UK perspective on the changing landscape of non-invasive cardiac testing.

Objective: To document UK rates of exercise treadmill testing, functional stress testing and CT coronary angiography (CTCA). Specific aims were to determine how rates have changed in the context of changing guideline recommendations within the UK and to identify regional inequalities in the utilisation of testing modalities. Secondary objectives were to compare these trends with national data on revascularisation. Methods: 159 acute National Health Service trusts were served Freedom of Information (FOI) requests to provide total numbers of CTCA and functional imaging tests for each financial year from 2011-2012 to 2016-2017. Results: The FOI requests yielded data from 88% of Trusts, increasing from 81.9% in 2011-2012% to 92.1% in 2016-2017. Exercise treadmill tests (ETTs) were performed by over 97% of Trusts. ETT was the most commonly performed diagnostic test in the UK across the study period despite declining by 8.4%. Utilisation of non-invasive stress imaging tests increased by 80.9% during the same period. Myocardial perfusion scintigraphy and stress echocardiography increased by 25.8% and 73.9%, respectively. The 268% increase in CTCA scans was yet greater. Trends in test utilisation during the study period showed important regional differences between devolved nations. Comparably, only small changes in rates of invasive coronary angiography and revascularisation have been reported during the study period. Conclusion: Non-invasive imaging in UK Trusts has increased substantially since 2010 with only a small decline in use of the ETT and minimal changes in rates of invasive coronary angiography and revascularisation in the same time period

In vivo antioxidant potential of lepidium sativum l. Seeds in albino rats using cisplatin induced nephrotoxicity

The present study was designed to investigate to possible potential nephrocurative, nephroprotective activity and in vivo antioxidant potential of 200mg/kg and 400mg/kg ethanolic extract of Lepidium sativum L. seeds was use to against cisplatin (5mg/kg, i.p.) induced nephrotoxicity. The experimental protocol designed as the animals were divided into six groups (n=6) like control, model control, two curative (200mg/kg and 400mg/kg), and two protective groups (200mg/kg and 400mg/kg, were received vehicle, cisplatin, cisplatin + extract, and extract + cisplatin respectively. After 6th days, blood collected from retro-orbital sinus of rats and determined urea and creatinine level in serum of each group after then rats were sacrificed for quantitative estimation of various enzymes and ATPase content in kidney tissue. A single dose of cisplatin induced loss in body weight, increase urine excretion, increased urea & creatinine level in serum; it was significantly recovered by 200mg/kg and 400mg/kg in curative and protective groups. The enzyme estimation in kidney tissue it found that increase malondialdehyde, superoxide dismutase, catalase and reduced glutathione level, it was significantly monitored by 200mg/kg and 400mg/kg in curative and protective groups. These are defined as vivo antioxidant potential. The level of brush border enzymes like Na+ / K+ ATPase, Ca++ ATPase and Mg++ATPase were found significantly reduced after single dose cisplatin injection. It was overcome by treatment of same extract in curative and protective groups. Finally it is concluded that the present study data conformed nephrotoxicity induced by cisplatin due oxidative stress and ethanolic extract of Lepidium sativum L. seeds may have nephroprotective and curative activity.Keywords: Cisplatin; Nephrotoxicity; urea; creatinine; glutathione; Lipid peroxidatio

In vivo antioxidant potential of lepidium sativum l. Seeds in albino rats using cisplatin induced nephrotoxicity

The present study was designed to investigate to possible potential nephrocurative, nephroprotective activity and in vivo antioxidant potential of 200mg/kg and 400mg/kg ethanolic extract of Lepidium sativum L. seeds was use to against cisplatin (5mg/kg, i.p.) induced nephrotoxicity. The experimental protocol designed as the animals were divided into six groups (n=6) like control, model control, two curative (200mg/kg and 400mg/kg), and two protective groups (200mg/kg and 400mg/kg, were received vehicle, cisplatin, cisplatin + extract, and extract + cisplatin respectively. After 6th days, blood collected from retro-orbital sinus of rats and determined urea and creatinine level in serum of each group after then rats were sacrificed for quantitative estimation of various enzymes and ATPase content in kidney tissue. A single dose of cisplatin induced loss in body weight, increase urine excretion, increased urea & creatinine level in serum; it was significantly recovered by 200mg/kg and 400mg/kg in curative and protective groups. The enzyme estimation in kidney tissue it found that increase malondialdehyde, superoxide dismutase, catalase and reduced glutathione level, it was significantly monitored by 200mg/kg and 400mg/kg in curative and protective groups. These are defined as vivo antioxidant potential. The level of brush border enzymes like Na+ / K+ ATPase, Ca++ ATPase and Mg++ATPase were found significantly reduced after single dose cisplatin injection. It was overcome by treatment of same extract in curative and protective groups. Finally it is concluded that the present study data conformed nephrotoxicity induced by cisplatin due oxidative stress and ethanolic extract of Lepidium sativum L. seeds may have nephroprotective and curative activity.Keywords: Cisplatin; Nephrotoxicity; urea; creatinine; glutathione; Lipid peroxidatio

Impact of pulmonary valve replacement on left ventricular rotational mechanics in repaired tetralogy of Fallot

