New Oral Anticoagulants Are Not Superior to Warfarin in Secondary Prevention of Stroke or Transient Ischemic Attacks,but Lower the Risk of Intracranial Bleeding: Insights from a Meta-Analysis and Indirect Treatment Comparisons

Purpose

Patients with Atrial Fibrillation (AF) and prior stroke are classified as high risk in all risk stratification schemes. A systematic review and meta-analysis was performed to compare the efficacy and safety of New Oral Anticoagulants (NOACs) to warfarin in patients with AF and previous stroke or transient ischemic attack (TIA).

Methods

Three randomized controlled trials (RCTs), including total 14527 patients, comparing NOACs (apixaban, dabigatran and rivaroxaban) with warfarin were included in the analysis. Primary efficacy endpoint was ischemic stroke, and primary safety endpoint was intracranial bleeding. Random-effects models were used to pool efficacy and safety data across RCTs. RevMan and Stata software were used for direct and indirect comparisons, respectively.

Results

In patients with AF and previous stroke or TIA, effects of NOACs were not statistically different from that of warfarin, in reduction of stroke (Odds Ratio [OR] 0.86, 95% confidence interval [CI] 0.73- 1.01), disabling and fatal stroke (OR 0.85, 95% CI 0.71-1.04), and all-cause mortality (OR 0.90, 95% CI 0.79 -1.02). Randomization to NOACs was associated with a significantly lower risk of intracranial bleeding (OR 0.42, 95% CI 0.25-0.70). There were no major differences in efficacy between apixaban, dabigatran (110 mg BID and 150 mg BID) and rivaroxaban. Major bleeding was significantly lower with apixaban and dabigatran (110 mg BID) compared with dabigatran (150 mg BID) and rivaroxaban.

Conclusion

NOACs may not be more effective than warfarin in the secondary prevention of ischemic stroke in patients with a prior history of cerebrovascular ischemia, but have a lower risk of intracranial bleeding.     

PCR-DGGE and real-time PCR dsrB-based study of the impact of heavy metals on the diversity and abundance of sulfate-reducing bacteria

Sulfate-reducing bacteria (SRB) are widely used for heavy metal (HM) treatment in bioreactors but their growth and biological activity can be inhibited by such treatment. Here, bioreactor experiments were used to investigate changes in the SRB community and the copy number of the dissimilatory sulfite reductase β-subunit functional gene (dsrB) under high doses of sulfates and HMs. The SRB community was investigated using polymerase chain reaction denaturing gradient gel electrophoresis (PCR-DGGE) and sequencing techniques, while the dsrB gene abundance was measured by quantitative real-time PCR (qRT-PCR). The sulfate reduction rate was initially much higher in reactors without HMs than in those containing HMs (p = 0.001). Sulfate levels were reduced by 50% within the first 3 days of operation. As a result, the HM removal rate was initially much lower in the reactors containing HMs. Most of the HMs reduced to safe limits within 9 ~ 12 days of operation. The SRB community mainly consisted of Desulfovibrio vulgaris, D. termitidis, D. desulfuricans, D. simplex and Desulfomicrobium baculatum, as determined by PCR-DGGE. qRT-PCR revealed a decreasing trend in the copy numbers of a functional gene (dsrB) after 6 days in samples lacking HMs; however, the opposite trend was observed in the HM-containing samples.     

Comparison of Phytochemical Profile and Bioproperties of Methanolic Extracts from Different Parts of Tunisian Rumex roseus

