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Abstract Low-density lipoprotein cholesterol (LDL-C) is an important factor in the development of cardiovascular disease, making its management a key aspect of cardiovascular health. While high-dose statin therapy is often recommended for LDL-C reduction, careful consideration is needed due to patient-specific factors and potential side effects. This study aimed to develop a machine learning (ML) model to estimate the likelihood of achieving target LDL-C levels in patients hospitalized for coronary artery disease and treated with moderate-dose statins. The predictive performance of three ML models, including Extreme Gradient Boosting (XGBoost), Random Forest, and Logistic Regression, was evaluated using electronic medical records from the Asan Medical Center in Seoul across six performance metrics. Additionally, all three models achieved an average AUROC of 0.695 despite reducing features by over 43%. SHAP analysis was conducted to identify key features influencing model predictions, aiming insights into patient characteristics associated with achieving LDL-C targets. This study suggests that ML-based approaches may help identify patients likely to benefit from moderate-dose statins, potentially supporting personalized treatment strategies and clinical decision-making for LDL-C management.

Abstract Recent years have witnessed a tremendous popularity growth of optimization methods in high-frequency electronics, including microwave design. With the increasing complexity of passive microwave components, meticulous tuning of their geometry parameters has become imperative to fulfill demands imposed by the diverse application areas. More and more often, achieving the best possible performance requires global optimization. Unfortunately, global search is an intricate undertaking. To begin with, reliable assessment of microwave components involves electromagnetic (EM) analysis entailing significant CPU expenses. On the other hand, the most widely used nature-inspired algorithms require large numbers of system simulations to yield a satisfactory design. The associated costs are impractically high if not prohibitive. The use of available mitigation methods, primarily surrogate-based approaches, is impeded by dimensionality-related problems and the complexity in microwave circuit characteristics. This research introduces a procedure for expedited globalized parameter adjustment of microwave passives. The search process is embedded in a surrogate-assisted machine learning framework that operates in a dimensionality-restricted domain, spanned by the parameter space directions being of importance in terms of their effects on the circuit characteristic variability. These directions are established using a fast global sensitivity analysis procedure developed for this purpose. Domain confinement reduces the cost of surrogate model establishment and improves its predictive power. The global optimization phase is complemented by local tuning. Verification experiments demonstrate the remarkable efficacy of the presented approach and its advantages over the benchmark methods that include machine learning in full-dimensionality space and population-based metaheuristics.

Abstract The divide between the rich and poor in the European housing market is fast rising. Latest research indicates that Europe is dealing with an increasing number of homeless people. Every city in Europe has them—homeless people compelled to live on street corners, frequently hiding themselves with cardboard. Rain, snow, and temperatures below zero pose a threat to their lives on a daily basis. There are many varied kinds of services that have been discovered, but it is difficult to keep track of everyone and guarantee that they have a warm night's sleep in the winter. The current article suggests accommodation as a workaround until they can receive high-intensity support, a way to keep a single person warm and safe during the winter. The focus is on devising a strategy that not only ensures the warmth and safety of individuals during the harsh winter months but also seeks to industrialize the construction of shelters, ensuring affordability below the cost of winter hospitalization for a homeless person. Crucially, the article introduces an additional layer to this initiative by highlighting the dual purpose of these individual shelters. Beyond being a means to provide respite for the homeless during severe weather, these shelters are envisioned as immediate response units in the event of emergencies such as earthquakes in urban areas. The article explores the potential impact of this multi-layered approach on transforming urban landscapes and fostering resilient communities.

Purpose: To estimate the proportion and pattern distribution of glaucoma disease in a teaching hospital of North-East India. MATERIALS AND METHODS: Retrospective hospital-based study of glaucoma cases from January 2014 to December 2022. Results: Out of a total of 89725 new patients, 449 patients had glaucoma with a prevalence of 0.50% (95% CI: 0.46%-0.55%) of which 361 (80.4%) were ≥40 years and 88 (19.6%) were

Cinnamyl alcohol dehydrogenase (CAD) is a crucial enzyme in the final stage of lignin monomer biosynthesis. This study focuses on the CAD gene family within Gossypium hirsutum. Through comprehensive genomic analysis, we identified 29 GhiCAD genes within the Gossypium hirsutum genome using a bioinformatics approach. Phylogenetic analysis revealed that the GhiCAD family can be categorized into four subgroups, which are closest to the evolutionary relationship with Arabidopsis thaliana. There are multiple cis-acting elements on the promoters of GhiCAD genes associated with abiotic stress responses. Some GhiCAD genes demonstrated high expression in various tissues like root, leaf, and sepal, as well as in fiber and ovule at different developmental stages (10 days post anthesis (DPA), 15 DPA, 20 DPA, 25 DPA). The transcript levels of GhiCAD23 were notably elevated when exposed to PEG treatment and drought stress (DS). GhiCAD23 is also co-expressed with many known drought response genes, suggesting its involvement in the plant’s reaction to DS. Employing virus-induced gene silencing (VIGS) technology to silence the GhiCAD23 gene, it was found that silencing GhiCAD23 reduced the tolerance of cotton to DS. Under DS, the relative leaf water content, superoxide dismutase (SOD), and catalase (CAT) enzyme activities of the GhiCAD23-silenced cotton plants were decreased by 31.84%, 30.22% and 14.19%, respectively, while malondialdehyde (MDA) was increased by 72.16% compared with the control cohort. Drought promotes the accumulation of lignin, and it was found that silencing the GhiCAD23 reduces lignin accumulation in cotton under DS. The analysis of phenotypic and physiological indicators indicates that GhiCAD23 is vital in cotton’s resistance to DS. This investigation provides an important reference for future comprehensive exploration of the GhiCAD23 gene’s function in cotton’s DS response mechanism.

