bluuebunny/crossref_metadata_2025 huggingface dataset:
A phase II, randomized study of nivolumab (nivo) or nivo plus BMS-986205 with or without intravesical Bacillus Calmette-Guerin (BCG) in BCG-unresponsive, high-risk, non-muscle invasive bladder cancer (NMIBC): CheckMate 9UT.
Authors: Hahn Noah M. , Chang Sam S. , Meng Maxwell , Shore Neal D. , Konety Badrinath R. , Steinberg Gary D. , Gschwend Juergen E. , Nishiyama Hiroyuki , Palou Redorta Juan , Taylor John Arthur , Elegbe Ayanbola , Lambert Alexandre , Zhu Li , Ishii Yuko , Maeda Toshiki , Raybold Bradley , Grossfeld Gary , Fischer Bruce S. , Rutstein Mark , Witjes Alfred
Published: March 2019

TPS493

Background: Immune checkpoint inhibitors, including nivo (anti–PD-1), have demonstrated favorable tolerability and efficacy profiles, ushering in a new treatment (tx) paradigm for advanced bladder cancer (advBC). However, an unmet need exists for new effective tx options in earlier stages of disease, specifically for patients (pts) with BCG-unresponsive, high-risk NMIBC. Increased IDO and PD-L1 expression in NMIBC tumors (Inman, et al. Cancer 2007; Hudolin, et al. Anticancer Res 2017), support the combination of anti–PD-1 and IDO1 inhibition in NMIBC. BMS-986205, a selective, potent, once-daily IDO1 inhibitor that works early in the IDO1 pathway, has demonstrated clinical activity in combination with nivo in pts with immunotherapy-naive advBC who received ≥ 1 prior line of therapy (objective response rate, 37%; Tabernero, et al. J Clin Oncol 2018;36(suppl) [abstr 4512]). These findings provide a rationale for investigation of nivo + BMS-986205 ± intravesical BCG therapy in BCG-unresponsive high-risk NMIBC. Here we describe a phase 2, randomized, open-label study assessing the safety and efficacy of nivo ± BMS-986205 ± intravesical BCG in pts with BCG-unresponsive, high-risk NMIBC. Methods: Pts aged ≥ 18 years with BCG-unresponsive (per February 2018 FDA guidance), high-risk NMIBC, defined as carcinoma-in-situ (CIS) with or without papillary component, any T1, or Ta high-grade lesions, will be enrolled. Pts must have urothelial carcinoma as the predominant histological component (>50%). Key exclusion criteria include locally advanced or metastatic BC, upper urinary tract disease within 2 years, prostatic urethral disease within 1 year, and prior immunotherapy. Using a novel adaptive-type design, pts will be randomized to 1 of 4 tx arms with nivo ± BMS-986205 ± BCG. Primary endpoints include proportion of pts with CIS with complete response (CR), duration of CR in pts with CIS, and event-free survival for all pts without CIS. Secondary endpoints are progression-free survival and safety. This global study in 13 countries is underway, with a target enrollment of 436 pts. ( Clinical trial information: NCT03519256.
EV-301: Phase III study to evaluate enfortumab vedotin (EV) versus chemotherapy in patients with previously treated locally advanced or metastatic urothelial cancer (la/mUC).
Authors: Petrylak Daniel Peter , Rosenberg Jonathan E. , Duran Ignacio , Loriot Yohann , Sonpavde Guru , Wu Chunzhang , Gartner Elaina M , Melhem-Bertrandt Amal , Powles Thomas
Published: March 2019

TPS497

Background: Standard first-line treatment for patients (pts) with la/mUC is cisplatin-based chemotherapy or carboplatin-based chemotherapy for pts unfit for cisplatin. Immune checkpoint inhibitors (CPIs) are standard treatment options for pts who progressed during or after platinum-based chemotherapy. While some pts with la/mUC achieve durable responses with CPIs, less than 25% of pts respond. Following failure of a CPI, no therapies are approved. Enfortumab vedotin is a fully humanized monoclonal antibody that delivers the microtubule-disrupting agent monomethyl auristatin E to tumors expressing Nectin-4, which is expressed in 97% of mUC pt samples (Petrylak et al. ASCO, 2017). In a phase 1 study (EV-101; NCT02091999), single-agent EV 1.25 mg/kg was generally well tolerated and demonstrated a confirmed objective response rate (ORR) of 42% across the overall population of pts with mUC; in pts with prior CPI therapy or liver metastasis at baseline confirmed ORRs of 42% and 36% were observed. A pivotal phase 2 study of EV in la/mUC pts with prior CPI treatment (EV-201; NCT03219333) is ongoing. Methods: EV-301 is a global, multicenter, open-label phase 3 trial (NCT03474107) enrolling adult pts with la/mUC and an ECOG performance status score ≤1, who have received a prior platinum-containing chemotherapy, and have experienced disease progression during or following treatment with a CPI. Approximately 550 pts will be randomized (1:1) to receive EV (1.25 mg/kg) administered by IV infusion over approximately 30 minutes on Days 1, 8, and 15 of each 28-day cycle ( Arm A), or investigator choice of IV docetaxel, paclitaxel, or vinflunine (EU only) on Day 1 of each 21-day cycle ( Arm B). Treatment with the study drug will continue until radiological disease progression, intolerance, or other discontinuation criterion is met. Radiological assessments of tumor response status will be performed at baseline and every 8 weeks. The primary endpoint is overall survival; secondary endpoints include progression-free survival, duration of response, and overall response rate, as well as assessment of safety/tolerability, and quality-of-life parameters. Clinical trial information: NCT02091999.
A phase III, randomized, open-label, multicenter, global study of first-line (1L) durvalumab in combination with standard of care (SoC) chemotherapy and durvalumab in combination with tremelimumab and soc chemotherapy versus soc chemotherapy alone in patients with unresectable locally advanced or metastatic urothelial cancer (UC).
Authors: Galsky Matt D. , Necchi Andrea , Sridhar Srikala S. , Ogawa Osamu , Ruscica Dario , Angra Natasha , Bellmunt Joaquim
Published: March 2019

