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Background With the emergence of coronary computed tomography (CT) angiography, anomalous aortic origin of a coronary artery (ANOCOR) is more frequently diagnosed. Fractional flow reserve derived from CT (FFRCT) is a noninvasive functional test providing anatomical and functional evaluation of the overall coronary tree. These unique features of anatomical and functional evaluation derived from CT could help for the management of patients with ANOCOR. We aimed to retrospectively evaluate the physiological and clinical impact of FFRCT analysis in the ANOCOR registry population. Methods and Results The ANOCOR registry included patients with ANOCOR detected during invasive coronary angiography or coronary CT angiography between January 2010 and January 2013, with a planned 5‐year follow‐up. We retrospectively performed FFRCT analysis in patients with coronary CT angiography of adequate quality. Follow‐up was performed with a clinical composite end point (cardiac death, myocardial infarction, and unplanned revascularization). We obtained successful FFRCT analyses and 5‐year clinical follow‐up in 54 patients (average age, 60±13 years). Thirty‐eight (70%) patients had conservative treatment, and 16 (30%) patients had coronary revascularization after coronary CT angiography. The presence of an ANOCOR course was associated with a moderate reduction of FFRCT value from 1.0 at the ostium to 0.90±0.10 downstream the ectopic course and 0.82±0.11 distally. No significant difference in FFRCT values was identified between at‐risk and not at‐risk ANOCOR. After a 5‐year follow‐up, only one unplanned percutaneous revascularization was reported. Conclusions The presence of ANOCOR was associated with a moderate hemodynamic decrease of FFRCT values and associated with a low risk of cardiovascular events after a 5‐year follow‐up in this middle‐aged population.

International audience; We describe a patient with coronavirus disease 2019 (COVID-19) and multiple concomitant thromboses occurring on the 9th day of hospital stay. Thromboses were found in distinct zones of the aorta, as well as in the renal, humeral, and pulmonary arteries. The extensive biological workup performed following this catastrophic thrombotic syndrome found no evidence for underlying prothrombotic disease. In light of current evidence regarding endothelium abnormalities related to COVID-19, this extreme case of catastrophic thrombotic syndrome suggests that COVID-19 can induce severe arterial thrombosis following intense endothelial activation.

INTRODUCTION Infectious endocarditis is still a challenge with a high mortality and complication rate despite the progress made in its management. DESCRIPTION OF CLINICAL CASE A 58 years old female, with a history of mitral and aortic mechanical prosthesis for rheumatic valvular disease and mitral infectious endocarditis with Aggregatibacter Actinomycetemcomita due to an apical abscess was referred to our service for persistent fever. The clinical examination revealed irregular mechanical prosthesis beats, with no heart murmurs and no signs of heart failure, but with a tender splenomegaly. The laboratory tests showed an inflammatory syndrome, but no positive blood cultures. An extensive panel for endocarditis was negative for Coxiella burnetii, Brucella Spp, Legionella Spp, Mycoplasma Spp and for the immunology markers (rheumatoid factor, antinuclear antibodies and anti-cardiolipin antibodies) ECG AF, 88 bpm, PVC bigeminy, LBBB. Infectious endocarditis was the most likely diagnosis considering the fever, the inflammatory syndrome, the presence of the mechanical valves and the history of endocarditis. An echocardiography was performed that showed a non-dilated left ventricle with a preserved EF, no aortic prosthesis dysfunction, nor mitral; a dilated RV with normal function, moderate tricuspid regurgitation, no intracardiac masses and no pericardial effusion. The TEE revealed no vegetation, no abscess or pseudoaneurysms and no dehiscence of the prosthetic valves. The Endocarditis Team was reunited and empirical antimicrobial therapies with Amoxiciline, Gentamicine and Cloxaciline for 6 weeks, as well as a PET scan were recommended. The PET-CT revealed abnormal fixation in the posterior-inferior part of the aortic valve. As we had only one major criterion and two minor criteria for the diagnosis of endocarditis a radiolabeled leukocytes SPECT CT that showed no pathological fixation was realised. The result was inconclusive as it was performed at the end of the antimicrobial treatment. A computed tomography of the brain, thorax, abdomen and pelvis didn’t reveal any vascular phenomena. The tender splenomegaly was secondary to two hemangiomas. Also a dental computed tomography revealed an apical abscess of 1.2 that was treated after discharge with antibiotic prophylaxis. DISCUSSION This clinical case confirms that the diagnosis on infectious endocarditis can be challenging in patients with prosthetic valves. The multimodality imaging is of major importance for the diagnosis of these patients. Additionally the microbiological criteria was not met in this case as it was a blood culture-negative endocarditis with a history of previous antibiotic therapy. CONCLUSION Our knowledge of infectious endocarditis is constantly evolving. Blood culture negative endocarditis accounts for one third of cases and is still a challenge. The Endocarditis Team and multimodality imaging play a central role in the diagnosis and treatment of these patients. Abstract P1266 Figure. PET-CT showing AV abnormal fixation

