Revisiting methotrexate and phototrexate Zinc15 library-based derivatives using deep learning in-silico drug design approach

Introduction: Cancer is the second most prevalent cause of mortality in the world, despite the availability of several medications for cancer treatment. Therefore, the cancer research community emphasized on computational techniques to speed up the discovery of novel anticancer drugs. Methods: In the current study, QSAR-based virtual screening was performed on the Zinc15 compound library (271 derivatives of methotrexate (MTX) and phototrexate (PTX)) to predict their inhibitory activity against dihydrofolate reductase (DHFR), a potential anticancer drug target. The deep learning-based ADMET parameters were employed to generate a 2D QSAR model using the multiple linear regression (MPL) methods with Leave-one-out cross-validated (LOO-CV) Q2 and correlation coefficient R2 values as high as 0.77 and 0.81, respectively. Results: From the QSAR model and virtual screening analysis, the top hits (09, 27, 41, 68, 74, 85, 99, 180) exhibited pIC50 ranging from 5.85 to 7.20 with a minimum binding score of -11.6 to -11.0 kcal/mol and were subjected to further investigation. The ADMET attributes using the message-passing neural network (MPNN) model demonstrated the potential of selected hits as an oral medication based on lipophilic profile Log P (0.19-2.69) and bioavailability (76.30% to 78.46%). The clinical toxicity score was 31.24% to 35.30%, with the least toxicity score (8.30%) observed with compound 180. The DFT calculations were carried out to determine the stability, physicochemical parameters and chemical reactivity of selected compounds. The docking results were further validated by 100 ns molecular dynamic simulation analysis. Conclusion: The promising lead compounds found endorsed compared to standard reference drugs MTX and PTX that are best for anticancer activity and can lead to novel therapies after experimental validations. Furthermore, it is suggested to unveil the inhibitory potential of identified hits via in-vitro and in-vivo approaches.

In vivo analysis the effect of antibiotic growth promoters (AGPs), Oxytetracycline di-hydrate and Tylosin phosphate on the intestinal microflora in broiler chicken

Abstract The study was aimed to analyse the effects of antibiotic growth promoters (AGPs), Oxytetracycline di-hydrate and Tylosin phosphate on the intestinal microflora in broiler chicken. The AGPs were provided in different concentrations solely or in combinations for 42 days of rearing. Faecal samples were collected from the intestine (duodenum, jejunum and caeca) of broiler chicken on 14th, 28th and 42nd days of trial. Samples were cultured on different selective medium and bacterial identification was performed by different biochemical and molecular diagnostic tools. Results showed a significant effect of AGPs on the growth of pathogenic microorganisms such as Escherichia coli and Clostridium perfringens in the intestine. Interestingly, an impaired growth was observed for both bacterium showing a significant effect (P<0.05) of AGPs on E. coli and C. perfringens on day 14th, 28th, and 42nd. This effect was observed solely and in combination while using AGPs. Data further showed that the effect was more prominent in combination and with an increase concentration of AGPs. Remarkably, no impairment was seen on the growth of L. reuteri at different sites of intestine and duration (14th, 28th, and 42nd days). The results showed that the use of AGPs in diet has no harmful effect on beneficial bacteria, however, an impaired growth was seen on the harmful bacteria. It is suggested that a combination of AGPs (OXY-1.0+TP-0.5) is economical and have no harmful effect on the broiler chicken. The use of AGPs in a recommended dose and for a specific period of time are safe to use in poultry both as growth promoter and for the prevention of diseases.

An evaluation of spectral and statistical parameters of ion pair complexation of Zafirlukast using chromogenic dyes in solid dispersion-based formulations

The purpose of present work was to develop a novel analytical method for orally given leukotriene antagonist Zafirlukast (ZST), present in Meglumine and Eudragit EEPO based solid dispersion formulation. Four simple, extraction-free, fast, and economical methods based on charge transfer complexation among nitrogen of ZST with sulfonyl group comprising chromogenic mediator bromophenol blue (BPB-Method B), bromothymol blue (BTB-Method C) and bromocresol green (BCG-Method D). The first method (A) is based on the analysis using 0.1 M HCl as a solvent at λmax 242 nm while chromogenic methods yield color complex at λmax 415 nm (BPB-Method B), λmax 420 nm (BTB-Method C) and λmax 435 nm (BCG-Method D). The Beer's Law stayed linear in the concentration ranges of 1-10, 10-75, 5-40 and 15-100 μg/ml for methods A, B, C and D, respectively. The spectral and thermodynamic characterization of each method was carried out by the application of Molar Absorptivity, LOD, LOQ, Association Constant and Gibbs free energy (ΔGo). The methods were statistically optimized and evaluated by F-Distribution Value, P-Value, Shapiro-Wilk P-Value, regression analysis, Q-Q plot, prediction interval, residual histogram and plots. Various experimental conditions affecting the complexation and stability of chromogenic complexes are cautiously studied including optimal temperature, chromogenic agent volume, color stability, recovery, precision and accuracy. All the measurements were executed under ICH guidelines. It can be established that proposed would be an appropriate prospective analytical approach for estimation of ZST in pure bulk, solid dispersions and dosage forms.

Metabolomics Analysis and Biochemical Profiling of Arsenic-Induced Metabolic Impairment and Disease Susceptibility

Our study aimed to conduct a comprehensive biochemical profiling and metabolomics analysis to investigate the effects of arsenic-induced metabolic disorders, with a specific focus on disruptions in lipid metabolism, amino acid metabolism, and carbohydrate metabolism. Additionally, we sought to assess the therapeutic potential of resveratrol (RSV) as a remedy for arsenic-induced diabetes, using metformin (MF) as a standard drug for comparison. We measured the total arsenic content in mouse serum by employing inductively coupled plasma mass spectrometry (ICP-MS) after administering a 50-ppm solution of sodium arsenate (50 mg/L) in purified water. Our findings revealed a substantial increase in total arsenic content in the exposed group, with a mean value of 166.80 ± 8.52 ppb (p < 0.05). Furthermore, we investigated the impact of arsenic exposure on various biomarkers using enzyme-linked immunosorbent assay (ELISA) methods. Arsenic exposed mice exhibited significant hyperglycemia (p < 0.001) and elevated levels of homeostatic model assessment of insulin resistance (HOMA-IR), hemoglobin A1c (Hb1Ac), Inflammatory biomarkers as well as liver and kidney function biomarkers (p < 0.05). Additionally, the levels of crucial enzymes linked to carbohydrate metabolism, including α-glucosidase, hexokinase, and glucose-6-phosphatase (G6PS), and oxidative stress biomarkers, such as levels of glutathione (GSH), glutathione reductase (GR), glutathione peroxidase (GPx), catalase, and superoxide dismutase (SOD), were significantly reduced in the arsenic-exposed group compared to the control group (p < 0.05). However, the level of MDA was significantly increased. Molecular analysis of gene expression indicated significant upregulation of key enzymes involved in lipid metabolism, such as carnitine palmitoyl-transferase-I (CPT-I), carnitine palmitoyl-transferase-II (CPT-II), lecithin-cholesterol acyltransferase (LCAT), and others. Additionally, alterations in gene expression related to glucose transporter-2 (GLUT-2), glucose-6-phosphatase (G6PC), and glucokinase (GK), associated with carbohydrate metabolism, were observed. Amino acid analysis revealed significant decreases in nine amino acids in arsenic-exposed mice. Metabolomics analysis identified disruptions in lipid metabolomes, amino acids, and arsenic metabolites, highlighting their involvement in essential metabolic pathways. Histopathological observations revealed significant changes in liver architecture, hepatocyte degeneration, and increased Kupffer cells in the livers of arsenic-exposed mice. In conclusion, these findings enhance our comprehension of the impact of environmental toxins on metabolic health and offer potential avenues for remedies against such disruptions.

