Performance of generative pre-trained transformers (GPTs) in Certification Examination of the College of Family Physicians of Canada.

INTRODUCTION: The application of large language models such as generative pre-trained transformers (GPTs) has been promising in medical education, and its performance has been tested for different medical exams. This study aims to assess the performance of GPTs in responding to a set of sample questions of short-answer management problems (SAMPs) from the certification exam of the College of Family Physicians of Canada (CFPC). METHOD: Between August 8th and 25th, 2023, we used GPT-3.5 and GPT-4 in five rounds to answer a sample of 77 SAMPs questions from the CFPC website. Two independent certified family physician reviewers scored AI-generated responses twice: first, according to the CFPC answer key (ie, CFPC score), and second, based on their knowledge and other references (ie, Reviews' score). An ordinal logistic generalised estimating equations (GEE) model was applied to analyse repeated measures across the five rounds. RESULT: According to the CFPC answer key, 607 (73.6%) lines of answers by GPT-3.5 and 691 (81%) by GPT-4 were deemed accurate. Reviewer's scoring suggested that about 84% of the lines of answers provided by GPT-3.5 and 93% of GPT-4 were correct. The GEE analysis confirmed that over five rounds, the likelihood of achieving a higher CFPC Score Percentage for GPT-4 was 2.31 times more than GPT-3.5 (OR: 2.31; 95% CI: 1.53 to 3.47; p<0.001). Similarly, the Reviewers' Score percentage for responses provided by GPT-4 over 5 rounds were 2.23 times more likely to exceed those of GPT-3.5 (OR: 2.23; 95% CI: 1.22 to 4.06; p=0.009). Running the GPTs after a one week interval, regeneration of the prompt or using or not using the prompt did not significantly change the CFPC score percentage. CONCLUSION: In our study, we used GPT-3.5 and GPT-4 to answer complex, open-ended sample questions of the CFPC exam and showed that more than 70% of the answers were accurate, and GPT-4 outperformed GPT-3.5 in responding to the questions. Large language models such as GPTs seem promising for assisting candidates of the CFPC exam by providing potential answers. However, their use for family medicine education and exam preparation needs further studies.

Development of bismuth sulfide nanorods and polyamidoamine dendrimer on reduced graphene oxide as electrode nanomaterials for electrochemical determination of salbutamol.

Dendrimers, a new class of nanomaterials, are receiving more attention in various fields. In this study, by combining the advantages of polyamidoamine (PAMAM) dendrimer with reduced graphene oxide (rGO) and bismuth sulfide (Bi2S3), we came to design a new composite and its application for electrochemical sensors was investigated for the first time. As a new approach in the preparation of the composite, PAMAM was used for the first time to increase the surface of Bi2S3 with rGO, which ultimately led to an increase in the active surface area of the sensor (5 times compared to the bare electrode). For the first time, we used the sonochemical method for interaction between PAMAM with Bi2S3 and rGO, which was a simpler and faster method to prepare the composite. The purposeful design of the composite was done by using the experimental design method to obtain the optimum composition of components. The new nanocomposite was successfully applied for simple and sensitive electrochemical sensing of salbutamol for controlling the health of food. Salbutamol is used as a prohibited additive in animal and poultry feed. The sensor has good sensitivity (35 times increase compared to the bare electrode) and a low detection limit (1.62 nmol/L). Moreover, it has acceptable selectivity, good repeatability (1.52-3.50%), good reproducibility (1.88%), and satisfactory accuracy (recoveries: 84.6-97.8%). An outstanding feature of the sensor is its broad linear range (5.00-6.00 × 102 nmol/L). This sensor is well suited for the determination of salbutamol in milk, sausage, and livestock and poultry feed samples.

A Double-Blinded Randomized Controlled Trial Comparing Eptifibatide Bolus Only Versus Bolus Plus Infusion In Patients Undergoing Primary Percutaneous Coronary Intervention For ST-Elevation Myocardial Infarction.

