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We developed a multiplexed point-of-care immunodiagnostic assay for antibody detection in human sera made through the vertical stacking of functional paper layers. In this multiplexed vertical flow immunodiagnostic assay (xVFA), a colorimetric signal is generated by gold nanoparticles captured on a spatially-multiplexed sensing membrane containing specific antigens. The assay is completed in 20 minutes, following which the sensing membrane is imaged by a cost-effective mobile-phone reader. The images are sent to a server, where the results are rapidly analyzed and relayed back to the user. The performance of the assay was evaluated by measuring Lyme-specific antibodies in human sera as model target antibodies. The presented platform is rapid, simple, inexpensive, and allows for simultaneous and quantitative measurement of multiple antibodies and/or antigens making it a suitable point-of-care platform for disease diagnostics.

Background: Rates and importance of periprocedural myocardial injury (PMI) after crossing coronary chronic total occlusions (CTOs) is not well understood. This study sought to investigate long-term clinical implications of PMI in patients undergoing percutaneous coronary intervention (PCI) for single CTO utilizing antegrade technique., Methods: Out of 11,957 patients undergoing non-urgent PCI, a total of 1110 patients with symptomatic angina and single CTO were treated by antegrade PCI and observed for up to 10 years. The primary objective included cardiac death, while the secondary aim comprised all major adverse cardiovascular and cerebrovascular event (MACCE) rate., Results: Troponin-defined PMI occurred in 4.7% patients (n = 52). At 1 year, the cardiac death and MACCE rates were significantly higher in patients with vs without PMI (hazard ratio [HR], 5.72; 95% confidence interval [CI], 1.59-20.49; P=.01; HR, 1.84; 95% CI, 1.07-3.18; P=.03, respectively). At long-term follow-up, patients with PMI had a trend toward a higher incidence of cardiac death than patients without PMI (HR, 2.51; 95% CI, 0.99-6.33; P=.05) and no differences were demonstrated in terms of overall MACCE between both groups (HR, 1.19; 95% CI, 0.73-1.93; P=.49). After propensity score adjustment, no significant differences were observed regarding the short-term and long-term outcomes., Conclusion: CTO-PCI is a safe procedure if routinely performed in symptomatic patients at a high-volume center. PMI does not influence long-term outcomes after antegrade CTO-PCI.

Aims: The effectiveness of revascularization of chronic total occlusion (CTO) remains intriguing. Thus, we sought to investigate whether a successful PCI for single CTO improves outcomes in a setting of stable angina and chronic occlusion of single coronary artery., Methods and Results: Of 11 957 consecutive patients referred for nonurgent PCI between 2003 and 2010, 1110 displayed single CTO and were enrolled to the central CTO-registry database. The primary end-point included all-cause mortality, the secondary end-point a composite of safety outcome measure of all-cause death, nonfatal-MI, the need for urgent revascularization and stroke. The major adverse cardiovascular event (MACE) records were extracted from the national administrative database and all patients were linked to the long-term follow-up. Since the patient assignment was not random, we performed the propensity scoring to minimize selection bias; 734 patients (66%) had a successful PCI-CTO. Compared with successful procedures, unsuccessful procedures had similar rates of all-cause death both in crude (HR, 0.78; 95%CI, 0.49-1.25; P = 0.30) and adjusted analysis (HR, 0.80; 95%CI, 0.50-1.28; P = 0.34). A similar, significant reduction in overall MACE was noted with successful PCI-CTO compared with unsuccessful procedure in unadjusted (HR, 0.74; 95%CI, 0.56-0.96; P = 0.020) and adjusted calculation (HR, 0.73; 95%CI, 0.56-0.96; P = 0.019). Patients after successful PCI-CTO as compared with failed recanalization less frequently underwent surgical revascularization. The benefit was sustained at 3 years follow-up., Conclusions: Successful PCI for single CTO does not improve long-term survival, nonetheless, is associated with reduced overall MACE and the need for surgical revascularization., (© 2015 Wiley Periodicals, Inc.)

