Immediate versus staged complete revascularization in patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease: results from a prematurely discontinued randomized multicenter trial.

BACKGROUND: We aimed to compare clinical outcomes between immediate and staged complete revascularization in primary percutaneous coronary intervention (PCI) for treating ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD). METHODS: A total of 248 patients were enrolled in a prospective, randomized, and multicenter registry. Immediate revascularization was defined as one-time PCI of culprit and non-culprit lesions at the initial procedure. Staged revascularization was defined as PCI of non-culprit lesions at a later date (mean, 4.4 days; interquartile range, 1-11.4), following initial culprit revascularization. The end points were major adverse cardiovascular events (MACE; composite of total death, recurrent myocardial infarction, and revascularization), any individual components of MACE, cardiac death, stent thrombosis, and stroke at 12 months. RESULTS: During a follow-up of 1 year, MACE occurred in 12 patients (11.6%) in the immediate revascularization group and in 8 patients (7.5%) in staged revascularization group (hazard ratio [HR] 1.60, 95% confidence interval [CI] 0.65-3.91). The incidence of total death was numerically higher in the immediate group than in the staged group (9.7% vs 2.8%, HR 3.53, 95% CI 0.97-12.84); There were no significant differences between the 2 groups in risks of any individual component of MACE, cardiac death, stroke, and in-hospital complications, such as need for transfusion, bleeding, acute renal failure, and acute heart failure. This study was prematurely terminated due to halt of production of everolimus-eluting stents (manufactured as PROMUS Element by Boston Scientific, Natick, Massachusetts). CONCLUSIONS: Due to its limited power, no definite conclusion can be drawn regarding complete revascularization strategy from the present study. Further large randomized clinical trials would be warranted to confirm optimal timing of complete revascularization for patients with STEMI and MVD.

Oenanthe javanica Ethanolic Extract Alleviates Inflammation and Modifies Gut Microbiota in Mice with DSS-Induced Colitis.

Oenanthe javanica, commonly known as water dropwort, has long been used to treat acute and chronic hepatitis, abdominal pain, alcohol hangovers, and inflammation in various traditional medicine systems in Asia. However, whether O. javanica has beneficial effects on colitis-induced intestinal damage remains elusive. This study tested the hypothesis that O. javanica has anti-inflammatory and antioxidant activities in mice with dextran sulfate sodium (DSS)-induced colitis. First, treatment of O. javanica ethanol extract (OJE) inhibited the production of inflammatory cytokines in lipopolysaccharide-affected macrophages. Second, in mice with DSS-induced colitis, OJE administration reduced pathological damage to the colon while alleviating weight gain and decreasing colon length, including inflammation and mucosal necrosis. In addition, OJE significantly (p < 0.01) restricted the activation of nuclear factor-κB (NF-κB) and the secretion of pro-inflammatory mediators and increased the expression of Nrf2-phase 2 antioxidant enzymes. The results of 16S rRNA gene sequencing workflows for taxonomic assignment analysis confirmed that the diversity (richness and evenness) of fecal microbiota was markedly elevated in the OJE group. OJE administration reduced the abundance of Proteobacteria including Escherichia and increased the abundance of the genus Muribaculum. These results suggested that OJE exerts beneficial effects on inflammation and gut microbial composition in a mouse model of colitis.

Anti-Diabetic Effects of Allium hookeri Extracts Prepared by Different Methods in Type 2 C57BL/J-db/db Mice.