Chemical Characterisation, Antidiabetic, Antibacterial, and In Silico Studies for Different Extracts of Haloxylon stocksii (Boiss.) Benth: A Promising Halophyte

The objective of the study is to evaluate the chemical characterisation, and biological and in silico potential of Haloxylon stocksii (Boiss.) Benth, an important halophyte commonly used in traditional medicine. The research focuses on the roots and aerial parts of the plant and extracts them using two solvents: methanol and dichloromethane. Chemical characterisation of the extracts was carried out using total phenolic contents quantification, GC-MS analysis, and LC-MS screening. The results exhibited that the aerial parts of the plant have significantly higher total phenolic content than the roots. The GC-MS and LC-MS analysis of the plant extracts revealed the identification of 18 bioactive compounds in each. The biological evaluation was performed using antioxidant, antibacterial, and in vitro antidiabetic assays. The results exhibited that the aerial parts of the plant have higher antioxidant and in vitro antidiabetic activity than the roots. Additionally, the aerial parts of the plant were most effective against Gram-positive bacteria. Molecular docking was done to evaluate the binding affinity (BA) of the bioactive compounds characterised by GC-MS with diabetic enzymes used in the in vitro assay. The results showed that the BA of γ-sitosterol was better than that of acarbose, which is used as a standard in the in vitro assay. Overall, this study suggests that the extract from aerial parts of H. stocksii using methanol as a solvent have better potential as a new medicinal plant and can provide a new aspect to develop more potent medications. The research findings contribute to the scientific data of the medicinal properties of Haloxylon stocksii and provide a basis for further evaluation of its potential as a natural remedy.

The impact of age on the 99th percentile of cardiac troponin

Introduction

The 99th percentile upper reference limit (URL) of cardiac troponin (cTn) is diagnostic cutoff for myocardial infarction (MI). Several factors are known to lead to an increase in cTn including sex, kidney function, left ventricular function and various comorbidities. Similarly, studies have shown that cTn concentration of patients increase with age. However, the impact of age on the concentration of cTn in healthy individuals is unclear as several studies of healthy populations showed little to no impact of age.

Purpose

To determine the effect of age on the URL of cTn for the Danish population.

Methods

We invited active and retired blood donors with the aim of including 250 participants of each sex in each of four age groups, &lt;50, 50–60, 60–70 and &gt;70 years, for a total of about 2000 participants. cTn levels were measured by 4 cTn assays (Siemens Atellica and Vista cTnI, Roche cTnT and Abbott Alinity cTnI). The age specific URL were calculated using the non-parametric method. Quantile regression for the 99th percentile was adjusted for sex and creatinine concentration.

Results

A total of 2287 participants were sampled in the study, of which 4 (0.2%) were excluded due to a history of heart disease and 7 (0.3%) were excluded due to insufficient plasma for screening biomarkers. The median age was 58.6 (IQR 48.2–69.7), and 52.6% were female. Figure 1 shows the distribution of cTn concentrations in age intervals. There was a significant increase in cTn with age for all assays (all p&lt;0.001). After adjusting for sex and creatinine concentration, increasing age was only significantly associated with cTnT (0.40 ng/L increase per year, p=0.03). Figure 2 panel A shows the age specific URL for each assay, where we observed a significant difference for cTnT with the URL increasing from 15.8 ng/L (90% CI 12.4–33.9 ng/L) for participants &lt;50 years to 37.6 ng/L (90% CI 34.6–41.5 ng/L) for participants &gt;70 years. The proportion of participants with concentrations above the manufacturers URL increased with age for cTnT from 1.5% in participants &lt;50 years to 25.6% for participants &gt;70 years (p&lt;0.001), figure 2 panel B. This changed little when removing participants with decreased kidney function (eGFR &lt;60 mL/min/1.73 m2) as 24.3% of the remaining participants &gt;70 years had a cTnT above the URL.

Conclusions

The concentration of cTn increased with age for all assays. This was clearest for cTnT in which the 99th percentiles of participants were significantly different for participants age &gt;70 years of whom a quarter had cTnT levels above the level for myocardial injury according to the manufacturer's URL.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): HelsefondenMauritzen La Fountaine Foundation

Pharmacological evaluation of the hypoglycemic and anti- Alzheimer’s activities of aerial parts of Breynia distachia (Phyllanthaceae)

Purpose: To determine the cytotoxic, bronchorelaxant, spasmolytic, antidiabetic, α-glucosidase, acetylcholinesterase, butyrylcholinesterase, α-chymotrypsin and lipoxygenase inhibitory attributes of methanol and dichloromethane extracts of the aerial parts of Breynia distachia.Methods: The dichloromethane and methanol extracts of the aerial parts of the plant were prepared by maceration. Various ex vivo assays were employed, such as the brine shrimp lethality assay, lipoxygenase inhibitory activity assay, α-glucosidase inhibitory assay and α-chymotrypsin assay, as well as assays to assess the spasmolytic and bronchorelaxant activity. Meanwhile, the hypoglycaemic effect were analysed using an alloxan-induced diabetic model in Wistar albino rats.Results: The methanol extract (aerial) showed significant (p ≤ 0.05) cytotoxicity towards brine shrimp larvae at concentrations of 10, 100 and 1,000 μg/mL, respectively, whereas the dichloromethane extract (aerial) of the plant showed non-significant (p ≥ 0.05) results. The methanol extract (aerial parts) also demonstrated significant (p ≤ 0.05) α-glucosidase inhibitory activity and lipoxygenase inhibitory activity, with IC50 (half-maximal inhibitory concentration) values of 40.37 ± 5.29 μg/mL and 132.9 ± 0.33 μg/mL, respectively, while the dichloromethane extract exhibited significant (p ≤ 0.05) α-glucosidase inhibitory activity, with an IC50 value of 135.43 ± 8.29 μg/mL. An in vivo antidiabetic model showed that the administration of 150 and 300 mg/kg methanol extract of the aerial parts significantly (p ≤ 0.05) lowered the blood glucose level in alloxan-induced diabetic rats compared to control (treated with water).Conclusion: Data from different in vitro and in vivo models suggest that the methanol extract (aerial parts) of B. distachia shows significant cytotoxic, bronchorelaxant, spasmolytic, antidiabetic and anti-Alzheimer’s activity Hence, these findings validate the folkloric use of B. distachia and highlight the need to further explore its medicinal potential and the phytoconstituents responsible for its pharmacological actions.

Study of human knowledge and attitude toward urban birds in Faisalabad city, Pakistan

Birds are very valuable indicators of species richness and endemic patterns in a specified ecosystem, which eventually help the scientist to measure the environmental degradation. The aim of present study was to know human knowledge and attitude toward urban birds in Faisalabad city, Pakistan. The study conducted in four consecutive months: November 2019 to February 2020. Population of birds was noted from eight residential towns of Faisalabad city, data were collected through questionnaire. Faisalabad has a reasonably large population of birds and present data show that, there is a significant difference between favorite bird of residential areas and institutions. The pigeon received the most likeness in bird population among residential area residents, while the myna received the least. The most popular bird in Faisalabad institutions was the sparrow, while the least popular bird was the common myna. Bird adaptation percentage of residential areas and institutional areas of Faisalabad was the highest for parrot and sparrow respectively. People in residential areas and institutions, on the other hand, adapted least to common myna. It is concluded that people of the study area like birds and offered food and high population of birds are present in study area.

Rapid pacing is an independent predictor for high implantation depth using self-expandable devices in TAVR

Background/Introduction

Optimizing valve implantation depth (ID) plays a crucial role in minimizing conduction disturbances and achieving optimal functional integrity. Until now, the impact of intraprocedural fast (FP) or rapid ventricular pacing (RP) on the implantation depth has not been investigated.

Purpose

Therefore, we aimed to 1) evaluate the impact of different pacing maneuvers on ID, and 2) identify the independent predictors of deep ID.

Methods

562 TAVR patients with newer-generation self-expandable devices were retrospectively enrolled and further separated into patients undergoing TAVR under FP (n=331; 58.9%) and RP (n=231; 41.1%). The final ID was analyzed, and the underlying functional, anatomical, and procedural conditions were evaluated by univariate and multivariate analysis.

Results

The highest ID was reached under RP in severe aortic valve calcification and valve size 26 mm. Multivariate analysis identified left ventricular outflow (LVOT) calcification (OR 0.56 [0.37–0.85], p=0.006*), a bicuspid valve (OR 0.34 [0.11–1.0], p=0.049*), valve size 26 mm (OR 0.47 [0.28–0.81], p=0.006*), and RP (OR 0.57 [0.37–0.87], p=0.010*) as independent and highly preventable predictors for deep valve deployment. Independent risk factors for deep ID were the use of a 34 mm device (OR 1.96 [1.22–3.15], p=0.005*) and mild aortic valve calcification (OR 1.62 [0.01–2.61], p=0.046*). In a model of protective factors, ID was significantly reduced with the number of protective criteria (0–2 criteria: −5.6±2.6 mm vs. 3–5 criteria: −4.5±2.0 mm; p&lt;0.0001*).

