ST Score Research Articles

Clinical impact of a cardiac intensivist in an adult cardiac care unit from the RESCUE registry

Abstract Funding Acknowledgements None. Purpose Dedicated intensive care unit (ICU) physician staffing is assocated with a reduction in ICU mortality rates in general medical and surgical ICUs. However, limited data area available on the role of cardiac intensivist in the cardiac intensive care unit (CICU). We investigated the association of cardiac intensivist-directed care with clinical outcomes in adult patients admitted to the CICU. Methods The SMART-RESCUE study is a multicenter, retrospective and prosective registry of patients that presented witth cardiogenic shock (CS). Between January 2014 and December 2018, 1,247 patients with CS were enrolled from 12 major centers in Korea. The study population was divided into 2 groups, according to the presence of a cardiac intensivist. The primary outcome was in-hospital mortality. Results THe analysis with SMART-RESCUE registry included 1,247 patients with CS (n=552 in the group with cardiac intensivist and n=695 in the group without cardiac intensivist) (Table 1). The in-hospital survival rate was significant higher in the group with intensivist than that in the group without intensivist (72.1% vs 59.2%, p < 0.001) (Figure 1). Cardiac intensive care with cardiac intensivist was associated with a reduction in risk-adjusted in-hospital mortality (adjusted odds ratio for in hospital death, 0.53; 95% confidence interval: 0.401 to 0.704; p < 0.001). Survival analysis also revealed significantly higher death free survival in te group with intensitivst. In multivariable analysis, cardiac intensivist, chronic kidney disease, ECMO-cardiopulmonary resuscitation, ST elevation myocardial infarction presentation and vasotrope-inotrope score were selected to be significant prognostic predictors for death in the CICU. Concluison: The presence of a dedicated cardiac intensivist was associated with a reduction in hospital mortality rates in patients with cardiovascular disease who required critical care.

Incidence and Predictors of Left Ventricular Thrombus Formation After Acute Myocardial Infarction With ST-Segment Elevation.

Background and objective Our prospective study aimed to evaluate the frequency and risk factors of left ventricular thrombus (LVT) occurring after acute ST-segment elevation myocardial infarction (STEMI) in the era of primary percutaneous coronary intervention (PCI). Methods Our study included 131 patients diagnosed with acute STEMI who were followed up and treated. The presence of the thrombus was determined by transthoracic echocardiography (TTE). Study patients were evaluated as cases of thrombus (+) and thrombus (-). The relationship of electrocardiographic measurements such as the number of leads with pathological Q waves, ST segment deviation score, QT dispersion, and echocardiographic measurements such as ejection fraction (EF), end-systolic and end-diastolic volumes, and wall motion score index (WMSI) with LVT was investigated. LVT risk factors were identified. Results The median age of the study patients was 59.7 ± 11.7 years, and 84.7% were male. The incidence of LVT was 17.6% (23 patients). While the anterior STEMI rate was 86.9% in the thrombus (+) group, it was 50.9% in the thrombus (-) group (p<0.001). While WMSI was 2.1 ± 0.44 in the thrombus (+) group, it was calculated as 1.40 ± 0.31 in the thrombus (-) group (p<0.001). In the thrombus (+) group, EF was found to be lower, end-systolic and end-diastolic volumes were higher, and the rate of moderate and severe mitral regurgitation and the rate of aneurysmatic segment detection were higher. LVT had a moderate correlation with WMSI (r: 0.613; p<0.001), the presence of an aneurysmatic segment (r: 0.549; p<0.001), and EF (r: -0.514; p<0.001). Presentation with anterior STEMI (odds ratio [OR]: 4.266; p<0.001), WMSI (OR: 7.971; p=0.012), the number of leads with pathological Q waves detected at discharge (OR: 3.651; p=0.009), the presence of an aneurysmatic segment (OR: 2.089, p=0.009), and EF (OR: 1.129, p=0.006) were identified as independent risk factors of the presence of LVT. The area under the curve for WMSI was found to be 0.910 (95% CI: 0.852-0.968). A WMSI cut-off of 1.56 identified LVT with 91% sensitivity and 70% specificity (Youden index: 0.617). Conclusion In the primary PCI era, LVT incidence after acute STEMI is still significant. Anterior STEMI, the number of leads with pathological Q waves detected at discharge, WMSI, aneurysm formation, and low EF are independent risk factors for LVT. Among these risk factors, the variable with the highest diagnostic power is WMSI.

Comparison of upfront versus deferred cytoreductive nephrectomy in patients with metastatic renal cell carcinoma receiving systemic therapy: A systematic review and meta-analysis.

