A meta-analysis of randomized trials on clinical outcomes of paclitaxel-eluting stents versus bare-metal stents in ST-segment elevation myocardial infarction patients

A meta-analysis was performed to address the efficacy and safety of paclitaxel-eluting stent (PES) in ST-segment elevation myocardial infarction (STEMI) patients. A systematic literature search was conducted to identify all randomized clinical trials in mortality, recurrent myocardial infarction (rMI), repeat revascularization (RR), and stent thrombosis (ST). A total of 4190 STEMI patients were enrolled in six randomized trials comparing PES with bare-metal stent (BMS). The pooled repeat revascularization rate was 5.7% in PES group, significantly lower than 10.0% in BMS group with an odds ratio (OR) of 0.56, 95% confidence interval (CI) [0.44, 0.72] (P<0.00001). No significant difference was found between PES and BMS groups in mortality at one year after the indexing procedure (3.9% vs. 5.1%, OR 0.88, 95% CI [0.63, 1.21], P=0.42). Similarly, rMI rate did not differ significantly between the two groups (3.4% vs. 4.1%, OR 0.80, 95% CI [0.56, 1.13], P=0.21). PES was also associated with the comparable pooled rate of definite stent thrombosis with BMS (2.3% vs. 2.4%, OR 0.81, 95% CI [0.52, 1.26], P=0.35). The results show that PES improved clinical outcomes in STEMI patients with a decreased need for repeat revascularization and no concerns for safety.     

音乐在PCI术后早期急性心肌梗死患者中的应用

目的:探讨音乐应用于PCI术后早期急性心肌梗死患者的作用,促进患者康复.方法:便利抽样100名PCI术后AMI患者,分对照组和音乐组各50例,采用《HAD》和《AIS》调查并记录患者实验前后血压、心率、呼吸.结果:音乐组患者焦虑、睡眠质量、血压、心率、呼吸得分差值下降多于对照组,但抑郁得分较对照组高(P＜0.05).结论:音乐可缓解患者的焦虑,提高睡眠质量,维持血压、心率、呼吸处于相对较低水平.但音乐可释放抑郁情绪,应注意心理护理.     

Diagnostic accuracy of heart fatty acid binding protein (H-FABP) and glycogen phosphorylase isoenzyme BB (GPBB) in diagnosis of acute myocardial infarction in patients with acute coronary syndrome

Introduction:

This study aimed to assess whether heart fatty acid-binding protein (H-FABP) and glycogen phosphorylase isoenzyme BB (GPBB) could be used for the accurate diagnosis of acute myocardial infarction (AMI) in acute coronary syndrome (ACS) patients.

Materials and methods:

The study included 108 ACS patients admitted to a coronary unit within 3 h after chest pain onset. AMI was distinguished from unstable angina (UA) using a classical cardiac troponin I (cTnI) assay. H-FABP and GPBB were measured by ELISA on admission (0 h) and at 3, 6, 12, and 24 h after admission; their accuracy to diagnose AMI was assessed using statistical methods.

Results:

From 92 patients with ACS; 71 had AMI. H-FABP and GPBB had higher peak value after 3 h from admission than cTnI (P = 0.001). Both markers normalized at 24 h. The area under the receiver operating characteristic curves was significantly greater for both markers in AMI patients than in UA patients at all time points tested, including admission (P < 0.001). At admission, the H-FABP (37%) and GPBB (40%) sensitivities were relatively low. They increased at 3 and 6 h after admission for both markers and decreased again after 24 h. It was 40% for H-FABP and approximately 2-times lower for GPBB (P < 0.01). In AMI patients, both biomarkers had similar specificities, positive- and negative-predictive values, positive and negative likelihood ratios, and risk ratios for AIM.

Conclusion:

H-FABP and GPBB can contribute to early AMI diagnosis and can distinguish AMI from UA.     

