Coconut fragrance and cardiovascular response to laboratory stress: results of pilot testing.

There is preliminary evidence that pleasant fragrances may alter response to stressors in different settings. This pilot study examined the effect of coconut fragrance on cardiovascular response to standard laboratory stressors. While inhaling coconut fragrance (n = 17) or air (n = 15), subjects performed a Stroop color-word task and a mental arithmetic task. Heart rate (HR), heart period variability (HPV) and blood pressure were measured during the 5-minute baseline, the task, and the recovery periods. The results indicated that subjects breathing coconut fragrance had higher HR and lower HPV than those who performed tasks while breathing air. HR response to mental arithmetic seemed to be blunted in the subjects breathing coconut; however, the lack of a difference in HPV seems to indicate that the blunting may be due to decreased sympathetic response, not decreased parasympathetic withdrawal under stress. Blood pressure recovery was slightly enhanced in subjects under coconut fragrance. Thus, the results of this pilot test suggest that coconut fragrance may alter cardiovascular activity both at rest and in response to stressors. Future experimentation should attempt to replicate and extend these findings in larger samples in clinical settings.

A pilot study to assess the effects of a guided imagery audiotape intervention on psychological outcomes in patients undergoing coronary artery bypass graft surgery.

Depression and anxiety are associated with increased risk of postoperative cardiac events and death in patients who have undergone coronary artery bypass graft surgery. These risks persist even several months after the procedure. Guided imagery has been used with cardiac surgery patients for some time and with numerous anecdotal reports of considerable benefit. In addition, this therapy is low-cost and easy to implement, and the literature holds ample evidence for its efficacy in symptom reduction in various patient populations. It was thus hypothesized that preoperative use of guided imagery would reduce postoperative distress in patients undergoing coronary artery bypass graft. Fifty-six patients scheduled to undergo coronary artery bypass graft at Columbia University Medical Center were randomized into 3 groups: guided imagery, music therapy, and standard care control. Patients in the imagery and music groups listened to audiotapes preoperatively and intraoperatively. All patients completed psychological, complementary medicine therapies use, and other assessments preoperatively and at 1 week and 6 months postoperatively. Only preoperative distress was predictive of postoperative distress at follow-up. Use of complementary medicine therapies was high in all groups and this fact, in addition to the small sample size, may have accounted for the lack of significant relationship between imagery and postoperative distress. Regardless, this complementary and alternative medicine therapy remains palatable to patients. Given its efficacy in other patient populations, it is worth exploring its potential utility for this population with a larger sample.

Haemostatic role and histopathological effects of a new haemostatic agent in a rat bladder haemorrhage model: an experimental trial.

OBJECTIVE: To investigate the haemostatic efficacy and histopathological effects of a new haemostatic agent, Ankaferd BloodStopper (ABS; Ankaferd Drug Cosmetic Co., Istanbul, Turkey) in a rat bladder haemorrhage model. ABS is a unique combination of five plant extracts that has been used in Turkish traditional medicine as a haemostatic agent for external traumatic bleeds. MATERIALS AND METHODS: In all, 20 male Sprague-Dawley rats were divided into two equal groups. In both groups, the mucosa was damaged on the posterior wall (PW) of the bladder. The liquid form of ABS was applied to the bleeding area of one group (group 1) and 0.9% NaCl to the bleeding area of the other group (group 2, controls). The solutions were applied drop by drop with a 2 mL injector until the bleeding stopped and the bleeding times recorded. For histopathological examination, two tissue samples were taken from all rats in each group; one from the damaged mucosa in the PW and one from undamaged mucosa in the lateral wall (LW). Two sections were prepared from all samples. One section was stained with haematoxylin and eosin (H&E), and the rest was used for immunohistochemical staining for fibronectin. RESULTS: The mean bleeding times were 65 s and 147 s for groups 1 and 2, respectively (P < 0.001). In the pathological specimens stained with H&E, fibrosis and other studied pathological features were similar in the LW samples in groups 1 and 2. Similarly, there were no differences between the PW samples of groups 1 and 2. In the pathological specimens stained for fibronectin, the number of attenuated cells was similar in the LWs of group 1 and 2 (P = 0.21) as well as in the PWs of each group (P = 0.066). CONCLUSIONS: ABS decreased bleeding time and did not increase fibrotic reactions in rat bladder tissue.

Feasibility and effectiveness of a brief meditation-based stress management intervention for patients diagnosed with or at risk for coronary heart disease: a pilot study.

Extensive research has led to the development of a psychobiological model of cardiovascular disease. This model suggests that psychological factors such as depression, anxiety, hostility, and stress may affect the development and progression of coronary heart disease (CHD). Recent studies have also demonstrated that meditation-based stress reduction programs are useful interventions for patients with various medical and psychological symptoms. The objective of this pilot study was to gather preliminary information regarding the feasibility of implementing a brief meditation-based stress management (MBSM) program for patients with CHD, and those at high risk for CHD, at a major metropolitan hospital that serves a predominately non-local patient population. The secondary aim of this study was to investigate the possibility that such an intervention might reduce depression, as well as perceived stress, anxiety, and hostility, while improving general health scores. The overall feasibility results indicate that this MBSM intervention was highly feasible with regard to both recruitment and retention of participants. In fact, 40% of patients requested further training. In addition, after completion of the 4-week intervention, participants reported significant reductions in depression and perceived stress. In conclusion, the present study demonstrated that the brief meditation-based stress management program was well-received by patients and can successfully be used as a supportive program for patients at risk or diagnosed with CHD.