Background: Sudden cardiac death (SCD) is a major public health concern worldwide, affecting all age and social groups. Methods: In this retrospective study, of the 8265 autopsies performed in the Institute of Legal Medicine, 1618 cases of SCD were included. The aim of this study is to identify demographic characteristics, etiological factors, epidemiological characteristics and risk factors that lead to SCD. Results: The highest incidence of SCD was in age group 40–69 years (65.0%), 71.6% of this age group being men. Of the total number, 32.1% (520) occurred in the emergency room. The most common cause of sudden death is represented by coronary atherosclerotic disease, reported in 89.8% (1453) of cases, tricoronary lesions being found in 60% (870) of cases. Etiological factors of SCD encountered during autopsies were acute myocardial infarction in 13.9% (225), dilated cardiomyopathy 43.9% (710), cardiac hypertrophy 579 (36.07%), pericarditis 1.9% (30), myocarditis 1.73% (28) and adipositas cordis 5% (81). Along with epicardial fat and BMI, alcohol consumption was recorded in 17.9% (290), this being a potential trigger. Conclusions: Based on forensic autopsy and histological findings, a wide variety of factors are involved in the etiopathogenesis of SCD, some of which can be eliminated through preventive measures implemented early.

Coronary artery disease (CAD) is a non-communicable disease that is the main cause of death and loss of disability-adjusted life years (DALYs) globally. Patients can experience various complications that affect the severity of the disease. Various factors, especially self-management behavior, can influence the severity of CAD patients. This study aimed to determine the relationship between self-management behavior and the severity of CAD in Dr. Zainoel Abidin Regional General Hospital Banda Aceh. This study used a cross-sectional design from March 28 to May 19, 2023. The sample consisted of 221 CHD patients who had undergone coronary angiography, were selected using purposive sampling, and met the inclusion and exclusion criteria. Data was collected through guided interviews using the self-management scale (CSMS) and syntax score. Data were analyzed descriptively and inferentially. Data analysis showed a significant relationship between self-management behavior and the severity of CAD. Daily life management (p=0.000, OR=5.334), disease management (p=0.000, OR=2.633), and emotional management (p=0.000, OR=2.047) were associated with the severity of CAD. Logistic regression indicated that daily life management was the most dominant factor associated with the severity of CAD (OR=5.334). Good daily life, disease, and emotional management can help reduce the risk of complications and improve the prognosis of CAD patients. Self-management behavior, particularly daily life management, is significantly related to the severity of CAD in Dr. Zainoel Abidin Regional General Hospital patients.

Objective This study aimed to investigate a variety of machine learning (ML) methods to predict the association between cardiovascular risk factors and coronary artery disease-reporting and data system (CAD-RADS) scores. Methods This is a retrospective cohort study. Demographical, cardiovascular risk factors and coronary CT angiography (CCTA) characteristics of the patients were obtained. Coronary artery disease (CAD) was evaluated using CAD-RADS score. The stenosis severity component of the CAD-RADS was stratified into two groups: CAD-RADS score 0-2 group and CAD-RADS score 3–5 group. CAD-RADS scores were predicted with random forest (RF), k-nearest neighbors (KNN), support vector machines (SVM), neural network (NN), decision tree classification (DTC) and linear discriminant analysis (LDA). Prediction sensitivity, specificity, accuracy and area under the curve (AUC) were calculated. Feature importance analysis was utilized to find the most important predictors. Results A total of 442 CAD patients with CCTA examinations were included in this study. 234 (52.9%) subjects were CAD-RADS score 0–2 group and 208 (47.1%) were CAD-RADS score 3–5 group. CAD-RADS score 3-5 group had a high prevalence of hypertension (66.8%), hyperlipidemia (50%) and diabetes mellitus (DM) (35.1%). Age, systolic blood pressure (SBP), mean arterial pressure, pulse pressure, pulse pressure index, plasma fibrinogen, uric acid and blood urea nitrogen were significantly higher (p

(1) Background: “Eagle Syndrome”, also known as “stylalgia” or a “stylohyoid chain anomaly”, typically manifests with ipsilateral orofacial pain, a foreign body sensation in the throat, and ear-related symptoms. Despite these common presentations, its potential association with carotid artery dissection is not widely acknowledged. (2) Methods: This article presents an extremely rare case of a patient diagnosed with an ischemic stroke in the left hemisphere, followed by the dissection of the left internal carotid artery, initially with an unidentified cause. Subsequent examinations revealed elongated left styloid processes directly compressing the dissected artery. (3) Results: After initial treatment involving pharmacological and mechanical thrombectomy, styloidectomy restored blood flow to the internal carotid artery. The patient remained symptom-free during a 12-month follow-up. (4) Conclusions: This case emphasizes the importance of considering anatomical variations within the stylohyoid chain when assessing young individuals with neurological symptoms. Furthermore, it underscores the potential benefits of early surgical intervention in reducing the morbidity and mortality associated with this condition.