TPS499

Background: Despite high response rates to 1L SoC for locally advanced or metastatic UC chemotherapy (gemcitabine +cisplatin or gemcitabine + carboplatin for patients who are cisplatin-ineligible [poor performance status, impaired renal function, comorbidities]), most patients experience disease progression. Novel strategies like combining chemotherapy and immunotherapy offer hope for improving clinical outcomes. Durvalumab is a selective, high affinity, engineered human IgG1 mAb that blocks PD-L1 binding to PD-1 and CD80. Tremelimumab is a human IgG2 mAb directed against CTLA-4. The mechanisms of action of PD-1 and CTLA-4 are nonredundant, so targeting both checkpoint pathways may have additive or synergistic efficacy compared to monotherapy. Studies in other tumor types of platinum-based chemotherapy combined with checkpoint blockade have yielded improved efficacy with acceptable safety and support exploration of this approach for 1L locally advanced or metastatic UC. Methods: NILE is a randomized, open-label, multicenter, global trial that will enroll approximately 1265 patients who will be randomized (1:1:1) to durvalumab + SoC chemotherapy, durvalumab + tremelimumab + SoC chemotherapy, or SoC chemotherapy as 1L-line therapy in patients with histologically or cytologically documented, unresectable, locally advanced or metastatic transitional cell carcinoma of the urothelium. Primary endpoints are progression-free survival using blinded independent central review assessments per RECIST 1.1 and overall survival (OS). Secondary endpoints include objective response rate, OS at 24 months, proportion of patients alive and progression free at 12 months, duration of response, disease control rate, time from randomization to second progression, and HRQoL. Safety, pharmacokinetics, immunogenicity, and biomarkers will also be assessed. The study opened for enrollment in September 2018. Clinical trial information: NCT03682068.
P3BEP (ANZUP 1302): An international randomized phase III trial of accelerated versus standard BEP chemotherapy for adult and pediatric male and female patients with intermediate and poor-risk metastatic germ cell tumors (GCTs).
Authors: Zhang Alison Yan , Toner Guy C. , Lawrence Nicola Jane , Stockler Martin R. , Martin Andrew James , Ford Kate , Stevanovic Amanda Gwendolyn , Wyld David , Walpole Euan Thomas , Troon Simon , Hanning Fritha J. , Mallesara Girish , Weickhardt Andrew James , Birtle Alison Jane , Davis Ian D. , Grimison Peter S. ,   Australian and New Zealand Urogenital and Prostate Cancer Trials Group
Published: March 2019

TPS539

Background: Bleomycin, etoposide, cisplatin (BEP) given 3-weekly x 4 remains standard 1st line chemotherapy for metastatic GCTs. Acceleration of standard regimen with shorter cycle lengths has improved cure rates in other cancers. This is the first international randomised clinical trial for intermediate and poor-risk metastatic extracranial GCTs involving both adult and paediatric age group males and females. We aim to determine if accelerated BEP is superior to standard BEP. Methods: DESIGN: Open label, randomised, stratified multicentre, 2 stage, phase 3 trial. Primary endpoint for stage I (n = 150) is the achievement of a complete response (CR), and for entire trial (n = 500) is progression free survival (PFS). SAMPLE SIZE: 150 and 500 patients gives > 80% power to detect a 20% improvement in achieving a CR and 7% absolute improvement in 2yr PFS, respectively. POPULATION: Males and females aged 11-45 years with intermediate or poor-risk metastatic GCTs of the testis, ovary, retroperitoneum or mediastinum for 1st line chemotherapy. TREATMENT: Randomisation 1:1 to 4 cycles of “standard BEP” or “accelerated BEP”: cisplatin 20mg/m2 IV D1-5; etoposide 100mg/m2 IV D1-5; bleomycin 30000 IU IV weekly; and pegylated G-CSF SC D6 or Filgrastim daily; given every 3 weeks or every 2 weeks respectively. Accelerated BEP arm receives 4 additional weekly doses of bleomycin. ASSESSMENTS: Response assessments at 30 day safety assessment, and 6 months from randomisation or after all post-chemotherapy intervention is completed. Regular follow-up up to 5 years, then annually. Archival tumour tissue and baseline blood collected for translational substudies. STATUS: 25 sites open in ANZ, 11 sites open in UK (led by Cambridge Clinical Trials Unit), 19 sites open in the USA (led by Children’s Oncology Group). As of 23rd October 2018, 59 patients have been recruited. Clinical trial information: NCT02582697.
An open-label phase II study to evaluate PT2977 for the treatment of von Hippel-Lindau disease-associated renal cell carcinoma.
Authors: Jonasch Eric , Park Eric Kristopher , Thamake Sanjay , Hirmand Mohammad , Linehan W. Marston , Srinivasan Ramaprasad
Published: March 2019

