Safety and outcome of coronary interventions with special reference to anticoagulation and stent type

University of Turku, Faculty of Medicine, Department of Cardiology and Cardiovascular Medicine, Doctoral Programme of Clinical Investigation, Heart Center, Turku University Hospital, Turku, Finland Division of Internal Medicine, Department of Cardiology, Seinäjoki Central Hospital, Seinäjoki, Finland Heart Center, Satakunta Central Hospital, Pori, Finland Annales Universitatis Turkuensis Painosalama Oy, Turku, Finland 2015 Antithrombotic therapy during and after coronary procedures always entails the challenging establishment of a balance between bleeding and thrombotic complications. It has been generally recommended to patients on long-term warfarin therapy to discontinue warfarin a few days prior to elective coronary angiography or intervention to prevent bleeding complications. Bridging therapy with heparin is recommended for patients at an increased risk of thromboembolism who require the interruption of anticoagulation for elective surgery or an invasive procedure. In study I, consecutive patients on warfarin therapy referred for diagnostic coronary angiography were compared to control patients with a similar disease presentation without warfarin. The strategy of performing coronary angiography during uninterrupted therapeutic warfarin anticoagulation appeared to be a relatively safe alternative to bridging therapy, if the international normalized ratio level was not on a supratherapeutic level. In-stent restenosis remains an important reason for failure of long-term success after a percutaneous coronary intervention (PCI). Drug-eluting stents (DES) reduce the problem of restenosis inherent to bare metal stents (BMS). However, a longer delay in arterial healing may extend the risk of stent thrombosis (ST) far beyond 30 days after the DES implantation. Early discontinuation of antiplatelet therapy has been the most important predisposing factor for ST. In study II, patients on long-term oral anticoagulant (OAC) underwent DES or BMS stenting with a median of 3.5 years’follow-up. The selective use of DESs with a short triple therapy seemed to be safe in OAC patients, since late STs were rare even without long clopidogrel treatment. Major bleeding and cardiac events were common in this patient group irrespective of stent type. In order to help to predict the bleeding risk in patients on OAC, several different bleeding risk scorings have been developed. Risk scoring systems have also been used also in the setting of patients undergoing a PCI. In study III, the predictive value of an outpatient bleeding risk index (OBRI) to identify patients at high risk of bleeding was analysed. The bleeding risk seemed not to modify periprocedural or long-term treatment choices in patients on OAC after a percutaneous coronary intervention. Patients with a high OBRI often had major bleeding episodes, and the OBRI may be suitable for risk evaluation in this patient group. Optical coherence tomography (OCT) is a novel technology for imaging intravascular coronary arteries. OCT is a light-based imaging modality that enables a 12–18 µm tissue axial resolution to visualize plaques in the vessel, possible dissections and thrombi as well as, stent strut appositions and coverage, and to measure the vessel lumen and lesions. In study IV, 30 days after titanium-nitride-oxide (TITANOX)-coated stent implantation, the binary stent strut coverage was satisfactory and the prevalence of malapposed struts was low as evaluated by OCT. Long-term clinical events in patients treated with (TITANOX)-coated bio-active stents (BAS) and paclitaxel-eluting stents (PES) in routine clinical practice were examined in study V. At the 3-year follow-up, BAS resulted in better long-term outcome when compared with PES with an infrequent need for target vessel revascularization. Keywords: anticoagulation, restenosis, thrombosis, bleeding, optical coherence tomography, titanium

The Brazilian consumer's understanding and perceptions of organic vegetables: a Focus Group approach

Focus Group is a tool which generates, through interview sessions with a small number of participants, preliminary data to be used in subsequent quantitative stages. Many consumer studies use qualitative research with the aim of obtaining information and opinions on a specific product or situation. The objective of the present study was to obtain knowledge on the opinion, understanding and perception of the Brazilian consumer with respect to vegetables, focusing on organic products, using Focus Group Sessions. Four Focus Group Sessions were held with men and women in different environments, following a previously elaborated interview guide. In this study, it was observed that the consumers demonstrated being interested in having a healthy diet, based on fruit, vegetables and natural products. However, only a few declared consuming organic foods. Some participants did not know what the term organic meant, and most of them think that organic products are still very expensive, are not easily available in the supermarkets, do not have a good appearance, mainly in terms of size and packaging, and their certification is not always trustworthy. Almost all participants stated that they read package labels and among the items most observed were best-before date, nutritional information, production system and price. This study has identified important vegetable attributes perceived by the consumer, favouring the planning of a subsequent quantitative research. The results suggest that more information on the benefits of organic agriculture has to be passed on to consumers in order to contribute to a higher consumption of such products.