Aim– to analyze the relationship between fQRS and myocardial fibrosis in CAD patients using SPECT. Material and methods.Retrospectively, we have analyzed the anamnesis and examinations of 116 patients with suspected coronary heart disease. The fQRS was assessed according to the criteria of Das M. et al., 2006, along with the presence of a pathological Q wave and a slow increase in the amplitude of the R wave. We analysed the transient myocardial ischemia and/or myocardial scarring using stress/rest SPECT with technetium-99m. Results.fQRS was significantly more frequently detected in patients with stable and partially reversible perfusion defects – 44.1% and 52.2%, respectively, versus 13.0% and 5.5% in patients without perfusion defects or with reversible perfusion defects, p 0.05. Among 28 patients with QRS fragmentation and myocardial fibrosis, 19 (67.8%) had classical signs of fibrosis on the ECG, 9 (32.1%) had no ECG-registered fibrosis but fQRS was detected. The sensitivity of fQRS marker in detecting myocardial fibrosis reached 84.4%, the specificity was 63.3%. Conclusion.fQRS complex is an informative marker for detecting myocardial scarring in patients with coronary artery disease. Analysis of fQRS in daily clinical practice may increase the diagnostic value of electrocardiography in the detection of fibrosis.

Aims. To investigate the association of the aortic propagation velocity (APV) with coronary artery disease (CAD) in patients with stable angina pectoris (SAP) through SYNTAX scores (SS). Methods. The study population comprised 214 SAP subjects who received a coronary angiography. The APV and carotid intima-media thickness (CIMT) were examined and SS was calculated. Subjects were grouped following specific SS criteria: SS less than 22 (low) and SS greater than or equal to 22 (high). Results. High SS subjects had lower APV compared to low SS [39.0 (32.0-51.7) vs. 55.0 (45.0-62.0) cm/s, respectively; P

Abstract Background and Aims Little is known about the clinical relevance of pericardial fat volume (PFV), compared to other conventional cardiovascular risk factors, as predictors of coronary atherosclerosis severity among postmenopausal women. Our main aim was to assess the association of PFV and cardiovascular risk factors with coronary atherosclerosis burden, including occlusive coronary artery disease (CAD) (luminal stenosis >50%), coronary artery calcium score (CAC) >100, and plaque types in postmenopausal women. Methods Patients who had chest pain of angina and referred for 64‐slice multi‐detector CT (MDCT) angiography examination to exclude occlusive CAD presence were enrolled in this retrospective study. Results A total of 241 women with absence of menses for more than 2 consecutive years and not taking hormone replacement therapy were enrolled in the present study. Increased PFV (OR [CI] = 1.1 [1−1.3], p = 0.004), age (OR [CI] = 1.1 [1−1.4], p = 0.002), and diabetes mellitus (OR [CI] = 2 [1−4], p = 0.025) were significant predictors of occlusive CAD presence. Increased PFV (OR [CI] = 1.1 [1−1.4], p = 0.017) and increased age (OR [CI] = 1.2 [1.1−1.4], p 100 than other cardiovascular risk factors. Regarding coronary plaque types, increased age (OR [CI] = 1.1 [1.1−1.3], p = 0.001) showed a significant association with coronary calcified plaque presence while increased body mass index(OR [CI] = 1.2 [1−1.4], p = 0.018) showed a significant association with coronary non‐calcified plaque presence. Conclusion Higher PFV values showed an independent association with occlusive CAD and significant coronary calcification. This may imply that increased PFV is likely associated with the development of advanced and severe phenotype of coronary atherosclerosis among postmenopausal women with suspected CAD.