BACKGROUNDS: The use of eptifibatide combined with heparin during percutaneous coronary intervention (PCI) in patients presenting with ST-elevation myocardial infarction (STEMI) is recommended to be followed by continuous infusion. Recently, there are some suggestions that using bolus only may be sufficient and cost-effective but randomized trials are lacking. AIMS: The goal of this study was to evaluate these two approaches in a double-blinded randomized control trial. METHODS: The primary PCI patients who received bolus eptifibatide were randomized to 75 mg IV eptifibatide infusion or placebo blindly. The patients were followed up for the primary outcome of vascular or bleeding complications and secondary outcome of ischemic complications. RESULTS: 330 patients (165 from each group) completed the study. The mean age was 57.67 ± 11.53 years and 77.3 % were male. Major bleeding was seen in 1 patient in each group. Hematoma occurred in 8.5 %. The relative risk of hematoma and ecchymosis in bolus plus infusion group to bolus only group were 0.988 (95 % CI: 0.486-2.006) and 1.032 (95 % CI: 0.729-1.459). Multivariate analysis confirmed no significant differences in the bleeding event. Furthermore, there was no significant difference in in-hospital death or any ischemic events. (Cath lab death: 1.4 % in bolus only vs zero % in the control group, p = 0.217, stent thrombosis was seen in one patient in each group). CONCLUSION: There were no differences in the risk of access site ecchymosis, hematoma or major bleeding. Ischemic events and stent thrombosis rates were also similar. Our study suggests that using eptifibatide bolus only during PCI of patients with STEMI is safe and can be cost-saving.

Opium Addiction and Correlation with Early and Six-month Outcomes of Presenting with ST Elevation Myocardial Infarction Treated Initially with Thrombolytic Therapy.

BACKGROUND: Myocardial infarction is one of the most important causes of mortality worldwide. The role of opium addiction in the outcome of myocardial infarction is not known with many unproven beliefs surrounding it. This study was designed to evaluate the effects of opium addiction on in-hospital and six-month outcomes of patients presenting with ST elevation myocardial infarction (STEMI). METHODS: This study was performed on STEMI patients who were initially treated medically in two hospitals without any primary percutaneous coronary intervention (PCI) facility. A total 117 opium addicted patients and 217 non-opium-addicted controls were followed during hospitalization and six months thereafter. The primary endpoint of this study was the in-hospital composite of death, heart failure, recurrent chest pain, and recurrent STEMI. RESULTS: The composite endpoint was not significantly different either in-hospital or after six-month follow up (RR=0.851, 95% CI: 0.578-1.253 and RR=0.899, 95% CI: 0.578-1.253 relatively). Multivariate analysis also confirmed that opium addiction was not a predictor of in-hospital or six-month adverse outcome. CONCLUSION: The present study revealed that in-hospital and six-month adverse outcomes in opium addicted patients presenting with STEMI were not significantly different in comparison to patients without any opium addiction.

Incidence and severity of electric scooter related injuries after introduction of an urban rental programme in Vienna: a retrospective multicentre study.

PURPOSE: Electric scooters (e-scooters) are an emerging way of mobility in cities around the world. Despite quickly rising numbers of e-scooters, limited studies report on incidence and severity of e-scooter-associated injuries. The aim of our study was to report on these injuries and identify potential protective measures to ultimately decrease e-scooter-associated morbidity. METHODS: We performed a retrospective multicentre study including all patients, who were admitted to three major trauma departments in Vienna from May 2018 to September 2019. We analysed patients' data, including demographics, injury pattern, types of injury and subsequent treatment. RESULTS: A total number of 175 patients (115 males, 60 females) sustained e-scooter-associated injuries. Patients' mean age was 34.4 years [4-74]. While the mean Injury Severity Score (ISS) was 3.4, 11 patients presented with an ISS ≥ 9 and 2 patients with an ISS ≥ 16. ISS increased with age. Older patients (≥ 40 years) presented a significantly higher ISS than younger patients (< 40 years) (P = 0.011). Seventy-one patients (40.6%) sustained major injuries affecting head (35.2%) and upper extremities (36.6%). Twenty-three patients (13.1%) required surgery leading to hospitalization of 11 days on average [1-115]. E-scooter-associated injuries increased during late afternoon plateauing at 8.00 pm. However, the largest share of patients (39.2%) sustained their injuries during early night (8.00 pm to 1.59 am) with especially young adults (19-39 years) being at risk. CONCLUSION: The popularity of rideshare e-scooters across cities worldwide seems to be on the rise, so are e-scooter-associated injuries. These injuries should be considered high-energy trauma affecting primarily head and upper extremity; indeed, 17.7% sustained major head injuries. Therefore, the mandatory use of a helmet seems to be adequate to decrease head injury-associated morbidity. Ultimately, given the remarkably high rates of nighttime injuries, an e-scooter ban during night could further cut injury numbers in half.

