Clinical Outcomes Following Percutaneous Coronary Intervention With Drug‐Eluting Stents Versus Bare Metal Stents in Patients on Chronic Hemodialysis

Background

Patients on chronic hemodialysis (HD) are recognized as a high‐risk group for adverse events after percutaneous coronary intervention, and whether drug‐eluting stents (DES) are associated with improved outcomes over bare metal stents (BMS) is still uncertain. The purpose of this study was to assess the efficacy of DES compared with BMS at short‐ and long‐term follow‐up (FU) in an unselected sample of HD patients.

Methods and Results

In the time period 2005–2010, consecutive patients on chronic HD treated with percutaneous coronary intervention (PCI) and stent implantation were retrospectively selected and analyzed. A total of 169 patients were selected, 77 treated exclusively with BMS and 92 exclusively with DES. Baseline clinical characteristics were similar in the 2 groups as well as the number of treated vessels, treated lesions, and the stent per patient ratio. At longest available FU, no difference between the 2 study groups was found in terms of cardiac death (18.2% vs 16.3%, P = 0.83), myocardial infarction (2.5% vs 8.6%, P = 0.09), cerebrovascular accidents (0% vs 1.1%, P = 0.98), and target vessel revascularization (TVR) (9.1% vs 16.3%, P = 0.17). Major adverse cardiac and cerebrovascular events‐free survival at 1,500 days in the BMS and DES groups was 57.6% and 50.9% (P = 0.11), respectively.

Conclusions

PCI in patients on chronic HD treatment is associated with a high incidence of adverse events at FU, mainly represented by death. In our study, the use of DES was not associated with a reduction of target lesion revascularization (TLR) and TVR.

     

Urinary isoflavonoid phytoestrogen and lignan Excretion After Consumption of Fermented and Unfermented Soy Products

Objective To compare the effects of consumption of fermented and unfermented soy products on excretion of urinary isoflavonoid phytoestrogens and lignans in healthy men.Design A randomized, crossover trial consisting of two 9-day feeding periods following 5 days of baseline data collection.Subjects Healthy men, aged 20 to 40 years, were recruited from the University of Minnesota Twin Cities community. Of the 22 subjects who began the study, 17 completed all feeding periods.Interventions Fermented soy product (112 g tempeh) or unfermented soy (125 g soybean pieces) was consumed during each controlled feeding period.Main outcome measure Urine samples collected while subjects consumed their habitual diets and on the last 3 days of each feeding period were analyzed for isoflavonoid and lignan content by isotope dilution gas chromatography-mass spectrometry.Statistical analysis performed Comparisons of isoflavonoid and lignan excretion were analyzed using the general linear model procedure. Orthogonal contrasts were used to determine treatment differences of interest.Results Urinary excretion of isoflavonoids (equol, O-desmethylangolensin [O-DMA], daidzein, genistein) was higher and excretion of lignans (enterodiol, enterolactone) was lower when subjects consumed soy-supplemented diets than when they consumed their habitual diets (P<.05). Urinary isoflavonoid excretion and lignan excretion were similar when subjects consumed tempeh and soybean pieces diets; however, recovery of daidzein and genistein was significantly higher when subjects consumed the tempeh diet than when they consumed the soybean pieces diet (P<.002). When fed soy, 5 of 17 subjects excreted high amounts of equol. These five subjects tended to excrete less O-DMA and daidzein than the 12 subjects who excreted low amounts of equol (P<.06).Conclusions Fermentation of soy decreased the isoflavone content of the product fed but increased the urinary isoflavonoid recovery. This finding suggests that fermentation increases availability of isoflavones in soy. J Am DietAssoc. 1995; 95:545-551.     

Benzodiazepine Prescribing and Withdrawal for 3234 Patients in 15 General Practices

Benzodiazepines are still widely prescribed in general practice,despite repeated warnings about the problems associated withtheir use. Other studies have shown that a variety of interventionscan reduce prescribing, but these have been restricted to relativelyfew general practices or patients. We co-ordinated an auditof benzodiazepine prescribing and withdrawal in 15 practicescaring for 87 900 patients across a district. In total 3234patients (37 per 1000 registered patients) were discovered tobe taking the drugs at the start of the programme, and 16% ofthese people stopped taking the drugs by the conclusion of theaudit 8 months later. There was no relation between successat benzodiazepine cessation and initial levels of prescribing,nor with practice size. Younger patients were significantlymore likely to stop benzodiazepines than those over the ageof 65.     

