Delays in Primary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction Patients Presenting With Cardiogenic Shock

Objectives

This study sought to examine whether quality improvement initiatives across multiple ST-segment elevation myocardial infarction (STEMI) systems translated to faster first medical contact (FMC)-to-device times for patients presenting with cardiogenic shock (CS).

Corticosteroids and immunomodulators: postoperative infectious complication risk in inflammatory bowel disease patients

BACKGROUND & AIMS: Many patients with inflammatory bowel disease receive corticosteroids and 6-mercaptopurine/azathioprine during elective bowel surgery. We investigated the postoperative infection risk for patients undergoing elective bowel surgery who were receiving corticosteroids and/or 6-mercaptopurine/azathioprine before surgery compared with patients not receiving these medications. METHODS: A retrospective cohort study was conducted on 159 patients with inflammatory bowel disease who underwent elective bowel surgery. There were 56 patients receiving corticosteroids alone, 52 patients receiving 6-mercaptopurine/azathioprine alone or with corticosteroids, and 51 patients receiving neither corticosteroids nor 6-mercaptopurine/azathioprine. Postoperative infectious complications to time of discharge were categorized into major and minor complications. RESULTS: Patients receiving corticosteroids had an adjusted odds ratio for any and major infectious complications of 3.69 (95% confidence interval [CI], 1.24-10.97) and 5.54 (95% CI, 1.12-27.26), respectively. The adjusted odds ratio for patients receiving 6-mercaptopurine/azathioprine for any and major infectious complications was 1.68 (95% CI, 0.65-4.27) and 1.20 (95% CI, 0.37-3.94), respectively. CONCLUSIONS: Preoperative use of corticosteroids in patients with inflammatory bowel disease who are undergoing elective bowel surgery is associated with an increased risk of postoperative infectious complications. 6-Mercaptopurine/azathioprine alone and the addition of 6-mercaptopurine/azathioprine for patients receiving corticosteroids was not found to significantly increase the risk of postoperative infectious complications.     

Treatment strategies for carotid stenosis in patients at increased risk for surgery

The purpose of carotid revascularization is stroke prevention. The merits of carotid revascularization as well as the type of revascularization are dependent on the “natural risk” and the “revascularization risk.” In general, the natural risk of stroke in any patient with carotid stenosis (CS) is dependent on the symptomatic status of the patient and CS severity. Contemporary choices for carotid revascularization include carotid endarterectomy (CEA) and carotid artery stenting (CAS). Anatomical (hostile neck situations, severe bilateral CS, CEA restenosis) and clinical (severe cardiopulmonary diseases, prior cranial nerve injury) factors may increase the risk of CEA. Likewise, anatomical (complex aortic arch and brachiocephalic arterial anatomy, presence of thrombus, and heavy calcification) and clinical (need for heart surgery within 30 days) factors may increase the risk of CAS. Other factors such as the presence of symptomatic CS (transient ischemic attack or stroke within 6 months), decreased cerebral reserve, chronic kidney disease, and age older than 75 years may increase the risk of CEA and CAS. In general, symptomatic patients with severe CS exceed revascularization risk. In contrast, asymptomatic patients who are high risk for CEA should be considered for CAS because the natural risk of stroke should undergo careful assessment of baseline cognitive function, aortic arch and carotid artery anatomy, and likelihood of survival for 3 years. Patients who have normal cognitive function, favorable anatomy, and high likelihood of survival more than 3 years should be considered for CAS, whereas patients with multiple unfavorable features may be treated with optimal medical therapy, without revascularization.     

Interaction of material stiffness and negative pressure to enhance differentiation of bone marrow‐derived stem cells and osteoblast proliferation

Negative pressure wound therapy (NPWT) results in improved wound repair and the combined use of NPWT with elastomeric materials may further stimulate and accelerate tissue repair. No firmly established treatment modalities using both NPWT and biomaterials exist for orthopedic application. The goal of this study was to investigate the response of osteoblasts and bone marrow‐derived mesenchymal stem cells to negative pressure and to determine whether a newly developed elastic osteomimetic bone repair material (BRM), a blend of type I collagen, chondroitin 6‐sulfate, and poly (octanediol citrate) could enhance the osteoblastic phenotype. The results indicate that proliferation and alkaline phosphatase activity of hFOB1.19 osteoblasts were significantly increased with exposure to 12 hr of negative pressure (?125 mmHg). Follow‐on studies with rat and human mesenchymal stem cells confirmed that negative pressure enhanced osteoblastic maturation. In addition, a significant interaction of negative pressure and electrospun BRM resulted in increased mRNA expression of alkaline phosphatase, osteopontin, collagen1α2, and HIF1α, whereas little or no effect on these genes was observed on electrospun collagen or tissue culture plastic. Together, these results suggest that the use of this novel biomaterial, BRM, with NPWT may ultimately translate into a safe and cost‐effective clinical application to accelerate bone repair.     