Os sistemas Computer-Aided Diagnosis (CAD) auxiliam a deteção e diferenciação de lesões benignas e malignas, aumentando a performance no diagnóstico do cancro da mama. As lesões da mama estão fortemente correlacionadas com a forma do contorno: lesões benignas apresentam contornos regulares, enquanto as lesões malignas tendem a apresentar contornos irregulares. Desta forma, a utilização de medidas quantitativas, como a dimensão fractal (DF), pode ajudar na caracterização dos contornos regulares ou irregulares de uma lesão. O principal objetivo deste estudo é verificar se a utilização concomitante de 2 (ou mais) medidas de DF – uma tradicionalmente utilizada, a qual foi designada por “DF de contorno”; outra proposta por nós, designada por “DF de área” – e ainda 3 medidas obtidas a partir destas, por operações de dilatação/erosão e por normalização de uma das medidas anteriores, melhoram a capacidade de caracterização de acordo com a escala BIRADS (Breast Imaging Reporting and Data System) e o tipo de lesão. As medidas de DF (DF contorno e DF área) foram calculadas através da aplicação do método box-counting, diretamente em imagens de lesões segmentadas e após a aplicação de um algoritmo de dilatação/erosão. A última medida baseia-se na diferença normalizada entre as duas medidas DF de área antes e após a aplicação do algoritmo de dilatação/erosão. Os resultados demonstram que a medida DF de contorno é uma ferramenta útil na diferenciação de lesões, de acordo com a escala BIRADS e o tipo de lesão; no entanto, em algumas situações, ocorrem alguns erros. O uso combinado desta medida com as quatro medidas propostas pode melhorar a classificação das lesões.

Background: Patients with atrial fibrillation undergoing percutaneous coronary intervention have indications for oral anticoagulation and dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor inhibitor. The concurrent use of all three agents, termed triple oral antithrombotic therapy (TAT), increases the risk of bleeding. A number of prospective trials showed that the omission of aspirin mitigates the risk of bleeding without affecting major adverse cardiovascular event (MACE). Materials and Methods: The databases of PubMed, Embase, and Cochrane Central databases were searched from inception to October 2019. Relevant randomized control trials comparing dual antithrombotic therapy (DAT) versus TAT were identified and a metanalysis was performed using random-effect model. The safety endpoints of interest were thrombolysis in myocardial infarction criteria (TIMI) major and minor bleeding, TIMI major bleeding, and intracranial bleeding. The efficacy endpoints of interest were MACE and individual components of MACE. Results: Six trials with 11,722 patients were included. For safety endpoint, DAT was associated with significantly lower incidence of TIMI major and minor bleeding [RR: 0.58, 95% CI 0.44–0.77, P = 0.0001], TIMI major bleeding [RR: 0.55, 95% CI 0.42–0.73, P < 0.0001] as well as intracranial bleeding [RR: 0.35, 95% CI 0.16–0.73, P = 0.006] compared with TAT. No significant difference was observed for MACE [RR: 0.96 (0.79–1.17) P = 0.71] or any of the individual components of MACE between the two groups. Conclusion: Omission of aspirin from TAT in patients with Atrial Fibrillation (AF) after percutaneous coronary intervention is associated with lower risk of bleeding without compromising the efficacy in terms of mortality and cardiovascular thrombotic events.

Abstract Background Elevated lipoprotein(a) [Lp(a)] and fibrinogen (Fib) are both associated with coronary artery disease (CAD). The atherogenicity of Lp(a) can be partly due to the potentially antifibrinolytic categories. We hypothesize that patients with higher Lp(a) and Fib may have worse outcomes. Methods In this prospective study, we consecutively enrolled 8,417 Chinese patients with stable CAD from March 2011 to March 2017. All subjects were divided into 9 groups according to Lp(a) (Lp(a)-Low, Lp(a)-Medium, Lp(a)-High) and Fib levels (Fib-Low, Fib-Medium, Fib-High) and followed up for CVEs, including nonfatal acute myocardial infarction, stroke, and cardiovascular mortality. Kaplan–Meier, Cox regression and C-statistic analyses were performed. Results During a median of 37.1 months’ follow-up, 395 (4.7%) CVEs occurred. The occurrence of CVEs increased by Lp(a) (3.5 vs. 5.3 vs. 5.6%, p = 0.001) and Fib (4.0 vs. 4.4 vs. 6.1%, p

Introduction Breast Cancer is the most prevalent type of cancer among women and is also the second major cause of cancer. Due to the acquired resistance of cancer cells against conventional therapies and recurrence of the sickness after treatment, new therapeutic strategies based on triggering apoptosis have been proposed. The purpose of the present study is to introduce a cytotoxic effect of biological silver nanoparticles toward breast cancer MCF-7 cells and evaluation of the caspase-activated DNase (CAD) gene expression at mRNA level. Materials and Methods Silver nanoparticles were synthesized according to the recent biosynthesize method. Afterward, the Silver nanoparticles were inspected using transmission electron microscopy (TEM) analysis. Different concentrations of 6.25, 12.5, 25, 50, 100, and 200 µg/ml of Nanosilver particles were treated on MCF-7 cells for 24 hours and the results were evaluated using the MTT assay and IC50 were measured. The level expression of CAD gene was evaluated using real-time PCR. Results Silver nanoparticles were mostly spherical, having an average size of 9.13±4.86 nm. Silver nanoparticles demonstrated a dose-dependent toxic effect toward MCF-7 cells. The IC50 value of silver nanoparticles was measured 49μg/mL. In addition, the expression of CAD decreased by 0.77 fold, compared to the control group. Conclusion The results of the present study demonstrated that the silver nanoparticles can induce cytotoxicity against breast cells and it is necessary to perform more tests against animal models.

