Glycoprotein IIb/IIIa inhibitors use in the setting of primary percutaneous coronary intervention for ST elevation myocardial infarction in patients pre‐treated with newer P2Y12 inhibitors

ObjectivesWe sought to investigate the safety and potential benefit of administrating glycoprotein IIb‐IIIa inhibitors (GPIs) on top of more potent P2Y12 inhibitors.BackgroundA number of clinical trials, performed at a time when pretreatment and potent platelet inhibition was not part of routine clinical practice, have documented clinical benefits of GPI in ST‐segment elevation myocardial infarction (STEMI) patients at the cost of a higher risk of bleeding.MethodsWe used the data of a prospective, ongoing registry of patients admitted for STEMI in our center. For the purpose of this study only patients presenting for primary percutaneous coronary intervention and pretreated with new P2Y12 inhibitors (prasugrel or ticagrelor) were included. We compared patients who received GPI with those who did not.ResultsEight hundred twenty‐four STEMI patients were included in our registry; GPIs were used in 338 patients (41%). GPI patients presented more often with cardiogenic shock and Thrombolysis in myocardial infarction (TIMI) flow grade <3. GPI use was not associated with an increase in in‐hospital or 3‐month mortality. Bleeding endpoints were similar in both groups.ConclusionsOur study suggests that GPI may be used safely in combination with recent P2Y12 inhibitors in STEMI patients in association with modern primary percutaneous coronary intervention strategies (radial access and anticoagulation with enoxaparin) with similar bleeding and mortality rates at hospital discharge and 3‐month follow‐up.     

The effects of familiarity and emotional expression on face processing examined by ERPs in patients with schizophrenia

BACKGROUND: The main objective of the study was to determine whether patients with schizophrenia are deficient relative to controls in the processing of faces at different levels of familiarity and types of emotion and the stage where such differences may occur. METHODS: ERPs based on 18 patients with schizophrenia and 18 controls were compared in a face identification task at three levels of familiarity (unknown, familiar, subject's own) and for three types of emotion (disgust, smiling, neutral). RESULTS: The schizophrenic group was less accurate than controls in the face processing, especially for unknown faces and those expressing negative emotions such as disgust. P1 and N170 amplitudes were lower and P1, N170, P250 amplitudes were of slower onset in patients with schizophrenia. N170 and P250 amplitudes were modulated by familiarity and face expression in a different manner in patients than controls. CONCLUSIONS: Schizophrenia is associated with a genelarized defect of face processing, both in terms of familiarity and emotional expression, attributable to deficient processing at sensory (P1) and perceptual (N170) stages. These patients appear to have difficulty in encoding the structure of a face and thereby do not evaluate correctly familiarity and emotion.     

Deep brain stimulation of the nucleus accumbens core and shell: opposite effects on impulsive action

The nucleus accumbens is gaining interest as a target for deep brain stimulation in refractory neuropsychiatric disorders with impulsivity as core symptom. The nucleus accumbens is composed of two subterritories, core and shell, which have different anatomical connections. Here, we tested the hypothesis that stimulation of the nucleus accumbens core and shell would have different effects on impulsivity. Rats received bilateral stimulation at the level of the nucleus accumbens core or shell during a reaction time task. Stimulation of the nucleus accumbens core significantly decreased impulsivity, while stimulation of the shell increased it. Our results support the hypothesis that the nucleus accumbens is a potential target to treat neuropsychiatric disorders related to impulsivity by deep brain stimulation. However, different behavioral effects resulting from stimulation of the subterritories should be taken into account.     

