Varespladib and cardiovascular events in patients with an acute coronary syndrome: the VISTA-16 randomized clinical trial

IMPORTANCE: Secretory phospholipase A2(sPLA2) generates bioactive phospholipid products implicated in atherosclerosis. The sPLA2inhibitor varespladib has favorable effects on lipid and inflammatory markers; however, its effect on cardiovascular outcomes is unknown. OBJECTIVE: To determine the effects of sPLA2inhibition with varespladib on cardiovascular outcomes. DESIGN, SETTING, AND PARTICIPANTS: A double-blind, randomized, multicenter trial at 362 academic and community hospitals in Europe, Australia, New Zealand, India, and North America of 5145 patients randomized within 96 hours of presentation of an acute coronary syndrome (ACS) to either varespladib (n = 2572) or placebo (n = 2573) with enrollment between June 1, 2010, and March 7, 2012 (study termination on March 9, 2012). INTERVENTIONS: Participants were randomized to receive varespladib (500 mg) or placebo daily for 16 weeks, in addition to atorvastatin and other established therapies. MAIN OUTCOMES AND MEASURES: The primary efficacy measurewas a composite of cardiovascular mortality, nonfatal myocardial infarction (MI), nonfatal stroke, or unstable angina with evidence of ischemia requiring hospitalization at 16 weeks. Six-month survival status was also evaluated. RESULTS: At a prespecified interim analysis, including 212 primary end point events, the independent data and safety monitoring board recommended termination of the trial for futility and possible harm. The primary end point occurred in 136 patients (6.1%) treated with varespladib compared with 109 patients (5.1%) treated with placebo (hazard ratio [HR], 1.25; 95%CI, 0.97-1.61; log-rank P = .08). Varespladib was associated with a greater risk of MI (78 [3.4%] vs 47 [2.2%]; HR, 1.66; 95%CI, 1.16-2.39; log-rank P = .005). The composite secondary end point of cardiovascular mortality, MI, and stroke was observed in 107 patients (4.6%) in the varespladib group and 79 patients (3.8%) in the placebo group (HR, 1.36; 95% CI, 1.02-1.82; P = .04). CONCLUSIONS AND RELEVANCE: In patients with recent ACS, varespladib did not reduce the risk of recurrent cardiovascular events and significantly increased the risk of MI. The sPLA2inhibition with varespladib may be harmful and is not a useful strategy to reduce adverse cardiovascular outcomes after ACS. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01130246. Copyright 2014 American Medical Association. All rights reserved

Feasibility study into self-administered training at home using an arm and hand device with motivational gaming environment in chronic stroke

© 2015 Nijenhuis et al. Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.BACKGROUND: Assistive and robotic training devices are increasingly used for rehabilitation of the hemiparetic arm after stroke, although applications for the wrist and hand are trailing behind. Furthermore, applying a training device in domestic settings may enable an increased training dose of functional arm and hand training. The objective of this study was to assess the feasibility and potential clinical changes associated with a technology-supported arm and hand training system at home for patients with chronic stroke. METHODS: A dynamic wrist and hand orthosis was combined with a remotely monitored user interface with motivational gaming environment for self-administered training at home. Twenty-four chronic stroke patients with impaired arm/hand function were recruited to use the training system at home for six weeks. Evaluation of feasibility involved training duration, usability and motivation. Clinical outcomes on arm/hand function, activity and participation were assessed before and after six weeks of training and at two-month follow-up. RESULTS: Mean System Usability Scale score was 69 % (SD 17 %), mean Intrinsic Motivation Inventory score was 5.2 (SD 0.9) points, and mean training duration per week was 105 (SD 66) minutes. Median Fugl-Meyer score improved from 37 (IQR 30) pre-training to 41 (IQR 32) post-training and was sustained at two-month follow-up (40 (IQR 32)). The Stroke Impact Scale improved from 56.3 (SD 13.2) pre-training to 60.0 (SD 13.9) post-training, with a trend at follow-up (59.8 (SD 15.2)). No significant improvements were found on the Action Research Arm Test and Motor Activity Log. CONCLUSIONS: Remotely monitored post-stroke training at home applying gaming exercises while physically supporting the wrist and hand showed to be feasible: participants were able and motivated to use the training system independently at home. Usability shows potential, although several usability issues need further attention. Upper extremity function and quality of life improved after training, although dexterity did not. These findings indicate that home-based arm and hand training with physical support from a dynamic orthosis is a feasible tool to enable self-administered practice at home. Such an approach enables practice without dependence on therapist availability, allowing an increase in training dose with respect to treatment in supervised settings. TRIAL REGISTRATION: This study has been registered at the Netherlands Trial Registry (NTR): NTR3669 .Peer reviewe

