Reduction In Index Research Articles

Improving the hemocompatibility of centrifugal mechanical circulatory support devices at low flow rates.

An innovative solution has been recently proposed for the treatment of heart failure with preserved ejection fraction (HFpEF), using a centrifugal mechanical circulatory support (MCS) device. We sought firstly to assess the hemocompatibility of the proposed device. HFpEF treatment requires the blood pump to operate at low blood flow rate (0.05-0.5 L/min). Given high blood trauma expected in these conditions, we sought secondly to investigate design improvements in order to reduce this risk. Computational fluid dynamics was used to analyze the blood fluid filled within the centrifugal pump and to estimate the blood trauma due to its operation. This assessment is based on the computation of integrated quantities such as the hemolysis index and the turbulent dissipation energy. The hemolysis index associated with the present device is comparable to the figures from HVAD. With the proposed pump, for instance, an index of 0.0036 is obtained at 1 L/min and 3000 rpm. Using thinner blades for the impeller allows a 12% reduction of the hemolysis index in average, while reducing its diameter leads to an index 2.8 folds lower at 0.5 L/min. The present investigation shows the promising hemocompatibility of our centrifugal pump. Concerns about very high hemolysis generated at low flow rates could be overcome by reducing the impeller diameter. Experimental validations are planned to support our findings.

Treatment Outcomes in Awake Endoscopy With Advanced Programming in Hypoglossal Nerve Stimulation.

Hypoglossal nerve stimulation (HNS) is a treatment option for patients with moderate-to-severe obstructive sleep apnea. In the post-implant period, awake endoscopy with advanced programming (AEAP) can be employed to improve apnea hypopnea index (AHI) reduction and/or patient comfort. This study describes response patterns to HNS after AEAP as well as patient-specific patterns in our patient population. Retrospective evaluation of 17 consecutive patients who underwent AEAP between June 2019 and December 2022. Post-AEAP AHIs were used to create 2 response groups, which facilitated analysis of patient-based characteristics. AHI reporting, deemed non-titration AHI (NT-AHI), is the whole-night AHI resulting from non-titration studies. Chi-squared, Pearson correlation coefficient, and independent samples t-test were used to determine significance deemed as P < .05. Fifteen of 17 patients (88.2%) presented for failed NT-AHI reduction, and 2/17 (11.8%) presented for comfort measures. Eleven patients (65%) showed an improvement in post-AEAP NT-AHI; 6 (35%) patients failed to improve. Four patients with either lateral wall collapse or concentric wall collapse at the tongue base failed to improve NT-AHI compared to a single patient who showed an improved NT-AHI (P = .017). Of the 2 patients who presented with discomfort, patient 1/2 demonstrated improvement in device usage, and patient 2/2 reported improved comfort while maintaining average device usage. AEAP is a powerful tool that offers the ability to identify settings conducive to increased therapy efficacy and improved treatment tolerability. Airway phenotypes are closely correlated with treatment efficacy, and as such, careful anatomical consideration of the upper airway must be performed when titrating therapy. Amongst the different treatment options for obstructive sleep apnea, hypoglossal nerve stimulation has been shown to be effective in positive-airway-pressure intolerant patients. This article explores response patterns to AEAP and highlights the importance of careful anatomical considerations of the upper airway. Level 3.

Vitamin B12 Protects Against Genotoxicity Induced by Cisplatin.

Cisplatin is an effective synthetic chemotherapeutic drug used for cancer treatment. Vitamin B12 has been shown to possess anti-genotoxic activity. This study aimed to investigate the effect of vitamin B12 on chromosomal damage induced by cisplatin. The level of sister chromatid exchanges (SCEs) and chromosomal aberrations (CAs) were measured in cultured human blood lymphocytes treated with cisplatin and/or vitamin B12. The results showed a significantly elevated frequency of CAs and SCEs of cisplatin-treated cultures compared to the control (P < 0.05). The CAs and SCEs induced by cisplatin were significantly lowered by pretreatment of cell cultures with vitamin B12. In addition, cisplatin caused a slight reduction in the mitotic index (MI), while vitamin B12 did not modulate the effect of cisplatin on MI. Vitamin B12 can protect human lymphocytes against genotoxicity associated with cisplatin.

