Triple antiplatelet therapy for preventing vascular events: a systematic review and meta-analysis

Background  

Dual antiplatelet therapy is usually superior to mono therapy in preventing recurrent vascular events (VEs). This systematic review assesses the safety and efficacy of triple antiplatelet therapy in comparison with dual therapy in reducing recurrent vascular events.     

Social participation of adolescents with cerebral palsy: trade-offs and choices

This article reports on the findings of a qualitative study about the experiences and perceptions of adolescents with cerebral palsy (CP) in relation to social participation. A phenomenological approach was used to interview 10 adolescents with CP, 17 to 20 years of age, selected using purposeful sampling. An iterative process of data collection and analysis resulted in four themes about social participation. The themes of experience, barriers, and supports, and tradeoffs supported the current view of participation as a dynamic interaction between person and environment. The fourth theme of making choices described the unique challenges facing adolescents with CP in terms of deciding what was most important and meaningful to them now and in their future. Health care professionals can support adolescents as they develop the capacity to make their own decisions during the transition to adult living by ensuring that assessments and interventions address social participation.     

Palpitations in athletes

In an athletic population, the incidence of palpitations varies from 0.3% to as high as 70%, depending on age and type of sport being studied. Palpitations, or an awareness of an increased or abnormal heart beat, are rare in the school-age athlete, but much more common in older endurance athletes. The majority are felt to be benign, with prognosis relating to type of specific rhythm disturbance and presence or absence of underlying heart disease. Atrial fibrillation can account for up to 9% of rhythm disturbances in elite athletes, and up to 40% in those with long-standing symptoms. In athletes with premature ventricular beats (PVCs), underlying heart disease is more likely to be present in those with a high PVC burden, defined as >/=2000 PVCs/24 hours. Choice of monitoring device is crucial in making a proper diagnosis of the specific rhythm disturbance. For symptoms occurring within a 24-hour period, simple Holter monitoring is adequate to make a diagnosis. However, if symptoms occur less frequently, clinicians must choose one of the other available monitoring devices. Most importantly, choice of device should depend on which device is most likely to detect the rhythm disturbance. Other cardiac testing such as echocardiography, stress testing, endomyocardial biopsy, genetic testing, electrophysiologic testing, or cardiac magnetic resonance imaging may be indicated as well. The majority of palpitations in athletes will be first identified by screening examination, or by a complaint from the athlete. The third and most current pre-participation examination monograph recommends asking the athlete if he/she has palpitations with exercise. The assumption has been made that palpitations occurring at rest in athletes are benign, but this theory has not been validated prospectively in a large cohort of the athletic population. Specific rhythms can often be treated with radiofrequency ablation, with return to sports provided there is no significant high risk underlying heart disease present. Athletes with known malignant ventricular rhythm disturbances, or underlying substrate for such, who have undergone implantation of an automatic implanted cardioverter-defibrillator are not recommended to return to sport because there is no data on the safety and efficacy of defibrillators in this clinical setting, and certain athletic activities may result in damage to the device.     

Mortality experiences among 15+ year survivors of childhood and adolescent cancers

BACKGROUND: Studies of childhood and adolescent cancer survivorship have tended to focus on limited survival intervals (e.g., 5 and 10 years). Our report evaluates gender-specific overall mortality, as well as mortality by age group, and by cause, among 15+ year survivors of cancer diagnosed during childhood or adolescence. PROCEDURE: This was a retrospective cohort study of 565 15+ year childhood cancer survivors from Roswell Park Cancer Institute's Long-Term Follow-Up Project. Sex- and age-specific person-years at risk were accumulated and applied to age-specific mortality rates for New York State, excluding New York City. Standardized mortality ratios (SMRs), and 95% confidence intervals, were calculated and compared to mortality risks of the general population. RESULTS: Second malignancy was the leading cause of death among male and female survivors (15/38 deaths, 39%). Excess overall mortality was noted among both males (SMR = 284) and females (SMR = 371). Significant mortality excesses were seen in both genders for deaths due to primary malignant neoplasms and secondary malignancies, as well as cardiac deaths among males. Excess mortality was noted across most age strata. In the scenario of no cancer relapse, overall mortality in both genders did not differ significantly from the general population. CONCLUSIONS: Long-term survivors of childhood and adolescent cancers continue to demonstrate significant excess mortality. However, overall mortality among 15+ year survivors without a relapse appears to be comparable to the general population. The leading cause of death among 15+ year survivors is second malignancy in this study, which represents a novel and important finding in terms of long-term follow-up.     

