Impact of concomitant use of proton pump inhibitors and clopidogrel or ticagrelor on clinical outcomes in patients with acute coronary syndrome

Background There is great debate on the possible adverse interaction between proton pump inhibitors (PPIs) and clopidogrel. In addition, whether the use of PPIs affects the clinical efficacy of ticagrelor remains less known. We aimed to determine the impact of concomitant administration of PPIs and clopidogrel or ticagrelor on clinical outcomes in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI). Methods We retrospectively analyzed data from a “real world”, international, multi-center registry between 2003 and 2014 (n = 15,401) and assessed the impact of concomitant administration of PPIs and clopidogrel or ticagrelor on 1-year composite primary endpoint (all-cause death, re-infarction, or severe bleeding) in patients with ACS after PCI. Results Of 9,429 patients in the final cohort, 54.8% (n = 5165) was prescribed a PPI at discharge. Patients receiving a PPI were older, more often female, and were more likely to have comorbidities. No association was observed between PPI use and the primary endpoint for patients receiving clopidogrel (adjusted HR: 1.036; 95% CI: 0.903–1.189) or ticagrelor (adjusted HR: 2.320; 95% CI: 0.875–6.151) (P_interaction = 0.2004). Similarly, use of a PPI was not associated with increased risk of all-cause death, re-infarction, or a decreased risk of severe bleeding for patients treated with either clopidogrel or ticagrelor. Conclusions In patients with ACS following PCI, concomitant use of PPIs was not associated with increased risk of adverse outcomes in patients receiving either clopidogrel or ticagrelor. Our findings indicate it is reasonable to use a PPI in combination with clopidogrel or ticagrelor, especially in patients with a higher risk of gastrointestinal bleeding.     

Chemical composition of polyphenols extracted from strawberry pomace and their effect on physiological properties of diets supplemented with different types of dietary fibre in rats

Purpose

The objective of this study was to establish the composition of polyphenolic preparations obtained from industrial strawberry pomace with two methods of extraction: the water and the water-alcoholic one and then to analyse their effects in the gastrointestinal tract depending on the composition of dietary fibre—cellulose or fructooligosaccharides (FOS).

Methods

Freeze-dried water extract (PTW), containing 5.1 % of ellagic acid, 0.2 % of proanthocyanidins, and soluble carbohydrates as a major part, and water–alcohol extract (PTE), containing 17.1 % of ellagic acid and 10.9 % of proanthocyanidins, were administered, in the equivalent quantity of 0.06 % of ellagic acid, to 4- to 8-week-old rats (8 animals per group), as a component of modified AIN-93 diets containing 5 % of cellulose or FOS.

Results

The addition of strawberry pomace extracts had no effect on either the diet intake or the body weight of experimental rats. Both extracts, similarly to FOS, beneficially reduced the activity of β-glucuronidase in caecal digesta, with the PTW effect being significantly higher than that of PTE (7.59 vs. 9.20 μmol/h/g, P = 0.001). In comparison with PTE, the PTW extract significantly increased the caecal digesta mass (1.45 vs. 1.27 k/kg BW) and the total production of SCFA (86.1 vs. 71.4 μmol/100 g BW). The extract enhanced the physiological effect of FOS by inhibiting the activity of β-glucuronidase, increasing the caecal digesta mass and SCFA production. Such an effect was not recorded in the case of the PTE preparation.

Conclusions

The addition of strawberry pomace extracts affected the activity of certain enzymes of intestinal microflora and its most important products.     

Endoscopic lateral orbitotomy

Background

Lateral orbitotomy can be minimalized using contemporary endoscopy.

Methods

Anatomy of the temporal fossa/orbital wall junction is described. The attachment of the temporal fascia is cut off from the orbital rim through a 1.5 cm skin incision in the lateral orbital wrinkle. The temporal muscle is detached from the bone to create a space for the telescope. An appropriate bone opening in the lateral orbital wall is created with the aid of neuronavigation to handle intraorbital pathology.