Synthesis and characterization of erbium silica glass and glass-ceramics for potential low-emissivity coating applications

Silica glasses co-doped with varying concentrations of Er3+ (0.8, 1.5, 4, and 8 mol %) were fabricated employing the sol-gel technique. The effects of erbium concentration were evaluated through several characterization techniques, including X-ray diffraction (XRD), differential scanning calorimetry (DSC), scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FTIR), UV-visible transmission spectroscopy, and photoluminescence analysis. The incorporation of erbium ions significantly altered the structural, optical, and photoluminescence properties of the doped glasses. XRD analysis revealed the presence of SiO2 in both tetragonal and hexagonal forms, along with Er2SiO5 crystalline phases. SEM images showed irregular rod-shaped structures with agglomeration and micro-flake cubic shapes. FTIR spectroscopy provided insights into the structural characteristics of the materials. Notably, the optical band gap energy of the glassy films increased, accompanied by fluctuating Urbach energy and a slight reduction in the refractive index, attributed to structural changes within the glass network. Photoluminescence spectra indicated strong emissions at 523 and 543 nm, corresponding to the transitions 2H11/2 → 4I15/2 and 4S3/2 → 4I15/2, respectively. Additionally, a notable near-infrared emission at 1532 nm was observed, linked to the transition 4I13/2 → 4I15/2. The color coordinates of the produced glasses were found to be near the green or yellow regions, suggesting potential applications in optical amplifiers, lasers, and low-emissivity coatings.

Environmental Concentrations of 6PPD and 6PPD-Quinone Induce Hepatic Lipid Metabolism Disorders in Male Black-Spotted Frogs

Aquatic environments are generally contaminated with N-(1,3-dimethylbutyl)-N’-phenyl-p-phenylenediamine (6PPD) and its oxidation product 6PPD-quinone (6PPD-Q). Recently, 6PPD-Q was found lethally toxic to some specific species, especially salmonid silverfish. This study investigated male black-spotted frogs (Pelophylax nigromaculatus) exposed to 6PPD and 6PPD-Q with different environmental concentrations (0, 1, and 10μg/L) for 21 days, after which biochemical, metabolomic, gene expression analyses, and molecular docking were conducted. 6PPD and 6PPD-Q were both found to bioaccumulate in frogs’ livers in a dose-dependent manner and produce a significant reduction of the hepatosomatic index. Metabolomics data showed that 6PPD and 6PPD-Q induced distinct alterations in metabolite expression, predominantly within pathways associated with the biosynthesis of unsaturated fatty acids as well as the metabolism of arachidonic and linoleic acids. Exposure to 10μg/L 6PPD and 6PPD-Q increased the cholesterol level by 2.22 and 4.35 folds, and the triglyceride level by 1.90 and 2.25 folds, respectively. 6PPD-Q inhibited the enzyme activity and gene expression involved in lipolysis, and promoted the lipid synthesis. Moreover, 6PPD and 6PPD-Q bound to peroxisome proliferators-activated receptors of α and γ. In conclusion, 6PPD and 6PPD-Q with environmental concentrations induced frogs’ lipid metabolism disorders. These findings contribute to our understanding of 6PPD and 6PPD-Q health risks in amphibians.

Elucidating the role of weight loss and glycaemic control in patients with type 2 diabetes.

To investigate the independent contributions of glycated haemoglobin (HbA1c) reduction and weight loss to clinical outcomes in patients with type 2 diabetes (T2D) treated with antidiabetic drugs, including glucagon-like peptide-1 receptor agonists (GLP-1RAs). This observational, retrospective cohort study used deidentified electronic health record-derived data from patients evaluated at the Cleveland Clinic (1 January 2000-31 December 2020). Cohort A included 8876 patients with newly diagnosed T2D treated with any of six antidiabetic drug classes. Cohort B included 4161 patients with T2D initiating GLP-1RA treatment. The effects of body mass index (BMI) and HbA1c reduction, variability, and durability on clinical outcomes were investigated. In Cohort A, each 1% BMI reduction was associated with 3%, 1%, and 4% reduced risk of heart failure (p = 0.017), hypertension (p = 0.006), and insulin initiation (p = 0.001), respectively. Each 1% (~11 mmol/mol) HbA1creduction was associated with 4% and 29% reduced risk of hypertension (p = 0.041) and insulin initiation (p = 0.001), respectively. In Cohort B, each 1% BMI reduction was associated with 4% and 3% reduced risk of cardiovascular disease (p = 0.008) and insulin initiation (p = 0.002), respectively. Each 1% (~11 mmol/mol) HbA1c reduction was associated with 4% and 16% reduced risk of chronic kidney disease (p = 0.014) and insulin initiation (p = 1 × 10-4), respectively. Lower BMI variability and greater BMI durability were associated with decreased risk of clinical outcomes in both cohorts. Antidiabetic medication-associated, and specifically GLP-1RA-associated, weight loss and HbA1c reductions independently reduce real-world clinical outcome risk.

