Platelet count and MPV,routinely measured but ignored parameters used in conjunction with the diagnosis of acute coronary syndrome: single study center in Iranian population, 2010

Background

Myocardial infarction is the major cause of morbidity and mortality in industrialized countries. Platelet count and the mean platelet volume (MPV), a simple and reliable indicator of platelet size which correlates with platelet activation, might associate with troponin in acute chest pain.

Methods

We analyzed MPV of 851 patients who were admitted to Rasoul-e-Akram Hospital with acute chest pain during the year 2010. Two blood samples were taken from each patient within 4 hours of their arrival for routine hematology, including platelet count and MPV, and cardiac troponin T. Also, electrocardiograms of the patients were recorded. Association of MPV and platelet count with troponin was observed.

Results

The patients in troponin positive group, who had also ischemic electrocardiographic changes, had higher MPV values than non- acute coronary syndrome (ACS) patients with normal cardiac troponin T levels (9.9 vs 9.5 fl with p< 0.001). In troponin negative group, the mean of platelet count was higher than that in the positive group (221683 vs 198814/µl with p< 0.001).

Conclusion

MPV and platelet count are inexpensive laboratory tests which can be measured in association with other laboratory biomarkers in patients presenting with acute chest pain.This could help to lower hospitalization rates and also avoid misdiagnosis and having complications of patients with ACS.     

Meta‐analysis of standard,restrictive and supplemental fluid administration in colorectal surgery

Background:

Optimal fluid therapy for colorectal surgery remains uncertain.

Methods:

A simple model was applied to define standard, restrictive and supplemental fluid administration. These definitions enabled pooling of data from different trials. Randomized controlled trials on fluid amount (standard versus restrictive or supplemental amount) and on guidance for fluid administration (goal‐directed fluid therapy by oesophageal Doppler‐derived variables versus conventional haemodynamic variables) in patients with colorectal resection were eligible for inclusion. The primary outcome measure was postoperative morbidity. Secondary endpoints were mortality, cardiopulmonary morbidity, wound infection, anastomotic failure, recovery of bowel function and hospital stay. A random‐effects model was applied.

Results:

Nine randomized controlled trials were included. Restrictive fluid amount (odds ratio (OR) 0·41 (95 per cent confidence interval (c.i.) 0·22 to 0·77); P = 0·005) and goal‐directed fluid therapy by means of oesophageal Doppler‐derived variables (OR 0·43 (95 per cent c.i. 0·26 to 0·71); P = 0·001) significantly reduced overall morbidity. There were no significant differences in the secondary endpoints analysed.

Conclusion:

Using standardized definitions, this meta‐analysis suggests that restrictive rather than standard fluid amount according to current textbook opinion, and goal‐directed fluid therapy rather than fluid therapy guided by conventional haemodynamic variables, reduce morbidity after colorectal resection. Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.     

Meta-Analysis of the Clamp-Crushing Technique for Transection of the Parenchyma in Elective Hepatic Resection: Back to Where We Started?

Background  After introduction of the clamp-crushing technique in the 1970s, various devices have been developed for transection of the liver with the aim of further reducing blood loss and improving the outcome of patients who undergo hepatic resection. We performed a meta-analysis to quantitatively compare the clamp-crushing technique to any subsequently introduced transection technique with respect to patients’ perioperative outcome. Methods  A systematic literature search was conducted to identify randomized controlled trials comparing the clamp-crushing technique to any alternative method of hepatic transection. Relative risks (RR) were calculated for each outcome and reported along with their 95% confidence intervals (95% CI). Meta-analyses were stratified for the various types of transection techniques compared with the clamp-crushing technique and were carried out by a random effects model. Results  Seven randomized controlled trials with a total of 554 patients were included in final analyses. Analyses of overall morbidity (RR .89; 95% CI, .63–1.25), biliary leakage (RR 1.03; 95% CI, .50–2.13), transfusion rates (RR .69; 95% CI, .31–1.51), and mortality RR (.20; 95% CI, .02–1.65) revealed no difference between the clamp-crushing and alternative transection techniques. None of the identified studies demonstrated a clinically important benefit of an alternative transection method in terms of blood loss, parenchymal injury, transection time, and hospital stay. Conclusions  This meta-analysis does not indicate a benefit of any alternative transection technique on patients’ perioperative outcome compared with the clamp-crushing technique. The clamp-crushing technique remains the reference technique for transection of the parenchyma in elective hepatic resection. Nuh N. Rahbari, Moritz Koch authors contributed equally to this article.     

Validation of Prognostic Scoring Systems for Patients Undergoing Resection of Colorectal Cancer Liver Metastases

Background  

Several prognostic scoring systems have been established for patients undergoing resection of colorectal cancer (CRC) liver metastases; however, comparative analyses of their prognostic relevance is still lacking in the literature. The aim of the present study was to assess the predictive value of five published scoring systems in an independent patient cohort for the purpose of external validation.     

Is Transesophageal Echocardiography Necessary before D.C. Cardioversion in Patients with a Normal Transthoracic Echocardiogram?

