A Rare Association of Takotsubo Cardiomyopathy with High-degree Atrioventricular Block

Here we present a case of a patient who got trapped in an elevator; on initial evaluation patient was found with bradycardia; on further evaluation electrocardiogram (EKG) showed new onset 2nd-degree Mobitz type 2 AV block. On admission patient developed ischemic changes on EKG and troponin elevation. Transthoracic echocardiogram showed reduced ejection fraction as well as apical inferior, anterior, lateral, and septal hypokinesia. Coronary angiography showed nonobstructive coronary artery disease and ventriculogram demonstrated anterolateral and apical hypokinesia suggesting takotsubo cardiomyopathy (TCM). Atrioventricular block (AV) is rarely seen as initial presentation of TCM and has a prevalence of about 2.9%. AV block during early presentation of TCM poses a therapeutic dilemma with regard to the timing and the need to place a temporary or permanent pacemaker. The decision to place a permanent pacemaker may be on a case-by-case basis and more research is needed on formulating standardized recommendations in patients with TCM and conduction tissue abnormalities

Morphological Characterization and Lumped Element Model of Graphene and Biochar Thick Films

Carbon based materials exhibit interesting mechanical, thermal and electrical properties which make them excellent contenders for use as fillers in composites as film. Graphene has been vastly used among the carbon-based materials. More recently eco-friendly carbon-based materials like biochar have emerged. The deployment of carbon-based materials in films needs to be studied since films are more versatile and permit the exploitation of electrical properties of such materials over circuits and systems. Typical circuits and systems exploiting electrical properties of novel materials perform a number of applications including sensing, detection, tunable devices and energy harvesting. In this paper, films composed of 9:1 graphene or biochar are deployed on a microstrip line. The morphological properties of graphene and biochar and their respective films are studied with Raman spectra and Field Emission Scanning Electron Microscope (FESEM). The electrical properties (four-point probe measurements and scattering parameter measurements) of the films. Low frequency measurements are used as starting point for circuit models estimating the lumped impedance of the films. From the morphological characterization it is shown that biochar films appear as granulates carbonaceous materials whereas graphene films contains several flakes forming a network. From the low frequency measurements and microwave characterization it is seen that graphene films are more conductive as compared to biochar films. In many applications, it is useful to know the surface impedance of the film since it varies on interaction with any external stimulus (variation of pressure, humidity, gas, etc.)

Apport de l’échographie dans les traumatismes oculaires à Parakou (Bénin)

Introduction: Décrire l’apport de l’échographie réalisée avec un appareil polyvalent dans les traumatismes oculaires. Méthodes: Il s’agit d’une étude prospective descriptive réalisée du 01 février au 01 aout 2010 dans le service d’imagerie médicale du CHD Borgou. Trente deux (32) patients présentant un traumatisme oculaire avec baisse de l’acuité visuelle ont bénéficié d’une échographie oculaire réalisée grâce à un échographe polyvalent. Résultats: L’âge moyen de nos patients était de 29,40 ans (extrêmes 1 et 68 ans). Le sexe ratio (H/F) était de 1,67.Sur 39 yeux traumatisés, l’il droit était atteint dans 22 cas (56,4%), et l’il gauche dans 17 (43,6%) cas. Les contusions ont constitué la variété anatomo-clinique la plus fréquente : 32 cas (82%). Les différentes lésions observées étaient : une hémorragie isolée du vitré 13 cas (33,3%), un décollement rétinien 6 cas (15,4%), un décollement choroïdien 6 cas (15,4%), un décollement postérieur du vitré 5 cas (12,8%), une cataracte 5 cas (12,8%) et une luxation postérieure du cristallin dans 3 cas (7,7%). Conclusion: L’échographie oculaire même réalisée avec un appareil polyvalent permet un bilan lésionnel satisfaisant des traumatismes oculaires.Key words: Traumatisme oculaire, échographie, hémorragie vitréenne, décollement de la rétin

Genetic variation of CYP2C19 affects both pharmacokinetic and pharmacodynamic responses to clopidogrel but not prasugrel in aspirin-treated patients with coronary artery disease