Morpho-physiological traits and stress indices reveal divergence in early-stage salt stress response in elite soybean germplasm

This study assessed the salt stress response of seventy soybean genotypes by exposing seedlings to sodium chloride (NaCl) concentrations of 0, 75, 100, and 125 mM. Salinity stress significantly reduced root length, shoot length, fresh and dry root/shoot weight, and root/shoot ratio. A total of 62 genotypes germinated at 125 mM, showing significant phenotypic variation in traits such as root length, shoot length, fresh shoot weight, and dry shoot weight. Pearson’s correlation analysis revealed a strong positive correlation between most morpho-physiological traits, suggesting their interdependence. Eight salinity tolerance indices i.e., Fresh Weight Stress Tolerance Index (FWSI), Dry Weight Stress Tolerance Index (DWSI), Root Length Salinity Index (RLSI), Shoot Length Salinity Index (SLSI), Salinity Tolerance Index (STI), Salinity Susceptibility Index (SSI), Tolerance Index (TI), and Percent Reduction (PR) were calculated to assess genotypes response. Na+ concentration and antioxidant activities significantly increased under salt stress compared to the control. The activities of antioxidant enzymes, as well as the levels of reactive oxygen species (ROS) such as H2O2 and O2−, were markedly higher under salt stress compared to the control. Hierarchical cluster analysis grouped genotypes into six clusters, with clusters V and VI comprising genotypes exhibiting higher salt tolerance based on high FWSI, DWSI, and STI values, and low PR, SSI, and TI values. Eight salinity tolerance indices, including Fresh Weight Stress Tolerance Index (FWSI), Dry Weight Stress Tolerance Index (DWSI), Root Length Salinity Index (RLSI), and Salinity Tolerance Index (STI), were used to evaluate the genotypes’ responses. The study revealed that the average FWSI value for all genotypes under treatments was 54.20 ± 12.93. The highest FWSI was recorded for the genotype Black (92.52), followed by NIBGE-224 (84.70) and NIBGE-183 (81.05). In contrast, Malakand-96 had the lowest FWSI (28.49), followed by SPS-10 (32.74) and SPS-08 (34.55). PGRA-91 had the highest STI (0.83), followed by SPS-9 (0.75) and NIBGE-115 (0.72), while NIBGE-335, SPS-24, and Malakand-96 had the lowest STI values. Positive correlations were observed between root length and shoot length (0.69**), shoot length and fresh shoot weight (0.63**), and other related traits. Overall, this study identified promising soybean genotypes with varying degrees of salt tolerance. These findings can be utilized in breeding programs to develop salt-tolerant soybean varieties for salinity-affected agricultural lands.

Dielectric Barrier Discharge Cold Plasma Improves Storage Stability in Paddy Rice by Activating the Phenylpropanoid Biosynthesis Pathway.

A nonthermal pretreatment using dielectric barrier discharge cold plasma (DBD-CP) was developed to improve the stress resistance of paddy rice during postharvest storage. The physicochemical properties, bioactive characteristics, and secondary metabolites of paddy rice were assessed after applying an optimized DBD-CP procedure, with enzyme activities and gene expression monitored over a 60 day storage period at 35 °C. A 17.06% reduction in the total color change index was noted in the DBD-CP group. Bioactive compounds, particularly gallic acid, were significantly increased, enhancing the defense mechanisms against high-temperature stress. Nontargeted metabolomics analysis indicated an upregulation of phenylpropanoid metabolism in DBD-CP-treated rice compared to controls, with notable increases in secondary metabolites such as coumaric acid, caffeic acid, and sinapic acid, suggesting potential biomarkers for stress resistance. Further verification showed significant enhancements in key enzymes of phenylpropanoid metabolism, including phenylalanine ammonia lyase (PAL), cinnamic acid-4-hydroxylase (C4H), plant coumaric acid-3-hydroxylase (C3H), and cinnamyl alcohol dehydrogenase (CAD), with increases ranging from 1.71 to 2.28 times. Gene expression levels of OsPAL7, OsC4H4, and OsCAD2 aligned with these enzymatic changes post-DBD-CP treatment. In conclusion, DBD-CP treatment can modulate phenylpropanoid metabolism in paddy rice, thereby enhancing bioactive compound levels to reduce stress damage during high-temperature storage.

