Impact of Different Measures of Body Size on the Radiation Dose During Coronary Angiography and Percutaneous Coronary Intervention: Results from a Large Single Center Cohort.

Efforts to reduce and optimize the radiation exposure during coronary angiography and intervention have pointed at patients' body size as a major determinant of irradiation for the patients and operators. We aimed at comparing body weight and body mass index (BMI) among consecutive patients undergoing angiographic procedures (coronary angiography and/or interventions) in a single center. Patients were divided in normal weight (NW, BMI <25 Kg/m2) and overweight (OW, BMI ≥25 Kg/m2). Patients' dose exposure was evaluated as dose area product (DAP), time of exposure (fluoroscopy duration), and relative DAP (DAP/minutes of exposure). We included 748 patients, 61.6% undergoing percutaneous coronary interventions and 56.8% classified as OW. OW patients were more often men (P < .001), with history of hypertension (P < .001) and diabetes (P = .001). Mean DAP and relative DAP were significantly higher among OW compared with NW patients (P < .001). DAP and relative DAP were directly related with body weight (both r = .22, P < .001); a similar linear association was also described for BMI (r = .18, P < .001 and r = .19, P < .001, respectively). At multivariate analysis, however, body weight, but not BMI, independently predicted the DAP. Therefore, body weight should be considered as the preferred indicator of body size in the setting and optimization of radiation exposure during coronary diagnostic and intervention procedures.

The FAST-STEMI Network in Biella From 2013 to 2019: Impact of the Delocalization of the Hospital Facilities on Ischemia Time and In-hospital Outcomes.

BACKGROUND: The optimization of the strategies for myocardial revascularization has improved the outcomes of patients with ST-segment elevation myocardial infarction. In Piedmont, the FAST-STEMI regional network was created for improving the management and transportation of ST-segment elevation (STEMI) patients to primary percutaneous coronary intervention facilities, reducing the time to reperfusion. Within this network, the Hospital of Biella was delocalized in December 2014 to a new suburban structure designed for an easier access, which might have shortened the duration of patients' transportation and ischemia, with potential positive prognostic effects. The aim of the present study was to define the impact of the decentralization of the hospital structure on the time to reperfusion and in-hospital outcomes among STEMI patients admitted to the Hospital of Biella. METHODS: We included STEMI patients admitted to our urban hospital between 2013 and 2019 and included in the FAST-STEMI database. The primary endpoint was the duration of ischemia, defined as pain to balloon (PTB). The primary outcome endpoint (PE) was in-hospital mortality. RESULTS: We included 276 consecutive patients with STEMI undergoing primary percutaneous coronary intervention between 2016 and 2019 in the new hospital facility, which were compared with 170 patients treated between 2013 and June 2014 in the prior structure. Patients' characteristics included a mean age of 67.5 ± 12.5 years, 72.1% males and 18.7% patients with diabetes. In the new facility, the median PTB was 188 minutes [interquartile range: 125-340 min], reduced as compared with the period 2013-2014 [215 (128.5-352 min), P = 0.002]. The median in-hospital stay was also shorter (P = 0.004), whereas a nonsignificant improvement was noted for ejection fraction (EF) at discharge (P = 0.14). A linear relationship was demonstrated between PTB and the EF (r = -0.183, P = 0.003) in patients treated between 2016 and 2019 while not affecting the length of hospitalization or in-hospital outcomes. In fact, in-hospital death occurred in 36 patients, 8% in the new structure versus 7.7% in 2013-2014 [hazard ratio (HR) (95% confidence interval [CI]) = 1.20 (0.59-2.42), P = 0.62]. The independent predictors of mortality were patients' age and EF at discharge (age ≥ 75 y: adjusted HR [95% CI] = 6.75 [1.51-30.1], P = 0.01; EF: adjusted HR [95% CI] = 0.91 [0.88-0.95], P < 0.001). CONCLUSIONS: The present study shows that, among the STEMI patients treated in our center, the delocalization of the hospital facilities and the optimization of the FAST-STEMI network reduced the duration of ischemia, with positive effects on left ventricular function at discharge. However, this did not translate into a significant benefit in survival, which was instead conditioned by the aging of the population.