This study aimed to conduct a pooled analysis to compare the outcomes of patients with metastatic renal cell carcinoma (mRCC) who received presurgical systemic therapy (ST; including immunotherapy and/or targeted therapy) followed by cytoreductive nephrectomy (deferred CN; dCN) with those who underwent upfront CN (uCN) followed by ST. The present study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A comprehensive search was conducted in PubMed, Embase, Web of Science, Scopus, and Cochrane Library database to identify eligible comparative studies up to April 2023. To evaluate their relevance, pooled hazard ratio (HR) with 95% confidence intervals (CIs) were calculated. A total of 3157 patients were included in nine studies. The dCN group was observed to be correlated with superior overall survival (OS) compared to the uCN group (HR=0.71, 95% CI 0.57-0.89, P=0.003). Moreover, we conducted subgroup analyses according to the type of ST, sample size, gender, age, and risk score, and observed similar outcomes for OS across most subgroups. The results of this study demonstrated that dCN may be associated with improved OS compared to uCN in patients with mRCC receiving ST. However, no significant differences were found between uCN and dCN groups in the immunotherapy-based combinations subgroup. Further research is needed to confirm these results.

Work-life balance among mental health professionals in a tertiary care neuropsychiatry centre in India.

Stress and distress are common among Mental Health Professionals (MHP). MHPs avoid seeking professional help to address their stress, leading to increased vulnerability to stress and mental health conditions. Inadequately addressed stress directly impacts their service delivery and well-being. However, a serious dearth of literature from India has examined the extent of work-life balance (WLB) stress and psychological distress (PD) among MHP. This cross-sectional study aims to assess WLB and examine the relationship between perceived stress (PS), PD, burnout, and WLB among MHP in a tertiary care neuropsychiatry center. Using stratified random sampling, 101 MHP were evaluated using Pareek's work-life balance scale, Stamm's professional quality of life (ProQoL) scale, WHO's self-reporting questionnaire, and Cohen's perceived stress scale. Data were analyzed using appropriate parametric or non-parametric tests. The overall mean score on WLB was 80.45 (SD = 10.21), the PS scale was 24.86 (SD = 6.87), the burnout score was 22.68 (SD = 6), the ST score was 21.18 (SD = 6.35), and PD score was 5.07 (SD = 5.23). The level of WLB score was average to below average among 64% of participants. There is a positive correlation between WLB and compassion satisfaction (CS) and a negative correlation between ST and PS. The study found that the nature of the job, CS, and PD shall predict WLB. Stress, burnout, ProQoL, and WLB of MHPs vary significantly by job, income, and staying with family, indicating that MHPs are equally vulnerable to stress and burnout and imbalanced WLB, which require appropriate interventions.

ST Segment Score on Initial Electrocardiogram (ECG) as a Predictor of In-Hospital Outcome of ST-Elevated Myocardial Infarction (STEMI) Patients

Introduction: The process of myocardial infarction progresses over several hours and therefore most patients present when it is still possible to salvage myocardium. ECG is usually a sensitive and specific way of confirming diagnosis. ST segment score (STSS) in myocardial infarction is emphasized but not often quantified. HJ Wellens gave cutoff for STSS in anterior wall MI (AWMI)of 12 mm and inferior wall MI (IWMI)of 7 mm. In this study the predictive value of ST Segment Score (STSS) with patients of STEMI on admission ECG &amp; after thrombolysis had been assessed. Objectives: Identify patients at higher risk early in the course of their hospital admission &amp; correlation of initial ECG and post thrombolysis ECG regarding clinical outcome. Materials and Methods:Considering inclusion and exclusion criteria 112 patients admitted in CCU, DMCH during october 2007 to september 2008 were studied of which 64 were inferior STEMI and 48 were anterior STEMI. Like admission ECG, after 90 minutes of starting thrombolytic,another ECG was recorded and calculated. Echocardiography was done for each patient before discharge. Data was collected in a pre-designed form. Results: The mean age of Group-I was 55.2±12.2 years and that of Group-II 56.9±14.1 years, Group-III 59.2±11.7 years,Group-IV 55.0±12.6 years. Of the 30 patients studied in Group-I 76.7% was male and 23.3% female. Smoking was the most prevalent (60% in Group I, 58.8% in Group II) risk factor. In post thrombolytic ECG shows that in Group-I mean sum of ST elevation decreased to 3.9 ± 1.1 mm from 4.8 ± 1.2 mm. which was approximately (45+14)% of ST resolution, in Group-II(50+19%),in Group-III (55+19)%, in Group-IV(45+23)%. Conclusion: Significant differences were seen in chest pain, killip class,arrhythmia, echocardiographic LVEF, duration of hospital stay in patients with AWMI &amp; STSS above 12 mm and IWMI &amp; STSS above 7 mm in comparison with below these level even after use of thrombolytics. Medicine Today 2022 Vol.34(2): 88-92

Effect of rostral ventrolateral medulla in electroacupuncture pretreatment for alleviating myocardial ischemia-reperfusion injury 延髓头端腹外侧区在电针预处理减轻心肌缺血再灌注损伤中的作用