Children with Developmental Dysplasia of Hip - Our Experience of Outcome at a Tertiary Care Centre

Objective: To assess the operative outcome of children who underwent surgical management for developmental dysplasia hip at a tertiary care center. Study Design: Case series. Place and Duration of Study: Pak-Emirates Military Hospital, Rawalpindi Pakistan, from Jan to Oct 2021. Methodology: This case series included 25 children who underwent triple procedure encompassing open reduction, femoral shortening and Salter’s pelvic osteotomy. Post-operative analysis of the clinical outcome was done using McKay’s classification and radiological assessment done using Severin’s classification. Results: Age of enrolled participants ranged from 02 to 07 years, mean age being 4.3±1.45 years, of which 8(32%) were male and 17(68%) were female. Mean pre-operative acetabular index was 40.3±3.38 while the mean post-operative acetabular index was 25.1±3.10. On follow-up, one child had subluxation while another had complete dislocation of the hip joint. Conclusion: Triple procedure with open reduction, femoral shortening and Salter’s osteotomy gives satisfactory results in patients aged 2 to 7 with substantial reduction in post-operative acetabular index.

Reduced canopy cover and development compromises weed suppression by buckwheat in cover crop mixtures

Buckwheat (Fagopyrum esculentum Moench) is a common cover crop typically grown for its rapid establishment and superior weed suppression. One challenge of incorporating buckwheat into crop rotations, however, is its short generation time, which requires in-season management to prevent viable seed production and volunteers in subsequent crops. Mixing buckwheat at reduced seeding rates with other cover crop species is one way for producers to reduce volunteer potential; however, this may compromise weed suppression. To investigate mechanisms behind buckwheat weed suppression and how using buckwheat in mixtures can affect suppression, we collected a series of morphological measurements in buckwheat monocultures and in three, two-way and four, three-way cover crop species mixtures and modeled their response over the growing season. We found that while buckwheat height and relative growth rate were unaffected with increasing species richness, there was a significant reduction in maximum leaf area index (3.75 vs. 2.85 vs. 2.82 cm2 cm-2) in mixture. Buckwheat monocultures provided superior season-long weed suppression compared to mixtures (85% vs. 53% vs. 50%). Principal component analysis showed that increased height and leaf area index values were associated with greater weed suppression. The link between reduced leaf area index and weed suppression in mixtures compared to buckwheat monocultures suggests that the rapid leaf development and canopy cover associated with buckwheat is a key mechanism behind weed suppression. In practice, producers should expect a dilution effect and weed suppression to be compromised when the buckwheat seeding rate is reduced in mixtures.

Efficacy and safety of ephedra-containing oral medications: a systematic review, meta-analysis, and exploratory dose–response analysis for weight reduction

IntroductionDespite the widespread use of ephedra in various forms, including food supplements and herbal prescriptions, comprehensive studies reviewing its efficacy and safety across different countries are lacking.MethodsWe systematically searched 5 electronic databases and conducted a meta-analysis of 16 randomized controlled trials (RCTs) on ephedra-containing oral medications (EOMs), performing a dose–response analysis for weight loss.ResultsThe meta-analysis results revealed a statistically significant reduction in the body mass index (BMI) (MD: 1.5 kg/m2; 95% CI: −2.46 to −0.54) and secondary outcomes like body weight (BW) and waist circumference (WC). The dose–response analysis indicated a correlation between ephedra and weight reduction. The safety analysis showed no significant difference in adverse effects between the treatment and control groups (RR = 0.99, 95% CI = 0.80 ∼ 1.21, and p = 0.90).DiscussionIn conclusion, EOMs demonstrated effectiveness in promoting weight loss, and the dose–response analysis indicated a correlation between ephedra and weight reduction. However, additional research is necessary due to the limited number of studies and inconsistent results among the assessment criteria. Moreover, if prescribed by traditional medicine physicians within the permissible daily ephedrine dosage range of 150 mg set by the Food and Drug Administration (FDA) and monitored by healthcare professionals, the risk of severe adverse events is likely to be minimal.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=387895, identifier CRD42023387895.

