Descriptive Characteristics of Multiple Myeloma Patients in King Abdulaziz Medical City National Guard

Background Multiple myeloma (MM) is a hematological malignancy characterized by the production of monoclonal immunoglobulin. It is the second-most common hematological malignancy. The survival rate varies depending on age at diagnosis, comorbidities, and treatment.This study aims to assess the prevalence of clinical and laboratory characteristics among multiple myeloma patients. Methods This is an observational study of multiple myeloma patients who were admitted to King Abdulaziz Medical City - National Guard between January 2015 and December 2020. Patient records were reviewed to derive clinical and laboratory characteristics. Descriptive data analysis and survival analysis were obtained using SPSS. Results Our study included 151 patients, 95 of whom were males and 56 were females, and the mean age of diagnosis with MM was 62.6 (SD = 13.4). Among 151 MM patients, the most common clinical signs were bone lesions and renal disease, with a percentage of 66.9% and 46.4%, respectively. Death rates throughout the time of study conduction were 19.2%, accounting for 29 patients, and the median overall survival was 5.1 years with a 95% confidence level. Testing the association between survival rates and gender showed that death rates in females were significantly higher than in males (p-value = 0.023). Patients with anemia had a significantly higher hazard ratio in both unadjusted and adjusted analyses (aHR = 2.61; 95% CI = 1.21-5.65). Conclusion There was a relationship between survival and gender, which suggests a protective factor favoring the male gender. Clinical and laboratory characteristics, including bone marrow lesions, anemia, and renal disease, were the initial presentation; thus, a detailed history focused on symptoms should be taken when any of these symptoms are reported.

Ulnar artery access for intracranial mechanical thrombectomy procedure: A salvage option after failed trans-femoral and trans-radial access

84 years old gentle man with past medical history of hypertension and diabetes presented with sudden onset right sided weakness and aphasia for two hours. Initial neurological assessment revealed National Institute of Health Stroke Scale (NIHSS) 17. Computed tomography (CT) scan demonstrated minimal early ischemic changes along left insular cortex with occlusion of left middle cerebral artery (MCA). Based on clinical and imaging findings, decision was made to perform mechanical thrombectomy procedure. Initially, right common femoral artery approach was utilized. However, due to unfavorable type-III bovine arch, left internal carotid artery could not be engaged via this approach. Subsequently, access was switched to right radial artery. Angiogram revealed small caliber radial artery, with larger caliber ulnar artery. Attempt was made to advance the guide catheter through the radial artery, however significant vasospasm was encountered. Subsequently, ulnar artery was accessed and successful thrombolysis in cerebral infarction (TICI) III left MCA reperfusion was achieved with a single pass of mechanical thrombectomy via this approach. Post procedure neurological examination demonstrated significant clinical improvement. Doppler ultrasound 48 hours after the procedure demonstrated patent flow in radial and ulnar arteries with no evidence of dissection.

Heat generation/absorption effect on natural convective heat transfer in a wavy triangular cavity filled with nanofluid

This study is numerically executed to investigate the influence of heat generation or absorption on free convective flow and temperature transport within a wavy triangular enclosure filled by the nanofluid taking the Brownian effect of nanoparticles. The water (H2O) is employed as base fluid and copper (Cu) as nanoparticles for making effective Cu-H2O nanofluids. The perpendicular sinusoidally wavy wall is cooled at low temperature while the horizontal bottom sidewall is heated non-uniformly (sinusoidal). The inclined wall of the enclosure is insulated. The governing dimensionless non-linear PDEs are executed numerically with the help of the Galerkin weighted residual type finite element technique. The numerically simulated results are displayed through average Nusselt number, isothermal contours, and streamlines for the various model parameters such as Hartmann number, Rayleigh number, heat generation or absorption parameter, nanoparticles volume fraction, and undulation parameter. The outcomes illustrate that the temperature transport rate augments significantly for the enhancement of Rayleigh number as well as nanoparticles volume fraction whereas reduces for the increment of Hartman number. The heat transfer is significantly influenced by the size, shape, and Brownian motion of the nanoparticles. The rate of heat transport increases by 20.43% considering the Brownian effect for 1% nanoparticle volume. The thermal performance increases by 8.66% for the blade shape instead of the spherical shape of nanoparticles. In addition, heat transfer is impacted by the small size of nanoparticles. The thermal transport rate increases by 35.87% when the size of the nanoparticles reduces from 100 to 10 nm. Moreover, the rate of heat transmission increases efficiently as the undulation parameter rises. It is also seen that a crucial factor in the flow of nanofluids and heat transmission is the heat generation/absorption parameter that influences temperature distribution, heat transfer rates, and overall thermal performance.

