Effect of Colchicine on Progression of Known Coronary Atherosclerosis in Patients with STable CoROnary Artery Disease CoMpared to Placebo (EKSTROM) Trial - Rationale and Design.

BACKGROUND: Cardiovascular disease is the major cause of mortality in the United States. Despite lifestyle modification and traditional risk factor control residual inflammatory risk remains an untreated concern. Colchicine is an oral, medication that has been used for gout, mediterranean fever and pericarditis for decades. In recent trials, colchicine has been shown to reduce major adverse cardiovascular events, however the mechanism of benefit remains unclear. The objective of the randomized, double-blind, placebo controlled EKSTROM trial is to evaluate the effects of colchicine 0.5mg/day on atherosclerotic plaque. METHODS: Eighty-four participants will be enrolled after obtaining informed consent and followed for 12 months. Eligible patients will be randomly assigned to colchicine 0.5mg/day or placebo in a 1:1 fashion as add-on to their standard of care. All participants will undergo coronary computed tomography angiography (CCTA) at baseline and at 12 months. RESULTS: As of November 2023, the study is 100% enrolled with an expected end of study by the second quarter of 2024. The primary endpoint is change in low attenuation plaque volume as measured by CCTA. Secondary endpoints include change in volume of different plaque types (including total atheroma volume, noncalcified plaque volume, dense calcified plaque volume, remodeling index), change in inflammatory markers (IL-6, IL-1ß, IL-18, hs-CRP), change in pericoronary adipose tissue attenuation, change in epicardial adipose tissue volume and attenuation and change in brachial flow mediated dilation. CONCLUSION: EKSTROM is the first randomized study to assess the effects of colchicine on plaque progression, pericoronary and epicardial fat. EKSTROM will provide important information on the mechanistic effects of colchicine on the cardiovascular system.

The impact of carbohydrate restriction-induced elevations in low-density lipoprotein cholesterol on progression of coronary atherosclerosis: the ketogenic diet trial study design.

BACKGROUND: Despite innovations in pharmacotherapy to lower lipoprotein cholesterol and apolipoprotein B, risk factors for atherosclerotic cardiovascular disease (ASCVD), ASCVD persists as the leading global cause of mortality. Elevations in low-density lipoprotein cholesterol (LDL-C) are a well-known risk factor and have been a main target in the treatment of ASCVD. The latest research suggests that ketogenic diets are effective at improving most non-LDL-C/apolipoprotein B cardiometabolic risk factors. However, ketogenic diets can induce large increases in LDL-C to >190 mg/dl in some individuals. Interestingly, these individuals are often otherwise lean and healthy. The influence of increased levels of LDL-C resulting from a carbohydrate-restricted ketogenic diet on the progression of atherosclerosis in otherwise metabolically healthy individuals is poorly understood. This observational study aims to assess and describe the progression of coronary atherosclerosis in this population within 12 months. METHODS: Hundred relatively lean individuals who adopted ketogenic diets and subsequently exhibited hypercholesterolemia with LDL-C to >190 mg/dl, in association with otherwise good metabolic health markers, were enrolled and observed over a period of 12 months. Participants underwent serial coronary computed tomography angiography scans to assess the progression of coronary atherosclerosis in a year. RESULTS: Data analysis shall begin following the conclusion of the trial with results to follow. CONCLUSION: Ketogenic diets have generated debate and raised concerns within the medical community, especially in the subset exhibiting immense elevations in LDL-C, who interestingly are lean and healthy. The relationship between elevated LDL-C and ASCVD progression in this population will provide better insight into the effects of diet-induced hypercholesterolemia.

Testosterone therapy and the risk of cardiovascular disease in older, hypogonadal men.