ObjectiveTo observe the effects of pretreatment with electroacupuncture (EA) on neuron activity in the rostral ventrolateral medulla (RVLM) of rats with myocardial ischemia-reperfusion injury (MIRI) and explore the central regulatory mechanism of EA in attenuating MIRI. MethodsOf 72 SD rats, 12 were randomly allocated into the group of EA pretreatment + RVLM nucleus damage (EA + RVLM lesion group). The other 60 rats were randomized (20 rats each) into a sham-operation group, a model group, and an EA pretreatment group (EA group). Except for the rats in the sham-operation group, the models of MIRI were prepared by ligating the left anterior descending coronary artery in the model, EA, and EA + RVLM lesion groups. The rats of the EA group were intervened with EA at “Shénmén (神门HT7)” and “Tōnglĭ (通里HT5), 1 mA in current intensity and 2 Hz in frequency, for 20 min each time per day. Before modeling, the intervention was given for seven consecutive days. In the EA + RVLM lesion group, 3 weeks after microinjection with the neuronal apoptotic virus at bilateral RVLM, the same EA intervention as the EA group was provided. Afterward, the MIRI models were prepared. In the model group, no EA intervention was given. Using Powerlab electrophysiolograph, ST segment displacement value and arrhythmia score were recorded and analyzed before modeling, 30 min after ligation, and 120 min after reperfusion in each group. The concentration of cardiac troponin (cTnl) was detected with an ELISA assay kit. Using immunofluorescence staining, the expression level of c-fos protein of RVLM was detected in the sham-operation, model, and EA groups separately. Plexon multichannel acquisition processor was adopted to record the neuronal firing and field potential of RVLM in the sham-operation, model, and EA groups. ResultsST segment displacement value, arrhythmia score, and cTnl concentration 30 min after ligation and 120 min after reperfusion were all elevated in the model group compared to the sham-operation group (all P < 0.01). ST segment displacement value, arrhythmia score, and cTnl concentration were lower in the EA group compared to the model and EA + RVLM lesion groups (P < 0.01). Compared with the sham-operation group, the expression level of c-fos and the total firing frequency in RVLM were significantly higher in the model group (P < 0.01). However, the expression level of c-fos and the total firing frequency in RVLM were lower in the EA group compared with the model group (P < 0.01). ConclusionElectroacupuncture pretreatment may induce changes in c-fos protein expression and neuronal activity in RVLM to mitigate myocardial lesions. RVLM plays an important role in electroacupuncture pretreatment for alleviating MIRI.

Association of Quantitative ST- Segment Depression with Early Mortality among Naive Patients of Non- ST- Segment Elevation Acute Coronary Syndrome

Objective: To determine the association of quantitative ST– segment depression with early mortality within 30 day in patients with first non-ST – segment elevation acute coronary syndrome (NSTE-ACS). Methodology: This descriptive case series study was conducted at the cardiology department of LUMHS, from October 2016 to March 2017. Patients with NSTE-ACS and positive cardiac biomarkers, patients older than 25 years and both genders admitted to CCU were included. The ST-Segment depression was assessed on 12 lead electrocardiography. The ST segment is the line that starts from the end of the QRS complex (J wave) to the beginning of the T wave. Normally ST segment is straight line and, isoelectric to base line, ST segment depressed below isoelectric line is said ST depression, down sloping or flat depressed ST segments indicate coronary ischemia, more than 0.5 mm ST depression significant for ischemia. All patients were followed for 30-days for early mortality. All information obtained was recorded on the study Performa. Results: A total of 148 cases with acute myocardial infarction were integrated; the patient's average age was achieved as, 42.5±5.43 years, and males were in the majority 96(64%). On electrocardiography, ST-Segment depression was found in 60.13%, which is further divided into 0.5mm, &gt;0.5-0.9 mm, &gt;1-1.9 mm, and &gt;2 mm with percentages of 12.83%, 22.29%, 16.89%, and 8.12%, respectively. Short term mortality was significantly associated with the severity of ST segment depression score (p-value 0.001). Conclusions: In the study conclusion, the severity of ST-Segment depression score was observed to be significantly correlated with short term mortality (30-day) in cases with early NSTE-ACS.

Functional amino acid supplementation postweaning mitigates the response of normal birth weight more than for low birth weight pigs to a subsequent Salmonella challenge

Previous work has shown that dietary supplementation with key functional amino acids (FAA) improves growth performance and immune status of disease-challenged normal birth weight (NBW) pigs. It is not known whether FAA supplementation attenuates the effects of a subsequent disease challenge or whether this response is similar in low birth weight (LBW) pigs. The objective was to determine the effects of birth weight and FAA supplementation during the postweaning period in Salmonella-challenged pigs. Thirty-two LBW (1.08 ± 0.11 kg) and NBW (1.58 ± 0.11 kg) pigs were assigned to a nursery feeding program at weaning (25 d) for 31 days in a 2 × 2 factorial arrangement. Factors were birth weight category (LBW vs. NBW) and basal (FAA–) or supplemented FAA profile (FAA+; Thr, Met, and Trp at 120% of requirements). At d 31, pigs were placed onto a common grower diet and, after a 7-d adaptation period, were inoculated with Salmonella Typhimurium (ST; 2.2 × 109 colony-forming units/mL) and monitored for 7-d postinoculation. Growth performance, rectal temperature, fecal score, indicators of gut health, ST shedding score in feces, intestinal ST colonization and translocation, and blood parameters of acute-phase response and antioxidant balance were measured pre- and postinoculation. Inoculation with ST increased temperature and fecal score, and the overall rectal temperature was higher in LBW compared to NBW pigs (P < 0.05). Postinoculation (d 7), reduced:oxidized glutathione was increased in NBW compared to LBW pigs (P < 0.05). Salmonella shedding and translocation to spleen were lower in NBW-FAA+ compared to NBW-FAA− pigs (P < 0.05). Postinoculation average daily gain was higher in NBW-FAA+ (P < 0.05) compared to the other groups. Postinoculation haptoglobin, superoxide dismutase, and colonic myeloperoxidase were increased in LBW-FAA− pigs (P < 0.05). Ileal alkaline phosphatase was decreased in LBW compared to NBW (P < 0.05). Overall, FAA supplementation represents a potential strategy to mitigate the effect of enteric disease challenge in NBW, but not LBW pigs.