Computational investigation of magnetized hybrid nanofluids heat transport and flow through elongational surface with thermal radiation and wall slip

The improved thermal performance of recently discovered hybridized nanofluids has become essential in large scale thermal processes. In fact, this is highly efficient technique to introduce the thermal efficiency of tranditional heat transferring fluids. The behavior of the nanofluid can be significantly impacted by the unsteady heating and magnetic field effects that may be present in many applications. Therefore, the current study investigat the unsteady magnetized flow of hybrid nanofluid with heat transport characteristics subject to thermal radiation and slip at the surface wall. The shrinking/stretching surface is chosen as a flow source, which is frequently occure in polymer technology, which deals with the deformability of elastic sheets, and in metallurgy, where continued strips are cooled. The novel form of shrinking surface flow is fundamentally a reverse flow and exhibits physical characteristics that differ significantly from the channel flow scenario. The distinctive features of this scruinity is the use of empirical relations to approximate the optimum thermophysical attributes of a C u - A l 2 O 3 / water hybrid nanofluid in order to model the 2-dimensional flow past a flat shrinking/stretching sheet under the action of radiation, Lorentz forces and realastic boundary condition responses. The governing system of modelled equation are assembled using the Tiwari-Das model in conjunction with a hybrid mass-based nanofluid model. The bvp4c algorithm is employed within the computer MATLAB programme. The hybrid nanofluid flow shows conclusive improvement in the frictional coefficient and heat transport performance. However, the effectiveness the unsteadiness parameter deteriorates the heat transmission. In the contiguity of a suction parameter, multiple outcomes appear to arise for both stretched and shrinking instances. The coefficient of energy transport improves as the magnetic factor is augmented, however the skin coefficient of friction exhibits dual behavior for the second solutions. A time-dependence investigation is undertaken to figure out the reliability of the twin solutions, and it is discovered that merely one of them remains stable and aesthetically credible.

Awareness of healthcare providers on environment-friendly practices in operating rooms in selected hospitals in Riyadh, Saudi Arabia

Climate change will have a great impact on humanity in upcoming years and will affect the health of all living creatures. Hospitals play a significant role in climate change due to their substantial waste production and they are considered a profound pollution source, with the Operating Theater as a main contributor. This study was aimed to examine the level of knowledge among healthcare professionals in Saudi Arabia concerning the proper implementation of operating room (OR) environmental procedures and efficient management of hospital waste. This is a cross sectional study performed across 3 hospitals in Riyadh, Saudi Arabia. The hospitals included are Prince Sultan military hospital, National guard hospital and King Salman hospital. The study included all the staff and health workers in OR (operating room), excluding all staff and health workers not in OR. The study took place between September 1 and November 1, 2022. None of the study participants mentioned that their institute or hospital fully engaged in Greenhealth Greening the OR initiative. Almost 1 to 3rd of the study participants (38.1%) mentioned that endorsement and participation in the practice of Greenhealth Greening the OR initiative was not implemented at all, and 45% of the participants were completely unaware of such an initiative. The study's findings suggest that healthcare providers in Saudi Arabia are not fully aware of environmentally friendly practices. Further, the current initiatives undertaken by the hospital administration fall short in attaining environmentally sustainable benchmarks.

Salvageable Intra-stent Coil Embolization Treatment for Spinal Dural Arteriovenous Fistula in a Child

Spinal dural arteriovenous fistulae (SDAVF) are rare diseases that exhibit abnormal connections between arteries and veins. They are even rarer in the pediatric population and pose diagnostic and treatment challenges for physicians. Its presentation varies depending on the site and size of the SDAVF. Multiple management options are available, which are usually tailored depending on the patient's condition. Here, we present a rare case of SDAF in a four-year-old girl who initially presented with bilateral lower limb weakness. The patient was then treated successfully using primary major fistula point stenting and intra-stent coiling, with complete closure achieved. Full recovery was achieved over the course of follow-ups. The deep analysis of SDAVF, its classification, and the utilization of the best available endovascular tools by a dedicated neurovascular team offer the best outcome in dealing with complex spinal neurovascular pathologies.

