Chrysin and flunixin meglumine mitigate overloaded copper-induced testicular and spermatological damages via modulation of oxidative stress and apoptosis in rats.

This study aimed to evaluate the possible protective actions of chrysin and flunixine meglumine on testicular and spermatological injuries experimentally stimulated by copper. We separated 36 male Sprague-Dawley rats into six equal groups: control, chrysin, flunixine meglumine, copper, copper +chrysin and copper +flunixine meglumine. Chrysin (50 mg/kg/bw/po), flunixine meglumine (2.2 mg/kg/bw/ip) and copper (500 mg/kg/bw/po) were administered day to day for 21 days. Copper administration caused significant morphological, physiological and biochemical alterations compared to the control group, which are as follows: production of oxidative stress, thanks to rise in testis lipid peroxidation and fall in antioxidant enzyme concentrations, decrease in sperm quality and increase in morphologic sperm abnormalities, suppression of spermatogenesis and prominent alterations in the testis histomorphology and induction of apoptosis in the testis tissues. On the other hand, compared to the copper group, treatment with chrysin or flunixine meglumine significantly attenuated these alterations. In conclusion, chrysin and flunixine meglumine have benefits such as antioxidant, antiapoptotic and anti-inflammatory against copper-induced testicular and spermatological damages in rats via the modulation of oxidative stress and apoptosis. Consequently, chrysin is a natural product which has comparable therapeutic actions to flunixine meglumine on the male reproductive system.

Does measurement of the jugular foramen diameter on MRI help to differentiate transverse sinus thrombosis from unilateral transverse sinus hypoplasia?

BACKGROUND AND PURPOSE: The transverse sinus (TS) is a frequent location of cerebral venous thrombosis. However, unilateral TS hypoplasia is a frequent variation and radiological imaging pitfall in the diagnosis because it may mimic unilateral TS thrombosis. The purpose of this study is to find a cutoff value for bilateral jugular foramen (JF) diameter ratios on magnetic resonance imaging (MRI) for differentiating TS thrombosis from TS hypoplasia. MATERIALS AND METHODS: We retrospectively reviewed magnetic resonance venography results for 174 patients with reduced unilateral TS caliber resulting from either unilateral thrombosis (80 patients) or unilateral hypoplasia (94 patients). We calculated the ratio by proportioning the diameter of the JF ipsilateral to the TS with caliber reduction to the diameter of the contralateral JF. The Mann-Whitney U test was used to compare the ratios between thrombosis and hypoplasia groups, and the cutoff value was calculated by receiver-operating characteristic curve analysis. RESULTS: The ratio of bilateral JF diameters was lower in patients with hypoplasia than those with thrombosis (P < .01). The cutoff value to determine the diagnosis of TS hypoplasia with maximum accuracy was 0.638, with a sensitivity of 91.3% and specificity of 64.9%. CONCLUSION: In equivocal cases, calculating the cutoff value by proportioning the diameter of JF ipsilateral to the TS with caliber reduction to the contralateral JF seems to be an efficient, quick, and straightforward method and valuable aid to differentiate TS thrombosis from TS hypoplasia.

Search for the G spot: microvessel and nerve mapping of the paraurethral anterior vaginal wall.

INTRODUCTION AND HYPOTHESIS: Orgasm and other sexual responses such as pain, arousal and lubrication may be mediated by nerve fibers and vessels in the lamina propria and muscularis of the vaginal wall, in which case the number of nerve fibers and vessels would be associated with sexual functions. The aim of the study is to map the distribution of nerves and vessels in the anterior vaginal wall along the paraurethral region in a systematic fashion. METHODS: Specimens were taken from women with anterior vaginal wall prolapse undergoing colporrhaphy anterior repair. All specimens were mapped in a standard way starting 15 mm proximal to the external urethral orifice. Selected blocks of samples were immunohistochemically stained: actin, smooth muscle Ab-1 and S100 Protein Ab-1. The numbers of microvessels and nerves in the lamina propria and muscularis were counted in five consecutive high-power fields of a light microscope. Pairwise comparisons of proximal, distal, right and left paravaginal microvessel and nerve fiber density were analyzed with paired-sample t-test or Wilcoxon signed-rank test. RESULTS: Vaginal nerve fibers in the lamina propria and muscularis have a fairly even distribution in the anterior vaginal wall. Vaginal small vessel vascularization and microvascularization are also evenly distributed, with no concentrated site along the paraurethral region of the anterior vaginal wall. CONCLUSIONS: Nerve fiber, nerve bundle, microvessel and small vessel densities in the lamina propria and muscularis were fairly regular, with no concentrated site on the paraurethral region of the anterior vaginal wall.