Objectives We evaluated the predictors of in-stent restenosis (ISR) and the angiographic patterns for ostial lesions of the right coronary artery (RCA) to better identify this population at risk. Background Although the prevalence of ISR of the RCA is diminishing, the mechanisms of restenosis are still unknown. Methods Between January 2003 and December 2017, we recruited 550 consecutives patients undergoing a coronarography for ostial lesion of RCA. 149 angioplasties are realized for acute coronary syndrome (ACS) or stable angina. Restenosis, defined as a stenosis within 5 mm distance, proximal or distal to the previously placed stent, with ≥ 50% diameter stenosis, appeared for 46 patients. These patients were included in the IRS+ group. We defined also an IRS- group composed by 44 patients without restenosis in the initial population. We used Chi square test and Mann Whitney test for univariable analysis of ISR predictors. Multiple logistic regression analysis was used to determine the independent factors of ISR, and the adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) were calculated. Results We diagnosed 46 of 149 patients with RCA-ISR, which were classifiable between 19,8% of restenosis in case of implantation of a drug-eluting stent (DES) and 53,6% of restenosis in case of bare metallic stent (BMS). By univariable analysis we found 7 statistically significant predictors of ISR in our population: mono-troncular lesions, ad-hoc angioplasty, BMS stenting, guiding-catheter diameter, early generation DES, post-dilatation, anti-platelet drugs. After multivariable analysis, ad-hoc angioplasty and the BMS stenting were the only independent predictors of ISR (aOR, 0.23; 95% CI, 0.39–0.58; P = 0.009 and respectively aOR, 0.21; 95% CI, 0.39–0.55; P = 0.002) ( Fig. 1 ). Conclusion We found a high prevalence of RCA-ISR in our study population. The risk of ISR is higher in patients with ad-hoc angioplasty or in case of BMS implantation.

SPIRIT 2013 Checklist: Recommended Items to address in a clinical trial protocol and related documents. (PDF 167 kb)