Hybrid MWCNT and TiO2 Nanoparticle-Suspended Waste Tyre Oil Biodiesel for CI Engines

Nowadays, scarcity arises in almost all our basic needs, including water, fuel, and food. Recycling used and scrapped things for a valuable commodity is highly appreciable for compensating for the globally fast-growing demand. This paper aims to investigate waste tyre oil for preparing biodiesel for CI engines by enhancing their performance with hybrid nanoparticles for preparing nanofuel and hybrid nanofuel. The nanoparticles (30-40 nm) of MWCNT and TiO2 were utilized to prepare nanofuels with nanoparticle concentrations of MWCNT (300 ppm) and TiO2 (300 ppm), respectively. In the case of hybrid nanofuel, the nanoparticle concentration of MWCNT (150 ppm) and TiO2 (150 ppm) was preferred. The performance of the proposed nanofuel and hybrid nanofuel with pure diesel was evaluated. The proposed fuel performance outperforms the combustion performance, has higher engine efficiency, and has fewer emissions. The best performances were noticed in hybrid nanofuel that has 32% higher brake thermal efficiency than diesel and 24% and 4% lower BSFC and peak pressure than diesel, respectively. The emission performance is also 29%, 50%, and 13% lower in CO, HC, and CO2 emissions than that in pure diesel.

Pontine Infarction and Vertebral Artery Dissecting Aneurysm as the First Presentation of Behçet’s Disease: A Case Report

Behçet’s disease (BD) is a systemic disease of inflammatory origin that appears most often in the third or fourth decade of life. Behçet’s disease is hallmarked predominantly by mucocutaneous lesions and ocular involvement. Vertebral artery dissection and neurological manifestations are rare complications in Behçet’s disease. We examine the case of a medically free 33-year-old male who was admitted to the emergency department complaining of sudden-onset dizziness, vomiting, and tinnitus. Neurological examination revealed fluctuating consciousness, multiple gaze nystagmus, motor deficit in the upper and lower limbs, bilateral Babinski sign, and truncal ataxia. Magnetic resonance imaging (MRI) showed a right pontine hyperintense lesion on T2-weighted images (T2WI). A right vertebral angiogram four months after the incident showed a dissection in the mid-cervical third of an anomalous duplicated origin arm of the right vertebral artery. This case describes an uncommon form of initial presentation of Behçet’s disease via a pontine infarction triggered by a dissecting aneurysm in an anatomically rare variant of the vertebral artery.

Body Mass Index and its relation to patients with Acute Myocardial Infarction

Funding Acknowledgements

Type of funding sources: None.

Objective

Obesity is frequently encountered in patients with acute coronary syndrome, but whether it is the cause of a detrimental effect on Troponin after acute coronary syndrome remains an area of research. We investigated the effects of the body mass index (BMI) in post-myocardial infarction (MI) patients, and see the difference in troponin and other parameters between normal and over-weight patients.

Design

A retrospective cohort study.

Place

Ministry of National Guard health affair, Jeddah, Saudi Arabia

Duration of the study

One year from January 2019-January 2020

Methodology

Data were extracted from the electronic medical files of patients hospitalized due to acute ST-elevation MI to examine the association between BMI and MI. The patients (n=63) were categorized in BMI groups (kg/m2) using the baseline measurements, to assess the independent factors associated with a patient with a high BMI who had a MI.

Results

In total, 61 post-MI patients with a mean age of 56.9 ± 11.2 years were included in the study. The average BMI was 28.5 ± 6.5 kg/m2. Just more than a third (37.4%, n=23) were in the normal BMI category, 19 (31.2%) overweight, and 19 (31.2%) obese/morbid obesity. The left ventricle mass was 93.74 ± 32.69 gram and LVEF 44.02% ± 10.02. There was a significant difference in the mean level of troponin and mean heart rate between the BMI groups (normal vs. overweight groups). A fair correlation between BMI and LV mass was noted. No statistically significant relation could be linked to high body mass with total cholesterol, LDL, or AST/ALT.

Conclusions

In this pilot study, the group with a high BMI had a statistically significant lower troponin level and higher mean heart rate. Such data need to be considered when assessing a patient’s risk. In addition, obese persons with a MI had a higher LV mass

Endoscopic gastroplasty versus laparoscopic sleeve gastrectomy: a noninferiority propensity score-matched comparative study

BACKGROUND AND AIMS

Endoscopic bariatric therapies are less-invasive alternatives to bariatric surgery, and endoscopic gastroplasty (ESG) represents the latest evolution. This study aims to compare weight loss, safety, and comorbidity resolution of ESG compared with laparoscopic sleeve gastrectomy (LSG).

