Hematologic parameters and angiographic progression of coronary atherosclerosis

Hematologic parameters have prognostic importance in cardiovascular disease. However, the relation between atherosclerosis progression and hematologic parameters is not well defined. A total of 394 patients requiring repeat coronary angiography were included in the study. According to angiography, patients were divided into 2 groups, progressive (n = 196) and nonprogressive (n = 198) diseases. Hematologic parameters including mean platelet volume (MPV) and neutrophil/lymphocyte (N/L) ratio were measured. Glucose, creatinine, and cholesterol were significantly higher in the progressive group. Mean platelet volume count was similar in both groups. The N/L ratio was significantly higher in the progressive group (5.0 ± 5.1 vs 3.2 ± 3; P = .001). In multivariate analysis, the N/L ratio was significantly related with progression (relative risk [RR]: 2.267, 95% CI: 1.068-4.815, P = .03). Progression rate was significantly high in patients with high N/L ratio (39% vs 56%). Our results suggest that the N/L ratio is a predictor of progression of atherosclerosis.     

Effect of Patient State Index Monitoring on the Recovery Characteristics in Morbidly Obese Patients: Comparison of Inhalation Anesthesia and Total Intravenous Anesthesia

PurposeObese patients have a significantly higher risk of adverse effects associated with general anesthesia. The purpose of this study was to evaluate the effects of Patient State Index (PSI) monitoring on recovery from anesthesia and the incidence of any postoperative complications among patients undergoing bariatric surgery with total intravenous anesthesia (TIVA) and inhalational anesthesia.DesignThis prospective, double-blind, and randomized controlled trial was conducted between February 2017 and August 2017 and included 120 morbidly obese patients (body mass index >40 kg/m²).MethodsPatients were randomly divided into four groups; group P-PSI (n = 30): TIVA with PSI monitoring; group P (n = 30): TIVA without PSI monitoring; group D-PSI (n = 30): desflurane with PSI monitoring; and group D (n = 30): desflurane without PSI monitoring. The discharge time from the postanesthesia care unit (PACU), postoperative complications, and hemodynamic parameters were recorded and evaluated.FindingsNo significant differences were found in demographic data, duration of anesthesia, admittance to PACU, discharge from PACU, modified Aldrete scores, and perioperative mean blood pressure and heart rate. Nausea and vomiting scores were significantly lower in group P-PSI, group P, and group D-PSI compared with group D.ConclusionsAlthough TIVA and inhalational anesthesia can be safely used for obese patients, intraoperative PSI monitoring may decrease the discharge time from PACU and reduces incidence of postoperative nausea and vomiting caused by inhalation anesthetics.     

The treatment of depression in chronic low back pain: review and recommendations.

The prevalence of major depression in patients with chronic low back pain (CLBP) is approximately three to four times greater than that reported in the general population. In spite of these high prevalence rates, there have been few systematic attempts to investigate the efficacy of treatment for major depression in patients with CLBP. While several studies have examined the efficacy of antidepressant medication and psychological treatment in patients with chronic pain, most of these studies have focused on treating chronic pain rather than depression. The few studies that have specifically addressed the treatment of depression in CLBP indicate that tricyclic antidepressants and cognitive-behavioral approaches may be effective means of treating depressed chronic pain patients. Clinical issues related to diagnostic confounds, rehabilitation outcome, and conceptualizations of the relation between pain and depression are discussed. It is argued that, in patients with clinical levels of depression, treatment modalities specifically targeting depressive symptomatology deserve serious consideration as an integral component of pain management programs.     

Protective effects of nebivolol against anthracycline-induced cardiomyopathy: A randomized control study

Background

We aimed to evaluate the effect of prophylactic nebivolol use on prevention of antracycline-induced cardiotoxicity in breast cancer patients.

Methods

In this small, prospective, double-blind study, we randomly assigned 45 consecutive patients with breast cancer and planned chemotheraphy to receive nebivolol 5 mg daily (n = 27) or placebo (n = 18). Echocardiographic measurements and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels were obtained at baseline and at 6-month of chemotherapy.

Results

Both studied groups had comparable echocardiographic variables and NT-pro-BNP levels at baseline. At 6-month, the left ventricular (LV) end-systolic and end-diastolic diameters increased in the placebo group (LVESD: 29.7 ± 3.4 to 33.4 ± 4.5 mm; LVEDD: 47.2 ± 3.8 to 52.0 ± 4.6 mm, p = 0.01 for both) but remained unchanged in the nebivolol group (LVESD: 30.4 ± 3.5 to 31.0 ± 3.6 mm, p = 0.20; LVEDD: 47.0 ± 4.4 to 47.1 ± 4.0 mm, p = 0.93). The placebo group also had lower LVEF than the nebivolol group (57.5 ± 5.6% vs. 63.8 ± 3.9%, p = 0.01) at 6-month. NT-pro-BNP level remained static in the nebivolol group (147 ± 57 to 152 ± 69 pmol/l, p = 0.77) while it increased in the placebo group (144 ± 66 to 204 ± 73 pmol/l, p = 0.01).

