BackgroundBecause most human stroke victims are elderly, studies of experimental stroke in the aged rather than the young rat model may be optimal for identifying clinically relevant cellular responses, as well for pinpointing beneficial interventions.Methodology/Principal FindingsWe employed the Affymetrix platform to analyze the whole-gene transcriptome following temporary ligation of the middle cerebral artery in aged and young rats. The correspondence, heat map, and dendrogram analyses independently suggest a differential, age-group-specific behaviour of major gene clusters after stroke. Overall, the pattern of gene expression strongly suggests that the response of the aged rat brain is qualitatively rather than quantitatively different from the young, i.e. the total number of regulated genes is comparable in the two age groups, but the aged rats had great difficulty in mounting a timely response to stroke. Our study indicates that four genes related to neuropathic syndrome, stress, anxiety disorders and depression (Acvr1c, Cort, Htr2b and Pnoc) may have impaired response to stroke in aged rats. New therapeutic options in aged rats may also include Calcrl, Cyp11b1, Prcp, Cebpa, Cfd, Gpnmb, Fcgr2b, Fcgr3a, Tnfrsf26, Adam 17 and Mmp14. An unexpected target is the enzyme 3-hydroxy-3-methylglutaryl-Coenzyme A synthase 1 in aged rats, a key enzyme in the cholesterol synthesis pathway. Post-stroke axonal growth was compromised in both age groups.Conclusion/SignificanceWe suggest that a multi-stage, multimodal treatment in aged animals may be more likely to produce positive results. Such a therapeutic approach should be focused on tissue restoration but should also address other aspects of patient post-stroke therapy such as neuropathic syndrome, stress, anxiety disorders, depression, neurotransmission and blood pressure.

ObjectivesWe evaluated the safety and efficacy of orbital atherectomy in real‐world patients with severe coronary artery calcification (CAC).BackgroundThe presence of severe CAC increases the complexity of percutaneous coronary intervention as it may impede stent delivery and optimal stent expansion. Atherectomy may be an indispensable tool for uncrossable or undilatable lesions by modifying severe CAC. Although the ORBIT I and II trials report that orbital atherectomy was safe and effective for the treatment of severe CAC, patients with kidney disease, recent myocardial infarction, long diffuse disease, severe left ventricular dysfunction, and unprotected left main disease were excluded.MethodsThis retrospective study included 458 consecutive patients with severe CAC who underwent orbital atherectomy followed by stenting from October 2013 to December 2015 at 3 centers.ResultsThe primary endpoint of major adverse cardiac and cerebrovascular events at 30 days was 1.7%. Low rates of 30‐day all‐cause mortality (1.3%), myocardial infarction (1.1%), target vessel revascularization (0%), stroke (0.2%), and stent thrombosis (0.9%) were observed. Angiographic complications were low: perforation was 0.7%, dissection 0.9%, and no‐reflow 0.7%. Emergency coronary artery bypass graft surgery was performed in 0.2% of patients.ConclusionIn the largest real‐world study of patients who underwent orbital atherectomy, including high‐risk patients who were not surgical candidates as well as those with very complex coronary anatomy, acute and short‐term adverse clinical event rates were low. A randomized clinical trial is needed to identify the ideal treatment strategy for patients with severe CAC.

