher in the CC group, compared with those in the AC group (p &lt; 0.05). In addition, the Th17/Treg ratio was lower in the CC group compared with that in the HC group (p &lt; 0.05).ConclusionThe Th17/Treg ratio was increased in the acute immune liver injury model and decreased in the chronic liver injury model. Th17/Treg imbalance may play a critical role in liver injury occurrence and development.

Factors associated with adverse neurodevelopment outcome using Bayley III scale at 3 to 6 month follow-up

Introduction: As the survival rate of preterm infants has increased, the management of long-term complications, especially neurodevelopmental impairment, becomes important. Several studies have suggested that adverse neurodevelopment could be induced by systemic inflammation in preterm infants. Preterm infants with systemic inflammation would have impaired neurodevelopment and which biomarkers and neurophysiologic studies during inflammation are associated with poor neurodevelopment. Objective: To assess the factors associated with adverse neurodevelopment outcome using bayley iii scale at 3 to 6 month follow-up. Materials and methods: This prospective cohort study was conducted in Department of Paediatrics, Mugda Medical College Hospital, Dhaka, Bangladesh from July 2021 to December 2021. After taking informed written consent (annexure-III) from parents of the selected premature infants to participate in the study, a total of 82 neonates were enrolled. Hospitalized inborn and out born babies were included consecutively. Results: A total 54 patients were analyzed in 1st follow up visit by using Bayley scale III. Mean cognitive score were 81.67±7.58 and 73.50±10.16 in ACS exposed and ACS unexposed group (p-0.001).Mean language score were 85.33±6.73 vs. 77.88±9.98, (p- 0.002). Mean motor score were 84.50±9.83 vs. 76.83±12.03 in ACS exposed and ACS unexposed group (p- 0.013). Though all scores were below normal in both groups, ACS exposed group had relatively better score than ACS unexposed group at 3 months of age. During 2nd follow up 47 infants were assessed at 6 months of age, mean cognitive score in ACS group was 84.88±12.32 and in ACS unexposed group was 75.71±15.67.which was statistically significant(p- .030).Motor and language composite scores were higher at 6 months in ACS group but no difference between two groups were statistically significant. Conclusion: Our prospective cohort study showed that systemic inflammation induced by clinical infection and NEC is associated with poor neurodevelopment in preterm infants. These results may help estimate the neurodevelopmental risk of individual patients who have inflammatory illness and narrow down the target population of neuroprotection in the future.

Glycerol Valorization Towards Glycolic Acid Production Over Cu-Based Biochar Catalyst.

Glycerol valorization towards high-value chemicals is of particular importance to increase the value chain of biodiesel production. In this study, the catalytic activity of a series of cheap Cu-based catalysts for glycerol conversion is investigated. Cu supported on activated carbon (AC, obtained through carbonization of coconut shell) exhibits outstanding catalytic activity for the selective conversion of glycerol into glycolic acid (GcA) in O2 atmosphere, affording up to 68.3 % GcA yield. The combination of experimental results with theoretical calculations reveals that glyceraldehyde is the key reaction intermediate. The high specific surface area and surface oxygenated groups of AC enable the formation of CuO nanoparticles with small size and uniform dispersion. In addition, the surface oxygen vacancy on Cu/AC might help to activate reaction intermediates, and the electron transfer from Cu to AC facilitates the oxidation of glycerol to GcA. Cu loaded onto AC also significantly inhibits C-C breakage to generate formic acid as a byproduct. This work might aid the development of approaches for glycerol application and afford profitable possibilities for sustainable biodiesel.

Prospective Evaluation of Automated Contouring for CT-Based Brachytherapy Treatment Planning of Gynecologic Malignancies