Coronary artery disease (CAD) is the leading cause of death followed by cancer, in men and women. With risk factors being endemic and the increasing costs of healthcare for management and treatment, myocardial perfusion imaging (MPI) finds a central role in risk stratification and prognosis for CAD patients, but it comes with its limitations in that the referring clinician and managing team must be aware of and use at their advantage. This narrative review examines the utility of myocardial perfusion scans in the diagnosis and management of patients with ECG alterations such as atrioventricular block (AVB), and medications including calcium channel blockers (CCB), beta blockers (BB), and nitroglycerin which may impact the interpretation of the exam. The review analyzes the current evidence and provides insights into the limitations, delving into the reasons behind some of the contraindications to MPI.

Atrial fibrillation and coronary artery disease are commonly coexisting conditions that necessitate the use of an oral anticoagulant as well as dual antiplatelet therapy. Commonly referred to as triple oral antithrombotic therapy (TT), this helps prevent ischemic stroke and myocardial infarction but comes at the expense of an increased risk of bleeding. There is a growing body of evidence that the omission of aspirin from TT has the same preventive efficacy in terms of major adverse cardiacvascular and cerebrovascular events (MACCE) with significantly lower bleeding events. The combination of antiplatelet agents and direct oral anticoagulants (DOAC) is a matter of ongoing research. However, initial studies showed favorable safety profile of DOAC over vitamin K antagonist in combination with antiplatelet agents.

Background and Aim: Considering the effect of coronary heart disease (CAD) on the health status, the present study aimed to investigate the effectiveness of Mindfulness-Based Stress Reduction on health status and disease symptoms of patients with CAD after CABG. Materials and Methods: The research method was single subject. The statistical population of study included all patients with coronary artery disease in Tabriz city who referred to Shahid Madani Hospital in Tabriz during the second six months of the year 2016 for rehabilitation after surgery. The study sample consisted of four available CAD patients. Seattle's Angina Questionnaire (SAQ) and a researcher-designed scale for CAD symptoms were used as tools. Data were analyzed through recovery percentage, PND, SMD and visual analysis of chart method. Ethical Considerations: This study with research ethics code 2384411 has been approved by research ethics committee at Tabriz university of medical sciences, Iran. Findings: Results indicated that MBSR has a moderate efficiency in improving the disease symptoms. The effectiveness of MBSR is relatively low in improving the health status of patients with CAD. Conclusion: It can be concluded that MBSR is a relatively effective treatment on reducing disease symptoms of CAD patients and is a relatively poor intervention to improve the health status of these patients.

Introduction According to the American College of Radiology and the American Cancer Society, CTC has been recognized as a valuable screening method for detecting CRC in people at medium risk as an alternative to endoscopic colonoscopy. The condition for the proper interpretation of this procedure is the patient’s preparation for the examination. The evaluation of the test includes: topogram, transverse images (as reference images), multifaceted reconstructions and three-dimensional images (3D navigator). Materials and methods The literature on the use of CTC in the diagnosis of CRC was analyzed. A review of the scientific literature indexed in the PUBMED database from the last 10 years was carried out. Results The introduction of dual energy computed tomography (DECT) clearly improved the diagnostic accuracy of CTC. The main advantage of DECT is the possibility of obtaining iodine maps and VNC (virtual non-contrast) – a ’’virtual’’ native image (without the use of contrast). DECT allows you to monitor the results and extent of iodine capture on VNC and iodine map images, respectively, without using pre-recorded tomographic images. Pilot tests showed that DECT is an effective tool in CT colonography diagnostics and electronic colon loop cleaning after barium labeling. The use of the Computer Aided Diagnosis (CAD) algorithm in high energy tomography helps in the diagnosis and detection of intestinal tumors. Conclusions The development of modern technologies used in CT colonography proves that it is a safe and acceptable technique for patients. Lack of invasiveness, low radiation dose and high diagnostic efficiency of CTC may encourage more people to undergo colorectal cancer screening in the future.

Aim: The development of coronary artery disease (CAD), a highly prevalent disease worldwide, is influenced by several modifiable risk factors. Predictive models built using machine learning (ML) algorithms may assist clinicians in timely detection of CAD and may improve outcomes. Materials & methods: In this study, we applied six different ML algorithms to predict the presence of CAD amongst patients listed in ‘the Cleveland dataset.’ The generated computer code is provided as a working open source solution with the ultimate goal to achieve a viable clinical tool for CAD detection. Results: All six ML algorithms achieved accuracies greater than 80%, with the ‘neural network’ algorithm achieving accuracy greater than 93%. The recall achieved with the ‘neural network’ model is also the highest of the six models (0.93), indicating that predictive ML models may provide diagnostic value in CAD.