Effect of Age on Procedural Success, Complications, and Clinical Outcome From a Large Angioplasty Registry.

BACKGROUND: Increasing age appears to be a risk factor for adverse outcome in patients undergoing percutaneous coronary intervention (PCI). The goal of this study was to compare procedural success, complications, and 12 months major adverse cardiac events (MACE) based on age using a large angioplasty registry. METHODS: This registry included 10,412 patients with at least 12-month follow-up from April 1993 to April 2011. Patients were divided into 3 age groups: group 1 age < 60 (n = 6195), group 2 age 60-75 (n = 3724) and group 3 elderly age ≥ 75 (n = 493). RESULTS: Procedural success rate was not significantly different across the 3 age groups. (96.9% in group 1, 97.1% in group 2, and 96.1% in elderly group, P = 0.759). Procedural complications occurred in 179 (2.9%) of group 1, 98 (2.6%) of group 2 and 15 (3.0%) of elderly group (P = 0.678). In-hospital complications increased with increasing age (311 [5.0%] in group 1, 235 [6.3%] in group 2, and 46 [9.3%] in elderly group; P < 0.001). Twelve-month MACE also increased with increasing age (235 [4.1%] in group 1, 169 [4.9%] in group 2 and 26 [5.7%] in elderly group; P = 0.021). Multivariate analysis showed that age was not a predictor for unsuccessful PCI, procedural complications, or 12-month MACE. However, increasing age was independent predictors of in-hospital complications and death. CONCLUSION: Despite increased in-hospital complications with increasing age, procedural success, and complications were not higher in elderly. Our data suggest that PCI should not be denied in elderly if indicated with procedural safety similar to other age groups.

Qualitative and quantitative analysis of Teucrium polium essential oil components by GC-MS coupled with MCR and PARAFAC methods.

INTRODUCTION: Teucrium polium is a herbal plant which has curative potential and pharmacological characteristics. Therefore, establishment of accurate analytical methods for characterising its active components is of prime importance. OBJECTIVE: Because of the complex nature of essential oil samples, some results of direct gas chromatography-mass spectrometry (GC-MS) analysis maybe unreliable. Therefore, GC-MS is coupled with chemometric methods to resolve experimental information taken from chromatographic peaks, and assign compounds to them more correctly. METHODS: Essential oil of T. Polium of Koohbanan suburb (Kerman, Iran) was extracted by hydro-distillation. Then the T. polium essential oil was qualitatively analysed using GC-MS coupled with multivariate curve resolution (MCR), to resolve experimental information taken from chromatographic peaks, and assign compounds to them more correctly. After that, the method of parallel factor analysis (PARAFAC) was implemented to quantify the concentrations of five major components of the T. polium essential oil. RESULTS: The number of identified components increases from 74 using the direct method of analysis to 106 using the MCR method. It is shown that α-pinene (8.93 µg/L), cis-verbenol (3.98 µg/L) and myrtenal (1.02 µg/L) are the most abundant components in the T. polium essential oil. CONCLUSION: By coupling GC-MS and chemometric resolution methods such as MCR-alternating least squares (ALS) and PARAFAC more information with higher precision and accuracy can be obtained from raw experimental data. Also, it is shown that by implementing the PARAFAC method on the GC-MS data, it is possible to measure the concentration of the constituents of co-eluted, overlapped or embedded chromatographic peaks.

Application of Geant4 Monte Carlo simulation in dose calculations for small radiosurgical fields.

