"Tombstoning" of ST segment in acute myocardial infarction -- effect on clinical course

INTRODUCTION: There are many reports evaluating the effects of the amplitude of ST segment elevation in acute myocardial infarction with ST segment elevation (STEMI) on infarction zone and course. There are, however, few publications dealing with the effects of ST segment elevation shape in STEMI patients on their clinical course and prognosis. AIM: Assessment of the rate of "tombstoning" of ST segment (TOMB-ST) in STEMI patients and the effects on their clinical outcome. METHODS: The study involved 207 consecutive patients with STEMI hospitalised in the period 2000-2002 analysed with respect to the in-hospital complication rate. RESULTS: On admission, TOMB-ST was observed in 55 (26.1%) subjects. TOMB-ST was more common in anterior MI (39.8%) than in inferior MI (10.6%). Patients with TOMB-ST compared to non-TOMB-ST ones had a significantly higher mortality rate (38.2% vs 9.9%, p <0.001), heart failure (45.6% vs 28.3%, p <0.026), ventricular fibrillation (18.1% vs 6.4%, p <0.016), and lower left ventricular ejection fraction (40.9% vs 48.6%, p <0.001). The sum of amplitudes of ST segment deviations (SigmaST) >20 mm was indicative for the subgroup of patients with TOMB-ST and trend towards higher mortality (40% vs 30%, NS). However, in patients without TOMB-ST, SigmaST >20 mm identified two subgroups with significantly different mortality rates (20% vs 4%, p=0.001). CONCLUSIONS: TOMB-ST was observed in one fourth of patients with STEMI. This abnormality was associated with an increased mortality rate, higher incidence of heart failure and ventricular fibrillation as well as decreased left ventricular ejection fraction. In the population with TOMB-ST, increased mortality was independent of the total amplitude of ST segment displacement; this relation was, however, observed in patients with STEMI without TOMB-ST.     

Polymorphic ventricular tachycardia in acute myocardial infarction without ST elevation in a patient with thrombocytopenia

67-year-old woman with thrombocytopenia (treated with prednisolon and azathiopryn) was admitted because of acute myocardial infarction without ST segment elevation (NSTEMI). From the 2nd day we observed increasing QTc interval from 461 ms with normal potassium level. Suddenly on the 6th day of the so far uncomplicated AMI ventricular fibrillation developed and was successfully treated with DC shock, and amiodarone (150 mg i.v.) was administered because of recurrent NSVT. Potassium level was 2.9 mmol/l. Within the next 2 days in the morning hours we observed episodes of recurrent polymorphic ventricular tachycardia (PMVT), always progressing into ventricular fibrillation (VF). The ECG showed QT interval--520 ms, QTc--602 ms. The patient was given an increasing dose of beta-blocker and lidokaine in i.v. infusion. After this regimen PMVT/VF did not recur and QT was normalized. Additionally successful PCI of LAD with 80% stenosis was performed. The paper discusses the problem of PMVT in the settings of AMI.     

The changing face of European healthcare education: the Hungarian experience

Throughout Europe, higher education is undergoing great changes in order to establish what is being called the European Higher Education Area (EHEA) based on the Bologna process. The goal being the establishment of a uniform, transparent and efficient development of professionals in a higher education system that can react in a flexible way to the changes in the labor market, and to the challenges presented by increasing globalization. The aim of this article is to provide an overview of the Bologna process and to give a summary of the implemented initial stages in the health care higher education of Hungary. As a consequence, the Hungarian higher education in healthcare has undergone considerable reforms to facilitate transition into this new system. The results indicate that the new structure in health sciences is not compatible with other way of European countries of introducing Bologna reforms, although the content of the former BSc curriculum still remained the same. MSc programs are still being discussed.     

