Low levels of plasma proteins: malnutrition or inflammation?

Levels of several plasma proteins, including albumin, transferrin, and transthyretin (prealbumin), have been proposed as markers for protein energy malnutrition. However, many other factors, especially inflammatory disease and drug or hormone therapy, affect levels of these proteins. These factors probably account for the majority of low levels of transthyretin. Levels of albumin and other proteins may be helpful in determining increased risk of morbidity and mortality, but better markers are needed for diagnosis of protein energy malnutrition per se.     

Bivalirudin in ST-segment-elevation myocardial infarction: for better or worse?

Bivalirudin and heparin are the major available parenteral anticoagulants for percutaneous coronary intervention (PCI) in ST-segment-elevation myocardial infarction. Even though hard clinical outcomes are comparable with both drugs, bivalirudin appears to be safer (less bleeding events) at the expense of lower short-term efficacy (more acute stent thrombosis events). The selection of anticoagulation during PCI in ST-segment-elevation myocardial infarction should be individualized, taking into account the patient’s ischemic and bleeding risk. In patients with increased bleeding risk, bivalirudin might be preferable to heparin, whereas in complex PCI with increased risk for stent thrombosis, heparin is preferable. Further clinical studies are needed to elucidate the role of these drugs in PCI for ST-segment-elevation myocardial infarction in the era of radial approaches, new potent antiplatelet agents and the use of glycoprotein IIb/IIIa inhibitors.     

Neonatal CNS infection and inflammation caused by Ureaplasma species: rare or relevant?

Colonization with Ureaplasma species has been associated with adverse pregnancy outcome, and perinatal transmission has been implicated in the development of bronchopulmonary dysplasia in preterm neonates. Little is known about Ureaplasma-mediated infection and inflammation of the CNS in neonates. Controversy remains concerning its incidence and implication in the pathogenesis of neonatal brain injury. In vivo and in vitro data are limited. Despite improving care options for extremely immature preterm infants, relevant complications remain. Systematic knowledge of ureaplasmal infection may be of great benefit. This review aims to summarize pathogenic mechanisms, clinical data and diagnostic pitfalls. Studies in preterm and term neonates are critically discussed with regard to their limitations. Clinical questions concerning therapy or prophylaxis are posed. We conclude that ureaplasmas may be true pathogens, especially in preterm neonates, and may cause CNS inflammation in a complex interplay of host susceptibility, serovar pathogenicity and gestational age-dependent CNS vulnerability.     

Controlling inflammation: a fat chance?

The inflammatory response protects the body against infection and injury but can itself become deregulated with deleterious consequences to the host. It is now clear that several endogenous biochemical pathways activated during defense reactions can counterregulate inflammation. New experimental evidence adds resolvin E1 to this group of endogenous inhibitors and provides further rationale for the beneficial effects of dietary supplementation with fish oils. It also highlights an unexpected twist in the pharmacology of aspirin.     

Progenitor/stem cell transplantation for repair of myocardial infarction: Hype or hope?

Despite significant therapeutic advances, heart failure remains the predominant cause of mortality worldwide. Currently, progenitor/stem cell biology holds great promise for a new era of cell-based therapy for salvaging the failing heart. However, the translational arm of progenitor/stem cell science is in a relatively primitive state. For the time being, the clinical trials have been both encouraging and disappointing. How to improve the engraftment, long-term survival and appropriate differentiation of transplanted progenitor/stem cell within the cardiovascular tissues may be the key issues to facilitate the transition of cardiogenic stem cell research from bench to bedside. In this review article we discuss the state-of-the-art in adult stem cell therapies for cardiovascular diseases and approaches to release cardiac regeneration potentials of progenitor/stem cells.     

Folic acid, inflammation, and atherosclerosis: false hopes or the need for better trials?

An increasing body of evidence supports the existence of a strong link between inflammation, endothelial dysfunction, and the onset and progression of atherosclerosis. However, a cause-effect relationship between these phenomena has not been demonstrated yet. Although some inflammatory markers, such as C-reactive protein, have been recently shown to improve risk stratification and to strongly predict cardiovascular outcome, it is largely unknown whether modifications of these markers might provide salutary effects and reduce cardiovascular morbidity and mortality. The B-vitamin folic acid has recently gained attention because of its potential to provide beneficial effects on surrogate end-points, such as endothelial function, in patients at high cardiovascular risk. However, the role of folic acid in mitigating the pro-inflammatory state associated with atherosclerosis is controversial. Despite the theoretical arguments supporting the potential anti-atherosclerotic and anti-inflammatory effects of folic acid, the current evidence is limited, deriving from small trials on different study populations, using folic acid often in combination with other vitamins and for different treatment periods. This review will consider the current evidence supporting the role of some well-established inflammatory markers in predicting cardiovascular outcomes, the mechanisms by which folic acid might exert anti-inflammatory effects, the epidemiological data relating folic acid concentrations with inflammatory markers, the published interventional studies on the effects of folic acid supplementation on these markers, and the factors that need to be considered in designing future trials.     

Acute myocardial infarction: disposition to the operating room?

Given their low incidence, mechanical complications of AMI represent a diagnostic and therapeutic challenge for the EP. When the panoply of medical interventions has reached its limitation, surgical treatment plays a role in the management of the patient who has AMI. For patients who have CS and severe compromise of myocardial reserve, surgical intervention might represent the only means of restoring blood flow to the myocardium. For patients who have mechanical complications, correction of the defect before the onset of terminal organ failure might provide long-term survival.     

Herbal or complementary medicine: fact or fiction?

Although herbal medications have been used in medical therapy since the dawn of civilization, they have not undergone careful scientific assessment. Some herbal derivations are exceptional and have become standard therapy in cardiovascular disease; eg, digitalis, reserpine, and aspirin. The high prevalence of herbal use around the world and in the United States today may have a negative impact on patient care when herbal preparations are used in combination with medications ordered by healthcare providers who are not advised of the patient's use of herbs. Healthcare providers need to be familiar with all herbal medications in order to prevent potentially serious reactions between conventional and herbal medications. They should be asking patients about herbal use when first obtaining a medical history. Patients who use alternative therapies do not tell their healthcare providers about such use.     

E-Cigarettes: Promise or Peril?

Electronic cigarettes (e-cigarettes) use a heating element to vaporize nicotine and other ingredients, simulating the visual, sensory, and behavioral aspects of smoking without the combustion of tobacco. An ever-growing number of companies around the world manufacture a wide variety of e-cigarette brands, despite scant information on the safety of the ingredients for human inhalation. This article provides an overview of the history, production, and marketing of e-cigarettes, the contents of e-cigarettes and vapor, how they are used, public health concerns, and implications for nursing practice, research, and policy development.