Conclusion

Endoscopic lateral orbitotomy is an original alternative to the microsurgical Krönlein approach and yields good functional and cosmetic results.     

Immunohistochemical Characteristics and Distribution of Neurons in the Paravertebral,Prevertebral and Pelvic Ganglia Supplying the Urinary Bladder in the Male Pig

The distribution and chemical coding of neurons supplying urinary bladder in the male pig were studied in the sympathetic chain ganglia, inferior mesenteric ganglia and anterior pelvic ganglia. The combined retrograde tracing and immunohistochemistry for tyrosine hydroxylase (TH), dopamine beta-hydroxylase (DBH), neuropeptide Y (NPY), somatostatin (SOM), galanin (GAL), vasoactive intestinal polypeptide (VIP), nitric oxide synthase (NOS), calcitonin gene-related peptide (CGRP), substance P (SP), choline acetyltransferase (ChAT) and vesicular acetylcholine transporter (VAChT) were applied in the experiment. Bladder-projecting neurons were found in all the ganglia studied. The majority of sympathetic ganglia neurons (inferior mesenteric ganglia and sympathetic chain ganglia) expressed immunoreactivity (IR) to DBH. In sympathetic chain ganglia these neurons simultaneously expressed NPY, GAL or VAChT, while in inferior mesenteric ganglia they contained NPY, SOM and/or GAL. A small number of these bladder-projecting neurons was VAChT-IR and some contained NPY. In the pelvic ganglia bladder-projecting neurons formed two populations: DBH- and VAChT-IR. Some of DBH-IR neurons contained IR to NPY, SOM or GAL, while VAChT-IR neurons were NPY-, SOM- or NOS-IR. The results indicate that sympathetic ganglia contain mainly adrenergic neurons, while pelvic ganglia contain both adrenergic and cholinergic neurons. All these neurons contain typical combinations of neuropeptides.     

Comparison of CO2 Separation Efficiency from Flue Gases Based on Commonly Used Methods and Materials

The comparison study of CO₂ removal efficiency from flue gases at low pressures and temperatures is presented, based on commonly used methods and materials. Our own experimental results were compared and analyzed for different methods of CO₂ removal from flue gases: absorption in a packed column, adsorption in a packed column and membrane separation on polymeric and ceramic membranes, as well as on the developed supported ionic liquid membranes (SILMs). The efficiency and competitiveness comparison of the investigated methods showed that SILMs obtained by coating of the polydimethylsiloxane (PDMS) membrane with 1-ethyl-3-methylimidazolium acetate ([Emim][Ac]) exhibit a high ideal CO₂/N₂ selectivity of 152, permeability of 2400 barrer and long term stability. Inexpensive and selective SILMs were prepared applying commercial membranes. Under similar experimental conditions, the absorption in aqueous Monoethanolamine (MEA) solutions is much faster than in ionic liquids (ILs), but gas and liquid flow rates in packed column sprayed with IL are limited due to the much higher viscosity and lower diffusion coefficient of IL. For CO₂ adsorption on activated carbons impregnated with amine or IL, only a small improvement in the adsorption properties was achieved. The experimental research was compared with the literature data to find a feasible solution based on commercially available methods and materials.     

Durian (Durio zibethinus Murr.) cultivars as nutritional supplementation to rat's diets.