TPS680

Background: In von Hippel-Lindau (VHL), renal cell carcinomas (RCC) are of clear cell histology (ccRCC). HIF-2α has been established as an oncogenic driver in ccRCC, where VHL deficiency is the underlying genomic alteration. In this setting, HIF-2α accumulates under normoxic conditions, driving the expression of genes associated with progression of ccRCC, including vascular endothelial growth factor A ( VEGFA), cyclin D1 and other factors that contribute to tumor growth and proliferation. Management of VHL-associated renal tumors most often involves active surveillance until surgery is recommended for tumors larger than 3 cm to reduce the risk of metastasis. Repeated surgical procedures, which are often required, can carry significant morbidity. Systemic therapy options that can delay or obviate the need for surgery by reducing tumor size are needed. Methods: This open-label Phase 2 study will evaluate the efficacy and safety of PT2977, a highly selective small molecule inhibitor of HIF-2α, in VHL patients who have at least 1 measurable ccRCC (per RECIST 1.1). PT2977 will be administered orally at 120 mg once daily. Key inclusion criteria include a germline VHL alteration and at least 1 measurable solid ccRCC but no tumor > 3.0 cm requiring immediate surgical intervention. Patients may have VHL-associated tumors in other organ systems. Key exclusion criteria include prior systemic therapy for VHL, evidence of metastatic disease, and history of a non-VHL-associated invasive malignancy in the past 2 years. The primary endpoint is objective response rate (ORR) of ccRCC tumors per RECIST 1.1. Secondary endpoints include duration of response (DOR), time to response (TTR), progression-free survival (PFS), time to surgery (TTS) for ccRCC tumors, and efficacy evaluations for non-ccRCC tumors. Safety and pharmacokinetics of PT2977 will also be evaluated. Patient recruitment is ongoing. Funding: Peloton Therapeutics, Inc. Clinical trial information: NCT03401788.
Contribution of individual quadriceps muscles to knee joint mechanics
Authors: Han Seong-won , Sawatsky Andrew , de Brito Fontana Heiliane , Herzog Walter
Published: March 2019

Many attempts have been made to determine the contribution of individual muscles in an agonistic group to the mechanics of joints. However, previous approaches had the limitations that muscles often could not be controlled in a precise manner, that individual muscles in an agonistic group could not be activated individually, and that individual muscle contributions could not be measured in an actively contracting agonistic group. Here, we introduce a surgical approach that allows for controlled activation of individual muscles of an agonistic group. The approach is illustrated for the vastus lateralis (VL), vastus medialis (VM), and rectus femoris (RF) of the rabbit quadriceps femoris group. We provide exemplar results for potential applications of the approach, such as measuring the pressure distribution in the patellofemoral joint, and the torque–angle relationship of VL, VM and RF when activated individually and when the three muscles are activated simultaneously.
The quantity-quality trade-off: differential effects of daily food times on reproductive performance and offspring quality in diurnal zebra finches
Authors: Mishra I. , Kumar V.
Published: March 2019

Abundant food supply is crucial to reproductive performance, as shown by restricted food availability experiments, in small-sized vertebrates including birds. However, whether daily times of feeding would affect the reproduction is largely unknown. Present study investigated the effects of daily food availability times on reproductive performance and quality of eggs and offspring survivors in zebra finches (Taeniopygia guttata). To randomly paired birds kept under 12 h light per day for about 52 weeks, food availability period was restricted to 4 h in morning (FA-M) or evening (FA-E), with controls on food ad libitum; thus, daily food deprivation period began after 4 h of food in FA-M and was continuous with nighttime starvation in FA-E. Both food restrictions adversely affected reproductive health as shown by reduced sex steroids and mesotocin levels, but not general metabolism as indicated by no-difference in thyroxin and triiodothyronine levels. Food for 4 h negatively affected the reproductive performance, although with differences between FA-M and FA-E pairs. Particularly, there was delayed onset of reproduction and compromised reproductive success in FA-E, but not in FA-M pairs; conversely, the offspring health was severely compromised in FA-M, but not in FA-E pairs. Furthermore, FA-M females were in better health, implicating sex-biasness in parental food provisioning. Overall, we demonstrate trade-off of ‘quantity’ (offspring produced and/ or survived) for ‘quality’ (how good offspring were in health) in response to daily food availability times in zebra finches that much like humans are diurnal and retain the ability to reproduce throughout the year.
Pollen reverses decreased lifespan, altered nutritional metabolism, and suppressed immunity in honey bees (Apis mellifera) treated with antibiotics
Authors: Li Jianghong , Heerman Matthew C. , Evans Jay D. , Rose Robyn , Li Wenfeng , Rodríguez-García Cristina , DeGrandi-Hoffman Gloria , Zhao Yazhou , Huang Shaokang , Li Zhiguo , Hamilton Michele , Chen Yanping
Published: March 2019