Objectives We investigated whether maintenance therapy with clopidogrel 150 mg/day produces greater platelet inhibition than the standard 75-mg/day dose and whether the higher maintenance dose increases platelet inhibition in low responders to clopidogrel 75 mg/day. Background Patients show interindividual variability in their platelet response to clopidogrel. Low responders could potentially obtain greater clinical benefit from greater doses of clopidogrel. Methods One hundred fifty-three elective percutaneous coronary intervention patients were randomized to clopidogrel 150 mg/day (n = 58) or 75 mg/day (n = 95) for 4 weeks, with vasodilator-stimulated phosphoprotein assay-guided switching to clopidogrel 150 mg/day after 2 weeks in low responders (platelet reactivity index ≥69%). All patients received aspirin 75 mg/day. Results After 2 weeks, clopidogrel 150 mg/day produced a significantly lower platelet reactivity index than clopidogrel 75 mg/day (43.9 ± 17.3% vs. 58.6 ± 17.7%; p l 0.0001). The proportion of low responders was significantly lower in patients randomized to clopidogrel 150 mg/day than in those randomized to clopidogrel 75 mg/day (8.6% vs. 33.7%; p = 0.0004). In the clopidogrel 75 mg/day group, 64.5% (20 of 31) of low responders became responders after switching to clopidogrel 150 mg/day for 2 weeks. No major bleeds occurred during the study; the incidence of minor bleeds was similar in each treatment group. Conclusions In elective percutaneous coronary intervention patients, a 150-mg/day clopidogrel maintenance dose produces greater inhibition of platelet function than clopidogrel 75 mg/day. In low responders to clopidogrel 75 mg/day, switching to clopidogrel 150 mg/day overcomes low responsiveness in a majority of patients. These findings warrant further clinical evaluation. (VASP-02; EudraCT number: 2004-005230-40).

This study investigates the influence of treatment of plastic and extracellular matrix (ECM) proteins with chlorhexidine or benzalkonium chloride on subsequent adherence of Candida albicans. Three concentrations were tested for each antiseptic: (i) chlorhexidine, MIC (6.25-12.5 mg/L), 80 x MIC and 800 x MIC; and (ii) benzalkonium chloride, MIC (3.12 mg/L), 40 x MIC and 1600 x MIC. Chlorhexidine and benzalkonium chloride activities were correlated with the tested concentrations. Antiseptics used at MIC were unable to modify the adherence to plastic or ECM proteins. Chlorhexidine (80 x MIC) induced a decrease in plastic adherence of 31% of the 15 strains used and an increase in ECM protein adherence of 13% of strains. Benzalkonium chloride (40 x MIC) induced a decrease in adherence to ECM proteins or plastic of 13-27% of strains. Our results indicated that the treatment with 1600 x MIC benzalkonium chloride could induce the opposite effect on adherence, depending on the surface: 60% of the strains showed an increase in their adherence to ECM proteins, whereas 93% of the strains showed a decrease in their adherence to plastic. A similar phenomenon was observed after treatment with 800 x MIC chlorhexidine: 60% of the strains showed an increase in their adherence to ECM proteins, whereas 67% showed a decrease in adherence to plastic. Treatment of medical devices with at least 5000 mg/L of chlorhexidine or benzalkonium chloride could therefore reduce C. albicans adherence to plastic surfaces, but would be unable to prevent fungal adherence to ECM proteins.

International audience; AIMS: Proof-of-concept evidence suggests that mechanical ischaemic post-conditioning (PostC) reduces infarct size when applied immediately after culprit coronary artery re-opening in ST-elevation myocardial infarction (STEMI) patients with thrombolysis in myocardial infarction 0-1 (TIMI 0-1) flow grade at admission. Whether PostC might also be protective in patients with a TIMI 2-3 flow grade on admission (corresponding to a delayed application of the post-conditioning algorithm) remains undetermined. METHODS AND RESULTS: In this multi-centre, randomized, single-blinded, controlled study, STEMI patients with a 2-3 TIMI coronary flow grade at admission underwent direct stenting of the culprit lesion, followed (PostC group) or not (control group) by four cycles of (1 min inflation/1 min deflation) of the angioplasty balloon to trigger post-conditioning. Infarct size was assessed both by cardiac magnetic resonance at Day 5 (primary endpoint) and cardiac enzymes release (secondary endpoint). Ninety-nine patients were prospectively enrolled. Baseline characteristics were comparable between control and PostC groups. Despite comparable size of area at risk (AAR) (38 +/- 12 vs. 38 +/- 13% of the LV circumference, respectively, P = 0.89) and similar time from onset to intervention (249 +/- 148 vs. 263 +/- 209 min, respectively, P = 0.93) in the two groups, PostC did not significantly reduce cardiac magnetic resonance infarct size (23 +/- 17 and 21 +/- 18 g in the treated vs. control group, respectively, P = 0.64). Similar results were found when using creatine kinase and troponin I release, even after adjustment for the size of the AAR. CONCLUSION: This study shows that infarct size reduction by mechanical ischaemic PostC is lost when applied to patients with a TIMI 2-3 flow grade at admission. This indicates that the timing of the protective intervention with respect to the onset of reperfusion is a key factor for preventing lethal reperfusion injury in STEMI patients. CLINICAL TRIAL NUMBER: NCT01483755.