A Phase 2 Trial of Flavopiridol (Alvocidib) and Cisplatin in Platin-Resistant Ovarian and Primary Peritoneal Carcinoma: MC0261

PURPOSE: Based upon promising preclinical and phase 1 trial results, combined flavopiridol and cisplatin therapy was evaluated in patients with ovarian and primary peritoneal cancers. METHODS: A two cohort phase 2 trial of cisplatin (60mg/m(2) IV) immediately followed by flavopiridol (100mg/m(2) IV, 24h infusion; 21day cycles) was undertaken in patients with recurrent platin-sensitive or platin-resistant disease (progression>vs. ≤6months following prior platin-based therapy). Measurable disease (RECIST) - or evaluable disease plus CA125 >2X post-treatment nadir - and ECOG performance ≤2 were required. RESULTS: Forty-five patients were enrolled between December 23, 2004 and February 25, 2010: 40 platin-resistant (Group 1), and 5 platin-sensitive (Group 2). In Group 1, the median number of treatment cycles was 3 (range 2-12). Only 10% of patients incurred grade 4 toxicities, but grade 3 toxicities were common (65%): neutropenia (17.5%); nausea (12.5%); vomiting, fatigue, thrombosis, anemia (10% each). Seven patients (17.5%) achieved a confirmed response (1 CR, 6 PR; median duration 118days); ten additional patients (25%) attained maintained stable disease. Median time to progression was 4.3months; overall survival was 16.1months. Pilot translational studies assessed ascites flavopiridol level; surrogate marker studies were uninformative. In Group 2, although 4 of 5 patients responded (2 confirmed PRs with median time to progression, 10.8months and median overall survival 20.6months) the cohort was closed due to poor accrual. CONCLUSIONS: The assessed flavopiridol and cisplatin regimen displayed clinical activity in platin resistant and sensitive ovarian/primary peritoneal cancers, meriting further study.     

Compression Strength of PLA Bolts Produced via FDM

The aim of this research was to define the compression strength of polylactic acid bolts produced using the fused deposition modelling method. In accomplishing this, static and cyclic compression tests for different metric thread sizes were carried out in accordance with ISO 4014. Tests were conducted on M42, M48, M56, M60, and M64 threads, while samples with three different types of pitch—one nominal and two fine threads—were prepared for each diameter. Standard ISO 604 for defining the compression modulus Ec was implemented as the test basis. Accordingly, the mean compression modulus value Ec for all measurements was 917.79 ± 184.99 MPa. Cyclic compression tests were then carried out on samples with the M64 × 4 thread. Fifty thread loading cycles were carried out for each variant to obtained different strain amplitude values and strain frequencies. Our work indicated that the values of the storage modulus defined in cyclic tests E′ increased, while the values of the loss modulus E″ decreased when the value of the strain frequency increased. We found it not possible to determine the nature of the changes in the value of the storage modulus E′ in the function of the strain amplitude. We did, however, observe an increase in the value of the loss modulus E″, together with the increase in the tested range of the strain amplitude. The determined mechanical values can be therefore be used for designing threaded connections made of polylactic acid using the fused deposition modelling method.     

Synthesis and anti-HIV-1 activity of 4,5,6,7-tetrahydro-5-methylimidazo[4,5,1-jk][1,4]benzodiazepin-2(1H)-on e (TIBO) derivatives. 2

In the first paper of this series a new structure with anti-HIV-1 activity was disclosed and analogues were synthesized to explore the structure-activity relationship of changes in the substituent (R) attached at the N-6 position of 9. This study describes the syntheses and anti-HIV-1 testing of analogues with variations of the five-membered urea ring of the 4,5,6,7-tetrahydro-5-methylimidazo[4,5,1-jk] [1,4]benzodiazepin-2(1H)-one (TIBO) structures. Although many different rings were synthesized to replace the cyclic urea of TIBO, most were found to be inactive in inhibiting the replication of the HIV-1 virus in MT-4 cells. The exceptions were replacement of the urea oxygen with sulfur or selenium to give the corresponding thio- or selenoureas. These were found to be more active than the oxygen counterparts. A small series of analogues was synthesized and tested which allowed direct comparison of urea and thiourea derivatives. Without exception, the latter were always more active than the former. The most active compound of this series (8d) was found to inhibit the HIV-1 virus with an IC50 of 0.012 microM which is comparable to that of AZT.