Nutrition is involved in regulating multiple aspects of honeybee biology such as caste, immunity, lifespan, growth and behavioral development. Deformed wing virus (DWV) is a major pathogenic factor which threatens honeybee populations, and its replication is regulated by nutrition status and immune responses of honeybees. The alimentary canal of the honeybee is home to a diverse microbial community that provides essential nutrients and serves to bolster immune responses. However, to what extent gut bacteria affect honeybee nutrition metabolism and immunity with respect to DWV has not been investigated fully. In this study, newly emerged worker bees were subjected to four diets that contained 1) pollen, 2) pollen and antibiotics, 3) neither pollen nor antibiotics, 4) antibiotics alone. The expression level of two nutrition genes target of rapamycin (tor) and insulin like peptide (ilp1), one nutritional marker gene vitellogenin (vg), five major royal jelly proteins genes (mrjp1-5), one antimicrobial peptide regulating gene relish (rel), and DWV virus titer and its replication intermediate, negative RNA strand, were determined by qRT-PCR from the honeybees after 7 days post antibiotic treatment. Additionally, honeybee head weight and survival rate were measured. We observed that antibiotics decreased the expression of tor and rel, increased DWV titer and its replication activity. Expression of ilp1, five mrjps, vg, and honeybee head weight were also reduced compared to bees on a pollen diet. Antibiotics also caused a significant drop in survivorship, which could be rescued by addition of pollen to diets. Of importance, pollen could partially rescue the loss of vg and mrjp2 while also increasing head weight of antibiotic-treated bees. Our results illuminate the roles of bacteria in honeybee nutrition, metabolism, and immunity; which confer the capability of inhibiting virus replication, extending honeybee lifespan, and improving overall health.
High-Intensity Interval Training Improves Left Ventricular Contractile Function
Authors: HUANG YU-CHIEH , TSAI HSING-HUA , FU TIEH-CHENG , HSU CHIH-CHIN , WANG JONG-SHYAN
Published: March 2019

Introduction

Improved myocardial contractility is a critical circulatory adaptation to exercise training. However, the types of exercise that enhance left ventricular (LV) contractile and diastolic functions have not yet been established. This study investigated how high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) influence LV mechanics during exercise.

Methods

Fifty-four healthy sedentary men were randomized to engage in either HIIT (3-min intervals at 40% and 80% of V˙O2max, n = 18) or MICT (sustained 60% of V˙O2max, n = 18) for 30 min·d−1, 5 d·wk−1 for 6 wk or to a control group (n = 18) that did not engage in exercise intervention. LV mechanics during semiupright bicycle exercise tests were measured by two-dimensional speckle-tracking echocardiography.

Results

Before the interventions, acute bicycle exercise increased (i) peak basal/apical radial and circumferential and peak longitudinal strains and strain rates, (ii) peak basal/apical rotations and torsion, and (iii) peak systolic twisting and early diastolic untwisting velocities in the LV. After the interventions, the HIIT group exhibited greater LV mass and diastolic internal diameter as well as higher ratio of E wave to A wave and early diastolic propagation velocity than did the MICT group. Despite decreased peak apical rotation and torsion, HIIT enhanced peak apical radial strain and strain rate as well as shortened the time to reach peak untwisting velocity in the LV during exercise. However, the LV mechanics during exercise were unchanged in the control group.

Conclusion

HIIT but not MICT induces eccentric myocardial hypertrophy. Moreover, HIIT effectively improves the LV mechanics during exercise by increasing contractile and diastolic functions.
Friedewald’s equation for calculating LDL-cholesterol: Is it the time to say “Goodbye” and adopt direct LDL cholesterol methods?
Authors: Khan Sikandar Hayat , Niazi Najmusaqib Khan , Sobia Farah , Fazal Nadeem , Manzoor Syed Mohsin , Nadeem Ahmed
Published: March 2019

Objectives: To measure correlation and concordance between measured LDL cholesterol (mLDLc) and Friedewald’s calculated LDL cholesterol (cLDLc). To compare the mLDLc and cLDLc values for various anthropometric measures and biochemical indices including insulin resistance, nephropathy, glycated hemoglobin and triglycerides.

Methods: Two hundred thirty two subjects were included in this cross-sectional analysis from Jan-2016 to July-2017 from a target population visiting PNS HAFEEZ hospital. Mean age of the subjects was 46.56(±11.95) years (n=232). These subjects underwent clinical evaluation including measurement of anthropometric measurements, biochemical testing for fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), lipid profile, urine albumin creatinine ratio (UACR), and insulin. Correlation and concordance between mLDLc and Friedewald’s cLDLc were measured. Finally, Comparison of risk evaluation for mLDLc and cLDLc between groups formulated based upon UACR (Based upon a cut off of 2.5 mg/g) and fasting triglycerides (Group-1 :< 1.0 mmol/L, Group-2: 1.0-1.99 mmol/L and Group-3 :> 1.99 mmol/) was carried out.

Results: There was significant positive linear correlation between mLDLc and cLDLc [r=0.468, <0.001]. Kendall’s Coefficient of concordance between mLDLc and cLDLc was 0.055 (p<0.001). Differences evaluated by one way ANOVA analysis for mLDLc between various triglycerides groups were only significant between group-1 and group-2 [{Group-1:Mean=2.40, (2.19-2.61), n=43}, {Group-2:Mean=2.81, (2.69-2.92),n=136}, [{Group-3:Mean=2.59,(2.37-2.81), n=53}],(p=0.004) in comparison to cLDLc [{Group-1:Mean=2.63, (2.43-2.84), n=43}, {Group-2:Mean=2.85, (2.76-2.93), n=136}, [{Group-3:Mean=2.75, (2.60-2.90),n=53}]. Calculated method for LDLc showed higher UACR than mLDLc. (p=0.021)

Conclusion: cLDLc over estimates LDL-cholesterol in comparison to mLDLc. The correlation between cLDLc and mLDLc was only moderate. However, cLDLc provided better degree of risk prediction for nephropathy and glycated hemoglobin than mLDLc.

