Efficacy of coronary sinus reducer implantation in patients with chronic total occlusion of the right coronary artery

Background: Clinical efficacy of coronary sinus reducer (CSR) in refractory angina (RA) patients with ischemia due to the chronic total occlusion (CTO) of the right coronary artery (RCA) remains unknown. Aims: To evaluate the efficacy of CSR implantation in RA patients with CTO RCA and compare them to CSR recipients with left coronary artery (LCA) ischemia. Methods: Consecutive patients with CTO RCA from 2 centres were prospectively included and compared to patients with LCA ischemia. All patients underwent evaluation of angina severity and quality of life (QOL) at baseline and after 12 months. In a subgroup of CTO RCA patients stress cardiac magnetic resonance (CMR) imaging was also performed. Results: Twenty-two patients with CTO RCA and predominant inferior and/or inferoseptal wall ischemia (CTO RCA group) were compared to 24 patients with predominant anterior, lateral and/or anteroseptal wall ischemia (LCA group). While Canadian Cardiovascular Society (CCS) angina score mean (SD) improved in CTO RCA group from 2.73 (0.46) to 1.82 (0.73) (P < 0.001) and in LCA group from 2.67 (0.57) to 1.92 (0.72) (P < 0.001), there was no intergroup difference (P = 0.350). Significant improvement in all Seattle Angina Questionnaire domains was observed. Stress CMR did not show significant reduction of ischemic inferior and/or inferoseptal segments, however improvements in transmurality index (P = 0.03) and myocardial perfusion reserve index in segments with inducible ischemia (P = 0.03) were observed in CTO RCA group. Conclusions: In CTO RCA patients CSR implantation alleviated angina symptoms and improved QOL. Extent of improvement was comparable to that observed in patients with LCA ischemia

Oxytetracycline hyper-production through targeted genome reduction of Streptomyces rimosus

Most biosynthetic gene clusters (BGC) encoding the synthesis of important microbial secondary metabolites, such as antibiotics, are either silent or poorly expressed; therefore, to ensure a strong pipeline of novel antibiotics, there is a need to develop rapid and efficient strain development approaches. This study uses comparative genome analysis to instruct rational strain improvement, using Streptomyces rimosus, the producer of the important antibiotic oxytetracycline (OTC) as a model system. Sequencing of the genomes of two industrial strains M4018 and R6-500, developed independently from a common ancestor, identified large DNA rearrangements located at the chromosome end. We evaluated the effect of these genome deletions on the parental S. rimosus Type Strain (ATCC 10970) genome where introduction of a 145 kb deletion close to the OTC BGC in the Type Strain resulted in massive OTC overproduction, achieving titers that were equivalent to M4018 and R6-500. Transcriptome data supported the hypothesis that the reason for such an increase in OTC biosynthesis was due to enhanced transcription of the OTC BGC and not due to enhanced substrate supply. We also observed changes in the expression of other cryptic BGCs; some metabolites, undetectable in ATCC 10970, were now produced at high titers. This study demonstrated for the first time that the main force behind BGC overexpression is genome rearrangement. This new approach demonstrates great potential to activate cryptic gene clusters of yet unexplored natural products of medical and industrial value

Identifikacija enojajčnih dvojčkov v policijskih postopkih

Purpose: The aim of the study was to review the treatment of identical twins in crimes and to determine to what extent people notice the switch of identities, to what extent they can distinguish between twins, and what factors are related to the ability to distinguish them. Design/Methods/Approach: We carried out an analysis of literature and a case review about identification of identical twins in police procedures and for the purpose of the article, an online survey was conducted among the general public. Findings: In line with existing research, the survey showed that age, but not gender or length of acquaintance, was related to the ability to distinguish between twins. The ability to distinguish between twins is positively correlated with the observation of confusion between them. Our survey of the public found that the most common indicators for distinguishing between identical twins were facial features, behavior, a distinctive voice, and recognizable accessories. Research Limitations/Implications: A review of the literature on the identification and treatment of twins in relation to criminality reveals several gaps in knowledge. More attention should thus be paid to the problem in the future, possibly to establish criteria for prosecution and to raise awareness that such deviant behavior can occur. In our research, we conducted survey among general public in the future maybe a survey of the experts should be conducted for more comprehensive view of the issue. Among the proposals for further research, it would be reasonable to consider the analysis of cases of identical twins in police practice. Originality/Value: In our own research, we examined the factors associated with identity swapping among identical twins.Namen: Namen prispevka je pregled obravnavanja enojajčnih dvojčkov pri kaznivih dejanjih in prikaz ugotovitev raziskave, v kolikšni meri ljudje opazijo zamenjavo identitete dvojčkov ter kateri dejavniki so povezani s sposobnostjo razlikovanja med njimi. Metode: Opravili smo analizo literature in pregled primerov o identifikaciji enojajčnih dvojčkov v policijskih postopkih, za namen prispevka pa smo izvedli tudi spletno anketo med širšo javnostjo. Ugotovitve: Ugotovili smo, da več kot polovica ljudi opaža zamenjavo identitete dvojčkov ter da je s sposobnostjo ločevanja med dvojčki povezana njihova starost, ne pa tudi trajanje poznanstva. Ravno sposobnost ločevanja med dvojčkoma je povezana z opažanjem zamenjave identitete, ne pa tudi spol dvojčkov. Raziskava je pokazala, da so najpogostejši identifikatorji razlikovanja med enojajčnimi dvojčki obrazne poteze, vedenje, značilen glas in drugi prepoznavni identifikatorji. Omejitve/uporabnost raziskave: Pregled literature o identifikaciji in obravnavi dvojčkov v povezavi s kaznivimi ravnanji razkriva več vrzeli v znanju. Problemu bi bilo zato treba v prihodnje posvetiti več pozornosti in morda vzpostaviti merila za pregon in ozaveščanje, da do tovrstnih deviantnih vedenj ne bi prišlo. V prihodnje bi bilo treba izvesti tudi raziskavo med strokovnjaki za bolj celovit pregled problematike. Izvirnost/pomembnost prispevka: V naši raziskavi smo preučili dejavnike, povezane z zamenjavo identitete med enojajčnimi dvojčki

