Low‐Dose Heparin for Elective Percutaneous Coronary Intervention

Objectives

We evaluated the safety and efficacy of low‐dose heparin (40 IU/kg) for elective percutaneous coronary intervention (PCI).

Background

Current guidelines recommend a 70–100 IU/kg bolus of heparin for elective PCI, but this dose may be associated with increased bleeding risk. Low‐dose heparin may have an advantage in this regard, but has not been well studied.

Methods

From January 2008 to October 2012, 300 patients underwent elective transfemoral PCI and were treated with an initial bolus of 40 IU/kg of heparin at the UCLA Medical Center. Dual antiplatelet therapy with clopidogrel and aspirin was administered prior to or just after diagnostic coronary angiography. The primary end‐point was the composite of cardiac death, myocardial infarction, urgent target vessel revascularization for ischemia, or major bleeding within 30 days after PCI.

Results

The mean activating clotting time was 233 ± 28 seconds. The primary end‐point occurred in 2.3%. The cardiac death rate was 0.3% but was not related to the PCI. The myocardial infarction rate was 1.3%. Urgent target vessel revascularization occurred in 1 patient (0.3%). The major bleeding rate was 0.3%. No stent thrombosis occurred.

Conclusion

Using a lower dose of heparin with dual antiplatelet therapy is safe and is associated with a low bleeding risk after transfemoral PCI while providing suppression of ischemic events. This may also represent a cost savings compared with other antithrombotic strategies. A randomized clinical trial comparing low‐dose heparin with bivalirudin in patients is required to determine the optimal anticoagulation strategy. (J Interven Cardiol 2014;27:58–62)

     

Utilization of 1-hydroxybenzotriazole in mixed anhydride coupling reactions

The coupling of Boc-Val-OH to either H-Pro-OBzl or H-Pro-Gly-Val-Gly-OBzl by the mixed anhydride method leads to the formation of a urethane by-product in yields of 40–60%. This side reaction can be suppressed by the addition of HOBt to the reaction mixture before the amino component is added. This results in a substantially increased yield of the desired peptide.     

口服维生素C对人眼房水中抗坏血酸盐浓度的影响(英文)

AIM: To study oral administration of vitamin C onhuman aqueous humour ascorbate concentration.METHODS: High performance liquid chromatography(HPLC) coupled with electrochemical detector (ECD)was used. The effect of oral administraion of variousdoses of ascorbic acid, 0 (control), 1.0, 1.5., 2.0,3.0, and 5.0 g, on its concentration in aqueoushumour, obtained from volunteer cataract patients wasstudied. RESULTS: The concentration of ascorbicacid in aqueous humour of control group (without     

An Innovation in Pacemaker Lead Implantation via Persistent Left Superior Vena Cava: The “3D Alpha Curve” Stylet

Persistent left superior vena cava (PLSVC) draining into coronary sinus is typically detected incidentally during transcatheter interventions using left subclavian venous approach. In our experience, we have encountered this anomaly on a few occasions and in all these cases we successfully implanted leads in the right ventricle (RV) by shaping the stylet into a “U‐shaped” or “pigtail‐shaped” curve. Herein, we report a case of an adult male who underwent successful dual‐chamber pacemaker implantation via PLSVC through left axillary venous approach. In this case, we were unable to deliver the lead into RV using aforementioned stylets. As an innovation, we used a “three‐dimensional alpha curve”‐shaped stylet that facilitated an easy entry of pacing lead into the RV.     

Rectal steroids suppress bone formation in patients with colitis

Background : The aetiology of bone loss in inflammatory bowel disease is multifactorial, but oral corticosteroids are an important contributory factor. Rectally administered steroids are widely used in patients with distal disease, but very little is known about their effect on bone metabolism. The aim of this study was to investigate the effect of a standard course of rectal prednisolone on biochemical markers of bone turnover.
Methods : In a longitudinal study of 10 patients, biochemical markers of bone turnover were measured before, during and after treatment with prednisolone metasulphobenzoate (Predfoam, Pharmax Ltd) 20 mg twice daily for 2 weeks. Bone formation markers measured were serum osteocalcin (BGP), bone-specific alkaline phosphatase (BALP) and procollagen carboxy-terminal propeptide (PICP). Urinary deoxypyridinoline (dPyr) was measured to assess bone resorption.
Results : Disease activity scores improved during treatment (difference in mean Powell–Tuck score=2.3 (±3.1), 95% CI: 0.11–4.48, P =0.04). There was a significant fall in BALP ( P =0.02) during treatment, and a rapid but non-significant fall in BGP ( P =0.19). PICP (0.42), and urinary dPyr (0.30) did not change significantly during treatment.
Conclusions : Following a standard 2-week course of rectal prednisolone metasulphobenzoate, we observed a significant fall in bone-specific alkaline phosphatase activity. These results suggest that bone formation is suppressed in patients with distal colitis treated with pharmacological doses of rectal steroids.     

High-dose topical calcipotriol in the treatment of extensive psoriasis vulgaris

Summary Ten patients with extensive plaque psoriasis were treated with calcipotriol ointment (50 μg/g) for 2 weeks (200 g for 1 week, followed by 300 g during the second week). Mean improvement in psoriasis area and severity index (PASI) was 71%. Mean 24 h urine calcium rose from 4.79 mmol/24 h to 7.27 mmol/24 h ( P <0.000l). Urine calcium returned towards baseline after stopping calcipotriol. Mean serum calcium also rose slightly, hut significantly, from 2.26 mmol/l to 2.32 mmol/l (P<0.005). and fell again in the washout phase. Individual serum calcium values remained within the normal range throughout the study. Topical calcipotriol is an effective, rapidly acting and safe in-patient treatment for extensive plaque psoriasis.     

Vitamin D analogues in psoriasis: effects on systemic calcium homeostasis

Vitamin D and its analogues are effective in the treatment of psoriasis. The principal concern about the use of these agents is the possibility of adverse effects on systemic calcium homeostasis. We review the effects of vitamin D and its analogues on systemic calcium homeostasis and discuss the implications for patients with psoriasis.