Introduction: Regarding scarce knowledge about bleeding in non-valvular atrial fibrillation (AF) patients with simultaneous coronary artery disease (CAD) under triple anti-coagulant therapy, this study was carried out to recognize the risk of hemorrhage and preventive programming. Materials and Methods: In this performed prospective, 150 consecutive patients with non-valvular atrial fibrillation and concurrent coronary disease, candidate for triple therapy with Asprin 80 mg, Clopidogrel 75 mg and Rivaroxaban 15 mg (in Shohada, Loghman, Modarres, and Labafinezhad centers, in Tehran, Iran during Jan 2019 to Jan 2020 were enrolled and the incidence rate of bleeding and compliance were evaluated for one month. Results: The results in this study demonstrated that 87.3% had compliance and completely use three drugs. Bleeding occurred in 0.6 % (4 patients), no major bleeding , only one minor bleeding as GIB, three minimal cases (totally 4 bleeding cases), 3 cases with epistaxis, 7 patients with ecchymosis, 6 subjects with hematuria, no one required discontinuation of drug. Diabetes mellitus, hypertension, female sex, older age, higher HASBLED Score, and higher CHADS-VASC Score were related to lack of compliance (P < 0.05). Conclusion: Incidence rate of bleeding in atrial fibrillation plus coronary concurrent patients, candidate for triple therapy with ASA, Clopidogrel and Rivaroxaban is low. Also the bleeding is minor and the compliance is high showing that majority of cases use routinely these triple therapy regimen.

Introduction: Coronary artery disease (CAD) is rapidly developing epidemic in India due to increasing urbanization and a change to a sedentary lifestyle. Aim: Aim of study was to determine the value of ultrasound measurements of internal carotid artery intima-media thickness as a surrogate marker for coronary artery disease, to compare measurements of internal carotid artery intima-media thickness with findings of coronary angiography and to establish correlation between internal carotid artery intima-media thickness and various risk factors for coronary artery disease. Methods: The prospective study comprise of 200 patients who had clinically suspected CAD and undergone coronary angiography admitted to department of medicine and cardiology in our hospital during time period from august 2018 to February 2020. Carotid Doppler of each patients undergoing coronary angiography was done and intima media thickness of bilateral ICA were taken. Results: The largest increase in intimal medial thickness was observed in hypertensive patient. In our study 138 patients (69%) are male and 62 patients (32%) are female. Males are affected more than female by CAD in our study. Incidence of CAD is highest amongst the patients within range of 51- 60 years that is 39.5%. In the present study, 97.22 % patients having dyslipidemia had IMT > 0.8, while 93.5 % patients having hypertriglyceridemia had IMT > 0.8. Conclusion: The conclusion of this study is that increase in the carotid intramural thickness have a high and specific likelihood of CAD and that ultrasound examination of the carotid arteries can effectively predict atherosclerosis of the coronary arteries.

Abstract Background The purpose of this study is to provide the relevant equations and the reference tables needed for calculating the maximum errors in implant positioning attributed to the properties of the mechanical parts of any CAD/CAM implant surgical guide, especially the in-office manufactured ones. Methods An algorithm was developed and implemented in C programming language in order to accurately calculate the maximum error at the apex, error at the neck, vertical error at the apex and deviation of implant axis, between the planned and the actual implant position. The calculations were based on the parameters of total length (= implant length + offset), offset (distance from neck of implant to the lip of the metal sleeve), clearance (space between the bur and the sleeve), sleeve length. The variability of the parameters was constrained: (1) implant length, 8–18 mm; (2) sleeve length, 4–7 mm; (3) clearance, 50–410 μm; and (4) offset values, 6–17 mm. Multiple regression analysis was conducted to quantify the relationship between the error at the apex and the error at the neck and various predictors. Results The equations used for the bespoke estimation of the errors in implant positioning along with three reference tables of the various errors tabulated are presented. The maximum error at the apex of the implant was computed 2.8 mm, the maximum deviation of the implant axis 5.9° and the maximum error at the neck (entrance) of the implant was estimated 1.5 mm. The vertical error between the planned and actual implant position can be considered negligible (

Dual energy radiographic imaging is a method to provide material information and can be used to differentiate between various tissue types. Dual energy X-ray absorption (DEXA) can be applied for breast density, osteoporosis or bone fracture analysis. To support radiologists with the assessment of DEXA images, machine learning can be applied. Specifically, deep convolutional neural networks (DCNNs) can be used for medical image analysis. In this work a DCNN is proposed and evaluated for automated detection of bone splinters in DEXA phantom images. The image data consists of 47 phantoms with (35) and without (12) bone splinters. Material decomposition and energy weighting results in additional image channels. Various DCNN architectures and parameters were explored. A classification rate in regions with 90 % and without 99 % bone splinters was achieved.