应用抗Xa活性测定肝素、低分子肝素及利伐沙班的性能验证

目的评价CS5100全自动血凝仪(简称CS5100)应用抗Xa活性检测血浆肝素、低分子肝素(LMWH)水平及利伐沙班的性能验证。方法参照美国临床和实验室标准协会文件对CS5100应用抗Xa活性检测血浆肝素、LMWH及利伐沙班水平的精密度(批内精密度及日间精密度)、准确度、线性、参考区间、携带污染率性能进行验证。结果CS5100检测血浆肝素、LMWH及利伐沙班水平的批内精密度及日间精密度符合厂家说明书给定的标准;准确性验证结果偏倚在生物学变异系数(CV)要求内;应用试剂配套稀释液时血浆肝素水平的线性验证试验未达标;应用体检健康者血浆作稀释液时肝素、LMWH及利伐沙班水平的线性验证试验理论值和实测值的回归方程均符合要求;携带污染率各参数CV<10%;参考区间验证通过。结论CS5100检测血浆肝素、LMWH及利伐沙班水平的精密度、准确度、携带污染率、线性结果均符合质量控制要求,能够保证检验质量。但要注意检测结果超过线性时,要使用体检健康者血浆作稀释液手动上机检测。     

Stratus CS cardiac troponin I method: performance characteristics including imprecision at low concentrations

OBJECTIVES: Define performance characteristics of the Stratus CS cardiac troponin I (cTnI) assay in routine practice. METHODS: Imprecision at low cTnI values was assessed according to NCCLS EP5-A. Linearity was assessed by regression analysis; the reference interval was determined in 345 healthy individuals. Minimum detectable concentration (MDC) was assessed with 20 replicates of zero calibrator, and method correlation and bias (n = 77) were by Passing-Bablok regression and Bland-Altman plot. RESULTS: cTnI of 0.06 microg/l corresponded to the 10% CV; the 99th percentile of the reference population was 0.07 microg/l. Linearity extended from 0 to 50.0 microg/l and the MDC was 0.010 microg/l. The method comparison equation was Stratus CS = 1.00 (Dimension RxL)-0.02 microg/l with no bias. CONCLUSIONS: The Stratus CS cTnI assay in routine practice has performance characteristics appropriate for clinical use, including good correlation to a central laboratory cTnI method and imprecision of a high sensitivity troponin method with a CV of <10% at the 99th percentile of the reference population.     

Deficiency of fat-soluble vitamins in chronic pancreatitis: A systematic review and meta-analysis

Background and aimsChronic pancreatitis (CP) patients are at risk for fat-soluble vitamins (A, D, E, K) deficiency, but available studies are small and heterogeneous. We conducted a systematic review and meta-analysis to determine the prevalence of fat–soluble vitamins deficiency in CP patients.MethodsMedline was searched up to January 2016 for case series and case-control studies reporting prevalence of fat-soluble vitamin deficiency in CP patients. The prevalent deficiency rate was pooled for included studies, and deficiency rate between CP and controls, with relative odds ratio (OR) and 95% confidence interval (CI) calculated for case-control studies.ResultsTwelve studies including 548 patients included. With a random-effect model, the pooled prevalence rate of vitamin A, D and E deficiency were 16.8% (95%CI 6.9–35.7), 57.6% (95%CI 43.9–70.4) and 29.2% (95%CI 8.6–64.5) respectively, with considerable heterogeneity (I² = 75%, 87.1% and 92%). Only one study evaluated vitamin K deficiency. The pooled OR for vitamin D deficiency in CP cases compared with controls was 1.17 (95% CI 0.77–1.78). Sensitivity analyses showed lower prevalence of vitamin A and E, and higher prevalence of vitamin D deficiency in high-quality studies. The rate of pancreatic exocrine insufficiency did not seem affect the deficiency rates, while the use of different cut-offs influences results and heterogeneity for vitamin E, but not A.ConclusionsFat-soluble vitamins deficiency is frequent in CP patients, with considerable heterogeneity. There is, however, no apparent increased risk of vitamin D deficiency in CP compared to controls. Larger, high-quality studies are necessary to better estimate the prevalence of fat-soluble vitamins deficiency, including vitamin K.     