Among potential virulence factors of Candida albicans, enzymes seem to play an important role. Many studies concern the secreted aspartic proteinases (saps), and the degradation of some components of the subendothelial extracellular matrix by the isoenzyme sap2 has been proved. Nevertheless, other proteolytic enzymes could be involved in the pathogenicity of the yeast. We studied the degradation of four constitutive proteins of the extracellular matrix: type I and IV collagens, laminin and fibronectin, by a 95-kDa metallopeptidase, localised in the cell wall of C. albicans. Each of these constituents was incubated with the purified enzyme and its degradation products analysed by an electrophoretic method. We observed that type I collagen and fibronectin were totally degraded by the enzyme whereas type IV collagen and laminin were only partially degraded. The C. albicans metallopeptidase may play a role in the degradation of the subendothelial extracellular matrix components. This enzyme could facilitate the migration of the yeast in the tissues after crossing the endothelial layer, allowing the fungal invasion of target organs.

This paper reports on three cases of patients with an apparently normal heart admitted for sustained monomorphic ventricular tachycardia. The only abnormal finding showed in the electrocardiogram (ECG) in sinus rhythm that exhibited an entity associated with incomplete right bundle-branch block and persistent ST-segment elevation. The ECG entity was variable and disappeared transiently. Spontaneous ventricular tachycardia in one patient was inducible by programmed stimulation. There was no underlying heart disease. The origin of the ventricular tachycardia in one patient was located by pace mapping in the left ventricle at the left ventricular basal septum. The follow-up (from 6 months up to 6 years) demonstrated a good prognosis. This particular ECG entity associated with monomorphic ventricular tachycardia could have been missed because of the variations in the ECG in sinus rhythm and was associated with a favorable prognosis.

A novel aminopeptidase was purified by high performance liquid chromatography from a cytosoluble 100,000 g extract of Candida albicans on the basis of its ability to cleave L-arginine 7-amino-4-methylcoumarin. The purification factor was 36 and the yield was 20%. The native enzyme had a mol. wt of 52 kDa as demonstrated by SDS-PAGE in the presence or absence of reducing conditions and exhibited an iso-electric point of 4.3. The aminopeptidase showed optimum activity at pH 7.2, a Michaelis constant of c. 50 microM and a Vmax at 19 mM AMC released/min/mg of protein for L-Arg-AMC. This enzyme was shown to cleave at low affinity L-leucine-7-amino-4-methylcoumarin as demonstrated by the spectrofluorimetric method. The enzyme was strongly inhibited by specific metallo-enzyme inhibitors-EDTA and o-phenanthroline. Furthermore, there is evidence that a similar or identical enzyme occurs in other C. albicans clinical isolates and other Candida spp.

