Treatment and outcomes of acute coronary syndrome in the cancer population

Background:

Randomized trials have established the benefit of medical therapy and revascularization in the treatment of acute myocardial infarction (MI). Cancer and cardiovascular disease are the 2 most common diseases worldwide. In clinical practice, cancer patients are frequently afflicted with MI. The benefit of medical and/or revascularization therapy in the cancer population with MI is less well known.

Hypothesis:

Medical and revascularization therapy reduces mortality in cancer patients with MI.

Methods:

After approval by the institutional review board, we retrospectively reviewed all patients with a discharge diagnosis of acute MI who were admitted to the University of Texas MD Anderson Cancer Center between December 2000 and October 2006 and evaluated the association between cardiac treatments with survival outcomes.

Results:

A total of 456 patients with a discharge diagnosis of acute MI were identified and included in the study, of which 386 had non–ST‐segment elevation MI (NSTEMI) and 70 had ST‐segment elevation MI (STEMI). Compared with patients with NSTEMI, patients who had STEMI were more often prescribed aspirin (66% vs 43%; P = 0.004), β‐blockers (61% vs 46%; P = 0.018), and thrombolytic therapy (9% vs 0.3%; P = 0.0001). In the multivariable analysis, aspirin use was associated with a 23% decreased risk of death (hazard ratio [HR]: 0.77, 95% confidence interval [CI]: 0.60‐0.98, P = 0.033) and β‐blocker use was associated with a 36% decreased risk of death (HR: 0.64, 95% CI: 0.51–0.81, P = 0.0002). Statins (HR: 0.82, P = 0.18) and catheter‐based revascularization (HR: 0.57, P = 0.09) did not have an impact on the risk of death. Compared with patients with limited cancer, advanced cancer patients were twice as likely to die (HR: 2.12, 95 CI: 1.47–3.04, P < 0.0001). Previous chemotherapy (P = 0.005) and chest radiotherapy (P = 0.017) were associated with increased 1‐year mortality, whereas hyperlipidemia (P = 0.018) was protective.

Conclusions:

In this study of cancer patients with MI, medical therapy with aspirin and β‐blockers was associated with improved survival. The authors have no funding, financial relationships, or conflicts of interest to disclose.     

Comparative Analysis of Static and Viscoelastic Mechanical Behavior of Different Luting Material Categories after Aging

The longevity of indirect restorations is primarily determined by the appropriate selection of the luting material. The function of a luting material is to seal the restoration and hold it in place for the time required for service. The mechanical behavior of luting materials and in particular their aging behavior, therefore, play a decisive role. The study provides a comparative analysis of the static and dynamic mechanical behavior of the most commonly used luting material categories—zinc phosphate cement, glass–ionomer cement, resin-modified glass–ionomer cement, resin-based composites, and self-adhesive resin-based composites—and their aging behavior. It also takes into account that luting materials are viscoelastic materials, i.e., materials that respond to external loading in a way that lies between an elastic solid and a viscous liquid. Flexural strength and modulus were determined in a three-point bending test followed by fractography analysis. The quasi-static and viscoelastic behavior was analyzed by a depth-sensing indentation test provided with a dynamic mechanical analysis (DMA) module at 20 different frequencies (1–50 Hz). The fracture toughness was evaluated in a notchless triangular prism (NTP) test. Material type exhibits the strongest influence on all measured properties, while the effect of aging becomes more evident in the material reliability. The variation of the viscoelastic parameters with aging reflects cement maturation or polymer plasticization.     

Anticoagulation in heart failure without atrial fibrillation: gaps and dilemmas in current clinical practice

Data from observational and post‐hoc analyses suggest that heart failure (HF) itself may be associated with higher risk of thromboembolic events compared to populations without HF. Although oral anticoagulants (OACs) might be a therapeutic option in individual cases, anticoagulation therapy in HF patients in sinus rhythm is not generally recommended, as the implementation of OACs in clinical practice in this HF population is not supported by large randomized clinical trials to date. Indeed, the available data suggest that the risk of major bleeding overshadows the potential anti‐thromboembolic benefit of OACs in HF patients in sinus rhythm with no net beneficial effect on mortality rates. In this review we explore the current available evidence for the clinical outcomes of anticoagulation therapy in patients with HF in sinus rhythm, highlighting the current gaps in knowledge, which may guide the design of future randomized clinical trials focusing on the efficacy and safety of anticoagulant therapy in this HF population.     

Electroanatomic remodeling of the left atrium in patients undergoing repeat pulmonary vein ablation: mechanistic insights and implications for ablation

Introduction: There is limited information describing late changes in the electroanatomic characteristics of the left atrium (LA) associated with recurrence after an anatomical circumferential pulmonary vein ablation (CPVA) for atrial fibrillation (AF).
Methods and Results: Forty-seven patients (57 ± 8 years) undergoing a repeat ablation after CPVA were included. Using an electroanatomic mapping system, we measured the bipolar voltage by averaging points in the pulmonary vein (PV)-LA junction and four other LA sites. Conduction velocity and AF cycle length (AFCL) were also measured and the results are compared with the first procedure. After an initial decrease observed at the end of the first procedure, voltage and conduction velocity returned to intermediate values in all LA sites, with lower voltage at the LIPV antrum (P = 0.004), and lower conduction velocity across the LIPV and RSPV (P < 0.001). Conduction gaps were more prevalent at the septal aspect of the right PV encircling lines (85%), between the left atrial appendage (LAA) and the LSPV (70%) and lines at the posterior wall (71%). There was a nonsignificant increase in AFCL, with a more widespread distribution of organized electrograms (32.4% vs 46.6%).
Conclusion: Recurrence after CPVA is associated with a reverse process of voltage and conduction velocity increase across ablated areas, especially the PV-LA junction, and is related to the presence of conduction gaps, which are distributed mostly at the septal aspect of the lines encircling the right PVs and at the LAA-LSPV area. Organization of atrial electrograms seen during AF ablation is maintained at a repeat procedure.     