Mechanistic insight into protonolysis and cis-trans isomerization of benzylplatinum(II) complexes assisted by weak ligand-to-metal interactions. A combined kinetic and DFT study.

Low-temperature NMR measurements showed that protonolysis and deuterolysis by H(D)X acids on meta- and para-substituted dibenzylplatinum(II) complexes cis-[Pt(CH(2)Ar)(2)(PEt(3))(2)] (Ar = C(6)H(4)Y(-); Y = 4-Me, 1a; 3-Me, 1b; H, 1c; 4-F, 1d; 3-F, 1e; 4-Cl, 1f; 3-Cl, 1g; 3-CF(3), 1h) in CD(3)OD leads directly to the formation of trans-[Pt(CH(2)Ar)(PEt(3))(2)(CD(3)OD)]X (4a-4h) and toluene derivatives. The reaction obeys the rate law k(obsd) = k(H)[H(+)]. For CH(2)Ar = CH(2)C(6)H(5)(-), k(H) = 176 ± 3 M(-1) s(-1) and k(D) = 185 ± 5 M(-1) s(-1) at 298.2 K, ΔH(double dagger) = 46 ± 1 kJ mol(-1) and ΔS(double dagger) = -47 ± 1 J K(-1) mol(-1). In contrast, in acetonitrile-d(3), three subsequent stages can be distinguished, at different temperature ranges: (i) instantaneous formation of new benzylhydridoplatinum(IV) complexes cis-[Pt(CH(2)Ar)(2)(H)(CD(3)CN)(PEt(3))(2)]X (2a-2h, at 230 K), (ii) reductive elimination of 2a-2h to yield cis-[Pt(CH(2)Ar)(CD(3)CN)(PEt(3))(2)]X (3a-3h) and toluene derivatives (in the range 230-255 K), and finally (iii) spontaneous isomerization of the cis cationic solvento species to the corresponding trans isomers (4a-4h, in the range 260-280 K). All compounds were detected and fully characterized through their (1)H and (31)P{(1)H} NMR spectra. Kinetics monitored by (1)H and (31)P{(1)H} NMR and isotopic scrambling experiments on cis-[Pt(CH(2)Ar)(2)(H)(CD(3)CN)(PEt(3))(2)]X gave some insight onto the mechanism of reductive elimination of 2a-2h. Systematic kinetics of isomerization of 3a-3h were followed in the temperature range 285-320 K by stopped-flow techniques. The process goes, as expected, through the relatively slow dissociative loss of the weakly bonded solvent molecule and interconversion of two geometrically distinct T-shaped three-coordinate intermediates. The dissociation energy depends upon the solvent-coordinating ability. DFT optimization reveals that along the energy profile the "cis-like" [Pt(CH(2)Ar)(PMe(3))(2)](+) intermediate is strongly stabilized by a Pt···Î·(2)-C1-C(ipso) bond between the unsaturated metal and benzyl carbons. The value of the ensuing stabilization energy was estimated by computational data to be greater than that found for similar ß-agostic Pt···Î·(2)-CH interactions with alkyl groups containing ß-hydrogens. An observed consequence of the strong stabilization of "cis"-[Pt(η(2)-CH(2)Ar)(PMe(3))(2)](+) is the remarkable acceleration of the rate of isomerization, greater than that produced by the so-called "ß-hydrogen kinetic effect". Kinetic and DFT data concur to indicate that electron donation by substituents on the benzyl ring leads to further stabilization of the "cis"-[Pt(η(2)-CH(2)Ar)(PMe(3))(2)](+) cationic species.

Pro-inflammatory cytokine genes influence the clinical features of frontotemporal lobar degeneration.

