Successful Clinical Experience Research Articles

Feasibility and Favorable Responses Following Investigational CAR T-Cell Therapy for Relapsed and Refractory Infant ALL

Infants with B-cell acute lymphoblastic leukemia (B-ALL) continue to have significantly worse outcomes compared to older children with B-ALL, and those with relapsed or refractory (R/R) infant ALL have especially dismal outcomes with conventional treatment. CD19-targeting chimeric antigen receptor (CAR) T-cell therapy has demonstrated remarkable success in the treatment of R/R childhood B-ALL, though the majority of reports have been in non-infant patients. Barriers to the successful implementation of CAR T-cell therapy in infant B-ALL include challenges related to apheresis, product manufacturing and disease-specific considerations such as lineage switch. We describe our experience utilizing two experimental CD19-CAR T-cell products, SCRI-CAR19 or SCRI-CAR19x22, for 19 patients with R/R infant B-ALL enrolled on three clinical trials. CAR T-cell products were successfully manufactured in 18/19 (94.7%) patients, with a median age of 22.5 months at enrollment (range, 14.5-40.1 months). Sixteen of 17 (94.1%) treated patients achieved a complete remission without detectable minimal residual disease. The 1-year leukemia free survival was 75% and 1-year overall survival was 76.5%, with a median follow up time of 35.8 months (range, 1.7-83.6 months). Cytokine release syndrome (CRS) occurred in 14/17 (82.4%) patients, with only 1 patient experiencing Grade 3 CRS. Neurotoxicity occurred in 2/17 (11.8%) patients with all events ≤ Grade 2. With the successful early clinical experience of CAR T-cell therapy in this population, more systematic evaluation specific to infant ALL is warranted.

Brexpiprazole augmentation in a clozapine-resistant young schizophrenic patient: a successful case report.

IntroductionAlthough clozapine is considered the most effective drug for Treatment Resistant Schizophrenia (TRS), only 40% of patients treated will meet clinical response. Literature reviews and meta-analytic data offer no definite conclusions about the most effective clozapine augmentation strategies. Nevertheless, it has been suggested that the lack of evidence should not discourage clinicians from trying out new strategies in individual patients. Brexpiprazole is a novel 5-HT and DA modulator antipsychotic that exhibits partial agonism to D2/D3 and 5HT1A receptors, antagonism to 5HT2A and α-1B/2C receptors and represents a promising new drug in the pharmacotherapy of schizophrenia for both acute and maintenance treatment. In current literature there is no evidence of experiences in brexpiprazole augmentation for clozapine resistant patients.ObjectivesThis case report describes a successful clinical experience of brexpiprazole augmentation in a complicated case of clozapine resistant paranoid schizophrenia with consistent negative symptoms, the clinical evolution and metabolic improvement consequent to this therapy combination.MethodsIn a 27 male TRS patient, sequentially treated with adequate doses of risperidone, cariprazine, aripiprazole and olanzapine monotherapy, prescribed for adequate time, clozapine treatment was started, with a gradual titration from 25 to 300 mg/day, without significant clinical response on both positive and negative symptoms. Successively was introduced fluoxetine, from 10 to 30 mg/day, with no relevant clinical improvement. After 2 months of pharmacological stabilization with clozapine and fluoxetine described dosages, brexpiprazole was introduced starting from 1 mg/day and rapidly increasing till 4 mg/day.ResultsAfter 6 weeks of treatment, PANSS positive and negative subscales showed a significant decrease, respectively from 28 to 17 and from 42 to 20, while general psychopathology subscale decreased from 66 to 34. Negative sub-items with major improvement were those regarding blunted affect, emotional withdrawal, poor rapport, and passive/apathetic social withdrawal. Brexpiprazole augmentation also allowed to slowly decrease (in 6 months) clozapine dose till actual 150 mg/day, with a significant improvement in general tolerability and a slow decline in metabolic parameters (BMI from 36.5 to 30.3; fasting glucose from 112 to 92 mg/dL; total cholesterol from 248 to 182 mg/dL; total triglycerides from 392 to 198 mg/dL).ConclusionsIn this case report brexpiprazole augmentation in a clozapine resistant young schizophrenic patient was an effective strategy with significant symptoms improvement, in particular in PANSS general psychopathology and PANSS negative subscales. The consequent clozapine dose reduction contribute to the slow decrease in metabolic parameters considered.Disclosure of InterestNone Declared

