Rotational Atherectomy for Left Main Coronary Artery Disease in Octogenarians: Transradial Approach in a Tertiary Center and Literature Review

Objectives

The aim of this study was to appreciate the safety and effectiveness of transradial percutaneous coronary intervention (PCI) with rotational atherectomy for highly calcified left main coronary artery (LMCA) disease in octogenarians.

Background

Conventional surgery is still considered the preferred management for LMCA disease; but, when the lesion is severely calcified, and the patient is unsuitable for surgery, the interventional cardiologist faces a complex PCI traditionally approached by femoral access.

Methods

Between June 2004 and December 2010, octogenarians with calcified LMCA disease who were primary denied for surgical revascularization were enrolled. Procedural success and major adverse cerebral and cardiovascular events (MACCE) including death, nonfatal myocardial infarction, target lesion revascularization (TLR), or stroke during long‐term follow‐up were evaluated.

Results

Forty‐two consecutive patients≥80 years had undergone stenting for calcified LMCA disease (13 with rotational atherectomy, the “Rota” group, and 29 without rotational atherectomy, the “without Rota” group). Procedural success was good (92.3% vs. 96.6%, respectively, p = NS). Mean follow‐up time was 25.7 ± 21.4 and 28 ± 32.3 months, respectively. There was a TLR in 25% and 11.1%, respectively; p = NS. No difference was detected in terms of overall in‐hospital or long‐term mortality or MACCE.

Conclusion

Rotational atherectomy followed by stent implantation by transradial approach, when applied to heavily calcified lesions, appeared to be a safe and effective strategy for the treatment of LMCA disease in octogenarians who were refused for surgery. (J Interven Cardiol 2013;26:173–182)

     

Changes in plasma IL4, TNF�� and CRP in response to regular passive smoking at home among healthy school children in Khartoum, Sudan

Background

Regular exposure to tobacco smoke at home causes airway inflammation and altered cytokine regulation; however, there is variation between individuals of different countries.

Objective

To determine effects of passive smoking on plasma IL4, TNFá, and CRP in healthy male school-children in Khartoum.

Methods

A total of 135 male school-pupils (69 passive smokers and 66 non-smokers) were selected randomly from three primary schools for boys in Khartoum. Information about smoking history was collected from each pupil and his parents using a questionnaire. Plasma CRP, IL4 and TNFá were measured using commercially available ELISA kits.

Results

Plasma IL4 and TNFá in the passive smokers (mean ± SEM) is at 2.92 ± 0.93 and 19.78 ± 4.67 pg/ml respectively; whereas in the non-smokers . It is at 0.45 ± 0.28 and 5.05 ± 1.54 pg/ml respectively. The difference between the two groups is statistically significant (p <0.05). The mean plasma IL4 and TNFá were lowest with no exposure, higher with moderate exposure, and highest with heavy exposure (P < 0.05). Plasma CRP showed insignificant difference between the two groups.

Conclusion

Passive smoking causes significant rise in plasma TNFá and IL4 with a dose dependent effect among school-pupils in Khartoum.     

Altered age-related trajectories of amygdala-prefrontal circuitry in adolescents at clinical high risk for psychosis: a preliminary study