How to cite this:Khan SH, Niazi NK, Sobia F, Fazal N, Manzoor SM, Nadeem A. Friedewald’s equation for calculating LDL-cholesterol: Is it the time to say “Goodbye” and adopt direct LDL cholesterol methods? Pak J Med Sci. 2019;35(2):388-393.   doi: https://doi.org/10.12669/pjms.35.2.679

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Vitamin D status in under five children in diverse communities of Karachi
Authors: Moorani Khemchand Netaram , Mustufa Muhammad Ayaz , Hasan Syed Furqan , Kubar Naseem
Published: March 2019

Background & Objective: Vitamin D deficiency (VDD) prevalence is very high in pediatric population in developing countries including Pakistan. VDD contribute significantly to morbidity and mortality among children under five years. Therefore, it is vital to study vitamin D levels in population for future interventions and disease control. Our objective was to determine 25(OH)D levels in children of one to 59 months of age in socio-economically diverse communities of Karachi, Pakistan.

Methods: The cross- sectional analytical survey was carried out over 6 months from January -June 2017. Following proportionate sampling technique four clusters were randomly selected from Korangi, Saddar, Sindhi para and Manzoor colony, Karachi. Blood samples for 25(OH)D and zinc levels were carried out using ELISA and colorimetry. VD level <20 ng/ml was defined as VDD and serum zinc <65ug/dl as low zinc levels. Data including area of residency, gender, ethnicity, parent’s education, family income, house status, duration of sun exposure and history of VD and zinc intake in last 3 months was collected from parents / care seekers on pretested and pre-coded semi-structured questionnaire. Data was analyzed using SPSS version-20. Frequencies and percentages were computed for categorical variables like gender, type of malnutrition whereas mean with standard deviation was used for VD and zinc levels and vitamin D status was compared in three different residential categories according to nutritional status.

Results: Out of 120 children, 67 (56%) were boys and 53 (44%) girls. Mean VD level was 22.8±14.8 ng/ml. Around 60% (70) children were VD deficient, whereas 15 % (18) had insufficient 25(OH)D levels. VDD was more prevalent among low socio-economic group with no obvious difference in age category. Mean zinc level was 123.8±47.45 ug/dl and it was either normal or high (42%) rather than low. Malnutrition was observed in 65% children and majority (82%) of them were undernourished. Optimal sun exposure was reported in 24% children only.

Conclusion: Vitamin D deficiency was highly prevalent in our study population. Children of low socio-economic strata and with sub-optimal sun light exposure are at high risk of vitamin D deficiency. Unexpectedly, high zinc levels in majority of our children with low VD status needs further evidence to substantiate this inverse relation.

How to cite this:Moorani KN, Mustufa MA, Hasan SF, Kubar N. Vitamin D status in under five children in diverse communities of Karachi. Pak J Med Sci. 2019;35(2):414-419. doi: https://doi.org/10.12669/pjms.35.2.680

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Aspirin in combination with clopidogrel in the treatment of acute myocardial infarction patients undergoing percutaneous coronary intervention
Authors: Zhang Xiaoyan , Qi Lizhen , Liu Yongxuan
Published: March 2019

Objective: To investigate the clinical effect of aspirin combined with clopidogrel on acute myocardial infarction after percutaneous coronary intervention (PCI).

Methods: One hundred thirty two patients with acute myocardial infarction who were admitted to the hospital between December 2016 and December 2017 were divided into a control group and an observation group according to random number table, 66 each group. Both groups were given emergency PCI and symptomatic treatment. The control group was given aspirin on the basis of conventional treatment before and after operation, while the observation group was given clopidogrel treatment on the basis of the treatment the same as the control group. The treatment lasted for 4 months. The clinical efficacy of the two groups was analyzed, and the cardiac function indicator, coagulation indicator and occurrence of adverse reactions were compared before and after treatment.

Results: There was no thrombosis at the infarct site in coronary angiography after treatment in both groups. The efficacy in the observation group and control group were 89.4% and 81.8%, respectively; there was no significant difference between the two groups. The incidence of re-thrombosis in the two groups was 1.5% and 12.1% respectively, which was significantly lower in the observation group than in the control group (P<0.05). The cardiac function indicator of both groups improved after treatment, especially the observation group (P<0.05). There was no significant difference in prothrombin time (PT), activated partial thromboplastin time (APTT), prothrombin activity (PA) and platelet aggregation rate (PAR) in the two groups before treatment (P>0.05). There was also no significant difference in PT and PA before and after treatment (P>0.05). The APTT and PAR were significantly different after treatment (P<0.05), and the PAR of the observation group was significantly higher than that of the control group (P<0.05). The incidence of adverse reactions in the observation group was 7.58%, which was not significantly different with that of the control group (12.12%) (P<0.05).

Conclusion: Aspirin combined with clopidogrel can effectively reduce the occurrence of re-thrombosis after PCI and improve the recovery of cardiac function after acute operation, moreover the safety is high. It has important clinical application values.

