Myocardial FFR (Fractional Flow Reserve) in patients with angiographically intermediate coronary artery stenosis - an initial institutional experience

Background: The clinical significance of coronary artery stenosis of intermediate severity can be difficult to determine. The management of intermediate coronary lesions, defined by a diameter stenosis of ≥40% to ≤70%, continues to be a therapeutic dilemma for cardiologists. The 2-dimensional representation of the arterial lesion provided by angiography is limited in distinguishing intermediate lesions that require stenting from those that simply need appropriate medical therapy. In the era of drug-eluting stents, some might propose that stenting all intermediate coronary lesions is an appropriate solution. However, the possibility of procedural complications such as coronary dissection, no reflow phenomenon, in-stent restenosis, and stent thrombosis requires accurate stratification of patients with intermediate coronary lesions to appropriate therapy. Myocardial fractional flow reserve (FFR) is an index of the functional severity of coronary stenosis that is calculated from pressure measurements made during coronary angiography. The objective of the study is to evaluate the usefulness of FFR in patients with angiographically intermediate coronary artery stenosis.Methods: 20 patients with intermediate coronary stenosis and chest pain of uncertain origin. The Exercise Electrocardiography (TMT), Myocardial Perfusion Imaging study (MPI), Quantitative Coronary Angiography (QCA) were compared with the results of FFR measurements.Results: 20 patients were undergone FFR measurement during the study period. With the mean age of 57.25±11.2 and male patients were 16 (80%), female patients 4 (20%), in all 13 patients with an FFR of 0.75 tested negative for reversible myocardial ischemia on TMT and MPI study. No revascularization procedures were performed in 7 (35%) patients, and no adverse cardiovascular events were noted in all these patients during 6 months of follow-up.Conclusions: In patients with coronary stenosis of intermediate severity, FFR appears to be a useful index of the functional severity of the stenosis and the need for coronary revascularization.

Effect of Benzothiazole based conjugates in causing apoptosis by Regulating p53, PTEN and MAP Kinase proteins affecting miR-195a and miR-101-1

<p>Abstract</p> <p>Background</p> <p>Hepatocellular carcinoma (HCC) accounts for majority of liver cancers and is the leading cause of cancer related death in Asia. Like any other cancer, HCC develops when there is a mutation to the cellular machinery that causes the cell to replicate at a higher rate and results in the loss of apoptosis. Therefore, a delicate balance between the expression of various genes involved in proliferation and apoptosis decide the ultimate fate of the cell to undergo rapid proliferation (cancer) or cell death.</p> <p>Results</p> <p>The benzothiazole based compounds exhibited effective cytotoxicity at 4 μM concentration and have shown G1 cell cycle arrest with decrease in levels of G1 cell cycle proteins such as cyclin D1 and Skp2. Involvement of tumour suppressor proteins such as PTEN and p53 was studied. Interestingly these compounds displayed decrease in the phosphorylated forms of AKT, p38 MAPK and ERK1/2 which play a vital role in cell proliferation. Compounds have exhibited strong and significant effect on the expression of micro RNAs such as miR-195a & miR-101-1 which regulate hepatic cell proliferation.</p> <p>Conclusions</p> <p>The cell cycle arrest and apoptotic inducing nature of these compounds was revealed by FACS, BrdU cell proliferation and tunel assays. Compounds affected both tumour suppressor proteins as well as proteins that are involved in active cell proliferation. Micro RNAs whose target is Cyclin D1 such as miR-195a and miR-101-1 that is required for growth of hepatoma cells was drastically affected. These compounds caused apoptosis by activating caspase-3 and PARP.</p

Quality of a life skills training program in Karnataka, India - a quasi experimental study