Background— The value of prehospital initiation of glycoprotein IIb/IIIa inhibitors remains a controversial issue. We sought to investigate whether in-ambulance initiation of abciximab in patients with ST-segment elevation myocardial infarction (STEMI) improves ST-segment elevation resolution (STR) after primary percutaneous coronary intervention (PCI). Methods and Results— MISTRAL (Myocardial Infarction with ST-elevation Treated by Primary Percutaneous Intervention Facilitated by Early Reopro Administration in Alsace) is a prospective, randomized, double-blind study. Two hundred and fifty-six patients with acute STEMI were allocated to receive abciximab either in the ambulance (ambulance group, n=127) or in the catheterization laboratory (hospital group, n=129). The primary end point was complete (>70%) STR after PCI. Complete STR was not significantly different between the 2 groups (before PCI, 21.6% versus 15.5%, P =0.28; after PCI, 70.3% versus 65.8%, P =0.49). Thrombolysis In Myocardial Infarction (TIMI) 2 to 3 flow rates before PCI tended to be higher in the ambulance group (46.8% versus 35%, P =0.08) but not after PCI (70.3% versus 65.8%, P =0.49). Slow flow tended to be lower (5.6% versus 13.4%, P =0.07), and distal embolization occurred significantly less often in the ambulance group (8.1% versus 21.1%, P =0.008). One- and 6-month major adverse cardiac event rates were low and similar in both groups. Conclusions— Early ambulance administration of abciximab in STEMI did not improve either STR or TIMI flow rate after PCI. However, it tended to improve TIMI flow pre-PCI and decreased distal embolization during procedure. Larger studies are needed to confirm these results. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00638638.

Immunocompromised patients are at high risk of developing Candida infections. Although cell-mediated immunity is generally believed to play the main role in defence against fungi, antibodies could also be effective in immune defence by different mechanisms of action. The adherence capacity of four strains of Candida albicans to polystyrene and to some extracellular matrix components was investigated after incubation of the yeasts with non-specific and specific anti-C. albicans IgG. Experiments were carried out using a colorimetric method based upon the reduction of XTT tetrazolium (2,3-bis[2-methoxy-4-nitro-5-sulfophenyl]-2H-tetrazolium-5-carboxanilide) by mitochondrially active blastospores in the presence of menadione. Incubation of the yeasts with IgG, specific or not, caused a decrease in the capacity for adherence to the surfaces studied. There was no significant effect of the specificity of the tested antibodies on the reduction of adherence capacity. In conclusion, total IgG could play a role in blocking the binding of C. albicans to host and medical device surfaces. These results suggest that regular survey of levels of total IgG in patients suffering from severe hypogammaglobulinaemia could be of interest for the prevention of systemic candidiasis.

Five antifungal agents with different mechanisms of action were compared for their ability to affect mitochondrial dehydrogenase activity and adherence capacity of Candida albicans to polystyrene and extracellular matrix proteins. Only amphotericin B inhibited mitochondrial dehydrogenase activity when the culture medium was supplemented with galactose. 5-Fluorocytosine and terbinafine did not affect this activity, whereas itraconazole and fluconazole improved it. Furthermore, in these experimental conditions, the effect of sub-inhibitory concentrations of antifungals on adherence was dependent on the tested antifungal and the adherence surface: amphotericin B inhibited adherence to polystyrene and fibrinogen, but improved adherence to extracellular matrix. For all surfaces tested, when culture medium was supplemented with galactose, fluorocytosine did not affect adherence, and itraconazole, fluconazole and terbinafine inhibited adherence. Our results also confirmed the influence of the carbohydrates: sub-minimum inhibitory concentrations (MIC) of itraconazole increased or did not modify the mitochondrial metabolism of yeasts when the culture medium was supplemented with galactose, but this antifungal always decreased mitochondrial metabolism when the culture medium was supplemented with glucose. These data indicate that antifungals used below their MIC values can have various effects. It is important to distinguish the effects of antifungals on the metabolism of C. albicans from effects on its adherence capacity. The former effects are linked to the viability of the yeast and the latter depends on the colonization of cellular as opposed to inert surfaces.