How to cite this:Zhang X, Qi L, Liu Y. Aspirin in combination with clopidogrel in the treatment of acute myocardial infarction patients undergoing percutaneous coronary intervention. Pak J Med Sci. 2019;35(2):348-352. doi: https://doi.org/10.12669/pjms.35.2.87

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
FACTORES QUE INFLUYEN EN LA SALUD DE LOS ESTUDIANTES DE SECUNDARIA EN BAJA CALIFORNIA, MÉXICO
Authors: Cantú González Valeria , Rodríguez Macías Juan Carlos
Published: March 2019

INTRODUCCIÓN. En México se estableció la salud como un derecho en 1983. Desde entonces, con el objetivo de reducir problemas, enfermedades y situaciones de riesgo que están presentes en la población mexicana, las escuelas han sido objeto de las políticas públicas en materia de salud. Como parte de dichas políticas, se incluyeron en el currículum de educación básica, temas de relevancia social, entre ellos, la salud, con el propósito de atender los problemas que presentan los escolares en este tema y con el fin de fomentar una cultura de la prevención. No obstante, se carece de evidencia empírica sobre el grado de cumplimiento y resultados de dicha política nacional. El estudio tuvo como objetivo explorar los conocimientos, prácticas y variables de contexto que influyen en la salud de los estudiantes de secundaria en Baja California. MÉTODO. Se aplicaron dos instrumentos a 14.545 estudiantes de tercero de secundaria que estaban inscritos en el ciclo escolar 2014-2015 de los cinco municipios de Baja California. El primer instrumento fue un examen de conocimientos en salud denominado Examen al Egreso de la Educación Básica en el Área de Salud (EXEEBAS). El segundo, un cuestionario de contexto que incluyó una sección llamada Tú y tu salud donde se indagó sobre las prácticas en salud. La técnica de análisis que se utilizó para determinar los factores que influyen en la salud de los estudiantes fue el modelamiento de ecuaciones estructurales. RESULTADO. La dieta correcta, prácticas alimenticias, ejercicio de una sexualidad responsable y consumo de sustancias (prácticas en salud) de los estudiantes de tercero de secundaria influyen en su salud física. Además, dichas prácticas en salud a su vez están relacionadas con los conocimientos en salud y factores académicos que tienen los estudiantes. DISCUSIÓN. Ante la importancia que tienen las prácticas en salud se requiere revalorar la formación en el autocuidado y fomentar la autorregulación con el fin de fortalecer la salud de los estudiantes de educación básica con miras de tener en el futuro una población más sana.
Negotiating spaces and voicing resistance: Nireeksha and women’s theatre in India
Authors: Gopinath Swapna
Published: March 2019

Indian theatre has a long and rich tradition of adapting theory and practice from a variety of representational modes from western theatre that subsequently played key roles in major political and cultural upheavals and provided fodder for social changes and progress in Indian social and cultural life. Feminist theatre practice in India clearly demonstrates this cross-cultural interaction, and Nireeksha from the southern state of Kerala is one among them. As a women’s theatre, Nireeksha has a unique history of survival not only through its theatre productions but also through its committed social work in bringing women and children together as part of its community projects. This article focuses on Nireeksha’s incessant struggle to build resistance and find a creative space within the main stream theatre and patriarchal society of Kerala. I do a close analysis of Nireeksha’s performances and its methodology of practice to understand and explain how aesthetics and ideology inform the practice and processes of the leading women’s theatre groups in Kerala.
Schooling an ensemble: The Forsythe Company’s Whole in the Head
Authors: Vass-Rhee Freya
Published: March 2019

This embedded ethnographic study focuses on The Forsythe Company’s 2010 creation of Whole in the Head, the cast of which brought already-expert new dancers into collaboration with experienced ensemble veterans. The devising practice during the making of this ‘Schulwerk’ yielded teaching and learning opportunities to all of the participants, whilst the emergent and distributed opportunities afforded by the devising context scaffolded the ensemble’s development as a complicit, choreographically productive community informed by specific somatic approaches to movement generation. Moving among unexpected etymological linkages of the term skill across languages, the analysis shows how the devising process of this work enhanced crucial expert-specific skills across the full ensemble, inviting consideration of the nature of skill and its expansion within communities of experts.
The critical potential of somatic collectivity under post-Fordism
Authors: Colin Noyale
Published: March 2019

The last decade of scholarship in dance has produced a number of literary contributions which account for the need to theorize the radical potential of dance as a site for political activism in the context of global social and economic crises. As a practitioner, teacher and theorist in dance and performance, working in a UK university, I am interested in exploring the potential of somatics to resist a seemingly utilitarian incorporation of somatic principles into the agenda of neo-liberalism under post-Fordist conditions. In this article, I refer to somatics as an umbrella term to discuss practices related to the dance field including protests, walks, flashmobs and choreographic explorations of performative participation. While these practices might not be widely recognized as somatic practices, I argue that all operate at a somatic level and point to an ever-shifting relationship between the individual, the collective and the social environment. I reflect on a number of theoretical ideas pertaining to the relations between the development of somatics and the intensification of cultural capitalism in contemporary western society. In doing so, I aim to theorize somatics as critical and political practices of collective forms of being and working together. Drawing on instances of collective embodiment, I argue for the politicization of somatic practices as it relates to ideas of affect, ethics and time. I suggest that embodied expressions of collectivity as politicized somatics can develop valid tactics to counter what I observe to be a mimetic phenomenon between dance practices and capitalism. I propose the concept of somatic collectivity as a way to describe the critical potential of collective embodiment found in dance and its expanded field of practices.
Reflections on the GYROKINESIS® Method: Interview with Juliu Horvath
Authors: Adams Marianne
Published: March 2019

