Serum IL-8 is a marker of white-matter hyperintensities in patients with Alzheimer's disease

Introduction Neuroinflammation and cerebrovascular disease (CeVD) have been implicated in cognitive impairment and Alzheimer's disease (AD). The present study aimed to examine serum inflammatory markers in preclinical stages of dementia and in AD, as well as to investigate their associations with concomitant CeVD. Methods We performed a cross-sectional case–control study including 96 AD, 140 cognitively impaired no dementia (CIND), and 79 noncognitively impaired participants. All subjects underwent neuropsychological and neuroimaging assessments, as well as collection of blood samples for measurements of serum samples interleukin (IL)-6, IL-8, and tumor necrosis factor α levels. Subjects were classified as CIND or dementia based on clinical criteria. Significant CeVD, including white-matter hyperintensities (WMHs), lacunes, and cortical infarcts, was assessed by magnetic resonance imaging. Results After controlling for covariates, higher concentrations of IL-8, but not the other measured cytokines, were associated with both CIND and AD only in the presence of significant CeVD (CIND with CeVD: odds ratios [ORs] 4.53; 95% confidence interval [CI] 1.5–13.4 and AD with CeVD: OR 7.26; 95% CI 1.2–43.3). Subsequent multivariate analyses showed that among the types of CeVD assessed, only WMH was associated with higher IL-8 levels in CIND and AD (WMH: OR 2.81; 95% CI 1.4–5.6). Discussion Serum IL-8 may have clinical utility as a biomarker for WMH in AD. Longitudinal follow-up studies would help validate these findings

Anaerobic Digestion Of Mixed Chemical Pulping And Palm Oil Mill Effluent In Suspended Growth Anaerobic Digester.

The feasibility of anaerobic digestion treating palm oil mill effluent (POME) with addition of chemical pulping wastewater (black liquor) was studied in semi-continuous fed digesters under thermophilic (55°C) condition. The anaerobic digestibility of POME with and without addition of black liquor (2.5% and 5% by volume) was compared. Black liquor is an effluent obtained from pulping processes and it has high toxicity level and poor biodegradability. The digesters contained POME without black liquor functioned as a control in this study. The chemical oxygen demand (COD) reduction for hydraulic retention time (HRT) of 5 days and 10 days were examined to evaluate the effect of HRT on the performance of the digesters. The results depicted that COD reduction could be achieved up to 87% in the digester without black liquor and 79% reduction in COD with black liquor added. Fourier Transform Infrared (FTIR) spectroscopy was used to identify the functional group of POME operated under thermophilic temperatures and with or without addition of black liquor. Differences in the functional group were depicted within ten days HRT for both conditions. The results of this work could be used as a basis to enhance the possibility of anaerobic digestion in treating the chemical pulping wastewater which is initially known difficult to degrade biologically

Definition and recommendations of advance care planning:A Delphi study in five Asian sectors

Background: In Confucian-influenced Asian societies, explicit end-of-life conversations are uncommon and family involvement in decision-making is crucial, which complicates the adoption of culturally sensitive advance care planning. Aim: To develop a consensus definition of advance care planning and provide recommendations for patient-centered and family-based initiatives in Asia. Design: A five-round Delphi study was performed. The rating of a definition and 84 recommendations developed based on systematic reviews was performed by experts with clinical or research expertise using a 7-point Likert scale. A median = 1 and an inter-quartile range = 0–1 were considered very strong agreement and very strong consensus, respectively. Setting/participants: The Delphi study was carried out by multidisciplinary experts on advance care planning in five Asian sectors (Hong Kong/Japan/Korea/Singapore/Taiwan). Results: Seventy-seven of 115 (67%) experts rated the statements. Advance care planning is defined as “a process that enables individuals to identify their values, to define goals and preferences for future medical treatment and care, to discuss these values, goals, and preferences with family and/or other closely related persons, and health-care providers, and to record and review these preferences if appropriate.” Recommendations in the domains of considerations for a person-centered and family-based approach, as well as elements, roles and tasks, timing for initiative, policy and regulation, and evaluations received high levels of agreement and consensus. Conclusions: Our definition and recommendations can guide practice, education, research, and policy-making in advance care planning for Asian populations. Our findings will aid future research in crafting culturally sensitive advance care planning interventions, ensuring Asians receive value-aligned care.</p

Reversal of cardiac damage in patients with symptomatic severe aortic stenosis following transcatheter aortic valve implantation: An echocardiographic study