This study was conducted to evaluate whether Allium hookeri can control diabetic symptoms. Aqueous extract (AE1: 100 mg/kg BW, AE2: 200 mg/kg BW) and ethanol extract (EE1: 100 mg/kg BW, EE2: 200 mg/kg BW) of A. hookeri were orally administrated to diabetic mice (C57BL/J-db/db) for 8 weeks. The negative (NC) and the positive (PC) control groups were treated with 0.9% saline and metformin (150 mg/kg BW), respectively. Glucose and lipid profile (triglyceride, total cholesterol (TC), LDL-C, and HDL-C) as biochemical parameters, toxicological factors such as liver/kidney functional parameters (ALT, AST, BUN, and Cr), and NK cell activity in blood were measured. Oral glucose tolerance test (OGTT) and histopathological examination were also conducted. Compared with the NC group, AE and EE decreased blood glucose, HbA1c, area under the curve (AUC) during OGTT, and leptin levels while increasing adiponectin levels. Serum lipid profiles and toxicological factors levels were reduced by the A. hookeri extract. Interestingly, HDL-C, glomerular mesangial expansion score in the kidney, and NK cell activity were effectively controlled in EE groups. Based on the results, EE is considered to be more effective in reducing high blood glucose, lipid profile, and related factor levels than AE, and is comparable to metformin in some biomarkers. It can be presumed that EE can more effectively control the major anomalies in the diabetic model than AE, and it may be used to prevent diabetic symptoms without toxicity in the Type 2 diabetic model.

The effect of antiplatelet drug on coronary endothelial and microvascular function: comparison with ticagrelor and clopidogrel.

BACKGROUND/AIMS: Coronary endothelial and microvascular function play important roles in cardiovascular disease. We aimed to evaluate the effect of ticagrelor on coronary artery function and tested the antiplatelet effect of low dose ticagrelor in East-Asian patients. METHODS: Sixty-one consecutive patients with non-significant coronary disease were included in the study. Initially, patients were randomized in 1:1:1 ratio to receive drugs: ticagrelor 90 mg twice a day (bid; n = 22), ticagrelor 45 mg bid (n = 19) or clopidogrel 75 mg once a day (qd; n = 20) and then divided into two groups (ticagrelor vs clopidogrel) for evaluation of coronary artery function, and three groups for evaluation of antiplatelet function. Endothelial dysfunction was measured by coronary flow reserve (CFR), and changes in the levels of asymmetric dimethylarginine (ADMA), cluster of differentiation (CD) 40 ligand, and P-selectin. Microvascular function was evaluated as index of microvascular resistance (IMR). Platelet reactivity was assessed by VerifyNow P2Y12 assay. RESULTS: The levels of CFR, ADMA, and CD 40 ligand were not different between the two groups. However, P-selectin was lower in the ticagrelor group compared with clopidogrel group. IMR was significantly lower in the ticagrelor group compared with clopidogrel group (median, 15.0 [interquartile range, 12.0 to 21.0] vs. 47.5 [23.0 to 67.5], p = 0.014). There was significant difference in platelet inhibition among the three groups (ticagrelor 90 mg bid vs. ticagrelor 45 mg bid vs. clopidogrel 75 mg qd; 85.57 ± 47.63 vs. 120.33 ± 51.09 vs. 256.42 ± 55.10, p < 0.001). CONCLUSION: It is hypothesized that ticagrelor might ameliorate the coronary microvascular function. When compared with clopidogrel, low dose ticagrelor exhibited satisfactory antiplatelet effect in the present study.

Efficacy and Safety of Dual-Drug-Eluting Stents for de Novo Coronary Lesions in South Korea-The Effect Trial.