The Geant4 toolkit was used to develop a Monte Carlo (MC)-based engine for accurate dose calculations in small radiation field sizes. The Geant4 toolkit (version 10.1.p02) was used to simulate 6-MV photon beam of a Varian2100C linear accelerator that is being used for stereotactic radiosurgery (SRS) treatment with small radiation fields. Geometric models of 3 in-house designed radiosurgical divergent cones, with the diameters of their projections at the isocenter being 10, 20, and 30 mm, were simulated. The accuracy of the MC simulation technique was examined by reproducing several different simulated dosimetric parameters of the primary beams with the experimental data. The dose distributions are first checked for single beams for each cone, then standard multiple field (SMF) techniques are applied. A sample set of DICOM files from computed tomography (CT) scan imaging of a patient's head was converted to the Geant4 geometry format to implement MC-based engine for a clinical test. To validate the accuracy of the MC-based calculations for SMF arrangements, the isodose lines from MC simulation in water phantom were compared with the measured isodose lines using EBT3 Gafchromic film in Solid Water phantoms. Agreements between measured and simulated depth dose values and beam profiles for SRS cones were generally within 2%/2 mm. For output factors, the largest discrepancy was observed for 10 mm SRS cone, which was 1.7%. For SMF techniques, in SRS cones, the MC simulation and EBT3 Gafchromic film dosimetry were in acceptable agreement (5%/5 mm). Excellent agreement between the results of the MC-based and measured dose values for both single and SMF techniques in SRS cones indicates the ability of the Geant4 toolkit to be applied as the platform for treatment planning of advanced radiotherapy techniques.

The Correction of Focal Point Displacement Caused by the Refraction of the Beams in High-Intensity Focused Ultrasound.

Nowadays, high-intensity focused ultrasound (HIFU) as nonionizing radiation is used for cancer treatment. Basically, the function of HIFU is similar to conventional ultrasound. Ultrasound beams are perverted when crossing the border of different environments. This decreases the beam's focus within the tumor and may induce damage to the normal tissues. In this study, we aim to develop appropriate algorithms for correcting the focal point displacement duced by the beam's refraction. First, the level of displacement due to difference in two specific tissues was calculated for one element of the transducer and, then, it extended to all of the elements. Finally, a new focal point was calculated, which is considered as a desired focal point of the transducer in which the maximum temperature occurs. Designed algorithms were implemented in MATLAB software. A HIFU simulator (by the Food and Drug Administration of US) was used to simulate HIFU therapy. The proposed algorithm was tested on four models with two layers of tissue. Results illustrated the use of proposed algorithm results for 78% correction in the focal point displacement. In addition, it was noted that a part of this displacement was caused by the absorption of the beam in the tissues. The proposed algorithm can significantly correct the focal point displacement in HIFU therapy and consequently prevent damage to the normal tissues.

The combination of A-966492 and Topotecan for effective radiosensitization on glioblastoma spheroids.

Radiotherapy is one of the modalities in the treatment of glioblastoma patients, but glioma tumors are resistant to radiation and also chemotherapy drugs. Thus, researchers are investigating drugs which have radiosensitization capabilities in order to improve radiotherapy. PARP enzymes and topoisomerase I enzymes have a critical role in repairing DNA damage in tumor cells. Thus, inhibiting activity of these enzymes helps stop DNA damage repair and increase DSB lethal damages. In the current study, we investigated the combination of TPT as a topoisomerase I inhibitor, and A-966492 as a novel PARP inhibitor for further radiosensitization. U87MG cells (a human glioblastoma cell line) were cultured in Poly-Hema coated flasks to reach 300 µm-diameter spheroids. Treatments were accomplished by using non-toxic concentrations of A-966492 and Topotecan. The surviving fraction of treated cells was determined by clonogenic assay after treatment with drugs and 6 MV X-ray. The γ-H2AX expression was measured by an immunofluorescence staining method to examine the influence of A-966492, TPT and radiation on the induction of double stranded DNA breaks. Treatments using the A-966492 drug were conducted in concentration of 1 µM. Combining A-966492 and TPT with radiation yielded enhanced cell killing, as demonstrated by a sensitizer enhancement ratio at 50% survival (SER50) 1.39 and 1.16 respectively. Radio- and chemo-sensitization was further enhanced when A-966492 was combined with both X-ray and TPT, with SER50 of 1.53. Also γ-H2AX expression was higher in the group treated with a combination of drugs and radiation. A-966492 is an effective PARP inhibitor and has significant radio-sensitivity on U87MG spheroids. By accumulating cells in the S phase and by inhibiting the DNA damage repair, TPT enhanced radio-sensitivity. A-966492 combined with TPT as a topoisomerase I inhibitor had additive radio-sensitizing effects. As a result, applying PARP and topoisomerase I inhibitors can be a suitable strategy for improving radiotherapy in clinics.