Pharmacokinetics and dose proportionality of three Tramadol Contramid OAD tablet strengths

A three-way crossover study in 27 human volunteers was conducted to characterize the pharmacokinetics and to assess the dose proportionality of 100 mg, 200 mg and 300 mg strengths of a novel once-a-day tramadol controlled-release tablet (Tramadol Contramid OAD) following single-dose administration. Serial blood samples were collected at predefined timepoints over a 48 h period and racemic tramadol and O-desmethyltramadol concentrations in plasma were determined using a validated LC-MS/MS method. Pharmacokinetic parameters were derived using noncompartmental methods. Following dose normalization and logarithmic transformation of concentration-dependent parameters, the results were compared using analysis of variance (ANOVA). The residual variability thereby obtained was used to construct 90% classical confidence intervals. The two one-sided tests procedure was used for all pairwise comparisons. Dose proportionality was concluded since the 90% CI for the ratio of geometric means was included in the acceptance range of 0.80-1.25 for all comparisons.     

Efficacy and Safety of Anticoagulants in Patients with Atrial Fibrillation and History of Falls or Risk of Falls: A Systematic Review and Multilevel Meta-Analysis

Drug Safety - Atrial fibrillation (AF) is a major cause of stroke. Anticoagulants substantially reduce risk of stroke but are also associated with an increased risk of bleeding. Because of that,...     

L’(in)égalisation des chances dans le sport

For Dubet (2010), the social justice system is based on two types of equality: places and opportunities. The latter, which prevails today, is together with fair play one of the core values of sport. The contradictions of the sports model of justice may thus be questioned. Sport would dramatize and bring coherence to the marriage of competition and justice (Ehrenberg, 1991). Nevertheless, doping, match-fixing and bribery regularly undermine this ideal (Brohm, Perelman & Vassort, 2004). Meritocracy and equality of opportunity, which are the founding myths of sports, cannot keep the defeated from feeling inferior or humiliated (Quéval, 2004). The devices sets, aiming at providing equal opportunities in sports, carry with them various forms of inequality in starting points. The professional tennis ranking system, the adapted sports divisions based on a “degree” of cognitive impairment, or the handicaps allowances, may reveal the introduction of perverse incentives in institutions that in theory are committed to equity.     

Acute respiratory insufficiency caused by diffuse pulmonary hemorrhage]

Two cases of adult respiratory distress syndrome due to diffuse pulmonary haemorrhage are reported. The first patient was treated with azathioprine, prednisolone, cyclosporine and ranitidine for haemorrhagic rectocolitis; the second has untreated primary biliary cirrhosis. Haemoptysis only occurred in the latter. Both had severe isolated hypoxaemia. Chest X-rays revealed bilateral alveolar infiltrates. Bronchoscopies showed a diffusely bleeding bronchial tree. Both patients recovered after having been mechanically ventilated with positive end-expiratory pressure for six and eight days respectively. The cause of the diffuse pulmonary haemorrhage was, in the first case, severe thrombocytopaenia (17,000 G.1-1) of central origin, and, in the other patient, an unspecified vasculitis. Diffuse pulmonary haemorrhage should be added to the list of possible causes of the adult respiratory distress syndrome.     

Cardiovascular changes after pulmonary embolism from injecting calcium phosphate cement

Concerns have been raised that the use of calcium phosphate (CaP) cements for the augmentation of fractured, osteoporotic bones may aggravate cardiovascular deterioration in the event of pulmonary cement embolism by stimulating coagulation. The aim of the present study was therefore to investigate the cardiovascular changes after pulmonary embolism of CaP cement using an animal model. In 14 sheep, 2.0 mL CaP or polymethylmethacrylate cement were injected intravenously. Cardiovascular parameters and antithrombin levels were monitored until 60 min postinjection. Postmortem, lungs were subjected to CT scanning, and 3D reconstruction of the cement was performed. Intravenous injection of CaP cement resulted in a more severe increase in pulmonary arterial pressure and decrease in arterial blood pressure. Disintegration of the CaP cement seemed to be the reason for the more severe reaction. There was no evidence of thromboembolism. Disintegration of CaP cement in circulating blood does not only compromise the mechanical properties, but also represents a risk of cardiovascular complications. Reliable cohesion of CaP cements in an aqueous environment is essential for clinical applications such as osteoporotic bone augmentation.