Noninvasive programmed stimulation in the setting of ventricular tachycardia catheter ablation

In the setting of catheter ablation of ventricular tachycardia (VT), invasive programmed ventricular stimulation (PVS) is considered an important tool to assess the (residual) inducibility of ventricular arrhythmias and determine the acute success of the procedure. In patients with cardiovascular implantable electronic devices, noninvasive programmed stimulation via implantable cardioverter‐defibrillator (ICD) leads can be an alternative to the invasive PVS with intracardiac catheters. The advantages of noninvasive programmed stimulation include preprocedure planning of the electrophysiology procedure to ensure optimal conditions for successful catheter ablation of VT. Following the procedure, noninvasive programmed stimulation has been shown to be used as a guide for repeat early ablation, to offer better programming of ICD, to offer prognostic value regarding the VT recurrence, and to guide antiarrhythmic drug therapy. The noninvasive nature of noninvasive programmed stimulation makes it an attractive alternative to PVS in patients with ICD who have not undergone catheter ablation of VT to obtain prognostic value regarding the occurrence of VT.     

Uterine prolapse after pelvic trauma: case report and literature review

Up to date, the connection of pelvic trauma with genital prolapse is not widely recognized. These cases could be classified in a group where disruption of normal anatomy of the pelvis is apparent (i.e., pelvic fracture), and in a second group, where pelvis remains unaffected by the pelvic trauma (i.e., seat belt-related injuries). The aim of the report is to describe the management of a 39-year-old nulliparous patient presenting with stage III uterine prolapse after pelvic trauma; the patient had a history of Mitrofanoff’s procedure for neurogenic bladder followed by closure of the bladder neck and permanent suprapubic urinary catheter for intractable incontinence. The prolapse was managed with a mesh anterior colporraphy combined with sacrospinous hysteropexy. At 3 months follow-up, she is well with no prolapse recurrence.     

Gluteo-vaginal sinus formation complicating posterior intravaginal slingplasty followed by successful IVS removal. A case report and review of the literature

Posterior intravaginal slingplasty (IVS) is a technique used for the treatment of apical prolapse. Type III meshes have been mostly used with this technique. In this article, a case of bilateral gluteo-vaginal sinus tract formation that complicated a posterior vaginal slingplasty with a type III mesh is presented. At 3 months follow-up, the patient complained for bulking through the vagina, continuous offensive vaginal discharge, and constant pain at the buttocks. She had prolapse recurrence, and there was defective healing at the gluteal entry points of the posterior IVS. Ten months after the initial surgery, she underwent a laparotomic subtotal hysterectomy and sacrocervicopexy with prolene type I mesh. At the same time, the posterior mesh was removed allowing the surgeon to discover communication of the canal of the mesh extending from gluteal incisions to the vagina epithelium. The sinus tract was managed surgically with excision of the surrounding tissues. There was no recurrence or other complications at 2 months follow-up.     

Objective Response to First-Line Treatment as a Predictor of Overall Survival in Metastatic Breast Cancer: A Retrospective Analysis from Two Centers over a 25-Year Period

IntroductionThe purpose of this study was to study the efficacy of subsequent treatment lines for metastatic breast cancer (MBC), as well as the association between radiologic objective response rate (ORR) and overall survival (OS).MethodsIn this retrospective study, consecutive patients treated for MBC in two centers in Greece from January 1, 1992, to December 31, 2016, were identified and clinicopathologic data regarding tumor characteristics and administered treatments were collected. The efficacy per treatment line in terms of ORR, progression-free survival (PFS) and OS, as well as the prognostic value of ORR at first line were investigated.ResultsA total of 977 patients with MBC were identified; 950 received any treatment. At first line, ORR was 43.5%, PFS 11.4 months (95% CI 10.4–12.4), and median OS 52.4 months (95% CI 47.7–57.1). Lower ORR and shorter PFS were observed with each subsequent line. Median OS was significantly longer for patients that had an objective response at first line, 61.9 months (95% CI 51.1–69.7) for responders versus 41.3 months (95% CI 44.1–63.3) for nonresponders (p < 0.001). In multivariable analysis, failure to achieve an objective response was an independent predictor of poor survival (hazard ratio 1.70, 95% CI 1.34–2.15, p < 0.001).ConclusionLate treatment lines for MBC seem to have limited efficacy, while response to first-line therapy is associated with long-term survival. The latter should be considered in the treatment strategy of patients with MBC.     