Sex disparities in acute myocardial infarction care and outcomes.

AIM: We investigated sex-based and regional outcomes after contemporary percutaneous coronary intervention (PCI) with the Xience V stent in patients with acute myocardial infarction (AMI). METHODS AND RESULTS: This patient level pooled analysis includes three multi-center, prospective post-market registries performed in the US, Japan, and China. A total of 1,938 patients treated with Xience V stents in the setting of AMI were enrolled. Compared to men, women had higher major adverse cardiac events (MACE) (14.1% vs. 9.8% P < 0.01, RR 1.4, 95% CI 1.1-1.4) and all-cause mortality (10% vs. 6.2% P < 0.01, RR 1.61, 95% CI 1.14-2.27) at one year, without any significant difference in device specific outcomes of target vessel failure (TVF). US patients compared to the patients from China and Japan had increased MACE (female: 18% vs. 7.1%, P = 0.0012, male: 15.7% vs. 4.1%, P < 0.0001). Multivariable analysis demonstrated that major bleeding was the strongest predictor of MACE (OR 10.51, 95%CI 4.01-27.50, P < 0.0001), MI (OR 4.26, 95%CI 1.37-13.29, P = 0.012), and all-cause death (OR 5.3, 95%CI 2.32-12.13, P < 0.0001). CONCLUSION: Women with AMI who underwent PCI with XIENCE DES have higher all-cause mortality at one year in compared to men. Region based outcomes demonstrated increased MACE among US patients compared to the patients from China and Japan. After adjusting for differences in demographics, major bleeding, rather than female sex, predicted the higher observed all-cause mortality.

Investigation of the effects of in ovo taurine injection on hatching characteristics and stress reduction potential.

BACKGROUND: In ovo application is the process of administering some nutrients or components into the egg. The main purpose of this application is to ensure that some nutrients are provided to chicks with a short incubation period. Few studies were conducted with taurine in fertile eggs; especially, no observation of hatchability and chick quality has been found. In addition, taurine has an anti-stress impact that fights oxidative factors. OBJECTIVE: To assess the hatchability and chick quality after in ovo taurine administration. To determine the stress that may occur as a result of in ovo application and whether taurine has a stress-reducing effect. METHODS: A total of 1200 fertile eggs from a 34-week-old broiler breeder (Ross 308) flock were categorized into 4 groups with 75 eggs per replicate: control (uninjected), taurine group (0.30 mL dissolved taurine in distilled water), sham control (sterile distilled water) and perforation (eggs perforated and then waxed). On day 14 of incubation, an in ovo injection was administered to the albumen. Data on hatching parameters and hepatic HSP70 levels were obtained using relevant formulas and western blotting, respectively. RESULTS: Control chicks exhibited higher hatchability than other groups, with the taurine group showing the lowest hatchability. The HSP70 levels were the highest in the perforation group compared to the control group. An increase of 21.37% in the taurine group and 83.45% in the sham control group was observed compared to the control group. CONCLUSIONS: The findings suggest that in ovo application may induce increased stress, whereas taurine may have positive effects in mitigating the stress caused by in ovo application.

Xenotransplantation of Microencapsulated Parathyroid Cells as a Potential Treatment for Autoimmune-Related Hypoparathyroidism.