The genus Rumex (Polygonaceae) is distributed worldwide and the different species belonging to it are used in traditional medicine. The present study aimed at the evaluation of the phytochemical profile and the biochemical properties of methanolic extracts from different parts (roots, stems, and leaves) of Rumex roseus, a wild local Tunisian plant traditionally used as food. The phytochemical analysis on the extracts was performed using standard colorimetric procedures, HPLC-DAD, and HPLC-DAD-ESI-MS; then, several in vitro cell-free assays have been used to estimate their antioxidant/free radical scavenging capability (TAC-PM, DPPH, TEAC, FRAP, ORAC, SOD-like activity, and HOCl-induced albumin degradation). Additionally, anti-inflammatory effect of these extracts was evaluated in an in vitro model of acute intestinal inflammation in differentiated Caco-2 cells. The results showed that the methanolic extracts from stems and, especially, leaves contain substantial amounts of flavones (apigenin and luteolin, together with their derivatives), while the extract from roots is characterized by the presence of tannins and quinic acid derivatives. All the extracts appeared endowed with excellent antioxidant/free radical scavenging properties. In particular, the extract from roots was characterized by a remarkable activity, probably due to its different and peculiar polyphenolic composition. Furthermore, both Rumex roseus roots and stems extracts demonstrated an anti-inflammatory effect in intestinal epithelial cells, reducing TNF-α-induced gene expression of IL-6 and IL-8. In conclusion, R. roseus methanolic extracts have shown to be potential sources of bioactive compounds to be used in the prevention and treatment of pathologies related to oxidative stress and inflammation.     

Refolding of a denatured α-chymotrypsin and its smart bioconjugate by three-phase partitioning

α-Chymotrypsin inactivated with 8 M urea and 100 mM dithiothreitol could be completely reactivated by subjecting it to three-phase partitioning (TPP). TPP consisted of adding 30% w/v ammonium sulfate and t-butanol (volume equivalent to aqueous solution of denatured α-chymotrypsin) at 25°C. The activated α-chymotrypsin was recovered as an interfacial precipitate between the upper organic and lower aqueous phase. It was found that this could be extended to a thermally inactivated smart bioconjugate of α-chymotrypsin with Eudragit S-100 (a reversibly soluble–insoluble methmethacrylate). The thermally inactivated bioconjugate had to be further subjected to urea and dithiothreitol before refolding by three-phase partitioning. Ninety per cent of the activity of the bioconjugate could be recovered. The free enzyme and its bioconjugate which lost activity in the presence of 90% dioxane recovered 94 and 90% of their activities, respectively, by employing TPP. The refolded free enzyme and its bioconjugate were evaluated in terms of V_max/K_m and their fluorescence emission spectra.     

Molecular docking analysis of COX-2 for potential inhibitors

Cyclooxygenase-2 (COX-2) is liked with breast cancer. Therefore, it is of interest to design and develop new yet effective compounds against COX-2 from medicinal plants such as the natural alkaloid compounds. We document the optimal binding features of aristolochicacid with COX-2 protein for further consideration.     

Effects of oxidizing and reducing agents on ovine pulmonary artery responses to nitric oxide donors, sodium nitroprusside and 3-morpholino-sydnonimine

Nitrovasodilators-sodium nitroprusside (SNP; 10(-9)-10(-4) M) and 3-morpholino-sydnonimine (SIN-1; 10(-9)-10(-4) M) produced concentration-dependent relaxation of the fourth generation sheep pulmonary artery, preconstricted with 5-hydroxytryptamine (1 microM). Oxidizing agents [oxidized glutathione (GSSG, 1 mM) and CuSO4 (5 and 20 microM)] and reducing agents [dithiothreitol (DTT, 0.1 mM), ascorbic acid (1 mM) and reduced glutathione (GSH, 1 mM)] caused opposite effects on nitric oxide (NO)-induced vasodilation in the artery. Ascorbic acid and GSH potentiated the NO responses, while GSSG and CuSO4 inhibited relaxation caused by the nitrovasodilators. DTT, however, reduced the relaxant potency and efficacy of SNP and SIN-1. Pretreatment of the pulmonary artery strips with DTT (0.1 mM) inhibited SNP (10 microM)-induced Na(+)-K(+)-ATPase activity, while ascorbic acid (1 mM) and GSH (1 mM) had no effect either on basal or SNP (10 microM)-stimulated 86Rb uptake, an index of Na(+)-K(+)-ATPase activity, in ovine pulmonary artery. The results suggest that reducing agents like ascorbic acid may have beneficial effect in improving the vascular function under oxidative stress.     