A 95 kDa metallopeptidase of Candida albicans could be involved in the process of dissemination of the yeast. Matrix metalloproteases (MMPs) are also responsible for collagen breakdown in inflammatory and malignant processes. We tested six compounds on the C. albicans enzyme. Doxycycline, gentamicin, cefalothin, galardin, and elaidic and oleic acids are known for their capacity to inhibit some MMPs. Amongst these agents, only oleic acid was able to markedly inhibit the purified metallopeptidase at very low concentrations. Moreover, this fatty acid inhibited the secretion of the enzyme in the culture medium without altering the yeast viability.

Percutaneous coronary intervention (PCI) as a treatment of coronary artery disease can be a simple, rapid procedure with a clear benefit for the patient, but it could also become a complex procedure with fatal consequences. These complications depend on the lesion itself, material used and also on operating staff. In this case we report a coronary artery dissection of the circumflex (CX) artery caused by inflation of an oversized balloon. We discuss here the management and evolution of this complication.

Fungus ball of the paranasal sinus is the growth of a fungal mass (mycetoma) within the sinus cavity, usually caused by molds; endoscopic surgery is the usual treatment ([2][1], [4][2]). Because of the poor viability of the fungi, diagnosis based on fungal cultures of nasal secretion or material

Kais Mrabet [Orateur] (1), Romain Chopard (1), Nicolas Meneveau (1), Sidney Chocron (2), Jean-Eric Wolf (3), Jean-Christophe Eicher (4), Olivier Bouchot (4), Laurent Jacquemin (5), Nicolas Bischoff (5), Francois Schiele (1) (1) CHU Besancon, Cardiologie, Besancon, France (2) CHU Besancon, Chirurgie Cardiaque, Besancon, France (3) CHU Dijon, Cardiologie, Dijon, France (4) CHU Dijon, Dijon, France (5) CH Mulhouse, France

The CYP2C19*2 genetic variant is known to contribute to low responsiveness to clopidogrel treatment, leading to a higher rate of cardiovascular events. Systematic identification of the 2C19*2 carriers to predict the individual patient's response to clopidogrel is a matter of debate.Data of the VASP-02 study comparing patients’ responsiveness to 75 and 150 mg/day maintenance dose of clopidogrel (Aleil et al., J Am Coll Cardiol Intv 2008) were reanalyzed by determining the 2C19*2 carrier status of the patients. Platelet reactivity index (PRI) was determined using the VASP method. A PRI>69% defines low responsiveness to clopidogrel.In the 37 non responder patients, 42.4% were 2C19*2 carriers versus 22.0% in the responder patients (p=0.022). After multivariate analysis, 2C19*2 polymorphism and high body weight were two independent predictors of high PRI (odds ratio [95% confidence interval] 3.39 [1.06-10.84] p=0.039 and 3.14 [1.19-8.30] p=0.021) respectively. Increasing the maintenance dose of clopidogrel from 75 to 150 mg/day in non responder patients resulted in a significant decrease of PRI from 76.4±4.6 to 62.8±10.4% (p

The recent discovery of self-resolving Cryptosporidium infection in immunocompetent patients has aroused growing interest in this parasite, which has thus far been known to affect mainly immunodeficient individuals. Following the hospitalization of two children attending the same day-care center in February 1986 Cryptosporidium oocysts were found in the stools of one of them. This led to an epidemiological investigation to assess the frequency of Cryptosporidium oocysts in the stools of children attending the 7 day-care centers in the city of Poitiers, France. Testing for Cryptosporidium oocysts was performed on formalinized stools, after smear staining by the modified Ziehl-Neelsen procedure. Each positive stool was also submitted to virological and bacteriological examination. Stool specimens from 235 children were studied: 9 (3.8%) of them had Cryptosporidium oocysts in their stools. Four of the children had diarrhea, and 5 (2.2%) were asymptomatic. The existence of healthy carriers should lead to caution in the interpretation of stool parasitology.