Conclusions

Prophylactic use of nebivolol treatment may protect the myocardium against antracycline-induced cardiotoxicity in breast cancer patients.     

Prognostic value of neutrophil/lymphocyte ratio in patients with ST-elevated myocardial infarction undergoing primary coronary intervention: A prospective,multicenter study

Objective

The pre-procedural neutrophil to lymphocyte ratio (N/L) is associated with adverse outcomes among patients with coronary artery disease but its prognostic value in ST-segment elevation myocardial infarction (STEMI) has not been fully investigated. This study evaluated the relations between pre-procedural N/L ratio and the in-hospital and long-term outcomes in STEMI patients undergoing primary percutaneous coronary intervention (PCI).

Methods

A total of 682 STEMI patients presented within the first 6 h of symptom onset were enrolled and stratified according to tertiles of N/L ratio based on the blood samples obtained in the emergency room upon admission.

Results

The mean follow-up period was 43.3 months (1–131 months). In-hospital in-stent thrombosis, non-fatal myocardial infarction, and cardiovascular mortality increased as the N/L tertile ratio increased (p < 0.001, p < 0.001, p = 0.003, respectively). Long-term in-stent thrombosis, non-fatal myocardial infarction and cardiovascular mortality also increased as the N/L ratio increased (p < 0.001, p < 0.001, p = 0.002, respectively). On multivariate analysis, N/L ratio remained an independent predictor for both in-hospital (OR 1.189, 95% CI 1.000–1.339; p < 0.001) and long-term major (OR 1.228, 95% CI 1.136–1.328; p < 0.001) adverse cardiac events.

Conclusion

The N/L ratio was an independent predictor of both in-hospital and long-term adverse outcomes among STEMI patients undergoing primary PCI. Our findings suggest that this inexpensive, universally available hematological marker may be incorporated into the current established risk assessment model for STEMI.     

Relation of left atrial spontaneous echocardiographic contrast in patients with mitral stenosis to inflammatory markers

Spontaneous echocardiographic contrast (SEC) is the presence of smoke-like echoes with a characteristic swirling motion of blood in echocardiography. Previous clinical studies have demonstrated that SEC is a risk factor for left atrial thrombus formation and an important indicator of potential systemic embolism originated from heart. An established relation exists between the inflammatory status and the prothrombotic state. Therefore, we investigated the role of inflammatory status on SEC in patients with mitral stenosis (MS). A total of 62 consecutive patients with MS who undergoing mitral balloon valvuloplasty were enrolled in the present study. The patients were divided into 2 groups according to the formation of SEC in the left atrium. Of the 62 patients, 32 (mean age 45 ± 12 years; 75% women) were in the SEC-negative group and 30 patients (mean age 45 ± 11 years; 63% women) were in the SEC-positive group. The high-sensitive C-reactive protein levels were significantly greater in the SEC-positive group than in the SEC-negative group (3.9 ± 2.2 vs 10.6 ± 6.3, p = 0.024). The neutrophil levels (64.6 ± 9.4 vs 72.6 ± 8.6) were significantly greater in the SEC-positive group, and the lymphocyte levels (24.4 ± 6.9 vs 18.3 ± 6.0) were significantly greater in the SEC-negative group (p = 0.001 for each). The neutrophil/lymphocyte (N/L) ratio was also significantly greater in the SEC-positive group (3.0 ± 1.8 vs 4.5 ± 1.8, p = 0.003). In the receiver operating characteristics curve analysis, a N/L ratio > 3.1 mg/dl had a 80% sensitivity and 72% specificity in predicting SEC in patients with MS. On multivariate analysis, high-sensitive C-reactive protein (odds ratio [OR] 1.235, 95% confidence interval [CI] 1.040 to 1.466; p = 0.016), N/L ratio (OR 1.461, 95% CI 0.977 to 2.184; p = 0.02), left atrial volume (OR 3.012, 95% CI 1.501 to 5.611; p = 0.001), and mitral valve area (OR 0.135, 95% CI 0.020 to 0.503; p = 0.017) were independent risk factors of SEC in patients with MS. In conclusion, the high-sensitive C-reactive protein and N/L ratio were independently associated with SEC in patients with MS.     