Abstract Background Youth focused Life Skills Education and Counseling Services (YLSECS) program, trained teachers/National Service Scheme (NSS) officers to deliver Life Skills Education (LSE) and counseling services to college going youth in the state of Karnataka in India. Available evaluation of life-skills training program have neglected the recording and or reporting of outcome among those trained to implement life-skills training program. Present paper highlights the quality of YLSECS training program and change in perception among teachers/NSS-officers trained in-terms of improvement in their cognitive/affective domains. Methods YLSECS program focused on World Health Organization identified ten essential domains of life-skills. Participants of the YLSECS program were trained by adopting facilitatory approach based on the principles of Kolb’s learning theory. Quasi experimental study design was used to evaluate the outcome of training among participants. Quality of the training was assessed using scoring system and change in perception was assessed using Likert scale. Statistical significance of change in perception before and after training was assessed by paired‘t’ test for proportion. Results Overall, 792 participants rated the quality of training as either “good” or “excellent”. Post-training, significant (p < 0.001) proportion of the participants reported improved awareness about life-skills (before training 49.9 to 74.4% vs post-training range from 91.6 to 95.1% for various domains). There was statistically significant (p < 0.001) increase in participants reporting “very confident” in teaching various life skill domains (before training from 22.7 to 34.2% for various domains and post-training it ranged from 65.2 to 74.7% for various domains). There was modest increase in participants reporting perceived ability to conduct life-skills workshop “without assistance” post-training (before training from 16.8 to 22.9% for various domains vs post-training ranged from 29.8 to 36.8% for various domains). Interestingly, considerable proportion of participants who prior to training reported being confident in providing life skills training (without any assistance), later (i.e post training) reported they need some/more assistance for the same. Conclusion YLSECS training program significantly improved participants knowledge and confidence in imparting life-skills and highlight the need for continued handholding of participants for effective implementation of LSE and counseling service program

Novel Etoposide Analogue Modulates Expression of Angiogenesis Associated microRNAs and Regulates Cell Proliferation by Targeting STAT3 in Breast Cancer.

Tumor microenvironment play role in angiogenesis and carcinogenesis. Etoposide, a known topoisomerase II inhibitor induces DNA damage resulting in cell cycle arrest. We developed a novel Etoposide analogue, Quinazolino-4β-amidopodophyllotoxin (C-10) that show better efficacy in regulating cell proliferation and angiogenesis. We evaluated its role on expression of microRNAs-15, 16, 17 and 221 and its targets Bcl-2, STAT3 and VEGF that dictate cell proliferation and angiogenesis. Docking studies clearly demonstrated the binding of Etoposide and C-10 to STAT3. We conclude that combination of Etoposide or C-10 with miR-15, 16, 17 and 221 as a new approach to induce apoptosis and control angiogenesis in breast cancer

Improving bethesda reporting in thyroid cytology: A team effort goes a long way and still miles to go…

Context: Fine-needle aspiration cytology is the first step in evaluation of thyroid nodules. Although the Bethesda classification for reporting thyroid cytology has been purported that this uniformity in reporting cytology thereby facilitating clinical decision-making, there are also studies indicating that the reporting percentage and the rates of malignancy in each category vary considerably from center to center making the clinical decision more difficult. Aim and Materials and Methods: We looked at our retrospective cytology and histopathology data of thyroid nodules operated between 2012 and 2014 and then prospectively collected data during 2015–2016. In the prospective arm, for every thyroid nodule that was sampled, there was a discussion between the endocrinologist and the cytopathologist on the risk of thyroid cancer (based on the patient's history, examination findings, sonographic pattern, and the cytological appearance). Results: We noted that there was considerable improvement in reporting standards with the rates of nondiagnostic cytology dropping from 11% to 5%, an increased reporting of Bethesda Category 2 and 6 which are the definitive strata of benign and malignant nodules (38% to 41% in Category 2 and 7% to 11% in Category 6) with a high specificity (100%). There was a decline in numbers of Category 4 and 5 (13% to 9% in Category 4 and 12% to 3% in Category 5). The reporting prevalence of Category 3 increased from 19% to 27%. Conclusions: We conclude that a team approach between the clinician who performs the ultrasound and the reporting cytopathologist improves Bethesda reporting, its predictive value, and thus potentially avoiding unnecessary thyroidectomies in benign thyroid nodules and hemithyroidectomies in thyroid cancers

Combinatorial effect of C-10 and microRNAs on its target genes.

<p>(A and B) MCF-7 and MDA-MB-231 cells were transfected with microRNA-15, 16, 17 and 221 for 24 h followed by treatment with Cisplatin, Etoposide or C-10 and incubated for 24 h. Western blot analysis showing decrease in levels of Bcl-2, STAT3 and VEGF proteins. GAPDH was used as loading control in all combinations separately.</p