Low Iron Diet Improves Clinical Arthritis in the Mouse Model of Collagen-Induced Arthritis

Background: In response to inflammation, the absorption of nutritional iron is restricted. Since the pathophysiological significance of the presence and uptake of iron in chronic inflammation is still unknown, we tested the effect of a low iron diet on the clinical course of arthritis in the mouse model of collagen-induced arthritis (CIA). Methods: Six- to eight-week-old male DBA/1 mice were fed either a normal (51 mg/kg) or a low iron diet (5 mg/kg) starting four weeks before the first immunization. From day 4 after the second collagen booster made on day 25, the development of arthritis was regularly monitored until the end of the experiment (day 34), using a standard clinical arthritis score. Concentrations of mouse anti-bovine and anti-mouse collagen type 2 IgG antibodies were measured by ELISA; blood cell counts were performed and mediators of inflammation, tissue matrix degradation, oxygenation and oxidative stress were measured in the mouse sera of both diet groups at the end of the experiment by bead-based multiplex assay. Fe2+, Fe3+, oxidized and reduced glutathione (GSH and GSSG) and malondialdehyde (MDA) were quantified in whole paw tissue by ELISA. Quantitative PCR was performed in the tissues for glutathione peroxidase 4 and other key regulator genes of iron metabolism and ferroptosis. We used nonparametric tests to compare cross-sectional data. Nonlinear regression models were used for longitudinal data of the arthritis scores. Results: Mice fed a low iron diet showed a significantly less severe course of arthritis compared to mice fed a normal iron diet (p &lt; 0.001). The immune response against bovine and mouse type 2 collagen did not differ between the two diet groups. Mice fed a low iron diet exhibited significantly lower serum levels of tissue inhibitor of metalloproteinase-1 (TIMP-1), a central regulator of inflammation and tissue matrix degradation (p &lt; 0.05). In addition, a low iron diet led to a significant reduction in red blood cell indices, indicating restricted iron uptake and latent iron deficiency, but had no effect on hemoglobin concentrations or red blood cell counts. There were no differences between the dietary groups in Fe2+ or Fe3+ content in the paws. Based on calculation of the GSH/GSSG ratio and high MDA levels, high oxidative stress and lipid peroxidation were likewise detected in the paws of both diet groups of mice. Consequently, no differences associated with gene expression of key regulators of iron metabolism and ferroptosis could be detected between the paws of both diet groups. Conclusions: Restricted dietary iron intake alleviates immune-mediated inflammation in CIA without causing anemia. This finding suggests a promising option for dietary treatment of arthritis in inflammation. The underlying mechanism causing reduced arthritis may be linked to the complex regulatory network of TIMP-1 and appears to be independent from the local iron levels, oxidative stress and ferroptosis in the synovial tissues.

Biocontrol Efficacy of Bacillus thuringiensis Strain 00-50-5 Against the Root-Knot Nematode Meloidogyne enterolobii in Pepper

The root-knot nematode Meloidogyne enterolobii is a major constraint to pepper production in tropical regions. In the long-term practice of root-knot nematode management, bacterial nematicides have attracted increasing attention as effective biocontrol agents. In this study, we evaluated the efficacy of Bacillus thuringiensis strain 00-50-5 (Bt 00-50-5) against M. enterolobii through in vitro, greenhouse and field trials. The cell-free supernatant of Bt 00-50-5 exhibited potent nematicidal activity against second-stage juveniles (J2s) of M. enterolobii, with mortality rates of 98.0% and 100% after 24 h and 36 h of exposure, respectively. In addition, Bt 00-50-5 showed inhibitory effects on the hatching of M. enterolobii eggs, resulting in a remarkable 96.6% reduction in the egg hatching rate after 6 days compared to the control. The pot trials showed that both pepper root galls and egg masses were reduced, and plant growth was improved after treatment with Bt 00-50-5. The field trials showed that the gall index was significantly reduced, with a 66.3% and 68.2% reduction in disease index in 2020–2021 and 2021–2022, respectively, and pepper yield was improved, with a 96.2% and 93.1% increase in yield in 2020–2021 and 2021–2022, respectively, compared to the control. These results indicate the potential use of Bt 00-50-5 as an effective biocontrol agent against M. enterolobii.