Magnitude of ST-segment Elevation Is Associated with Increased Acute Inflammatory Response and Myocardial Scar in Patients with Acute Myocardial Infarction Undergoing pPCI

ABSTRACT Background: The integrated ST segment elevation score (ISSTE) score objectively quantifies the ECG changes before and after primary percutaneous coronary intervention (pPCI) for ST segment elevation myocardial infarction (STEMI). The inflammatory response is a major component in scar formation and remodeling process of the myocardial tissue following myocardial infarction (MI). Cardiac magnetic resonance imaging (CMR) precisely quantifies the cardiac function and assesses the pattern of the myocardial scar tissue. The aim of the study was to evaluate the relations between the ISSTE score and: (1) acute inflammatory biomarkers and (2) extent of the myocardial scar determined by CMR in STEMI treated with pPCI. Material and methods: One hundred thirty STEMI patients were included in the study, who underwent pPCI in the first 12 hours from symptom debut. ISSTE-1 was calculated at presentation and 2 hours following pPCI (ISSTE-2). Inflammatory biomarkers were determined at admission and day 5, followed by LGE-CMR at 4 weeks, with quantification of cardiac function and extent of infarct size (IS) and transmurality. Patients were divided in low and high ISSTE groups based on the median values. Results: No significant differences were noted in terms of CMR parameters or inflammatory biomarkers and between the groups with low or high ISSTE-1. Significantly higher levels of day-5 hs-CRP (p = 0.03) and day-1 IL-6 (p = 0.02), MMP-9 (p = 0.05) were recorded in high ISSTE-2 groups. LV IS mass (23.11 ± 5.31 vs. 57.94 ± 8.33, p = 0.001), percentage (13.55 ± 6.22 vs. 27.15 ± 7.12, p = 0.001) and transmurality (p = 0.001) was significantly higher in ISSTE-2 group. ISSTE-2 significantly correlated with LV IS mass (r = 0.391, p &lt;0.0001), percentage (r = 0.541, p &lt;0.0001) high transmurality (r = 0.449, p &lt;0.0001) and LV EF (r = -0.397, p &lt;0.0001). Conclusions: A high ISSTE-2 score is associated with increased inflammatory response exhibited by elevated serum IL-6 and MMP-9 levels determined on the day of admission, and with persistently increased serum hs-CRP levels on day 5 of the acute event. A higher ISSTE-2 score is associated with larger myocardial scar extent expressed by IS, higher transmurality and reduced LV EF at 1-month LGE CMR follow-up.

Measurement, processing and analysis of stress magnetocardiograms

Magnetocardiography (MCG) measures weak magnetic fields originating due to the electrical activity of the heart. MCG offers distinct diagnostic information on the cardiac electrophysiology in a variety of dysfunctions. This list includes myocardial ischemia, which is associated with reduced blood supply to the heart, electrically manifested as changes in the ST segment of the cardiac cycle. As opposed to the conventional measurement of electrocardiogram (ECG) on subjects undergoing physical stress test to investigate these ST changes, rest MCG itself has been demonstrated to be more sensitive. Considerable interest exists among researchers to investigate MCG signals measured during physical exertion as well to explore the possibilities of improvements in its sensitivity. This paper portrays the MCG measurements of a few subjects under rest and during moderate cycling in supine posture using a non-magnetic bicycle ergometer. The work details the signal processing steps followed in processing MCG to refine the signal quality in computing the parameter, ST fluctuation score in an automated manner. Significant changes are seen on the ST fluctuation scores measured on a few healthy subjects across rest and stress conditions. These results persuade its possible use on MCG measured on subjects with ischemic heart diseases by treating this analysis as baseline measurements.