METHODS

This was a propensity score-matched study of patients who underwent ESG or LSG. Primary outcome was weight loss at 6, 12, 24, and 36 months. A noninferiority margin of 10% total weight loss (%TWL) was used. Secondary outcomes were safety and comorbidity resolution.

RESULTS

A 1:1 propensity score match yielded 3018 patient pairs. Average age and body mass index (BMI) were 34 ± 10 years and 33 ± 3 kg/m², respectively, and 89% were women. Mean percentage of excess weight loss at 1, 2, and 3 years after ESG was 77.1% ± 24.6%, 75.2% ± 47.9%, and 59.7% ± 57.1%, respectively. Mean percentage of excess weight loss at 1, 2, and 3 years after LSG was 95.1% ± 20.5%, 93.6% ± 31.3%, and 74.3% ± 35.2%, respectively. The mean difference in %TWL was 9.7% (95% confidence interval [CI], 6.9-11.8; P < .001), 6.0% (95% CI, -2.0 to 9.4; P < .001), and 4.8% (95% CI, -1.5 to 8.7; P < .001) at 1, 2, and 3 years, respectively. Noninferiority was demonstrated at all follow-up visits. Fourteen ESG patients developed adverse events (.5%) versus 10 LSG patients (.3%). Comorbidity remission rates after ESG versus LSG were 64% versus 82% for diabetes, 66% versus 64% for dyslipidemia, and 51% versus 46% for hypertension, respectively. Eighty ESG patients (2.7%) underwent revision to LSG for insufficient weight loss or weight regain, and 28 had resuturing after primary ESG (.9%).

CONCLUSIONS

ESG induces noninferior weight loss to LSG with similar comorbidity resolution and safety profiles.

A106 THE EPIDEMIOLOGY OF COMPLEX COLONIC POLYPS: A POPULATION BASED STUDY OF THE SOUTHWEST ONTARIO COLONOSCOPY COHORT

Background

Complex polyps are well recognized amongst endoscopists, but its definition varies in the literature and from one endoscopist to another. Despite its clinical importance, the epidemiology of complex polyps is poorly understood.

Aims

To assess the epidemiology of complex polyps on a population level, and in FIT positive individuals.

Methods

The Southwest Ontario Colonoscopy cohort is a prospective database consisting of all adult patients undergoing colonoscopy at 21 hospitals in Southwest Ontario. Data is collected through a mandatory quality assurance form completed by the endoscopist after each procedure. All outpatient adult colonoscopies for any indication were included. Incomplete colonoscopies, repeat procedures, and poor preparation colonoscopies were excluded. A manual review of the colonoscopy report was completed in cases where the description of the complex polyps was missing. The primary outcomes were the prevalence of complex polyps in the cohort, and in FIT positive patients. Secondary outcomes include endoscopic description of the complex polyp, rates of attempted and complete resection, and identification of possible associations between patient and endoscopist factors with complex polyp detection and removal. A multivariate logistic regression model was generated to assess for factors associated with complex polyp detection.

Results

From February 2019 to December 2020, 43389 colonoscopies were included, of which 1459 were for FIT positive patients. 2294 patients had a complex polyp, with a prevalence of 5.3% [95% CI 0.051–0.055], while the prevalence was 17.1% [95% CI 0.152–0.191] in the FIT positive cohort. Compared to average-risk patients undergoing colonoscopy for colon cancer screening, the odds ratio (OR) of detecting a complex polyp in individuals with positive FIT was 4.12 [95% CI 3.42–4.98, p<0.0001]. Among complex polyps,1324 (57.7%) were described as large (>2cm) and 1290 (56%) described as sessile. Of 2294 patients with complex polyps,1992 (86.8%) [95% CI 0.855–0.882] underwent a removal attempt, with successful complete removal as determined by the endoscopist achieved in 1905 patients (95.6%) [95% CI 0.947–0.965]. Compared to gastroenterologists, general surgeons and internists were less likely to detect a complex polyp, OR 0.67 [95% CI 0.61–0.73, p <0.0001] and 0.36 [95% CI 0.20–0.67, p=0.0011] respectively. Trainee involvement was associated with higher rate of complex polyp detection, OR 1.20 [95% CI 1.07–1.35, p=0.0022]. Females were less likely to have a complex polyp compared to males, OR 0.71 [95% CI 0.65–0.77, p<0.0001].