Conclusion

Data from this retrospective analysis indicate that RP is an independent predictor to reach a higher implantation depth using self-expandable devices.

Funding Acknowledgement

Type of funding sources: None.

Electrocardiographic predictors of recovery from pacemaker dependency after transcatheter aortic valve implantation: a meta-analysis

Background

Transcatheter aortic valve implantation (TAVI) is a well-established alternative to surgery for the treatment of patients with severe symptomatic aortic stenosis at high and intermediate surgical risk. The occurrence of electrical conduction disturbances with the need for permanent pacemaker (PPM) implantation remains one of the most frequent complications of the procedure. But PPM dependency after TAVI is often transient and conduction abnormalities may improve over time.

Purpose

We performed a meta-analysis to summarize available studies that reported the incidence of new PPM after TAVI and investigated the rate and possible predictors of recovery from PPM dependency during follow-up.

Methods

The authors conducted a literature search in PubMed and MEDLINE databases from January of 2012 until February of 2021. Eleven observational studies (n=6794) met inclusion criteria for the final analysis. The effect size was estimated using a random-effects model with 95% confidence interval (CI).

Results

PPM implantation was performed in 902 patients after TAVI (13.3%), mostly due to high degree atrioventricular (AV) block (81.3%). A follow-up of 683 patients was performed after a median period of 139 days. 322 of the patients examined during follow-up (48.6%) showed recovery from PPM dependency. Regarding secondary endpoints' analysis of relative risk (RR) and mean difference (MD) predictors of PPM recovery during follow-up were female sex (RR 1.37; 95% CI 1.10–1.71; p=0.006), preexisting coronary artery disease (RR 1.12; 95% CI 0.99–1.27; p=0.08) and reduced left ventricular ejection fraction (MD −2.08%; 95% CI 0.23–3.93%; p=0.03). ECG predictors for long-term PPM dependency after TAVI appeared to be preexisting right bundle branch block (RBBB) (RR 1.84; 95% CI 1.38–2.45; p&lt;0.0001), bifascicular block (RR 4.41; 95% CI 1.64–11.86; p=0.003) and prolonged QRS duration (MD 8.69 ms; 95% CI 0.11–17.28 ms; p=0.05). While postprocedural complete heart block was highly predictive for long-term PPM dependency after TAVI (RR 1.35; 95% CI 0.97–1.89; p&lt;0.0001), patients with recovery of PPM dependency showed more indications other than complete heart block for PPM implantation like lower degree AV block or sick sinus syndrome (RR 2.28; 95% CI 1.53–3.38; p&lt;0.0001). Especially postprocedural AV block grade I (RR 1.73; 95% CI 0.96–3.14; p=0.07) and new left bundle branch block (LBBB) (RR 1.94; 95% CI 1.22–3.08; p=0.005) turned out to be predictors of PPM recovery during follow-up.

Conclusion

This structured meta-analysis proved new PPM implantation in 13.3% of patients following TAVI with half of the cases (48.6%) recovering from PPM dependency during follow-up. Therefore, it should be considered to carefully reassess the indication for PPM rather than to immediately implant PPM after TAVI, especially regarding postprocedural ECG predictors for early pacemaker recovery (lower degree AV block, postprocedural LBBB).

Funding Acknowledgement

Type of funding sources: None.

Comparative analysis of various sources of selenium on the growth performance and antioxidant status in broilers under heat stress

The supplementation of Selenium-enriched probiotics is effective in reducing oxidative stress and maintaining meat quality stability in broiler chicken especially under heat stress. An experimental study was conducted to perform Comparative analysis of Selenium yeast with inorganic Se in broilers under heat stress. A total of 120 broilers chicks of one day were assigned to 4 groups each consisting 30 chicks fed on same basal diet but different selenium sources. The basal diet of group D1 was not supplemented with Se source (Negative control), group D2 basal diet was supplemented with inorganic selenium (Sodium selenite 0.22mg/Kg starter phase and 0.15mg/Kg finisher phase), group D3 basal diet was supplemented with commercially available organic selenium (Seleno-methionine 0.22mg/Kg starter phase and 0.15mg/Kg finisher phase) and group D4 basal diet was supplemented with self-developed organic selenium (Se-enriched yeast 0.22mg/Kg starter phase and 0.15mg/Kg finisher phase). The performance parameters i.e. feed intake (FI), live body weight (BW) and FCR were not significantly (p>0.05) effected by selenium supplementation in the starter phase but were significantly (p<0.05) effected in the finisher phase. Selenium supplementation significantly (p<0.05) effected serum Se level in different supplemented groups. Higher serum Se value (58.20±0.06) was recorded in D4 group. Similarly significantly lower selenium value was recorded for D4 and higher was recorded for D1 (11.36±0.08). However lower serum Paraoxonase (PON) value was recorded for D4 (13.24±0.01) and higher for D1 (13.33±0.03). Comparatively self-developed Se enriched yeast increased the Se accumulation and improved antioxidant system. Glutathione peroxidase (GPx) was found higher in D4 (12.333±0.03) followed by D3, D2 and D1 respectively. Whereas superoxide dismutase (SOD) was significantly lower (p<0.05) in D4 (0.1437±0.003) followed by D3 (0.1457±0.002). Selenium supplementation increased the bird's survival rate. Birds fed on Se enriched yeast showed higher Se deposition and better antioxidant capacity as compared to other sources of selenium. Se-enriched yeast displayed an improved result on Se deposition in tissues, and oxidative capacity, meat tenderness and immune response level as compared to other sources of selenium.

Combination of eudragit EPO with poloxamers for improved solubility and dissolution of Zafirlukast: An evaluation of solid dispersion formulations

This study investigated the effect of solid dispersions (SD) on solubility and release of Zafirlukast (ZA) by physical mixture (PM), solvent evaporation (SE) and kneading method (KM) with Eudragit EPO (EPO) as binary component and Poloxamer 188 (P188) and Poloxamer 407 (P407) as ternary components. The binary and ternary systems caused an increase of 322 folds and 356 folds in aqueous solubility of ZA, respectively. Formulations were characterized for solubility, FTIR, PXRD, DSC, SEM and dissolution studies. P407 was found to be an excellent solubility booster in combination with EPO. It was concluded that solubility and dissolution rate of ZA increased significantly when SD of the ZA was prepared by solvent evaporation method (1:7 ratio) using 15% P407 as ternary component.

Role of digital health in improving physical and mental well-being during COVID-19 pandemic

Introduction

Due to the COVID-19 pandemic, there is a steep rise in the acceptance of telemedicine and digital health, including increased interest in pursuing mental health treatment through telepsychiatry. Digital health helps following social distancing measures and increases the health outcomes.

Objectives

To see the role of digital health in improving physical and mental well-being during COVID-19 Pandemic

Methods

This study is a part of a large global project where 240 people inquired advice on phone app during COVID-19-Pandemic. Later on, a short study was conducted on the same population through survey to evaluate the effectiveness of digital health/tele-mental health. We also searched PubMed, Google Scholar, PsychInfo, and Medline for words “Digital Health, Tele-mental health, COVID-19-Pandemic”. Reviewed 40 articles and included 3 in this review1,4,5.

Results

We received a total of 98 responses. 65.6% people reported that online health resources are helpful in relieving pandemic-induced anxiety/stress, 66.2% reported to continue online health services after pandemic, 37.7% noted that digital health saves times in waiting areas, 46% reported lack of physical interaction with doctor as a disadvantage of digital health, and 40.3% reported comfort in using tele-mental health. Our literature review has shown barriers like privacy concerns and technological issues1. Provision of tele-psychiatry is safe and effective in continuity of mental health care.4,5

Conclusions

There has been an increased inclination towards digital health during any disaster. During COVID-19-Pandemic, digital health has increased access to mental health care and reduced risk of infection. The drawbacks include poor patient-doctor relationship, reimbursement concerns, and lack of confidentiality.