The effect of neomycin inclusion in milk replacer on the health, growth, and performance of male Holstein calves during preweaning

The prophylactic use of oral antimicrobials, such as neomycin, in milk replacer (MR) or whole milk is a common practice in calf-rearing that is thought to aid in preventing disease. Heavy reliance on antimicrobials is of concern not only because of the development of antimicrobial resistance, but also because of the potentially negative effects on health. The objective of this study was to investigate the effects of neomycin on calf health and growth performance. One hundred and sixty calves (approximately 3-10 d of age), distributed across 2 experimental periods, were stratified by body weight (BW) and serum total protein, and assigned to 1 of 3 treatments: control (CON; nonmedicated MR, n = 60), short-term antibiotic (ST; neomycin mixed in MR from d 1-14, n = 50), or long-term antibiotic (LT; neomycin in ​MR from d 1-28, n = 50). Arrival BW (47.69 ± 0.87 kg) and serum total protein (5.67 ± 0.09 g/dL) were not different between treatment groups. Neomycin in ST and LT was dosed in MR at a rate of 20 mg/kg of BW and was adjusted weekly according to BW. Calf BW was measured weekly for 49 d, and health indicators (fecal score, attitude score, respiratory score, and rectal temperature), MR intake, starter intake, and the use of additional electrolytes and antimicrobials were recorded daily. Calves in the CON group experienced a higher proportion of days with diarrhea (20.32 ± 0.02%) compared with ST (14.70 ± 0.02%) or LT (13.80 ± 0.02%) calves, as well as longer bouts of diarrhea (7.45 ± 0.38 d, 5.69 ± 0.46 d, and 5.62 ± 0.45 d for CON, ST, and LT calves, respectively). Calves in the CON group also experienced higher fecal scores (score of 0.64 ± 0.04) than ST (score of 0.53 ± 0.04) or LT (score of 0.49 ± 0.04) calves, especially at d 7. However, no differences were observed in other health-related measures. The time to reach first diarrhea and first respiratory illness was not different between treatments, nor was the time to recover from respiratory illness. The time to intervention with additional electrolytes or antimicrobials was not different between treatment groups. Furthermore, growth performance, feed intake, and feed conversion ratio were not different. No differences were found when comparing ST and LT, except in the defined daily dose of total antimicrobials received. Calves in the LT group received a higher overall dose than ST calves, and both ST and LT calves received a higher dose than CON calves, which received no prophylactic antimicrobials. Given that there were no differences in performance variables and no additional health benefits aside from reduced fecal scores in calves fed neomycin, current practices involving the use of antimicrobials on dairy and veal operations need to be considered more prudently.

Development and Validation of the Long Coronavirus Disease (COVID) Symptom and Impact Tools: A Set of Patient-Reported Instruments Constructed From Patients’ Lived Experience

ObjectivesTo develop and validate patient-reported instruments, based on patients' lived experiences, for monitoring the symptoms and impact of long covid.DesignThe long covid Symptom and Impact Tools (ST and IT) were constructed from the answers to a survey with open-ended questions to 492 patients with long COVID. Validation of the tools involved adult patients with suspected or confirmed COVID-19 and symptoms extending over three weeks after onset. Construct validity was assessed by examining the relations of the ST and IT scores with health related quality of life (EQ-5D-5L), function (PCFS, post-COVID functional scale), and perceived health (MYMOP2). Reliability was determined by a test-retest. The "patient acceptable symptomatic state" (PASS) was determined by the percentile method.ResultsValidation involved 1022 participants (55% with confirmed COVID-19, 79% female, and 12.5% hospitalized for COVID-19). The long COVID ST and IT scores were strongly correlated with the EQ-5D-5L (rs = -0.45 and rs = -0.59 respectively), the PCFS (rs = -0.39 and rs = -0.55), and the MYMOP2 (rs = -0.40 and rs = -0.59). Reproducibility was excellent with an interclass correlation coefficient of 0.83 (95% confidence interval 0.80 to 0.86) for the ST score and 0.84 (0.80 to 0.87) for the IT score. In total, 793 (77.5%) patients reported an unacceptable symptomatic state, thereby setting the PASS for the long covid IT score at 30 (28 to 33).ConclusionsThe long covid ST and IT tools, constructed from patients’ lived experiences, provide the first validated and reliable instruments for monitoring the symptoms and impact of long covid.

Functional amino acid supplementation, regardless of dietary protein content, improves growth performance and immune status of weaned pigs challenged with Salmonella Typhimurium.

High dietary protein may increase susceptibility of weaned pigs to enteric pathogens. Dietary supplementation with functional amino acids (FAA) may improve growth performance of pigs during disease challenge. The objective of this study was to evaluate the interactive effects of dietary protein content and FAA supplementation above requirements for growth on performance and immune response of weaned pigs challenged with Salmonella. Sixty-four mixed-sex weanling pigs (13.9 ± 0.82 kg) were randomly assigned to dietary treatments in a 2 × 2 factorial arrangement with low (LP) or high protein (HP) content and basal (AA-) or FAA profile (AA+; Thr, Met, and Trp at 120% of requirements) as factors. After a 7-d adaptation period, pigs were inoculated with either a sterile saline solution (CT) or saline solution containing Salmonella Typhimurium (ST; 3.3 × 109 CFU/mL). Growth performance, body temperature, fecal score, acute-phase proteins, oxidant/antioxidant balance, ST shedding score in feces and intestinal colonization, fecal and digesta myeloperoxidase (MPO), and plasma urea nitrogen (PUN) were measured pre- and postinoculation. There were no dietary effects on any measures pre-inoculation or post-CT inoculation (P > 0.05). Inoculation with ST increased body temperature and fecal score (P < 0.05), serum haptoglobin, plasma superoxide dismutase (SOD), malondialdehyde (MDA), PUN, and fecal MPO, and decreased serum albumin and plasma reduced glutathione (GSH):oxidized glutathione (GSSG) compared with CT pigs (P < 0.05). ST-inoculation reduced average daily gain (ADG) and feed intake (ADFI) vs. CT pigs (P < 0.05) but was increased by AA+ vs. AA- in ST pigs (P < 0.05). Serum albumin and GSH:GSSG were increased while haptoglobin and SOD were decreased in ST-inoculated pigs fed AA+ vs. AA- (P < 0.05). PUN was higher in HP vs. LP-fed pigs postinoculation (P < 0.05). Fecal ST score was increased in ST-inoculated pigs on days 1 and 2 postinoculation and declined by day 6 (P < 0.05) in all pigs while the overall score was reduced in AA+ vs. AA- pigs (P < 0.05). Cecal digesta ST score was higher in HP vs. LP-fed pigs and were lower in AA+ compared with AA- fed pigs in the colon (P < 0.05). Fecal and digesta MPO were reduced in ST pigs fed AA+ vs. AA- (P < 0.05). These results demonstrate a positive effect of FAA supplementation, with minimal effects of dietary protein, on performance and immune status in weaned pigs challenged with Salmonella.