Clinical Experience with Organ-Preserving Surgery in Placenta Accreta

Introduction. A higher number of repeated cesarean sections determine a higher risk of placental ingrowth into the scar area of the uterus. The absence of current clinical guidelines in this field necessitates the need for development of various methods for organ-preserving surgery in placenta accreta, which preserve a woman’s reproductive function, as well as reduce risks for future pregnancies and childbirth.Materials and methods. The paper presents the successful clinical experience of organ-preserving surgical treatment of placental ingrowth, excluding the stage of fundal cesarean section (Perinatal Center, Noyabrsk, Yamalo-Nenets Autonomous District).Case description. The paper describes two clinical cases of successful organ-preserving surgical treatment of placental ingrowth with preservation of reproductive function and provision of a more favorable prognosis for subsequent reproductive plans due to excluding formation of two scars on the uterus in different localizations.Results and discussion. Early dissection of adhesions in order to provide access to the surgical site is crucial and reduces the blood loss after fetal extraction and the risk of intraoperative complications such as bladder, ureteric and intestinal injury. Temporary compression hemostasis via performing endovascular temporary balloon occlusion of the infrarenal aorta, or via temporary turnstile hemostasis using a Foley catheter, allows for organpreserving surgery that excludes the formation of two scars on the uterus in different localizations without increasing the amount of blood loss.Conclusion. Surgical tactics in organ-preserving treatment of placental ingrowth excludes the stage of fundal cesarean section, and involves the cesarean section at the border of the uterine-placental hernia and the body of the uterus with subsequent metroplasty. The surgery performed demonstrate the optimal result – a relatively low blood loss, a short duration of the operation and, above all, more favorable prognosis for subsequent reproduction.

Student Selection of Preceptors for Immersive Clinical Education Experiences Through an Advocacy Lens

Context Immersive clinical education is an integral component of athletic training curricula. The flexibility in the requirements allows programs to be innovative in their curricular design and to meet the needs of their learners. Objective The purpose of this educational technique is to describe the process for empowering students to choose preceptors and clinical sites that meet their needs. Background Traditionally, program administrators assign students to preceptors and clinical sites based on proximity and availability of clinicians surrounding the institution. However, this may limit the options for students to find preceptors and mentors who are best suited to prepare them for future clinical practice. Description In our program, we empower students to pursue their immersive clinical education experience with a preceptor and/or clinical site that will meet their personal and professional needs as a learner and future clinician. Advantages Preceptors and alumni have noted increased engagement when students are invested in the selection process. Students are encouraged to advocate for their needs personally and professionally, to place themselves in the best environment for their future success. More specifically, historically marginalized students have the opportunity to identify a preceptor with similar demographic characteristics, who may be better suited to mentor them as a future professional, when geographic proximity has been a challenge in the past. Conclusions Students and program administrators partner to select preceptors who provide opportunities for a successful immersive clinical experience, who align with the student's future career goals, and who provide mentorship. Historically marginalized students in less diverse regions may benefit the most from this model because they can overcome geographic proximity challenges to identifying effective preceptors and mentors.