Detection and quantification of Roundup Ready® soybean residues in sausage samples by conventional and real-time PCR

The increasing presence of products derived from genetically modified (GM) plants in human and animal diets has led to the development of detection methods to distinguish biotechnology-derived foods from conventional ones. The conventional and real-time PCR have been used, respectively, to detect and quantify GM residues in highly processed foods. DNA extraction is a critical step during the analysis process. Some factors such as DNA degradation, matrix effects, and the presence of PCR inhibitors imply that a detection or quantification limit, established for a given method, is restricted to a matrix used during validation and cannot be projected to any other matrix outside the scope of the method. In Brazil, sausage samples were the main class of processed products in which Roundup Ready® (RR) soybean residues were detected. Thus, the validation of methodologies for the detection and quantification of those residues is absolutely necessary. Sausage samples were submitted to two different methods of DNA extraction: modified Wizard and the CTAB method. The yield and quality were compared for both methods. DNA samples were analyzed by conventional and real-time PCR for the detection and quantification of Roundup Ready® soybean in the samples. At least 200 ng of total sausage DNA was necessary for a reliable quantification. Reactions containing DNA amounts below this value led to large variations on the expected GM percentage value. In conventional PCR, the detection limit varied from 1.0 to 500 ng, depending on the GM soybean content in the sample. The precision, performance, and linearity were relatively high indicating that the method used for analysis was satisfactory.

Optimization and validation of a methodology to determine total arsenic, As(III) and As(V), in water samples, through graphite furnace atomic absorption spectrometry

The Graphite furnace atomic absorption spectrometry (GF AAS) was the technique chosen by the inorganic contamination laboratory (INCQ/ FIOCRUZ) to be validated and applied in routine analysis for arsenic detection and quantification. The selectivity, linearity, sensibility, detection, and quantification limits besides accuracy and precision parameters were studied and optimized under Stabilized Temperature Platform Furnace (STPF) conditions. The limit of detection obtained was 0.13 µg.L-1 and the limit of quantification was 1.04 µg.L-1, with an average precision, for total arsenic, less than 15% and an accuracy of 96%. To quantify the chemical species As(III) and As(V), an ion-exchange resin (Dowex 1X8, Cl- form) was used and the physical-chemical parameters were optimized resulting in a recuperation of 98% of As(III) and of 90% of As(V). The method was applied to groundwater, mineral water, and hemodialysis purified water samples. All results obtained were lower than the maximum limit values established by the legal Brazilian regulations, in effect, 50, 10, and 5 µg.L-1 para As total, As(III) e As(V), respectively. All results were statistically evaluated.

Production and characterization of lipid microparticles produced by spray cooling encapsulating a low molar mass hydrophilic compound

The objective of this research was to produce and characterize lipid particles (MpLs) that may be used as carriers of high amounts of hydrophilic core and evaluate the influence of the core amount on the performance of lipid microparticles. The MpLs were produced by spray cooling from solid and liquid lipid mixtures (stearic and oleic fatty acids and partly hydrogenated vegetable fat) containing glucose solution as core and soy lecithin as surfactant. The performance of MpLs was evaluated by means of the effective amount of encapsulated core, the core amount present on the surface of MpLs (superficial glucose) and the core release profile in aqueous solution. Morphological observations showed that MpLs presented spherical shape and a rugged and continuous surface, and an average diameter between 25 and 32 µm. The effective amount of encapsulated core was greater than 78% for all formulations evaluated. Larger amounts of superficial glucose were found in formulations in which more concentrated glucose solutions were used, regardless of the glucose lipid-solution ratio. The release results showed that core retention was significantly influenced by the glucose solution concentration, whereas release modulation was influenced by the glucose lipid-solution ratio.

Experimental results and modeling of poultry carcass cooling by water immersion

Poultry carcasses have to be chilled to reduce the central breast temperatures from approximately 40 to 4 °C, which is crucial to ensure safe products. This work investigated the cooling of poultry carcasses by water immersion. Poultry carcasses were taken directly from an industrial processing plant and cooled in a pilot chiller, which was built to investigate the influence of the method and the water stirring intensity on the carcasses cooling. A simplified empiric mathematical model was used to represent the experimental results. These results indicated clearly that the understanding and quantification of heat transfer between the carcass and the cooling water is crucial to improve processes and equipment. The proposed mathematical model is a useful tool to represent the dynamics of carcasses cooling, and it can be used to compare different chiller operational conditions in industrial plants. Therefore, this study reports data and a simple mathematical tool to handle an industrial problem with little information available in the literature.

Obtention and characterization of gluten-free baked products

This work had as objective the development of gluten-free breads and muffins using rice flour and maize and cassava starches. From seven samples resulting from a Simplex-Centroid design, the sensory and instrumental analyses of specific volume, elasticity, and firmness were performed. For the sensory analysis, the optimized formulation contained 50% of rice flour and 50% of cassava starch, and for the instrumental evaluation, the optimal simultaneous point for the three conducted analyses were 20% of rice flour, 30% of cassava starch, and 50% of maize starch. A comparative analysis of specific volume, elasticity, firmness, and triangular test was performed with pre-baked, baked, and frozen bread. Physicochemical, nutritional, and microbiological analyses were performed for both bread and muffin according to the Brazilian legislation.