The genomic landscape of pediatric rheumatology disorders in the Middle East

The landscape and clinical utility of comprehensive genomic investigations for a wide range of pediatric rheumatic disorders have not been fully characterized in the Middle East. Here, 71 pediatric patients, of diverse Arab origins, were clinically and genetically assessed for a spectrum of rheumatology-related diseases at the only dedicated tertiary children's hospital in the United Arab Emirates. Clinical genomic investigations included mainly (76%) next-generation sequencing-based gene panels and whole-exome sequencing, along with rapid sequencing in the intensive care unit and urgent setting. The overall positive yield was 46.5%, whereas dual diagnoses were made in two cases (3%). Although the majority (21/33, 64%) of positive findings involved the MEFV gene, the remaining (12/33, 36%) alterations were attributed to 11 other genes/loci. Copy number variants (CNVs) contributed substantially (5/33, 15.2%) to the overall diagnostic yield. Sequencing-based testing, specifically rapid sequencing, had a high positive rate and delivered timely results. Genetic findings guided clinical management plans and interventions in most cases (27/33, 81.8%). We highlight unique findings and provide additional evidence that heterozygous loss of function of the IFIH1 gene increases susceptibility to recurrent fevers. Our study provides new insights into the pathogenic variation landscape in pediatric rheumatic disorders.

Stroke after transcatheter aortic valve implantation: new insights into risk prediction

Background

Stroke is still a feared complication following transcatheter aortic valve implantation (TAVI), associated with increased mortality and severe impact on patients' daily living. Despite technological development and knowledge improvement, cerebrovascular events (CVE) are still not predictable so far and simple risk scores are lacking.

Purpose

This study aimed to evaluate different preprocedural factors that may favour stroke after TAVI, especially regarding severity of aortic calcification.

Methods

From May 2011 to January 2018 a total of 1365 patients underwent TAVI with a balloon-expandable (n=442, 32.4%) or self-expandable (n=923, 67.6%) device at our institution. All patients underwent multi-slice computed tomography (MSCT) before TAVI. To obtain the significant factors for stroke risk prediction we performed multivariate regression analysis and selected the optimal cut-off values according to the maximum Youden index for dichotomization of the risk score items. Finally, we used receiver operating characteristics (ROC) analysis and areas under the ROC curves (AUC) to validate our risk score in comparison to other existing models.

Results

60 of 1365 patients (4.4%) had new neurological impairment after TAVI during hospital stay (mean 11.2±6.7 days). We performed propensity score matching (1:10) to balance baseline characteristics between patients with and without stroke following TAVI, resulting in 56 patients with in-hospital stroke and 521 patients without. Preprocedural factors associated with stroke turned out to be history of prior stroke (OR 1.94; 95% CI 0.85–4.43; p=0.114), aortic valve area ≥0.545 cm2 (OR 3.11; 95% CI 1.16–8.34; p=0.024), atrioventricular angle ≥48.5° (OR 2.32; 95% CI 1.20–4.49; p=0.013), RCC Agatston Score ≥447.2 AU (OR 1.8; 95% CI 0.94–3.44; p=0.077), LVOT Agatston Score ≥262.4 AU (OR 2.01; 95% CI 1.08–3.75; p=0.028) and ascending thoracic aorta Agatston Score ≥116.4 AU (OR 2.21; 95% CI 1.17–4.17; p=0.015). ROC analysis showed that our risk model had an AUC of 0.73 (95% CI 0.66–0.80; p&lt;0.001), a sensitivity of 70.6%, a specificity of 69.0%, a positive predictive value of 19.5% and a high negative predictive value of 95.7%. Our risk model appeared to be the best for stroke prediction after TAVI compared to other risk scores used in literature before like EuroSCORE II (AUC 0.50; 95% CI 0.43–0.58; p=0.950) or CHA2DS2-VASc Score (AUC 0.62; 95% CI 0.55–0.70; p=0.004).

Conclusion

Especially aortic root calcium volume assessed by MSCT predicts CVE after TAVI and could be integrated into a six items risk model for preprocedural prediction of stroke after TAVI. This model could guide us in identifying those patients who are most likely to benefit from transcatheter cerebral embolic protection devices.

Funding Acknowledgement

Type of funding source: None

Use and success evaluation of percutaneous aortic balloon valvuloplasty in different hemodynamic entities of severe aortic stenosis in the TAVR era

Background

In the era of transcatheter aortic valve replacement (TAVR), there is renewed interest in percutaneous balloon aortic valvuloplasty (BAV), which may qualify as the primary treatment option of choice in special clinical situations. Success of BAV is commonly defined as a significant mean pressure gradient reduction after the procedure.

Purpose

To evaluate the correlation of the mean pressure gradient reduction and increase in the aortic valve area (AVA) in different flow and gradient patterns of severe aortic stenosis (AS).

Methods

Consecutive patients from 01/2010 to 03/2018 undergoing BAV were divided into normal-flow high-gradient (NFHG), low-flow low-gradient (LFLG) and paradoxical low-flow low-gradient (pLFLG) AS. Baseline characteristics, hemodynamic and clinical information were collected and compared. Additionally, the clinical pathway of patients (BAV as a stand-alone procedure or BAV as a bridge to aortic valve replacement) was followed-up.

Results

One-hundred-fifty-six patients were grouped into NFHG (n=68, 43.5%), LFLG (n=68, 43.5%) and pLFLG (n=20, 12.8%) AS. Underlying reasons for BAV and not TAVR/SAVR as the primary treatment option are displayed in Figure 1. Spearman correlation revealed that the mean pressure gradient reduction had a moderate correlation with the increase in the AVA in patients with NFHG AS (r: 0.529, p&lt;0.001) but showed no association in patients with LFLG (r: 0.145, p=0.239) and pLFLG (r: 0.030, p=0.889) AS. Underlying reasons for patients to undergo BAV and not TAVR/SAVR varied between groups, however cardiogenic shock or refractory heart failure (overall 46.8%) were the most common ones. After the procedure, independent of the hemodynamic AS entity, patients showed a functional improvement, represented by substantially lower NYHA class levels (p&lt;0.001), lower NT-pro BNP levels (p=0.003) and a numerical but non-significant improvement in other echocardiographic parameters like the left ventricular ejection fraction (p=0.163) and tricuspid annular plane systolic excursion (TAPSE, p=0.066). An unplanned cardiac re-admission due to heart failure was necessary in 23.7% patients. Less than half of the patients (44.2%) received BAV as a bridge to TAVR/SAVR (median time to bridge 64 days). Survival was significantly increased in patients having BAV as a staged procedure (log-rank p&lt;0.001).

Conclusion

In daily clinical practice, the mean pressure gradient reduction might be an adequate surrogate of BAV success in patients with NFHG AS but is not suitable for patients with other hemodynamic entities of AS. In those patients, TTE should be directly performed in the catheter laboratory to correctly assess the increase of the AVA. BAV as a staged procedure in selected clinical scenarios increases survival and is a considerable option in all flow states of severe AS. (NCT04053192)

Figure 1

Funding Acknowledgement

Type of funding source: None

Performance of the Corevalve Evolut R and PRO in severely calcified anatomies: a propensity-score matched analysis

Background

The Corevalve Evolut R and PRO belong to the newer generation of self-expandable valves and are increasingly used to treat patients with severe aortic stenosis. Over the years, technical advancements and increasing experience with the procedure itself are responsible for excellent clinical and hemodynamic results. Patients with severely calcified native aortic valve anatomies still pose a special task to the implanting team since the risk for intraprocedural complications might be increased.

Purpose

To evaluate the hemodynamic and clinical performance of the CoreValve Evolut R and PRO in patients with severely calcified native aortic valve anatomies.

Methods

Baseline characteristics, imaging data and procedural outcome of patients undergoing transfemoral transcatheter aortic valve implantation with the CoreValve Evolut R and PRO from 09/2015 to 03/2018 were prospectively collected. Patients underwent high-resolution multisclice computed tomography (MSCT). A pre-specific threshold of 600 Hounsfield units was set to account for the hyperdensity of the applied contrast medium and to enable comparability with MSCT thresholds, derived by non-contrast enhanced MSCT scans. Patients were divided by the extent of calcification into a severely calcified anatomy group (men &gt;2062AU, woman &gt;1377AU) or a not severely calcified anatomy group (men &lt;2062AU, woman &lt;1377AU). Propensity score matching with the variables log EuroSCORE, LVOT calcium load and the cover index in a 1:2 fashion was performed and clinical and hemodynamic results in accordance with VARC II were collected.

