Background: Primary PCI (PPCI) with noreflow (NR) has been previously associated with worse outcomes. Objectives: We aimed to identify the prevalence of NR in patients with ST elevation myocardial infarction (STEMI) undergoing PPCI in the current era and its predictors with short term outcome. Methods: This prospective study enrolled 310 consecutive STEMI patients underwent PPCI. Patients were divided into 2 groups: patients with normal flow and others with NR whose (final TIMI flow <3 in the absence of coronary dissection or spasm) compared for demographic, procedural characteristics, ST resolution and short term outcomes. Results: 293 patients were finally included. NR was observed in 91 (31.06%) patients. The occurrence of NR was associated with higher mortality (25.3% vs. 3%, P=0.003) compared to patients with normal flow. Multivariate logistic regression analysis showed that high thrombus burden (thrombus grade ≥4), reference luminal diameter ≥3 mm, symptoms to first medical contact time ≥4h, anterior infarctions and syntax score ≥19 were independent predictors of NR. Using thrombus aspiration was found to be protective against NR only in patients with high thrombus burden which was associated with mortality reduction. Conclusion: In the contemporary era of PPCI, NR is more likely to occur in patients with high thrombus burden presenting late and is still associated with marked increases in adverse outcomes. Thrombus aspiration can prevent NR in patients with high thrombus burden.

Background: Primary PCI (PPCI) with noreflow (NR) has been previously associated with worse outcomes. Objectives: We aimed to identify the prevalence of NR in patients with ST elevation myocardial infarction (STEMI) undergoing PPCI in the current era and its predictors with short term outcome. Methods: This prospective study enrolled 310 consecutive STEMI patients underwent PPCI. Patients were divided into 2 groups: patients with normal flow and others with NR whose (final TIMI flow 3 in the absence of coronary dissection or spasm) compared for demographic, procedural characteristics, ST resolution and short term outcomes. Results: 293 patients were finally included. NR was observed in 91 (31.06%) patients. The occurrence of NR was associated with higher mortality (25.3% vs. 3%, P=0.003) compared to patients with normal flow. Multivariate logistic regression analysis showed that high thrombus burden (thrombus grade ≥4), reference luminal diameter ≥3 mm, symptoms to first medical contact time ≥4h, anterior infarctions and syntax score ≥19 were independent predictors of NR. Using thrombus aspiration was found to be protective against NR only in patients with high thrombus burden which was associated with mortality reduction. Conclusion: In the contemporary era of PPCI, NR is more likely to occur in patients with high thrombus burden presenting late and is still associated with marked increases in adverse outcomes. Thrombus aspiration can prevent NR in patients with high thrombus burden.

Background: Primary PCI (PPCI) with noreflow (NR) has been previously associated with worse outcomes. Objectives: We aimed to identify the prevalence of NR in patients with ST elevation myocardial infarction (STEMI) undergoing PPCI in the current era and its predictors with short term outcome. Methods: This prospective study enrolled 310 consecutive STEMI patients underwent PPCI. Patients were divided into 2 groups: patients with normal flow and others with NR whose (final TIMI flow 3 in the absence of coronary dissection or spasm) compared for demographic, procedural characteristics, ST resolution and short term outcomes. Results: 293 patients were finally included. NR was observed in 91 (31.06%) patients. The occurrence of NR was associated with higher mortality (25.3% vs. 3%, P=0.003) compared to patients with normal flow. Multivariate logistic regression analysis showed that high thrombus burden (thrombus grade ≥4), reference luminal diameter ≥3 mm, symptoms to first medical contact time ≥4h, anterior infarctions and syntax score ≥19 were independent predictors of NR. Using thrombus aspiration was found to be protective against NR only in patients with high thrombus burden which was associated with mortality reduction. Conclusion: In the contemporary era of PPCI, NR is more likely to occur in patients with high thrombus burden presenting late and is still associated with marked increases in adverse outcomes. Thrombus aspiration can prevent NR in patients with high thrombus burden.