OBJECTIVES: Hypoparathyroidism occurs as a part of a complex autoimmune syndrome or iatrogenically after neck surgery. The disease presents many challenges, such as hypocalcemia, hyperphosphatemia, and low/undetectable parathormone levels. Allotrans - plantation of parathyroid tissue or cells has been reported as a promising option to overcome these effects. Transplantation of microencapsulated parathy - roid tissue or cells offers an immune escape, which particularly restores the parathyroid function for autoimmune-related hypoparathyroidism. So far, clinical and in vivo studies have demonstrated limited graft survival and instability for the available biocompatible materials. In addition, the transplant site, proper local isolation, and biocompatibility of materials are directly related to survival rate. MATERIALS AND METHODS: A microencapsulated parathy - roid xenotransplant model by using high guluronic acid-containing ultrapure alginate transplanted into rat omentum was tested in vivo for 1 year. RESULTS: After stability of empty microcapsules was ensured, parathyroid cells were microencapsulated and transplanted in rats, with results compared versus rats with naked (nonencapsulated) parathyroid cells (both groups followed for 64 weeks). Rats remained normocalcemic, and preinflammatory cytokine levels showed dramatic changes. Despite a delay posttransplant, parathormone levels increased significantly. All retrieved microencapsules elicited pericapsular fibrotic overgrowth; however, the fibrosis area was shown to be well tolerated. CONCLUSIONS: The possible role of accumulation/cell infiltration of immune response remains to be elucidated. In conjunction with this, the use of nonencapsulated parathyroid cells was also positively correlated with survival rates. A similar evaluation using ultrapure alginate materials and omental transplantation may enable the future determination for the long-term effects of correction of parathor - mone insufficiency in patients with severe hypocalcemic responses and other endocrine diseases.

MENTOR study: Matching expectations and needs to optimize relationships in cardiovascular fellowship training.

Study objective: Mentorship is a key component of successful cardiology training. This study sought to understand the alignment of mentorship priorities for fellow-in-training (FIT) mentees and faculty mentors. Design: Cross-sectional survey study. Setting: Online. Participants: Cardiology mentors and FIT mentees in the State of Connecticut. Interventions: None. Main outcome measures: Likert-scale graded valuations on the importance of and satisfaction with various categories of mentorship by both mentors and mentees. Results were analyzed using Mann-Whitney, Kruskal-Wallis and Wilcoxon signed-rank tests, where appropriate. Results: Forty-eight percent of FITs (n = 34) and 16% of faculty mentors (n = 34) responded to the survey. Of those, 74% of FITs identified a mentor within the first year of fellowship either by directly contacting the mentor or meeting them through a clinical rotation. Mentors significantly undervalued the importance to FITs of providing research opportunities (4.5 vs 3.6, p < 0.05), helping them make contacts (4.5 vs 3.7, p < 0.05) and providing job-search support (4.3 vs 3.3, p < 0.05). In contrast, mentors overestimated the value of work-life balance and clinical mentorship to FITs. Conclusions: FITs value support in research, job search support, and networking more than mentors realize, leading to an expectation-satisfaction gap in those areas of mentorship. Further studies to examine how mentors and mentees can best align their expectations may improve the efficacy of the mentorship process.

Usefulness of Intra-aortic Balloon Pump in Patients With Cardiogenic Shock.