Background: Pranayama is a science of breathing which involves prolongation and control of breath. It is known through various studies that yogic practices improve respiratory and cardiovascular function, reduce stress, anxiety and enhance overall well-being and quality of life. However, hemodynamic effects of short term yoga are not well known. Objective: To study the acute hemodynamic effects of pranayama in stable post coronary artery bypass grafting (CABG) patients. Study Design: Case control study. Methods: 60 post CABG patients were divided into - a) study group and b) control group (30 patients each). Cardiorespiratory parameters were noted in control group without pranayama and in study group, 5, 10, 15, 20 and 30 minutes after pranayama. Results were analyzed statistically. Results: There was a reduction in systolic blood pressure (126.10 ± 14.54 to 118.67 ± 13.74; p

Background and Aim: Coronary artery disease (CAD) is a multifactorial inherited disorder in which the arteries that blood to the heart muscle become hardened and narrowed. We aimed at investigating the role of rs5186 (A1166C) polymorphism the angiotensin II type 1 receptor (AGTR1) gene as risk factors in some Iranian CAD patients. Materials and Methods: In this case-control study 137 samples were selected from 141 CAD Iranian patients, who had had CABG surgery. Besides, 137 healthy controls matched for age, sex, and ethnicity were taken. After extracting DNA of the blood samples, A1166C AGTR1 gene polymorphism was studied using tetra-primer ARMS-PCR method. The results of a single tube T-ARMS-PCR were validated using DNA sequencing method. For genetic analysis dominant, co-dominant, and recessive models of multiple logistic regression were applied using SPSS software (V: 22). Results: It was found that 67.4% of the cases belonged to AA genotype, genotypes amounted 26.9% to AC, and 5.7% to CC. A significant association of AGTR1 polymorphisms with CAD was found. Conclusion: Polymorphism A1166C AGTR1 gene can have an effective role in increasing the risk of coronary artery disease; thus, it can be used in clinical studies.

The article discusses the problem of COPD combined with CAD, determination of inflammatory markers and the prognostic BODE, DOSE and ADO indices. The aim of the study was to evaluate the effect of PCV13 immunization on clinical and functional manifestations of systemic inflammation in patients with COPD and CAD, as well as the relationship with the prognostic markers. Material and methods: The study included 36 male patients with COPD and 36 patients with COPD and CAD, FC II-III stable angina who were treated at Regional Clinical Hospital _4 in Chelyabinsk during the period 2015--2016. Conclusions: 1. Patients with COPD combined with CAD had statistically significant clinical and functional disorders manifested by an increase in the degree of dyspnea and reduction in FEV1. 2. In patients with COPD concomitant with CAD, against the background of the comorbidities, the levels of systemic inflammation markers — C-reactive protein, fibrinogen and procalcitonin — were more overt than in patients only with COPD. 3. Monitoring changes in procalcitonin levels could be used as an additional highly informative method for estimating the probability of the presence of bacterial inflammation and effectiveness of therapy. 4. The prognostic BODE, DOSE and ADO indices tend to decrease unidirectionally under the impact of vaccination with pneumococcal conjugate vaccine. 5. PCV13 can reduce the level of systemic inflammation within 1 year after its application.

The expression of Vitis vinifera polygalacturonase inhibiting protein 1 (VviPGIP1) in Nicotiana tabacum has been linked to modifications at the cell wall level. Previous investigations have shown an upregulation of the lignin biosynthesis pathway and reorganisation of arabinoxyloglucan composition. This suggests cell wall tightening occurs, which may be linked to defence priming responses. The present study used a screening approach to test four VviPGIP1 and four NtCAD14 overexpressing transgenic lines for cell wall alterations. Overexpressing the tobacco-derived cinnamyl alcohol dehydrogenase (NtCAD14) gene is known to increase lignin biosynthesis and deposition. These lines, particularly PGIP1 expressing plants, have been shown to lead to a decrease in susceptibility towards grey rot fungus Botrytis cinerea. In this study the aim was to investigate the cell wall modulations that occurred prior to infection, which should highlight potential priming phenomena and phenotypes. Leaf lignin composition and relative concentration of constituent monolignols were evaluated using pyrolysis gas chromatography. Significant concentrations of lignin were deposited in the stems but not the leaves of NtCAD14 overexpressing plants. Furthermore, no significant changes in monolignol composition were found between transgenic and wild type plants. The polysaccharide modifications were quantified using gas chromatography (GC–MS) of constituent monosaccharides. The major leaf polysaccharide and cell wall protein components were evaluated using comprehensive microarray polymer profiling (CoMPP). The most significant changes appeared at the polysaccharide and protein level. The pectin fraction of the transgenic lines had subtle variations in patterning for methylesterification epitopes for both VviPGIP1 and NtCAD14 transgenic lines versus wild type. Pectin esterification levels have been linked to pathogen defence in the past. The most marked changes occurred in glycoprotein abundance for both the VviPGIP1 and NtCAD14 lines. Epitopes for arabinogalactan proteins (AGPs) and extensins were notably altered in transgenic NtCAD14 tobacco.

Resumen INTRODUCCIÓN La enfermedad coronaria estable posee varios tratamientos con beneficio probado tanto en mortalidad como en incidencia de eventos agudos. Sin embargo, el control de los síntomas, especialmente en aquellos que no responden a terapia de primera línea, sigue siendo controvertido. Este resumen pretende evaluar el papel de la ranolazina como terapia adicional al tratamiento antianginoso estándar en pacientes que persisten sintomáticos a pesar de éste. MÉTODOS Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES Identificamos cuatro revisiones sistemáticas que en conjunto incluyeron 16 estudios primarios, todos correspondientes a ensayos aleatorizados, de los cuales cuatro son atingentes para la pregunta específica. Concluimos que en pacientes con enfermedad coronaria estable que persisten sintomáticos a pesar de terapia antianginosa estándar, el tratamiento adicional con ranolazina podría disminuir los episodios de angina semanales pero aumentando la incidencia de efectos adversos, y resulta en poca o nula diferencia en el riesgo de muerte o infarto agudo al miocardio.