PURPOSE: Transesophageal echocardiography has emerged as an accepted approach before D.C. cardioversion for atrial fibrillation. The frequency of atrial thrombi detected on transesophageal echocardiography has varied from 7% to 23%. Many patients undergoing transesophageal echocardiography have had a previous transthoracic echocardiogram. Though transthoracic echocardiography has a low yield for the detection of intracardiac thrombi, it is highly accurate in diagnosing a structurally abnormal heart. The purpose of this study was to assess the frequency of thrombi detected by transesophageal echocardiography in patients with an entirely normal transthoracic echocardiogram and hence the advocacy of a selective approach in performing transesophageal echocardiography in patients undergoing D.C. cardioversion for atrial fibrillation. METHODS: 112 consecutive patients with atrial fibrillation who had undergone transesophageal echocardiography before D.C. cardioversion were evaluated. They all had a transthoracic echocardiogram within the 2 months preceding their transesophageal echocardiogram. Based on their transthoracic echocardiographic study, they were divided into two groups: Group 1 consisted of patients with a normal transthoracic echocardiogram and Group 2, those with an abnormal study. RESULTS: Thrombi or spontaneous echo contrast were found in 14 of 112 patients (16%). All however were detected in Group 2 patients. There was no patient with a normal transthoracic echocardiogram who had thrombus on his/her transesophageal echocardiogram. CONCLUSIONS: Our results suggest that a selective approach may be exercised in the use of transesophageal echocardiography prior to D.C. cardioversion for atrial fibrillation. Patients with an entirely "normal" transthoracic echocardiogram may proceed directly to cardioversion without a precardioversion transesophageal echocardiogram.     

Invasion front-specific expression and prognostic significance of microRNA in colorectal liver metastases

The tumor edge of colorectal cancer and its adjacent peritumoral tissue is characterized by an invasion front-specific expression of genes that contribute to angiogenesis or epithelial-to-mesenchymal transition. Dysregulation of these genes has a strong impact on the invasion behavior of tumor cells. However, the invasion front-specific expression of microRNA (miRNA) still remains unclear. Therefore, the aim of the present study was to investigate miRNA expression patterns at the invasion front of colorectal liver metastases. Laser microdissection of colorectal liver metastases was performed to obtain separate tissue compartments from the tumor center, tumor invasion front, liver invasion front and pure liver parenchyma. Microarray expression analysis revealed 23 miRNA downregulated in samples from the tumor invasion front with respect to the same miRNA in the liver, the liver invasion front or the tumor center. By comparing samples from the liver invasion front with samples from pure liver parenchyma, the tumor invasion front and the tumor center, 13 miRNA were downregulated. By quantitative RT-PCR, we validated the liver invasion front-specific downregulation of miR-19b, miR-194, let-7b and miR-1275 and the tumor invasion front-specific downregulation of miR-143, miR- 145, let-7b and miR-638. Univariate analysis demonstrated that enhanced expression of miR-19b and miR-194 at the liver invasion front, and decreased expression of let-7 at the tumor invasion front, is an adverse prognostic marker of tumor recurrence and overall survival. In conclusion, the present study suggests that invasion front-specific downregulation of miRNA in colorectal liver metastases plays a pivotal role in tumor progression.     

Carbohydrate Intake and Overweight and Obesity among Healthy Adults

Background

Little is known about the dietary habits of people with optimal body weight in communities with high overweight and obesity prevalence.

Objective

To evaluate carbohydrate intake in relation to overweight and obesity in healthy, free-living adults.

Design

We used a cross-sectional analysis.

Subjects/setting

The Canadian Community Health Survey Cycle 2.2 is a cross-sectional survey of Canadians conducted in 2004-2005. There were 4,451 participants aged 18 years and older with anthropometric and dietary data and no comorbid conditions in this analysis.

Main outcome measures

Outcome variables were body mass index (BMI; calculated as kg/m²) and overweight or obesity status (dichotomous) defined as BMI ≥25 compared with BMI <25 based on measured height and weight. Diet was evaluated by 24-hour dietary recall based on the Automated Multi-Pass Method.

Statistical analyses performed

Weighted regression models with bootstrapping and cubic splines were used. Outcome variables were BMI and overweight or obesity, and predictors were daily nutrient intake. Adjustment for total energy intake, age, leisure time energy expenditure, sex, smoking, education, and income adequacy was performed.

Results

Risk of overweight and obesity was decreased in all quartiles of carbohydrate intake compared to the lowest intake category (multivariate odds ratio quartile 2=0.63; 95% confidence interval: 0.49 to 0.90; odds ratio quartile 3=0.58; 95% confidence interval: 0.41 to 0.82; odds ratio quartile 4=0.60; 95% confidence interval: 0.42 to 0.85). Spline analyses revealed lowest risk among those consuming 290 to 310 g/day carbohydrates.

Conclusions

Consuming a low-carbohydrate (approximately <47% energy) diet is associated with greater likelihood of being overweight or obese among healthy, free-living adults. Lowest risk may be obtained by consuming 47% to 64% energy from carbohydrates.