Human ovarian granulosa cells and follicular fluid indices: the relationship to oocyte maturity and fertilization in vitro

The study investigates the correlation between oocyte maturity and fertilization and a variety of hormonal parameters in follicular fluid and ovarian granulosa cells. A methodology for purification of granulosa cells from contaminating blood cells is also established. A total of 63 follicular aspirates were collected at oocyte retrieval from 30 women superovulated using the long luteinizing hormone- releasing hormone (LHRH analogue)/human menopausal gonadotrophin regimen. Oestradiol, progesterone, testosterone and human chorionic gonadotrophin (HCG) were quantified in follicular fluid and granulosa cells were immunostained for human chorionic gonadotrophin. Immunopurification of granulosa cells from contaminating blood cells was performed. HCG in follicular fluid was significantly high in follicles yielding immature (grade 3) oocytes (P=0.002); there was no correlation with fertilization. Aspirates from follicles containing mature (grade 1) oocytes and oocytes that subsequently fertilized had significantly more granulosa cells immunobound to HCG (P < 0.001, P=0.02). Moreover, the immunomagnetic purification technique provided >98% pure population of granulosa cells. The data demonstrate that HCG in follicular fluid and on granulosa cells may help to predict oocyte maturity and fertilization. Furthermore, immunomagnetic beads provide a reliable procedure for the purification of ovarian granulosa cells.      

Protective cytotoxic T lymphocyte responses against paramyxoviruses induced by epitope-based DNA vaccines: involvement of IFN-gamma

Plasmid DNA vectors have been constructed with minigenes encoding a single cytotoxic T lymphocyte (CTL) epitope from either the M2 protein of respiratory syncytial virus (RSV) or from the nucleoprotein of measles virus (MV) with or without a signal sequence (also called secretory or leader sequence). Following intradermal immunization, plasmids in which the CTL epitopes were expressed in-frame with the signal sequence were more effective at inducing peptide- and virus- specific CTL responses than plasmids expressing CTL epitopes without the signal sequence. This immunization resulted in protection against MV-induced encephalitis and a significant reduction in viral load following RSV challenge. The reduction of viral load following RSV challenge was abrogated by prior injection with anti-IFN-gamma antibodies. These results highlight the ability of epitope-based DNA immunization to induce protective immune responses to well-defined epitopes and indicate the potential of this approach for the development of vaccines against infectious diseases.      

阿片受体拮抗剂在TNF－α所致体温升高中的作用

为探索细胞介素ＴＮＦ－α升体温效应与下丘脑前部、视前区（ＰＯＡＨ）中的阿片受体的关系。应用脑神经核团微量注射方法给自由状态下的雄性ＳＤ大鼠ＰＯＡＨ区微量注射ＴＮＦ－α致热源。给药前３０ｍｉｎ分别用通常阿片受体拮抗剂Ｎａｌ（１０～２０μｇ）和特异性阿片受体μ、δ和κ的拮抗剂ＣＴＡＰ（１．０～２．５μｇ）、ＮＴＩ（０．２５～０．５μｇ）和ｎｏｒ－ＢＮＩ（０．１～３μｇ）对ＰＯＡＨ做预处理。结果：单独给ＴＮＦ－α可致剂量相关的体温升高△Ｔ（１℃～１．４℃）；经Ｎａｌ１０μｇ，ＣＴＡＰ１．０μｇ和ＮＴＩ０．５μｇ处理后使ＴＮＦ－α的升体温效应减弱；用Ｎａｌ２０μｇ，ＣＴＡＰ２．５μｇ和ＮＴＩ０．２５μｇ处理后可完全阻断ＴＮＦ－α所致的体温升高；ｎｏｒ－ＢＮＩ（０．１～３μｇ）对ＴＮＦ－α的升体温效应无影响。