Role of l-Arginine on Dyslipidemic Conditions of Acute Myocardial Infarction Patients

Oxidative stress conditions associated with atherosclerosis leads to oxidative modification of low-density lipoprotein (LDL). The body’s capabilities to inhibit LDL oxidation and to remove or neutralize the atherogenic oxidized LDL (ox-LDL) are limited. When the LDL cholesterol level increases in the blood, it leads to dangerous consequences like atherosclerosis, leading to myocardial infarction. The major effect of an antioxidant in the LDL environment is to prevent the formation of ox-LDL (during atherogenesis. Strategies to reduce LDL oxidation and prevent atherogenesis can involve the enrichment of arterial cells with potent antioxidants that can prevent oxidative damage to the arterial wall. The objective of this study is to evaluate the effect of l-arginine on serum lipid and cholesterol levels in the patients of acute myocardial infarction (AMI). The study consisted of 70 AMI patients and 60 healthy individuals (serving as control) age 55–65 years. Serum levels of total cholesterol, high density lipoprotein (HDL), LDL and Triglycerides were determined on day 1 and day 15 of l-arginine administration (oral dose 3 g/day). The total cholesterol/HDL and the LDL/HDL ratio were calculated and compared. As per the observations, l-arginine administration was found to improve the lipid profile of the subjects. Hence it could be used as an adjuvant therapy for AMI and as a preventive measure for the onset of the disease in the healthy elderly also.     

急性心肌梗塞的心电图诊断——附5例报告

结合临床,对5例心肌梗塞患者心电图的变化进行了分析与诊断,尤其是对一些在心电图上不出现典型改变而易漏诊的心肌梗塞病例进行了分析.     

AMI患者PCI术对血浆BNP水平变化的初步临床观察

目的:观察PCI术对AMI患者血浆中BNP的水平变化,初步探讨PCI对AMI患者预后的影响.方法:采用快速荧光免疫测定法对20例AMI患者PCI治疗前后和20例对照组血浆BNP水平进行检测.结果:AMI患者血浆BNP在AMI患者PCI术与对照组比较有显著性差异(P＜0.05),PCI治疗后呈明显下降趋势.结论:AMI患者PCI治疗血浆BNP水平变化说明PCI术能对改善AMI患者的预后有重要意义.     

Early association of electrocardiogram alteration with infarct size and cardiac function after myocardial infarction

Objective: Myocardial infarction (MI) is the main cause of heart failure, but the relationship between the extent of MI and cardiac function has not been clearly determined. The present study was undertaken to investigate early changes in the electrocardiogram associated with infarct size and cardiac function after MI. Methods: MI was induced by ligating the left anterior descending coronary artery in rats. Electrocardiograms, echocardiographs and hemodynamic parameters were assessed and myocardial infarct size was measured from mid-transverse sections stained with Masson's trichrome. Results: The sum of pathological Q wave amplitudes was strongly correlated with myocardial infarct size (r = 0.920, P < 0.0001), left ventricular ejection fraction (r = (0.868, P < 0.0001) and left ventricular end diastolic pressure (r = 0.835, P < 0.0004). Furthermore, there was close relationship between MI size and cardiac function as assessed by left ventricular ejection fraction (r = (0.913, P < 0.0001) and left ventricular end diastolic pressure (r = 0.893, P < 0.0001). Conclusion: The sum of pathological Q wave amplitudes after MI can be used to estimate the extent of MI as well as cardiac function.     

Mothers’ Reactions to the Diagnosis of Cerebral Palsy: Associations with their Educational Level

The resolution of diagnosis of one’s child involves coming to terms with the child’s medical condition and accepting it both emotionally and cognitively. This study examined the relation between maternal resolution of the child’s diagnosis of cerebral palsy (CP) and their educational levels. We also aimed at understanding maternal resolution status with regard to other demographic variables. The sample consisted of mothers with children aged 2–7, being diagnosed with CP. Resolution of diagnosis was assessed using the Reaction to Diagnosis Interview. The obtained results suggested the connection between maternal level of education and their attitude toward the child’s diagnosis. Demographic variables were identified as possible protective or risk factors for the resolution process. This article points to the importance of providing adequate psychosocial aid to mothers of children with developmental disabilities.     