Objective: This study aimed to check the sensitivity of multiple newly developed 3T MRI breast sequences using CAD software, in pre-sampling diagnosis of breast cancer, in an attempt to minimize unnecessary invasive sampling or surgical procedures. Patients and methods: This was a prospective study, included 120 female patients, presented with debatable or malignancy suspected mammo-sonographic results. The study protocol was approved by the ethics committee in Al-Mana General Hospital. Results: 36 patients’ tumors were reported as benign and 84 were reported as malignant. Biopsy approved 33 tumors as benign and 87 as malignant tumors. These results gave indices of 93.1% sensitivity and 90.9% specificity. Conclusion: 3T MRI breast with CAD is very sensitive imaging tool, that can help to avoid unnecessary invasive procedures.

Objective(s): Coronary artery disease (CAD) is the leading cause of death in both male and female worldwide. The main cause of CAD is the atherosclerosis of coronary arteries, which is, mostly caused by genetic alteration. 50% of such cases occur in mitotic cells where single-strand breaks occur spontaneously or due to ionizing radiation. X-ray repair cross-complementing protein 1 (XRCC1) as a key element, participate in the base excision repair (BER) and Single-strand Break Repair (SSBR) pathways. It has been suggested that XRCC1 functions as a scaffold protein able to coordinate and facilitate the various steps of DNA repair pathways. Two Single Nucleotide Polymorphisms (SNPs) (Arg194Trp and -77T>C) were reported to affect the function and expression of XRCC1, respectively. Materials and Methods:A case-control study was performed to investigate the relation between these polymorphisms and the CAD development. A population of 406 individuals was screened for SNPs by Restriction Fragment Length Polymorphisms (RFLP) method. Results: XRCC1 Arg194Trp polymorphism was associated with increased risk of CAD in examined population under a dominant model (Odds-ratio=2.604, P-value=0.001). Also the SNP of -77T>C revealed a protective role in the population under a dominant model (Odds-ratio=0.618, P-value=0.032). Conclusion:Our findings demonstrated a contributory role of these two SNPs in CAD. Furthermore, our results support the role of DNA damages and the malfunctions of DNA repair system in cardiovascular disease development in Iranian patients.

Prevention of coronary artery disease requires control of risk factors. It is not enough to take out guidelines, it is necessary to implement the guidelines. There are a number of studies which have shown that quite often guidelines are not followed.In this article, we have abstracted the essence of the guidelines into simple to follow algorithms so that they are easy to remember and also teach. For Cardiovascular risk reduction, general measures include stopping smoking, perform 150 minutes of moderate activity per week and take a low fat and low salt diet. For hypertension: All classes of drugs are suitable but generally (NICE 2011) Angiotensin receptor blockers or Angiotensin converting enzyme inhibitors for young (55 years, many with isolated systolic hypertension) Calcium channel blockers, diuretics if needed , are prefered. Combinations are used if monotherapy does not work. For dyslipidemia: Statin benefit groups are defined and manifest coronary artery disease and Diabetics above 40 years should get high dose statins. Lipid levels are only tested to look for compliance or further intensification of regime. Diabetes: Metformin is the drug of choice, Sulfonylureas can be used in combination. Glyptins are also safe and can be used. Other drugs should be used with the help of the endocrinologist.

Objective: Coronary artery disease (CAD) is a multi-factorial and heterogenic disease with atherosclerosis plaques formation in internal wall of coronary artery. Plaque formation results to limitation of the blood reaching to myocardium leading to appearance of some problems, such as ischemia, sudden thrombosis veins and myocardial infarction (MI). Several environmental and genetic factors are involved in prevalence and incident of CAD as follows: hypertension, high low density lipoprotein-cholesterol (LDL-C), age, diabetes mellitus, family history of early-onset heart disease and smoking. According to genome wide association studies (GWAS), five polymorphisms in the 9p21 locus seem to be associated with the CAD. We aimed to evaluate the remarkable association of two polymorphisms at 9p21 locus, rs1333049 and rs10757274, with CAD. Materials and Methods: This experimental study was conducted in Golestan, Aria Hospitals and Genetics Lab of Shahid Chamran University in the city of Ahvaz, Iran, in 2010- 2011. The collected blood samples belonging to 170 CAD patients (case group) and 100 healthy individuals (control group) were analyzed by tetra-primer amplification refractory mutation system (ARMS)-polymerase chain reaction (PCR) technique. The results were analyzed using software package used for statistical analysis (SPSS; SPSS Inc., USA) version 16. A value of p