The debate over the cardiovascular (CV) implications of testosterone therapy (TT) have resulted in diverging safety recommendations and clinical guidelines worldwide. This narrative review synthesizes and critically evaluates long-term studies examining the effects of TT within the context of aging, obesity, and endogenous sex hormones on CV disease (CVD) risk to support informed clinical decision-making. Observational studies have variably linked low endogenous testosterone with increased CVD risk, while randomized controlled trials (RCTs) demonstrate that TT yields cardiometabolic benefits without increasing short-term CV risk. The TRAVERSE trial, as the first RCT powered to assess CVD events, did not show increased major adverse cardiac events (MACE) incidence; however, its limitations - specifically the maintenance of testosterone at low-normal levels, a high participant discontinuation rate, and short follow-up - warrant a careful interpretation of its results. Furthermore, findings from the TTrials cardiovascular sub-study, which showed an increase in non-calcified plaque, indicate the need for ongoing research into the long-term CV impact of TT. The decision to initiate TT should consider the current evidence gaps, particularly for older men with known CVD. The CV effects of maintaining physiological testosterone levels through exogenous means remain to be fully explored. Until more definitive evidence is available, clinical practice should prioritize individualized care and informed discussions on the potential CV implications of TT.

Occlusion of femoral artery using Foley catheter: A REBOA inspired tale to save a life.

In this case report, we emphasized the need to control bleeding in emergency departments by any measure possible, as it is the first step toward successful resuscitation for saving the lives of patients with active bleeding.

Perceived social support in pregnant women with gestational diabetes attending hospitals in western Iran compared to healthy controls and its relationship with perceived anxiety.

Background/purpose: Due to the importance of social support in pregnant women, especially those with gestational diabetes that cause anxiety and stress in them and requires effective and enough attention, this study aims to assess perceived social support of pregnant women with gestational diabetes in western Iran compared to healthy controls and its relationship with their perceived anxiety. Methods: This is a descriptive/analytical study with a cross-sectional design conducted on 180 pregnant women with gestational diabetes (n = 89) and without gestational diabetes (n = 91) referred to the obstetrics and gynecology clinics of two hospitals (Asalian and Shahid Rahimi) in Khorramabad, western Iran. Data collection tools were a demographic checklist, the Multidimensional Scale of Perceived Social Support (MSPSS), and the Beck Anxiety Inventory (BAI). Collected data were analyzed in SPSS v.20 software using chi square test, independent t-test, one-way ANOVA, and Pearson correlation test. Results: The difference between the two groups was significant in terms of perceived support from family (p = 0.001), perceived support from friends (p = 0.006), and anxiety (p = 0.047). Pearson correlation test results showed a significant negative relationship between the scores of MSPSS and BAI in patients (r= -0.329, p = 0.001) and controls (r=-0.204, p = 0.006). There was a significant difference in the MSPSS score among diabetic women in terms of having fetal macrosomia (p = 0.005), occupation (p = 0.003), education (p = 0.001), and frequency of pregnancy (p = 0.010). Conclusions: The perceived social support level is higher in diabetic pregnant women compared to healthy peers in western Iran. Improvement of social support from family and friends can reduce the anxiety of pregnant women with/without diabetes.

Effects of reservoir rock pore geometries and ultrasonic parameters on the removal of asphaltene deposition under ultrasonic waves.

Asphaltene deposition around the wellbore is a major cause of formation damage, especially in heavy oil reservoirs Ultrasonic stimulation, rather than chemical injection, is thought to be a more cost-effective and environmentally friendly means of removing asphaltene deposition. However, it seems to be unclear how crucial features like reservoir pore geometries and ultrasonic parameters affect this ultrasound treatment. In this work, five two-dimensional glass micromodels with different pore geometries were designed to assess the impact of pore geometries on the ultrasonic removal of asphaltene deposition. Experiments were undertaken in an ultrasound bath at a set frequency (20 kHz) and adjustable powers (100-1000 W). Direct image analysis before, during and after sonication was used to assess the impact of pore geometry and a change in ultrasonic parameter on the removal of asphaltene deposition. The effectiveness of ultrasound treatment at various sonication periods were found to be reliant on the pore geometries of the individual micromodels. For micromodels with throat sizes 300 µm and pore shapes as circle, square and triangle, an increase in ultrasonic power from 400 to 1000 W resulted in an increase in the percentage of removed asphaltene deposition after 2 h from 12.6 to 14.7, 11.5 to 14.63, and 5.8 to 7.1 percent, respectively.

Recent applications of ultrasonic waves in improved oil recovery: A review of techniques and results.

