Reliability of coronary computed tomography angiography in acute coronary syndrome in an emergency setting.

BACKGROUND: Cardiovascular computed tomography (cardiovascular CT) is currently used as a fast non-invasive method for the visualization of coronary plaques and walls and the assessment of lumen stenosis severity. Previous studies demonstrated the high negative predictive value of CT for the exclusion of coronary lumen stenoses. In this study we hypothesize that coronary CT angiography (CTA) represents a reliable method as diagnostic procedure in acute coronary syndrome (ACS) even in emergency settings. METHODS: 36 patients (51 lesions) with ACS who underwent cardiovascular CT, intravascular ultrasound (IVUS) and invasive coronary angiography (ICA) within 48 h were included. The percentage of coronary stenoses were measured and compared by three methods. Influence of available predictors that can potentially affect the measurement results was assessed. RESULTS: Cardiac CTA provided comparable results to IVUS (mean difference -0.45%, PPV: 98%, NPV: 75%). ICA tends to estimate lower stenoses degrees than cardiac CTA and IVUS (mean difference 13.19% and 13.64%, respectively). The final diagnosis and positive remodeling did not lead to any significant influence on measurements. CONCLUSIONS: The cardiovascular CT results show that even in emergency settings it is possible to identify morphological changes as sequels of coronary artery sclerosis with comparable results to the reference method IVUS. Deviations of IVUS and cardiovascular CT from ICA are comparable and can to a large extent be explained by differences in the measurement technique.

[Experience with Prasugrel in the Treatment of Patients with Acute Coronary Syndrome].

BACKGROUND: Dual antiplatelet therapy (DAPT) with aspirin and one of inhibitors of P2Y12 receptors (clopidogrel, ticagrelor, prasugrel) is an international standard of receptors (clopidogrel, ticagrelor, prasugrel) is an international standard of is an international standard of treatment strategy in patients with acute coronary syndrome (ACS). PURPOSE: to analyze experience of prasugrel use in the National Medical Cardiology Research Center in comparison to similar groups of patients treated with other P2Y12 inhibitors for determination of optimal place of DAPT with prasugrel in ACS patients. Materials and methods. We included in this retrospective study 40 patients who received therapy with prasugrel, ticagrelor, or clopidogrel in connection with urgent percutaneous coronary intervention (PCI) performed in the Department of Urgent Cardiology from May to December 2018. We analyzed specific characteristics of prasugrel treated patients including disease history, features of clinical presentation and coronary anatomy, use of strategies of escalation and de-escalation, as well as inhospital mortality, development of complications and side effects. Results. New P2Y12 inhibitors were more effective in patients with higher risk of atherothrombosis compared with risk of bleeding. Median of implanted stents in ticagrelor and clopidogrel groups was equal to 1, in the prasugrel group - 2 stents per PCI. When multivascular stenting was performed the choice usually was made in favor of prasugrel or ticagrelor, excluding cases with presence of limiting factors - use of oral anticoagulants (OAC) (n=4) and prehospital thrombolytic therapy (n=5). Of note was close to statistical significance high number of side effects related to ticagrelor use (n=3, 23.08%, p=0.057). There were no significant differences between groups in rates of unfavorable outcomes and complications. Conclusion. Administration of prasugrel can be considered in patients with high risk of atherothrombosis: with diabetes, with large number of implantable stents. The choice between ticagrelor and prasugrel can be made with consideration of the potential for side effects that significantly impair the quality of life of patients. Main limitations for application of both prasugrel and ticagrelor are the need to permanent use of OAC, prehospital thrombolytic therapy, and higher cost compared to clopidogrel.

Preclinical Toxicity of Paclitaxel Biopolymer Formulation.

BACKGROUND: Poly(hydroxyalkanoates) (PHA) have recently attracted increasing attention due to their biodegradability and high biocompatibility, which makes them suitable for the development of new prolong drug formulations. OBJECTIVE: A preclinical toxicology study of paclitaxel biopolymer formulation (PBF) (paclitaxel-loaded poly(3- hydroxybutyrate) (PHB) microparticles) was done in order to assess its safety and to forecast side and toxic effects in a clinical study on patients. METHOD: PHB microparticles loaded with antitumor cytostatic drug PTX were obtained by spray-drying method using Nano Spray Dryer B-90. The comprehensive study of cytotoxicity (on bone marrow stem cells), acute and chronic toxicity, allergenic and pyrogenic properties, histological investigation (in mice, rats and rabbits) of obtained PBF was carried out. RESULTS: The acute toxicity study showed that PBF is much less toxic in equivalent PTX-content doses than PTX in conventional formulation when administered intraperitoneally to mice and rats. However, the chronic toxicity study showed that at intraperitoneal administration PBF has distinct cumulative properties and toxic effects that prevent PBF from clinical testing in current composition. CONCLUSION: Thus, the PBF as a prolong drug needs to correct its parameters for further drug formulation development.

Therapeutic effect of a single peritumoural dose of IL-2 on transplanted murine breast cancer.

Interleukin-2 therapy is not clearly effective against breast cancer both in mouse models and in human patients. However, the study of IL-2 therapy of breast cancer remains important, as 3,700 women died from this malignancy in the Netherlands in 2000. Previously we have shown the therapeutical efficacy of a single peritumoural IL-2 application in different experimental models and in veterinary patients. Here we apply this mode of IL-2 therapy to advanced mouse mammary carcinoma models, i.e., severe metastasised tumours in A/Sn mice and non-metastasised carcinomas in BALB/c mice. Mice with advanced transplanted mammary carcinomas were given a single peritumoural treatment with 2.5 x 10(6) IU IL-2 at days 10-14 after i.p. or s.c. inoculation of 10(6) carcinoma cells. Within each experiment it was always possible to distinguish relatively slowly and fast growing tumours which allows the therapeutical effect of IL-2 in tumours with different growth rates to be studied. A new approach to analyse results enabled us to show that survival of mice with transplanted, advanced metastasised breast cancer can be significantly improved after a single local treatment with IL-2. Advanced relatively fast i.p and s.c. growing mammary carcinomas seem to be more sensitive to a single IL-2 treatment than relatively slowly growing tumours. IL-2 was most effective against non-metastasised mouse breast cancer.