Topical cyclosporine a (0.05%) treatment in dry eye patients: a comparison study of Sjogren's syndrome versus non-Sjogren's syndrome.

To evaluate the clinical effect of topical cyclosporine A (CsA) (0.05%) on dry eye patients with Sjogren's syndrome (SS) and non-Sjogren's syndrome (NSS). This retrospective comparative study includes the dry eye (DE) patients who were treated with topical CsA. DE patients were divided into two groups as follows: DE with Sjogren's syndrome (DE-SS) and DE with Non-Sjogren's syndrome (DE-NSS). Dry eye parameters were recorded at baseline and each visit. Schirmer's test 1 scores were 2.7 ± 0.5mm at baseline and 3.5 ± 0.7mm at 12th month in DE-SS, 2.9 ± 0.7mm at baseline and 9.5 ± 0.7mm in DE-NSS groups at 12th month. Mean ST score was higher in DE-NSS group than DE-SS group at sixth and 12th months of the treatment (both p = 0.001). Tear break-up time score showed a significant improvement in DE-NSS group, and it was lower in DE-NSS group than DE-SS group group at sixth and 12th months of the treatment (p = 0.044 and 0.027, respectively). Mean OSDI score was lower in DE-NSS group than DE-SS group at sixth and 12th months of the treatment (p = 0.030 and 0.032, respectively). Topical CsA seems to be more effective in the treatment of the DE-NSS.

Efficacy of COVID-19 Vaccination on the Symptoms of Patients With Long COVID: A Target Trial Emulation Using Data From the ComPaRe e-Cohort in France

Background: Long COVID is a complex multiorgan disorder that can affect patients’ lives severely. Recent reports suggest that symptoms improve after COVID-19 vaccination. Methods: We used data from the ComPaRe long COVID cohort to emulate a target trial evaluating the effect of vaccination among patients with long COVID who still had persistent symptoms at baseline. Vaccinated patients were matched to unvaccinated controls in a 1:1 ratio by their propensity scores. Outcomes, all measured at 120 days after baseline, include disease severity (long COVID ST, range 0-53), rate of complete remission (ie, disappearance of all symptoms), disease impact on patients’ lives (long covid IT, range 0-60), and the proportion of patients reporting an unacceptable symptom state. Vaccinated patients reported all adverse events occurring after vaccination in free text. Findings: In total, 455 patients were allocated to the vaccination group and 455 to the control group; 545 (60·1%) had confirmed infections, and 81 (8·9%) had been hospitalized during their acute COVID-19. By 120 days, vaccination reduced the long COVID symptoms (mean (SD) ST score in the vaccination group 13·0 (9·4) vs. 14·8 (9·8) in the control group; mean difference: -1·8, 95% CI -2·5 to -1·0) and doubled the rate of patients in complete remission (remission rate 16·6% vs 7·5%, HR: 1·97, 95% CI 1·23 to 3·15). Furthermore, vaccination reduced both disease impact on patients’ lives (mean (SD) IT score 24.3 (16·7) vs 27·6 (16·7); mean difference: -3·3, 95% CI -6·2 to -0·5) and the proportion of patients with an unacceptable symptom state (38.9% vs 46.4%, risk difference -7·5%, 95% CI -14·4 to -0·5). In the vaccination group, two (0·4%) patients reported serious adverse events leading to hospitalisation. Interpretation: COVID-19 vaccination lowers the severity and life impact of long COVID at 120 days among patients with persistent symptoms.Funding Information: The authors received no specific funding for this work.Declaration of Interests: The authors declare no competing interests and no financial associations that may be relevant or seen as relevant to the submitted manuscript. The authors have no association with commercial entities that could be viewed as having an interest in the general area of the submitted manuscript.Ethics Approval Statement: All patients provided online consent before participating in the cohort. The Institutional Review Board of Hôtel-Dieu Hospital, Paris, approved the study (IRB: 0008367).

