Acute simultaneous proximal occlusion of two major coronary arteries in acute myocardial infarction: successful treatment with percutaneous coronary intervention

Background: Acute myocardial infarction (AMI) due to acute simultaneous proximal occlusion of two major coronary arteries (ASOMC) is a rare but life‐threatening situation. Most patients die suddenly or go into cardiogenic shock (CS). In patients with AMI due to ASOMC identified by coronary angiography (CA), percutaneous coronary intervention (PCI) performed in both infarct‐related arteries (IRAs) at the same time as diagnostic CA is the fastest option to complete revascularization. However, no prospective studies regarding the outcome of such procedures have been published so far. Methods: In this prospective single‐center study, between October 2004 and March 2007, consecutive patients with acute coronary syndrome (ACS) reporting to our university hospital and regional referral center were evaluated for ASOMC by means of emergent CA. When diagnosed with ASOMC, PCI of the IRAs was performed. Clinical data were obtained at baseline, discharge, after 6 months, and after 1 year. Results: Out of 417 patients with ACS, 379 patients (90.9%) suffered an AMI. In 5 patients CA revealed an ASOMC. PCI was performed in 4 patients. One patient with severe triple‐vessel disease was referred for emergent coronary artery bypass graft (CABG) surgery after conventional PCI of one IRA. One patient died in‐hospital due to early in‐stent thrombosis after PCI. At 6‐month follow‐up and at 1‐year follow‐up, 4 patients were alive. Conclusion: In spite of the complex interventions, PCI patients had low in‐hospital mortality and good clinical results at 1‐year follow‐up. Our observations are important in the clinical decision‐making process of AMI due to ASOMC.     

Positionspapier zur „Automatisierten Externen Defibrillation“

Ohne ZusammenfassungDiese Leitlinie ist ursprünglich erschienen in: Z Kardiol 94:287–295 (2005)Herausgegeben vom Vorstand der Deutschen Gesellschaft für Kardiologie Herz- und Kreislaufforschung—in Zusammenarbeit mit der Deutschen Gesellschaft für Internistische Intensivmedizin und Notfallmedizin Bearbeitet im Auftrag der Kommission für klinische Kardiologie (R. H. Strasser, D. Andresen, G. Ertl, F. de Haan, H. Mudra, A. Osterspey, H.-J. Trappe, K. Werdan, außerdem G. Arnold, E. Fleck, H. M. Hoffmeister)     

Prognosis and follow-up of patients with ventricular tachycardias or ventricular fibrillation without coronary heart disease

We studied the follow-up of 49 patients (pts), mean age 34 +/- 9 years, without coronary artery disease who had sustained (duration greater than 30 s) monomorphic ventricular tachycardia (smvt) (n = 42) or ventricular fibrillation (vf) (n = 7). There were 9/49 pts (18%) with smvt who had right ventricular dysplasia (RVD) and 32/49 pts (65%) without structural heart disease ("idiopathic" ventricular arrhythmia) (26/32 pts with smvt and 6/32 pts with vf). There were 6/49 pts (12%) with congestive (COCM) and 2/49 pts (4%) with hypertrophic (HOCM) cardiomyopathy. Mean follow-up was 49 +/- 13 months. During the follow-up 1/9 pts (11%) with RVD died postoperatively from heart failure, 1/26 pts (4%) with idiopathic smvt from cancer and 2/6 pts (33%) with COCM from heart failure. There were no deaths in pts with idiopathic vf. Recurrent smvt occurred in 5/9 pts (56%) with RVD, in 10/26 pts (39%) with idiopathic smvt, in 2/6 pts (33%) with idiopathic vf, in 3/6 pts (50%) with COCM and in 1/2 pts (50%) with HOCM. Our data show that pts with smvt or vf without coronary artery disease have a good prognosis. However, there is a high incidence of recurrent ventricular arrhythmia in these patients.     

Diagnosis and management of asthma in preschoolers: A Canadian Thoracic Society and Canadian Paediatric Society position paper

Asthma often starts before six years of age. However, there remains uncertainty as to when and how a preschool-age child with symptoms suggestive of asthma can be diagnosed with this condition. This delays treatment and contributes to both short- and long-term morbidity. Members of the Canadian Thoracic Society Asthma Clinical Assembly partnered with the Canadian Paediatric Society to develop a joint working group with the mandate to develop a position paper on the diagnosis and management of asthma in preschoolers.In the absence of lung function tests, the diagnosis of asthma should be considered in children one to five years of age with frequent (≥8 days/month) asthma-like symptoms or recurrent (≥2) exacerbations (episodes with asthma-like signs). The diagnosis requires the objective document of signs or convincing parent-reported symptoms of airflow obstruction (improvement in these signs or symptoms with asthma therapy), and no clinical suspicion of an alternative diagnosis. The characteristic feature of airflow obstruction is wheezing, commonly accompanied by difficulty breathing and cough. Reversibility with asthma medications is defined as direct observation of improvement with short-acting ß₂-agonists (SABA) (with or without oral corticosteroids) by a trained health care practitioner during an acute exacerbation (preferred method). However, in children with no wheezing (or other signs of airflow obstruction) on presentation, reversibility may be determined by convincing parental report of a symptomatic response to a three-month therapeutic trial of a medium dose of inhaled corticosteroids with as-needed SABA (alternative method), or as-needed SABA alone (weaker alternative method). The authors provide key messages regarding in whom to consider the diagnosis, terms to be abandoned, when to refer to an asthma specialist and the initial management strategy. Finally, dissemination plans and priority areas for research are identified.     