The metabolic pathways leading to the formation of prasugrel and clopidogrel active metabolites differ. We hypothesized that decreased CYP2C19 activity affects the pharmacokinetic and pharmacodynamic response to clopidogrel but not prasugrel. Ninety-eight patients with coronary artery disease (CAD) taking either clopidogrel 600 mg loading dose (LD)/75 mg maintenance dose (MD) or prasugrel 60 mg LD/10 mg MD were genotyped for variation in six CYP genes. Based on CYP genotype, patients were segregated into two groups: normal function (extensive) metabolizers (EM) and reduced function metabolizers (RM). Plasma active metabolite concentrations were measured at 30 min, 1, 2, 4, and 6 h post-LD and during the MD period on Day 2, Day 14, and Day 29 at 30 min, 1, 2, and 4 h. Vasodilator-stimulated phosphoprotein (VASP) and VerifyNow (TM) P2Y12 were measured predose, 2, and 24 +/- 4 h post-LD and predose during the MD period on Day 14 +/- 3 and Day 29 +/- 3. For clopidogrel, active metabolite exposure was significantly lower (P = 0.0015) and VASP platelet reactivity index (PRI, %) and VerifyNow (TM) P2Y(12) reaction unit (PRU) values were significantly higher (P < 0.05) in the CYP2C19 RM compared with the EM group. For prasugrel, there was no statistically significant difference in active metabolite exposure or pharmacodynamic response between CYP2C19 EM and RM. Variation in the other five genes demonstrated no statistically significant differences in pharmacokinetic or pharmacodynamic responses. Variation in the gene encoding CYP2C19 in patients with stable CAD contributes to reduced exposure to clopidogrel's active metabolite and a corresponding reduction in P2Y(12) inhibition, but has no significant influence on the response to prasugrel

Characterisation and evaluation of the regenerative capacity of Stro-4+ enriched bone marrow mesenchymal stromal cells using bovine extracellular matrix hydrogel and a novel biocompatible melt electro-written medical-grade polycaprolactone scaffold

Many skeletal tissue regenerative strategies centre around the multifunctional properties of bone marrow derived stromal cells (BMSC) or mesenchymal stem/stromal cells (MSC)/bone marrow derived skeletal stem cells (SSC). Specific identification of these particular stem cells has been inconclusive. However, enriching these heterogeneous bone marrow cell populations with characterised skeletal progenitor markers has been a contributing factor in successful skeletal bone regeneration and repair strategies. In the current studies we have isolated, characterised and enriched ovine bone marrow mesenchymal stromal cells (oBMSCs) using a specific antibody, Stro-4, examined their multipotential differentiation capacity and, in translational studies combined Stro-4+ oBMSCs with a bovine extracellular matrix (bECM) hydrogel and a biocompatible melt electro-written medical-grade polycaprolactone scaffold, and tested their bone regenerative capacity in a small in vivo, highly vascularised, chick chorioallantoic membrane (CAM) model and a preclinical, critical-sized ovine segmental tibial defect model.Proliferation rates and CFU-F formation were similar between unselected and Stro-4+ oBMSCs. Col1A1, Col2A1, mSOX-9, PPARG gene expression were upregulated in respective osteogenic, chondrogenic and adipogenic culture conditions compared to basal conditions with no significant difference between Stro-4+ and unselected oBMSCs. In contrast, proteoglycan expression, alkaline phosphatase activity and adipogenesis were significantly upregulated in the Stro-4+ cells. Furthermore, with extended cultures, the oBMSCs had a predisposition to maintain a strong chondrogenic phenotype. In the CAM model Stro-4+ oBMSCs/bECM hydrogel was able to induce bone formation at a femur fracture site compared to bECM hydrogel and control blank defect alone. Translational studies in a critical-sized ovine tibial defect showed autograft samples contained significantly more bone, (4250.63 mm3, SD = 1485.57) than blank (1045.29 mm3, SD = 219.68) ECM-hydrogel (1152.58 mm3, SD = 191.95) and Stro-4+/ECM-hydrogel (1127.95 mm3, SD = 166.44) groups.Stro-4+ oBMSCs demonstrated a potential to aid bone repair in vitro and in a small in vivo bone defect model using select scaffolds. However, critically, translation to a large related preclinical model demonstrated the complexities of bringing small scale reported stem-cell material therapies to a clinically relevant model and thus facilitate progression to the clinic