Results

Ninety-eight patients with severely calcified anatomies (SC) could be identified and were matched with 196 patients with lower calcified (LC) anatomies. Patients with severely calcified anatomies were older (SC: 83.1 years vs. LC: 80.3 years, p&lt;0.001) and had a smaller aortic valve area (SC: 0.63cm2 vs. LC: 0.70cm2, p=0.028). The mean implantation depth did not differ (SC 5.4mm±2.4 vs. LC: 5.1±2.2, p=0.554). Pre-dilatation was more often performed in the SC group (SC: 30.6% vs. LC: 15.8%, p=0.003) and the stroke/TIA rate did not differ (SC: 5.1% vs. LC: 3.5%, p=0.532). In SC patients, a permanent pacemaker implantation was significantly more often needed (SC: 28.5% vs. LC:7.6%, p&lt;0.001). The mean pressure gradient after the procedure was effectively reduced (SC: 7.1mmHg±3.9 vs. LC: 7.8±3.7mmHg, p=0.477). No aortic regurgitation (AR) was more often present in patients with SC anatomies (SC: 72.5% vs. LC: 85.2%, p=0.011). The aortic regurgitation index numerically differed between groups without reaching statistical significance (SC: 24.1±7.1 vs. LC: 27.3±6.7, p=0.067).

Conclusion

The CoreValve Evolut R and PRO show a good clinical safety profile and excellent hemodynamic results even in patients with severely calcified anatomies. In those patients, a permanent pacemaker implantation was more often necessary.

Funding Acknowledgement

Type of funding source: None

Pontine gliomas a 10-year population-based study: a report from The Canadian Paediatric Brain Tumour Consortium (CPBTC)

BACKGROUND

Diffuse intrinsic pontine gliomas (DIPG) are midline gliomas that arise from the pons and the majority are lethal within a few months after diagnosis. Due to the lack of histological diagnosis the epidemiology of DIPG is not completely understood. The aim of this report is to provide population-based data to characterize the descriptive epidemiology of this condition in Canadian children.

PATIENTS AND METHODS

A national retrospective study of children and adolescents diagnosed with DIPG between 2000 and 2010 was undertaken. All cases underwent central review to determine clinical and radiological diagnostic characteristics. Crude incidence figures were calculated using age-adjusted (0-17 year) population data from Statistics Canada. Survival analyses were performed using the Kaplan-Meier method.

RESULTS

A total of 163 patients with pontine lesions were identified. Central review determined one-hundred and forty-three patients who met clinical, radiological and/or histological criteria for diagnosis. We estimate an incidence rate of 1.9 DIPG/1,000,000 children/year in the Canadian population over a 10 years period. Median age at diagnosis was 6.8 years and 50.3% of patients were female. Most patients presented with cranial nerve palsies (76%) and ataxia (66%). Despite typical clinical and radiological characteristics, histological confirmation reported three lesions to be low-grade gliomas and three were diagnosed as CNS embryonal tumor not otherwise specified (NOS).

CONCLUSIONS

Our study highlights the challenges associated with epidemiology studies on DIPG and the importance of central review for incidence rate estimations. It emphasizes that tissue biopsies are required for accurate histological and molecular diagnosis in patients presenting with pontine lesions and reinforces the limitations of radiological and clinical diagnosis in DIPG. Likewise, it underscores the urgent need to increase the availability and accessibility to clinical trials.

Cytotoxic and antioxidant potentials of ellagic acid derivatives from <i>Conocarpus lancifolius</i> (Combretaceae)

Purpose: Isolation, characterisation and structure elucidation of compounds obtained from Conocarpus lancifolius and screening of their pharmacological effects in vitro.Methods: After collection, authentication and extraction from whole C. lancifolius plants, screening for secondary metabolites, thin-layer  chromatography and subsequent open column chromatography were performed for phytochemical analysis and subsequent purification of the compounds. The chemical structures of the isolated compounds were elucidated using spectroscopic (UV-visible, infrared and mass) spectroscopy, and nuclear magnetic resonance (1H-NMR, 13C-NMR including BB, DEPT-135, 90 and two-dimensional correlation techniques, including HMBC and HSQC). The cytotoxic and antioxidant potentials of extracts and compounds obtained from C. lancifolius were evaluated using in vitro models.Results: Two ellagic acid derivatives, 2,3,8-tri-o-methylellagic acid (A) and 3-O-methylellagic acid 4-O-β-D-glucopyranoside (B), were isolated. Both compounds (A and B) were cytotoxic in a variety of cancer cell lines, including murine lymphocytic leukaemia (P-388, half-maximal inhibitory concentration (IC50) =3.60 and 2.40 μg/mL, respectively), human colon cancer (Col-2, IC50 = 0.76 and 0.92 μg/mL, respectively) and human breast cancer (MCF-7, IC50 = 0.65 and 0.54 μg/mL, respectively). Moreover, both compounds showed significant antioxidant potential in vitro.Conclusion: C. lancifolius extract and isolated ellagic acid derivatives (compounds A and B) possess cytotoxic and antioxidant properties. These findings suggest that C. lancifolius contains bioactive compounds that can be potentially developed as natural cytotoxic and antioxidant compounds. Keywords: Conocarpus lancifolius, Ellagic acid, Combretaceae, Cytotoxic activity, Antioxidant

Synthesis, computational studies, tyrosinase inhibitory kinetics and antimelanogenic activity of hydroxy substituted 2-[(4-acetylphenyl)amino]-2-oxoethyl derivatives

The over expression of melanogenic enzymes like tyrosinase caused many hyperpigmentaion disorders. The present work describes the synthesis of hydroxy substituted 2-[(4-acetylphenyl)amino]-2-oxoethyl derivatives 3a-e and 5a-e as antimelanogenic agents. The tyrosinase inhibitory activity of synthesized derivatives 3a-e and 5a-e was determined and it was found that derivative 5c possesses excellent activity with IC50 = 0.0089 µM compared to standard kojic acid (IC50 = 16.69 µM). The presence of hydroxyl groups at the ortho and the para position of cinnamic acid phenyl ring in compound 5c plays a vital role in tyrosinase inhibitory activity. The compound 5d also exhibited good activity (IC50 = 8.26 µM) compared to standard kojic acid. The enzyme inhibitory kinetics results showed that compound 5c is a competitive inhibitor while 5d is a mixed-type inhibitor. The mode of binding for compounds 5c and 5d with tyrosinase enzyme was also assessed and it was found that both derivatives irreversibly bind with target enzyme. The molecular docking and molecular dynamic simulation studies were also performed to find the position of attachment of synthesized compounds at tyrosinase enzyme (PDB ID 2Y9X). The results showed that all of the synthesized compounds bind well with the active binding sites and most potent derivative 5c formed stable complex with target protein. The cytotoxicity results showed that compound 5c is safe at a dose of 12 µg/mL against murine melanoma (B16F10) cells. The same dose of 5c was selected to determine antimelanogenic activity; the results showed that it produced antimelenogenic effects in murine melanoma (B16F10) cells. Based on our investigations, it was proposed that compound 5c may serve as a lead structure to design more potent antimelanogenic agents.