BACKGROUND/AIMS: Recent studies suggested a role for pro-inflammatory mediators in frontotemporal lobar degeneration (FTLD). The objective of this study was to evaluate the association of functionally active polymorphisms in pro-inflammatory cytokine genes with the occurrence and the clinical features of the disease. METHODS: Using a case-control study, we compared allelic and genotypic frequencies of several polymorphisms in the interleukin (IL)-1alpha, interleukin (IL)-1beta, interleukin (IL)-6 and tumor necrosis factor (TNF)-alpha genes between 110 FTLD patients and 119 healthy controls. RESULTS: No significant association between the examined polymorphisms and the disease was found. However, in comparison with remaining genotypes, patients carrying the T/T genotype of the IL-1beta gene showed a significantly lower age at onset of the disease. In addition, scores of the Frontal Assessment Battery were significantly modified by the IL-6 -174G>C polymorphism. CONCLUSION: Our findings support a role for pro-inflammatory cytokine genes in the pathogenesis of frontotemporal lobar degeneration.

Synchronized fluxional motion and cyclometalation of ligands in platinum(II) complexes.

Oscillation of the 2,9-dimethyl-1,10-phenanthroline (dmphen) ligand between nonequivalent exchanging sites in [Pt(Me)(dmphen)(P(o-tolyl)3)]+ and phosphane rotation around the Pt-P bond take place at the same rate. Thus, this cationic complex behaves as a molecular gear, exhibiting a fascinating synchronism between two otherwise independent fluxional motions. The process (DeltaG(3330)(#) = 68.5 +/- 0.2 kJ mol(-1)) was found to be unaffected by (i) the nature of various counteranions (X = PF6- 1, SbF6- 2, CF3SO3- 3, BF4- 4, BArf- 5), (ii) the polarity or the electron-donor properties of the solvent and, (iii) the addition of weak nucleophiles. Restricted phosphane rotation around the Pt-P bond impedes free dmphen oscillation in a 14-electron three-coordinate T-shaped intermediate, containing eta1-coordinated dmphen, generated by easy Pt-N bond dissociation from [Pt(Me)(dmphen)(P(o-tolyl)3)]+. 1-5 undergo easy orthoplatination, leading to new [Pt(dmphen){CH2C6H4P(o-tolyl)2-kappaC,P}]X cyclometalated Pt(II) compounds (X = PF6- 1, SbF6- 2, CF3SO3- 3, BF4- 4, BArf- 5). The kinetics of the cyclometalation of 3 and 4 were followed in tetrachloroethane by both 1H NMR and spectrophotometric techniques (kobs = 1.7 x 10-4 s(-1) at 333 K, DeltaH = 59.3 +/- 3 kJ mol(-1), and DeltaS = -141 +/- 8 J K(-1) mol(-1)). Ring opening of dmphen is again a prerequisite for C-H bond activation, which takes place through a multistep oxidative-addition reductive-elimination pathway. The molecular structure of cyclometalated 10 shows a butterfly shape with two o-tolyl rings projected above and below the coordination plane. Variable-temperature 1H NMR spectra revealed hindered rotation around the P-Cipso(o-tolyl) bonds at rather mild temperatures (DeltaG(3330)(#) = 55.2 +/- 0.4 kJ mol(-1)). Dmphen oscillation results very slowly and is dependent on the nature of the counteranions, of the solvents, and is strongly accelerated by the presence of weak nucleophiles that act as catalysts, according to an associative mode of activation.

beta-Hydrogen Kinetic Effect.