Longevity and optimal health: working toward an integrative methodology.

Efforts to foster a research dialogue between traditions as seemingly divergent as Western biomedicine and Indo-Tibetan medical and self-regulatory practice require a carefully conceived set of methodological guidelines. To approach a useful methodology, some specific structural differences between traditions must be negotiated, for example the Indo-Tibetan emphasis on holism in medicine and ethics, which appears to run contrary to Western trends toward specialization in both clinical and research contexts. Certain pitfalls must be avoided as well, including the tendency to appropriate elements of either tradition in a reductionistic manner. However, research methods offering creative solutions to these problems are now emerging, successfully engendering quantitative insight without subsuming one tradition within the terms of the other. Only through continued, creative work exploring both the potentials and limitations of this dialogue can collaborative research insight be attained, and an appropriate and useful set of methodological principles be approached.

Bradycardic therapy improves left ventricular function and remodeling in dogs with coronary embolization-induced chronic heart failure.

Both beta-adrenergic blockade and bradycardia may contribute to the therapeutic effect of beta-blockers in chronic heart failure (CHF). This study tested the relative importance of bradycardia by comparing cilobradine (Cilo), a sinus node inhibitor, with a beta-blocker, metoprolol (Meto), in an established canine model of CHF. Dogs were chronically instrumented for hemodynamic and left ventricular (LV) volume measurements. CHF was created by daily coronary embolization via a chronically implanted coronary (left anterior descending coronary artery) catheter. After establishment of CHF, control (n=6), Meto (30 mg/day, n=5), Cilo (low) (1 mg/kg/day, n=5), or Cilo (high) (3 mg/kg/day, n=5) was given orally for 12 weeks. Systemic hemodynamics, echocardiography, and pressure volume analysis were measured at baseline, at CHF, and 3 months after treatment in an awake state. Protein levels of cardiac sarcoplasmic reticulum calcium-ATPase (SERCA2a), ryanodine receptor (RyR2), and Na+-Ca2+ exchanger (NCX1) were measured by Western blot. RyR2 protein kinase A (PKA) phosphorylation was determined by back-phosphorylation. After 12 weeks, Meto and Cilo (high and low) produced similar bradycardic effects, accompanied by a significantly improved LV dP/dt versus control [Meto, 2602+/-70; Cilo (low), 2517+/-45; Cilo (high), 2579+/-78; control, 1922+/-115 mm Hg/s; p<0.05]. Both Meto and Cilo (high) normalized protein levels of SERCA2a and NCX1 and reversed PKA hyperphosphorylation of RyR2, in contrast to controls. High-dose cilobradine effectively produced bradycardia and improved cardiac function after CHF, comparable with metoprolol. Restored protein levels of SERCA2a and improved function of RyR2 may be important mechanisms associated with cilobradine therapy.

Music, imagery, touch, and prayer as adjuncts to interventional cardiac care: the Monitoring and Actualisation of Noetic Trainings (MANTRA) II randomised study.

BACKGROUND: Data from a pilot study suggested that noetic therapies-healing practices that are not mediated by tangible elements-can reduce preprocedural distress and might affect outcomes in patients undergoing percutaneous coronary intervention. We undertook a multicentre, prospective trial of two such practices: intercessory prayer and music, imagery, and touch (MIT) therapy. METHODS: 748 patients undergoing percutaneous coronary intervention or elective catheterisation in nine USA centres were assigned in a 2x2 factorial randomisation either off-site prayer by established congregations of various religions or no off-site prayer (double-blinded) and MIT therapy or none (unmasked). The primary endpoint was combined in-hospital major adverse cardiovascular events and 6-month readmission or death. Prespecified secondary endpoints were 6-month major adverse cardiovascular events, 6 month death or readmission, and 6-month mortality. FINDINGS: 371 patients were assigned prayer and 377 no prayer; 374 were assigned MIT therapy and 374 no MIT therapy. The factorial distribution was: standard care only, 192; prayer only, 182; MIT therapy only, 185; and both prayer and MIT therapy, 189. No significant difference was found for the primary composite endpoint in any treatment comparison. Mortality at 6 months was lower with MIT therapy than with no MIT therapy (hazard ratio 0.35 (95% CI 0.15-0.82, p=0.016). INTERPRETATION: Neither masked prayer nor MIT therapy significantly improved clinical outcome after elective catheterisation or percutaneous coronary intervention.

Emerging role of integrative medicine in cardiovascular disease.