Scanning electron microscopy observations of the hedgehog stomach worm, Physaloptera clausa (Spirurida: Physalopteridae).

Background: Physaloptera clausa (Spirurida: Physalopteridae) nematodes parasitize the stomach of the European hedgehog (Erinaceus europaeus) and cause weight loss, anorexia and gastric lesions. The present study provides the first morphological description of adult P. clausa from the stomachs of infected hedgehogs, using scanning electron microscopy (SEM). Methods. From June to October 2011, 10 P. clausa from European hedgehogs were fixed, dried, coated and subjected to SEM examination. Results: Males and females (22-30 mm and 28-47 mm, respectively) were stout, with the cuticle reflecting over the lips to form a large cephalic collarette and showing fine transverse striations in both sexes. The mouth was characterized by two large, simple triangular lateral pseudolabia, each armed with external and internal teeth. Inside the buccal cavity, a circle of internal small teeth can be observed. Around the mouth, four sub-median cephalic papillae and two large amphids were also observed. The anterior end of both male and female bore an excretory pore on the ventral side and a pair of lateral ciliated cervical papillae. In the female worm, the vulva was located in the middle and the eggs were characterized by smooth surfaces. The posterior end of the female worm was stumpy with two large phasmids in proximity to its extremity. The posterior end of the male had large lateral alae, joined together anteriorly across the ventral surface, with subequal and dissimilar spicules, as well as four pairs of stalked pre-cloacal papillae, three pairs of post-cloacal papillae, and two phasmids. Three sessile papillae occured anteriorly and four posteriorly to the cloaca. Conclusions: The present SEM study provides the first in-depth morphological characterization of adult P. clausa, and highlights similarities and differences with P. bispiculata P. herthameyerae, Heliconema longissimum and Turgida turgida

Phytochemical Properties of Mentha longifolia L. Essential Oil and its Antimicrobial Effects on Staphylococcus Aureus

Background & Aim: Due to the side effects of chemical and synthetic preservatives, consumers have recently become more eager to use foods containing natural preservatives from plants, animals and microbial sources. In the present study, biochemical composition and antibacterial effects (MIC) of Mentha longifolia L. essential oil against Staphylococcus aureus have been evaluated. Methods: In this experimental study, the biochemical composition and antibacterial prosperities of this essential oil was determined by the Gas chromatography/ mass spectrophotometer (GC/MS) and micro dilution method respectively. The morphological and membrane changes of the bacterial cell under the effect of this essential oil were evaluated by transmission electron microscopy. The collected data was analyzed by the SPSS software using ANOVA. Results: The chemical analysis of the essential oil by Gas chromatography/ mass spectrophotometer (GC/MS) revealed the presence of 22 substances (95.30%), mainly including Pulegon (31.54%), 1,8 Cineol (15.89%), Menthoforan (11.8%) and Cis- Isopulegon (9.74%). Minimum inhibitory concentration of the essential oil determined under different temperature and pH values showed to be in the range of 75-1200 µg/ ml. Conclusion: The MIC results and membrane cell damage observed in the electron microscopy evaluation indicated that this essential oil have a high antibacterial activity. Therefore, this essential oil can be combined with other agents for the preservation of foods against pathogenic and toxigenic microorganisms