Ultrasound technique is an inexpensive and ecofriendly technology commonly used in oil and gas industry to improve oil recovery and its applications have been successfully tested in both laboratory and field scales. In this technique, high-power ultrasonic waves are utilized downhole to improve oil recovery and reduce formation damage in near wellbore region that causes a reduction in hydrocarbon production rate due to the penetration of mud, scale deposition, etc. In most of the cases, barriers for the oil flow to the wellbore are effectively removed by using the ultrasound technique and the effect of improved oil recovery may last up to several months. The aim of this paper is to provide an overview of recent laboratory, field and mathematical studies to serve as reference for future extensive examination of ultrasound assisted improved oil recovery. As an added value to this field of study, research gaps and opportunities based on the review of recent works were identified and factors that needs to be considered to improve the outcome of future studies were recommended.

Mechanistic Investigation of LSW/Surfactant/Alkali Synergism for Enhanced Oil Recovery: Fluid-Fluid Interactions.

The combination of chemical enhanced oil recovery (CEOR) and low salinity water (LSW) flooding is one of the most attractive enhanced oil recovery (EOR) methods. While several studies on CEOR have been performed to date, there still exists a lack of mechanistic understanding on the synergism between surfactant, alkali and LSW. This synergism, in terms of fluid-fluid interactions, is experimentally investigated in this study, and mechanistic understanding is gained through fluid analysis techniques. Two surfactants, one cationic and one anionic, namely an alkyltrimethylammonium bromide (C19TAB) and sodium dodecylbenzenesulfonate (SDBS), were tested, together with NaOH used as the alkali, diluted formation brine used as the LSW, and the crude oil was collected from an Iranian carbonate oil reservoir. Fluids were analyzed using pendant drop method for interfacial tension (IFT) measurement, and Fourier transform infrared spectroscopy for determination of aqueous and oleic phase chemical interaction. The optimum concentration of LSW for IFT reduction was investigated to be 1000 ppm. Additionally, both surfactants reduced IFT significantly, from 28.86 mN/m to well below 0.80 mN/m, but in the presence of optimal alkali concentration the IFT dropped further to below 0.30 mN/m. IFT reduction by alkali was linked to the production of three different types of in situ anionic surfactants, while in the case of anionic and cationic surfactants, saponification reactions and the formation of the C19TAOH alcohol, respectively, were linked to IFT reduction. The critical micelle concentration and optimal alkali concentration when using cationic C19TAB were significantly lower than with the anionic surfactant; respectively: 335 vs 5000 ppm, and 500 vs 5000 ppm. However, it was found that SDBS was more compatible with NaOH than C19TAB, due to occurrence of alkali deposition with the latter beyond the optimal point.

The Efficacy and Safety of Modified Docetaxel, Cisplatin, and 5-Fluorouracil Vs. Epirubicin, Oxaliplatin, and Capecitabine Regimen in the Advanced Gastric Cancer: A Randomized Controlled Clinical Trial.

INTRODUCTION: One of the major challenges of advanced gastric cancer treatment is the lack of a standard regimen for patients. However, several clinical trials have shown that modified docetaxel, cisplatin, and 5-fluorouracil (m-DCF) and epirubicin, oxaliplatin, and capecitabine (EOX) regimens are superior to other regimens. METHODS: This randomized, single-center clinical trial was performed on 40 patients with advanced gastric cancer. The first group received the m-DCF regimen as follows: docetaxel (40 mg/m2) on the first day; cisplatin (40 mg/m2) on the first and second days; and 5-fluorouracil (400 mg/m2) from the first to fourth day. The second group received the EOX regimen, including epirubicin (50 mg/m2) and oxaliplatin (130 mg/m2) i.v on the first day and capecitabine at a twice-daily dose of 625 mg/m2 p.o for 21 days. Treatment was applied every three weeks for a total of eight cycles in both groups. In each group, the overall and progression-free survival rates and toxicity were assessed. RESULTS: A total of 40 patients were enrolled in this study (21 samples in the m-DCF group and 19 samples in the EOX group), 62.5% of whom were male. The median survival rate was 14.00 (95% CI: 11.82-16.18) months in the m-DCF group and 15.00 (95% CI: 9.56-20.43) months in the EOX group; however, differences between the groups were not significant. The progression-free survival rate was higher in the EOX group, although there was no significant difference between the two groups. Also, there was no significant difference regarding the side effects (e.g., toxicity) or need for supportive care between the groups. CONCLUSION: It seems that both m-DCF and EOX regimens are similar in terms of survival and toxicity and are recommended as first-line treatment for advanced gastric cancer with respect to the patient's status.