Conclusions

Complex polyps are more prevalent than previously reported in the literature, with a high prevalence among the FIT positive population compared to other indications of colonoscopy.

Funding Agencies

None

Distribution and Molecular Identification of Culex pipiens and Culex tritaeniorhynchus as Potential Vectors of Rift Valley Fever Virus in Jazan, Saudi Arabia

Entomologic investigations were conducted in the Al-Darb, Al-Reath, Al-Aridah, Abuareesh, Al-Ahad, Samttah, Sabyah, Damad and Beash areas by CO2-baited CDC miniature light traps in the Jazan region. Vectors were identified morphologically, as well as COI gene segment amplification and sequencing. The relative abundance (RA%) and pattern of occurrence (C%) were recorded. The presence of the Rift Valley fever virus (RVFV) in pooled mosquito samples was investigated by reverse transcriptase-polymerase chain reaction (RT-PCR). Culex pipiens (C. pipiens) and Culex tritaeniorhynchus (C. tritaeniorhynchus) were found with RA% values of 96% and 4%, respectively, in the region. Significant variations in vector population densities were observed in different districts. The C. pipiens was found highly abundant in all districts and RA% value (100%) was recorded in the Al-Darb, Al-Reath, Al-Aridah, Samttah and Damad areas, whereas RA% values (93.75%, 93.33%, 92.30% and 91.66%) were noted in Al-Ahad, Sabyah, Abuareesh and Beash districts, respectively. RA% values for C. tritaeniorhynchus were recorded as 8.33%, 7.70%, 6.66% and 6.25% in Beash, Abuareesh, Sabyah and Al-Ahad areas, respectively. The pattern of occurrence for C. pipiens and C. tritaeniorhynchus was recorded as 100% and 44.4% in the region. Phylogenetic analysis of C. pipiens and C. tritaeniorhynchus exhibited a close relationship with mosquitoes from Kenya and Turkey, respectively. All mosquito samples tested by RT-PCR were found negative for RVFV. In summary, the current study assessed the composition, abundance, distribution of different mosquito vectors and presence of RVFV in different areas of the Jazan region. Our data will help risk assessments of RVFV future re-emergence in the region.

Ten-Year Outcomes of Children and Adolescents Who Underwent Sleeve Gastrectomy: Weight Loss, Comorbidity Resolution, Adverse Events, and Growth Velocity

BACKGROUND

To date, there are insufficient data on long-term outcomes of weight loss surgery in children and adolescents with obesity beyond 5 years of follow-up. This study aimed to analyze durability of weight loss and comorbidity resolution, growth velocity, and adverse events associated with laparoscopic sleeve gastrectomy (LSG) in children and adolescents with severe obesity.

STUDY DESIGN

In this prospective cohort study, 2,504 children and adolescents with class II/III obesity who were enrolled in a multidisciplinary, family-based pediatric obesity management program underwent LSG between 2008 and 2021. Weight loss, growth, comorbidity resolution, and adverse event data during the first 10 years after LSG were analyzed.

RESULTS

The cohort age was 5 to 21 years at the time of operation, and 55% were female. Mean ± SD percentage of excess weight lost during short- (1 to 3 years; n = 2,051), medium- (4 to 6 years; n = 1,268), and long-term (7 to 10 years; n = 632) follow-up was 82.3% ± 20.5%, 76.3% ± 29.1%, and 71.1% ± 26.9%, respectively. Complete comorbidity remission at long-term follow-up was observed in 74%, 59%, and 64% of type 2 diabetes, dyslipidemia, and hypertension cases, respectively. Mean ± SD height z-score change at short-, medium-, and long-term follow-up was 0.1 ± 0.5, 0.1 ± 1.2, and 0.0 ± 0.8, respectively, representing no significant change in growth velocity. There were 27 adverse events (1%) with no procedure-related mortality.

CONCLUSIONS

Long-term follow-up after LSG in children and adolescents demonstrates durable weight loss, maintained comorbidity resolution, and unaltered growth.

