Successful utilization of a novel aspiration thrombectomy catheter (Pronto) for the treatment of patients with stent thrombosis.

Stent thrombosis is a rare but catastrophic complication of percutaneous coronary intervention (PCI). Thrombolytic therapy is ineffective for the treatment of patients with stent thrombosis, while primary PCI in such patients is limited by a high thrombus burden in the culprit vessel often leading to distal embolization and extensive tissue infarction. We present three patients with stent thrombosis successfully treated with the adjunctive use of a novel and new aspiration thrombectomy device (Pronto).     

Fruit and vegetable intake among rural youth following a school-based randomized controlled trial

Objective

We implemented a theory-based randomized controlled trial (Living Free of Tobacco, Plus (LIFT +) in ten rural middle schools and assessed impact on tobacco use and fruit/vegetable (F/V) intake in 2008-2010. Data on F/V intake at baseline, immediate post intervention, and 1-year follow-up are presented.

Methods

Schools were randomized to intervention or control groups. Goal setting, peer leaders, and class workshops with parent involvement, were intervention features; community partners were supportive. Seventh graders filled out surveys on health behaviors, psycho-social variables, and demographic characteristics. Adjusted models comparing intervention and control conditions were analyzed.

Results

Sample (n = 1119) was 48.5% female, 50% White, with a mean age of 12.7 years. Mean F/V servings were significantly higher in intervention schools at immediate post (3.19 servings) and at 1-year (3.02 servings) compared to controls (2.90, 2.69 respectively). Knowledge of 5-a-day recommendation was significantly higher in intervention schools at immediate post test (75.0%) versus controls (53.8%) but not at 1-year follow-up.

Conclusions

Intervention schools reported significantly higher mean F/V servings at post intervention and 1-year, and for knowledge of F/V recommendations at immediate post compared to controls. Higher levels of parent and community involvement may further increase F/V intake in future interventions.ClinicalTrials.gov Identifier: NCT01412697.     

Value of the unaided clinical diagnosis in dyspeptic patients in primary care

Objectives: Attempts to establish a clinical diagnosis in dyspeptic patients have generally been unrewarding. However, studies in unselected dyspeptic patients are lacking. The aim of this study was to determine the value of the unaided clinical diagnosis by general practitioners (GP) and by experienced gastroenterologists (GA) in unselected dyspeptic patients in primary care.
Methods: Three hundred forty-seven patients with epigastric pain/discomfort for more than 2 wk who were consulting general practitioners (  n = 73  ), but without alarm symptoms. GPs and GAs gave a provisional diagnosis based on an unstructured interview. All patients underwent endoscopy within 5 days of referral. Validity of the provisional diagnoses was measured using the endoscopic diagnoses as the gold standards.
Results: For GPs, the sensitivity of a provisional diagnosis of peptic ulcer was 61% [95% confidence intervals (CI): 46–74%]; for specificity 73%, the 95% CI was 68–78%; and for positive predictive values, it was 28%, the 95% CI was 20–37%. GAs were more reluctant to predict ulcer, leading to a higher specificity: 84% (95% CI: 79–88%), but a similar sensitivity: 55% (95% CI: 40–69%). The GPs were unable to distinguish between functional and organic dyspepsia (chance-corrected overall validity: 9%; 95% CI: 0–18%). GPs and GAs agreed in their provisional diagnosis in only 45% of the patients, in whom the diagnosis was confirmed by endoscopy in 2/3.
Conclusion The unaided clinical diagnosis given by the GP and by the GA in dyspeptic patients in primary care is unreliable. Nearly half of patients with ulcer or esophagitis were misclassified, despite a high susceptibility to organic disease. Different patients were problematic for GPs and GAs, which may indicate that most dyspeptic patients do not present with symptoms characteristic of a specific disease.     

Hypoglycemia,S‐ACE and ACE genotypes in a Danish nationwide population of children and adolescents with type 1 diabetes

Johannesen J, Svensson J, Bergholdt R, Eising S, Gramstrup H, Frandsen E, Dick‐Nielsen J, Hansen L, Pociot F, Mortensen HB, The Danish Society for Diabetes in Childhood and Adolescence. Hypoglycemia, S‐ACE and ACE genotypes in a Danish nationwide population of children and adolescents with type 1 diabetes. Objective: High S‐ACE levels have been shown to predispose to increased risk of hypoglycemia, however; some inconsistency relates to the risk of the ACE genotype. We investigated the association between S‐ACE level at diagnosis and ACE genotype to long‐term risk of severe hypoglycemia in more than 1000 children and adolescents with type 1 diabetes being part of the Danish Registry of Childhood diabetes over a 10‐yr period. Research design and methods: The Registry provided annual registration of clinical data, e.g., HbA1c, blood glucose monitoring, insulin type and dosage and acute diabetic complications (hypoglycemia and DKA). A BioBank coupled to the Registry comprised serum for measuring S‐ACE levels and DNA for ACE genotyping. Results: A total of 1037 individuals were included, aged 9.97 yr (SD 3.84). A total of 622 severe hypoglycemic episodes were observed in 270 individuals. Associations to increased risk of hypoglycemia generated from a negative binominal model were long diabetes duration (p < 0.0001) and high S‐ACE level (p = 0.0497) when adjusted for ACE genotype. In the stratified analysis, S‐ACE and insulin dosage were associated with hypoglycemia in girls (p = 0.026 and 0.028, respectively). An association of S‐ACE level to ACE genotype was identified; however, no difference in the frequency of hypoglycemia, diabetes duration or HbA1c was demonstrated between ACE genotypes. Conclusion: This large nationwide cohort has identified an increased risk for hypoglycemia associated with higher S‐ACE level, however only in girls. A strong association was found between ACE genotype and S‐ACE levels, but ACE genotype was not related to risk of hypoglycemia.     