Hydroxyl substituted benzoic acid/cinnamic acid derivatives: Tyrosinase inhibitory kinetics, anti-melanogenic activity and molecular docking studies

The inhibition of tyrosinase is an established strategy for treating hyperpigmentation. Our previous findings demonstrated that cinnamic acid and benzoic acid scaffolds can be effective tyrosinase inhibitors with low toxicity. The hydroxyl substituted benzoic and cinnamic acid moieties of these precursors were incorporated into new chemotypes that displayed in vitro inhibitory effect against mushroom tyrosinase. The most active compound, (2-(3-methoxyphenoxy)-2-oxoethyl (E)-3-(4-hydroxyphenyl) acrylate) 6c, inhibited tyrosinase with an IC₅₀ of 5.7 µM, while (2-(3-methoxyphenoxy)-2-oxoethyl 2, 4-dihydroxybenzoate) 4d had an IC₅₀ of 23.8 µM. In comparison, the positive control, kojic acid showed tyrosinase inhibition with an IC₅₀ = 16.7 µM. Analysis of enzyme kinetics revealed that 6c and 4d displayed noncompetitive reversible inhibition of the second tyrosinase enzymatic reaction with K_i values of 11 µM and 130 µM respectively. In silico docking studies with mushroom tyrosinase (PDB ID 2Y9X) predicted possible binding modes in the catalytic site for these active compounds. The phenolic para-hydroxy group of the most active compound 6c is predicted to interact with the catalytic site Cu⁺⁺ ion. The methoxy part of this compound is predicted to form a hydrogen bond with Arg 268. Compound 6c had no observable toxic effects on cell morphology or cell viability at the highest tested concentration of 91.4 µM. When dosed at 91.4 µM onto B16F10 melanoma cells in vitro6c showed anti-melanogenic effects equivalent to kojic acid at 880 µM. 6c displayed no PAINS (pan-assay interference compounds) alerts. Our results show that compound 6c is a more potent tyrosinase inhibitor than kojic acid and is a candidate for further development. Our exposition of the details of the interactions between 6c and the catalytic pocket of tyrosinase provides a basis for rational design of additional potent inhibitors of tyrosinase, built on the cinnamic acid scaffold.

P3742Transcatheter aortic valve implantation in large annuli: incidence and predictors of specific adverse events with the largest self-expanding device

Background

The recently released largest self-expanding transcatheter aortic valve device (STHV-34) is characterized by good results but nevertheless demands an experienced team for the implantation in large annuli.

Purpose

Looking at multi slice computed tomography (MSCT) and procedural data, we tried to identify characteristics that could explain intraprocedural VARC-2 and valve specific non-VARC-2 events.

Methods

We performed a single center retrospective analysis in 80 patients treated with STHV-34. STHV-34 patients were separated into subjects without events (NE, n=43, 54%) and the following adverse events: resheathing/-capture processes (RS/C, n=19, 24%), valve dislodgments (VD, n=21; 26%), infolding (IF, n=6, 8%) and complete dislocation with bail-out valve-in-valve implantation (ViV, n=3, 4%). Events were further categorized in non-VARC-2 and VARC-2. The analysis sought for underlying anatomical conditions and defined risk factors by multivariate analysis.

Results

Primary device success was reached in 96% and immediate postprocedural absence of moderate-to-severe aortic regurgitation was 100%. We identified specific anatomical conditions predisposing for non-VARC-2 and VARC-2 events: RS/C: annular calcium load<1600 AU (OR 47 [CI 1.4–216], p=0.0004). IF: peripheral kinking (RR 5.0 [CI 1.0–24], p=0.0478) and previous RS/C maneuvers (83%). ViV: annular ellipticity index (NS 1.2±0.1 vs. ViV 1.4±0.1, p=0.0049), aortic angulation (AA) angle (NS 54.0±7.0° vs. ViV 61.7±1.5°, p=0.0240) and LVOT-AO angle (NS 149.1±18.9° vs. ViV 130.3±3.5°, p=0.0470).

Conclusion

We confirm high procedural success for the largest currently available STHV-34. The incidence of intraprocedural non-VARC-2 and VARC-2 events are associated with anatomical characteristics that may influence valve selection and implantation strategy.

P5583Micro-movement during transcatheter aortic valve implantation with a contemporary self-expandable prosthesis

Background

Precise positioning of the prosthesis is a crucial step during transcatheter aortic valve implantation. In some cases, contemporary self-expandable prostheses show micro-movement (MM) during the final phase of release.

Purpose

We aimed to establish a definition for MM, evaluated the incidence of MM using the CoreValve Evolut RTM, investigated potential risk factors for MM and the associated clinical outcomes.

Methods

MM was defined as movement of the prosthesis of at least 1.5 mm from its position directly before release compared to its final position. Patients were grouped according to the occurrence (+MM) or absence (-MM) of MM. Baseline characteristics, imaging data and outcome parameters in accordance with the updated valve academic research consortium (VARC-2) criteria were retrospectively analyzed.

Results

We identified 258 eligible patients. MM occurred in 31.8% (n=82) of cases with a mean magnitude of 2.8±2.2 mm in relation to the left coronary cusp and 3.0±2.1 mm to the non-coronary cusp. Clinical and hemodynamic outcomes were similar in both groups. The mean pressure gradient was effectively reduced after TAVI (-MM vs. +MM: 7±3.4 mmHg vs. 8±3.9 mmHg, p=0.326) with consistency over a follow-up period of at least three months (-MM vs. +MM: 6.7±3.7 mmHg vs. 7.9±8.4 mmHg, p=0.168). At three months follow-up most of the patients presented with no aortic regurgitation (-MM vs. +MM: 64% vs. 67.9%, p=0.569). Mild aortic regurgitation was observed in 34.2% of the -MM group and in 29.5% of the +MD group (p=0.414). Moderate aortic regurgitation occurred in 1.9% of all patients with no differences between groups (-MM vs. +MM: 1.9% vs. 2.6%, p=0.662). Patients with MM presented with a more symmetric calcification pattern (-MM vs. +MM: 27.3% vs. 40.2%; p=0.037) and a larger aortic valve area (-MM vs. +MM: 0.6 cm2 ± 0.3 vs. 0.7 cm2 ± 0.2; p=0.014), which was found to be a potential risk factor for the occurrence of MM in a multivariate regression analysis (OR 3.5; 95% CI: 1.1–10.9; p=0.032)

Conclusion

MM occurred in nearly one third of patients and did not affect clinical and hemodynamic outcome. A larger aortic valve area was the only independent risk factor for the occurrence of MM.

P2467Fusion imaging (Anatomical Intelligence) enables automated left atrial appendage sizing in real-time a single center pilot study

Background and purpose

Percutaneous left atrial appendage occlusion (LAAO) depicts an alternative treatment for patients with atrial fibrillation who are deemed for long-term oral anticoagulation therapy. In order to perform a successful LAAO accurate sizing of left atrial appendage (ostium, landing zone and depth) for device selection is essential. Echo-Fluoro fusion imaging in real-time offers with its latest prototype a patient-specific segmented automated 3D heart model and sizing of left atrial appendage (LAA). We therefore aimed to evaluate the automated segmented LAA sizing by comparing to 2D transesophageal (TOE) and MSCT measurements as gold standard.

Methods

We studied prospectively data of 8 consecutive patients who were admitted to our clinic for left atrial appendage closure. MSCT was performed preprocedural and analyzed with commercially available 3mensio software (Pie medical imaging). 2D TOE measurements and automated segmentation of the LAA and sizing were performed during the procedure by a highly experienced team of periinterventional cardiac imaging specialist and structural heart disease interventionalist who were blinded to the prior MSCT analysis. Dimension of ostium, landing zone (10 mm into the LAA parallel to the ostial plane at the level of the left circumflex for Amplatzer device) and depth (perpendicular to the ostial plane) were obtained in different TOE views according to instructions for use of Amulet Occluder. In order to generate an automated 3 D heart model, a high-quality 3D TOE image of the LAA volume and surrounding structures was acquired. After successful ECG-gated segmentation a 3 D heart model was generated. Automated LAA sizing followed in real-time. All measurements were taken into consideration before device selection. A Kruskal Wallis test was used to compare mean ranks of independent samples. A concordance analysis according to Kendall W was carried out to investigate reliability.

Results

The mean age of the patients was 82,6±4.15 years and half of the patients were female. All procedures were conducted successfully. The mean values of ostium and landing zone were comparable in TOE, automated sizing and MSCT sizing (ostium: 23,78±2,15 mm vs 25,71±5,25 mm vs 27,35±3,3 mm; (p=0,175); landing zone 22,13±3,18 mm vs 23,57±3,31 mm vs 24,00±3,51 mm; (p=0,377)). Furthermore, a significant concordance between the measurements was shown (ostium W= 0,991; p=0.045, landing zone W=0,835, p=0.014).

Conclusion

Automated LAA sizing acquired by fusion imaging may be an elegant real-time alternative for precise LAA Occluder device selection and needs to be investigated further.

