Statin therapy is associated with fewer deaths in patients with bacteraemia

Objective Beneficial effects with statin use are increasingly reported in a variety of patient groups. There is in vitro and clinical evidence for its antiinflammatory and immunomodulatory therapeutic roles. We aimed to assess the association between statin administration and mortality in bacteraemic patients.Design A retrospective cohort analysis.Setting A 300-bed acute general hospital.Patients and participants All patients (n=438) requiring hospital care for an episode of bacteraemia during the years 2000–2003 were included. Statin use, patient outcome, and clinical and laboratory variables were collected.Interventions None.Measurements and results There was a significant reduction in all-cause hospital mortality (10.6% vs. 23.1%, p=0.022) and death attributable to bacteraemia (6.1% vs. 18.3%, p=0.014) in patients who were receiving statin therapy at the time of bacteraemia (n=66). The reduction in all-cause hospital mortality (1.8% vs. 23.1%, p=0.0002) and death attributable to bacteraemia (1.8% vs. 18.3%, p=0.0018) was more pronounced in the patients who continued to receive statin therapy after the diagnosis of bacteraemia (n=56). The apparent mortality benefit persisted after controlling for differences between the groups. Statin use prior to admission was associated with a reduced adjusted hospital mortality rate (odds ratio 0.39; CI 95% 0.17, 0.91; p=0.029), and continuing statin use after bacteraemia increased this effect (odds ratio 0.06; CI 95% 0.01, 0.44; p=0.0056).Conclusion This retrospective study demonstrates a significant survival benefit associated with continuing statin therapy in bacteraemic patients. The potential for statins as an adjuvant therapy in sepsis warrants further investigation.Electronic Supplementary Material Supplementary material is available in the online version of this article at Work was performed at Ipswich Hospital (Ipswich) and Princess Alexandra Hospital (Brisbane), Australia.This article refers to the editorial at .The authors have no financial interest in the products discussed in this paper. The authors have not received sponsorship or funding or have any conflicts of interest.     

Impact of radiation dose on late clinical outcome after intracoronary radiation therapy: three-year follow-up of Long WRIST.

To determine the safety and efficacy, including the impact, on the late recurrence rate of an incremental gamma-radiation dose from 15 to 18 Gy, we report the 3-year clinical outcome of Washington Radiation for In-Stent Restenosis Trial for Long Lesions (Long WRIST). One hundred eighty patients with recurrent in-stent restenosis (ISR) were enrolled in the Long WRIST series and treated with (192)Ir with 1 month of antiplatelet therapy. Between 6 months and 3 years, the need for repeat revascularization was low and similar among the three groups. At 3 years, target lesion revascularization (TLR) and major adverse cardiac events (MACE) were less frequent in the 18 Gy group than in the 15 Gy group (P = 0.12 for TLR, P < 0.05 for MACE) and less frequent in the 15 Gy group as compared to the placebo group (P < 0.05 for TLR and MACE). At 3 years, a higher dose of 18 Gy with (192)Ir continues to improve the outcome of patients treated for ISR when compared to patients treated with 15 Gy or placebo.     

Response of Pulmonary Vein Potentials to Burst Pacing

BACKGROUND: Pulmonary vein potentials recorded at the ostia of pulmonary veins (PV) are a useful guide for segmental isolation of the PV in patients with atrial fibrillation (AF). Even during coronary sinus pacing at 600 ms, atrial (A) and PV potentials can overlap in 50-60% of patients making the accurate identification of PV potentials very difficult. METHODS: Nineteen patients (M:F 15:4) with paroxysmal AF underwent segmental isolation of one or more PV. Coronary sinus (CS) pacing was performed at cycle lengths of 600/550/500/450/400/350/300 ms and bipolar electrograms were recorded from the 10 or 20 pole Lasso catheter placed at the atrial-PV junction in 27 pulmonary veins. Stimulus (S) to A, S-PVP and A-PVP intervals were measured during CS pacing at the different cycle lengths at sweep speed of 200 mm/sec. RESULTS: During CS pacing at 600 ms the A and PV potentials were significantly overlapped (A-PVP < or = 25 ms) in 15 of 27 (55%) veins. During pacing at 300 ms, the A and PV potentials were significantly separated (A-PVP > or = 25 ms) in 9 of the 15 veins where A and PV potentials overlapped and 21 of all 27 (78%) veins. In two patients pacing at 300 ms was associated with 2:1 conduction block from atrial to PV fascicle. CONCLUSIONS: Coronary sinus pacing at cycle length of 300 ms demonstrated better separation of A and PV potentials compared to pacing at 600 ms. This strategy is easier and less time consuming compared to extrastimuli testing. It also confirms that the electrophysiological properties of PV fascicles are different from that of the adjacent atrial musculature.     

A Homogeneous, Ligase-Mediated DNA Diagnostic Test

Single-nucleotide variations are the most widely distributed genetic markers in the human genome. A subset of these variations, the substitution mutations, are responsible for most genetic disorders. As single nucleotide polymorphism (SNP) markers are being developed for molecular diagnosis of genetic disorders and large-scale population studies for genetic analysis of complex traits, a simple, sensitive, and specific test for single nucleotide changes is highly desirable. In this report we describe the development of a homogeneous DNA detection method that requires no further manipulations after the initial reaction is set up. This assay, named dye-labeled oligonucleotide ligation (DOL), combines the PCR and the oligonucleotide ligation reaction in a two-stage thermal cycling sequence with fluorescence resonance energy transfer (FRET) detection monitored in real time. Because FRET occurs only when the donor and acceptor dyes are in close proximity, one can infer the genotype or mutational status of a DNA sample by monitoring the specific ligation of dye-labeled oligonucleotide probes. We have successfully applied the DOL assay to genotype 10 SNPs or mutations. By designing the PCR primers and ligation probes in a consistent manner, multiple assays can be done under the same thermal cycling conditions. The standardized design and execution of the DOL assay means that it can be automated for high-throughput genotyping in large-scale population studies.