How far cardio metabolic and psychological factors affect salt sensitivity in normotensive adult population?

AIM: To evaluate the prevalence of salt sensitivity and the impact of cardiometabolic and psychological characteristics on salt sensitivity in normotensive population. METHODS: Of all participants, anthropometric measurements and fasting venous blood samples were collected, and study questionnaires were completed. Salt Sensitivity was defined based on the difference in mean arterial pressure with infusion of 2 L of normal saline followed by a low sodium diet and administration of three doses of oral furosemide the day after. RESULTS: Of 131 participants, 56 (42.7%) were diagnosed with salt sensitivity. Crude and age and sex adjusted regression analysis showed that low-density lipoprotein cholesterol and depression were positively associated with salt sensitivity (OR = 1.02, 95%CI: 1.01-1.04 and OR = 1.15, 95%CI: 1.00-1.34, respectively). CONCLUSION: The high prevalence of salt sensitivity and its significant relation with prevalent risk factors necessitates considering its reduction actions at the population level and the need for further research.

Enhancement of radiosensitivity of melanoma cells by pegylated gold nanoparticles under irradiation of megavoltage electrons.

PURPOSE: Gold nanoparticles (GNP) have significant potential as radiosensitizer agents due to their distinctive properties. Several studies have shown that the surface modification of nanoparticles with methyl polyethylene glycol (mPEG) can increase their biocompatibility. However, the present study investigated the radiosensitization effects of mPEG-coated GNP (mPEG-GNP) in B16F10 murine melanoma cells under irradiation of 6 MeV Electron beam. MATERIALS AND METHODS: The synthesized GNP were characterized by UV-Visible spectroscopy, dynamic light scattering, transmission electron microscopy, and zeta potential. Enhancement of radiosensitization was evaluated by the clonogenic assay at different radiation doses of megavoltage electron beams. RESULTS: It was observed that mPEG-GNP with a hydrodynamic size of approximately 50 nm are almost spherical and cellular uptake occurred at all concentrations. Both proliferation efficiency and survival fraction decreased with increasing mPEG-GNP concentration. Furthermore, significant GNP sensitization occurred with a maximum dose enhancement factor of 1.22 at a concentration of 30 µM. CONCLUSIONS: Pegylated-GNP are taken up by B16F10 cancer cells and cause radiosensitization in the presence of 6 MeV electrons. The radiosensitization effects of GNP may probably be due to biological processes. Therefore, the underlying biological mechanisms beyond the physical dose enhancement need to be further clarified.

Passive immunization against Pseudomonas aeruginosa recombinant PilA in a murine burn wound model.

Pseudomonas aeruginosa type IV pili have an essential role in twitching motility, colonization and biofilm formation. In this study, we investigated the efficacy of intraperitoneal administration of rabbit anti-recombinant PilA (anti-r-PilA) immunoglobulin G (IgG) against P. aeruginosa infection in a mouse burn-wound model. After burn and infection, mortality rate was assessed in all mice, and that of mice passively immunized with rabbit anti-r-PilA IgG was compared to non-immunized mice. Bacterial quantities in the skin and internal organs were measured to determine the level of systemic infection. Results showed that passive immunotherapy with anti-r-PilA IgG protected the burned mice infected with P. aeruginosa strains, PAO1 and the clinical isolate (CI). Anti-r-PilA antibodies enhanced the opsonophagocytosis of these strains. Moreover, the administration of anti-r-PilA IgG was also successful in reducing the bacterial burden in infected mice. The reduction of systemic bacterial spread increased the survival rate of passively immunized mice. Findings of this study revealed an improved survival rate of 62.5%, thus confirming the protective effect of anti-r-PilA IgG.