The properties of Mon Thong, Chani and Kan Yao durian (Durio zibethinus Murr.) cultivars were compared in vitro and in vivo studies in order to find the best one as a supplement to antiatherosclerotic diet. Total polyphenols (361.4+/-35.3 mgGAE/100g FW), flavonoids (93.9+/-8.9 mgCE/100g FW) and total antioxidant capacity determined by DPPH and beta-carotene-linoleic acid assays (261.3+/-25.3 microMTE/100g FW and 77.8+/-7.8% of inhibition) were maximal in Mon Thong in comparison with Chani and Kan Yao and showed a good correlation between these three variables (R(2)=0.9859). Five groups of rats were fed diets supplemented with cholesterol and different durian cultivars. Diets supplemented with Mon Thong and to a lesser degree with Chani and Kan Yao significantly hindered the rise in the plasma lipids (TC - 8.7%, 16.1% and 10.3% and (b) LDL-C - 20.1%, 31.3% and 23.5% for the Chol/Kan Yao, Chol/Mon Thong and Chol/Chani, respectively) and the decrease in plasma antioxidant activity (P<0.05). Nitrogen retention remained significantly higher in Chol/Mon Thong than in other diet groups. Diet supplemented with Mon Thong affected the composition of plasma fibrinogen in rats and showed more intensity in protein bands around 47 kDa. No lesions were found in the examined tissue of heart and brains. Mon Thong cultivar is preferable for the supplementation of the diet as positively influenced the lipid, antioxidant, protein and metabolic status. The durian fruit till now was not investigated extensively, therefore based on the results of this study durian cultivars can be used as a relatively new source of antioxidants.     

Traumatic injuries to the oculomotor nerve

PURPOSE OF THE STUDY: A collective summary of the pathogenesis, character and clinical significance of damage to the oculomuscular innervation, arising from closed head trauma, based on our own clinical observations, together with a review of literature on the topic. MATERIALS AND METHODS: The clinical and pathophysiological evaluation of injuries to the oculomotor (III) nerve based on a prospective study in our clinic, dating from 1994 onwards: the clinical material consisted of 600 patients admitted to our Department of Neurosurgery following head trauma, the subgroup consisted of 38 patients, who died following major head trauma. RESULTS: Few authors focus on damage to the innervation of oculomotor muscles, the diagnosis of damage being difficult due to the usually poor clinical condition of such patients, the interdisciplinary nature of the resulting damage, and their delayed ophthalmological evaluation. The oculomotor (III) nerve is the nerve most frequently damaged amongst the cranial nerves, taking into account the innervation of the ocular system nerves (II-VII). Of clinical importance is differentiating between the mechanism of damage, paying particular attention to intracranial damage. The mechanisms of damage can be distinguished by: 1) partial tearing of the parasympathetic fibres contused against the petroclinoid ligament, 2) total tearing of the parasympathetic nerve root, 3) complete tear of one or both oculomotor nerves at the interpeduncular base, 4) nerve root tear, resulting from vessel perforation. The oculomotor nerve has the ability to regenerate. The regenerative process should occur within 3 to 5 months, that is without pathological synkinesis. If this process prolongs, this may lead to unpleasant consequences, such as the "misdirection phenomenon". CONCLUSIONS: Primary damage to the oculomuscular innervation resulting from closed head trauma is an integral component of such conditions. Early diagnosis and neuroprotective therapy may prevent pathological regeneration.     

Obstetrical hysterectomy

OBJECTIVE: Obstetrical hysterectomy still remains life saving operation. The aim of study was to determinate the frequency, indications and complications after the operation in the hospital in Zielona Góra, Poland. MATERIALS AND METHODS: A retrospective review based on hospital data of 36 patients undergoing obstetrical hysterectomy over the period of 11 years was undertaken. RESULTS: The incidence of obstetrical hysterectomy during 1990-2001 et the Department of Obstetrics and Gynaecology in the district hospital in Zielona Góra was 1: 593 deliveries. Post partum hysterectomy occurred in 0.021% of normal deliveries and 1.03% of cesarean sections. The most common indications were placenta increta and placenta accreta /61.1%/, followed by uterine atony /13.8%/ and rupture of the uterus /11.1%. The most frequent complications were shock and lesion of the urinary bladder/both 5.6%/. The maternal mortality was 2.8%. CONCLUSIONS: 1. The most common indications for the obstetrical hysterectomy are: placenta's pathologies; uterine atony and rupture of the uterus. 2. Obstetrical hysterectomy is connected with high risk of complications and maternal mortality.