Effect of Coronary Sinus Reducer Implantation on Aerobic Exercise Capacity in Refractory Angina Patients—A CROSSROAD Study

Coronary sinus reducer (CSR) implantation is a new treatment option for patients with refractory angina pectoris. However, there is no evidence from a randomized trial that would show an improvement in exercise capacity after this treatment. The aim of this study was to evaluate the influence of CSR treatment on maximal oxygen consumption and compare it to a sham procedure. Twenty-five patients with refractory angina pectoris (Canadian Cardiovascular Society (CCS) class II–IV) were randomized to a CSR implantation (n = 13) or a sham procedure (n = 12). At baseline and after 6 months of follow-up, the patients underwent symptom-limited cardiopulmonary exercise testing with an adjusted ramp protocol and assessment of angina pectoris using the CCS scale and Seattle angina pectoris questionnaire (SAQ). In the CSR group, maximal oxygen consumption increased from 15.56 ± 4.05 to 18.4 ± 5.2 mL/kg/min (p = 0.03) but did not change in the sham group (p = 0.53); p for intergroup comparison was 0.03. In contrast, there was no difference in the improvement of the CCS class or SAQ domains. To conclude, in patients with refractory angina and optimized medical therapy, CSR implantation may improve oxygen consumption beyond that of optimal medical therapy

The Impact of Coronary Sinus Reducer on Arrhythmic Properties in Patients with Refractory Angina

Background: Treatment with a coronary sinus reducer (CSR) is a new therapeutic option for refractory angina patients. Preclinical studies have shown antiarrhythmic properties of coronary sinus narrowing. The possible antiarrhythmic effect of CSR implantation is unknown. This study aimed to determine the possible antiarrhythmic effects of CSR implantation as assessed by high-resolution electrocardiogram (hrECG) parameters. Methods: 24 patients from the Crossroad study randomized to either CSR treatment (n = 12) or a sham procedure (n = 12) had hrECG recorded at baseline and after 6 months. T-peak and T-end interval (TpTe) defined as the time difference between the peak amplitude of the T wave and the global end of the T wave, spatial angle between QRS complex and T axis defined as the angle between the ventricular depolarization and repolarization vectors using maximal (QRSTP) and mean (QRSTM) vector amplitudes and spatial ventricular gradient (SVG) calculated as integral of ECG voltages over the entire QRST complex were analyzed. Additionally, we analyzed parameters of QT and heart rate variability using time and frequency domain. Results: At baseline, all analyzed parameters were comparable between both groups and heart rate remained constant. The intragroup analysis did not show any significant change in TpTe, QRSTP, QRSTM, SVG, QT, and heart rate variability at follow-up. Furthermore, intergroup comparison between CSR implantation and sham procedure also did not show any significant difference in the change of analyzed parameters. Conclusions: Compared to the sham procedure, CSR implantation did not demonstrate a significant impact on the arrhythmogenic substrate assessed with hrECG. Clinical Trial Registration: Unique Identifier: NCT04121845, https://classic.clinicaltrials.gov/ct2/show/NCT04121845

Efficacy of coronary sinus reducer implantation in patients with chronic total occlusion of the right coronary artery

Background: Clinical efficacy of coronary sinus reducer (CSR) in refractory angina (RA) patients with ischemia due to the chronic total occlusion (CTO) of the right coronary artery (RCA) remains unknown. Aims: To evaluate the efficacy of CSR implantation in RA patients with CTO RCA and compare them to CSR recipients with left coronary artery (LCA) ischemia. Methods: Consecutive patients with CTO RCA from 2 centres were prospectively included and compared to patients with LCA ischemia. All patients underwent evaluation of angina severity and quality of life (QOL) at baseline and after 12 months. In a subgroup of CTO RCA patients stress cardiac magnetic resonance (CMR) imaging was also performed. Results: Twenty-two patients with CTO RCA and predominant inferior and/or inferoseptal wall ischemia (CTO RCA group) were compared to 24 patients with predominant anterior, lateral and/or anteroseptal wall ischemia (LCA group). While Canadian Cardiovascular Society (CCS) angina score mean (SD) improved in CTO RCA group from 2.73 (0.46) to 1.82 (0.73) (P &lt; 0.001) and in LCA group from 2.67 (0.57) to 1.92 (0.72) (P &lt; 0.001), there was no intergroup difference (P = 0.350). Significant improvement in all Seattle Angina Questionnaire domains was observed. Stress CMR did not show significant reduction of ischemic inferior and/or inferoseptal segments, however improvements in transmurality index (P = 0.03) and myocardial perfusion reserve index in segments with inducible ischemia (P = 0.03) were observed in CTO RCA group. Conclusions: In CTO RCA patients CSR implantation alleviated angina symptoms and improved QOL. Extent of improvement was comparable to that observed in patients with LCA ischemia