Management of the post-procedural period in aesthetic medicine – prevention of complications and reduction of the rehabilitation period

The post-treatment period plays a great role in the prevention of complications and shortens the rehabilitation time. The article provides up-to-date international statistics on the number of cosmetic procedures performed annually according to the International Society for Aesthetic and Plastic Surgery (ISAPS). A successful clinical experience of using a repair cream con taining oat plantlets extract, l-ALA-l-GLU dipeptide and hyaluronic acid as post-procedure care on the example of 2 patients is described. In the first case, a 32-year-old patient presented with postacne scars underwent a fractional radiofrequency ablation procedure followed by application of a cream with oat plantlets extract on the left side of the face, and a cream with dexpanthenol on the right side for 10 days. 5 minutes after application on the left side, the patient noted a pronounced reduction in burning, tingling, itching and soreness sensation. The entire post-treatment period also was faster and more comfortable on the side of the face, where the cream with oat plantlets extract was applied and ended successfully by the 8th day after the procedure. On the comparison side, the full rehabilitation process took 10 days. In the second case, a 27-year-old patient with acne, after a chemical peeling procedure, as a final remedy and further post-procedure care used the cream with oat plantlets extract on one side of the face, and a cream recommended by the manufacturer of peeling systems on the other side. When re-examined after 7 days, there was also a faster regression of inflammatory elements, post-procedural erythema and edema, dryness and discomfort after peeling were less pronounced on the side of the face where the cream with oat plantlets extract was applied. Repair cream containing oat plantlets extract, l-ALA-l-GLU dipeptide, and hyaluronic acid showed excellent efficacy and tolerability, had synergistic efficacy (moisturizing, healing, preventing aesthetic defects). The authors consider to recommend it as a mean of post-procedural rehabilitation.

Telomere pathology in ontogenesis in patients with Turner syndrome

According to present medical databases there many trials to provide in vivo researches in vivo to confirm/refute shortening process of telomeres among patients with Turner syndrome. Despite the successful clinical experience of providing such patients with Turner syndrome, a lot of omics (proteomic and metabolomic) aspects still stay unclear. Main disadvantages of most researches are small volume and minimized mathematical correlation with chronic disease (coronary heart disease, essential hypertension, cardiovascular malformations). Finally, organization of international prospective multi-centered researches in vivo including patients with mosaic cariotype and co-operation between physicians and biologists are optimal solutions for this present problem.

Contrast-enhanced spectral mammography: successful initial clinical institute experience

BackgroundContrast-enhanced spectral mammography (CESM) is a relatively newly developed advanced application with modification of digital mammography by the use of a contrast agent, but still has little known efficacy among Egyptian patients. Our aim in this study is to share our initial experience in evaluating symptomatic patients with different ACR breast parenchyma especially in dense breast parenchyma as it is always challenging in diagnosis.ResultsCESM in this study gave a sensitivity of 92% and specificity of 85% in characterization of benign and malignant lesions. For postoperative cases, sensitivity was 85% and specificity was 60%. For chemotherapy cases, sensitivity was 85% and specificity was 76%. Contrast uptake was noted in 68% of masses. Cavitary benign lesions were noted in 22.1% of cases. Multifocal and multicentric carcinomas were detected in 39.7% of pathologically proved malignant masses. Statistical analysis revealed sensitivity, specificity, and accuracy of 82.9%, 76.5%, and 81.0% for conventional mammograms as compared to 92.7%, 82.4%, and 89.7% for CESM respectively.ConclusionCESM is a promising technique that can enhance the specificity of conventional mammograms. It is an easy, simple, and rapid contrast-based procedure, especially for characterization of lesions in dense breast parenchyma. It performs proper diagnosis for high-risk patients and follow-up response to different lines of management.

Principles of using esmolol in the practice of anesthesiologists and intensive care physicians

Prevention and reduction of cardiac risk remains an important issue in anesthesiology and intensive care. There is a successful clinical experience in the use of esmolol for the correction of hemodynamic and ischemic disorders in acute coronary syndrome, in the perioperative period with excessive activation of the sympathoadrenal system. A large number of works are devoted to the use of esmolol as a drug that prevents hemodynamic changes due to tracheal intubation. The aim of the study was to evaluate the use of esmolol and dexmedetomidine as intravenous adjuvants in general analgesia during thyroidectomy in patients with thyrotoxicosis. The use of esmolol (Biblock) and dexmedetomidine in anesthesia for thyroidectomy, suppresses the hemodynamic response caused by surgical stress. Both adjuvants stabilize oxygen consumption and maintain a stable metabolism. Both drugs are quite effective as intravenous adjuvants in general analgesia for thyroidectomy in patients with thyrotoxicosis. They are the drugs of choice and can be recommended in practical anesthesiology.