Background: There are limited data on the long-term safety and efficacy of drug-eluting stents (DES) implantation in patients with stable angina referred for elective percutaneous coronary intervention (PCI) of chronic total occlusion (CTO). We therefore aim to investigate whether DES compared with bare-metal stent (BMS) implantation improves long-term outcomes after successful recanalization of single CTO., Methods: A total of 345 consecutive patients who underwent successful recanalization of single CTO and received DES or BMS in the Cardioangiology Laboratories of the Medical University of Gdansk between January 1, 2006 and December 31, 2010 were included in the CTO Registry database. We compared the 1-year and long-term clinical outcomes of 137 consecutive patients who underwent PCI for CTO and DES implantation with outcomes of 208 patients after successful CTO treatment with BMS implantation. The median follow-up was 22.6 ± 3 months (21.0 ± 3.9 months for DES vs 23.6 ± 1.5 months for BMS; P<.001). The primary endpoints included a composite of all-cause death and non-fatal myocardial infarction (MI) and composite safety endpoint of major adverse cardiovascular events (MACEs), including death, MI and symptom-driven target lesion revascularization (TLR). A secondary endpoint was a symptom-driven TLR., Results: After stent implantation we noted lower rates of the composite endpoint at 1-year (9.5% DES vs 18.3% BMS; P=.01) and long-term follow-up (11.7% DES vs 21.1% BMS; P=.02) due to fewer episodes of TLR in the DES group (5.1% DES vs 14.4% BMS; P=.006 at 1-year follow-up; 7.3% DES vs 14.4% BMS; P=.04 at long-term follow-up). No significant differences were documented in the rate of death, MI, or in-stent thrombosis between investigated subsets. After adjusting for patient and procedural characteristics as well as propensity, BMS implantation remained independently associated with an increased hazard of 1-year MACE (adjusted hazard ratio [AHR], 2.09; 95% confidence interval [CI], 1.2-3.64; P=.005) and long-term MACEs (AHR, 1.99; 95% CI, 1.18-3.38; P<.01)., Conclusions: DES implantation during PCI for single CTO reduces MACE rate at 1-year and long-term follow-up due to the significant reduction of TLR in the DES group. Therefore, DES implantation should be preferred as an optimal treatment strategy of single CTO in stable angina patients.

Background: Uridine (Ur) and hypoxanthine (Hx) are the major end products of ischemic nucleotide breakdown in the human heart. Hypoxanthine is further metabolized to uric acid (UA). The aim of the study was the evaluation of whether changes in nucleotide concentrations during exercise correlate with electrocardiography (ECG) changes, and the severity of coronary artery disease (CAD)., Methods: Twenty-nine males with CAD and 11 controls without CAD (mean age 56.1 vs. 51.45) were subjected to treadmill exercise. The test was considered positive if ECG showed more then 1 mm ST segment depression. Venous blood samples taken before and 10 minut after the exercise were analysed by high performance liquid chromatography., Results: Twenty-two out of 29 patients with CAD and 6 of 11 in the control group had abnormal exercise stress tests according to ECG criteria only. Mean Ur was positive in the CAD group and negative in the control group (0.45 SEM +/- 0.09 microM/L vs. -0.43 SEM +/- 0.21 microM/L, p < 0.0001). UA was positive in the CAD group (15.31 SEM +/- 5.52 microM/L) and negative in the control group (15.31 SEM +/- 5.52 microM/L vs. -48.18 SEM +/- 13,8 microM/L, p < 0.00001); Hx increased in both groups, and the change was not significantly different. Correlations of CAD-index with ST depression, Ur and UA, were: r = 0.43 (p < 0.005), r = 0.62 (p < 0.001), and r = 0.39 (p < 0.01), respectively. Sensitivity of any increase of uridine was superior to 1.5 mm ST depression during exercise., Conclusions: Blood Ur and UA concentration changes during exercise correlate with severity of CAD. We observed slightly greater accuracy of uridine change in comparison to ST changes, thus being a possible new tool in diagnosis of CAD. (Cardiol J 2007; 14: 573-579).

The aim of work was to try to use a new technic of 24 hour Holter ECG, recorded simultaneously from the chest surface and supraventricular in order to differentiate between ventricular and supraventricular origin of heart arrhythmia. We investigated 20 patients but analysed 18 (in two cases we failed to obtained transesophageal ECG). The presence and time RP' of retrograde atrial depolarization during extrasystoles was analysed, usually hidden on chest surface ECG. In three cases we changed the diagnosis after analysis of transesophageal ECG. We did not observe any complications of prolonged transesophageal ECG recording.