Characterization of four Acidovorax phages and their potential in phage biocontrol for lamb's lettuce seed decontamination.

Bacterial black spot, caused by Acidovorax valerianellae, is responsible for significant yield losses in lamb's lettuce (Valerianella locusta) in many producing countries, especially Europe. Currently, no resistant varieties of V. locusta are available that effectively control the disease under field conditions. Bacteriophage-based biocontrol has been suggested as a sustainable and natural alternative strategy to combat bacterial pathogens. In this study, novel phages infecting A. valerianellae and Acidovorax cattleyae, Alfacinha1, Alfacinha3, Acica, and Aval, were isolated and characterized. Based on comparative genomics, these phages represent three new phage genera. Aval and Acica phages revealed genomic features characteristic of temperate lifestyle, encoding toxins likely associated with lysogenic conversion, which contrasts with Alfacinha1 and Alfacinha3. The latter was selected for application as a biocontrol agent during seed steeping. This phage reaches an 87% reduction in the A. valerianellae concentration on artificially infested seeds. Importantly, this reduction results in an increased germination rate from 58.9% to 93.3%. Moreover, the infected seedlings had a dramatic reduction in vigor index after 22 days of growth, whereas the phage-treated ones had a vigor index similar to the negative control, reinforcing the ability of bacteriophages to effectively reduce disease progression. We further evaluated the impact of lipopolysaccharides in phage suspensions on the development of seedlings. Here, we demonstrated that the presence of lipopolysaccharides do have an impact on seedling development, significantly reducing the number of roots developed. This study shows how genomic analyses and tailored bioassays represent an essential route to ensure safe phage application and demonstrates the potential of a phage-based biocontrol strategy against A. valerianellae.IMPORTANCEBacteria continue to globally cause serious damage to a variety of crops. One example is a bacterial black spot of lamb's lettuce caused by Acidovorax valerianellae. It has spread across Europe, resulting in economic losses of at least 10% in tonnage annually. Faced with the inefficiency of conventional control methods, an alternative and sustainable strategy based on the use of bacteriophages was pursued in this study. We present for the first time the isolation and characterization of A. valerianellae-specific phages. Moreover, we assessed their biocontrol potential in seed decontamination since the disease primarily spreads from seeds to seedlings. Interestingly, seed treatment with one of our phages reaches an 87% reduction in bacterial concentration. More importantly, this reduction results in an increased germination rate from 58.9% to 93.3%. Finally, our study demonstrated for the first time the need for removing endotoxins from phage suspensions as they impact plant development when used as a biocontrol agent.

Shared Medication PLanning In Home Hospice to Address Medication Regimen Complexity and Family Caregiver Burden: A Brief Report.

Objective: Medication management in home hospice is challenging for family caregivers (FCGs). We tested a patient-centered medication review and FCG support program delivered by hospice staff called "Shared Medication PLanning In (SiMPLIfy) Home Hospice." Methods: A pilot cluster-randomized trial at two U.S. home hospice agencies measured the primary outcome of reduction in Medication Regimen Complexity Index (MRCI) (range 0 [no medications]-no upper limit) and secondary outcome of Family Caregiver Medication Administration Hassle Scale (FCMAHS) (range 0 [no hassle-120 [greatest hassle]). Results: Twenty-two patient-FCG dyads enrolled. Mean baseline MRCI in the intervention group = 39 (95% CI: 30.9, 47.1) and control group = 25.5 (95% CI: 21.0-30.1). Half of intervention patients (3 of 6) had reduced MRCI compared with 26.7% (4 of 15) control patients (p = 0.07). MRCI was not significantly associated with caregiver burden. FCMAHS differed between spousal and nonspousal FCGs (p = 0.12). Conclusion: A clinician-FCG-patient communication program in home hospice is feasible and may reduce medication complexity. SiMPLIfy has the potential to reduce polypharmacy.