<h3>Purpose/Objective(s)</h3> The use of artificial intelligence to automatically-contour OARs in gynecologic radiation treatment has been well-established in the literature. Yet, there is limited data on the prospective use of AC in clinical practice. The objective of this study was to assess the accuracy and efficiency of AC for CT-based brachytherapy treatment planning of gynecologic malignancies. <h3>Materials/Methods</h3> An in-house AC tool was used to automatically-delineate five organs-at-risk (OARs) used for gynecologic radiation treatment planning: the bladder, small bowel, sigmoid, rectum and urethra. The accuracy of each auto-contour was evaluated by the treating physician using a 5-point Likert scale: a score of five indicated the contour could be used without edits, while a score of one indicated the contour was unusable (Table 1). To assess the efficiency of AC in clinical practice, the planning time of a prospective AC cohort was compared to the planning time of a retrospective MC cohort. Planning time of each case was quantified as the time between import of CT image to TPS and final plan approval. Mean, standard deviation and standard error of each cohort's time to approval was analyzed via unpaired t-test with Welch's correction. <h3>Results</h3> Eight prospective AC cases from January 2022 to February 2022 and thirty retrospective MC cases from July 2021 to January 2022 were included in the study. The average time to plan approval in the AC cohort was 30% less than MC cohort (AC vs MC, 109.0 ± 6.4 minutes vs. 155.1 ± 15.4 minutes, p=0.0092). The AC group had less time variance between cases with a standard deviation of 17.0 minutes, compared to a 31.5-minute variance of the MC cohort. The mean accuracy score in the AC cohort was 4.8 (SD=0.7) for the bladder, 4.0 (SD=0.9) for the small bowel, 4.2 (SD=0.7) for the sigmoid, 4.6 (SD=0.7) for the rectum, and 4.8 (SD=0.4) for the urethra. No auto-contoured OARs required major edits from the attending physician. Physician slice-by-slice review of the AC contours took on average 3.6 minutes (SD=1.6) revising OARs (including edits if needed) and overall contouring time (included adding targets) took an average of 14.1 minutes (SD=6.0). <h3>Conclusion</h3> Automated contouring appears to be safe and accurate for use in clinical practice. Clinical implementation of AC shows promise to streamline radiation treatment workflows and decrease time required to design and approve gynecologic brachytherapy plans.

Patient Outcomes in Laparoscopic Appendectomy With Acute Surgical Care Model Compared to Traditional Call

IntroductionShift-based models for acute surgical care (ACS), where surgical emergencies are treated by a dedicated team of surgeons working shifts, without a concurrent elective practice, are becoming more common nationwide. We compared the outcomes for appendectomy, one of the most common emergency surgical procedures, between the traditional (TRAD) call and ACS model at the same institution during the same time frame. MethodsA retrospective review of patients who underwent laparoscopic appendectomy for acute appendicitis during 2017-2018. ACS and TRAD-patient demographics, clinical presentation, operative details, and outcomes were compared using independent sample t-tests, Wilcoxon rank-sum tests and Fisher's exact or χ2 tests. Multiple exploratory regression models were constructed to examine the effects of confounding variables. ResultsDemographics, clinical presentation, and complication rates were similar between groups except for a longer duration of symptoms prior to arrival in the TRAD group (Δ = 0.5 d, P = 0.006). Time from admission to operating room (Δ = −1.85 h, P = 0.003), length of hospital stay (Δ = −2.0 d, P < 0.001), and total cost (Δ = $ −2477.02, P < 0.001) were significantly lower in the ACS group compared to the TRAD group. Furthermore, perforation rates were lower in ACS (8.3% versus 28.6%, P = 0.003). Differences for the outcomes remained significant even after controlling for duration of symptoms prior to arrival (P < 0.05). ConclusionsAcute appendicitis managed using the ACS shift-based model seems to be associated with reduced time to operation, hospital stay, and overall cost, with equivalent success rates, compared to TRAD.

Utilization of air-cooled ventilation to reduce heat stress in Nuami sheep in Saudi Arabia

Tropical and temperate countries experience significant economic losses in summer due to heat stress. It is possible to mitigate thermal stress through advances in environmental management, for instance, better accommodations, improved cooling systems, and improved feeding strategies. We examined the influence of ventilation on Nuami ewes in hot climates to determine their physiological efficiency and thermoregulation. Ten dry, non-cycling Nuami sheep were allocated to two treatments (n=5): The control (C) group was kept at ambient temperature, while the treatment (AC) group was kept at air-cooled temperature. Respiratory rate, rectal temperature, and infrared images of representative body regions were recorded weekly. There was a significant difference in climatic conditions between the two rooms. In comparison to the C group, AC sheep gained weight. Dry matter intake (kg/day) increased, water consumption (l/day) decreased, WI/DMI ratios fell, and respiratory rates fell 1.5 times in AC sheep compared to C sheep. AC group showed lower rectal, rump, and leg temperatures than the C group. Regardless of climate variations, the temperatures of the eyes and belly stayed pretty constant due to their physiological, anatomical, and coat characteristics. Therefore, cooled-air ventilation is the best method to reduce heat stress in livestock in the summer.