Even without any immunologic barrier, as in autografts, reversal of diabetes induced by islets transplantation is not definitive and a secondary failure generally occurs. Factors involved in this failure were investigated in 13 male dogs undergoing total pancreatectomy and extemporaneous islets reinjection in the portal circulation. Five dogs died from postoperatory complications, three remained diabetic, and five were normoglycemic without insulin therapy for a duration of two to 26 weeks. Factors associated with failure appeared to be: (a) hemorrhage during dissection of pancreas prior to islets isolation, (b) imperfect collagenase digestion. Moreover, duration of this period of normoglycemia was negatively correlated with glycemia on the 20th postoperatory hour (r = 0.759, p less than 0.05), suggesting a possible relationship between glycemia and further graft outcome. Therefore, such a multifactorial statistical analysis seems to be helpful for the study of multiple technical parameters associated with the prognosis of islets transplantations.

Hyperglycemia is a powerful predictor of worse outcome after ST segment-elevation myocardial infarction (STEMI). Previous studies showed that hyperglycemia could be related to impaired myocardial reperfusion. This relation may be explained by absolute or relative insulin deficiency resulting in increasing toxic effect of circulating free fatty acids or in reducing glucose use in anaerobic manner in myocardium. The present study evaluates glycemic parameters, plasma insulin level, insulin resistance by index Quicki (1/log insulin + log glycemia in mg/dL) and index Homa (insulin x glycemia in μmol/L/22.5) in 105 patients with STEMI and successful percutaneous primary coronary intervention (PCI). The maximum ST elevation of single electrocardiogram (ECG) lead before and 60 minutes after PCI was measured and patients were then divided into 2 groups according to the degree of ST-segment resolution (STR): not complete ( Of the 105 patients, 62 (59.0%) had complete STR, 43 (41.0%) experienced not complete STR. Not complete STR group had a trend to a higher mean admission glucose level (1.8 ± 1.5 g/l vs 1.4 ± 0.5 g/l, p = 0.1) and a significative higher glycated haemoglobin level (6.8 ± 1.9% vs 6.1 ± 0.9%, p = 0.008). However no difference was observed for plasma insulin level (21.4 ± 23.6 mU/l vs 21.1 ± 18.4 mU/l), index Quicki (0.32 ± 0.07 vs 0.30 ± 0.04) and index Homa (142.3 ± 171.4 vs 146.7 ± 158.6) respectively in complete and not complete STR groups. In conclusion, this study confirms the association between hyperglycemia and electrocardiographic signs of complete reperfusion in patients with STEMI after PCI but this relation does not seem to be related to a absolute plasma insulin deficiency or an insulin resistance.

Background This prospective study evaluated pre-hospital anti-thrombotic association of bivalirudin (bolus 0.5 mg/kg followed by an infusion of 1.75 mg/kg/ hour) and prasugrel (60 mg loading dose) on in-hospital outcome in patients with acute myocardial infarction treated by primary angioplasty. Methods and results From June 2010 to October 2011 seventy-one consecutive patients of 54.2±9.2 years old were included, including 27 patients (38.0%) with anterior myocardial infarction and 15 patients (21.1%) with a TIMI risk score >2. The culprit artery was occluded in 46 patients (64.8%). Primary coronary angioplasty was performed 5.0±8.6 hours after symptom onset, with radial access in 58 patients (81.7%). TIMI III culprit vessel recanalisation was obtained in 71 patients (100%). Angioplasty procedure used 1.1±0.7 stents with effective thrombectomy in 31 patients (60.7%) in 51 thrombectomy attempts. AntiIIBIIIA glycoprotein treatment was administered during angioplasty in 15 patients (21.1%). Peak troponin I reached 211.9±882.9 ng / ml, left ventricular ejection fraction was 51.6±9.4%. During hospitalization we observed a MACE rate of 4.2% (1 death, 1 ischemic target vessel revascularisation and 1 reinfarction) and no stent thrombosis. Bleeding complication rate was 2.6% according to HORIZON criteria and 0% for severe or intermediate bleeding and 2.6% for moderate bleeding according to GUSTO classification. Conclusion In-hospital outcome in patients treated by primary angioplasty after pre-hospital bivilarudine and prasugrel treatment seems to have a low risk of ischemic and bleeding complications.