Partial characterization and inactivation of peroxidases and polyphenol-oxidases of umbu-cajá (Spondias spp.)

A crude extract of Spondias spp. was evaluated for the influence of pH and temperature on the activity and stability of its peroxidases and polyphenol-oxidases. In order to evaluate the conditions for the inactivation of the enzymes by heat treatment and by addition of a reducing agent, a factorial experimental design (n = 3) was employed using the Statistica (6.0) software package for data analysis. The optimal conditions found for peroxidases were: pH = 5.0 and temperature = 40 ºC, and for polyphenol-oxidases they were pH = 7.0 and temperature = 40 ºC. The peroxidases and polyphenol-oxidases were stable at all pH values tested (3.0 - 10.0) and maintained more than 60% of their activity at temperatures above 30 and 40 ºC, respectively. To achieve the total inactivation of these enzymes, two alternatives can be suggested: incubation at 92 ºC for 3.15 minutes with 200 mg.L-1 of ascorbic acid or incubation at 96 ºC for 2.80 minutes with 100 mg.L-1 of ascorbic acid.

Effect of wheat flour protein variations on sensory attributes, texture and staling of Taftoon bread

The quality of flat breads depends in part on the textural properties of breads during storage. These properties are largely affected by flour protein quality and quantity. The present study aimed to examine differences between sensory properties, textural and staling of Tandoori breads made from flours of different quality and different quantities of protein. This was implemented by using three flours with 9.4, 11.5 and 13.5% protein contents and different protein qualities shown by Zeleney sedimentation volume 16.25, 22.75 and 23.25 mL respectively. Bread strips were submitted to uniaxial compression between two parallel plates on an Instron Universal Testing machine, and firmness of the breads was determined. Results indicated the differences in the sensory attributes of breads produced by flours of different protein content and quality, demonstrating that high protein high quality flours are not able to sheet and expand under the high temperature - short time conditions employed in Taftoon bread production and are therefore not suitable for this kind of bread. Results showed that flour with 11.5% protein content, produced bread with better sensory characteristics and acceptable storage time.

Fatty acids, cholesterol, oxidative rancidity, and color of irradiated shrimp

The effect of gamma irradiation (0, 2, 4, and 6 kGy doses) applied to frozen and packed headed shrimp on the fatty acid profile, cholesterol content, and lipid and color stability was evaluated. Myristic acid was higher in shrimp irradiated with 4 and 6 kGy and palmitic acid was higher in samples irradiated with 2 and 6 kGy compared to non-irradiated samples. Stearic and behenic acids were lower in shrimp irradiated with 6 kGy compared to non-irradiated shrimp. With regard to non-irradiated shrimp, palmitoleic, oleic, and linoleic acids and total monounsaturated fatty acids were higher in shrimp irradiated with 6 kGy. Saturated fatty acid and cholesterol contents in irradiated samples were not different from those in non-irradiated shrimp. Lipid oxidation was higher in samples irradiated with 2, 4, and 6 kGy. Redness and yellowness of cooked shrimp were higher in samples irradiated with 6 kGy than in those in non-irradiated samples. The application of irradiation in doses up to 6 kGy on frozen and packed headed shrimp does not affect negatively the fatty acid profile, cholesterol content, and lipid and color stability.

Antioxidant activity, cito- and phototoxicity of pomegranate (Punica granatum L.) seed pulp extract

In the present work, a hydroethanolic extract was prepared from the entire seeds of pomegranate [Punica granatum L. (Punicaceae)] with Cachaça, a distilled Brazilian alcoholic beverage, protected from light for an 80-hour period. The desorption curve of the seeds, presented an optimal time extraction of approximately 24 hours. The extract was divided into two samples: protected from light, (Extract 1), or not, (Extract 2). The extracts were characterized by UV-Visible absorption spectroscopy, quantification of total phenolics by the Folin-Ciocalteu method, and the antioxidant activity was determined by the DPPH quenching method. Extract 2 presented 9.8% less total polyphenols than Extract 1. The pomegranate seeds extract lost 79% of its antioxidant activity during light exposure. Extract 1 up to 3% (w/v) showed neither cyto nor phototoxicity in the Hela cells. In conclusion, Punica granatum L. seeds contain a significant total polyphenol and TEAC amount and they can be used in simple extractive process, by direct contact with Cachaça in up to 80 hours in the darkness, which gives it good coloration, taste, and smell. This extract showed neither cytotoxicity nor post-irradiation phototoxicity with solar simulator even though the extract proved photoinstable.