Outcomes of post-acute coronary syndrome patients enrolled in a phase 2 cardiac rehabilitation program

Abstract Introduction Cardiac rehabilitation (CR) is a class I recommendation in the management of patients with acute coronary syndrome (ACS), namely ST-elevation myocardial infarction (STEMI) and non-ST acute coronary syndrome (NST-ACS). Reported mortality and recurrent cardiovascular (CV) events are still unacceptably high in these patients. Purpose To assess CV outcomes of patients enrolled in a CR program and its association with ACS presentation. Methods Single-center, retrospective observational study that included all consecutive post-ACS patients enrolled in a phase 2 CR program in 2017, with a follow-up of 24 months. Group 1 were patients with STEMI; group 2 were patients with NST-ACS. Major adverse cardiovascular events (MACE) were defined as a composite of death, non-fatal ACS, non-fatal stroke, and unplanned revascularization. Results Of the 202 ACS patients who attended the CR program in 2017, 4 were excluded due to missing data. Of the 198 patients analyzed (age 60.3±10.7 years, 82% male), 101 patients had a STEMI and 97 NST-ACS. STEMI patients were significantly younger (57±9.5 vs. 63±10, p&amp;lt;0.001), with fewer CV risk factors (diabetes 16% vs. 32%, p=0.008; hypertension 51% vs. 72%, p=0.002; obesity 17% vs. 31%, p=0.020; dyslipidemia 54% vs. 77%, p&amp;lt;0.001), except for active smoking (53% vs. 29%, p=0.001), and were less likely to have previous history of coronary artery disease (9% vs. 31%, p&amp;lt;0.001). During the 3-month CR program, both groups achieved significant reduction in body mass index, LDL-Cholesterol, functional capacity, and smoking cessation rates. At 3-, 12-, and 24-months evaluation, both groups showed no differences in risk factor management, nor differences in lipid-lowering therapy, namely percentage of high-intensity statin and ezetimibe use. STEMI patients were treated more frequently with ticagrelor (86% vs. 67%, p=0.001) at baseline. MACE occurrence was significantly lower in STEMI patients (11% vs. 28%, p=0.003), driven mainly by recurrent ACS (4% vs. 15%, p=0.006). Conclusions In our study, NST-ACS patients had significantly higher CV disease burden and worse outcomes at 24-month follow-up. Despite the heightened CV risk in this group, secondary prevention treatment intensity was similar in both groups.

Early echocardiographic changes and reverse remodeling after transcatheter aortic valve implantation

Abstract Introduction Our hospital is a tertiary centre performing more than 500 transcatheter aortic valve implantation (TAVI) procedures annually. In this study we present early echocardiographic changes post-TAVI. Methods Clinical data collection and comprehensive echocardiography was performed the day before and 3.5±1.6 months after TAVI. Data analysis compared pre- and post-TAVI evaluations. Results A total of 101 patients were analyzed. Mean age was 80.1±6.8 years and 40% were female. TAVI was performed transfemorally in all patients, with 83% receiving a balloon expandable valve. NYHA class improved from 2.5±0.6 to 1.4±0.5 after TAVI (p&amp;lt;0.001) Echocardiographic parameters are summarized in Table. Global longitudinal strain (GLS) improved from -17±4% pre-TAVI to -18±4% post-TAVI (p&amp;lt;0.001), with no notable change in LVEF. A significant reverse remodeling with ≥10% reduction in left ventricular mass index (LVMi) was observed in 52% of patients following TAVI (from 124±32 to 110±29 g/m2, p&amp;lt;0.001) (Figure). Predictors of LVMi reduction were pre-TAVI LVMi and absence of comorbid hypertension (OR=1.02, 95% CI=1-1.03, p=0.03 and OR=0.31, 95% CI=0.11-0.84, p=0.02 respectively). There was no significant improvement in diastolic function, including left atrial strain. Conclusions Early post-TAVI assessments showed significant reverse remodelling with improvements in GLS and LVMi after TAVI. Predictors of LVMi reduction post-TAVI were absence of comorbid hypertension and higher baseline LVMi. There was no notable changes in diastolic function.