Background: The inflammatory basis of diabetes mellitus directed the researchers’ attention to the immune system for better management and prevention of complications. Metoclopramide (MCA; the only US Food and Drug Administration-approved for gastroparesis) has the ability to restore immune function through increasing prolactin secretion. This study aimed to test the effect of BSA/MCA nanoparticles (NPs) on modulating immune response. Methods: BSA/MCA NPs were fabricated by desolvation and evaluated in vitro via measuring loading efficiency, particle size, and surface charge. The selected formula was further evaluated via differential scanning calorimetry and release behavior. Then, NPs were injected into rats (25 mg MCA/kg/week) for 3 weeks to be evaluated histopathologically and immunologically via measuring proinflammatory cytokines, such as IL1β, IL6, and TNFα, in addition to measuring regulatory T-cell frequency. Results: MCA was successfully loaded on BSA, achieving high encapsulation efficiency reaching 63±2%, particles size of 120–130 nm with good polydispersity, and a negative surface charge indicating that entire positively charged drug was encapsulated inside NPs. Differential scanning calorimetry thermography of selected NPs showed an obvious interaction between components and cross-linking of BSA molecules using glutaraldehyde, resulting in sustained release of MCA (around 50% within 3 days). MCA NPs significantly restored the immune response via decreasing proinflammatory cytokines and increasing regulatory T-cell frequency when compared to control and free MCA (drug not loaded in NPs)-treated groups. Histopathological examination of this MCA NPs-treated group did not show the characteristic lesions of diabetes, and apoptosis nearly disappeared. Conclusion: BSA/MCA NPs could be considered a new modality for treatment of gastroparesis, in addition to management of diabetes itself and preventing its complications via an MCA-immunomodulatory effect.

Background: The inflammatory basis of diabetes mellitus directed the researchers’ attention to the immune system for better management and prevention of complications. Metoclopramide (MCA; the only US Food and Drug Administration-approved for gastroparesis) has the ability to restore immune function through increasing prolactin secretion. This study aimed to test the effect of BSA/MCA nanoparticles (NPs) on modulating immune response. Methods: BSA/MCA NPs were fabricated by desolvation and evaluated in vitro via measuring loading efficiency, particle size, and surface charge. The selected formula was further evaluated via differential scanning calorimetry and release behavior. Then, NPs were injected into rats (25 mg MCA/kg/week) for 3 weeks to be evaluated histopathologically and immunologically via measuring proinflammatory cytokines, such as IL1β, IL6, and TNFα, in addition to measuring regulatory T-cell frequency. Results: MCA was successfully loaded on BSA, achieving high encapsulation efficiency reaching 63±2%, particles size of 120–130 nm with good polydispersity, and a negative surface charge indicating that entire positively charged drug was encapsulated inside NPs. Differential scanning calorimetry thermography of selected NPs showed an obvious interaction between components and cross-linking of BSA molecules using glutaraldehyde, resulting in sustained release of MCA (around 50% within 3 days). MCA NPs significantly restored the immune response via decreasing proinflammatory cytokines and increasing regulatory T-cell frequency when compared to control and free MCA (drug not loaded in NPs)-treated groups. Histopathological examination of this MCA NPs-treated group did not show the characteristic lesions of diabetes, and apoptosis nearly disappeared. Conclusion: BSA/MCA NPs could be considered a new modality for treatment of gastroparesis, in addition to management of diabetes itself and preventing its complications via an MCA-immunomodulatory effect.