Introduction: In challenging listening situations, speech perception with a cochlear implant (CI) remains demanding and requires high levels of listening effort, which can lead to increased levels of listening-related fatigue. The body of literature on these topics increases as the number of CI users rises. This scoping review aims to provide an overview of the existing literature on listening effort, fatigue, and listening-related fatigue among CI users and the measurement techniques to evaluate them., Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statements were used to conduct the scoping review. The search was performed on PubMed, Scopus, and Web of Science to identify all relevant studies., Results: In total, 24 studies were included and suggests that CI users experience higher levels of listening effort when compared to normal hearing controls using scales, questionnaires and electroencephalogram measurements. However, executing dual-task paradigms did not reveal any difference in listening effort between both groups. Uncertainty exists regarding the difference in listening effort between unilateral, bilateral, and bimodal CI users with bilateral hearing loss due to ambiguous results. Only five studies were eligible for the research on fatigue and listening-related fatigue. Additionally, studies using objective measurement methods were lacking., Discussion: This scoping review highlights the necessity for additional research on these topics. Moreover, there is a need for guidelines on how listening effort, fatigue, and listening-related fatigue should be measured to allow for study results that are comparable and support optimal rehabilitation strategies., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Philips, Jacquemin, Lammers, Mertens, Gilles, Vanderveken and Van Rompaey.)

Introduction: Accumulating evidence suggests a role of the brainstem in tinnitus generation and modulation. Several studies in chronic tinnitus patients have reported latency and amplitude changes of the different peaks of the auditory brainstem response, possibly reflecting neural changes or altered activity. The aim of the systematic review was to assess if alterations within the brainstem of chronic tinnitus patients are reflected in short- and middle-latency auditory evoked potentials (AEPs)., Methods: A systematic review was performed and reported according to the PRISMA guidelines. Studies evaluating short- and middle-latency AEPs in tinnitus patients and controls were included. Two independent reviewers conducted the study selection, data extraction, and risk of bias assessment. Meta-analysis was performed using a multivariate meta-analytic model., Results: Twenty-seven cross-sectional studies were included. Multivariate meta-analysis revealed that in tinnitus patients with normal hearing, significantly longer latencies of auditory brainstem response (ABR) waves I (SMD = 0.66 ms, p < 0.001), III (SMD = 0.43 ms, p < 0.001), and V (SMD = 0.47 ms, p < 0.01) are present. The results regarding possible changes in middle-latency responses (MLRs) and frequency-following responses (FFRs) were inconclusive., Discussion: The discovered changes in short-latency AEPs reflect alterations at brainstem level in tinnitus patients. More specifically, the prolonged ABR latencies could possibly be explained by high frequency sensorineural hearing loss, or other modulating factors such as cochlear synaptopathy or somatosensory tinnitus generators. The question whether middle-latency AEP changes, representing subcortical level of the auditory pathway, are present in tinnitus still remains unanswered. Future studies should identify and correctly deal with confounding factors, such as age, gender and the presence of somatosensory tinnitus components., Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display&#95;record.php?ID=CRD42021243687, PROSPERO [CRD42021243687]., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Jacxsens, De Pauw, Cardon, van der Wal, Jacquemin, Gilles, Michiels, Van Rompaey, Lammers and De Hertogh.)

[This corrects the article DOI: 10.3389/fnagi.2021.647285.]., (Copyright © 2021 Simoes, Daoud, Shabbir, Amanat, Assouly, Biswas, Casolani, Dode, Enzler, Jacquemin, Joergensen, Kok, Liyanage, Lourenco, Makani, Mehdi, Ramadhani, Riha, Santacruz, Schiller, Schoisswohl, Trpchevska and Genitsaridi.)