This article explores the development of the GYROKINESIS® method, examines somatic principles related to the method and includes an interview with Juliu Horvath, its founder and creator. Topics within the interview include the concepts of sensing energetic flow, daily practice as means for sustainability and the role of playfulness and physical spirituality in bodywork. Woven within the interview are observations about the method from my background as a dance professor and experiential insights from participation in Gyrokinesis coursework with the founder. Pleasure in practice and my felt sense are documented through multidimensional sensory tracking. Perspectives include the descriptive experience of sensate flow and the perceptions that arise from teaching and learning within a living method. The article concludes with questions for further practice-based research in the Gyrokinesis method and suggests the need for further theoretical research in somatic sustainability.
The sourcing of Somatic Theatre Praxis: Breathing with a goat, contemplating 2000 turkeys and an unexpected interview
Authors: Jürgens Stephan
Published: March 2019

In this article the notion of ‘Somatic Theatre Praxis’ (suggested by theatre director and scholar Teresa Izzard) is used as an umbrella term to describe recent tendencies in the contemporary performing arts to employ somatic practices at all stages of work – training, rehearsal, dramaturgy and performance. The main topic under scrutiny – the sourcing of Somatic Theatre Praxis – particularizes the process of designing a novel somatic experience for the actor, which materializes dramaturgical questions and vision as much as it shapes the somatic practices subsequently introduced and employed during all phases of the creative process. As a case study on sourcing Somatic Theatre Praxis, this article presents my artistic collaboration with Portuguese theatre director João Brites on the production of The Divine Comedy – Inferno (2017). In the context of the fields of performance theory and embodied cognition I discuss examples of documented studio work to show how somatic practices informed specific acting and composition techniques used by Brites in the framework of his ‘Consciousness of the Actor on the Scene’ (CAC) system. The article concludes by drawing on contrasting conceptions of new dramaturgies in the performing arts to arrive at a tentative theoretical contextualization of the work created by João Brites and his theatre company Teatro O Bando.
Book Reviews
Authors: Cisneros Rosemary E. Kostic , Weil Sharon
Published: March 2019

Isadora Duncan in the 21st Century – Capturing the Art and Spirit of the Dancer’s Legacy

Andrea Mantell Seidel (2016), North Carolina: McFarland and Company Inc., Publishers, 272pp., ISBN 978-0-78647-795-1, Ebook; ISBN 978-1-47662-369-6, p/bk, $29.95

Infinite Waves of Health and Creativity: A Virtual Somatic Summit

An ongoing series of live and recorded interviews with somatic experts Somaticsummit.com
Measuring Humans against Gods: on the Digression of Plato’s Theaetetus
Authors: Larsen Jens Kristian
Published: March 2019

The digression of Plato’s Theaetetus (172c2–177c2) is as celebrated as it is controversial. A particularly knotty question has been what status we should ascribe to the ideal of philosophy it presents, an ideal centered on the conception that true virtue consists in assimilating oneself as much as possible to god. For the ideal may seem difficult to reconcile with a Socratic conception of philosophy, and several scholars have accordingly suggested that it should be read as ironic and directed only at the dramatic character Theodorus. When interpreted with due attention to its dramatic context, however, the digression reveals that the ideal of godlikeness, while being directed at Theodorus, is essentially Socratic. The function of the passage is to introduce a contemplative aspect of the life of philosophy into the dialogue that contrasts radically with the political-practical orientation characteristic of Protagoras, an aspect Socrates is able to isolate as such precisely because he is conversing with the mathematician Theodorus.
“An Erring Conscience is an Absurdity”: The Later Kant on Certainty, Moral Judgment and the Infallibility of Conscience
Authors: Knappik Franz , Mayr Erasmus
Published: March 2019

This article explores Kant’s view, found in several passages in his late writings on moral philosophy, that the verdicts of conscience are infallible. We argue that Kant’s infallibility claim must be seen in the context of a major shift in Kant’s views on conscience that took place around 1790 and that has not yet been sufficiently appreciated in the literature. This shift led Kant to treat conscience as an exclusively second-order capacity which does not directly evaluate actions, but one’s first-order moral judgments and deliberation. On the basis of this novel interpretation, we develop a new defence of Kant’s infallibility claim that draws on Kant’s account of the characteristic features of specificallymoraljudgments.
The Metaphysics of Recollection in Plato’sMeno
Authors: Schwab Whitney
Published: March 2019

Recollection is central to the epistemology of Plato’sMeno. After all, the character Socrates claims that recollection is the process whereby embodied human souls bind down true opinions (doxai) and acquire knowledge (epistêmê). This paper examines the exchange between Socrates and Meno’s slave to determine (1) what steps on the path to acquiring knowledge are part of the process of recollection and (2) what is required for a subject to count as having recollected something. I argue that the key to answering these questions is to get clear on the kind of process recollection is supposed to be. In particular, I argue that recollection is a process akin to the kind of process Aristotle calls “changes” (kinêseisor incompleteenergeiai). The key feature of such processes is that they aim at an end beyond themselves and are not complete until that end comes about. In the case of recollection, the end is knowledge, but inferior mental states, such as false opinion, puzzlement (aporia), and true opinion can come about because of a process of recollection without making it the case that the subject has recollected anything. I argue that this interpretation provides a textually supported and philosophically coherent understanding of Socrates’ conception of recollection.
Simple modules over the Lie algebras of divergence zero vector fields on a torus
Authors: Dubsky Brendan Frisk , Guo Xiangqian , Yao Yufeng , Zhao Kaiming
Published: March 2019

Let

n
≥
2

{n\geq 2}

be an integer,

𝕊
n

{\mathbb{S}_{n}}

the Lie algebra of divergence zero vector fields on an n-dimensional torus, and

𝒦
n

{\mathcal{K}_{n}}

the Weyl algebra over the Laurent polynomial algebra

A
n

=

ℂ
⁢

[

x
1

±
1

,

x
2

±
1

,
…
,

x
n

±
1

]