Gender difference in efficacy of intra-aortic balloon pump in acute myocardial infarction patients complicating with cardiogenic shock

Objective: To investigate the effect of gender on the efficacy of intra-aortic balloon pump(IABP) applied in patients with cardiogenic shock complicated by acute myocardial infarction(AMI). Methods: A total of 209 patients diagnosed as cardiogenic shock complicated by AMI admitted in Fuwai Hospital from June 2012 to May 2018 were enrolled in our study. We collected the data from medical records and investigated their clinical manifestation and laboratory examination and IABP support, as well as 28-day (from diagnosis of cardiogenic shock) mortality retrospectively. Kaplan-Meier survival analysis was used to compare the 28-day survival rates of patients of different genders/with or without IABP treatment. Adjustment for age, systolic blood pressure, ST segment elevation myocardial infarction, dual antiplatelet, coma, APACHEⅡ score and SAPSⅡ score, Cox regression analysis was used to detect the affect of IABP treatment on the risk of all-cause mortality in different crowd, and using Z test to evaluate the modification effect of gender on IABP treatment efficacy. Results: A total of 209 patients were included in this study, with 148 males (80 (54.05%) cases received IABP support) and 61 females (22 (36.06%) cases received IABP support). A total of 102 patients received IABP treatment. The 28-day survival rate of male patients was higher than that of females (39.2% (58/148) vs. 26.2% (16/61), Log-rank P=0.034). The 28-day survival rate of patients receiving IABP was significantly higher than that of non-IABP groups (46.1% (47/102) vs. 25.2% (27/107), Log-rank P=0.001 7). Among female patients, there was no statistically significant difference in 28-day survival rate between those who received IABP and those who did not receive IABP (P=0.889). While in male patients, the 28-day survival rate of those who received IABP was higher than that of those who did not receive IABP (51.2% (41/80) vs. 25.0% (17/68), P=0.001). The survival rate of male patients treated with IABP was higher than that of male patients who did not receive IABP, female patients who did not receive IABP and female patients who received IABP (all P<0.05). After multiple regression analysis and adjustment of confounding factors, it was found that IABP implantation can significantly reduce the 28-day mortality risk in male patients (HR=0.44, 95%CI 0.25-0.77 P=0.004). While it had no inpact on the death risk in female patients(P= 0.401). The impact of IABP implantation in patients of different genders was significantly different (Z=-2.32, P=0.020). Conclusion: In AMI patients complicating cardiogenic shock, there is a gender difference in the impact of IABP implantation on the 28-day mortality risk, and protective effects are seen only in men.

P1437 Integrated ST segment elevation score as a new predictor of the myocardial scar extent determined with LGE-CMR at 1-month follow-up after STEMI

Abstract Funding Acknowledgements Funded by the research grant PlaqueImage, contract number 26/01.09.2016, SMIS code 103544, by the European Union and the Government of Romania Background The inflammatory response in the acute phase of a myocardial infarction, as well as in later phases contributes to the healing process of the infarcted myocardium and the left ventricular remodeling. Restoration and improvement of LV function highly depends on the magnitude of scar formation. Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) imaging has been validated for an accurate determination of the myocardial scar size and transmurality. The recovery of ST segment elevation is a liable marker of vessel patency following PCI. Purpose The aim of the study was to validate a new integrated score of ST segment elevation score (ISSTE) as a new predictor of the myocardial scar tissue size, in relation with increased inflammatory biomarkers, with the extent of myocardial fibrosis at one month, assessed with LGE-CMR, after STEMI. Methods We included 65 patients with STEMI who underwent urgent revascularization with PCI in the first 12 hours from the onset of symptoms. The ISSTE was determined by summing the ST segment elevation in all registered ECG leads at presentation (ISSTE-1) and at 2 hours (ISSTE-2) after primary PCI. Blood samples were also collected at baseline and day-5 for determination of serum hs-CRP levels. At 1-month follow-up all patients under LGE-CMR (1.5T scanner) for evaluation of the myocardial scar extent (volume, percentage, transmurality). Results ISSTE-2 was significantly correlated with day-5 hs-CRP serum levels (r = 0.546, 95%CI: 0.030-0.832, p = 0.037), although no significant correlations were noted with baseline hs-CRP levels (r= 0.238, p = 0.407). There were no significant correlations between ISSTE-1 score and the myocardial scar percentage (r = 0.241, p = 0.11) or high transmurality volume (r = 0.194, p = 0.21), while ISSTE-2 significantly correlated with myocardial scar mass (r = 0.406, 95%CI: 0.107-0.637 p = 0.007) and high transmurality volume (r = 0.344, 95%CI: 0.0320-0.596, p = 0.0273). The restoration of the ST segment, reflected by the difference between ISSTE-1 and ISSTE -2 is correlated with the infarct size mass (r = 0.336, 95%CI: 0.0307 -0.584, p = 0.027). Conclusion The magnitude of ST segment elevation determined at 2 hours after PCI was associated with the inflammatory response at day 5 after STEMI and it may serve as a predictor for the extent of the myocardial scar tissue determined with LGE-CMR at 1 month following STEMI. The ISSTE-1 score calculated at presentation does not reflect extent of the affected myocardial tissue following PCI.