Lenalidomide enhances the efficacy of anti-BCMA CAR-T treatment in relapsed/refractory multiple myeloma: a case report and revies of the literature

We report successful clinical experience using anti-BCMA CAR-T combined with lenalidomide in a patient who was refractory to a previous CAR-T treatment. The patient was a 51-year-old man, and was diagnosed with IgD-λ multiple myeloma(MM) in October 2015. 10 courses of chemotherapy including immunomodulators and proteasome inhibitors were used for remission and autologous hematopoietic stem cell transplantation was performed. MM relapsed after 12 months of remission. His disease continued to progress after multiple chemotherapy regimens, mouse anti-BCMA CAR-T and human-derived anti-BCMA CAR-T therapy. After a conditioning chemotherapy regimen of fludarabine and cyclophosphamide, patient took lenalidomide on day -1 and human-derived anti-BCMA CAR-T cells were infused on the next day. He suffered grade 2 cytokine-releasing syndrome(CRS) and grade 3 myelosuppression after infusion, and were resolved after symptomatic treatment. Very good partial response (VGPR) was achieved 14 days after CAR-T treatment, and had been maintained for more than 8 months. We demonstrated for the first time in patients that anti-BCMA CAR-T cell therapy combined with lenalidomide is feasible and effective in the treatment of RRMM. It provides a new strategy for RRMM patients who do not respond to anti-BCMA CAR-T cell therapy alone, and the adverse event is reversible.

CARMAT total artificial heart implantation: report on the first successful clinical experience as bridge to heart transplantation

CARMAT total artificial heart implantation: report on the first successful clinical experience as bridge to heart transplantation

Effects of Homeopathic Phosphorus on Encephalitozoon cuniculi-Infected Macrophages In-Vitro.

Encephalitozoon cuniculi (E. cuniculi), a fungus that acts as an intracellular pathogen, causes a marked neurological syndrome in many host species and is a zoonotic concern. Although no well-established treatment for this syndrome is known, previous successful clinical experience using homeopathic phosphorus has been described in which symptom remission with no mortality occurred in 40/42 animals by means of unknown immunological mechanisms. The latter observation was the main motivation for this study. To verify, in an in-vitro model, if macrophages infected with E. cuniculi can change in function after treatment with different potencies of phosphorus. RAW 264.7 macrophages were infected with E. cuniculi in-vitro and treated with various homeopathic potencies of phosphorus. The vehicle was used as a control solution (0.06% succussed ethanol). After 1 and 24 hours, the following parameters were analyzed: parasite internalization (by the Calcofluor staining method), lysosome activity (by the acridine orange method), cytokine/chemokine production (by the MAGPIX system), and cell ultrastructure. Automatic image analysis was used when applicable, and the experiments were performed in triplicate. Treatment with vehicle alone increased interleukin (IL)-6, tumor necrosis factor alpha and monocyte chemotactic protein -1 production (p ≤ 0.05) and reduced the number of internalized parasites (p ≤ 0.001). A progressive and time-dependent increase in RANTES (regulated on activation, normal T-cell expressed and secreted) and lysosome activity (p ≤ 0.002) was observed only after treatment with the highest potency of phosphorus (Phos 200cH), together with decreased apoptosis rate, intense parasite digestion, and the presence of non-internalized spores. Phos 200 cH has a modulatory action on the activity of infected macrophages, especially a specific increase in RANTES, a key element in the prognosis of E. cuniculi-infected and of immunosuppressed patients bearing infections.