BACKGROUND: Drug-eluting stents (DESs) are commonly used in percutaneous coronary intervention (PCI) procedures; however, complications including in-stent restenosis and stent thrombosis are significant challenges. The dual-DES is a stent that elutes two drugs to target various stages of the restenosis reaction. This study investigated the safety and efficacy of dual-DES in clinical practice. METHODS: This study included 375 patients who underwent PCI with Cilotax™ or DXR™ dual-DESs at one of 13 centers in South Korea. The primary endpoint was target lesion failure (TLF) within 1 year. The secondary endpoints were cardiac death, myocardial infarction (MI), target lesion revascularization (TLR), and stent thrombosis. RESULTS: The rates of TLF in dual-DESs (3.7%) were comparable to those reported in conventional DES. In addition, the DXR™ group had a significantly lower rate of TLF than the Cilotax™ group. In multivariate analysis, the DXR™ group had a lower risk of TLF (adjusted hazard ratio (HR) 0.30, 95% CI 0.09-0.92, p = 0.036) and MI (adjusted HR 0.16, 95% CI 0.03-0.82, p = 0.027) than the Cilotax™ group. CONCLUSION: Dual-DESs had similar clinical outcomes regarding efficacy and safety as conventional DES. Among the dual-DES, the DXR™ stent as a new generation dual-DES had more favorable clinical outcomes than the Cilotax™ stent.

Changes in microbial growth, carotenoids, and water-soluble tannin content of ripe persimmon beverage after ultra-high pressure treatment.

To avoid the loss of carotenoids and increasing the tannin content associated with pasteurization, we tested ultra-high pressure treatment of ripe persimmon beverage. We compared microbial counts (aerobic bacteria, coliforms, and mould), carotenoid contents, and water-soluble tannin contents between heat- and ultra-high pressure-treated beverages. No microbial contamination was detected after pasteurization or ultra-high pressure treatment at 400 MPa for more than 5 min. Ultra-high pressure treatment significantly prevented the reduction in carotenoids (lutein, zeaxanthin, ß-cryptoxanthin, ß-carotene, lycopene), with losses of 3.9-28.7%, as compared to the 65% loss after pasteurization. Moreover, ultra-high pressure did not induce an increase in water-soluble tannin, which causes astringent taste, whereas water-soluble tannins were increased three times by heat treatment. In conclusion, ultra-high pressure showed the same microbial control effect as pasteurization, while it did not cause carotenoid degeneration and increased tannin and thus, it better maintained the quality of ripe persimmon beverage.

Anti-adipogenic effects of Tropaeolum majus (nasturtium) ethanol extract on 3T3-L1 cells.

Background: Edible flowers, Tropaeolum majus has been used as a disinfectant and an antibiotic, and for wound healing, but the anti-obesity effects of this plant have not been reported previously Objective: We investigated the anti-adipogenic effects of T. majus ethanol extract (TME) on 3T3-L1 cells. Design: 3T3-L1 cells were differentiated in the presence of different concentrations of TME. Lipid accumulation levels were determined using Oil-Red O staining and a triglyceride content assay. Changes in the expression of proteins related to adipocyte differentiation in 3T3-L1 cells were determined by SDS-PAGE and western blotting. Results: The highest inhibition of lipid accumulation was observed at a TME concentration of 300 µg/mL. Additionally, TME concentrations ranging from 20 µg/mL to 500 µg/mL led to a decrease in the expression of adipocyte differentiation regulators, peroxisome proliferator-activated receptor γ, CCAAT element binding protein α, and sterol regulatory element binding transcription factor 1. This decrease was shown to be concentration-dependent. Discussion: Taken together, the results of this study demonstrate that TME inhibits lipid accumulation and reduces the expression PPARG, CEBPA, and SREBF1, which regulate adipocyte differentiation in 3T3-L1 cells. Conclusions: TME may be a potential novel therapeutic agent for the prevention and treatment of obesity.

The relationship between the left atrial volume and the maximum P-wave and P-wave dispersion in patients with congestive heart failure.

