Clinical characteristics of patients with exercise-induced ST-segment elevation without prior myocardial infarction.

BACKGROUND: Exercise-induced ST-segment elevation is a relatively uncommon problem and occurs more frequently in patients who have had a myocardial infarction. Data is limited on the characteristics of Taiwanese patients without prior myocardial infarction who develop exercise-induced ST-segment elevation. METHODS AND RESULTS: Exercise-induced ST-segment elevation developed in 9 of 6,147 consecutive patients without myocardial infarction who underwent treadmill exercise testing at out institution over a 4-year period. The clinical and angiographic characteristics of these patients were studied. Angiographically normal coronary arteries with coronary vasospasm were found in 5 patients, hemodynamically significant coronary stenosis was found in 3 patients, and coexisting spasm in angiographically normal coronary arteries combined with hemodynamically significant coronary stenosis in the different vessel was found in 1 patient. During a median follow-up of 71 months, 2 patients with coronary vasospasm developed recurrent angina after self-discontinuation of calcium antagonists and 2 patients (1 with coronary vasospasm and 1 with hemodynamically significant coronary stenosis) died of cardiac causes before arrival at the emergency department. CONCLUSION: Coronary vasospasm was a more common underlying pathology of exercise-induced ST-segment elevation in this Taiwanese cohort. Coronary angiography +/- intracoronary ergonovine provocation testing is necessary in these patients to identify the underlying pathology and appropriate treatment.     

Design of physostigmine-loaded polymeric microparticles for pretreatment against exposure to organophosphate agents

Physostigmine is an anti-cholinesterase used for the pretreatment of a poisoning caused by highly toxic organophosphorus neurotoxins. The aim of this study is to design a polymeric microparticle system for sustained release of physostigmine. In this paper, we have attempted to encapsulate physostigmine in microparticles made from poly(D,L-lactide-co-glycolide) (PLGA) with various contents of glycolide and poly(D,L-lactide) (PLA) using spray-drying and single emulsion techniques. It was found that during the single emulsion process, most of the physostigmine molecules were lost in the external aqueous phase. However, more than 90% encapsulation efficiency of physostigmine was obtained using the spray-drying technique. SEM micrographs revealed that spherical microparticles containing physostigmine with a smooth surface were yielded with PLA, PLGA 50:50, RG 502 (PLGA 50:50 with a lower molecular weight) and PLGA 65:35 but PLGA 85:15, PLGA 75:25 and PLGA 50:50 with a high concentration produced microparticles with irregular shapes. An increased inlet temperature yielded a higher physostigmine release rate from the PLA microparticles. Physostigmine release from the microparticles showed a biphasic pattern, characterized by an initial burst release followed by a sustained release for PLGA 65:35, PLGA 50:50 and RG 502 or a non-detectable release for PLGA 85:15, PLGA 75:25 and PLA. A sustained-release of physostigmine with a low initial burst over 1 week was achieved from RG 502 microparticles, which would be used as an injectable dosage form in our further animal studies.     

High body mass index is not associated with coronary artery disease in angina patients with chronic kidney disease: a coronary angiography study

BACKGROUND: High body mass index (BMI) is an established risk factor for coronary artery disease (CAD) in the general population. This relationship is less clear in CAD patients with different stages of chronic kidney disease (CKD) because many complications of CKD can cause malnutrition and low BMI. We studied the association of BMI and angiography-confirmed CAD in CKD patients. METHODS: Thousand one hundred thirty-three patients admitted for coronary angiography was stratified by CKD classification. Demographic, clinical, hemodynamic, and angiographic findings were assessed. CKD patients (n = 980) were divided into angiographic CAD and non-CAD groups to compare traditional CAD risk factors. Patients with angiography-confirmed CAD (n = 496) were further analyzed for the association between BMI and CAD risk at different stages of CKD patients. RESULTS: Mean BMI was 27.4 +/- 4.1, 27.7 +/- 4.0, 25.9 +/- 3.5, 24.2 +/- 3.8, 23.2 +/- 3.0 and 23.8 +/- 4.2 kg/m for normal renal function, stage I, II, III, IV, and V CKD patients, respectively. Male, old age, presence of CKD, diabetes, hypertension, smoking, and higher cholesterol had significant association with angiographic CAD in the CKD sub-cohort. Obesity was not related to CAD in the CKD sub-cohort. Using WHO category for obesity, mild CKD patients were more likely to be overweight (62.8%) and obese (72%); meanwhile, most moderate and severe CKD patients were not obese (P < 0.05). Only 17.6% and 18.8% of moderate and severe CKD patients were obese (P < 0.05), by Taiwan classification. CONCLUSION: High BMI was not associated with angiographic CAD in CKD patients with angina.     

Large right atrial thrombus with pulmonary embolism

We present the cases of two patients, aged 67 and 77 years, who were admitted for the evaluation of rapidly progressive dyspnea and syncope, respectively. Both patients developed large right atrial thrombi with pulmonary embolism. The first patient received recombinant tissue plasminogen activator and survived with an uneventful result, whereas the second patient received operative thrombectomy followed by intravenous heparin and died 15 days later of pulmonary infarction with pulseless electrical activity. Data from these limited experiences suggest that thrombolytic therapy might be considered in patients with right heart thrombi with pulmonary embolism.     

Periodontal disease and risk of mortality and kidney function decline in advanced chronic kidney disease: a nationwide population-based cohort study

Clinical Oral Investigations - Periodontal disease is prevalent in patients with chronic kidney disease (CKD) and potentially associated with kidney function decline. However, it is uncertain...