Effects of pH management during deep hypothermic bypass on cerebral oxygenation: alpha-stat versus pH-stat

Objective: There is a remarkable lack of scientific evidence to support the option to use alpha-stat or pH-stat management, as to which is more beneficial to brain protection during deep hypothermic CPB. This study examined cortical blood flow (CBF), cerebral oxygenation, and brain oxygen consumption in relation to deep hypothermic CPB with alpha-stat or pH-stat management. Methods: Twenty-two pigs were cooled with alpha-stat or pH-stat during CPB to 15℃ esophageal temperature. CBF and cerebral oxygenation were measured continuously with a laser flowmeter and near-infrared spectroscopy, respectively. Brain oxygen consumption was measured with standard laboratory techniques. Results: During CPB cooling, CBF was significantly decreased, about 52.2%±6.3% (P＜0.01 vs 92.6%±6.5% of pH-stat) at 15℃ in alpha-stat,whereas there were no significant changes in CBF in pH-stat. While cooling down, brain oxygen extraction (OER) progressively decreased, about 9.5%±0.9% and 10.9%±1.5% at 15 ℃ in alpha-stat and pH-stat, respectively. At 31℃ the decreased value in pH-stat was lower than in alpha-stat (29.9%±2.7% vs 22.5%±1.9%; P＜0.05). The ratio of CBF/OER were 2.0±0.3 in alpha-stat and pH-stat, respectively; it was kept in constant level in alpha-stat, and significantly increased by 19℃ to 15℃ in pH-stat (4.9±0.9 vs 2.3±0.4; P＜0.01). In mild hypothermia, cerebral oxyhemoglobin and oxygen saturation in alpha-stat were greater than that in pH-stat (102.5%±1.4% vs 99.1%±0.7%; P＜0.05). In deep hypothermia, brain oxygen saturation in pH-stat was greater than that in alpha-stat (99.2%±1.0% vs 93.8%±1.0%; P＜0.01), and deoxyhemoglobin in pH-stat decreased more greatly than that in alpha-stat (28.7%±6.8% vs 54.1%±4.7%; P＜0.05). Conclusions: In mild hypothermic CPB, brain tissue oxygen saturation was greater in alpha-stat than in pH-stat. However, cerebral oxygenation and brain tissue oxygen saturation were better in pH-stat than in alpha-stat during profound hypothermia. PH-stat strategyprovided much more oxygen to brain tissue before deep hypothermic circulatory arrest.     

TCD study of hemodynamic changes in PCA response to photic stimulation

ＩＮＴＲＯＤＵＣＴＩＯＮＭａｎｙｉｍａｇｉｎｇｔｅｃｈｎｉｑｕｅｓ,ｌｉｋｅＰＥＴ ,ｆＭＲＩａｎｄＳＰＥＣＴ ,ｃａｎｄｅｍｏｎｓｔｒａｔｅｉｎｃｒｅａｓｅｓｉｎｒｅ ｇｉｏｎａｌｃｅｒｅｂｒａｌｂｌｏｏｄｆｌｏｗ(ＣＢＦ)ｏｒｍｅｔａｂｏｌｉｃｒａｔｅｄｕｒｉｎｇｃｅｒｔａｉｎｎｅｕｒｏｎａｌｓｔｉｍｕｌａｔｉｏｎ .Ｂｕｔｔｈｅｓｅｔｅｃｈｎｉｑｕｅｓａｒｅａｌｗａｙｓｅｘｐｅｎｓｉｖｅａｎｄｍｏｒｅｔｉｍｅｃｏｎｓｕｍｉｎｇａｎｄｒｅｐｅａｔｅｄｍｅａｓｕｒｅｍｅｎｔｓａｒｅｄｉｆｆｉｃｕｌｔ.Ｔ…