Background: The inflammatory basis of diabetes mellitus directed the researchers’ attention to the immune system for better management and prevention of complications. Metoclopramide (MCA; the only US Food and Drug Administration-approved for gastroparesis) has the ability to restore immune function through increasing prolactin secretion. This study aimed to test the effect of BSA/MCA nanoparticles (NPs) on modulating immune response. Methods: BSA/MCA NPs were fabricated by desolvation and evaluated in vitro via measuring loading efficiency, particle size, and surface charge. The selected formula was further evaluated via differential scanning calorimetry and release behavior. Then, NPs were injected into rats (25 mg MCA/kg/week) for 3 weeks to be evaluated histopathologically and immunologically via measuring proinflammatory cytokines, such as IL1β, IL6, and TNFα, in addition to measuring regulatory T-cell frequency. Results: MCA was successfully loaded on BSA, achieving high encapsulation efficiency reaching 63±2%, particles size of 120–130 nm with good polydispersity, and a negative surface charge indicating that entire positively charged drug was encapsulated inside NPs. Differential scanning calorimetry thermography of selected NPs showed an obvious interaction between components and cross-linking of BSA molecules using glutaraldehyde, resulting in sustained release of MCA (around 50% within 3 days). MCA NPs significantly restored the immune response via decreasing proinflammatory cytokines and increasing regulatory T-cell frequency when compared to control and free MCA (drug not loaded in NPs)-treated groups. Histopathological examination of this MCA NPs-treated group did not show the characteristic lesions of diabetes, and apoptosis nearly disappeared. Conclusion: BSA/MCA NPs could be considered a new modality for treatment of gastroparesis, in addition to management of diabetes itself and preventing its complications via an MCA-immunomodulatory effect.

Background: The inflammatory basis of diabetes mellitus directed the researchers’ attention to the immune system for better management and prevention of complications. Metoclopramide (MCA; the only US Food and Drug Administration-approved for gastroparesis) has the ability to restore immune function through increasing prolactin secretion. This study aimed to test the effect of BSA/MCA nanoparticles (NPs) on modulating immune response. Methods: BSA/MCA NPs were fabricated by desolvation and evaluated in vitro via measuring loading efficiency, particle size, and surface charge. The selected formula was further evaluated via differential scanning calorimetry and release behavior. Then, NPs were injected into rats (25 mg MCA/kg/week) for 3 weeks to be evaluated histopathologically and immunologically via measuring proinflammatory cytokines, such as IL1β, IL6, and TNFα, in addition to measuring regulatory T-cell frequency. Results: MCA was successfully loaded on BSA, achieving high encapsulation efficiency reaching 63±2%, particles size of 120–130 nm with good polydispersity, and a negative surface charge indicating that entire positively charged drug was encapsulated inside NPs. Differential scanning calorimetry thermography of selected NPs showed an obvious interaction between components and cross-linking of BSA molecules using glutaraldehyde, resulting in sustained release of MCA (around 50% within 3 days). MCA NPs significantly restored the immune response via decreasing proinflammatory cytokines and increasing regulatory T-cell frequency when compared to control and free MCA (drug not loaded in NPs)-treated groups. Histopathological examination of this MCA NPs-treated group did not show the characteristic lesions of diabetes, and apoptosis nearly disappeared. Conclusion: BSA/MCA NPs could be considered a new modality for treatment of gastroparesis, in addition to management of diabetes itself and preventing its complications via an MCA-immunomodulatory effect.

Background: The inflammatory basis of diabetes mellitus directed the researchers’ attention to the immune system for better management and prevention of complications. Metoclopramide (MCA; the only US Food and Drug Administration-approved for gastroparesis) has the ability to restore immune function through increasing prolactin secretion. This study aimed to test the effect of BSA/MCA nanoparticles (NPs) on modulating immune response. Methods: BSA/MCA NPs were fabricated by desolvation and evaluated in vitro via measuring loading efficiency, particle size, and surface charge. The selected formula was further evaluated via differential scanning calorimetry and release behavior. Then, NPs were injected into rats (25 mg MCA/kg/week) for 3 weeks to be evaluated histopathologically and immunologically via measuring proinflammatory cytokines, such as IL1β, IL6, and TNFα, in addition to measuring regulatory T-cell frequency. Results: MCA was successfully loaded on BSA, achieving high encapsulation efficiency reaching 63±2%, particles size of 120–130 nm with good polydispersity, and a negative surface charge indicating that entire positively charged drug was encapsulated inside NPs. Differential scanning calorimetry thermography of selected NPs showed an obvious interaction between components and cross-linking of BSA molecules using glutaraldehyde, resulting in sustained release of MCA (around 50% within 3 days). MCA NPs significantly restored the immune response via decreasing proinflammatory cytokines and increasing regulatory T-cell frequency when compared to control and free MCA (drug not loaded in NPs)-treated groups. Histopathological examination of this MCA NPs-treated group did not show the characteristic lesions of diabetes, and apoptosis nearly disappeared. Conclusion: BSA/MCA NPs could be considered a new modality for treatment of gastroparesis, in addition to management of diabetes itself and preventing its complications via an MCA-immunomodulatory effect.