Our evolution toward a more integrative approach toward healing will accelerate if we can alter the different perspectives that patients and physicians bring to their relationship. This article reviews lessons that have been acquired using alternative approaches to facilitate the recovery of patients undergoing invasive procedures. After identifying that most of our patients use alternative therapies but prefer not to discuss these therapies with their surgeons, we began to routinely refer our patients to a coordinator trained in this field. The resulting integrative medicine program offers massage, yoga, audiotapes, and additional customized treatments. The coexisting research laboratory designs and conducts well-organized research endeavors evaluating the efficacy of therapies being offered. By mixing clinical practice with conventional research, we seek to emulate the successful formula used in allopathic medicine.

Application of microwave energy in cardiac tissue ablation: from in vitro analyses to clinical use.

BACKGROUND: Recently, there has been renewed interest in simplifying a surgical cure for atrial fibrillation. Microwave energy ablation provides an easier and faster surgical technique, in lieu of traditional "cut and sew," which can also be applied on the beating heart. METHODS: Specific absorption rate (SAR) and thermal profiles were determined after microwave energy ablation intended for clinical application. Lesion geometry measures obtained in vitro with tissue equivalent media were compared with values collected from animal myocardium. RESULTS: Thermal profile analysis demonstrated lesion penetration depths of 2.5, 3, and 5 mm after 8, 16, and 24 seconds, respectively, with microwave power application of 40 W. Dosimetric studies performed using animal myocardium corresponded to the thermal profile analysis and showed that lesion depth was controlled by the output power and the ablation time. CONCLUSIONS: Lesion geometry in tissue using microwave energy is similar to that predicted from in vitro analysis. The ablation depths and thermal profile of microwave ablation is favorable for performing atrial ablation, and this is corroborated by favorable early clinical results.

The technology in use for the surgical ablation of atrial fibrillation.

The purpose of this article is to present and evaluate the various technologies recently developed for the surgical treatment of atrial fibrillation as alternatives or adjuncts to the traditional Maze III procedure and other "cut and sew" techniques. The discussion contains a detailed consideration of the biophysical background of the most common ablation techniques, their mode of tissue injury, the methods of use, and the related complications through a review of the existing literature and analysis of experimental results. All of the current technologies presented are still being tested to augment the success rates and reduce the incidence of complications, although all are not available for clinical use. Radiofrequency and cryoablation have been used clinically on large numbers of patients with varying results. Microwave technology has been used in small groups of patients, and the results are to be evaluated. Laser technology is still in an experimental phase, and the clinical results are forthcoming. True transmurality, reduction of operative time, friendly use of ablation devices, and substantial reduction of complications appear to be the key factors for broad adoption of alternative energy sources for surgical ablation.

Massage therapy for patients undergoing cardiac catheterization.

CONTEXT: Anxiety and its pharmacological treatment can interfere with cardiac catheterization. Massage therapy has been used primarily in nonmedical settings for relaxation and stress reduction, and some research demonstrates its efficacy in medical environments. OBJECTIVE: First, to determine whether massage could be administered under "normal" conditions in an interventional cardiology center. Second, to evaluate the efficacy of massage in reducing anxiety before, during, and after a cardiac catheterization procedure. DESIGN: A prospective, randomized, controlled, single-masked, pilot study. SETTING: An interventional cardiology center at an urban hospital in New York, NY PATIENTS: Seventy-eight patients (59 men, 19 women), with a mean age of 60.1 years who were scheduled for an elective, diagnostic catheterization based on routine clinical practices. INTERVENTION: Treatment subjects received a standardized, 10-minute massage. Control subjects spent 10 minutes of quiet time with a massage therapist. MAIN OUTCOME MEASURES: We evaluated the feasibility of incorporating massage into the time period between the patient's arrival at the hospital and catheterization, patient interest in receiving massage, and staff support of this complementary therapy. We further evaluated self-ratings of anxiety and pain or discomfort on visual analog scales, vital signs, cortisol levels, and analgesic or anxiolytic intake. RESULTS: A 10-minute massage was feasibly incorporated before catheterization. Seventy percent of the patients consented to participate, and staff supported the intervention. Mean anxiety scores on a 166 mm visual analog scale dropped by 16.2 mm (SD, 24.6) in the massaged group and by 6.8 mm (SD, 17.3) in the control group (P = .081). No statistically significant results were found in pain or discomfort visual analog scale scores (P =.491), blood pressure (P = .827), heart rate (P = .935), respiration rate (P=.916), or analgesic and anxiolytic usage (P > or = .252). Cortisol levels are discussed as exploratory, data. CONCLUSIONS: The results of the study suggest that a 10-minute massage before an invasive cardiac procedure is insufficient to decrease stress measurably.

The Internet as a research tool in complementary and alternative medicine: a pilot study.

Information on the use of complementary and alternative medical (CAM) therapies is sometimes difficult to obtain from consumers. The purpose of this study was to evaluate the Internet as a research tool in CAM to obtain information from these consumers about the use of psychotropic herbs and drugs. A survey on psychotropic herb and drug usage was posted on 138 mental-health newsgroups on the Internet. After 38 days, 72 (71%) of the 102 respondents reported usage of psychotropic medication and 68 (67%) reported usage of psychotropic herbs during the preceding 12 months. The Internet is a potential tool to reach consumers of CAM for research purposes. The study design requires modification, and the findings need cautious interpretation for further research using the Internet as a venue.