From bioequivalence to biosimilars: How much do regulators dare?

The main advantage of an abbreviated licensing pathway is the possibility of extrapolating efficacy and safety data from an original medicinal product to a subsequent "copy" version, thereby reducing the clinical development programme in particular. For small-molecule chemically synthesized generics, such an abbreviated licensing pathway was established decades ago, whereas it was only more recently implemented for similar biological medicinal products, so-called biosimilars. Clinicians and patients have repeatedly expressed concerns about the efficacy and safety of biosimilars, especially in 'extrapolated' indications for which no own clinical data have been generated. Generic drugs usually contain well-defined active ingredients whose "identity" with that of the originator, the so-called reference product, is easily verifiable. Biological substances are generally more complex and difficult to characterize. They are produced in living organisms and therefore naturally exhibit some intrinsic variability, i.e. microheterogeneity. Since the chosen expression system and the manufacturing conditions influence the quality characteristics of a biological substance, mostly its posttranslational modifications such as the glycosylation pattern, it is unlikely that two independent manufacturing processes can achieve completely identical biologicals. A biosimilar, especially if it is a glycoprotein, can therefore, at best, be highly similar to the reference product. It seems that the not-identical-but-(highly)-similar-paradigm for biosimilars is often not well understood and causes confusion. However, while at first glance an abridged approval pathway for biosimilars appears to be daring, it is in fact based on sound scientific reasoning. A biosimilar applicant has to provide a considerably larger package of comparative data than a generic applicant to ensure that the biosimilar can indeed rely, for the purpose of licensing, on the efficacy and safety experience gained with the reference product. While for a generic, the demonstration of similar in vitro dissolution and in vivo bioavailability (so-called 'bioequivalence') is sufficient to conclude therapeutic equivalence with the reference product, for a biosimilar, comparable physicochemical, biological and functional characteristics as well as efficacy and safety/immunogenicity with the reference product must be demonstrated. In addition, unlike generics, any extrapolation to other indications of the reference product must be scientifically justified. More than 10 years of successful clinical experience with biosimilars in the EU support the credibility of the scientific principles guiding the biosimilar concept. So far, there has been no need for either withdrawal of an approved biosimilar or for additional labelling because of efficacy or safety concerns.

Related liver fragment transplantation for type 1 glycogenosis: the first Russian experience The paper describes two clinical examples of successful related liver fragment transplantation for type 1 glycogenosis in a one-year-old boy and a 6-year-old girl. The given first successful clinical experience suggests that liver fragments for type 1 glycogenoses can be transplanted from live related donors and offers promise

Related liver fragment transplantation for type 1 glycogenosis: the first Russian experience The paper describes two clinical examples of successful related liver fragment transplantation for type 1 glycogenosis in a one-year-old boy and a 6-year-old girl. The given first successful clinical experience suggests that liver fragments for type 1 glycogenoses can be transplanted from live related donors and offers promise

VARIATIONS OF MICROBIOCENOSIS AND ACID-BASE BALANCE OF THE SKIN WITH ACNE VULGARIS AND THE POSSIBILITY OF THEIR CORRECTION WITH EUBIOTIC COMPLEX

Presents a modern concept of the pathogenesis of acne vulgaris, data on the role of microbial factors and dysbiotic disorders in the development of endogenous intoxication. Endogenous intoxication syndrome (EIS) has a damaging effect on tissues, forming a complex of metabolic disorders that lead not only to suppression of the immune system organs functions, but also to interaction impairments of its individual effector links, causing the tendency of the macroorganism to nonspecific types of inflammation. The use of eubiotic complex “Eubikor” in the complex therapy of acne vulgaris leads to the normalization of the microbiocenosis of skin and parameters of the acid-base balance. The paper also provides its own successful clinical experience of using eubiotic complex “Eubikor” in the treatment of patients with acne vulgaris.

Is Platelet-Rich Plasma (PRP) Effective in the Treatment of Acute Muscle Injuries? A Systematic Review and Meta-Analysis.