Aging and selective sensorimotor strategies in the regulation of upright balance

Background  

The maintenance of upright equilibrium is essentially a sensorimotor integration task. The central nervous system (CNS) has to generate appropriate and complex motor responses based on the selective and rapid integration of sensory information from multiple sources. Since each sensory system has its own coordinate framework, specific time delay and reliability, sensory conflicts may arise and represent situations in which the CNS has to recalibrate the weight attributed to each particular sensory input. The resolution of sensory conflicts may represent a particular challenge for older adults given the age-related decline in the integrity of many postural regulating systems, including musculoskeletal and sensory systems, as well as neural processing and conduction of information. The effects of aging and adaptation (by repeated exposures) on the capability of the CNS to select pertinent sensory information and resolve sensory conflicts were thus investigated with virtual reality (VR) in the present study.     

Sport fields as potential catalysts for physical activity in the neighbourhood

Physical activity is associated with access to recreational facilities such as sports fields. Because it is not clear whether objectively- or subjectively-assessed access to facilities exerts a stronger influence on physical activity, we investigated the association between the objective and perceived accessibility of sport fields and the levels of self-reported physical activity among adults in Edmonton, Canada. A sample of 2879 respondents was surveyed regarding their socio-demographics, health status, self-efficacy, levels of physical activity, as well as their perceptions of built environment in relation to physical activity. Neighbourhood-level data were obtained for each respondent based on their residence. Accessibility to facilities was assessed using the enhanced Two-Step Floating Catchment Area method. Geographic Information Systems were employed. A logistic regression was performed to predict physical activity using individual- and neighbourhood-level variables. Women, older individuals, and individuals with higher educational attainment were less likely to be physically active. Also, individuals with higher self-efficacy and higher objectively-assessed access to facilities were more likely to be physically active. Interventions that integrate provision of relevant programs for various population groups and of improved recreational facilities may contribute to sport fields becoming catalysts for physical activity by generating movement both on the site and in the neighbourhood.     

Co-Microencapsulation of Anthocyanins from Cornelian Cherry (Cornus mas L.) Fruits and Lactic Acid Bacteria into Antioxidant and Anti-Proliferative Derivative Powders

Driven by the modern lifestyle, the consumers are interested in healthier and balanced diets, including both probiotics and natural antioxidants. The beneficial health effects of probiotics are mainly due to their capacity of modulating the human intestinal microbiota, although achieving at least a 6 log of viable cells at the targeted site is still challenging. Therefore, in this study, an attempt to improve the bioaccessibility of Lacticaseibacillus casei (L. casei) 431^® through a co-microencapsulation by complex coacervation and freeze-drying, using an extract from Cornelian cherry and two biopolymeric matrices, whey protein isolates and casein (WPI-CN) and inulin (WPI-I), was studied. The powders showed a comparable anthocyanin content of around 32.00 mg cyanidin-3-rutinoside (C3R)/g dry matter (DM) and a microbial load of about 10 Log CFU/g DM. A high stability of the lactic acid bacteria was assessed throughout 90 days of storage, whereas the anthocyanins’ degradation during storage followed a first order kinetic model, allowing the estimation of a half-time of 66.88 ± 1.67 days for WPI-CN and 83.60 ± 2.46 days for WPI-I. The in vitro digestion showed a high stability of anthocyanins in the simulated gastric juice, whereas the release in the simulated intestinal juice was favored in the variant with inulin (up to 38%). The use of casein permitted to obtain finer spherosomes, with smaller diameters, whereas a double encapsulation was obvious in both variants, thus explaining the high resistance in the gastric environment. The anti-proliferative effect against the human colon cancer cell line (HT-29) was also demonstrated. No cytotoxicity has been found for the concentrations between 1 and 25 μg/mL for the WPI-I variant, whereas a cell proliferation effect was observed at low concentrations of 1–5 μg/mL.     

Effect of the Preparation Conditions on the Catalytic Properties of CoPt for Highly Efficient 4-Nitrophenol Reduction

CoPt alloys with Pt contents from 15 to 90% were prepared using low-cost electrochemical deposition. Different samples were synthesized from electrochemical baths at pH = 2.5 and 5.5 in a solution with and without saccharin as an additive. The morphology, composition and crystalline structure of the as-prepared samples were investigated by High Resolution—Scanning Electron Microscopy (HR-SEM), Atomic Force Microscopy (AFM), Ultra-high Resolution—Transmission Electron Microscopy (UHR-TEM), Energy-Dispersive X-ray Spectroscopy (EDX), and X-ray Diffraction (XRD). XRD investigations revealed that fcc crystalline structure transforms into hcp crystalline structure when the pH of the electrochemical bath is increased from 2.5 to 5.5 as well as when saccharin is added to the electrochemical bath. The catalytic performance of the CoPt alloys for the nitro to amino phenol compounds conversion was investigated for all the prepared samples, and the results show that the conversion degree increases (from 11.4 to 96.5%) even though the Pt content in the samples decreases. From the samples prepared from the electrochemical bath with saccharin, a study regarding the effect of contact time was performed. The results indicated that after only 5 min, the CoPt sample prepared at pH = 5.5 in the presence of saccharin completely converted the nitro compound to an amino compound.