Ultrasound-assisted CO2 flooding to improve oil recovery.

CO2 flooding process as a common enhanced oil recovery method may suffer from interface instability due to fingering and gravity override, therefore, in this study a method to improve the performance of CO2 flooding through an integrated ultraosund-CO2 flooding process is presented. Ultrasonic waves can deliver energy from a generator to oil and affect its properties such as internal energy and viscosity. Thus, a series of CO2 flooding experiments in the presence of ultrasonic waves were performed for controlled and uncontrolled temperature conditions. Results indicate that oil recovery was improved by using ultrasound-assisted CO2 flooding compared to conventional CO2 flooding. However, the changes were more pronounced for uncontrolled temperature conditions of ultrasound-assisted CO2 flooding. It was found that ultrasonic waves create a more stable interface between displacing and displaced fluids that could be due to the reductions in viscosity, capillary pressure and interfacial tension. In addition, higher CO2 injection rates, increases the recovery factor in all the experiments which highlights the importance of injection rate as another factor on reduction of the fingering effects and improvement of the sweep efficiency.

Effect of ultrasound radiation duration on emulsification and demulsification of paraffin oil and surfactant solution/brine using Hele-shaw models.

Ultrasound technique is one of the unconventional enhanced oil recovery methods which has been of interest for more than six decades. However, the majority of the oil recovery mechanisms under ultrasound reported in the previous studies are theoretical. Emulsification is one of the mechanisms happening at the interface of oil and water in porous media under ultrasound. Oppositely, ultrasound is one of the techniques using in oil industry for demulsification of oil/water emulsion. Therefore, the conditions in which emulsification becomes dominant over demulsification under ultrasound should be more investigated. Duration of ultrasound radiation could be one of the factors affecting emulsification and demulsification processes. In this study a technique was developed to investigate the effect of long and short period of ultrasound radiation on emulsification and demulsification of paraffin oil and surfactant solution in porous media. For this purpose, the 2D glass Hele-shaw models were placed inside the ultrasonic bath under long and short period of radiation of ultrasound. A microscope was used above the model for microscopic studies on the interface of oil and water. Diffusion of phases and formation of emulsion were observed in both long and short period of application of ultrasound at the beginning of ultrasound radiation. However, by passing time, demulsification and coalescence of brine droplets inside emulsion was initiated in long period of ultrasound application. Therefore, it was concluded that emulsification could be one of the significant oil recovery mechanisms happening in porous media under short period of application of ultrasound.

Concordance of the tuberculin skin test and T-SPOT(®).TB test results in kidney transplant candidates.

BACKGROUND: Detection of latent tuberculosis infection (LTBI) in transplant candidates is very important. The tuberculin skin test (TST) and interferon-gamma release assays (IGRAs) are standard immunologic tools for LTBI detection. The aim of this study was to compare the TST results and T-SPOT(®).TB test (a type of IGRAs) in kidney transplant candidates for the screening of LTBI and follow the patients with positive test for an activation of tuberculosis (TB) after transplantation and using anti-TB prophylaxis. MATERIALS AND METHODS: This study was a prospective study and carried out in 44 renal transplant candidates from March 2010 to February 2011 in the teaching hospitals of Isfahan University of Medical Sciences, Iran. TST and T-SPOT(®).TB test were performed and their results evaluated. Patients with a positive skin test and/or T-SPOT(®).TB test were started on anti-TB prophylaxis and followed after transplantation for an activation of their LTBI for 1 year. RESULTS: Overall, 8 (18.2%) patients were positive for TST and 6 (13.6%) patients for T-SPOT(®).TB test. The agreement between TST and T-SPOT(®).TB test was moderate (κ = 0.49, 95% confidence interval 0.145-0.839). The overall agreement between TST and T-SPOT(®).TB test was 86%. No relation was found between the underlying diseases and TST or T-SPOT(®).TB test positivity. Although isoniazid prophylaxis was used for patients with positive TST and/or T-SPOT(®).TB test, one patient had reactivation of TB. CONCLUSION: In kidney transplant candidates both TST and T-SPOT(®).TB test were comparable for the diagnosis of LTBI with reasonable agreement between the tests. However, further studies are needed to determine the ability of T-SPOT(®).TB test to detect LTBI and to evaluate the need for prophylaxis in these patients.