First Case of a Compound Heterozygosity for Two Nondeletional α-Thalassemia mutations,Hb Constant Spring and Hb Quong Sze

Nondeletional α-thalassemia (α-thal) is the result of point mutations in critical regions of the α-globin genes, affecting mRNA processing, mRNA translation, or α-globin stability. Hb Constant Spring (Hb CS, HBA2: c.427T?>?C) is the most common nondeletional α-thal that results from a nucleotide substitution at the termination codon of the α2-globin gene. Hb Quong Sze (Hb QS, HBA2: c.377T?>?C) is another nondeletional α-thal in South China with the missense mutation at codon 125 of the α2-globin gene making this hemoglobin (Hb) variant highly unstable. Although homozygosity for Hb CS (α^CSα/α^CSα) or Hb QS (α^QSα/α^QSα) has been reported, clinical pictures vary from severe hemolysis that developed early in life to only mild anemia, no clinical phenotypic data of compound heterozygosity for Hb CS/Hb QS (α^CSα/α^QSα) has been described. In this report we describe an adult case with such a compound heterozygosity who presented with a mild α-thal.     

Molecular Epidemiology of Hemoglobinopathies in Cambodia

Determining the magnitude of the thalassemia problem in a country is important for implementing a national prevention and control program. In order to acquire accurate thalassemia prevalence data, the gene frequency of α- and β-thalassemia (α- and β-thal) in different regions of a country should be determined. The molecular basis of thalassemia in Cambodia was performed by polymerase chain reaction (PCR)-based techniques in a community-based cross-sectional survey of 1631 unrelated individuals from three regions, Battambang, Preah Vihear and Phnom Penh. Thalassemia mutations were detected in 62.7% of the three studied population of Cambodia. Hb E (HBB: c.79G?>?A) was the most common β-globin gene mutation with a frequency ranging from 0.139 to 0.331, while the most frequent α-globin gene mutation was the –α^3.7 (rightward) deletion (0.098–0.255). The other frequencies were 0.001–0.003 for β-thal, 0.008–0.011 for α-thal-1 (– –^SEA), 0.003-0.008 for α-thal-2 [–α^4.2 (leftward deletion)], 0.021–0.044 for Hb Constant Spring (Hb CS, HBA2: c.427T?>?C) and 0.009–0.036 for Hb Paksé (HBA2: c.429A?>?T). A regional specific thalassemia gene frequency was observed. Preah Vihear had the highest prevalence of Hb E (55.9%), α-thal-2 (24.0%) and nondeletional α-thal (15.1%), whereas Phnom Penh had the lowest frequency of thalassemia genes. Interestingly, in Preah Vihear, the frequency of Hb Paksé was extremely high (0.036), almost equivalent to that of Hb CS (0.044). Our results indicate the importance of micromapping and epidemiology studies of thalassemia, which will assist in establishing the national prevention and control program in Cambodia.     

胰岛素泵联合罗格列酮钠强化治疗2型糖尿病的临床探讨

目的采用胰岛素泵（CSⅡ）联合罗格列酮钠强化治疗2型糖尿病,评价其临床疗效。方法将75例2型糖尿病患者随机分为胰岛索泵联合罗格列酮钠治疗（CSⅡ＋罗格列酮钠）组22例,单纯胰岛素泵治疗（CSⅡ）组20例、多次皮下注射胰岛素治疗（MDI）组33例,均连续治疗2周。比较三组治疗前后体重、血糖、糖化血红蛋白、空腹胰岛素、C肽、胰岛素用量、血糖达标时间、低血糖发生率及胰岛素抵抗指数（HOMA—IR）、胰岛素敏感指数（1AI）。结果胰岛素泵联合罗格列酮钠治疗组胰岛素用量最少,HOMA-IR降低最明显,IAI明显增加,低血糖发生率低,体重增加不明显。结论胰岛素泵联合罗格列酮钠强化治疗2型糖尿病,在有效控制血糖的同时节约胰岛素用量,减轻胰岛素抵抗。