P2274Single-center experience with different regimes of antiplatelet therapy and oral anticoagulation in transcatheter aortic valve replacement

Background

Antithrombotic therapy in transcatheter aortic valve replacement (TAVR) is highly controversial. Dual antiplatelet therapy (DAPT) for 3–6 months with aspirin and clopidogrel is the current recommendation. Whereas in patients with indication for OAC several regimes were described, ranging from OAC monotherapy to dual and even triple therapy. Besides vitamin K antagonists (VKA), non-Vitamin K oral anticoagulants (NOAC) are frequently used in TAVR patients with indication for permanent OAC.

Purpose

We therefore aimed to evaluated different antithrombotic regimes and their impact on outcome.

Methods

We performed a single center retrospective analysis in 1160 patients treated by transfemoral approach (TF TAVR). Primary endpoints were 30-day mortality, stroke and bleeding according to VARC-2 criteria. Secondary endpoint was all-cause mortality at 1 year.

Results

In 1160 patients with TF TAVR, a broad range of regimes occurred in clinical practice. The majority of patients were on DAPT (637 patients, 55.0%), followed by VKA + clopidogrel (186 patients, 16%). Other patients received OAC mono (98 patients; 9%), triple therapy (93 patients; 8%), NOAC mono (31 patients; 3%), single antiplatelet therapy (SAPT, 40 patients; 4%) or NOAC + clopidogrel (31 patients, 3%).

All-cause mortality 30 days after TF TAVR differed between the regimens. (SAPT/OAC+SAPT/N-OAC+DAPT 0.0% vs DAPT 3.6% vs OAC 10.2% vs. NOAC 1.3% vs NOAC+SAPT 0.3%; pANOVA<0.0001). Severe bleeding events were comparable (SAPT 5.0% vs DAPT 2.4% vs OAC 7.1% vs NOAC 1.3% vs OAC+SAPT 3.2% vs NOAC+SAPT 0.0% vs. N-OAC+SDPT 4.3%; pANOVA=0.15). Stroke rates were comparable in all subcohorts as well (SAPT 5.0% vs DAPT 3.0% vs OAC 7.1% vs NOAC 2.7% vs OAC+SAPT 1.6% vs NOAC+SAPT 0.0% vs. N-OAC+DAPT 1.1%; pANOVA=0.13). Only 2 hemorrhagic strokes (5.6%) appeared under DAPT and OAC mono respectively, whereas all others were of thromboembolic origin (94.4%). Surprisingly, all-cause mortality at one-year after TF TAVR was higher in OAC patients compared to all other used regimes (logrankoverallp=0.0012).

Conclusion

Data from our retrospective analysis indicate that a variety of different antithrombotic regimes occur even in a single centre analysis. All-cause mortality was enhanced in patients with oral anticoagulation. Therefore, clinical trials need to investigate if this is only explained by additional atrial fibrillation.

P1857Risk calculator for prediction of iatrogenic atrial septal defect persistence following percutaneous mitral valve repair

Background

The rising number of new percutaneous interventions for left-sided heart disease leads to increased occurrence of iatrogenic atrial septal defect (iASD). The percutaneous mitral valve repair (PMVR) for severe, symptomatic mitral regurgitation (MR) also requires intraprocedural puncture of the interatrial septum. In some cases iASD is persisting and becomes haemodynamically relevant with enhanced right heart overload due to significant left-to-right-shunting.

Purpose

This study aimed to evaluate pre- and periprocedural factors that may favour persistence and haemodynamic relevance of iASD in patients after PMVR.

Methods

In 2015, 75 consecutive patients with severe MR (age 74.8±10.5y) and following PMVR were enrolled. After 12 months, 57 patients completed their follow up (FU) including clinical conditions, transthoracic echocardiography (TTE), and cardiovascular magnetic resonance (CMR) whenever feasible. We evaluated the impact of comorbidities as well as intraprocedural, haemodynamic and functional characteristics that may favour persistence of iASD by multivariate analysis. Haemodynamic relevance of iASD was defined as right heart overload with predominantly significant enlargement of the right atrium (RA), impairment of right heart function as defined by fractional area shortening (FAC), and ratio of pulmonary to systemic blood flow (Qp/Qs>1) when available.

Results

18 out of 57 patients (32%) showed a persistent iASD (+iASD), being associated with a specific combination of comorbidities as well as pre-procedural and periprocedural factors that can be summarised by a multifactorial iASD risk calculator (+iASD vs. -iASD: 6.3±2.9 vs. 3.9±2.7; p=0.0058). 11 iASD (61%) became haemodynamically relevant (+hd iASD) with a significant right heart overload (RA area +hd iASD vs. -hd iASD: baseline 23.1±4.1 vs. 23.2±4.3; FU 30.7±6.3 vs. 20.1±4.6; p<0.0001), reduced RV function (FAC +hd iASD vs. -hd iASD: baseline 41.0±10.3 vs. 29.9±7.2; FU 25.3±7.2 vs. 29.1±13.2; p<0.0156) and left-to-right shunting (Qp/Qs -iASD vs. +hd iASD vs. -hd iASD: 1.0±0.3 vs. 1.7±0.4 vs. 0.8±0.1 L/min; p=0.0011).

Conclusion

This study shows for the first time, that persistence of iASD can be predicted by pre- and periprocedural factors using a risk calculator that may additionally guide careful follow up imaging and therapeutic action after PMVR to avoid development of progressive heart failure.

The Pediatric Toronto Extremity Salvage Score (pTESS): Validation of a Self-reported Functional Outcomes Tool for Children with Extremity Tumors

BACKGROUND

The physical function of children with sarcoma after surgery has not been studied explicitly. This paucity of research is partly because of the lack of a sufficiently sensitive pediatric functional measure. The goal of this study was to establish and validate a standardized measure of physical function in pediatric patients with extremity tumors.

QUESTIONS/PURPOSES

(1) What is the best format and content for new upper- and lower-extremity measures of physical function in the pediatric population? (2) Do the new measures exhibit floor and/or ceiling effects, internal consistency, and test-retest reliability? (3) Are the new measures valid?

METHODS

In Phase 1, interviews with 17 consecutive children and adolescents with bone tumors were conducted to modify the format and content of draft versions of the pediatric Toronto Extremity Salvage Score (pTESS). In Phase 2, the pTESS was formally translated into French. In Phase 3, 122 participants between 7 and 17.9 years old with malignant or benign-aggressive bone tumors completed the limb-specific measure on two occasions. Older adolescents also completed the adult TESS. Floor and ceiling effects, internal consistency, test-retest reliability, and validity were evaluated.

RESULTS

Feedback from interviews resulted in the removal, addition, and modification of draft items, and the pTESS-Leg and pTESS-Arm questionnaires were finalized. Both versions exhibited no floor or ceiling effects and high internal consistency (α > 0.92). The test-retest reliability was excellent for the pTESS-Leg (intraclass correlation coefficient [ICC] = 0.94; 95% CI, 0.90-0.97) and good for the pTESS-Arm (ICC = 0.86; 95% CI, 0.61-0.96). Known-group validity (ability to discriminate between groups) was demonstrated by lower mean pTESS-Leg scores for participants using gait aids or braces (mean = 68; SD = 21) than for those who did not (mean = 87; SD = 11; p < 0.001). There was no significant difference between pTESS arm scores among respondents using a brace (n = 5; mean = 73; SD = 11) and those without (n = 22; mean = 83; SD = 19; p = 0.13). To evaluate construct validity, we tested a priori hypotheses. The duration since chemotherapy correlated moderately with higher pTESS-Leg scores (r = 0.4; p < 0.001) but not with pTESS-Arm scores (r = 0.1; p = 0.80), and the duration since tumor resection correlated moderately with higher pTESS-Leg scores (r = 0.4; p < 0.001) but not pTESS-Arm scores (r = 0.2; p = 0.4). Higher VAS scores (that is, it was harder to do things) antecorrelated with both pTESS versions (pTESS-Leg: r = -0.7; p < 0.001; pTESS-Arm: r = -0.8; p < 0.001). To assess criterion validity, we compared the pTESS with the current "gold standard" (adult TESS). Among adolescents, strong correlations were observed between the TESS and pTESS-Leg (r = 0.97, p < 0.001) and pTESS-Arm (r = 0.9, p = 0.007).