Comparative evaluation of the effects of hydroxyethyl starch on coagulation state of patients during brain tumor surgeries in comparison to crystalloids by thromboelastography.

BACKGROUND: Hypercoagulability has been reported in primary brain tumors which can lead to thrombotic complications. Hydroxyethyl starch (hetastarch) is a synthetic colloid solution with adverse effects on blood coagulation. The aim of this study was to evaluate the protective effect of hetastarch in reducing thromboembolic events in these patients. MATERIALS AND METHODS: In a double-blinded clinical trial, 60 brain tumor surgery patients were randomly divided into two groups and given 10 mL/kg hetastarch or normal saline during surgery. Blood coagulation was compared before and after infusion of these fluids within and between groups by thromboelastography (TEG). RESULTS: There were no significant differences in bleeding (P = 0.126), duration of surgery (P = 0.504), and fluid intake (0.09L) between the two groups. Percentage of changes in R (R: Time to initiate fibrin formation), K (K: Measure of the speed taken to reach a specific level of clot strength), and Ly30 (Ly30: Percent of fibrin distraction after 30 minutes of clot formation) in the crystalloid group were -20.61 ± 26.46, -30.02 ± 49.10, and 1.27 ± 22.63, and that in the colloid group were 22.10 ± 26.11, 41.79 ± 37.15, and 59.09 ± 37.12, respectively. Deterioration in hemostasis during and after surgery was not observed. CONCLUSION: There was a reduction in the speed of clot formation and increase in clot lysis in the hetastarch group. Coagulability was decreased in the colloid group. Infusion of 10 mL/kg hetastarch in brain tumor resection surgeries can probably decrease susceptibility of these patients to deep vein thrombosis (DVT) and thromboembolic events.

A technique for evaluating the oil/heavy-oil viscosity changes under ultrasound in a simulated porous medium.

Theoretically, Ultrasound method is an economical and environmentally friendly or "green" technology, which has been of interest for more than six decades for the purpose of enhancement of oil/heavy-oil production. However, in spite of many studies, questions about the effective mechanisms causing increase in oil recovery still existed. In addition, the majority of the mechanisms mentioned in the previous studies are theoretical or speculative. One of the changes that could be recognized in the fluid properties is viscosity reduction due to radiation of ultrasound waves. In this study, a technique was developed to investigate directly the effect of ultrasonic waves (different frequencies of 25, 40, 68 kHz and powers of 100, 250, 500 W) on viscosity changes of three types of oil (Paraffin oil, Synthetic oil, and Kerosene) and a Brine sample. The viscosity calculations in the smooth capillary tube were based on the mathematical models developed from the Poiseuille's equation. The experiments were carried out for uncontrolled and controlled temperature conditions. It was observed that the viscosity of all the liquids was decreased under ultrasound in all the experiments. This reduction was more significant for uncontrolled temperature condition cases. However, the reduction in viscosity under ultrasound was higher for lighter liquids compare to heavier ones. Pressure difference was diminished by decreasing in the fluid viscosity in all the cases which increases fluid flow ability, which in turn aids to higher oil recovery in enhanced oil recovery (EOR) operations. Higher ultrasound power showed higher liquid viscosity reduction in all the cases. Higher ultrasound frequency revealed higher and lower viscosity reduction for uncontrolled and controlled temperature condition experiments, respectively. In other words, the reduction in viscosity was inversely proportional to increasing the frequency in temperature controlled experiments. It was concluded that cavitation, heat generation, and viscosity reduction are three of the promising mechanisms causing increase in oil recovery under ultrasound.