Molecular mechanisms of osteoporotic hip fractures in elderly women.

A common manifestation of age-related bone loss and resultant osteoporosis are fractures of the hip. Age-related osteoporosis is thought to be determined by a number of intrinsic factors including genetics, hormonal changes, changes in levels of oxidative stress, or an inflammatory status associated with the aging process. The aim of this study was to investigate gene expression and bone architecture in bone samples derived from elderly osteoporotic women with hip fractures (OP) in comparison to bone samples from age matched women with osteoarthritis of the hip (OA). Femoral heads and adjacent neck tissue were collected from 10 women with low-trauma hip fractures (mean age 83±6) and consecutive surgical hip replacement. Ten bone samples from patients undergoing hip replacement due to osteoarthritis (mean age 80±5) served as controls. One half of each bone sample was subjected to gene expression analysis. The second half of each bone sample was analyzed by microcomputed tomography. From each half, samples from four different regions, the central and subcortical region of the femoral head and neck, were analyzed. We could show a significantly decreased expression of the osteoblast related genes RUNX2, Osterix, Sclerostin, WNT10B, and Osteocalcin, a significantly increased ratio of RANKL to Osteoprotegerin, and a significantly increased expression of the enzymes superoxide dismutase 2 (SOD2) and glutathione peroxidase GPX3, and of the inflammatory cytokine IL6 in bone samples from hip fracture patients compared to controls. Major microstructural changes in OP bone were seen in the neck and were characterized by a significant decrease of bone volume, trabecular number, and connectivity density and a significant increase of trabecular separation. In conclusion, our data give evidence for a decreased expression of osteoblast related genes and increased expression of osteoclast related genes. Furthermore, increased expression of SOD2 and GPX3 suggest increased antioxidative activity in bone samples from elderly osteoporotic women with hip fractures.

Active Immunization with Recombinant PilA protein Protects Against Pseudomonas aeruginosa Infection in a Mouse Burn Wound Model.

Pseudomonas aeruginosa as an opportunistic human pathogen that causes lethal infections in immunocompromised patients. Type IV pili are critical factors in virulence and colonization of P. aeruginosa in acute burn wound infection. The immunogenicity and efficacy of P. aeruginosa recombinant PilA (r-PilA) was evaluated in an experimental model of burn wound sepsis as a vaccine candidate. In this study, female C57BL/6 mice were divided into five groups. Mice in the experimental groups received either r-PilA vaccine alone or in combination with the alum adjuvant or complete Freund's adjuvant (CFA). Mice in the negative control group received phosphate-buffered saline (PBS). In order to characterize the response of Th1-Th2 to immunization, the cytokine profiles of spleen cells isolated from r-PilA immunized mice were investigated. Total IgG titers and isotopes were measured using ELISA method and finally, in order to study the systemic infection, bacterial titers in the liver, spleen and blood were also determined. Active immunization with r-PilA, which is followed by two booster shots, was sufficient to generate a robust immune response in mice. Cytokine analysis demonstrated the secretion of IL-4 and INF-É£ from splenocytes in response to in vitro antigen stimulation. The IgG response to r-PilA was a Th2 type response consis¬¬ting predominantly of the isotype IgG1 accompanied by lower levels of IgG2a. In conclusion, in this burned mouse model, vaccination with r-PilA can increase the humoral immunity, thereby leading to an effective protection against P. aeruginosa infection.

Evaluation of S100B in the diagnosis of suspected intracranial hemorrhage after minor head injury in patients who are receiving platelet aggregation inhibitors and in patients 65 years of age and older.

