The ESC ACCA EAPCI EORP acute coronary syndrome ST-elevation myocardial infarction registry

Aims 

The Acute Cardiac Care Association (ACCA)–European Association of Percutaneous Coronary Intervention (EAPCI) Registry on ST-elevation myocardial infarction (STEMI) of the EurObservational programme (EORP) of the European Society of Cardiology (ESC) registry aimed to determine the current state of the use of reperfusion therapy in ESC member and ESC affiliated countries and the adherence to ESC STEMI guidelines in patients with STEMI.

Methods and results 

Between 1 January 2015 and 31 March 2018, a total of 11 462 patients admitted with an initial diagnosis of STEMI according to the 2012 ESC STEMI guidelines were enrolled. Individual patient data were collected across 196 centres and 29 countries. Among the centres, there were 136 percutaneous coronary intervention centres and 91 with cardiac surgery on-site. The majority of centres (129/196) were part of a STEMI network. The main objective of this study was to describe the demographic, clinical, and angiographic characteristics of patients with STEMI. Other objectives include to assess management patterns and in particular the current use of reperfusion therapies and to evaluate how recommendations of most recent STEMI European guidelines regarding reperfusion therapies and adjunctive pharmacological and non-pharmacological treatments are adopted in clinical practice and how their application can impact on patients’ outcomes. Patients will be followed for 1 year after admission.

Conclusion 

The ESC ACCA-EAPCI EORP ACS STEMI registry is an international registry of care and outcomes of patients hospitalized with STEMI. It will provide insights into the contemporary patient profile, management patterns, and 1-year outcome of patients with STEMI.

Efficient cesiation in RF driven surface plasma negative ion source

Experiments on hydrogen negative ions production in the large radio-frequency negative ion source with cesium seed are described. The system of directed cesium deposition to the plasma grid periphery was used. The small cesium seed (∼0.5 G) provides an enhanced H(-) production during a 2 month long experimental cycle. The gradual increase of negative ion yield during the long-term source runs was observed after cesium addition to the source. The degraded H(-) production was recorded after air filling to the source or after the cesium washing away from the driver and plasma chamber walls. The following source conditioning by beam shots produces the gradual recovery of H(-) yield to the high value. The effect of H(-) yield recovery after cesium coverage passivation by air fill was studied. The concept of cesium coverage replenishment and of H(-) yield recovery due to sputtering of cesium from the deteriorated layers is discussed.

[Types of hospital property and the relative rate of cesarean section occurrence]

AIM

To determine the influential significance of types of hospital property over methods of delivery and other related medical issues

METHODS AND MATERIALS

The research includes 61 662 deliveries over the period of 01.01.2013-31.12.2013, registered in the Birth Information System (BIS) maintained by the National Center of Public Health and Analyses . It is a retrospective research that compares the portion of cesarean sections (C-sections), premature births, the birth weight of newborns, and APGAR scores at the first minute after birth in three types of hospitals, divided by their property types--municipal, state owned, and private. Alternate analysis has been used--comparison of relative portion indices. We used t-test to determine significant differences among surveyed indicators with established level of significance p < 0.05.

RESULTS

The rate of C-sections out of all deliveries for the period of 2013 totals 38.40%. One can determine important differences in this rate among different types of hospitals, the highest rate reaching 59.63% in private hospitals. Health institutions with more than 1000 deliveries per year also show a greater amount of accomplished c-sections. The percentage of birth before 37 weeks of gestation and of birth weight below 2500 g is greatest in state owned hospitals, and the portion of newborns with APGAR scores measuring above 7 is greatest in municipal hospitals.

CONCLUSIONS

There is a tendency in the rise of the portion of c-sections, and from 2012 to 2013 this rise runs up to 2.39%. However, there is a lack of data to relate significant greater proportion of c-section deliveries in private hospitals to any medical reasons. Therefore, some additional research should be done to give a more objective explanation to the reasons as well as the consequences that follow a change in obstetrical behavior that eventually leads to a rise in c-section deliveries.