Quercetin alleviates cadmium chloride-induced renal damage in rats by suppressing endoplasmic reticulum stress through SIRT1-dependent deacetylation of Xbp-1s and eIF2α

Endoplasmic reticulum (ER) stress plays a key role in cadmium chloride (CdCl2)-induced nephrotoxicity. Sirtuin-1 (SIRT1) is a potent inhibitor of ER stress. In this study, we examined whether the protective effect of quercetin (QUR) against CdCl₂-induced nephrotoxicity in rats involved modulation of SIRT1 and/or ER stress. Adult male rats were divided into five groups (n = 8, each) and treated for eight weeks as follows: control, control + QUR, CdCl₂, CdCl₂ + QUR, and CdCl₂ + QUR + EX-527 (a SIRT1 inhibitor). Treatment of rats with QUR preserved the glomerulus and tubule structure, attenuated interstitial fibrosis, increased creatinine excretion, and reduced urinary levels of albumin, N-acetyl-β-D-glucosaminidase, and β2-microglobulin in CdCl₂-treated rats. Concomitantly, QUR increased renal levels of Bcl-2, reduced mRNA levels of CHOP, and protein levels of Bax, caspase-3, and cleaved caspase-3, but failed to reduce the mRNA levels of GRP78, PERK, eIf2α, ATF-6, and xbp-1. QUR also reduced the renal levels of reactive oxygen species, tumour necrosis factor, and interleukin-6 and the nuclear activity of NF-κB in the control and CdCl₂-treated rats but increased the nuclear activity of Nrf2 and levels of glutathione and manganese superoxide dismutase. Additionally, QUR increased the total levels and nuclear activity of SIRT1 and reduced the acetylation of eIf2α and xbp-1. The nephroprotective effects of QUR were abrogated by treatment with EX-527. Thus, QUR ameliorated CdCl₂-induced nephrotoxicity through antioxidant and anti-inflammatory effects and suppressed ER stress mediated by the upregulation or activation of SIRT1-induced deacetylation of Nrf2, NF-κB p65, eIF2α, and xbp-1.

Ellagic acid improved diabetes mellitus-induced testicular damage and sperm abnormalities by activation of Nrf2

Diabetes mellitus induces testicular damage, increases sperm abnormalities, and impairs reproductive dysfunction due to induction of endocrine disturbance and testicular oxidative stress. This study evaluated the reproductive protective effect of ellagic acid (EA) against testicular damage and abnormalities in sperm parameters in Streptozotocin (STZ)-induced diabetic rats (T1DM) and examined some possible mechanisms of protection. Adult male rats were segregated into 5 groups (n = 12 rat/each) as control, control + EA (50 mg/kg/day), T1DM, T1DM + EA, and T1DM + EA + brusatol (an Nrf-2 inhibitor) (2 mg/twice/week). All treatments were conducted for 12 weeks, daily. EA preserved the structure of the seminiferous tubules, prevented the reduction in sperm count, motility, and viability, reduced sperm abnormalities, and downregulated testicular levels of cleaved caspase-3 and Bax in diabetic rats. In the control and diabetic rats, EA significantly increased the circulatory levels of testosterone, reduced serum levels of FSH and LH, and upregulated Bcl-2 and all steroidogenic genes (StAr, 3β-HSD1, and 11β-HSD1). Besides, it reduced levels of ROS and MDA but increased levels of GSH and MnSOD and the transactivation of Nrf2. All these biochemical alterations induced by EA were associated with increased activity and nuclear accumulation of Nrf2. However, all these effects afforded by EA were weakened in the presence of brusatol. In conclusion, EA could be an effective therapy to alleviated DM-induced reproductive toxicity and dysfunction in rats by a potent antioxidant potential mediated by the upregulation of Nrf2.

Melatonin Improves Memory Deficits in Rats with Cerebral Hypoperfusion, Possibly, Through Decreasing the Expression of Small-Conductance Ca2+-Activated K+ Channels