Beer industry in Brazil: Economic aspects, characteristics of the raw material and concerns

Barley is one of the most cultivated grains in the world with numbers rising every year due to market demand. In the past decade, Brazil has shown impressive numbers considering beer production. However, barley cultivation does not reach the necessary amount for the beer industry which raises the need to import barley or to use some alternatives, such as, adjuncts. The most common adjunct used is corn, which is considered a good source of carbohydrates, but also a very contaminated grain. Research and monitoring of all of the steps of the chain is being carried out to improve not only the malt quality but also the competitiveness in world market

Recovering history: Philip Morton Shand and the mission of modernism

Within the context of Modern architectural history the position of Philip Morton Shand (1888 - 1960) as a key figure in its dissemination has been historically understated. Although not a designer, his role as architectural critic and writer in conjunction with the breadth of his international contacts enabled him to bridge a gap between continental Europe and England. His contributions to the major English architectural journals (i.e. Architect's Journal, Architectural Review and the Architectural Association Journal) between the late 1920s and early 1950s, in addition to his travels, language skills and his involvement in the CIAM and the MARS Group, facilitated the dissemination of ideas to the English-speaking population. Beyond his architectural writings, Shand was also a connoisseur of wine and food and published seminal texts on the topics. However, despite his significant literary contributions, a biography of Shand has not yet been written. An investigation into Shand's life and activities, particularly during the interwar years, will hopefully illuminate the magnitude of his involvement in the architectural scene and its effects on the dissemination of Modern architectural history

Urticaria : recommendations from the Italian Society of Allergology, Asthma and Clinical Immunology and the Italian Society of Allergological, Occupational and Environmental Dermatology

Background: Urticaria is a disorder affecting skin and mucosal tissues characterized by the occurrence of wheals, angioedema or both, the latter defining the urticaria-angioedema syndrome. It is estimated that 12-22% of the general population has suffered at least one subtype of urticaria during life, but only a small percentage (estimated at 7.6-16%) has acute urticaria, because it is usually self-limited and resolves spontaneously without requiring medical attention. This makes likely that its incidence is underestimated. The epidemiological data currently available on chronic urticaria in many cases are deeply discordant and not univocal, but a recent Italian study, based on the consultation of a national registry, reports a prevalence of chronic spontaneous urticaria of 0.02% to 0.4% and an incidence of 0.1-1.5 cases/1000 inhabitants/year. Methods: We reviewed the recent international guidelines about urticaria and we described a methodologic approach based on classification, pathophysiology, impact on quality of life, diagnosis and prognosis, differential diagnosis and management of all the types of urticaria. Conclusions: The aim of the present document from the Italian Society of Allergology, Asthma and Clinical Immunology (SIAAIC) and the Italian Society of Allergological, Occupational and Environmental Dermatology (SIDAPA) is to provide updated information to all physicians involved in diagnosis and management of urticaria and angioedema

Designing Irreversible Inhibitors—Worth the Effort?

This is the peer-reviewed version of the following article: González-Bello, C. (2016). Designing Irreversible Inhibitors-Worth the Effort?. Chemmedchem, 11(1), 22-30, which has been published in final form at https://doi.org/10.1002/cmdc.201500469. This article may be used for non-commercial purposes in accordance with Wiley-VCH Terms and Conditions for Self-ArchivingDespite the unquestionable success of numerous irreversible drugs that are currently in clinical use, such as acetylsalicylic acid (Aspirin) and penicillin, the number of such approved drugs is much lower than that of noncovalent drugs. Over the years, the potential off‐target effects of these types of compounds have been the primary concern that has hampered their development. However, their remarkable advantages over noncovalent drugs and a better analysis of the risks have decreased the widespread skepticism surrounding them. The design of irreversible inhibitors is a challenge, particularly considering that in some cases their efficacy is due to complex and unexpected mechanisms of action. In this review the main advantages of irreversible inhibition are summarized, and the complexity of certain covalent modification mechanisms is highlighted with selected examplesSpanish Ministry of Economy and Competitiveness. Grant Number: SAF2013-42899-R Xunta de Galicia. Grant Number: GRC2013-041 European Regional Development Fund (ERDF)S