Emotion processing deficits are prominent in schizophrenia and exist prior to the onset of overt psychosis. However, developmental trajectories of neural circuitry subserving emotion regulation and the role that they may play in illness onset have not yet been examined in patients at risk for psychosis. The present study employed a cross-sectional analysis to examine age-related functional activation in amygdala and prefrontal cortex, as well as functional connectivity between these regions, in adolescents at clinical high risk (CHR) for psychosis relative to typically developing adolescents. Participants (n=34) performed an emotion processing fMRI task, including emotion labeling, emotion matching, and non-emotional control conditions. Regression analyses were used to predict activation in the amygdala and ventrolateral prefrontal cortex (vlPFC) based on age, group, sex, and the interaction of age by group. CHR adolescents exhibited altered age-related variation in amygdala and vlPFC activation, relative to controls. Controls displayed decreased amygdala and increased vlPFC activation with age, while patients exhibited the opposite pattern (increased amygdala and decreased vlPFC activation), suggesting a failure of prefrontal cortex to regulate amygdala reactivity. Moreover, a psychophysiological interaction analysis revealed decreased amygdala-prefrontal functional connectivity among CHR adolescents, consistent with disrupted brain connectivity as a vulnerability factor in schizophrenia. These results suggest that the at-risk syndrome is marked by abnormal development and functional connectivity of neural systems subserving emotion regulation. Longitudinal data are needed to confirm aberrant developmental trajectories intra-individually and to examine whether these abnormalities are predictive of conversion to psychosis, and of later deficits in socioemotional functioning.     

A comparison of adolescent- and adult-onset first-episode, non-affective psychosis: 2-year follow-up

This study aimed to compare 2-year outcome among individuals with early-onset (EO; <18?years) versus adult-onset (AO) first-episode, non-affective psychosis. We compared clinical and treatment characteristics of 43 EO and 189 AO patients 2 years after their inclusion in a clinical epidemiologic population-based cohort study of first-episode psychosis. Outcome variables included symptom severity, remission status, drug abuse, treatment utilization, cognition and social functioning. At baseline, EO patients were more symptomatically compromised. However, these initial baseline differences were no longer significant at the 2-year follow-up. This study challenges the findings of a larger and older literature base consisting primarily of non-comparative studies concluding that teenage onset indicates a poor outcome. Our results indicate that adolescent-onset and adult-onset psychosis have similar prognostic trajectories, although both may predict a qualitatively different course from childhood-onset psychosis.     

Guidelines for timely initiation of chemotherapy: a proposed framework for access to medical oncology and haematology cancer clinics and chemotherapy services

These guidelines, informed by the best available evidence and consensus expert opinion, provide a framework to guide the timely initiation of chemotherapy for treating cancer. They sit at the intersection of patient experience, state‐of‐the‐art disease management and rational efficient service provision for these patients at a system level. Internationally, cancer waiting times are routinely measured and publicly reported. In Australia, there are existing policies and guidelines relating to the timeliness of cancer care for surgery and radiation therapy; however, until now, equivalent guidance for chemotherapy was lacking. Timeliness of care should be informed, where available, by evidence for improved patient outcomes. Independent of this, it should be recognised that shorter waiting periods are likely to reduce patient anxiety. While these guidelines were developed as part of a proposed framework for consideration by the Victorian Department of Health, they are clinically relevant to national and international cancer services. They are intended to be used by clinical and administrative staff within cancer services. Adoption of these guidelines, which are for the timely triage, review and treatment of cancer patients receiving systemic chemotherapy, aims to ensure that patients receive care within a timeframe that will maximise health outcomes, and that access to care is consistent and equitable across cancer services. Local monitoring of performance against this guideline will enable cancer service providers to manage proactively future service demand.     

Widespread short-latency stretch reflexes and their modulation during stumbling over obstacles

The present study investigated whether short-latency stretch reflexes are present during human stumbling reactions. While subjects walked on a treadmill, the forward sway of the foot was unexpectedly obstructed with an obstacle. All subjects showed reflex responses with average latencies of 34–42 ms in both the upper and the lower leg flexors and extensors of the obstructed leg. The amplitudes of these responses depended on the phase in the step cycle and were not strictly related to either the background activity of the corresponding muscles or variations in the perturbation. Hence, mechanisms at a premotoneuronal level might play a role in the active phase-dependent control of these responses. The coactivation of antagonists as well as the lack of obvious kinesiologic consequences following the responses suggest that the short-latency responses may generate joint stiffness. This may be a first line of defense in preparing for the functional reaction, which is generated by longer latency responses, in order to take appropriate action concerning the obstacle.