CONCLUSIONS

Both pTESS versions exhibited no floor or ceiling effects and had high internal consistency. The pTESS-Leg demonstrated excellent reliability and validity, and the pTESS-Arm demonstrated good reliability and reasonable validity. The pTESS is recommended for cross-sectional evaluation of self-reported physical function in pediatric patients with bone tumors.

LEVEL OF EVIDENCE

Level II, outcome measurement development.

SHORT COMMUNICATION-Anticancer activity of Ziziphus mauritiana roots against human breast cancer cell line

This study was designed to evaluate the anticancer activity of Ziziphus mauritiana roots. The dichloromethane and methanol extracts were prepared and anticancer activity was investigated the by using MTT assay. Human breast cancer cell line (MCF-7) was used in this study. 50μg/ml of dichloromethane extract of the roots of plant exhibited significant anticancer activity (70%) against the breast cancer cell line with IC₅₀ 20.34±0.9 using doxorubicin as standard. The study indicated that Ziziphus mauritiana has anticancer activity against MCF-7 cell line.

Dexibuprofen amide derivatives as potential anticancer agents: synthesis, in silico docking, bioevaluation, and molecular dynamic simulation

BACKGROUND

The amide derivatives of nonsteroidal anti-inflammatory drugs have been reported to possess antitumor activity. The present work describes the synthesis of dexibuprofen amide analogues (4a-j) as potential anticancer agents.

METHODS

The title amides (4a-j) were obtained by simple nucleophilic substitution reaction of dexibuprofen acid chloride with substituted amines in good yield and chemical structures were confirmed by FTIR, 1H NMR, 13C NMR and mass spectral data.

RESULTS

The brine shrimp lethality assay results showed that all of the synthesized compounds are non-toxic to shrimp larvae. The inhibitory effects on tumor growth were evaluated and it was observed that N-(2,5-dichlorophenyl)-2-(4-isobutylphenyl) propionamide (4e) and N-(2-chlorophenyl)-2-(4-isobutylphenyl) propionamide (4g) exhibited excellent antitumor activity compared to all other derivatives. The compound 4e bearing 2,5-dichloro substituted phenyl ring and 4g possesses 2-chloro substituted phenyl ring exhibited 100% inhibition of the tumor growth. The anticancer activity was evaluated against breast carcinoma cell line (MCF-7) and it was observed that derivative 4e exhibited excellent growth inhibition of cancer cells with IC50 value of 0.01±0.002 µm, which is better than the standard drugs. The docking studies against breast cancer type 1 susceptibility protein BRCA1 (PDBID 3K0H) exhibited good binding affinities, which are in good agreement with the wet lab results. The compounds 4e and 4g showed the binding energy values of -6.39 and -6.34 Kcal/mol, respectively. The molecular dynamic (MD) simulation was also carried out to evaluate the residual flexibility of the best docking complexes of compounds 4e and 4g. The MD simulation analysis assured that the 4e formed a more stable complex with the target protein than the 4g. The synthesized amide derivatives exhibited were devoid of gastrointestinal side effects and no cytotoxic effects against human normal epithelial breast cell line (MCF-12A) were found.

CONCLUSION

Based upon our wet lab and dry lab findings we propose that dexibuprofen analogue 4e may serve as a lead structure for the design of more potent anticancer drugs.

Sustained release biodegradable solid lipid microparticles: Formulation, evaluation and statistical optimization by response surface methodology

For preparing nebivolol loaded solid lipid microparticles (SLMs) by the solvent evaporation microencapsulation process from carnauba wax and glyceryl monostearate, central composite design was used to study the impact of independent variables on yield (Y1), entrapment efficiency (Y2) and drug release (Y3). SLMs having a 10-40 μm size range, with good rheological behavior and spherical smooth surfaces, were produced. Fourier transform infrared spectroscopy, differential scanning calorimetry and X-ray diffractometry pointed to compatibility between formulation components and the zeta-potential study confirmed better stability due to the presence of negative charge (-20 to -40 mV). The obtained outcomes for Y1 (29-86 %), Y2 (45-83 %) and Y3 (49-86 %) were analyzed by polynomial equations and the suggested quadratic model were validated. Nebivolol release from SLMs at pH 1.2 and 6.8 was significantly (p < 0.05) affected by lipid concentration. The release mechanism followed Higuchi and zero order models, while n > 0.85 value (Korsmeyer- Peppas) suggested slow erosion along with diffusion. The optimized SLMs have the potential to improve nebivolol oral bioavailability.

Antioxidant, Acetylcholinesterase, Butyrylcholinesterase, and α-glucosidase Inhibitory Activities of Corchorus depressus

Background:

Corchorus depressus (Cd) commonly known as Boa-phalee belonging to the family Tiliaceae having 50 genera and 450 species. Cd is not among the studied medicinal agent despite its potential in ethnopharmacology.

Objectives:

The present study investigated antioxidant, acetylcholinesterase (AChE), butyrylcholinesterase (BChE), and α-glucosidase inhibitory activities of Cd. The dichloromethane and methanolic extracts of the Cd were evaluated for biological activities such as antioxidant and enzyme inhibitory activities of AChE, BChE, and α-glucosidase.

Materials and Methods:

Antioxidant activity was evaluated by measuring free radical scavenging potential of Cd using 1,1-diphenyl-2-picrylhydrazyl. Enzyme inhibition activities were done by measuring optical density.

Results:

The methanol extract of roots of Cd showed potential free radical scavenging activity 99% at concentration 16.1 μg/ml. AChE was inhibited by aerial part of dichloromethane fraction by 46.07% ± 0.45% while dichloromethane extracts of roots of Cd possessed significant activity against BChE with 86% inhibition compared with standard drug Eserine at concentration 0.5 mg/ml. The dichloromethane extract of roots of Cd showed 79% inhibition against α-glucosidase enzyme activity with IC₅₀ 62.8 ± 1.5 μg/ml.

Conclusion:

These findings suggest Cd as useful therapeutic option as antioxidant and inhibition of AChE, BChE, and α-glucosidase activities.

SUMMARY

The aerial parts and roots of Corchorus depressus (Cd) were extracted in dichloromethane and methanol

The extract of roots of Cd showed free radical scavenging activity 99% at concentration 16.1 mg/ml, Ach inhibition by aerial parts of dichloromethane fraction by 46.07%, and 79% inhibition against a-glucosidase enzyme activity with IC₅₀ 62.8 ± 1.5 mg/ml

The dichloromethane and methanolic extracts of Cd exhibited antioxidant inhibition of acetyl cholinesterase, butyrylcholinesterase, and a-glucosidase activities.

Abbreviations used: DPPH: 1,1-diphenyl-2-picrylhydrazyl, Cd: Corchorus depressus, AChE: Acetylcholinesterase, BChE: Butyrylcholinesterase, AD: Alzheimer's disease.

Association between the antioxidant uric acid and depression and antidepressant medication use in 96 989 individuals

OBJECTIVE

In the last decade, several studies have suggested that depression is accompanied by increased oxidative stress and decreased antioxidant defenses. We tested the hypothesis that high levels of the antioxidant uric acid are associated with lower risk of hospitalization with depression and use of prescription antidepressant medication.

METHOD

We examined plasma levels of the antioxidant uric acid in 96 989 individuals from two independent cohort studies. Logistic regression and Cox proportional hazards regression models were multivariable adjusted for age, gender, alcohol, smoking, income, body mass index, C-reactive protein, hemoglobin, triglycerides, cardiovascular disease, diabetes, and intake of meat and vegetables. Results were performed separately in each study and combined in a meta-analysis.

RESULTS

In both studies, high uric acid was associated with lower risk of hospitalization as in-patient or out-patient with depression and antidepressant medication use. A doubling in uric acid was associated with an effect estimate of 0.57 (95% CI 0.49-0.65) and 0.77 (0.73-0.81) for hospitalization with depression and antidepressant medication use. The association was consistent across strata of all covariates. Results were attenuated in Cox regression analyses with less statistical power.

CONCLUSION

High plasma levels of uric acid were associated with low risk of depression hospitalization and antidepressant medication use.