Predictors of survival in cardiogenic shock (CS) treated with intra-aortic balloon pump (IABP) are not clearly understood. In this retrospective study, we sought to evaluate patient characteristics and impact of timing of IABP in treatment of CS. Patients presenting to the Yale New Haven Hospital in CS who received IABP between February 2013 and April 2017 were included in the study. We assessed baseline characteristics and clinical predictors of 30-day mortality. Hundred ninety-three (n = 193) patients were included in this study. Mean age was 68.8 ± 14.5 years. Thirty percent (30%) were women, 38% had cardiac arrest, and left ventricular ejection fraction was 33.7 ± 14.9%. Overall 30-day mortality was 36%. Thirty-day mortality was 24% when IABP was placed within less than 1 hour of onset of CS versus 49% when implanted ≥1 hour after recognition of CS (p = 0.001). Mortality was 18%, 21%, 36%, and 74% for patient requiring 0, 1, 2, and 3 or more inotropes after IABP placement (p < 0.001). In multivariate analysis, advancing age, cardiac arrest on presentation, time to IABP implantation, and number of inotropes needed after IABP implantation predicted 30-day mortality. In the 193 patients, 134 (69.4%) presented with CS from ACS and 59 (30.6%) with CS from non-ACS-related causes. No difference in mortality was noted between the ACS and non-ACS groups 34.3% versus 40.7% (p = 0.39). In conclusion, early use of IABP in CS was associated with significant improvement in 30-day mortality regardless of the etiology of CS. Continued need for significant inotropic support after IABP is associated with worse prognosis and maybe used as an indicator for need to escalate to higher levels of support.

The Clinical Utility of a Precision Medicine Blood Test Incorporating Age, Sex, and Gene Expression for Evaluating Women with Stable Symptoms Suggestive of Obstructive Coronary Artery Disease: Analysis from the PRESET Registry.

Background: Evaluating women with symptoms suggestive of coronary artery disease (CAD) remains challenging. A blood-based precision medicine test yielding an age/sex/gene expression score (ASGES) has shown clinical validity in the diagnosis of obstructive CAD. We assessed the effect of the ASGES on the management of women with suspected obstructive CAD in a community-based registry. Materials and Methods: The prospective PRESET (A Registry to Evaluate Patterns of Care Associated with the Use of Corus® CAD in Real World Clinical Care Settings) Registry (NCT01677156) enrolled 566 patients presenting with symptoms suggestive of stable obstructive CAD from 21 United States primary care practices from 2012 to 2014. Demographics, clinical characteristics, and referrals to cardiology or further functional and/or anatomical cardiac studies after ASGES testing were collected for this subgroup analysis of women from the PRESET Registry. Patients were followed for 1-year post-ASGES testing. Results: This study cohort included 288 women with a median age 57 years. The median body mass index was 29.2, with hyperlipidemia and hypertension present in 48% and 43% of patients, respectively. Median ASGES was 8.5 (range 1-40), with 218 (76%) patients having low (≤15) ASGES. Clinicians referred 9% (20/218) low ASGES versus 44% (31/70) elevated ASGES women for further cardiac evaluation (odds ratio 0.14, p < 0.0001, adjusted for patient demographics and clinical covariates). Across the score range, higher ASGES were associated with a higher likelihood of posttest cardiac referral. At 1-year follow-up, low ASGES women experienced fewer major adverse cardiac events than elevated ASGES women (1.3% vs. 4.2% respectively, p = 0.16). Conclusions: Incorporation of ASGES into the diagnostic workup demonstrated clinical utility by helping clinicians identify women less likely to benefit from further cardiac evaluation.

Evolving Concepts in Diagnosis and Management of Cardiogenic Shock.

Despite efforts at early revascularization in acute coronary syndrome and advancing technologies in the field of temporary mechanical circulatory support (TMCS), the mortality from cardiogenic shock (CS) remains very high. Treatment of these patients involves understanding the trajectory of the condition and making complex decisions regarding the appropriate selection of medical and device therapies. The current definition of CS is not universally applicable and defines shock in absolute terms. CS should be thought of as a continuum rather than a binary diagnosis and is best defined as a clinical syndrome of tissue hypoperfusion resulting from cardiac dysfunction. Early intervention with appropriate timing and selection of apposite TMCS device may be the key to improving outcomes. TMCS device selection is a complex process requiring consideration of the severity of CS, patient-specific risks, technical limitations, overall goals of care, and assessment of futility of care. In this review, we discuss identification and pathophysiology of CS, and critically review acute management strategies, both medical and mechanical therapies and outline areas that need further investigation.