Determination of thermobacteriological parameters and size of Bacillus stearothermophilus ATCC 7953 spores

In order to determine thermobacteriological parameters for B. stearothermophilus spores, they were diluted in a saline solution medium and in ground corn-soybean mix, distributed in TDT tube, and submitted to heat for a specific period of time. The D value (time to reduce 1 log cycle of microbial count under a certain temperature) and z value (variation of temperature to cause 10-fold change in D value) were estimated. To estimate their dimensions, the spores were visualized by using a scanning electron microscope. D121.1 ºC and z values for these spores, as determined in the saline solution, were 8.8 minutes and 12.8 ºC, respectively. D121,1 ºC and z values determined in the corn-soy mix were 14.2 minutes and 23.7 ºC, respectively. The micrographs indicated that the spores have homogeneous shape and size, with length and diameter of 2 and 1 µm, respectively. These results confirm that the spore is highly thermal-resistant, and it is a good biological indicator to evaluate the extrusion process as a feed sterilizer.

Effect of soaking and cooking on phytate concentration, minerals, and texture of food-type soybeans

The increasing consumption of soybeans due to its bioactive compounds has attracted interest in describing the grain's constituents and variation during processing. Phytate has been the aim of much research since it chelates essential minerals but also has beneficial antioxidant effects. This study evaluated the variation of phytate, calcium, zinc, and iron during soaking and cooking of soybeans. The phytate: Zn and phytate: Fe molar ratios were determined in order to estimate the bioavailability of these minerals. Six food-type varieties were used: BR 36, BRS 213, BRS 216, BRS 232, BRS 155, and Embrapa 48. The samples were soaked in water 3:1 (w/w) for 12 hours at room temperature and cooked. Cooking time was determined by modeling the softening of each variety using fractional conversion. Water content, phytate, and minerals were determined in raw, soaked and cooked samples. The water content of raw grains for all varieties was 9.9 g.100 g-1 increasing to a range of 58.1-63.7 g.100 g-1 after soaking and 63.1-66.0 g.100 g-1 after cooking. Soaking caused a significant reduction in phytate (23-30%), but cooking caused no additional reduction. The phytate: Zn molar ratio was 20 indicating that zinc absorption could be impaired, while the phytate: Fe molar ratio was 8, below the level of compromising absorption

Hygienic-sanitary quality of vegetables and evaluation of treatments for the elimination of indigenous E. coli and E. coli O157:H7 from the surface of leaves of lettuce (Lactuca sativa L.)

The purpose of this study is to evaluate the hygienic-sanitary quality of vegetables and irrigation water and assess the effectiveness of lemon juice and vinegar in reducing E. coli strains inoculated on lettuce. One hundred and forty samples of vegetables and 45 samples of irrigation water were investigated for thermotolerant coliforms and Salmonella spp. In order to verify the effectiveness of natural household sanitizers in reducing E. coli in inoculated lettuce, four treatment solutions were tested: fresh lemon juice, alcohol vinegar, lemon juice-vinegar mixture, and lemon juice-vinegar-water mixture. The microbiological analysis revealed high rates of contamination by thermotolerant coliforms and identified the presence of E. coli in 32% of the tested vegetable samples and 56% of the water samples. While no significant statistical difference (p < 0, 05) was identified in the tested solutions, the treatment with a combination of lemon juice and vinegar resulted in the highest Decimal Reductions (DR) of E. coli O157: H7 while the treatment with vinegar alone was the most effective against the indigenous E. coli strain

Influence of food components on lipid metabolism: scenarios and perspective on the control and prevention of dyslipidemias

Cardiovascular diseases (CVD) are the main causes of death in the Western world. Among the risk factors that are modifiable by diet, for reducing cardiovascular disease risks, the total plasma concentrations of cholesterol, triglycerides, LDL-C, and HDL-C are the most important. Dietary measures can balance these components of the lipid profile thus reducing the risk of cardiovascular diseases. The main food components that affect the lipid profile and can be modified by diet are the saturated and trans fats, unsaturated fats, cholesterol, phytosterols, plant protein, and soluble fiber. A wealth of evidence suggests that saturated and trans fats and cholesterol in the diet raise the total plasma cholesterol and LDL-C. Trans fats also reduce HDL-C, an important lipoprotein for mediating the reverse cholesterol transport. On the other hand, phytosterols, plant proteins, isoflavones, and soluble fiber are protective diet factors against cardiovascular diseases by modulating plasma lipoprotein levels. These food components at certain concentrations are able to reduce the total cholesterol, TG, and LDL-C and raise the plasma levels of HDL-C. Therefore, diet is an important tool for the prevention and control of cardiovascular diseases, and should be taken into account as a whole, i.e., not only the food components that modulate plasma concentrations of lipoproteins, but also the diet content of macro nutrients and micronutrients should be considered.