The prevalance of QT prolongation in chronic viral liver disease is high and the risk of complications is increased. We wanted to study the QT interval prolongation at the patients diagnosed with chronic hepatic disease and also to evaluate some of clinical and biochemical variables. We studied a cohort with 126 patients diagnosed with chronic viral hepatic diseases hospitalised to Cardiology Department, to the County Hospital of Craiova, between Octomber 2016 and January 2018. We aimed to determine the occurrence of QT interval prolongation in a large series of patients with chronic hepatic disease of viral etiology. We wanted to evaluated the QT prolongation to clinical and biochemical variables. The QT interval was measured by a standard 12-lead ECG for each patient, with prolongation defined as 460 ms. Multiple clinical and biochemical variables were evaluated including sex, age, areas (rural/urban) the frequency of arrhythmic events (PACs, PVCs, Atrial fibrillation, Bradycardia, Tachycardia), NT proBNP, Hb,uric acid, creatinine, alanine aminotransferase (ALT), aspartate aminotransferase (AST) , cholesterol, triglyceride, etc. The group of patients was composed by 43 woman and 83 men. From 43 women, representing 65.06% (461.56 �42.03) and from 83 men, means 66.67% (461.14 � 45.10) presented interval QT prolongation. Studing the distribution of hepatic etiologies we can see that 34 patients had hepatitis B, 35 patients hepatitis C, 5 patients B and C dual virus infection and 52 patients with chronic liver disease of etiology other than viral. We registered close results about QT interval prolongation on group, sex and origine group of patients. The value of QT interval to our patients was higher compared to other values recorder in other studies, at the patients with chronic hepatic disease, despide the fact we chose a higher value of QT prolongation. The highest value of QT interval was in the group of age between 60 and 69, even if in other studies we notice a prolonged QT interval at patients over 70 years old. The biological and biochemical profile of chronic hepatic disease of the subjects included in our study showed no statistical difference between male and female patients.We found a higher incidence of arrhythmic events, at patients with chronic hepatic disease of viral etiology, especially to premature atrial contraction and atrial fibrillation.We found a couple of correlation between QT interval prolongation and the evolution of chronic hepatic disease of viral etiology. It is very important to develop a strong and complex strategies to prevent and to treat the arrhythmic event presented at the patients diagnosticated with hepatic disease, because of the higher risk of developing life-threatening arrhythmias, includen sudden cardiac death.

Objective We sought to evaluate whether automated coregistration of optical coherence tomography (OCT) with angiography reduces geographic miss (GM) during coronary stenting. Background Previous intravascular ultrasound or OCT studies have showed that residual disease at the stent edge or stent edge dissection was associated with stent thrombosis or edge restenosis. This has been termed GM. Methods Two hundred de novo coronary lesions were randomized in a 1:1 ratio to OCT‐guided percutaneous coronary intervention (PCI) with versus without automated coregistration of OCT with angiography. GM, the primary endpoint, was defined as angiographic ≥type B dissection or diameter stenosis >50% or OCT minimum lumen area <4.0 mm2 with significant residual disease or dissection (dissection flap >60°) within 5 mm from the stent edge. Results The prevalence of GM was not different comparing OCT‐guided PCI with versus without automated coregistration (27.6% vs 34.0%, P = 0.33). However, there was a trend toward a reduced prevalence of significant distal stent edge dissection in lesions with automated coregistration (11.1% vs 20.8%, P = 0.07). The discrepancy in the distance between planned versus actual implanted stent location with automated coregistration was significantly shorter than without coregistration (1.9 ± 1.6 mm vs 2.6 ± 2.7 mm, P = 0.03), especially the prevalence of ≥5 mm discrepancy that was less frequent with automated coregistration. Conclusions Automated coregistration of OCT with angiography did not reduce the primary endpoint of GM after stent implantation.

Background and Objectives: At present, thyroid disorders have a great incidence in the worldwide population, so the development of alternative methods for improving the diagnosis process is necessary. Materials and Methods: For this purpose, we developed an ensemble method that fused two deep learning models, one based on convolutional neural network and the other based on transfer learning. For the first model, called 5-CNN, we developed an efficient end-to-end trained model with five convolutional layers, while for the second model, the pre-trained VGG-19 architecture was repurposed, optimized and trained. We trained and validated our models using a dataset of ultrasound images consisting of four types of thyroidal images: autoimmune, nodular, micro-nodular, and normal. Results: Excellent results were obtained by the ensemble CNN-VGG method, which outperformed the 5-CNN and VGG-19 models: 97.35% for the overall test accuracy with an overall specificity of 98.43%, sensitivity of 95.75%, positive and negative predictive value of 95.41%, and 98.05%. The micro average areas under each receiver operating characteristic curves was 0.96. The results were also validated by two physicians: an endocrinologist and a pediatrician. Conclusions: We proposed a new deep learning study for classifying ultrasound thyroidal images to assist physicians in the diagnosis process.