The BCL2/BAX/ROS pathway is involved in the inhibitory effect of astragaloside IV on pyroptosis in human umbilical vein endothelial cells

Context Astragaloside IV (AS-IV) is extracted from Astragalus membranaceus (Fisch.) Bunge (Fabaceae). However, its effects on endothelial cell injury remain unclear. Objective To investigate the mechanisms underlying the effects of AS-IV on lipopolysaccharide (LPS)-induced endothelial injury in vitro. Materials and methods Human umbilical vein endothelial cells (HUVECs) were pre-treated with AS-IV (100 µmol/mL), 4-hydroxy-3-methoxyacetophenone (APO, 10 µmol/mL), N-acetylcysteine (NAC, 50 µmol/mL) and Ac-YVAD-cmk (AC, 5 µmol/mL) for 2 h before 1 μg/mL LPS 24 h exposure. Untreated cells cultured without any exposure were used as controls. Cell viability, reactive oxygen species (ROS) and pyroptosis assays were performed. The pyroptosis related proteins were detected by western blot. Results The rate in late pyroptosis (Q2-2) of AS-IV (13.65 ± 0.74%), APO (13.69 ± 0.67%) and NAC (15.87 ± 0.46%) groups was lower than the LPS group (21.89 ± 0.66%, p < 0.05), while the rate in early pyroptosis (Q2-4) of AS-IV group (12.00 ± 0.26%) was lower than other groups (p < 0.05). The expression of NOX4, GSDMD, NLRP3, ASC and caspase-1 decreased after AS-IV, NAC or AC intervention (p < 0.05). The ROS production in AS-IV (4664 ± 153.20), APO (4094 ± 78.37), NAC (5103 ± 131.10) and AC (3994 ± 102.50) groups was lower than the LPS (5986 ± 127.30) group, while the mitochondrial BCL2/BAX protein expression ratio increased in AS-IV, APO and NAC groups (p < 0.05). Discussion and conclusions AS-IV suppressed pyroptosis in LPS-activated HUVECs by inducing ROS/NLRP3-mediated inhibition of the inflammatory response, providing a scientific basis for clinical applications of AS-IV.

Acute coronary syndrome and stress: Is there a relationship?

IntroductionAcute coronary syndrome (ACS) is the result of a complex pathophysiological process with various dynamic factors. The 10-item Perceived Stress Scale (PSS-10) is a validated instrument for estimating stress levels in clinical practice and may be useful in the assessment of ACS. MethodsWe carried out a single-center prospective study engaging patients hospitalized with ACS between March 20, 2019 and March 3, 2020. The PSS-10 was completed during the hospitalization period. The ACS group was compared to a control group (the general Portuguese population), and a subanalysis in the stress group were then performed. ResultsA total of 171 patients with ACS were included, of whom 36.5% presented ST-elevation myocardial infarction (STEMI), 38.1% were female and the mean PSS score was 19.5±7.1. Females in the control group scored 16.6±6.3 on the PSS-10 and control males scored 13.4±6.5. The female population with ACS scored 22.8±9.8 on the PSS-10 (p<0.001). Similarly, ACS males scored a mean of 17.4±6.4 (p<0.001). Pathological stress levels were not a predictor of major adverse cardiovascular events or severity at admission. ConclusionsACS patients had higher perceived stress levels compared to the control group. Perceived stress level was not associated with worse prognosis in ACS patients.

A retrospective study of Enterococcus faecalis infective endocarditis: comparison of clinical characteristics and outcomes associated with treatment.