First experimental results from 2 MeV proton tandem accelerator for neutron production

A 2 MeV proton tandem accelerator with vacuum insulation was developed and first experiments are carried out in the Budker Institute of Nuclear Physics (Novosibirsk). The accelerator is designed for neutron production via reaction (7)Li(p,n)(7)Be for the boron neutron-capture therapy of the brain tumors, and for explosive detection based on 9.1724 MeV resonance gamma, which are produced via reaction (13)C(p,gamma)(14)N, absorption in nitrogen.

Cytotoxic activity of a podophyllotoxin-like lignan from Linum tauricum Willd

The present study describes the preliminary evaluation of the cytotoxic activity of a podophyllotoxin-like compound 4'-demethyl-6-methoxypodophyllotoxin (4'-DM-6-Mptox), isolated as one of the main lignans of Linum tauricum Willd. ssp. tauricum. The cytotoxic effects 4'-DM-6-Mptox were assessed by the MTT-dye reduction assay against the human leukemic cell lines HL-60, BV-173 and LAMA-84. DNA-fragmentation analysis and NF-kB inhibition assay were performed in order to elucidate some of the mechanistic aspects of the cytotoxic action of the investigated compound. 4'-DM-6-Mptox was found to exert prominent cytotoxicity, with IC50 values being several-fold lower than those of the referent antineoplastic agent etoposide. The DNA-fragmentation analysis revealed that 4'-DM-6-Mptox treatment triggered apoptosis in BV-173 and HL-60 cells. In our hands 4'-DM-6-Mptox was found to induce concentration-dependent NF-kB inhibition in HeLa cells as assessed by the IL-6 luciferase gene reporter assay, which though not quite prominent, at least partly contributes to the cytotoxic potential of the tested lignan. On the basis of the results obtained it could be concluded that 4'-DM-6-Mptox necessitates further pharmacological and toxicological evaluation as a possible chemotherapeutic agent. Furthermore due to its relatively high concentrations in the described plant source the possibility for its use as a precursor for the semisynthetic production of lignan-based drugs, could be considered.

Comparative assessment of the cytotoxic effects of carboxylato-bridged dinuclear platinum (II) complexes against human tumor cell lines

The cytotoxic effects of a series of carboxylato-bridged dinuclear platinum (II) complexes with acetate (BAP), propionate (BPP) and valerate (BVP) ligands were evaluated in a panel of human tumor cell lines. BAP proved to be the most potent antineoplastic agent, whose cytotoxic effect reached and even outclassed that of the referent drug cisplatin. This compound also exerted substantial efficacy against a broader spectrum of tumor models including the multidrug-resistant HL-60/Dox cell line. In the latter case, BAP showed lower resistance index than cisplatin. BAP was furthermore found to induce apoptosis in different cell lines as evidenced by DNA-laddering and Cell-death ELISA. Our experimental data give us reason to conclude that the dinuclear Pt(II) complex with acetate ligands is perspective for further detailed pharmacological and toxicological evaluation as an antineoplastic drug candidate.

Preparation, physicochemical characterization and pharmacological study of novel ruthenium(III) complexes with imidazole and benzimidazole derivatives

Complex compounds of ruthenium(III) with 1,2-dimethylimidazole (CAS 1739-84-0), 2-phenylimidazole (CAS 670-96-2) and 2-aminobenzimidazole (CAS 934-32-7) were prepared and were characterised by physicochemical methods. Coordination sites were determined. The complexes were tested for cytotoxic activity using MTT (3-(4,5-dimethyithiazol-2-yl)-2,5-diphenyltetrazolium bromide) dye-reduction assay and the values LD50 were evaluated.