Background: The inflammatory basis of diabetes mellitus directed the researchers’ attention to the immune system for better management and prevention of complications. Metoclopramide (MCA; the only US Food and Drug Administration-approved for gastroparesis) has the ability to restore immune function through increasing prolactin secretion. This study aimed to test the effect of BSA/MCA nanoparticles (NPs) on modulating immune response. Methods: BSA/MCA NPs were fabricated by desolvation and evaluated in vitro via measuring loading efficiency, particle size, and surface charge. The selected formula was further evaluated via differential scanning calorimetry and release behavior. Then, NPs were injected into rats (25 mg MCA/kg/week) for 3 weeks to be evaluated histopathologically and immunologically via measuring proinflammatory cytokines, such as IL1β, IL6, and TNFα, in addition to measuring regulatory T-cell frequency. Results: MCA was successfully loaded on BSA, achieving high encapsulation efficiency reaching 63±2%, particles size of 120–130 nm with good polydispersity, and a negative surface charge indicating that entire positively charged drug was encapsulated inside NPs. Differential scanning calorimetry thermography of selected NPs showed an obvious interaction between components and cross-linking of BSA molecules using glutaraldehyde, resulting in sustained release of MCA (around 50% within 3 days). MCA NPs significantly restored the immune response via decreasing proinflammatory cytokines and increasing regulatory T-cell frequency when compared to control and free MCA (drug not loaded in NPs)-treated groups. Histopathological examination of this MCA NPs-treated group did not show the characteristic lesions of diabetes, and apoptosis nearly disappeared. Conclusion: BSA/MCA NPs could be considered a new modality for treatment of gastroparesis, in addition to management of diabetes itself and preventing its complications via an MCA-immunomodulatory effect.

Visfatin, an adipocytokine with insulin-mimetic activity, has been previously reported to associate with obesity. Herein, we aimed to investigate the serum level of visfatin and association with proinflammatory markers and insulin resistance in obese type 2 diabetic patients. A case control study was carried out among 80 diabetics and 40 non-diabetic healthy controls, after obtaining Anthropometric measurements and blood pressure. Serum level of visfatin and C-reactive protein (CRP) were measured by Enzyme Immunoassay. Interleukin 6 (IL6), tumor necrosis factor α (TNF-) were measured by ELISA and the homeostasis model assessment for insulin resistance was calculated as a marker of insulin resistance. Compared to healthy controls, diabetic patients showed a significant high serum levels of visfatin (40.33±9.98 vs 19.03±8.22), (P= 0.001), IL6 (12.06±2.69 vs 6.02±3.03), (P0.0001), TNF- (13.53±2.54 vs 8.70±3.40), P0.0001) and CRP (7.77±1.61 vs 6.01±1.99), (P=0.003). Also there was a strong positive correlation between serum level of visfatin, IL6, TNF- and CRP and some anthropometric characteristics including (WC,BMI and insulin resistance). Furthermore, among 80 diabetic patients, serum level of visfatin was positively correlated with IL6 (r=0.47, P0.0001), TNF- (r=0.62, P0.0001), CRP (r=0.4, P=0.002) respectively. In conclusion, there is a strong positive correlation between visfatin serum level and the inflammatory markers IL6, TNF- and CRP in type 2 diabetic patients. There is also a positive correlation with insulin resistance and BMI which indicates association of visfatin with obesity and type 2 diabetes mellitus.