This study investigated the expression pattern, regulation of expression, and the role of hippocampal small-conductance Ca²⁺-activated K⁺ (SK) channels in memory deficits after cerebral hypoperfusion (CHP) with or without melatonin treatment, in rats. Adults male Wistar rats (n = 20/group) were divided into (1) a sham (2) a sham + melatonin (3) a two-vessel occlusion (2-VO) model, and (4) a 2-VO + melatonin. Melatonin was administered (i.p.) to all rats at a daily dose of 10 mg kg^-1 for 7 days starting at the time of 2-VO-induction. In contrast to 2-VO rats, melatonin increased the latency of the passive avoidance learning test and decreased time to find the hidden platform in Water Morris Test in all tested rats. In addition, it concomitantly downregulated SK1, SK2, and SK3 channels, downregulated mRNA levels of TNFα and IL-1β, enhanced BDNF levels and activity of PKA levels, and restored the levels of cholinergic markers in the hippocampi of the treated-rats. Mechanistically, melatonin significantly prevented CHP-induced activation of ERK1/2, JNK, and P38 MAPK at least by inhibiting ROS generation and enhancing the total antioxidant potential. In cultured hypoxic hippocampal neurons, individual blockage of MAPK signaling by the MEK1/2 inhibitor (U0126), but not by the P38 inhibitor (SB203580) or JNK inhibitor (SP600125), completely prevented the upregulation of all three kinds of SK channels. These data clearly confirm that upregulation of SK channels plays a role in CHP-induced memory loss and indicate that melatonin reverses memory deficits after CHP in rats, at least by, downregulation of SK1, SK2, and SK3 channels in their hippocampi.

Fas/FasL-mediated cell death in rat's diabetic hearts involves activation of calcineurin/NFAT4 and is potentiated by a high-fat diet rich in corn oil

This study investigated if calcineurin/nuclear factor of activated T cells (NFAT) axis mediates the cardiac apoptosis in rats with type 1 diabetes mellitus (T1DM)-induced rats or administered chronically high-fat diet rich in corn oil (CO-HFD). Also, it investigated the impact of chronic administration of CO-HFD on Fas/Fas ligand (Fas/FasL)-induced apoptosis in the hearts of T1DM-induced rats. Adult male Wistar rats (140-160 g) were classified as control: (10% fat) CO-HFD: (40% fat), T1DM, and T1DM + CO-HFD (n=20/each). In vitro, cardiomyocytes were cultured in either low glucose (LG) or high glucose (HG) media in the presence or absence of linoleic acid (LA) and other inhibitors. Compared to the control, increased reactive oxygen species (ROS), protein levels of cytochrome C, cleaved caspase-8 and caspase-3, myocardial damage and impeded left ventricular (LV) function were observed in the hearts of all treated groups and maximally in T1DM + CO-HFD-treated rats. mRNA of all NFAT members (NFAT1-4) were not affected by any treatment. CO-HFD or LA significantly up-regulated Fas levels in both LVs and cultured cardiomyocytes in a ROS dependent mechanism and independent of modulating intracellular Ca²⁺ levels or calcineurin activity. T1DM or hyperglycemia significant up-regulated mRNA and protein levels of Fas and FasL by activating Ca²⁺/calcineurin/NFAT-4 axis. Furthermore, Fas/FasL cell death induced by recombinant FasL (rFasL) or HG media was enhanced by pre-incubating the cells with LA. In conclusion, activation of the Ca²⁺/calcineurin/NFAT4 axis is indispensable for hyperglycemia-induced Fas/FasL cell death in the cardiomyocytes and CO-HFD sensitizes this by up-regulation of Fas.

Patent ductus arteriosus in premature infants: to treat or not to treat?

OBJECTIVE

Closing patent ductus arteriosus (PDA) is a widely accepted approach in the management of very low birth weight (VLBW) infants. Our objective is to test the hypothesis that conservative management (no treatment) of PDA will not affect survival without chronic lung diseases (CLD).

STUDY DESIGN

This retrospective study utilizes a prospectively collected database to compare two cohorts of VLBW infants. Infants in the first group (2001 to 2009) had their PDA treated with pharmacological and if necessary with surgical ligation. PDA in the second group (2010 to 2014) was not treated with medical or surgical intervention. The primary outcome was survival without oxygen requirement at 36 weeks. Pulmonary and non-pulmonary morbidities were also compared. Logistic regression analyses were performed to control for confounders.

RESULTS

This study included 643 VLBW infants, of them 415 infants in the Treat group and 228 in the No-Treat group. The rate of survival without CLD did not differ between Treat and No-Treat groups (78.4% vs 83.9%, respectively; adjusted odds ratio (aOR)=1.72, confidence interval (CI): 0.92 to 3.23, P=0.09). Mortality declined in No-Treat group (15.2% vs 10.5%, aOR=0.51, CI: 0.25 to 0.99, P=0.049), but the two groups did not differ in the incidence of CLD among survivors (5.8% vs 5.0%,=P0.47). Pulmonary complications and non-pulmonary morbidities did not differ between groups.