New lanthanide complexes of 4-methyl-7-hydroxycoumarin and their pharmacological activity

Complexes of cerium(III), lanthanum(III) and neodymium(III) with 4-methyl-7-hydroxycoumarin (Mendiaxon, Hymecromone) were synthesized by the mixing of equimolar amounts of the respective metal nitrates and 4-methyl-7-hydroxycoumarin sodium salt in water. The complexes were characterized and identified by elemental analysis, conductivities, IR, (1)H and (13)C NMR spectroscopies and mass spectral data. DTA and TGA have been applied to study the compositions of the compounds. The newly synthesized compounds were assayed for acute intraperitoneal and per oral toxicity, influence on blood clotting time and the most active complex was investigated for spasmolytic activity. The complexes of cerium(III) and neodymium(III) showed marginal cytotoxic activity against transformed leukemic cell lines (P3HR1 and THP-1) as compared to the inorganic salts.

Cytotoxic activity of cerium complexes with coumarin derivatives. Molecular modeling of the ligands

Cerium complexes of Umbellipherone, Mendiaxon, Warfarin, Coumachlor, and Niffcoumar have been synthesized by reaction of the ligands with cerium nitrate in a stoichiometric ratio of 1:2. The formation of the complexes has been proved on the basis of elemental analysis, conductivities, IR spectroscopy, and 1H-NMR spectroscopy. The molecules of the ligands were optimized by means of the semiempirical quantum mechanical method PM3 to the energetically most stable conformers. All the ligands were characterized by molecular and submolecular electronic indices and the putative donor centers are proposed. It is concluded that the lactone- and the keto-carbonyl groups of Warfarin, Coumachlor, and Niffcoumar are bonded to the metal ion as bidentate ligands. The other two coumarins are bonded as monodentate ligands. Conductivity measurements show the non-electrolytic nature of the complexes. Cytotoxic screening by MTT assay was carried out. The cerium complexes were found to be more active than the inorganic salts.

Activated granulocytes oxidize the endogenous stem cell inhibitory peptide pGlu-Glu-Asp-Cys-Lys (pEEDCK) to the stimulatory dimer: a redox-mediated mechanism for demand-induced hematopoietic regulation

We have previously shown that the pentapeptide pGlu-Glu-Asp-Cys-Lys (pEEDCK), which is associated with mature leukocytes, maintains pluripotent hematopoietic stem cells (colony-forming units-spleen [CFU-S]) in a quiescent state under physiological conditions. It is also known that its oxidation product, the disulfide-bonded homodimer (pEEDCK)2, is a growth factor for CFU-S in vivo. In this paper we report on the combined actions of the monomer and dimer in inducing rapid changes in stem cell proliferation in vivo. A single injection of 20 microg/kg synthetic dimer into mice stimulated CFU-S proliferation (60% in S-phase after 9-11 hours) and population expansion. Stimulated CFU-S traversed one cell cycle, with an estimated S-phase time of 5.5 hours, and then become quiescent again. Proliferation of CFU-S in response to dimer showed no sensitivity to the inhibitory effects of monomeric pEEDCK, whereas CFU-S proliferation did display sensitivity to inhibition after injection of cytosine arabinoside or doxorubicin. Products of mature granulocytes undergoing an oxidative burst reaction rapidly oxidized monomeric pEEDCK to the dimer. The suppressive effect of endogenous pEEDCK monomer on stem cell proliferation was thus converted within minutes to a stimulatory signal (dimer). Because many in vivo situations (e.g., infection) requiring increased hematopoiesis involve granulocyte and macrophage activation, the formation of dimer from endogenous pEEDCK monomer may provide an almost instantaneous demand-induced emergency signal for increasing stem cell proliferation and blood cell production.

[The use of ketamine in an experimental model of generalized cerebral ischemia]

Thus far, a sufficiently effective cerebroprotective substances has not been discovered. Glutamate overproduction plays a key role in ischemic brain lesion. Ketamine is assigned to the group of commonly used clinical anesthetics, being also familiar as NMDA antagonist. Sodium fluoride-induced cerebral ischemia in mice is used as a model of circulatory ischemic lesion. As shown by the experimental data, simultaneous administration of NaF + ketamine has no effect whatsoever on the survivorship of animals, as compared to that in the control group treated with NaF alone. Beforehand treatment of mice with 150 mg/kg ketamine brings about considerable prolongation of the survival term (15 per cent of the animals survive for more than 2 hours). The inference is reached that ketamine is endowed with cerebroprotective activity largely attributable to glutamate antagonism at the level of ischemia involved neurons.