Correlation between ST segment shift and cardiac diastolic function in patients with acute myocardial infarction

BackgroundDiastolic dysfunction is the early sign of myocardial ischemia that usually occurs earlier than ECG changes. Aim of the studyTo determine the existence of a correlation between ST segment shift and diastolic dysfunction among patients with AMI. MethodsFourty six patients with significant ST segment elevation or depression and having symptoms of acute myocardial infarction for <12 h were enrolled in this study. Patients were examined for serial ECG, cardiac enzymes, and echocardiography. ResultsThere was no significant correlation between ST segment elevation or depression and majority of the diastolic indices. Few diastolic parameters; such as, E/A ratio of the mitral valve and deceleration time of the tricuspid valve showed a direct correlation with the ECG changes. Whereas, the Tei Index of the LV function showed a borderline correlation to the ST segment elevation at discharge. ConclusionOverall, there was no correlation between either ST segment elevation or depression and the LV or RV diastolic function in patients with acute coronary syndrome (ACS). Improvement of the ST segment total score was associated with improvement of the diastolic function grades at discharge. Moreover, this association has shown an evidence of dose response relationship, the more improvement in total score at discharge the more improvement in diastolic function grade level.

Utility of ST score on admission as a marker for outcome in acute myocardial infarction in a resource constrained setting

Introduction: An early and specific indicator is needed to prognosticate acute myocardial infarction (MI). This indicator should be simple, quick, reliable, non-invasive, inexpensive, and easily applicable to all the patients especially in a resource-constrained setting. The present study tried to evaluated efficacy of ST score on electrocardiography as a prognostic indicator in acute ST-elevated MI (STEMI). Materials and Methods: A prospective study was conducted on consecutive thrombolysed patients of STEMI admitted in teaching hospital. ST score defined as sum of ST-segment elevation in all leads related to infarct location was calculated in standard 12-lead electrocardiographic tracings immediately on admission and then serially postthrombolysis at 90 min, 6 h, 24 h, and day 3 and 5 of admission. Primary end-point was all-cause mortality at 30 days. Results: The mean ST score between survivor and nonsurvivor was 19.27 mm and 16.16 mm, respectively. The score on admission in patients who had poor outcome was significantly higher than those who had good outcome (poor = 20.27 mm vs. good outcome = 12.47 mm; P = 0.002). This difference persisted throughout but was maximum at 90-min postthrombolysis (13.82 mm vs. 7.39 mm; P = 0.0001). The optimal cutoff point maximizing sensitivity and specificity was found at 11 mm for both anterior- and inferior wall MI (IWMI) with a sensitivity of 73% and specificity of 58%. Conclusion: This study concludes that an increase of 1 mm in ST score increased the odds of complications by 1.06 (95% confidence interval [CI], 1.01–1.2) for anterior-wall MI and by 1.09 (95% CI, 0.96–1.2) for IWMI. In a resource-constrained health facility where electrocardiography may be the only available equipment, ST score can easily and effectively be used to stratify patients into high-risk and low-risk categories.

Value of ST- Segment Depression with T-Wave Inversion in Lateral Leads I, aVL, V4-V6 in Diagnosing the Left Main or Left Main Equivalent Coronary Artery Disease

Background: Critical stenosis in the proximal part of the left anterior descending, severe 3 vessel disease and left main stem stenosis have all been recognized as clinical conditions complicated by a high incidence of large infarction, pump failure, arrhythmias and sudden death in patients with acute coronary syndrome (ACS). As many effective treatment modes are available currently, early recognition of those circumstances is crucial for appropriate management.Methods: this observational study was carried out at the Department of Cardiology, National Institute of Cardiovascular Disease (NICVD), Dhaka. Patients (30 patients) with NSTEACS having ST-segment depression with T-wave inversion maximally in leads I,avL,V4-V6 were considered as cases (Group I) and those (30 patients) with ST-segment depression without T-wave inversion in lateral leads were controls (Group II). Coronary angiogram (CAG) was done during in-hospital stay.Results: In present study, it was evident that among group I patients, 43.3% had stenotic lesion in left main artery (LM) and 26.67% in LM equivalent coronary artery (LME CA), whereas had no stenotic lesion in LM and 3.33% had LME CA lesion in group II patients. Low cost, widely available ECG criteria is supposed to be useful predictor of left main or left main equivalent coronary artery obstruction (Sensitivity=95%, Specificity= 76%, Positive predictive value= 70.0% and Negative predictive value= 97.0%) and high ST–segment changes score (&gt;18 mm (100%) &amp;/or ³10mm (80%) was an additive predictor of LM or LMECA lesion.Conclusion: Maximum ST- segment depression with T-wave inversion in the lateral leads I, aVL, V4-V6 on admission ECG can predict the critical LM or LMECA obstruction in patients with NSTEACS. It can help to provide prompt and appropriate management earlier to reduce the mortality &amp; morbidity.Cardiovasc. j. 2017; 9(2): 135-141