OBJECT: Cranial CT (CCT) scans and hospital admission are increasingly performed to rule out intracranial hemorrhage in patients after minor head injury (MHI), particularly in older patients and in those receiving antiplatelet therapy. This leads to high radiation exposure and a growing financial burden. The aim of this study was to determine whether the astroglial-derived protein S100B that is released into blood can be used as a reliable negative predictive tool for intracranial bleeding in patients after MHI, when they are older than 65 years or being treated with antiplatelet drugs (low-dose aspirin, clopidogrel). METHODS: The authors conducted a prospective observational study in 2 trauma hospitals. A total of 782 patients with MHI (Glasgow Coma Scale Score 13-15) who were on medication with platelet aggregation inhibitors (PAIs) or were age 65 years and older, independent of antiplatelet therapy, were included. Clinical examination, bloodwork, observation, and CCT were performed in the traumatology emergency departments. When necessary, patients were admitted and observation took place on the ward; in these patients, CCT was performed during their hospital stay. Patients with severe trauma, focal neurological deficits, posttraumatic seizures, anticoagulant therapy, alcohol intoxication, coagulation disorder, blood sampling more than 3 hours after trauma, and unknown time of the trauma were excluded from the study. The median age of the patients was 83 years, and 69% were female. Sensitivity, specificity, and positive and negative predictive values of S100B with reference to CCT findings were calculated. The cutoff of S100B was set at 0.105 µg/L. RESULTS: Of the 782 patients, 50 (6.4%) had intracranial bleeding. One patient with positive results on CCT scan showed an S100B level below 0.105 µg/L. Of all patients, 33.1% were below the cutoff. S100B showed a sensitivity of 98.0% (CI 89.5%-99.7%), a negative predictive value of 99.6% (CI 97.9%-99.9%), a specificity of 35.3% (CI 31.9%- 38.8%), and a positive predictive value of 9.4% (CI 7.2%-12.2%). CONCLUSIONS: Levels of S100B below 0.105 µg/L can accurately predict normal CCT findings after MHI in older patients and in those treated with PAIs. Combining conventional decision criteria with measurement of S100B can reduce the CCT scan and hospital admission rates by approximately 30%.

Atorvastatin and prevention of contrast induced nephropathy following coronary angiography.

BACKGROUND: Contrast induced nephropathy (CIN) is one of the most common complications after radiographic procedures using intravascular radiocontrast media. The aim of the current study was to assess the effect of atorvastatin on prevention of CIN in patients undergoing coronary angiography. MATERIALS AND METHODS: In a clinical trial study, 200 patients referred for angiography were randomly divided into two groups of using 80 mg atorvastatin and placebo before the procedure. Furthermore, 100 patients who were under chronic treatment of statins were included as the third group. Serum creatinine (Scr) levels before and after the procedure were evaluated and incidence of CIN (post-procedural Scr of >0.5 mg/dl or >25% from baseline) was assessed. RESULTS: Mean age of the participants was 60.06 ± 0.69 years and 276 (92%) were male. There were no significant differences between group with respect to age and gender. In pre-operation atorvastatin, placebo and long term statin groups, the incidence of CIN was 1%, 2% and 1%, and mean changes of Glomerular filtration rate (GFR) was 3.68 ± 1.32, -0.77 ± 1.21 and 1.37 ± 0.86; and mean changes of creatinine (Cr) was -0.05 ± 0.02, 0.02 ± 0.02 and -0.01 ± 0.01 respectively. (P = 0.776, 0.026 and 0.041 respectively). In pre-operation atorvastatin group, Cr decreased, and GFR increased significantly (P = 0.019 and 0.007 respectively). CONCLUSION: pre-operation short term high dose atorvastatin use was associated with a significant decrease in serum Cr level and increase in GFR after angiography.

Molecular evidence of osteoblast dysfunction in elderly men with osteoporotic hip fractures.

Osteoporosis is extremely frequent in post-menopausal women; nevertheless, osteoporosis in men is also a severe and frequently occurring but often underestimated disease. Increasing evidence links bone loss in male idiopathic osteoporosis and age related osteoporosis to osteoblast dysfunction rather than increased osteoclast activity as seen in postmenopausal osteoporosis. The aim of this study was to investigate gene expression of osteoblast related genes and of bone architecture in bone samples derived from elderly osteoporotic men with hip fractures (OP) in comparison to bone samples from age matched men with osteoarthritis of the hip (OA). Femoral heads and adjacent neck tissue were collected from 12 men with low-trauma hip fractures and consecutive surgical hip replacement. Bone samples of age matched patients undergoing hip replacement due to osteoarthritis served as controls. One half of the bone samples was subjected to RNA extraction, reverse transcription, and real-time polymerase chain reactions. The second half of the bone samples was analyzed by static histomorphometry. From each half samples from four different regions, the central and subcortical region of the femoral head and neck, were analyzed. OP patients displayed a significantly decreased RUNX2, Osterix and SOST expression compared to OA patients. Major microstructural changes in OP bone were seen in the subcortical region of the neck and were characterized by a significant decrease of bone volume, and a significant increase of trabecular separation. In conclusion, decreased local gene expression of RUNX2 and Osterix in men with hip fractures strongly supports the concept of osteoblast dysfunction in male osteoporosis. Major microstructural changes in the trabecular structure associated with osteoporotic hip fractures in men are localized in the subcortical region of the femoral neck.