Muscle lesions account for one-third of sport-related injuries, thus representing a substantial problem for both players and their teams. The use of platelet-rich plasma (PRP) injections is rapidly growing in clinical practice, prompted by an unmet clinical need with a large commercial market. However, after early reports of positive preliminary experience, higher quality studies recently questioned the real benefit provided by PRP injections to promote muscle healing and return to sport. To evaluate the effect of platelet-rich plasma (PRP) injections on outcomes following acute muscle injuries. Meta-analysis of randomized, controlled trials (RCTs), Level I. PubMed (MEDLINE), Cochrane (CENTRAL), Web of Science, clinicaltrials.gov, who.int, isrctn.com, greylit.org, opengrey.eu. RCTs investigating the effect of PRP for the treatment of acute muscle injuries against at least one control group including patients treated with placebo injection or physical therapy. The outcomes evaluated were time to return to sport, re-injuries, complications, pain, muscle strength, range of motion (ROM)/flexibility, muscle function, and imaging. Six studies, involving 374 patients, were included in the meta-analysis. The time to return to sport evaluated in all six studies was significantly shorter in patients treated with PRP (mean difference=-7.17days). However, if only the double-blind studies (n=2) or studies including only hamstring injuries (n=3) were considered, non-significant differences were found. Re-injuries (relative risk=-0.03) and complications (relative risk=0.01) were also similar between the two groups (p>0.05), nor were any substantial differences found regarding pain, muscle strength, ROM/flexibility, muscle function, and imaging. The performance bias was high risk due to the lack of patient blinding in four studies. The quality of evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) was therefore low or very low. The promising biological rationale, the positive preclinical findings, and the successful early clinical experience of PRP injections are not confirmed by the recent high-level RCTs. Therefore any benefit in terms of pain, function, return to sport, and recurrence using PRP injections for the treatment of acute muscle injuries is not supported. Due to the bias in the studies, the heterogeneity of the findings, and the limited sample size, the evidence should be considered to be of low or very low quality.

Results of intravenous immunoglobulin use and treatment in the South Province of Turkey

Objective In this study, we aimed to evaluate the use of intravenous immunoglobulin (IVIG) in our clinic and investigate the effect of its treatment on diseases in patients with pemphigus. Materials and methods Age, sex, disease, skin biopsy result, duration of illness, treatments received, IVIG adverse effects, and clinical course were recorded by screening medical records of patients with different diagnoses receiving IVIG. The findings were evaluated retrospectively. Findings The total number of cases treated with IVIG was 21. A total of 14 cases were diagnosed as having pemphigus, and three cases were diagnosed as having pyoderma gangrenosum, one (4.8%) case as Sweet syndrome, one (4.8%) case as lichen planus, one (4.8%) case as resistant urticaria, and one (4.8%) case as hyperimmunoglobulin E syndrome. The mean time to start IVIG treatment from diagnosis in patients with pemphigus was 2.62±2.3 years (minimum–maximum: 1–10 years). The mean number of cure IVIG treatment cycles given to patients was 11.38±7.63 (minimum–maximum: 1–30). In patients with pemphigus, a partial remission was achieved with an average cure IVIG treatment cycle of 2.71±3.3 (minimum–maximum: 0–10 cures). In three (21.4%) of the pemphigus cases that received IVIG, the treatment was terminated owing to remission. In pemphigus cases where the treatment was terminated owing to remission, the mean number of IVIG cycles was 12.7±5.9 (minimum–maximum: 6–17). Conclusion IVIG treatment has become a reliable treatment option in our clinic, which is preferred owing to successful treatment results and clinical experience in many different diseases, especially pemphigus.

Clinical Instructors' Perspectives on the Clinical Education of Internationally Educated Physical Therapists: Diversity's Impact on the Experience.