{A_{n}=\mathbb{C}[x_{1}^{\pm 1},x_{2}^{\pm 1},\dots,x_{n}^{\pm 1}]}

. For any

𝔰
⁢

𝔩
n

{\mathfrak{sl}_{n}}

-module V and any module P over

𝒦
n

{\mathcal{K}_{n}}

, we define an

𝕊
n

{\mathbb{S}_{n}}

-module structure on the tensor product

P
⊗
V

{P\otimes V}

. In this paper, necessary and sufficient conditions for the

𝕊
n

{\mathbb{S}_{n}}

-modules

P
⊗
V

{P\otimes V}

to be simple are given, and an isomorphism criterion for nonminuscule

𝕊
n

{\mathbb{S}_{n}}

-modules is provided. More precisely, all nonminuscule

𝕊
n

{\mathbb{S}_{n}}

-modules are simple, and pairwise nonisomorphic. For minuscule

𝕊
n

{\mathbb{S}_{n}}

-modules, minimal and maximal submodules are concretely determined.
Growth hormone deficiency in children with antenatal Bartter syndrome
Authors: Spector-Cohen Inna , Koren Ariel , Sakran Waheeb , Tenenbaum-Rakover Yardena , Halevy Rephael
Published: March 2019

Background

Bartter syndrome is a group of rare autosomal-recessive renal disorders characterized by hypokalemic hypochloremic metabolic alkalosis associated with severe growth failure; the exact causes for growth retardation are unclear. GH deficiency (GHD) has been reported in a few cases of Bartter syndrome. The aim of our study was to determine the prevalence of GHD in children with antenatal Bartter syndrome and to assess their response to GH therapy.

Methods

Ten patients aged 1.5–14.5 years and diagnosed with antenatal Bartter syndrome were enrolled. Seven children with short stature underwent GH stimulation tests.

Results

Common presenting symptoms were failure to thrive and polyuria. The mean patient height at study entry was −2.7 standard deviation (SD) (range 0.89 to −5.95) and mean weight (SD) was −1.7 (range 1.89 to −4.11). A decline in height and weight (SD) was observed over the years. GHD was diagnosed in four children and GH therapy was started in all of them. Two patients responded very well and gained >1 SD in height, one patient stopped therapy due to non-adherence and one had a poor response.

Conclusions

In addition to other important causes for poor growth in antenatal Bartter syndrome, our findings suggest that GHD should also be considered as a cause of growth retardation and therefore, clinical assessment of the GH axis is recommended. GH therapy has a role in the treatment of growth failure in some individuals with Bartter syndrome.
An exploratory study into social and healthcare variables of maternal mortality: a case-control study
Authors: Nosratabadi Mehdi , Amini Rarani Mostafa , Shahidi Shahla , Rahimi Nadia
Published: March 2019

Background

Regarding the important role the mothers’ health plays in shaping nations’ well-being, this study endeavored to explore the main social and healthcare factors related to maternal mortality.

Methods

In this case-control study, data (viz., all maternal mortalities) were gathered from the national maternal mortality surveillance system. Likewise, control data (viz., alive mothers) were obtained from mother health records in 22 health centers located in 21 cities of Isfahan, Iran. The data were related to the years 2001–2016. Case and control groups were matched according to year of delivery, mother’s age at delivery time and city of residence.

Results

Analysis of the gathered data revealed that during the years 2001–2016, 171 maternal mortalities occurred in Isfahan. In view of that, 523 mothers were selected as the control group. Most of the mothers attended high school (36%), were housewives (64%), delivered by cesarean section (59%) and suffered from different kinds of proximate medical causes (55%). The logistic regression results showed that being an immigrant, having a history of proximate medical cause, vaginal delivery and illiteracy raised the odds ratios (ORs) of maternal mortality up to 5.87, 4.41, 2.28 and 1.84 times, respectively. In contrast, using public antenatal care and planned pregnancy have had a protective, significant effect on maternal mortality (ORs <1).

Conclusion

The results suggested that in addition to social factors including immigrant status and low level of education which led to the increase of maternal mortality, healthcare factors including proximate medical causes, delivery method and antenatal care seem to be essential in tackling the issue of maternal mortality.
Quantum dot plasmonics: from weak to strong coupling
Authors: Bitton Ora , Gupta Satyendra Nath , Haran Gilad
Published: March 2019

The complementary optical properties of surface plasmon excitations of metal nanostructures and long-lived excitations of semiconductor quantum dots (QDs) make them excellent candidates for studies of optical coupling at the nanoscale level. Plasmonic devices confine light to nanometer-sized regions of space, which turns them into effective cavities for quantum emitters. QDs possess large oscillator strengths and high photostability, making them useful for studies down to the single-particle level. Depending on structure and energy scales, QD excitons and surface plasmons (SPs) can couple either weakly or strongly, resulting in different unique optical properties. While in the weak coupling regime plasmonic cavities (PCs) mostly enhance the radiative rate of an emitter, in the strong coupling regime the energy level of the two systems mix together, forming coupled matter-light states. The interaction of QD excitons with PCs has been widely investigated experimentally as well as theoretically, with an eye on potential applications ranging from sensing to quantum information technology. In this review we provide a comprehensive introduction to this exciting field of current research, and an overview of studies of QD-plasmon systems in the weak and strong coupling regimes.