IntroductionA synergistic antibiotic combination of a penicillin and gentamicin (AG) or ceftriaxone (AC) is used in the management of Enterococcus faecalis infective endocarditis (EFIE). We compare the treatment outcomes between AG and AC, including low and high dose ceftriaxone (1 and 2 g 12 hourly).MethodsA retrospective cohort study of patients treated for EFIE at single tertiary centre (2012–2019). Outcome measures examined were 90- and 180-day mortality, treatment associated adverse events and relapse of bacteraemia (within 1 year).Results39 patients were enrolled [61.6% given (AC) (n = 24), 24% received ACL (n = 10) and 34% received ACN (n = 14)], 38.4% received AG (n = 15). We noted a difference in the mortality outcomes at 90 and 180 days between those treated with AG and AC overall (6.7% and 33.3%, respectively) although this did not reach statistical significance (P = 0.114, P = 0.061). No significant difference was noted between these groups in incidence of relapsed bacteraemia with two cases noted in the AC cohort (8.3%, 2/24) and none observed (0/15) in the AG cohort (P = 0.662, P = 0.414). A greater number of adverse events was observed in the AG group (11/15, 73.3%) compared to the overall AC group (6/24, 25.0%) (P = 0.009), with no difference between the high and low dose ceftriaxone groups (P = 0.05).ConclusionCombination treatment of EFIE with AC is associated with a reduced number of adverse events in comparison to AG groups. Although increased mortality was observed in the AC group, this did not reach statistical significance, and reflects the greater comorbidities and reduced capacity for surgical source control in this cohort.

Adaptive Responses of the Sea Anemone Heteractis crispa to the Interaction of Acidification and Global Warming.

Simple SummaryThis study investigated the effects of the interaction of acidification and warming on the photosynthetic apparatus and sterol metabolism of sea anemone Heteractis crispa. Thermal stress is the dominant driver of the deteriorating health of H. crispa, which might be relatively insensitive to the impact of ocean acidification; upregulation of chlorophyll content is suggested as an important strategy for symbionts to adapt to high pCO2. However, warming and acidification (alone or combined) significantly affected the cholesterol or sterol levels. Indeed, environmental changes like warming and acidification will affect the sterol metabolism and health of H. crispa in the coming decades.Ocean acidification and warming are two of the most important threats to the existence of marine organisms and are predicted to co-occur in oceans. The present work evaluated the effects of acidification (AC: 24 ± 0.1 °C and 900 μatm CO2), warming (WC: 30 ± 0.1 °C and 450 μatm CO2), and their combination (CC: 30 ± 0.1 °C and 900 μatm CO2) on the sea anemone, Heteractis crispa, from the aspects of photosynthetic apparatus (maximum quantum yield of photosystem II (PS II), chlorophyll level, and Symbiodiniaceae density) and sterol metabolism (cholesterol content and total sterol content). In a 15-day experiment, acidification alone had no apparent effect on the photosynthetic apparatus, but did affect sterol levels. Upregulation of their chlorophyll level is an important strategy for symbionts to adapt to high partial pressure of CO2 (pCO2). However, after warming stress, the benefits of high pCO2 had little effect on stress tolerance in H. crispa. Indeed, thermal stress was the dominant driver of the deteriorating health of H. crispa. Cholesterol and total sterol contents were significantly affected by all three stress conditions, although there was no significant change in the AC group on day 3. Thus, cholesterol or sterol levels could be used as important indicators to evaluate the impact of climate change on cnidarians. Our findings suggest that H. crispa might be relatively insensitive to the impact of ocean acidification, whereas increased temperature in the future ocean might impair viability of H. crispa.

Nitrogen-doped oxidized activated carbon as efficient metal-free bifunctional material for bisphenol removal: A tuning of surface chemistry

Nitrogen modified oxidized activated carbon (N-OAC) was prepared by nitric acid oxidation and ammonia hydrothermal treatment of activated carbon. The surface functional groups of AC were changed by controlling the synthetic conditions and characterized. It was found that oxygen and nitrogen functional groups was introduced on the surface of AC. The deeper degree of oxidation was in favour of N doping. With well-suited amount of oxygen and nitrogen modification, the adsorption and activation ability toward persulfate could be enhanced simultaneously. The adsorption experiment showed that the maximum adsorption capacity (qm) of N-OAC for bisphenol A (BPA) obtained from a Langmuir isotherm was 147 mg g−1 at 298 K, which was about 1.23 and 1.5 times than that of AC (121 mg g−1) and N-free-OAC (108 mg g−1). N-OAC could also activate persulfate, producing strong oxidizing sulfate radicals. The apparent degradation rate constant of BPA on N-OAC was 0.039 min−1, being about 39 times than that (0.001 min−1) on AC. After adsorption equilibrium within 120 min, the use of N-OAC (240 mg L−1) and persulfate (4 mmol L−1) almost completely removed the added bisphenols (60 mg L−1) at pH 6.6 within 60 min. A synergistic effect and correlation between the adsorption ability, catalytic performance and chemical structures of N-OAC was discussed.