Association of cholesteryl ester transfer protein genotypes with CETP mass and activity, lipid levels, and coronary risk

Alexander Thompson, MRes, MPhil; Emanuele Di Angelantonio, MD, MSc; Nadeem Sarwar, MRPharmS, MPhil; Sebhat Erqou, MD, MPhil; Danish Saleheen, MBBS, MPhil; Robin P. F. Dullaart, MD, PhD; Bernard Keavney, MD, FRCP; Zheng Ye, PhD; John Danesh, DPhil, FRCP

JAMA. 2008;299(23):2777-2788.

Context  The importance of the cholesteryl ester transfer protein (CETP) pathway in coronary disease is uncertain. Study of CETP genotypes can help better understand the relevance of this pathway to lipid metabolism and disease risk.

Objective  To assess associations of CETP genotypes with CETP phenotypes, lipid levels, and coronary risk.

Data Sources  Studies published between January 1970 and January 2008 were identified through computer-based and manual searches using MEDLINE, EMBASE, BIOSIS, Science Citation Index, and the Chinese National Knowledge Infrastructure Database. Previously unreported studies were sought through correspondence with investigators.

Study Selection  Relevant studies related principally to 3 common (TaqIB [rs708272], I405V [rs5882], and –629C>A [rs1800775]) and 3 uncommon (D442G [rs2303790], –631C>A [rs1800776], and R451Q [rs1800777]) CETP polymorphisms.

Data Extraction  Information on CETP genotypes, CETP phenotypes, lipid levels, coronary disease, and study characteristics was abstracted from publications, supplied by investigators, or both.

Results  Ninety-two studies had data on CETP phenotypes, lipid levels, or both in 113 833 healthy participants, and 46 studies had data on 27 196 coronary cases and 55 338 controls. For each A allele inherited, individuals with the TaqIB polymorphism had lower mean CETP mass (–9.7%; 95% confidence interval [CI], –11.7% to –7.8%), lower mean CETP activity (–8.6%; 95% CI, –13.0% to –4.1%), higher mean high-density lipoprotein cholesterol (HDL-C) concentrations (4.5%; 95% CI, 3.8%-5.2%), and higher mean apolipoprotein A-I concentrations (2.4%; 95% CI, 1.6%-3.2%). The pattern of findings was very similar with the I405V and –629C>A polymorphisms. The combined per-allele odds ratios (ORs) for coronary disease were 0.95 (95% CI, 0.92-0.99) for TaqIB, 0.94 (95% CI, 0.89-1.00) for I405V, and 0.95 (95% CI, 0.91-1.00) for –629C>A.

Conclusions  Three CETP genotypes that are associated with moderate inhibition of CETP activity (and, therefore, modestly higher HDL-C levels) show weakly inverse associations with coronary risk. The ORs for coronary disease were compatible with the expected reductions in risk for equivalent increases in HDL-C concentration in available prospective studies.

     

Safety and efficacy of suprachoroidal triamcinolone acetonide for the management of serous choroidal detachment prior to rhegmatogenous retinal detachment surgery: A Pilot study

Purpose:To study the safety and efficacy of pre-operative suprachoroidal triamcinolone acetonide (SCTA) for achieving reduction/resolution of serous choroidal detachment (CD) associated with rhegmatogenous retinal detachment (RRD).Methods:This was a prospective, noncomparative, interventional pilot study. All consecutive patients presenting with RD and coexisting CD underwent transconjunctival injection of SCTA before proceeding with vitrectomy/scleral buckle surgery. Sequential ultrasound B scans were performed for assessing the change in height of the CD.Results:The mean age of the cohort was 53.8 ± 10.8 years (range: 39–72 years). The CD was present in a median of 3 quadrants; the cumulative mean CD height was 5.59 mm (range: 2.02–9.42 mm). Following SCTA, a successful response (>50% reduction) was seen in five eyes by day 3 and in two eyes by day 5. Three eyes failed to respond to SCTA and required surgical drainage before proceeding with vitrectomy. No intraprocedural injection-related complications were noted. A transient rise in the intraocular pressure (30 mmHg) was seen in one eye following vitrectomy and was managed successfully with topical antiglaucoma medicationsConclusion:Suprachoroidal administration of triamcinolone appears to be a safe and effective technique to achieve CD resolution in eyes with RRD.