Variant rs2200733 on Chromosome 4q25 Confers Increased Risk of Atrial Fibrillation: Evidence From a Meta‐Analysis

Variant rs2200733 on Chromosome 4q25 Confers Increased Risk . Introduction: Several genome‐wide association studies have identified rs2200733, a single‐nucleotide polymorphism (SNP) at 4q25 to be the most common chromosomal variant present in patients with atrial fibrillation (AF). We aimed to explore the association of rs2200733 with AF through a systematic review and meta‐analysis. Method: An extensive literature search was performed on PubMed, and other databases using the key words “genetics” and “AF.” Seven case‐control studies evaluating the association via multivariate analysis were identified including a total of 83,335 subjects (10,546 with AF, 72,789 referent individuals without AF). Meta‐analytic estimates were derived using random effects models. Potential sources of heterogeneity were examined in sensitivity analyses, and publication biases were estimated. Result: At pooled analysis, there was a strong independent association between the variant rs2200733 and the risk of AF (OR 1.89 [95% CI 1.62–2.16], P < 0.001). Minor allelic frequencies for SNP rs22000733 were significantly more prevalent in AF population than non‐AF. Metaregression results revealed that country of descent (logOR 0.38, P = 0.45) or site of study (logOR: ?0.16, P = 0.41) did not moderate the overall effect size. Conclusion: Variant rs2200733 on chromosome 4q25 independently confers increased risk of AF. This finding will aid in improving our understanding of AF pathophysiology, risk prediction, and stratification of treatment strategy. (J Cardiovasc Electrophysiol, Vol. 24, pp. 155‐161, February 2013)     

Ventricular Cross Stimulation in a Dual Chamber Pacing System: Phenomenon Analysis

Seven cases of ventricular cross stimulation from a group of 23 patients implanted with DDD devices are presented. In two patients the phenomenon was observed at the moment of DDD programming at nominal values, and in five other patients it was reproduced by increasing the atrial output voltage up to ten volts. In all 23 patients cross stimulation disappeared permanently within 24 hours after implantation. From the onset of cross stimulation to its end, atrial and ventricular threshold voltages were unchanged, while the atrial and ventricular impedances significantly decreased. These results suggest that an important role in the phenomenon occurs by impedance variation at the interface between the pulse generator and body tissue.     

Reversal of chlorpromazine-induced avoidance depression by the N-methyl-d-aspartate antagonist,dizocilpine, in mice

Abstract— The non-competitive N-methyl-d -aspartate (NMDA) antagonist MK-801 (dizocilpine) was tested, alone or in combination with chlorpromazine, in mice previously trained in the shuttle-box. The lowest doses of dizocilpine (0·02 and 0·04 mg kg^?1) attenuated the disrupting action of the neuroleptic (1·5 mg kg^?1) on avoidance-performance, while avoidance depression induced by 1·5 and 2 mg kg^?1 chlorpromazine was completely or almost completely reversed by 0·08 mg kg^?1 NMDA antagonist. The highest dose (0·16 mg kg^?1) of dizocilpine did not ameliorate avoidance-performance of mice receiving 2 mg kg^?1 chlorpromazine, perhaps because of ataxic effects produced by the drug combination, at these doses. The results support suggestions for a potential use of NMDA antagonists in the treatment of extrapyramidal side-effects of neuroleptics.     

Relationship between body weight and blood pressure and some metabolic parameters in psoriatic patients

The relationship between body weight and blood pressure, total serum cholesterol, triglycerides, uric acid and glucose was investigated in 203 psoriatic patients in comparison with 904 healthy controls. In the psoriatic patients, these parameters were clearly related to their body weight. Those psoriatic patients of normal weight exhibited lower mean values of all the parameters compared with overweight psoriatic patients while they did not differ from control subjects of normal weight. Our results suggest that only overweight psoriatic patients exhibit the metabolic abnormalities frequently reported in the literature, while psoriatic patients of normal weight do not differ from the general population in this respect.