Background In repaired tetralogy of Fallot (rTOF), abnormal left ventricular (LV) rotational mechanics are associated with adverse clinical outcomes. We performed a comprehensive analysis of LV rotational mechanics in rTOF patients using cardiac magnetic resonance (CMR) prior to and following surgical pulmonary valve replacement (PVR). Methods In this single center retrospective study, we identified rTOF patients who (1) had both a CMR ≤ 1 year before PVR and ≤ 5 years after PVR, (2) had no other intervening procedure between CMRs, (3) had a body surface area > 1.0 m2 at CMR, and (4) had images suitable for feature tracking analysis. These subjects were matched to healthy age- and sex-matched control subjects. CMR feature tracking analysis was performed on a ventricular short-axis stack of balanced steady-state free precession images. Measurements included LV basal and apical rotation, twist, torsion, peak systolic rates of rotation and torsion, and timing of events. Associations with LV torsion were assessed. Results A total of 60 rTOF patients (23.6 ± 7.9 years, 52% male) and 30 healthy control subjects (20.8 ± 3.1 years, 50% male) were included. Compared with healthy controls, rTOF patients had lower apical and basal rotation, twist, torsion, and systolic rotation rates, and these parameters peaked earlier in systole. The only parameters that were correlated with LV torsion were right ventricular (RV) end-systolic volume (r = − 0.28, p = 0.029) and RV ejection fraction (r = 0.26, p = 0.044). At a median of 1.0 year (IQR 0.5–1.7) following PVR, there was no significant change in LV rotational parameters versus pre-PVR despite reductions in RV volumes, RV mass, pulmonary regurgitation, and RV outflow tract obstruction. Conclusion In this comprehensive study of CMR-derived LV rotational mechanics in rTOF patients, rotation, twist, and torsion were diminished compared to controls and did not improve at a median of 1 year after PVR despite favorable RV remodeling

Optimising cardiometabolic risk factors in pregnancy: a review of risk prediction models targeting gestational diabetes and hypertensive disorders

Cardiovascular disease, especially coronary heart disease and cerebrovascular disease, is a leading cause of mortality and morbidity in women globally. The development of cardiometabolic conditions in pregnancy, such as gestational diabetes mellitus and hypertensive disorders of pregnancy, portend an increased risk of future cardiovascular disease in women. Pregnancy therefore represents a unique opportunity to detect and manage risk factors, prior to the development of cardiovascular sequelae. Risk prediction models for gestational diabetes mellitus and hypertensive disorders of pregnancy can help identify at-risk women in early pregnancy, allowing timely intervention to mitigate both short- and long-term adverse outcomes. In this narrative review, we outline the shared pathophysiological pathways for gestational diabetes mellitus and hypertensive disorders of pregnancy, summarise contemporary risk prediction models and candidate predictors for these conditions, and discuss the utility of these models in clinical application.Eleanor P. Thong, Drishti P. Ghelani, Pamada Manoleehakul, Anika Yesmin, Kaylee Slater, Rachael Taylor, Clare Collins, Melinda Hutchesson, Siew S. Lim, Helena J. Teede, Cheryce L. Harrison, Lisa Moran, and Joanne Enticot

Anticitrullinated protein antibody (ACPA) in rheumatoid arthritis: influence of an interaction between HLA-DRB1 shared epitope and a deletion polymorphism in glutathione s-transferase in a cross-sectional study

Abstract Introduction A deletion polymorphism in glutathione S-transferase Mu-1 (GSTM1-null) has previously been implicated to play a role in rheumatoid arthritis (RA) risk and progression, although no prior investigations have examined its associations with anticitrullinated protein antibody (ACPA) positivity. The purpose of this study was to examine the associations of GSTM1-null with ACPA positivity in RA and to assess for evidence of interaction between GSTM1 and HLA-DRB1 shared epitope (SE). Methods Associations of GSTM1-null with ACPA positivity were examined separately in two RA cohorts, the Veterans Affairs Rheumatoid Arthritis (VARA) registry (n = 703) and the Study of New-Onset RA (SONORA; n = 610). Interactions were examined by calculating an attributable proportion (AP) due to interaction. Results A majority of patients in the VARA registry (76%) and SONORA (69%) were positive for ACPA with a similar frequency of GSTM1-null (53% and 52%, respectively) and HLA-DRB1 SE positivity (76% and 71%, respectively). The parameter of patients who had ever smoked was more common in the VARA registry (80%) than in SONORA (65%). GSTM1-null was significantly associated with ACPA positivity in the VARA registry (odds ratio (OR), 1.45; 95% confidence interval (CI), 1.02 to 2.05), but not in SONORA (OR, 1.00; 95% CI, 0.71 to 1.42). There were significant additive interactions between GSTM1 and HLA-DRB1 SE in the VARA registry (AP, 0.49; 95% CI, 0.21 to 0.77; P < 0.001) in ACPA positivity, an interaction replicated in SONORA (AP, 0.38; 95% CI, 0.00 to 0.76; P = 0.050). Conclusions This study is the first to show that the GSTM1-null genotype, a common genetic variant, exerts significant additive interaction with HLA-DRB1 SE on the risk of ACPA positivity in RA. Since GSTM1 has known antioxidant functions, these data suggest that oxidative stress may be important in the development of RA-specific autoimmunity in genetically susceptible individuals

SDHA mutated paragangliomas may be at high risk of metastasis

NT is funded by The Medical College of Saint Bartholomew’s Hospital Trust (1115519)