Cocoa flavanols alleviate early diastolic dysfunction by decreasing left atrial volume in healthy elderly individuals

Abstract Background Enlargement of the left atrium (LA) predicts future cardiovascular events. Current guidelines recommend cocoa flavanol (CF) intake as it provides cardiovascular and metabolic benefits, although underlying mechanisms are not fully revealed. In this study, we hypothesized that CF intake reverses LA enlargement as a surrogate marker for diastolic dysfunction in elderly individuals without cardiovascular diseases. Methods and Results In a randomized, double-blinded trial, we investigated the effects of CF on systolic and diastolic heart function in healthy elderly individuals. Precise assessment of left-atrial and left-ventricular volume as well as strain rates, all together as emblems of early subclinical cardiac impairment, and markers of systolic function were measured by high-resolution cardiac magnetic resonance (CMR) imaging before and after CF intake. Sixty-three participants (59% male) aged ≥ 55 years received either 500 mg CF (n=30) or a placebo (n=33) twice daily for 30 days. CF counteracted subclinical cardiac dysfunction, evidenced by a reduction in maximal LA volume and LA volume index by 12.6±3.5% (p=0.0063 and p=0.0067) and LV end-diastolic volume (LVEDV) and LVEDV index by ~4.9±1.9% (p=0.049 and p=0.0413). CF intake did not influence strain, strain rate, and systolic function parameters, while the systolic blood pressure decreased by 7 mmHg [~4.7±1.9% (p=0.04)]. Conclusion We provide evidence that CF intake mitigates early changes of diastolic dysfunction and improves cardiovascular health by reversing left atrial and left ventricular remodeling. Cocoa flavanol consumption may prevent age-related cardiac changes in healthy elderly individuals and promote a health span free from cardiovascular diseases.

Assessing the Impact of Wheat Flour and Baker's Yeast Restricted Diet vs. Calorie Restriction in NAFLD Patients

IntroductionNon-alcoholic fatty liver disease (NAFLD) is a prevalent and nonalcoholic progressive liver disorder associated with metabolic disturbance. This study aimed to compare the efficacy of wheat flour or baker's yeast-restricted diet with traditional calorie restriction in NAFLD patients.Material and methodsAnalyzed data was obtained from 243 individuals with NAFLD who completed the study. Of these patients, 54 belonged to Group (1) (Standard Diet, SD); 104 belonged to Group (2) (Wheat Flour-Free Diet, WFFD); and 85 belonged to Group (3) (Yeast-Free Diet, YFD). The intervention period lasted 6 months, during which participants' dietary compliance was closely monitored.ResultsAt the end of the six-month trial, both the WFFD and HFD groups exhibited a noteworthy reduction in body mass index (BMI) and triglyceride (TG) levels when compared to a standard diet that only involved calorie restriction. Furthermore, a notable reduction in the severity of liver steatosis was seen in these groups (p&lt;0.05). The SD group did not exhibit any significant changes in these metrics. The WFFD group experienced a notable reduction in HSI values (p&lt;0.05). Cluster analysis revealed that the obese group had higher HSI, weight, and BMI values throughout the study period, indicating a more advanced stage of NAFLD.ConclusionsTo summarize, this study highlights the significance of food constituents and dietary strategies in the treatment of NAFLD. It suggests that limiting the intake of wheat flour and baker's yeast specifically could have positive effects on liver well-being.

3D transesophageal echocardiographic assessment of acute reverse remodeling of the tricuspid annulus after transcatheter edge-to-edge repair.

Our study aims to evaluate the acute remodeling of the tricuspid valve annulus immediately after the T-TEER by using intraprocedural transesophageal three-dimensional (3D) echocardiography. We prospectively enrolled 62 consecutive symptomatic patients with at least severe TR, who underwent T-TEER with the TriClip System between March 2021 and June 2024. The following parameters were assessed using a multiplanar reconstruction analysis performed off-line using a 3D dataset: septal-lateral (SL) and antero-posterior (AP) annulus diameters; annulus area; annulus perimeter and eccentricity index.The acute procedural success was achieved in 85,5%. We observed an acute reduction in SL (from a median of 43 to 38 mm, p<0,0001), AP (from a median of 46 to 45 mm, p<0,0001), area (from a median of 17,9 to 15,95 cm2, p<0,0001), perimeter (from a median of 145,5 to 137 mm, p<0,0001) and eccentricity index (from 0,92 to 0,87, p<0,0001). The TV annulus was progressively larger in patients with higher residual TR. Analysis of the subgroups according to procedural success showed an acute inverse remodeling of the TV annulus independent of the acute procedural success. The TV geometry necessitates the use of 3D echocardiography for accurate assessment of annular remodeling post T-TEER. The reduction in TR grade and TV annulus dimensions begins immediately after TriClip implantation. Concurrently, the baseline TV geometry influences the procedural results.