Effect of Early Treatment With Tirofiban on Initial TIMI Grade 3 Flow of Patients With ST Elevation Myocardial Infarction.

BACKGROUND: Before primary percutaneous coronary intervention (PCI) in patients with ST elevation myocardial infarction (STEMI), it is not clear whether a routine early administration of glycoprotein IIb/IIIa inhibitors in the emergency ward is beneficial or their administration in selected cases in the catheterization laboratory. OBJECTIVES: The present randomized clinical trial sought to investigate whether an earlier administration of Tirofiban could exert any impact on TIMI grade 3 flows and ST resolution in the electrocardiography of patients with STEMI before primary PCI. MATERIALS AND METHODS: Patients with STEMI within twelve hours of symptom commencement were included if primary PCI was planned to be performed within ninety minutes of admission and excluded if they had contraindications for Tirofiban. Seventy patients were randomized to receive 25 µg/kg of bolus Tirofiban early in the emergency ward (the early Tirofiban group) in three minutes and 70 did not receive Tirofiban (the control group). The primary endpoint of the study was a Thrombolysis in Myocardial Infarction (TIMI) grade 3 flows on the initial angiogram. The study is registered as IRCT201105126463N1 in: www.irct.ir. RESULTS: The study population had a mean age of 57.17 ± 10.09 years and included 79.3 % males. TIMI grade 3 flow was seen in 15 (21.4 %) patients of the Tirofiban group and 7 (10 %) of the control group (P = 0.06, odds ratio = 0.407, and 95 % confidence interval = 0.155-1.072). Complete ST resolution was seen in 30 (42.9 %) patients of the Tirofiban group and 34 (48.6 %) of the control group (P = 0.5). CONCLUSION: Although TIMI grade 3 flows trended to be higher in the patients who received early Tirofiban in the emergency ward, the difference did not constitute statistical significance and possible benefits, therefore, require further clarification.

Ramadan fast in patients with coronary artery disease.

BACKGROUND: Fasting during the month of Ramadan is of vital significance amongst Muslims; however, little is known about the effects of this kind of fasting on patients with coronary artery disease (CAD). OBJECTIVES: This nonrandomized prospective observational pilot study was designed to investigate the effects of Ramadan fast on the symptoms of CAD. PATIENTS AND METHODS: Patients with documented CAD were consecutively (nonrandomized) included in the study, and those with heart failure (ejection fraction < 50%), renal failure, gout, and insulin-treated diabetes were excluded. Patients had the choice of fasting during Ramadan if they so wished and to break their fast as soon as symptoms such as dyspnea and chest pain occurred (fasting group) or not fasting (control group). RESULTS: A total of 148 patients completed the study. Mean (mean ± SD) age of the patients was 61.5 ± 11.7 years and 50% were male. Finally, 66 patients (44.6%) accomplished Ramadan fast with an average of 22.27 ± 10.46 days of fasting. Occurrence of chest pain was not significantly different between the fasting and non-fasting groups (4 out of 66 [6.1%] vs. 8 out of 82 [9.8%] respectively; P = 0.42). In addition, patients who fasted during Ramadan did not experience a higher frequency of a combined endpoint of chest pain and dyspnea (4 out of 66 cases in the fasting group [6.1%] vs. 11 out of 82 in non-fasting group [13.4%]; P = 0.14). CONCLUSIONS: In the present study, the patients with CAD were able to observe Ramadan fast safely and their combined endpoint of chest pain and dyspnea was not significantly different from that of the non-fasting ones. We would suggest that patients with CAD and normal left ventricular function could fast during Ramadan.