Genetic variability on adiponectin gene affects myocardial infarction risk: The role of endothelial dysfunction

Background

Adiponectin is an adipokine with an important role in cardiovascular system conferring anti-inflammatory and anti-atherogenic effects. Two common single nucleotide polymorphisms (SNP) on adiponectin gene, rs2241766 and rs1501299, have been associated with insulin resistance and diabetes mellitus risk however their effects on cardiovascular risk remain unclear. We examined the impact of rs2241766 and rs1501299 on circulating adiponectin levels, endothelial function and cardiovascular disease risk.

Methods

We recruited in total 594 subjects; 462 patients with angiographically confirmed coronary artery disease (CAD) and 132 controls matched for age and gender. rs2241766 and rs1501299 were genotyped by polymerase chain reaction and restriction endonuclease digestion. Serum adiponectin levels were determined by enzyme-linked immunosorbent assay. Endothelial function was assessed by the flow mediated dilatation (FMD) of the brachial artery.

Results

rs2241766 had no effects on circulating adiponectin levels or FMD. In subjects without CAD, carriers of the T/T alleles at rs1501299 had lower adiponectin levels (p = 0.001) and impaired endothelial function (p < 0.05). After multivariate adjustment none of the SNPs had any effect on CAD risk. However, carriers of the T allele at rs1501299 were at increased myocardial infarction (MI) risk, independently of classic risk factors (OR = 2.558 [95%CI = 1.587–4.123], p = 0.0001). The number of T alleles in both SNPs was strongly associated with MI history (p = 0.0001).

Conclusions

rs1501299 polymorphism of adiponectin gene affects circulating adiponectin levels and endothelial function in subjects without CAD. Presence of the T variant at rs1501299 on adiponectin gene is independently associated with increased myocardial infarction risk.     

Use of angioplasty in the management of complicated perioperative infarction following bypass surgery

The optimal level of heparin anticoagulation for elective PTCA is unknown. To determine if PTCA complications are related to the level of anticoagulation, serial ACT values were prospectively measured in 189 patients undergoing 201 elective PTCA procedures. The mean heparin dose before balloon inflation (pre-inflation) was 10,100 units, and the mean dose per procedure was 13,200 units. The mean pre-inflation ACT was 295 sec, but was <300 sec in more than 50% of patients. Acute complications were not related to any ACT parameter and the development of new intracoronary thrombus was not observed. In elective PTCA procedures, the routine monitoring of ACT values is unnecessary when standard heparin doses are used. © 1993 Wiley-Liss, Inc.     

Identification of the factors responsible for the in vitro pro-oxidant and cytotoxic activities of the olive polyphenols oleuropein and hydroxytyrosol

The olive polyphenols oleuropein and hydroxytyrosol were reported recently to produce extracellular hydrogen peroxide (H₂O₂) under standard culture conditions. The precise factors responsible for this production and the conditions promoting or retarding it are critical for the interpretation of the in vitro results. In this study, a systematic evaluation of the components of the most commonly used culture media revealed that sodium bicarbonate is the defining cause for the production of H₂O₂ by these polyphenols. The produced H₂O₂ caused extensive oxidative DNA damage and significant decrease in cell viability of cancer (MDA-MB-231) and normal (MCF-10A, STO) cells alike. Sodium pyruvate and the antioxidant N-acetyl cysteine (NAC) totally reversed these effects. Therefore, we conclusively identified the culture conditions that promote H₂O₂ production by these polyphenols, producing artifacts that may be misinterpreted as a specific anticancer activity. Our findings raise considerable questions regarding the use of culture media with sodium bicarbonate or sodium pyruvate as components, for the in vitro study of these and possibly other plant polyphenols.     

Phase I study of continuous mitomycin-C infusion in concomitant radiochemotherapy of primary inoperable advanced head and neck cancer

Purpose: A phase I trial to evaluate the maximum tolerated dose (MTD) of continuous mitomycin-C infusion in radiochemotherapy of inoperable HNSCC. Methods: Twenty-one patients were treated with 70 Gy (2 Gy/day) and simultaneous chemotherapy (5-FU 600 mg/m2/day and MMC, both as continuous infusion on days 1–5 and 36–40. The MMC dose was dependent on dose escalation levels I–IV: 2/2.6/3.2/4 mg/m2/day. Results: Dose limiting toxicity (DLT) (grade 3 mucositis and/or dysphagia) occurred at dose level IV (MMC 4 mg/m2/day). Accordingly, dose escalation level III (MMC 3.2 mg/m2/day) was set as the MTD. One and 2-year survival rate: 66.7 and 29.5%, disease free survival: 47.6 and 22.8%, respectively. Conclusions: Our study demonstrates that continuous infusion of 5-FU/MMC can be safely administered at a MMC dose of 3.21 mg/m2/day on days 1–5 and 36–40 in concomitant radiochemotherapy. A phase II study should be initiated to establish the role of this regimen in the treatment of head and neck cancer.