The effect of lithium on growth factor production in long-term bone marrow cultures

We have previously reported that lithium chloride (LiCl) stimulates the production of granulocyte-macrophage colony-forming cells (GM-CFC), pluripotent stem cells (CFU-S), and differentiated granulocytes, macrophages and megakaryocytes in murine Dexter marrow cultures and that this effect appears to be mediated indirectly by a radioresistant adherent marrow cell. In this study we have established that exposure of murine Dexter cultures to LiCl (4 mEq/L) causes an increase of colony-forming cell megakaryocytes (CFU-meg) over 1 to 6 weeks of culture in both supernatant (188% to 611%) and stromal phases (123% to 246%). Moreover, we have shown that lithium treatment of either irradiated (1,100 rad) or unirradiated stromal cells increased production of activities stimulating formation of megakaryocyte, granulocyte, macrophage, and mixed lineage colonies and proliferation of the factor-dependent cell line, FDC-P1. This FDC-P1 stimulatory activity was completely blocked by an antibody to purified recombinant granulocyte-macrophage colony stimulating factor (rGM-CSF). The baseline or lithium-induced--stromal-derived bone marrow colony stimulating activity was partially blocked by the antibody to rGM-CSF and by an antibody to purified colony stimulating factor I (CSF-1); the two antibodies combined resulted in greater than 90% inhibition of the lithium-induced marrow stimulatory activity. In addition, radioimmunoassay (RIA) showed that although CSF-1 was detectable in supernatants of these cultures, exposure to lithium did not increase CSF-1 levels. These data indicate that Dexter stromal cells produce CSF- 1 and GM-CSF and that lithium appears to exert its stimulatory effects on in vitro myelopoiesis by inducing production of GM-CSF.     

急性阑尾炎多层螺旋CT扫描征象与血清炎性标志物的相关性研究

目的探讨急性阑尾炎多层螺旋CT征象与血清炎性标志物的关系。方法收集2012年1月至2013年12月于同济大学附属杨浦医院经手术病理证实的具有完整临床及影像资料的急性阑尾炎患者66例,对所有患者的急性阑尾病变程度行CT分级,分析其与患者白细胞(WBC)计数、中性粒细胞百分比(NEUT%)及血清C反应蛋白(CRP)水平的相关性。结果急性阑尾炎CT分级与患者WBC计数与CRP水平呈正相关(P0.05),穿孔性阑尾炎患者NEUT%及CRP水平明显高于其他患者。CRP水平与阑尾直径、阑尾积液、回盲部变化、阑尾周围炎性条纹、小肠积液呈正相关(P0.05),WBC计数与回盲部变化及阑尾周围炎性条纹呈正相关(P0.05)。结论WBC计数及CRP水平与急性阑尾炎CT分级有关,CRP对急性阑尾炎的诊断及其严重程度的判断更有优势;CRP、NEUT%是穿孔性阑尾炎的重要预测因子,WBC可以更好地发现早期阑尾周围的炎性反应,综合分析CT表现与血清炎性标志物能更准确地诊断急性阑尾炎。     

纳米羟基磷灰石/硫酸钙复合人工骨顺铂缓释系统注射液的制备与研究

目的研制可注射α-CSH-nano-HA/PHBV-PEG顺铂释药系统,为骨转移瘤提供新型的局部药物缓释系统。方法α-CSH-nano-HA/PHBV-PEG载顺铂制成可注射用α-CSH-nano-HA/PHBV-PEG cis-platinum缓释微球,研究其结构、释药特性、可注射性以及力学性能。结果(1)第1、3、5、7天缓释微球的释药浓度分别为97.5、90.7、83.2、68.5μg/mL,第7天后趋于稳定。(2)可注射α-CSH-nano-HA/PHBV-PEG顺铂释药系统在液固比为0.7时可注射性强,与此同时缓释药系统随着液固比的增大凝固时间延长。结论α-CSH-nano-HA/PHBVPEG顺铂释药系统具有良好的注射性能和缓释作用。     

定量三维彩色多普勒超声联合血清β-HCG检查对胎盘功能低下的诊断

目的 评估定量三维彩色能量多普勒超声(three-dimensional color power Doppler ultrasound,3D-CPD)联合β-HCG检查对胎盘功能低下的诊断价值.方法 选择2012年5月至2014年3月在昆明医科大学第四附属医院接受产检的产妇368例,利用GE公司E8三维超声系统对胎盘的血管化指数(VI)、血流指数(FI)和血管化-血流指数(VFI)进行测量,同时利用化学发光法测定β-HCG水平.并存产后记录新生儿体长、体重和生命体征综合评分(Apgar评分).结果 产后共有58例新生儿体重＜2 500 g,为观察组,另外3 10例新生儿体重＞2 500 g,为对照组.对照组VI、FI和VFI分别为(12.5±5.6)、(47.2±3.3)和(9.0±2.6),观察组为(10.2±4.8)、(40.6±4.1)和(4.2±1.7),差异具有统计学意义(P＜0.05);观察组β-HCG水平为(29453.0±229.5) mIU/mL,中位数≥2.5 mom,对照组β-HCG水平为(8 442.6±47.2) mIU/mL,中位数＜2.5mom,观察组β-HCG水平明显高于对照组(P＜0.05);新生儿基本情况相比,观察组新生儿体长、体重和Apgar评分明显低于对照组(P＜0.05).结论 3D-CPD联合β-HCG检查对胎盘功能异常具有重要的诊断价值,有利于围产期了解胎盘功能及估计胎儿预后.