Molecular Identification of Cryptosporidium viatorum Infection in a Patient Suffering from Unusual Cryptosporidiosis in West Bengal,India

In this study, we have collected and screened a total of 268 stool samples from diarrheal patients admitted to an Infectious disease hospital in Kolkata for the presence of Cryptosporidium spp. The initial diagnosis was carried out by microscopy followed by genus specific polymerase chain reaction assays based on 70 kDa heat shock proteins (HSP70). DNA sequencing of the amplified locus has been employed for determination of genetic diversity of the local isolates. Out of 268 collected samples, 12 (4.48%) were positive for Cryptosporidium spp. Sequences analysis of 70 kDa heat shock proteins locus in 12 Cryptosporidium local isolates revealed that 2.24% and 1.86% of samples were showing 99% to 100% identity with C. parvum and C. hominis. Along with the other 2 major species one recently described globally distributed pathogenic species Cryptosporidium viatorum has been identified. The HSP70 locus sequence of the isolate showed 100% similarity with a previously described isolate of C. viatorum (Accession No. {"type":"entrez-nucleotide","attrs":{"text":"JX978274.1","term_id":"441431305","term_text":"JX978274.1"}}JX978274.1, {"type":"entrez-nucleotide","attrs":{"text":"JX978273.1","term_id":"441431303","term_text":"JX978273.1"}}JX978273.1, and {"type":"entrez-nucleotide","attrs":{"text":"JN846706.1","term_id":"385399407","term_text":"JN846706.1"}}JN846706.1) present in GenBank.     

Vibrotactile feedback for conveying object shape information as perceived by artificial sensing of robotic arm

This work is a preliminary study towards developing an alternative communication channel for conveying shape information to aid in recognition of items when tactile perception is hindered. Tactile data, acquired during object exploration by sensor fitted robot arm, are processed to recognize four basic geometric shapes. Patterns representing each shape, classified from tactile data, are generated using micro-controller-driven vibration motors which vibrotactually stimulate users to convey the particular shape information. These motors are attached on the subject’s arm and their psychological (verbal) responses are recorded to assess the competence of the system to convey shape information to the user in form of vibrotactile stimulations. Object shapes are classified from tactile data with an average accuracy of 95.21 %. Three successive sessions of shape recognition from vibrotactile pattern depicted learning of the stimulus from subjects’ psychological response which increased from 75 to 95 %. This observation substantiates the learning of vibrotactile stimulation in user over the sessions which in turn increase the system efficacy. The tactile sensing module and vibrotactile pattern generating module are integrated to complete the system whose operation is analysed in real-time. Thus, the work demonstrates a successful implementation of the complete schema of artificial tactile sensing system for object-shape recognition through vibrotactile stimulations.     

Arsenic and heavy metals health risk assessment through drinking water consumption in the Peshawar District,Pakistan

This study aimed to assess the drinking water quality and human potential health risk in Peshawar, which is the most populous district of Khyber Pakhtunkhwa Province, Pakistan. Water was randomly collected throughout Peshawar District (urban = 45 samples and rural = 29 samples). These samples were analyzed for heavy metal (As, Cd, Co, Cu, Cr, Hg, Ni, Pb, and Zn) concentrations using the atomic absorption spectrometer (Perkin Elmer, AAS-PEA-700). Heavy metal concentrations in drinking water revealed the highest pollution index (PI) values—17.80, 11.92, 7.50, and 5.70 for the Pb, Cr, Cd, and Ni, respectively. The contaminations of Cd and Pb were significantly higher (p < .05) than their maximum allowable limits set by the World Health Organization. Heavy metal contaminations in drinking water were evaluated for health risk assessment: the chronic risk or hazard quotient (HQ) and cancer risk. Results revealed that HQ values were >1 for the Cd and Pb, suggesting that the exposed human beings could be at chronic risk. Therefore, serious measures such as drinking water treatments and contamination controlling policies are needed to avoid the hazardous effects of toxic heavy metals.