A combined kinetic and DFT study of the uncatalyzed isomerization of cationic solvent complexes of the type cis-[Pt(R')(S)(PR3)2]+ (R' = linear and branched alkyls or aryls and S = solvents) to their trans isomers has shown that the reaction goes through the rate-determining dissociative loss of the weakly bonded molecule of the solvent and the interconversion of two geometrically distinct T-shaped 14-electron three-coordinate intermediates. The Pt-S dissociation energy is strongly dependent on the coordinating properties of S and independent of the nature of R'. The energy barrier for the fluxional motion of [Pt(R')(PR3)2]+ is comparatively much lower ( approximately 8-21 kJ mol-1). The presence of beta-hydrogens on the alkyl chain (R' = Et, Prn, and Bun) produces a great acceleration of the reaction rate. This accelerating effect has been defined as the beta-hydrogen kinetic effect, and it is a consequence of the stabilization of the transition state and of the cis-like three-coordinate [Pt(R')(PR3)2]+ intermediate through an incipient agostic interaction. The DFT optimization of [Pt(R')(PMe3)2]+ (R' = Et, Prn, and Bun) reproduces a classical dihapto Pt....eta2-HC agostic mode between the unsaturated metal and a dangling C-H bond. The value of the agostic stabilization energy (in the range of approximately 21-33 kJ mol-1) was estimated by both kinetic and computational data and resulted in being independent of the length of the hydrocarbon chain of the organic moiety. A better understanding of such interactions in elusive reaction intermediates is of primary importance in the control of reaction pathways, especially for alkane activation by metal complexes.

Effect of adjunctive lamotrigine treatment on the plasma concentrations of clozapine, risperidone and olanzapine in patients with schizophrenia or bipolar disorder.

The effect of lamotrigine on the steady-state plasma concentrations of the atypical antipsychotics clozapine, olanzapine, and risperidone was investigated in patients with schizophrenia or bipolar disorder stabilized on chronic treatment with clozapine (200-500 mg/day; n = 11), risperidone (3-6 mg/day; n = 10) or olanzapine (10-20 mg/day; n = 14)). Lamotrigine was titrated up to a final dosage of 200 mg/day over 8 weeks, and pharmacokinetic assessments were made at baseline and during treatment weeks 6 and 10, at lamotrigine dosages of 100 and 200 mg/day respectively. The plasma concentrations of clozapine, norclozapine, risperidone, and 9-hydroxy-risperidone did not change significantly during treatment with lamotrigine. The mean plasma concentrations of olanzapine were 31 +/- 7 ng/mL at baseline, 32 +/- 7 ng/mL at week 6, and 36 +/- 9 ng/mL at week 10, the difference between week 10 and baseline being statistically significant (P < 0.05). Adjunctive lamotrigine therapy was well tolerated in all groups. These findings indicate that lamotrigine, at the dosages recommended for use as a mood stabilizer, does not affect the plasma levels of clozapine, risperidone, and their active metabolites. The modest elevation in plasma olanzapine concentration, possibly due to inhibition of UGT1A4-mediated olanzapine glucuronidation, is unlikely to be of clinical significance.

Olanzapine augmentation of paroxetine-refractory obsessive-compulsive disorder.

The aim of the present study was to investigate the effect of adjunctive olanzapine in patients with obsessive-compulsive disorder (OCD) refractory to paroxetine. Twenty-one patients unresponsive to treatment with paroxetine, administered for at least 12 weeks at the dose of 60 mg/day, participated to a 12-week open-label, add-on trial with olanzapine (10 mg/day). The psychopathological state was evaluated by the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and by Clinical Global Impression (CGI). Three patients did not complete the 12-week adjunctive treatment with olanzapine. In the 18 completers, the mean Y-BOCS score decreased significantly from 27.1+/-4.0 at baseline to 20.1+/-3.9 at final evaluation (P<.001). Seven patients (38.9%) were rated as responders at final evaluation. Steady-state plasma concentrations of paroxetine were not modified during olanzapine coadministration. The drug combination was generally well tolerated and initial sedation and weight gain were the most frequent unwanted effects. Our findings confirm the results of previous studies and indicate that the addition of olanzapine to ongoing treatment with serotonin reuptake inhibitors (SRI) may be beneficial in some patients unresponsive to SRI monotherapy.