Cardiac Effects of Chronic Graft-versus-Host Disease after Stem Cell Transplantation

Chronic graft-versus-host disease (GVHD) develops as a result of the immunologic response that donor T-lymphocytes generate against host tissue after allogeneic stem cell transplantation. We tried to elucidate the contribution of cardiac dysfunction to the high morbidity and mortality rates observed after GVHD.Forty patients who had undergone bone marrow transplantation were enrolled in this prospective study: 14 patients who had been diagnosed with chronic GVHD (manifestations beyond day 100 after hemopoietic cell transplantation) and 26 patients who had not. All patients had undergone baseline echocardiography before bone marrow transplantation and were monitored. After the expected period of time had elapsed for GVHD after transplantation, these patients were divided into 2 groups in accordance with whether or not they developed chronic GVHD.No significant differences were observed before bone marrow transplantation in the 2 groups'' broad attributes or in their laboratory and echocardiographic findings (P >0.05). After transplantation, high-sensitivity C-reactive protein levels and erythrocyte sedimentation rates were significantly higher in the chronic GVHD group (P < 0.001 and P=0.01, respectively). Mean left ventricular mass was 227 ± 32.3 g in the GVHD group and 149.3 ± 27.4 g in the non-GVHD group (P < 0.001). The E/A flow rate was significantly higher in the non-GVHD group.This study shows that chronic GVHD increases left ventricular mass and impairs left ventricular diastolic function in patients who have developed chronic GVHD. In addition, it shows that inflammatory markers increase to higher levels in these patients. Comprehensive studies with larger samples are needed to more fully elucidate the cardiac effects of this disease.Key words: Bone marrow transplantation, C-reactive protein, diastole, left ventricular, graft vs host disease/prevention & control, hematopoietic stem cell transplantation/adverse effectsStem cell transplantation is acknowledged as the basic treatment approach in many hematologic diseases. In patients who receive allogeneic bone marrow transplantation (BMT), graft-versus-host disease (GVHD) is the leading cause of morbidity and death. Graft-versus-host disease is a result of immunologic responses to the host''s tissues by the donor''s T-lymphocytes.^1–5 Because the host''s immune system is suppressed, it is less resistant to the donor''s lymphocytes.^6,7 The organs that are most commonly affected by GVHD are the liver, lungs, skin, gastrointestinal system, and lymphoid tissues. The risk of developing GVHD is higher in elderly hosts than in younger hosts and in older hosts whose donors are young. The incidence of GVHD after BMT is approximately 35% to 50%. The clinical manifestation of chronic GVHD often differs from that of acute GVHD. Mostly mesenchymal tissues are affected in chronic GVHD.^8,9 The diagnostic and therapeutic approaches to diffuse organ involvement are well known for both acute and chronic GVHD, but the body of knowledge on cardiac involvement is more limited.After the 2005 National Institutes of Health (NIH) Consensus Development Project on Chronic GVHD, major changes in the diagnosis, classification, and grading of chronic GVHD were proposed. Rather than focus on the customary 100 days post–bone marrow transplantation as the dividing line between acute and chronic GVHD in regard to the continued manifestation of symptoms, the proposed NIH Consensus Criteria invoke the diagnostic characteristics of the syndromes in order to classify them. Accordingly, those manifestations (dermal, oral, hepatic, ocular, respiratory, and gastrointestinal) occurring beyond day 100 are considered diagnostic of classic chronic GVHD. A revised scheme for grading the severity of GVHD assigns a score for each involved organ with attention to functional impairment and provides a global summary score (mild, moderate, or severe) that takes into account the number of organs involved and the severity of the condition of those organs.¹⁰ Yet we still define classic chronic GVHD as manifestations beyond day 100 after allogeneic hemopoietic cell transplantation. According to this older criterion, 14 patients were in our classic chronic GVHD group. The other 26 patients had neither chronic nor acute GVHD.The purpose of this prospective study was to find out whether there are cardiac effects in patients who develop GVHD after receiving BMT and to determine their extent.     

Influence of local and environmental temperatures on cutaneous circulation with use of laser Doppler flowmetry

The purpose of this study was to determine a standard set of conditions for detecting peripheral arteriosclerosis with ischemia. One series of studies was done to determine the influence of room temperature on peripheral flow in healthy subjects and patients with peripheral vascular disease. The room temperature was varied from 30 degrees to 35 degrees C. The temperature from 24 degrees to 30 degrees C had only minor effects on the circulation. Thus, it seemed appropriate to use a room temperature in the lower range, usually 23 degrees C. Another series of studies showed the effect of changing skin temperatures locally at the finger tip or toe tip on the plantar and volar surfaces in healthy subjects and in patients with peripheral vascular disease. Results showed that as temperature was increased from 10 degrees to 45 degrees, there was a marked increase in the finger and toe circulations, which was considerably greater in the normal subjects as compared with those with digital disease. The ideal temperature at which to work as a routine is 40 degrees C as opposed to the lower temperatures, which did not separate healthy subjects from patients with peripheral vascular disease. A third experiment was done to study normal subjects and patients by using the finger circulation as control against the toe circulation when the conditions were a local skin temperature of 40 degrees C and a room temperature of 23 degrees C. A toe-finger index was established to detect abnormalities in the circulation.(ABSTRACT TRUNCATED AT 250 WORDS)