Purpose: The aim of this study was to understand the nature and extent of clinical instructors' (CIs') involvement in the clinical education of internationally educated physical therapists (IEPTs) while exploring CIs' perceptions of the similarities among and differences between IEPTs and Canadian-trained students. Method: In this qualitative descriptive study, 13 semi-structured interviews were conducted with CIs who were involved in a bridging programme for IEPTs. Data were coded using NVivo version 10, and common themes emerged through qualitative thematic analysis. Results: The majority of CIs perceived IEPTs' backgrounds to be diverse as a result of their varied previous clinical experience, physiotherapy scope of practice, and life stressors. Their diverse backgrounds contributed to the similarities and differences found in their skills, their personal motivation, and the education process, leading to successes and challenges in the clinical environment. Conclusions: Differences between IEPTs and Canadian-trained students stem from IEPTs' diverse backgrounds. Recognizing this diversity while demonstrating cultural competence will promote a successful clinical experience for both IEPT learners and CIs, which will ultimately facilitate the integration of IEPTs into the Canadian health care system.

Spectroscopic investigation of Bovine Liver Catalase interactions with a novel phen-imidazole derivative of platinum

Successful clinical experience of using cisplatin and its derivatives in cancer therapy has encouraged scientists to synthesize new metal complexes with the aim of interacting with special targets such as proteins In this regard, biological effects of [Pt(FIP)(Phen)](NO3)2 compound which contains a novel phen-imidazole ligand, FIP, was investigated on bovine liver catalase (BLC) structure and function. Various spectroscopic methods such as UV–visible, fluorescence, and circular dichroism (CD) were applied at two temperatures 25 and 37°C for kinetics and structural studies. As a consequence, the enzymatic activity decreased slightly with increasing the platinum compound’s concentration up to 30 μM and then remained constant at near 80% after this concentration. On the other hand, the fluorescence quenching measurements revealed that despite slight changes in activity, catalase experiences notable alterations in three-dimensional environment around the chromophores of the enzyme structure with increasing platinum complex concentration. Moreover, quenching data showed that BLC has two binding sites for Pt complex and hydrogen bonding interactions play a major role in the binding process. Furthermore, CD spectroscopy data showed that Pt(II) complex induces significant decrease in α-helix content of the secondary structure of BLC, but notable increase in random coil proportion accompanying a slight decrease in β-sheet content. All in all, hydrogen bonding interactions which are mainly involved in the binding process of the novel phen-imidazole compound to BLC significantly alter the protein structure but slightly change its function. This might be a promising outcome for chemotherapists and medicinal chemists to investigate in vivo properties of this novel metal complex with significant binding tendency to a macromolecule in the low concentrations without decreasing its intrinsic function.

Cardiac Electrophysiology Under MRI Guidance: an Emerging Technology.

MR-guidance of electrophysiological (EP) procedures offers the potential for enhanced arrhythmia substrate assessment, improved procedural guidance and real-time assessment of ablation lesion formation. Accurate device tracking techniques, using both active and passive methods, have been developed to offer an interface similar to electroanatomic mapping platforms, and MR-compatible EP equipment continues to be developed. Progress to clinical implementation of these technically complex fields has been relatively slow over the last 10 years, but recent developments have led to successful clinical experience. However, further advances, particularly in harnessing the full imaging potential of CMR, are required to realise the mainstream adoption of this powerful guidance modality.

Cardiac Electrophysiology Under MRI Guidance: an Emerging Technology

MR-guidance of electrophysiological (EP) procedures offers the potential for enhanced arrhythmia substrate assessment, improved procedural guidance and real-time assessment of ablation lesion formation. Accurate device tracking techniques, using both active and passive methods, have been developed to offer an interface similar to electroanatomic mapping platforms, and MR-compatible EP equipment continues to be developed. Progress to clinical implementation of these technically complex fields has been relatively slow over the last 10 years, but recent developments have led to successful clinical experience. However, further advances, particularly in harnessing the full imaging potential of CMR, are required to realise the mainstream adoption of this powerful guidance modality.