Endothelin plasma levels during heart surgery: influence on pulmonary artery pressure?

OBJECTIVE

Some studies found endothelin-1 to be a trigger for pulmonary hypertension. Endothelin-1 is an endothelial derived substance with generally vasoconstrictive properties, but probably vasodilatory effects on pulmonary arteries. The aim of the present study was to look for influences of endothelin-1 plasma values on pulmonary artery pressure.

METHODS

Endothelin-1 levels during and after cardiac surgery and correlations to pulmonary artery pressure were tested in 10 control patients and 21 patients with pulmonary hypertension (mean pulmonary arterial pressure > 20 mmHg, systolic pulmonary arterial pressure > 30 mmHg).

RESULTS

According to endothelin-1 values before anaesthesia (normal value below 4 pg/ml) patients with pulmonary hypertension could be divided into a "high endothelin-1" (10 patients, mean 8.25 +/- 2.06 pg/ml) and a "normal endothelin-1" (11 patients, mean 2.13 +/- 0.86 pg/ml) subgroup (p < 0.01). Values of the "high endothelin-1" group decreased until end of operation (from 7.58 +/- 2.35 to 2.95 +/- 1.44 pg/ml, n = 6) when pulmonary artery pressure returned to normal. Otherwise they slightly increased (from 9.43 +/- 2.24 to 11.07 +/- 1.96 pg/ml, n = 4). Levels of the "normal endothelin-1" group increased (to 2.55 pg/ml). Endothelin-1 values peaked on the intensive care unit (ICU) in all patients. Baseline endothelin-1 and systolic pulmonary artery pressure values correlated well with each other (r = 0.73, p < 0.001). Endothelin-1 decreased after extracorporeal circulation in all patients in whom pulmonary artery pressure tended to normalise, whereas no rise in pulmonary artery pressure paralleled the marked increase in endothelin-1 on the ICU. Vasodilatory effects of endothelin on pulmonary arteries can attribute to this course.

CONCLUSIONS

Endothelin-1 seems not to trigger pulmonary hypertension but rather to vasodilate pulmonary vasculature.

Influence of different flow modi during extracorporeal circulation on endothelial-derived vasoactive substances

Influences of shear stress on endothelin (ET) as well as prostacyclin (PGF) levels are common findings in different experimental settings. Thus, plasma levels of both substances seem to be a good tool to verify if different flow modi can be produced in blood vessels by generating pulsatile flow with a roller pump. In the present study, 20 patients scheduled for elective aortocoronary bypass operation were divided into two groups at random. One group was perfused with nonpulsatile (CON-group) and the other with pulsatile flow (PULS-group) during extracorporeal circulation. ET and PGF plasma levels were monitored perioperatively together with parameters of renal function and haemodynamic data. ET values were only slightly elevated at the end of extracorporeal circulation (mean baseline value; CON 3.1 pg/ml and PULS 3.2 pg/ml; mean maximal values at the end of cardiopulmonary bypass (CPB) 4.0 pg/ml and 3.9 pg/ml respectively). Prostacylin values (median baseline values: CON 56.7 pg/ml and PULS 57.1 pg/ml) peaked at the end of operation (median CON 117.8 pg/ml and PULS 137.5 pg/ml respectively) with a subsequent small decrease. No differences between the groups could be observed at any time point with respect to vasoactive substances, urine output (CON 6.5 ml/min and PULS 6.2 ml/min) or haemodynamics during CPB. This confirms studies emphasizing that no effective microvascular pulsatile flow is generated by conventional pulsatile flow-generating devices. In the present study, normothermia and a constant flow rate were maintained during CPB. Aortic cannulae (body-surface-related not maximal large diameters) were inserted. Altering these procedures may have led to more pronounced differences between the groups. All patients had an uneventful course after the operation. Similar to other reports, the present study was not able to demonstrate any benefit of pulsatile perfusion during extracorporeal circulation.