CONCLUSIONS

Conservative management (no treatment) of PDA may not compromise survival without CLD and is not associated with increased morbidities in VLBW infants. Prospective physiological studies are needed to determine the sector of VLBW infants, if any, who could benefit from PDA treatment.

Time to viral suppression is not related to achievement of SVR12 in HCV GT1-infected patients treated with ombitasvir/paritaprevir/ritonavir and dasabuvir with or without ribavirin

High rates of sustained virologic response at post-treatment week 12 (SVR12) were achieved in six phase 3 trials of ombitasvir (OBV, an NS5A inhibitor), paritaprevir (an NS3/4A protease inhibitor) co-dosed with ritonavir (PTV/r) + dasabuvir (DSV, an NS5B RNA polymerase inhibitor) (ie, 3D regimen) with or without ribavirin (RBV) in adults with chronic genotype (GT) 1 hepatitis C virus (HCV) infection. We assessed whether time to first HCV RNA value below the lower limit of quantification in patients with and without cirrhosis was associated with achievement of SVR12. Data were analysed from GT1-infected patients enrolled in six phase 3 studies of 3D ± RBV. Patients who experienced non-virologic failure were excluded from analysis. HCV RNA was determined using the Roche COBAS TaqMan RT-PCR assay (lower limit of quantification, LLOQ =25 IU/mL). SVR12 was analysed by week of first HCV RNA suppression, defined as HCV RNA <LLOQ. The analysis included a total of 2027 patients. Cumulative proportions of subjects with initial HCV RNA suppression <LLOQ at weeks 1, 2, 4 and 6 were 31%, 81%, 99% and 100%, respectively. SVR12 was achieved by 98%, 97%, 98% and 92% of patients with initial suppression at Weeks 1, 2, 4 and 6, respectively (P=.42, trend test). Across six phase 3 trials of 3D ± RBV, most patients achieved viral suppression by week 2. Time to viral suppression was not associated with subsequent achievement of SVR12, suggesting that on-treatment virologic monitoring may not be necessary with this regimen.

Silver nanoparticles exhibit size-dependent differential toxicity and induce expression of syncytin-1 in FA-AML1 and MOLT-4 leukaemia cell lines

Human endogenous retrovirus (HERV) sequences make up ~8% of the human genome and increased expression of some HERV proteins has been observed in various pathologies including leukaemia and multiple sclerosis. However, little is known about the function of these HERV proteins or environmental factors which regulate their expression. Silver nanoparticles (AgNPs) are used very extensively as antimicrobials and antivirals in numerous consumer products although their effect on the expression of HERV gene products is unknown. Cell proliferation and cell toxicity assays were carried out on human acute T lymphoblastic leukaemia (MOLT-4) and Fanconi anaemia associated acute myeloid leukaemia (FA-AML1) cells treated with two different sizes of AgNPs (7nm and 50nm diameter). Reverse-transcriptase polymerase chain reaction and western blotting were then used to the assess expression of HERV-W syncytin-1 mRNA and protein in these cells. FA-AML1 cells were more sensitive overall than MOLT-4 to treatment with the smaller 7nm sized AgNp's being the most toxic in these cells. MOLT-4 cell were more resistant and showed no evidence of differential toxicity to the different sized particles. Syncytin-1 mRNA and protein were induced by both 7 and 50nm AgNPs in both cell types yet with different kinetics. In summary, the observation that AgNPs induce expression of syncytin-1 in FA-AML1 and MOLT-4 cells at doses as little as 5 µg/ml is grounds for concern since this protein is up-regulated in both malignant and neurodegenerative diseases. Considering the widespread use of AgNPs in the environment it is clear that their ability to induce syncytin-1 should be investigated further in other cell types.

Transporters as Drug Targets in Neurological Diseases

Membrane transport proteins have central physiological function in maintaining cerebral homeostasis. These transporters are expressed in almost all cerebral cells in which they regulate the movement of a wide range of solutes, including endogenous substrates, xenobiotic, and therapeutic drugs. Altered activity/expression of central nervous system (CNS) transporters has been implicated in the onset and progression of multiple neurological diseases. Neurological diseases are heterogeneous diseases that involve complex pathological alterations with only a few treatment options; therefore, there is a great need for the development of novel therapeutic treatments. To that end, transporters have emerged recently to be promising therapeutic targets to halt or slow the course of neurological diseases. The objective of this review is to discuss implications of transporters in neurological diseases and summarize available evidence for targeting transporters as decent therapeutic approach in the treatment of neurological diseases.