Background: Severe aortic stenosis (AS) results in cardiac damages, such as left ventricular hypertrophy, left atrial enlargement, pulmonary pressure elevation and in advanced stage, right ventricular damage. Généreux and colleagues proposed a staging classification based on these extra-valvular damages in 2017, with increasing stage representing more cardiac damage. While regression of these cardiac damages is expected following aortic valve replacement, the reversal of cardiac damage based on this staging system has not been described. Purpose: This study aimed to describe and stage the changes in cardiac structure and function at 6 months and 1 year after transcatheter aortic valve implantation (TAVI) in patients with symptomatic severe AS. Methods: This was a retrospective, single center, longitudinal observational study. Echocardiographic data of patients who underwent TAVI were retrieved and analysed. Results: From May 2018 to Feb 2021, 31 patients underwent TAVI. 5 patients were excluded due to death <6 months post-procedure (n=2) and incomplete echocardiographic data (n=3). The mean age of the remaining 26 patients was 70.9±9.4 years, 57.7% were male, and 34.6% bicuspid aortic valve. After TAVI, transvalvular aortic mean pressure gradient reduced from 45.2±14.5 mmHg to 8.0±5.4 mmHg (p<0.001), and aortic valve area increased from 0.57±0.21 cm2 to 1.75±0.68 cm2 (p<0.001). At baseline, 6-month and 1-year, the left ventricular mass index (LVMi) were 183.4±60.7g/m2, 150.8±55.3 g/m2 and 126.8±42.1 g/m2 (p<0.001) respectively; left-atrial volume index (LAVI) were 60.4±22.8 ml/m2 , 51.7±23.8ml/m2, and 48.1±23.6ml/m2 (p=0.009) respectively; left ventricular ejection fraction (LVEF) were 52.3±25.4%, 64.2±29.3%, and 62.4±12.1% (p=0.005) respectively. Based on the proposed cardiac damage staging for AS, at baseline 38% of patients were stage 1, 65.4% stage 2, 7.7% stage 3 and 23.1% stage 4. At 1 year, 8.3% were stage 0, 29.2% stage 1, 58.3% stage 2, and 4.2% stage 4. 12 patients (46%) showed improvement in cardiac damage staging, and the other 14 (54%) remained in the same stage. Conclusion: In patients with symptomatic severe AS, there were overall significant regression in LVMi and LAVI, and improvement in LVEF at 1 year after TAVI. However, improvement in cardiac damage staging was observed in only 46% of patients

Electrical characteristics and clinical outcomes during left bundle branch area pacing in patients with narrow QRS and comparison in mechanical synchrony with his bundle pacing, biventricular pacing and right ventricular apical pacing

Conduction system pacing preserves physiological electrical synchrony in comparison to conventional right ventricular apical pacing (RVAP). Left bundle branch area pacing (LBBAP), an alternative modality to His Bundle Pacing (HBP) has been recently reported to have higher implant success rates, stable electrical parameters, and fewer lead-related problems. Limited evidence demonstrated that LBBAP may circumvent the technical and electrophysiological difficulties encountered in His bundl

Echocardiographic improvement of left atrial booster pump and reservoir function observed in heart failure with improved ejection fraction and its prognostication

The novel subgroup of Heart Failure with improved ejection fraction(HFimpEF) is focused on improving left ventricle systolic function, but there is sparse data on left atrial(LA) recovery. Recent studies observed reversal remodelling of LA echocardiographic volume indices in HFimpEF. However, there is a lack of data on the echocardiographic description of volumetric LA functions, such as booster pump and reservoir dysfunction, in patients with HFimpEF

The role of extracellular volume fraction in predicting left ventricular reverse remodelling and adverse outcomes in patients with non-ischemic cardiomyopathy and reduced left ventricular ejection fraction

Cardiac magnetic resonance (CMR) permits the quantification of extracellular volume fraction (ECV) which is a surrogate marker of myocardial interstitial fibrosis. ECV has been shown to predict heart failure (HF) events. Conversely, left ventricular reverse remodelling (LVRR) defined as decrease in chamber volumes and improvement in function, has a positive impact on prognosis. In patients with non-ischemic cardiomyopathy (NICM), the role of ECV in LVRR is not established

Impact of total ischemic time (TIT) on 1-month clinical outcomes at a tertiary cardiology centre (TCC) with a limited primary percutaneous coronary intervention (LPPCI) service in the management of ST-elevation myocardial infarction (STEMI)

PPCI is the recommended treatment strategy over fibrinolytic for treatment of STEMI. However, majority of hospitals offer only a LPPCI service or fibrinolytic strategy for STEMI. TIT is associated with clinical outcomes for both treatment strategies. At a single public access tertiary cardiology centre (SPATCC) covering a large geographical area, a LPPCI service is provided