PURPOSE: A maximum P-wave duration (Pmax) of > or = 110 msec and a P-wave dispersion (PWD) > or = 40 msec are accepted indicators of a disturbance in interatrial conduction and an inhomogeneous propagation of the sinus impulse, respectively. The left atrial (LA) volume has been reported to be strongly associated with a systolic and diastolic dysfunction and is considered to be an index of atrial remodeling. We aimed to investigate the relationship between LA volume and Pmax or PWD in patients with congestive heart failure (CHF). PATIENTS AND METHODS: Sixty-one patients with CHF were enrolled in this study. The study population was classified into four groups: two groups were divided according to the Pmax (> or = 110 msec or < 110 ms), and the other two groups were formed based on the PWD (> or = 40 msec or < 40 msec). The left atrial volume index (LAVi) was measured by three-dimensional (3-D) transthoracic echocardiography. The Pmax and PWD were measured from a 12-lead electrocardiogram. RESULTS: There were significant differences in the ejection fraction (EF), diastolic function, and LAVi between patients with a Pmax > or = 110 ms or a PWD > or = 40 ms and those with a Pmax < 110 ms or a PWD < 40 ms. The LAVi was independently associated with a disturbance in interatrial conduction and an inhomogeneous propagation of the sinus impulse. The LAVi can be used to identify patients with a disturbance in interatrial conduction and an inhomogeneous propagation of the sinus impulse with reasonably good accuracy. CONCLUSION: We concluded that a disturbance in interatrial conduction and an inhomogeneous propagation of the sinus impulse in patients with CHF is associated with an increase in the LA volume and a deleterious systolic and diastolic dysfunction.

Superior vena cava syndrome caused by encircling soft tissue.

Superior vena cava syndrome can occur from benign conditions that might not alter life expectancy. Here we present a case of a superior vena cava (SVC) obstruction caused by soft tissue encircling the SVC, which was strongly suspected of being an unusual focal type of fibrosing mediastinitis. A 39-year-old man with no prior medical history presented with a four-week history of facial plethora, headache and dilated veins of the neck with a dark purple color change on the anterior chest wall. Radiology examinations, including venography, and computed tomography with a 3-dimensional volume-rendering image of the chest, had revealed severe narrowing of the SVC due to tiny encircling soft tissue and collateral vessels. A total occlusion of the SVC occurred as a result of a thrombus that developed within 1 day after the diagnostic SVC angiogram. The patient underwent stent deployment three days after the administration of thrombolytic therapy.

3D geometry of a normal tricuspid annulus during systole: a comparison study with the mitral annulus using real-time 3D echocardiography.

AIM: This study was done to explore the 3D geometry of the normal tricuspid annulus and compare it with the mitral annulus (MA), using real-time 3D echocardiography (RT3DE) and newly developed 3D computer software. METHODS: Thirteen left ventricular (LV) and 13 right ventricular (RV) volumetric images were obtained using RT3DE from normal subjects. LV and RV volumetric data were segmented into 16 rotational apical planes (angle increment=11.25 degrees ) around the rotational axis from the apex through the center of two annuli, using newly developed 3D software (TomTec, Co., Munich, Germany). Two hinge points of the MA and the TA were traced in each plane during early and late systole. The MA and the TA were then automatically reconstructed with those 32 traced points. 3D surface (3DMAA, 3DTAA) and 2D projected areas (2DMAA, 2DTAA) of the annuli were calculated automatically as well, from those fitted data. For a comparison between the two annuli, the 3D and 2D area measurements of both annuli were corrected (c) according to the height of each patient (c2DMAA, c2DTAA, c3DMAA, and c3DTAA). Non-planarity of the annuli was estimated by their non-planar angles (MA: the angle between the anterior and posterior parts of the annulus; TA: the angle between the septal and free wall parts of the annulus). RESULTS: The TA revealed a less non-planar saddle shape than did the MA, which had a significantly wider non-planar angle (167.7+/-3.2 vs 145.5+/-6.1 degrees , p<0.01) and a round or oval appearance on the projected view. The c2DTAA was significantly larger than the c2DMAA during early systole (p<0.01). However, there was no significant difference between the c3DTAA and c3DMAA during early and late systole (p>0.01). CONCLUSION: We assessed the 3D geometry of the MA and the TA by 3D reconstruction using RT3DE and newly developed computer software. The TA had a less non-planar shape compared with the MA, with either a round or oval appearance on the projected view.